Childbirth, Newborn Care, and Returning Home
Also known as: Postpartum care, Newborn care, Returning home after birth, Fourth trimester
Overview
Childbirth marks the end of pregnancy and the start of a new chapter for the family. In the United States, about 3.6 million births occur each year, according to the CDC, the vast majority in a hospital setting. The period after birth, known as the postpartum period, covers roughly the first six weeks after delivery. This phase is physically and emotionally intense for the mother, the newborn, and the whole family. Good preparation and appropriate medical follow-up make the transition smoother.
Causes and risk factors
Several factors can affect the course of childbirth and the postpartum period:
- Prematurity: birth before 37 weeks of pregnancy, which increases risks for the newborn
- Fetal macrosomia: a higher birth weight, a factor in obstetric complications
- Gestational diabetes and pregnancy-related high blood pressure: common maternal complications
- Perineal tears or an episiotomy: risks associated with vaginal delivery
- Postpartum depression: about 1 in 8 new mothers report symptoms
- A history of C-section, multiple pregnancy, or fetal malposition also raises the risk of complications
Symptoms
Several things are normal after birth but should still be monitored:
- Lochia: vaginal bleeding for up to 6 weeks, gradually decreasing
- Perineal or abdominal pain, including afterpains from uterine contractions during breastfeeding
- Breast engorgement if breastfeeding
- Intense fatigue, disrupted sleep, and mood swings (the “baby blues” in the first few days)
- In newborns: neonatal jaundice, feeding difficulties, and initial weight loss (normally about 10% to 12% of birth weight)
- Signs of infection: fever, redness, or discharge at an incision site
Diagnosis
Postpartum follow-up includes a clinical exam of the mother (uterus, perineum, C-section or episiotomy incision, breasts) and the newborn (weight, reflexes, jaundice). Additional tests may be ordered: blood tests to screen for anemia or infection, a newborn screening (heel-stick test) for rare metabolic conditions, and a newborn hearing screening. A postpartum checkup is recommended within 3 weeks of delivery, followed by a comprehensive visit by 12 weeks after delivery.
Treatments
Postpartum care is comprehensive and personalized:
- Regular medical follow-up: home visits from a nurse or midwife, and pediatric checkups for the newborn (first days, by 1 month, and at regular well-child visits through the first year)
- Pain relief: acetaminophen and NSAIDs for postpartum pain
- Pelvic floor rehabilitation: pelvic floor (Kegel) exercises to strengthen the muscles that support the bladder, uterus, and bowel; ask your doctor when it is safe to begin
- Breastfeeding support: guidance from a nurse, midwife, or lactation consultant if difficulties arise
- Postpartum depression treatment: psychotherapy and, if needed, antidepressants compatible with breastfeeding
- Phototherapy for neonatal jaundice if needed
- Postpartum contraception: to discuss with your doctor at the postpartum checkup
Prevention
For a smoother transition home, several steps help:
- Prepare for the return home before delivery: baby supplies, and a support network of family or professionals
- Accept help from loved ones, and consider arranging home visits from a nurse or midwife
- Respect rest periods and avoid strenuous activity in the first few weeks
- Monitor the newborn’s weight regularly, and see a doctor if weight loss is excessive
- Maintain a balanced diet and adequate hydration, especially if breastfeeding
- Practice thorough hand hygiene to help prevent newborn infections
When should you see a doctor?
See a doctor promptly for a fever of 100.4°F (38°C) or higher, heavy or foul-smelling bleeding, chest pain, difficulty breathing, or signs of severe depression in the mother. In the newborn, intense jaundice, a high fever, poor weight gain, or breathing difficulties call for urgent medical attention.
Key takeaway: The postpartum period is an essential transition that calls for regular medical follow-up, for both mother and newborn. Lean on healthcare professionals, and report any unusual symptom right away.
Sources
- MedlinePlus: Going home after having a baby, U.S. National Library of Medicine, postpartum recovery and warning signs
- CDC HEAR HER: Urgent Maternal Warning Signs, urgent maternal warning signs including trouble breathing, chest pain, and fever of 100.4°F or higher
- MedlinePlus: Premature infant, U.S. National Library of Medicine
- MedlinePlus: Kegel exercises, U.S. National Library of Medicine, pelvic floor muscle training
- MedlinePlus: Normal growth and development, U.S. National Library of Medicine, normal newborn weight loss after birth
- Office on Women’s Health: Postpartum depression, U.S. Department of Health and Human Services
- CDC/NCHS: Births in the United States, 2023, National Center for Health Statistics, annual U.S. birth count
- AAFP: Postpartum Care, An Approach to the Fourth Trimester, American Academy of Family Physicians, ACOG postpartum visit timing (within 3 weeks and a comprehensive visit by 12 weeks)