It was our first full day at home with our 3-day-old son, Noah. By 7 p.m., he was sleeping in his bassinet and I was resting when our pediatrician called. Blood test results revealed Noah had jaundice and needed treatment. At the hospital. Right now.
We spent that night and most of the next day in the hospital -- me on a cot, my husband in a creaky chair, and Noah in an isolette, a tiny blocker over his eyes, basking in the UV light that would help his body fight the toxins of this common newborn illness. I wish that I'd had the perspective then to see that jaundice would be a passing problem -- it's highly curable -- but even once we were home, the experience left me an emotional wreck. I struggled to settle into a routine.
Feeling out of sorts is just part of the postbirth experience. "Those first days are a complex mix of physical, psychological, and social changes," says Leena Mittal, M.D., director of the Reproductive Psychiatry Consultation Service at Brigham and Women's Hospital, in Boston. Here's how to gracefully clear the hurdles ahead.
Your Body Is in Shock From Delivery. Most first-time moms-to-be spend so much time obsessing about childbirth that the struggles of recovery aren't on their radar. "I didn't realize it would be so traumatic," says Sarah Camacho, a mom of two in Denver, recalling a lot of "down there" discomfort from her vaginal delivery. "I had to use a squirt bottle every time I went to the bathroom to soothe the pain of my stitches, and I felt bruised. I couldn't sit down without a donut pillow. Even walking was exhausting."
If you deliver vaginally, you are going to be extremely sore -- a baby the size of a Virginia ham did just come out of a very small spot. Ice the area for the first 24 hours and then take frequent warm baths to soften stitches and to keep them from feeling tight, says Laura Riley, M.D., an American Baby advisory board member and author of You and Your Baby: Pregnancy. The good news? "Because a lot of blood flows to your vagina, the area heals quickly -- in a matter of days," she says.
For cesarean births, pain medication (OTC or prescription) can relieve the soreness and pulling at your incision site. "It's important that you take enough medication during the first week so you feel good enough to move around, which is what encourages recovery," explains Dr. Riley. Your C-section incision will take four to six weeks to fully heal, so keep an eye out for infection. If it leaks, smells, burns, or looks red, or if you develop a fever of more than 100.4 degrees F, call your doctor.
No matter how you delivered, you can expect a lot of cramping during this time as your uterus shrinks to its pre-pregnancy size. If you're nursing, the pain will be strongest when your baby latches on, which signals your body to start releasing oxytocin, the contraction-triggering hormone. And all postpartum women experience a few weeks of lochia, vaginal discharge that includes blood, mucus, and bits of placental tissue. Have plenty of sanitary napkins on hand; don't use tampons for at least six weeks, because they can introduce bacteria.
Shall we go on? Incontinence, hemorrhoids, and urinary tract infections (UTIs) may enter into the picture. To help prevent incontinence, perform frequent Kegels (tightening vaginal muscles as if you're attempting to stop the flow of urine), and for hemorrhoids, move around, guzzle water, and take a stool softener. Tell your doctor about any pain when urinating or if you develop a fever, since either symptom could signal a UTI.
Your Baby May Develop Jaundice. The tricky thing about this condition, caused when levels of bilirubin build up too excessively in a newborn's bloodstream, is that it often appears when your baby is 3 to 5 days old, which is when you're likely already at home. The telltale yellow coloring usually starts at the head and works its way down, says Lisa M. Asta, M.D., associate professor of clinical pediatrics at the University of California in San Francisco. About 60 percent of newborns will experience some degree of jaundice, according to the Centers for Disease Control and Prevention. Most cases resolve on their own, but because jaundice can cause brain damage if left untreated, pediatricians don't take it lightly. "It's stressful for parents during Baby's first days," says Dr. Asta, "but jaundice levels that fall outside of the accepted range are very curable." Many pediatricians will have you schedule a newborn visit about two days after you get home from the hospital to check for jaundice. Always call your pediatrician if your baby's abdomen, arms, legs, or the whites of his eyes are yellow. If your baby has already been diagnosed with jaundice, and he becomes fussy, hard to wake, or is not feeding well, tell your doc.
When Noah was examined during his hospital discharge, the nurse mentioned he was a little yellow, but it never occurred to me that we'd be back there the next day. However, because Noah was two weeks early and on the small side (5 pounds 15 ounces at birth) and because his bilirubin numbers were high, his pediatrician wanted to be aggressive with treatment. Other babies with jaundice may get sent home with a bili blanket, a flexible lighted pad that Baby rests on (supervised) as it breaks down the bilirubin molecules.
Nursing Is the Hardest It Will Ever Be. When moms of older kids dreamily tell you how much they "loved, loved" nursing their infants, they are not talking about the first seven days. Even when your baby latches on correctly (his lips flipped out, chin pressed close, jaw and ear moving slightly), shooting pain at latch-on is common for the first week or two. Still, the nursing session itself shouldn't hurt after the latch, says Lisa Marasco, a lactation consultant in Santa Maria, California. "I see moms who wait to get help because they think scabs, cracks, and bleeding are part of nursing," says Marasco. That's exactly what happened to Chicago mom Claudia Rozenberg. "In the hospital, nursing was fine, but at home it felt like my daughter was biting an open sore," she recalls. "I had tears running down my face. My teeth were clenched." A friend urged her to see a lactation consultant. "I met with one the next day and it was the best two hours of my life," says Rozenberg. "She showed me positions that made nursing 100 times better."
Your just-emerging supply may stress you out too. While milk can come in as early as 36 hours after birth, for some women it can take four to five days -- and yet you have a hungry babe in your arms. Just keep offering your breast to both stimulate milk production and eke out every bit of the nutrient-rich colostrum for your newborn, says Marasco. You may start to feel like you're nursing all the time -- because, um, you are -- but it won't always be this way.
You May Cry a Lot. "I had a healthy baby, I knew I should be happy, but I couldn't stop sobbing about the trauma and disappointment of my unplanned C-section," recalls Megan Orringer, a mom in Ann Arbor, Michigan. With over a third of babies in the U.S. now delivered this way, feeling sad about not having the birth experience they planned jolts many women. And regardless of how you delivered, your body is on a hormone roller coaster during these first weeks. The highs can help you bond with your baby, but you may hit lows you've never experienced before. Adds Dr. Riley: "Your body doesn't feel like your own, your boobs hurt, your bottom is sore, you're not sleeping, you may not have much help. The postpartum blues magnify all of that stress."
Bonding isn't necessarily automatic, either. It's okay to feel somewhat disconnected from your newborn at first, or to be anxious about not knowing how to take care of your baby. Give yourself time to just be with your little one: Doing tasks like feeding and changing him will help your confidence grow, says Dr. Mittal. When he's alert, focus on him. Hold your baby, noting what positions he prefers. Sing, imitate his sounds, and make eye contact with him. If you continue to feel indifferent or anxious, or your feelings of sadness worsen, especially if you begin to have thoughts of harming yourself or your baby, you may have postpartum depression. Contact your ob-gyn, who can steer you to help right away.
You Realize What True Sleep Deprivation Actually Is. At first, the adrenaline rush of having a baby carries you through. Then comes the crash -- the rude awakening that this is no temporary matter. "I labored through the night and struggled to sleep in the maternity ward," recalls Emily Jo Hoover, a mom in Pacifica, California. "At home, my baby wanted to nurse all night. Then after a day that included a doctor's appointment and seeing a lactation consultant, I started shaking from exhaustion."
Everyone has a different threshold for sleep deprivation, so don't compare yourself to friends. Be open to trying suggestions like "nap when the baby naps." I was a bit of a skeptic about this "tired" advice. (Sleep? I have too much to do!) But I forced myself to give it a go, and it helped me maintain my energy. Yes, one 24-hour cycle blended into the next, but this lasted for only a few weeks until Noah started dozing for longer stretches.
Helpful People are So Unhelpful. Your email inbox will be full of "No pressure, but we'd love to come by" messages from family and friends. Discuss now with your partner who makes the first-week cut. Grandparents, sibs, and best friends only? Neighbors too? "I loved having our mothers, siblings, and my aunt surrounding us with their support," says Riva Marker, a mom in Brooklyn, New York. "It boosted my adrenaline, but my wife, Erica, wanted us to bond with our son as just a threesome." Next time, Marker says they will plan to have some private-time for their immediate family first.
It's perfectly okay to be selfish about placing the needs of your nuclear family first and making others wait, Dr. Mittal says. Plus, there are more ways eager pals can help: Say yes to their homemade soups; let them walk the dog or drop off groceries and take a quick baby peek.
You're on Your Way. The jaundice, gone. The stitches, dissolved. In the months to come, the sleep will (eh, sort of) return and you'll become one of those moms reminiscing about how much you loved nursing. But the tears? Total mom thing. Noah is now 18 months old, and I still sob on occasion. Surprisingly, it's the little moments that continue to get me. Like watching him sit up on his own, or hearing his laugh, or when he plants a toothy kiss -- and some spit -- on my nose. I get a little teary now just thinking about it.
Originally published in the January 2014 issue of American Baby magazine.
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