Thursday, 19 October 2017

You and Your Baby

What To Expect Soon After The Birth

After the birth of your baby, the midwife (and doctor where required) will complete a thorough
assessment of you and your baby. DSC 1089-1They will discuss with you what to expect during your stay in
hospital and prepare you for going home. This varies based on your individual need, and ranges
from you staying in hospital only a few hours up to a number of days.

Whether you stay in hospital or have an early discharge, you can expect:

• Postnatal examinations of you and your baby
Screening tests for your baby
• Feeding support and advice
• Preparation for your transition home.

You baby may sometime require further monitoring or support, for example if they were born premature (born before 37 weeks) or they require monitoring of their blood sugars. Where possible the baby will receive special care in our unit. In some circumstances a transfer to a mainland unit is necessary if the baby requires additional support.

Information before you leave the hospital

In preparation of your discharge from hospital, the midwife will give you information about:

• Who to call if you have a concern about you or your baby
• What to expect, and what is normal soon after giving birth
• How to know your baby is well and when to seek advice
• Pelvic floor exercises
• Contraception advice
• Information about making an appointment to register your baby
• Registering your baby with a GP and follow up care


Whether you are in hospital or at home, the maternity team is there to guide and support you.
Please do not hesitate to ask for help, we are here to answer any questions or signpost you to further support where required.

Feeding

Breastfeeding

Breastfeeding is a skill that is partly instinctive and partly learnt; there are lots of different positions for breastfeeding.

For further information please read our leaflet.

Other useful leaflets:

Off to a Good Start: All you need to know about breastfeeding your baby
Expressing and Storing Breast Milk
How Safe is...
Mastitis
Bosom Buddies
Breastfeeding your Baby
Tongue-tied and Feeding


Bottle FeedingThere are a few important guidelines to remember when feeding your baby using bottles, using expressed breast milk or infant formula.

Formula Guide for Parents

Getting to know your baby

Cord Care (Belly Button)

Shortly after birth, the midwife will clamp the umbilical cord close to your baby’s belly button (navel) with a plastic clip. They then cut the cord, leaving a small bit of it with the clamp attached.

The stump of the cord will drop off between 7-10 days following the birth. It usually does not require any special attention, other than normal careful washing and drying at bath time. Keep the baby’s navel clean and dry until this happens. It is best to avoid bathing your baby until it drops off.

It is very common for the stump to bleed slightly as it separates and your midwife will advise you how to care for this. Usually all that is required is to ensure the nappy does not rub on the area. If there is any heavy bleeding, discharge, redness, or bad smell around the cord stump you should contact your midwife or health visitor.

Skin

Skin
At birth, the top layer of your baby's skin is very thin and easily damaged. Over the first month (or longer in premature babies), your baby's skin matures and develops its own natural protective barrier. Vernix (the white sticky substance that covers your baby's skin in the womb) should always be left to absorb naturally. This is a natural moisturiser, and it protects against infection in the first few days.

If your baby is overdue, their skin may be dry and cracked. This is because all the protective vernix has been absorbed. Do not use any creams or lotions as they may do more harm than good. The top layer of your baby's skin will peel off over the next few days, leaving perfect skin underneath. Wash your baby with plain water only for at least the first month.

For more information baby care back to basics.

Jaundice

When they're about three days old, many babies develop mild jaundice. This will make their skin and the whites of their eyes look a bit yellow. This usually fades within 10 days or so, but more severe jaundice may need treatment.

Newborn babies with jaundice

Jaundice in newborn babies is common because their livers are immature. Severely jaundiced babies may be treated with phototherapy. The baby is undressed and put under a very bright light, usually with a soft mask over their eyes. The special light helps to break down the chemical that causes jaundice. It may be possible for your baby to have phototherapy by your bed so that you don’t have to be separated.

This treatment may continue for several days, with breaks for feeds, before the jaundice clears up. In some cases, if the jaundice gets worse, an exchange transfusion of blood may be needed (some of your baby’s blood will be removed and replaced with blood from a donor). This is not common. Some babies have jaundice because of liver disease and need different treatment. A blood test that checks for liver disease is done before phototherapy is started.

Stools

Your baby’s first stool will be made up of something called meconium. This is sticky and greenish/black.

After a few days the stool will change to a yellow or mustard colour. Breastfed babies' stool is runny and doesn't smell. Formula fed babies' stool is firmer, darker brown and more smelly.

Some infant formulas can also make your baby's stool dark green. If you change from breast to formula feeding, you'll find that your baby's stool become darker and more paste-like.

Pale stool may be a sign of jaundice. If you're worried, speak to your midwife or health visitor.

How often should my baby do a poo?

In the first 4 weeks your baby should pass stools every day that are at least the size of a £2 coin. At the beginning your baby will pass a black tar-like stool called meconium. After 4 days breastfed babies should pass at least 2 yellow stools in 24 hours that are normally loose and formula- fed babies will pass a firmer, more bulky stool at least one stool every day. Bottle fed babies are more prone to constipation. If your baby is showing signs of pain or straining when stooling or if during the first 4 weeks is not passing stools every day seek further advice from your midwife, health visitor or GP.

Is it normal for my baby's stool to change?

From day to day or week to week your baby's stool will probably vary. If you notice a marked change of any kind, such as the stool becoming very smelly, very watery or harder, particularly if there's blood in them, you should talk to your doctor or health visitor.

Pale stool may be a sign of jaundice. If you're worried, speak to your midwife or health visitor.

Screening Tests For Your Newborn Baby

When your baby is born, he or she is entitled to a range of routine health checks and tests. These include:

  • a physical examination
  • a hearing test
  • a blood test (taken from the baby's heel)
Most babies are healthy and won't have any of the conditions or problems that the screening tests are looking for. But for those babies that do have a health problem, the benefits of screening can be enormous. Early treatment can improve the baby's health and prevent severe disability or even death.

The checks and tests are quick and won't harm your baby. We will need your consent will be required for your baby to have the checks and tests.

Physical Examination of the Newborn

After birth all babies are examined by the midwife. A more detailed physical examination of your baby will be undertaken by a specialist midwife or by a paediatrician within 6 to 72 hours of birth and again at 6 to 8 weeks old (usually by the GP). As well as being a top-to-toe physical check, these examinations help identify those babies who may have a problem with their eyes, heart, hips and in boys, testicles. The GP should examine the baby between 6-8 weeks after birth.

Newborn hearing screening

A very small number of babies are born with hearing loss. Your baby will be given a quick and simple test to check their hearing. Identifying hearing loss early will ensure that babies and parents can get the support they need and help the development of the child's language and social skills.

Newborn blood spot screening (heel prick test)

When your baby is between 5 days old, the newborn bloodspot screening test will be offered to your baby. This involves taking a sample of blood from their heel.
All babies are tested for:

  • Phenylketonuria (PKU) – an inherited condition where they cannot process a substance called phenylalanine and they are treated early through a special diet.
  • Congenital Hypothyroidism – babies with this condition do not have enough of the hormone Thyoxine, which is essential for growth. Early treatment with thyroxine tablets can prevent serious disability.
  • Sickle Cell Disease – this is an inherited condition which affects the red blood cells. If a baby has this condition they may experience extreme pain, serious infections which can lead to damage to various organs of the body. Early treatment can reduce the risk of serious illness.
  • Cystic Fibrosis – this is an inherited condition which affects the digestion and lungs. Babies may not gain weight very well and have chest infections frequently. Early treatment is with a high-energy diet, medication and physiotherapy.
  • MCADD (Medium-chain acyl-CoA dehydrogenase deficiency) – this is an inherited condition in which babies have problems breaking down fats to make energy for the body, which can be very serious for the baby. Once diagnosed, special attention needs to be given to the baby’s diet – ensuring that they are fed regularly.

Your guide to newborn screening

You and your body after birth

The Baby Blues

During the first week after childbirth, many women get what's often called the ‘baby blues’. This is probably due to the sudden hormonal and chemical changes that take place in your body after childbirth.

Symptoms can include:
  • feeling emotional and irrational
  • bursting into tears for no apparent reason
  • feeling irritable or touchy
  • feeling depressed or anxious
All these symptoms are normal and usually only last for a few days.

Bleeding after the birth

After the birth, you will bleed from your vagina. This will be quite heavy at first, which is why you'll need super-absorbent sanitary towels. Do not use tampons until after your 6-8 week postnatal check as they can cause infections.

While breastfeeding you may notice that the bleeding is redder and heavier. You may also feel cramps like period pains, known as 'after pains'. This is because breastfeeding causes the womb (uterus) to contract.

Gradually the bleeding will become a brownish colour and may continue for some weeks until it stops. If you find you are losing blood in large clots, you should save your sanitary towels to show the midwife as you may need some treatment.

Your Breasts

Your breasts will be larger at first and if you are breastfeeding regularly. If you don't intend to breastfeed from the start, you don't need to do anything. But on the third or fourth day, your breasts may be tender because the milk is still being produced. Wearing a firm, supportive bra may help. Your breasts will get smaller again in a week or so. Speak to your midwife if you're very uncomfortable.

Red, painful area on the breast

This is most common in women who are breast feeding and maybe due to infective or non-infective mastitis (inflammation of the breast).

An over-supply of milk can build up in your breasts for a variety of reasons. If your baby is not well attached it may be hard for them to take your milk effectively, and some parts of your breast may not be drained during a feed. This is the area of your breast that may feel sore or painful. It is worth checking to see if this is a possible cause so that you can prevent it from happening again. If you’re not sure, ask for help. Other common causes include wearing a bra that's too tight, a knock or blow to the breast, and missing a feed.

It’s important to deal with a sore breast or a blocked duct as soon as possible so that it doesn’t lead to mastitis.

If you have mastitis you're likely to have at least two of the following symptoms:
  • breast or breasts that feels hot and tender
  • a red patch of skin that's painful to touch
  • general feeling of illness, as if you have flu
  • feeling achy, tired and tearful
  • you may have an increased temperature
This can happen very suddenly and can get worse very quickly. It's important to carry on breastfeeding as this helps to speed up your recovery. If you think you might have a blocked duct or mastitis, try the following:
  • Check and improve the attachment of your baby at the breast – ask your midwife, health visitor or volunteer breastfeeding supporter
  • Feed your baby more often
  • Let your baby feed on the tender breast first
  • If your breasts still feel full after a feed or your baby can’t feed, hand express some milk to relieve the fullness
  • Warmth on your breast before a feed can help the milk to flow and make you feel more comfortable.
  • Try warm flannels or a bath or shower
  • While your baby is feeding, gently stroke the lumpy or tender area towards your nipple with your fingertips. This should help the milk to flow
  • Get as much rest as possible.
  • If you can, take a painkiller such as paracetamol or ibuprofen
Mastitis may also be a sign of infection. If there's no improvement within 6 hours, or you start to feel worse, contact your GP or healthcare professional immediately. If necessary, they can prescribe antibiotics that can be taken while breastfeeding.

Family Planning and contraception

Contraception (family planning) may be the last thing on your mind when you have just had a baby, but it is something you need to think about if you want to delay or avoid another pregnancy soon after this baby.

A lot of unplanned pregnancies happen in the first few months after childbirth, so even if you’re not interested in sex at the moment, it is better to be prepared. 

Contraception

Contraception choices available include:

  • Male condom / Female condom
  • The Pill (taken daily)
  • Injection: given in the buttocks every 3 months
  • Implant: a small flexible rod inserted in the upper arm lasting up to 3 years
  • Coil: a plastic/copper device inserted into the womb. The IUS is a long-acting reversible contraceptive (LARC) method. It works for five years, so you don't have to think about contraception every day or each time you have sex. The brand name of the IUS used in the UK is Mirena.
Contraception leaflet

Postnatal depression

Depression after having a baby can be extremely distressing.

Many women suffer in silence and their friends, relatives and health professionals don't always know how they're feeling.

Postnatal depression usually occurs 2 to 8 weeks after the birth, although sometimes it can happen up to a year after the baby is born.

Symptoms such as tiredness, irritability or poor appetite are normal if you've just had a baby. But these are usually mild and don't stop you leading a normal life.

If you have postnatal depression, you may feel increasingly depressed and despondent. Looking after yourself or your baby may become too much. Other signs of postnatal depression are:
  • anxiety
  • panic attacks
  • sleeplessness
  • extreme tiredness
  • aches and pains
  • feeling generally unwell
  • memory loss or being unable to concentrate
  • feelings of not being able to cope
  • not being able to stop crying
  • loss of appetite
  • feelings of hopelessness
  • not being able to enjoy anything
  • loss of interest in the baby
  • excessive anxiety about the baby
Getting help for postnatal depression

If you think you have postnatal depression, don't struggle alone. It's not a sign that you're a bad mother or are unable to cope. Postnatal depression is an illness and you need to get help, just as you would if you had the flu or a broken leg.

Talk to someone you trust, such as your partner or a friend. Or ask your health visitor to visit you. Many health visitors have been trained to recognise postnatal depression and know techniques that can help. If they can't help, they'll know someone who can.

It's also important to see your GP. If you don't feel up to making an appointment, ask someone to do it for you.

Treatment


Milder cases of postnatal depression can be treated with counselling. This can be given by the health visitor or a therapist. More severe cases often require antidepressants and you may need to see a specialist.

It's important to let your GP know if you're breastfeeding. If you need to take antidepressants, they'll prescribe a type of medication that is suitable.

Leaflets

Talking About Postnatal Depression

Pandas Foundation (Pre and postNatalDepression Advice and Support) Leaflets