Care of the Newborn- Postpartum Instructions from a Midwife

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Care of the Newborn- Postpartum Instructions from a Midwife

These are the instructions I give to my home birth families right after the birth. They are the basics of what is normal for the baby in the first few hours/days after having a baby.

Feeding tips: As soon as the baby is born she can be placed at your breast. Babies have a natural sucking relfex in the first hours and do best if nursing is established right away. The first few days are colostrum which is clear and it might feel like the baby is not getting anything. Just remember new babies have very small stomachs about the size of a cherry so don't need to eat much but need to eat often.

After your milk comes in and is well established is a good time to begin a feed/wake/sleep pattern for your baby. Do not let your baby sleep longer or wait more than four hours to nurse during the day and six hour at night. Some babies need to nurse much more even every hour to establish a good milk supply. Really most babies will nurse every 2-3 hours. Keep your baby awake for 15-30 minutes after each daytime feeding. The pattern should be eat-wake-sleep. A newborn needs approximately 16-20 hours of sleep a day until 6-8 weeks of age. In the first few weeks it is best to nurse your baby when she cries. Don’t be afraid to give her the breast as comfort. You will not spoil your baby. There is a great debate on schedule vs. demand feeding. The answer is age and baby and you. Please know newborns need their moms and crying is their way of communicating a need. A really good resource is the The No-Cry Sleep Solution: Gentle Ways to Help Your Baby Sleep Through the Night Paperback by Elizabeth Pantley. 

For more information on nursing read The Womanly Art of Breastfeeding. I highly encourage you to attend a La Leche League meeting. They have them in most medium to large size communities and are a great resource. 

A baby that is nursing well and has alert times is a good indication of a strong, healthy baby. A sick baby usually refuses to nurse and is lethargic. Normal newborn weight gain should be ½-1 once per day until three months. It is normal for a newborn to lose weight in the first few days after birth but should regain birth weight within two weeks. If you suspect a slow weight gain, keep your baby dressed warm with hat and socks on, nurse for longer periods and shorten the time between feedings. Colder babies tend to burn more calories than warmer babies and have slower weight gain. If you still suspect a slow weight gain after following these guideline or if your baby is lethargic and is not nursing well get support. La Leche League Leaders are available to help women and it is free.

One good sign that your baby is getting plenty of milk is wet diapers. After the third day you should notice 6-8 wet cloth diapers or 5-6 disposable diapers a day. Your baby should have 1-3 bowel movements daily. If your baby does not have a bowel movement every day don’t freak out. For yourself, try drinking fresh carrot juice, and for your baby, try gently massaging his belly in a clockwise direction.

Remember that your baby cannot regulate its own temperature. You must be alert to temperature extremes. If your baby’s temperature is high, you may have dressed him too warmly. Undress to just a T-shirt and check again in 45 minutes. If it continues to be out of range, or rises or falls to subnormal limits, then call your care provider.

Physiological jaundice (where baby looks yellowish) begins 2-3 days after birth and is considered normal. A baby that is jaundiced at birth or in the first 24-hours indicates a possible problem and should be seen by a physician. You can give your baby sun baths for normal physiological jaundice. Place them with the liver exposed in the sun for 10-15 minutes twice a day. Colostrum will also help with jaundice.

Use a bulb syringe if baby seems congested or stuffy. Squeeze the bulb before placing in nose or month. Slowly release as your remove it and expel contents.

Use olive oil to massage into baby’s skin if dryness occurs, especially around the ankles and wrists. Also apply to diaper area to aid in an easier cleanup of meconium during the first few days.

Cord care: In general you do not need to do anything to the cord except keep it dry. If you live in a humid climate or feel like it is extra goopy you can coat the cord with goldenseal powder. Do this at each diaper change giving special attention the base (where it connected to the abdomen). Try not to breath in the golden seal powder and beware it will stain clothes. Cover the cord with 4 by 4 to protect baby clothes or leave the baby naked if it is warm enough. Once the cord falls off (3-14 days) discontinue goldenseal and begin dripping rubbing alcohol in the navel until completely dry. Report any abnormal odor or redness around navel to your care provider. The navel may have a spot of blood after the cord falls off.

Newborn girls may have vaginal discharge in the first few days which is reddish in color. This is normal due to abundant female hormones and is like a mini menstrual cycle.

Newborn boys/girls may have an orange colored discharge (uric acid) in the urine the first few days after birth. This is normal.

Newborn boys/girls may have swollen breast nipples and secrete breast milk if pressed. This is due to female hormones from the mom in the womb and will resolve in a day or two.

Give sponge baths to baby until the cord falls off. You may use salt water (3-6 tbsp. salt) on the baby to help with rash or baby acne.

Don’t cut newborns nails as they are connected still with skin. If your baby is scratching herself then put gloves on them.

I hope this summary helps you to know what is normal and what to expect or even what questions to ask about your newborn. Postpartum can be a beautiful time of bonding and enjoying your new baby. Be empowered to ask questions and know what is normal. Please send me a message or make an appointment with me if you have any questions. I love supporting moms and new babies in the postpartum season.

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