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by Anna

Community Midwife (Little One's First Week)

The morning after our discharge (Little One's 3 day birthday) we had a visit from the community midwife as expected. It was all a little bit chaotic. We had arrived home the previous evening and, because Little One was a tiddler we didn’t have much that fitted her (she was drowning in the newborn stuff). We had just got some "tiny baby" sized clothes which were being washed and dried. Whilst waiting for her new wardrobe to be ready Little One and I were engaging in a spot of skin to skin inside my dressing gown.

This was how we were when we greeted the midwife. Fortunately it was the same midwife who had taken care of us during Little One's stint "inside" so it was a bit like greeting an old friend. She had a student midwife with her as well.

The appointment was a bit of a blur but they weighed little one and asked about how she had been doing with feeding… Not good was the answer. We had only been back on the boob for a day and although Little One was latching on she seemed to be losing interest after a couple of sucks. They checked over my technique and gave me some advice on feeding. Little One had lost a bit of weight and they said that this often happens but that they would have to keep an eye on it.
I was also checked over. 

I had a few concerns about my pelvic floor… (Too much information alert…) On a few occasions I had found that I was only aware that I needed the loo when I was properly desperate and that sometimes (erm, how to put this) I was having a little accident before making it to the toilet. As I was still wearing the maternity pads it hadn't gotten messy but it was still very disconcerting!

The midwife wasn't concerned and everything downstairs (apparently!) was as it should be. She said that some incontinence was expected in the immediate aftermath but to keep doing pelvic floor exercises and that for most people things should go back to normal soon (which it did within the week).

Our next appointment was on Little One's five day birthday. This time we had a nearly qualified student midwife out on her own. (Our midwife was on her holidays). This visit was to take blood for some routine tests but, because at the three day appointment there were concerns about Little One’s feeding, she checked her weight. She was a bit jaundice and she had been sleeping a lot and the midwife said that she thought she might benefit a full check-up at Alder Hey. She telephoned her supervisor and confirmed that we should take Little One to Alder Hey to check on her because of her poor feeding and weight loss (she had lost 16% of her, already tiny, birth weight).

The midwife was very calm about it all and made it all seem very routine. She asked that we go as soon as possible to Alder Hey (as they would be expecting us) but hadn't scared us. It is only in retrospect that I know that had we not either taken her in right away, or supplemented her feed with some formula, that she probably would have become fairly unwell.
Little One spent 2 nights in hospital (with me not leaving her side). She was given some extra milk (a mixture of expressed breast milk and formula) via a naso gastric tube whilst she got up to strength.
It was a tough first week for Little One… First two nights in the Women’s, three nights at home, then two at Alder Hey. There were a lot of tears (and a lot of guilt about the feeding).
After our discharge we had some further appointments with the midwife to check on us both but they were a lot less dramatic as Little One had started putting on weight and we were both doing OK. I also had a further appointment at the hospital to follow up on my complication and as I was also back to normal I was discharged from their care.

Clinical comment

The first night home is always a little chaotic with a new baby, it’s amazing how much a little one can accumulate in just three days. I'm so happy you mention skin to skin, this is an excellent way to bond with your little one and can help fractious babies to settle, we would also encourage dads to partake in skin to skin time too.

It is our aim at the Liverpool Women’s to provide continuity of care. Our community midwives hold their own caseload of women, which means your named midwife will provide all of your antenatal and postnatal care, should you opt for a homebirth in the future she may even be there for the birth too!
Learning the art of breastfeeding can take some time, there is lots of support for mums both in the hospital and at home, the Liverpool Women’s has a dedicated infant feeding team and we work very closely with the following peer support groups.

BAMBIS (Liverpool area) 0151 702 4411
BreastStart (Sefton) 0151 291 8024
Bosom Buddies (Knowsley) 0151 244 3269

It is normal for babies to lose some weight initially and this is monitored by the community team, as is jaundice, if either of these becomes a concern further investigation and possible referral would be required, as your midwife quite rightly did.

Stress incontinence can occur after having a baby, we do recommend women commence pelvic floor exercises as soon as they feel up to it, this will help to strengthen these muscles post delivery. If this problem had persisted your midwife could have referred you to our Urodynamics team.
Just a few bits of information now you are home...

Don't forget to register the birth of your baby within 6 weeks, this can be done by making an appointment at LWH or St Georges Hall. Once you have your birth certificate you can apply for child benefit. A Health Visitor should make contact with you soon to make an appointment to visit you at home. She will discuss again some of the information you will already have received from our midwives regarding safe sleeping and immunisations.

Last but not least! It's time to consider what form of contraception you would like to use! Discuss this with your midwife or GP.  Wishing you all the best for the future.

Maple East Community Team

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29 April 2013