Baby's First Days

 

Congratulations!

Welcome to the new addition to your family, becoming a parent is like nothing else you’ll ever do.  Ahead of you lies much delight, love and many challenges.  Recognising that this is a tiring, busy time of life, with everyone’s focus being on the newborn, we have endeavoured to make the information easily accessible, with references for you to follow up if you want more information.  Also, remember that your baby is unique and will certainly not do things in a textbook manner, but all babies respond to love and cuddling.

 

Whether the birth has been calm or more traumatic, there’s nothing like the moment when your baby is placed in your arms for the first time.

Help with breathing

A few babies need some help to get their breathing settled.  If your baby needs this, baby will be put on a resuscitation trolley and given oxygen, and perhaps have their breathing passages suctioned clear of mucus.  Most babies only need a few minutes’ treatment.

Skin-to-skin

Unless your baby needs special care, after the birth you will get to hold and begin to get to know your new baby immediately.  A good way to do this is to hold your baby so that her skin is next to your skin.  This helps to calm your baby, make her feel safe, and keeps her nice and warm.  Even if you have had a caesarean you should still be able to lie down with your baby next to you.

Your baby’s sight isn’t yet well developed – she can only focus on things about an arm’s length away – but she may well turn and gaze at your face.  It’s as if after hearing your voice for the past five months, she now wants to get to know who you are.  All being well you will put your baby to the breast soon after birth.  Many babies are very alert and start to suck immediately.  Don’t worry if your baby does not start to suck straight away, she will eventually if you continue with the skin-to-skin.  Sometimes you may need some help – just ask your LMC.

This will allow your baby to get some of the benefits of colostrum, (the first milk), which contains vital antibodies which will help protect your baby from illness.

For more information on how to breastfeed, check out our breastfeeding sections which has heaps of advice about breastfeeding positions, expressing, frequency and more.

Newborn screening

Newborn Metabolic Screening

As soon as possible after 48 hours of age, your baby will be offered a blood test (heel prick test) for this screening.  This test screens for over 20 rare metabolic disorders which can all be treated early before babies get sick.

Newborn Hearing Screening

Soon in all areas, newborn babies will be offered screening for hearing loss soon after their birth.  Screening is carried out by specially trained ‘screeners’ and babies who do not pass the screen are referred to an audiologist for diagnostic testing.  most babies referred will not have hearing loss.

Meet your baby

Newborn babies often aren’t the soft, clean chubby babies you see pictured in magazines.  Your baby has just come through the complicated process of birth and may show signs of it.  Here are some of the things you may notice:

The skin – may still be bluish, or covered in ‘vernix’, the white substance that protected him while he was in the amniotic fluid; it may also be blotchy.

The head – may be a bit pointed due to ‘moulding’ where the skull bones overlap slightly during the journey down the birth canal.  This happens because there are two soft spots (fontanelles) on the front and back of the head, where the bones have not yet grown together – they will close as your baby grows.

The cord – after it is clamped and cut, there will be a blue-white stump still attached to your baby’s tummy; it will shrivel up and drop off after about a week.

The genitals – babies of both sexes may have slightly swollen breasts and genitals – the effect of your hormones at work in the baby’s body.  These effects will soon wear off.

Your baby will also be weighed, measured and checked by your LMC.  If you have chosen to give vitamin K, it is usually done at this time.  Also, if you have had a hospital birth, a paediatrician (a doctor who specialises in the care of babies and children) may carry out some tests designed to spot any potential problems before you go home.  This is a good opportunity to ask any questions about your baby.  If you are at home, this examination will be carried out by your LMC.

Moving to a ward

If you have given birth in the maternity unit, you may be moved to a postnatal bed.  You will be encouraged to keep your baby with you all the time.  You may decide to stay in the maternity unit only a few hours but can expect to stay two days or longer if you have had a caesarean.

Coping if your baby needs special care

If your baby is very small, or ill, he may be taken to the neonatal unit.  This is a very worrying experience for new mothers and fathers alike.  Just when you most want to hold and care for your baby, you can’t.  Reassure yourself that your baby is getting the best care possible, and the care he needs.  Staff will make sure that you get to hold and cuddle your baby as soon as possible.

 

Your baby’s appearance can change quickly in the first days and internal changes also occur to adapt to life outside the womb. Her head may have been squeezed and will look quite different in a day or so. Vital breathing, circulation and other internal changes happen at birth and in the following days

Newborn Examination

An initial check straight after birth should confirm that breathing is established and that all the external features look normal. Your baby should receive another full check within the first 24 hours by your LMC.

This examination checks for any problems with all parts of the body, and especially the heart and circulation, eyes, palate, anus and hips. Some problems can need early intervention, others just need reassurance and observation as they correct themselves. Newborn babies can be deficient in vitamin K (which is important in the control of bleeding). You will be asked whether you want your baby to have an injection of Vitamin K, or three oral doses of vitamin K. This is to prevent a rare but potentially dangerous form of haemorrhage which affects a small number of babies.

If your LMC detects any concerns your baby will be referred to a Paediatrician.

Newborn Hearing Screening

You will be offered newborn hearing screening to check whether you baby can hear well.  If baby can’t hear, it is hard for him/her to understand and communicate with you.  If your baby does have a hearing loss, finding it early is good for language, learning and social development.  Screening is usually done before you and your baby go home from the hospital or if you birth at home will need to be arranged through the local hospital.  newborn hearing screening is simple and safe – most babies sleep through it.

Your Baby’s Skin

At birth babies are covered with a creamy substance (vernix). This protected the skin from the amniotic fluid in the uterus and will come off without help in the first few days.

Dry Skin

Babies who were overdue can have dry cracked skin after birth but this soon becomes normal soft skin. Dry skin is very common in the first few weeks. Soap or baby bathing liquid can sometimes dry baby’s skin even more. Bathing without soap is fine – warm water alone is enough. It may help to lightly rub a small amount of a baby moisturising cream or baby oil on her skin, or use a few drops of baby oil in the bath. Oil will make her skin slippery and require extra care when holding in the bath.

Hormonal Spots (Baby Acne)

Most babies get spots that look like acne on their face, head and upper body between 3 to 6 weeks of age. They can last for a few weeks. They are caused by baby’s hormone levels settling down from the high levels received from mum before birth.

No treatment or creams are needed. They are best left alone as they do not scar or become infected. If squeezed they can become infected. If they become crusty or weepy see your midwife or doctor.

Septic spots

These are white or yellow pus filled spots that look like small blisters. The skin around them is often red and maybe weepy. They can be difficult to tell apart from hormonal spots. They can occur around the nappy area or in neck, arm or leg creases. Antibiotics may be needed to clear the infection and stop it spreading. Discuss any concerns with your midwife, or other health professional.

Chapped skin

A dry rash on the face can be caused by dribbling saliva (for an older baby). This generally clears on its own but may be helped with a little baby moisturising cream.

Birthmarks

Many babies are born with a birthmark (naevus). Some different birthmarks are:

  • Dark red or pink patches (often called ‘stork bites’) on the eyelids, top of the nose and back of the neck. These are very common and usually fade over the first few months.
  • ‘Strawberry’ naevus – more correctly called vascular malformations. These birthmarks grow from red dots to form reddish or bluish lumps which rarely grow large and need treatment. Most grow without harm before fading in the second year, occasionally not fading completely.
  • Flat purple birthmarks (often called port wine stains) – are present at birth and are permanent. They can be treated with laser treatment by a skin specialist.

Jaundice

Many healthy babies develop a yellowish colour of their skin a few days after birth. This usually goes by 7- 10 days. It is due to a temporary build up of yellow pigment (bilirubin) until the liver matures enough to get rid of it. Sometimes jaundice can be a sign of underlying problems such as blood group differences, infection or liver problems. If you notice yellow colour of your baby’s skin and eyes, tell your midwife. A blood test can check the level of jaundice. If the level is high your baby may need further checking and may also need phototherapy (using special lights) to help reduce the jaundice level.

Blood Tests

Newborn metabolic Screening (Guthrie test)

After they are 48 hours old babies can have a blood sample taken from their heel.  Your LMC  will give you information about this and ask if you consent to screening and for storage of your card.  If you consent the blood sample is taken and sent to the laboratory for testing for 28 rare metabolic disorders.  If treated early irreversible damage can be avoided in many cases.  Disorders include Amino acid disorders, Fatty Acid oxidation disorders and others like Cystic Fibrosis and hypothyroidism.  Your LMC will be notified if any positive screening result is found.  They will provide you with information about diagnostic testing needed to find out for sure if your baby has a condition or not and if necessary organise for you to see a paediatrician.

Umbilical Cord/Tummy Button

Soon after birth, the umbilical cord is clamped and cut.

  • The plastic clamp is usually removed 24-48 hours after birth.
  • The remaining stump usually shrivels and separates within 7-10 days. It may ooze or bleed slightly for a few days afterwards.
  • Keep the area clean and dry and free from any creams or powder, to avoid infection.
  • If it bleeds often, is red, sticky or smelly it may be infected. Talk to your midwife or doctor about this. Rarely a bleeding stump can indicate Vitamin K deficiency or another bleeding disorder.
  • Some tummy buttons stick out. This is called an umbilical hernia. The bulge is soft and does not cause any pain or bowel problems. It can take up to five years to disappear as the muscles around them tighten slowly. Very rarely do they need surgery, and early surgery can do more damage than good.

Shape of Baby’s Head

Your baby may have an unusual shaped head and/or soft swelling towards the back of the head at birth.  This is normal and is due to pressure as the head moves through the birth canal.  This will soon correct itself.  Occasionally, there is a soft swelling, on one or both sides of the head (cephalhaematoma) caused by bleeding into the outside layer of the skull bone during the birth.  It may take up to a few months to disappear.

The back of your baby’s head may become flattened from sleeping on their back with head in the same position.  Their brain growth and development are not affected by this flattening.  Flattening can be reduced by alternating the direction (to the left and to the right) their head is turned in the cot.

If you are concerned about your baby’s head shape or size, talk to your LMC or other health professional.

The Fontanelles

These are ‘soft spots’ on the top of the baby’s head where the skull bones have not yet fused together.  Babies’ heads grow very quickly and the fontanelle allows this rapid growth, and the moulding of the skull bones during birth.

  • the smaller back fontanelle closes by about 6-8 weeks while the larger front fontanelle on the top of her head gradually closes over 9-18 months
  • washing or touching it will not harm your baby’s head
  • it is normal to notice the fontanelle pulsating (going up and down at the same rate as the baby’s heartbeat)
  • the front fontanelle usually feels a little tense and looks slightly raised when the baby cries.  if it is still bulging and tense when baby is settled and quiet or is sat up, contact your doctor at once, especially if baby seems unwell and you cannot settle her.  It is also normal if it appears sunken as long as the baby is well and having normal wet nappies
  • if your baby is not drinking well or has vomiting or diarrhoea, a sunken fontanelle may be a late sign of dehydration.  Baby needs to see a doctor.

Cradle Cap/Hair

Cradle cap looks like thick scaly areas on the baby’s head.  It does not hurt your baby and requires no treatment.  If you wish to treat it because of appearance, massage baby or olive oil onto baby’s scalp.  A few hours later, rub it lightly (with a towel, your finger or a soft baby’s toothbrush) and then wash her hair.  This may be repeated over several days for the cradle cap to completely go.

Brushing her hair regularly and only washing with shampoo once a week can help prevent cradle cap.  Special preparations for cradle cap can be brought from chemists, but are not usually necessary.  It is common for your baby’s hair to fall out especially at the back of the head.  The hair will grow back over the next few months.

Your Baby’s Eyes

Baby’s eye colour may change gradually over weeks and months after birth. Many babies have red or purple patches on the eyelids and puffy skin for a day or two due to pressure during delivery. Your midwife will check your baby’s eyes for cataracts after birth. A cataract gives the pupil a white or grey appearance. However, this is a very rare occurrence.

Sticky Eye

Many babies develop ‘sticky eye’ because the tear ducts are tiny and become easily blocked. When this happens a clear or white sticky fluid collects in the eye as the tears evaporate. To clean her eyes use a separate cotton wool ball or clean tissue for each eye. Moisten with cool (previously boiled) water and gently wipe the eye from the inside corner to the outside. Discard the cotton wool ball and use a clean one to wipe dry.

A common remedy is to squirt some breastmilk in the corner of the eye.  If the problem persists, the white of the eye appears red, or the discharge is yellow or green see a doctor.

Sneezing/Blocked Noses

Sneezing is very common in babies. Babies usually breathe through their noses rather than their mouths so sneezing helps to keep her nose clear. Most babies sound increasingly snorty or snuffly in the first couple of months and may become noisier or even block their nose when they have a cold.

Breasts and Genitals

It is normal for babies to have some of their mother’s hormones in their blood for a few days after birth. For girls, the breasts may swell and occasionally may discharge a few drops of milk. Also, as light bloodstained vaginal discharge may occur. This does not require any special care.

For boys, the breasts may also swell from the hormone changes. Occasionally a boy’s testicles have not descended into the scrotum at birth. Discuss if your baby boy’s testicles are not down, or if you are concerned about baby’s breast swelling, with your midwife, doctor or other health professional.

Penis Care

Newborn boys’ foreskin (skin at the end of the penis) does not need any special care. Normal washing in the bath is enough. The foreskin does not need pulling back/retracting or any cleaning under it. You need to see your doctor if you notice your baby boy’s:

  •   urine stream (flow) is weak, dribbles or stops and starts
  •   foreskin is very swollen when he wees and it balloons out
  •   pus or blood is coming out of the end of the foreskin.

If you’re standing there with baby wipes in one hand and wondering which hand to use to take the nappy off, relax.  Midwives will show you how to change nappies, and how to give your baby a bath. 

The contents of first nappies may be different to the rest – your baby passes a greenish-black substance called meconium.  This is the remains of everything they swallowed while they were in the amniotic fluid.  They should pass this within 24 hours of birth.  as you begin feeding your baby, his bowel movements gradually turn yellow.

1.  Your baby’s first poo will be black, thick, tar-like and sticky – called meconium.

2.  This is a ‘traditional stool’ and is brown/green in colour, as it becomes more yellow

3.  This is a ‘changing’ stool (poo) green-yellow in colour before the yellow breastfed poo

4.  A breastfed baby’s poo may look ‘seedy’ which is normal

5.  A breastfed baby’s poo can be watery in consistency – this is normal

6.  Formula fed baby’s poo is often more ‘pastey’ in consistency and lighter in colour.

Some women say that it was only when they got home that they realised that the baby was really theirs.  It’s a big responsibility, but help is at hand.

Getting home safely

If you’re being driven home, your baby will need a car safety seat, suitable for his age.  It is a legal requirement in NZ to have baby in an approved car safety seat.

Continuing care

Your LMC will visit you at home or from the local maternity unit.  At each visit, your LMC will examine your abdomen, to make sure that your uterus is returning to normal, your stitches, to check that they are healing well, and your legs, to check for blood clots.  She may also check your temperature and blood pressure regularly.  She may ask about your blood loss, how your breasts feel, and if you are opening your bowels and urinating regularly.  (No wonder we have no modesty left after having a baby!)  All these physical things do need checking just in case there is a problem.

At four to six weeks your Well Child provider/Tamariki or a nurse/Plunket take over care and support from the LMC.  She will also visit you, check your baby’s health and development, and introduce you to the baby clinic, where you can go to have your baby checked and weighed.  You can also encourage your partner to get involved in the baby’s care as much as possible.  Let him learn how to do things for himself and give him time to get to know his baby through those everyday tasks.

Twins or more?

Caring for one child is daunting enough …. having two or more at the same time can be a real drain on your energies.  Midwives will help you find a comfortable breastfeeding position and routine, but you would also benefit from extra help – who can you ask to give a hand?  If you’re alone, or your partner can’t help out much, make the babies your priority.  Keeping the house sparkling clean can wait.

Up and down

Once you return home with your baby, your fellings may yo-yo from on a high, delighted to have your baby, to feeling tired, sore, tired and tearful.  This is very normal and most new mothers find these first days and weeks both exhilarating and difficult.  It’s a big change in your life, both physical and emotional, and takes some getting used to.  Try to give yourself some time, deal with the physical problems and gradually things will settle down.  Your LMC or Plunket nurse will be able to help.  If you find your mood swings do not settle, see your doctor.  A few women develop postnatal depression in the weeks after birth.  If this happens to you, ask for help – don’t struggle on alone, there are organisations that can be a lifelife (see Who can help?).

Feeling blue

The level of pregnancy hormones in your body drops off rapidly in the few days after the birth.  It’s so common for women to break down in tears on about the third or fourth day after the birth, that it’s known as the ‘third day blues’ or ‘baby blues’.  You may feel low, but this is not postnatal depression – that’s much more lasting.  It’s a temporary reaction to hormone changes.  No matter how much you have been looking forward to this time, you may feel a huge sense of anticlimax.  You may simply feel too tired to get very excited, or overwhelmed by it all.  Don’t worry – ‘bonding’ with a new baby isn’t an instant process for everyone.  The more you touch and hold him, the better you’ll know him, and love will gradually grow.

Postnatal depression

Pre birth if you can, nominate one or two advocates, friends, people who know you well, who could look out for you and who could verbalise if they were concerned should you develop any of the PND signs or symptoms.

Safe as houses?

Make sure your house is as safe as possible before you bring your newborn home.

  • put in smoke detectors
  • keep a fire extinguisher in the house
  • put in carbon monoxide detectors if you use gas or oil heating
  • put together a first-aid kit and consider taking a baby first-aid course
  • pin up emergency telephhone numbers next to your telephone
  • put non-slip pads under rugs that don’t have non-slip backs
  • set your water heater to 50C to avoid scalds
  • protect your baby from secondhand smoke – make your home (and car) smokefree.  If you do smoke, make a commitment to only smoke outside and never smoke around children.  Smokefree signage is available from your Public Health Unit.

Clothing

  •   Keep the environment at a temperature that is comfortable for you
  •   As a general rule, baby will need one more layer of clothing than you
  •   Baby will need a hat if it is cold outside because she can lose a lot of heat from the surface of her head
  •   Make sure baby has clothes that are easy to take on and off
  •   Avoid ribbons and ties, especially at the neck, they can strangle baby
  •   Make sure the clothing is loose, with room for growth, rather than too tight
  •   Ensure bootees and socks are big enough.

Feet

Babies don’t really need anything on their feet except for socks when it is cold. Once your baby starts to walk routinely, you may want to get shoes to protect her feet from stubbed toes and sharp objects. Shoes should be wide enough so that the toes are not crowded together.

All babies have fairly flat feet to start with. The arch gradually becomes more defined as the child starts to stand and walk. Almost all infants look as they have slightly bowed legs, this is normal and should correct by two years. Many young children look as if they may be pigeon-toed or knock kneed, by about three years this should be correcting itself spontaneously.

Trimming Nails

You might be surprised how quickly your baby’s nails grow.  They need to be kept tidy and trim so that baby does not scratch themselves.  You can use baby scissors or an emery board.

Bathing

Some new babies love their bath, others hate it. Most enjoy it as they grow older.

  •   A daily bath is not always needed. A face, hands and bottom wash is fine on days when you don’t feel like     facing bath time.
  •   Make sure the room is warm and that you are not in a rush, or likely to be interrupted.
  •   Choose a time when baby isn’t too hungry or too tired.
  •   Gently splash water on her, avoiding her face
  •   She may prefer a bath with an adult.

Bath Safety tips

  • Have everything you need ready before you begin
  • Always put cold water in the bath first
  • Make sure the cold and hot water are thoroughly mixed before testing the temperature
  • Use the inside of your wrist-never your fingers to test the temperature
  • A bath thermometer should not read more than 36 degrees C
  • Never leave your baby alone in the bath. A small baby can drown in a few centimetres of water if the phone or front doorbell rings, ignore it or take your baby with you, wrapped in a towel

Massage

  • Some babies love a massage after the bath
  • Massage works best in a warm, peaceful environment. It is a lovely way to soothe, relax and bond with your baby
  • The way you massage is not important just do whatever your baby enjoys
  • Try massaging from baby’s head and stroke downward over all parts of the body
  • Use a gentle circular motion with your fingers
  • Baby massage oil will help your hands slide over baby’s body, but avoid highly perfumed oils as they may irritate the skin.

Ask your midwife or other health professional for information about baby massage groups in your area.