Bringing Your Baby Home: A Few Tips for a Calmer Hospital Departure
by Sylvia Brown and Mary Dowd Struck

The day before you are to check out, send home as much as possible especially flowers, plants, gifts, and any large items.

You probably will still be wearing maternity clothes -- or at least ample, roomy clothes -- for another two weeks. For the next two to six months, be prepared to wear clothes that are at least two sizes larger than your pre-pregnancy clothes.

When leaving the hospital, you will probably be escorted to the door in a wheelchair. Some hospitals allow you to walk to the door unescorted. Once you are released by the nurse or aide, carry only the baby and your handbag, and a burp cloth in case the baby spits up. Ask the person accompanying you home to carry everything else.

A new mother walks more slowly than usual, especially after a cesarean. Take your time. Checking out of the hospital always takes more time than you think it will. If you are still taking painkillers, keep them handy, so as to be at ease on the way home.

Ask the person accompanying you to bring the car close to the hospital door.

If you have never put a baby in a car seat, do not underestimate how complicated this can be at first. You should have at least read the instructions beforehand and preferably practiced at home. Some mothers prefer to settle the baby into the car seat while still in the hospital, and then install the seat in the car with the baby already in place. Do not forget that you should never place the car seat in front of an airbag. Pediatricians also advise against leaving the baby in a car seat for several hours. Once on the road, resist the temptation to take the baby in your arms to comfort or feed him. If you must take him out of the seat, ask the driver to pull over to the side of the road.

In winter, ask your family to turn up the heat in your home to 72F, the night before you come home, so that the temperature will be comparable to that of your hospital room. Once you are at home, you can reduce the temperature one degree every day until you reach your household's normal temperature. To save your partner needless trips to the pharmacy, buy all your sanitary napkins ahead of time for the four to six weeks during which you will be bleeding (special postpartum, extra-long and extra-absorbent for the early days or "overnight" pads, then normal ones for day and night, and finally smaller pads for light flows).

Before leaving the hospital, ask for the direct number of the maternity ward and the name of a nurse or two (and their shift hours) that you call from home if you have an important question. Many hospitals provide a call service or "warm line" for new mothers with questions.

Copyright © 2003 Sylvia Brown with Mary Dowd Struck

Additional articles from The Post-Pregnancy Handbook by Sylvia Brown and Mary Dowd Struck:

The Nursing Mother's Diet

From Partner to Father - The Importance of Expectations Management

To Purchase, click on one of the links below:

• Amazon U.S.
• Amazon UK
• Amazon Canada

While a number of books exist which deal with various aspects of the postnatal experience - breastfeeding, exercise, motherhood, post-partum depression - this is the first complete source of information on what a woman experiences both physically and emotionally in the days, weeks and months after childbirth. It is also the only book in its field which balances medical advice with practical tips and numerous references to alternative remedies. From Sylvia Brown, a mother, and Mary Dowd Struck, RN, MS, CNM, a nurse/midwife, comes The Post-Pregnancy Handbook, a wonderfully comprehensive, honest self-help guide which every new (and repeat) mother should keep by her bedside. Read more about the book here.

Sylvia Brown wrote The Post-Pregnancy Handbook in response to her own frustration at the lack of comprehensive information for the mother in the weeks and months after childbirth. Sylvia graciously answered questions from StorkNet Members.

StorkNet: Hello, Sylvia, and welcome to StorkNet! We love The Post-Pregnancy Handbook and are very grateful that you are here to chat about it and take questions from our site readers. Thank you for taking the time out of your schedule. You explained that you wrote this book in response to your own frustration at the lack of information for new mothers after childbirth. So with that in mind, do you have a favorite chapter? A specific topic that struck close to home more than others? What's next for you?

Sylvia: Hello Nancy. I'm delighted to share some of the advice and information that I gathered in researching The Post Pregnancy Handbook. All of it comes from medical sources. My job was to make it clear and easy to understand. Before writing the book, I sent questionnaires to 300 new moms on the topics that they wanted covered. But as a mother of two myself, I consider my three most important chapters to be the ones on the pelvic floor, postnatal depression and loosing weight after childbirth. These happen to be three of the most misunderstood topics relating to the post-pregnancy period. So I very happy that your readers have sent me questions on all of these!

Right now, The Post Pregnancy Handbook exists in America and France. I am currently working on a British edition and hope to produce a Spanish edition soon. Each version requires an almost complete re-write because childbirth is approached so differently from one country to the next!

StorkNet: Sylvia, what a great endeavor that will be. I imagine the research is quite interesting if you are rewriting the book to assist different cultures. We would be interested to know some of the differences you have discovered. Our membership is comprised by women from all over the world, so we'll announce your upcoming editions.

We're anxious to read your replies, so let's get to the questions...

Maria: Does your book discuss how to deal with the onslaught of visitors who insist on "just stopping by" the first couple weeks, well-meaning mother-in-laws, and other intrusions? Do you have any suggestions? This time around I just want help, but no visitors who stay. Is that logical?

Sylvia: Hi Maria. Isn't it amazing how people just seem to pop out of the woodwork when you're just home from the hospital with a newborn! You are absolutely right to demand peace and quiet, especially if this is your second baby (you'll probably be more tired because you'll also be caring for the needs of your older child). This is a time when your partner can play a vital role in "guarding your door." Here are some of my suggestions:

• Record a message on your answering machine giving all the vital statistics that people want to know about the new baby. Then don't pick up the phone. Send out an e-mail mailing (with a photo if you have a digital camera!)
• Plan one or two "open houses" in two or three weeks (or whenever you feel ready) after the birth when friends and family can come by to see the baby.
• For really close friends and family, suggest that they come by at a specific time either bringing a meal, or the ingredients to a meal which they can cook and WASH UP at your house.
• Suggest to friends and family that they give you hours of housekeeping time or a subscription to a diaper service or a food delivery services (a close friend can organize this) rather than yet another outfit for the baby.
• Make certain that visitors don't smoke inside your home. Ask them to speak quietly.
• If you feel uncomfortable breast-feeding in front of visitors, ask them to leave or to entertain themselves with television or magazines while you nurse in another room. Don't feel rushed. Your baby is your first priority.
• Make sure that visitors don't ignore your older children.

I noticed you mention mothers-in-law. This is a tricky topic. If you are already having a difficult relationship with your in-laws, this is not the time to bring tensions into your home. Later on, however, the baby may provide a bridge between the two families. If you plan to have your mother or mother-in-law around to help with housekeeping, she may have her own habits and ideas. Are you ready to let her do it her way, at least for a while? If you plan to have both your mother and mother-in-law around, be aware of potential conflicts between the two grandmothers. This is one of the vital topics to discuss with your partner well before the birth. Remember, you will be more sensitive than normal - you don't need additional sources of stress.

Cathy: Do you suggest using a wrap or snugli? Are they really safe? I'm worried about carrying my baby at first. I have slight back problems.

Sylvia: Cathy, opinions differ on whether a wrap and/or a Snugli® may exacerbate back pain. Part of the problem is that many women don't know how to adjust a Snugli®. You can't imagine the number I see on the street who have theirs strapped much too low! You have to be able to kiss the top of the baby's head just by bending your neck down. I find wraps are good for newborns and the Snugli® for older babies. You might want to try putting your baby in a Snugli® facing out while you are sitting down. In many other cultures, babies are carried on their mothers' backs.

A few more posture tips (at a time when your back is particularly sensitive - 50% of new mothers suffer from back pain): Don't carry a baby over six months old on your hip - this will pull your spine to the side; Don't bend over to lift your older children (or to tie a shoelace). To lift a child, kneel on one knee, tighten your pelvic floor and abdominal muscles, breathe out, and then stand up with the child in your arms.

Whitney: I had my son just over 7 months ago, and am still really struggling with weight loss. I still have about 25 pounds to lose (combined from two pregnancies -- we lost our first son late term, and then I got pregnant again quickly, so the two pregnancies were only a few months apart). My son is eating two servings of solids a day, and other than that I'm exclusively breastfeeding. It seems like most of the women I know shed the pounds fairly effortlessly, and are back to their regular clothes, or one size up, by this point. I'm still wearing clothes that are two sizes larger, and I had to fight to get into those. Any ideas? Suggestions? I've been trying to follow the Weight Watchers lactation program, but I'm hungry all of the time, and am having a hard time sticking to it. Thanks!

Sylvia: First of all, Whitney, congratulations on the birth of your little boy, especially after your painful loss. Because of your two pregnancies, you are in a special category and should not compare yourself to your friends. Let me tell you a little about the mechanism of weight loss after childbirth:

Much depends on your size before you became pregnant. About one third of new mothers, who were "skinny" before pregnancy and gained only 25-30 pounds, will be back to their normal weight about three months after childbirth. Older moms, 3rd or 4th time mothers, or borderline overweight women will loose most of their excess weight between the 3rd and 6th months after childbirth. Overweight women (10-15% of the population) will loose most of their excess weight six to nine months after childbirth. They also benefit the most from breastfeeding for a long time (more than five months).

You are probably in the second to third group. This means that your weight loss will begin about now. Please, please keep breastfeeding! For the first six months, your body had high levels of the hormone prolactin, which stimulates milk production. Prolactin also tends to stimulate appetite and make nursing moms retain fluid. Now finally, your prolactin levels have dropped, but because you are still breastfeeding, your metabolism remains high. Your body will start using up its fat reserves now, especially on the thighs (yippee!). Make sure that you are getting about 2500 calories a day (you burn 750 breastfeeding) which include 12-15 grams of protein (6-11 will go back out in your milk), distributed as 50-60% complex carbohydrates, 25-30% fat, 20% protein. Your excess weight will come off. It just takes a little longer.

Sylvia: Hello Corrie. You have hit upon my favorite topic. I'm always shocked at how little attention the pelvic floor gets in America. Whenever I meet with new mothers' groups, I always ask who had their pelvic floor muscles tested at their six-week check-up and almost nobody raises their hand. I also keep meeting women who start an exercise program far too early after childbirth, and before toning their pelvic floor. No wonder so many women have incontinence and sexual dysfunction problems (they get much worse after menopause, so the time to do something is NOW). Unfortunately, most women are too embarrassed to talk about it, even to their doctor (they wait on average 7 years before seeking help - who wants to have bad sex for seven years!) So thanks for speaking up.

During pregnancy, the weight of the uterus increases by twenty to thirty times. As it grows, the uterus pushes the bladder downward. Furthermore, the muscles and ligaments that normally hold up the reproductive and digestive organs are how weaker under the effects of relaxin. Childbirth will then stretch and distend these muscles, no matter how well a woman prepares for delivery - after a vaginal delivery, the pelvic floor looses about 50% of its tone. Episiotomies, tears and abnormal straining during the expulsion phase all add to the damage. If the pelvic floor muscles are not restored to their proper tone, the sphincters can no longer clamp down properly on the bladder (and in some cases on the anal) opening, causing leakage.

It is therefore essential to begin gentle pelvic floor toning exercises (described in my book) in the days after childbirth and to practice these for nine minutes a day for the first six weeks. Pelvic floor exercises are also very helpful in speeding the healing process after an episiotomy or tearing. DO NOT BEGIN AN EXERCISE PROGRAM UNTIL YOUR PELVIC FLOOR HAS RECOVERED ITS TONE. Your health practitioner should check your pelvic floor tone at your postpartum check up. If they don't ASK FOR IT!

In your particular case, Corrie, please get your doctor to recommend a urologist NOW, while you are still pregnant. A specialized physiotherapist can watch you do your kegels, help you get them right, and suggest other exercises for your specific needs. You probably should plan to have several sessions of urinary physiotherapy after childbirth too. In France, the government pays for every new mother to have ten such sessions! It means fewer hysterectomies and long term problems, which will end up costing them much more. Good luck. Don't take no for an answer.