Your baby

Wel­come to our world! What baby goes through in her first few days

Your Pregnancy - - Contents -

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.)

BREATH­ING

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.

UM­BIL­I­CAL CORD

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.

FUR­THER TESTS

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.

JAUNDICE

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.

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