Book 4 by Stephanie Penland

a woman-centered birth

book

Evidence Based Practice for Women During Birth

The

Postpartum section

After the Birth

The Postpartum â&#x20AC;&#x201D; Birth Guide

The weeks and the months that follow your babies birth will be filled with lots of joy and many sleepless nights. You will discover who you are as a parent, and you will rise to the challange. It is amazing what we can do if we will only trust and educate ourselves, and surround ourselves with a good support system.

41, 42, 43

Postpartum After the Birth The

Postpartum should be

Amazing, Fulfilling

and Empowering

n The Postpartum

A Womanâ&#x20AC;&#x2122;s Confidence, her ability to give birth, and care for her baby, are either Enhanced or Diminished by every person who gives her care, and the type of environment, she births in.

n The Postpartum

Title Page book

section

k The Beginning l The Middle m The Arrival n The Postpartum o The Birth Story

01 The Postpartum — Birth Guide 02 The First Hour After Birth 03 Getting to Know Your Baby 04 Breast-Feeding 05 Postpartum Care — The Care you need 06 Postpartum Care — The First Month 07 The Father & Relationships 08 Postpartum ipv signs

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k Designer Stephanie Penland l Photographers 01 Isaiah Beiser Photography 02 Edited by Tres Photography 03 Stephanie Penland 04 Catherine Byrd 05 Istock Photography 06 Michael Penland m Writers 01 Stephanie Penland 02 Crystal Wolf 03 Illana Pearlman n Printer 01 Alpha Graphics 02 Kodak M700 03 Cougar smooth text 80#, Natural o Details 01 Font Archer Pro 02 Chartwell

These books are intended for the pregnant mother to learn and make educated decisions about her heath care during and after the birth of her baby. They are a resource and a way for her to share and engage those around her in a conversation about why she has chosen the type of birth she wants, be it a home-birth or a hospital birth.

a woman-centered birth

book

Evidence Based Practice for Women During Birth

The

Postpartum section

After the Birth

The First Hour After the Birth

The doctors used to keep women in the hospital for 10 days after the birth of the baby because they were very worried about complications. Ina May Gaskin, midwife, recommending home visits for mothers by a postpartum doula, nurse, or midwife, quoted in Harperâ&#x20AC;&#x2122;s Bazaar, September 2009 338

section 02 The First Hour Following the Birth

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The First Hour After the Birth start | The First Hour Following the Birth by Michel Odent CPM ÂŠ 2002 Midwifery Today Donâ&#x20AC;&#x2122;t Wake the Mother! The hour following birth is undoubtedly one of the most critical phases in the life of human beings. It is not by chance that all human groups have routinely disturbed the physiological processes in this short period of time, via beliefs and rituals. Our cultural milieus are to a great extent shaped at the beginning of the mother-newborn interaction. The First Hour Following the Birth may be looked at from a multitude of complementary perspectives. My objective is to catalogue 12 perspectives in order to demonstrate the real dimension of this enormous subject. Perspective k The Sudden Need to Breathe We do not need to develop this widely documented perspective. It is well understood that during The First Hour Following the Birth the baby must suddenly use its lungs. This implies, in particular, the heart must urgently pump blood to the pulmonary circulation. The prerequisite is that the pulmonary and system circulations separate by closure of the connections between them ductus arteriosus and foramen ovale. Perspective l The Behavioral Effects of Hormones This perspective needs to be developed, so recent are the available data. Today we are in a position to explain that all the different hormones released by mother and fetus during the first and second stages of labor are not yet eliminated during the hour following birth. All of them have a specific role to play in the mother-newborn interaction. Until recently the behavioral effects of these hormones had not even been known. The key hormone involved in birth physiology is undoubtedly oxytocin hormone. Its mechanical effects have been well known for a long time effects on uterine contractions for the birth of the baby and the delivery of the placenta; effects on the contractions of the myoepithelial cells of the breast for the milk ejection reflex. Prange and Pedersen demonstrated the behavioral effects of oxytocin for the first time in 1979 via experimentation with rats: An injection of oxytocin directly into the brain of virgin rats induced a maternal behavior.

section 02 The First Hour Following the Birth

This experiment laid the foundation for a new generation of studies. He results of hundreds of such studies can be summarized: Oxytocin is the typical altruistic hormone; it is involved whatever the facet of love one considers. These data appear important when one knows that, according to Swedish studies, it is after the birth of the baby and before the delivery of the placenta that women have the capacity to reach the highest possible peak of oxytocin. As in any other circumstances, sexual intercourse or lactation the release of oxytocin is highly dependent on environmental factors. It is easier if the place is very warm so that the level of hormones of the adrenaline family is as low as possible. It is also easier if the mother has nothing else to do but look at the babyâ&#x20AC;&#x2122;s eyes and feel contact with the babyâ&#x20AC;&#x2122;s skin, without any distraction. The way oxytocin is released is a new avenue for research. To be effective, this release must be pulsatile: The higher the frequency of pulses, the more effective this hormone is. Oxytocin is never released in isolation. It is always part of a complex hormonal balance. That is why love has so many facets. In the particular case of the hour following birth, in physiological conditions, the high peak of oxytocin is associated with a high level of prolactin, which is also known as the motherhood hormone. This is the most typical situation for inducing love of babies. Oxytocin and prolactin complement each other. Furthermore, estrogens activate the oxytocin and prolactin receptors. If we can always think in terms of hormonal balance these would not be an issue. It was also in 1979 that the maternal release of morphine-like hormones during labor and delivery was demonstrated. The release of these endorphins is now well documented. In the early 1980s we learned that the baby also releases its own endorphins in the birth process, and today there is no doubt, for a certain time following birth, both mother and baby are impregnated with opiates. The property of opiates to induce states of dependency is well known, so it is easy to anticipate how the next step of a dependency or attachment will likely develop. Even hormones of the adrenaline family often seen as hormones of aggression have an obvious role to play in the interaction between mother and baby immediately after birth. During the very last contractions before birth the level of these hormones in the mother peaks. That is why, in physiological conditions, as soon as the fetus ejection reflex starts, women tend to be upright, full of energy, with a sudden need to grasp something or someone. They often need to drink a glass

n The Postpartum

of water, just as a speaker may do in front of a large audience. One of the effects of such adrenaline release is that the mother is alert when the baby is born. Think of mammals in the wild, and we can more clearly understand how advantageous it is for the mother to have enough energy — and aggressiveness — to protect her newborn baby if need be. Aggressiveness is an aspect of maternal love. It is also well known that the baby has its own survival mechanisms during the last strong expulsive contractions and releases its own hormones of the adrenaline family. A rush of noradrenaline enables the fetus adaptability to the physiological oxygen deprivation specific to this stage of delivery. The visible effect of this hormonal release is that the baby is alert at birth, with eyes wide open and dilated pupils. Human mothers are fascinated and delighted by the gaze of their newborn babies. It is as if the baby was giving a signal, and it certainly seems that this human eye-to-eye contact is an important feature of the next step of the mother and baby relationship among humans. The highly complex role of hormones of the adrenaline-noradrenaline family in the interaction between mother and baby has not been studied for a long time. A small number of animal experiments open the way to further research. Mice that lack a gene responsible for the production of noradrenaline leave their pups scattered, unclean and unfed, unless they are injected with a noradrenalineproducing drug when giving birth. From the hormonal perspective it appears clearly that sexuality comes full circle. In all the different episodes of our sexual life the same hormones are released and similar scenarios are reproduced. During sexual intercourse, both partners — male and female — release oxytocin and endorphins. It is the next step of an attachment that is following the same model as the mother baby attachment during the hour after birth. Our current knowledge of the behavioral effects of different hormones involved in the birth process helps us to interpret the concept of a sensitive period introduced by ethologists. It is clear that all the different hormones released by the mother and by the baby during labor and delivery are not eliminated immediately. It is also clear that all of them have a specific role to play in the later interactions between mother and baby.

section 02 The First Hour Following the Birth

Perspective m First Hour and Metabolic Adaptation As long as the baby is in the womb the nutrients, particularly the vital fuel glucose, are provided in a continuous mode via the cord. Immediately after birth the baby must adapt. The remarkable ability of the neonate to respond to significantly low glucose value has been studied in depth by M. Cornblath in the United States, and by Jane Hawdon, Laura Derooy and Suzanne Colson Suzanne's article Womb to World, Midwifery Today Issue 61, page 12 in the United Kingdom. As I've said before I am conservative and so the idea that birth is part of a sexual experience was really off the wall to me. However at the hospital while birthing my placenta I was hit with a rush of oxytocin to rival any orgasm I've ever had. Though it was not in what I would call a sexual experience but rather a magnificent one.

Perspective n The Bacteriological Point of View At birth, a baby is germ free. An hour later there are millions of the germs covering her mucous membranes. To be born is to enter the world of microbes. The question is, which germs will be the first to colonize the babyâ&#x20AC;&#x2122;s body? Bacteriologists know that the winners of the race will be the rulers of the territory. The germ environment of the mother is already familiar to the newborn because mother and baby share the same antibodies igg. In other words, from a bacteriological point of view, the newborn human baby urgently needs to be in contact with only one person â&#x20AC;&#x201D; her mother. If we add that early consumption of colostrum will help establish an ideal gut flora, there is no doubt that, from this point of view, the hour following birth is a critical period with lifelong consequences. Our gut flora can be presented as an aspect of our personality that cannot be easily modified later on in life.

Perspective o Starting up the Process of Thermoregulation While in the womb the baby never had any opportunity to experience differences in temperature apart from possible episodes of maternal fever. Once more, the first minutes following birth appear as an interruption of continuity. As the mechanisms of thermoregulation are not yet mature at birth there are theoretical reasons to be worried about the cases of maternal hyperthermia during labor that are induced by an epidural anesthesia or a too hot bath. Such situations might present challenges in a dangerous way the thermoregulation of the baby by exaggerating the differences of temperature between the contractions and the extra-uterine environments.

n The Postpartum

Perspective p Adaptation to Gravity During that first hour a relationship to gravity is established. Suddenly the vestibular nerve, which serves equilibrium, is carrying to the brain an unprecedented flood of impulses from the semicircular canals, utricles and saccules. Perspective q The Ethnological Approach Ethnology has now established itself as a science by publishing databases. Today its material on pregnancy, childbirth and the first days following birth is easily accessed. Most cultures in one way or another disturb the first contact between mother and baby during the hour following birth. The most universal and intriguing way is simply to promote a belief, such as the belief that colostrum is tainted or harmful to the baby, even a substance to be expressed and discarded. Such a belief necessitates that, immediately after birth, the baby must not be in her motherâ&#x20AC;&#x2122;s arms. This implies rituals such as the ritual of cutting the cord immediately. The first contact between mother and baby can be disturbed through many other rituals: bathing, rubbing, tight swaddling, foot binding, smoking the baby, piercing the ears of the girls, opening doors in cold countries, etc. It would take many volumes to present a comprehensive study of the characteristics of a great number of cultures in relation to how they challenge the maternal protective instinct during the sensitive period following birth. However, a simple conclusion can be drawn from a rapid overview of the data we have at our disposal: The greater the social need for aggression and an ability to destroy life, the more intrusive the rituals and beliefs are in the period surrounding birth. If disturbing the first contact between mother and baby and promulgating such excuses as the belief that colostrum is bad are so universal, it means that these behaviors have carried evolutionary advantages. After taking into account and combining all the perspectives that indicate the importance of the hour following birth, and after referring to perinatal rituals and beliefs, we are in a position to claim that the cultural milieus are to a great extent shaped during the hour following birth. We can consider the hour following birth in the context of our modern societies. end |

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k Designer Stephanie Penland l Photographers 02 Edited by Tres Photography 06 Michael Penland m Writers 01 Stephanie Penland 02 Crystal Wolf 03 Illana Pearlman n Printer 01 Alpha Graphics 02 Kodak M700 03 Cougar smooth text 80#, Natural o Details 01 Font Archer Pro 02 Chartwell

a woman-centered birth

book

Evidence Based Practice for Women During Birth

The

Postpartum section

After the Birth

Getting to Know Your Baby

Perhaps you have never seen a newborn baby before, you may be quite surprised the first time you see what your child looks like when they first come out, blue, messy, just weird. Newborns look different from babies who are a few weeks old.

Postpartum is Exciting

Breath Deeply

Relax and Enjoy

section 03 Getting to Know your Baby

n The Postpartum

Getting to Know your Baby Perhaps you have never seen a newborn before, you may be quite surprised the first time you see your child. Newborns look quite different from babies who are a few weeks old. Here are some of the normal things that you may notice about your newborn. Your Baby's Skin Your baby's skin may be covered with vernix, a slippery white coating that protected your baby's skin during pregnancy. It will wash off or absorb into your baby's skin in the first 24 â&#x20AC;&#x201C; 48 hours. Milia are white spots that may appear around your baby's nose. Although the may last for a few weeks, they do not need to be treated. Washing with clear water is all that is needed. Lanugo is the fine downy hair that may be found on your baby's forehead, ears and shoulders. It usually disappears by two months of age. Your baby's skin may be dry or peeling, especially on their hands and feet. He's come out of a very moist environment to one that is quite a bit dryer! Newborn rash is very common in the first month and will usually go away on its own. Mongolian Spots are black or blue spots that may be found on any part of the baby's body, but usually on the back or bottom, if the baby has any at all. These spots usually fade by five years of age. Storkbites are reddish areas that may appear on your baby's forehead, eyelids, nose or back of the neck. These fade and usually disappear by 24 months. Your Baby's Head Soft Spots There are two soft spots, called fontanels, on the top and the back of your baby's head where the bones of the skull have not yet joined. The bones grow together as our baby gets older. Touching the soft spots will not harm your baby but do be gentle as it is tender and a trauma can be damaging.

section 03 Getting to Know your Baby

Hair Your baby may have lots of hair or none at all. Babies may lose some of their hair shortly after birth. Your baby's hair may also change color. Eyes Babies love to look at their parents' faces. Studies have found that full-term newborns can recognize their own mother's face as early as four hours after birth! Your newborn's can best see you at a distance of about 8 â&#x20AC;&#x201C; 10 in, 20 â&#x20AC;&#x201C; 25 cm. The eyelids may be swollen for a few days after birth, but this will go away on its own. It is quite common for a baby's yes to change color during the first year. Nose After birth, your baby's nose may be flat or misshapen. It will gain a normal shape in time. Head Shape Few newborns have perfectly shaped heads. It may take up to 6 weeks for your baby's head to become rounded after birth. Flat Areas on the Head The skull bones are soft until about one year of age. As a result, flat areas on the head can develop very quickly, often within the first two months. Babies who lie on their backs looking straight up may develop a flat area on the back of the head called brachycephaly. Babies who tend to lie with their heads turned to one side may develop flatness only on one side of their head plagiocephaly, which can lead to changes in facial symmetry. Plagiocephaly will change your baby's appearance but does not affect your baby's mental or physical growth and development. However, the changes in appearance can be permanent if not addressed as early as possible. Preventing Flat Head When your Baby is Sleeping Place your baby's head at the opposite end of the crib every other night. For example, lay your baby one way on even days, the other way on odd days. Your baby will tend to turn towards the door and any noises in the house. Change your baby's head position during sleep. For example, you can place your baby's head to the left for one nap and to the right for the next nap. If you baby likes to sleep directly on the back of their head, try to encourage your baby to turn their head to alternate sides.

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If there is brightly colored wallpaper behind one side of the crib, cover it with a solid colored sheet to encourage your baby to look into the room. keep crib-bar toys on the room side of the crib. If your baby always wants to look in one direction, try to position his or her head in the other direction as much as possible. Unless advised by your doctor, do not put your baby to sleep in a car seat, bouncy seat or swing. Do not use sleep devices such as wedges or rolled up blankets or towels to keep your baby in position. Once your baby starts rolling over he or she can choose their own sleep position Though my baby never did tummy time, screamed his head off if I tried, he turned out just fine, strong and walked at 10 months.

Giving Baby Tummy Time One of the best things you can do to prevent a flat area on your baby's head is to provide early supervised tummy time when your baby is awake.

› Strengthens the muscles in the neck, shoulders, back and tummy › Develop early head control › Develop arm reach › Learn to roll over › Learn to crawl

It takes time for your baby to develop the muscle strength to enjoy this position and he or she may fuss at first. Start by laying your baby on his or her tummy on your chest while you lie in a reclined position. You can also place your baby on his or her tummy across your lap. These positions are not safe for sleeping. Another idea is to roll up a small towel and place it under your baby's chest, placing their arms in front of the towel. This will make it easier for your baby to hold their head up. Young babies will not be able to hold their heads up but you can still place them on their tummies when awake and position them to look in alternate directions. Another good play position for your baby is side-lying. Placing a rolled up towel behind your baby's back and in front of his or her tummy when playing on his or her side will prevent your baby from rolling.

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k Designer Stephanie Penland l Photographers 02 Edited by Tres Photography 04 Catherine Byrd m Writers 01 Stephanie Penland 02 Crystal Wolf 03 Illana Pearlman n Printer 01 Alpha Graphics 02 Kodak M700 03 Cougar smooth text 80#, Natural o Details 01 Font Archer Pro 02 Chartwell

a woman-centered birth

book

Evidence Based Practice for Women During Birth

The

Postpartum section

After the Birth

Breast-Feeding

Most women make the decision during pregnancy whether they are planning to breast-feed or not. Iâ&#x20AC;&#x2122;ll try it and see what happens is a common attitude for some women. What most women

donâ&#x20AC;&#x2122;t realize is that many times the Breast-feeding relationship between a newborn and a new mom, does indeed take some work. But the encouraging thing is that almost all problems that a new mom encounters in the early days of Breast-feeding can be remedied with the right support and information. By having quality resources readily available, a mom is already giving her Breast-feeding relationship a great start.

Breast-Feeding Can Be

Rewarding &

Challenging

section 04 Breast-Feeding

n The Postpartum

Breast-Feeding Breast-milk is produced naturally by women and provides the basic nutrition for a baby during the first several months of life. Breast milk has three different and distinct stages: colostrum, transitional milk, and mature milk. Visit with a Lactation Consultant to learn more about Breast-feeding and breast milk Colostrum is the first stage of breast milk that occurs during pregnancy and lasts for several days after the birth of the baby. It is either yellowish or creamy in color. It is also much thicker than the milk that is produced later in Breastfeeding. Colostrum is very high in protein, fat-soluble vitamins, minerals, and immunoglobulins. Immunoglobulins are antibodies that pass from the mother to the baby and provide passive immunity for the baby. Passive immunity protects the baby from a wide variety of bacterial and viral illnesses. 2 â&#x20AC;&#x201C; 4 days after birth, colostrum will be replaced by transitional milk. Transitional Milk occurs after colostrum and lasts for approximately two weeks. The content of transitional milk includes high levels of fat, lactose, water-soluble vitamins, and contains more calories than colostrum. Mature Milk is the final milk that is produced in the breast, 90% of it is water, which is necessary to maintain hydration of the infant, and the other 10% is comprised of carbohydrates, proteins, and fats which are necessary for both growth and energy. There are two types of mature milk: foremilk or hind-milk. Foremilk This type of milk is found during the next step of the feeding and contains water, vitamins, and protein. Hind-Milk This type of milk occurs after the initial release of milk and contains higher levels of fat, and it is necessary for weight gain. Both fore-milk and hind-milk are necessary when breast-feeding to ensure the baby is receiving adequate nutrition will grow and develop properly. You might looking into taking a supplement that helps deliver vitamins, minerals, and much needed nutrients that are important for healthy and plentiful breast-milk production.

section 04 Breast-Feeding

Most women make the decision during pregnancy whether they are planning to breast-feed or not. I’ll try it and see what happens is a common attitude for some women. What most women don’t realize is that many times the breast-feeding relationship between a newborn and a new mom, does indeed take some work. The encouraging thing is that almost all problems that a new mom encounters in the early days of breast-feeding can be remedied with the right support and information. By having quality resources readily available, a mom is already giving her Breast-feeding relationship a great start. Getting Breast-feeding Help In most areas, there are a variety of resources. Breast-feeding help may come from a neighbor who successfully breast fed her own children or can be a certified lactation consultant who is qualified to work with moms with the most complicated breast-feeding issues. Postpartum Doulas Postpartum doulas are women who assist new families in the days and weeks after a new baby arrives. They often have training in general breast-feeding support and often will have a list of other breast feeding resources if a problem is beyond their expertise. LaLeche League – lll is an organization that supports and promotes breast feeding through support groups lead by moms. lll leaders are moms who have successfully breast-fed their own children and want to offer support and encouragement to other moms. They offer help over the phone and through their community support groups that usually meet monthly. Lactation Consultants & Breast-feeding Counselors Your local hospital, pregnancy center or health department may have people on staff that are called Lactation Consultants or Breast-feeding Counselors. Often these are support people who work frequently with new moms and are trained to help with initial Breast-feeding support and issues.

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Board Certified Lactation Consultant â&#x20AC;&#x201C; ibclc The lactation consultant who is board certified had gone through comprehensive training and board testing to qualify as someone who can offer extensive support in the most complicated breast-feeding problems. Hospitals sometimes will have bclc as part of their staff on the postpartum floor or may offer a Breast-feeding support center staffed with these types of lactation consultants. The Type of Support You Need Breast-feeding help is something individual for each woman. Sometimes all a new mom needs is someone to come along beside her and believe in her ability to breast-fed her baby. In this case, a postpartum doula, a Laleche League leader, a breast-feeding counselor or even a close friend may be all she needs. If the issue seems more serious or if the mom is feeling completely over whelmed by breast-feeding, she should contact someone who can help her come up with solutions to the problems she is encountering. This may be someone like a breastfeeding counselor or a Laleche League leader â&#x20AC;&#x201D; but the contact number for a board certified lactation consultant should also be handy in case problems persist. If you are pregnant and interested in breast-feeding your baby, it is a great idea to gather these numbers beforehand so that you may contact them from the hospital or as soon as you get home. The key to overcoming most breast-feeding problems is early support and early detection of issues.

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a woman-centered birth

book

Evidence Based Practice for Women During Birth

The

Postpartum section

After the Birth

Postpartum â&#x20AC;&#x201D; The Care you need Postpartum care in the usa is inadequate, generally consisting of a single visit with a physician around six weeks after birth. Women with known complications may receive more attention;

The lack of care for women in the weeks that follow after the birth and after they have returned home with the new baby can mean complications are missed. c.y. Cheng et al, Postpartum Maternal Health Care in the United States: A Critical Review, Journal of Perinatal, Vol.15 3, 2006, pp.34 â&#x20AC;&#x201C; 42

Postpartum is More Than

Just After the Birth it's

an Adjustment

section 05 Postpartum â&#x20AC;&#x201D; Care the Care you need

n The Postpartum

Postpartum â&#x20AC;&#x201D; The Care you need It seems we are all given lists for how to prepare for birthing. We are told the list of what to have at home for our home birth: flashlight, wash cloths, receiving blankets, newborn hats, and the list goes on. We are told what to pack to take to the hospital: birth plan, nightgowns, music, phone numbers, etc. Yet some how, with all of our prenatal care and birthing preparation lists we aren't given a what to have postpartum list. Some of the postpartum surprises talked about very often, except for perhaps by veteran mothers in mom's groups. So what are some things to be prepared for immediately following birthing? Some of these have already been mentioned throughout the books, lactation, placentophagy, and postpartum doula. Here is a breakdown of what a collection of mothers said they wish they knew for the immediate postpartum time frame. It is split up into what they wish they knew about their Physical being, their Emotional state, things to Have or Not Have, Baby Care and Miscellaneous tidbits. Physical Your belly doesn't instantly flatten out after the baby and placenta are out don't expect to drive home in your pre pregnancy jeans. Hemorrhoids This condition is possible after birthing, especially after strenuous pushing however, anyone can get them. They can be painful and sitz baths can help prevent this or ease the pain if they do occur. Being In Pain Your perineal area may feel sore, sitting can be challenging. Muscle soreness overall can be painful. Cesarean incisions. After the birth you are going to want to Lay down a lot and rest and heal; this goes for vaginal or Cesarean. Resting is so very important that it has been stressed to rest even when you are feeling really good. It is easy to get dizzy and over-do it postpartum so going slow and allowing time to heal is critical. All women experience different physical things. Some have hair fall out from hormonal changes.

section 05 Postpartum â&#x20AC;&#x201D; Care the Care you need

How to Breast Feed So many think this will be a natural thing, however, it takes practice and can require guidance. There were numerous women that mentioned they wished they watched breast feeding videos and had more in person experience to help them those first few weeks. Knowing your local lll and if you will have a lactation consultant ahead of time is a good idea. It isn't much fun trying to find people after birthing. With breast-feeding, also knowing that a woman may not pump well but still does produce enough milk to feed her baby sufficiently. Get comfortable having your boobs out What is meant by this, is having some nursing friendly clothes available. Button down shirts are great and there is a whole line of nursing clothes out there. However, in those first few days postpartum looser clothing is more appealing to most women. Having your breasts at easy access with help your nursing relationship and will help prevent thrush because of the air flow. Helping you get your abs back after pregnancy, and what to specifically do to do this. Same goes for how to get their pelvic floor back in shape Pay attention to dietary and supplemental intake Make sure you are eating enough, especially with the extra calories that are burned nursing. Nutrition is key here. Balanced nutrition will help with strength, energy and increased immunity, overall health. A postpartum doula may help with this or a nutritionist that has knowledge about the postpartum period.

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Emotional Things Hormonal shifts can be really intense. We hear about the baby blues and postpartum depression, but you have no idea how your hormonal shifts are going to affect you until you are in those moments; And it can be different for each birth. As mentioned in another chapter, placentophagy can assist with this. Also, having a good support team greatly reduces the vulnerable and scary feelings that can come with these shifts. With the shifts above and the role change, to for the first six weeks are usually the most challenging. Knowing this can greatly help a woman and her family get through those first few weeks. The baby grows rapidly. Things change rapidly because of that. A good reminder that things will change is a nice head's up for that postpartum period. Adapting to Parenthood can bring anxiety if it is your first time around. The desire to do everything right can be overwhelming, so remind yourself that you are an amazing person and trust your inner knowing, and contact professionals when you have doubts. Do not overlook how much joy you will also feel. It is possible that you are about to feel more love than you ever knew existed. There's nothing that can prepare you for that. Overall, it is nice to know that there is a myriad of emotions that can take place and that they are all ok. It is also important to check in with yourself and if things are not flowing well and you are unable to heal or take on your new roles to seek professional help. There are wonderful people that work with wonderful women that go through these rough patches. Baby Love your baby, smell them, cuddle them, remember time flies and these moments are brief and precious. Try to sleep when baby sleeps. Take lots of pictures and back them up.

section 05 Postpartum â&#x20AC;&#x201D; Care the Care you need

Newborn poop is sticky...if you are thinking about using cloth you may want to consider a disposable for those first few days. Also depending on the size of your baby it will take a week or so before cloth fit the best. Car Seat Safety This is something that some hospitals have enforced more information on, so if you are birthing in a hospital find out if they will inspect your car seat installation before you put baby in it or if this is something you need to do before birthing. Vitamin k Know the pros and cons and where you stand before birthing so that after birthing you are not left with a wish I did/didn't do that position. Have a Pediatrician Picked out Beforehand So you are not having to go through and interview pediatrician after pediatrician to find out that fits with your belief systems and parenting styles. Read Parenting Books Before Birthing! The Witching Hours where sometimes the baby will cry and there seems nothing you can do to fix it. Do your best and comfort them through this time, but do not beat yourself up about it and know that it will pass. And in no way is this a suggestion to let them cry it out. Please do not do that. Your baby needs you, sometimes they do experience this witching hour. You will know it is this because they will fuss or cry during the same three hour time frame every night. Then there are the things that a woman wishes she got before she had her baby because going to the store is the least fun idea during this time.

n The Postpartum

Not So Obvious things you May Need Arnica For muscle soreness, homeopath, safe for nursing. Witch Hazel To make cooling pads for bottoms, also good for in case of hemorrhoids Menstrual Pads You will be bleeding for quite some time, make sure you are stocked up so you do not have to run to the store every oh so many days. Along with menstrual pads, make sure to have quite a few pair of period underwear. Typically the bigger cotton briefs are the most comfortable during this time. Nursing Pads Leaking is normal and it's a good idea to have some cloth or disposable nursing pads ready to go. Nursing Bra Your breasts will change as milk comes in, so it is challenging to get the best fit for this until a few weeks postpartum. However, to have at least one comfortable nursing bra will make life much easier for when you want to be wearing a bra.

section 05 Postpartum — Care the Care you need

Must Haves

› Carrier, sling › Some clothes both for you after and for the baby › Diapers and wipes

Don't Necessarily Need Time and time again I said, Gosh, I really didn't need that, and I wish I saved my money here. If you know ahead of time what type of parenting you are going to practice you may not fall prey to saying these things. For instance, if you know you are going to co-sleep you won't go out and buy a crib. However, if you do not and you simply go out and buy everything they say you should, you may end up with a mass supply of things that are never used. Some things that end up on that list are: Crib Co-sleeping has become a norm and a large portion of the mothers listed this as an item that was being used as an expensive storing unit instead of a bed for a baby. Changing Table Something you can decide to get later if you think it will be really beneficial to you. Bottles or Pump Start with just a few bottles and perhaps a hand pump to save on money until you know that you are going to be pumping often and storing etc. This is a big one that people splurge on only to end up not using bottles at all or to find out that mom has a tough time pumping. Clothes Yes you need clothes, but you will receive a lot of them as gifts and possibly hand me downs — the point is to not go overboard in this department unless you are purchasing for their older years. Bouncer Chairs Recommend getting this used at least in the next step, a lot of babies don't like them and quite a few of them are unsafe so make sure to check the recall lists. Baby Food Grinders you can smash it just as easily without purchasing an extra item to take up space in your home

n The Postpartum

Miscellaneous k Support You will be healing and taking care of a new little person. There is not time or energy to do housework, or cook enough meals. Having people signed up to help out is key. l Maternity Leave Know realistically how much time you really want off for postpartum or maternity leave. Some countries offer a year because a couple months is not necessarily enough time. m Food in the Freezer More than just a casseroles and lasagna., frozen veggies, pre made and frozen mashed potatoes, burritos, spinach pies, cookie dough, though eating too much sugar postpartum is not a good idea, so healthy cookies. New parents will tell you that navigating through those first few days after bringing home a new baby is anything but easy! Even for the most experienced parents, bringing home a new baby is challenging.

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a woman-centered birth

book

Evidence Based Practice for Women During Birth

The

Postpartum section

After the Birth

Postpartum â&#x20AC;&#x201D; The First Month

Postpartum Depression and Anxiety affects approximately 10 â&#x20AC;&#x201C; 24% of women. It can occur any time up to one year after giving birth.

Motherhood is

Important, Special

Amazing & Fun

section 06 The First Month

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The First Month You are now the proud owner of a new mom's body! The body that nurtured your baby for nine months is changing again. Mom's New Body It takes time for your body to recover from the birth, and if you are breast-feeding, you experience more changes. It's important for you to rest when you can and to eat well. After a Cesarean Birth It usually takes about four to six weeks for your incision to heal completely, but most women feel very well before this time. Until you are healed, it's important to: Take it easy During your recovery, avoid housework, and do not lift anything heavier than your baby. Have everything that you and your baby might need close to you, so you will not have to go up and down stairs. Support your Abdomen Use good posture when sitting, standing and walking. Hold your abdomen near the incision during sudden movements caused by coughing, sneezing or laughing. Limit Company For the first few weeks. Make sure any visitors give you some help. Too many visitors, however, will keep you from getting the rest you need to recover and care for your newborn. Stay Hydrated Drink lots of fluids. You will likely need extra fluids to replace those lost in delivery and breastfeeding. Also, empty your bladder frequently to help reduce the risk of urinary tract infections. Avoid Driving Ask your doctor when you can start driving. Before you take the car and baby out together, make sure you can manage the baby's car seat without hurting yourself. Severe pain in your abdomen or redness, swelling and oozing puss at your incision site may mean you have an infection. Contact your caregiver or your doctor immediately.

section 06 The First Month

Mom's New Emotions Talk about ups and down's! It's normal for a new mom to go through a wide range of emotions — from joy, excitement and amazement to fear, sadness, anger, and more often in a short period of time! Physical changes, fatigue, changing hormones, and pressure of this new on-the-job-training all contribute to this, and new parents are often surprised about the depth of all their emotions! New parents go through a time of adjustment after the new baby arrives, even if it's not the first one. Postpartum Emotions and the Blues During the first few weeks after the next step of your baby, you may have periods of postpartum blues. You may feel sad, cry for no apparent reason, feel very tired, or have poor concentration. Reasons for Postpartum Blues

› Hormonal changes › Lack of sleep › Disappointment › Lack of confidence in your new role as a mother › Changes in your relationships › Trying to do too much too soon › These symptoms gradually improve as mom gets more sleep and hormone levels come back to balance › Postpartum depression/anxiety

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Postpartum Depression or Anxiety affects approximately 10 – 24% of women. It can occur any time up to one year after giving birth. If you are having any of the following feelings, thoughts or behaviors after the birh of your baby, you may be experiencing Postpartum Depression and or Anxiety. And there are ways to help you out.

› Crying for no obvious reason › Feeling helpless › Feeling anxious or panicky › Feeling overwhelmed › Feeling angry or resentful › Feeling inadequate and not able to cope › Dramatic changes in sleep patterns › Frightening thoughts and feelings › No feelings for the baby › Feeling aggressive toward the baby or other family members › Feeling depressed — may range from sadness to thoughts of suicide › Repeated thoughts, ideas or actions that seem uncontrollable If you have any of these feelings, contact your doctor, midwife or public health nurse.

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k Designer Stephanie Penland l Photographers 02 Edited by Tres Photography 06 Michael Penland m Writers 01 Stephanie 02 Crystal Wolf 03 Illana Pearlman n Printer 01 Alpha Graphics 02 Kodak M700 03 Cougar smooth text 80#, Natural o Details 01 Font Archer Pro 02 Chartwell

a woman-centered birth

book

Evidence Based Practice for Women During Birth

The

Postpartum section

After the Birth

The Father & Relationships

One thing a lot of new parents, especially the spouse is not always prepared for is sleep disruption. There will be nights, sometimes weeks where you do not sleep every couple hours or perhaps not at all. Remember, this is normal!

Father & Relationships Are

Important, Special &

Worth Investing In

section 07 The Father & Relationships

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The Father & Relationships There's nothing like becoming a new mom, expect becoming a new dad, or a new partner. Remember that they will have a surge of emotions and life changes to deal with just like you. There is a huge responsibility to care for, protect, and provide for this new family. When you were pregnant you might have felt a bit distant from the reality of becoming a father. It is hard to imagine what your partner feels and is experiencing as they were not the one carrying the baby. Knowing and expecting this sudden surge of emotions and reality when your baby is born won't exactly change how they feel. It can help them to see it as normal and give you both choices as to how to deal with them. If you are a person who normally retreats into your cave you might want try expressing the emotions verbally before the baby comes. Communication will be key when you have a new born because there won't be time for anything else. While all the excitement of the first week or even month is going on remember that you want to include your husband or partner in all the activities. Not just include but ask their opinion, let them make decisions and let them aid in the care of the new baby. Most spouses get to take time off work. Use that time to develop your relationship as a family. It won't be easy but it will be rewarding. One thing a lot of new parents, especially the spouse isn't prepared for is sleep disruption. There will be nights, sometimes weeks where you don't sleep but every couple hours or not at all. This is normal. Another thing partners aren't always prepared for are the emotions involved. Feelings of inadequacy, and not being sure they can do this. Make sure you reassure them that they can do this, and that you want them to do this. When your spouse sees you in an emotional state help them to realize that you also have hormone shifts taking place on top of everything. Talk about it and be open with your feelings, both of you. Some things that can help are to rest as often as you can, and not put too many expectations on tasks.

section 07 The Father & Relationships

Helpful Tips for the Partner Try not to plan huge adventures, a walk around the block can be more than enough adventure for one day. Limit how many people come and see you. Ask your wife or partner what she needs, and tell her what you need. And remember it's ok to take some time for yourself, getting a coffee with a friend. Just make sure that you communicate your intentions and set a time you will be back. There's nothing worse then having a new born and not knowing when help is coming back. Spending alone time with your new baby is wonderful for both parents. Be active in learning about your babies cues, and what they need. To Learn how to change diapers and care for your child can be extremely empowering. You both should remember that you will do things differently and that it's okay. And don't be worried if it takes a while to get use to all this extra stuff. It takes time to learn and become efficient at anything, so don't be too hard on yourself or each other.

n The Postpartum

One thing a lot of new parents, especially the spouse is not always prepared for is sleep disruption. There will be nights, sometimes weeks where you don't sleep but every couple hours or not at all. Remember, this is normal!

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k Designer Stephanie Penland l Photographers 02 Edited by Tres Photography 03 Stephanie Penland m Writers 01 Stephanie Penland 02 Crystal Wolf 03 Illana Pearlman n Printer 01 Alpha Graphics 02 Kodak M700 03 Cougar smooth text 80#, Natural o Details 01 Font Archer Pro 02 Chartwell

a woman-centered birth

book

Evidence Based Practice for Women During Birth

The

Postpartum section

After the Birth

Postpartum & ipv Signs

Data on what abuse specifically looks like during postpartum is very difficult to find.

The following is an incomplete list of some of the ways ipv manifests itself during the postpartum period; each have degrees of severity and no one sign guarantees violence is present; taken as a whole, however, this is a good starting point for making an assessment of a motherâ&#x20AC;&#x2122;s safety and risk of experiencing ipv and other complications. ipv Postpartum Signs Illana Pearlman â&#x20AC;&#x201D; ceo & Founder Nature Nurture Birth

Intimate Partner Violence

Know the Signs

and Get Help

section 08 Postpartum & ipv Signs

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Postpartum & ipv Signs start | IPV Postpartum Signs Illana Pearlman — CEO & Founder Nature Nurture Birth Data on what abuse specifically looks like during the postpartum period is very difficult to find. The following is an incomplete list of some of the ways ipv manifests itself during the postpartum period; each have degrees of severity and no one sign guarantees violence is present; taken as a whole, however, it is a starting point toward making an assessment of a mother’s safety and risk of experiencing ipv and other complications. Acknowledging the facts give the health professionals working with women of childbearing age, an opportunity, as doctors, as midwives, or as doulas to assess a mother’s risk for pregnancy and postpartum-induced ipv and provide her with tools and resources to help her make safe choices for herself and baby. Increased risk in postpartum complications for the mother, such as heavy bleeding, higher susceptibility to infections such as mastitis. Baby is at a Higher Risk for Neglect with Intimate Partner Violence

› Life of the mother and baby are at risk › The mother has a 40% increased risk for having postpartum depression › Negative impact on our communities and society as a whole

Specific ipv Signs to Look Out For, Postpartum

› Partner blames mother when baby cries, the baby’s crying because you don not have enough milk a may lead to partner unnecessary formula feeding a breast-fed baby against a mother’s wishes. › Partner is withdrawn and unhelpful to mother and baby may not be true when visitors are around; partner may actually be overly helpful when visitors are around as a way of hiding the abuse.

section 08 Postpartum & ipv Signs

› Partner withholds any medications or products necessary for mother’s recovery from birth, i.e. withholding pain meds, sitz bath herbs, hygiene supplies, etc. › Partner won’t allow visitors particularly the new mother’s support system and people closest to her. › Partner won’t allow mother access to additional support systems, such as new mother’s groups, childbirth class reunions, etc. › Partner is overly jealous of baby. › Partner pressures mother to resume sex before she feels ready and healed. › Partner makes lewd sexual jokes about breast-feeding or when she does not want her breasts to be touched. › Partner threatens to kidnap the baby if the mother was to leave. › Mother shows signs of postpartum depression. › Emotional abuse, such as verbal threats, can be just as damaging as physical violence, and it is still abuse. › Name-calling, yelling, hitting, kicking, put-downs, breaking things, threatening, humiliation, pulling hair, hurting pets, restricting access to resources such as money. Do, for Helpers

› Provide mom with a list of resources, shelters, and hot lines be very careful not to leave such information out in the open where her partner could find it and possibly punish her because of it. › Offer to set up appointments for the mom to meet with a counselor if she cannot keep any information or resources in her immediate home, calendar or home. › Help the mom come up with a safety plan or refer her to someone who can help her come up with such a plan. › Help the mom come up with a plan for childcare or provide her with information on free low-cost childcare if she has appointments or meetings she does not want her children attending. › Plan a follow-up checking-in postpartum phone call or meeting for all mothers well before the standard 4 – 6 week meeting. › Provide information about single parenting and a resource list that includes books, websites, support groups, hot lines, and childcare

n The Postpartum

information; the thought of being a single parent can feel over whelming and scary, particularly for a newly postpartum mother Don’t, for Helpers

› Do not ask questions such as: Is anyone abusive in your home? Do you feel safe in the presence of others, including friends and family, or doctors? › Do not ask judgmental questions, such as why don’t you just leave? If it was ever that simple or easy she would have already left or perhaps she has tried to leave many times before. › Do not ask questions in a rushed or hurried way; studies have shown that when women felt the questioner was rushed, they were less likely to disclose the abuse.

Do not tell the mother whether she should stay or leave; she needs to make this decision herself. Instead, you may hand the mother a list of common abusive behaviors and then say something like this: It seems like your partner’s actions are similar to some of the abusive actions presented on this list. It sounds like it may be difficult for your body to fully recover from the birth in this type of environment. Thus, you are letting the mother know that staying could inhibit her recovery while suggesting leaving might help her recovery, but still putting her in a position where she must make her own decision of whether to stay or leave the relationship. Additional Facts

› Violence during pregnancy strongly predicts that violence after the pregnancy is likely to occur. › Women who are victims of ipv have a 40% increased risk of developing postpartum depression. › Recent immigrants were among the least likely to leave a violent relationship one year postpartum. › usa born women who were employed during their pregnancy were among the most likely to leave an abusive relationship one year after the postpartum period.

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k Designer Stephanie Penland l Photographers 01 Isaiah Beiser Photography m Writers 01 Stephanie Penland 02 Crystal Wolf 03 Illana Pearlman n Printer 01 Alpha Graphics 02 Kodak M700 03 Cougar smooth text 80#, Natural o Details 01 Font Archer Pro 02 Chartwell

a woman-centered birth

book

Evidence Based Practice for Women During Birth

The

Postpartum section

After the Birth

Note Book

Take notes and begin this journey...

Intimate Partner Violence

Know the Signs

and Get Help

sect ion 00 Note Book

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Notes for Book 4

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