NEWBORN CARE

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Now that your baby has arrived, you may have some questions about your baby. The following instructions should help guide you through the early days.  If you are planning on utilizing pediatrician support during this time, please call your pediatrician to let them know your beautiful baby has arrived. We will perform your baby’s newborn metabolic screen at your first postpartum appointment. You should make an appointment for your healthy baby within the first week with your pediatrician, but please note that we will refer you more urgently as needed.

Newborns breathe faster than adults at rest and their respirations (breaths) are sometimes irregular. Average is 40-60 breaths in a minute when at rest. Your baby may sound congested, snort or sneeze after birth - all is normal.

Keeping baby skin to skin is the best rule of thumb. Keep baby dressed in one layer more than you are comfortable in. It is normal for a baby’s hands and feet to be blue/ purple - this is not a sign that they are cold.

Your baby should urinate in the first 24 hours. Until your milk is in, the wet diapers may not be as frequent. After 2-3 days, diapers should be wet every 3 to 4 hours (if it is hard to tell if there is urine in a diaper with all of the moisture wicking options, use a small towel in the diaper). Sometimes uric acid crystals will be found in a wet diaper. These crystals can look orange/red and be mistaken for blood (also known as brick dust, for reference of what it can look like). This can be normal, and usually happens right before your milk comes in. Some female babies will pass a small amount of mucus and blood from their vagina. Your baby’s first bowel movements are a dark, tarry, sticky substance called meconium. The baby should pass some meconium in the first 24 hours. This is easily washed off with warm water and coconut/olive oil. Apply oil after diaper changes to make the clean-up easier. Gradually, the meconium changes to a green-brown color, then yellow green. Babies can have bowel movements after every feeding, or once every 3-4 days. A healthy, breastfed baby will not get constipated.

Healthy breastfed babies will have some yellowing to their skin around 2-5 days after birth. Before birth, babies need more red blood cells for oxygenation. After birth, they get rid of the surplus red blood cells by breaking them down, and part of this process is bilirubin in the blood. This bilirubin is what turns the skin yellow. This is called physiologic, or normal, jaundice. If a baby gets yellow in the first 24 hours after birth, this is NOT normal and called pathological jaundice. You can help the processing of bilirubin by nursing your baby often, putting baby unclothed in indirect sunlight for 20 minutes a day.

The skin of a newborn changes rapidly, coming from a water environment to air. Peeling on a newborn is normal. You can use gentle oils (coconut/olive/jojoba) on baby’s skin. Avoid harsh fragrances. You may see pimple-type rashes on your baby. These are also normal.

You may notice red spot(s) on the sclera (whites) of your baby’s eyes. These are broken blood vessels from during the birth. These will go away on their own, usually in the first two weeks. Your baby’s tear ducts are immature and do not work fully right after birth. This means that bacteria can easily grow without the flushing of tears. If your baby’s eyes get a yellow-green discharge or become crusty, you can wipe them with a warm, wet cotton ball. Breastmilk is naturally antibacterial and makes handy eyedrops as well.

Babies of both sexes can have engorged nipples. Some may also have a drop or two of pale white secretions. This is due to the hormones left over from the mother. The same hormones may cause the scrotum to be enlarged, or the labia to be swollen. Some female babies will pass a small amount of mucus and blood from their vagina.

All babies cry at times. While crying can be a sign of boredom, fatigue, loneliness, discomfort, a need to be held, simply communicating, etc.- most crying in the early weeks mean hunger or a desire to be close. Most babies tend to have fussy periods during the day or night. Evenings are a common time for babies to get fussy. Your baby may want to be held more, or even nurse more often. If you’ve changed and fed your baby and nothing has soothed him, sometimes a change of scenery (walk outside or a

car ride) can change a baby’s mood. If you feel yourself getting anxious about your baby’s crying, ask another person to hold your baby while you take a break.

You can expect the umbilical cord stump to dry and fall off anywhere from 4-14 days after birth. Keep stump as dry as possible and this will expedite the process. You can utilize Cord Care after most diaper changes, as these herbs help the drying out process safely. Do not use alcohol as this will preserve the cord and delay it falling off. You may notice a slight smell as it dries. Call your midwife if you notice oozing or bleeding from the cord.

Babies do not need a full bath right away, and too frequent bathing can dry out their sensitive skin. Keep the areas behind the ears and in the neck folds clean, as these are the areas where breastmilk and spit-up can collect. You can bathe your baby in a sink, a baby bath, or in the bath/shower with you, but there is no need to bathe them in the immediate postpartum period.

Both gas and spitting up are a completely normal part of being a baby. Most of the time breastfed babies do not need to be burped after feeding, but some babies are the exception to this rule. Your baby is more likely to need to be burped if he cried to signal, he was hungry. If after a minute or two of patting your baby’s back you have not brought up a burp, feel free to stop and try again later. You will not always be able to get a burp, and it does no harm. Gas is not preventable, although there are some things you can do to help with the discomfort:

1. Gently but firmly massage your baby’s belly in a clockwise, circular motion. This will help gas bubbles move through the intestines.