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.
Feeding 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.
If you’re breastfeeding, take it one step at a time. Your goal right now is to get your baby to latch on correctly—lips flipped out,chin close to your breast, jaw and ear moving slightly in a rhythmic motion as she sucks, says Laura Jana, M.D., a pediatrician and author of Heading Home With Your Newborn. While some tingling or irritation at latch-on is common for the first week or two, the nursing session shouldn’t hurt. (In the first few days, it may induce some uterine cramping, which is normal.)
If your breast or nipple hurts or you’re concerned about your supply, talk to your doctor and consider hiring a lactation consultant to show you different ways to latch and see whether your baby is eating enough. Check if the hospital’s specialist is available, or find one at ilca.org.
Keep in mind that milk can come in anywhere from 36 to 72 hours after birth, and for some, it could take four to five days.This can happen for a number of reasons, including gestational diabetes, a long, stressful birth, or a cesarean.
While you’re waiting, continue offering your breast to stimulate milk production. Lisa Marasco, a lactation consultant in Santa Maria,California, explains: “Your body expect your baby to be at the breast very soon to start suckling. If that doesn’t happen, you can mimic the baby with hand-expression and pumping to get the milk going sooner.”
Opting to formula-feed? Choosing a brand can be overwhelming, so ask your pediatrician for one she recommends.Know that formulas come in three general forms: powders, which need to be mixed with water; concentrates, which come in liquid form but must be diluted with water; and ready-to-use liquids, which can be poured directly into bottles. The type you choose may depend on both your baby’s preference and your budget.
Whether you breast- or bottle-feed, record when feedings occur to track what’s going on and help you know whether your baby’s eating the right amount.
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."
Tending to a newborn will require you to wake up every two to three hours to feed during the night. To try to keep up on your own sleep, consider taking cat naps whenever your baby sleeps or match your own bedtime to your baby’s.
If you’re formula-feeding, alternate late-night bottles with your partner so you can take turns getting to sleep early. If you’re breastfeeding, you can begin that same switch-off routine as soon as you and your baby have mastered nursing and you’re ready to pump and offer breast milk in a bottle. (This is generally approved by around a month, but speak to your pediatrician or lactation consultant first.)
It can also be game changing—rest wise—if your partner handles all the other middle-of-the-night “fun,” like diapering, burping, reswaddling, and changing dirty pajamas. Newborns snooze 16 to 18 hours a day, but usually not at the “right” times. During the day, wake him for a feeding if he slumbers for more than four hours at a stretch so he maintains his weight gain. At night, keep the lights dim during diaper changes and feedings to avoid waking him up fully. When your baby can’t settle down but you know he’s been fed and had enough to eat, soothe him by rocking, giving him a pacifier, or swaddling.
And as hard as it is to pause the snuggles, never share your bed with your newborn.
Take Care of Her Skin.
We know: There’s nothing like that first bath photo! But hold off on sudsing her up during the first week. Studies show that the vernix—the white, waxy substance that covers your baby in the womb and that she’ll be coated with at birth—helps lower her skin’s pH level and serves as a protective barrier from irritants once she arrives.
It also contributes to the makeup of her skin’s microbiome, a layer of microorganisms that help keep her skin healthy. (Every baby’s microbiome is different. The mix of bacteria depends on whether she was born vaginally or via C-section, whether you formula-feed or breastfeed, where you live, and more.) Washing your baby with a cleanser can disrupt the microbiome’s formation, which may make her more susceptible to skin issues like eczema down the line, says Sandy Skotnicki, M.D, a dermatologist in Toronto and author of Beyond Soap.
Of course, with all the diapers your baby will go through in a day (8 to 12, on average), some cleaning is essential. Breastfed babies often poop with every feeding in their first weeks of life, and formula-fed babies can poop three to four times a day.
Washing with water alone won’t remove poop and pee completely, so if your baby has an extra-dirty diaper, it’s okay to wash her more thoroughly. Use a soft cloth and a gentle pH-adjusted cleanser that protects and nourishes the microbiome on her messy skin. You should continue to use this product at bath time after the first week. To prevent rashes, go for super absorbent diapers and fragrance-free (either synthetic or organic) wipes. If the area is irritated, apply a plain petroleum jelly or a zinc-oxide paste.
Make peace with your new normal.
You likely won’t have the energy to socialize like you did pre-baby, so talk with your partner about which visitors will make the cut. It’s okay to make some people wait. Eager pals can help in other ways: Accept their homemade soups, let them walk the dog, and welcome their groceries. They can peek at your baby then.
As far as chores go, you might find you can’t get much done. “Caring for a baby is time-consuming,”says Deborah Ledley, Ph.D., a psychologist and author of Becoming a Calm Mom. “Feeding alone takes eight hours. That’s a full day’s work!”
Be realistic. You might set one non-baby-related goal everyday, like doing a load of laundry or writing two thank-you cards. If your baby doesn’t want to be put down, use a swing or wear him in a carrier as you check off your to-do list. If you can’t manage to keep your home tidy, let yourself off the hook.
“Managing household chores has been the most stressful part since our second child was born,” says Drea Dalzell, of Sartell, Minnesota. “I remember to ask for help and rely on my in-laws for that extra bit of sanity. I may be less focused on cleaning, but I’d rather spend time with my girls."