Instructions for Baby after Birth

Many women are choosing options like early discharge and home or birth center births, which require their husbands, families or friends to take full care of them and their newborn babies at home soon after the birth. The advantages to this are that the woman may feel more comfortable and rest more easily in her own environment. This also gives the newborn unlimited contact with his/her mother and father. Mothers and babies are carefully screened after birth to rule out those problems after birth, your midwife will thoroughly examine both the baby and the mother and can usually identify those who may need further care. Parents are informed on what observations to make before the midwife leaves. The large majority of women are healthy and safe with non-medical care at home. Information in your postpartum packet contains advice for the first few days’ postpartum and important observations to make. Do not hesitate to call your midwife with concerns or questions.

 

Care of the Newborn

The first day of life is a time of transition from fetal to newborn life. In the uterus your baby is protected form harsh stimulation and in never cold, lonely or hungry, all the baby’s needs are met. During labor, the rhythmic uterine contractions massage the baby and prepare him/her for breathing which will be the first new task after birth. At birth and in the first few hours afterward, circulatory changes occur so that all the baby’s blood passes through the lungs for oxygen. The umbilical circulatory system shuts down. The baby learns to signal hunger and suckle effectively and the body starts digestion and elimination.

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Care during this time is directed toward close observation of breathing, heart rate, and temperature, as well as ability to eat and eliminate waste. If a problem in any of these areas develop you must be able to identify it and take corrective action. The baby also needs to be clean, dry and protected from infection. Since the newborn has difficulty maintaining his/her body heat being cold can cause stress to the infant. For the first 24 hours you should take your infants temperature every 4 hours and adjust clothing and the room temperature accordingly. A good rule of thumb is to have room temperature at 80 degrees if the baby is naked and reduce it by 10 degrees for each layer of clothing you add. One of the most effective articles of clothing is a knitted hat body heat can be lost through the top of the head.

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You also need to plan for someone who is well rested and alert to help with mother and baby care at all times the first 24-48 hours. This might be the father, family member or labor support person, remember the father also went through labor and birth with you, be mindful he may also need to catch up on rest. Arrangements should be made well before the birth so that everyone is prepared. Make sure you understand specific instructions and do not feel uncomfortable asking your midwife questions.

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How the baby looks:

The full term newborn usually weighs seven or more pounds and is approximately 20 inches long. The head may be somewhat oblong form molding during birth. There are two fontanels or soft spots (one at the top od the head and one at the back of the head) you need not worry about touching them as tough membranes cover and protect the tissue underneath. Fine downy hair called lanugo may be present. A lotion like yellow/white substance called vernix may cover the baby in in varying amounts. The vernix protected the baby’s skin in uteruo and normally absorbs into the skin after birth. Skin color varies depending on the baby’s racial background and state of activity. Newborns are often quite pink after birth and may turn red during crying or vigorous activity. It is not uncommon for hands and feet to be blue or cool to touch due to normal circulatory imbalance. The face and lips should NEVER be blue except when crying very hard. Mottling of the skin, rashes, peeling and flaking are all normal unless accompanied by other symptoms notify your midwife or pediatrician with any concern.

 

The breast and genitals of babies (both sexes) may be swollen. There may be a slight secretion of fluid from the baby’s breast, which should not be squeezed out. The female newborn may have a vaginal discharge for 3-5 days that may or may not be tinged with blood. The effects are from the mothers hormones transmitted through the placenta and are temporary.

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The first bowel movements are called meconium and are black, tar like substance. The next several stools are transitional stools, which are greenish brown in color. By one week of age the breastfed baby will have yellow, soft or liquid stools anywhere from one with each feeding or one a week. Stools of bottle fed babies tend to be darker in color and more formed with a stronger odor.

 

How the baby acts:

An understanding of normal infant behavior will help you interpret your child’s behavior and cues. Researchers categorize infant behavior into states: quiet (deep sleep), active (light sleep), quiet alert, active alert and crying. Throughout the day and night the infant passes through these states either smoothly, one at a time, or more irregularly. Most infants will spend some time in each daily. Walking, talking, singing, feeding, holding, or rocking the baby can often help him/her move from crying or fussing into more quiet states. Your baby learns while he/she is in the quiet alert state, so you should take this time to talk and play with your baby. Each infant is unique and responds to each parent in a unique way. Some newborns need a lot of stimulation while others do not. Some newborns are easily soothed while others are not. Try different things with your baby to find out what works best for you both.

 

After an initial alert period of a few hours after birth most babies become sleepy and quiet for extended periods of time in the first few days. This is a normal reaction to the stress of labor and birth and adjustment to extrauterine life.

 

Important Observations of the Newborn

You should keep track of your baby’s vital signs (temperature, pulse, respirations) nursing and elimination. Babies who develop problems usually have deviations from normal in some of these areas. A Newborn Monitoring form is included in this packet to help you monitor your newborn the first 24 hours.

 

Temperature

Take your baby’s temperature every 4 hours the first 24 hours after birth. The baby’s temperature (taken under the arm) should be between 97.3 and 98 degrees. To take underarm temperature, place the thermometer in the baby’s armpit and hold baby’s arm against the body making sure the thermometer stays in place until thermometer signals completion. This can be easily done while infant is sleeping or nursing. Notify your midwife of anything abnormal.

 

Respirations

The normal range of respirations will be 30-60 breaths per minute (irregularity is normal.) To determine your baby’s respiration rate count the number of breaths for 30 seconds and multiply the number by 2. Counting respirations is not an easy task to do without practice so don’t be discouraged, take respirations when the baby is quiet sometimes it helps watching the rise and fall of chest.
Areas of concern: Labored breathing, nostrils flaring, grunting on expiration chest retraction, wheezing, breathing very fast

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Pulse

The normal range for a newborn is 120-160 beats per minute and some irregularity may me normal. You can feel your baby’s pulse by placing two fingers on his/her chest over the heart. Count for 30 seconds multiply by 2.

 

Elimination

The baby should have a bowel movement and urinate at least once in 24 hours. Once the colostrum changes to true milk (3-5 days after birth) the baby should have 6-8 wet diapers a day (sometimes more) occasionally in the first few weeks you will notice a pink/orange streak on the diapers after the baby urinates. A harmless substance called urate in the urine causes this.

 

Mucus

If the baby’s nose or throat has enough mucus to make the breathing noisy, you may suction “gently” with the bulb syringe that arrived in your birth kit. Your midwife will direct you on use. Sneezing and coughing are normal ways your baby will clear his/her own airway and may do this frequently. Breathing is typically shallow, erratic and a little stuffy.

 

Jaundice

Call 911 and notify your midwife immediately if the baby looks yellow within the first 24 hours of life. It is normal for the baby’s skin and eyes to become yellow after 24 hours, but it usually resolves by the 10th day. The best solutions for resolving jaundice are frequent nursing and exposure to natural sunlight. Frequent nursing will help flush the excess bilirubin from your baby’s system. The safest way to sunbathe your baby is to place them near a sunny window (in a warm room) wearing only a diaper for 15 min. a few times a day. The window will protect them from UV rays.

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Skin Care and Bathing

Do not immerse your baby in water until the cord has fallen off and is healed. The baby can be bathed with a soft washcloth or wet wipes as needed 24 hours after birth. If your baby’s skin is dry use olive oil or an unscented, non-mineral based lotion to lubricate their skin. You do not need to wash off the vernix it is harmless and still protects the baby’s skin.

 

Feeding

A newborn should nurse at least every 2-3 hours for at least 10 minuets at a time. As the baby ‘s stomach grows you will be able to space out the feedings. Do not give your baby anything but breast milk. A breastfed baby should be nursed frequently and as often as the baby is hungry. This may be as often as 8-18 times a day. How the baby takes the nipple into mouth is important to avoid nipple soreness for the mother refer to postpartum book for proper nursing positions and latching a good rule of thumb is make sure a large amount or areola goes into the infants mouth while nursing and break suction before taking the baby off the nipple. If you hear clicking sounds while baby is nursing he/she is not latched on well and your nipples may become sore. If nursing full time avoid bottles and pacifiers the first 6 weeks of life to avoid nipple confusion. Milk is produced in a supply demand “the more you nurse the more milk you produce.” If you encounter problems call your midwife.

 

Cord Care

The cord should fall off naturally in 3-10 days it is not necessary to accelerate this process. The cord should be kept clean and dry during the healing process. Do not pick of pull on the cord and avoid diaper rubbing against it. Notify your midwife if you notice redness, odor, discharge or area around the cord is hot to touch your newborn may have an infection and needs to been seen by a pediatrician.

 

Call 911 and notify your midwife in case of an emergency

• Your baby turns yellow in the first 24 hours of life

• Your baby’s mouth of lips turn blue

• Your baby shows any signs listed above with breathing difficulties

 

Areas of concern for the newborn notify your midwife...

• Temperature is less than 97.3 or greater then 98 (Axillary) after clothing and room temperature has been adjusted

• Baby’s temperature keeps changing even when room temperature and clothing remains the same

• Respirations fewer than 30 of more then 60 breaths per minute while resting

• Labored breathing with grunting, retraction of the ribs or flaring nostrils

• Pulse outside of the normal range of 120-160 beats per minute

• No passage of urine or stool in 24 hours

• Excessive sleepiness (sleep periods lasting longer than 6 hours after delivery)

• Hyper irritability or extreme reaction to ordinary stimulation like diaper changing, being picked up, etc.

• Jaundice on the first day of life (first 24 hours)

• Poor feeding, no interest or exhausted by it.