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.

What can I expect immediately after a vaginal birth?

Once you have completely birthed your baby, and all is well, she or he will usually be given to you for a cuddle. Early skin-to-skin contact between you and your baby immediately after childbirth has been shown to have many benefits in terms of bonding with your baby, enhancing your mothering skills and parenting behaviour, improving breastfeeding outcomes and reducing infant crying. Your midwife will also wish to monitor you and your baby’s immediate recovery from childbirth for at least an hour in the Labour/ Birth Suite and allow you time to rest and recover.

These are some of the things that you may expect during your time in the Labour/Birth Suite prior to your transfer to the Postnatal Ward:

• Your baby’s adaptation to the world outside the uterus will be assessed at 1 and 5 minutes after birth using the Apgar Score. If your baby has a low Apgar Score or you had an assisted birth, the Neonatal Team may be ready to assess and/or resuscitate your baby at this time (for more information on the Apgar Score, please refer to the Glossary).
• Your baby will then be checked over and towel dried to remove any blood from the birth. Babies are not usually bathed during the first 24 hours after birth because they are still adapting to maintaining their temperature outside the uterus.
• If you are planning to breastfeed and all is well, baby should be given the opportunity to feed as soon as possible after birth, preferably within the first hour when she/he is in a quiet and alert state. This can be encouraged by keeping her/him in close skin to skin contact with your chest and asking your midwife to assist with the feed when your baby begins mouthing around in search of the breast. This quiet time immediately following birth is also an important bonding opportunity for your new family. Use it to discover and get to know your new baby.
• There may be other members of the Maternity Team present to help clear up after the birth.
• Your midwife will assess your vital signs (respiratory rate, pulse, blood pressure, and temperature), feel your uterus and check your vaginal loss and any stitches if you had a tear or episiotomy.
• If you had an IV infusion during labour, your midwife will advise when it can be removed.
• If you had an epidural in labour the epidural catheter will usually be removed during this time.
• You may be offered other pain relief options, such as Panadol, as needed or indicated. Please ask for pain relief early rather than waiting for the pain to worsen.
• If you had a tear or episiotomy sutured, you may be offered an ice pack to reduce any swelling and pain.
• You will be encouraged to empty your bladder.
• If all is well you may like to have a shower and change clothes. If you had an epidural and have not yet regained full sensation in your legs you may have a sponge bath and change of bed clothes.
• You will be offered refreshments, although it is not uncommon for some women to experience nausea or vomiting after birth.
• You may like to rest and sleep to recover from childbirth.
• When your midwife is satisfied that all is well, you and your baby will be transferred to the postnatal ward. If both you and your baby are healthy, you will have your baby room in with you 24 hours a day to promote breastfeeding and to practice sleep and settling strategies, prior to discharge.
• Please be aware that general visiting is usually not permitted in the Birth/Delivery Suite at many of our hospitals. We therefore ask that you inform friends and family to come at the next scheduled visiting hours.
• You may like to take the opportunity to discuss and/or debrief the events of the birth, ask any questions about the care you received and your plan for postnatal care and discharge from hospital. This can be done either in the Labour/Birth Suite or later in the Postnatal Ward, depending on how you are feeling.

What can I expect immediately after a caesarean birth?

In general, your recovery from a caesarean birth is similar to that of a vaginal birth, but there are a few key differences because you have had major surgery:

• Your baby is usually handed to the Neonatal Team initially after the caesarean birth to be assessed with the Apgar Score (for more information on the Apgar Score, please refer to the Glossary), dried and checked and if required, resuscitated by the Accredited Medical Practitioner or Paediatrician. If you have had an epidural or spinal for your caesarean birth, your baby will then be handed to you and your birth partner for a cuddle while the obstetrician completes the surgery. If you have had a general anaesthetic, your partner will be waiting outside and a member of the Neonatal Team will bring your baby to them once baby has been checked over.
• Once the obstetrician has completed the surgery, you will likely be transferred to a Recovery Room or similar area prior to transfer to the Postnatal Ward. Some of our hospitals are encouraging early breast feeding in the Recovery Room so please check this with your hospital.
• Your midwife will observe your vital signs and/or conscious state (if you had general anaesthesia) and vaginal loss more frequently following a caesarean birth, depending on the reason for the caesarean, the type of anaesthesia and your wellbeing following surgery.
• Your midwife will check that your abdominal dressing is dry and intact (it may be removed the following day or remain in place for a few days depending on your obstetrician’s preference).
• Rarely, you may have a drain at the caesarean site which is also generally removed the following morning.
• You will have an IV infusion during and immediately after the caesarean birth and this is generally removed the following morning or after you have passed wind. Passing wind is an indication that your gastrointestinal system is working well and you are able to tolerate fluids and food.
• Bed rest is encouraged for the first few hours, especially if you had an epidural or spinal block for your caesarean birth, until you have fully recovered.
• You may be given medications to reduce the risk of surgical complications such as deep vein thrombosis or infection.
• You may be assisted to the shower on the evening of or morning after your operation.
• You may have free fluids on return to the Postnatal Ward until you have passed wind and then you may eat a normal diet (and this may vary according to your obstetrician’s preference). It is not uncommon to feel nauseated or to vomit following caesarean birth.
• You will be offered pain relief options as required (these could be intramuscular injections, rectal (suppositories in the back passage) and oral medications or a combination of these.
• You will have a urinary catheter in place to drain your bladder and this is generally removed on the following morning.
• You may have stitches or staples to close your abdominal wound and your obstetrician and/or midwife can advise you whether these need to be removed and when.
• Being active as soon as possible after your caesarean birth can help you to recover quicker. Please check with your midwife and hospital about postnatal exercise classes and the availability of physiotherapy.

What else can I expect for my baby/babies immediately after birth?

After your baby’s Apgar Score is assessed, you’ve had skin-to-skin contact and perhaps breastfed your baby, you may expect the following things to occur for your baby:

• The baby’s cord will have been clamped and cut shortly after the birth. The cord stump will usually dry up, turn a dark colour and eventually drop off within 5-7 days.
• Your baby’s birth weight and measurements will be recorded. Baby’s weight is rechecked as per your hospital protocol, which could be on days 2, 3 or 4 and on discharge (most babies will have an initial weight loss of about 10% of their birth weight which they usually regain by the time they go home).
• Two identification name tags will be applied.
• Your baby will be fully checked by your midwife within the first 24 hours of birth and may be checked by a Paediatrician as necessary or as required.
• The Vitamin K (injection or oral dose) and Hepatitis B immunisation will be administered with your consent (Please see the chapter on Caring for your baby for more detail about why vitamin K and Hepatitis B immunisation is recommended for newborn babies).
• Your baby’s bowel motion and passing of urine will be observed and recorded.

You and your baby will stay together during your time in hospital. However, if your baby is premature or the Paediatrician recommends further observation and specialised care, she/he may be taken to a Special Care Nursery in your hospital for observation and treatment. The Maternity Services Team will keep you informed of her/his progress and encourage both you and your partner to be with her/him whenever you can.

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:

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.

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.