Six Week Check-Up

Do you have new first time parents in your life? You’ve probably gotten them a gift and visited to meet the new wee one. You’ve probably puzzled over what a new family needs and how to help out.

There are lots of great ideas out there. Here’s one I particularly liked as it really rang true for my experience as a new parent. To take it one step further, I’d like to challenge everyone out there to do the Six Week Check-up. That is, make a point of checking in with the new mom as her baby nears the six week mark.

Why Six Weeks?
Do you remember the six week check up after you had your first baby? Do you remember what else was going on for you then? Maybe you haven’t had kids yet or maybe your kids are older and now that you’ve left the sleep-deprived haze, those early days are all a blur. Let me remind you:

The first few weeks were all bliss, staring at baby in awe, proudly presenting her to family and friends, feeling totally bonded to your partner for producing this perfect little angel. But now? Dad has gone back to work. The whirlwind of out-of-town visitors is slowing or they’ve all come and gone. Friends and family have all met baby and are back to their regular lives: working, house renos, family vacation. The new baby celebrations have all ended: the baby shower or meet the baby party was a few weeks ago. Friends are no longer dropping in with a cute onesie or yet another handmade blanket. The email congratulations have tapered off. In short, everyone else’s excitement has worn off. For them, now it’s business as usual.

For mom? She’s home alone with baby and the reality of her new life is finally starting to hit her. This likely means getting used to the isolation of maternity leave. The first few weeks felt like a well-deserved vacation, especially after the aches and pains and fatigue of working while pregnant. But now, she’s kind of bored. She’s surprised by how much she misses talking to adults when she’s staring at the four walls and nursing AGAIN. She’s surprised by how much she misses the noise of the office (or the restaurant or the store or wherever it was for her) when she realises how quiet it is at home alone while her friends and partner are at work. When she sees her friends, she realizes she has surprisingly little to talk about now that she can’t talk about her work. She wonders what to do with herself and she misses that productive self, that woman who excelled at her work. It’s lonely and she feels a little lost in a culture that defines people by the work they do.

After the standard first few weeks rest and recovery, she was feeling great and tried to get back to her normal routine, only to find that she’s still exhausted. Mama’s beginning to realise that her plans of continuing life as before with baby in tow might be a little unrealistic. Her thoughts of tackling some of those crafting projects gathering dust during her “year off” seem laughable now as she struggles to sleep enough, keep the house clean, shower and eat lunch. By 6 weeks, the new family is likely out of the extra freezer food they prepared before the birth and friends are no longer dropping off casseroles. Offers to throw a load of laundry in or pick up groceries while new mom grabs a nap have petered out. Mom’s learning to navigate the grocery store with baby (and all the baby gear) now. Every day is a list of laundry, nursing, diapers, nursing, napping, nursing, dishes, nursing, more laundry, more nursing, more diapers. She’s surprised at how little she accomplishes and she might be starting to get run down around the 6 week mark because she’s trying to do too much. Back to regular life?

Not exactly.

At 6 weeks, baby often goes through a growth spurt (also 3 weeks, 3 months & 6 months) which means that he’ll be cluster feeding. Mom will feel like she’s nursing all day and all night. It will feel like she can’t attend to the most basic things (like brushing her teeth) because baby is rooting and hungry every five minutes. Considering that the support and help have often faded away by this point, this particular growth spurt can be pretty overwhelming. Also, because baby is acting so hungry and fussy, mom may start to worry about her supply.

After 6 weeks learning to breastfeed, some women may have the hang of it and some may still be struggling but all are still vulnerable to fear, doubt and bad advice. They might feel on the verge of giving up. They might feel that they gave it everything they could and they just weren’t able to do it. They could all use encouragement and support now. As PhD in Parenting says in her post on When to Give Up on Breastfeeding:

“tell her that you know how hard it is. Tell her that you are proud of her for trying so hard. Tell her that it is her choice whether to continue or not and that you fully support her no matter what her decision is and that she is a great mother no matter what decision she makes. Read up about what it really means to support a breastfeeding mother. Give her a hug. Let her cry.”

Speaking of crying, here’s another reason six weeks postpartum is an important time to check up on your new parent friends: ever heard of purple crying? It is inconsolable, unpredictable LONG bouts of crying every evening. This crying tends to increase in the second week of life and peak around the sixth week. This means your new mama friend who is home alone with baby all day may also be spending her evenings walking the floor with a baby who just can’t be soothed no matter what she tries. Check out this graph showing crying patterns and note the peak at 6 weeks of age despite the wide range of distribution for all infants. New parents need your support at this time.

Lastly, everyone’s heard her birth story. Maybe twice. When mama starts recounting the details, they move on to other topics. But she hasn’t finished processing the event. It’s a major rite of passage and she may need to go over it, and over it, and over it. Especially if it wasn’t what she was expecting (true for most of us) but even more so if it was traumatic. She may be feeling horribly guilty, violated, disappointed, let down and conflicted. Other people don’t want to hear her go on about it anymore, they want her to focus on her healthy baby and get over it (“I mean it was over a month ago, right? And look at your beautiful baby. It’s all over now”). She may think there’s something wrong with her that it’s still so upsetting. She might need to talk about it again. And she might need to be pointed in the direction of good resources like Solace for Mothers and International Cesarean Awareness Network.

What is the 6 Week Check-Up?
It’s an opportunity to remember that 6 weeks with a new baby is not a long time. Everything is still new to your friends and even though your excitement might have worn off, they are still adjusting to parenthood. What can you do?

• Renew your offers to pick up groceries or throw some laundry in for them.
• Ask mom to go for a walk with you during the day (on your lunch break if you work).
• Pop in with lunch for her. Hold the baby while she eats.
• Encourage mom to get out of the house by joining a mom’s group, play group, neighbourhood drop in centre, La Leche League group, mom & baby yoga class. Offer to go with her if appropriate.
• Call during the week and let her know that you are thinking about her (and she isn’t forgotten).
• Drop off a casserole.
• Ask her sincerely how she is coping.
• Listen actively.
• Ask her to tell you her birth story again.
• Encourage her efforts to breastfeed. Let her know that it will get easier.
• Tell her that sometimes baby’s cry a lot and it doesn’t mean she is doing anything wrong.
• Remind her that it won’t always feel so overwhelming.
• Be real – tell her a story about a time when you struggled in the beginning so she knows that she’s not alone and that we all struggled at first.

I remember sitting on my bed rocking a screaming baby back and forth waiting for my husband to get home from work. I remember feeling so inept and in over my head. I remember feeling like I couldn’t reach out and ask for help. Right then, a phone call or a knock on the door from a caring friend wouldn’t have stopped baby’s crying or alleviated my sleep deprivation but it sure was what I needed.

Postpartum Care – What to Expect

Though pregnancy changes your body in many ways, sometimes the most dramatic changes happen after delivery, during the postpartum period. Here’s what to expect.

Painful perineum
Your sensitive perineum has been stretched to the limit and it may possibly have been bruised or torn. If it has been cut into, it’s bound to smart. Ask the nurse to instruct you on “peri-care”. Heat increases blood flow and promotes healing; cold numbs pain and decreases swelling. Both measures are necessary to heal a traumatized perineum. The nurse will tuck an ice pack up against your perineum as soon as possible (it will feel so good). She will advise you about soaking in a warm sitz bath (or the tub) and show you how to squirt warm or cool water over your perineum, using a peribottle.

Soothe the wound. Spray menstrual pads with either water, witch hazel mixed with water, or perineal wash, squeeze out the excess and put them in the freezer—the cool temperature will feel amazing to your tender perineum. Change and replace as needed.

Prevent pain and stretching during bowel movements. Hold a clean pad firmly against the wound and press upward while you bear down. This will help relieve pressure on the wound.

Sit down carefully. To keep your bottom from stretching, squeeze your buttocks together as you sit down. If sitting is uncomfortable, use a doughnut-shaped pillow to ease the pressure.

Do your Kegels. These exercises help tone your pelvic floor muscles. Simply tighten your pelvic muscles as if you’re stopping your stream of urine. Starting about a day after delivery, try it for five seconds at a time, four or five times in a row. Repeat throughout the day. Look for signs of infection. If the pain intensifies or the wound becomes hot, swollen and painful or produces a pus-like discharge, contact your health care provider.

Vaginal discharge
You’ll have a vaginal discharge called lochia for up to eight weeks after delivery. Expect a bright red, heavy flow of blood for the first few days. If you’ve been sitting or lying down, you may notice a small gush when you get up. Don’t be alarmed if you occasionally pass blood clots. The discharge will gradually taper off, changing from pink or brown to yellow or white. To reduce the risk of infection, use sanitary napkins rather than tampons.

Contact your health care provider if:

• You soak a sanitary pad every hour for more than two hours
• You feel dizzy
• The discharge has a foul odor
• Your abdomen feels tender
• You pass clots larger than a golf ball
• You have a temperature of 100.3 F or higher

Contractions
During the first few days after delivery, you may feel contractions sometimes called afterpains. These contractions help prevent excessive bleeding by compressing the blood vessels in the uterus. Afterpains tend to occur when you’re breast-feeding and seem to be more noticeable with second or third babies. Medications used to control hemorrhaging after delivery can increase afterpains as well.

Usually these pains resemble menstrual cramps. If necessary, your health care provider may prescribe pain medication. Many medicines are safe even if you’re breast-feeding. Contact your health care provider if you have a fever or if your abdomen is tender to the touch. These signs and symptoms could indicate a uterine infection.

Difficulty urinating
Swelling or bruising of the tissues surrounding the bladder and urethra may lead to difficulty urinating. Fearing the sting of urine on the tender perineal area may have the same effect.

To encourage urination, contract and release your pelvic muscles. It may help to place hot or cold packs on your perineum, straddle the toilet like a saddle or use a peribottle to pour water across your perineum while you urinate.

Difficulty urinating usually resolves on its own. Contact your health care provider if it hurts to urinate or if you have an unusually frequent urge to urinate. These may be symptoms of a urinary tract infection.

Leaking urine
Pregnancy and birth stretch the connective tissue at the base of the bladder and may cause nerve and muscle damage to the bladder or urethra. You may leak urine when you cough, strain or laugh. Fortunately, this problem usually improves within three months. In the meantime, wear sanitary pads and do your Kegel exercises.

Hemorrhoids
If you notice pain during a bowel movement and feel swelling near your anus, you may have hemorrhoids (stretched and swollen veins in the anus or lower rectum). To ease any discomfort while the hemorrhoids heal, soak in a warm tub and apply chilled witch hazel pads to the affected area. Your health care provider may recommend a topical hemorrhoid medication as well.

To prevent constipation and straining, which contribute to hemorrhoids, eat foods high in fiber—including fruits, vegetables and whole grains—and drink plenty of water. Remain as physically active as possible. If your stools are still hard, your health care provider may recommend a stool softener or fiber laxative.

Bowel movements
You may find yourself avoiding bowel movements out of fear of hurting your perineum or aggravating the pain of hemorrhoids or your episiotomy wound. To keep your stools soft and regular, eat foods high in fiber, drink plenty of water and remain as physically active as possible. Ask your health care provider about a stool softener or fiber laxative, if needed.

Another potential problem for new moms is the inability to control bowel movements (fecal incontinence)—especially if you had an unusually long labor. Frequent Kegel exercises can help. If you have persistent trouble controlling bowel movements, consult your health care provider.

Sore breasts
Several days after delivery, your breasts may become heavy, flushed, swollen and tender. This is known as engorgement. It happens when your milk comes in. The discomfort usually lasts less than three days. In the meantime, it helps to nurse often or to express milk. Stroke your breasts gently but firmly toward the nipple. Apply warm or cold washcloths or ice packs, or try a warm bath or shower. You can also apply cabbage leaves to your breasts. Find out more on treating sore breasts.

Leaking milk
Leaky breasts are another common problem for new moms. You can’t do anything to stop the leaking, but nursing pads worn inside your bra can help keep your shirt dry. Avoid pads that are lined or backed with plastic, which can irritate your nipples. Change pads after each feeding and whenever they get wet. Try not to wear breast pads for long periods of time as they can irritate tender nipples. If nighttime leaking is a problem, place a towel under your breasts at night.

Hair loss
During pregnancy, elevated hormone levels put normal hair loss on hold. The result is often an extra-lush head of hair. But now it’s payback time. After delivery, your body sheds the excess hair. Within six months, your hair will probably be back to normal. Shampoo only when necessary, and find a hairstyle that’s easy to maintain. Avoid hair dryers, curling irons and harsh chemicals.

Skin changes
You may notice small red spots on your face. These are caused by small blood vessels breaking during the pushing stage of labor. Expect the spots to disappear in about a week.

Stretch marks won’t disappear after delivery, but eventually they’ll fade from reddish purple to silver or white. Any skin that darkened during pregnancy—such as the line down your abdomen (linea nigra)—may slowly fade as well.

Weight loss
After you give birth, you’ll probably feel flabby and out of shape. You may even look like you’re still pregnant. Don’t worry. This is perfectly normal. Most women lose about 10 pounds during birth, including the weight of the baby, placenta and amniotic fluid. During the first week after delivery, you’ll lose additional weight from leftover fluids. After that, healthy eating and regular exercise can help you gradually return to your pre-pregnancy weight. Expect that this might take some time.

Mood changes
In addition to physical changes, childbirth also triggers a jumble of powerful emotions. Mood swings, irritability, sadness and anxiety are common. Many new moms experience a mild depression, sometimes called the baby blues. The baby blues typically subside within seven to 10 days. If your depression deepens or you feel hopeless and sad most of the time, contact your health care provider. Prompt treatment is important.

Profuse sweating
Another way your body gets rid of the excess fluids accumulated during your pregnancy is by perspiring more, especially at night. For the first night or two wear cotton clothing to absorb the perspiration and cover your sheet and pillow with a towel to absorb the night sweats. Excessive sweating is most prominent during the first week and gradually subsides by the end of the first month.

Constipation
Your bowels may be as reluctant to work as your bladder is, and for similar reasons. The muscles involved in passing a stool may have been traumatized during passage of the baby. Drugs and anesthetics temporarily cause the intestines to be a bit sluggish; and your bowels were probably emptied naturally by the normal “diarrhea” that normally precedes birth. Besides these physical causes for problems with bowel movements, many mothers have a psychological reluctance to do any pushing with their perineal muscles, either for fear of hurting these tissues or because of a desire to rest them. Yet the sooner you get your intestines moving, the better you will feel.

Gas and bloating
The bowel sluggishness that contributes to constipation also may make you feel gassy, especially if you are recovering from a cesarean birth. Drinking and eating frequently, but in smaller amounts, and getting your body moving again, will ease these discomforts.

At your postpartum checkups, your health care provider may check your vagina, cervix and uterus to make sure you’re healing well. He or she may also do a breast exam and check your weight and blood pressure. This is a great time to talk about birth control, breastfeeding and how you’re adjusting to life with a new baby.

Share any concerns you may have about your physical or emotional health. Chances are, what you’re feeling is entirely normal. Look to your health care provider and support network for assurance as you enter this new phase of life.

Reprinted with permission from SCKOON.