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Introduction
The end of your journey
has come after 40 weeks. The fruit of your labour (literally)
will soon be in your hands.
There are a few things
you might want to know about your new arrival. Typically,
a newborn baby has the following characteristic appearance:
-
Head: Your baby’s head
appears large for the body and may have an elongated
shape or appear to have some ‘bumps’. This is due
to changes called molding, which occurs in labour
and delivery. Small bumps called ‘caput’ usually
disappear in 1 – 2 days. Soon the head gets rounder.
The head circumference is 33 – 35 cm.
- Colour: Depending
on the parents, the skin colour of newborn varies.
In general, newborn babies look flushed and pink all
over. However, the palms and soles of the feet may
look dusky or little bluish soon after birth.
Immediate
Care
There are certain standard procedures followed by a health
personnel in the delivery room. These are described
below:
At delivery 
of the head (even before the shoulders and
body deliver), the
mouth is gently suctioned by a rubber or plastic device.
This cleans the airway and is especially necessary in
cases where the liquor was meconium
stained.
After the baby is born completely, the birth attendant
supports the baby’s head and body, keeping them at the
same level as your perineum, while the cord is clamped
and cut.
It was the lifeline joining the baby to you until birth. This
now has to be cut. There are different views on when
and who should cut the cord. Usually, the cord is cut
once the pulsation stops to allow maximum blood from
the placenta to reach the baby. In certain medical conditions
however, your doctor may feel it is necessary to cut
the cord earlier or later.The cord is clamped and cut
by the doctor or nurse. If you wish your birthing partner
(spouse) can cut the cord.
Your baby has come from your
nice warm womb into the cold world outside. A very important
adaptation is maintenance of body temperature. Your
doctor will gently dry the baby, especially the head,
and wrap her / him in a warm dry towel. The baby is
now kept under a warmer light to maintain temperature.
A small or pre-term baby may require a special machine
or incubator for this.
Initially, more importance was given to the mother, as labour
was often hazardous. It was an anaesthetist, Virginia
Apgar, who described the "Apgar score" which is used
in most hospitals to describe the condition of the baby
at birth. Assessment by this score at 1 minute from
birth indicates the need for neonatal resuscitation
by identifying a baby who is sick.
Repeat scores at 5 – 10 minutes indicate how well the
baby is maintaining herself / himself with the doctor’s
help.
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Sign
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Score 0
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Score 1
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Score 20
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Heart rate.
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Absent.
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< 100
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> 100
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Respiratory effort.
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Absent.
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Irregular.
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Good crying.
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Muscle tone.
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Flaccid.
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Some limb tone.
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Active.
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Reflex irritability (of catheter in nostril)
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None.
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Cry or grimace
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Vigorous cry cough or sneeze.
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Colour.
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Blue-White
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Body pink extremities blue.
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Completely pink.
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The maximum score is 10. A baby born in good condition score
9.
A newborn’s eyes are reflex tightly closed and often
smeared with blood, amniotic fluid and vernix. Hence
they are usually wiped gently with sterile saline swabs.
In some hospitals, to prevent neonatal conjunctivitis,
your doctor may recommend using medicated eyedrops (1%
silver nitrate) or eye ointment (such as erythromycin).
In most centres, a single
intramuscular injection of vitamin K 0.1 mg is given
to the baby. This helps the baby’s blood clotting system
and prevents bleeding.
It is recommended to start
breastfeeding as soon as possible. In fact, some believe
in putting your baby to your breast as soon as the cord
in clamped and cut. Allowing the baby to suckle immediately
stimulates release of oxytocin, a hormone which helps
your placenta to separate. This option should be discussed
by you with your doctor earlier.
Often the baby is handed over to the neonatologist (doctor
who specialties in babies) if present at delivery, or
the attending nurse. They will usually finish the initial
evaluation of the baby including Apgar scoring, and
will wipe the baby and suction the mouth, as discussed
above. After the cord is tied (by sterile linen ties
or a disposable plastic cord clamp) and you are through
with delivering the placenta, the baby is given to you
for feeding. Feeding can be started even before the
episiotomy
is sutured. Remember,
the sooner you start to feed the baby, the better it
is, since the newborn baby bonds and suckles more enthusiastically.
Even if you feel too tired to feed, your spouse or relative
or a nurse can help you by supporting the baby at
your breast to make it easier for you.
Care
on 1st Day
Other than the immediate care discussed above there
are a few more important issues on the first day of
your baby’s life.
- Measuring and recording weight, length and head circumference.
- Taking baby’s footprints for hospital records (usually).
- Examine the body orifices (openings) to detect potentially
risky conditions like imperforate anus, tracheo-oesophageal
fistula.
- Assessing the gestational age and maturity of the baby to
confirm adequate development of various reflexes and
body systems. This is most important in babies born
early or late.
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Prevention
Of
Infection
Newborns are very vulnerable to infection.
Careful hand washing by those handling the baby
including yourself is important. Preferably avoid
over exposing the baby to too may visitors. Visitors
are inevitable – it is easier to keep the baby
in the nursery during visiting hours. So that
you don’t have to tell people to be careful!
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Screening
Tests
as indicated
Usually, your doctor or nurse collects blood from the
umbilical cord after the cord is cut at delivery.
These samples are sent for baby’s blood group and
haemoglobin in all cases. In select cases, additional
tests such as Coomb’s test and cord bilirubin are
done if you are Rh-negative Tests for infections
(VDRL, HIV) or for blood disorders (G-6PD deficiency)
are sometimes asked for. In selected cases, a spot
test using blood collected by pricking the heel
of the baby may be done for TSH (to detect hypothyroidism)
or Guthrie test (for phenylalanine to detect
phenylketonuria) or others may be required where
a particular disease is suspected. |
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Continuation
of Breastfeeding: Remember that mother’s milk is the
best for a baby. Even if you are tired, or your
breasts and nipples feel sore, or you feel there
is very little milk coming out, DON’T give up. The
first day is the toughest. Persist in giving the
baby only breast milk. Resist from giving any other
feeds. Your baby will soon settle down to a proper
routine! |
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Father’s
Role : Let the Dad also spend time holding
the baby and being with you both. This helps in
bonding . |
First Week of
Life
- Being
Prepared: In the 9 months of anticipation
of delivery, we are sure you must have made enough
preparation at home to receive your ‘prize’ – the
newborn baby. Few essentials to keep ready at home
include:
Baby clothes (at least ˝ dozen ‘jhablas’ or dresses that
open completely).
Cloth diapers or nappies (a large 24" square cloth, if folded
properly is an efficient nappy – however you get pre-stitched
cloth diapers with central padding and Velcro fasteners
which may be easier to use).
Baby wraps (cheerful prints on cotton or cotswood materials,
about 21/2 feet square or rectangle make good swaddling
clothes).
Washing items only for baby:
- a small tub,
- a receptacle for dirty linen (such as a bucket with
a lid),
- a mug.
- Towels (2 large and 4 small).
- Plastic squares or small sheets.
- Toiletries:
- Baby soap, preferably one, which is hypo-allergenic
and non-scented, is most suitable for baby’s
tender skin.
- Oil or Vaseline for applying on baby’s body.
- Hair oil for baby.
- Powder.
- Cotton swabs or babies wipes for wiping your baby’s
bottom after passing stools.
- Disinfectant such as Savlon or Dettol which can be
put into the bucket containing dirty linen until
wash.
- Fabric softener is useful to use at least once a week
to make baby’s towels and diapers soft.
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Your room should be prepared so that both you and baby are
comfortable as soon as you reach home. In particular,
plan your baby’s sleeping arrangements in advance.
You may want a separate baby cot. Some mothers prefer
to have baby sleeping with them on the same bed for
a while. In either case, you could place a plastic
sheet under the bed clothes to prevent soakage of
the bedding in case baby’s diapers leak!
- Going Home: After
a normal delivery, most first-time mothers will be
home by the fourth or fifth day. In case of moms who
are experienced, they may be sent home earlier. Your
doctor will assess both your baby’s and your condition
to decide when it is safe for you to go home.At discharge,
make sure you have got all your baby’s records and
the investigation reports with you.
- Bathing your baby:
As discussed earlier. It is now common practice
not to bathe the baby on the first day. Often, till
the cord falls off, you may prefer to give a sponge
bath rather than a full tub bath to the baby. This
helps to keep the cord dry, but is more time-consuming
In most Indian homes, there is a trained massage-lady-cum-bath-lady
(the ‘bai’) who comes to massage and bathe the baby.
It is not a must to have such a person. It can be
fun for you to bathe the baby yourself. However having
someone to do it for you, gives you time off to relax
and catch up on some sleep!
If you are bathing the baby yourself, keep the following tips
in mind to make bathing more enjoyable:
- Keep all bath items ready (soap, wash cloths, cotton, towels
and change of clothes).
- The room or bathroom should warm, with windows closed.
- Always test the water first. Remember to fill cold water
first in the tub, then add hot water till the temperature
is right, to avoid accidental use of very hot water.
- Hold the baby firmly at all times supporting her / his neck
properly.
- Wash the baby’s face carefully with minimum of soap, using
swabs or a washcloth to clean the eyes.
- Avoid getting water in the ears.
- Dry the areas of creases and skin folds – groin, armpits,
back of knees, neck, etc.
- Take the baby wrapped in a blanket away from the bathing
area before powdering / dressing up.
- Do not apply kajal in the eyes or oil to the nose and ears.
Care of special
areas
Trimming can be done with nail scissors
(available in a child care store). It is best done immediately
after a bath, when nails are soft. If your baby is a
sound sleeper you may do it during the sleep. If not,
occasionally you may draw blood because the baby is
restless – most mothers do so at sometime. Applying
pressure stops bleeding and needs no further care.
During the 1st week you may see an excessive discharge or even
bleeding from the genitalia of your baby girl. This
is normal and due to the hormones passed from the mother
to the child. The vulva and vagina needs no special
cares, except that while washing, the movement should
be from the front to the back.
- Penis
The uncircumcised penis needs no special
care. Do not try and retract the foreskin, as it is
generally adherent to the glans.
Activity. During the 1st few weeks, a cheesy white substance may be seen
at the tip of the penis, which is a collection of the
dead cells from the glans and is normal.The circumcised
penis needs special care only till the wound heals.Plain
soap and water cleaning is ideal for cleaning the penis.
No special cleaning is needed. Do not put
cotton swabs, etc. to clean the ear. Do not put oil
in your baby’s ears.
It is self-cleaning. If there is excessive
mucus, just wipe off the mucus. Do not use cotton swabs,
tissues, fingernails to remove mucus as the delicate
membrane of the nose may start bleeding.
Even if you do not bathe the baby daily, there
is no problem as long as you keep the baby clean by
taking care of the following things:
Wipe your baby’s bottom from front to back with a wet wipe
or wet cotton swab, then wash with water, everytime
he/she has a bowel movement.
At least twice a day, wash your baby’s bottom with soap and
water after a bowel movement. Make sure all the soap
is rinsed off.
Brush or comb your baby’s head daily to remove scaling dry
skin and keep her / his hair tidy.
Your baby will pass urine and stools many times a day,
more so in the first week. Do not worry, most babies
settle down to a routine after the first few weeks.
In particular, you may notice that everytime your baby
feeds she may wet or soil himself/herself. This is due
to an inbuilt mechanism called the ‘gastro-colic reflex’.
This will also settle with time, but remember to check
his/her nappy after every feeding. You need to decide
on what is the type of underclothing you will provide
for your baby.
Nappies or cloth diapers are re-usable, and eco-friendly. More
importantly, until your baby grows a little older, preferably
a month old, his /her tender skin may not tolerate disposable
diapers. This is often seen that disposable diapers
which have perfume, makes some babies break out
in a rash Cloth diapers should be washed in warm or
hot water using detergent. Addition of an antiseptic,
which also acts as a bleaching agent may be advisable.
This is more important if you do not wash the diaper
immediately. The diaper should be rinsed well to remove
all traces of the detergent. Once a week, a fabric softener
may be used to keep the diapers soft.
A wet or dirty diaper makes your baby’s skin sore or red,
and can lead to rash.
Frequent changing should be done as necessary, particularly
before and after your baby sleeps.
While cleaning your baby’s bottom, wash the diaper area from
front to back (never the other way) to avoid infection.
If your baby has a rash, let her bottom dry after each diaper change. Keep her
diaper off for some time to allow ventilation.
A zinc-oxide cream can be used on your baby’s clean, dry
bottom to prevent and treat rash.
Talcum powder is better avoided as it can worsen a rash,
and may act as an irritant.
A newborn baby has no other means to express himself/herself
other than crying. He/she may cry for different reasons,
and may cry loudly or softly. Listen to him/her, hold
him/her and don’t get hassled yourself. The various
causes for crying include:
- Hunger – your baby may want a feed.
- Wet or Dirty diaper – your baby needs changing.
- Temperature – your baby may be hot or cold.
- Gas or colic – the baby's tummy may be hurting. Try to burp
him/her or change position .
- Attention – your baby may just want you to talk to him/her,
play with him/her or hold him/her.
- Noise or crowds – your baby may want a little peace and quiet
too!
- Most importantly, don’t get nervous if your baby seems
to be crying a lot. He/she will settle down soon.
If you are tired or need a break, ask your spouse
or other family member to take over for a while until
your feel better.
Babies have big head in relation to their bodies, and their
necks are not strong enough to support the head for
the first few months. Hence special care is required
when carrying them.
Remember
a few things to do:
- Support his/her neck and head well whenever you lift your
baby.
- Wrapping or swaddling the baby before carrying often helps.
- Do not change position suddenly or toss him/her in the air.
- Do not let children handle your baby unless an adult is there
to supervise or help.
- A ‘startle’ response of throwing out his/her arms and legs
is not unusual when trying to pick up your baby. Being
gentle yet firm is the key to making your baby comfortable.
The small stump of the umbilical cord usually dries up and
shrivels up. It may become brown or blackish in colour
.Do not worry, this is normal. It is important to see
that there no foul smell or greenish yellow discharge.
Link to when to call your doctor in Care of the new
born. That could be a sign of infection.
In the daily hygiene routine, you must keep the cord stump
dry and clean. It may be better to give only sponge
baths until the cord stump falls off. Your doctor may
recommend wiping the cord with spirit or eau-de-cologne
after baby’s bath. The umbilical cord stump will usually
fall off in 5 to 10 days.
When To Call Your Doctor?
If you notice any of the following changes in the cord area,
let your doctor know:
Bad smell from cord area.
Bleeding from the cord stump.
Brown, green or yellow discharge
from the bottom of the cord.
Reddish and / or hot, painful area at the bottom of the cord.
There are many minor things related to your newborn baby that
are really normal, but cause worry, as they appear different
or abnormal. These are a few things that you may notice
which are harmless or will subside with time.
- Colour of skin :
The baby’s skin and mouth are usually pinkish,
more so in fair skinned babies, the hands and
feet may appear blue sometimes. This is usually
due to feeling cold. So see that your baby is
kept warm.
- Skin texture and feel :
Some babies may have dry, cracking or peeling
skin. This is more common if your went beyond
your due date. Link to postdatism. Other babies
have seemingly excess soft furry hair on their
upper body. This will go away soon. Skin peeling
may also occur. As long as the area underneath
is healthy, do not worry.
- Milia:
There may be small white bumps (like acne) on
the face, especially on the nose, chin or cheeks.
These are just distended sebaceous glands. They
should not be rubbed or squeezed. They will
disappear on their own within a few weeks
- Erythema toxicum / ‘fifth disease’ :
These are reddish patches like a ‘slapped check’
appearance on the face or trunk. These typically
may be seen in the first week and will clear
up on their own.
- Stork bites:CARTOON:
Many babies have small pale pink spots on the nose,
eyelids and back of the neck. These were believed
to be due to the legend of the stork holding
the baby to deliver it to the mother’s womb!
They vanish after a few months.
- Birthmarks and Mongolian spots :
Some babies may have a birthmark. Your doctor
will check before you go home. Some babies,
more often in dark-skinned races, may have bluish
spots that look like bruises on their bottom
or back. These well-defined areas are called
Mongolian spots. They are harmless. Some people
believe that they are a sign of good luck! They
will go away in several months, but usually
by the first birthday.
- Breast swelling :
In the first few days after birth your hormones
may still be affecting the baby’s breast tissue.
Many babies, male or female, may have slightly
engorged or swollen breasts. Whitish discharge,
often called ‘witch’s milk’ can be seen oozing
from the nipples. Remember do not press or try
to remove this, as it will stop automatically
within a few days.
- Genitals:
Due to mothers hormones some girl babies may
have a little clear or blood stained discharge
from the vagina. The labia may look little swollen.
This will settle by the end of the first week,
so do not do anything about this. Baby boys
have a foreskin covering the tip of the penis.
In many newborn boys, the foreskin cannot be
slid back completely. As long as this does not
interfere with passing urine, there is no need
to do anything about it. link to circumcision.
Do not try to retract the skin forcibly either.
A baby boy should also have both his testicles
in the sac below his penis.
- Newborn Teeth :
Some babies may have one or more teeth at birth.
This is not uncommon. But these teeth are usually
shed by 6 months. If they hurt you while breastfeeding
or are loose, they can be removed.
- Jaundice:
Physiological jaundice is very common in babies.
It usually starts after the first 24 hours and
will disappear within a week. You can tell that
your baby is jaundiced if;
- the skin looks yellow,
- the whites of the eyes look yellow,
- You press on a skin area (e.g.: nose,
skin) and the yellow colour shows when the pressure
is cleared.
Jaundice is more common if your baby is low birth
weight, Link to birth weight, or you had a difficult
labour and delivery, you were diabetic in pregnancy,
or the baby had bruises during delivery. If
your doctor feels the jaundice is significant,
your baby’s blood may be checked for bilirubin
level. Usually the levels do not exceed 10 mg
% in physiological jaundice, and as such no
specific treatment may be required. One important
thing to do is feed your baby as often as possible.
By increasing excretion of bile salts and pigments
in stools, this helps the jaundice to disappear
quicker. Another treatment is exposure of baby’s
skin to light. You may be advised to keep the
baby uncovered in the sunrays near a window
at dawn or dusk. Please remember to avoid excess
exposure to direct sunlight and follow your
doctor’s instructions at all times. Your doctor
is the best person to tell you if any special
treatment is necessary.
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- Babies with special needs
Some babies may need some
extra attention from you and the doctor after birth.
These include:
- Low birth weight babies (less than 2.5kg).
- Babies born too early (premature).
- Babies with pathological jaundice.
- Babies with infection.
- Those needing an operation soon after birth.
- Those with low blood sugar.
- Babies of diabetic mothers.
- In such situation your baby may need to stay in hospital for
a longer time and may even be kept in an intensive
care unit for newborns. Your doctor and other medical
staff will help you and teach you how to take care
of your baby.
Your first week of motherhood is now over. How does it feel?
You are now more experienced at handling your baby’s
daily routine. There are still a few things you may
want to know or that are not yet settled completely.
These include.
(1) Sleeping Pattern
When talking about newborns, one of the first pictures that
comes to mind is a weary mother with lack of sleep.
Remember that things can only get better with time. Your baby
will develop his / her own sleep pattern, but this may
take sometime, usually many weeks. Some babies sleep
fitfully for just an hour or two at a time. Some may
sleep many hours at a stretch. Some days may be good
for you, with your baby sleeping well and giving you
time to rest. Some days may not be so good.
These are a few things that help babies to sleep better.
- Most babies sleep well after feeding
well, (like adults).
- Some babies sleep better often being
tied in a cloth (swaddled). Link to swaddling
the baby in Care of the newborn.
- Some sleep well after being rocked
(such as in a crib or swinging cradle).
- Some babies sleep well after a bath
or massage.
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You will soon find what works best for your baby. Try to avoid
carrying the baby around to put her to sleep, as this
habit will be difficult to break.
(2) Play
As your baby is growing up, she will stay awake for longer
periods. Each baby has his/her own personality, even
so soon after birth. By a few weeks of age, you will
get an idea as to what he/she wants to do. Newborn babies
recognise the mother by smell, voice and appearance,
although proper fixation of gaze on an object or person
may not be obvious till a month or more from birth.Your
baby may want to look at moving objects like a hanging
toy on the crib, or pictures. Some find music enjoyable
while some like mirrors.
(3) Clothing
Just like adults dress according to the weather, babies also
need to be dressed suitably. However a general guideline
is that clothing should be soft, not tight, and should
not have prickly or poky attachment (like stiff laces
or sharp buttons).
- See to that appropriate under-clothing is used (nappies
or diapers). Check the nappy frequently.
- In warm weather, look out for heat rashes. A red, raised rash
may appear if the baby is too warm. While going to
the sun, use a bonnet or a sun-umbrella to keep his/her
head covered. Remember that babies have a delicate
skin, so it is best to avoid over-exposure to the
elements like sun, wind or rain.
- In cool or cold weather it is better to have more layers of
clothes than a single thick garment. Woollen clothing
like sweater, bonnet or booties should be made of
soft wool and preferably worn over cotton under-garments.
A light woollen blanket can be used as a swaddling
cloth.
- How to wrap / swaddle your baby - picture.
(4) Temperature
If your baby is not looking or acting normal, looks down or
sick you may need to check his/her temperature. If he/she
is sweating first of all check that you have not over-clothed
him/her!You may need to check the temperature if your
baby is
- Having persistent diarrhoea or vomiting.
- Is unusually fretful or fussy.
- Feels hot.
- Has a dry mouth or flushed skin.
- Has a rash.
- Is not feeding.
- Breaths differently (noisy, fast or irregular).
- A special rectal thermometer may be used for this purpose but
your doctor/nurse will instruct you how to use this.
Never put a thermometer in baby’s mouth at this age.
Normal body temperature is about 37 C (36.1 C to 37.8
C). A temperature higher than 37.8 C (100 F) should
be reported to your doctor.
(5) Umbilical Cord
The umbilical cord stump usually falls off by the 10th
day. If the cord has not fallen off by the 14th day or there is redness or discharge at the base,
you need to call the doctor.
(6) When to seek help?
You may need to call your doctor if you feel your baby is looking
sick or having any of the following problems:
Fever, temperature above 38.8 C (100 F).
Vomiting repeatedly or in a forceful manner.
Loose, watery, greenish stools more that 3 – 4 times a day.
Keeps refusing to feeds.
Does not pass enough urine (at least 5 – 6 times daily).
Behaves unusually, is irritable or fussy, despite all your
efforts.
(7) Circumcision
In certain families or communities you may
want to get your baby boy circumcised i.e.: remove the
foreskin at the tip of the penis.This is a personal
choice and should be made by both parents together,
with your doctor’s help, if necessary. It is a minor
surgery and can be done before discharge from hospital
(within the first week) or later. Medically it is required
only for severe phimosis where the foreskin is very
tight and interferes with passing urine.
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Baby
Characteristics
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