A Guide to the First 48 Hours After Birth for Mom

You carried your baby for nine long months, and now they are finally here! After laboring and birthing your baby, they are out in the world and in your hands!

Your labor may not have gone how you anticipated. You might need time to process what just happened. But now you are in charge of this tiny little human and you have no idea what to do.

In the first 48 hours after birth, a lot of changes will occur in your body as you recover from birth, and will continue to change for the next forty days. Some are normal and expected. Others are warning signs and need to be communicated to your provider.

Often providers and childbirth classes educate families on what pregnancy and birth will look like, but they leave out the postpartum period. This time, like pregnancy, is another transition period with predictable stages. When you know what to expect, you may feel more confident in your ability to parent and take care of yourself. 

Immediately After Birth 

It is important for mom and baby to be together skin-to-skin, especially on baby’s first day of life. If at all possible, do this immediately after baby is born. You can have your baby on your chest within minutes after birth while you deliver your placenta.

Skin-to-skin contact regulates your infant’s body temperature and produces oxytocin in your body. You will never get these precious moments after birth back. Immediately being skin to skin with your baby can help to develop a strong latch which is important for breastfeeding.

Breasts

Breast engorgement is a normal physiological response to breast tissue swelling with milk, blood and other fluids. It can feel like fullness and slight tenderness and can occur about 24 hours after delivery. Some relief measures you can take to help with engorgement are:

• Expose the nipples to air
• Feed baby frequently. Use both breasts at each feed.
• Take a warm shower. Or apply moist warm towels to your breasts before feeding.
• Manually express colostrum or milk before putting baby to breast.

If you are not planning on breastfeeding your breasts may get engorged. Apply crushed iced in bags for comfort and to bring relief. 

If you choose to breastfeed it is important that your‌ baby learns how to attach with a deep latch. Allow your baby to latch on the breast as often as possible the first couple of days. Their sucking will start stimulating your milk to come in and help establish a good milk supply. A proper deep latch will prevent discomfort and other issues in the future.

Tips for Establishing Breastfeeding:

• You will know your baby has a good latch if you hear baby swallowing. Watch for a suck, swallow, breathe rhythm.
• Remember nose to nipple. Bring the baby into the breast. Wait for your baby to open their mouth as wide as they can, then place them onto the breast.
• Watch their lower lip as you latch. This should be the first part to touch your breast. Anchor the lower lip away from the nipple.
• When you take baby off the breast, first break the suction with a clean finger. Then pull baby off.
• After a feed, check the shape of your nipples. If they’re long and rounded, that means the baby had a deep latch. If the nipple looks like a tube of lipstick, this means baby did not have a deep latch. Connect with a midwife, doula, or lactation consultant on ways to correct the latch.
• Avoid using soap on your nipples. If you are using nipple shields, pump six times a day for a minimum of 15 minutes on each breast. Follow up with a lactation consultant.

With breastfeeding, cramping of the uterus may occur in the first few days. Cramping may be more intense if this is your second or third pregnancy. This is normal, as the uterus is contracting down to its pre-pregnancy size.

More Tips for Help Breastfeeding

For Comfort Measures, You Can:

• Take acetaminophen (Tylenol) 1000mg every 4 hours as needed
• Take Ibuprofen 400-800mg every 6 hours as needed
• Take After-Ease herbal tincture -1 dropperful every 2 hours as needed
• Use a hot water bottle or heating pad on uterus
• Keep the bladder empty to avoid pressure on the uterus

Sore and cracked nipples, painful breastfeeding, clogged ducts, and mastitis are common, but they are not normal. Reach out to a lactation consultant, preferably an IBCLC, as soon as possible to prevent breastfeeding issues.

Vaginal Bleeding

Vaginal bleeding will be heaviest for the first 24 hours. Then it will gradually decrease. Clots the size of a golf ball or smaller are normal.

If you have been laying down for an extended period and then stand up, you may feel a gush and pass several clots at once. This is normal, there is no need for alarm.

Over the next few weeks, the amount of blood and color of blood should gradually lessen. The medical term for the blood, fluid mixture leaving your vagina after birth is lochia. Your lochia will start dark red, then transition to pink and then whitish/yellow. This resembles a menstrual period but will last anywhere from two to six weeks.

• Days 1-4: Red
• Days 4-10: Pink
• Days 10-28: Whitish yellow

If your bleeding has been decreasing in amount and color and then suddenly increases in amount and darkens in color, your body is signaling you overextended yourself. Listen to your lochia. Substantially reduce your activity for the next few days. Drink more fluids and rest. This will encourage healing of the placental site.

Recovery is typically complete when vaginal discharge subsides. If at this time you feel healed and you desire to be intimate with your partner and have sex, you may. Make sure the episiotomy is healed before being intimate.

What is Not Normal?

If your bleeding seems really heavy, first empty your bladder. Then massage the uterus and nurse the baby. This will stimulate oxytocin to be released, which helps the uterus to contract. If this does not improve bleeding, call your Midwife or doctor.

When You Should Call your Midwife or Doctor

If during the first two weeks reach out to your Midwife or doctor if you experience any of the following:

• You have any episodes of fainting
• You have a heavy bright red flow and are soaking two pads an hour with clots present
• You have a headache, shortness of breath, or prolonged dizziness with heavy bleeding.
• Pain, tenderness or swelling in the calves or thighs as this could indicate a blood clot.
• If you experience two or more of these symptoms, go to the hospital.

GI/GU

You may have to urinate more frequently 48 – 72 hours after delivery. This is normal.

Throughout your postpartum period, drink lots of fluids. Six-eight glasses of water a day is the recommendation. If you are breastfeeding, the recommendation doubles.

72 -96 hours after delivery, you should have a normal bowel movement. Constipation can be extremely painful if you have any tears or sutures from delivery. To prevent constipation: eat foods high in fiber, stay hydrated and drink prune juice.

You can take over-the-counter stool softeners or herbal teas to encourage a soft bowel movement. Start this soon after delivery to prevent having to strain or bear down. Eat frequently throughout the day. Prioritize warming foods such as broths, soups and meals that are easy to digest.

Perineal Care

Cleanse from front to back each time you use the toilet or use a peri bottle to clean yourself. A sitz bath or a frozen pad with witch hazel and aloe vera can provide comfort and promote healing. If you had an episiotomy or stitches, you can apply cream that your provider may have prescribed to you.

When to Call Your Midwife or Doctor

If you have sutures or stitches from a tear, call your provider with any signs of infection. Signs of infection include:

• Redness
• Heat 
• Discharge
• Pain 

Bathing

Bathe in a tub or shower as desired. If you have sutures or stitches, check with your provider when you can take a bath. Keep showers short and not too hot for the initial few days postpartum to prevent lightheadedness.

Activity

Take it slow. During the first 10 days, concentrate on your own physical needs and feeding your infant. This is a privilege, but try your best to prioritize your healing and feeding by staying in bed for the first 24 hours. Get up to use the bathroom and to care for the baby.

For the following six days, try to avoid doing housework, cooking or caring for older children. Nap when baby naps for at least the first two weeks. Call on the support of relatives, neighbors and friends or hire a postpartum doula or outside help. Do not entertain anyone while you are recovering from delivery.

The best prevention of excessive blood loss and postpartum depression is to rest. Rest will help you to heal quickly. Lift nothing that weighs more than your baby for four weeks.

If you had a cesarean, no lifting for six weeks. After the third week postpartum, as you begin to feel healed, you can slowly resume your normal responsibilities.

Social Needs

Postpartum blues can be a normal occurrence during the first few weeks after delivery. Often when the mature milk comes in around day four postpartum, sadness and the “baby blues” can also set in.

The body is dealing with a lot of hormonal changes. Know that this will pass. It’s helpful to have a trusted friend or family member visit during the fourth or fifth day. 

If the feelings of sadness continue or progress into overwhelm, isolation, anxiety, panic, shame, guilt, and hopelessness, it is time to reach out for professional support. This is not the normal “baby blues” and could be signs of postpartum depression, anxiety or other mood disorders(PMADS). While PMADS are very common, they are not a normal part of the postpartum period and will require additional support to help navigate this time period. 

The Postpartum Period is a Season

To help support you in your transition into parenthood, prioritize rest and sleep. Try to nap when the baby is sleeping. If you feel unable to nap, you may ask someone to watch the baby so you can do something that makes you feel comforted. A bath, a massage or talking to a friend over a warm meal may help you feel more like yourself. 

The postpartum period is a transition. Your body is adjusting to baby leaving the womb and your newborn is acclimating to life outside. Be easy on yourself and take it slow.

Your body is changing and it will take time to adjust to the stretching and opening that occurred during birth. Reach out to family, friends, practitioners or your health care provider if you have questions‌. Know that this will not last forever and you are not alone during this time. ASK FOR HELP!

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