6-weeks and Counting
Birth Planning
In your 34-week prenatal appointment we’ll give you a pocket folder with lots of handouts. This page is the digital equivalent of the 34-week planning folder. We have uploaded all of the documents from that folder below.
Scroll through this page to find:
Birth Checklists - What you’ll need for your birth, Forms to review etc
Postpartum Safety Instructions for Mother and Newborn
Referrals for pediatricians
Emergency Reference Sheet
Preparing for a Waterbirth
Postpartum Safety & Information -
Mother
Congratulations on the birth of your precious baby! And, welcome to what we call the “postpartum period”. This phase of your “new normal” will include a lot of changes and possibly some challenges. We want to provide you with some guidelines and instructions to help you have a safe, healthy postpartum period.
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These 5-activities will be your repeating cycle for the first 4 days. You will move through these roughly every 2-1/2 hours:
Empty your bladder
Get a bottle of water and a bite to eat
Breastfeed your baby
Back to sleep
Your ONLY job is to rest and feed your baby. Please stay in your bedroom either in your bed or on your bed of the first 4-days (at least).
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Rest: Birth is hard work! Rest will help you recover more quickly.
o 3 Days IN the Bed: Stay in bed with your baby, skin to skin. Do nothing except take care of your baby.
o 3 Days ON the Bed (or couch): You can be more mobile but please mostly rest.
3 Weeks AROUND the House: Take it easy. Sleep when your baby sleeps. Taking care of yourself and the baby now will make it easier for you to resume a more normal schedule very soonDescription text goes here
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Perineal Care: Rinse your perineum with a bottle of warm water while you are urinating and/or rinse your perineum after using the restroom. Pat dry (avoid wiping). Ice packs may be soothing and reduce pain and swelling. If you have any kind of laceration, keep your legs together to help facilitate healing. If you have stitches, do not immerse yourself in a bath for 2 weeks.Description text goes here
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Nutrition and Hydration: For the best recovery, ADD an additional 500 calories every day to your diet. Continue taking your prenatal supplements. Stay well hydrated and eat a healthy diet with a variety of fresh foods and plenty of whole grains, fruit and vegetables.
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Uterus and bleeding: Your uterus should be firm and no higher than your belly button. Bleeding may be heavy for the first 12-24 hours. It will gradually slow down and become darker in color and less in amount over the next 2-3 weeks. You may have clots, especially after you’ve been laying down. You should not soak more than 1 pad per hour.
Remember – 2 pads in 1 hour is too much. If you are bleeding too much, Empty your bladder, Rub your belly, and breastfeed your baby.
If you fill a pad in less than 20 minutes, or if you have gushing blood that seems like a hemorrhage, call 911, lay down, rub your belly, and breastfeed your baby until help arrives.
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Elimination: Make a habit of attempting to empty your bladder every 2 hours, even if you don’t feel the urge. Keeping your bladder empty will minimize postpartum bleeding and cramping. Eat healthy high-fiber foods, or foods you know help you stay regular. It is alright to take a stool softener if you have difficulty having a bowel movement.
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Pain Relief: The first choice for pain relief is ice. You can make ice packs to wear in your underwear by freezing maxipads with ¼ cup of water in them.
Over the counter remedies may be helpful for hemorrhoid relief.
Ibuprofen may help with both pain relief and swelling. You may take up to 600 mg every 6 hours.
There is an herbal tincture called "After Ease" that works well for postpartum contractions. (This is especially helpful for your 2nd or 3rd birth)
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Breast Care: You may have noticed the appearance of Montgomery Glands -- slightly raised lumps around the dark part of the nipple. They are creating oil to moisturize the skin of the nipple. Avoid doing anything that will strip that skin of those important oils; do not use alcohol, soap or drying agents on the nipples.
If your nipples are sore or breastfeeding is painful, it may be a sign of poor positioning or an ineffective latch. Use pure lanolin cream or a pure healing salve on your nipples after each feeding if you are sore. Call me so we can help troubleshoot solutions. Breastfeeding may be uncomfortable for the first several days, but it should not be extremely painful for any extended period of time.
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Call us if:
You or your baby runs a fever over 100.4o F.
Your bleeding is so heavy that you fill a pad in less than 30 minutes.
Your baby turns yellow in the first 24-hours.
You have any questions or concerns.
Margie Wallis, LM CPM: 469-643-9433
In case of an emergency, call 911.
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Postpartum blues: It is not uncommon for new mothers to experience feelings of depression or sadness. These feelings are known as “baby blues”. You may feel like crying “for no reason”, feel exhausted or overwhelmed. Make sure you are getting plenty of rest, a lot of support and nurturing from your husband and other loved ones, and get as much sleep as you can. You should feel like “your old self” within a week or 2.
In some cases, the feelings of depression or sadness are more severe, or continue for more than 2 weeks. And, sometimes the thoughts and emotions are more serious, and may be an indication of postpartum depression. If you or your family is concerned that you are not enjoying motherhood, or you are feeling angrier or sadder than normal, please call me and let me know. We will help come up with a plan to make sure you and the baby are both doing well.
To help with mood support, take Vitamin D3, get plenty of sunshine. sleep as much as is possible (even asking others to help take care of the baby if you need a nap). Talk to your doula, your partner and your midwife.
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Birth Control & Intercourse: Do not resume sexual intercourse until 6-weeks after your birth. It is important to wait until your body has had time to heal before introducing anything into the vagina. When you are ready to resume an intimate relationship, please consider your contraceptive options.
Breastfeeding is not an entirely effective method of birth control. Many couples choose barrier methods. Some choose prescriptions. I would be glad to discuss your options with you.
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Welcome to Motherhood: Remember to slow down. Enjoy this time with your baby. Nursing and cuddling your baby will help both you and the baby move into this beautiful new relationship together.
Research is very clear that keeping your baby skin-to-skin and keeping your baby with you continuously has compelling neurological and developmental benefits.
You cannot spoil a newborn. Babies grow up so quickly. You will never regain this special time. Cherish every moment.
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In case of an emergency, call 911. Then unlock your front door and take your baby to the front door to reduce the response time. If someone else is there, have them stand out by the street and wave the ambulance down.
When to call 911: If the thought "should I call 911" ever occurs to you, it's a sign you are sensing there's an emergency. Don't talk yourself out of it. just make the call. It's always better to err on the side of caution.
A few reasons to definitely call 911:
If you are bleeding so heavily you feel unwell, light headed, or if rubbing your belly doesn't stop the bleeding.
If you or the baby has a seizure
If you are concerned and it feels like an emergency.
Postpartum Safety & Information -
Newborn
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Research is very clear that keeping your baby skin-to-skin and keeping your baby with you continuously has compelling neurological and developmental benefits.
Ideally, the newborn should be in only a diaper on the bare skin of either Mom or Dad for the first 72-hours. These are the essential hours to establish breastfeeding and bring in the milk. Avoid anything that disrupts that important relationship. (limit time with other people).
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Body Temperature: Babies are just miniature people. Their temperature should be 98.6. But sometimes their temperature varies. The “ok range” is 97.7 – 99.9.
If the temperature drops below 97.7, please get the baby skin to skin and cover yourselves with a blanket.
If it goes to 99.9, please take a layer off the baby. A fever is anything over 100.4.
Take the baby’s temperature under the his/her armpit with a digital thermometer. If your baby feels warm, the first thing to do is unwrap the baby or take a layer of clothes off. Recheck the temperature. If the temperature is still elevated in 30 minutes, recheck it. A fever of 100.4 or more is a reason to take your baby to the emergency room.
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Choking: Sometimes, babies will gag or choke as they bring up fluid from their stomach.
If your baby is choking, tilt the baby to the side pat his/her back. If you see thick mucous or secretions, use the bulb syringe to try to remove it.
Always suction the mouth before the nose to prevent the baby from inhaling and choking on the secretions.
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Nursing: Your newborn should eat 8-10 times each day.
The feedings may take 20-30 minutes at first, please don't let him/her nurse longer than that at one sitting because it will actually require more calories than they are able to get in a feeding.
The baby is getting a dense, nutritious milk called colostrum. It’s exactly what the baby needs. Do not give the baby formula or water unless your midwife or pediatrician have recommended it for a very specific need.
Please be diligent to get 8 - 10 feeds in. Call your midwife if you can’t get the baby to eat often enough.
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Diapers & Contents: Your baby’s gut is being colonized by living organism as he/she takes in your colostrum. As the gut is activated by the various strains of microorganisms, your baby will begin having bowel movements.
Typically, a newborn has 1 poopy diaper in the first 24 hours of life, 2 poopy diapers on day 2, 3 on day 3 and so-on until day 6.
Most breastfed babies continue to have 6 poopy diapers and an additional 3-4 wet diapers every day while breastfeeding. If your baby has not had a bowel movement in the first 24 hours, or goes longer than 24-hours without a bowel movement, call your midwife so we can assess breastfeeding and recommend a care plan.
BM Color: During the first few days, the baby’s stools will be dark, thick, and sticky with a substance called “meconium.” Once the meconium is out of the baby’s system, the bowel movements will begin to change color . . . Dark green . . . lighter green . . . lime yellow . . . bright yellow. We can help you understand more about the quality of your breastmilk based on the color of your baby’s bowel movements.
Wet Diapers: In addition to bowel movements, your baby should be voiding every day. Most newborns urinate about 3-4 times each day. The urine should be clear. If it is dark yellow, or red, it may be a sign of dehydration. Call your midwife if you see dark urine.
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Your baby will have residual hormones from birth. Some girls have a faux period. If you see a little bit of "bloody show" in your baby's diaper, please take a photo of it and send it to your midwife so we can confirm that it's normal for your baby.
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Sleeping: Your baby will be asleep most of the day . . . and tend to be awake more at night. Please try not let your baby sleep longer than 2 -3 hours at a time until your milk comes in. After your milk is established (day 3 or 4) your baby may sleep 3-4 hours ONCE during the day, but must still get 8-10 feeds in.
Safe sleep guidelines include: Babies should room in with their parents -- it’s good for all of you. Other safe sleep habits:
Put your baby on his/her back to sleep.
Keep the room cool (70o- - 74o)
Do not over-dress the baby. Dress the baby so he/she feels warm (but not hot) to the touch.
Do not put any blankets, pillows, toys, or bumper pads in the crib You may swaddle the baby tightly, but no loose blankets.
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Crying/Soothing: Your baby has had a big day too! He/she is adjusting to life outside of the womb.
The most comforting thing you can do your baby is keep him/her close to you. Skin-to-skin care (with either mom or dad) is ideal. Feed the baby continuously, and keep him/her in contact with you most of the rest of the time to help him/her adjust to life outside the womb.
If the baby is crying inconsolably, do a “head-to-toe” inspection and think through the types of things that may be distressing to your baby. If you can’t sooth or calm the baby within 20-30 minutes, call your midwife. We will be glad to help you figure out what’s going on.
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Cord Care: Your baby’s umbilical cord is made up of 3 blood vessels that literally go straight into his/her circulatory system. It’s important to keep the stump clean and dry and prevent infection. Do not put ointments or powders on the cord. Also, fold the diaper down to make sure air circulates around the cord. If you see signs of infection around the base of the cord, call your midwife.
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Bathing: Your baby will not need a full bath until the umbilical stump falls off. Just wipe off the “dirty” or “stinky” parts with a warm wash cloth for these first few days
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Signs of Wellness: In addition to a normal body temperature, babies should have other “normal signs of wellness.”
Like all people, healthy babies have a good appetite, normal bowel movements, and react / respond to their environment.
The baby’s breathing may be irregular, but it should not be labored. If the baby is struggling to breathe (nostrils are flaring, abdomen is retracting) call your midwife immediately.
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Skin color: Jaundice after 24-hours is a perfectly normal process as the baby’s liver breaks down red blood cells. The byproducts of that normal process are yellow. Billiruben has a yellow color to it.
If too much bilirubin accumulates, it can be problematic. The best way to make sure your baby stays healthy is to feed him/her often. Bowel movements will remove the bilirubin from his/her system.
You should also hold your baby in indirect sunlight for 15-30 minutes every day to help his body process the bilirubin.
Your midwife will check your baby’s skin color during your postpartum visits. If your baby’s skin turns yellow before 24-hours, or if the eyes and extremities turn yellow, we will refer you to a pediatrician for additional care.
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Newborn Hearing Screen: The State of Texas requires every baby to have his/her hearing tested.
We recommend PGV Pediatrics. Dr. Agrawal is not only one of the most well-respected physicians, she's a genuinely loving and caring physician who shares our holistic philosophy. One great way to meet her is to schedule your baby's hearing screen with her.
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Car Seat: The State of Texas requires that all newborns be restrained in a car seat. Your newborn should be well secured into a rear-facing car seat anytime you are taking him/her in the car. Please leave the car seat in the car, though. It is important for the baby to be carried, or worn in a sling, rather than being put in a car seat that turns into a stroller that turns into an activity seat.
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Here are the steps to getting your baby’s birth certificate:
Using the information from Birth Certificate Worksheet in the portal we will file the birth data with Texas Vital Statistics.
We upload a Verification of Birth Facts into your portal and ask you to proof read it carefully before signing it.
Once you sign that it is perfect, we will release the birth certificate / file the birth with the state
The baby’s social security card will automatically be sent to you when the info has been processed.
You can order a copy of the birth certificate online: https://www.texas.gov/texas-vital-records/
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If your baby turns blue, or is unresponsive call 911.
If you call 911, take your baby to the front door, unlock the door and wait for paramedics.
Call your midwife if:
You or your baby runs a fever over 100.4o F.
Your baby turns yellow in the first 24-hours.
You have any questions or concerns.
Margie Wallis, LM CPM: 469-643-9433
