What to expect when you're expecting (172 page)

So give yourself that time—time to get used to being a mother (it’s a major adjustment, after all) and time to get to know your baby, who, let’s face it, is a newcomer in your life. Meet your baby’s basic needs (and your own), and you’ll find that love connection forming—one day (and one cuddle) at a time. And speaking of cuddles, bring ’em on. The more nurturing you do, the more like a nurturer you’ll feel. Though it may not seem like it’s coming naturally at first, the more time you spend cuddling, caressing, feeding, massaging, singing to, cooing to, and talking to your baby—the more time you spend skin to skin and face to face—the more natural it will start feeling, and the closer you’ll become. Believe it or not, before you know it, you’ll feel like the mother you are (really!), bound to your baby by the kind of love you’ve dreamed of.

“My new son was premature and was rushed to the NICU right away. The doctors say he’ll be there for at least two weeks. Will it be too late for good bonding when he gets out?”

Not at all. Sure, having a chance to bond right after birth—to make contact, skin to skin, eye to eye—is wonderful. It’s a first step in the development of a lasting parent-child connection. But it’s only the first step. And this step doesn’t have to take place at delivery. It can take place hours or days later in a hospital bed, or through the portholes of an incubator, or even weeks later at home.

And luckily, you’ll be able to touch, talk to, or possibly hold your baby even while he’s in the NICU. Most hospitals not only allow parent-child contact in such situations, they encourage it. Talk to the nurse in charge of the NICU and see how you can best get close to your newborn during this trying time. For more on the care of premature babies, see
What to Expect the First Year.

Keep in mind, too, that even moms and dads who have a chance to bond in the birthing room don’t necessarily feel that instant attachment (see the previous question). Love that lasts a lifetime takes time to develop—time that you and your baby will start having together soon.

“Having the baby room in with me sounded like a great idea when I was pregnant. But back then I had no idea how tired I was going to be. What kind of mother would I be, though, if I asked the nurse to take her?”

You would be a very human mother. You’ve just completed one of life’s greatest challenges, childbirth, and are about to begin an even greater one, child rearing. Needing a little bit of rest in between is completely normal—and completely understandable.

Full-time rooming-in is a wonderful option in family-centered maternity care, giving new parents the chance to start getting to know their new arrival from minute one. But it’s not a requirement, and it’s not for everyone. Some women handle it easily, of course—maybe because their deliveries were a breeze or because they came on the job with previous newborn experience. For them, an inconsolable infant at 3 a.m. may not be a joy, but it’s not a nightmare, either. However, for a new mom who’s been without sleep for more hours than she can count, who’s drained from labor and delivery, and who’s never been closer to a baby than a diaper ad (sound familiar?), such predawn bouts can leave her feeling overwhelmed and underprepared.

If you’re happy having your baby room with you, great. But if you committed to this sleeping arrangement only to realize you’d really rather get some sleep, don’t feel you can’t opt out. Partial rooming-in (during the day but not at night) may be a good compromise for you. Or you might prefer to get a good night’s sleep the first night and start rooming-in on the second. Just make sure that baby is brought to you for feedings—and not given any supplementary bottles—if you’re nursing.

Be flexible. Focus on the quality of the time you spend with your baby in the hospital rather than the quantity, and don’t feel guilty about factoring your own needs into the equation. Round-the-clock rooming-in will begin soon enough at home. Get the rest you need now and you’ll be better equipped to handle it later.

“What will my recovery from a C-section be like?”

Recovery from a C-section is similar to recovery from any abdominal surgery, with a delightful difference: Instead of losing an old gallbladder or appendix, you gain a brand-new baby.

Of course, there’s another difference, arguably less delightful. In addition to recovering from surgery, you’ll also be recovering from childbirth. Except for a neatly intact perineum, you’ll experience all the same postpartum discomforts over the next weeks (lucky you!) that you would have had if you’d delivered vaginally: afterpains, lochia, perineal discomfort (if you went through a lengthy labor before the surgery), breast engorgement, fatigue, hormonal changes, and excessive perspiration, to name a few.

As for your surgical recovery, you can expect the following in the recovery room:

Pain around your incision.
Once the anesthesia wears off, your wound, like any wound, is going to hurt—though just how much depends on many factors, including your personal pain threshold and how many cesarean deliveries you’ve had (the first is usually the most uncomfortable). You will probably be given pain relief medication as needed, which may make you feel woozy or drugged. It will also allow you to get some needed sleep. You don’t have to be concerned if you’re nursing; the medication won’t pass into your colostrum, and by the time your milk comes in, you probably won’t need any heavy painkillers. If the pain continues for weeks, as it sometimes does, you can safely rely on over-the-counter pain relief. Ask your practitioner for a recommendation and dosing. To encourage healing, also try to avoid heavy lifting for the first few weeks after the surgery.

Possible nausea, with or without vomiting.
This isn’t always an aftereffect of the surgery, but if it is, you may be given an anti-nausea medication.

Exhaustion.
You’re likely to feel somewhat weak after surgery, partly due to blood loss, partly due to the anesthetic. If you went through some hours of labor before the surgery, you’ll feel even more beat. You might also feel emotionally spent (after all, you did just have a baby—and surgery), especially if the C-section wasn’t planned.

Regular evaluations of your condition.
A nurse will periodically check your vital signs (temperature, blood pressure, pulse, respiration), your urinary output and vaginal bleeding, the dressing on your incision, and the firmness and level of your uterus (as it shrinks in size and makes its way back into the pelvis). She will also check your IV and urinary catheter.

Once you have been moved to your room, you can expect:

More checking.
The nurse will continue to monitor your condition.

Removal of the urinary catheter.
This will probably take place shortly after surgery. Urination may be difficult, so try the tips on
page 426
. If they don’t work, the catheter may be reinserted until you can pee by yourself.

Encouragement to exercise.
Before you’re out of bed, you’ll be encouraged to wiggle your toes, flex your feet to stretch your calf muscles, push against the end of the bed with your feet, and turn from side to side. You can also try the exercises on
pages 466
and
467
. They’re intended to improve circulation, especially in your legs, and prevent the development of blood clots. (But be prepared for some of them to be quite uncomfortable, at least for the first 24 hours or so.)

To get up between 8 and 24 hours after surgery.
With the help of a nurse, you’ll sit up first, supported by the raised head of the bed. Then, using your hands for support, you’ll slide your legs over the side of the bed and dangle them for a few minutes. Then, slowly, you’ll be helped to step down on the floor, your hands still on the bed. If you feel dizzy (which is normal), sit right back down. Steady yourself for a few more minutes before taking a couple of steps, and then take them slowly; the first few may be extremely painful. Though you may need help the first few times you get up, this difficulty in getting around is temporary. In fact, you may soon find yourself more mobile than the vaginal deliveree next door—and you will probably have the edge when it comes to sitting.

A slow return to a normal diet.
While it used to be routine (and still is in some hospitals and with some physicians) to keep women on IV fluids for the first 24 hours after a cesarean delivery and limit them to clear liquids for a day or two after that, starting up on solids much sooner may be a better bet. Research has shown that women who start back on solids earlier (gradually, but beginning as early as four to eight hours post-op) have that first bowel movement earlier and are generally ready to be released from the hospital 24 hours sooner than those kept on fluids only. Procedures may vary from hospital to hospital and from physician to physician; your condition after the surgery may also play a part in deciding when to pull the plug on the IV and when to pull out the silverware. Keep in mind, too, that reintroduction of solids will come in stages. You’ll start with fluids by mouth, moving on next to something soft and easily tolerated (like Jell-O), and on (slowly) from there. But your diet will have to stay on the bland and easily digested side for at least a few days; don’t even think about having someone smuggle in a burger yet. Once you’re back on solids, don’t forget to push the fluids, too—especially if you’re breastfeeding.

Referred shoulder pain.
Irritation of the diaphragm, caused by small amounts of blood in your belly, can cause a few hours of sharp shoulder pain following surgery. A pain reliever may help.

Probably constipation.
Since the anesthesia and the surgery (plus your limited diet) may slow your bowels down, it may be a few days until you pass that first movement, and that’s normal. You may also experience some painful gassiness because of the constipation. A stool softener, suppository, or other mild laxative may be prescribed to help move things along, especially if you’re uncomfortable. The tips on
page 427
may help, too.

Abdominal discomfort.
As your digestive tract (temporarily put out of commission by surgery) begins to function again, trapped gas can cause considerable pain, especially when it presses against your incision line. The discomfort may be worse when you laugh, cough, or sneeze. Ask the nurse or doctor to suggest some possible remedies. A suppository may help release the gas, as may strolling up and down the hall. Lying on your side or on your back, your knees drawn up, taking deep breaths while holding your incision can also bring some relief.

To spend time with your baby.
You’ll be encouraged to cuddle and feed your baby as soon as possible (if you’re nursing, place the baby on a pillow over your incision or lie on your side while nursing). And yes, you can even lift your baby. Hospital regulations and your condition permitting, you’ll probably be able to have modified or full rooming-in; having your spouse bunking with you, too, will be a big help. Don’t push the rooming-in agenda, though, if you’re not up to it—or just want some rest.

Removal of stitches.
If your stitches or staples aren’t self-absorbing, they will be removed about four or five days after delivery. The procedure isn’t very painful, although you may have some discomfort. When the dressing is off, take a good look at the incision with the nurse or doctor; ask how soon you can expect the area to heal, which changes will be normal, and which might require medical attention.

In most cases, you can expect to go home about two to four days postpartum. But you’ll still have to take it easy, and you’ll continue to need help both with baby care and self-care. Try to have someone with you at all times during the first couple of weeks.

“In the hospital, the nurses changed my baby’s diaper, gave him a bath, and told me when to nurse him. Now that I’m home with him, I feel underprepared and overwhelmed.”

It’s true that babies aren’t born with how-to’s written on their cute, dimply bottoms (wouldn’t that be convenient?). Fortunately, they do typically come home from the hospital with instructions from the staff about feeding, bathing, and changing diapers. Already lost those? Or maybe they ended up smeared with mustardy poop the first time you tried to change baby’s diaper while simultaneously trying to read the instructions for changing baby’s diaper? Not to worry; there’s a wealth of information out there to help you tackle your new job as new parent both in books and online. Plus, you’ve probably already scheduled the first visit to the pediatrician, where you’ll be armed with even more information—not to mention answers to the 3,000 questions you’ve managed to accumulate (that is, if you remember to write them down and bring them along).

Of course, it takes more than know-how to make a parenting expert out of a new parent. It takes patience, perseverance, and practice, practice, practice. Luckily, babies are forgiving as you learn. They don’t care if you put the diaper on backward or forgot to wash behind their ears at bath time. They’re also not shy about giving you feedback: They’ll definitely let you know if they’re hungry, tired, or if you’ve made the bathwater too cold (though at first you may not be able to tell which complaint is which). Best of all, since your baby’s never had another mom to compare you with, you definitely stack up really well in his book. In fact, you’re the best he’s ever had.

Still suffering from a crumbling of confidence? What might help most—besides the passing of time and the accumulation of experience—is to know that you’re in good company. Every mom (even those seasoned pros you doubtless eye with envy) feels in over her head in those early weeks, especially when postpartum exhaustion—teamed with nightly sleep deprivation and the recovery from childbirth—is taking its toll on her, body and soul. So cut yourself plenty of slack (and while you’re at it, cut yourself a piece of cheese and maybe a slice of bread, too—low blood sugar can contribute to that overwhelmed feeling), and give yourself plenty of time to adjust and to get with the parenting program. Pretty soon (sooner than you think), the everyday challenges of baby care won’t be so challenging anymore. In fact, they’ll come so naturally, you’ll be able to do them in your sleep (and will often feel as though you are). You’ll be diapering, feeding, burping, and soothing with the best of them—with one arm tied behind your back (or at least, one arm folding laundry, catching up on e-mail, reading a book, spooning cereal into your mouth, or otherwise multitasking). You’ll be a mother. And mothers, in case you haven’t heard, can do anything.