Taking Care of Your Baby

 

Things to Watch for Right after Your Birth

The most important needs of the newborn are warmth, a clear airway, nourishment and love. I like to encourage long hours of skin to skin contact in the first few days. Studies show that continued skin to skin contact contributes to infant temperature stabilization, breathing regulation and encourages a good breastfeeding relationship.  Skin to skin contact actually decreases breastfeeding problems, stimulates milk production and helps newborn establish correct latch onto breasts with less nipple soreness.

 

Please call us immediately if you notice any of these signs below or have questions:

 

Difficulty breathing –normal respirations are 40-60 per minute

Blue skin, color of face or chest (slight blueness around the mouth may be normal if the baby is crying)

Retractions around the collarbone or ribs with each breath

Wheezing loudly with each inspiration

Grunting with each expiration and any signs of struggling for air

Jaundice in the first 24 hours

Lethargic baby with no periods of alertness and floppy muscle tone

Profuse salivation or sweating

Failure to nurse or suck well

Fontanels (soft spots on head) that bulge or are deeply sunken when baby is at rest

Tremors, twitching or convulsions –not to be confused with the normal startle reflex

A weak or high pitched cry that may sound like a cat

 

Helpful information on caring for your newborn.

 

Temperature

Newborns are unable to regulate their own temperature for the first 24 hours, so they rapidly take on the temperature of their environment.  It is important to keep them warm.  A chilled baby will breathe fast and increase his/her heart rate to stay warm. This could lead to respiratory distress and depletion of glucose stores so be sure to keep your baby warm for the first few days. Baby’s normal underarm temperature should be between 97-99 degrees. If baby’s temperature is warmer than this, the baby may sweat and become dehydrated.  Remember a mother’s or father’s skin makes an excellent temperature regulator. After a few days, the baby can regulate his/her own temperature more easily.  We are lucky in Hawaii as the temperature is nearly always the right temperature for a newborn. Newborns hands and feet are normally cool, so the best place to see if baby is comfortable and not to cold is to check baby is the back of the neck.

 

Sleeping with your baby

The newest recommendation is to position your baby on his/her back to sleep in a wide spread initiative to prevent Sudden Infant Death Syndrome (SIDS).  Some parents are hesitant to leave their baby’s on their backs in case of spitting up. Some parents initially sleep with their infants on their own chests in the first few days.  I advise that you can sleep with your baby if you are not taking any medications or are intoxicated in any way.  If you chose to sleep with your baby, I would suggest placing baby alongside your belly and chest while you are lying on your side with the infant faced outwards, that way your infant will not nuzzle at your breasts all night, that way you both can get sleep and still feel very close.  After all you infant has been sleeping, hearing your heartbeat and respirations for his/her entire womb life. If you place your baby in a co-sleeper or crib your baby should be placed on his/her back in the same room that you sleep in for the first few months.

 

Keeping baby clean

We do not normally wash your infant right after birth as the amniotic fluid has many antibacterial properties that protect your baby’s skin.  In a few days you may decide to cleanse you baby’s skin.  We advise a warm water or oil sponge bath until the cord stump falls off. Use coconut oil or any other natural oil, not mineral oil as mineral oil robs baby’s skin of vitamins. Usually washing the face, creases and bottom is enough. Check the folds of the neck for milk drippings.  Cotton balls soaked in warm water are good for this. You may also wash the hair with a natural baby shampoo. Babies love to be massaged with coconut or olive oil after their baths and it feels good for mommy too. An excellent book on this subject is called Loving Hands by Dr. Leboyer.

 

Baby’s skin

Many babies have milia, tiny white spots on the nose and face.  These are clogged pores that will clear up within a few weeks. “Stork bites” are also quite common.  These are light red areas that most commonly seen on the eyelids, between the eyebrows and at the base of the neck. They are caused by a patch of capillaries too close to the skin.  They will face in time, although may be visible for several years when the baby cries or is angry.  Another common condition is the newborn rash.  Up to half of all newborns develop these red splotches that come and go rapidly. Many infant develop newborn acne, small pimples on the face that disappear by 3-4 months.

 

Many newborns, especially overdue ones, have a lot of peeling skin around crease marks, particularly on the hands and feet. Sometimes their whole body will peel. Use a good oil or lotion to keep the skin moist. Welda makes excellent baby products.

 

If your baby develops diaper rash, expose the sore area to air and sunlight. If you are using disposable diapers make sure that they are unscented. If using cloth diapers try going without the outer cover and changing diapers often. Destitin clears up most rashes in short order.  Natural products include white clay powder, Vitamin E, and Aloe Vera. If your baby’s bottom turns bright red all over, think what you have eaten in the past few days as this may be causing your baby’s stool to become acidic. If the rash does not resolved consider that it could be yeast that is causing the rash and seek medical advice.

 

Taking baby out

Fresh air is good for your baby, so fell free to take walks as soon as you are up for it. Just keep baby at a comfortable temperature. Small babies are quite portable, don’t forget the diaper bag! Most newborns will adjust easily to new situations and go to sleep if overstimulated. You may find them particularly fussy later though, in an attempt to rid themselves of the tension they are storing.

 

It is usually best to avoid large groups of people for the first two months to give your baby a chance to develop his/her immune system before being exposed to any viruses. After two months you can usually take your infant anywhere, however avoid anyone obviously ill. We recommend waiting at least two months before any major traveling. This gives you both a chance to recover from birth, get to know each other and establish a good milk supply and breastfeeding relationship.

 

Circumcision

There is no medical reason to circumcise your son. The only reason parents decide on circumcision is for social and religious reasons. It is a decision you will have to make without being swayed by the public. If you do decide to circumcise we will have a pediatrician whom we will recommend for you.  Circumcision for other than religious reasons is a western concept; most European countries seldom offer male circumcision to their newborns. This is an important issue that deserves some real thought. Please do you research on the issue.

 

If you do decide to circumcise, it is important to wait until the 8th day day the maximum levels of vitamin K and also to let him have the chance to bond with you and be nursing well. He should be in good health and blood clotting factors functioning well. If there is doubt about this he should have a vitamin K shot prior to the procedure. Be sure to explain the procedure to him and stay with him to comfort him immediately afterwards. It does hurt.

 

If you decide not to circumcise, there is no special care you need to give your son’s penis. The foreskin will retract gradually over time.  As he grows, just teach him to pull the skin back, clean under it with warm water and return to the normal position. It is very similar to teaching a girl to clean in the folds of her labia.

 

Newborn Screening Tests

State law requires that this blood test be completed. This test checks for several genetic inborn errors of metabolism that can be detected in your newborn’s blood.  Most of these conditions are rare; however it is important that they are detected sooner rather than later for early intervention. Undetected, these conditions can have severe consequences for your baby. We usually offer this test at 2-3 days old at the home visit. There is an $85.00 fee for this test. The test involves a tiny heal prick and can often be completed in the mother’s arms. We recommend breastfeeding immediately after to provide comfort.

 

Birth Certificate

You will need to register your infant’s birth by 30 days of the event.  At your 2 week visit we will provide you with the necessary paper work and information of scheduling an appointment with the Department of Health. Your infant’s social security number will be applied for at the same time. If you wait too long to file you will have to go through the court system with an attorney to file a birth certificate.

 

Baby’s Medical Insurance

It is your responsibility to add your infant to your insurance plan.  We will provide you with the necessary documentation to start the process.  You will need to contact your insurance company or social services worker if you are on the Quest insurance program.  You will be responsible and billed for your baby’s exams and home visits if you do not obtain insurance coverage for your newborn.

 

Breastfeeding

Your breasts had colostrum in them while you were pregnant and that is what the baby nurses until your milk comes in.  Colostrum has antibodies from you that pass your immunities temporarily to your baby. It is a wonderful substance that we refer to as “liquid gold”. Even though you may feel your baby is not getting much nourishment, your baby is getting just what he/she needs.

 

Milk can begin to come in as soon as the first day after delivery but usually appears on the second or third day.  It looks this and watery, very much like skim milk. The first part may even appear a little bluish.  The fat content increases in the hind milk and it usually appears may creamy.  Many substances besides food can be transmitted in the breastmilk. It is wise to check with someone before taking any medications while breastfeeding. More than 100 mg of vitamin B6 may reduce your supply. Blessed Thistle, hops, and borage help to increase milk supply so a tea of these herbs plus alfalfa, red raspberry and/or nettles for general health can be helpful. There are several “Mother’s Milk” teas available at the health food store.

 

When your milk comes in your breasts may swell and get hard.  You need to nurse frequently to keep your breasts empty. At first you may run a slight fever and feel flu like, please can if temperature is 100.4 or over. A warm cloth applied to your breasts may take away some of the discomfort as may a snug fitting bra.  The swelling will go down in the next few days. If engorgement becomes enough of a problem that the baby cannot grasp the nipple he/she may become frustrated and cry or may even refuse the breast despite appearing hungry.  Enough milk must be removed to allow the baby to nurse easily.  Hand express some milk using a stroking / squeezing motion behind the nipple.  Ask us to show you if you feel you need help.

 

You may breastfeed either lying on your side, laid back or sitting up. Make sure your nipples are hard and easy to grasp. Express a bit of milk or colostrum and leave it on the nipple.  Pinch the area behind the nipple and touch it to the baby’s cheek; this will stimulate the rooting reflex and the baby will turn to the nipple. Then hold the breast so that most of the areola (dark part) goes into the baby’s mouth.  The nipple should be aimed slightly upward so that the tip[ touches the roof of the baby’s mouth; this stimulates the sucking reflex.

 

Alternate the starting breast and offer both breasts at each feeding.  It is suggested to nurse baby on one side until baby self-detaches then burp baby.  After burping and stimulating him/her offer baby the other breast, this way baby receives the hind milk (fatty milk) as well as nurses on both sides.  It is normal for your baby to feed about every 1-2 hours for 10 to 20 minutes with some clutter feeds in between and one long period of 3-4 hours between feedings (hopefully at night). We recommend demand feeding to meet baby’s feeding needs.

 

Nursing frequently is very important in the first few weeks of life. It will flush the baby’s intestines of meconium and prevent jaundice.  It will also help prevent engorgement.  Nurse your baby at least every 3 hours or so during the daytime. At night let him/her sleep until he/she wakens, unless you have a reason to nurse more frequently such as engorgement or jaundice. If the baby takes both breasts at each feeding the baby may go longer between feedings.

 

If your baby likes to suck for more than just feeding purposes, that is fine.  You can either use your breasts or if you are tired and sore, your little finger.  Turn it so the soft part is against the roof of the baby’s mouth. Dad can do this as well.

 

Sore nipples

Some women experience soreness for the first week to ten days after birth. Start the baby nursing on the least sore side first so that the letdown will have occurred and the baby will not have to suck as hard on the sore nipple.  It can be helpful to offer the sore side before baby is very hungry so he/she does not suck so hard. You can encourage the letdown before the baby starts to nurse by using warm compresses on the breast and stroking the breast. Hot shower steam works well also. Keep sore nipples dry and exposed to air as much as possible. The heat from sunlight is very soothing. Healing salve, coconut oil and/or lanolin can keep your nipples stay supple and nourished.

 

Burping

Once your milk is in, you may need to burp the baby after nursing on each breast until you discover how much air your baby swallows. Noisy fast eaters usually need burping more than slow, quite ones.  There are three different positions and you will discover which works best for you and your baby: 1) hold th baby on your shoulder, over a diaper and pat; 2) support the baby sitting on your lap and run your fingers up his/her back; 3) lay the baby on his/her stomach or your lap and gently pat.

 

Spitting up

Some babies spit up after almost every feeding.  It is nothing to worry about unless it is projectile vomiting, that is vomiting that lands several feet in front of the baby. Laying the baby on his/her stomach after eating may help prevent spitting up, as may sitting an infant in an infant seat. Be sure you are in the room if you place your baby on his/her stomach for any length of time. Be sure to burp baby frequently during feeding if your baby spits up a lot. Other things that newborns do a lot are sneeze and hiccup.  Neither is a cause for concern.

 

Colic

Colic has been broadly identified as inconsolable crying for which no physical cause can be found, which lasts more than 3 hours a day and occurs at least 3 days per week and continues for 3 weeks. Colic usually ends by the time the baby is 3 months old and there is some research suggesting it actually is the baby’s adjustment to normal sleep pattern, a process all infants must go through as their nervous systems mature.  It can be very difficult for some families.

 

Many babies have a fussy period in the evening. It may be their way of discharging all the tension they stored during the day.  Keep that time peaceful as possible and don’t take the baby’s crying personally. It is also one of the only ways your infant can get exercise, as he/she moves arms and legs around while crying.

 

Colicky babies also have spells of noise and rumbling in the gut, excessive gas and/or apparent abdominal pain with legs drawn up onto the abdomen. Gently massage the abdomen up the baby’s right side, across the top and down the left side to encourage air bubbles through the colon. Carrying baby over your forearm, face down (football carry) sometimes helps, as does any of the following herb teas, catnip, chamomile, peppermint and fennel.

 

Although the role of the mother’s diet in her baby’s colic is controversial, think if you have eaten anything unusual in the last 24 hours. Traditional offenders include broccoli, cabbage, and uncooked greens however, don’t assume your baby is bothered by any food until you have tested it several times.  Volatile oils such as those found in garlic and onion do pass though the breast milk, however studies have shown that babies whose mothers ate garlic nursed more than babies whose mothers did not.  Babies do not seem to mind flavor.

 

By far the most common offender in your diet that can upset your baby’s tummy is cow’s milk.  Many babies are allergic to the protein in cow’s milk and those proteins can pass through your milk. Omit all milk products in your diet for 3 days and see if baby improves. If so you can gradually reintroduce milk products into your diet, starting with yogurt.

 

Expressing and storing breast milk

Many women find they can manually express milk easily and so do not need a breast pump.  Others prefer the pump. We recommend a cylinder type breast pump for occasional use and an electric double pump for women returning to school or work. You can store the expressed milk directly in the Playtex Nurser bags.  Refrigerate the milk immediately.  If you are not going to use it within 24 hours, put it in the freezer.  Milk will keep in the freezer compartment of a one door refrigerator for two weeks and for up to 6 months in a two door refrigerator freezer and up to 1 year in a floor, deep freezer.  Be sure to label with the date that it was collected.  The best time to start pumping if returning to work or school is about when your infant is two weeks old after you have established a good milk supply.  Morning pumping seems to be the time when the breasts produce the most abundant amount of milk.

 

Mastitis

A plugged milk duct will usually be tender, reddened and hardened. Massage it, put a hot pack and ginger compresses on the area. Nurse the baby frequently on that side pointing the chin towards the area of soreness. Drink lots of fluids, taking vitamin C, treat yourself like you have the flu.  Please us if you should get a fever, chills or body aches.

 

 

 

Roxanne Estes

Certified Nurse Midwife

Tel: 808 935-0211