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Postnatal and Parenting

In the hospital, after birth

The fourth stage in the Labour/Birth Suite

The first hour or so after childbirth has been called the “fourth stage” to highlight the special importance of this time of physical and psychological recovery from childbirth. It is also a very special time of discovery and getting to know your new baby. Generally you can expect to stay in the Labour/Birth Suite until you and your baby have recovered from the birth, after which you will be transferred to the Postnatal Ward.

Ongoing care in the postnatal ward leading to discharge from hospital

The aim of postnatal care is to assist you and your baby towards attaining optimal health following pregnancy and childbirth. It is anticipated that approximately six weeks after childbirth your body will return to its non-pregnant state. During your stay in hospital, your midwives will care for you, support you and assist you to care for your new baby. They will also monitor your transition from childbirth for any common problems and possible complications associated with the postnatal period. There are several routine checks, tests and possible treatments common to this time that you should be aware of.

Each day or more frequently, depending on your individual circumstances, your midwife may ask you about and/or check you/your:

  • Vital signs such as temperature, pulse, and respirations (Your blood pressure is checked e.g. if you had pre-eclampsia or high blood pressure). Let your midwife know if you have a fever, feel unwell, shivery, feel weak or dizzy, have a headache or any other symptoms that concern you
  • Uterus – is normally felt at or below your umbilicus (belly button), not tender
  • Vaginal blood loss – colour, amount, clots, odour. Changing from red to lighter colour, not excessive in amount or large clots and no bad odour
  • Breasts – soft or hard, milk ‘coming in’, appearance of breasts and nipples, and any signs of engorgement or infection. Let your midwife know if you experience painful, hot, red, swollen breasts, breast lumps, sore, cracked or bleeding nipples
  • Perineum (for mothers who had vaginal births) – the area should be clean and dry, checked for swelling and bruising, any gaping of stitches, signs of infection (hot, red, swollen)
  • Urine - passing normally with no stinging, burning or trouble emptying your bladder, pale yellow colour, not cloudy, no bad odour
  • Bowel motions – ask your midwife for advice if you are constipated or are worried about this
  • Pain – please request pain relief as required for after-pains and perineum/wound pain, particularly before breast feeding and other activities that may increase pain
  • Abdominal suture line (for mothers who had a caesarean birth) – report any pain, redness, gaping of stitches or swelling in the wound to your midwife
  • Legs and circulation – please report any excessive swelling of your ankles, feet or legs, in particular, if you have calf pain and swelling or redness
  • Emotional wellbeing, and getting the balance right between activity, health eating, and exercise, and sleeping and getting enough rest
  • Confidence with feeding and caring for your baby
  • Baby – s/he is feeding and settling well, passing urine and normal bowel motions, her/his skin and cord is clean and dry
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What tests or treatments may I expect?

Blood or other tests may be ordered for mothers who have had pre-existing medical or pregnancy conditions such as gestational diabetes, pre-eclampsia or complications during labour and birth such as postpartum haemorrhage (PPH), as part of the ongoing plan of care for the postnatal period.

Mothers whose blood group is Rhesus negative, and their baby’s blood group is Rhesus positive (as tested by the sample of cord blood taken at birth) will be offered the Anti-D injection in the postpartum period in hospital (within 72 hours of birth). If an Rh negative woman falls pregnant to an Rh positive man, there is a good chance that her baby’s blood group will be Rh positive. During the pregnancy and birthing process, there is a risk that some of the baby’s blood cells will get into the mother’s blood stream and she will form antibodies against the baby’s blood. If a mother who has developed the antibodies has another Rh positive baby, her antibodies will cross the placenta and may damage the baby’s red blood cells. Untreated babies may be anaemic, have a risk of brain damage or even die before birth. This condition is called ‘haemolytic disease of the newborn’ or ‘HDN.’ The anti-D injection helps the mother to stop making the antibodies against her baby and reduces the risk of HDN.

Mothers who tested negative to measles, mumps, and rubella in pregnancy may be offered the MMR vaccination after birth.

Whooping cough vaccination is an important consideration in the postnatal period. Several studies of infants with whooping cough show that parents were the main source of infection. Newborns don’t have enough immunity to whooping cough until they have their second dose at age 4 months, so it is vital that they aren’t exposed during that time.

If there is anything at all you are concerned about, please raise these issues with your midwife who can advise and assist you and/or liaise with your obstetrician. Each mother and baby is unique and even if you have had children in the past, there may be concerns with this birth or baby that you might like to discuss with your midwife/obstetrician.

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How long will I be in hospital following childbirth?

There is some variation but in general you may expect to be in hospital for 4-5 nights following a vaginal birth and 5-6 nights following a caesarean birth, depending on your particular circumstances, you and your baby’s wellbeing and your hospital’s policy on length of stay. Some of our hospitals offer hotel accommodation following childbirth so please check with your hospital or their Website. Additionally our facilities provide comprehensive postnatal education programs during your stay. These cover topics such as caring for and feeding your baby, parenting skills, coping at home and community resources. Many of our hospitals have midwives available to provide advice 24hrs a day in the immediate post discharge period. They can be contacted on the direct midwifery line via your hospital Website.