Sleep, rest, and relaxation

Try to make sure you’re getting enough rest so you have the energy to look after your baby. Finding time to rest will not be easy with a premature baby so here are a few ways to get some rest and relaxation:

• Try to sleep when your baby is sleeping; go to bed early, and take short naps whenever you can!
• If you can’t sleep, use quiet time to eat a meal, read, listen to music, have a bath, or simply sit quietly.
• If housework is bothering you then ask family and friends for help.
• Be honest about how you’re feeling and ask for support if you feel exhausted or overwhelmed. Every parent of a premature baby will face different challenges, depending on their home life.

Accept all help from family, friends, or volunteers. Take time to be with your partner, and spend time with any older children. Here are some helpful tips on how you can ask others to help you. Tell them exactly what you need.

Ask them to:

• Prepare meals that are easy to re-heat or cook.
• Do the shopping or laundry.
• Help to pick up/care for other children.
• Provide lifts for shopping or any other journeys.
• Come to visit and bring food with them so you have company while you eat.

You can read more about looking after yourself and exercise on the following NHS websites;

Looking after yourself at www.tommys.org and Birth to Five (Chapter 9 Your own life.PDF)

Exercise and pregnancy at Royal College of Obstetrics and Gynaecology

Healthy eating and drinking

After bringing your baby home, healthy eating and drinking will help you cope especially if you are breastfeeding. Here are a few simple tips on healthy eating and drinking:

• Try to eat regular meals – breakfast, lunch and a main meal every day and be careful of your portion size if you are trying to lose weight. Include milk and dairy products for protein, calcium, and vitamins and eat as little as possible of fried food; drinks and confectionery high in added sugars (such as cakes, pastries and fizzy drinks); and other food high in fat and sugar (such as some take-away and fast foods).
• This can be difficult when you are caring for a premature baby, especially if you have other children. Ask for help with cooking and shopping, or arrange an online delivery.
• Fruit and vegetables provide vitamins and iron. Bread, potatoes and cereals have energy, fibre and vitamins.  Meat, fish, beans, pulses, and grains provide protein and iron. It is important to include a balance of these foods in your everyday meals, particularly if you’re breastfeeding as you’ll need a healthy diet to provide for your own needs as well as those of your premature baby.
• Don’t be afraid to ask friends, family, or grandparents for help with shopping and meal preparation. Ask them to prepare some simple snacks and meals so you can eat when  you are able.

The following websites will take you to sites with help and support on keeping fit and healthy after giving birth.

NHS Choices

Northern Ireland Local links at enjoyhealthyeating.info and getalifegetactive.com

Drinking

• Drink plenty of fluids. Aim for at least 2 litres (six to eight glasses) each day.
• If you’re worried about getting enough fluids, you can check your hydration by checking the colour of your wee. Pale-coloured wee is normal, but if it’s a dark yellow colour or smells strongly, then you should drink more water.
• Caffeine is a stimulant and might increase your anxiety so limit it to no more than 200mg or 2 cups of instant coffee daily.
• Drink decaffeinated tea and coffee, herbal drinks, and water.
• Limit the number of energy drinks you have, as they can be high in caffeine.
• Advice from the NHS is that you should not drink more than one or two units of alcohol a week when breastfeeding as it passes through to the baby in your breast milk. The only way to be certain that your baby will not be harmed, is not to drink at all when pregnant or breastfeeding.

The following sites approved by midwives and doctors will give you further information on eating, drinking, and alcohol consumption while breastfeeding.

NHS Choices | Royal College of Obstetrics and Gynaecology | Chapter 1 ‘Feeding your baby’

Losing weight

If you are concerned about your weight talk to your GP or Health Visitor. Being overweight or obese and the lifestyle associated with it can lead to problems that can affect you and your family’s health. If you have a BMI of 30 or more, (this is based on your height and weight) ask your GP to recommend a local weight-loss programme based on a balanced, healthy diet, regular physical activity and slow weight loss over time. Also ask your family and partner to help by supporting you. You will be more likely to reach and maintain a healthy weight if you have the support of a group and your family. Not only will you feel better about yourself and your own health but you will also be improving your baby’s and your family’s health. For advice on losing weight, healthy recipes and healthy eating for children the following organisations have helpful advice.

NHS Choices | Choose to live better | Healthy Choices Booklet | Eat Well

Looking after yourself through the first weeks and months with your premature baby can be hard – especially if they are very little, unwell or have a disability. Some days you won’t rest, exercise, or manage to eat properly but remember that getting outside to walk with your baby, eating healthy meals and staying active will make you feel physically and emotionally better.

If looking after yourself becomes difficult then talk to your partner and friends. Ask for help and don’t be afraid to talk to your GP or health visitor for support. Tiny Life has full details of baby and toddler groups in your area at TinyLife support. If you are not keen on organised groups you could get together with people you meet at the clinic, playgroup, or nursery.

The following sources and links may help. TinyLife | The Department of Health – Birth to five book Chapter 9: Your own life

Breast Care

Breast care is important not just in the days after giving birth, but for as long as you are feeding your baby. Here are a few things to consider when you are at home:

• Whether you are breast feeding or not, wearing a supportive nursing bra may help with any breast discomfort you feel in the six weeks after birth.
• If you are breastfeeding, neonatal unit staff will have taught you how to express and store your milk safely and will also have shown you how to use a breast pump. If you need to hire a breast pump, contact TinyLife support.
• If you are experiencing discomfort and you’re breastfeeding, then expressing milk will relieve the discomfort. Speak to your midwife or health visitor if you’re very uncomfortable.

You may experience some problems breastfeeding which can occur at any stage: if you do, follow this link for help.
Breastfeeding at home section

Caring for Stitches/Tears

If you have experienced tearing and/or an episiotomy when giving birth these are likely to be well healed by the time you go home with your premature baby. If you are still healing, here are some tips:

• Shower and wash the area frequently and gently with clean, warm water to help it heal.
• After bathing, dry yourself carefully.
• Sit down gently until you are healed.
• If you’re breastfeeding and need painkillers, check with your midwife, health visitor, GP, or pharmacist before you buy over-the-counter painkillers such as ibuprofen or paracetamol.
• Stitches usually dissolve naturally once the cut or tear has healed but sometimes they have to be taken out. Ask your midwife or GP if you’re worried.
• Vaginal bleeding will gradually become a brownish colour and may continue for up to six weeks after birth.
• Tampons are not recommended until after your 6 week postnatal check because they can cause infection.

If at any stage you find you are losing blood in large clots or notice a foul smell from your stitches, you should save your sanitary towels to show your midwife or GP as you might have an infection and may need some treatment.  Breastfeeding can cause cramps similar to period pains known as “after pains” which will make the bleeding redder and heavier in the first ten days.

Caring for your bowel/bladder

Problems with going to the toilet will probably be sorted by the time your premature baby goes home with you but this advice may help:

• Your tummy will often be quite ‘stretchy’ after delivery and will usually be bigger than before pregnancy because the muscles have stretched.
• If you eat well and do your postnatal exercises, your shape should gradually return to normal.
• Breastfeeding will help as it tightens the womb.
• Shower once or twice a day and keep.
• It’s common to leak urine accidentally after having a baby if you laugh, cough, or move suddenly. Pelvic floor exercises can help with this.
• If the problem lasts for more than three months see your GP who may refer you to a physiotherapist.
• To prevent constipation, eat plenty of fresh fruit, vegetables, wholegrain cereals, wholemeal bread, and drink plenty of water.
• Piles (haemorrhoids) are very common after birth but they usually disappear within a few days so ask your midwife for advice if you’re concerned.

Caring for your Pelvic floor

Postnatal exercises will help tone up the muscles of your pelvic floor and tummy, and help you get your shape back. The muscles of the pelvic floor form a cradle or hammock under your pelvis, supporting your bladder, womb, and bowel. You use these muscles when you wee, empty your bowels and when you have sex.

Having a baby can stretch and weaken these muscles so making them stronger means you are less likely to have a leaky bladder and more likely to enjoy sex.

Do the following exercises either sitting or standing anywhere:

1. Squeeze and draw up your back passage as if you’re holding in wind.
2. At the same time, squeeze your front passage as if you’re stopping the flow of urine.
3. Tightening and releasing the muscles slowly – this is a short squeeze. Rest for a second, then repeat these squeezes until you feel the muscles get tired. Now relax.
4. This time, hold the squeeze for as long as you can, but no longer than 10 seconds, then relax.
5. It’s important to keep breathing normally while you do these exercises. Make sure you don’t pull in your stomach or squeeze your buttocks when you squeeze.
6. Do these exercises 10 times, four to six times a day.
7. You may find it helps to imagine you are stopping yourself passing urine. Try stopping and starting (or slowing down) the flow of urine while you are on the toilet.

Ask your midwife, health visitor, or GP for advice if you have any problems with passing urine or going to the toilet.  They will advise you on where to go to get help.

The Bladder and Bowel Foundation website will also help: www.bladderandbowelfoundation.org

Caesarean section care

If you have had a Caesarean section it will take a longer time to recover than it does from a vaginal birth.

• You will be given regular painkillers to help with the wound pain in the first few days after birth. You may also have daily injections to prevent blood clots for five days, ten days or up to six weeks depending on your risk factors.
• You can drive as soon as you can move without pain and feel that you can safely perform an emergency stop of the car. This is usually 4 – 6 weeks after delivery. Be sure to check with your car insurance company first as they may require clearance from your GP or Midwife.
• If you find you are losing blood in large clots, notice a foul-smell from your discharge or caesarean section wound, or notice any redness of the wound, save your sanitary towels and tell your midwife or GP as you may need some treatment for a wound or womb infection.
• Deep vein thrombosis (DVT) is a serious condition where a clot develops in the deep veins of your legs and travels from your legs to your lungs. This is a risk in the first six weeks after birth and is prevented by keeping active. Get advice from your GP or midwife if you are considering  air travel during this time. The GP or health visitor can give you advice on travelling and sitting exercises to keep your circulation moving.
• Contact your midwife, GP or health visitor immediately if you have any severe pain, a cough, shortness of breath, or any signs of swelling or pain in your lower legs as these are the signs of a clot in your legs or lung.

More advice on recovering from a caesarean section can be found  at the following NHS Choices website:

http://www.nhs.uk/Conditions/Caesarean-section/Pages/Recovery.aspx

Additional Links :

National Institute for Health and Care Excellence (NICE): caesarean section.
Royal College of Obstetricians and Gynaecologists (RCOG): birth after previous caesarean (PDF, 494kb).
Royal College of Obstetricians and Gynaecologists (RCOG): caesarean section (PDF, 206kb). The 6-8 week postnatal check.
The Department of Health booklet ‘Birth to Five’ – a guide to parenthood and the first 5 years of a child’s life can be accessed here- www.publichealth.hscni.net

Do I need it?

It is a good idea to make time to talk to your GP about 6-8 weeks after the birth of your baby especially, if you have experienced a premature birth. You might want to make a list of questions to take along with you, especially if you are concerned about the reasons for your premature birth.

What to expect?

There are no set guidelines for a postnatal check for mums but it usually involves a chat about your birth to check how well you are physically and emotionally, how you are feeling, and to discuss contraception.

Here are some things the GP might ask or check:

• How you’re feeling as part of a general discussion about your mental health and wellbeing.
• If you still have any vaginal discharge and whether you have had a period since giving birth.
• Your blood pressure will be checked if you had blood pressure problems during pregnancy or immediately after birth.
• You may be offered an examination to see if your stitches have healed if you had an episiotomy or caesarean section.
• If you were due for a cervical screening test while pregnant, this should be rescheduled for 12 weeks after giving birth.
• You will be asked about pain during sex and discuss options for contraception.
• If you are overweight or obese with a BMI of 30 or more, you may be weighed. Your doctor should give you weight loss advice and guidance on healthy eating and physical activity and support group advice.
• If your premature baby is home before the 6- 8 week check, the check for mum will often be combined with your baby’s physical examination.