Newborn
Care – Class Notes
These
are notes from my newborn care class that I teach, and are normally meant to be
accompanied by demonstrations, visual aids, and practice sessions. I strongly
encourage all expectant parents to attend newborn care classes to gain a better
understanding of this topic, and help give them a little more confidence to
make it through those early weeks.
Things
to do Before the Baby comes
Supplies and Equipment.
Babies
don’t need a lot… Before the baby’s birth, you need only buy some basics:
diapers, a few simple outfits, a place for them to sleep (can be a crib, a
bassinet, or your bed), and a car seat to bring them home from the hospital.
The only other essential I would add, personally, is a sling or front pack of
some sort.
It’s also good to plan where to change baby’s diaper, and come up with
something to use as a diaper bag.
Stores
are full of things for babies, but all those are optional. You don’t need a
baby bathtub, and all the special baby soaps, oils, and lotions. You don’t need
a baby monitor if you put your napping infant down in whatever room you are in,
and the baby sleeps nearby at night time. You don’t need musical recordings and
stuffed animals that play recordings of human heart beats: simply keep the
child near to you. You don’t need special high tech baby development toys: your
baby’s favorite images to look at will be the faces of the people who love him,
and as he gets older, some of his favorite toys can be simple things like
plastic spoons and measuring cups, and pots and pans to bang on.
So,
if you want to buy a lot of things for your child, or you have friends and
family who buy lots of little gifts, that’s great. But also know that the main
thing a baby needs is loving people nearby.
Decisions. There are some decisions you’ll want
to make before the baby comes.
·
Care
Provider: It is best to choose your baby’s doctor before the birth. You can
choose either a pediatrician, who specializes in children, or a family practice
doctor who can treat the whole family. After you determine what caregivers and
care settings are covered by your insurance, ask for references and
recommendations from friends, family, doctor or midwife. If possible, schedule
a prenatal interview with your chosen caregiver to be certain his or her style
and philosophy are similar to your own. See birth books or websites for more
information on choosing a doctor.
·
Cord
Blood Donation or Storage: After the baby’s umbilical cord has been clamped and
cut, it is possible to collect the cord blood for donation or for storage for
the family’s personal use. Stem cells from cord blood can be used to treat
leukemia, other cancers, and other illnesses. If this is something you are
interested in, you must research it
and plan for it before the birth, so the supplies can be available. To my
knowledge, the only hospital collecting donor cord blood in
·
Circumcision:
It’s best to find out more about circumcision, and decide about circumcision
before the baby is born. The procedure is generally done by an OB/Gyn before
the baby is discharged from the hospital, although it can be delayed if
desired. Circumcision is a controversial topic, with strong feelings on both
sides: I encourage you to seek out information on it, and make your own
decisions. To find out more, check out the website of the
·
Feeding.
Before the birth, it’s a good idea to examine your plans for feeding the baby.
Breastmilk is best for baby, and breastfeeding is also good for your health. If
you are planning to breastfeed, find out about breastfeeding and resources for
support before the baby is born. Most hospitals offer classes in breastfeeding,
which will teach about how to breastfeed, how to avoid common problems, how to
combine work and breastfeeding, and other topics to help you get started.
Newborn
Procedures:
Immediately
after birth, the baby’s nose and mouth are typically suctioned to remove
fluids, and to make sure his breathing is well-established. They may pass him
up to lay on your chest at this point, as he is wiped off. At this time, your
baby’s general condition is observed to see if he needs any assistance. If he
is not breathing well on his own yet, they may give him a little oxygen before
returning him to your arms. This is not uncommon.
Apgar scores: Caregivers will check baby’s heart
rate, respiratory effort (is he breathing slowly and irregularly, or breathing
well and crying lustily), muscle tone, reflexes and skin color. These are added
up to an Apgar score, which gives a snapshot of the baby’s condition at 1
minute after birth and 5 minutes after birth. Caregivers generally don’t
mention the scores to parents, these are more for record-keeping. A thorough
exam will be done sometime in the first 24 hours.
Cutting
the Cord: Shortly
after birth, the umbilical cord is clamped and cut. The timing of this is
somewhat controversial: many physicians clamp and cut immediately, some sources
recommend that the baby be placed on mother’s abdomen and cord-clamping be
delayed until after the cord has stopped pulsing. If you have any strong
feelings about this, talk to your doctor before the birth, and remind them
during delivery. (Often the father can cut the cord if he would like to. To
some fathers, this is a very significant symbolic event. To others, it doesn’t
interest them. Again, just let your caregiver know your preference.)
Newborn eye care: Within one hour after the baby’s
birth, the baby’s eyes are treated with erythromycin or tetracycline ointment,
to prevent infection and possible blindness if the newborn is exposed to
infections during birth. These treatments cause blurry vision for a short
period of time. If the baby is very bright and alert after birth, it is ideal
to wait until the end of the first hour for these treatments to allow the
parents the bonding time, and allow breastfeeding to begin without
interruptions. If the mother has had a c-section, and is not able to nurse
right away, it may be best to request the eye treatment early so the baby’s
eyes are less blurry when mom is ready to start nursing. This treatment is
required in almost all states. Some will allow parents to sign a waiver to
avoid it. Talk to your doctor in advance about this.
Blood Tests. Blood is obtained by a heel prick,
and is tested for such things as PKU, hyperthyroidism, galactosemia, sickle
cell anemia, and sometimes hypoglycemia. Most of these conditions are quite
rare, but they can cause severe health issues for the baby, so the sooner
treatment and preventative care are begun, the better. Again, this is required
by the state.
Vitamin K shot (or oral vitamin K). Another required procedure. Vitamin K helps
the infant’s blood to clot well. However, they do not get much vitamin k from mother
during pregnancy or breastfeeding, and there is a rare chance of developing a
bleeding disorder. A vitamin K shot at birth helps to prevent this disorder.
Oral vitamin K is an option in many places; however, it requires multiple
doses, rather than the single shot.
Normal
Newborn Appearance
For
information about normal newborn appearance, check out videos about newborns,
or look at this website:
www.lpch.org/DiseaseHealthInfo/HealthLibrary/newborn/newappr.html
12
months of pregnancy
I
want to share with you an important concept that will help you to understand
your newborn better. Let’s go back a bit: 4 million years ago, human ancestors
began walking upright, and when this happened, their pelvises became smaller to
accommodate the upright stance. Then, by about 1.5 million years ago, the size
of the hominid brain had doubled. So, in order for the babies’ heads to fit
through their mothers’ pelvises, they needed to be born sooner. (see Meredith
Small, Our Babies, Ourselves)
The
result of this is that human babies are born neurologically immature: their
brains are not fully developed. Compared to any other mammal, the human baby is
extremely dependent on its caregivers: it is not able to regulate its
temperature, it needs to be fed frequently, and it is easily overstimulated.
Many people have found that human babies tend to be most content when their
first few months resemble life in the womb: if they are carried much of the
time, fed frequently, kept at a comfortable temperature, if they hear white
noise (such as a parent’s heart beat) and given the opportunity to rest when
tired.
Baby
Communication
Baby Cues. Babies have lots of ways to
communicate their needs to their caregivers. Some are subtle, but if you learn
to speak their language, and respond to these early cues, babies may have less
need to escalate up to full-scale crying.
·
Hunger
Cues. Rooting, tongue thrusts, sucking, wiggling.
·
Tired.
May stare off and yawn. May rub at ears or eyes. May turn her head from side to
side as though fighting sleep. Eyes may roll back under eyelids.
·
Too
hot. Breathes rapidly and may have a clammy neck. Too cold: skin may be marbled
or blotchy.
·
Bored
or overstimulated. Turns away from something, looks away.
·
Calming
themselves: may do a repetitive, moaning cry to “blow off steam”
·
Pain.
Comes on suddenly, is louder than a normal cry, may be high-pitched, and baby
may hold his breath for longer.
Temperament. Babies have all different sorts of
temperaments, and each has its rewards and challenges. Once, when I led a PEPS
group, I had two extreme babies in the group: One who cried for a significant
portion of the day, with a high-pitched, pained sounding cry. One almost never
cried: just sat and looked out at the world. The first mother wished her baby
cried far less than she did; however, when this baby wasn’t crying, she was one
of the most interactive newborns I’d ever seen: smiling and cooing at her
mother. The second mother was jealous of this: her laid-back son was not only
hard to upset, he was also hard to interact with: when you played with him, he
didn’t smile or respond much at all… just let the world go by. She said sadly
“I don’t even know if he cares that I’m around.”
I
encourage you to do what you can to tune in to your baby’s temperament: if books
recommend something that you just can’t make work for your child, look at a
different book!
Elimination. Diapering. Interactive /
Practice. 15 minutes.
Diapering. Here’s a brief description of how to change a diaper: www.geocities.com/unitedfathersofthesoutherntier/page2.html
And
an amusing description with some illustrations: http://www.paternityangel.com/Articles_zone/Nappies/Nappies1.htm
For
info on how cloth diaper services work, see www.diapernet.com/ For info on washing your own cloth diapers,
see www.diaperpin.com/howto.asp
Baby
Poop
·
Meconium.
Greenish black, tarry stools, which baby will produce for the first few days
after birth. This is the substance that was in the intestines before birth.
·
After
day 3 or so (after your milk comes in), the baby’s stools will change. The
normal stools of a breastfed baby are yellow, mustardy looking, loose stools;
may have curds like cottage cheese. They are fairly mild-smelling. Some babies
have a bowel movement after every feeding; breastfed babies should have at
least 2 bowel movements a day for the first month. After that, some babies only
have a few bowel movements a week (some babies still have 10 a day).
o
Constipation
is rare in breastfed babies.
o
Very
wet stools are normal in breastfed babies. Diarrhea is different: mucousy,
foul-smelling, potentially blood-tinged… usually in a child who appears ill and
listless. For an online guide to all the colors and smells of baby poop, and
what they mean, see http://www.drjaygordon.com/pediatricks/poop.htm
·
Formula-fed
babies may have only one or two putty-like stools per day. Odor is stronger
than with breastfed babies. Constipation is much more common with formula-fed
babies.
·
To
prevent diaper rash: Change diapers frequently, especially after the baby has a
bowel movement. Clean baby’s bottom well, making sure to get every bit of stool
from each of the creases and crevices of baby’s bottom. After cleaning, leave
baby’s bottom exposed to fresh air for a few minutes, whenever possible. (note:
if you have a boy, lay a washcloth or diaper on his penis to prevent showers!)
Generally, the cleaning and the fresh air will be enough to prevent diaper
rash, and no creams or ointments are needed. If you do choose to use ointments,
be certain to only touch the ointment with clean hands. If you contaminate the
ointment with bacteria, then the ointment will continue to re-infect the baby,
rather than clearing up the rash.
·
Disposable
diapers can be so absorbent that it is difficult to tell when there is urine in
them. If you are not certain if/when your baby is peeing, you can take a little
piece of paper towel or toilet tissue and tuck it in the diaper, then check
that to be certain.
·
Night-time
diapering: Most babies wake frequently, so some parents wonder whether they
should change a diaper every time baby wakes up. Opinions vary, but here’s what
worked for me, with cloth diapers. If the diaper was poopy, I always changed it.
If it was just wet, then I watched baby’s mood: if she seemed uncomfortable, I
would change her. However, if she was barely awake and just needed to be
settled back to sleep, I wouldn’t rouse her / upset her by changing her diaper.
Following this method, my kids remained rash-free and did well. Note that as they slept longer stretches, I
needed to double-diaper them, tucking two cloth diapers inside the diaper cover
for overnight.
Swaddling.
http://www.lamaze.com/baby/care/articles/0,9474,167856_195186-2,00.html
Crying
and Sleeping. See
separate articles on this site.
Bathing
/ Medical Care
Cord Care: the cord will fall off about two
weeks after the birth. The goal of cord care is to prevent infection, to keep
the cord dry most of the time, and to help the cord separate from the belly.
Clean the cord daily, or when it is soiled, with warm water or alcohol wipes.
Fold diapers down so they do not cover the cord area. Keep hands clean while
working in the cord area. Some caregivers recommend no tub baths until the cord
falls off. Sponge-bathing (washing the baby with a warm washcloth) will be
fine.
Sponge-baths: lay the baby on a towel (with a diaper on),
have a bowl of warm water and a washcloth, and mild liquid soap nearby. Use
another towel or blanket to cover the baby. Wash his face first, with clean
water, no soap. Then add a small amount of soap to the water, and wash his
head, arms, chest, and legs, uncovering only the part you are washing, keeping
the rest covered for warmth. Make sure you clean out all the creases and folds.
Wash the diaper area last, then dry him off and re-diaper.
For
regular bathing, you don’t need a special baby bathtub, and special baby shampoos
and oils and such. You can bathe the baby in a sink, or a baby bathtub, or in
the tub with you or your partner (you get in the tub first, and have someone
hand the baby to you so you can bathe it, then hand it off to be dried.) Use
any mild soap. Remember that wet babies are very slippery, and you need to be
careful! Also, remember that if you’re calm, baby will be too. If you stress
about bathing, so will he.
Temperature Taking. Anytime your baby seems sick
(listless, fussy, runny nose), take his temperature. Ear thermometers are the
quickest and easiest, but less accurate than the other options. Using a mercury
thermometer or digital thermometer under the arm (axillary) is somewhat more
accurate. Rectal temperatures are even more accurate, but are generally not
recommended to parents. Axillary is generally recommended.
To
check baby’s temperature, place the thermometer under the baby’s arm, centering
the bulb in the armpit, making sure no clothing blocks it. Then cuddle your
baby for a few minutes, holding his arm at his side. In a newborn under one
month of age, an axillary temperature above 99.5 degrees Fahrenheit should be
reported to baby’s dr.
Back to Childbirth Education on the Web