New Parents : He Looks Like a Pixie Is my baby ok (part 1)

What will happen once my baby is out?

The doctor or midwife will first check your baby’s breathing and
assure that the airway is clear of mucus or amniotic fluid. A few babies
need help with breathing and are given oxygen after birth. This may be
done while the baby is on your abdomen or in a special warmer close by.
If only mild stimulation and oxygen are needed, baby pinks up quickly
and is dried and wrapped and given directly back to you. An initial
assessment (Apgar scoring) is performed by the nurse at one and five
minutes and can be done right on your abdomen or in the warmer.

At this point, the
midwife may place a hand on your uterus, called the fundus, to assure
that it is contracted. In “active management” of the third stage of
labor, oxytocin via an injection or in the IV is administered causing a
firm contraction and the placenta is delivered or expressed. If a more
conservative approach is favored by your caregiver, signs of placental
separation are noted and you will be asked to push the placenta out into
a basin. After the third stage is complete, an assessment of the
perineum and vagina are made and stitches, if any are needed, are placed
under local anesthetic.

Q:	What is the Apgar score?
A:	Apgar is an assessment tool performed at one and five minutes after birth to assess the health of a newborn baby and whether they need additional care . It was developed in the 1950s and still used as a simple, quick, effective, assessment.

What if there is a problem with my baby’s breathing?

If there are signs that your baby is having problems breathing,
the midwife will give immediate treatment and also ask a pediatrician or
neonatal nurse to check your baby. Sometimes just gently rubbing a
baby’s skin can improve breathing or a baby may need a little more
oxygen. If you received labor analgesia, this can have an effect on the
baby’s breathing and your baby may have to be given an injection of a
drug called Naloxone to reverse the effects. If there are continued
concerns about a baby’s breathing, the baby will be transferred to the neonatal care unit for a short time for observation
.

Will I be able to have skin-to-skin contact with my baby after the birth?

This shouldn’t be a problem, especially if you have had a normal
delivery. It is thought that skin-to-skin contact shortly after the
birth has many beneficial effects for both the mother and baby. As well
as assisting the bonding process, it helps regulate a baby’s
temperature, breathing, and heart rate. Skin-to-skin contact also helps
establish breast-feeding, since this is a time when most babies show
their natural instincts and root around looking for food, latching on
for their first feeding. The first hour of life the baby is quietly
alert, eyes are open and very receptive to breast-feeding and the sounds
of parents’ voices.

Q:	Will they clean up my baby first?
A:	This is something to discuss with your midwife or doctor before the birth. She will ask your preferences for whether to deliver your baby right onto your belly or, as some women prefer, onto the bed to be cleaned and dried before being handed over to you.

Q:	When will my baby be weighed?
A:	Your baby will have a head-to-toe checkup, be weighed, and will have his head circumference and body length measured. This may be done very quickly after the birth, but more usually it is done once you have had the opportunity to snuggle with your baby.

Q:	What is vernix?
A:	Most babies born before 40 weeks have some vernix, a white waxy substance, on their skin that protects them while they are in the amniotic fluid. After 40 weeks this begins to disappear. If it is present after birth, it doesn’t need to be wiped off since it will gradually be absorbed into the skin.

How will the cord be cut?

Once your baby is born, the usual practice is to place a plastic
cord clamp on the cord about 2–3 cm away from the baby’s tummy, and then
to clamp another about 3 cm away from the first cord clamp using
forceps; the cord in between the clamps is then cut using cord scissors.
There has always been some debate about the best timing for clamping
the cord. The most recent research suggests that delaying the clamping
of the cord for 2–3 minutes is most beneficial for the baby. This is
because the cord continues to pulsate for several minutes after the
birth so delaying cutting it allows more blood to pass from the placenta
to the baby. This boosts the baby’s oxygen supply and blood volume,
which in turn raises iron levels and reduces the risk of newborn anemia.

If you are
Rh negative the cord is clamped immediately. If you are Rh positive you
have a preference as to the timing of clamping and cutting the cord, you
can include this in your birth plan. If your birth partner would like
to be involved in cutting the cord with the midwife, discuss this prior
to the birth; this should be possible, providing all is well at the
delivery.

Do all newborn babies look the same?

Babies vary in appearance at birth and a variety of factors play a
part. Sometimes parents are surprised that instead of a soft-skinned
baby they are faced with a red-faced, wet, screaming individual. Some
aspects of your baby’s appearance may be temporary and related to the
birth or your baby adapting to life in the outside world, such as the
shape of his head, which may have been affected by the birth, or the
color of his skin (see Your newborn’s appearance ).
If your baby is born post dates, at around 42 weeks, he may have drier,
flakier skin than babies born around 40 weeks; if he is born
prematurely, he may still be covered in the fine downy hair called
lanugo, which will gradually disappear. Also, the type of delivery can
affect the way your baby looks after birth. If you have a cesarean, your
baby is less likely to have a distorted or “squashed” appearance to his
head since he has not had to squeeze through the birth canal.

I’ve heard that sometimes the genitals are quite swollen. Why is this?

The hormones produced by your body in pregnancy, namely estrogen
and progesterone, cross the placenta and so are present in the baby
during pregnancy and immediately after the birth. One of the side
effects of these hormones can be swollen genitals in both newborn boys
and girls. In girls, the swelling can be accompanied by a reddening of
the skin and some baby girls may have a vaginal discharge. As the
hormone levels drop, the discharge may include a small amount of blood,
all of which is normal. Hormone levels can also cause swelling of the
breasts in both boys and girls. After the birth, any swelling and
discharge goes away quite quickly since the baby does not produce
hormones and levels drop to zero in the first week.

Will he be wrinkly?

A newborn baby’s appearance changes over the first hours and days
of life. Immediately after birth, babies tend to have a wrinkly
appearance because they have been in a bag of fluid for the last nine
months, much the same as we get if we stay in the bath for too long. As
their skin adapts to being in the outside world, the wrinkles disappear.
If a baby is very overdue, the skin can appear quite dry and in most
cases will flake. In this situation, it will also appear wrinkly due to a
lack of moisture. Once a newborn baby’s skin starts to flake, there is
nothing that can be done to stop it, and you should not use any
moisturizing products to try to prevent it. Rest assured that the layer
of skin underneath will be fine.

My baby’s face is covered in spots. Will they go away?

Newborn babies have very sensitive skin. They have been protected
in a safe environment in pregnancy and following the birth their skin
needs to adjust to the outside world. That is why rashes and spots may
occur. The most common rash in newborns is called erythema toxicum
neonatorum, which occurs in around 50 percent of newborn babies and is
usually noticeable around 1–5 days after the birth. This consists of
small red spots that appear and disappear all over the skin except for
on the palms of the hands and soles of the feet. It isn’t harmful and it
doesn’t indicate an infection. It can’t be passed on to others and it
usually disappears within two weeks without any treatment. Milia is
another noticeable skin change occurring in about 40 percent of newborn
babies. These are pin-head-sized white spots, which usually appear over
the nose and cheeks, but can also occur on other parts of the face.
These are blocked pores containing some sebum (an oily substance
produced by the skin) and, again, they disappear without treatment.

My baby has a big red strawberry mark on his head. Will it be there forever?

Birth marks are fairly common and most disappear in the first few
years of life. Strawberry birth marks start as a red dot and tend to
grow in size for about a year, but usually disappear by five years.
Other marks include pink patches of skin, called stork bites, and
Mongolian spots, which are patches of skin with a bluish tinge that
occur on babies of African or Asian descent. They usually occur at the
bottom of the back but may extend over the bottom and are due to the
concentration of pigment cells in the skin; they often disappear by
three to four years of age. Port-wine stains are larger red marks that
tend to occur on the face and neck. These birth marks are permanent, so
you may want to talk to a skin specialist about whether there are
treatments to reduce them.

Should I be careful about using products on my baby’s skin?

Yes, you do need to exercise caution. Since a baby’s skin is very
sensitive, it can react to any chemicals that it comes into contact
with, including some baby bath products. The very best option is to use
nothing other than plain water on a baby’s skin until he is at least a
month old, and to continue to be careful about which products you use on
your baby in the following months.

You can use oils to
massage your baby. Pure vegetable oil or olive oil is best; avoid
aromatherapy or mineral oils, which may be harmful to a baby’s skin, and
nut-based oils, as there is a possible link between these and the
development of nut allergies.

Will my baby have any blood tests before we leave the hospital?

Besides the newborn blood spot tests (see Newborn tests and checks ), other occasions when a blood test may be required include:

If a baby is lethargic or jittery a blood glucose test will be performed.
If a baby shows significant signs of jaundice, to check the bilirubin levels and rule out a more serious underlying condition in the baby, such as anemia or an infection.
If the mother is Rhesus negative
, although if this is the case
then a sample of blood is usually taken from the umbilical cord at the
time of birth to determine the baby’s blood group and the baby’s Rhesus
factor.

If the hospital
does suggest taking blood from your baby, then a midwife, doctor, or
other health professional should clearly explain to you the reasons why
they recommend this course of action and ask for your consent prior to
blood being taken from your baby.

I’ve heard that they check babies’ hips. Why is this?

Hip checks are performed on all babies, initially after birth and
then at the time of discharge and at the well-child checkups.

There are two
conditions that are being looked for. One is a congenital dislocation of
the hip. The other is developmental hip dysplasia which causes the hips
to “click” or “pop” when the baby’s legs are rotated outward. The
screening for these conditions may be carried out by your pediatrician
or the midwife. If a problem is found, a splint may be recommended to
align the hip correctly and ensure the socket develops normally.

Why do they measure the baby’s head?

Measuring a baby’s head is done to assess development, and brain
growth. Most babies have their head measured immediately after the
birth, but this probably isn’t the most accurate measurement since the
head may have changed shape as it passed through the birth canal. It is
not until a few days later that it settles into its normal shape. Your
pediatrician repeats the measurement at the two-week checkup in the
first few weeks after the birth and this is generally used as the
baseline measurement on your baby’s growth chart. Measurements taken
throughout the first year are recorded by your doctor at each visit.

Why do some newborns have jaundice?

Just over half of all newborns suffer from jaundice. Usually it
isn’t noticeable until 2–3 days after the birth and clears by 14 days.
The most common cause is high levels of hemoglobin (the oxygen-carrying
part of the blood) before birth. Once babies are born and breathe for
themselves, their hemoglobin count doesn’t need to be so high; these
blood cells die off and are processed as waste by the liver. In small
babies, the liver is immature and takes a while to cope with the
workload. The result is that instead of this waste product, known as
bilirubin, being passed in the urine and stools, it stays in the body
for a while and gives the skin a yellow/orange color. In a healthy
full-term baby who is feeding well, jaundice will resolve on its own
without any treatment. Sometimes, if there has been bruising, the baby
is slow to feed, or is premature, the bilirubin levels continue to
increase, and in these cases phototherapy (ultraviolet light treatment)
is needed to reduce the bilirubin levels in the baby.

Any jaundice that occurs
within 24 hours of birth and any that continues after 14 days is
investigated to rule out and treat any medical problems.

How much will he cry, or will he be asleep all the time?

Many factors influence your baby’s sleep pattern, such as the
type of delivery you had; the gestation of your baby; his health at
birth; and the method of feeding your baby, with bottle-fed babies
tending to sleep for longer stretches. However, all babies need a lot of
sleep, approximately 16 hours each day, which consists of short
intervals of sleep intermingled with shorter periods of wakefulness
through the day.

My baby’s foot is turned in and we’ve been told he may need a splint. What is wrong with him?

This is known as talipes and affects 1 in 1,000 babies. It’s more
common in boys and affects one or both feet. Talipes may be positional
or structural. Positional talipes is caused by pressure compressing the
foot while it’s developing, as a result of its position in the uterus.
This may be resolved with exercises to help the foot regain its natural
position. Structural talipes is more complex and is caused by several
factors, including a genetic predisposition. This needs prompt treatment
while the tissues are soft to manipulate the foot. Splints, strapping,
or casts may be used to hold the foot in place. In some cases, if this
is not effective, surgery to straighten the foot may be suggested. Both
surgical and manipulation methods have a good success rate. Your child
will have regular reviews in childhood and adolescence, particularly
during growth spurts, and more surgery may be needed in adolescence.
There are organizations to contact for support and advice