You and Your Newborn

A Guidebook for Parents

When to Call Baby's Doctor
A Newborn Primer
Taking Baby Home
Caring for Mom Postpartum
Postpartum Emotions

When to Call Baby´s Doctor

No matter how well you try to keep baby safe and healthy, s/he will get sick from time to time. It´s important to know when to call the doctor right away and when to wait for a day or two to see if there´s improvement. Contact your baby´s doctor if you notice any of the following symptoms:

Skin or eyes appear yellow or a yellow color is progressing down the body toward the tummy (jaundice).
Baby is not nursing well or is having difficulty feeding.
Baby is difficult to waken or very irritable when awake.
Rectal temperature is below 97.6°F or above 100.4°F.
Ther is redness around the umbilical cord, a foul smell, and/or drainage from the cord.
You see drainage or bleeding from circumcision.

Remember, if you have any baby care questions or concerns, MNCC nurses may be reached 24 hours a day at (908) 788-6171. Medical questions should be directed to your baby´s doctor.

Items to have on hand:

Thermometer
Tylenol or Motrin for babies
First aid equipment
Ipecac (to induce vomiting in case of poisoning) – Don´t use ipecac unless directed by Poison Control

Dehydration

Nearly all newborns lose some of their birth weight, often up to 10%, in the first 3 or 4 days of life. Dehydration, however, is not normal.

Most babies gain back their birth weight within 2 to 3 weeks.

All babies eat frequently. During the day, feed baby every 2–3 hours if breastfeeding, every 3–4 hours if bottlefeeding, even if this means waking your baby.

At night, don´t let more than

five hours between feedings if you are breastfeeding
six hours between feedings if you are bottlefeeding

Set the clock and wake your sleepy baby at night to feed.

However, no matter how your baby is being fed, you can tell he is getting enough if:

He´s reasonably content between feedings
He´s gaining weight
He has 6 – 8 wet diapers and regular bowel movements each day.

If your baby sleeps all the time and shows little interest in feeding, he could become dehydrated. Call your doctor immediately if baby exhibits any or all of the following symptoms:

Listlessness (baby does not appear alert when awake).
Sleepiness beyond the norm.
Skin loses elasticity (when pinched, it stays pinched looking).
Fever (over 100.4°F rectally).
Sunken eyes.
Pasty, dry mouth and tongue.
The soft spot (fontanel) on the top of the head looks sunken.
Gray or yellow skin color or other unusual color changes.
Not enough wet and/or soiled diaper
Too much weight loss.

Jaundice

Jaundice is yellowing of the skin caused by excess bilirubin in the skin tissue. Nearly half of all newborns become jaundiced in the first weeks of life, premature babies even more so, as their livers are less mature than those of full term infants.

Usually, no treatment is required for jaundice. If jaundice occurs within 24 hours of birth or increases after the fifth day, notify your doctor immediately.

Feed your baby frequently! Some jaundiced babies become sleepy and will need to be wakened and stimulated to nurse or take a bottle. But frequent feedings will help your baby get rid of the extra bilirubin by stimulating the passing of meconium. These first, bilirubin–rich stools need to be passed quickly, or the bilirubin will be reabsorbed into the baby´s blood. Water supplements do not help in getting rid of bilirubin, and in fact may increase the jaundice. This is because water may interfere with breast or bottle feeding, and thus delay the passing of meconium.

Call your baby´s doctor if:

S/he seems too sleepy to breast or bottle feed.
His skin appears yellow. To check for this, take the baby over to a sunny window (artificial light makes everyone look a little yellow!) Look at the whites of his eyes, to see if they appear yellow. Press with your finger on the middle of his forehead, and check for the skin color immediately upon removing your finger. Note if it has a yellow tone. Jaundice appears in the face first, and then progresses down the body. It disappears in reverse order, from bottom to top.
The jaundice increases, even if you have been to your doctor about it.
You are at all worried about your baby´s health.

Feeding

Young babies cannot go through the night without being fed, so expect several feedings to occur during the night. When baby gains enough weight, and is about 3 months of age, s/he will usually begin to sleep through the night.

You may call (908) 788-6335, (908) 788-6634 or (908) 788-6171 with feeding questions any time.

Spitting Up and Vomiting

Babies often spit up after being fed. Occasional vomiting is likewise normal. Neither is a concern so long as baby is gaining weight, does not have a fever, and is acting well. If you do have concerns, call your doctor.

Diaper Care

Baby´s diaper should be changed before every feeding. If you use commercial wipes, use the fragrance– and alcohol-free kind.

Report any green, watery, foamy, mucusy, or bloody stools to your doctor. Don´t be concerned with the number of stools so long as baby is comfortable and gains weight.

To clear up diaper rash, apply Desitin, zinc oxide or diaper cream liberally before diapering. You can also expose baby´s bottom to the air for a while. Call your doctor if a diaper rash is not healing after a few days, even with treatment.

Clothing

Simply dress baby as you would yourself, plus one more layer, according to the weather and to common sense. Hats should also be used outdoors, to keep the cold or the sun away.

To check if your baby is dressed correctly, feel the back of her neck. Don´t let the hands and feet be your guide, as they will almost always be cooler than the rest of the body.

Bathing

Important: Do not use powders or lotions on your baby as these may cause irritation – and powders may even cause asthma. Bathe your baby 2 to 3 times a week, but wash your baby´s face, neck and hands every day.

Sponge bathe baby until the umbilical cord has fallen off and the cord area has completely healed. Except for the scalp, use only warm, clear water. While bathing, never leave the baby unattended.

Tub bathe baby after the umbilical cord falls off and heals completely. You may now begin using mild baby soap on the body (not the face), but use sparingly – 2 or 3 times per week.

Umbilical Cord Care

Your baby´s umbilical cord will probably fall off within 7 to 14 days. Try to keep the area dry during baths, and do not use bandages, powder, or ointment. Fan–fold baby´s diaper below the cord until it heals.

For baby boys…

Care of the uncircumcised penis

Your baby´s foreskin may or may not be easily retractable after he is born. If your doctor recommends, you can gently retract the foreskin as far as can be done easily to wash the tip of the penis. Do not push the foreskin back any further than it can easily go! If the foreskin doesn´t retract, do not force it. Even if you can´t retract the foreskin, clean the penis using mild soap and water. No extra cleaning is needed. The foreskin will begin to retract on its own. By the time your son is 5–6 years old, the foreskin will usually be easily retractable. Talk to your doctor if you have any questions.

Circumcision Care

If you baby has been circumcised, it will take about a week to heal. Cleanse the area gently with a cotton ball and clear water at each diaper change (take special care to clean the head of the penis in order to reduce the filmy covering).

Do not be alarmed by the following, they are part of the normal healing process:

Black material on baby´s diaper.
Extreme redness.
Swelling.
Filmy, mucous discharge around the wound.

Contact your physician if:

Swelling increases or does not disappear in a few days.
The penis becomes noticeably redder than it was originally, with pus forming.
The penis is bleeding more than a few drops.

Taking Baby´s Temperature

You don´t have to take your baby´s temperature every day, but it´s a good idea to take it a few times to get an idea of what your baby´s normal temperature is. If your baby is excessively fussy or acting ill, take the temperature. Make sure you tell the doctor´s office how you took the temperature, as "normal" varies with the method used.

You may take baby´s temperature rectally or under the armpit. A digital thermometer is safer, although a mercury thermometer can be used; both should have a rectal tip.

An ear thermometer is not recommended for children under 18 months, as it has been shown to be inaccurate.

"Fever strips" which go on the forehead, will only give a rough reading, and should be followed by an armpit or rectal temp if the baby seems ill.

A Newborn Primer

Crying

Crying is your baby´s most powerful way to send messages. Your baby´s cry may mean many things. She will make different cries depending on what she wants. Remember that every cry does not mean he is hungry – you will soon learn his hungry cry. Some crying is to be expected. It does not mean that you have done something wrong. Remain patient, and don´t be afraid of spoiling your baby. When you answer his cries quickly, he quiets more quickly, and you will be teaching the important lesson of trust.

When you answer quickly, your baby learns to send messages better. There´s usually an easy answer; feeding, changing her diaper, or changing her position. When you answer these requests quickly, you build your baby´s all–important trust and self–confidence. It is impossible to spoil a baby – except by ignoring her cry. A baby whose cries are ignored may develop a sense of helplessness and become more difficult to care for in the long run.

Calming Your Fussy Baby

Crying is often related to hunger, and feeding is the obvious solution. However, periods of crying with no obvious cause and no ready cure plague many parents. Here are a few suggestions. Give several a try. One may work today and another may work tomorrow. Be flexible, and know that "this too will end".

Sleep

Always put your baby on his/her back to sleep. Toys, heavy blankets and comforters should be kept out of the crib. If you need to put a blanket on the baby in the crib, put the baby ‘feet to foot’, that is, at one end of the crib, with his feet close to the end. Tuck a light blanket in on both side and the foot, below the baby´s armpits so he can´t get the blanket over his face.

How much sleep does a baby need? The amount depends a great deal on age. Babies require a great deal of sleep during the first year, although the exact amount is always changing:

Newborns will sleep approximately 16 hours out of 24. But, as you´ve noticed, your infant can´t sleep more than a few hours at a time. However, some babies sleep cycles may seem quite irregular.
By 3 or 4 months of age, your baby will probably sleep a little less – about 13 to 15 hours. This sleep may occur in 4 or 5 periods with most occurring at night. Many babies fall back asleep by sucking on their fingers to comfort themselves.
By 6 months, your baby will sleep a total of over 14 hours, with 12 occurring at night. She probably will welcome a 1 – 3–hour nap in the morning and afternoon.
Between 6 months and 1 year, your baby reduces total daily sleep by about ½ hour.

Taking Baby Home

Car Seat Safety

Did you know that 85% of car seats are installed improperly or used incorrectly? Figuring out how to use a car seat is an early challenge to new parents, especially since there seem to be as many different kinds of car seats as there are cars.

A certified car seat technician can assist you with proper car seat installation. Contact them for an appointment at (908) 788-6634.

To install the car seat:

Always follow the manufacturer´s instructions.
Buckle the car seat in the back seat of your vehicle, never the front.
Baby must face the rear of your vehicle until he is 12 months old and 20 lbs.
Always use a seat belt to anchor the car seat snugly. The base should not move more than 1 inch after the belt is tightened.
If the seat belt won´t stay tight, move the car seat to another location and try another belt.
If your vehicle´s back seat slopes sharply, place a rolled towel underneath the base to level it. This will help keep baby at a comfortable angle and make sure his breathing is not impaired.

To secure baby in the seat:

Place him in the seat and pull the harness straps over his head and centered over each shoulder.
Attach the harness straps to the retainer clip. It should always be centered across the chest at the armpit level.
Tighten the harness until there is 1 finger–width of space at the collar bone and no more than 2 finger-widths elsewhere. Never let baby ride with a loose harness or with straps off the shoulders.
Do not use a "newborn car seat cushion" or thick padding under your baby as the harness straps will not fit snugly and baby will not be secure.
In cold weather, do not wrap baby in a blanket or snowsuit before buckling the harness as it will not fit securely. Instead, after baby is secured, fold several thin blankets over the harness in as many layers as needed.

Caring for Mom Postpartum

When to Call Mom´s Physician

Cesarean birth only: Pain, redness, or drainage from the incision site.
Foul-smelling vaginal discharge, abdominal pain.
After rest, increase in vaginal discharge and/or passing of clots.
Signs of mastitis – hard, painful breasts (after engorgement).
Temperature above 100.4°F.

Vaginal Discharge

Vaginal bleeding and discharge will last 4 – 6 weeks.

For the first week or so, your discharge should look and smell clean, like fresh blood, and contain no large clots. It will then start to turn pink, and, after approximately 10 days, it will turn yellowish in appearance and have a slight odor. Notify your physician if bleeding returns.
The flow should decrease over time and stop after 6 weeks.
Use your peri bottle until the lochia stops.
Do not use a tampon, or take a vaginal douche until after your 6–week checkup. Tub baths, hot tubs/Jacuzzis and swimming can be resumed after 2 weeks if your doctor permits.
Contact your physician if you notice an increase in flow that does not slow down after a decrease in activity. Soaking more than one pad per hour is a sign that you should call your doctor.

Episiotomy Care

Peri-care after voiding or having a bowel movement.
Topical anesthetic (Dibucaine).
Kegel exercises

After 2 weeks, you may resume tub baths with your doctor´s approval. Your stitches will dissolve around that time, as well.

Cesarean Birth Care

Most women, whether the birth was abdominal or vaginal, will spend their first week at home concentrating on recovering and caring for their new baby. To enhance this important time, it is a good idea to limit visitors and extra activities.

A safe rule is not to lift anything heavier than your baby.
Climb stairs slowly and only when necessary.
To enhance circulation, elevate your feet as often as possible and avoid crossing your legs.
Ask your doctor or nurse-midwife about when you should start driving.

Incision Care

Contact your doctor if you notice pain, redness, or drainage from the incision site. You will experience numbness if the skin nerves were also cut.

Kegel Exercises

Kegels are designed to strengthen and provide voluntary control of a muscle called pubococcygeus (pronounced "pew–bo–kak–se–gee–us," called PC for short). The PC muscle is part of the sling of muscle stretching from your pubic bone in front to your tailbone.

Reasons to do Kegels regularly:

They can help increase bladder control.
They can increase circulation in the genital area.
They can be helpful after childbirth in restoring the muscle tone of the vagina.
They might help to increase sexual arousal started by other kinds of stimulation.

The next time you urinate, sit on the toilet and spread your legs apart. See if you can stop and start the flow of urine without moving your legs. That´s the PC muscle, the one that turns the flow on and off. Once you have been successful, do not do these exercises while urinating as it may lead to other problems. Instead, do them at other times.

How to Do the Exercises

Tighten the PC muscle as you did to stop the urine. Hold for a slow count of 3. Relax the muscle.

At first, do 5 each of these exercises 10 times every day. You can start out with less, working up to doing 10 sets of exercises per day.

These are lifetime exercises, to prevent the pelvic floor from relaxing too much!

Postpartum Emotions

The Blues

"The blues" is the most common, least severe, and most well-known of the postpartum reactions. It may suddenly occur in the first few days after delivery, often on the third or fourth day. This feeling of letdown after the emotionally charged experience of birth is experienced by 50 – 70% of new mothers. Symptoms are unpleasant, but usually disappear on their own, sometimes as quickly as they came. These may include:

Crying for no apparent reason
Impatience
Irritability
Restlessness
Anxiety

Postpartum Depression

Although 1 in 10 new mothers experience varying degrees of postpartum depression, it still remains one of the least understood postpartum reactions. It can occur within days of delivery or appear gradually – sometimes up to a year later. A woman suffering from postpartum depression can experience one or a combination of these symptoms:

Nervousness, anxiety, panic
Sluggishness, fatigue, exhaustion
Sadness, hopelessness
Appetite and sleep disturbances
Poor concentration, confusion, memory loss
Over– or under-concern for the baby
Uncontrollable crying, irritability
Lack of interest in the baby
Guilt, inadequacy, worthlessness
Fear of harming the baby and/or herself
Exaggerated highs and lows
Lack of interest in sex

Postpartum Psychosis

This reaction is the most severe, and, fortunately, the least common. It occurs in approximately 1 out of every 1,000 women, usually within 2 weeks of birth. Symptoms are exaggerated and severe, and may include:

Insomnia
Hallucinations
Agitation
Bizarre feelings and behavior

Postpartum psychosis is a serious emergency and requires immediate medical help.

Who is Affected?

Postpartum reactions can affect any woman who has given birth within the past year.

What Causes It?

The causes of postpartum blues, depression, and psychosis are not known. We do know that the postpartum period is a time of enormous biochemical upheaval as well as a time of social and psychological adjustments that place many demands on the new mother and her family. It is important to realize that these symptoms are not a sign of weakness or inadequacy. It is also important to realize that if a woman has experienced a clinical depression or a postpartum depression in the past, she is at higher risk for one developing again.

Treatment

Fortunately, even though the causes are not completely understood, effective treatment for postpartum reactions is available.

Reaching out for the proper help is an important step toward recovery – get help as soon as possible if you have any concerns. Talk to your physician and/or nurse–midwife.

If you would like to talk to a mother who has recovered from postpartum depression, contact Depression After Delivery. Support groups and additional information about postpartum blues, depression, and psychosis are also available. Call them at 1-800-944-4773 or 1-215-295-3944 (address: PO Box 1282, Morrisville, PA 19067). Or call (908) 788-MOMS (6667) for local resources.

You can also check the Support Groups for meetings of The Rocking Horse Club (a Depression After Delivery support group).