HEALTH COLUMN: Caring for baby - The first week after birth (Part 2)

Birthing with Bridget

HEALTH COLUMN: Caring for baby - The first week after birth (Part 2)

Bringing your baby home from the hospital is such an exciting time but there is no denying that it also can be extremely nerve-wrecking, especially for first time parents

Hello everyone, I hope this finds you safe and well.
We have moved into phase 2 of the easing of the Covid restrictions.
As a county we seem to be doing extremely well, but we must keep up our good work. Life goes on.
Babies are still being born and new parents are bringing their beautiful babies’ home. Bringing your baby home from the hospital is such an exciting time but there is no denying that it also can be extremely nerve-wrecking, especially for first time parents.
Last week we talked about baby care in the hospital after birth. I hope you found this information useful.
This article will discuss baby care, helpful advice and tips as your new baby settles into life at home, in the first week and beyond.
As well as all the other things to get used to, you may spend some time worrying about getting your baby into a good routine.
But you should try not to be overly concerned about this; it is important to recognise the need for time to adjust to the new addition to your family.
Allow things to settle down, be flexible and use this precious time to bond with your baby.
Creating a Safe Sleeping Environment
Newborns will sleep a lot in the first few weeks. From 1 week of age until 3 months newborns will sleep on average 16 hours over a 24-hour period. After those first few weeks where everyone is learning, bonding and adjusting to parenthood, there are some things you can do to foster good sleeping habits that will stand to you and your baby’s sleep routine into the future. These include:
l -Always try to put your baby down awake.
l Do not worry if your baby stirs when you put her/him down to sleep.
l Maximise the difference between day and night from early on. Keep the house bright and airy, take in fresh air with your baby where possible during the day. At night, keep noise to a minimum. This in time will help your baby develop their internal body clock.
l Practice a regular evening routine.
l Ensure your baby bedroom is a peaceful place.
While the quantity of sleep your baby gets is important, it is also essential that you create a safe sleeping environment for your newborn thus reducing the risk of SIDS (Sudden Infant Death Syndrome, known to many as cot death) and helping to promote healthy sleep associations.
There are 4 important factors for your baby’s safe sleeping.
1. Sleeping positions. Babies should always be laid to sleep on their back with their feet touching the foot of the cot. I remember and teach this by saying “back to bed, foot to foot”. Covers should come no higher than your baby’s nipple line and should be well tucked in at the sides to avoid them falling over the baby’s face.
2. Quit smoking. Exposure to tobacco smoke can dramatically increase the risk of SIDS, unfortunately this includes smoking in pregnancy. It is difficult to quit. Please talk to your GP/midwife if you want to and would like some support. If you can’t give up, then make sure your home is a smoke free environment.
3. Seperate cot. The safest place for your baby to sleep is in a crib or cot in your room for the first 6 months. For safety reasons you should never bring your baby into bed with you to sleep. I know this can be very difficult especially at night-time for breastfeeding Mums. Accidents can and do happen, your baby could fall out of bed and be injured or could get caught between the wall and the bed.
4. Room temperature. It is important that you keep your baby’s room a safe and comfortable temperature. If babies get too hot, they are at increased risk of SIDS. A baby can get too hot if the room is too warm or if they are covered with too many blankets or clothing. You do not want your baby to get cold either. Aim to keep your baby’s room temperature between 16-20 C (61-68 F). Ideally, the room should be 18 C (64 F), the best way to monitor the temperature is to use a room thermometer, some home heating systems have thermometers in each room.
I often tell new parents, if you can walk around the room comfortably in your pyjamas, without feeling too hot or too cold, then the room is a good temperature for your baby.

Public Health Nurse and The Heal Prick Test
Your public health nurse (PHN) is the nurse that looks after you and your family in the community after you are discharged from hospital. Some PHN’s are midwives but all are trained in baby care, breastfeeding and child development.
Expect a visit from your PHN within the first 48-72hrs home from hospital. Your PHN is there to support and guide you and to answer any concerns that may arise.
This is the start of you and your baby’s relationship with the PHN as the PHN will carry out developmental assessments on your baby as they progress from baby-toddler into pre-school age. Some PHN’s run breastfeeding support groups and baby and parent groups in your local community.
Unfortunately, due to Covid 19 these are stopped at present, but hopefully soon small groups will be able to meet up again.
New Mums, especially first time Mums, benefit greatly from these groups. They are highly informative and supportive but the social aspect of getting out and about and talking is so important.
Mums and their new babies are being discharged home now sooner from hospital, providing that both are well. It is therefore unlikely that the heal prick test will take place in the hospital.
The heal prick test, otherwise called the PKU, or now referred to as the newborn blood screen, is usually performed on day 4 of the baby’s life.
This test detects rare metabolic disorders and looks for the cystic fibrosis gene, in all 8 rare disorders are screened for.
This test is performed on all babies born in the Republic of Ireland. Your hospital will arrange for your PHN to come to your home and carry out the heal prick test. This often takes place as part of the PHN’s first visit to see you and your baby.
This test is sent to a special laboratory based in Temple Street Children’s Hospital, in Dublin. If any abnormalities are detected, your hospital and your GP will be contacted urgently.
No news is good news, so if you hear nothing back from the test that means all is well. Parents will only be contacted if the test needs to be repeated, or if the lab is concerned about the result. Although these conditions are rare detecting them early can prevent disability or death. Treatment can begin, if anything has been detected, and this treatment will result in better outcomes. Usually the heal prick test is performed on day 4 of your baby’s life, often the PHN will ring to say she will be performing the test on a certain day. If you know when the test will be performed or on night 3, before bed, put 2 pairs of warm socks on both of your baby’s feet, under the baby grow. Do not take these off until the test is over. The warmer the feet are the easier the blood will come. This will greatly help your baby and the PHN.

Vitamin D Supplement for your Baby
Babies need a 5microgram supplement of vitamin D3 every day from birth to 12months of age. Before February 2020 this was recommended for all babies, breast or bottle feeding. However, from the end of February 2020 the guidelines changed slightly.
All babies who are being breast feed should continue to receive a vitamin D supplement, even if their Mums took vitamin D in pregnancy or while breastfeeding. You do not need to give a vitamin D supplement to your baby if they are feeding more than 300mls, which is 10oz (ounces) of infant formula per day.
This is because there has been an increase in the amount of vitamin D added to infant formula. This is due to a change in EU Law as of February 2020. There are many suitable infant vitamin D3 supplements available to buy in Ireland. Use a supplement that contains only D3.
Vitamin D is importance because it helps our bodies use calcium to build and maintain strong bones and teeth. Children (and adults) in Ireland have low levels of vitamin D, which can lead to weak bones.
In severe cases low levels of vitamin D can cause rickets in children. There has been an increase in the number of cases of rickets in Ireland in recent years. Vitamin D is known as the “sunshine vitamin” because our bodies can make vitamin D from the sun.
However, it is not possible for babies to safely get their vitamin D from the sun as their skin is too sensitive and should not be exposed to direct sunlight.
Also, babies aged 0-12 months grow quickly and have a greater need for vitamin D to form strong bones. Vitamin D3 (cholecalciferol) is the preferred form of vitamin D for infants.
The vitamin D3 product you use should be in a liquid form suitable for infants and should only contain vitamin D3. Products that contain other vitamins, such as multivitamins should not be used. Research is showing that vitamin D plays an important role in helping our immune system.
If your doctor has already prescribed vitamins for your baby (often premature babies are discharged home on vitamins), you need to ask before giving your baby any additional vitamin products. If you forget to give your baby their daily vitamin D supplement, then start again the next day, but do not give more than 1 dose per day.
You do not need a prescription to buy vitamin D3, they are available in pharmacies.

Bottle Feeding your Baby
Breastfeeding is best and it is advised for all babies. However, it is a Mum’s right to choose weather she breast or bottle feeds.
Some new Mums report that they would like to receive more information about bottle feeding, such as safe preparation and storage of bottles.
Bottle fed babies should receive their first bottle feed within the first hour of life. Bottle fed babies should be fed every 3-4 hours for the first 6 weeks.
They may start to have a longer sleep during the night, as the weeks go on. Around 6 weeks of age your bottle-fed baby may be feeding every 4 hours during the day and sleeping up to 6 hours at night.
Not all babies are the same. Some like to have big feeds every 4 hours and some like smaller feeds every 2.5-3 hours. It is safe to allow them to sleep for up to 6 hours overnight provided your baby has feed well during the day and has had wet and dirty nappies.
Formula fed babies have a higher incidence of stomach bugs due to poor hygiene or incorrect storage of feeds.
Therefore, preparing and storing bottles properly is particularly important. The HSE has an excellent booklet, available on their website. This booklet is called; How to prepare your baby’s bottle feed.
It will likely be given to you in the hospital, often as part of you discharge pack. Often you are so busy after a new baby, but these hospital packs contain lots of helpful information, try and make time to have a good read through your pack.
Here are a few of my key points regarding making up bottles.
l Always wash your hands well before you start.
l Steam is the best way to sterilise feeding equipment.
l Always let the boiled water cool in the kettle for 30 minutes, but no longer. This will make sure that the water is not too hot, but also that it is not less than 70C. Using water warmer than 70 C to make feeds will kill any harmful bacteria that might be present in the formula.
l Throw away any feed that your baby has not taken within 2 hours. When the
baby is not feeding from the bottle always put the cap back on the teat, to keep it clean.
l Never use a microwave to rewarm feeds. Microwaves heat unevenly and may cause “hot spots” that could scald your baby’s mouth. Check the temperature of a bottle by putting a few drops on the inside of your wrist.
It is recommended that parents prepare one bottle at a time.
It is safest to make up a fresh feed each time you need one, and to give it straight to your baby. If you need to prepare feeds in advance to use later, make up individual bottles, cool them quickly and place them in the back of the fridge (5 C or below).
Throw away any feed in the fridge that you have not used within 24 hours. Never store bottles in the fridge door.
When feeding your baby, tilt the bottle slightly so that the teat is always full of milk not air.
You will see bubbles inside the bottle as your baby feeds. Your baby may feed in short bursts of sucking then rest in between.
This gives you an opportunity to take the bottle away and to wind your baby. Gently sit your baby upright and pat or rub their back.
There is no right or wrong way to wind a baby, as long as they are up straight the wind will move.
If you hear a lot of noisy sucking sounds while your baby drinks, s/he may be taking in too much air.
To help your baby swallow less air, hold him/her so they are propped up a little. Often babies like to have a little suck to go to sleep.
I advise changing your baby’s nappy ¾ way through a bottle feed, and save that last ¼ to soothe them after a nappy change . Newborns will often drift back to sleep then, with a full tummy and clean, fresh bum.

Breastfeeding after Colostrum
In the last article we talked at length about breastfeeding in the first few days and the amazing substance called colostrum that is present in your breasts for the first few days after birth.
The colostrum will turn into milk on day 3 or day 4 post-delivery. Depending on supply and demand. Often your breasts become full, they can feel hard to touch.
You are usually delighted that the milk has some in and that your hard work has paid off.
Often however, babies do not latch well, initially to those hard, full breasts. The reason, I believe, is because their little noses have been used to touching a soft breast and now, they can not fully latch onto this hard breast.
An incredibly good tip is to hand express, a good amount, of milk out before you attempt to latch your baby on. This softens the breast; the baby will recognise it and somewhat break the hard seal within the breast.
Continue as you were doing before, offering the second breast to your baby after they have fed off the first breast and have been winded.
However, you may find now that the milk is in, that your baby does not take much from the second breast, they may be satisfied with a feed from one breast.
You will know from how full and engorged your breasts are which side the baby is due to feed on next. Be careful to get the baby to feed from both breasts at some point during the day as it is still all about supply and demand. You want an equal supply in both breasts.
Hand expressing some milk out to soften the breasts is my best piece of advice for you, when the milk comes in.

Eye Care, Cord Care and Nappy Care
All newborns cry but they do not make tears. Without tears the eyes can often get sticky. With or without sticky eyes, I recommend cleaning babies eyes daily in the first few weeks. If the eyes are sticky use cooled boiled water if the eyes are fine use normal water.
Parents often clean their baby’s eyes as part of topping and tailing. Topping and tailing means washing your baby from head to toe instead of having a bath.
Topping means washing your baby’s face, neck and hands. Always start with the eyes. Dip a clean piece of cotton wool in warm water and squeeze it out. Then gently sweep it across your baby’s eye, starting from the corner near their nose, across their eye and up and down the back of their ear.
Use a fresh piece of cotton wool for each wipe so that you do not spread anything that you have removed. One wipe and one dry per eye is fine.
The umbilical cord is what connects the baby to the placenta inside your womb. Shortly after birth this cord will be cut safely and with a sterile technique by your midwife or doctor.
A clamp is placed on the umbilical cord at the baby’s side before it is cut. Separation of the cord stump from the baby takes on average 9 days and this cord clamp will remain on and will fall off with the cord stump.
For those 9 days and for several days after the cord and clamp have separated from your baby, you will need to clean around the cord stump.
Fashions in caring for the neonates umbilical cord stump have come and gone over the years in an effort to reduce the risk of neonatal infections. Good hand washing, skin-to-skin contact at birth and rooming the baby in with Mum in the first 24 hours after birth, when possible, area all particularly important.
These things all reduce the risk of cross infection and allows baby’s skin to be colonised by Mum’s healthy skin flora.
Care has ranged from application of antiseptic, antibiotic powders, alcohol wipes, drying powders, bathing baby in antiseptic to not bathing baby at all to simply doing nothing.
Currently, what we midwives recommend is if the cord stump is clean and dry, do nothing, leave it alone. An important piece of advice is to always fold down the nappy under the cord stump so that no pee or poo gets onto the stump.
I recommend putting on the nappy as normal and then folding it down, instead of trying to close the nappy under the cord stump, as often this way the nappy is too loose and pee escapes.
It the cord stump becomes oozy, and it often does, take some water and a clean cotton wool piece, pretend the cord stump is the face of a clock and clean from 12-6, then dump, and repeat on the other side with a fresh piece of cotton wool.
Take a dry, soft piece of cotton wool and dry it in the same way. You may need to do this for a few days after the cord stump falls off also, as it is likely to be somewhat oozy.
Finally, nappy care. When topping and tailing your baby always work from top to bottom i.e. eyes, cord then nappy. That way you are not carrying any poo/pee on your hands up their little body. Some parents use water and cotton, some use wipes. It does not matter as long as your baby’s bum is clean and dry. My Mums will know I have a mantra, wash, dry Vaseline.
Drying their wee bums is so important, you would never get out of the shower and not dry your bottom, so why do we wipe our babies bums and then put the nappy straight on!!
Always dry their wee bums with a soft towel or with a baby drying pad, try to get ones that the fluff does not come off. Then, I am a believer, in a good layer of Vaseline on the cheeks of their bum.
The reason is, poo especially the first poos, called meconium, are so sticky you need to rub hard to get them off.
With Vaseline, they will just glide off and the Vaseline acts like a barrier for the bum, and no sore bums from rubbing too hard. Always clean little girls from front to back.
Little girls may pass a sticky discharge from their vagina in the first few weeks of life, this is normal, and happens because your little girl was exposed to your hormones when she was in your womb.
With little boys always point their penis down when changing a nappy, otherwise prepare to be splashed on.
Do not buy too many bundles of the same size of nappies as your baby will move up the sizes quickly. Parents get faster and faster at nappy changes; they get lots and lots of practice!!!
I really hope that you have found this article helpful. Remember 80% of the time, when your baby cries, they are hungry, wet or windy, let them be your go to 3 first.
I tell all first parents as they leave the hospital, do not worry too much about something this week, next week you will be worrying about something else and forgotten all about this week’s worry. Welcome to parenthood!!!
Remember this advice and tips are just a guide. If you are concerned about anything speak to your GP, midwife, hospital midwife, hospital doctor or PHN.
If you would like to contact me regarding the articles or antenatal classes in the future you can reach me at: birthingwithbridget@gmail.com

Take care,
I hope the sun comes back,
Bridget the Midwife.

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