Feeding Your Bundle of Joy

As soon as you welcome your little bundle of joy, you have to make a decision about feeding the baby, breast or bottle. Feeding your baby should come out of love not out of a sense of duty.

Please give adequate thought to decide on which method you would want to feed the baby. If you later want to switch from bottle to breast, it may not be possible, as without the stimulation of the baby sucking, the breasts may stop producing milk. Always bear in mind, whichever method you opt for, your love and attention is as much important to your baby as the milk you feed.

Breast Feeding

• There is no substitute for the colostrum that your breasts produce in the first few days. This equips the baby with antibodies needed to fight infection in the early months.
• Breast milk meets a baby’s needs perfectly with the right kind of nutrients.
• It is easily digested
• It is naturally hygienic
• It is available at the right temperature for the baby.
• It helps in developing a stronger bond between the mother and the child.
• It helps the mother shrink back to the pre pregnancy size soon.

Bottle Feeding

Though a bottle fed baby is more at risk of picking up micro-organisms that may cause diarrhea, there are some advantages: 

• It helps your partner take an active role in feeding the baby
• You can monitor how much milk your baby has taken
• A mother’s tiredness or illness, which may reduce breast milk supply, does not affect bottle fed babies.

Sterilizing and Good Hygiene

Bottle fed babies are at higher risk for bacteria entering their bodies through milk causing gastro enteritis which may be life threatening in a young baby. You must wash and sterilize everything that comes into contact with your baby’s feed.

Washing

• Use hot soapy water to wash all bottle, teats, caps, jug, funnel , spoon and knife thoroughly
• Scrub well around the neck, screw , thread and the insides of the bottle to remove all traces of milk
• Use salt inside the teats and move it around by squeezing and massaging the teats to remove any milk traces.
• Rinse all the equipments under running water.

Sterilizing

• Fill a large vessel with cold water and add sterilizing liquid.
• Put the equipments in and fill the bottles to make them stay immersed.
• Jiggle the items around until you see no air bubbles at all. Put the float in and the lid on
• Leave for at least the minimum time
• Take out items as needed and rinse in boiled water
• Drain on kitchen paper.

Sterilizing By Boiling

Wash all the equipments then boil for 25 minutes. Keep everything fully submerged.

• Electric Sterilizer

This just takes the bottles and teats. You must wash everything well first.

If you are exercising adequate care, you need not worry too much about bottle feeding too. Breast or bottle is an independent decision which the parents should take and enjoy the whole experience of welcoming a child into your family.

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Getting Back to Normal

After delivery, your familiar bump may be gone but your tummy won’t be completely flat yet. You may feel some discomfort in the first days after birth. Talk to your doctor if something bothers you.

After pains

Once you start breastfeeding your baby, you may feel stomach cramps. This is a good sign that your womb is contracting back to its pre pregnancy size. The pains may last several days

What to do

If the contractions are severe, you need to talk to your doctor who may prescribe a mild pain killer.

Bladder

In the first days, the body loses the extra fluid gained during pregnancy so you may need to urinate more often.

What to do

• You may be sore post delivery and urinating may be difficult, but try to do it as soon as possible after birth
• Get up and about to encourage the flow
• Soak in a warm bath. Don’t worry if you pass urine in water as urine is sterile. Wash yourself well afterwards
• Sometimes turning the water tap on induces urine flow
• If you have stitches, pour warm water over them as you pass urine which will give you freshness and a germ free environment.

Bleeding

You may have vaginal bleeding for as long as two to six weeks. It stops earlier for breast feeding mothers. The discharge is heavy and bright red at first and gradually slows down and becomes brownish in color.

What to do

• Wear sanitary napkins to catch the flow.
• Avoid using tampons at this stage as they may cause infection.

Bowels

You may not need to empty your bowels for a couple of days after birth

What to do

• As soon as you can, start walking as this helps the bowel movements to start.
• Drink plenty of water
• Eat high fiber food
• When you want to empty your bowel do so immediately but don’t push too much
• Though you won’t open up any stitches while clearing the bowels, you may still choose to hold a clean sanitary napkin against the area.

Stitches

These may be very sore for a day or two. Within a week, the external ones fall off and the dissolving ones dissolve.

What to do

• Practice pelvic floor exercises to speed up the healing
• Relax in a warm bath to keep the stitches clean. Dry them thoroughly with a hair dryer on cool setting
• Soothe soreness by applying an ice pack to the affected area
• Lie down or sit on a rubber ring to ease the pressure off the stitches.

Post Partum Blues

Many women feel low after delivery, mostly when the milk comes out. This may happen due to

• Hormonal changes in the body
• The feeling of anticlimax that happens after birth

What to do

• The pleasure of having a baby will more than compensate for the after effects of birth.
• Post natal concerns are temporary and are expected to vanish soon
• If you feel that it is prolonged, lasting more than four weeks, see your doctor.
• If  the depression is severe, see your doctor

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Caesarean Section

If it is a planned operation, you can ask for an epidural anesthesia from the doctor, so that you remain awake during the delivery period and can hold the baby immediately after birth. However, in a general anesthesia you make wake up feeling very groggy and disoriented.

Let the doctor decide on a general or epidural anesthesia if it is an emergency operation.

Some of the reasons for cesarean section:

Here are the reasons why you may have a planned or emergency caesarean, rather than a vaginal birth:

• History of one caesarean section.
• Baby is in a bottom-down, or breech, position.
• Baby is in a sideways (transverse) position, or keeps changing his position (unstable lie).
• You might  be having low-lying placenta (placenta praevia).
• Medical condition like as heart disease or diabetes.
• You have lost a baby in the past, either before or during labor.
• You’re expecting twins or more.
• Your baby is not growing as well as he should be in your womb (uterus).
• You have severe pre-eclampsia or eclampsia, making it dangerous to delay the birth.

What is done:

• Your pubic hair is shaved
• A drip is put in your arm
• A tube is inserted in your bladder
• You will be given anesthesia
• A screen is set up between you and the surgeon in case of an epidural anesthesia
• Generally the cut is made horizontally just above the pubic hairline and is almost invisible on healing.
• The surgeon drains away the amniotic fluid
• The baby is lifted out, sometimes using forceps
• You get to hold the baby as the placenta is delivered
• The start of the surgery to birth takes about 5 minutes
• A further 20 minutes are spent on stitching you up
• You or your partner can hold the baby while the surgeon stitches you up.

After The Operation

• You will be asked to walk almost soon after birth
• The incision can be painful in the initial few days so ask for pain relief
• Don’t be scared that your moving around might open up the cut.
• Stand tall and cup your hands over the wound
• Two days after the operation begin gentle exercises. Ask your doctor to guide you
• You can have a bath once the dressing is removed
• If the stitches are soluble, they need not be removed, else they would be removed about five days after birth
• You will start feeling much better after about a week
• Don’t strain yourself for at least six weeks
• The scar usually fades in three to six months.

How to Breast Feed after a Caesarean Section

Put a few pillows beside you and support the baby over them. This way the baby will not be resting on your wound and you can breast feed him comfortably.

Risks and Complications for the Mother

According to the American pregnancy association some of the risk factors associated with cesarean are:

• Infection: It may occur due to the incision due to any kind of infection
•  Hemorrhage or increased blood loss: There is more blood loss in a cesarean delivery than with a vaginal delivery. This can lead to anemia or a blood transfusion (1 to 6 women per 100 require a blood transfusion.
• Injury to organs: Possible injury to organs such as the bowel or bladder.
• Adhesions: Scar tissue may form inside the pelvic region causing blockage and pain. Adhesions can also lead to future pregnancy complications such as placenta previa or placental abruption
• Extended hospital stay: After a cesarean, the normal stay in the hospital is 3-5 days after the birth, if there are no complications.
• Extended recovery time: The amount of time needed for recovery after a cesarean can range from weeks to months. Extended recovery can have an impact on bonding time with your baby (1 in 14 report incisional pain six months or more after surgery⁴).
• Reactions to medications: There can be a negative reaction to the anesthesia given during a cesarean or negative reaction to pain medication given after the procedure.
• Risk of additional surgeries: Includes possible hysterectomy, bladder repair or another cesarean.
• Maternal mortality: The maternal mortality rate for a cesarean is higher than with a vaginal birth.
• Emotional reactions: Some women who have had a cesarean report feeling negatively about their birth experience and may have trouble with initial bonding with their baby⁵.

Risks and Complications for the Baby

• Premature birth: If gestational age was not calculated correctly, a baby delivered by cesarean could be delivered too early and have low birth weight^.
• Breathing problems: When delivered by cesarean, a baby is more likely to have breathing and respiratory problems. Some studies show the existence of greater need for assistance with breathing and immediate care after a cesarean than with a vaginal delivery^.
• Fetal injury: Very rarely, the baby may be nicked or cut during the incision (on average, 1 or 2 babies per 100 will be cut during the surgery^.

Cesarean section is a normal procedure these days ask your doctor if you have any apprehensions regarding the same. Some of the above mentioned risks do not happen in all the cases and can be easily dealt with correct medical intervention.

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Assisted Delivery

(Use of Forceps & Suction)

Assisted delivery procedure is used when

• The mother is too tired and cannot push further
• The mother cannot push the baby out probably because the baby has a big head
• The baby shows signs of distress during labor
• The baby is breech (poised to come out buttocks or feet first)
• The baby is premature and the head needs protection from the pressure exerted during the birth process

Forceps

• The mother is given local anesthesia in the pelvic floor area
• Episiotomy (a small cut near the vaginal opening) is  done
• The forceps are positioned on either side of the baby’s head and gently pulled to deliver the baby
• The mother can help by pushing
• The rest of the body of the baby is delivered normally
• The forceps form a cage around the baby’s head protecting it from pressure.

Vacuum

• A small metal cup is connected to a vacuum pump
• It is passed into the vagina and attached to the baby’s head.
• The baby is gently pulled through the birth canal
• The mother can help by pushing

To avoid chances of having an assisted delivery:

• Stay active during pregnancy
• Practice pelvic floor exercises
• Keep upright posture during delivery.

Are there any risks associated with a forceps delivery?

Forceps delivery is a common procedure and you should not worry if your doctor is doing the same. The benefits of correct use of forceps overrides the risks such as delayed birth, or those of a cesarean delivery for certain women who may have their own health risks.

However, there are some possible risks to the mother include:

• Perineum Pain (the soft tissue between your vagina and your anus)
• Tears in the lower Genital Tract Tears and Abrasions (this is also an expected risk in non-forceps vaginal deliveries.)  If your doctor performs an episiotomy to repair tears, there is also a risk of postpartum bleeding and infection.)
• Difficulty  in  Urinating
• Short- or long-Term Urinary or Bowel Incontinence (involuntary urination or defecation)
• Secondary Anemia Due to Blood Loss
• Third Degree Tear
• Injuries to the Bladder and/or Urethra
• Uterine Rupture — when the uterine wall is torn, which could allow the baby or placenta to be pushed into the mother’s abdominal cavity
• Pelvic Organ Prolapse (Tearing, or weakening of the muscles and ligaments supporting pelvic organs, causing pelvic organs to drop lower in the pelvis.)

Possible risks to your baby include:

• Facial Injuries Due to the Pressure of the Forceps
• Facial Palsy (weakness in the facial muscles which can be temporary or permanent)
• Eye Injuries (including minor external eye trauma, strabismus (crossed eye), and other eye injuries)
• Skull Fracture
• Bleeding Within the Skull
• Seizures

According to mayo clinic some of the risk factors involved with vacuum delivery are:

•  Pain in the perineum — the tissue between your vagina and your anus — after delivery
• Lower genital tract tears and wounds
• Short-term difficulty urinating or emptying the bladder
• Short-term or long-term urinary or fecal incontinence (involuntary urination or defecation)
• Anemia — a condition in which you don’t have enough healthy red blood cells to carry adequate oxygen to your tissues — due to blood loss during delivery
• Weakening of the muscles and ligaments supporting your pelvic organs, causing pelvic organs to drop lower in the pelvis (pelvic organ prolapse)

Possible risks to your baby include:

• Scalp wounds
• A higher risk of getting the baby’s shoulder stuck after the head has been delivered, which could lead to an injury to the network of nerves that sends signals from the spine to the shoulder, arm and hand (brachial plexus), or a collarbone fracture
• Skull fracture
• Bleeding within the skull

However, it is important to note that these procedures are quite safe and are done by doctors usually these days. It is a normal procedure performed by an obstetrician and you need not worry if you undergo the same.

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Labor and Normal Delivery

You will be better prepared to deal with labor if you know exactly what will happen to your body at each stage. It is always better if you can practice relaxation and breathing techniques beforehand to help you cope with labor.

Signs of Labor

• The waters breaks:

The bag of fluid that surrounds the baby breaks. It may be either a sudden flood of water or a trickle of fluid if the baby’s head has engaged.

What should be done?

You need to go to the hospital at once even if contractions haven’t started as you might catch an infection. Call the hospital at once and in the mean time wear a sanitary napkin to absorb the flow.

• Vaginal bleeding:

Thick blood stained mucus that blocks the neck of the womb passes out of the vagina. This may happen during the early stages of labor.

What should be done?

The show may happen a few days before labor starts. Wait until the waters break or you experience back or stomach pain.

• Contractions:

This can start as a mild back ache or shooting pain down your thighs. As time passes, you may experience stomach contractions which seem like bad period pains.

What should be done?

When you start feeling the contractions, see how regular they are. If the contractions are coming less frequently, less than every 5 minutes or so and are not so painful, you don’t need to go to the hospital immediately. Initial labour lasts a normal of 12 to 14 hours and it is better to spend some of this time in the comfort of your home. Take a warm bath if your waters haven’t broken. Move around a bit and take rest as and when you feel like.

• False starts:

Braxton and Hicks contractions starts very early in pregnancy as the womb keeps contacting throughout. In the final weeks, these may become really strong making you think you are in labour. In labour, the contractions are very regular and grow stronger and more frequent with passing time.

First Stage

In this stage the muscles of the womb contract to open up the cervix to allow the baby to pass through at birth. This takes around 10 to 12 hours for the first baby.

Ways to help yourself

• Keep moving between contractions
• During contractions take up a comfortable position
• Stay as upright as possible
• Concentrate on your breathing to calm your mind
• Sing or moan and groan to release pain
• Take one contraction at a time and don’t think about others to follow
• Pass water often

Transition

The most difficult time is the end of the first stage when the contractions are the strongest. They last for about a minute and are a minute apart; this stage may last for about half an hour

Second Stage

Once the cervix has dilated and you can push, the second stage has begun. Pushing is hard work but each effort brings your baby’s birth closer. This stage usually lasts about an hour for the first baby.

Third Stage

During or just after birth you will be given a syntometrine injection in your thigh which makes the womb contract strongly and delivers the placenta almost immediately.

After Birth

You will be cleaned up and stitched if needed. The baby will be weighed and measured. The umbilical cord will be clamped and cut

Birth is the climax of labor and your baby has finally arrived. You can now touch and cuddle and feel a great sense of relief along with a protective urge towards the new born.

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