Postnatal Care

Emotional wellbeing 

Many mothers will experience the 'baby blues' after childbirth. Baby blues are a normal response to your changing hormones along with lack of sleep and adjusting to new life with your baby. 

Symptoms of the baby blues can include:

• Bursting into tears for no obvious reason 
• Feeling irritable or overly sensitive 
• Feeling low 
• Feeling restless or anxious.

These symptoms are normal and usually last for a few days. 

​​​​​Postnatal depression 

Postnatal depression affects more than one in ten new mothers. It can start at any time during the first year after childbirth. 

Symptoms include:

• A persistent (long-term) feeling of sadness or low mood
• Lack of enjoyment and loss of interest in things that would usually make you happy
• Lack of energy and feeling tired all the time 
• Feeling irritable 
• Loss of appetite or eating too much (comfort eating) 
• Trouble sleeping 
• Difficulty in bonding with your baby or not enjoying your time together
• Withdrawing from your partner, friends, or family
• Finding it difficult to concentrate or make decisions
• Frightening thoughts, for example, about hurting your baby
• Thinking about suicide or self-harm.

A lot of women find it difficult to know that they have postnatal depression because it can develop very slowly. 

How are you, partner? 

It is important to understand that partners can also experience postnatal depression. It isn’t clear why this happens, but it is thought that: 

• First time parents are more likely to experience symptoms 
• Hormonal changes can play a part in causing depression
• Postnatal depression in partners is more likely if the mother is experiencing depression
• Other issues such as money problems, new responsibilities or worrying about your baby can cause postnatal depression.

Postpartum psychosis 

Sometimes new mothers experience severe mental illness called postpartum psychosis. This is an emergency, which requires immediate medical help. 

Symptoms include:

• Confusion or racing thoughts
• Feeling unusually elated, frightened or tearful
• Unable to sleep
• Beliefs that are unusual or concerning to others 
• Seeing, hearing, or sensing things that other people can’t.

How to get help 

There is support available if either you or your partner are worried. We encourage you to make your partner, friends, and family aware of the signs of postnatal depression and postpartum psychosis so they can support you if needed. 

Please speak to your midwife, health visitor or GP as soon as possible if you have any problems with your mood, mental health, or emotional wellbeing. 

For urgent help, please go to your nearest A&E or contact your local CRISIS team immediately: 

Royal Liverpool University Hospital 

Tel: 0151 706 2000

Whiston Hospital      

Tel: 0151 426 1600 

Aintree University Hospital                          

Tel: 0151 525 5980 

Wirral University Teaching hospital          

Tel: 0151 678 5111  

One in four women experience domestic abuse at some point in their lives. Pregnancy can be a trigger for domestic abuse. Also, existing abuse can get worse either during pregnancy or after your baby is born. 

Domestic abuse can be physical, sexual, emotional, psychological, or financial and is often a combination of different types. 

Domestic abuse puts you and your baby in danger and can cause you to experience emotional and mental health problems. 

Getting help 

For immediate danger, dial 999 and ask for the police. 

If you are not in immediate danger, dial 101 to report domestic abuse. 

If you are experiencing domestic abuse, you can also speak to your midwife, health visitor or GP. 

You can also contact the National Domestic Abuse Helpline using their online chat function or by calling their 24-hour helpline on 0808 2000 247.

There is also free, confidential advice on the Refuge, Women's Aid or Liverpool Domestic Abuse Service websites.

Shortly after birth, the midwife will clamp the umbilical cord close to your baby’s navel with a plastic clip. The midwife or your partner then cuts the cord with the clamp attached. The cord takes about a week to dry out and drop off. Keep the navel clean and dry until this happens. If you notice any bleeding or discharge from the navel tell your midwife, health visitor or doctor. 

After your baby is born, your midwife will ask for your permission to give vitamin K to the infant via an injection. This vitamin will prevent a serious bleeding condition called Haemorrhagic Disease of the Newborn which, although rare, can be life-threatening. 

This is a diamond-shaped area on the top of your baby’s head where the skull bones haven’t yet fused together. The fontanelle may take about a year before the bones close over. 

Most babies have little marks and spots, mainly around the head and face. Most common are the little pink ‘stork marks’ on the forehead and upper eyelids or marks on the nape of the neck. Most of them will go away eventually. Strawberry marks, with their dark red and slightly raised appearance, can appear a few days after the birth. They may take a while to disappear but are generally nothing to worry about. Spots and rashes are not unusual but you should tell your midwife or doctor if there is marked change in your baby’s behaviour, such as an unwillingness to feed, sleeplessness or irritability. If you are concerned about a birthmark, please consult your midwife, health visitor or GP. 

It is also quite common for a newborn to have some swelling and bruises on their head, or to have bloodshot eyes. This is usually due to the pushing and squeezing of childbirth and they will disappear in time. If you are worried about any bumps or bruises talk to the midwives looking after you. 

Skin

The top layer of a newborn’s skin is very thin and easily damaged but over the first month, as it matures, it will develop its own natural protective barrier. We would advise against the use of moisturisers or other products initially which can be quite harsh for a newborn’s sensitive skin. 

It is also normal for newborns' skin to peel in the first two weeks after they are born. Your newborn is shedding their top layers of skin as they transition from the uterus into the outside world. Their skin is developing its own natural barrier. 

Jaundice

At three days old, many babies develop mild jaundice with their skin and whites of their eyes taking on a yellow tinge. This usually fades within 10 days, though more serious jaundice may need treatment. If this is the case your midwife will discuss it with you.

Every cigarette harms your baby.  Do not smoke in the house. 

Babies and children exposed to a smoky atmosphere are: 

• Four times increased risk of cot death. 
• Two times more likely to have asthma attacks and chest infections 
• More likely to need hospital care in their first year of life, contributing to more than 9,500 hospital stays. 

We suggest that any smokers, parents or visitors:

• Always smoke outside away from baby 
• Remove any outside clothes on entering your home. 
• Wash your hands before handling baby
• Do not smoke in a car with under 18’s - it is illegal.

Pregnancy is possible as soon as three weeks after having a baby. Every person differs as to when they might feel ready or comfortable to have sex again after having a baby, and you should not feel pressured or worry about this. Nevertheless, many unplanned pregnancies do occur in the months after having a baby. Even if you would like more children, it is recommended to space pregnancies out by at least 12 months to allow yourself to recover and improve the chances of a healthy future pregnancy. Contraception comes in many forms and is a way to prevent or delay pregnancy. 

Which method will be suitable for me? 

This depends on:

• What you and your partner prefer 
• Your medical history 
• Any problems during your pregnancy 
• If you are breastfeeding.

Short-acting options (if you may want to have another baby soon)

• Combined hormonal contraception – pill, patch or vaginal ring. 
• Progestogen only pill 
• Condoms - male or female 
• Diaphragm or cap with spermicide.

These are all effective methods if used correctly. Condoms and the progestogen only pill can be started straight away and can be used if you are breastfeeding. 

Long-acting reversible contraception

• Contraceptive progestogen implant - lasts for three years 
• Progestogen intra-uterine device (hormonal coil) – lasts for six years
• Copper intra-uterine device (copper coil) – lasts for three to ten years
• Contraceptive progestogen injection – lasts for 13 weeks (Depo-Provera).

These methods are all highly effective and can be easily removed. Fertility returns immediately with all these apart from the injection, which can take six to twelve months. The implant and injection can be started straight away. Intrauterine devices can be inserted at the time of caesarean birth, or from four weeks after having a baby. These can all be used if you are breastfeeding. 

Permanent methods of contraception- If you are sure that you never want any more children, you may wish to consider female sterilisation or male sterilisation (vasectomy). 

Lactational amenorrhoea method (LAM) – breastfeeding can be used as a natural contraception, although it is less effective than other methods. 

This is only reliable if: 

• You are exclusively breastfeeding including at night
• You are having no periods
• Your baby is less than six months old.

Two in a hundred women using this method get pregnant in the first six months. 

Remember to use condoms to protect from sexually transmitted diseases, as the other options do not provide protection. 

More information 

At Liverpool Women’s University Hospital: you can speak to your midwife or doctor about your options. 

At your GP practice your six-week postnatal check is a good opportunity to discuss contraception, or you can speak to a practice nurse. 

There are many sexual health clinics in Liverpool and the surrounding areas that can provide contraception: 

Liverpool, Knowsley, Cheshire East, Warrington and Halton - Axess sexual health

Tel: 0300 323 1300 

St Helen’s Sexual Health

Tel: 01744 646473 

Southport, Bootle, Maghull, Netherton - Sefton Sexual Health

Tel: 01695 656550 

Sexual Health Wirral

Tel: 0300 123 5474 

Lancashire and West Lancashire

Tel: 0300 1234 154 

Wigan and Leigh

Tel: 01942 483188

Your community midwife will see you at home the day after you are discharged from the hospital. 

More visits will be offered depending on your individual need and you can also access one of our many ‘postnatal drop-in clinics’ which are run in a variety of settings. Ask you community midwife about the ones nearest to you. 

If you live outside our area, it will be a midwife from another hospital. The purpose of home visits is to monitor your recovery from childbirth, assess the wellbeing of your baby and offer screening tests. 

If a midwife has not contacted you the day after going home, please call the community midwife team you were discharged to. 

Postnatal checks 

• The day after your discharge. This may be a phone call.
• Day 5-8 to weigh baby and carry out baby’s blood spot screening test 
• Day 10-14 to transfer your care to the health visitor.

If needed, the midwife can provide care for up to 28 days following your baby’s birth. 

Life as a new parent can be extremely challenging whilst at the same time being a wonderful experience. In those early days, we would encourage you to accept any help that is offered by your family and friends.  

If at any time you feel that you need extra support speak to your midwife or health visitor.  

Sleep deprivation is not unusual when you have a new baby. Rest when you can. If your baby has a nap during the day you may wish to catch up on sleep too. 

Talk to your midwife about when to restart regular exercise. The type of birth you had may affect how soon you can. 

The perineum is the area between the vagina and the anus (back passage). If you have had stitches, these may feel tight, tender, or uncomfortable for a few days, but this should improve with time. The stitches usually dissolve naturally when the wound has healed. This may take several weeks. 

The following may help you to remain comfortable: 

• Pouring a cup of warm tap water over the area whilst passing urine, to reduce stinging
• Pain relief: Paracetamol and an anti-inflammatory medication such as ibuprofen are safe to use when breastfeeding 
• Dihydrocodeine is safe to use in pregnancy but can cause constipation so should be used with caution
• Pelvic floor exercises should be started straight away if possible as this helps aid the healing process by encouraging blood flow, along with improving sensation and strength to help with control of both the bladder and bowel
• Keep your stitches clean and dry, to prevent infection
• Changing your sanitary pads four to six hourly, or sooner if full
• Clean the area with plain water only. Try to avoid applying anything soapy, perfumed, or oily to the area and avoid long baths until the stitches feel fully healed.

If you have had a third or fourth degree tear you will be referred to the perineal clinic for follow up. You will be seen at around 6 weeks post birth and again at around six months. At this appointment you will be assessed by a urogynaecology midwife, and a referral made to a pelvic health physiotherapist if required. 

Why does bleeding happen after giving birth? 

Bleeding is normal after having a baby and lasts between two to six weeks. 

For the first week, your bleeding may be heavy and bright red. It will gradually, change to pink then brown, and eventually to yellow white. 

Do I need to do anything about the bleeding? 

No, but it may be helpful stock up on two or three packs of maternity pads. Do not use tampons or menstrual cups for 6 weeks as they can bring bacteria into your womb, causing an infection. Always wash your hands before and after changing your pad. You may need to change your pad every two hours to start with. 

Why do I have cramps? 

You may feel ‘period-like’ pains (afterpains) as the womb moves back into place. The cramps and bleeding can be heavier when you breastfeed. This is because breastfeeding hormones are getting your uterus back to its pre-pregnancy shape. 

When will my periods start again? 

If you bottle feed your baby or combine bottle with breastfeeding, your first period could start from 6 weeks after birth. If you fully breastfeed, it can be anytime during your breastfeeding journey.  

Constipation 

It can take three to five days to open your bowels (do a poo) after giving birth. 

• Try to eat foods high in fibre, such as fresh fruit, vegetables, wholegrain cereals and bread
• Aim for five+ portions fruit/veg per day
• Drink when you’re thirsty, ideally aiming for at least 1.5ltrs of water - if you are breastfeeding aim for about three litres of drinks every day
• If you are still having difficulty doing a poo, your GP/pharmacy can give you medicine to soften your poo. 

Piles (haemorrhoids) 

Piles are swollen lumps inside and around your bottom (anus). They are painful and uncomfortable when going to the toilet. These are common after giving birth and usually disappear within a few days. 

Piles can be managed by avoiding constipation, using good hygiene, creams, stool (poo) softeners and pain relief medication if needed. These can be bought over the counter at a pharmacy. 

Passing urine (peeing) 

The first few times it might sting. If you find yourself leaking urine unintentionally, ‘pelvic floor exercises’ will help strengthen your muscles and stop accidents, and you can start gently after birth. 

Sometimes your urge to pass urine is temporarily reduced post birth, so make sure you go to the toilet regularly, even if you do not feel as though you need to. A normal pattern is to go between two to four hours depending on how much you are drinking, so bear this in mind. 

Talk to your midwife if you have difficulty/pain when peeing, your pee smells unpleasant; or if pelvic floor exercises are not helping. 

After your six-week check, exercises such as swimming or classes can slowly be resumed. 

You are slightly more likely to develop blood clots in the legs (deep vein thrombosis) or lungs (pulmonary embolus) during pregnancy and in the first six weeks after birth. These types of blood clot are called venous thromboembolism (VTE). Your risk of developing a VTE is increased if you are: over 35 years, have a BMI over 35, had a ventouse, forceps or caesarean birth, are a smoker or you or a close family member has had a VTE in the past. You may have noticed the staff caring for you are using these risk factors to calculate a VTE score, which helps to guide the management for individual people during pregnancy and after birth. 

Your legs may be sore if you have been sitting or lying down for a long time. Try to move around as much as possible, standing up and walking will help with both recovery and constipation. To help blood flow, you can do regular ankle exercises. If given compression stockings (socks) to help with circulation, continue wearing them until you are active again. Some women are sent home with daily injections to thin the blood. It is important to complete the course of these injections. 

Attend your local accident and emergency unit if you notice: 

• Pain, redness, swelling or lumps in your legs 
• Pain in your chest, or in the back or shoulders.

In rare situations, blood clots can move from the legs and into the lungs. You should seek immediate medical help if breathing is difficult, or you are coughing up blood. These can be signs of pulmonary embolism (blood clot in the lung). 

Back care 

During pregnancy, the ligaments of your body soften and stretch to make room for your baby. These ligaments remain soft for up to five months after the baby is born. It is therefore important to protect your back in your day-to-day life. 

Getting out of bed: Bend your knees, roll on to your side and use your arms to push yourself into a sitting position. 

Sitting: Sit with your bottom back in the chair to support your lower back. When feeding your baby, you may wish to put the baby on a pillow, so you are in a comfortable position. 

Standing: Stand upright and tuck your bottom in. Always stand and walk tall with your tummy drawn in. When changing your baby, make sure your back is straight. If you are changing your baby on a low table or bed, kneel on the floor, keeping your back straight. 

Lifting: When you lift your baby (or anything else), make sure you bend your knees and keep your back straight. Do not twist when lifting. 

Pelvic floor exercises 

The pelvic floor consists of layers of muscles supporting the pelvis. The muscles attach to the pubic bone at the front and to the base of the spine at the back, forming a supportive ‘bowl’ between your legs. Pelvic floor exercises should be started straight away if possible as this helps aid the healing process by encouraging blood flow, along with improving sensation and strength to help with control of both the bladder and bowel. 

What do the pelvic floor muscles do? 

The pelvic floor muscles support the bladder, uterus (womb) and bowel. They prevent the leakage of urine when you cough, sneeze, laugh or run. They control the three openings – the anus (back passage), vagina (birth canal) and urethra (bladder opening). They increase pleasure during sex. 

How to do pelvic floor exercises

Pelvic floor exercises can be performed in any position, and no-one will know you are doing them: 

• Tighten the muscles around your back passage, as if trying to stop the passing of wind
• At the same time, tighten around your front passages (vagina and bladder), as if trying to stop the flow of water
• Your buttocks, legs and tummy should not move
• Do these exercises every day. 

Work towards two to three sets per day of 10 x fast squeezes and 10 x squeeze and holds, aiming to hold for 10 seconds eventually, but focus on the quality of the squeeze rather than the quantity at first and increase as you get stronger. It can take three to five months of regular exercises to notice an improvement in strength and then when you feel strong and can complete those sets easily, maintain that strength by doing just one set per day for the rest of your life.  

Associating these exercises with a regular activity like brushing your teeth, when feeding your baby may help you to remember to do the exercises regularly. 

Abdominal muscles 

During pregnancy, the abdominal (tummy) muscles are stretched and elongated, which weakens them. In the later stages of pregnancy, the muscles separate to allow the baby to grow, creating a gap. When your baby is born, this gap may still be present. 

Deep abdominal exercise 

It is important to help support and close the gap: 

• Lay on your side or on your back, and let your tummy relax
• As you breathe out, gently draw in the lowest part of your tummy towards your spine (back) 
• Hold this for a few seconds and then let go
• Repeat four to five times, resting between each one
• Aim to hold for 10 seconds and to repeat 10 times
• Once confident, try tightening the pelvic floor at the same time. 

Pelvic tilt 

Once you can do the deep abdominal exercise, move onto this: 

• Lay on your back with knees bent
• As you breathe out, draw in your tummy as before and tilt your pelvis backwards by gently squeezing your buttocks. You should feel your back flatten onto the floor or mattress. 
• Hold this position for five seconds, and then relax
• Repeat these four to five times (increase the hold to a 10 second hold, repeating 10 times)
• You may also like to try this lying on your side. 

When can I start exercising? 

When you feel ready. Start gently by walking with 10 minutes a day and increase the time and distance as you feel able.