Written by midwife and creator of Bumpnbub, Aliza Carr.
If you choose to give birth in a hospital or birth centre, what happens after you've given birth? Let's chat about this important topic.
After your baby is born, you will initially spend time in the birth suite or the recovery area having skin to skin and bonding with your new baby. During this time, bub will begin to transition to extra-uterine life and have their first breastfeed or bottle-feed. If you have a straightforward vaginal birth, you may have the option to go home after 4-6 hours. Otherwise, you will be transferred to the postnatal ward, where healthcare professionals will look after you and your baby. This is the beginning of your postpartum journey, where you and your partner will increase your confidence and knowledge in caring for your baby before being discharged home. Midwives will be the main health professionals that will care for you and bub 24 hours a day in the hospital, with their role being to guide, support, educate and empower you and your partner as you transition into parenthood. Another healthcare professional that you may see after birth is a physiotherapist, usually on day one or two post-vaginal birth or C-section, to assess your movement, abdominal separation and pelvic floor if needed. A physiotherapist is an excellent source of information regarding your recovery post-birth and can also recommend safe exercises and postnatal follow-up if required.
If you have a vaginal birth with no complications, many hospitals will offer you and your partner the opportunity to be discharged directly from the birth suite if you choose. Being discharged straight home does have advantages and disadvantages, and your hospital should organise appropriate follow-up for you and bub, including midwife home visits. It is also absolutely okay if you want to stay in the hospital on the postnatal ward before taking your new bundle of joy home. How long you stay in hospital after giving birth is determined by your preferences and other important factors such as;
- Whether or not you are in a public or private hospital,
- if you had any birth or postnatal complications,
- what number baby this is for you,
- how bub is feeding and adapting to the outside world,
- if you have good support at home and,
- getting clearance from a doctor or midwife, as well as bub's paediatrician before you go home.
The normal length of stay after a vaginal birth is around 24 hours in a public hospital and 3-4 days in a private hospital. After a C-section, you will typically stay three days in a public hospital and five days in a private one. In some situations, you may go home before the average length of stay, or you may be in hospital for longer. Before being discharged home, your midwife will provide you and your partner with postnatal education, including resources, helpline numbers, and information on how to access support in the community. Your midwife or obstetrician will also inform you of the recommended follow-ups for you and bub in the postpartum period. While you are in the hospital, your stay may be slightly different depending on if you have a vaginal birth or C-section.
What To Expect In Hospital After A Vaginal Birth
After giving birth to your beautiful baby, you will spend a few hours in the birth suite before being transferred to the postnatal ward (if you choose to remain in the hospital). The midwives on the ward will be checking your observations and blood loss, as well as your stitches (if you had any) to ensure your perineum is not too swollen or bruised. If you have an epidural in labour, a midwife will be present when you get out of bed for the first time after birth to ensure movement and sensation has returned in your legs. Once you are stable on your feet and feeling well, your midwife will also remove the catheter from your bladder, which is inserted in labour after you have an epidural. The first time you pass urine after the catheter is removed (or even if you didn't have a catheter) may be uncomfortable and sting, so it is a good idea to stand in the shower or pour water over your perineum as you pass urine for the first time to minimise the discomfort. Midwives on the postnatal ward will assess your perineum every day, with your consent, even if you haven't had stitches and encourage good perineal care. Caring for your perineum in the postnatal period involves; frequent pad changes (every 3/4hrs), taking pain relief if needed, lying on your side and using ice appropriately for the first three days.
What To Expect In Hospital After A C-Section
After birthing your baby via a C-section, you and bub will be transferred to recovery, where you will be monitored for about an hour before going to the postnatal ward. Your midwife on the ward will undertake regular observations on you and bub in the first 12-24hrs post-C-section, including checking your wound, blood loss, urine output and giving you medication if you feel sick or have any pain. You can commence a light diet a few hours after your C-section if you aren't feeling sick and drink fluids to thirst. As you will not be able to get out of bed straight after your C-section, your midwife will give you and your partner lots of help with bub. As a C-section is a major operation and you will be in bed for some time afterwards, your doctor will explain there is a risk of having a blood clot. To minimise your risk of a blood clot (known as deep vein thrombosis or DVT), your doctor or midwife will likely recommend giving you a small injection containing a blood thinner every day while in hospital and wearing compression stockings. Your midwife will help to apply your compression stockings in hospital, and they are encouraged for up to six weeks after a C-section, especially while you are resting at home. Another way to lower your risk of a blood clot and promote a quicker recovery is early mobilisation. About 12 hours after your C-section, or the next day, your midwife will offer you some strong pain relief before helping you to get out of bed for the first time. Effective analgesia is a key factor in encouraging early mobilisation. After you get out of bed, your midwife will assist you to have a shower (which normally feels like the best shower of your life) and remove the catheter tube that was placed in your bladder during the C-section, which means you can then pass urine normally.
In the early days following your C-section, the easiest tasks, such as getting out of bed, may be challenging at first, but midwives and physiotherapists will help you with techniques to assist you in moving gently. If your wound feels sore at any time, make sure you ask your midwife for pain relief which will help you to move comfortably and care for your baby. A healthy diet, plenty of water and moving around after a C-section will assist your bowels and elimination. Due to having surgery, strong pain medication and being less mobile than usual, constipation is common. Your doctor or midwife will prescribe you some stool softeners or laxatives in the days or weeks after your C-section if needed. While you are in hospital, your midwife will also inspect your wound and ensure it is healing well and there are no signs of infection. Before discharge, your midwife will inform you of when to have the dressing on your wound removed, depending on which type of dressing it is. Most C-section wounds have dissolvable stitches, although sometimes there is a stitch that needs to be removed in the hospital or by your GP.
What To Expect In Hospital For Your Baby
Immediately after birth or in the first 24hrs of life, a paediatrician or experienced midwife will conduct a full head to toe examination on your baby as a baseline assessment. If you have consented for your baby to have a vitamin K injection, this will normally be given to bub in the birth suite or theatre before being transferred to the postnatal ward. While in hospital, your midwife will monitor bub for any rashes or jaundice and track their output to ensure they have passed urine and meconium before you are discharged home. Midwives on the postnatal ward will support you and bub with breastfeeding or bottle-feeding and provide you with feeding education no matter which feeding method you choose. Lactation Consultants in the hospital can also provide hands-on guidance with feeding if you have any concerns. If you and your partner decide to formula feed your baby, Maternity Care in Australia guidelines states that while on the postnatal ward, you should be taught how to prepare the correct quantity of formula, physically feed your baby a bottle and know how to correctly clean and sterilise bottles. Your baby's first bath may also occur in hospital, normally after 24-48hrs or as per your preference. If you have never bathed a baby before or want a refresher, your midwife can give you and your partner a demonstration on bathing bub first.
When your baby is between 48-72hrs old, your midwife will gain your consent to perform a short test called the Neonatal Screening Test (NNST). NNST is a universal test that involves a heel prick and placing drops of bub's blood on the test paper. This gets sent away and tested for different metabolic conditions that do not have obvious symptoms in babies, such as cystic fibrosis. On day three, your baby also gets weighed to determine how much weight they have lost since birth. It is completely normal for bubs to lose up to 10% of their birth weight by day three due to fluid loss and only consuming small amounts of colostrum or formula. If you have been discharged home before day three, a midwife will usually visit you at home to conduct the NNST, weigh bub and see how your feeding is going. If anything was missed in the hospital, such as the bath demonstration or any education you are unsure about, ensure you ask your midwife, child health nurse or obstetrician at your postnatal follow-up.