ļ»æEpisode 207 - The First 2 Weeks Postpartum (Part 2)
[0:00] Welcome to the Great Birth Rebellion podcast. I'm your host, Dr. Melanie Jackson. I'm a clinical and research midwife with my PhD, and each episode, I cast a critical eye over current maternity care practice by grappling with research and historical knowledge to help you get the best out of your pregnancy, birth, and postpartum journey.
[0:24] Welcome to today's episode of the Great Birth Rebellion podcast. I'm your host, Dr. Melanie Jackson and this is part two. So part one of this episode is in the previous episode and the last episode is definitely a prerequisite for this one. So you know what the heck I'm talking about. But today I'm continuing my conversation about the first two weeks postpartum and the things that I recommend to my clients for how they can most healthfully adjust to becoming a mother, particularly in those first two weeks after birth. We've already spoken about a whole raft of things. Mostly we're stuck in the first two days as well. So today is the conclusion to that conversation about the first two weeks postpartum. And this is all based on the experiences that I've had with my own clients over the last 18 years. So I care for women as a midwife in the pregnancy, birth, and postpartum all the way up to six weeks. So I have an intimate look into what happens for women in those first few weeks post-birth.
[1:32] And that's what we're talking about today, getting you through those two in the most healthful way possible so that you and your baby can thrive. So have a listen to last week. If you haven't already, this is part two. And this episode is sponsored by my dear friend and birth prep extraordinaire, Poppy Child from Pop That Mama. She's a doula and hypnobirthing practitioner and her online hypnobirthing course called The Birth Box has already helped thousands of women get ready for labor. Listen to this recent review of The Birth Box. The woman says, I'm a first-time mom and I gave birth to my beautiful baby boy yesterday. I've been listening to The Birth Box on repeat for the past few months, including the day in which I went into labor, and I had the most empowering birth experience, and I can honestly say that listening to The Birth Box was a huge part of this success.
[2:27] Reframing the pain that you experience during labor can be a purposeful pain instead of a harmful pain. And that really helped me to know that. And just being able to surrender to the wild ride that birth is and let my body take over was the most incredible thing. And this is coming from a pelvic floor physiotherapist based here in Australia. She says, I will recommend it to all my patients. And you know me I'm so picky about what I will endorse but I do get behind the work that Poppy is doing and in the birth box you'll learn tools to help you manage pain and how to stay steady when labor gets intense it's all about giving you knowledge confidence and a mindset that actually works when the big day comes and for the big days that will follow.
[3:17] Birth Box is rated five stars across the board. And with my code, Melanie, you'll get 25% off. So if you're preparing for birth, go to the checkout. You'll be so glad you did. The link is in the show notes. Use the code Melanie to get your 25% off. And we're going to kick off exactly
[3:37] where I ended and give you some more strategies for how to work through the first two weeks. So my next point for you, we finished off talking about your very first wee and poo last week. Now I want to give you a few more other practical tips for how to adapt. So my next suggestion is, is that you adopt a system that makes it so everything you need is within hands reach, arms reach, whatever you want to say, within arms reach.
[4:05] So in the bathroom next to the toilet, put pads right next to the toilet, top up your perineal spray bottle, make sure there's lots of rolls of paper that when you need to wee or poo or do anything in the shower, when you go there, everything that you need is right there. And it might be that you need to top it up and I hope it's not. I hope there's people around you who are capable of making sure that these things happen. But if you set yourself up with some little caddies that are stocked with things and maybe talk the rest of the support crew about what's in these caddies and why it's important that the next to the toilet caddy contains your spray bottle, your peri bottle, some pads and enough toilet paper that you don't have to call out for anything. So some little caddies in the most common places that you'll be. In the bedroom, bedside table with everything that you need within hand's reach, whatever it is you want to use. If you're breastfeeding and you have a specific spot that you're feeding, maybe you've.
[5:13] Side table, everything that you need. And you might choose to have a mobile caddy that has everything that you need or have little stations set up around the house. You might be in the laundry. Same thing. When I had my first babies, we had a two-story house. So I intentionally put, identical items upstairs that I needed every day and downstairs so that I didn't need to traverse the stairs. If I was downstairs, I knew I had everything I needed. If I was upstairs, I knew I had everything I needed so I kind of split everything in two and this continued when my kids were little I didn't want to have little kids downstairs and they have to go up and down the stairs for things all the time I made sure that the upstairs stock was the same as the downstairs stock and this can be helpful if you've got a single level house and there's not lots of stairs having a movable trolley or something on wheels can be super handy that just wherever you You go, that thing is there and you've got everything you need. But if you kind of, I was more of a sort of stations girl. I had little stations set up around the house where I could go if I needed to have a seat and I knew everything was there.
[6:23] So those are a few things that you can do. That's a little system. Adopt that system. The other thing that's really handy, if you've got little kids, make a similar station for them. Or if you have a caddy, make one whole tray, one whole section of your caddy, things that you can use to keep your other kids busy. Or you might have easy snacks, little games, books, whatever it is, something, fidget things that they can play with when they come over to you that interest them. Little bits of play-doh, I don't know, whatever you can think of that interests your kids that you can also put in their caddy. And it's a way for you to still interact with them, but everything's within arm's reach.
[7:07] All right, I want to talk now about if you're breastfeeding, what's going to happen to your boobies in the first two weeks? And this is all about your milk coming in. specifically in the first week there is a lot of change that happens but initially your baby will come out baby skin to skin as we talked about in the last episode and the first two days of suckling, They'll be predominantly getting colostrum. And the good news is, is that is all they need. It's a small volume, but it's highly concentrated. And the baby doesn't need anything more than the small amounts of colostrum that it's going to get, droplets of colostrum. Its tummy is literally the size of a marble in the first day. And it only slightly gets slightly bigger every day. But again, the baby doesn't need 30, 40 or 50 mils of milk. It needs just the dense droplets of colostrum or whatever is there in your breasts. Babies are super clever.
[8:12] Actually, before they're born, they put on this layer of what we call brown fat. And brown fat is the fat that breaks down really easy to create other nutrients for your baby to live off. And they also come with what I call a packed lunch. Enough fluids, enough energy in brown fat to survive the few days that it's going to take for your milk to come in. And for that reason, it's actually completely normal and expected that your baby would lose up to 10% of its birth weight because it's using that extra body weight that it put on. It's using the pack lunch that it brought out from the uterus into life to survive those first few days while the baby's waiting for your milk to come in. So please hear me, your colostrum is adequate and ideal in terms of volume and the density and the nutrition. It's everything your baby needs. You don't need to add anything else. Your baby around day two or day three may appear to be ravenously hungry and it may be ravenously hungry, but that is important because what the baby's going to do is spend, maybe it'll feel like 12 hours almost nonstop feeding. And women talk about this. It's around day two. It can be different, two or three.
[9:42] And the baby is ravenously hungry because it's running out of its packed lunch. And it's saying to you, time to bring the milk in mom. I need more volume. I'm starting to get hungry. I'm running out of my lunchbox. So the baby will feed and feed and feed and feed off this breast and that breast and this breast and that breast. And that is sending strong messages to your body of like, it is time to make the milk. So that part of your milk coming years is important. Something that women can be tempted to do on these days where the baby feels like it's constantly feeding is.
[10:24] Is they think either their milk supply is insufficient and they worry that their baby's hungry and they desperately want to feed the baby. Okay, it makes total sense that you want your baby to be full and satisfied. The thing is, is the baby needs to be a little bit agitated because the baby is telling your body that it's time to make milk. So if you do something like give the baby a top-up of formula if you weren't planning on formula feeding, and giving the baby a top up and the baby's full and satisfied and falls asleep, you've just gone ahead and impacted on the messaging that your baby was sending to your body about milk production. So you can start to interrupt how much milk your body's going to make and how quickly because you went ahead and satisfied the baby.
[11:14] Now, this is, again, generally speaking, if your baby's well, it's okay. They will ride through this. There will be a night where they just feed ravenously or a day where you think, gosh, the baby's just constantly feeding. Then what will happen is you'll wake up after a nap one day and your boobs will be full of milk. They will have received the message. Your baby's going to have a big, huge feed and fall asleep. And then you're going to spend the next 12 hours looking at your baby, wishing that it would wake up more because your boobs are so full of milk. So it goes from like famine to feast, and that is the process of your milk coming in. So this is what you can expect in the first, let's be generous and say first one to four days.
[12:03] Your milk could come in. If you've had babies before, your milk is likely to come in sooner because your body is aware of what needs to happen. But if you haven't, it could be day three, day four. If you've had a cesarean, sometimes it can be even longer than that. So just be aware though that there is a process.
[12:23] The big story here is that you'll start with colostrum and that is plenty. Your baby will start to get hungry and it'll feed ravenously and frequently, but that is purposeful and important because that's the cue to your body to start making milk. And then all of a sudden your milk will come in. It could be quite the dramatic event where you wake up after a nap and your boobs are literally full. They will feel hard. They could feel painful and sore to touch. That's normal. You're going to start with oversupply and then over the next three to four, five, six weeks, your body will settle down. But it'll always start off in oversupply where you feel like your boobs are full and rocky and firm. That's not mastitis and it's not a problem. It's just that's the sensation of your milk coming in. That will be full of milk. And then you might get letdowns and wet bras and you'll have to manage the dripping out of your milk. Sometimes you're going to let down when you just look at your beautiful little baby or the baby starts crying or you see a photo and all of a sudden milk just starts pouring out. This can be the early experience of your milk coming in.
[13:41] What I also want to tell you about is around day three.
[13:48] I call this the crying day. About day three is the crying day. The hormones of your birth are starting to wear off. And there's this big hormonal shift that accompanies your milk coming in. It's been a few days of very little sleep because you're looking after your baby, especially if it's your first. There's quite the mental load of even understanding if you're even doing it right.
[14:12] And everything's starting to land. Maybe your bum hurts. Maybe your tailbone hurts. Maybe your baby has spent that whole night ravenously feeding, and then you've just had enough. Your tolerance is gone, and you just feel like crying. Can I just tell you, this is completely normal, really associated with the milk coming in, that transition of the milk coming in. I call it the crying day, because typically when I arrive on day three, all women call me crying. They can't understand it. They're intolerant of everything. Everything sets them off. They just feel like crying. This is normal. It's completely okay. Some people have given it names, but I just call it the crying day. It's completely normal. The other thing it can correlate with is the first few days, people ask visitors not to come. Maybe they need a little rest.
[15:08] Then day three, they think, maybe I could have some visitors, but they're not ready for visitors yet. Day three, crying day. can I suggest you do not plan anything for around day three or for postpartum because one of those days could be your crying day and the people around you need to know that the best thing they can do for you is just make sure that you have food, water, nourishment, support, that they're looking after everything else around you because you're going to need to have a nice big cry. It can be quite cathartic but any of the tiniest little thing can set you off. And here was what set me off, day three crying day.
[15:48] I specifically had a craving for, and I really don't have cravings for this usually, specifically had a craving for a tuna mayonnaise and shallot sandwich. I said to my husband, I want a sandwich. I want mayo and tuna and shallots. Right. He went ahead, did the thing. He's a great husband, knows exactly how to care for me, brought me the sandwich and I looked at tears.
[16:17] And he said, what's the matter? And I said to him, I just imagined it would be different. In my head, I thought it would have more mayonnaise. I had imagined this sandwich and what he bought me did not exactly match the picture of the sandwich I had in my head. That is what set me off on day three of crying day. And from that day on, we jokingly have a phrase. If I asked my husband for something and there's any vague thought that maybe he might not nail the request he asked me a question of how do you imagine that in your head and then I can give him a more vivid description of what I'm imagining in my head because he does desperately want to satisfy my needs which is amazing and I love him for that but you know this is the question how does that look in your head and it stems all the way back to 13 years ago on the crying day when I was delivered a sandwich that did not match the expectation in my head and that's what set me off but please know.
[17:25] There is a crying day somewhere around the time where your milk comes in or just before and everyone around you needs to be aware that you're okay. This is normal. It's just kind of everything's come to a head. Your tolerances are gone. Your hormones are shifting. Your milk's coming in and you're reaching a peak tiredness possibly. It may not happen to you. Sometimes I explain this to women and they go, Mel, I didn't get the crying day. Good for you. That's great. but if you feel like crying it's possible you are at crying day and I want to tell you that this is different to postpartum depression if you feel like crying in the first two weeks of your post-birth please don't sit there and think oh my gosh maybe I have postpartum depression.
[18:14] Postpartum depression is very different to the feeling of just wanting to have a cry and it usually doesn't develop in that first two weeks. It's usually something that can be looked back at over time where you look back and go, yeah, I feel like this could be postpartum depression. That's a full clinical diagnosis to have postpartum depression. Please know if you feel like crying in the first two weeks, it may just be the big shift. It may be some feelings of disappointment. bit, it's unlikely in the first two weeks to be able to pinpoint that this is postpartum depression. So please don't let your mind go all the way there.
[18:56] The other thing that you should be aware of though, and this is incredibly rare, but it's something that's if there's a big emotional shift that's happening, this more likely happens in the first two weeks. It's an early acute circumstance. And there's a rare condition called postpartum psychosis. It happens in around one in 1,000 women. That's how rare it is. And there's usually risk factors.
[19:24] It's a severe psychiatric emergency, and it usually develops within the first two weeks after childbirth. As I said, about one in 1,000 women will experience postpartum psychosis. It needs immediate medical attention.
[19:41] It is a medical emergency because it's an acute mental illness event. It's completely out of your control. You did not do this to yourself. There's nothing you can do to change it in the immediate circumstance when you're in it. Your care team, so if this is happening, the woman's support people and family need to step in and help her. They need to identify it. She cannot help herself in a state of postpartum psychosis. She is actually potentially a danger to herself and possibly her baby by no fault of her own. So this is about the people around her recognizing that something unusual is going on and stepping in. So there can be a range of symptoms. So women who have postpartum psychosis, again, quite rare, one in 1,000, they become confused and disorientated. They might not know what day or time it is. They can't concentrate. They feel foggy. They can't function. They feel overloaded. They could be signs of a physical anxiety or agitation. They can't stay still. They kind of get a little bit manic. Their mood is all variable all over the place. They might range from manic to irritable, depressed, insomnia. They might not feel like they want to sleep and they actually could go days without sleeping like a manic episode.
[21:11] They experience things like delusions, incredibly intrusive thoughts. They can build paranoia. They can start to see things. It's like hallucinations and they have impaired sensations. Maybe they hear things, smell things, see things that aren't really there. It's incredibly odd and it's an acute event. It overcomes them. And I have seen this only one time. I was actually a student and I was a student doing placement in special care nursery. And there was a woman there, she'd had twins and they were preterm and they were being cared for in the special care nursery. And so she was coming up and down through the day to feed them and care for them and go and have a rest. And one day she came out of the lift and she approached one of the special care nurses and told her that in the lift, she'd just seen a ghost. And ignorantly, that special care nurse sort of took it very lightly, had a laugh and said something to the effect of, well, did you ask get the lotto numbers?
[22:25] Now, in the handover between shifts, this special care nurse was handing over to the next team and said, oh, haha, had a laugh. This woman with the twins commented that she saw a ghost in the lift and she explained the interaction. And fortunately, on shift that day was a midwife working in special care and she made it very clear to this special care nursery nurse that this could well be a sign of postpartum psychosis, not to be laughed at, not to be taken lightly, that this woman had reached out with an unusual circumstance that's outside of her control. And we weren't to laugh at this. This woman needed help. And thankfully, she did get help. She did have postpartum psychosis. And the midwife was able to identify that where the special care nurse kind of didn't even think about postpartum psychosis as being a cause. She kind of brushed it off. So in the first two weeks.
[23:33] It can be a time of emotional upheaval. There can be hormonal reasons why you feel like crying. You might be feeling overwhelmed from all of the drop balls that have just happened. Your birth may not have been what you wanted. You may be in pain. There may have been complications. It's a hugely emotional time. So expect that there's going to be some upheaval. I absolutely hope that your time is blissful and that none of this eventuates. But please know that if it does, most of the time the emotional upheaval is normal and occasionally there can be a pathological mental illness that develops in these first two weeks. Quite rare and very profound. Something that's not within your control but that you definitely need to seek help for. But that's what I want to say for now in this very shallow way about postpartum depression. Postpartum psychosis and the expectation of the day three to five crying day as your milk comes in and postpartum depression is a whole big area to discuss I can't fully discuss it today but it's unlikely that the first two weeks are going to be at time of diagnosis for postpartum depression if that's what your concern might be happening.
[24:58] Now, let's talk about safe sleeping in the first two weeks with your baby. This is a topic for a whole podcast episode, but there are a few options when we think about safe sleeping with your baby. And in this time where you're getting feeding sorted out and you're trying to get enough sleep, learn about your new baby and develop the skills for parenting, the recommendations are that the baby sleep in your room. So the baby is within eyesight of you when sleeping. This can be in a cot, in a bassinet, in a side sleeper, in a co-sleeper, or you can have strategies to safely co-sleep with your baby in the bed. Whatever it is you choose to do, the important part about safe sleeping is that you're prepared and that everybody else is aware of the sleeping arrangements. These are the safest sleep strategies you can have. What you don't want to do is plan to have your baby in a bassinet outside of the bed and then due to circumstances change your mind and bring the baby into the bed without adequate planning or letting your partner know that the baby's in the bed for example.
[26:09] The other thing is, is that it's important that when sleeping, every sleep is planned. So if you're planning on sleeping your baby in the cot, the cot is ready or the bassinet, the bassinet is ready, the co-sleeper is ready or the family bed is ready. The important thing is to not do things like out of tiredness, sleep the baby on a couch or with you in a chair in your arms. The accidents that can happen with sleeping are usually in times where the parent has, put the baby to sleep somewhere where it wouldn't normally sleep, where it wasn't the plan to sleep there, or where a tired parent would do something like fall asleep with the baby on a chair or a couch. So again, I won't go into full details about all of the stats and the safety or not safety of various sleeping locations. The most important thing is that whatever you plan to do that you're prepared and that everybody is aware so that you can create safe sleeping places and prevent sleeping accidents. Right next thing.
[27:21] I need you to know that every day in the first two weeks post-birth is going to be different to the last. Anything that was horrible the day before probably won't be horrible the next day or there's going to be a change in that circumstance. It's amazing how fast things change day to day in the first two weeks. I wish I could explain it to you, but it's the things that can change in 24 hours post-birth are exceptional so just know that whatever's happening now won't last including the amazing gorgeous things they all are fleeting in the first two weeks now I actually hate the phrase this too shall pass I remember being early postpartum and so many people were like this too shall pass and I just wanted to punch them in the throat because the phrase was like it just, diminished the experience I was having. Like, oh, it's going to be over. Don't worry. But what I do want to tell you is that everything changes really fast in the first two weeks. So if you're having a really shit time, just remember, it's probably going to change. Also, if you're having a really amazing time, just relish it and love it and soak that situation in because it's going to change. It's on such a quick change cycle in the first two weeks.
[28:50] Honestly, though, the first two weeks, we are all just winging it, trying to work out what to do, trying to learn who our baby is, trying to care for our basic needs. We're all just trying and experimenting every day and it will change from day to day. So you've kind of got to have some relaxation and acceptance around the events that are just happening and kind of surrender to it without trying too hard to get everything to comply with exactly how you want it all to be because that's going to make it harder for you.
[29:26] What I do suggest, though, in this time of turmoil in the first two weeks.
[29:33] See, and oh gosh, I even want to punch myself in the throat saying this, make some time for you. Okay, it doesn't have to be much. Even if you think about today I'm going to take 20 minutes. Okay, hopefully it happens for you, it might not happen. Think about what am I going to do in the 20 minutes that I have that I'm putting aside just for me.
[30:00] I'll tell you the three things that I found most nourishing for me personally, and they could be completely different for you. But if you write down three things that would be super nourishing to you in the postpartum days, that might only take 20 minutes. All right.
[30:19] I love to have a cup of tea on my own. That's always been part of my self-care in the morning. Just a hot drink on my own in some silence or you know often these days it's with my husband, but back when I had little kids it was on my own so same thing happened when I was postpartum if I thought it's gonna take 20 minutes you can set a timer if you need to and let everybody know I'm just having 20 minutes you sort yourselves out for 20 minutes and sitting in the sun direct sun almost like I'm sunbaking with a cup of tea, 20 minutes. I can't tell you how game-changing it is. It's like a switch gets flicked that somehow fills your cup a little bit. The other thing that I love and that I recommend still to all of my clients, it's something my osteopath taught me and I prioritized osteopathic care after both of my births. It was something I've done for our whole family and for myself, postpartum. But she said, if you can't get here and if you feel like you really, your body's just really sore and you need to readjust yourself.
[31:36] Lie down on the floor, maybe on some carpet or something, or put down something flat and soft on the ground. Lay down completely flat. Close your eyes and just feel your body sinking into the ground. Consciously just soften your muscles from your forehead, all the way from your forehead, cheeks, jaw, throat, tongue, everything. Shoulders belly hands arms but unclench everything let your feet go floppy let your legs go soft and lay there for 20 minutes in silence with nothing on you no baby on you no children around you as quiet as you can or maybe you might need to put some music in your ear pods if your household's a bit busier. But it can feel like a one-hour massage just to lay flat postpartum. Again, it's so simple, but take the time to do something. Or you might just want to have a 20-minute shower and just completely zone out in the shower. I'm just saying you probably won't, if you don't prioritize it, you probably won't get time for yourself. So you have to just allocate it and be disciplined in taking it.
[32:56] All right, and the last two things I want to talk about for you, Mama, well, three really, is managing postpartum visitors. I feel like I do a whole episode on this. But only invite people into your home if they are going to bring you something. If they're coming to just see the baby, they are taking from you. They're taking your rest time. They're taking your energy because if they weren't there, you'd be doing something else. They're possibly going to give your baby some kind of illness if they come with a cold or something like that. If they're just coming to see the baby, they are coming to take something for themselves and it's not a nourishing visit. So if you are inviting postpartum visitors, it's important that they are there to serve your purposes. Okay. so they're coming insist that they bring something if they say oh i'll come at one o'clock great can you also bring lunch for us all.
[34:02] Set an expectation. For me, if we were having postpartum visitors, I would do things like really set a clear boundary. Yes, that's great. Come at 2.30, but my midwife is coming at 3.00. So when she gets there, I'll have to get you to leave. So they have this really clear expectation that you're welcome to visit for half an hour. Honestly, you will not be interested in having people for longer than that unless they're there specifically to serve a purpose like tidy the house and do laundry and look after your other children and whatever it is you need to do and if you don't feel comfortable with them being in your house while you're in your pajamas they're not the people who should be visiting you in the first two weeks you want to only have people in your house that you don't have to get ready for who you don't have to serve a cup of tea who will actually come and serve you a cup of tea and that when they leave you feel more cared for and more nourished than you did before they got there.
[35:01] If your visitors come and you feel drained afterwards they weren't the right postpartum visitors. So select them carefully and set a standard for what you expect. Tell them how long they could stay, tell them what time, tell them what to bring and when they come say I'm so glad you're here the dishwasher needs packing and give them jobs to do although if they're great postpartum visitors they already know to bring a meal they already know to tidy up and they already know to look after your other children so that's what I'll say about managing postpartum visitors is you set the expectation and ensure that they're a nourishing visitor and not somebody that will take and drain from you the next thing I'm going to say is okay rest this is like the most cliche thing you could ever say to a woman you need to rest it is absolutely true but that doesn't mean you have to be in bed sleeping isolated and like stuck in a.
[36:05] For me, I went absolutely bonkers resting in inverted commas in bed because then I could hear my husband and my other children downstairs laughing.
[36:15] Or my other child downstairs having a great time and all I thought was I want to be down there and it wasn't until I gave myself permission to go and actually sit on the couch with my new baby and actually be part of the family's events that day that I actually started to enjoy my postpartum more so don't be so fixated on an ideology that says you have to rest in bed you do have to rest You shouldn't be sitting up at chairs and tables and partaking in the usual life of your family, but you can go and lie down on the couch or recline and rest on a deck outside in the sun with your baby. That is all rest and nourishment. You don't have to be locked in a room stuck on a bed, unless you want to. Some women love that, but whatever feels restful to you, do that. And rest is just not pushing yourself to do things that you can't do, that you don't want to do. Just listen to your body. If your body's saying, oh, I desperately want to go downstairs, go downstairs. You're the boss of your postpartum as well. But just don't feel forced back into life sooner than you're ready. Because this part of your life, when all the balls drop, the balls drop analogy that I spoke about in the last episode. Again, if you haven't listened to the last episode, you've got to go back there.
[37:39] But when all the balls drop for you and your life changes and your identity changes, society expects that you have not got your shit together. They know she's just had a baby and they don't have any expectations on you. I would milk that as long as you can. Milk the fact that society and the people around you, their expectations of you have significantly dropped because they know that you are now recovering from birth and caring for a baby and don't raise their expectations too soon. Take as much rest and time as you need to recover. Before you start allowing people to expect things of you that you're not ready to provide. And that's kind of part of, although people expect women to somehow get back, you can draw out that time as long as you want. I'm not ready to get back into real life yet. I'm happy in my baby bubble. And just stay there as long as you need. That's also rest and take it. Don't get into life too soon because the minute you re-enter society, they have an expectation that you're back. Whereas if the longer you take out, the longer you get to enjoy that postpartum bubble and rest.
[38:58] All right, I'm going to finish this mama section just talking about some uncomfortable but normal things. All right, postpartum sweating. Oh my gosh, it usually comes with breastfeeding and the hormones that come with that. But don't be surprised if you sweat at night. You are likely to feel touched out you may have some fleeting intrusive thoughts again fleeting is the word and when I say intrusive it's not like that you want to hurt people or your baby it's like intrusive of like worried that something's going to happen to your baby for example or like you can think of worst case scenarios and things like that that just fleeting thoughts that come in. This is a really common thing for women. We just desperately love and want to protect our children. And sometimes we have this response of letting our mind go too far down the possible scenario avenue. So occasional intrusive thoughts, not uncommon.
[39:59] If you feel as though you want to hurt yourself or your baby, that's completely different. You could be sinking more into a postpartum psychosis type situation. The sore tailbone I spoke about is another uncomfortable but normal thing. Sore shoulders from holding your baby and sitting in the weirdest positions to feed it.
[40:19] Extreme tiredness. Don't underestimate the impact of extreme tiredness. It's a rare form of torture and getting little pockets of sleep, power naps, is going to be your saving grace in this time. You will likely lose patience and tolerance. And these are some really normal but uncomfortable things that happen postpartum. And can I say though, a lot of those things can be mitigated by having good support and a village around you.
[40:53] All right. That's what I want to say about your experience postpartum in the first one to two weeks. And now I'm going to give just a short introduction to your baby in the first one to two weeks. Now, newborn babies, as tiring as they can be, have relatively few needs. You can almost tick off in one hand if you've given your baby what they need. So they do need comfort and cuddles and closeness, like to feel that nurturing. They need sleep just whenever they want, whenever they get tired. They need feeding.
[41:35] They need warmth and shelter. And they need clean nappies and clothes and gentleness around them. They need to feel safe and have their basic needs met. But very few needs for a newborn baby.
[41:53] And in the first few days, as I said, they're born, they'll have a suckle early in after the birth, usually a lengthy sleep as they adjust from the birth. And then they'll be up, they'll want to eat from either a bottle or your breast around 9 to 16 feeds in a 24-hour period. And we talk about on-demand feeding. If your baby's showing feeding cues and wants to eat, pop it on the boob or prepare a bottle.
[42:25] The thing with early babies in that one to two weeks after birth, typically if they're asleep, they're tired, if they're sleepy. If they're awake, they're ready for a feed. It's usually they wake for feeds in the first two weeks. But you can expect them to have up to 9 to 16 feeds of shorter or longer periods, smaller or larger volumes of milk. They don't have to have this scheduled feeding. They don't feed three hourly. That's not a normal physiological baby thing that they do. And they don't need the same volume every single feed. Especially breastfed babies will have shorter feeds, longer feeds, more, less milk. This is all very normal so expect that from feeding I already spoke about the about day two or three they start to get very ravenous you'll have that really excessive feeding day before your milk comes in on day one they will wee once day two they will wee twice day three they will wee three times and then so on until their nappies are soaked that is the wee expectation And I will tell you, the first few days, the wee should be pretty diluted.
[43:46] As we get to this ravenous feeding phase, you know, around day two or three where they're running out of their packed lunch and they're trying to tell your body to make more milk, their urine could become a little more concentrated.
[44:01] And there's this phenomena. It should only happen once if they're well and healthy and if your milk comes in. And they actually, because of their concentrated urine, they get what we call, it looks like a brick dust. like this orange dusty particles that rest on the top of the nappy. Some people say, oh, it looks a little bit like a blood smear. It's actually like urine crystals that crystallize on the top of the nappy because it's concentrated, basically because they are running out of their packed lunch and their fluids, and they're a little bit dehydrated. Once your milk comes in, that should all clear up. But if it continues, you definitely need to seek care from a midwife or lactation consultant or GP. Potentially, it could be that they're not getting enough in for whatever reason, or it could be an underlying symptom of another issue. But don't freak out if just the one time you see what looks like a little bit of like orangey dust on the nappy. That's pretty common as they're waiting for your milk to come in. That's the we expectations. But from about day three and certainly once your milk comes in, but if you're bottle feeding, you might not experience this kind of behavior that I'm talking about because you can adjust the milk supply immediately. But for breastfed babies, this is a really normal circumstance.
[45:30] So that's wee. Otherwise, the nappy should always be pretty full of wee once your milk's in. Now, poo is different. So all babies, when they're born, they're born with a bowel full of their first poo, which has been building throughout their whole development, and it's called meconium. And it is black and tarry and sticky. If you've got the wherewithal, you could paste your baby's bum with some kind of oil, you know food based oil maybe coconut oil or almond oil olive oil whatever it is and that can stop the meconium from sticking to their bum for the first poos it just makes nappy changes a bit smoother but it'll start with meconium and as your milk comes in.
[46:19] It'll transition to what we call transitional poo, which looks like a green, like an army green colour. And then that'll be like day two, maybe three. And then once your milk's fully in and all the meconium's completely gone, the breastfed baby poos are yellowy in colour. They're quite sweet to smell and they can be like a pasty or seedy mustard. So there could be some little bits of milk curds in there as well. That's the normal progression so usually by day five six seven possibly sooner the baby will have completely yellow mustardy poo so that's a normal transition and the sooner they do their meconium poo the better because if they hold on to meconium too long it can increase the chances of the baby having jaundice but those are normal poos but the thing that parents are absolutely obsessed with is the number of poos that a baby does and the color so typically your baby will poo at least once a day possibly more but also every two to three days is also completely normal, they say they say that anything up to 10 days without a poo for a breastfed baby is normal however.
[47:47] In my experience, a baby that doesn't poo that long is likely to have something underlying. The times where I've seen that are times of things like poor milk supply for the mother. So while people say it can be normal up to 10 days for a breastfed baby not to poo, I think that's pretty unlikely, pretty rare. The more likely thing is that they'll poo daily, multiple times a day, or any time, you know, even every two or three days. But typically it's going to be daily. First few days it's going to be meconium. Then there'll be transitional poo, which is like a dark, dark green, and it'll transition to yellow and mustardy pasty. Really normal. I actually don't know the colour of a normal bottle-fed baby's poo.
[48:41] Simply because, I mean, I breastfed my babies, but also most of my clients breastfeed. So I'm just realizing now that I actually don't know what color a formula-fed baby's poo would be. So I apologize for that. I should have looked that up sooner.
[48:58] Okay, so that's feeding for babes. the next thing that I get the most messages about in photos from my clients postpartum is the baby's belly button so here's what to expect with the belly button probably if everything's normal you'll be sent home and your baby will still have their cord stump on and maybe a cord clamp or a cord tie unless they've been removed it usually falls off in the first week or so, and around depends on your baby but at the time where it starts to detach let's say it's day four day five your baby's belly button is detaching I typically get messages from parents with a photo going does this look normal to you what it will look like what the belly button will look like as it's starting to detach is if you were to look in and I don't encourage you to open the belly button up and like really get curious about the inside. But it almost looks like inside the stump where the cord is attached, it kind of starts to look pussy and goopy and sloppy. What that is, is that's your, the skin underneath granulating and healing actually, because it's getting ready to push that old cord off. But on the inside, it starts to almost look a little bit like it's pussy and goopy.
[50:24] And it can be associated with a different smell at the time where it's starting to detach. And parents sometimes have trouble. They think maybe that's an infection or there's something wrong. And so they want to know, is this normal? So the way we just differentiate between an infected belly button, because that is possible, babies can get umbilical infections. The way we differentiate between an umbilical infection and just what normally happens when the cord stump falls off is to compare what's happening inside the belly button to the skin on the outside so if it's all normal then inside yes it will look a bit sloshy it could be a little bit weepy maybe some little smudges of blood around the outside of the belly button and yeah that little bit of a smell, and inside it kind of looks like, oh, it's a little bit goopy and pussy. But if you pay attention to the skin on the outside of the belly button, if that looks normal and unchanged and just like normal skin, what the belly button looked like before, and there's no...
[51:36] Redness or swelling, it's probably not an umbilical infection. Something that's really obvious with an umbilical infection is it's red and swollen. The skin around it is actually looks angry and red and swollen. Sometimes the baby can also have an infection, a fever.
[51:57] And if it's starting to get worse and spread, you get these little red, what we call like flares that are coming out from the baby's belly button so an infected belly button starts to look swollen and angry and there's a few solutions for this it does always need treatment you can't just leave an infected belly button some at-home treatments might include a really good solid clean with like a rubbing alcohol a cleaning alcohol or a salt wash some midwives suggest doing like a salt wash but even then if it's gone too far you may need to get antibiotic cream I've seen used just topical antibiotic cream at the top but if you've left it go too long the baby may need IV antibiotics for an umbilical infection they're not very very common the times where I've seen them in my clinical life for babies that were born at home is the two ones that I saw were both related to siblings kind of interfering with the belly button. One mother said, oh, actually ā€“.
[53:07] Her brother had sneezed onto the baby's belly button and it was like a really like juicy sneeze and that baby developed an umbilical infection at like day nine or ten really late and the other one was a similar situation where the sibling had been you know meddling around with the belly button must have introduced bacteria so you don't need to do anything particularly special for the belly button I wouldn't play around with it or apply anything to it just keep it clean and dry and outside of the nappy so if you keep the nappy below the belly button so it doesn't end up getting soaked or collecting moisture or getting covered in poo you're just trying to keep it clean dry keep have a look at it when you're changing the nappy if the inside looks a little bit goopy and a little bit bloody and there's a little bit of smudge on the nappy that's okay it's probably about to detach but if the outside skin is looking swollen and red and the baby seems unwell this is more likely to be an umbilical infection that definitely needs medical attention.
[54:12] Now there's two more things I want to talk about with newborn care in the first few days or the first few weeks. I'm not going to talk about sleep because that's a whole thing and I did this episode with Pam Douglas in the Great Birth Rebellion podcast which is all about
[54:28] getting your baby to sleep in the early weeks. I will link that in the show notes below. What I want to talk about to you finally in the first two weeks is jaundice for your newborn.
[54:38] So if your baby's going to develop jaundice, it's most likely.
[54:43] Nine times out of 10, well, nine times out of 1,000, going to be in the first two weeks.
[54:50] Normal jaundice, where the baby's skin becomes a little bit of a yellow tone, that's what we call jaundice. Normal physiological jaundice usually appears around day three. We get much less worried about this kind of jaundice. The more concerning jaundice is jaundice that comes on suddenly within the first few days of life there's more likely to be a pathological jaundice and if you're in hospital they may possibly pick that up and already have happened while you've been there but certainly if you suddenly notice your baby becoming yellow and you're concerned that it's too yellow or it's before three days definitely contact your health care provider but beyond three days, that's likely to be just what we call physiological jawness. Now what happens for babies is when they're in utero, they have a different kind of hemoglobin that's circulating in their bloodstream. So hemoglobin is what's attached to your red blood cells that helps us transport oxygen. We have it as well and the baby has it in utero, but it's a different type that carries more oxygen because in utero is a lower oxygen environment than when they are breathing air. So when they're born, they don't need this type of hemoglobin anymore and the body starts to break it down because it doesn't really use it. It doesn't need as much because there's more oxygen out here than there was in utero.
[56:18] And it breaks down the pieces, and part of the pieces of that hemoglobin is a substance called bilirubin. And so there's all this bilirubin circulating, and then the liver has to deal with it, and then the baby poops it out. So in ideal circumstances, the bilirubin breaks down, the liver processes it, it goes into the digestive system, and the baby poos it out. If there's been a lot of breakdown or the baby's somehow struggling to clear it, The body will store the bilirubin in the baby's skin, which is what gives it this yellow jaundice kind of color.
[56:55] And that's all well and fine because your baby can work this out in the meantime. So long as the baby is feeding, is alert to feed. So if your baby's having regular feeds and is behaving normally, but is also jaundice, it's likely to be completely fine. The babies we worry about with jaundice are the ones who become lethargic who cannot or do not feed and don't wake for feeds this is problematic and those babies need treatment however if your baby is appearing to be jaundice but also completely acting absolutely normally you're probably not in the danger zone of jaundice certainly have the jaundice checked by your healthcare professional, but you could manage this jaundice with daily and not heaps, but daily sun exposure for your baby because UV light breaks down the bilirubin in the skin. So if you were to have your baby in hospital that develops jaundice that needs treatment, they put the baby under UV lights, it breaks down the bilirubin in the skin and eases the burden on the liver.
[58:06] However, if you're at home, your baby's feeding well, you've got adequate milk supply, you don't have feeding issues, your baby's waking and rousable and behaving normally but just a bit yellow, then it's okay to put the baby in the sun for a few minutes, eat side, put the baby like a pancake, get the baby, have direct sun exposure on his body once a day and keep feeding and the jaundice will probably clear. The times where you need to be worried about jaundice is where your baby's behavior is starting to be affected and where it's prior to three days but hopefully you still have a care provider who's keeping an eye on you in those days postpartum in the first two weeks who will alert you to issues relating to jaundice.
[58:52] Expect that, yes, your baby might get jaundice and more likely to do so if you've had an induction. They say babies who have had optimal cord clamping, who actually got all their blood supply, are more likely to get jaundice. But that has not been my experience as a private midwife. All of my clients have optimal cord clamping and we leave the cord until the cord goes white and the blood's all drained into the baby or back into the placenta if they don't need it. And I've had very few circumstances where we've had to act on pathological genres. So anyway, that's just my experience with that. Whoa, I feel like I could keep going for hours and hours about postpartum. The two weeks postpartum, we haven't even got to week three, four, five or six, but I'm going to leave it there. And this is what I just, the things I desperately want to tell you about postpartum, there's a million other things I could tell you. But for now, that has been this week's episode of the Great Birth Rebellion podcast. I'm your host, Dr. Melanie Jackson, and I'll see you in the next episode of the Great Birth Rebellion podcast.
[1:00:05] To get access to the resources for each podcast episode, join the mailing list at MelanieTheMidwife.com and to support the work of this podcast, wear The Rebellion in the form of clothing and other merch at TheGreatBirthRebellion.com. Follow me, Mel, @MelanieTheMidwife on socials and the show @TheGreatBirthRebellion. All the details are in the show notes.
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