Hesperian Health Guides
Chapter 14: The first few hours after the birth
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 rest.
Contents
- 1 What to do for the mother
- 1.1 Check the mother's physical signs
- 1.2 Clean the mother's genitals, belly, and legs
- 1.3 Prevent heavy bleeding
- 1.4 Check the mother's genitals for tears and other problems
- 1.5 Help the mother urinate
- 1.6 Help the mother eat and drink
- 1.7 Watch the mother for infection
- 1.8 Watch how the mother feels about her baby
- 1.9 Help with breastfeeding
- 1.10 Give the new family some time alone
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.
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 birth, most women 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:
- 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. If it is soft, learn what to do.
- check the mother’s pads often (bed pads or pads she is wearing) 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 shock.
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).
If the mother has a tear
If you do not know how to sew a tear and 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.
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.
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 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
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 lie on something so her hips are higher than her head. Ask her to do squeezing exercises at least 4 times a day.
Watch her closely for 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.
urinate soon after the birth.
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:
- Check her bladder. If it is not full, help her drink fluids.
- See ways to help a woman urinate.
- If she still cannot urinate, she may need to have a catheter inserted. If you have not been trained to use a catheter, get medical help.
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 bleeding, 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.
Eating after birth
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.
Watch the mother for infection
After birth, a mother’s temperature is often a little higher than usual, especially during hot weather. But she may have an infection if she feels ill, has a fast pulse or a temperature above 38°C (100.4°F), or her belly feels sore when touched. Infection is more likely if her waters broke early in labor, if labor was long, or if she was exhausted during labor.
What to do
- Check to see if she is dehydrated.
- Give her lots of water and other fluids to drink.
If a fever or other signs continue, see medicines to treat womb infection.
Watch how the mother feels about her baby
There are many reasons why some mothers seem not to be interested in their babies. The mother may be ill or bleeding, or just very tired. She may not have wanted this baby, or be worried she cannot take care of it. Pregnancy and birth both make some women more likely to become depressed. These feelings can make it hard to care for a baby and to recover from birth.
What to do
- You might talk with the mother about how she feels, or you may feel it is better to watch and wait while letting her rest for a while.
- Encourage the mother to keep the baby close. Skin-to-skin contact helps both baby and mother.
- Encourage the family to help the mother sleep by watching the baby. The mother should also try to sleep when the baby sleeps.
- If the mother is depressed (or was depressed after a previous birth), talk to the family about how they can support her in the next weeks. Make sure a family member or friend can help the mother take care of the baby.
Check that the mother has enough to eat, and if she does not, connect her or the family to services that can help. Remind the mother that as her body heals from the birth, her mood and her sleep will improve if she moves a little each day.
Encourage her to begin physical activities she enjoys. Plan to check on the mother over the next few weeks.
Usually depression passes in time, but it may take weeks or even months.
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 baby:
- her womb will contract more quickly.
- the baby is less likely to get diarrhea and other illnesses.
- the mother will have more money for her family. (It is more
expensive to bottle feed a baby.)
See Chapter 16 for more on breastfeeding.
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.