Post Natal Care

 

This page contains general information about postnatal care and resources relating to South/ East Auckland.

You will be visited daily and in extreme circumstances, if we are unable to visit you due to attending a woman in labour you will receive a phone call whilst you are an inpatient. Your postnatal visits while an inpatient will be done by whichever midwife in our group is at the unit. The staff on the ward will look after you the rest of the time and help you with breastfeeding and mother craft. Please ring the bell and request assistance whenever you need help with breastfeeding, especially relevant for the first time mother’s.

You have a choice with your postnatal visits during the week once you are discharged to either make sure you are home on your midwife’s postnatal day, as it is difficult to give you an exact time when we will be there, or make an appointment to come in to clinic during the week. (Total of at least 5 visits).

 

Breastfeeding

 

Advantages of breastfeeding

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  • Healthy baby- antibodies, economical and always available, correct temperature and easily digested

  • Stools- 1 stool in 10 days or 10 stools in one day are all considered normal. They are a runny consistency and mustardy yellow in colour, this indicates that all is well and is how baby’s stool should look once the milk is in. Your baby’s stool will change colour from sticky black to brown to mustard yellow after the first few days.

 

Breastfeeding support: Wednesdays at the Botany Maternity unit, call to book an appointment on (09)534-6063. Val Furness offers private lactation consultancy, call her on (09)537-2673 or 027 393 4999

Principle of breastfeeding

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This works on a supply and demand principal. Your baby needs to suck to get the whole process working. As your baby sucks a hormone is released that gets the milk flowing. This hormone is the same one that is released when you go into labour. As a result, some women may experience contractions in their uterus when breastfeeding. This is called afterpains. This feels stronger if it is not your first baby. Please take any pain relief that is offered as this can be quite sore. You need to drink lots of water to build up a good milk supply. Aim for 2 glasses of water every time you feed.

 

  • Diet: A balanced nutritious diet high in calcium and protein is very important.

 

  • Foods to avoid: Avoid wind producing foods: Garlic, cabbage, onion, spicy foods, chocolate, green veges, acidic foods, citrus juices, fizzy cooldrinks and liqourice

 

  • A stress free lifestyle and rest helps your milk supply. This is often difficult in the first few weeks, but it is really important. Try and limit visitors and work a signal out with your partner when you have had enough so that people can be politely asked to leave.

Storage of Breastmilk

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4 Hours at room temperature; 48 hours in the fridge; 1 week in the freezing compartment of the fridge; 4 months in the freezer (4;2;4 rule). Breastmilk should not be defrosted in the microwave as this destroys the properties of the milk. Defrost in storage container by placing in warm water and then administer immediately. This will be room temperature milk, which is the best way to give milk.

 

World Health Organization recommends Exclusive Breastfeeding until 6 months, and continued Breastfeeding until 2 years. This gives them the maximum benefit from the breast as far as antibodies and goodness is concerned. If you feel a cold starting, take 500mg of vitamin C and 2 Zinc tablets (30mg) in the morning and then take 500mg of vitamin C every 6 hours. Continue this for a couple of days and you should find that your cold has almost gone. You do need to start though as soon as you feel the first symptoms. After 2 days of this go to just 500mg vitamin C with 2 Zinc in the morning and 500mg in the evening and then after 2 days of that down to 500mg of vitamin C with 2 Zinc in the morning. If you feel that you could need antibiotics but prefer not to take them, take 2 Garlic tablets 3 times a day as well. 

**Breastfeeding cookies to help with milk supply:

http://www.food.com/recipe/oatmeal-chocolate-chip-lactation-cookies-by-noel-trujillo-192346

  • Jungle juice recipe:

​Use this recipe daily, over a 24 hour period to help stimulate your milk production and increase your energy levels

50ml Schlehen Blackthorn Berry Elixir (Get from Natural Health company, Highland Park shopping centre)
1 litre apple juice
2 litres water
1 sachet Blackcurrant Rehidrat ( or any rehydration powder from a pharmacy)

Mix all together. Add 10 drops of rescue remedy to every glass just before you drink it...

  • Fenugreek tablets, Blessed Thistle, Borage, Chamomile, Dang Quai, Fennel, Garlic, Goats rue, St John's wort, St MAry's thistle- Taken as a water-based infusion or as tincture drops

  • Artemis Breastfeeding tea

Colic

  • Colic is crying that can last for several hours without an obvious reason. 

  • It can be difficult to soothe a baby with colic, but there are a few tips below to try to help your little one.

  • It's challenging for you and your whānau to care for a baby with colic, and it's important to take a break if you're feeling frustrated or angry.

  • Never shake your baby as it can lead to permanent brain damage or death (known as shaken baby syndrome).

What is colic?

Colic is crying that can last for several hours without an obvious reason. Colic won’t harm your baby or cause any long-term health issues, and most babies outgrow it after 16 weeks. 

It is common for babies to cry and have unsettled times. Some babies cry for longer periods and are more unsettled than others, and this is normal.  

Symptoms

 

Your baby may be suffering from colic if they:

  • cry for several hours for no reason (they aren’t hungry, nappy is clean and dry, and you’ve tried cuddling them)

  • clench their fists

  • draw their knees up and are hard to comfort.

Crying often occurs in the late afternoon or early evening. It may stop after your baby has a poo, passes gas, or they may continue crying until they fall asleep. They may seem okay for a while and then start crying again – usually at the same time each day or night.

How to help your baby

 

It can be difficult to soothe a baby with colic, but there are a few things you can try to help calm your little one:

  • hold your baby upright for feeds and burp them afterwards

  • if your baby is breastfed and seems worse after mum eats certain foods, talk to your Plunket nurse, or other Well Child provider

  • if your baby is bottle-fed, check you are preparing it correctly

  • hold your baby while they are crying and talk to them with a soothing voice

  • play soothing music

  • keep the lights dimmed

  • babies like to move so try gentle swaying, push them in a pram, or use a front pack to carry your baby while you do things around the house

  • give your baby a warm bath or a gentle stomach rub.

Caring for yourself

 

Caring for a baby suffering from colic can be exhausting and hard on both you and your whānau.

Sometimes your baby’s crying may really get to you. You may feel frustrated, helpless or angry – this is normal and it’s important to take a break if this happens.

If you are feeling frustrated, stressed or overwhelmed with your baby’s crying: 

  • give your baby to a trusted whānau member of friend, or put them down in a safe space for a few minutes to take a break

  • try to relax with a cup of tea, a book, or calming music

  • get some fresh air outside to help you and your baby, try going for a walk with the pram

  • call a trusted whānau member or friend, or PlunketLine.

** Remember to never shake your baby as it can lead to permanent brain damage or death (known as shaken baby syndrome).

  • Respond quickly: Responding quickly to your baby’s cry will not spoil your child or encourage them to cry more for attention. Instead, by reacting to your child right away, you’ll make them feel secure and safe, and you’ll show them that they can trust you to be there when they need you.

  • Breastfeed more: If your baby is crying, you can offer the breast even if you don’t think they're hungry. Breastfeeding is comforting for your child.

  • Burp your baby: Breastfed babies don't always need to be burped after feedings, but a forceful let-down or a robust milk supply can cause them to take in extra air. The same is true of crying. Since colic is associated with gas, burping is worth a try.

  • Hold your baby: Fussy and colicky babies need to be held and comforted more than calmer infants. Try placing your baby in the "colic hold" (with their stomach over your forearm). The pressure of your arm on their belly may make them feel better. If your baby has reflux or gas, hold them upright to help keep the contents of their stomach down instead. Skin-to-skin contact can also help ease little ones.

  • Offer a pacifier: If you have a healthy milk supply and your baby is over 4 weeks old and breastfeeding well, you can try a pacifier. Sucking is calming for infants.

  • Reduce stimulation: Make the baby’s environment calm. Turn down the lights and lower the TV volume or turn it off. It doesn’t have to be completely dark and quiet (some babies find consistent low sounds, like a white noise machine, comforting), but less stimulation may be effective.

  • Swaddle: Swaddling a baby in a blanket helps the baby feel secure. Swaddled babies startle less and tend to sleep better. Just remember to place your baby on their back to sleep to reduce the risk of sudden infant death syndrome (SIDS).

  • Use gentle movements: Try some gently rocking, an infant swing, or a walk in the stroller. A ride in the car can give you both a change of scenery. The hum of the engine and the motion of the drive can do wonders to soothe a baby.

  • Wear your baby: Your baby may cry less if you hold them close to your body. However, if you hold your baby all day, you may not be able to get anything else done. For the best of both worlds, use an infant carrier or a sling to hold your baby close and keep your hands free.

Eyes

Your baby’s eye colour may change gradually over the first few months after birth. Many babies have red or purple patches on their eyelids. These are called ‘stork bites’. If your baby gets hot they can look redder, then fade again as your baby cools off. They are nothing at worry about and will fade over time.  

Immunisation / Vaccinations

 

Several vaccines are part of the National Immunisation Schedule offered to all babies. In most cases, the first round of vaccines can be given at about 6 weeks of age through your local doctor’s surgery.

  • Vaccines stimulate your child’s body to make antibodies against infections. These antibodies will protect your child from the disease. This is called immunisation.

  • Your child does not have to receive immunisations – it is your choice.

  • The National Immunisation Register (NIR) is a computerised information system that will hold all the immunisation details of your child.

  • The NIR will prompt reminder notices form your doctor’s practice when your child’s immunisations are overdue.

  • You can choose to opt off the NIR but you will need to complete and sign an opt-off form.

  • Babies have their first immunisation at 6 weeks of age.

  • Ask your Midwife about BCG vaccination for Tuberculosis.

  • If you have Hepatitis B or are a carrier, your baby will need a vaccination at birth.

All vaccinations that are part of the schedule are free. Some vaccinations come in combination, so if you choose to only use some a cost for the individual vaccine may apply.

http://www.immune.org.nz/immunisation

https://www.healthed.govt.nz/resource/childhood-immunisation

http://www.health.govt.nz/our-work/preventative-health-wellness/immunisation/national-immunisation-register

Jaundice

  • jaundice means yellow colouring of the skin and the whites of the eyes

  • mild jaundice is common in newborn babies - it starts on the second or third day and settles over 7 to 10 days

  • there are many causes of jaundice

  • some types of jaundice are serious

  • jaundice that appears in the first 24 hours after birth is not normal - it needs checking by a doctor straightaway

  • jaundice at any age with pale poos and dark wee needs checking with a blood test

  • jaundice still there after 2 weeks of age needs checking by a doctor

  • severe jaundice can be serious - with correct early treatment long-term problems are rare

Jaundice is very common - over half of all babies have it.

At low or medium levels, jaundice does not cause problems. But bilirubin, the substance causing the jaundice, can be harmful at high levels. It can lead to deafness or brain damage. Babies with high levels need immediate treatment.

In most babies, jaundice is normal and natural and settles as the baby's organs mature and adjust after birth.

The medical term for this type of jaundice in newborns is physiological jaundice. This type of jaundice does not usually harm babies.

Some breastfed babies may stay jaundiced for longer than formula-fed babies. This is because of a normal and natural effect of breastmilk on babies. This type of jaundice is called breastmilk jaundice. It is not harmful.

There are many other reasons for jaundice and if you are concerned, you should talk to your midwife or your family doctor.

Each year in New Zealand, a small number of babies are born with liver disease which also causes jaundice. This is not normal and your doctor or midwife needs to see this.

Jaundice is likely to be normal if your baby:

  • becomes jaundiced after the first 24 hours after birth

  • wakes up of their own accord to demand feeds

  • looks well and feeds well

  • has dirty nappies (poo) that are yellow or green (not pale, white or light beige) in colour

  • has wee which is clear or straw-coloured, not yellow or dark

As the bilirubin level gets higher, your baby:

  • will become more obviously yellow over the whole body

  • may be sleepy and slow to wake up for feeding

  • may feed less well

If you are worried or have questions, ask your midwife or doctor to check your baby.

Normal (physiological) jaundice usually fades away after 1 or 2 weeks. Sometimes normal jaundice may last longer than this.

If your baby is jaundiced and has pale, white or light beige-coloured poo, take them to your family doctor. Your doctor can arrange an urgent appointment with a paediatrician.

Metabolic Screening

This is a screening test which detects rare but life-threatening metabolic disorders. It is a blood test done at 48 hours old or as soon as possible after this. Metabolic disorders are hard to diagnose without screening, and although these disorders cannot be cured, early treatment can prevent your baby becoming sick. The blood sample is collected from your baby’s heel onto a blood spot card. This card is then sent to the laboratory for testing. Your midwife should receive the results of the test within 10 days if the result is negative. If the result is positive your midwife will be notified as soon as possible. It is your decision to have your baby screened. Metabolic Screening is also called the Heel Prick Test, and the Guthrie’s test.

http://www.nsu.govt.nz/files/ANNB/Your_newborn_babys_blood_test.pdf

http://www.nsu.govt.nz/current-nsu-programmes/newborn-metabolic-screening.aspx

Nails

It's a good idea to keep your newborn's nails clean and short. But there are other ways of shortening them besides cutting them.

Your baby's nails grow quickly, so it's understandable if you're worried that he will scratch his face. You could gently peel off the ends with your fingers. His nails are so soft that the surplus will come away easily. An even safer way is to use an emery board to gently file your baby's nails. When your baby is a bit older, you can also use an emery board to neaten off any jagged edges after cutting.

Instead of shortening your newborn's nails, you could put mittens or socks on his hands to prevent him scratching himself. Or keep him wrapped up so he doesn't put his hands near his face.

It's best not to nibble the ends of your newborn's nails to keep them from getting too long. The bacteria from your mouth could cause an infection.

Your newborn's fingernails grow so quickly that you may have to shorten them more than once a week. His toenails grow more slowly, so they won’t need shortening as often.

Because your newborn’s nails are soft and flexible, it's hard to tell which bit of the nail growth is still attached to the quick. The tip of his finger will bleed if you trim too low. This will be sore for your baby, and the exposed quick may become infected.

It may be easier to cut your newborn's nails if you have someone to help you. One of you could gently hold your baby, while the other trims his nails. If your baby wriggles a lot, you could try cutting his nails while he's feeding or sleeping.

Press your baby's finger pad away from the nail to avoid nicking his skin, and keep a firm hold on his hand as you cut or clip. Cut the nail around the curve of the finger, and his toenails straight across. However, don't cut down the sides of his fingernails or toenails, as this may cause ingrown nails and infections.

If you accidentally nick the skin, try not to worry. Gently hold a piece of clean, damp cotton wool to his finger tip and apply a little pressure. The bleeding will soon stop. Don’t put a plaster on the cut, as your baby may choke on it.

When your baby is about a month old, his nails will have started to harden a little and will have a firmer free edge. This will make it easier to trim them using baby nail scissors or clippers with rounded ends, though you’ll still need to do this carefully.

Nappy rash

Nappy rash is a rash in the nappy area. Usually it's mild and doesn't bother your baby. However, sometimes it can be sore and severe.

Key points about nappy rash

  1. Nappy rash is caused by wetness, irritation or infection, or a combination of these.

  2. Most nappy rash can be prevented by changing nappies as soon as possible after they become wet or soiled, making sure the area is dry before putting the new nappy on, using a barrier cream or ointment, avoiding irritants and giving your baby nappy-free time.

  3. If your baby gets nappy rash, follow the prevention steps.

  4. If the rash gets worse or infected, or your baby gets a fever, see your doctor, pharmacist or Plunket nurse.

  5. They may suggest a mild steroid cream or ointment or an antifungal cream.

What causes nappy rash?

  • Wetness and rubbing

Constant wetness and rubbing can cause damage to your baby's skin. The longer a nappy is wet or soiled, the higher the risk there is of damage to their skin. This is because pee and poo contain substances that irritate skin. 

  • Irritation

The rash can be made worse by other things that irritate the skin in that area.

- Watery loose poo can make nappy rash worse.

- Some baby wipes and soap can cause dry skin or make the rash worse.

- Detergents and soaking solutions used for cloth nappies can irritate your baby's skin. 

  • Infection

Fungal or yeast (candida or thrush) thrives in warm moist areas. It is often present when there is a severe nappy rash. It can be treated with an antifungal cream. Bacterial infections can also occur where there is broken skin and can be treated with antibiotic medicines.

How can I prevent nappy rash?

Nappy rash can be prevented with simple measures around nappy changing, using a barrier cream or ointment, giving nappy-free time and choosing quality disposable nappies or taking good care of cloth nappies. 

 

  • Nappy change

- Change your baby's wet or soiled nappy as soon as possible after they become wet or soiled. This can be up to 12 times a day for young babies.

- When changing nappies that only contain pee, simply pat your baby's skin dry and reapply barrier cream.

- When changing nappies that contain poo, use a warm wet cloth for washing their bottom and a gentle fragrance-free cleanser. Wash the area gently. Too much cleaning can irritate the skin.

- Make sure your baby's bottom is properly dry before putting on a new nappy. Dry by patting, not by rubbing, with a towel.

  • Avoid the following as they can cause skin irritation:

- baby wipes – if you need to use baby wipes choose brands with minimal or no fragrance and that are for sensitive skin

- soaps, bubble bath and lotions 

- plastic pants

- talcum powder.

Barrier creams and ointments

Barrier creams or ointments may help to protect your baby’s skin from moisture. They form a barrier between your baby's skin and the poo or pee. Apply a barrier cream thickly at each nappy change.

Examples of barrier creams or ointments are:

  • zinc and castor oil ointment

  • white soft paraffin ointment

  • Bepanthen® ointment

  • Sudocrem®.

Nappy-free time

Give your baby as much nappy-free time as possible each day.

Nappies

If you are using disposable nappies, choose a good quality disposable nappy that allows moisture to be absorbed quickly.

If you are using cloth nappies: 

  • rinse soiled nappies immediately in cold water before washing

  • wash the nappies in a normal hot wash in the washing machine

  • don't use strong washing powders

  • rinse them twice to remove soap residue

  • dry outside on the line whenever possible rather than in the dryer – sunshine and fresh air are great germ killers.

Homemade baby wipes

https://www.favfamilyrecipes.com/homemade-baby-wipes-recipe/

Newborn Hearing Screening

 

Up to 170 babies are born each year in New Zealand with significant hearing loss. Picking up hearing difficulties early in life is very important as early intervention can make a significant difference to how your baby’s brain develops.

You will be offered to have this non-invasive screening test for your baby. It is either done before discharge if you are staying in hospital, or an appointment can be arranged for later in the first weeks of your baby’s life. Some babies will be offered further testing.

http://www.nsu.govt.nz/files/ANNB/HE1921_Your_Babys_Hearing_Screening.pdf

http://www.nsu.govt.nz/current-nsu-programmes/newborn-hearing-screening.aspx

Reflux

  • Reflux is normal and happens in about half of babies. For most babies, you don't have to do anything about reflux, as it's a natural process that will get better by itself.

  • There are things you can do to help like taking your time with feeds, burping your baby, and holding them upright after you feed them.

  • Reflux is unlikely to harm your infant or cause any long-term problems – it is different than vomiting.

  • Talk to your Plunket nurse or doctor if you are worried about your child's reflux.​

What is reflux?

 

Reflux occurs when your baby’s stomach contents are released back up towards their mouth. It is unlikely to harm your baby or cause any long-term problems. 

Your baby may have signs of reflux after a feed that include: 

  • bringing up milk during, or shortly after feeding 

  • burping, belching or swallowing hard. 

Reflux is not the same as vomiting

 

Reflux and vomiting are different. Reflux is effortless, while vomiting is forceful. Some reflux and regurgitation is normal and will usually improve as your infant grows and their digestive system matures. Reflux often increases between six weeks to four months, and for some children it will continue until they are 12 months old. 

If you aren’t sure whether your baby is experiencing reflux or vomiting, call PlunketLine to speak to a registered nurse. 

What causes reflux?   

 

The oesophagus is the tube connecting the throat to the stomach. At the end of an oesophagus, before the stomach, is a ring of muscle called a sphincter. This keeps food after it is swallowed in the stomach. Reflux or silent reflux occurs when the sphincter doesn't work correctly and allows stomach contents which can include food and stomach acids back up into the oesophagus. For some children, this can cause discomfort and periods of being unsettled.

Both reflux and silent reflux are common in infants as they have a shorter oesophagus and their sphincters are not fully developed. Reflux usually resolves without treatment as the sphincter strengthens and baby grows.

Tips to help your baby with reflux

 

You can help your child if they have reflux. 

During feeding: 

  • take your time with feeds 

  • try to stay calm and relaxed during feedings, if possible 

  • burp your baby during feeding 

  • don't force your baby to take more milk than they want – some babies like to eat smaller amounts more often 

  • for bottle feeding, check that the hole in the teat is not too big, as feeding too quickly can make reflux worse 

  • use large bibs and a towel or cloth after feeds to catch the milk and protect clothes. 

After feeding: 

  • hold your baby upright for a short time after they feed 

  • try not to handle your baby too much 

  • where possible, it may be helpful to change baby before or during a feed, rather than afterwards when their stomach is full.

If your baby brings up a lot of milk, they may be hungry again and you might need to feed them again sooner than usual.  

For most babies, you don't have to do anything about reflux. It is a natural process which will get better by itself. Changing formulas won't help and neither will a change from breastfeeding to bottles. 

There are thickened formulas for babies who are formula fed with reflux, although there is not a lot of research to support how effective these are. There are also many over-the-counter products aimed at reducing wind, colic and reflux, but there is no scientific evidence that shows these preparations work. If you choose to use such a preparation, make sure you choose one that has no alcohol or sugar. 

Silent Reflux

 

Silent Reflux is also known as Laryngopharyngeal Reflux or LPR. Silent reflux is when the weak muscle at the top of the stomach means some food is squeezed upwards into the oesophagus, causing the baby’s stomach contents come up the oesophagus and flow into the back of the throat and nasal passages.

However, unlike reflux, the stomach contents are not released back as far as the baby’s mouth, and there may not be any outward symptoms of spilling at all. This is a common condition in babies and for most of them, it is nothing to worry about. An estimated 8% of newborns experience either excessive or ‘silent’ reflux, which can result in a very unhappy baby.

With silent reflux, painful ‘heartburn’ symptoms are experienced instead of vomiting. Because there is no vomiting, this can be confused with wind or colic. Babies suffering from silent reflux typically experience discomfort 60-90 minutes after feeding.

Silent reflux is different to vomiting because reflux or spilling is effortless, while vomiting is forceful. 

As the baby’s stomach contents fall back into the stomach instead of being burped or spit up, it can be difficult to identify that silent reflux is upsetting your baby.

As long as your baby is healthy and growing normally, reflux is not usually something to be concerned about.

Symptoms

 

This type of reflux doesn’t always cause obvious symptoms, hence why it is called ‘silent’. Signs to look out for in your baby or young child might include:

  • hoarseness

  • chronic cough (or "barking")

  • noisy breathing, wheezing, or pauses in breathing

  • chronic respiratory conditions (such as bronchitis) and ear infections

  • Trouble feeding, spitting up or inhaling food

  • Difficulty gaining weight

  • gagging

  • nasal congestion

How to feed your baby if they have silent reflux

 

While breastfed and bottle fed babies suffer from reflux equally, studies have shown that reflux in breastfed babies tends to be shorter and less frequent than those who are bottle fed. Breast milk is generally digested faster than formula, so it has less time to hang around and cause trouble.

Regardless of how you are feeding your baby, you should follow the advice below:

Feed your baby in an upright position

If you are breastfeeding, you may need to try different positions to find the best one that will allow your baby to remain fairly upright during feeding. Some mothers report success by having their baby face their breast while straddling their leg. Others prefer to stand up while feeding their baby in a modified twin-style hold.

Keep feeds small and frequent

Your baby may prefer to feed often, and this is actually better for them than a large sudden intake of food as this causes less pressure on the stomach muscle.

Keep your baby upright

For at least half an hour after feeding, keep your baby upright. You may want to hold them on your shoulder or perhaps use a front pack or baby seat.

Introduce a reflux-friendly routine

Try to keep to a routine where your baby feeds when he wakes up, so that they’ll have plenty of time to allow the milk to digest before lying down to sleep.

Don’t let your baby fall asleep while feeding

Catnapping on the breast or bottle always leads to pain once the feed has finished so try to avoid feeding when your baby is tired.

Try feeding solid food first

Once your baby is old enough to be eating solid food, try offering this to him before his milk feed as this seems to keep the milk down. For younger babies, try a small amount of thickened milk at the beginning of a feed. Many bottle fed babies find relief from reflux when thickened formula is used.

http://www.cryingoverspiltmilk.co.nz

Safe sleeping

  • Face up: don't sleep baby on his/ her tummy or side. Baby should be sleeping on a firm surface, no pillow. Sleep baby in his/her own cot/ basinet/ pepi-pod/ wahakura.

  • Face clear: Place baby with feet to the bottom of the cot/ basinet, and ensure blankets won't cover baby's face while sleeping. NO polar fleece blanket!!!  No pillows, toys, loose bedding, bumper pads or necklaces (including amber beads and ‘teething’ necklaces). No pets in bed with baby...

  • Clothing and bedding that keeps baby at a comfortable temperature – one more layer of clothing than you would wear is enough; too many layers can make your baby hot and upset them

  • You can check that your baby is warm but not too hot by feeling the back of their neck or their tummy (under the clothes). Baby should feel warm, but not hot or cold. Your baby will be comfortable when their hands and feet are a bit colder than their body.

  • Room temperature should be kept at 20°C.

  • It is never safe to put your baby to sleep in an adult bed, on a couch or on a chair.

  • If you choose to sleep in bed with your baby, put them in their own baby bed beside you – for example, a pēpi-pod® or wahakura. This may help to reduce the risk of your baby suffocating while they are asleep.

  • Smoking could put your baby at risk for breathing difficulties. Stop smoking, or smoke outside, with outside clothes. Remove smoking clothes, wash hands and brush teeth before touching baby.

Skin care

It is recommended that you do not bath /shower your baby in the first few days. This can cause baby unnecessary stress and baby could become cold. The result could then be a very exhausted baby, who doesn't wake for normal feeding cues.

This could also dry your baby's skin and interfere with the normal skin barrier, washing off vernix, and natural bacteria.

Please don't use any baby products to bath baby, as the chemicals could dry and damage the skin barrier.

You could use perfume-free aqueous cream or a mineral oil like olive, almond or coconut oil (nothing in baby's face though...)

A nappy barrier cream could be used.

Most babies have dry skin and 'peel' the top layer of skin off. You can use aqueous cream or a mineral oil. It sometimestakes weeks to smooth out.

Baby acne

Baby acne is a common, usually temporary skin condition that develops on a baby’s face or body. It results in tiny red or white bumps or pimples. In almost all cases, the acne resolves on its own without treatment.

Baby acne is also known as neonatal acne. It occurs in about 20 percent of newborns.

Baby acne is different from infantile acne in that open comedones, or blackheads, don’t usually appear in baby acne. These symptoms are common in infantile acne. Infantile acne may also appear as cysts or nodules. In rare cases, it can leave scars without treatment.

Baby acne only happens in your baby’s first few months of life. Infantile acne can last until your child is 2 years old. Infantile acne is much less common than baby acne.

It’s unclear why baby acne develops. Some researchers believe it’s caused by maternal or infant hormones.

Like acne in adolescents and adults, baby acne usually appears as red bumps or pimples. White pustules or whiteheads may also develop, and reddish skin may surround the bumps.

Babies can develop acne anywhere on their face, but it’s most common on their cheeks. Some babies may also have acne on their upper back or neck.

Acne may become more pronounced if your baby is fussy or crying. Rough fabrics can irritate the acne, as can vomit or saliva that stays on the face.

Baby acne may occasionally be present at birth. But, in most cases it develops within two to four weeks after birth. And it may last for a few days or weeks, though some cases may last for several months.

Eczema

 

Eczema usually shows up as red bumps on the face. It may also appear on knees and elbows as your baby gets older. Eczema can become infected and appear yellow and crusty. It may worsen as your baby starts to crawl around and scrape up their knees and elbows. It is usually easy for your doctor to distinguish between baby acne and eczema.

The most common type of eczema is known as atopic dermatitis.

Seborrheic eczema is the condition most often misidentified as baby acne. It’s also known as seborrheic dermatitis and crib, or cradle, cap.

Eczema can be treated with over-the-counter (OTC) products such as Aquaphor and Vanicream. A mild medication may also be prescribed.

You may also be asked to remove food allergens from your home and give your baby daily probiotics.

Erythema toxicum

Erythema toxicum is another common skin condition that may appear as a rash, tiny bumps, or red blotches. It can be seen on your baby’s face, chest, or limbs in the first few days after they’re born.

It’s harmless, and it usually disappears in less than a week after birth.

Milia

Milia are tiny white bumps that may develop on your baby’s face. They occur when dead skin cells are caught in tiny pockets of skin and may appear within a few weeks of birth.

Milia are unrelated to baby acne and don’t require treatment.

  • Baby acne usually disappears without treatment.

  • Some babies have acne that lingers for months instead of weeks. To treat this stubborn form of baby acne, your baby’s pediatrician may prescribe a medicated cream or ointment that helps clear up the acne.

  • Don’t use OTC acne treatments, face washes, or lotions. Your baby’s skin is very sensitive at this young age. You might make the acne worse or cause additional skin irritation by using something that’s too strong.

1. Keep your baby’s face clean

Wash your baby’s face daily with warm water. Bath time is a great time to do this. You don’t even need to use anything but water, but if you want to, look for a mild soap or soap-free cleanser. Don’t hesitate to ask the pediatrician for recommendations.

Fragrance-free products are least likely to irritate your baby’s skin.

2. Avoid harsh products

Products with retinoids, which are related to vitamin A, or erythromycin, are commonly used for adult acne. However, they aren’t usually recommended for babies.

Don’t use any scented soaps, bubble bath, or other types of soaps that contain excessive chemicals.

3. Skip the lotions

Lotions and creams may aggravate your baby’s skin and make the acne worse.

4. Don’t scrub

Scrubbing the skin with a towel can further aggravate the skin. Instead, gently sweep a washcloth over the face in circular motions.

Once the cleanser is washed off, use a towel to pat your baby’s face dry.

5. Don’t squeeze

Avoid pinching or squeezing the acne. This will irritate your baby’s skin and may worsen the problem.

6. Be patient

Baby acne is typically harmless. It is not itchy or painful for your baby. It should quickly resolve on its own.

Sneezing/blocked noses

Babies nearly always breathe through their noses. Young babies have small nose tubes that naturally contain more mucus. Babies often sneeze, just like adults do, which helps keep their nose clear. 

Your baby may sound sniffly, since their nose is small and can easily become blocked – especially when they’ve got a cold. However, not all sneezes or sniffles mean that your baby has a cold. 

Sticky eyes

Your baby's tear ducts can sometimes become blocked, and this is called sticky eye. Tear ducts are tubes that drain fluid from the inside corner of the eye into the back of the nose. Newborns' tear ducts are naturally tiny and can block easily. When this happens, the normal eye fluids can’t properly drain away and fluid collects, making the eyes look watery and sticky. One or both eyes can be affected.

Your baby will usually grow out of sticky eye around three four months when their tear ducts are bigger.

If you notice your baby's eye looks watery or sticky you can carefully clean their eye and help the tear ducts to drain. Here are some tips to help clean your baby's eyes:

  • wash and dry your hands carefully before touching your baby’s face 

  • use a separate cotton wool ball or tissue each time you wipe the eye, and use a separate one for each eye 

  • moisten the cotton wool or tissue with cool, boiled water 

  • gently wipe the eye from the inside corner to the outside, discard  the ball or tissue and repeat with a clean one if the eye still looks sticky 

  • use another clean cotton wool swab or tissue to gently pat the eye dry 

  • repeat regularly a couple of times a day if needed.

Homemade normal Saline

100mls cooled boiled water, tip of a tsp of salt and tip of a tsp of baking soda. Normal saline can also be used to clean the cord and for blocked noses.

 

Umbilical care

Keep the cord and navel clean with plain water and keep it dry

The cord usually dries and falls off in 1-2 weeks' time

Before the cord falls off, there might be some yellow discharge and a really bad smell from the belly button. As long as the skin around the cord is not red or inflamed, this is nothing to worry about...

Vitamin K

 

Vitamin K is a blood clotting factor. It is produced by bacteria in the gut. Newborns have a lower level of Vitamin K since they initially have very little gut bacteria. A very small number of babies can develop severe internal bleeds due to this. Although this is uncommon (2-10 cases per 100 000 births), the consequences can be severe – leading to blood transfusions, brain damage, and death.

An injection of Vitamin K into the baby’s thigh soon after birth has been shown to reduce the incidence of this kind of bleeding dramatically. Three oral doses can be given instead over the course of six weeks, although this is not as effective as an injection.

It is your choice whether or not your baby has Vitamin K at birth. In some cases, Vitamin K would be more strongly recommended as the baby may be at higher risk. For example, premature babies (who have even lower levels of Vitamin K), babies of mothers on certain medications, sick babies, and those born by instrumental birth or a long labour where there is an increased chance of bruising.

http://www.patient.co.uk/doctor/Haemorrhagic-Disease-of-Newborn.htm

Well Child / Tamariki Ora

 

Your midwife or Lead Maternity Carer (LMC) will visit you up until 4-6 weeks after birth, providing care for you and your baby. Before discharge, your baby can be referred to a Well Child Provider. Visits may start at about 5 weeks and so overlap with your midwifery care. The Well Child visits are less frequent but continue until your child goes to school. The Well Child visits are for ensuring your child is growing well, and include discussions about introducing solids, dental hygiene, vaccinations, and development as appropriate to the child’s age.

Well Child visits are free. They are not compulsory, and you can change your provider or stop care if you wish at any time.

You will be given a Well Child book at your baby’s birth. This book contains information on child development, sickness warning signs, and first aid. There are expected weight and height charts for your child, and checklists for development for you to fill in. The book also contains records of any immunisations, hearing screening, and metabolic screening

General Reminders:

  • I will weigh your baby for the first time between 5 and 7 days old unless I am really concerned before that time. Baby can lose up to 7% to 10% of their birth mass at their first weigh and then they start gaining weight. By 2 weeks of age baby should have regained their birth mass.

  • To work out how much expressed Breastmilk / Formula baby needs, use this formula:

    • Weight x 150 / number of feeds in 24 hours (usually 7).

    • E.g Weight of 3.800kg x 150 = 570. Divide by 7=81.428                                             

    • Therefore, baby needs about 82mls every feed. This is the minimum baby will need, they can drink more if they want. This gives you an idea as to the minimum amount you need to express

  • Avoid using honey for baby until they are 1 years old. It can cause botulism.

  • Change the sleeping positions for baby so they don't learn to favour one side.

  • It is normal for all babies to be niggly between 17h00 and 22h00 at night. This is not colic. It is also normal for them to be quite windy at this time of night and appear as though they are cramping. You can use Wind drops/Infacol before feeds and massage their stomachs clockwise around their belly button. If they are really niggly, put them in a front pouch as this puts pressure on their stomach and so helps with the winds, as well as giving them the comfort of being close to you. You can also carry them over your arm and put pressure on their stomachs.

  • Sneezing and hiccoughing are very normal and nothing to be concerned about.

  • Baby can see light and dark and sees best about 20cms away from their eyes.

  • It is normal for baby to jerk or startle at a loud noise or sudden change in position.

  • Temperature: A newborn baby should be dressed in 1 layer more than you are comfortable wearing. Placing baby skin-to-skin, covered by a light blanket, will help them to regulate their temperature. If you want to know if your baby is too hot/cold, feel their chest/ back of their neck. The best way to take your baby’s temperature is under the armpit (Normal is 36.5 to 37.4˚C)

  • If you are Breastfeeding, putting baby to the breast often gives your baby valuable nutrient-rich colostrum, helps establish your milk supply, and helps both you and your baby learn how breastfeeding works.

  • Diapers/nappies: Keep track of the number of wet and soiled nappies your baby produces. If you have trouble telling when the nappy is wet, put a tissue in the clean nappy. Sometimes babies will have what looks like “brick dust” in the nappy for the first few days (a pinkish or orange coloured spot). These are called urate crystals, and are normal. Please tell the midwife if they persist, as it might be a sign of dehydration. A baby girl may have a small amount of bloody/mucous discharge from her vagina. This is a response to mother’s hormones and is normal.

  • Muscle tone: A newborn needs to be supported when held, but newborn babies should not feel completely limp in your arms.