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Mother Naked s Quick Guide To Birth Postpartum

Hi Friend I m so glad you re here I created this guide because I ve been exactly where you are right now I ve been super pregnant and had no clue what to expect from labor and birth I ve wanted to create boundaries and a stress free postpartum but had no clue where to start I had a days old newborn and was lost on how to effectively meet their needs and understand their cues I ve been in your shoes and now as a doula and a mom of 3 I want to guide you so you feel confident in your abilities to be the best mom for your new baby If no one else has told you lately You are the best person for your baby You will be a great mom It s okay if you think it s hard its not supposed to be easy but it s so so worth it I hope this guide meets you exactly where you are and brings you some reassurance that YOU CAN 100 DO THIS xoxo Erin MOTHER NAKED BIRTHWORK

Third Trimester Pregnancy Check In Date __________________________ 5 things to learn more about ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ My Mental Wellness Is Very Good S M T W T F S 5 things to I need to prepare ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ Could Be Better Bad I need help Journal I am Feeling ______________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ One thing I am excited about _________________________________________________ ________________________________________________________________________ ________________________________________________________________________ One thing I am nervous about ________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Some of my symptoms are __________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Something that makes me happy _____________________________________________ ________________________________________________________________________ ________________________________________________________________________

Labor Stages Phases There are 3 stages of labor and birth Early labor active labor and transition phases make up stage 1 Pushing is the second stage and lasts until the birth of the baby ies The third stage is the birth of the placenta Different people move through each stage at different rates Labor contractions are purposeful at every stage Here is an idea of how they are working Pre Early labor contractions are working to move tilt the cervix from a posterior to an anterior position Softening the cervix Your cervix begins firm like the tip of your nose and becomes soft like your earlobe Thinning Effacement Your cervix is usually 0 effaced about two inches long and gets to be 100 effaced like paper Dilation of the cervix from 0cm closed to 10cm fully dilated Rotating the baby Optimal position for birth is Occiput Anterior OA Head down facing your back Descent of the baby pushing the baby lower into the pelvis against the cervix then through the cervix under and around the pubic bone and finally through the vagina and perineum Stage 1 Phase 1 Early Labor How Long Average length for first births is 12 24 hours Can last days prodromal labor or a few hours For subsequent labors the early labor stage lasts approximately half the time of the first IMPORTANT Rest as much as possible during the early stage and stay hydrated Characteristics Contractions Inconsistent 3 30 mins apart Lasting 15s 45s Felt low in the uterus Cxns are moving the cervix into an anterior position thinning softening and dilation Dilation 0cm 6cm Effacement 0 to 100 some effacement may happen before the onset of labor Common symptoms Feeling crampy loss of mucus plug pinktinged mucus dull low back ache loose stool diarrhea

Stage 1 Phase 2 Active Labor How Long Approximately 2 12 hours on average for first labors For subsequent labors the active stage lasts approximately half the time of the first Sometimes even less Characteristics Contractions Consistent and regular 2 5 mins apart Lasting 60s90s Thinning dilation turning baby into position for birth Can now be felt up higher in the uterus and into the lower back hips Dilation 7cm 8cm IMPORTANT Change positions frequently to help labor progress smoothly help reduce pain Effacement 50 to 100 Common symptoms Bloody show membranes may rupture Noticeable change in mood Need to focus during contractions Stage 1 Phase 3 Transition How Long Approximately 2 hours or less for first labors For subsequent labors transition lasts approximately half the time of the first Sometimes even less Characteristics Contractions Very consistent 2 or less mins apart Lasting 60s 90s Peak intensity at the beginning of transition and stays that intensity until fully dilated Dilation 9cm 10cm fully dilated Effacement 100 completely IMPORTANT Transition is the most intense AND shortest stage of labor Common symptoms Likely that membranes release if they are still intact Lots of show contraction coupling contractions coming one on top of the other Vocalizing through contractions Increased pressure in the rectum

Stage 2 Pushing How Long Approximately 2 hours on average for first labors Possibly less 15mins or more 3 hours Characteristics Contractions Slow down to about 3 5 mins apart Lasting about 60s Turning baby and moving baby down the birth canal Dilation 10cm After 3 hours of pushing healthcare providers may begin looking into assisting The pushing phase is significantly shorter in subsequent labors IMPORTANT You can push in any position that feels comfortable to you Effacement 100 Common symptoms Strong Irresistible urge to push Increased pressure in the vagina and rectum between contractions Membranes usually release at this stage Intense sensations during crowning burning lots of pressure Stage 3 Birth of the Placenta How Long With expectant management unassisted delivery of the placenta can take between 1045 minutes after the birth of the baby With active management assisted delivery of the placenta is 3 10 minutes after the birth of the baby IMPORTANT Be assertive about your choices with regards to your placenta blood banking encapsulation etc Characteristics Contractions Remain but tapper off reduce in intensity significantly Working to detach and expel the placenta Skin to skin and nursing induce contraction to help the uterus reduce back to its normal size Common Practices Healthcare providers may do uterine massage to monitor bleeding and uterine firmness Intramuscular Pitocin is administered as part of active management Cord traction is used as part of active management

Ice Cube Exercise Instructions Gate Control Theory Your body can only process so many signals at once If you focus on pain you will feel pain If you are able to focus on something more pleasant as a distraction you will feel less pain overall For example watching a great movie while you are recovering from dental work may distract you from the pain in your mouth In this exercise you will practice 60 second labor contractions with a bag of ice Each time we try a contraction we will try different coping techniques Hold a small bag of ice in one hand eg Ziploc sandwich size or a handful of ice in a produce bag NOTE Please alternate hands between each practice 1 Baseline No Technique 2 Relaxation and Slow Breath 3 Focal Point real or imagined 4 Touch partners After the exercise answer the questions below Did you notice a difference between your baseline and coping techniques Which Technique was the most effective for you Are there any techniques you think could be as more effective than the ones we tried

Labor Cheat Sheet How do I know if I m in labor When should I go to the hospital Soft Signs Labor is imminent Go to the hospital or call your midwife immediately if Baby drops Loss of mucus plug You have bleeding more than pink brown tinges in your discharge Nesting Restlessness Irritability Nausea Diarrhea Foul smell to your amniotic fluid when your water breaks Green Brown colour to your amniotic fluid when your water breaks You haven t felt the baby move for a while 10 movements in 1 hour is ideal Be sure to talk with your Health Care Provider about any special circumstances ie GBS STIs or other factors that might change when is best to go to the hospital How to Time Contractions Contraction Your water breaks very uncommon Waters generally release later in the labor process Strong regular contractions getting stronger longer and closer together Bloody show Pink tinged mucous as the cervix begins to open Keep your Doula up to date on how you re feeling if you notice any changes How long a contraction lasts Contact your Doula at the first signs of labor bloody show loss of mucous plug contractions ie cramping and or waters breaking Frequency Beginning of one contraction to the beginning of the next 5 05 30 The duration of these contractions is 30 sec The frequency of these contractions is 4 mins 30 sec Remember 4 1 1 4 minutes apart lasting 1 minute consistently for 1 hour Hard Signs True labor signs Don t forget to talk to your Doula about how they would like to be updated To make sure that your Doula can arrive in a timely manner here are a few things to keep in mind Next Contraction 5 01 00 5 05 00 Cramping and lower backache When to call your Doula Duration 5 00 30 The cervix softens and opens Contact your Doula when contractions get into a pattern of 7 minutes apart lasting 1 minute consistently for 1 hour Be aware of weather conditions and do your best to contact your Doula with enough time for them to arrive given those conditions Communication with your Doula and other support people is important to ensure everyone is able to arrive and support you when you need them

Birth Preferences Know your options at every stage Stage 1 Early Active Labor Interventions augmentation of labor Membrane sweep AROM artificial rupture of membranes Foley cooks catheter Cytotec not compatible with VBAC Cervidil Prostaglandin Pitocin Forceps Vacuum Episiotomy Contraction and heart rate monitors Oxygen IV fluids Hep Lock Antibiotics Blood transfusion Non Invasive Natural labor induction Acupuncture Reflexology Nipple stimulation Castor Oil midwives brew Fetal Monitoring None Handheld Doppler Intermittent Continuous Internal fetal scalp wireless Cervical Exams None Limited As needed Relaxation Techniques Hypnobirthing Vocalization Breathing Techniques Visualization Focal Point Room atmosphere Music Dim Lighting Aromatherapy Wear your own clothes Students allowed Students not allowed in Quiet voices minimal distractions Pain Relief Hydrotherapy tub shower Hot cold packs TENS unit Massage Counterpressure Nitrous Oxide IV pain meds narcotic Sterile Water Injections Epidural Only offered when asked for Offered freely throughout labor Nutrition Drinking eating Ice chips IV fluids Sucker honey stick popsicle etc

Stage 2 Pushing Birth Labor birthing positions Pushing Toilet forwards backwards Ball rocking rolling hip circles Lunging Standing Laying down side back Dancing swaying Squatting Hands and Knees Birth Stool Directed Spontaneous with the urge Counting Holding breath Breathing baby down Labor down Side lying Hands and knees Squat Tug of war In Water Lying on back Perineal support Perineal stretching Warm compress Mineral oil Episiotomy Prefer to tear Mirror to watch Touch head when crowning Stage 3 Birth Of The Placenta After Delivery Delayed cord clamping Immediate cord clamping Lotus Birth placenta delivered attached to baby Partner mom cut cord Mom partner catch baby Pitocin to expel placenta control bleeding IV or IM Natural expulsion of placenta no Pitocin wait and see approach Fundal Massage Skin to skin immediately Weight measurement immediately Suction babies mouth and throat Deny suction Keep placenta personal capsules Stage 4 Immediate Postpartum Baby Immediate Postpartum Golden hour All assessments on mom All Assessments At warmer Erythromycin eye cream immediate or delayed Hepatitis B Vaccine immediate or delayed Vitamin K injection or sublingual Partner to be with baby if mom cannot Partner to stay with mom Bath asap Bath delayed denied Skin to skin w mom and or partner Breastfeeding Bottle feed Formula Pacifier

Cesarean Birth Options Spinal anesthesia General anesthesia Partner doula photographer present Photographs No small talk Music Clear Drape Drop drape watch birth Mirror to watch birth Bed angled for better view of birth Slow gentle delivery Delayed cord clamp One arm free Nausea meds or none Vaginal seeding Breastfeed in OR Breastfeeding in recovery Skin to skin in OR Skin to skin in recovery Partner skin to skin in OR Partner skin to skin in recovery Blood transfusion Iron supplements Legally and Ethically you have the right to make informed decisions about your medical care With the exception of emergencies where your or your baby s life is in danger you can always ask for more information and time to thoroughly consider all your options with your trusted support team Due Date ________________________________ Dr OB __________________________________ Place of birth _____________________________ Partner Name ________________________ Relationship __________________________ Present For Birth YES___ NO____ The most important thing about my birth is ________________________________________________________________________________ ________________________________________________________________________________ Additional Birth Preference Notes _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________

Cesarean Birth Overview First of all BIRTH IS BIRTH Approximately 1 in 3 people USA and CA Stats who give birth will do so by cesarean for various reasons In the event that you need or want to birth by cesarean or belly birth here is an overview of what you need to know about Cesarean Sections to ensure you feel informed and prepared What is a Cesarean A Cesarean or C Section is a surgical procedure by which a baby can be birthed This is done through incisions in the abdomen and uterus Is It Safe While a C Section is considered major abdominal surgery it can be preferable in situations where the benefits of the labor process or vaginal pelvic birth do not outweigh the risks Even if a mom has had a previous cesarean vaginal pelvic birth is under most circumstances safer Planned Cesarean Sections happen when the mom for any number of reasons makes the decision prenatally for their birth to happen via cesarean These are rarely emergent as they are planned weeks or months ahead of the birth however the weight of this decision can feel heavy and a mom s feelings around it positive or negative are valid Emergency Cesarean Sections happen quickly when there is an immediate concern for the health of the mom or the baby This can happen in as little as 30 minutes but can also take over an hour Crash Cesarean Sections are rare and happen when the life of the baby or mom hangs in the balance Heavy bleeding and severe or worsening eclampsia pre eclampsia are examples Risks and Side Effects Of a Cesarean Use your B R A I N to weigh the benefits and risks of a cesarean section under your specific circumstances Reaction or problems with the anesthesia before after the surgery Increased risk of infection and subsequent need for antibiotics Medically Clear Reasons For a Cesarean Fetal Distress Changes in the baby s heart rhythm may indicate that the baby is having problems These can happen with umbilical cord compression or if something is causing a decrease in oxygenated blood flow to the placenta baby s life support Malpresentation Malposition Some fetal presentations are not conducive to vaginal pelvic birth These include transverse lie baby is horizontal and depending on the healthcare provider breech positions Face or brow presentation and asynclitism baby s head is tilted in such a way that it will not fit through the pelvis NOTE Some malpositions can be corrected either prenatally or even during labor and do not always require a cesarean Cord Prolapse If the umbilical cord comes through the cervix before the baby it could get pinched by the baby s head foot during labor compromising the baby s oxygen supply This is cause for an immediate cesarean Placenta Previa This is when the placenta has grown over a part of or the entire cervix As the cervix dilates it causes the placenta to separate from the uterus resulting in bleeding which can then lead to reduced oxygen supply to the baby Placental Abruption If the placenta separates from the uterine wall before the baby is born it can cause bleeding and constant abdominal pain Again the baby s oxygen supply may be affected thus requiring a cesarean Failure to Progress ACOG defines failure to progress as 6 or more CMs dilation with adequate contractions for 4 or more hours and no progress If all options for helping the uterus rest and or stimulate stronger more effective contractions have been exhausted with no success a cesarean may be considered Risk of hemorrhage requiring a transfusion Longer hospital stay increasing the cost in some places Slower more painful recovery NOTE Regardless of the reason your provider is suggesting a cesarean it is your right to ask questions and consult your support team even if your provider says it is 100 necessary Risk of adhesions causing internal issues Risk of bowel urinary injury during surgery Remember Risk of blood clots in the legs pelvis Baby may have respiratory and or temperature issues Increased risk of future placenta accreta increta percreta Paralysis and death in extreme instances Your body is not a lemon Cesarean birth is birth and your body did NOT fail you nor did YOU fail your baby

Cesarean Birth Preferences My plan to have a cesarean birth includes a trial of labor Yes TOL OR TOLAC No Scheduled For The Birth Anesthesia Spinal anesthesia General anesthesia OR Atmosphere Partner present Doula present Photographs No small talk Music Immediate Postpartum Birth Experience One arm free Clear Drape Drop drape watch birth Mirror to watch the birth Bed angled to view birth Slow gentle delivery Blood transfusion Iron supplements Nausea meds Skin to skin in OR Skin to skin in recovery Delayed cord clamping Immediate cord clamping Lotus Birth Partner to cut the cord Keep the placenta Vaginal seeding Golden Hour Newborn Care Procedures Infant Feeding First feed in OR First feed in recovery Breastfeed Bottle Feed Syringe feed colostrum Newborn Procedures Lactation aid Cup feed Formula Expressed pumped milk Visit with IBCLC in hospital Erythromycin eye cream Hepatitis B Vaccine Vitamin K injection or sublingual Bath asap Bath delayed denied Legally and Ethically you have the right to make informed decisions about your medical care With the exception of emergencies where your or your baby s life is in danger you can always ask for more information and time to thoroughly consider all your options with your trusted support team Due Date ________________________________ Dr OB __________________________________ Place of birth _____________________________ Partner Name ________________________ Relationship __________________________ Present For Birth YES___ NO____ The most important thing about my birth is ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________

Hospital Birth Checklist Music Flameless Candle Birth Partner Support Water Bottle W Straw Long Phone Charger Slippers Birth Plan Preferences Comfortable Postpartum Panties Pillow Comfy Gown Pjs or Housecoat Nursing Bra and Pads if you re choosing to breastfeed Heat Cold Pack Hand Held Fan Gum Snacks Unscented Massage oil Makeup if it helps you feel more put together Toiletries toothbrush toothpaste shampoo deodorant etc Hair ties scrunchies headband Going Home Outfits for Baby Swaddle blanket sleep sack Soother if you re choosing to use one Car seat properly installed in your vehicle Camera ________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________

Home Birth Checklist Midwives Home Birth Checklist pool blue pads etc Flameless Candle Music Water Bottle W Straw Birth Partner Support Birth Plan Preferences Comfortable Postpartum Panties Nursing Bra pads if you re choosing to breastfeed Heat Cold Pack Hand Held Fan Gum Snacks Massage oil Toiletries toothbrush toothpaste shampoo deodorant etc Hair ties scrunchies headband Swaddle blanket sleep sack Soother if you re choosing to use one Activities for the kids if you have other children who will be present at the birth Essential Oils and Diffuser Laundry Baskets Dark Sheets on your bed Hospital Transfer Bag Ready ________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________

Pain Management During Labor Get to know the tools to help you cope Whether you want a medication free birth or struggle to imagine giving birth without them it can be helpful to know your options for both medical and non medical pain management It can also be helpful to think of pain management techniques as tools to help you successfully cope at every stage Non Medical Pain Management Options Hydrotherapy tub shower Buoyancy in a tub of warm hot water helps relieve pressure and pain A warm shower can be soothing and also provide relief from lower backache Hypnobirthing Techniques A method using calm breathing techniques deep relaxation guided mediation visualization and positive suggestions and affirmations to reduce fear anxiety and pain Breathing Techniques Taking a long breath in and a longer breath out stimulates the natural release of pain relieving endorphins Hot cold packs Applying hot cold packs to help relieve sore tired muscles and or relieve chills TENS Transcutaneous electrical nerve stimulation Electrodes are stuck to your skin and small pulses of electrical current to the body This is meant to distract your brain from the feeling of contractions Massage Your support person can massage areas where you naturally carry tension to relax the muscles Counterpressure Applying counter pressure with a hand fingers or ball to the hips and lower back Medical Pain Management Options NOTE Depending on where you choose to give birth your options might vary as not all facilities are the same Birthing at home also changes some of your medical pain management options For example when birthing at home the option for an epidural is not available and would require a hospital transfer Nitrous Oxide AKA Laughing Gas Commonly used in dental procedures it is a mixture of nitrous oxide NO2 and oxygen IV pain meds narcotics and narcotic like drugs Morphine Fentanyl and Stadol given through an IV in your hand wrist or arm Sterile Water Injections SWI Small amounts of sterile water 0 1mL to 0 2 mL are injected into the skin at 4 locations around your lower back sacrum to relieve pain in labor Epidural Analgesia An injection of a local anesthetic agent and an opioid analgesic agent into the lumbar epidural space blocking sensation ideally just below the breast to top mid thigh Use the Pain intensity scale to rate your pain help your support team understand how you are feeling coping Pain Intensity Scale Important things to keep in mind about PAIN during labor Is Purposeful Every surge is working to P Itbirth your baby Is Anticipated Pain discomfort is part of the A Itprocess Is Intermittent You will have periods of rest I Itbetween surges is Normal Pain is not an indication that N Itanything is wrong Pain during labor is normal but should NOT become suffering Pain does not equal suffering Suffering equals inability to cope with pain 0 1 2 3 4 5 6 7 8 9 Moderate Pain No Pain 10 Worst Possible Pain Another way of assessing pain in labor is by using the pain coping scale The higher the score the easier it feels for you to cope Use whichever scale you prefer is easiest for you Pain Coping Scale 10 No Need To Cope 9 8 Easy To Cope 7 6 5 4 Able To do 3 Rs 3 2 Need Lots Of Help 1 0 Can t Do It

Breathing Strategies For Labor Birth Proper breathing during the labor and birth process helps with relaxation maintaining rhythm and ritual and pain management and of course oxygen supply to the baby and uterus Here are some strategies to maintain good breath control at every stage Common Stressors That Effect Breathing The move transfer to the hospital Anxiety in a cold sterile environment A change in intensity or sensation Increased pain intensity during transition Emergencies Fear and inability to settle while things happen around you Anger or frustration Feeling unsupported by your birth team Exhaustion Increased pain and a sense of dread Grounding Breath Rest Breathing Contraction Breathing A long inhale longer exhale Slow deep wave like breaths Resume normal breathing pattern Breathe down into your belly A long exhale connects us to the parasympathetic nervous system Focus on slowing breathing down and relaxing the body Inhale Breathe down to your baby Conserve energy between waves Visualize riding the wave and or filling a balloon Sit lay lean whatever you can do to allow your body to make the most of the time between surges Feel your belly expand not your chest As you exhale draw your core muscles in and hug your baby forcing all the old air out allowing more space for new fresh oxygen Helps release natural stress relieving hormones Works well to help calm and refocus Make LOW Deep OH sounds Partners watch for where the mom may be holding tension Soothingly remind them to relax their whole body High pitched sounds tighten your pelvic floor and cause tension in your body which increases pain REMEMBER Don t forget to hydrate between contractions Maintaining good breath control can help reduce pain in labor by minimizing the amount of lactic acid that builds up in the muscles used for birth Transition Breathing Pant pant blow Breathe in and out rapidly through your mouth at about one breath per second Blow out a candle visualization Transition can be the most challenging time to maintain calm controlled breath Avoid hyperventilation and try blowing or panting at the peak of the contraction Resisting The Urge To Push Breathing While Pushing You may have to resist the urge to push if you are not fully dilated can cause the cervix to swell and or during crowning to avoid a tear Take quick short breaths and breathe out with your mouth in the shape of an O similar to panting Repeat the word house with lots of air behind it Imagine blowing a tissue off your face while you look up at the ceiling Follow your body s lead when you feel the urge to push or the need to bring your baby down Take a deep breath and on the exhale breathe down the back of the throat down the body towards the bum Some individuals breathe deeply through the surge and pushing urge while others hold their breath slightly and temporarily a few times throughout the surge

Support Strategies For Labor Birth While the birth process itself largely happens on its own supporting the process to happen under the most relaxed and focused circumstances is a learned skill Birth partners can benefit from learning certain techniques to enhance the support they provide Key Roles of Birth Partners Anticipate the mom s physical needs water food comfort Protect the mom s rhythm and ritual Facilitate informed choice by asking questions Offer verbal encouragement at key times Be a constant calm and reassuring presence for the mom Visualization Words Of Affirmation Roving Body Check A passive constant scan of the mom s body from the top of their head down to their toes checking for tension or clues as to what kind of support may be needed Do not underestimate the power of words in the birth space Gently encourage the mom to release any tension they are holding in their muscles Try to use phrases you know they identify with If they are grabbing or pushing on any part of their body during surges try to offer counter pressure or gentle touch massage so that they can focus on relaxing their muscles Common visualizations during labor are that of a rose or other flower blooming waves rushing in and out or the baby moving down with each surge Remind the mom that they are capable of birthing their baby Begin your visualization at the bottom of a surge close your eyes and focus on timing your breathing with the visualization of your choice Avoid talking about how much longer labor might be or how hard things might get Some hypnobirthing techniques include coached visualizations and can be useful for attention focusing as well Validate what they are expressing and avoid dismissing how they are feeling REMEMBER Birth Partners are active members of the birth team Anticipating a mom s needs during labor is also key Periodically offering water bits of food or other nourishment and suggesting comfort techniques can help a mom feel supported enough to focus on the process Gentle Massage Gently run your fingers along the moms arms legs back or neck Increased pressure can be used depending on the moms preference During the early stages of labor hand neck or foot massages using moderate pressure can help with relaxation and distraction Pay attention to the moms body language in case they reach a point where they no longer want this type of touch Counter Pressure Take Charge Routine Can offer relief from back labor and hip lower back discomfort Generally used in transition just before pushing or any other time a mom begins to panic or feel overwhelmed With the mom on their side place the heal of your hand on the top of the hip bone and firmly press down and forward slightly With the mom upright apply the same type of pressure using one hand on either side double hip squeeze Standing or laying use the heal of your hand to put firm pressure against a moms tail bone Place both hands on the moms shoulders and firmly but gently put pressure downward Instruct them to look into your eyes while you offer short matter of fact reassurance You are safe You are doing this The baby is doing well and will be here soon

Effective Positions For Labor Birth Having an idea of how to use different positions to your advantage during the labor process can greatly improve your birth confidence help manage pain and even help your labor progress at a smooth and potentially quicker rate Here are some effective positions to try as you work to birth your baby Combine with your instinctive rhythm ritual and comfort measures like counter pressure massage hydrotherapy a TENS machine and even an epidural

Informed Consent in Pregnancy and Birth Legally and Ethically you have the right to make informed decisions about your medical care With the exception of emergencies where your or your baby s life is in danger you can always ask for more information and time to thoroughly consider all your options with your trusted support team Informed Consent IS Your healthcare provider has a conversation with you about ALL of your options and their pros and cons including not going forward with their recommended treatment Informed Consent IS NOT Your healthcare provider refuses to discuss omits or glosses over your choices and their pros cons You have the opportunity to ask questions Your healthcare provider is dismissive of your questions refuses to answer or answers your questions in vague or confusing terms Your healthcare provider answers your specific questions with specific answers to your satisfaction not their own You are not given any time to discuss your options with your trusted support team You have the time and opportunity to discuss these with your support team Your healthcare provider pressures you into consenting or makes you feel afraid not to go forward with their recommended treatment You are given the chance to share your decision with your healthcare provider team Your decision is respected When discussing care options ask your provider these questions How will do you know _______ is happening requires intervention ie how do you know my labor has stalled and requires augmentation Why is this course of action necessary at this time is it an emergency Am I or is my baby currently in danger What if we try something different and re evaluate later What if I try some different positions or taking a walk to help things along and discuss this again in an hour You have autonomy over your body and your baby Just because you have all the information does NOT mean you have to consent Declining is a valid choice Your healthcare provider makes decisions about treatments and or procedures without informing or discussing them with you Use BRAIN to help you make informed decisions about your care B What Are The Benefits R What Are The Risks A What Are The Alternatives I Whats Your Intuition N What If We Do Nothing Ask your Doula or other support person to help you with this as you cope in labor

Failure to Progress How to manage slow or stalled labor ACOG American College Of Gynecology Says Definition of Arrest of Labor Failure to Progress Spontaneous labor More than or equal to 6 cm dilation with membrane rupture and one of the following 4 hours or more of adequate contractions eg more than 200 Montevideo units 6 hours or more of inadequate contractions and no cervical change Cited from the ACOG and Society for Maternal Fetal Medicine Obstetric Care Consensus Safe Prevention of the Primary Cesarean Delivery Reasons labor might slow stall Fear Sensory overload Failure to progress is when your labor reaches a certain point you continue to have regular contractions but you stop dilating or making progress Other Terms you might hear in conjunction with failure to progress Slow Progress is when you enter active labor and after some time your healthcare providers don t feel that things are progressing quickly enough Note This is not a medical term and differs from provider to provider Stalled Labor is when contractions slow down or stop altogether most common in early stages of labor Feeling unsupported Fetal mal positioning Tight pelvic muscles and ligaments Baby isn t engaging into the pelvis Tired uterus Natural ways to help labor progress Create oxytocin levels nipple stimulation kissing slow dancing laughing etc Working through fears Voice them to your support team Regain focus by Putting on a blindfold and headphones Asking unnecessary bodies to step out of the delivery room Loosen up tight muscles Rebozo sifting inversion side lying release massage psoas release bath or shower shake the apple tree Encourage better fetal positioning Hip rotations on a birth ball rebozo sifting inversion side lying release pelvic tilts Pelvic openers Hip squeezes squatting kneeling with ankles wider than knees Walcher s position sitting on a toilet or birthing stool Having a little rest or something to eat so that you can regain a bit of energy If Natural Help is Ineffective In some cases further interventions may be suggested by your health care provider such as synthetic oxytocin Pitocin epidural IV fluids artificial rupture of membranes AROM or cesarean section depending on other contributing factors It is your legal and ethical right to ask questions discuss and fully understand each of these options including the option to do nothing before consenting if you choose to do so Use BRAIN when deciding how to overcome failure to progress B What Are The Benefits R What Are The Risks A What Are The Alternatives I Whats Your Intuition N What If We Do Nothing Ask your Doula or other support person to help you with this as you cope in labor

Birth Partner Cheat Sheet How do I support my partner in labor While sometimes forgotten birth partners have a key role to play in the birth process Here are some tools to help birth partners participate in the birth as much as both partners desire at every stage Early Labor Keys Distraction One of the best ways to avoid going to the hospital too soon is to distract a mom until they can no longer be distracted You can suggest movies play board games go for a walk etc Do your best to help your partner go about their daily routine Rest It s important for both you and your partner to rest as much as possible in early labor Encourage your partner to take naps go to bed at a decent hour and help them avoid overdoing it with walking stairs and other commonly suggested labor progress tips Nutrition Help your partner stay hydrated and well fueled for the labor process by encouraging them to drink plenty of water and eat good sized meals during early labor Emotional Support Attention Focusing This technique is often used to recenter after either moving to the hospital from home or after there have been multiple interruptions to a moms rhythm and ritual For example saying things like Ok let s take some nice deep breaths and count to 10 Music White noise Creating a calm space The atmosphere of the birth space is an important factor in helping labor progress smoothly Dimming the lights putting on soft music or a white noise machine and doing your best to limit people coming in and out are good ways to keep the birth space calm and accommodating to the birth process Reassurance Sometimes all a mom needs is to hear that everything is ok If you sense they might be beginning to worry do your best to reassure them that they are safe and supported Remember moms and their partners have the right to informed consent Ask questions and use B R A I N to help your partner make informed decisions Active Labor Support Techniques Once you arrive at the hospital there are still plenty of ways you can support your partner Help make decisions Words of encouragement and affirmation Birth Partner s Hospital Bag It s important to make sure you have what you need to care for yourself during birth in order to be present and able to best support your partner Don t forget to pack care items for yourself in the hospital bag Comfy Change of Clothes Snacks Food Gum Lip Chap Toiletries toothbrush Water Bottle Glasses contacts they may dry out Phone Charger Try not to use counterproductive language Ex It can t be that bad you re overreacting calm down etc Make them laugh releases oxytocin but be mindful of when it s time to stop joking Massage counter pressure hip squeezes if that s comforting and wanted Ask first Help your partner change positions frequently Even if they have an epidural changing sides and using a peanut ball can help things along Getting water juice cold cloths ice chips etc

All About Your Newborn What to expect immediately after birth The day you ve been waiting for has finally arrived Your brand new baby is born and you simply can t keep your eyes off them Here are some common features and important information about your new arrival Your Newborns Size and Weight The average size and weight of a full term newborn is about 7lbs to 7 1 2lbs and 20 inches long Your unique little one could be lbs heavier or smaller and inches longer or shorter Typically newborns lose 5 10 of their body weight in the first three days Usually they return to their birth weight in 7 10 days and double it by six weeks Yes It s Normal Some odd but normal newborn features include Your newborn may be hairy Also called lanugo fine downy like hair may cover your newborn s back arms forehead ears and shoulders Stork Bites are a red area at the nape of the neck between the eyebrows on upper eyelids and around the nose that redden when your baby cries They are not permanent or an injury Most newborn s tear glands don t produce tears until 3 weeks of age Your newborn may develop a painless blister in the center of their lip due to intense sucking Sometimes this blister peels It requires no treatment and will disappear as the skin toughens Maternal hormones that reach the baby in utero sometimes cause newborns to have swollen breast tissue that may even leak milk Your Newborns Head Newborns heads are large in proportion to their bodies Your baby s head may be elongated or molded due to the pressure within your pelvis during labor and birth Their head will return to a normal rounded shape within hours or days Babys are born with two soft spots fontanels where the bones have not yet fused together One large diamond shaped spot on the top front part of the baby s head and a smaller triangleshaped spot at the back of their head Brushing or washing the scalp will not hurt your baby Important It s OK and common not to immediately fall in love with your newborn Attachment and bonding can take some time Be sure to be open with your support team about how you are feeling and don t be afraid to reach out for support Your Newborns Appearance Edema swelling You may notice swelling around your newborn s eyes thighs legs pubic area and genitals Skin color At birth your baby will appear greyish blue As they begin to breathe well their skin will turn more normal pinkish tones beginning in their face and trunk soon reaching their tiny fingers and toes Bruising and or Abrasions You may notice bruising on their head face or lower back Babies born with assistance from forceps or vacuum often have swelling bruising and occasionally abrasions on their scalp and face If an internal monitor was used during labor your newborn will have a small abrasion on the soft spot on top of their head Vernix Your baby may be born covered in a waxy shea butter textured whitish creamy substance that protects your newborn s skin

Help My Baby Won t Stop Crying All babies cry for many reasons It is normal for crying to increase at about 2 weeks of age The crying will gradually peak around 2 months and then start to decrease around 3 4 months During this time ALL babies have times when they are unable to stop crying no matter what you do to try and soothe them Crying you or them does not mean you are a bad parent 3 Reasons Your Baby Might Be Crying They re Hungry How Can You Soothe Your Baby Make Baby Comfortable Newborns need to eat every 1 2 hours in the first few days after birth and every 2 4 hours in the weeks and months thereafter Babies who are breastfed tend to feed more frequently as breast milk is easily digested and moves quickly through their system They re Uncomfortable Whether they have a dirty diaper scratchy tag clothes that are too tight illness or some sort of injury common after assisted births your baby will cry to let you know something is bothering them Sometimes babies simply need to release tension and also do so by crying Skin to skin Your heartbeat smell and warmth of your skin may comfort the baby Check baby s diaper Keep baby clean and dry Offer the breast if you are breastfeeding or a bottle if you are bottle feeding Offer a soother or teething ring if you use them Give your baby a gentle back tummy rub Gentle Motion They need soothing Walk or rock your baby Newborns spend 9 months or more in a warm snug environment being rocked gently by your movements and soothed by the sound of your voice Sometimes all they need is to feel the comfort of your closeness now that they re out in the cold loud world Use a baby swing Wear your baby in a sling or carrier Take them for a ride in the car Relaxing soothing sounds Hum or sing a lullaby Turn on the vacuum cleaner clothes dryer or dishwasher Use a white noise machine or app on your phone Helpful Reminders Feed your baby slowly and burp often Gas in your baby s tummy can be painful If you suspect your baby s crying is linked to feeding talk to your doctor or public health nurse IMPORTANT Never shake a baby for any reason Shaking even for a few seconds can cause serious and irreparable damage such as blindness the inability to walk learning problems or death Take a break don t shake If you begin to feel frustrated take a 15 minute break while the baby is in a safe place It s more important to keep calm than it is to stop the crying Put your baby in a safe place like their crib leave the room and shut the door Take 15 minutes to relax before trying to soothe your baby again Letting your baby cry for a few minutes is not harmful to them Plan ahead Make a list of people you trust who can come over right away if the crying becomes too much to handle Try to arrange regular breaks to give yourself a chance to rest

Newborn Hunger Cues Signals If and when possible try to respond to your newborn s hunger cues as soon as possible Crying is often a late hunger cue and may require you to calm your baby before feeding them to ensure they are relaxed and able to latch feed efficiently Early Cues I m hungry Stirring Mouth Opening Mid Cues Stretching Late Cues Crying Turning Head Rooting I m Really Hungry Increasing Movements Hand to Mouth Calm Me Then Feed Me Agitated Body Movements Turning Red

Breastfeeding Basics Top tips for a great start Unboxing Supply and Demand Demand is MILK REMOVAL not just suckling or time at the breast The more milk is removed from the breast the more milk will be produced 3 Components of Demand Audible signals cues crying fussing Is My Baby Nibbling or Drinking Nibbling trying to get milk The Baby s mouth is moving quickly The jaw moves up and down consistently with no pause in the downward motion Looks like when a baby sucks on a soother Babies are not receiving milk while they nibble Physical structural signals latch tongue or lip ties The ability for the system to work well and for baby to finish feeds not stopping before they are satisfied The best way to maintain a good supply barring any other problems with supply is to respond to your baby s cues and signals as soon as you can and feed your baby on demand Tips For a Pain Free Latch Cross Cradle Hold Ref Laura Kent Davidson ND IBCLC Have baby on their side tummy to tummy against you while you support their weight with your forearm Support their upper back with your wrist and cup the base of the baby s skull with your hand fingers together on the side of their face and thumb on the other side Line baby up so their nose is across from your nipple When baby opens wide bring them quickly to the breast so that their chin plants into the breast while their nose does not touch The pressure you apply while latching is between the baby s shoulder blades no pressure should be placed on the back of their head This pressure and line up will ensure the baby reaches for the breast allowing them to open wider and get a deeper latch Their upper lip should just pass the nipple while their lower lip is far from the nipple Drinking receiving and swallowing milk When your baby is drinking there is a pause in the downward motion of the baby s jaw followed by swallowing sounds Lots of nibbling could mean slow milk flow Try switching sides or use gentle compressions to increase flow Signs Your Baby May Not Be Finished falling asleep at the breast but not staying asleep once off rooting sucking hands after feeds baby won t settle or requires a tight swaddle to turn off baby won t sleep for a decent interval between feeds fussing at the breast and eventually breast refusal These can also be symptoms of other issues and are often related to feeding If you are worried or have questions get in contact with your Dr or an IBCLC Is my Baby Getting Enough One of the best ways to know if your baby is getting enough breast milk is to pay attention to their diaper outputs Day 1 1 wet and 1 thick black BM bowel movement Day 2 2 wet and 1 thick black BM This means more of the areola will be covered by the lower lip and jaw and will help them get more milk while increasing your comfort Day 3 3 wet and 1 runny light brown green or yellow BM Pain is NOT a normal part of breastfeeding Pain is often an indicator of a poor latch or other problem Reach out to your Dr or local IBCLC to help resolve the issue Day 5 5 wet and 1 runny mustard yellow BM Day 4 4 wet and 1 runny light brown green or yellow BM Day 6 6 wet and 1 runny mustard yellow BM Day 7 6 wet and 1 runny mustard yellow BM

Infant Feeding Reference Sheet Know what to expect as you learn to feed your baby How Much How Often Newborn Stomach Size Breast breast fed Babies In the early weeks of your newborn s life their stomach is very small You may feel like they are not eating enough Remember to watch for their hunger cues diaper outputs and signs of being satisfied after feeds It can be hard to measure how much your baby is eating in ounces when breastfeeding You can expect your newborn to eat every 2 3 hours AT LEAST in the first 24 hours In the first month you can expect your newborn to feed on demand every 2 3 hours during the DAY and every 3 4 hours at NIGHT About 8 12 times a day Formula fed babies In the first 48 72 hours you can expect your newborn to eat 1 2 1 ounce of formula every 3 4 hours You can expect your newborn to eat 2 3 ounces every 3 4 hours in the first few weeks Day 1 Size of a cherry 5 ml to 7 ml 1 to 1 5 tsp At the end of one month you can expect your newborn to eat 4 ounces every 4 hours Day 3 Size of a walnut 22 ml to 27 ml 75 to 1 oz One Week Size of an egg 45 ml to 60 ml 1 5 to 2 oz One Month Size of a plum 80 ml to 150 ml 2 5 to 5 oz If you have concerns about your newborn s feeding habits or weight gain don t be afraid to bring them up to your trusted healthcare provider or pediatrician Addressing feeding concerns issues early increases positive outcomes and reduces unnecessary stress suffering By 6 months you can expect your baby to eat 6 8 ounces about 4 5 times every 24 hours Human Milk Storage Guidelines Freshly Pumped Expressed Countertop 77 F 25 C Or Colder Up to 4 Hours Refrigerator 40 F 4 C Or Colder Up to 4 Days Freezer 0 F 17 C Or Colder Up to 6 Months 12 months is ok Thawed Previously Frozen Countertop 77 F 25 C Or Colder 1 2 Hours Safe Human Milk Handling Clean surfaces and wash your hands prior to handling human milk Label containers with the date time of storage Use hard plastic or glass containers bottles to store milk Store human milk in the back of the fridge freezer where the temperature is lower and consistent Refrigerator 40 F 4 C Or Colder Up to 1 Day Freezer 0 F 17 C Or Colder Never refreeze thawed human milk Leftover Use within 2 hours whether you refrigerate it or not NOTE It is not considered safe to mix freshly expressed human milk with milk that was pumped expressed previously and already chilled in the fridge Leftover milk still needs to be used within 2 hours of the last feed even when mixed with freshly pumped expressed milk Always follow the directions on the container for infant formula preparation and use

7 Keys To Postpartum Planning The goal of creating a postpartum plan is to create realistic expectations for yourself and your family while setting up the necessary support systems prenatally Typically folks spend a lot of time planning their birth and focus very little on how they will adjust afterward 1 Set boundaries around your laying in period 2 Plan to have practical support 3 Clearly divide up daily tasks 4 Prepare your relationship s 5 Consider your mental wellness prenatally 6 Create an accessible list of your healthcare team members 7 Research your village and plan to reach out if you need Use this workbook to help you create a plan that will improve your postpartum experience and help you feel confident and supported as a parent

Plan Your Laying In Period Setting up rules around your laying in period will help your friends family and other potential visitors should you have want them have a clear picture of your boundaries It will also help you avoid having to have uncomfortable or stressful conversations and interactions in the weeks following your baby s arrival Here are some useful guidelines to help you set healthy boundaries around your laying in period Who if anyone is welcome to visit be honest It s absolutely reasonable not to want everyone in your space following the birth of your baby _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ How long would you like visits to be 30 minutes or less is a valid answer _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ How do you plan on letting people know about these boundaries Email Phone calls Text Messages A Facebook Post perhaps Take some time to jot down what you want to say in such a message here _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ Remember CLEAR IS KIND It is your right to set boundaries and have them respected and you can be as creative as you like in communicating them Fill in the letter to visitors included in this workbook and hang it where your guests can see it

Practical Support Task Division When people ask offer to help let them know HOW Make a list of ways chores tasks your guests and the surrounding village can help out with If you have a partner or arranged support parent aunt sister etc it s a good idea to create a list of their responsibilities to ensure that everyday tasks are taken care of while you recover and care for your newborn Answer these questions and fill out the Postpartum Plan Outline at the end of this workbook Make a list of tasks that have to be done each day Assign each one to a partner support person or family member Task___________________________ Task___________________________ Task___________________________ Task___________________________ Task___________________________ Task___________________________ Task___________________________ Task___________________________ Person________________________ Person________________________ Person________________________ Person________________________ Person________________________ Person________________________ Person________________________ Person________________________ What are some key tasks your visitors can complete to be especially helpful and supportive maybe a complete a task get newborn snuggles arrangement could be applied ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ What are some tasks you may need to hire out ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ Make a list of helper services house cleaners meal services yard maintenance etc in your area ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________

A Focus On Relationships Having a new baby can put significant strain on your relationships If you have a partner it s a good idea to have a conversation before the baby arrives about how your relationship might change and how you can both adapt to ensure that both of your relational needs are being met in the postpartum period What are your love languages Each of you might hear I love you differently Write down how you and your partner can show each other extra love and support in specific ways HINT Love languages can be words of affirmation physical touch acts of service quality time or gift giving ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ What are some unique date night in ideas for the first few weeks after the baby arrives ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ Having a baby can feel like throwing a hand grenade into a relationship Lack of sleep physical discomfort hormones and emotional changes can have a significant impact on how you interact with your partner and others in your space Take some time to reflect on the things you currently do to support your partner when they experience fatigue discomfort or changes to their emotional wellbeing What are some things you might try in the postpartum period to support them through these changes ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________

Your Babymoon Door Sign Hello Thank you so much for all the love and attention you have showered on us as we have welcomed our newest family member We welcome and appreciate your continued support as we rest recover and get to know our newborn Here is how you can best support us during this time We ask that visits be made in groups of no more than _______ and be limited to ________ minutes long We hope you understand if this visit needs to be short as we may not have a whole lot of energy what with the lack of sleep and all Please do not visit if you are sick this includes bringing sick little ones to visit Kindly help me keep my little one healthy by washing your hands and refraining from kissing putting your face mouth on the baby We have been very busy caring for our newborn and adjusting to our new life Please excuse the mess We may need to breastfeed or pump during our visit I apologize if this makes you uncomfortable however this is our home and the baby needs to eat so it can not be avoided We really appreciate your support of my parenting choices and ask that you not offer any advice or anecdotes unless we ask xoxo Thank you so much for your visit and for all your love and support

Your Postpartum Mood Matters Whether you are a birth parent partner surrogate or adoptive parent you may be affected by postpartum mood disorders They are temporary common and treatable It s OK to ask for help A professional can help you recognize what is normal and what could be a sign of a postpartum mood disorder and create a support plan Your ability as a parent is NOT related to whether or not you struggle with your postpartum mood What Are The Signs Exhaustion Mood swings Irritability Sadness Trouble making decisions Changes in appetite Weepiness Feeling like you can t cope Extreme fatigue Inability to sleep PPMDs Baby Blues Mood swings Irritability Sadness Trouble making decisions Changes in appetite Weepiness Feeling like you can t cope Extreme fatigue Inability to sleep Mood swings Irritability Sadness Trouble making decisions Changes in appetite Weepiness Feeling like you can t cope Extreme fatigue Inability to sleep ALONG WITH Set Yourself Up For Postpartum Mental Wellness Plan your postpartum Plan to have extra support for day to day tasks so you can focus on your baby and recovery Set realistic expectations of yourself and of your newborn You are both learning Hopelessness apathy inertia lack of joy racing thoughts panic attacks extreme crying Don t want to be alone with baby Visions or extreme fear of harm coming to baby Obsessive thoughts or actions Make a list of resources and professionals who can support you should you need extra support or are unsure of anything along the way Know that you are not alone It s ok to ask for help IMPORTANT Exhaustion and Baby Blues improve with time and as you get more sleep As a rule of thumb any PPMD symptoms lasting longer than 2 weeks should be mentioned to your trusted healthcare professional What should I Do If you are experiencing mood swings irritability sadness are having trouble making decisions changes in your appetite weepiness are feeling like you can t cope extreme fatigue or an inability to sleep that doesn t improve after 2 weeks please reach out to someone you trust for help as these can be symptoms of a postpartum mood disorder and require attention and care

Your Postpartum Recovery Early Postpartum Period Whether you birth in a hospital birth suite at home or elsewhere it is important that you and your healthcare providers monitor your physical condition to ensure that there are no post birth complications After you return home it is equally as important to monitor your physical and emotional health and to inform your healthcare provider as soon as possible should any problems arise About Your Uterus In the 6 weeks post birth the uterus returns to its prepregnancy size Soon after birth your healthcare provider might use fundal massage to stimulate the uterus to contract This helps keep the uterus firm and prevents heavy blood loss You may experience afterpains pain discomfort as the uterus contracts Afterpains increase with each birth and typically disappear 1 week postpartum Ibuprofen is typically prescribed for afterpains You can consult with your healthcare provider immediately postpartum Menstruation typically resumes 4 to 8 weeks postpartum and can be but is not always delayed by breastfeeding Your first few cycles may be heavier and longer than usual OR lighter and shorter than usual They will return to normal eventually Optimal recovery requires rest Don t be afraid to set boundaries ask for help and or consider hiring a Postpartum Doula Postpartum Bleeding The total volume of postpartum lochia is typically between 200 500 ml and can last from 3 6 weeks Lochia Rubra Lasts 3 to 4 Days Like a heavy menstrual period May have small clots Smells fleshy like menstrual blood Lochia Serosa Last 4 to 10 Days Moderate to a small amount Overactivity and stress can increase flow change from Serosa back to Rubra Lochia Alba Last 10 to 28 days Small amount of creamy white ish discharge gradually disappears Perineal Care Tips Your perineum needs special care as it may be bruised and swollen You may also have had stitches due to a tear or episiotomy Here are some helpful tips to help Ice packs or pad sicles can help reduce swelling After or even during urination use a peri bottle to clean yourself with warm water Be sure to spray front to back to avoid infection from bacteria around the rectal area Pat don t wipe yourself dry also front to back If you are struggling to relax in order to urinate putting a drop or two of peppermint oil in the toilet before can stimulate the right muscles to relax making it easier to urinate You may be constipated or have fear around having a bowel movement post birth A stool softener NOT a laxative can help Drink lots of water and eat lots of fresh and dried fruits veggies to prevent constipation It is common to develop hemorrhoids post birth Most will disappear 1 month postpartum Witch hazel sitz baths and avoiding heavy lifting and constipation can help Do not use tampons before your postpartum follow up with your healthcare provider Do not use Douche products Sitz baths can help reduce soreness If you have had a cesarean be sure to follow your provider s instructions regarding baths A doughnut pillow or rolled up towel shaped into a circle can help take the pressure off your perineum while sitting Sitting on a firm surface may feel more comfortable if you have stitches Rest lay down as much as you can in the first 6 weeks postpartum When sitting and standing gravity can increase swelling and cause pelvic floor ache pain

Serious Postpartum Warning Signs In the days and weeks following birth it is important that you continue to monitor your physical postpartum recovery If you experience any of these warning signs report them to your trusted healthcare provider as soon as possible Fever oral or temporal temperature of 100 0 degrees F 38 degrees C or higher Burning with urination Blood in urine Inability to urinate Swollen red painful area on the leg especially in your calf that is hot tender to the touch Sore red hot painful area on the breast tissue with flu like symptoms Passing a blood clot larger than a lemon followed by heavy bleeding OR bleeding that soaks a pad within 1 hour or less Foul smelling vaginal discharge like rotten fish Vaginal itching or soreness Increased pain around episiotomy stitches site may be accompanied by pus like discharge or blood Cesarean Incision opening may be accompanied by pus like discharge or blood Rash or hives itchy or not Severe headache that is worse when upright and less painful when laying down New sudden onset of pain such as abdominal tenderness or burning near perineal stitches when urinating Pain tenderness in front or back of your pelvis may be accompanied by difficulty walking and or a grating sensation in your pubic joint Feeling extremely anxious panicky or depressed accompanied by rapid heart rate difficulty breathing uncontrollable crying feelings of anger or inability to sleep eat Not feeling safe in your relationship with your partner if you have one being verbally physically abused If you have ANY concerns or worries about your or your baby s health after birth don t be afraid to call your trusted healthcare provider Family Dr ____________________________ OB GYN or Midwife ______________________________ Health Link Public Health _____________________________________

Postpartum Mental Wellness Check In Date __________________________ 5 things to learn more about S M T W T F S 5 things to I need to prepare ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ Exhaustion and Baby Blues improve with time and as you get more sleep As a rule of thumb any PPMD symptoms lasting longer than 2 weeks should be mentioned to your trusted healthcare professional Signs of Exhaustion Baby Blues Signs of Possible PP Mood Disorder Mood swings Hopelessness Irritability Apathy inertia Sadness Lack of joy Trouble making decisions Racing thoughts Changes in appetite Panic attacks Weepiness Extreme crying Feeling like you can t cope Don t want to be alone with baby Extreme fatigue Visions or extreme fear of harm coming to baby Inability to sleep Obsessive thoughts or actions My Mental Wellness Is Very Good Could Be Better Bad I need help If you are experiencing mood swings irritability sadness are having trouble making decisions changes in your appetite weepiness are feeling like you can t cope extreme fatigue or an inability to sleep that doesn t improve after 2 weeks please reach out to someone you trust for help as these can be symptoms of a postpartum mood disorder and require attention and care Journal Doing this exercise made me feel ______________________________________________ I am in need of ____________________________________________________________

Helpful Resources Here is a list of my go to book and websites about all things pregnancy birth and postpartum If you have any specific topics you would like more information or resources on please let me know and I will find them for you Recommended Reading PSI Postpartum Support International Pregnancy Childbirth The Newborn The Complete Guide by Penny Simkin Others Resources and support for Postpartum Mood Struggles More The First 40 Day The Essential Art of Nourishing The New Mother by Amely Greeven Heng Ou and Marisa Belger La Leche League The Fourth Trimester by Kimberly Ann Johnson The Motherhood Complex by Abimbola Akande Caesarean Birth A Positive Approach to Preparation and Recovery By Leigh East The Womanly Art of Breastfeeding by Diane Wiessinger Diana West and Teresa Pitman Breastfeeding resources and community ICAN International Cesarean Awareness Network Resources and community support for cesarean births KellyMom Breastfeeding postpartum and parenting resources You Are Not Alone

Postpartum Planning Guide Your postpartum plan should include your plans strategies and resources for your postpartum recovery period It s important to remember to keep realistic expectations of yourself your baby and the people in your life who may want to lend a hand Having a plan and knowing where to reach out if you need extra help and support can make a huge difference for you and your family Baby Moon Rules Task Division NO SICK PEOPLE Everyone who DIDN T just birth a baby Guests might see boob is responsible for household chores Visitors are guests but whoever just had a baby ain t hosting Mom To Dos Recover Feed Baby Professional Support That is All Meal Plan Train Quick Whats the number for the Who s cookin Not the mom Pelvic Floor Physiotherapist Meals are now an accepted currency Keep your Dr Midwifes number handy Stock up on snacks fill the freezer Chiropractor Naturopath Having a baby is hungry work Community My Village Facebook Support Groups are great Who s a part of your ride or die tribe IRL Support Groups are better Make a list and check it twice Who Where can you go when parentlife is can you trust with your baby when you lonely can t even These are some examples of what you might want to include in each category of your postpartum plan On the following page you can fill in referencing your answers to the questions in this workbook OR fill it in as you research and plan more along the way

My Postpartum Plan The most important thing to me about my postpartum period is ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Baby Moon Rules ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Professional Support ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Community ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Task Division ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Meal Plan Train ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ My Village ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________

Today s Plan TOP PRIORITY DATE Important Reminders Plan of Action 8 00 AM 9 00 AM 10 00 AM Meal Plan BREAKFAST LUNCH DINNER 11 00 AM Water intake 12 00 PM I Am Feeling 1 00 PM Note to self 2 00 PM 3 00 PM 4 00 PM 5 00 PM 6 00 PM I Am Grateful For

Week At a Glance WEEK OF REMINDER Appointments Who Task On The Menu Monday Tuesday Wednesday Thursday Friday Saturday Sunday Habit Tracker Goal M T Goal Goal W T F S S M T W T F S S M T W T F S S