View source for A Book for Midwives:Chapter 14: The first few hours after the birth

{{bctrail|segments=2|chaptitle=Chapter 14: The first few hours after the birth}}
{{DISPLAYTITLE:Chapter 14: The first few hours after&nbsp;the&nbsp;birth}}
{{SideSupplement|bookabbreviation=abfm|pagealt=is from <br>pages 247 to 252 of|chapterpdf=http://hesperian.org/wp-content/uploads/pdf/en_midw_2021/en_midw_2021_14.pdf|bookurl=A Book for Midwives|booktitle=A Book for Midwives}}
{{chaptertoc|In this chapter:|
<ul class{{=}}"noprint">
<li>[[A Book for Midwives:Chapter 14: The first few hours after the birth|Chapter 14: The first few hours after the birth]]</li>
  <li>[[A Book for Midwives:Chapter 14: The first few hours after the birth|What to do for the mother]]</li>
  <li>[[A Book for Midwives:What to do for the baby: The first few hours after the birth|What to do for the baby]]</li>
  <li>[[A Book for Midwives:What to do for the baby: The first few hours after the birth#Clean up and answer the family’s questions|Clean up and answer the family’s questions]]</li>
</ul>}}
After the birth of the placenta, the mother's body should start to recover from labor. The baby should breathe normally and start to keep herself warm.

The midwife should stay for a few hours after the birth to make sure the mother and baby are healthy, and to help the new family to eat and&nbsp;rest.
<br>
<div  id="What to do for the mother"></div>
=What to do for the mother=
==== Check the mother's physical signs ====
Check the mother's temperature, pulse, and blood pressure regularly — at least once an hour if she is having any health problems.

==== Clean the mother's genitals, belly, and legs ====
Help the mother clean herself after the birth. Change any dirty bedding and
wash blood off her body.
[[Image:MW_Ch14_Page_247-1.png|right|230px|alt=illustration of the below: cleaning the genitals.]]
[[A_Book_for_Midwives:Clean_your_hands_and_wear_protective_clothing|Wash your hands and put on gloves]] before you touch the mother's genitals, just as you did before the birth. Clean the mother's genitals very gently, using very clean water and a sterile cloth. If you have some disinfectant, like betadine, add a little to the water. Do not use alcohol or any other disinfectant that might sting the mother. You can use a little mild soap or even salt if you do not have disinfectant.

Wash downward, away from the vagina. Be careful not to bring anything up from the anus towards the vagina. Even a piece of stool that is too small to see can cause infection.

==== Prevent heavy bleeding ====
After the birth, it is normal for a woman to bleed the same amount as a heavy monthly bleeding. The blood should also look like monthly blood — old and dark, or pinkish. The blood comes out in little spurts when the womb contracts, or when the mother coughs, moves, or stands up.

Very heavy bleeding is dangerous. To check for heavy bleeding in the first few hours after birth:
<div class="page-break"></div>
<div style="position: relative; width: 190px; height: 220px; float:left; font-style: italic; line-height: 110%;">[[Image:MW_Ch14_Page_248-1.png|left|130px|alt=a hand on a woman's belly, on top of the womb.]]
<div style="position: absolute; width: 115px; top: 165px; left: 25px;">Feel if the womb is getting hard.</div></div>

* feel the womb to see if it is contracting. Check it just after the placenta is born. Then check it every 5 or 10 minutes for 1 hour. For the next 1 to 2 hours, check it every 15 to 30 minutes. If the womb is hard, it is contracting as it should. Leave it alone between checks.  [[A_Book_for_Midwives:Check_the_mother’s_physical_signs#softwomb|If it is soft, learn what to do]].
* check the mother's pads often for too much bleeding — 500 ml (about 2 cups) is too much.
* check the mother's pulse and blood pressure every hour. Watch for signs of [[A_Book_for_Midwives:Check_the_mother’s_physical_signs#shock|shock]].
{{clr}}

==== Check the mother's genitals for tears and other problems ====
Use a gloved hand to gently examine the mother's genitals for tears, blood clots, or a hematoma (bleeding under the skin). Also check to see if the cervix has prolapsed (dropped down to the vaginal opening). 
[[Image:MW_Ch14_Page_248-2.png|right|127px]]
=====If the mother has a tear =====
If you do not know how to sew a tear, if there is nowhere nearby where she can go to have the tear sewn, or if the tear is small, it can probably heal without sewing.

Ask her to rest in bed for 2 weeks with her legs together most of the time. She should move her legs regularly, but she should not climb up or down steps or steep hills. Someone else should do the cooking and cleaning for the family. To speed healing, she should also eat plenty of healthy food.

[[A_Book_for_Midwives:Sewing_a_tear_or_an_episiotomy|Learn how to sew a tear]].

=====If the mother has a hematoma or pain in the vagina=====
Sometimes a woman may have a large amount of bleeding into the skin in her vagina, called a hematoma. The skin in this area is often swollen, dark in color, painful, and soft. Sometimes the mother feels dizzy and weak as if she were bleeding too much, even though the womb is hard and there is only a little bleeding from the vagina. Pain in the vagina can be a sign that she is bleeding into a hematoma.

<div style="position: relative; width: 235px; height:170px;float:right;">
[[Image:MW_Ch14_Page_249-1.png|200px|right|alt=a woman's vagina with a dark, swollen area inside.]]
<div style="position: absolute; left: 15px; top: 43px;">hematoma</div></div>

Although a hematoma is painful, it is usually not serious unless it gets very large. If the hematoma is growing, press on the area with sterile gauze for 30 minutes or until it stops growing. If the mother has signs of shock, treat her for [[A_Book_for_Midwives:Check_the_mother’s_physical_signs#shock|shock]] and get medical help so the blister can be opened and the trapped blood can come out. If you know how, you can drain it yourself by opening it with a sterile scalpel. After draining, put pressure on the area with a sterile gauze until the bleeding stops.

=====If the cervix can be seen at the opening of the vagina =====
<div style="position: relative; width: 150px; height: 160px;float:left;top:15px;">
[[Image:MW_Ch14_Page_249-2.png|110px|center|alt=the cervix showing at the opening of a woman's vagina.]]
<div style="position: absolute; left: 85px; top: 90px;">cervix</div></div>

If you can see the cervix at the vaginal opening after childbirth, the womb has prolapsed into the vagina. This problem is not dangerous, and the cervix will usually go back up inside the mother in a few days. You may be able to push the womb farther in with a gloved hand. Help the mother raise her hips so that they are higher than her head. Ask her to do [[A_Book_for_Midwives:Caring_for_the_body_for_good_health#kegels|squeezing exercises]] at least 4 times a day.

Watch her closely for [[A_Book_for_Midwives:Chapter_15:_The_first_weeks_after_the_birth#infection|signs of infection]] during the next 2 weeks.

If the cervix stays at the vaginal opening for a month or more, the mother
should get medical advice. A cervix that stays prolapsed can cause problems when
the woman has another child.

<div style="position: relative; width: 225px; height: 220px; font-style: italic; line-height: 110%; float:right;">[[Image:MW_Ch14_Page_249-3.png|150px|center]]
<div style="position: absolute; width: 205px; top: 188px; left: 35px;">A mother should try to <br>urinate soon after the birth.</div></div>

==== Help the mother urinate ====
A full bladder can cause bleeding and other problems. A mother's bladder will probably be full after birth, but she may not feel the need to urinate. Ask her to urinate within the first 2 to 3 hours. If she is too tired to get up and walk, she can squat over a bowl on the bed or on the floor. She can also urinate into a towel or thick cloth while lying down. If she cannot urinate, it may help to pour clean, warm water over her genitals while she tries.

If the mother cannot urinate after 4 hours:

<ol style="font-weight: bold;">
<li><span style="font-weight: normal;">
[[A_Book_for_Midwives:Care_for_the_mother_during_labor#urinate|Check her bladder]]. If it is not full, help her drink fluids.
</span></li>
<li><span style="font-weight: normal;">
[[A_Book_for_Midwives:Catheters|See ways to help a woman urinate]].
</span></li>
<li><span style="font-weight: normal;">
If she still cannot urinate, she may need to have a [[A_Book_for_Midwives:Catheters|catheter]] inserted. If you have not been trained to use a catheter, get medical help.
</span></li>
</ol>

<div class{{=}}speechbub style="position: relative; width: 310px; float:right; height:250px;">
[[Image:MW_Ch14_Page_250-1.png|right|295px|alt=a woman offering a bowl and cup to a woman lying in a hammock.]]
<div style="position: absolute; width: 120px; top: 7px; left: 160px;">You need lots of good food and drink to get your strength back after the birth.</div></div>

==== Help the mother eat and drink ====
Most mothers are ready to eat soon after birth, and it is good for them to eat any kind of nutritious food they want. If a new mother is not hungry, she should at least have something to drink. Fruit juice is good because it gives energy. Many women want something warm to drink, like herbal tea. Some juices, like orange juice, also have vitamin C, which can help healing. (But she should avoid soda pop like Coke that is full of sugar and chemicals but not nutrition.) Encourage her to eat soon, within the first few hours, and to drink often.

=====If the mother cannot (or will not) eat or drink after 2 or 3 hours =====
* The mother may be ill. Check for [[A_Book_for_Midwives:Check_the_mother’s_physical_signs#bleedingafter|bleeding]], [[A_Book_for_Midwives:Chapter_15:_The_first_weeks_after_the_birth#infection|infection]], and other signs of illness that may be taking away her appetite.
* The mother may be depressed (sad, angry, or without any feelings). Encourage her to talk about her feelings and needs.
* The mother may believe that certain foods are bad to eat after a birth. But she must eat to recover from the birth and to be able to care for her baby.

{{spannote|||[[Image:MW_Ch14_Page_250-2.png|right|290px]]
'''Eating after birth'''<br>
Midwives, healers, family members, and doctors may all have different advice about the food women should eat during pregnancy and after birth. The nutrition information in this book is based on the ideas most Western doctors, nurses, and midwives learn. Other systems of medicine and local customs prescribe different ways of eating, such as avoiding spicy foods, or only eating warm foods. Some of these ideas may not seem of value to those who practice Western medicine, but they still offer benefits.

However, some customs, such as avoiding protein, are dangerous. Eating only one kind of food is not enough, and avoiding certain foods can lead to serious health problems. After birth, women need to eat as much as or more than they did when they were pregnant. They need the same mix of foods: main foods, vegetables and fruits, and protein foods like beans, eggs, nuts, meat, or milk. Talk to the mother and her family about what she plans to eat after the birth. Help her eat a wide variety of healthy foods. See [[A_Book_for_Midwives:Chapter_4:_Helping_women_stay_healthy#Eating_well|more about nutrition]].}}

[[Image:MW_Ch14_Page_251-1.png|right|270px]]
==== Watch the mother's feelings about her baby ====
===== Mother is not interested in her baby =====
Some mothers do not feel good about their new babies. There can be many reasons for this. The mother may be very tired, or she may be ill or bleeding. She may not have wanted a baby, or may be worried that she cannot take care of one. She may be very depressed.

Worry or unhappiness during pregnancy means a greater chance of having them later. After birth, these feelings can make it harder to care for the baby. Support women to recover a better mood and better care for themselves and their babies.

=====What to do=====
*Check the mother for signs of blood loss or infection.
*Encourage the mother to keep the baby close. Skin-to-skin contact helps both baby and mother.
*You might talk to the mother about her feelings, or you may feel it is better to leave her alone, and to watch and wait.
*If the mother is depressed, or if she was depressed after a past birth, talk to the family about giving her extra attention and support in the next weeks. Usually this [[A_Book_for_Midwives:Chapter_15:_The_first_weeks_after_the_birth#support|depression]] passes in time, but sometimes it takes a few weeks or even months.
*Make sure someone in the family helps take care of the new baby.
*Encourage the mother to sleep when the baby sleeps. Encourage her family to help her sleep by watching the baby for her.
*Check that the mother has enough to eat, and if she does not, connect her to services that can help her.
*As her body heals from the birth, her mood and her sleep will improve if she moves a little each day. Encourage her to do some physical activities she enjoys.
<br>

<div style="position: relative; width: 225px; height:160px;float:left;">[[Image:MW_Ch14_Page_251-2.png|left|200px]]</div>

==== Watch the mother for infection ====
A new mother's temperature is often a little higher than normal, especially on a hot day. But if the mother feels ill, has a fever or a fast pulse, or feels soreness when her womb is touched, she may have an infection. Infection is more likely if her waters broke early in labor, if the labor was long, or if she was exhausted during labor.
=====What to do=====
<ol style="font-weight: bold;">
<li><span style="font-weight: normal;">
Check to see if she is [[A_Book_for_Midwives:Care_for_the_mother_during_labor#drink|dehydrated]].
</span></li>
<li><span style="font-weight: normal;">
Give her lots of water and other fluids to drink. 
</span></li>
</ol>

If she continues to have a fever, she may have an [[A_Book_for_Midwives:Chapter_15:_The_first_weeks_after_the_birth#infection|infection]].

[[Image:MW_Ch14_Page_252-1.png|right|180px]]

<div class="page-break"></div>
==== Help with breastfeeding ====
Breast is best for both the mother and baby. If the mother is not sure she wants to breastfeed, ask her to try breastfeeding just for the first few weeks or months. Even a short time of breastfeeding is better than none.

Make sure the mother understands that if she breastfeeds her&nbsp;baby:

{{spannote|||See how to [[A_Book_for_Midwives:Situations_that_affect_breastfeeding#hiv|help a mother with HIV/AIDS feed her baby safely]].|style=width:18%;float:right;margin-right:40px;|}}
* her womb will more quickly go back to its normal size.
* the baby is less likely to get diarrhea and other illnesses.
* the mother will have more money for her family. (It is more<br> expensive to bottle feed a baby.)
<br>
See [[A_Book_for_Midwives:Chapter_16:_Breastfeeding|Chapter 16]] for more on breastfeeding.

<br>
<div  class{{=}}speechbub style="position: relative; width: 310px; height:270;  float:left;">
[[Image:MW_Ch14_Page_252-2.png|center|260px|alt=a man speaking to a woman as she breastfeeds a baby.]]
<div style="position: absolute; width: 100px; top: 103px; left: 166px;">I am so proud and happy!</div></div>

==== Give the new family some time alone ====
If the mother and baby are healthy, give them time alone. New parents need time with each other and their new baby. They may also need privacy to talk, laugh, cry, or celebrate in some way.

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{{Previous and next sections|What to do for the baby: The birth of the placenta|What to do for the baby: The first few hours after the birth}}


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