Navigate Your Postpartum Journey


The postpartum period is frequently referred to as the fourth trimester. Your postpartum journey is just as important as your pregnancy and birthing experience—for both yourself and your newborn.


POSTPARTUM CARE

Postpartum care is care given to you by a doctor or a midwife after the baby is born. Every birth experience is different and even if you have other children, you may experience different symptoms after the birth of each child. The postpartum visit(s) may address any complications which have occurred during the birth process, assess for social and psychological well-being, and cover other topics such as: infant care and feeding; sex; birth spacing and contraception; sleep and fatigue and physical recovery and birth. The postpartum period (which may last up to a year after the birth of your baby) is also a time to ensure follow-up of medical conditions with other physicians and specialists, to ensure management beyond the postpartum period.

Caring for a newborn baby may be tiresome. The postpartum period is also a very important time to enlist the help of family and friends so that parents can get a much needed break and sleep. Connection to various community organizations may also be helpful.

BREASTFEEDING

There are different ways to nourish your child, including breastfeeding, expressed breast milk, or infant formula. Breastfeeding is a great way – and perhaps the best way – to build a bond with your baby and provide them with the nutrients they need for healthy development. Breastfeeding releases oxytocin, “the love hormone,” during skin-to-skin contact and can help reduce your risk of cancer and type 2 diabetes.

Breast milk is also healthy for your child because it:

  • Provides nutrients
  • Protects against allergies, diseases, and infections
  • Promotes healthier child weight
  • Promotes brain and intellectual development

Breastfeeding is recommended for the first 6 months. Afterwards, it should be continued for the next two years alongside the introduction of other foods.

From pumping to latching, breastfeeding can have its share of challenges. If you choose to breastfeed, here are a few tips to think about.

  • Need Help? You’re Not Alone.
    • If a facility is deemed “Baby Friendly” (all NYC Health and Hospitals (H+H) have this designation), this means that your provider and nursing staff will do their best to help you in your breastfeeding journey. You should ask your hospital if they have a Baby Friendly designation. Immediately after birth, your care team will place your baby on your chest for skin-to-skin contact. Skin-to-skin contact helps your baby regulate their body temperature, spend increased time in deep sleep, develop a stronger immune system, and improve breastfeeding.
    • Your first breastfeeding sessions may switch between going very well or can be overwhelming at times too. Although your natural instincts may set in, there are maternity nurses and lactation consultants available to coach you on positioning your baby and ensuring proper latching is achieved. After hospital discharge, home visiting services provide first-time families who are in public housing, engaged with child welfare, or live in low-income neighborhoods access to a nurse or doula, breastfeeding support, safe sleep education, mental health screenings, and connections to social services. If you are a first time parent who also enrolled in the NYC Nurse Family Partnership Program prior to 28 weeks of pregnancy, your personal nurse will continue offering you breastfeeding support as you and your baby adjust to the home setting after birth.
  • Your Comfort Matters.
    • If breastfeeding is making it hard for you to find the right position to sleep, a nursing pillow is strongly recommended to support the baby. Expect to wear nursing bras 24/7, along with nursing pads to prevent unexpected leakage. Eating a well-balanced diet and drinking plenty of water to support breastfeeding will also help milk production. You and your baby will be exhausted after the birth, so enlist the help of family members or friends to assist with bringing the baby to you, getting you what you need, and helping with household chores.
  • Bedtime with Baby.
    • Nursing at night while comfortable in bed is a goal. Minimize interruptions, use a nightlight with calming music, and wear a nursing nightgown or pajamas to make it easier. Lastly, put the phone down and enjoy your one-on-one time with your new baby! Don’t forget that after nursing, placing your baby on their back in a crib without excess bedding or toys is the safest way for your baby to sleep.
  • Keep Your Nipples Healthy.
    • Sore nipples are a common issue with breastfeeding, usually caused by poor latching. Sometimes, babies’ mouths slide down the nipple during feeding, despite correct latching. If there is more distance between the baby’s nose and your breast, gently break the suction and re-latch your baby. Babies know how much breast milk they need to take in. They usually end the feeding themselves by letting go of the breast or releasing the nipple when they fall asleep. Allowing your baby to determine the length of feeding will ensure the right balance of foremilk (released at the beginning of the feed, which contains more water to quench baby’s thirst) and hindmilk (which occurs at the end of the feed and contains more calories, satisfying your baby’s hunger). Lansinoh and other breastfeeding care creams can help soothe soreness in between feedings.
  • Milk Production Woes.
    • Breastfeeding is not as easy as moms may think but practice makes perfect, and you need to just give it time. Feeding frequencies vary but it’s usually every few hours for newborns. Keep in mind, the more often you breastfeed your baby, the body’s natural reaction is to increase the amount of breastmilk produced. When starting to breastfeed, try to put the baby to the breast when you notice your baby’s feeding cues. Try not to feed your baby any supplemental formula until your breastfeeding routine and therefore milk supply is well established. Your baby’s stomach is the size of a marble and your baby will take in enough breastmilk by breastfeeding alone. Your baby will benefit from suckling from your nipple, as there are special antibodies which are passed from your body to him during the process. Try to reserve use of a breast pump until breastfeeding is well established.
  • If you are still finding breastfeeding challenging when you get home, there may be appointments available where you gave birth for support via La Leche League referrals, doula services and community partners.
EXERCISE

Postpartum exercises should aim to strengthen the pelvic muscles, which are the set of muscles you use during childbirth, and lead you to a quicker recovery. It can also help reduce stress, anxiety, and weight gained during pregnancy.

Every body is different. First consult with your provider to ensure that you are ready to re-engage in pre-pregnancy level exercise before attempting an exercise plan. It is not recommended to engage in high-impact exercises for at least the first 12 weeks.

When you return to an exercise regimen, you should engage in low-impact aerobic activity for 20 to 30 minutes a day, and add on 10 minutes of simple postpartum exercises that help strengthen your abdominal muscles and other major muscle groups such as your legs, glutes, and back.

A low-impact postpartum exercise routine can safely include:

  • Pelvic tilt exercise to strengthen your abdominal muscles.
  • Kegel exercise to strengthen your pelvic floor muscles.
  • Belly breathing to help re-coordinate your breathing throughout your core.
  • Happy baby pose to loosen tight pelvic floor muscles
SELF-CARE AND HEALING

Your body will also require special attention after labor, including vaginal care to remain comfortable and heal smoothly, as well as ongoing breast care possibly through compresses and nipple ointments for those who choose or are able to breastfeed. Postpartum nurses and in-hospital lactation consultants should be able to assist you while you are in the hospital recovering.

  • Nipple Discomfort.
    • If your nipples become cracked or sore, breast milk is among the safest moisturizers available to soothe your nipples. You can also use purified lanolin to help your nipples retain water and prevent dryness or cracking. Warm water is all that is needed to clean your nipples. Try to reduce the amount of soap, shampoo, and other bathing cleansers that might further irritate the area.
    • You may also experience breast tenderness. If you are breastfeeding, apply warm washcloths or take a warm shower before breastfeeding. You can also place cold washcloths on your breasts, or try over-the-counter pain relievers. Regardless of whether you choose to breastfeed, you may want to wear a nursing bra to ensure your breasts feel supported and to prevent unexpected leakage.
  • Vaginal soreness.
    • If you experienced a vaginal tear or incision during childbirth, it might take a few weeks or longer to heal. To ease discomfort:
      • Sit on a pillow or padded ring.Cool the area with an ice pack, or place a chilled witch hazel pad between a sanitary napkin and the area between your vaginal opening and anus (perineum).Sit in a warm bath just deep enough to cover your buttocks and hips for five minutes. Use cold water if you find it more soothing.Take an over-the-counter pain reliever. Ask your health care provider about a numbing spray or cream, if needed.Talk to your health care provider about using a stool softener or laxative to prevent constipation.
  • Vaginal discharge.
    • After childbirth, the mucous membrane that lined your uterus during pregnancy will shed. As it sheds, you will have discharge consisting of this membrane and blood, which will be heavy and red for the first few days and then become a pinkish brown to yellow-white color. This is normal. A good set of postpartum pads can help absorb this discharge.
    • Consult your provider if you are experiencing persistent or increasing pain, consistent heavy vaginal bleeding, and vaginal tenderness. This may be a sign of infection or other medical issue.

Emotional Wellness

It is completely normal and expected to feel a wide range of emotions during the postpartum period. As much as you’re focused on taking care of your new baby, you have to make sure you’re taking care of yourself, too, including your mental well-being. If you feel the need to talk to someone about your emotions or you’re feeling overwhelmed, ask for help from your partner, family, and friends or from mental health experts.

Here are some common emotional health experiences you may have after pregnancy:

  • Baby blues” are the emotional highs and lows nearly 4 in 5 new parents feel during the first 1-2 weeks after childbirth, which then go away. Sudden hormonal changes following childbirth can make you feel tired and depressed. You may also be nervous about taking care of a baby and life transitions, or be losing sleep. If you have a partner, they can also have baby blues. Symptoms can include:
    • Feeling restless or anxious
    • Being impatient or grumpy
    • Uncontrolled crying
    • Difficulty concentrating
    • Mood swings
    • Loss of interest
    • Sadness
  • To help ease these feelings, try to get help from others like friends and family to help watch or care for your baby while you take time to care for yourself, sleep and relax. Find a local support group. Eat well, exercise, and avoid alcohol or drug use.
  • Postpartum depression are intense feelings of intense feelings of sadness, anxiety, or despair that you experience after childbirth that prevent you from being able to do your daily tasks. It may result from hormonal changes, a history of depression, or other compounding emotional factors. Postpartum depression usually occurs up to 1 year after having a baby, but usually starts about 1–3 weeks after childbirth. It is similar to baby blues but lasts longer and requires treatment. Symptoms can include:
    • Lack of energy
    • Difficulty concentrating
    • Feeling hopeless or inadequate
    • Having scary thoughts about yourself or your baby
    • Uncontrolled crying anxiety or worry
    • Overpowering guilt, sadness or panic
    • Fear of being alone
  • You should speak with your provider if you encounter any of these feelings or emotions. If you do not already have a mental health provider, you can start by calling 988 to seek free assistance, or ask your provider for referrals. For other common mental health conditions and strategies to manage them, see “Take Care of Your Emotional Well-Being.”

NUTRITION

Proper nutrition remains critical to your health and wellbeing. If you decide to breastfeed, what you eat can pass on to your baby in your breastmilk. In addition to maintaining some of the dietary recommendations provided for prenatal care  during the first year postpartum, it important that you:

  • Increase iodine and choline intake while breastfeeding to help with milk production. You should consume 290 mcg of iodine and 550mg of choline daily. Iodine can be found in dairy products, eggs, seafood, or in iodized table salt. Choline can be found in dairy and protein food groups, such as eggs, meats, some seafood, beans, peas, and lentils.
  • Avoid fish with high mercury levels. While fish is overall an excellent source of protein, vitamins and minerals, avoid those with high mercury levels as it can pass on to your child during breastfeeding. Eat 2-3 servings a week from the FDA’s “Best Choices” seafood list. (One serving is 4 ounces, or about the size of the palm of your hand prior to cooking).
  • Avoid caffeine. Caffeine can cause irritability, poor sleep, fussiness and regular movements among infants of breastfeeding parents who consume significant levels of caffeine in a day (3 or more cups of coffee). Caffeine can be found in coffee, tea, soda, energy drinks, and chocolate, among other food sources.
  • Avoid alcohol and other substances. Alcohol and substances can get into the bloodstream and transfer to your baby during breastfeeding. This can result in behavioral issues and depression for your child when they grow up. The postpartum period can also pose threats to someone’s sobriety, causing many to relapse during this time. Confide in your counselor or support system if you need support.
FAMILY PLANNING AFTER PREGNANCY

Speak with your provider during your initial follow-up appointments after discharge regarding contraception to prevent becoming pregnant soon after your current pregnancy. If you are thinking of having a second baby, wait 18-24 months before trying again to give your body time to recover. Remember, you should have control over your body and be able to safely return to regular activities according to your timeline.

If you are not breastfeeding, ovulation may occur within a few weeks of childbirth. If you are breastfeeding, ovulation may be delayed. Once ovulation occurs, you can get pregnant again. For most birthing people, ovulation occurs 2 weeks before their period starts. This means that you can get pregnant even if you have not yet had a menstrual period.

Some long-acting contraceptive devices like IUDs can be inserted immediately after you give birth, before leaving the hospital. Depo Provera, a progesterone-only shot, can also be given prior to discharge. Most other forms of contraceptives should be considered after being discharged from the hospital because they require you to wait a few weeks. All methods are also safe while breastfeeding, although a few may not be recommended during the first few weeks. Finally, you may want to consider consulting with your OB/GYN provider or Midwife about the best contraceptive method for you, as some might be less effective after childbirth.

Hormonal contraceptive methods during breastfeeding include:

Avoid using methods with estrogen for the first 3 weeks after giving birth, like birth control pills with estrogen.

Non-hormonal contraceptive methods during breastfeeding include:

HEALTH INSURANCE

Remember to update your health insurance company about your birth. There may be changes in your health insurance plan based on your family size. Once your baby is born, provide their information, including social security number, to the New York State of Health (NYSOH) Marketplace within three months of birth. Babies receive coverage for at least one year after birth, after which their insurance can be renewed. All children 18 and under qualify to receive health insurance through Child Health Plus if they are not covered under parental plans. If you are uninsured you can also continue to receive care under Medicaid for Pregnant People for up to 12 months postpartum.

PAID PARENTAL LEAVE

If you were working prior to childbirth, you and your partner have the right to receive paid New York State Paid Family Leave, which provides eligible employees with up to 12 weeks of job protected, paid time off to bond with a new child, care for a close relative with a serious health condition, or assist loved ones when a family member is deployed abroad in active military service. This time can be taken all at once, or in increments of full days. Paid Family Leave cannot be taken while you are pregnant.

Under New York City’s Paid Safe and Sick Leave Law, a mother or birthing person can also use accrued sick leave during any period of sickness or disability following the birth of her child. The other parent can use accrued leave to care for the mother during this period. Parents also can use leave to care for a child’s need for medical diagnosis, care, or treatment of an illness, injury, or health condition, or preventive medical care.

If you are having serious problems getting maternity leave or paid sick leave, A Better Balance is one organization that can help.

NEW PARENT SUPPORT GROUPS & RESOURCES

If you were working prior to childbirth, you and your partner have the right to receive paid New York State Paid Family Leave, which provides eligible employees with up to 12 weeks of job protected, paid time off to bond with a new child, care for a close relative with a serious health condition, or assist loved ones when a family member is deployed abroad in active military service. This time can be taken all at once, or in increments of full days. Paid Family Leave cannot be taken while you are pregnant.

Under New York City’s Paid Safe and Sick Leave Law, a mother or birthing person can also use accrued sick leave during any period of sickness or disability following the birth of her child. The other parent can use accrued leave to care for the mother during this period. Parents also can use leave to care for a child’s need for medical diagnosis, care, or treatment of an illness, injury, or health condition, or preventive medical care.

If you are having serious problems getting maternity leave or paid sick leave, A Better Balance is one organization that can help.


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