Childbirth Support

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After the birth

The last few weeks of your pregnancy were at least somewhat uncomfortable. The birth was long, hard work. But now, it's all over and you can relax and enjoy the bliss of being a new mother, right?

In general: Extreme fatigue and soreness are common in the first few weeks. It takes about four to eight weeks following an uncomplicated vaginal birth for the mother's body to complete the initial stage of recovery from childbirth. Rest as much as possible. Don’t lift anything heavier than your baby. Sleep when the baby sleeps. If you're breastfeeding, drink a glass of water after every feeding. Put off sex at least for the first six weeks. If you are not breastfeeding, you will probably begin menstuating again four to eight weeks after delivery.

Your uterus will continue contracting back to its origional shape, as well as shedding the remains of the "baby environment". This means that for the next 2 to 8 weeks you might have “menstrual-like” bleeding and uncomfortable to painful contractions. Try to keep your bladder empty, and when the pain is severe, lie on your stomach with a pillow under your abdomen.

Perineal Health (from Midwifery Today): The following herbs and essential oils can be used topically to help speed recovery to the perineum following bruising, stretching, and possibly stitching following birth:

Comfrey - Cell proliferant, vulnerary
Yarrow - Astringent, antiseptic
Rosemary - Astringent, antiseptic
Goldenseal - Antimicrobial, astringent
Witch hazel - Anti-inflammatory, vulnerary, astringent
Thyme - Antimicrobial, antispasmodic
Lavender - Antispasmodic, antimicrobial
Calendula - Anti-inflammatory, antimicrobial
Myrrh - Antimicrobial, astringent
Tea tree Essential Oil - Antiseptic, antimicrobial
Lavender Essential Oil - Antimicrobial, antispasmodic
Aloe vera - Vulnerary, antibacterial, analgesic

Make an Infusion: Bring 2 cups water to a boil; remove from heat and allow to cool slightly. Pour over two heaping teaspoons of the desired combination of herbs and cover tightly. Allow the mixture to steep for at least 1/2 hour (overnight is best), then strain well. Keep refrigerated for up to 3 days.

Method:

Spritz bottle: Put the undiluted mixture into a clean glass spray bottle and keep next to the toilet. Spray as needed, especially after urination.
Sitz bath: Soak the perineal area in a basin of water with the full 2 cups of tea added to an additional 6-10 cups of clean water. Use cold water if there is inflammation or swelling. Once that has subsided, experiment with warmer water until comfortable.
Regular Bath: Add the full 2 cups of tea to bath water.
Peri Bottle: This is a plastic squirt bottle (a water bottle with a pop-up top works) that can be used to irrigate the perineal area. Greatly reduces stinging if used during urination. With clean water, dilute the tea by half and fill the bottle.
Compress: Soak a clean cloth in the cooled mixture and apply to the sore area. Try freezing the cloth ahead of time for a cold compress.

For essential oils recommended above:

Sitz baths: Add up to 5 drops
Spray bottle: add 10-15 drops
Peri bottle: Add 5 drops per 500 ml

Caution: Many essential oils, if used undiluted, can cause serious damage to tissues. Be sure to use only those that have been recommended by a professional for undiluted use. Both lavender and tea tree oils are safe when used as directed in this article.
- Stacelynn Caughlan, ClN, CH, The Birthkit No. 30

Bathroom stuff: Your bowels, bladder and urethra may have been “traumatized” by the birth. You might be constipated. You might feel gassy and bloated. You might have hemorroids. You might have stitches. Be easy on yourself. Don't lift anything heavy. Don't strain when you go to the bathroom - try to caugh through it instead. Use witch hazel to refresh those areas. Take warm or cool baths for 20 minutes 2 or 3 times a day. Drink a lot of water. Try sleeping on your side, which takes pressure off the rectal veins. Eat small amounts, slowly and often. Make sure to eat fresh fruits, vegetables, and whole grain products to avoid constupation.

Your breasts: When your milk comes in, two to five days after delivery, your breasts may become painfully full and hard. If you're not breastfeeding, the engorgement should subside within a few days. If you are breastfeeding, it may take a week or more for your baby and your breasts to work out a demand-and-supply relationship.

Apply bags of crushed ice to your breasts several times a day; stand under a warm shower, which should trigger "letdown" and release some milk; express a little breast milk with a breast pump or by hand; massage your breasts, stroking gently but firmly toward the nipple.

You will need at least two bras one cup size larger than your pre-motherhood days. Don't wear anything binding - it may result in various painful breast problems. If you are using pads in your bra to absorb the leaking milk, don't use the ones lined with plastic - it might cause chapped nipples. Don't use soap on your nipples - it'll dry them out. If your nipples become sore, dry, cracked or chapped, use a lanolin-based creme like Lansinoh® for Breastfeeding Mothers.

If you are not breastfeeding, binding your breasts, ice packs, and avoidance of breast stimulation are effective in diminishing milk production and decreasing discomfort. Do not express milk from your breast as this will stimulate milk production.

To bind your breasts, use an extra wide elastic (Ace) bandage or a tightly woven band of cloth about 12 inches by 6 feet. Wrap it tightly around your chest two or three times, being sure to flatten your breasts. Pin in place. Rewrap every few hours. Wear binding 24 to 48 hours. Every 4 hours or so during the daytime, ice your breasts for at least 20 minutes. This will provide temporary relief of pain and help reduce the tissue inflammation and swelling. Use a sports ice bag or several bags of frozen peas over your breasts.

The first weeks: Try to rest as much as possible. Don't put too many demands or expectations on yourself. Don't worry if your house isn't spotless. Don't let anyone make demands on your time - these weeks are for you to rest and begin getting to know your baby. Your family and your partner are not your priority right now - you don't have to clean, cook, take phone calls or entertain visitors. You might want to put a "Mother and baby resting - do not disturb" sign on your door.

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Postpartum depression

New mothers and new babies are seen in unrealistic light in our culture. In the pictures, they are always smiling, glowing with joy. The babies are smiling, quiet and sleeping. The mothers are tender and adoring. It is generally assumed that after the woman gives birth, she will naturally know how to be the "perfect mother". Truth is, motherhood is not completely instinctual. Not all women immediately fall completely in love with their babies.

Meanwhile, you are still hurting. You are bleeding. You are exhausted. Your breasts are swollen. It hurts to go to the bathroom. Your body still doesn't look the way it used to. Your baby doesn't yet know how to smile. All it know is how to cry. Your house is getting messier by the day. On top of all that, your hormones are in turmoil and you are more emotional than ever.

Is it any wonder that so many new mothers get depressed? They are overwhelmed and unable to find the time or space to tend to their own well-being. They feel alone, uncertain, and distressed. Weepiness, anxiety, irritability and mood swings are quite normal at this time.

What you can do:

Make caring for your own well-being a priority.
Rest as much as you need.
Maintain a healthy diet.
Don't try to do chores when the baby sleeps - use this time for yourself - take a nap, read, take a bath, watch a movie, or pamper yourself in some other way.
Order food from your favorite restaurant.
Don't get stuck in the house - take a break and go out for dinner or a movie with your partner. Meet a friend for lunch. Schedule a massage.
Lower your demands on yourself.
Tell your partner if you are too sore or tired.
Talk about your feelings with your partner, family or friends.
Ask others to dust your house, do your laundry, buy your groceries, or cook meals.
Pass off the baby to your partner for diaper changes.
Go to La Leche League meetings if you're breastfeeding.
Join a new mothers' group.
Take a 15 minute walk 2 - 3 times a week.
Remember that your baby will learn to smile eventially.
Talk to your baby: She or he likes hearing your voice, and will not think you whiny or weak, or get tired of hearing your complaints and self-doubts. Plus, it might help her/him build a larger vocabulary.

The majority of people with postpartum depression are average people who are otherwise responsible and capable. But depression makes them feel incapable and they have an unrealistic view of their incapacity.

You might want to seek help if you experience the following:

Your depression significantly interferes with your ability to care for your baby and yourself, or carry out other normal daily functions.
Intense fatigue or sleeplessness.
Feelings of hopelessness and helplessness.
Lack of motivation or loss of interest in yourself and your family.
You have aggressive impulses and want to harm your baby or feel revulsion about caring for your baby.
Suicidal urges.

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Herbal remedies (from Wise Woman Herbal by Susun S. Weed)

Perineal tears: A cut is considered prefereble to a tear by the medical profession, as it is easier to suture, but most women and midwives prefer tears. Tears heal easier and quicker, usually involve less depth and tissue damage, are less painful, and heal with less scar tissue. Many tears do not need suturing since they approximate well and heal better without stitches. The following remedies can be used equally well for healing minor tears, lacerations, or surgical cuts.

Comfrey leaf: Drink it and sit in it! Drinking a cup a day of Symphytum leaf infusion biulds new cells rapidly and helps alleviate pain. A sitz bath sooths and heals, keeps the tissues flexible, and holds itching to a minimum.
Herbal sitz baths can prevent infection, aid healing, and offer pain relief. Yarrow, Rosemary, Golden Seal, Oak bark, Witch Hazel, Sea Grape bark, Myrrh and many others are useful. Use at least two quarts of the herbal infusion. CAUTION: If you have stitches, limit sitz baths to one a day.
To promote scar-free healing, vitamin E is best used after the tear is well closed, or after the third day on a sutured wound. Frequent applications are most effective. Take special care with cleanliness, as the oil attracts dirt. Be sure to use only pure vitamin E oil, as synthetics and preparations often contain flavoring oils and substances not intended for use on sensitive skin surfaces.

Varicose veins & hemorrhoids: Sometimes varicosities and hemorrhoids won't appear until after the delivery. These remedies prevent and deal safely with these problems.

Avoid tight clothing, knee-high stockings, crossing your legs, sitting in one position for a long time, high heeled shoes, and straining at the toilet.
Avoid internal use of Aloe vera products, and tea of Yellow or White Sweet Clover, as these herbs draw blood to the lower half of the body and can increase the problem.
Raw garlic, onions and lecithin (especially the liquid form) help veins maintain or regain elasticity. Eat them daily.
Green leafy vegetables, oats, buckwheat, wheat germ, and okra nourish and strengthen the entire circulatory system.
Foods rich in vitamins A, C, E, and B complex (B6 for hemorrhoids) are recommended for all circulatory problems.
Rutin is specific for repairing broken capillaries. Buckwheat, Rue and Elder leaves are notable sources of rutin. CAUTION: do not take rutin tablets during pregnancy.
Beets cleanse the liver and promote easy elimination, thus relieving stress on hemorrhoids.
Oatstraw tea or infusion is useful to strengthen the capillaries. Drink one or two cups daily.
Nettle leaf infusion improves the elasticity of the veins. Use at least one cup per day.
Raw parsley is beneficial to the veins. Use it abundantly in salads.
As "first aid", apply Witch Hazel (from the drugstore) compresses to varicose veins and hemorrhoids. The astrigency is pain relieving and helps tighten the tissues and reduce the swelling.
Use a Plantain and Yarrow ointment to relieve pain and shrink hemorrhoids within a few days.
Eliminate even severely swollen, protruding and bleeding hemorrhoids with herbal sitz baths. Perpare an infusion of Witch Hazel, making 8 cups (4 oz. of dried herb in a half galon of boiling water, steeped for 8 hours). Separate the liquid from the herbs and pour it into a shallow basin or pan. Sit in this for 15 minutes at least twice a day. This may be repeated as often as you desire, using the same liquid over and over.

Fatigue & Mood Changes: This is the perfect opportunity to touch your own deep emotional truths... to acknowledge and resolve your inner disharmonies, and to recreate your life...

Use exercise, relaxation, meditation, diet and herbs to improve your energy and moods, but don't neglect emotional and spiritual work.

Ten minutes of exercise done regularly does more to prevent fatigue and depression than an occasional arduous workout.
Restrict white sugar, honey, fructose, maple syrun, etc. from your diet. Instead, eat nuts, yogurt and cheese.
Drink Raspberry leaf tea to be calm, or add Peppermin or Spearmint for a lift of spirits and renewed sense of energy.
An infusion of dried Skullcap (Scutellaria lateriflora) nourishes and strengthens the nerves. Drink two cups daily for several months if your nerves feel frayed and you are easily upset.
Lemon Balm (Melissa) leaves infusion, one or two cups with milk and honey, every day for a week or two.
Brew Chamomile flowers briefly, a teaspoon to a cup of water, and drink the pleasantly aromatic tea freely with milk and honey.

Lactation:

Simple teas or infusions of nourishing herbs such as Comfrey, Raspberry leaf, Nettles, or Alfalfa encourage a plentiful supply of breast milk and a relaxed, healthy mother. These mineral rich nourishing herbs also protect you from mineral loss during the stress of nursing and infact care. Rotate, using each one for a week, to derive the unique benefits that each offers.
Apricots, asparagus, green beans, carrots, sweet potatoes, peas, pecans, and all leafy greens such as beet greens, parsley, watercress and dandelion leaves are considered helpful in increasing and sustaining lactation.
Fennel/Barley Water: prepare barley water by soaking half cup regular barley in 3 cups of cold water overnight or by boiling for 25 minutes. Strain out barley and discard or add to a soup. Store in the refrigerator. Pour 1 cup boiling barley water over 1 teaspoon fennel seeds and steep for no longer than 30 minutes. This combination not only increases the breast milk, but eases after-pains and settles the digestion.

Painful breasts & sore nipples: Poulices, compresses, and soaks are the best first aid for painful breasts. Even hot water alone has a beneficial effect, as it stimulates circulation and eases the tension in the taught tissues. Frequent (4-5 times a day) short (3-5 minutes), consistent applications work better than sporadic, lengthy treatments. If infection is present, throw away poulticing materials after use. If there is no infection, brews and towels may be reused a number of times.

Breast infections can often be a sign of too little rest. Take a daily nap, and ten minute breaks every two hours: put your feet up, enjoy a cup of violet leaf infusion, relax deeply. It is important to nurse often, keeping the breasts empty to promote prompt healing.

Use a hot compress of parsley or comfrey leaves. Place a hanful of fresh or dried leaves in a clean cotton towel or diaper, tie with a rubber band, and steep in simmering water for 10-15 minutes. Compress the breast with the hot, wet bundle. Apply for 5-10 minutes right before nursing.
Prepare a cold poulice of grated raw potatoe to draw out the heat of inflammation, localize infection and unblock clogged tubes. Grate raw potato and apply directly to the breasts, covering with a clean cotton cloth. Remove or replace when dry.
Make an infusion of dried marshmallow root, steeping two ounces in a half gallon of boiling water overnight. Reheat the infusion to near boiling. Pour in into the sink or basin and soak breasts until the infusion cools. This slippery and slimy infusion sooths tender tissues, opens clogged ducts and tubes, powerfully draws out infection, and diminishes the pain of engorged, inflamed breasts and sore nipples.
Echinacea root (Echinacea augustifolia) is an excellent treatment for even severe cases of mastitis (pain, fever, acute tenderness). To prepare an infusion, use one ounce of the root in a pint of boiling water and steep for at leat eight hours. Drink two cups daily until the fever comes down. Then make a lighter infusion: one ounce of root in a quart of boiling water; drink one or two cups daily for another week.
Expose the breasts to air for long periods of time.
Expose the breasts to sunlight for a few minutes.
Rub olive oil, sweet almond oil, or lanolin into the nipples.
Place the baby at the breast correctly, making sure that the entire areola (dark area) in in her/his mouth and that the nipple is centered.
Experiment with diffrerent nursing positions.
Nurse often, so that the baby doesn't get hungry enough to tear at the breast.
Avoid washing nipples with soap. Soap removes natural oils and predisposes the nipples to chapping and cracking. Cologne, deodorant, and powder should also be kept away from the nipples.

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Breastfeeding (from La Leche League FAQ)

Advantages of breastfeeding:

It's easy. The milk is always available to the baby. The mother doesn't have to worry about heating a bottle when her baby is ready to eat. She doesn't have to worry about keeping breastmilk warm or cold when going out. And best of all, a mother can feed her baby in bed at night, allowing her to get as much rest as possible.
It's best for baby. Breastmilk has antibodies in it from the mother that pass to the baby and help protect him against illness and allergies.
Breastmilk is easily digested. Mothers don't have to worry about their babies being constipated or thirsty, because babies get an adequate amount of water from breastmilk.
Sucking at the breast helps with good oral development. Breastfed babies have fewer speech impediments. Breastfed babies have good cheekbone development and jaw alignment. Consequently, there is less chance of needing braces and other orthodontial work.
Breastfeeding also is good for the mother. The baby's sucking at the breast causes uterine contractions right after birth. The contractions lead to less bleeding for the mother, and return the uterus to its pre-pregnancy shape much faster.
Recent research has shown that having been breastfed substantially decreases a woman's risk for developing premenopausal breast cancer. By breastfeeding, a woman can reduce her risk of premenopausal breast cancer by 20%.

Colostrum is the first milk your breasts produce in the early days of breastfeeding. It's low in fat, and high in carbohydrates, protein, and antibodies to help keep your baby healthy. It is extremely easy to digest, and is therefore the perfect first food for your baby. It is low in volume but high in concentrated nutrition for the newborn. Colostrum has a laxative effect on the baby, helping him pass his early stools, which aids in the excretion of excess bilirubin and helps prevent jaundice.

Foremilk & hindmilk: Foremilk, the initial milk that baby gets upon latch-on, is much like skim milk. It is initially satisfying, high in volume and low in fat and calories. As the feeding progresses, the fat content goes up and the corresponding milk more closely resembles whole milk. Finally, toward the end of the feeding, the hindmilk is high in fat, high in calories and low in volume. Think of hindmilk as a rich creamy dessert. Lactose (milk sugar) concentration is relatively constant throughout the feeding. --Melissa Clark Vickers

Basic Steps for Optimal Positioning

Position yourself comfortably with back support, pillows supporting your arms and in your lap and your feet supported by a footrest or a telephone book.
Position baby close to you, with his hips flexed, so that he does not have to turn his head to reach your breast. His mouth and nose should be facing your nipple.
Support your breast so it is not pressing on your baby's chin. Your baby's chin should drive into your breast.
Use your nipple to tickle the center of your baby's bottom lip. This will encourage him to open his mouth wide (like he is yawning). Aim your nipple slightly towards the roof of his mouth, bringing baby to you, chin first.
Attach or latch baby onto your breast. Encourage him to open his mouth wide and pull him close by supporting his back (rather than the back of his head) so that his chin drives into your breast. His nose will be touching your breast. Your hand forms a "second neck" for your baby.
If the latch is uncomfortable or painful, gently place your finger in the baby's mouth, between his gums, to detach him and try again.
When baby begins to receive milk, you will see his jaw working all the way back to his ear. His temples will wiggle. You will also hear him swallowing, quickly at first, then more slowly, as his appetite is satisfied.

Non-Nutritive Sucking (from Non-Nutritive Sucking by Katherine Dettwyler, PhD)
I don't think breastfeeding is "just" about feeding the baby, any more than sex is "just" about creating babies. Breastfeeding the baby does provide food, and water. It also provides immunological factors, which may be what the baby is after (and why they nurse so often when sick, not just for comfort). The process of breastfeeding itself also regulates the baby's temperature and heart rate and lowers its blood pressure, and puts it to sleep. And then of course there are all those important social and emotional factors going on during the exchange. Dr. Blackburn's research on the evolution of mammary glands suggests that the original purpose of "lacteal fluids" was to kill germs in the offspring's gastro-intestinal tract and protect it from infections, and the nutritive components of breast milk only evolved later.

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Books


*Postpartum Survival Guide* by Ann Dunnewold	This Isn't What I Expected: Overcoming Postpartum Depression by Karen Kleiman	Bestfeeding : Getting Breastfeeding Right for You by Mary Renfrew	Natural Family Living : The Mothering Magazine Guide to Parenting by Peggy O'Mara	Our Babies, Ourselves : How Biology and Culture Shape the Way We Parent by Meredith F. Small	The Post Pregnancy Handbook by Sylvia Brown