Postpartum Care

Basics of breastfeeding

Breastfeeding provides a time for you and your baby to relax together as she feeds. Establish a routine that’s comfortable to you.

Here are some items to have on hand:

• Nursing pillow to support your baby in your kap.
• Comfortable nuring stool to elevate your feet and ease strain on your back.
• A large glass of water and a healthy snack.

Help from the experts

As you and your baby get comfortable in your breastfeeding relationship, you may need advice from time to time. Make sure to consult your healthcare professional.

How to hold your baby while nursing

Cradle Hold

• Sit upright and place your baby on her side across your lap, facing you.
• Support the baby’s head, back, and bottom with your arm, then move her face near your breast.
• Brush her mouth or check with your nipple.
• When the baby begins to suck, make sure she takes enough of your nipple and areola in her mouth to properly latch on.

Football Hold

• Hold her head and neck in your hand. Let her feet extend toward your back.
• Use a pillow to support your baby and use your free hand to direct the baby’s mouth to your breast.
• Experts advice this position as helpful if you’ve had a cesarean delivery, have large breasts, or if you are nursing twins.

Side-Lying Position

• Lie on your side with your baby on her side, facing you.
• Position your baby’s head at your lower breast.
• When she’s attached to your breast, use your lower arm to support your head. Many hospitals suggest this position if you’ve has a cesarean section.

  Did You Know?

As your baby’s appetite increases during growing spurts, your milk volume also increases. Typical growth spurts occur at 10 to 14 days, 6 weeks, 3 months, and 6 months.

Latching on

The key to successful breastfeeding starts with your baby being able to properly latch on to your breast. Follow these steps to help ensure that your baby latches on correctly and is provided with adequate breast milk:

• To start, cup your breast with thumb on top and forefinger underneath, and lightly touch the baby’s lower lip with your nipple. This may be enough to stimulate her rooting reflex, and she’ll turn her head to your nipple, mouth wide open.
• When the baby opens her mouth wide, draw her in close. If she is latched on correctly, her lower lips curls down. Her mouth should be around the nipple and as much of the areola as possible. If she’s latched on, you should hear several sucks, a pause, then a swallow.
• When the baby is properly attached, there’s a strong seal between her mouth and your breast. To release the baby from the breast or to move the baby to the other breast, gently place your finger between her gums to break the sucking action.

Burping baby

From time to time, your baby may swallow small amounts of air during feeding, and this may cause an uncomfortable bubble in her tummy. To relieve the baby’s discomfort, place her over your shoulder and gently pat or rub her on the back to release the accumulated air. Try experimenting with different positions such as sitting up or across your lap.

Common breastfeeding issues

Breastfeeding is the most natural way for you to give your baby the best nutrition during her first years of life, Although nature's way is the very best you may experience one or more of the following situations that sometimes occur with breastfeeding, Here are some helpful tips on what to do:

Leaking Milk

Milk leaking from your breast is a normal physical reaction for breastfeeding moms right before nursing or when your baby cries,

• Use absorbent nursing pads inside your bra to collect any drips
• Change padding often

Sore nipples

Vigorous sucking or improper latching on may cause sore or cracked nipples,

• Try a new position while breastfeeding
• Air-dry your nipples after feeding your baby or showering
• Rub your own breastmilk or colostrum around your nipples
• Wear cotton clothing such as a nursing bra or loose-fitting top

Breast Pain

Tingling in your breasts may occur as your body adjusts to breastfeeding, If you experience tingling only when your baby is nursing, it's a normal sign of your body releasing milk.

• Use warm or cold compresses on your breasts between feedings
• If your breast is sore or hot or you experience a fever over 100° F, you may have a breast infection. Contact your doctor
• If you continue to experience pain after you and your baby are well adjusted to breastfeeding, your doctor may want to check out the symptoms

Breastfeeding’s skin-to-skin touching and close eye contact help create an intimate mother-child bond.

Troubleshooting the above issues

Slow milk-ejection reflex

To aid the process of let down for the release of milk in your breast:

• Before your baby begions to nurse, gently massage your breast for simulation
• Keep a positive attitude about breastfeeding, and enlist the help and encouragement of family members
• Stay relaxed and breastfeed your baby in a acalm, stress-free environment

Difficulty latching on

If your baby is not properly latched on to your breast during breastfeeding

• Try different breastfeeding positions to find one that works best
• Bring your baby’s mouth to your breast
• Make sure your baby takes the whole areola into her mouth, not just the nipple

Plugged ducts

A small hard lump may form in your breast. It may disappear on its own after a few days

• Start nursing with that breast first, and encourage your baby to nurse longer on that side
• Massage the area between feedings
• Apply a warm, wet cloth before nursing

Engorged breasts

Painful, hard, and swollen breasts result from the accumulation of milk as your breasts adjust to your baby’s needs.

• Nurse your baby frequently
• Try a new breastfeeding position
• Express a little milk if your breast is too full for your baby to latch properly
• Place a warm, wet cloth on your breasts to soften and ease the pain
• Between feedings, use cloth-covered cold packs to limit swelling

  Did You Know?

Breastfeeding is the best way to ensure a healthy start for both you and your baby. Medical authorities encourage doctors and hospitals to assist new moms in the breastfeeding experience as soon after birth as possible. Here’s an idea of what to expect:

Colostrum

Yellowish, translucent fluid your breasts secrete during the first few days of breastfeeding

• Contains easy-to-digest proteins, vitamins and minerals
• Contains antibodies to protect your baby from disease
• Frequent, short feedings help with your baby’s first bowel movement

Transitional milk

Marks the change from colostrum to regular breast milk in about three days from the onset of breastfeeding

• As milk comes in, your breasts may become very full and tender
• Continue to breastfeed consistently every two to three hours; don’t skip or prolong time between feedings. Consistency is important at this time to help your body establish milk production and to synchronize with your baby’s needs

Breast milk

Nature’s most perfect, nutritionally balanced food for your baby’s healthy, natural growth and development

• Evolves as your baby’s n utritional needs grow
• Contains more of the fats and proteins needed for energy, weight gain and healthy brain and cell development
• Is easy for your baby to digest

  Did You Know?

Breast milk actually changes to keep up with the baby even within the same feeding! As the baby begins a feeding, she gets the high-protein milk necessary for growth. The milk that follows has more of the fat she needs for energy and weight gain

Important Advice For Mothers

Breastfeeding provides the best nutrition and protection from illness for your baby. For most infants, breast milk is all that is needed for the first 6 months. Many mothers continue to breastfeed after 6 months and then give other foods as well. For advice on breastfeeding, consult your doctor or any health professional, or a friend or relative who has successfully breastfed. Frequent feeding is the best way to establish and maintain a good milk supply. A well balanced diet, both during pregnancy and after delivery, also helps sustain an adequate supply of breastmilk.

Remember: breast milk is the best and most economical food for your baby.

Seek advice

The use of foods which are not intended for young babies can be harmful. Unnecessary introduction of partial bottle-feeding or other foods and drinks, will have a negative effect on breastfeeding. Therefore always consult a health professional before introducing anything other than breastmilk.

Using a breast milk substitute

If a doctor or other health professional recommends an infant milk substitutes in addition to breastfeeding or ots replacement during the first 6 months, keep your family circumstances and cost in mind before deciding whether to use infant formula. You will need more than one can (475g) per week if your baby is only bottle-fed. Unboilded water, unboiled bottles or incorrect dilution can make your baby ill. Improper use of infant milk substitute and feeding bottles may have adverse implications on the health of the baby. Always follow instructions exactly. You should be aware of the difficulties in reverting to breast-feeding of infants after a period of feeding by infant milk substitute.

Important Notice: Mother’s milk is best for your baby. Infant food should be introduced only after 6 upto 24 months of age.

Consult with your doctor or midwife before starting any postnatal exercise program.

You may need more time than you think to heal from childbirth. This is especially true if you had a caesarean delivery. However, you can begin exercises to tone your pelvic floor and abdominal muscles as soon as you feel ready.

If you had an episiotomy (a cut in the perineum to widen the opening during delivery) or tore your perineum during birth, pelvic floor exercises can help to speed your recovery. See your doctor, midwife or physiotherapist for more information.

Gentle tummy exercise

Pregnancy splits your abdominal muscles down the middle. It is important to make sure your muscles have healed before you do any vigorous abdominal exercises, such as abdominal crunches.

In the meantime, you can tone your tummy by performing an exercise that strengthens the deepest muscle layer (transversus abdominus). You can perform this exercise lying down, sitting, standing, or on your hands and knees.

Be guided by your doctor, midwife, physiotherapist or exercise physiologist, but general guidelines include:

• Keep your lower back flat.
• Breathe out and draw your belly button back towards your spine. Your lower back shouldn’t flex or move.
• Hold this position and breathe lightly. Count to 10.
• Relax and repeat up to 10 times per set.
• Do 10 sets, as many times per day as you can.
• You may like to perform your pelvic floor exercises at the same time (see below).

Tummy exercise – stage two

Once the gap in your abdominal muscles has closed, you can progress to more demanding exercises. General guidelines include:

• Lie on your back, with bent knees and both feet on the floor. Put your hands on your thighs.
• Breathe out, contract your abdominal muscles and lift your head and shoulders off the floor. Slide your hands towards your knees. Only aim to get your shoulder blades off the floor.
• Keep your head and shoulders stable. Hold the position, then slowly ease your shoulders and head back to the floor.
• Repeat up to 10 times for one set.
• Perform around three sets per session.
• You may like to perform your pelvic floor exercises at the same time (see below).

Exercise for the lower abdominal muscles

The lower abdominal muscles are located below your belly button. To work these muscles gently, guidelines include:

• Make sure your abdominal muscles have healed. Until the gap is closed, only perform the ‘gentle tummy exercise’ option.
• Lie on your back with your knees bent and both feet flat on the floor.
• Contract your abdominal muscles.
• Slowly slide your feet away from you, aiming to straighten both legs. The idea is to straighten the legs without arching your lower back.
• If your back starts to arch, stop and slide your feet back towards your bottom.
• Aim for 10 repetitions per set.
• Perform around three sets per session.
• As your lower abdominal muscles get stronger, you’ll be able to slide your feet further and further away.

Pelvic floor exercises

The pelvic floor muscles are tightly slung between the tailbone (coccyx) and the pubic bone, and support the bowel, bladder, uterus (womb) and vagina. Childbirth can weaken these muscles and cause problems, such as incontinence, later in life.

To exercise them, you must first direct your attention to these muscles. To help you identify these muscles, they are the ones that you tighten to stop urinating (weeing). These exercises can be performed lying down, sitting or standing.

Try to relax your abdominal muscles. Don’t bear down or hold your breath. Gradually squeeze and increase the tension until you have contracted the muscles as hard as you can. Release gently and slowly. Then perform the exercises, which include:

• Squeeze slowly and hold for between five and 10 seconds. Release slowly. Repeat 10 times.
• Perform quick, short and hard squeezes. Repeat 10 times.
• Squeeze, then clear your throat or cough lightly. Repeat three times.
• Aim for five or six sets each day.

Types of postnatal exercise

Keep in mind that your ligaments and joints will be loose for at least three months following the birth, so avoid any high-impact exercises or sports that require rapid direction changes. Vigorous stretching should be avoided too. Recommended postnatal exercise includes:

• Brisk walking
• Swimming
• Aqua-aerobics
• Yoga
• Pilates
• Low-impact aerobic workouts
• Light weight training
• Cycling.

See your doctor for further recommendations and cautions.

General suggestions for aerobic exercise

Be guided by your doctor or midwife, but general suggestions include:

• Give yourself sufficient time to heal, particularly if you have had a caesarean birth.
• Consult with your doctor or midwife before starting any postnatal exercise program – you may be advised to wait or adapt your exercises.
• If you are having trouble with the techniques required in the above exercises, please consult a physiotherapist, exercise physiologist or other appropriately qualified and certified fitness professional.
• Aim for slow, gradual weight loss of around half a kilogram per week.
• Wear a supportive bra.
• Avoid any activities that place stress on the unstable pelvic floor and hip joints until strength and stability has improved. Be careful about activities that require sudden changes in direction (for example, high-impact aerobics, running and contact sports). This varies depending on the type of pregnancy and delivery you may have had.
• Initially, exercise for only five to 10 minutes at a time. Increase the length of your workouts gradually.
• Ideally, your exercise sessions should eventually last between 30 and 50 minutes.
• Drink plenty of water before, during and after exercise.
• Don’t push yourself too hard – if you feel breathless, slow down.
• If you experience pain, slow down or stop.

Remember that it may take you months to return to your pre-pregnancy shape and weight, so don’t be discouraged by slow progress.

Warning signs to slow down

Don’t overexert yourself. Your body gives out warning signs if you are exercising too hard, and these signs may include:

• Increased fatigue
• Muscle aches and pains
• Colour changes to lochia (post-partum vaginal flow) to pink or red
• Heavier lochia flow
• Lochia starts flowing again after it had stopped.

See your doctor or midwife for further information and advice.