Advice from Midwives on how to care for a New Born and their mommy.

A scene from a wonderful TV series called 'Call the Midwife'

I had both my babies at an Active Birthing Unit and the births were Midwife assisted births. I was with a wonderful, experienced and knowledgeable set of midwives. Before I took my babies home they gave me a very helpful set of notes and advice that they had put together on new born babies, without which I would have been quite lost. The notes were so helpful that I thought it would be a good idea to share them with others. Below are the exact notes as copied from the pamphlet my midwives gave me. The notes in orange are my two cents worth.  

Feeding.

We suggest you demand feed your baby – i.e. feed the baby when it is hungry. This usually means every 2 to 3 hrs counting from the start of the feed to the start of the next feed. I found that it was more important to simply feed my babies whenever they were hungry in the first couple of weeks. The best advice I got was from my GP who reminded me that you cannot spoil a baby in the first three months. Feeding on demand during this time also makes sure you build up your milk supply according to your baby’s needs.

BUT:

• You should determine whether the baby is hungry or actually needs comfort. Too much comfort sucking on a breast compromises the nipple and very few mothers manage to continue breastfeeding if their nipples are cracked and bleeding. I found Lansinoh nipple cream worked the best.
• You should aim to have baby sleeping for at least an hour before feeding again. If baby commences a feed after a poor sleep, then it won’t have enough energy to complete the feed. It will fall asleep on the breast, but wake soon afterwards because it didn’t feed well. This starts a “snack-napping” mode that is negative.
• You need to have made the maximum effort to provide a complete feed at the previous feeding session. A complete feed is important to prevent “snack-napping”

Follow these guidelines for a complete feed:

Do a 3-course meal (hors d’oeuvre/main meal/pudding). Feed, burp, feed, burp, change nappy and wash hands, feed again. I found this worked well in the first few days with the colostrum but once my milk came in Curious George only fed once from each side and Jelly bean fed from one or two sides depending on how she felt.

If you follow this process you will drain both breasts well, baby will not get too frustrated during the nappy change, and there will be less chance of winds becoming trapped in baby’s intestines.

There are times that babies ‘cluster feed’ i.e. they feed frequent sessions in the space of a couple of hours, but these babies FEED whilst on the breast they don’t dummy suck. Both my babies cluster fed towards the end of the day. This is how to tell the difference: all babies will start a feeding session with quick sucking movements and short rests. They then progress to quick, quick; long pumping action; swallow; rest.

A little trick they taught me to help baby latch properly it the bottom lip pop. When your baby latches pull down gently on their chin with your finger to make their bottom lip popover the outside of the nipple. If you are still struggling you can put your finger tip on their bottom lip and pop it out as well.

As the feeding progresses they do more quick sucks, less longer sessions of pumping and definitive longer rest periods. Please wake your baby up (move arms, tickle cheek, push baby’s back towards your chest) Jelly Bean was terrible at falling asleep in the first two weeks, sometimes I even had to undress her to keep her awake. Don’t let baby fall asleep because he/she will wake again in an hour to complete the feed! This is particularly important for night feeds – too many parents don’t persevere with a three course meal (they themselves are too tired) and a snowball effect of poor sleeps and poor feeds follows.

If your baby has fed well during the day and you are not concerned about any signs of compromise (e.g. a baby less than 2.5kgs), then you can let baby skip a feed at night. Just set the alarm clock to wake you 6 hours after starting the previous feed. Either the alarm or your baby will wake you – don’t lie awake listening to your baby’s grunts and groans.

Please remember that this advice is a guideline: some babies are content to feed from one breast at a time and then manage to sleep until the next feed. Do not clock watch your feeds: watch how your baby sucks and encourage it to take a full feed.

My only other note on breast feeding is that just when you think you know what their pattern is they will change it. The only certainty is change. 

Burping

You will need to hold your baby in such a way that simultaneously:

• you put pressure on baby’s stomach (just beneath the ribs)
• you put pressure on the baby’s lower spine so that it’s body straightens out and untraps air from the J-shaped stomach
• you make a V with your thumb and forefinger to support baby’s jaw (not baby’s neck as you will throttle the child)
• 
  

Another tip we found was that if there seems to be a stuck wind it helps to lay the baby flat for a minute and then pick them up again. This seems to displace the bubble.

Magphos tissue salts work wonderfully in helping winds come up more easily (better than telemant drops). Just crush the tablet and give baby a quarter of a tab dissolved in milk (breast or formula) before the feed.  

Baby’s Appearance

Sneezing and hiccups are normal and not signs of illness. A baby can also have pink/orange discharge in the urine called urates and these can continue till baby is 6 weeks old. Little girls can have a slightly bloody vaginal discharge due to normal hormonal changes. 

Cord Care

The quickest way for the cord to fall off is to do nothing to it. But it falls off by means of a rotting process and this can look scary especially to medical people, so they choose to use surgical spirits, which dries the cord but prolongs the process, as well as causing burning of the healthy skin around the umbilical cord. 

We advise Herbaforce Graze and weeping wound powder – sprinkle it under (at the base of) the cord stump until it falls off. Then continue using the powder because a scab will form in the open wound. It may bleed occasionally and this is normal. Be careful not to disturb the scab (with vigorous cleaning) otherwise the healing process will be delayed. The scab should come off after 3-4 days and leave a relatively well-healed belly button.

We used the Herbaforce powder with both our babies and it worked wonders. Jelly Bean’s actually fell off in less than a week. Basically you just need to move the stump to the side and powder the base, you do this all the way around.

Swaddling

Babies can be very unsettled in their arms are not kept close to their bodies, so if you are trying to encourage your baby to slow down and to sleep deeply then consider swaddling them. This is especially important at night because it promotes a deeper sleep for baby. During the day many babies cope without being swaddled but if you notice your baby doesn’t stretch further than a 45min sleep (when the deep sleep cycle ends) then consider using a swaddling technique.

Swaddling helped both my babies sleep. If you can keep it up (my son loved it) it also helps at that irritating stage where their arms ‘come alive’ and flail about waking them up.

Sleep Position

The recommend sleep position for your baby is on its back. If you have swaddled your baby then consider lying your baby on its side so that milk can dribble out of the mouth without choking them. Baby will automatically turn its head to the side if it is lying on its back but swaddling can immobilise the neck. It is vitally important that you prevent your baby from turning onto its stomach so please place a wedge/blanket against baby’s tummy. A wedge against baby’s back is not wrong but the important wedge is the one against baby’s tummy.

Sun tanning.

To minimise the incidence of neonatal jaundice, prevent nappy rash and provide baby with the vit D that it needs, we suggest you suntan your baby until it is 5 or 6 days old. 

Method: Undress baby completely but use an open nappy under the baby. Most parents worry baby will be cold. The danger is actually that baby will overheat or burn. Also warming a baby up is easier than treating jaundice. 

At 8h00 and 16h00: sit on a chair with the sun behind you so that when you lay baby on your lap (along the length of your legs) the sun will shine on its baby but its face will be shaded by your body. Suntan for 5min, then turn your baby around and suntan for another 5min. Sun tanning behind a window is not effective and is dangerous because mainly the infrared waves come through (which cause sunburn) and baby needs the UV light. 

This seems crazy for winter babies but it saved my two from going under the lights.

Cabbage Leaves

Please ask one of your family members/ friends to buy a large green cabbage and put it in your fridge at home. You will probably need the cabbage the third night after the birth which is when your milk ‘comes in’. At that stage your breast can become very full, hard, hot and uncomfortable and you may have difficulty latching your baby. You should peel a leaf off the cabbage, eat out the hard stem and place the leaf over your breast. Before you do that cut a hole to allow space for your nipple to protrude through.

There is an enzyme in the cabbage that reduces tissue swelling. It really makes a big different to breast that may become engorged (the milk stops flowing). Please wear the leaf from the end of one feed to the beginning of the next feed. 

This sounds crazy but works amazingly well. I also used Lansinoh gel pads which I kept in the fridge and wore at night under my cabbage leaves.

Salt Baths and Pours

It is important to promote cleanliness and healing of the vaginal and perineal areas. You should have a salt bath twice a day. Place a handful of salt in just enough water to cover your buttocks. Soak for 10min. More importantly, every time you pass urine you should pour salt water over the vulva. This is more effective that salt baths because the water reaches more mucus membranes and because you will do it more often than bathing. Prepare a jug or squeeze bottle with a small palm full of salt and place in your bathroom.

When I had Curious George I had a very bad tear and struggled to sit in a bath for the first few days. The midwives came up with an ingenious plan which was to put a clean plastic garden chair in the show and fill the hollow of the seat with salt and warm water. This worked very well.

Vaginal Bleeding (Lochia)

Your vaginal bleeding will be heavy for the first 24 hours, then it will decrease in quantity till you have just spotting. Then at 2 weeks, 4 weeks and 6 weeks the whole process will repeat itself but the bleeding should not be as heavy as during the first 24 hours. You may witness large clots (some times as large as the palm of your hand) that look like pieces of liver – this is normal. 

Baby’s Weight

Babies can lose up to 10% of their birth weight in the first 3 days of life. Baby should be back at birth weight when it is 10 -14 days old. Thereafter baby should gain a minimum of 150g per week. We suggest that you visit a baby clinic each week for the first 6 weeks and every month their after to keep track of baby’s growth.