Postnatal care

Inpatient Maternity Services Discharge Information

Congratulations on the birth of your baby. Now you are ready to be discharged from the hospital there are firstly some important things that you need to know and do.
UK law says you must register your baby’s birth within the first six weeks of their life by visiting the registry office. The appointment and birth certificate are free but you can purchase copies. You will be told what you need to bring with you to this appointment make a note of this so you remember to bring it with you. You can request an interpreter for the appointment if you need to use a language other than English. The main registry office is in Leeds City Centre at Merrion House but there are other local offices that might be more convenient. These are found in Armley, Dewsbury Road, Moor Allerton, Morley, Rothwell, Middleton, Seacroft and Yeadon. There are two important things to note, firstly both parents must attend the appointment if they are not married or in a civil partnership for the partner’s name to be added to the birth certificate. Secondly if you do not live in Leeds but you did give birth here you must register your baby in Leeds.
You will also need to register your baby at your GP practice. You can use the baby stickers provided with your hospital discharge notes to do this as these contain your baby’s NHS number.
You should also have a joint 6 to 8 week postnatal appointment with your GP for yourself and for your baby. You can book this appointment when you register your baby at the GP. This check-up will include a general welfare check for yourself and an infant physical examination, similar to the newborn check that was carried out on your baby on the postnatal ward before going home. The GP will also offer initial vaccinations for your baby and these are usually around 8 weeks of age. These can be found in your red book. The appointment aims to give your baby the best possible start to a healthy life. For more information you can find this on page four of your West Yorkshire and Harrogate local maternity and neonatal system postnatal care and support booklet. This is provided to you on discharge from the hospital.
The following information is important regardless of how you choose to feed your baby. Feeding your baby in the early postnatal period is a personal time that helps develop the bond between you and your baby. It can also be an anxious time for you both as you learn how to feed together. Looking and talking to your baby can help you both feel calm and secure. Responsive led feeding is recommended and involves identifying and responding to your baby’s cues such as moving their head side to side, opening their mouth wide, bringing their tongue over their lips or sucking their fists or fingers. 8 to 12 feeds in 24 hours are encouraged but if your baby shows more frequent cues always offer a feed. Cluster feeding where feeds are shorter and closer together is normal and occurs when establishing breastfeeding and during developmental milestones. Offering some feeds whilst having skin to- skin with your baby boosts the love hormone oxytocin which has many health benefits including calming you and your baby, regulating heart rate, breathing and their body temperature with yours, supporting brain development and promoting healing and lower blood pressure.
Monitoring your baby’s wet and dirty nappies in the first few weeks help you to know if feeding is going well. Meconium is the first poo your baby will pass, when your baby’s poo is changing from black and sticky to green and dark yellow soft and runny over several days this is a good sign. As a rough guide we would expect one wet nappy on day one two on day two and so on until about a week old. After this wet nappies should remain frequent throughout the day regardless of baby’s age. Pink urate crystals in a nappy indicate dehydration so inform your Community Midwife or Health Visitor if you see these. If you see blood in a dirty nappy always consult your GP or doctor. Constipation can occur if your baby hasn’t had a poo for 24 to 48 hours and it is a good idea to mention that formula fed babies are more likely to experience constipation as it takes longer for the gut to digest formula milk. There are links on the screen for sources of feeding support
Due to hormonal changes you may have noticed some changes to your breasts during pregnancy. These may include an increase in breast size, increased tenderness or a change in sensation of the breast and nipple changes in colour and size of nipple and areola or larger Montgomery glands. These are sebaceous oil glands which appear as small bumps around the areola during the postnatal period. It is important to be aware of potential further changes these can occur regardless of your preferred method of feeding. Usually 3 to 4 days after giving birth you may notice fuller heavier breasts, this is due to your milk coming in. Engorgement, blocked ducts, infection such as mastitis, cracked painful nipples and thrush are all potential concerns to be aware of. Ask your Midwife about anything you are unsure of and need help managing. If you notice unusual lumps, painful areas or discharge from the nipple or areola speak with your GP for further assessment and advice.
Newborn blood spot is a routine screening test offered when your baby is 5 days old. It is not compulsory but strongly recommended and usually completed by a Community Midwife. Maternity Support Worker or a Hospital Midwife if you are still in hospital on day five following the birth. The test involves a heel prick and four spots of blood on to a sample card. We encourage you to hold or feed your baby during the test to keep them calm. You will receive the results via post at about 6 to 8 weeks later and you will be contacted earlier if the screen is positive. Please refer to the NHS UK website for further information on this.
Next we share with you some ways you can care for yourself and your future health after giving birth. Pelvic floor exercises are beneficial for strengthening the muscles around the bladder bottom and vagina helping with urinary incontinence treating pelvic organ prolapse and making sex more comfortable. You can find your pelvic floor muscles by trying to stop your Wee when you go to the toilet but don’t do this regularly as it can damage your bladder. To strengthen your pelvic floor muscles sit comfortably and squeeze them 10 to 15 times without holding your breath or tightening other muscles. Nobody can see you doing them if you are doing them properly meaning you can do them anywhere. Try to add them into your daily routines such as when feeding your baby brushing your teeth or waiting for the kettle to boil. The NHS squeezy app is handy for further information and daily reminders. If you suffer urinary incontinence, suspect a prolapse or find that sex is uncomfortable book an appointment with your GP or Women’s Health physiotherapist.
The NHS cervical screening program advises free yearly cervical screening previously known as a smear test from age 25 onwards. If you have had to delay your routine cervical screening due to your pregnancy you will need to wait at least 12 weeks or 3 months after having your baby until you can go for this appointment. This time period is to ensure a better chance of getting clear results at your screening as pregnancy can affect this. Cervical cancer is difficult to identify by symptoms alone as these can often only develop when the cancer is well established if at all, meaning screening is the best way of reducing your risk. It can identify abnormal cells which can then be managed to prevent you developing cancer in the future
If you have not had long-term contraception provided to you before discharge from hospital it is important to think about this now because you can easily become pregnant again from 21 days following your birth. Many unplanned pregnancies happen a few months after giving birth especially if you are not exclusively breastfeeding. Your periods can restart from 5 to 6 weeks after birth and you don’t need to wait until your period returns to start using contraception. Contraception should be used from 3 weeks after birth, there are various types of contraception available including condoms, tablets, injections, hormonal implants and uterine coils. Contraception can be obtained from GP practices or the Leeds Sexual Health Centre which is located in the Merrion Centre and you can book an appointment online. There are some methods of contraception that we can provide to you before you leave hospital so please ask your Midwife about this before you leave. Be sure to inform your health practitioner about your breast feeding status to avoid hormone related contraception methods. Tommys have created a really useful tool for planning for future pregnancies which emphasizes the importance of optimizing your health and well-being prior to the start of pregnancy to ensure positive outcomes. More information on contraception can be found on pages 10 to 13 of your West Yorkshire and Harrogate local maternity and neonatal systems postnatal care and support booklet provided to you on discharge from hospital.
It is really important to consider your health and well-being post pregnancy. Evidence shows that weight gain between pregnancies is one of the biggest issues associated with increased risk and medicalization in future pregnancies. Physical activity and eating healthily are the two best ways to reduce this weight gain. It is safe to commence exercise as soon as you feel physically able. Even if you exercised before it is important to restart gradually, building up to an hour and a half of moderate level activity per week. Moderate activity will raise your heart rate and make you breathe faster and feel warmer. One way to tell if you’re working at this intensity level is if you can still talk but not sing. Examples of activities include brisk walking and water aerobics. Regular exercise also has psychological benefits including improved mood, decreased anxiety and depression and improved sleep. Improving your diet by cutting back on processed high sugar and high fat foods will also help you to maintain a healthy weight and therefore reduce yours and your child’s risk of diabetes in the future.
Your mental well-being is also vital to consider at this new time in your life. Many women can feel a little bit down, tearful or anxious in the first week after giving birth. This is often called the baby blues and is so common that it is considered normal however if your symptoms last longer or start later you could have postnatal depression. This can start at any time in the first year after giving birth and affects about one in 10 women in the UK. Symptoms include a persistent feeling of low mood, sadness or emptiness, a loss of interest in things you normally enjoy, withdrawing from friends and family and in some cases frightening thoughts about hurting yourself or your baby. Other mental health concerns can include anxiety panic attacks and psychosis. If you are concerned about your mental well-being when you’re at home please speak with your GP, Community Midwife or Health Visitor as soon as possible. It is really important to remember that having depression is not your fault it is an illness that support and treatment is available for. Partners can also experience these symptoms and support is available for them too. Have a look at these web pages for more information regarding postnatal health and well-being.
Following your baby’s birth your Community Midwife will provide support through home visits, phone calls or appointments in the early days and weeks. The pattern of visits will depend on your preferred infant feeding method with either a midwife or a support worker visiting on your baby’s third day to weigh them if you are breastfeeding. If your baby does lose weight further support will be offered on day five. A midwife will weigh your baby and offer the newborn blood spot screening test this is described earlier on in this video. If you do not live in Leeds your local community midwifery service will be notified of your discharge from the Leeds hospital and the care will be resumed by themselves once you are back home. The health visitor will visit you around day 10 and take over care from the maternity team until your child starts school. If you need to contact a Midwife for advice after you’ve been discharged from hospital you can find the contact numbers for all maternity services within the West Yorkshire and Harrogate local maternity and neonatal system on pages 45 and 46 of your postnatal care and support booklet. You can also call for advice on the 24-hour triage or maternity assessment department of your local hospital you can call up to 6 weeks following your birth. You can also call 111 for advice or 999 in an emergency. Babies can be seen by your GP or seen in your local A&E department. For people who live in Leeds it is important that you know that you need to go to the LGI A&E as this is where the Paediatric Services are. There is no children’s A&E at St James’s. Your Midwife will provide you with some final discharge advice and essential documentation for your discharge to be completed. This is the best time to ask any further questions you may have before you leave. We offer you our very best wishes and congratulations again on the birth of your baby. Thank you for listening.