The First Six Weeks

Expert advice on taking care of yourself and your new baby.


As the old saying goes, babies don't come with instruction manuals. Nor does childbirth automatically give a mom insight into what's happening to her own body. But that doesn't mean new parents have to be totally on their own.

From Web sites to books, there's more information available than ever before; you just have to know where to look. To help you get through the first six weeks after giving birth, here's some expert obstetric and pediatric advice, as well as a guide to the best information and support sources out there.

Taking Care of Baby

Bringing a baby home can be terrifying for first-time parents. However, as any experienced mom or dad will tell you, caring for a newborn is easier than it looks. Here's some soothing advice on caring for your baby from Gwenn O'Keeffe, M.D., a pediatrician at Harvard Vanguard Associates in Burlington, Mass., and a clinical instructor at Harvard Medical School in Cambridge, Mass.

Umbilical-cord stump: Keep the area where the cord attaches to the belly as clean and dry as possible. Wipe it after every diaper change, using a cotton swab or ball dipped in alcohol. Then fold the front of the diaper down so it doesn't cover the stump. Stick with sponge baths until the umbilical cord drops off, usually in two to four weeks. If the area becomes red or pus-filled, call the doctor: Though rare, umbilical-site infections can be serious.

Circumcision site: The area will be red and raw for a few days but should heal within a week. Your doctor probably will recommend applying a topical antibiotic ointment, such as Neosporin or bacitracin, or even plain petroleum jelly at each diaper change. If the site looks unusually swollen or red, seems warm or has pus on it, call your pediatrician immediately.

Crying spells: "Babies cry," O'Keeffe says. "It's normal." So instead of panicking, go through a mental checklist of what could be wrong. Is he hungry? Cold? Poopy? Gassy? Hot? Lonely? Nursing, rocking, bouncing or walking with your baby often helps — but not always. "Some babies just have irritable temperaments," O'Keeffe says. And some have colic, a term that doctors define differently.

Generally, a colicky baby is one who has long crying spells on a regular basis, usually every day at about the same time. Sometimes they have obvious gas pains during their crying spells, sometimes they don't. Doctors aren't sure what causes it, but rest assured that this, too, shall pass, usually by 4 to 6 months of age.

Bathing: Stick with sponge baths until the umbilical cord stump drops off. Wrap the baby in a towel on a cushioned surface and wash him with a soft cloth using warm water only. Unwrap just the body part you're washing so he stays warm. After the stump is gone, you can put the baby in a baby tub or in a sink lined with towels to keep him from slipping.

To prevent his skin from drying out, limit full baths to two or three times a week, and use only baby soap. Oils and lotions are unnecessary unless his skin is very dry; powder should be avoided since it's easily inhaled. Remember, newborns can get cold easily, so have all supplies and a warm towel ready before you start the bath.

Sleeping: Unless your pediatrician recommends otherwise, place your newborn on his back, and only on firm surfaces. Keep him well away from pillows and fluffy blankets or toys that could suffocate him.

When to Call the Pediatrician

If you're not sure whether to call your baby's doctor, err on the side of caution, says Gwenn O'Keeffe, M.D. These symptoms should have you on the phone immediately:

Fever: Pediatricians are very cautious with any fever in a baby younger than 8 weeks, especially if his rectal temperature is higher than 100.5 F. They are less alarmed after 8 weeks, but if your baby has a fever, isn't eating well or just looks "sick," phone the doctor.

Dry diapers: Your baby should have eight to 12 wet diapers a day; if he doesn't, he may not be eating enough. (Breastfeeding mothers should be especially attentive during the first few days, when the milk is coming in.)

Poop problems: The consistency and color of poop can vary, so don't be alarmed if your baby's bowel movements change from day to day and week to week. But diarrhea can cause dehydration. Call your pediatrician if your baby has watery stools or blood in his diaper.

Vomiting: Spitting up is normal, but if your baby vomits in large amounts or projectile vomits, or if his vomit is yellowish or greenish, his digestive tract could be blocked.

A White Tongue: Babies are susceptible to a fungal infection known as thrush, which causes the tongue to look white. Call your pediatrician if you notice this. Thrush is treated with an oral antifungal medication and usually clears up within a week or two. If you're nursing and your baby develops thrush, you may develop it on your nipples.

Signs of Umbilical-Cord Infection: These include pus or redness around the stump area.

Taking Care of You

Although everyone is fussing over your new baby, you need special care during the first six weeks postpartum, too. Here's advice from Paul Gluck, M.D., an obstetrician- gynecologist and chairman of the Baptist/South Miami Hospital Foundation in Miami, on how to care for yourself after delivery.

Episiotomy: During the first week or so, spritz the area with warm water mixed with a diluted iodine solution (no more than 50 percent iodine) in a squirt bottle whenever you use the toilet. Or sit in a warm Epsom salt bath several times a day. Use toilet paper gingerly — wipe from front to back to avoid fecal contamination. If constipation or bowel movements cause pain, ask your obstetrician about using an over-the-counter stool softener.

Lochia: For three to four weeks after delivery — either vaginal or Cesarean — you'll experience a discharge called lochia. It starts out bloody but turns yellowish in about two weeks. Use pads rather than tampons; the latter can irritate the area and increase your risk of infection. And although you might be tempted to douche, don't — douching can introduce bacteria and lead to infection.

Bleeding: If you notice a significant increase in vaginal bleeding or if it's more profuse than a heavy period, you may be doing too much too soon. When bleeding increases, Gluck says, "The first thing I tell a patient is to get off her feet and rest." Keep in mind, however, that your bleeding may increase slightly after breastfeeding, which releases hormones that cause the uterus to contract. Rest will often help here, too.

Cesarean Section Incision: Avoid strenuous activity for a month. "I recommend that the mother lift nothing heavier than her baby during that time," Gluck says. Slow walks are fine if you feel comfortable, but avoid driving or running errands for two weeks. As your incision heals, it may itch or feel numb. This is normal.

Breasts: Wash your breasts and nipples with a mild soap. If your nipples crack or bleed, see your doctor or a lactation consultant. Don't use any creams or lotions not recommended by a health professional. Painful breasts can be caused by infections or clogged milk ducts; see your doctor if you have pain or fever.

Nutritional Needs: Finding time for healthful cooking can be difficult when you have a newborn, but eating well is crucial, especially if you're breastfeeding. Elizabeth M. Ward, R.D., author of Pregnancy Nutrition: Good Health for You and Your Baby (John Wiley & Sons Inc., 1998), recommends filling your kitchen with healthful food that's easy to grab and requires little preparation: low-fat yogurt and cheese slices, pre-cut fresh fruits and vegetables, salads, peanut butter, hard-boiled eggs, water-packed tuna, single-serving bottles of vegetable and fruit juice, and whole-grain breads, cereals and rolls.

Relationships: For many couples, the stresses and demands of pregnancy, childbirth and caring for a newborn can strain a relationship. You and your husband may be too tired for sex. Set aside time for each other at least once a week to go on a date, even if it takes place at the dining room table while the baby sleeps.

Hugs, kisses and other expressions of affection are never off limits, but intercourse is verboten for four to six weeks because it takes about that long for the cervix to close fully and block contaminants that could cause infection. Ask your doctor about this before you leave the hospital.