Dazed and Confused: Post-Partum Days 3-5
All too frequently, I see mothers 3 to 5 days post partum who are simply just dazed and confused. Their hospital stay has been hard, and they are unsure, have lost confidence and are focused on numbers. Numbers of everything: bilirubin, weight loss, stool diapers, wet diapers, minutes at the breast (left and right), hours between feedings, time of last feeding, time to next feeding, hours slept or not slept.
Add to that a dazzling array of instruction for cord care, diaper care, skin care, and bathing and the often scary warnings about sleep placement, plus post-partum care for mom, conflicting (and often unsolicited) opinions from doctors, nurses, lactation consultants, family members and friends and you have a recipe for “dazed and confused.”
It’s heartbreaking watching a new mother in my exam room, tearful, trying to wade through what she wants to say and ask. Words like powerless, despair, anguish, and failure run through the subtext of the conversations. All that information, given with the best intentions, has created a truly and deeply hard situation.
It's really no wonder that the first large drop off in breastfeeding rates happens in the first week.
So, what can we do? Well, I love to say "worry in order." A simple philosophy really, to help prioritize what needs to come next. It does us no good to worry about college when our beautiful new baby is still hasn't learned the fine art of potty training. It does us no good to worry about potty training when the umbilical cord hasn't even fallen off. You get the picture- it's too easy to live your life all in the one moment. We don't need that, especially in the days immediately giving birth.
So, look at your baby. Soak in the newborn smell, admire the incredible delicacy of the hands. Watch the fun tongue movements and facial expressions. Enjoy watching that special peace on the face of a baby who is sleeping. Celebrate that you are the one who brought that beautiful baby into the world and then breathe. Just breathe.
What numbers are important? If it were up to me, all the clocks in the homes of new parents would be turned off. Rules about how long to feed aren't helpful. The number of feedings is important, but counting them doesn't take a clock. And the hormone that allows milk to be released from the breast, oxytocin, is exquisitely sensitive to stress. Makes perfect sense too. If you could release milk in front of a predator (you know my preference is a tiger, why? It works: easy to picture, hard to forget) in a place that really wasn't safe, the creatures trying to get you could use a trail of milk to track you down. Less stress, more oxytocin, more milk release and happier mom and baby.
What other tigers can we tackle as we worry in order? Well, visitors come to mind. I get it- everyone wants to meet the new baby. We take such good care of you when you're pregnant, throwing showers, opening doors, giving up our seats or whatever so you can be comfortable. The you have the baby and things change. I feel especially sorry for those mothers who have C-sections. Really, I think we'd pay more attention to you if you had your appendix out. Mothers who had a C-section had surgery, no way around that. After we have surgery, we relax and recover. But now you have to care for a new baby. No matter how your baby was born, you still have to recover, come to understand and embrace your birth experience, even if it was absolutely perfect but especially if it wasn't what you planned. If you have visitors on top of that, hopefully they are willing to help. If they aren't, or expect you to entertain, have a clean house or even clean clothes on, maybe they should wait until you and your new family are recovered and ready to have people come over. I love dad to step in here. He can protect his new family and decide when visitors are welcome.
Waking a sleeping baby is especially no fun. A baby who hasn't demonstrated feeding cues and is woken up anyway to eat might just snuggle against the breast and sleep. The breast is warm, smells good and familiar, represents safety and comfort and is a neat place to fall back asleep. Babies should be fed on cue.
It's easier on everyone if the baby is feeding when there is an interest is feeding. Now, there are cases where babies sleep and sleep and sleep and make everybody nervous. The best indicator that a baby is transferring enough milk is stool output. The first milk, colostrum, is full of sugars called oligosaccharides. They are a form of insoluble fiber, meaning they aren't digested, and therefore they act as a great laxative. The more colostrum a baby transfers, the more stool is produced. That stool goes from black and tarry stuff I swear you could build houses with, to green and tarry and less sticky to brown to yellow. And we'd love yellow stool on day 4, maybe 5 of life. I feel as if I turn perfectly intelligent people into "poop watchers." As long as your very sleepy baby is stooling and moving that meconium out, then we're transferring milk and all is well. No stool output and you should ask for help. Seriously, ask. There are armies of people out there who want to help. I know I have to give most new moms permission to get that help, so I am. Ask for help. In fact, in most prenatal breastfeeding classes I teach, I have moms raise their hands and promise me they will ask for help. Those of us trained and passionate about helping breastfeeding mothers want to hear from you. We are the hired help.
Why harp on this? Because another reason I see "dazed and confused" mothers in the immediate newborn period is that they are under the impression that pain is a part of breastfeeding. Not true. I can't tell you how many arguments I've had with new (and experienced) mothers where they think pain in the first few days is to be expected. Or that pain with the initial few sucks of the latch is normal. Now tell me. When is pain normal? It's a terrifically designed part of the human body which acts as a signal that something is wrong.
Pain is not normal. Pressure, soreness, maybe. But pain? No way. And nobody can look at the latch and say "well, it looks fine." Whether the latch is "fine" depends on your comfort when the baby latches. If the latch hurts, no matter what it looks like from the outside, something is wrong.
Too often we see the nipple and surrounding areola as a bull's-eye. And we treat it as such, trying to aim the baby's mouth to be centered over the nipple. What really needs to happen is that the baby's tongue needs to compress the milk ducts, which are behind the areola and nipple and compress them from below the nipple, not from the center of the bull's-eye target. When we center the baby's mouth with the nipple right in the middle, the baby will scrape the nipple for a few sucks before the tongue gets into the right spot. That hurts and pain is a sign that something is wrong.
If the latch keeps hurting, it's a lose-lose situation: the baby is not transferring milk because the tongue is in the wrong place and you are getting beat up, experiencing pain and nipple trauma. The baby is hungry , you're in pain- who wins? Nobody. The latch is not supposed to hurt. If it does, please, please, please ask for help. Pain is a tiger. It inhibits oxytocin and impairs milk release.
Getting the picture? Ask for help! Nobody wants you dazed and confused.
Jenny Thomas, MD, MPH, IBCLC, FAAP, FABM
Me and my son Ryan. I don't remember showering.
Actually, I don't remember this picture being taken.
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