Welcome to our world! What baby goes through in her first few days
THE BIG DAY
has finally arrived. Hours of labour are done, and you meet your new baby for the first time. And although you might have read a lot about everything that happens to a newborn baby in hospital, you probably don’t realise exactly how busy she’s going to be in the next three days… from a whole series of tests that she needs to undergo to all kinds of small adjustments that her little body needs to make in order to fit into life outside the womb. Most hospitals follow the same procedures as standard practice following baby’s birth, although not necessarily in the same way or in the same order. Doctors, midwives and labour nurses also have personal and professional preferences in terms of how they work. (If there were life-threatening complications for Mom and baby before, during or after the birth, a whole different approach is taken from the one we describe below.)
Baby’s respiratory reflex is completely operational minutes after a vaginal birth or caesarean. In utero, baby got her food and oxygen from the placenta via the umbilical cord, but now she needs to start breathing on her own, even if the cord has not been tied off yet. Most modern hospitals no longer suck babies’ little noses and throats clean with a small tube; they just wipe the little
mouth and nose if baby can comfortably breathe by herself. After baby’s first breath, her skin colour changes from blue tones to redder ones as oxygen flows from her little lungs to the rest of her small body for the first time and she can start functioning independently from Mommy. As soon as she’s calm and stabilised in her new environment, a black baby changes to a healthy purplish-gray, and a white baby turns pinker.
Directly after birth the obstetrician or midwife will place your baby on Mommy’s chest with the umbilical cord still attached to the placenta. Baby will lie wet, slightly crumpled and curled up and make important skin-on-skin contact with the Mommy who protected and cared for her for so long in her own body. Nowadays dads are almost without exception part of the whole birth process, and they’ll proudly tell you who cut the baby’s umbilical cord. They can take care of this important task while baby is on Mommy’s chest. Your baby’s umbilical cord is tied off 2.5cm from her little body with a naval clamp and 5cm further with another special clamp. Dad (or the obstetrician) then cuts the cord in between these two clamps. The stump of umbilical cord will dry up and fall off within 7 to 14 days and Mom or Dad should not fiddle with it. Keep this spot clean and dry (gently dab it dry after bathtime and apply a little medicinal antiseptic ointment with an ear bud) until it’s healed completely. Rather chat to the clinic sister if you’re uncertain if the process is running normally. The doctor will draw blood from the umbilical cord to determine if baby’s blood glucose level is normal. Your baby’s blood glucose level will be tested three more times after this first time: three hours after birth, six hours later and again six hours later. Babies who have a too low level do not suckle properly, are drowsy and can, in serious cases, even stop breathing. Should your baby’s blood glucose level be low and she doesn’t want to nurse, the staff will give her a small extra feed that will boost it (usually with a special little spoon or medicine dropper). If parents decided beforehand to store their baby’s stem cells for possible future medical use, the doctor will draw blood before the cord is cut.
FIRST SIPS OF MILK
In some maternity institutions baby can nurse from Mommy’s breast even before the umbilical cord has been cut or straight after, and get colostrum, which is the first nutritious sip of milk before breastmilk is produced. Baby’s sucking and olfactory reflex will instinctively lead her to Mommy’s nipple. The midwife or labour nurse will cover her with a towel so she doesn’t become cold and cover mom as well as baby with a blanket to ensure baby’s temperature remains constant. Baby’s tiny body now has to adapt to the temperature outside the warm and sheltered environment of the uterus, and she has to start regulating her own temperature. In some hospitals, baby might only nurse in the recovery room (following a caesarean) or after all the other tests.
WHAT DOES A NEW LITTLE BEING LOOK LIKE?
Your baby will probably still be partially covered with a white, fatty substance that protected her skin in the moist environment of the womb. This substance, called vernix caseosa, is secreted by oil glands in the skin and contains skin scales and fine little hairs. She might have fine little hairs covering her body, which is called lanugo and which protects baby in the womb. It’s not a sign that your baby is going to be hairy and it will disappear within a few weeks. Babies that are born before 40 weeks usually have more lanugo. The skin of some babies is dry, especially of those who spent more than 40 weeks in the womb, and their hands and feet can peel in the first couple of days. It’s a normal adjustment from the moist environment of the womb to the drier atmosphere she’s in after birth. It’s going to take a little while before the pores on your baby’s skin start functioning properly, and sweat and oil glands can become temporarily clogged, especially across her nose and the rest of her little face. The white “spots” or milia will disappear by themselves at some point and should not be squeezed. Some babies develop a reddish rash over their bodies (especially the back, shoulders, and bum) in the first few days after birth. It’s a normal reaction to the touch of fabric on their skin after a long stay in the sterile environment of the womb. Their tiny bodies adapt, and the rash quickly disappears. Some babies have purple-pink stains on their noses, eyelids, foreheads or behind their little necks that become especially pronounced when they cry. They are not permanent, fade and later disappear. Mama’s hormones ended up in baby’s bloodstream during pregnancy, and it’s normal for boys and girls’ breasts to appear swollen. The swollen breasts (sometimes there’s even a milky secretion) will flatten as your baby’s body gets rid of the hormones. Genitals appear proportionately bigger directly after birth (also because of Mommy’s hormones), and it’s normal. Girls might even have a vaginal discharge for the first while until Mom’s hormones have gone. Babies’ skulls are not fully fused yet, that’s why there are soft spots on top of and at the back of the little head that will close up in time. The fontanelle, as it’s called, helps baby to move through the birth canal because the soft skull plates can move towards each other to make birth possible. The heads of some babies are fairly misshapen after being squashed in the birth canal. Don’t worry – the skull will quickly (within 24 hours) look quite normal again. Perhaps the obstetrician had to use a suction cup, made from silicone and not metal, to help your little baby into the world. In this case there might be a purplish, swollen bruise behind the little head. It’s blood that’s trapped between the scalp and skull and will
MAMA’S HORMONES ENDED UP IN BABY’S BLOODSTREAM DURING PREGNANCY, AND IT’S NORMAL FOR BOYS’ AND GIRLS’ BREASTS TO APPEAR SWOLLEN
automatically be absorbed by baby’s body and disappear. If forceps were used, baby might have small marks to her tiny head and face that will also disappear within a few days.
EXAMINATIONS AND TESTS APGAR SCORE
The midwife or doctor has to determine how well baby’s body functions, and this is done through a standard test, called the Apgar score. The five elements that are examined during the Apgar process are breathing, heartbeat, skin colour, muscle tone, reflex and reaction. Every category is given a score out of 2, which means the maximum score is ten. Seven out of ten is still a good score for your baby, but babies with a score lower than five may need extra oxygen to regulate their breathing. Even babies with a score of seven can battle with breathing and may need oxygen. Babies with a shortage of oxygen breathe irregularly, their heart rate is mostly under 100, and their skin colour is blue or pale instead of a healthy pink. Babies should be examined according to the Apgar scale three times after birth: 1 minute after, 5 minutes after and 10 minutes after birth.
WEIGHT, HEAD CIRCUMFERENCE AND LENGTH
The midwife or obstetrician will obviously check if there aren’t apparent physical deviations and then weigh baby. This weight is later used as a guide to determine if she’s putting on sufficient weight. Anywhere between 2.5kg and 4.5kg is normal. Babies with a low birth weight might need extra care and attention. A baby’s weight can also be an indication of possible health problems. An unusually large baby may mean that Mom is suffering from diabetes. Your baby now gets a vitamin K jab in her thigh that helps with blood coagulation. The midwife will now also put a name bracelet on her wrist (and sometimes also the opposite ankle), so that there is no confusion about whose baby it is. In some hospitals, baby will be weighed and measured, but sometimes this is only done later, once baby can comfortably maintain her own body temperature (about four hours after birth). Although the size of the head and length depends on your baby’s size and weight, an abnormally small or large head can be indicative of a possible problem. The average head circumference of a baby of 3.3kg is approximately 35cm. An average length is 50cm.
The paediatrician will once again carefully examine your baby within the first 24 hours, and then daily thereafter until you’re discharged from hospital. The doctor will read the notes the gynaecologist made during the pregnancy to see if there were any problems that could have influenced the baby’s development. Then you’ll be rigorously examined from head to toe. Certain physical abnormalities such as the absence of limbs are obvious, but not all variations are immediately noticed. So the doctor will ensure that there are no physical problems that were not initially noticed or that could not be diagnosed. Among other things, the doctor will thoroughly examine the heart, lungs, skeleton, head, inside of the mouth, eyes, ears and limbs and ensure the intestines work properly and there is no obstruction in the gut. He or she will also determine whether your baby’s instinctive reflexes are present. In most hospitals your baby’s hearing will be tested by a trained audiologist before she goes home. Your baby will also get her first vaccination before being discharged from hospital: an oral polio vaccine and the BCG jab against tuberculosis. In some hospitals you can also complete the necessary paperwork to register your new baby at the Department of Home Affairs. Feel free to ask the hospital staff for more information.
Many newborn babies develop physiological jaundice – it affects more than 50 percent of full-term babies and more than 80 percent of premature babies. The condition is caused by increased levels of bilirubin, or gall pigments, in a newborn baby’s blood. Bilirubin is a waste product of haemoglobin that is broken down in the red blood cells. A newborn baby still has underdeveloped liver enzymes and is not yet in a position to independently get rid of the bilirubin. The condition develops within the first 24 hours after birth and looks like a light sunburn. It usually starts at the head and slowly moves downwards to the feet and in serious cases the whites of baby’s eyes will look yellow. Babies with jaundice will be carefully monitored and placed under ultraviolet lights if necessary (this is known as phototherapy) to help break down the bilirubin. It is important that baby’s eyes are properly shielded and protected from the lights to prevent eye damage. The more baby nurses, the more the chances of developing jaundice decrease. Research shows that the quicker baby starts nursing, the smaller the chance of getting jaundice. Moms who return home very soon after birth have to watch their babies carefully to make sure there’s no jaundice. If neglected, jaundice can lead to brain damage, and prolonged jaundice (longer than two weeks) in newborns can be the symptom of a serious illness. In such cases, further tests have to be carried out to determine the precise cause.