HEALTH COLUMN: Caring for baby - the first week after birth - Part One

Birthing with Bridget

HEALTH COLUMN: Caring for baby - the first week after birth - Part One

Skin-to-skin contact initiates bonding between you and your baby

Hello everyone, I hope you are all well.

This article is going to talk about caring for your baby directly after birth.

This is a magical, tiring, extremely special and anxious few days all together. Most full term, healthy babies and their Mums will be discharged from hospital at some stage during the first week.

Pre-Covid 19, all Mums stayed for a minimum of 24 hours in the maternity unit, unless that unit had a specialised community midwifery programme that provided follow-up care at home.

First time Mums following vaginal deliveries, especially the Mums that were breastfeeding, often stayed until day 3 post birth.

Mums post C-section usually went home with their baby on day 4 post birth. Covid 19 has changed this.

Most maternity units are trying to minimise the stay for women and their babies, provided the Mum and baby are well.

There is currently no visiting by anyone postnatally in most maternity units. Letterkenny maternity unit’s policy at present is that Mums and babies post vaginal delivery are discharged home after 24hours , providing both are well.

Mum and baby post C-section are discharged home after 48hours, providing both are well.

Mums are often delighted to get home, but Mums, especially first time Mums, are missing out on learning skills and tips on baby care that they pick up from midwives and experienced Mums on the postnatal ward.

Just because women are discharged home early does not mean that they have recovered from childbirth.

Parents and the baby need a period of adjustment, often called the transition to parenthood.

My clients well know that I talk about and believe in the fourth trimester.

This is the 12-13-week period after the birth of the baby.

The concept of the fourth trimester examines the psychosocial transition of women and men into parenthood and the new-born’s transition and adaption to extrauterine life. Put simply, it takes time for parents and babies to get to know each other.

Babies are also adjusting to the outside world; the light, the noise and being away from that constant sound that was their mother’s heartbeat. New parents need to go easy on themselves in the first few months. Everyone is learning. Babies do not come with instructions.

Keep them safe, feed, clean, dry and loved. Loved is especially important, you are not spoiling them, and I believe that after week 12 post birth a lot of the little issues will sort themselves out.

Baby Care in Hospital
Directly after birth, providing that the midwife or doctor has assessed that all is well with the baby and with you, the baby is placed on your tummy, under your nightdress (a good idea is for you to labour in a nightdress or a loose t-shirt). The baby’s skin is directly on your skin. This is called skin-to-skin contact.

This skin-to-skin contact initiates bonding between you and your baby; helps baby settle; keeps them warm and helps maintain a healthy temperature. It also settles their heartrate after birth and promotes breastfeeding.

It is a really lovely experience for Mum, so even if you do not plan to breastfeed skin-to-skin contact has so many benefits for you both.

The WHO recommend 60 minutes of skin-to-skin contact to promote breastfeeding, promote bonding and this lovely special time encourages normal infant breathing and heartrate patterns.

After a good period of skin-to -skin contact with your baby, your midwife will check the baby.

The baby will be weighed and given a basic examination performed by the midwife. This will check fingers and toes, the fontanelles (the soft spots on your baby’s skull), the spine and the palates of the mouth.

Many babies are a little “blue” when they are born, so don’t get a fright, it can take a minute or two for them to turn “pink” and many babies have a cone shaped head when born.

This occurs as they navigate their way out of the birth canal and it usually settles in a day or two. Also, babies’ hands and feet are slightly pale and cold for some time after birth.

If you are checking to see if your baby is warm enough; put your hand behind their neck or on their tummy, somewhere central in their body. The circulation to their hands and feet improves after the first few days.

Vitamin K will be offered to all newborn babies shortly after birth. This will be discussed with parents antenatally or in the delivery suite before the baby is born.

It is recommended that all newborn babies receive vitamin K. this is to prevent a rare but dangerous condition called haemorrhagic disease of the newborn.

Vitamin K can be given in two ways; a once off injection into a muscle, often the thigh muscle, shortly after birth, or as an oral dose after birth, which needs to be repeated in the first week of life and again at week 4 of age.

Most maternity units advocate for the once off injection after birth unless there is a medical reason not to.

This is because you know the baby has received the full dose, as the oral dose can be spat out by the baby and the parents do not have to remember to give two further doses at home.

Regardless of how you would like the vitamin K to be administered it is good to be aware of it and to do some research on it before the baby arrives.

The skin-to-skin contact, baby check, administration of the vitamin K will all take place in the delivery suite. Mums may also have a freshen-up, or a shower, if she feels up to it and if she has not had an epidural.

Tea and toast are usually provided to the new parents- often reported as the best tea and toast ever (not my words)!!!

The new parents make phone calls and share the fabulous news with family and friends.

After this incredibly special time the midwife will transfer the Mum and baby to the postnatal ward and due to Covid 19 restrictions, Dad will go home.

Normally, one midwife will look after one postnatal ward for the day, often 8am-9pm.

You will have another midwife taking care of you during the night shift. Most postnatal wards contain 6 bays. Mums and babies stay together. A well baby will be in their cots next to Mum’s bed.

Your midwife will perform a daily head-to-toe check of Mum and a daily head-to-toe check of the baby. Your midwife is there to assist you with feeding, breast or bottle feeding.

Answer your questions and give you information and advice to prepare you for discharge home and life at home with your baby.

A doctor called a paediatrician will carry out a full physical examination of your baby, including checking the baby’s hips before you are discharged home.

All newborn babies in Ireland now have a hearing test performed in hospital before they are discharged home. This is a relatively new service.

Some babies need to return for a repeat hearing test as they are just too young to assess their hearing.

Breastfeeding in the First Few Days
Breast milk is the ideal food for newborns and infants. It gives infants all the nutrients they need for healthy development. It is safe and contains antibodies that help to protect infants from common childhood illnesses such as diarrhoea and pneumonia.

Breast milk is readily available and affordable. Breastfeeding also benefits Mums. It reduces the risks of breast and ovarian cancer later in life and helps women return to their pre-pregnancy weight faster, it also lowers the rate of obesity.

Breastfeeding has many, many benefits but it is not always easy. It comes very naturally to some Mums and babies, but some Mums work hard, especially in the first few weeks to get breastfeeding established. Doing some research on breastfeeding antenatally, trying to get feeding established and keeping going for at least two weeks after birth and accepting help and support postnatally are my three best pieces of advice for pregnant woman hoping to breastfeed. www.breastfeeding.ie is a good place to start.

Skin-to-skin contact is the first step to promoting breastfeeding. The first breastfeed is encouraged during this skin-to-skin special time, in the first hour of life.

Some babies latch on really well at this first feed, others are too sleepy to be interested in feeding. Your midwife will help you assess the situation.

The important thing is that the baby attempts to feed within the first hour and even the licking/suckling at the breast will encourage further feeds.

Babies often sleep for a few hours after their first feed and in my opinion, this should be their longest sleep for the next few days. In the first few days, often up until day 3 or day 4, the breasts are full of colostrum, or “liquid gold”, as I call it.

This colostrum turns into milk on day 3 or day 4 depending on demand from your baby. It is all about supply and demand.

The more often the baby demands the better the supply will be. It is my belief that in the first few day’s babies should be awakened every 2 ½-3 hours and offered the breast. Some feeds will be better and longer than others depending on the feed before and how hungry / full your baby is.

The latch is particularly important. I intend to write a full article on breastfeeding, and we will talk about this in depth.

Until then put simply, bring your baby to your breast, placing their nose to your nipple.

Ensure their tummy is facing yours and check their mouth is wide open. Aim your nipple at the roof of your baby’s mouth.

Baby’s top lip should be curled up and their bottom lip curled down. When you look down you should see a K shape, like a K from the special K sign.

The baby should not be sucking on your nipple but should be getting some of the coloured area around the nipple, called the areola into its mouth. Your nipple is like a teat delivering the colostrum or milk and if the baby is just sucking on it, it will make it sore and cracked.

Women often use lanet based creams to heal the nipple. Colostrum hand-expressed and rubbed onto the nipple after a feed is also a good healer. Hand expressing some colostrum out before a feed is a good idea too, this lets the baby know where the food is.

Breastfeeding Positions and Helpful Tips
Your midwife will show you different positions to feed in before you leave hospital, including across the tummy and under arm hold, also called the rugby hold. I find the rugby hold an excellent position for the baby’s least favourite side.

Often babies have a favourite breast to feed off, and by using the rugby hold on the least favourite side babies think that they are on their favourite side, because they are laying the same way. Laying down on your side breastfeeding is also great especially post C-section, as it takes pressure off the wound and allows Mum to get some rest.

Try your best to put baby to the breast every 2 ½-3 hours in the first few days, until the milk comes in. this is not easy as often the baby will be sleepy.

I recommend changing your baby’s nappy before you breastfeed. This often helps to wake them up. I also advise that Mums go to the bathroom, get comfortable and have water to drink beside them before they start every breastfeed. It is good practice to offer the baby both breasts at each feed in the first few days.

Usually they take the longest and best feed from the first breast. Gently wind them before offering the second breast, often they do not feed as long from this breast. Start your next feed on the breast that you stopped feeding on.

This will help balance the milk supply to both breasts. A good tip is to bring extra hair elastics with you to hospital. Place the hair elastic on your wrist on the side corresponding with the breast you are next due to start feeding on.

Babies can fall asleep at the breast. Feeding them in their vest may help, they will not get cold as they are close to you and getting loads of your heat. I believe babies need to be working 80% of their time at the breast.

If they are sleeping and only taking an occasional suck, then it is likely that they are using you as a soother. Take them off the breast gently, by licking your little finger and placing it into their mouth.

This breaks the seal between their mouth and your breast. Never pull them off as this will hurt you. Stimulate your baby, maybe take off some of their clothes and try again.

Night 2 breastfeeding post delivery is a tough one. I call it the night from hell.

Your baby is now hungry as it has passed loads of big, black poo’s (called meconium-the first poo), and your milk has not yet come in.

Do your best, keep offering the breast and remember it will not be like this every night.

Hopefully all your hard work will pay off and by day 3 your milk will be in. The breastfeeding advice changes a little when your milk comes in, but we will cover this next week.

Getting Ready to Take Your Baby Home
You may have heard new parents talk about mucusy babies. Babies having mucus in their system is quite common during their first few days of life.

This is not the same as them swallowing meconium (poo) stained amniotic fluid. Babies will clear this mucus within 48-72hours. I find babies born fast or born by C-section are very prone to mucus.

You will know they have mucus as they sneeze, have little air/water bubbles coming out of their nose. These babies may not be too keen on feeding, either breast or bottle in the first few days. Keep offering them the food but do not force it. The mucus will move up or down.

Often babies have a mucusy vomit and it will clear, or massive black meconium nappies, or both. You will know it is cleared or gone when they seem less nasally and are really hungry for a feed.

It is vital to have confidence in your feeding method, weather you have chosen breast or bottle before you go home. If you are bottle feeding, make sure you know how to make and store bottles.

Have a steriliser, some new bottles and your formula of choice at home. I recommend not buying too many of any brand of bottle initially. Try a few different bottle brands and see which suits your baby best, then you can buy more of these.

Your baby’s car seat is likely to be at home and will be brought in by Dad when he collects you from the hospital.

Choose the right car seat for you and for your car. May sure you know how to strap the baby safely into the seat and how to fit it correctly into the car before you put your baby into it for the first time. I recommend practising with a teddy or a doll.

May sure your house will be warm and clean when you get home. Try and wash all baby’s clothes, bedding and towels in non-biological detergent before using.

If you had time to wash them at the end of pregnancy, then it will be greatly beneficial to you now. I advise storing nappies in a few locations around the house, that way upstairs or downstairs they are close.

If you get a burst of energy before you go into hospital, it is a great idea to make up some tasty healthy meals that you can freeze. These will be so handy in the early postnatal periods as both parents will get to enjoy this special time with their new baby.

Next week we will discuss caring for baby, part 2. This will look at helpful advice, parentcraft and tips as you welcome your new baby home. I hope you find this article informative, please don’t hesitate to contact me on; birthingwithbridget@gmail.com. Remember all the above information is just a guide. If you are concerned about anything please talk to your GP/ midwife, hospital doctor or hospital midwife.

Until next week,
Bridget the Midwife.

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