The first 4 days

Babies lose weight in the first few days because they use up their brown fat until breastfeeding or bottle feeding gets going. Parents may find their baby's weight loss worrying. Our maternity nurses and midwives keep a close eye on this, of course. We become particularly alert when a baby loses 7% of its birth weight. Is everything going well, or are additional measures needed? We want to prevent a baby from losing more than 10% of its weight.

Most babies turn slightly yellow, which becomes visible around the fourth day. This is caused by bilirubin, a waste product of blood. All babies renew their entire blood supply in the first few days, so a lot of bilirubin is released. If bilirubin levels become (much) too high, this can cause brain damage. Fortunately, this rarely happens, because we are all alert to the colour. Read more about your baby's colour here. The solution for jaundice is to ensure that feeding gets underway, as a baby gets rid of bilirubin through digestion. If a baby does become too yellow, we will take a blood sample (often at home). If the bilirubin level is too high, the baby will receive light therapy in hospital.

A child's crying and sleeping behaviour can vary from day to day. There may be clusters of hours when he or she suddenly wants to feed much more often, or there may be restless hours when your child mainly needs comfort and contact. Our tip for a restless child: do a check:

• Could they be hungry?
• Dirty nappy?
• Too hot or too cold?
• Is it a sucking need (offer breast or little finger to suck on)?

None of the above? Accept the restlessness, pick up your child and hold them close to let them feel that you are there. Where possible, do this as a team, so that your partner can rest while the other comforts the child.

• Approximately one wet nappy is added per day, so on day 3, three wet nappies are sufficient. It is therefore possible that you are changing empty nappies! 
• There may be urates in the nappy, which look like pink crystals. This can sometimes look like blood loss. This is a sign of dehydration in the child. This is harmless for the time being, but it is a signal to check carefully whether the child is feeding properly.
• The poo will start to change colour over the course of a few days, from black to brown, sometimes via green to mustard and finally yellow. When breastfeeding, we call the last stage of poo a 'spray nappy'. And it's not called a spray for nothing, so protect your wallpaper when you open the nappy!
   

• Engorgement: whether you are breastfeeding or not, almost everyone experiences engorgement. Your breasts become fuller due to an increase in fluid, glandular tissue and milk. This is an automatic reaction of your body after giving birth. Engorgement often peaks on the 4th day and can last for 1.5-2 days. Your breasts may be so engorged that they are sensitive or even painful. You may also experience a slight increase in temperature and feel feverish. This is normal. Taking paracetamol until the engorgement has passed can help. Other tips include: placing cooled cabbage leaves on your breasts, cooling with other cold compresses (after feeding), wearing a tight sports bra, and not showering too hot. If you are breastfeeding, feed your baby as often as they want to help reduce the engorgement. Pumping to reduce engorgement can be counterproductive. If you are not breastfeeding, drink 1-2 cups of strong sage tea per day, as this inhibits lactation and hopefully also reduces engorgement.
• Nipples: when your baby feeds, this suddenly puts a lot of strain on your nipples. If they are sensitive or the latching technique is not optimal, nipple cracks may develop. These are small wounds on your nipple. Tips for this are:
  • Be strict about proper latching; if in doubt or if it hurts, reposition your baby. See videos on latching.
  • After feeding, leave a drop of milk on your nipple and let it air dry.
  • Hydrogel pads (available at our practice)
  • If latching is painful and no longer possible, expressing milk may be an option. Always do this in consultation with your maternity nurse or midwife.

Fortunately, cracked nipples heal within 1-2 days with the right treatment. Do you have sore nipples but no cracks? Discuss this with your maternity nurse or midwife. Sometimes your nipples just need to get used to the feeling. Often it is due to incorrect latching technique or thrush (fungal infection).

• Uterus: hopefully, the afterpains will have stopped after the first 24 hours. You may still experience cramps while breastfeeding. These cause your uterus to shrink again. The maternity nurse will check whether it is shrinking properly. An empty bladder helps with this, so make sure you continue to urinate regularly. Uterine infection is rare, but if it occurs, the uterus will not descend properly, you will have a fever and abdominal pain, and your blood loss will smell more than usual. Always call if you notice these symptoms.
• Urination: urinate yourself at every feeding time. It may be that the feeling of needing to urinate has not yet fully returned, so it is wise to go even if you do not feel the urge. Rinse with a little water to clean yourself during the first few days, or even during urination if it feels like it is burning.
• Bowels: you may not be able to pass stool during these days. Your bowels need to return to their normal position after giving birth and are temporarily not functioning properly due to hormonal fluctuations. Eat enough fibre and drink 2 litres of water per day. After the fourth day, laxatives may sometimes be needed to get your bowel movements going. Important tip: do not hold it in! It is very nerve-wracking to have your first bowel movement after giving birth, especially if you have stitches. Fortunately, the stitches will not open and you cannot damage them. The trick is to sit down calmly and relax and let it happen.

• Blood loss is still normal, and large pads every 3 hours are still acceptable. It may also be that the loss is much less and a small pad is sufficient. Often, when you start moving around more, the blood loss increases slightly.
• Sutures: these days, any sutures you may have are still important and functional. So we will just leave them in place. From the 4th day onwards, the stitches may start to feel a little 'tight'. This is unpleasant, but a good sign. It means that the edges of the wound are healing! Tips for care are: rinse with water and air 1-2 times a day. So take off your knickers and dressing and lie naked on a cellulose mat under the blankets for a while. 
• Some wounds will subside a little. If there is bacteria in the wound or a lot of wound fluid, the wound will open up a little more instead of closing. This is annoying, because healing will take a little longer. But don't worry, it is actually good that the wound remains open for a while so that dirt and fluid can be removed. After that, the wound can heal just as nicely as any other wound. The maternity nurse will check the wound daily. Feel free to ask if you can look at it with a mirror; it often feels worse than it looks.

As mentioned in the introduction, you may experience some mental dips towards day 4. This is logical, given the drop in all pregnancy and birth hormones and all the physical challenges mentioned above. In any other situation, you would now retreat to process everything calmly and recover, but parenting and caring for your child also demands a lot. Try to accept that a lot is happening right now and that it is okay to have gloomy feelings and crying spells. Terms such as 'postnatal tears' and 'baby blues' were coined for this very reason. Crying it out, talking a lot and taking good care of yourself are the best things to do right now. Taking good care of yourself means eating nutritious (and tasty) food, showering and maintaining good hygiene, and getting as much sleep as possible. Are you not getting enough sleep? Let us know, as we can often come up with solutions to help you get more or better sleep. It is also a good idea to ask for help from those around you: bringing meals, doing the shopping, having a good chat. Do whatever you need to do. If the baby blues are progressing normally, you will see that things get a little better every day after the 4th or 5th day. If not, let us know!