Spanish for postpartum nurses: the patient who saturated a pad and didn’t call because she was told bleeding was normal, the patient whose baby has slept four hours and whom she has not woken to feed, and the patient who is going home today and has been calling her intrusive thoughts a «tontería» for three days

Valentina Rios gave birth to her first baby at 2:17 in the morning — twenty-six hours of labor, vaginal, epidural, no complications written in the chart. Her overnight nurse told her, in English with a Spanish phrase sheet left on the bedside table, that she should expect bleeding and cramping, that this was normal, that she should call if she was in severe pain or if something felt wrong.

By the morning shift change Valentina had saturated a pad completely and found, when she went to the bathroom, a clot larger than she had expected. She held it for a moment in a paper towel, trying to decide what it meant. She had been told that bleeding was expected. She had not been told what bleeding that was not expected looked like. The clot was large — like a small mandarin orange — but she had no clinical reference for what large meant in this context. She wrapped it in toilet paper and put it in the trash. She put in a new pad. She went back to bed. She did not press the call button.

Her husband Jorge was asleep in the chair by the window. The baby was in the bassinet. Everything, on the surface, was quiet.

Three postpartum assessments that arrive as a quietly sleeping patient, a quietly nursing baby, and a quietly cooperative first-time mother about to go home: Valentina Rios, twenty-eight, one day after a vaginal delivery, who has saturated a pad completely and found a large clot and decided to mention neither because she had been told bleeding was normal and she did not know what normal was supposed to look like; Isabel Morales, thirty-one, two days after delivering her second baby, who answers “bien, está tomando bien” at every lactation check, whose baby Tomás has slept for four consecutive hours, and whom she has not woken to feed because he was sleeping so peacefully and she was so exhausted, and whose baby is quiet at the breast not because he is content but because he no longer has the energy to demand; and Carmen López, twenty-six, three days postpartum with her first baby, going home today, who scored 7 on the Edinburgh Postnatal Depression Scale administered in English, who has answered “estoy bien, solo cansada” at every nursing check for three days, and who has been having intrusive thoughts about dropping the baby since the night of delivery and has been calling them “tonterías” because she has no other word for what is happening to her, and because she is afraid of what a nurse might do if she said them out loud.

The patient who didn’t call because she was told bleeding was normal

The morning postpartum nurse came in at seven-thirty for the first assessment of her shift. Valentina looked tired but not in distress — sitting upright, the baby in the bassinet beside her, Jorge stirring in the chair. The chart said: primipara, vaginal delivery, no complications, epidural discontinued, vitals stable on the midnight check. A routine first postpartum day.

The nurse did her assessment in order. Fundal height. Lochia. Perineum. But before the physical exam, she asked the question that opened what the chart had not captured.

“Valentina, antes de la evaluación quiero hacerle unas preguntas sobre el sangrado de esta noche. ¿Cuántas toallas ha saturado completamente desde que nació el bebé? — no manchadas, sino completamente empapadas de un lado a otro.”

Valentina paused. The distinction — manchadas versus saturadas — had never been made for her before. All the discharge instructions, all the phrase sheets, all the “expect bleeding” had not given her this single calibrating word.

“Completamente... dos. Tal vez tres. Esta de ahora creo que también.”

The nurse wrote this down. She moved to the next question.

“¿Notó algún coágulo — algún grumo de sangre, algo sólido — cuando fue al baño?”

A pause longer than the first.

“Sí. Uno. Esta mañana. Pensé que era normal — me dijeron que iba a haber sangrado.”

“¿Puede describirme el tamaño? ¿Era más pequeño que una pelota de golf, del tamaño de una pelota de golf, o más grande — como una mandarina, o más?”

Valentina looked toward the window for a moment, calibrating. “Como una mandarina. O un poco más grande.”

The nurse moved to the fundal assessment. With her hand on Valentina’s abdomen, she found the uterus mid-line, one fingerbreadth above the umbilicus — the expected position for one day postpartum. But when she palpated, the uterus was soft, without the firm globular contraction it should have had. She massaged, applying steady fundal pressure in circles. Under her hand she felt the uterus firm up. As it did, a gush of blood.

Valentina startled. “¿Eso es normal?”

“Es lo que esperaba de la evaluación. Le voy a explicar todo en un momento — primero déjeme revisar sus signos vitales.”

Blood pressure: 104 over 68. Her baseline on admission had been 122 over 78. Heart rate: 98. Baseline 72. Not yet in hemorrhagic shock — but the trend was there, and the boggy uterus with recurrent saturation and a large clot gave the complete picture: uterine atony, early postpartum hemorrhage, beginning before the morning shift had entered the room.

The nurse called the charge nurse, initiated the hemorrhage protocol, and administered an oxytocin bolus via the existing IV. She massaged again. She stayed in the room for the next forty minutes.

While she waited for the uterus to respond, she had time to ask what she had been wondering since the first answer.

“Valentina, el coágulo de esta mañana — ¿por qué decidió no llamar?”

Not accusatory. Exploratory.

“Me dijeron que el sangrado era normal. No sabía que ese no era el sangrado normal.”

This was not her failure. It was an education failure. The overnight nurse had given Valentina the right category — bleeding is expected after delivery — without giving her the subcategories that made that information actionable: what expected looks like, and what not expected looks like, in specific observable terms. Without those terms, Valentina had done exactly what a reasonable person does: she had classified her experience under the closest available category, which was “normal bleeding.”

The uterus firmed over the next thirty minutes. Repeat vital signs: BP 112 over 74, HR 86. The hemorrhage was contained. Valentina would not need a transfusion. Jorge, who had been awake since the charge nurse entered the room, sat beside Valentina and held her hand without speaking.

When things were stable and the attending had seen her, the nurse sat down to give Valentina the discharge teaching on lochia that should have been given — with these specific words — on admission to the postpartum unit.

“Hay sangrado que esperamos después del parto. En los primeros días las toallas se van a manchar — a veces bastante — pero no se van a saturar completamente de un lado a otro en menos de una hora. Ese es el primero. Hay sangrado que no esperamos: si en una hora una toalla queda completamente empapada, o si nota un coágulo más grande que una pelota de golf — necesita llamar de inmediato o ir a urgencias. No espere para ver si pasa. No piense que es normal porque le dijeron que habría sangrado. Esos dos son diferentes. ¿Puede decirme en sus propias palabras cuál es la diferencia?”

Valentina repeated it back. The nurse listened.

“Exacto. Eso es lo que necesito que sepa cuando se vaya a casa.”

What Valentina had needed on admission was not more reassurance that bleeding was expected. She had that. What she had needed was the calibrating language that made the reassurance safe to apply — the specific, countable, observable distinction between normal and not normal, in Spanish, with size anchors she could use.

The chart note the nurse wrote that evening included, under “teaching,” a new field she had been filling out for two years: patient verbalized specific thresholds for hemorrhage reporting before discharge. Not just “education provided.”

The patient whose baby is quiet at the breast because he no longer has energy to ask

Isabel Morales had breastfed her first baby for eight months. She was thirty-one and knew what breastfeeding felt like — the latch, the let-down, the fullness before and the softness after. When baby Tomás latched quickly and went quiet, she recognized the quiet. It meant he was eating.

She was wrong, and the familiarity was the reason she was wrong.

Tomás was two days old. He had been born at term, thirty-nine weeks, vaginal, without complications. Isabel was exclusively breastfeeding. At each nursing check — once per shift, sometimes twice — the nurse had looked in from the doorway: baby at breast, Isabel calm, both quiet. The chart noted breastfeeding adequate at each entry. The morning weight had shown Tomás down 8 percent from his birth weight. Still within the acceptable range for day two, technically. But trending.

The morning nurse came in for the nine o’clock assessment. She asked the standard breastfeeding check.

“¿Cómo está tomando el bebé?”

Isabel: “Bien. Está tomando bien. Me duele un poco el pezón pero creo que es normal.”

The nurse was about to move on. The chart was already open. But something about the scene gave her pause: Tomás was asleep in the bassinet at nine in the morning, entirely still, no rooting, no hand-to-mouth movements, no indication that he had recently demanded a feed or was about to. She put the tablet down and asked a different question.

“¿Cuántas veces ha tomado el bebé desde que se despertaron esta mañana?”

Isabel thought. “Esta mañana... una vez. Antes, como a las dos de la noche.”

“¿Y ayer, durante el día, cuántas veces tomó aproximadamente?”

Another pause. “Cuatro veces. Tal vez cinco.”

For a forty-eight-hour-old exclusively breastfed infant, four to five feeds per day was half the minimum. Tomás should have been feeding eight to twelve times per day. He had not been demanding. Isabel had not been waking him. She had learned, from her first baby, that a sleeping baby was a satisfied baby. This had been true of her first baby. It was not true of Tomás.

“Cuando está en el pecho, ¿puede usted escuchar cuando el bebé traga? No el movimiento de las mejillas o el chupeteo — sino el trago en sí, como un pequeño glu, glu.”

Isabel stopped. She had never been asked this before. With her first baby she had heard the swallowing without knowing to listen for it. With Tomás —

“...no. No lo escucho. ¿Se tiene que escuchar?”

“Sí. El sonido del trago es la señal de que la leche está pasando. Si escucha el chupeteo sin el trago, el bebé está trabajando pero no está transfiriendo leche.”

The nurse asked Isabel to try a feed now, with the nurse in the room. Isabel woke Tomás with a plantar stimulus — the nurse showed her how to stroke the sole of his foot. He roused slowly, with little protest. He latched within a few seconds. Both Isabel and the nurse watched. Isabel counted the suckles. No audible swallow.

After two minutes, Tomás released the nipple and closed his eyes.

“¿Puede mirar cómo quedó el pezón cuando lo soltó? ¿Está redondo, como siempre, o está un poco diferente en la forma?”

Isabel looked. The nipple was flattened, slightly tapered at the end — the shape of something that had been compressed rather than fully drawn in.

“...aplastado.”

“Eso me dice que el agarre es superficial — que el bebé está tomando el pezón pero no la areola. Cuando el agarre es superficial, el bebé puede chupar sin extraer leche. No está mal hecho — lo hace bien mecánicamente — solo necesita ir un poco más adentro.”

Isabel had breastfed before. She had a shallow latch corrected with this baby and had not recognized it, because the mechanics looked familiar and the baby had been quiet afterward. The quiet of a baby who has swallowed two minutes of colostrum without adequate transfer looks exactly like the quiet of a satisfied baby, until the weight starts to trend and the feeds thin out.

The nurse repositioned: guided Isabel’s hand to support the breast differently, helped her bring Tomás in chin-first with his head tilted back, waited for the wide open mouth before contact. The latch the second time was deeper. Tomás began to suckle. Within forty-five seconds, the nurse and Isabel both heard it: a small soft sound, barely there, repeating.

“Eso. ¿Lo oyó?”

“Sí.”

“Ese es el trago. Eso es lo que necesitamos escuchar.”

The nurse called the lactation consultant. She also explained to Isabel what had happened and what would come next, in specific terms.

“La leche todavía no ha llegado — usted todavía está produciendo calostro, que es la primera leche, la que tiene los anticuerpos. Es perfecta para el bebé en este momento, pero hay menos volumen que con la leche completa. Para que la leche llegue, el bebé tiene que tomar seguido — eso es la señal que le dice al cuerpo de usted que produzca más. Si toma poco, el cuerpo no recibe esa señal.”

“¿El bebé que duerme mucho es porque está satisfecho?”

“Con su primer bebé, probablemente sí. Con un bebé recién nacido en los primeros días que todavía está esperando que llegue la leche — no siempre. A veces el bebé que duerme mucho y que no pide es un bebé que ya no tiene la energía para pedir. Es una de las señales que buscamos para saber que necesita más ayuda. No es culpa de nadie — usted estaba haciendo lo que hizo con el primero, que funcionó. Con Tomás necesitamos un patrón diferente estos primeros días.”

Isabel was quiet for a moment. She looked at Tomás, who was still at the breast.

“¿Está bien él?”

“Está bien. Está bajando de peso, que es normal en los primeros días, pero está bajando un poco más rápido de lo que queremos. Lo que estamos haciendo ahora — el agarre mejor, las tomas más seguidas, despertar al bebé cada dos horas en vez de esperar a que pida — es exactamente lo que va a cambiar eso. La consultora de lactancia viene hoy a verlos a los dos.”

The lactation consultant observed two more feeds before discharge. At the afternoon weight check, Tomás was down 8.5 percent — slightly more, because the deep latch was new and his transfer was still building. But the pattern had changed. The swallowing was audible. The feeds were spaced two hours apart. Isabel had an alarm set on her phone.

The note the lactation consultant left for the pediatrician included one line the postpartum nurse had asked for: mother breastfed first infant successfully; re-teaching required for second infant due to silent shallow latch undetected by standard assessment; specific latch technique reviewed and transfer confirmed by audible swallow before discharge.

The mother who has breastfed before is not the mother who needs less assessment. She is the mother whose prior experience creates a pattern the second baby may not fit, and who may not question the silence because silence meant something different the first time.

The patient who is going home today and has been calling her intrusive thoughts a «tontería»

Carmen López was twenty-six, first baby, three days postpartum. She had been the easiest patient on the postpartum unit by every observable measure: no pain complaints beyond what was expected, cooperative with every assessment, smiling reliably when the nurse looked in. Her husband Rodrigo had been there every day. The baby was healthy. The chart was clean.

The Edinburgh Postnatal Depression Scale had been given to her at forty-eight hours. The nurse who administered it had handed her the English form with a verbal explanation in simple English. Carmen had answered as best she could. She scored 7. The electronic chart noted: EPDS 7, within normal range, reviewed with patient, no further follow-up indicated.

Carmen had not answered the EPDS honestly. Not because she intended to deceive — but because the English questions asked about feeling sad, feeling that things were getting on top of her, feeling unable to laugh at things, and she was not sad, things were not getting on top of her, and she had laughed at something Rodrigo said yesterday. She answered what the questions asked. The questions did not ask what was actually happening to her.

What was actually happening: since the night of delivery, she had been having the same thought, arriving without warning, arriving many times per day. She would be holding the baby — changing him, carrying him to the bassinet, sitting up with him at three in the morning — and the thought would arrive: y si se me cae. And what would happen if he fell. She would grip him more tightly. She would stand very still until the thought passed. And then she would put him down and stand over the bassinet for several minutes, making sure he was breathing, making sure he was fine. She knew he was fine. She had just put him there. She stood and watched anyway.

She had told no one. She had two reasons. The first: she thought the thoughts meant she was a bad mother, and she was ashamed of them. A good mother would not think about dropping her baby. She thought about it fifteen times a day. This was evidence of something wrong with her. The second reason, larger and less nameable: she had heard stories. Stories of mothers who said something to a nurse and the baby was taken. She did not know if these stories were true. She did not know if they applied to thoughts like hers. She was not willing to find out by accident.

The discharge nurse came in at ten in the morning. She had six patients to discharge today. Carmen’s chart was ready. The physician had signed the papers. The nurse had a Spanish handout for the discharge instructions, a follow-up appointment card for the OB at six weeks, and a pediatrician visit scheduled for day five.

She could finish this room in eight minutes.

She closed the door. She sat down — not on the edge of the bed, not standing, but in the chair that faced Carmen’s chair, at eye level. She put the clipboard in her lap. Rodrigo was in the hallway with the baby.

“Antes de que se vayan hoy, quiero hacerle unas preguntas sobre cómo ha estado durmiendo y cómo está pensando. No es para hacerla quedarse más tiempo — los papeles para irse están listos. Es solo para asegurarme de que tiene todo lo que necesita antes de salir. ¿Está bien si le pregunto?”

Carmen nodded.

“¿Cómo está durmiendo cuando el bebé duerme?”

“Más o menos. Estoy cansada.”

“Cuando el bebé está dormido y usted se acuesta, ¿logra dormirse? ¿O hay pensamientos que le siguen dando vueltas?”

A pause. Not a no. Not a yes. A considering pause.

“...a veces. Pienso en el bebé.”

“¿Qué tipo de pensamientos? ¿Preguntas sobre cómo lo está haciendo, o algo diferente?”

Carmen looked at the window. She looked back at the nurse. The nurse did not fill the silence.

“...diferente.”

The nurse asked the question she had been waiting to ask, the one that only arrived after three questions had established that this was not a routine dismissal.

“¿Ha tenido pensamientos que la sorprenden o la asustan — pensamientos de que algo podría pasarle al bebé, aunque usted sepa que no tiene sentido?”

The silence this time was different in kind. It was the silence of a person who recognizes something she has not been able to name.

“...sí.”

The nurse waited.

“Cuando lo cargo pienso... y si se me cae. Y lo aprieto muy fuerte. Y luego no puedo dejar de pensarlo aunque sé que no lo voy a soltar. Sé que es una tontería. Por eso no lo había dicho.”

The nurse did not say “no es ninguna tontería” immediately. She let one beat pass, to honor the weight of what Carmen had just said.

“¿Cuántas veces al día tiene ese pensamiento, aproximadamente?”

“Muchas. Quince, tal vez más. Cada vez que lo cargo. Cada vez que lo pongo en el bassinet.”

“¿Cuando llega el pensamiento, puede seguir haciendo lo que estaba haciendo, o tiene que parar?”

“Tengo que parar. Y apretar. Y luego lo pongo y me quedo mirando hasta que estoy segura de que está bien. Aunque sé que está bien. Lo acabo de poner.”

“¿Cuánto tiempo se queda mirando?”

“Varios minutos. A veces más.”

“¿De noche también?”

“Me levanto a revisar. Aunque no sea la hora de comer. Anoche me levanté cuatro veces.”

The nurse had what she needed. She asked the last question.

“¿Ha tenido pensamientos de hacerle daño al bebé a propósito — de que usted quisiera que algo malo le pasara?”

Carmen’s answer came quickly, almost before the question was finished. “No. Nunca. Es exactamente lo opuesto — tengo miedo de que algo le pase por mi culpa, aunque yo no quiera.”

“Eso es exactamente lo que necesitaba escuchar, y es una distinción muy importante. Lo que me está describiendo se llama pensamientos intrusivos. Son pensamientos que llegan sin que uno los invite — que son angustiantes precisamente porque van en contra de lo que uno quiere, porque los ama. Y hacen que uno haga algo para aliviar la angustia: apretar más fuerte, revisar, quedarse mirando. No son una tontería. Y no significan que es mala madre. Significan exactamente lo opuesto: una madre que no quisiera nada bueno para su bebé no tendría esos pensamientos. Los tienen madres que aman a su bebé y que tienen el cerebro trabajando de más para protegerlo en este momento.”

Carmen was crying. Not the kind of crying that looked like breakdown — the quiet, releasing kind, the kind that happens when something that has been held with both hands is finally named by someone else and does not turn out to be what you feared it was.

“¿A otras mamás les pasa?”

“Sí. Es muy común en el postparto, especialmente con el primer bebé. No es algo que usted tenga que resolver sola antes de salir.”

The nurse addressed the fear Carmen had not named.

“Quiero decirle algo sobre lo de hablar con la enfermera. Lo que me está describiendo no es una razón para separar al bebé de usted. Lo que me está describiendo es una señal de que necesita apoyo — no de que sea peligrosa. Son cosas muy diferentes. Muchas madres no dicen nada por miedo a exactamente eso, y lo entiendo. Estoy muy contenta de que lo dijera hoy.”

The social worker came to the room before discharge. A safety plan was written in Spanish: who to call at each level of concern, the 24-hour postpartum support line number, the specific language to use when calling (“Tengo pensamientos que no puedo controlar y necesito hablar con alguien”). A follow-up call was scheduled for day five. Rodrigo was asked to come back in; the nurse explained the safety plan to both of them together.

Carmen left with the baby at noon. She had a card in her pocket with three phone numbers and a note in her own handwriting: los pensamientos no son quién soy. The nurse had suggested she write it. Carmen had chosen the words.

The EPDS score of 7 had indicated no follow-up. The conversation had indicated a safety plan, a social work contact, a five-day call, and a warm handoff to outpatient mental health support. The difference between the 7 and the safety plan was one question — not a scale item, not a checkbox — asked by a nurse who had closed the door and sat down and waited.

What these three conversations have in common

Valentina had not concealed the clot. She had disclosed it when asked a question that gave her the calibrating language to know it was worth disclosing. Isabel had not misled anyone about the breastfeeding. She had answered what she was asked, which was whether the baby was taking well, and by her frame of reference — the frame built from breastfeeding her first baby — yes he was. Carmen had not hidden her intrusive thoughts strategically. She had weighed the cost of disclosure against the possible consequences and decided silence was safer; when a question arrived that named what she was experiencing without judgment, she answered it.

None of these patients was difficult. None of them was withholding. None of them required anything more than the specific question that their specific situation needed.

What the standard postpartum check had not provided — for any of them — was the question that found the thing. “¿Cómo se siente?” and “¿está todo bien?” get the answer the patient thinks she should give, the answer organized by what she has been told, what she is afraid of, and what she believes the nurse is able to hear. What broke through in each case was a question structured differently: quantitative, with calibrating anchors; observational, asking about countable behaviors rather than overall impressions; naming, using the specific language that made the patient’s private experience recognizable as clinical and treatable rather than shameful and private.

The postpartum nurse who works with Spanish-speaking patients is not simply translating the same postpartum assessment into a different language. She is conducting an assessment in which the standard questions, already imperfect in English, carry additional risk in Spanish: the patient who does not have clinical vocabulary for the distinction between saturated and stained, between transfer and suction, between intrusive thoughts and intention, cannot give the nurse what the nurse needs if the nurse does not give her the vocabulary first. The conversation that starts with the calibrating word — saturada, not manchada; the sound of swallowing, not the feeling of fullness; the thought that arrives even though you know it does not make sense — is the conversation where what needs to be found gets found.

Related conversations that inform this work: high-risk pregnancy language — including the preeclampsia warning sign sweep and the preterm labor contraction character assessment — are covered in Spanish for antepartum nurses. Labor and delivery conversations, including the epidural explanation, contraction-rate assessment, and second-stage pushing cues, appear in Spanish for labor and delivery nurses. Discharge instructions, including the structured return-precaution format that separates expected from not-expected in specific, observable terms, are covered in discharge instructions in Spanish. The approach to pain assessment when the reported number does not match the clinical picture — and the question that finds the real number — appears in pain scale in Spanish for nurses. Pregnancy complications in earlier stages, including the language for gestational diabetes management and preeclampsia education, are in pregnancy complications in Spanish.

Clinical Spanish for the conversations in this post

For the postpartum hemorrhage and lochia assessment:

• «¿Cuántas toallas ha saturado completamente desde que nació el bebé? — no manchadas, sino completamente empapadas de un lado a otro.» — How many pads have you soaked through completely since the baby was born? — not stained, but saturated all the way through.
• «¿Notó algún coágulo — algún grumo de sangre — cuando fue al baño?» — Did you notice any clot — any solid piece of blood — when you used the bathroom?
• «¿El coágulo era más pequeño que una pelota de golf, del tamaño de una pelota de golf, o más grande — como una mandarina?» — Was the clot smaller than a golf ball, about the size of a golf ball, or larger — like a small orange?
• «Hay sangrado que esperamos: las toallas se manchan pero no se saturan completamente en menos de una hora. Hay sangrado que no esperamos: toallas completamente empapadas en una hora, o un coágulo más grande que una pelota de golf.» — There is bleeding we expect: pads that get stained but do not soak through in less than an hour. There is bleeding we do not expect: pads soaked through in an hour, or a clot larger than a golf ball.
• «Si siente que el corazón le late muy rápido, o si se siente mareada cuando se para — eso junto con sangrado abundante es razón para llamar de inmediato.» — If you feel your heart beating very fast, or if you feel dizzy when you stand up — that together with heavy bleeding is a reason to call immediately.
• «Voy a hacerle un masaje del útero — puede sentir presión y puede salir algo de sangre. Es parte de la evaluación.» — I am going to massage your uterus — you may feel pressure and some blood may come out. That is part of the assessment.

For the breastfeeding assessment:

• «¿Cuántas veces ha tomado el bebé en las últimas 24 horas — completamente, desde que empieza hasta que suelta el pecho?» — How many times has the baby fed in the last 24 hours — completely, from when he starts to when he releases the breast?
• «¿Puede escuchar cuando el bebé traga? No el movimiento de las mejillas ni el chupeteo, sino el trago — como un pequeño glu, glu.» — Can you hear the baby swallow? Not the movement of the cheeks or the suckling, but the swallow — like a small glu, glu sound.
• «Cuando el bebé suelta el pecho, ¿cómo queda el pezón — redondo, como siempre, o aplastado o diferente en la forma?» — When the baby releases the breast, what does the nipple look like — round, as usual, or flattened or a different shape?
• «El bebé que está tranquilo en el pecho no siempre está satisfecho. A veces ya no tiene la energía para pedir.» — A baby who is quiet at the breast is not always content. Sometimes he no longer has the energy to demand.
• «La leche todavía no ha llegado. El bebé tiene que tomar seguido para que el cuerpo de usted reciba la señal de producir más. Cada dos horas, aunque esté dormido.» — The milk has not come in yet. The baby needs to feed often for your body to get the signal to produce more. Every two hours, even if he is asleep.
• «¿Cómo estaba la lactancia con su primer bebé en estos primeros días? ¿Escuchaba el trago?» — How was breastfeeding with your first baby in these first days? Could you hear the swallow?

For the postpartum mood and intrusive thought assessment:

• «Cuando el bebé está dormido y usted se acuesta, ¿logra dormirse? ¿O hay pensamientos que le siguen dando vueltas?» — When the baby is asleep and you lie down, are you able to fall asleep? Or are there thoughts that keep circling?
• «¿Ha tenido pensamientos que la sorprenden o la asustan — pensamientos de que algo podría pasarle al bebé, aunque usted sepa que no tiene sentido?» — Have you had thoughts that surprise or frighten you — thoughts that something could happen to the baby, even though you know it does not make sense?
• «¿Cuántas veces al día tiene ese pensamiento, aproximadamente?» — How many times a day do you have that thought, approximately?
• «¿Hace algo para aliviar la sensación cuando llega — revisar al bebé, asegurarse de que está bien, apretarlo más?» — Do you do something to relieve the feeling when it arrives — check on the baby, make sure he is okay, hold him tighter?
• «¿Ha tenido pensamientos de hacerle daño al bebé a propósito?» — Have you had thoughts of intentionally harming the baby?
• «Lo que me describe se llama pensamientos intrusivos. Son muy comunes en el postparto. No son una tontería, y no significan que es mala madre.» — What you are describing is called intrusive thoughts. They are very common in the postpartum period. They are not silly, and they do not mean you are a bad mother.
• «Lo que me está describiendo no es una razón para separar al bebé de usted. Es una señal de que necesita apoyo. Son cosas muy diferentes.» — What you are describing is not a reason to separate the baby from you. It is a sign that you need support. Those are very different things.