Ashley's Postpartum Visit

The photos and audio clips below are from a home postpartum visit with Ashley and baby (name still to be determined at that time) by Birth Assistant Hayley Duke from Roots Community Birth Center on February 3, 2019.

Below are photos, audio, and descriptions. Click the audio as you scroll through to hear the sounds that accompany the images. Transcript coming…

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Birth Assistant Hayley and Ashley meet in a living area of the home. Hayley warms the sling scale she’ll weigh baby in while Ashley undresses the baby.

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After recording baby’s weight, Hayley calms baby again to hand back to Ashley.

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Whatever infant feeding looks like for a new parent, it’s always a learning process. Ashley has decided to exclusively breastfeed her baby.

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The positioning of a parent’s body and a baby’s body make a difference in breastfeeding. And this can look different from the parent perspective than from the outside. Having a trained professional review a feeding session early on in postpartum can help correct habits — or identify issues like tongue-ties — before they cause large or painful problems.

Here, Birth Assistant Hayley corrects the position of baby’s body against Ashley’s, and draws attention to the position of baby’s lips also, showing Ashley how to encourage his mouth into a better shape on her breast, as well as how to unlatch in a way that’s safer for her nipple.

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Milk production actually begins during pregnancy. At birth, birthing bodies often already have colostrum, an early form of breastmilk full of antibodies and nutrients. The time referred to as when “the milk comes in” is actually when milk production increases and shifts from colostrum to mature milk — this typically happens within three days of birth.

Research indicates that the timing of increased milk production is hormonally controlled, which may account for some of the common symptoms like emotional swings and shivering that parents talk about happening alongside this change. Studies show that delays in milk production can happen for a variety of reasons like type of delivery or certain interventions during labor. And they also show that we can encourage on-time milk production through actions like practicing breastfeeding, hand expressing, and skin-to-skin time with baby.

After discussing Ashley’s breastfeeding experience for these first few days some more, Birth Assistant Hayley recommends avoiding nipple shields and pacifiers as much as possible to prevent nipple confusion.

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Birth Assistant Hayley and Ashley go over wet and soiled diaper counts. Counting wet and soiled diapers in the first days and weeks of postpartum is one of the ways that parents and care providers can get a sense of whether baby is eating enough.

When Birth Assistant Hayley notices some cracks in Ashley’s nipple on one side, she and Ashley talk about how to continue breastfeeding through soreness while she’s healing.

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Birth Assistant Hayley recommends continuing to feed with only breastmilk, and sticking to a more strict 2-hour feeding schedule that will require waking baby up to feed if he’s asleep when the next session is due — later in the visit, Hayley re-emphasizes that it’s common for babies with weight loss to be sleepier during feeding time and need some help getting woken up enough to eat — and she acknowledges that that can be challenging and frustrating while it lasts.

Ashley asks if she should pump in addition to nursing baby and Birth Attendant Hayley recommends not doing that so her breasts don’t overproduce milk and cause more engorgement.

Deciding when to pump can depend largely on circumstances like when a parent has to go back to school or work, or be apart from the baby for long periods of time. While some parents produce a lot of milk naturally, generally the amount of milk production in a parent’s body is guided by the feeding pattern — the body will produce based on how often milk is removed. Engorgement is when the breast overfills with milk and becomes hard and painful.

Ashley is experiencing engorgement during this visit. Hand expressing before feeding — which Ashley will do later on — is one of the helpful ways to manage this challenge.

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One of the great concerns in the first few days after a baby is born is going to the bathroom. Peeing can often come with a stinging feeling where tissues are sore or torn, and bowel movements can be particularly painful if hard. While being nervous is normal, fear doesn’t help the first poop problem — eating mindfully, drinking lots of fluids, and using a stool softener, from prune juice to something from over the counter — these will help prepare the postpartum body. Using a peri-bottle with warm water or an appropriate herbal mix to rinse the perineal area after a pee can help with healing there as well.

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Whether a baby is born vaginally or by cesarean, the postpartum body is healing in the weeks after birth. The uterine lining and the birthing canal are often the sources of normal postpartum bleeding, passing through as a flow and/or in clots. Postpartum bleeding usually stops within 5-6 weeks. Drinking plenty of water and resting are two important ways to support timely healing.

The fundus is the name for the upper part of the uterus. The fundal checks that began just after birth continue at home, with Ashley checking on it herself. During postpartum, the fundus should descend below the bellybutton day by day, until it’s unable to be felt by two weeks postpartum. This indicates that the uterus is healing well.

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Next Birth Assistant Hayley asks Ashley about how her perineal area is feeling.

The perineal area is the area between the anus and the vulva. Caring for the perineal area during postpartum often involves healing tears from childbirth. It’s common for birthing people to experience first and second-degree tearing in any birth. Frequently changing pads, using a peri bottle, patting the area dry and resting are examples of good care habits for treating perineal tears during postpartum.

Birth Assistant Hayley also emphasizes that while showers are good for rinsing off and getting clean, sitz baths during postpartum are more helpful with supporting healing.

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While postpartum chills aren’t fully understood, doctors speculate it’s often related to hormonal changes in the new parent’s body. It’s always a good idea to check in with your care provider, and let me them know if any other symptoms are occurring alongside this — for example, paired with a fever, chills may indicate an infection.

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Hormonal shifts, sleep deprivation, and the new challenges of parenthood naturally have an impact on new parents’ emotional and mental health. Checking in with your care provider about what you’re feeling and thinking is just as important as telling them what you’re physically feeling or experiencing.

There are degrees to the emotional signs and symptoms that new parents experience. Baby blues, which tend to last a few days or a few weeks, involve milder symptoms like mood swings, sadness, irritability, and crying.

Postpartum disorders like Postpartum Depression, Postpartum Anxiety, Postpartum Post-Traumatic Stress Disorder, or Postpartum Psychosis require intentional care from professionals for parents to manage and work safely through. Learn about these possible experiences early and know when to reach out for help.

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Typically, Birth Assistants from Roots visit with parents on day three. Hayley came to visit Ashley on day two instead because Ashley had called requesting support sooner. So in the audio clip above, she sets the plan for Ashley’s next visit to be the typical day five, but re-affirms that again she can always call if she needs to.

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Both cool compresses and warm applications can be helpful for treating engorgement before a baby nurses. Birth Assistant Hayley discusses this with Ashley based on what Ashley had already started trying herself at home.

Eye contact in newborns is an important indicator of a healthy nervous system.

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Safe sleep refers to putting a baby to sleep in a way most likely to protect them from dangers. Safe sleep guidelines include putting a baby to sleep on their back, not bed-sharing, not letting them sleep for long periods of time in strollers or carseats, and more. La Leche League has safe sleep guidelines that recognize the common desire and preference for many parents to co-sleep.

As Birth Assistant Hayley acknowledges when discussing with Ashley, safe sleep guidelines come from evidence-based research, and it’s up to parents how to use that information alongside their and their babies’ preferences and experiences.

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The second weight check of Ashley’s baby reveals that he gained four ounces in one feeding from one breast. While this doesn’t erase earlier concerns about weight loss since birth, it is a great indicator that when properly latches, baby is getting milk, and the increased nursing schedule Ashley is set to use moving forward will help baby continue to make healthy weight gains.

Jaundice is the build-up of a substance in the blood called bilirubin. It’s common in newborns, usually happening in the first days of life. Most cases are mild and easy to treat, but severe untreated jaundice can lead to brain damage. While not necessarily something to be concerned about, jaundice may last longer in breastfed babies. Like everything else, you can to your care provider about jaundice and caring for your baby.

Hand expression is a technique of using the hands to get milk from the breasts. It can be used early after birth to express colostrum as well as regularly throughout the breastfeeding relationship to stimulate milk production or provide relief to engorged breasts before feeding. While videos of this technique are available online, if possible, it helps to have a trained professional present to watch and guide the learning process.

While you’ll only hear a few minutes worth of audio, Birth Assistant Hayley and Ashley practice and review hand expression technique for at least 30 minutes of this visit.

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Ashley’s technique changes — from the position of her fingers, to the way that they move — from the start of practicing to the end.

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After asking for consent to do so, Birth Assistant Hayley demonstrates the hand expression technique on her breast. The differences in technique for hand expression can sometimes me easier to understand by feeling than seeing.

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When a first attempt at a latch is unsuccessful, Ashley goes back to hand express some more so the breast will be easier for baby to latch to in the next attempt.

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After the second session of hand expressing, the next attempt to latch is successful! Birth Assistant Hayley carefully takes Ashley’s blood pressure while baby breastfeeds.

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After answering a few additional questions about baby’s sleeping habits and pain Ashley was feeling in her hip, Birth Assistant Hayley and Ashley say goodbye. In total, the visit lasted about two hours.

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