The First Days Postpartum

Source: *The Birth Partner* (5th ed.) — Penny Simkin with Katie Rohs

The Immediate Postpartum Period (First Two Hours)

The first two hours after birth are important for both the birthing person and the baby. The care team is focused on physical stability. The family is focused on each other. Both are happening at the same time.

Skin-to-Skin Contact

The baby goes directly on the birthing person's bare chest, covered with warm blankets. This is the best possible environment for the baby's first hours:

• Warmer and more stable than a warming unit
• Regulates the baby's heart rate, breathing, and blood sugar
• Triggers the baby's instinctive feeding behaviors
• Supports the birthing person's oxytocin release and uterine contraction
• Begins the attachment process

A newborn placed skin-to-skin will nuzzle, root, mouth the breast, and eventually latch independently within 60 to 90 minutes if undisturbed. Do not rush this. Let the baby find the breast.

If the birthing person is unable to hold the baby (recovering from general anesthesia, medical complication), the birth partner holds the baby skin-to-skin with a blanket over both of them.

Uterine Monitoring and Massage

The nurse checks the uterus frequently to confirm it is contracting and firm (the size and consistency of a large grapefruit, located below the belly button). A soft uterus bleeds.

If the uterus is not contracting:

1. Nipple stimulation or nursing — releases oxytocin, causes the uterus to contract

2. Fundal massage — the nurse kneads the low abdomen until the uterus firms. This is painful. The birthing person can do it themselves at a less intense level with the same effect.

3. Pitocin or other uterotonic medications by IV or injection — most reliable method

Perineal Care

After a vaginal birth, the caregiver inspects the vagina and perineum for tears or episiotomy. If stitches are needed and no anesthesia is in effect, local anesthetic is injected first. The sutures are self-dissolving; they do not need to be removed.

An ice pack applied to the perineum immediately after birth brings significant relief. This is one of the most underused comfort measures in the postpartum period.

After a Cesarean

The birthing person spends 1 to 2 hours in recovery while the anesthesia wears off. The birth partner and baby can be present. IV fluids and monitoring continue. Early skin-to-skin is possible in recovery in most cases, even with a cesarean — advocate for it.

The First Days: Newborn Care Procedures

Many of these happen in the first hour. Some are required by law. Others are optional. Know what they are so you can participate in the decision-making.

Suctioning

Most healthy babies clear their airways through coughing and sneezing without intervention. The American Academy of Pediatrics recommends reserving suctioning only for babies who have obvious airway obstruction or require assisted ventilation. You can request that routine suctioning be skipped if the baby is vigorous.

Cord Clamping and Cutting

The umbilical cord contains the baby's blood — approximately 150 mL (5 fluid ounces) remains in the placenta at birth. Delayed cord clamping allows this blood to transfer to the baby.

**Benefits of delayed clamping:**

• Increases iron stores by up to 45%, reducing anemia risk for the first 6 months
• Provides oxygen via the cord as the baby transitions to air breathing
• Supports faster optimal respiration
• For premature babies: reduces the need for blood transfusions

**How to request it:** Include in the birth plan. Ask the caregiver at check-in. The cord can be clamped after it stops pulsing (usually 3 to 5 minutes), or after a set time (1 to 3 minutes minimum).

The birth partner may cut the cord. The nurse will hand you scissors and show you exactly where to cut. The cord has no nerve endings; it is painless.

Eye Medication

Erythromycin ointment is placed in the baby's eyes within the first hour to prevent infection from gonorrhea or chlamydia that may be present in the birth canal.

Required by law in most states regardless of the parents' STI status.

The ointment blurs the baby's vision temporarily. To preserve the early period of clear vision, ask the nurse to delay application for up to an hour after birth.

Vitamin K

An injection given in the baby's thigh within an hour of birth. Vitamin K is essential for blood clotting. Newborns have low vitamin K stores and cannot produce their own until they begin consuming and metabolizing milk.

The injection is briefly painful. The American Academy of Pediatrics recommends only the injectable form; oral forms do not prevent later-onset vitamin K deficiency bleeding (VKDB).

Particularly important if the baby had a difficult delivery, is premature, or will be circumcised.

Newborn Blood Tests

At least two sets of blood draws in the first 48 hours:

**Heel-stick tests:**

• Bilirubin level (to assess for jaundice)
• Blood glucose (to assess for hypoglycemia, especially in babies of diabetic mothers or babies who are large or small for gestational age)
• Newborn screening: a single heel stick can test for 30+ rare but serious metabolic and genetic conditions (PKU, congenital hypothyroidism, sickle cell, galactosemia, MCAD deficiency, and many others). Required by state law. Early detection enables treatment that prevents permanent disability or death.

**Umbilical cord blood at birth:** Blood typing and Rh factor.

Making blood draws less stressful for the baby: warming the heel before the draw (more blood flow, less squeezing), holding the baby upright, breastfeeding during the procedure — all of these reduce the pain response.

Hearing Screening

Performed while the baby is asleep. Electrodes are placed around the head to measure brain-wave and middle-ear responses to sound. Results are immediate.

If the initial screen is inconclusive or failed, repeat testing is offered. Early identification of hearing problems (2 to 4 per 1,000 births) allows early intervention and significantly better language development outcomes.

Warming Unit vs. Skin-to-Skin

A warming unit with an overhead heater and a skin thermostat is used for babies who need medical attention or whose temperature is dropping.

Disadvantages: separation from parents; risk of fluid loss through evaporation.

Skin-to-skin is consistently more effective than a warming unit at stabilizing the baby's temperature — and is safe even for babies receiving oxygen or tube feeds (with medical team agreement).

Newborn Screening Tests

State-mandated newborn screening panels vary but the March of Dimes recommends testing for at least 34 disorders. One heel stick provides enough blood for all. Early identification leads to early treatment.

Circumcision

A personal and often religious decision. The American Academy of Pediatrics states that health benefits exist but are not great enough to recommend universal circumcision; they advise parents to decide based on their own values.

**If circumcision is chosen:**

• Typically performed in the hospital on day 1 or 2, or at home as part of a religious ceremony on day 8
• Local anesthetic should always be used (injected at the base of the penis, or cream applied 20 minutes before)
• The foreskin is separated from the glans and removed
• Healing takes 7 to 10 days
• Keep the area clean; apply lubricating ointment; watch for signs of infection or poor healing

**If not circumcised:**

• Do not forcibly retract the foreskin. It adheres to the glans at birth and separates gradually over months to years.
• Clean the outside of the penis during baths, nothing more. Forced retraction causes damage.

The First Days: Postpartum Recovery

The Uterus

The uterus shrinks rapidly after birth, contracting to roughly the size of a grapefruit just below the belly button. Over 6 to 8 weeks it returns to its pre-pregnant size.

**Afterpains:** Uterine contractions that come and go, particularly intense in the first 48 to 72 hours, especially during breastfeeding (oxytocin released by suckling causes contractions). More severe after second and subsequent births. Use relaxation and breathing techniques. Pain medication is available if needed. These resolve within a few days.

Vaginal Discharge (Lochia)

Lochia is the postpartum discharge of blood, uterine lining, and other tissue. It is normal and expected.

• Days 1 to 4: heavy red flow, may contain some clots
• Week 2: lightens to pink or brownish
• Weeks 3 to 6: yellowish-white and diminishing

**When to call the caregiver:**

• Heavy bleeding lasting more than a few minutes after standing up (pooled blood is normal, prolonged heavy flow is not)
• Passing clots larger than a golf ball
• Sudden increase after lochia had already lightened
• Foul odor (possible infection)

Perineum Care

Even without stitches, the perineum will be swollen and sore for several days.

**What helps:**

• Ice pack for the first 24 hours (several damp washcloths folded and frozen in plastic bags work well; make several at once)
• Sitz bath: sitting in warm water for 20 minutes, 2 to 3 times per day. Not for washing; for relief.
• Witch hazel-soaked pads applied to the perineum (and to hemorrhoids)
• After using the toilet: pat gently front to back, or squirt with warm water from a bottle
• Kegel exercises: 10-second holds, 10 repetitions daily, while seated

Bladder and Bowels

**Urination:** The bladder has more capacity now that the baby is no longer pressing on it. If unable to urinate within a half day of birth, run water, try urinating in the bath, press gently above the pubic bone (not after cesarean). A catheter may be needed if these measures fail.

**Bowel movements:** May take a day or more to resume. Abdominal muscles are temporarily weak. The perineum is sore.

What helps:

• High-fiber foods: prune juice, raw fruits and vegetables, bran
• Stool softeners or bulk-producing laxatives
• Supporting the perineum with folded toilet paper while having a bowel movement
• Patience — it takes 1 to 2 weeks for normal patterns to return

Postpartum Emotions

Baby Blues

Very common in the first week to two weeks after birth. Characterized by mood swings, tearfulness, irritability, and emotional sensitivity that come and go without a clear external cause.

Cause: The sudden dramatic shift in hormone levels after delivery.

**What the birth partner can do:**

• Do not blame yourself and do not try to fix it
• Know that most people experience this and it resolves within a few days
• Allow crying without trying to stop it; offer warmth and presence
• Encourage rest above all else — sleep deprivation amplifies all of this
• Encourage visits from empathetic friends if the birthing person feels isolated
• Call the caregiver if it does not improve after two weeks or if it seems severe

Postpartum Depression and Anxiety

If the blue feelings persist beyond two weeks, intensify, or include inability to care for the baby, significant anxiety, panic attacks, or any thoughts of harm, this is beyond baby blues.

Postpartum Support International (postpartum.net or 800-944-4773) is the primary resource. A referral to a therapist or psychiatrist, combined with peer support, is the appropriate response.

**The 10-question Edinburgh Postnatal Depression Scale** can be reviewed at home to help identify whether what is happening is within the normal range or warrants professional support. Simkin includes it in the book and it is widely available online.

**Approximately 10% of fathers also experience postpartum depression.** This is real and often unrecognized. Birth partners deserve to acknowledge their own mental health needs during this period.

The Birth Partner's Own Feelings

Becoming a parent is enormous. The chaos, the disrupted sleep, the complete shift in lifestyle — this is a lot. You are allowed to find it hard. You are allowed to need a break. Plan for a few hours of your own time when someone else is present with the birthing person and baby. You will be more present and useful for having had it.

Practical Matters in the First Days

Sleep: The Recipe

Sleep deprivation is genuinely harmful to the postpartum parent. It reduces milk supply, amplifies mood disorders, impairs decision-making, and makes everything harder.

**The recipe:** Decide how many hours of sleep you each need per 24 hours to function. That is your target. Plan for it. Stay in bed (in sleeping clothes) until you have accumulated that many hours — even if it takes 12 hours in bed to get 7 hours of sleep.

This means: do not get up in the morning until you have slept enough, even if it feels lazy. The phone should be unplugged. A DO NOT DISTURB sign goes on the door. No appointments before noon for the first several weeks.

**Platoon sleeping:** One partner sleeps from early evening until midnight. The other is on baby duty. Then they switch. Each person gets one unbroken stretch of sleep. This does not work perfectly — feedings interrupt it — but it is significantly better than both being up for every waking.

**Many parents find more sleep is possible when the baby is in the same room or bed.** Co-sleeping safety requires: no smoking by either parent (and no smoking exposure during pregnancy); parents not obese; no alcohol or sedating medications; firm mattress; no heavy blankets, pillows, waterbeds, or stuffed animals near the baby; baby on their back. If these conditions cannot be met, a safe bedside bassinet is the next best option.

Feeding the Family

Good food in the first weeks is not optional — especially for a breastfeeding parent.

Before the birth: cook and freeze several dishes (soups, stews, casseroles). Stock easy-grab foods (yogurt, cheese, granola, raw vegetables, whole grain crackers).

Accept all offers of food help from friends and family. Organize a meal train via Mealtrain.com or a similar service. Ask for contributions every other day to avoid refrigerator overflow.

The breastfeeding parent needs 200 to 300 additional calories per day and at least 2 liters of fluid per day.

Getting Help

Accept help. Name what you need specifically when people ask: "Can you bring dinner on Thursday?" or "Can you stay with the baby for 3 hours on Saturday so we can both sleep?"

A postpartum doula can be a tremendous resource: trained in newborn care, lactation support, and household management. They do what you need done, not what they prefer. Some work overnight shifts. Some work for weeks. DoulaMatch.net for local postpartum doulas.

Coming Home from the Hospital

Before leaving: make sure you have follow-up appointment information, know who to call with concerns (caregiver and baby's doctor), and have the baby's doctor's name and number.

Before bringing the birthing person home: the car seat must be properly installed and a technician-checked. Make the bed with fresh linens. Tidy up. Stock easy food. Have the baby's space (bassinet, changing area) ready.

Let the homecoming be a moment. You have done something enormous.

The First Forty Days: A Different Way of Thinking About This Time

Source: *The First Forty Days* — Heng Ou, Amely Greeven, and Marisa Belger

Most birth preparation focuses on pregnancy and labor, with postpartum given a brief nod at the end. Heng Ou, a Chinese-American food practitioner who founded a postpartum food-delivery service, makes a different argument: the six weeks after birth deserve as much deliberate planning as the months before it.

Her reference point is the Chinese tradition of zuo yuezi, "sitting the month," in which the new mother is fed warming soups and teas, kept indoors and warm, and released from all household responsibility for roughly forty days. Variations of this protocol exist in nearly every traditional culture. Indian Ayurveda advises "forty-two days for forty-two years," meaning how a woman is nourished in the first six weeks shapes her energy for the next four decades. Korean tradition involves weeks of seaweed soup. Latin American families observe la cuarentena. The specifics differ; the underlying logic is the same: after the enormous effort of birth, the mother needs sustained, intentional care before she can return to caring for others.

The modern Western version of this tends to look like: the partner goes back to work after two weeks, the casseroles from friends stop arriving around week two, and the gestating person is left largely on her own with the newborn, pushing through fatigue on a diet of crackers and whatever can be assembled in under three minutes.

The birth partner's most practical contribution in the first forty days is to protect against exactly that pattern.

The Five Insights (As Practical Guidance)

Ou distills the global postpartum wisdom into five themes. For the birth partner, these translate into a concrete set of priorities.

**Retreat.** The new mother and baby need to be protected from the outside world for longer than people expect. This is not isolation; it is conservation of limited energy. Your job is to help manage the perimeter, keeping activity low, handling logistics so she does not have to, and letting the world wait. Trips out, even social ones, are more draining than they look. Plan for far more time at home than feels normal.

**Warmth.** Traditional postpartum protocols across cultures emphasize keeping the new mother warm, especially through her food. Cold foods and drinks slow digestion at a time when the body's digestive system is already compromised from the effort of birth. Warming soups, bone broth, hot teas, and soft cooked foods are what the body can actually use. Stocking the freezer before birth with ready-made warming soups is one of the highest-impact things the birth partner can do in the third trimester. If someone calls and asks what they can bring, the answer is: a pot of soup.

**Support.** The village that once surrounded new mothers no longer exists by default, which means you have to build it intentionally. Before birth, identify specific people who will bring food, hold the baby so she can shower, take older children to school, do a load of laundry. People want to help; they just need a specific ask. "Can you come Tuesday and bring dinner?" is infinitely more useful than "let us know if you need anything."

**Rest.** The current file covers platoon sleeping and the sleep recipe. Ou adds one more layer: resist the temptation to use the baby's nap windows to clean the house or catch up on tasks. Rest is the task. The body is in active recovery. Everything else can wait, or be done by someone else.

**Ritual.** Small acts of acknowledgment matter more than most birth partners realize. The transition into motherhood is enormous and goes largely unremarked in the excitement over the baby. A foot rub, a bowl of soup brought to bed, twenty minutes of uninterrupted conversation a few evenings per week, telling her specifically what you witnessed her do and what it meant, these gestures hold the relationship and signal that she is seen as a person, not just a feeding device.

Managing Visitors

Ou's "fantasy visitor" concept is worth sharing with everyone who plans to visit in the first weeks.

The fantasy visitor learns the mother is home, calls or texts first to ask if she can stop by and bring food. She knows there may be a note on the door that says "napping, leave food at the door" and she is not offended. If she does come in, she puts the food in the fridge, washes her hands, then washes all the dishes in the sink. She holds the baby only if the mother is struggling. She does not expect to be hosted. She stays forty-five minutes to an hour, asks how things are really going, and leaves without creating more work.

The birth partner's job is to run interference for visitors who do not match this description. This means explaining in advance that visits are short and scheduled, that the mother is not hosting, and that the best contribution any visitor can make is food, not company. This is especially important for your own family members. You are the right person to have that conversation with your relatives.

The End of Your Rope Is a Normal Part of This

Ou names something that most postpartum resources avoid: every parent will hit moments of severe frustration, helplessness, and feeling like they cannot take it anymore. These are not signs of weakness or inadequate love. They are indicators that the parent needs a break and has reached their limit.

The birth partner hits these moments too. The sleepless nights accumulate for you as well. The baby's cries are jarring for you too. And unlike the gestating parent, you do not have the same hormonal support (oxytocin release from nursing, prolactin) carrying you through.

The practice Ou recommends: when someone reaches the end of their rope, they say so. "I need ten minutes." "I need you to take the baby right now." "I can't do this alone tonight." The goal is to normalize asking for help before reaching the point of breaking, so the break happens at the natural limit rather than past it.

For the birth partner specifically: if you see her at her limit, do not wait for her to ask. Take the baby. Tell her to go shower or lie down. The most useful thing you can offer in that moment is not a solution, not comfort, but a hand reaching in and removing the immediate source of strain so she can breathe.

The Partner's Role in the Forty Days

Ou is direct about this: for the birth partner, the first forty days can feel lonely. The energy and attention that was once between the two of you is now directed toward the baby. That is biologically necessary; it is also disorienting if you are not expecting it.

Small things that matter, according to Ou:

Take charge of an early morning diaper change without being asked, so she can sleep a little longer.

Bring a glass of water every time she sits down to nurse. She needs two liters of fluid per day for milk production and will not remember to drink if she is focused on the baby.

Set aside twenty minutes two or three evenings per week to connect without the baby as the subject. A bowl of soup, a few minutes of actual conversation, some contact. This does not solve anything but it reminds both of you that you are still a team.

When she does something difficult, acknowledge it specifically. Not "you're doing great" but "I watched you get through that cluster feeding stretch from midnight to four, and it was remarkable."

And when in doubt, remember: all misperceptions are sharpened when you are both sleep-deprived and hungry. Eat something. Then address the issue.