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New Mother Care

After Delivery



New Mother Care After Delivery

The postpartum period begins with the birth of the baby and ends when reproductive organs have returned to
prepregnancy state. It is a time of rapid physical and psychological changes. This process usually takes 6 weeks. The
following information will provide some guidelines to follow for the first weeks. Consult your health care provider or
lactation consultant with questions about medications which are safe for breastfeeding moms.


of Drug


Relieve constipation


Instructions for Use

Side Effects

Call Your
Doctor if:










or taking antacids















& Anti-gas


Relieve gas pain









Soften stool to
relieve constipation


body to make red
blood cells


antibiotics and blood
pressure drugs




cereals and breads


bowel disease




antidepressants, alcohol, caffeine





of birth control pills



Sleeping Aid



Helps you fall















Treat infection

all the drug is gone

if you feel better


Relieve vaginal
infection due to yeast
or fungus
infection also




Section 2 ~ New Mother Care After Delivery

of Drug

(with Codeine)





to severe pain

to severe pain

Reduce swelling
and itching of




Instructions for Use

Side Effects

Call Your
Doctor if:

this drug



physician of other medicines that also
cause drowsiness, which may increase this
effect of oxycodone. Some medicines that
cause drowsiness are:
that needs mental alertness until you know
how oxycodone (or other pain relievers)
affects you
taken every 12 hours as needed


passing urine


Tylenol a day









Severe skin rash

gently rub in




Treat depression





blood thinners, cold
remedies, and other




Increase the level of

thyroid hormone in
your body.

every day





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If you are taking any medications, herbal or nutritional supplements, or you have any allergies, please tell your doctor.


Section 2 ~ New Mother Care After Delivery

P a in
The following pain scales can help you make decisions on using pain medication. Your nurse will ask you to rate your
level of pain about every eight hours, or sooner if you recently took pain medication. If your pain level is higher than
what your goal is, you can ask your nurse for medication, or other comfort measures like ice packs, warm packs, etc.

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Section 2 ~ New Mother Care After Delivery

Me d ica t io n s
If an iron supplement has been prescribed for you, it should be taken with meals. Iron may cause your stools to
turn dark green or black. If you are breastfeeding, you may notice your baby having increased periods of fussiness
while you are taking iron. If you have questions about any medications that have been prescribed for you, please
ask your nurse or doctor before leaving the hospital. If you are breastfeeding, discuss all prescribed, over-the-counter
medications and herbal medications with your babys doctor before you take them.

Cr a mp in g
You may continue to feel contractions (cramping) even after the birth as your uterus works to get back to its
prepregnant state. These contractions are the bodys way of helping the uterus become smaller, heal, and expel the
vaginal flow. Breastfeeding mothers may have more cramping during and after breastfeeding. Mothers who have had
other children may notice more cramping because the uterus has been stretched before with other pregnancies and
needs to work harder to get back into shape. Use of breathing and relaxation techniques, gentle abdominal massage,
frequent urination, and use of a mild pain reliever (see Take Home Medication Chart) will help you to be more
comfortable. Cramping usually disappear within 4 to 5 days after birth.

V a g in a l Disch a r g e
Vaginal discharge, called lochia, is a normal part of the recovery process. It will change during the days and weeks
small (grape-size) dark clots. The lochia should smell similar to your menstrual flow. It is normal to have a gush
or extra heavy flow when first getting up from lying down, and during or after breastfeeding (the uterus contracts
during breastfeeding). By the end of the first week, it should be brownish or pinkish in color. The discharge gradually
decreases in amount and changes in color from red to pink, brown, and, finally, yellowish-white.
In your first days at home, you may notice an increase of bright red bleeding due to an increase in your activity. This is
your bodys way of telling you that you need to slow down, take it easy, and rest more. Let the housework go and take
care of yourself. If you continue to have bright red bleeding or you saturate a maxipad every 20 minutes for one hour,
call your doctor. The vaginal discharge will normally continue for 3 to 6 weeks following delivery. Do not use tampons
or douche during this time.
If you notice a foul smell (like something rotten) from your flow, call your doctor.


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Re t u r n o f Me n st r u a t io n
Ovulation and menstruation return as your bodys hormones adjust after childbirth. It is difficult to know exactly when
ovulation and menstruation will begin again. It is dependent on the infant feeding method you have chosen.
Breastfeeding Mothers - The return of menstruation varies greatly among women who are breastfeeding. Some
women get their first period 6-8 weeks after delivery and some do not get a period the entire time they are
nursing. Women are less likely to resume menstruating if they are only breastfeeding, that is, giving no solids or
formula. Breastfeeding is NOT a reliable form of birth control. Even if your period has not returned, you may have
you can continue nursing. In some women, milk supply may decrease slightly during menstruation.
Non-Breastfeeding Mothers - If you do not breast feed, you will probably have a period within 6-8 weeks after
If you do not want to become pregnant, using birth control is important for both breastfeeding and non-breastfeeding
mothers. Remember, it is possible to become pregnant before your menstrual period resumes. (See Lifestyle
Effects on Breastfeeding.)
The first period for both breastfeeding and non-breastfeeding mothers may be longer and heavier or shorter than usual.
Remember, your body needs time to get back to normal. Give it time and soon you will feel like yourself again.

E p isio t o my Ca r e
An episiotomy is an incision made in the perineum to enlarge the vaginal opening at the time of delivery. Your doctor
uses stitches to close this incision right after the delivery. The stitches will dissolve and heal within 10 days. The
number of stitches used varies. Hygiene is very important in the healing of your stitches - keep your bottom clean and
dry. After a few days, you will notice perineal itching. This indicates healing.
the next 2 weeks or so).


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P a in Re lie f:
Using a hand mirror, you can see that your perineum may look bruised and swollen at first. Swelling of the tissues may
occur whether or not you have stitches.

Bla d d e r Fu n ct io n
In addition to emptying the bladder frequently to avoid cramping and vaginal bleeding, it will also help to prevent the
development of urinary tract infections (UTI). As the bladder remains full and emptying not complete, the stasis of
urine can cause bacteria to develop, causing an infection. The urinary system consists of the kidneys, ureters, bladder
and urethra. Infections of the urinary tract (UTIs) are the second most common type of infection in the body. You may
have a UTI if you notice:
If you think you have a UTI, it is important to see your doctor. Your doctor can tell if you have a UTI by testing a sample
of your urine.

Bo we l Fu n ct io n
Following birth, many new mothers are afraid to have their first bowel movement. It is common to fear pain and
stitches tearing. However, it is very unlikely that stitches will tear or become dislodged. Relax, take your time, and
of liquid a day), including hot fluids, eating foods that contain fiber and provide natural laxative effects (salads, raw
vegetable, fresh fruits, bran, prune juice) and limiting or avoiding high sugar or processed foods that constipate you.
If you are feeling constipated or have not had a bowel movement by the 4th or 5th day after birth, your doctor may
recommend a laxative, a stool softener, or a small enema.


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He mo r r h o id s
Hemorrhoids are varicose veins of the rectum. They may have developed during your pregnancy from the pressure of
the baby or during your delivery. Hemorrhoids usually shrink by themselves with time. Treatment for hemorrhoids is
similar to care of the stitches.
The following may help:




for long periods

time to time

Your doctor can prescribe medication

if these methods do not relieve the
discomfort. (See the Facts About
Your Take-Home Medications Chart
earlier in this section.)

Br e a st Ca r e
Regular breast self-exam can help you know how your breasts normally feel and look so you can notice any changes.
When you find a change, you should see your health care provider.
A breast self-exam is recommended every month a few days after your
period ends. During this time, your breasts are less tender or swollen. It
is important to do your breast self-exam at the same time every month.
Self-breast exam should be done by both breastfeeding and nonbreastfeeding mothers. If you are breastfeeding, you may feel the milk
glands. Become familiar with what is normal for you. Ask your nurse or
doctor if you have questions about the self-breast exam technique. Selfbreast exam should not be used as a substitute for periodic examinations
by your physician.
See your health care provider about a breast change when you have:
After the birth of a baby, hormonal changes occur in the body (estrogen and progesterone decrease, prolactin
increases). The increasing prolactin levels stimulate milk production. Your breasts may become full (engorged) by the
third or fourth day after birth. They may feel warm and painful. This may happen to breastfeeding, as well as, nonbreastfeeding mothers and is TEMPORARY (usually subsides in 24-48 hours).


Section 2 ~ New Mother Care After Delivery

S e lf- Br e a st E xa m
It is recommended that you continue doing your self-breast exam after
giving birth. Do the exam around the same time each month.

Ho w t o E xa min e Yo u r Br e a st s:
Look for Changes:
Step 1 - Sit or stand in front of a mirror with your arms at your sides.
Turning slowly from side to side, check your breasts for:



the other

Step 2 - Raise your arms above your head and repeat Step 1.
Feel for Changes (lumps or thickening in breasts):
In the Shower:
Step 1 - Raise one arm. With fingers flat, touch every part of each breast,
feeling for changes.
Step 2 - Use your right hand to examine your left breast, your left hand for your
right breast.
Lying Down:
Step 1 - Place a towel or pillow under your right shoulder and your right hand
behind your head.
Step 2 - Examine your right breast with your left hand. Fingers flat, press
gently in small circles starting at the outermost top edge of your breast and spiraling in toward the nipple.
Examine every part of the breast, including the area around the nipple.
Step 3 - Bring your arm down to your side and feel under your armpit for swellings.
Step 4 - Repeat steps 1-3 with your left breast.


Section 2 ~ New Mother Care After Delivery

Helpful hints for Relief of Engorgement Discomfort:

Non-Breastfeeding Mothers




them to cup your breast inside your bra. Leave on for 20 minutes or until leaves are wilted.)

Breastfeeding Mothers (see Breast Engorgement - Section 4 - Feeding Your Baby)







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latch on


Section 2 ~ New Mother Care After Delivery

Re st
Rest may be one of the most important things you need after giving birth. Rest is essential to recovery of labor
and birth. It is also easier to cope with the physical and psychological demands of parenting if you are well-rested.
Although you may have organized your daily activities in a special way before the baby was born, it may be easier
to roll with the punches once the baby gets home. Caring for yourself and the baby and enjoying this special time
together as a new family takes priority.
Some suggestions:
involves and do not expect you to entertain or feed them.
still tired.
Remember this time doesnt last forever. As your body gets back to normal, your strength and energy will return.

A ct iv it y
Activity is good for circulation and muscle tone. Start out gradually with frequent rest periods. Avoid heavy lifting and
heavy housework because it can delay healing. You may climb stairs in moderation. Plan ahead so you make as few
trips up and down stairs as possible.

Nu t r it io n a n d Die t
Proper nutrition is necessary for healing, strength, and energy. If you skip meals, which is easy to do when you are
busy with the baby, you may delay your recovery or feel weak. You should not go on a weight reduction diet until
after your six week check-up with your doctor. You can expect to lose about 11-14 pounds within the first week after
delivery. This loss includes weight of the baby, amniotic fluid, placenta, blood and other fluids. During the first week
of postpartum, you may lose an additional 5 pounds of fluid. The rest of the weight will come off, but it will take
some time. It is not recommended to lose weight too rapidly (a loss of 1/2 to 1 pound per week is recommended, even
with breastfeeding). If you lose weight too rapidly, it is not possible to maintain good health and have the stamina
necessary for the demands of your new baby.
Nutritious meals dont have to be fancy or expensive. Plan simple meals that can be prepared quickly. Sandwiches,
soups or frozen items that can be prepared in advance work well. Keep good snack foods on hand to help round out
the meal (examples: cheese, crackers, peanut butter, fresh or canned fruits, fresh vegetables, juices and milk).


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Section 2 ~ New Mother Care After Delivery

E xe r cise
After the birth of your baby, your abdominal muscles
may be loose and weak. Daily exercise can help
restore muscle strength and return your body to its
prepregnancy shape. It can actually help decrease
fatigue and increase your energy level and your general
sense of well-being. Exercise will help you get back into
your pre-pregnant clothes again. Do not wear a girdle this will not help your muscles regain their strength.
If you didnt exercise during pregnancy, start slowly with
easy exercises and gradually build up to more difficult
ones. If you exercised regularly throughout pregnancy,
you have a head start on getting back into shape, but
you should not try to return immediately to the level and
intensity of exercise you did before birth. Getting out of
bed and walking around is the first exercise you will do
after childbirth. Do this as soon as you are able to do.
You will want to design your own exercise program to meet your own needs. Walking is a good way to return to an
exercise program. Brisk walks several times a week will prepare you to do more strenuous exercise when you feel up
to it. Swimming is also an excellent postpartum exercise after the vaginal bleeding has stopped. It is not necessary for
you to set aside 30-45 minutes each day to exercise. The exercises will be just as effective if you squeeze in 5 minutes
here and there throughout the day.
Guidelines for Postpartum Exercise
 onsult your physician before beginning an exercise program if you had a Cesarean delivery, a complicated birth,
or postpartum complications. Otherwise, start when you feel up to it. (With the approval of your physician, some
exercises may be started 24 hours after a vaginal delivery).
 o stretching prior to any exercise routine, followed by a 5 minute warm-up and end with a cool-down and
 Do the exercises in bed until you are comfortable with the floor.
 Start out slowly and increase the intensity and duration gradually.
 Do each exercise slowly. Relax briefly after each repetition for a little longer before starting a new exercise.
 Listen to your body. If you are becoming breathless or feeling tired, slow down or stop.
 atch your balance. It takes some time for your center of gravity to return to its prepregnant state.
 Avoid sudden movements. The relaxing effect of pregnancy hormones causes ligaments and joints to temporarily
loosen, becoming more mobile and susceptible to sprains.
 ress in comfortable clothing. Wear a support bra and good athletic shoes that cushion any impact.
 Exercise on a firm surface (carpeted floor).
 o not arch your back at any time during exercise. The swayback position increases the risk of injury.


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S u g g e st e d A ft e r Bir t h E x e r cise s
Abdominal Tightening and Breathing
1. To shorten stretched abdominal muscles.
2. To relieve lower backache.
noon, and night.
Front Lying
1. To help tip uterus forward and encourage other pelvic
organs to resume their normal places.
2. To relax abdominal muscles.
Lie flat on your abdomen with a pillow under your head
and abdomen for one half hour. If your breasts ar sore,
two pillows under your hips and one under your chin and
shoulders will help. Do this every morning and night.
Pelvic Floor Toning (Kegels)
1. To strengthen muscles that were stretched during vaginal
2. To help prevent dribbling of urine.
3. To improve healing of the episiotomy.
4. To improve muscle tone in the vagina.
Empty your bladder. Pull in and tighten the muscles around the vagina, urethra ( opening to bladder), and rectum.
Squeeze and hold all the muscles as you count to five. DO NOT hold your breath and DO NOT tighten your buttocks.
Release the muscles and repeat. It may be easiest to do these when you are lying down with your lower legs raised.
Practice frequently, everyday (up to 50 times a day) after your baby is born, and for the rest of your life. No one will
waiting for the bus, standing in line at the grocery store, or while brushing your teeth.
Chin Lifts
1. To help tone abdominal muscles.
2. To relieve lower back ache.
four times, morning, noon, and night.


Section 2 ~ New Mother Care After Delivery

Foot Exercises
1. To improve circulation.
2. To strengthen and stretch leg and foot muscles.
3. To help leg fatigue.
4. To prevent leg cramping.
Sit in a chair or on the floor with your legs stretched straight
out in front of you. Move feet up and down, side to side, and in circles.
Pelvic Tilts
1. To strengthen abdominal muscles.
2. To relieve lower back discomfort.
3. To help reposition the uterus back to normal.
4. To improve posture.
Lie on your back with your knees bent. Roll your pelvis back by flattening the hollow of the back on the floor. Your
buttocks or shoulders should not raise off the floor. Hold this position for a count of five, then release. Repeat. Do this
four times, morning, noon, and night.
This exercise can also be done standing or on your hands and knees. When standing, tighten your abdominal muscles
to flatten your lower back against a wall or flat surface. On your hands and knees, arch your back, looking down and
back to your feet, then flatten your lower back by tightening and pulling the abdominal muscles inward and upward.
Do not let your lower back sag.
Straight Curl Ups
1. To strengthen and tone upper abdominal muscles.
Lie on your back with your knees bent. Breathing out, slowly curl
forward. Lift your head and shoulders and reach for your knees. Hold
for a count of five, and slowly lie back. Repeat. Do this four times,
morning, noon, and night.
Diagonal Curl Ups
1. To strengthen and tone upper abdominal muscles.
Lie on your back with your knees bent. Breathing out, slowly curl
forward as before, but reach with your right hand toward your left
knee. Hold this position for a count of five while you exhale and
slowly lie back and relax. Repeat with your left hand reaching for
your right knee. Do this four times, morning, noon, and night.


Section 2 ~ New Mother Care After Delivery

1. To strengthen buttock muscles.
Lie on your back with knees bent, arms at your sides. Raise
your hips so that your knees and chest are in a straight line.
Hold this position for a count of five, then slowly lower your
hips to the floor. Repeat. Do this four times, morning, noon,
and night.
1. Helps you to relax.
2. Cool down after exercise.
Lie on your back with your arms at your sides, palms up, and legs out straight. Bend your feet up (toes pointing
upward) to stretch the calves. Try to flatten the hollow in your back by pulling in the abdominal muscles. Pull your
shoulder blades together. Tuck your chin in to press out the curve in the back of the neck. Hold this stretched position
for a count of five and relax.
Aerobic Exercise
Examples include walking, swimming, jogging, bike riding, stair climbing.
Take precautions when exercising. Stop exercising if bright red bleeding or an increase in bleeding occurs, excessive
fatigue or pain is experienced, such as joint pain that increases during activity and persists after activity, HEAVY urine
leakage or pelvic pressure, beast infection or abscess. (This is somewhat stated on page 38 under The following
are signals that exercising should be discontinued)
Things to Avoid
legs while lying on back)
Be sure to maintain adequate amounts of fluid and rest between activities. Babys weight gain should continue to be
one or more sports bras if needed.


Section 2 ~ New Mother Care After Delivery

Finding Time to Exercise When You Have a Baby

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weight limitations and listen to physician during postpartum recovery)
alternate days.
Combine exercise in your everyday activities
exercise your legs.
rocking baby or standing in line.
(one watches the kids while the other exercises, then switch).
The following are signals that exercising should be discontinued:

W a r n in g S ig n s Fo llo win g De li v e r y
After you go home from the hospital, you should continue to watch for any abnormal changes in your health. Call your
doctor if you notice any of the following symptoms:


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P o st p a r t u m Ch e ck - u p
By 6 weeks, your uterus should be back to its normal
size and position. The average weight loss by the 6 week
check-up is approximately 15 to 22 pounds. However,
your body still has adjustments to make and weight loss
Make an appointment to visit your doctor about 6
weeks after delivery (patients who have had a Cesarean
delivery should be seen at about 2 weeks after delivery).
Your postpartum examination will include weight, blood
pressure, a blood test for anemia, internal and breast
examinations, and any other laboratory tests, such as a
Pap test. Your doctor will prescribe treatment or special
care if you need it.
The postpartum visit is a good time to talk to your doctor
about anything that concerns you - your health, your
weight, exercise, diet, work, and your feelings about your
baby. It is a good idea to write down your questions
and take notes so you will remember the answers. You probably discussed child spacing and birth control with your
partner and with your doctor after your baby was born. However, if you did not, the postpartum visit is an ideal time for
obtaining information about birth control and a birth control method, if you want to use one (See the Contraceptive
Choices chart).

Ce sa r e a n Bir t h ( C- S e ct io n ) R e co v e r y
Each birth is an event that is anticipated and savored by expectant
families. Not all Cesarean births are planned. You may experience
several different feelings following your Cesarean birth, depending on the
circumstances of the surgery and your expectations for your babys birth.
After a long and tiring labor, some women feel relieved to have a
Cesarean birth. If the surgery was done for emergency purposes, some
women feel thankful. Other women, with specific ideas for their delivery
may feel disappointed, cheated, and even angry. A sense of failure may
be common. All of these feelings are normal.
Whatever your feelings, it is important for you to share them with your
partner, your physician, the nursing staff, close friends, family, or others
who have had a cesarean birth. Expressing and sharing your feelings will
allow you to accept them sooner. Ask questions. If there are parts of the
birth you do not understand or remember, find out the answer.


Section 2 ~ New Mother Care After Delivery

Anesthesia Recovery
After a cesarean birth, the care you receive in recovery is the same as for a vaginal delivery except for the effects of
anesthesia and incision care. The following procedures will be done frequently:
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Your nurse will request that you take slow deep breaths and cough to clear your lungs. Place a pillow over your
abdomen and support your incision when coughing. If you had spinal anesthesia, the effects will wear off in about 2-5
hours. You will be given medication for pain as you need it when the anesthesia begins to wear off.
First 24 Hours
The first 24 hours are usually the most uncomfortable. You can request and obtain medication for pain. You may
have pain medication through your IV line and be able to medicate yourself as you need it. It should eliminate your
if you take these pain medications while breastfeeding.
Your IV and urinary catheter will remain in place for about 24 hours after delivery. Your diet will be determined by your
doctor. Usually you will start with clear liquids and advance to more food choices as your bowel activity increases.
the side of the bed and then get out of bed within several hours after delivery. Each time you get up it will be easier.
Moving is very important for a speedy recovery. To get out of bed:
abdominal muscles.
feeling faint.
forward. (Look straight ahead to help avoid feeling faint.)
Incision Care
Your abdominal incision may be covered with a gauze bandage. The location of the incision depends upon the reasons
for the cesarean and previous surgeries you may have had. The incision will be evaluated by your nurse and the


Section 2 ~ New Mother Care After Delivery

bandage removed at your doctors request. Once the bandage is removed, you can take a shower. Your physician may
want you to cover the incision with plastic while showering until it is healed. If you have staples, they may be removed
by your doctor or nurse before you leave the hospital. Small strips of tape, called steri-strips, will replace the staples.
Some women worry their incision will rupture or open. The incision is very durable.
The steri-strips will probably fall off after the first week. If not, you may remove them, starting with the outside strips.
A small amount of bruising with color changes of yellow/green are normal. Also you may notice some hardness along
the incision line. The incision heals quickly, but do not lift anything heavier than your baby for awhile. As healing takes
place, the incisional area may itch, pull or feel numb. If you were given an abdominal binder in the hospital, you
may continue to use it for comfort.
Infant Interaction
Depending on your babys condition, you may ask to see and hold him as soon as you feel able. Early, frequent
contact can help in the attachment process. We encourage you to hold and care for your baby as much as possible. If
someone is in your room to help care for your baby in the first 24 hours, you may enjoy keeping your baby with you.
Bowel Function
After abdominal surgery, it is common for bowel functions to be altered. Gas pains are a frequent complaint after the
first 24 hours. Suggestions to relieve or lessen gas discomfort:
Once you are eating solid foods again, your bowels will become more active. If your first bowel movement is difficult,
consult your doctor or nurse.
Cesarean mothers should follow the same instructions for home as mothers who deliver vaginally. The biggest
difference is that recovery time after a Cesarean birth will take longer. Frequent rest periods and a good diet are
essential for recovery. All new mothers need rest, but Cesarean mothers need even more. Remember, you are
recovering from surgery while caring for a new baby. You will tire easily. You should not drive for at least two weeks
and limit your stair climbing and lifting. We recommend that you plan to have help at home for the first week or two.
Suggested Guidelines for Cesarean Recovery:


Section 2 ~ New Mother Care After Delivery

Contact your physician if you experience any of the following symptoms:

E mo t io n a l Ch a n g e s
The birth of a baby is like no other experience in life. The intensity of feelings experienced after giving birth cannot be
compared to any other. Joy, exhilaration, excitement, fear, sadness, anxiety, confusion, exhaustion, love . . . these are
all within the wide range of emotions that are possible. And they are all NORMAL. Even though these first few days
after delivery can be the happiest in your life, dont be concerned if at times you feel sad, uncertain, overwhelmed, or
Caring for an infant is hard work. Regardless of how prepared you were or how much you looked forward to your babys
birth, new mothers often feel overwhelmed with the responsibility and the reality. Ambivalent feelings are very normal
and can last as long as a few months.
Most new mothers have these feelings in a mild form, called Postpartum Blues. These feelings of letdown, after the
emotionally charged experience of birth, occur in the first few days after delivery, usually appearing suddenly about
the third or fourth day. Symptoms may include crying for no apparent reason, impatience, irritability, restlessness, and
Some Common Feelings You May Experience:
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Section 2 ~ New Mother Care After Delivery

These feelings may be associated with abrupt changes in your hormone levels after the delivery. This is also a time of
social and psychological adjustment which places many demands on the new mother and her family (lack of sleep,
constant dependency of your newborn, possibly sore stitches, feeling of let down after the excitement and anticipation,
etc.). These feelings generally disappear in a few days, especially if you have the support of your partner, family, and
Some Ideas To Help You During This Time Of Transition:
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the beginning.
A few new mothers develop a more serious form of sadness and anxiety, called Postpartum Depression. It can occur
within days of the delivery or appear gradually, sometimes up to a year later.
Symptoms may include:
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How Fathers, Family, Friends Can Help
Postpartum depression threatens the mothers and fathers health, marriage, friendships and careers, as well as
the babys welfare. Dealing with issues of day-to-day living becomes a special challenge. With patience and
understanding, you can give invaluable support and assist a depressed mothers recovery.


Section 2 ~ New Mother Care After Delivery

may be very helpful. There are some medications that are considered safe during breastfeeding. Consult your
and her illness, not at her. She is doing the best she can in her current condition.

This condition is more intense and may require counseling and treatment. It is important to realize that Postpartum
Depression is a physical disorder and is not self-induced. A woman cannot pull herself together anymore than she
could if she had the flu, diabetes, or heart disease. However, all of the symptoms of sadness, from the mild to the
most severe, are temporary and treatable with support and skilled professional help. If the blues last more than a
few days or the depression begins to interfere with your ability to parent and function, call your physician. (To help you
identify when it might be appropriate to contact your physician, use the Postpartum Depression Screening Tool on the
next page.)
Postpartum Depression Support Links
Depression After Delivery - http://www.depressionafterdelivery.com/
The Online PPD Support Group - http://www.ppdsupportpage.com/
Suggested Reading
The Postpartum Husband: Practical Solutions for Living with Postpartum Depression http://www.postpartumstress.
Karen Kleiman, MSW, 2000
Mothering the New Mother:
Womens Feelings and Needs After Childbirth - http://www.newmarketpress.com/title.asp?id=439/t_blank
Sally Placksin. 2000
Down Came the Rain: My Journey Through Postpartum Depression http://www.hyperionbooks.com/titlepage.
Brooke Shields, 2005
What Am I Thinking? http://www.postpartumstress.com/whatbook.html/t_blank
Karen Kleiman, MSW, 2005
- An important one for those wanting another baby.
Resources: www.depressionafterdelivery.com (Depression After Delivery)
www.postpartum.net (Postpartum Support International)



Section 2 ~ New Mother Care After Delivery

E d in b u r g h P o st n a t a l De p r e ssi o n S ca le ( E PDS )
As you are pregnant or have recently had a baby, we would like to know how you are feeling.
1. Circle the number for each statement which best describes how often you felt or behaved this way in the
last seven days.
2. All items must be completed.

I have been able to laugh and see the funny side of

0 As much as I always could
1 Not quite so much now
2 Definitely not so much now
3 Not at all


Things have been getting on top of me.

3 Yes, most of the time I have not been
able to cope at all
2 Yes, sometimes I have not been coping as well
as usual
1 No, most of the time I have coped quite well
0 No, I have been coping as well as ever




I have looked forward with enjoyment to things.

0 As much as I ever did
1 Rather less than I used to
2 Definitely less than I used to
3 Hardly at all
I have felt so unhappy that I have had difficulty sleeping.
3 Yes, most of the time
2 Yes, sometimes
1 Not very often
0 No, not at all
I have blamed myself unnecessarily when things went
0 Not at all
1 Hardly ever
2 Yes, sometimes
3 Yes, very often


I have felt sad and miserable

3 Yes, most of the time
2 Yes, quite often
1 Not very often
0 No, not at all


I have been anxious or worried for no good reason.

3 Yes, quite a lot
2 Yes, sometimes
1 No, not much
0 No, not at all


I have been so unhappy that I have been crying.

3 Yes, most of the time
2 Yes, quite often
1 Only occasionally
0 No, never


I felt scared or panicky for no very good reason.

3 Yes, quite a lot
2 Yes, sometimes
1 No, not much
0 No, not at all

10. The thought of harming myself has occurred to me.

3 Yes, quite often
2 Sometimes
1 Hardly
0 Never
Add all circled numbers - Total =

A score of 10 - 12 has found to signify probable depression. Mothers who score above 13 are likely to be suffering from a
depressive illness of varying severity. Please contact your healthcare provider for a clinical assessment.
SOURCE: K.L. Wisner, B.L. Parry, C.M. Piontek, Postpartum Depression N Engl J Med Vol. 347, No 3, July 2002, 194-199.


Section 2 ~ New Mother Care After Delivery

Fa t h e r s
Fathers, as well as mothers, are making many changes as they adapt to
this new role of parenting. Taking on the new role of a father can create a
variety of feelings in men, as well.
Some of the feelings experienced by new fathers may include:
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A Special Message to Dads: Bringing your new baby home is a big change for the family. Your partner needs your
support, patience, and help. Try not to expect too much from her at this time. A clean, tidy house and gourmet meals
should not be expected. Support your wife/partner by helping out with household chores. She needs this time of rest
to recover fully from childbirth. You can also help her by spending time with your baby. A father who helps take care of
his baby feels more comfortable with his child and develops a special closeness. It is important for fathers and babies
to spend time together.
And Mothers - if Dad cleans, changes the baby, or cooks differently from you, let him do it his way. It may be different
from your way, but it really doesnt matter. Give yourself a break, use the time to rest.
Ten Tips for New Dads
New dads are seemingly left in the dark when it comes to new babies and postpartum moms. Heres a quick primer.
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show you some great holds for little ones whether it be a midwife, doctor, nurse, doula, mom, relative, friend, etc.

If you are feeling left out talk to your partner about it. Chances are its not on purpose.


New moms often have emotional ups and downs that are not predictable. Be supportive and offer an ear when
possible. Learn the warning signs of postpartum depression and seek help if the situation is heading out of


Support her with breastfeeding. Tell her that youre proud of her and protect her from well meaning but negative
comments about breastfeeding. Take a breastfeeding class during the prenatal period if possible.


Help with the other children or household. Remind mom to let the house go and to focus on her recovery and the
new baby.


New dads can also experience the blues or postpartum depression. Much in your life has changed and its
important to realize this and get help if you need it as well.


Remember that the only thing you cant do is breastfeed. You can change diapers, soothe a crying baby, carry the
baby, play with the baby, anything the baby needs done.


Section 2 ~ New Mother Care After Delivery

8. If you need help ask for it. Know who to call in your area for help and support whether it be a doctor or midwife, a
postpartum doula, lactation consultant, or the local babysitter.
9. Mom is going to need extra sleep and care while her body recovers. Get up with the baby when you can. Bring the
baby to her in the middle of the night if possible. If you must go back to work check in with her during the day.
Perhaps surprise her with some healthy take out food or fresh flowers.
10. Remember that adding a new baby to the mix is always going to stir your life up a bit, even if its not your first
baby. Learning to live with another human being takes time. Give yourself
a break if you need it as well.

Gr a n d p a r e n t s
Grandparents are very special people. They have a unique role and can be a
big help to you. When they want to spend some time loving and cuddling their
grandchild, look at that as a few extra moments for yourself. There may be
times when grandparents (and other relatives or friends) mean well and give
more advice than you want. Listen to them and, if you have other ideas, tell
them kindly. Things may have changed a lot since your parents had a baby
and some of their advice may not be current anymore. It is up to you and your
partner, and your babys doctor, to decide what is best for your baby. It takes
a little while before grandparents, parents, and the baby learn to feel relaxed
with their new relationship.

A d ju st in g t o P a r e n t h o o d
Throughout pregnancy, most couples focus on the pregnancy and prepare for
labor and birth. Suddenly, the role of parenthood is upon them and the role is
a permanent one. Once you are a parent, it is a lifetime commitment.
New parents may feel insecure about handling a newborn infant, especially if they have had little experience. Your
baby wont mind if you are a little awkward at first. Giving love is much more important than changing a diaper
By the time you become a parent, you will have developed a view of parenting through a combination of influences.
How one was parented has a major impact on how one will parent. Family and culture will influence roles and
responsibilities, displays of physical affection, communication patterns, and discipline methods. Media, as well as
friends, play a role in shaping your views on parenting. You may have watched relatives or friends raise their children
and thought how you would have acted. Pre-pregnant fantasies of being the perfect parent and having the perfect
child are common. Now you may feel that these fantasies will not come true. Realize all parents make minor mistakes,
and children can live through them.
As new parents, discuss openly, and in depth, your feelings and values related to parenting:


Section 2 ~ New Mother Care After Delivery

Talking over your ideas and feelings will help you understand each others actions as situations arise.
The joys of parenthood can be tremendous - the realization of knowing this is YOUR baby, feeling his tiny fingers
grasp yours, the thrill of witnessing his first step, watching him grow and develop his own personality. Continue to
support each other through the tough ones. As your child grows, remember you are also growing. Experience and
understanding of your child and your parenting role will come with time.

Mo mmy a n d Me : Ou t & A b o u t
Come and join in the fun, fellowship, support, and encouragement of other moms
along with their babies from 2-16 weeks postpartum. Meet weekly on Mondays
from 1:30-2:45 pm in the Aspirus Womens Health Birthing Center classroom. No
cost or registration required. Lactation services are available along with a scale to
weigh baby. Special speakers will present on occasion.

S ib lin g A d ju st me n t
If this is not your first child, you may be concerned about how your other children
will react to the new baby. You may be thinking about how you can help your
older child (children) feel a part of this exciting event. Brothers and sisters go
through a period of adjustment, too. A childs response to the birth of a sibling
depends on a variety of factors:
Siblings show their feelings in different ways. Generally, the
younger your other children are, the harder it may be for them
to accept a new brother or sister. Toddlers cant tell you how
get positive attention, they will misbehave. They may go back
to behavior they have outgrown, like bed-wetting, wetting their
pants, sleeping problems, temper tantrums, or wanting a bottle
or the breast. Older children may become quiet and withdrawn.
the only child, the youngest, or the only boy/girl. They may also
feel a loss of their territory and possessions, especially if they
are sharing a room with the new baby.


Section 2 ~ New Mother Care After Delivery

Your older child (children) will need time to adjust to their new role. Help him to see that it is fun and special to be
the older child:
a game or read to your older child. (You may be able to read to your older child while you are feeding the
and supplies, help push stroller, talk and sing to baby, hold the baby with supervision). Dont force their
your older child can understand.
hit the baby.
can be hurt).
Jealousy may still occur, even in the best-prepared older siblings. Recognize it as a normal part of the adjustment
period. Your older child (children) will be learning a valuable lesson in coping and adjusting with life changes. Most
sibling problems are temporary and will pass. Remember, be patient and flexible.

Be in g a Co u p le
When a new baby enters your lives, your couple relationship changes. When will things get back to normal? Things
will probably never be quite the same again, but you will begin to grow as a family. Parenting can be a time to draw
closer as you share joys and tensions. The key to this transition is working toward a new way of making you both feel
as loved as possible.


Section 2 ~ New Mother Care After Delivery

Special Needs
Both of your needs are important and should not be forgotten or pushed aside totally in concern for the babys needs.
A new mother needs love and confidence. She needs reassurance that her body is still desirable after childbirth. She
needs to be told this. She needs a supportive person nearby and to be told that she is a good mother.
A new father has special needs also. He also needs love and reassurance. He needs to know that the baby does not
diminish the love and caring concern that his wife/partner has for him. He needs to be told this too.
Time Together
The fatigue that accompanies recovering from childbirth and coping with the babys unpredictable demands can result
in less time together as a couple. When you both finally have time, you may be too tired to focus on each other. Plan
be perfect, that time will never come.
The addition of a new member to your family causes a change in communication patterns. Previous communication
methods may not work at this time. Though it usually is best to deal with issues as they arise, the interruptions of
a baby may not make this possible. This becomes more evident as your baby becomes a toddler with big ears.
Ongoing, open communication is vital, but you may have to work harder at making time to talk.
Sincere words of encouragement can make the role of a new parent easier and can help you feel closer as a couple.
Each of you is in a new role and has needs to feel love and support from the other. Express your appreciation with
words and actions. Remember, working at a relationship doesnt end when the family begins. Do little special things
situation and help strengthen your relationship.
Sexual Relationship
One of the biggest adjustments for the couple is their expressions of love. By working at your relationship and finding
time each day for physical closeness, hugs, touching, cuddling, and holding hands, you will feel closer as a couple. Most
women need to feel loved throughout the day in order to want to make love at night. Small gestures, such as a hug or
kiss, can help you feel closer to your partner. Couples need to realize there are more ways to say I Love You than by
sexual intercourse. Generally, most physicians recommend waiting until the stitches are healed, the vaginal bleeding has
stopped, and you feel physically comfortable. This is usually 3 to 4 weeks after childbirth, but may be as late as 6 weeks.
It can also be normal for couples to take much longer to feel like making love after birth. Your desire for sex can be
temporarily affected by birth. This may be a result of hormonal changes in your body, as well as fatigue and getting used
to having a baby around all the time.
Variations in feelings are normal:
(you may be a little sore or tender the first time,
which may be caused by tension).

pregnant again.


Section 2 ~ New Mother Care After Delivery

Following birth, the estrogen level is temporarily lowered, which causes less vaginal lubrication. This is especially true
in breastfeeding women. Also, some nursing women do not enjoy breast stimulation because their nipples or breasts
are tender. A woman may also have a milk let-down at the time of orgasm since the same hormone that controls letdown is also released with orgasm.
Ways you can be more comfortable:
lack of them.
use vaseline or petroleum jelly.
your partner. Be creative in showing your love.
(early morning, afternoon nap times, or even the
middle of the night after a feeding are beautiful
times for making love).

warm shower, giving each other a back rub or
massage, listening to music, holding, cuddling,
and spending more time with sexual foreplay.
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your side takes the pressure off the episiotomy
and may be more comfortable.
Sex can be spontaneous before children arrive,
but spontaneity is difficult following a birth. As you
recover physically and allow for time, you will grow
closer together.


Section 2 ~ New Mother Care After Delivery

Co n t r a ce p t iv e Ch o ice s

Side Effects

Does not protect form STDs.

Minor: headaches, weight gain, mood changes, dark skin areas,
The Pill
nausea, spotting, missed periods (normally disappear after 3
(also available in a patch) months).
Major: blood clots, heart attacks, high blood pressure, diabetes,
gall bladder disease, liver tumors. Higher risk if > 35 or smoker.
Some pills cannot be taken while breastfeeding.
Tubal Ligation





Natural Family

Male Condom

Female Condom

Approximate Cost


$25-30 per month. Reduced cost

through Family Planning.

99.5% effective. Effectiveness

affected by certain medications.

Permanent. Discomfort after surgery for a few days. 30% reversal $3500-4000 usually covered by
success with 60% pregnancy rate.
Permanent. Slight infection risk, slight discomfort after surgery.
Reversal success is 50% with a 50% pregnancy rate.

$900-1600 usually covered by


99.8% (1)

Given by injection which must be done during first 5 days of

period every 3 months. Minor: Irregular menstrual bleeding or
no menstruation, spotting between periods and missed periods.
Headaches, weight gain, possible changes in hair distribution.
Major: blood clots, depression (very rare).

$60 every 3 months. Reduced

through Family Planning.


Same as Depo-provera

$500-600/5 yrs.

Increased risk of pelvic inflammatory disease or tubal pregnancy.

Increased flow and discomfort with periods. If you have fever,
stomachache, or missed period, call MD right away.
Two methods:
Billings: checking cervical mucous to determine fertile period.
Basal body temperature: checking basal body temperature to
determine fertile period.
Both methods are unreliable.

Cost of kit
Basal body temperature

Less stimulation. May prolong orgasm. May develop latex allergy,

$6-12 for box of 12
but latex-free available. Small risk of breakage.

May develop latex allergy. Watch for tears.

Same price as male condom

Diaphragm Cervical

Has to be fitted by medical professional. Slight danger of toxic

shock syndrome if left in too long. May increase risk of UTI in
some women.

$10-30 plus cost of exam &


Foam, Jelly, Cream

High failure rate when used alone. Messy. Can be irritating.


Possible irritation.

$6 for box of 3




Chest pain, coughing up blood, dizziness or fainting spells, leg, arm

or groin pain, severe or sudden headaches, stomach pain (severe),
sudden shortness of breath, sudden loss of coordination, especially
$30 each
on one side of the body, swelling of the hands, feet or ankles, rapid
weight gain, vision or speech problems, weakness or numbness in the
arms or legs, especially on one side of the body


1. By preventing the sperm from reaching the egg
2. By keeping eggs from being released every month

99.7% (2)

96-98% (3)

Billings 85%
BBT 47%

90-98% if used correctly. More

effective if used with film or
foam. Do not use condom &
pouch together. (1)

90-95% (1)
Weight loss or gain can affect fit.
Consult MD.
71% - 99% when used with
condoms (1)
97% (1)
99% with condom

98 - 99%

3. By changing the lining of the uterus so a fertilized egg cannot


Section 2 ~ New Mother Care After Delivery

Bir t h Co n t r o l
Using birth control is important if you do not want to become pregnant. It is possible to become pregnant before your
menstrual period resumes, even if you are breastfeeding. If you do not plan to have another child soon, some form of
birth control is necessary the first time and every time you have sexual intercourse after the birth of your baby.
There are several birth control methods available. Some are more effective than others. There are artificial methods
that work by setting up barriers to prevent the sperm from meeting the egg or change the environment in which the egg
would implant. There are natural methods in which you stop having intercourse when the risk of pregnancy is greatest.
Some of the artificial methods require a doctors prescription and others can be bought at the drug store. Some
require planning and preparation before intercourse and others dont.

S e xu a lly Tr a n smit t e d Di se a s e s ( S TD s)
People may want to protect themselves or their partners from diseases that can be passed on by having intercourse.
These diseases are called sexually transmitted diseases (STDs) or also known as sexually transmitted infections
(STIs). Some STDs/STIs include acquired immunodeficiency syndrome (AIDS), chlamydia, herpes, genital warts,
gonorrhea, and syphilis. Talk with your family doctor about disease prevention.
Decreasing risk of STDs/STIs
and abstinence will decrease risk.
- The only sure way to prevent STDs/STIs is by not having sex. If you have sex, you can lower your risk of getting an
STD/STI by only having sex with someone who isnt having sex with anyone else and who doesnt have an STD/STI.
-You should always use condoms when having sex, including oral and anal sex.
- Male latex condoms can reduce your risk of getting an STD/STI if used correctly. Be sure to use them every time you
have sex. Female condoms arent as effective as male condoms, but should be used when a man wont use a male
-Remember, though, that condoms arent 100% safe and cant protect you from coming in contact with some sores,
such as those that can occur with herpes, or warts, which can be caused by HPV infection.
- Limit the number of sex partners you have. Ask your partner if he or she has, or has had, an STD/STI and tell your
partner if you have had one. Talk about whether youve both been tested for STDs/STIs and whether you should be
tested.Before you and your partner decide on which method to use, make sure you have discussed it fully. Some
things you may want to take into consideration:
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Remember, there are advantages and disadvantages to each method. Talk it over with your partner and your doctor
before you decide. It is recommended that you discuss birth control with your doctor before leaving the hospital.
However, if you do not, it is recommended to use condoms and contraceptive foam together during intercourse until
your 6-week appointment. Then you and your partner can discuss your choice of contraception with your physician.


Section 2 ~ New Mother Care After Delivery

Social Activities
Maintaining your outside interests, both those you share as a couple and those you enjoy individually, help to
increase couple closeness. You may decide to cut back on some activities, but dont give them all up entirely. Your
relationship with each other and your baby will be richer, if you stay interested and involved with the outside world.
Time for activities may need to be adjusted around your new parenting role, but it can be accomplished and will be
very rewarding.

Re t u r n in g t o Wo r k
One of the most difficult decisions a new mother must make is whether to return to work after the birth of her new
baby. For some families, there is no question - financially, the woman must work. Sometimes working is important for
a womans personal satisfaction or it may be important to maintain security or seniority of her position. But, there are
also women who choose to stay home with the new baby. Parenting is an important profession that can bring great
The decision about returning to work is a family decision that needs to be discussed with your partner. What is best for
your family? There are many things to consider. No matter what you decide, feel good about your decision.
How soon you decide to return to work is an individual choice. You need to consider your physical, emotional, and
financial situation. Most women do not feel they are back to prepregnant physical shape until at least 6 weeks
postpartum. Some take less time and others need more. This is dependent on:





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adequate rest).

Ch ild ca r e De cisio n s
and look around and dont rush into a decision.
Start preparing your infant for childcare by using babysitters early. It is recommended to introduce your baby to a
babysitter before 5 months of age. Between 5 and 12 months babies start to have stranger anxiety. If they have not
been exposed to anyone other than Mom and Dad, they may be frightened and this makes it difficult to leave.





Section 2 ~ New Mother Care After Delivery

Types of Childcare
Individual Care - one person who cares for your baby alone either in their home or yours. The care can be given by a
friend, relative, or paid provider.
Group Care - includes family daycare, babysitting co-ops, and daycare centers. Care is provided by one or more
caregivers and includes many children from different families.
The best childcare for your baby will depend upon:





No matter what type of childcare you are considering, interviews and visits are very important before you make your
decision. When visiting, bring your child. This allows you to observe how the person really relates to children. Bring
your list of questions and ask to see the house or facilities.
Suggested interview questions or observations:
Facility Clean? Safe?
Smoke detectors?
Where will child sleep?
Adequate space for play?
Type of diapers used? Do you provide?
What else do you need to provide?
Activities - What is a typical day like?
Toys available?
How many other children?
How much time does infant spend in crib?
Will they be taken outside? Will they be supervised?
Will they be taken in car? Where and when?
Materials available for activities?
Safety How often toys washed?
Gates by stairwells?
Broken toys?
Security checks?
Building kept locked?
Immunization records?
Discipline - Discipline policy?
How long do they let children cry?
Rock child to sleep?
Comforting and consoling observed?
Feeding Supportive of breastfeeding?
Introduce foods as you wish?
Illness Can bring sick child?
Will they give medications?
Caregivers - Background and experience?


Section 2 ~ New Mother Care After Delivery

Attitude toward baby?

Staff/infant ratio?
Certified in CPR?
Good childcare will make a difference in how you feel about returning to work. Take time to find out what is best for
your family. If you are comfortable and trust your childcare, you will be more efficient and productive at work. If you
are not satisfied, change childcare providers. Keep looking for childcare providers until you feel comfortable.

P r e v e n t io n o f Fa mily V io le n ce
Studies show that women are more likely to be the subject of family violence during their pregnancy. Battered women
have higher rates of low birthweight babies, preterm labor, and miscarriages than women who are not battered. It
happens to women of all races and economic levels.
It is important to recognize the signs and symptoms of family violence. Having a new baby in a family is a good time
Physical violence toward women is against the law. No woman or child deserves to be beaten. No matter what the
relationship problems are, if you are being beaten, it is NOT your fault. Men who show their anger and low self-esteem
by violence toward women and children need to learn another way to express anger. Help is available through social
service agencies, social workers, and therapists.

The Cycle of Violence

Most men who batter their partners show a behavior pattern that has been named The Cycle of Violence:
Phase 1 -

The Tension Building Phase, where there is increasing tension, anger, arguing, and blaming.

Phase 2 -

The Explosion - the violence happens. It can be physical, verbal, emotional, or sexual violence.

Phase 3 -

The Honeymoon / Calm Phase - the batterer is apologetic and remorseful - he says it will never happen
again or may threaten to kill himself if you leave him.

Over time, the violence tends to become worse and worse, and calm times become less and less. The batterer may
tell you that you are an unfit mother, and that he will take the baby away from you if you leave him. This is especially
difficult during this emotionally vulnerable time of hormonal changes.
You and your child do not deserve abuse. No matter how bad you feel about yourself, you did NOTHING to deserve
abuse. Wanting the abuse to stop does not mean you want the relationship to end. Unfortunately, you cannot control
his behavior, no matter how perfect you try to be. He has deeper problems and he needs help. You can break the
cycle of violence by seeking help for yourself and your child. Do not wait until he is ready to seek help.


Section 2 ~ New Mother Care After Delivery

Domestic Abuse Intervention Project

206 West Fourth Street
Duluth, MN 55206


Section 2 ~ New Mother Care After Delivery

Domestic Abuse Intervention Project
206 West Fourth Street
Duluth, MN 55206