The baby’s first cry at the time it takes its first breath is one of the most welcome sounds any mother hears. Yet motherhood is not easy. It is one of the most challenging tasks that face mothers, especially, those who are mothers for the first time. A newborn baby not only needs love, it needs proper caring and handling from the minute it is born, wiped dry, and placed on its mother’s chest for its first feed – breast milk is nature’s gift to all mothers, which for the next six months will provide all the nutrition it requires.
Senior Lecturer and Head, Dept. of Paediatrics, University of Colombo and Consultant Neonatologist , University Unit, De Soyza Hospital for Women, Dr Nishani Lucas, discusses in detail what every mother should know so that the future citizen of the 21st century will enjoy a healthy life from birth.
Excerpts from her interview with the Sunday Observer…
Q. Describe in detail what happens when a baby who spends 38- 42 weeks inside its mother’s womb, finally emerges from its safe cocoon to face the challenges of the outside world.
A. Baby will give its first cry at the time of birth, when it takes its first breath. If it does not cry at birth, it will require resuscitation. Thereafter the baby will be delivered onto your chest, wiped dry and placed between your breasts to receive skin to skin contact to be kept warm, to establish breastfeeding, to be colonized with your flora (good bacteria) and bond with you. Baby will be offered the breast once he/she shows hunger cues i.e licking, putting hands in the mouth, looking around, etc. The first breastfeed should be given within the first hour of birth to ensure optimum benefits. Baby should not be separated from the mother for weighing/ clearing of vernix caseosa (white sticky skin covering) until the first breastfeed is completed. Baby will be observed as to breathing pattern, heart rate etc and sent to the postnatal ward if the observations are within normal range.
Q. How do you know when the baby wants a feed?
A. The mother will be supported by the health staff to breastfeed the baby whenever the baby indicates that he/she is hungry according to the hunger cues just mentioned.
Q. Are night feeds important?
A. It is vital to feed in the night, as the hormone prolactin which increases production of the breast milk peaks around 2 am-3 am. However, you must not wake the baby up for feeds, but feed the baby when he is hungry. Waking the baby up results in an angry and confused baby who will not be interested in feeding.
Q. How long is a breastfeed?
A. Each feed may last from 5 to 15 minutes depending on the breast capacity i.e the amount of milk produced by the breast, this will vary between people as well as in the same person at different times of the day. Baby will latch off the breast when his/her stomach is full and go to sleep. Continuous feeding for hours / throughout the night is not recommended as the baby will keep the breast in the mouth as a pacifier rather than to obtain nutrition. This is also detrimental when starting solid food as baby is not hungry to eat in the morning. Once you feel the breast is empty and that baby has completed the feed, baby should be unlatched in the event that the baby does not do it by himself. Do not use the breast to soothe baby when crying, but use it for nutrition when baby is giving hunger cues.
Q. How often should you breastfeed?
A. The baby’s stomach is the size of a cherry (5ml) at the time of birth and increases to the size of an egg at the end of a month. Many babies will show hunger cues every 1 ½ to 2 hours soon after birth. If the baby has taken a larger feed he may sleep for longer and show hunger cues in 3-4 hours. The time between feeds depends on the amount of milk taken by the baby at each feed. As the baby gets older the space between feeds should get longer as the stomach grows larger and is capable of holding more milk at a given time. Therefore, baby should be feeding every three - four hours when three - four months old.
If a baby demands feeds before 1 ½ hours, it indicates that the baby is not getting enough milk, thereby the feeding technique should be corrected so that the baby latches on the breast. You should not wake the baby up for feeds but only feed in response to the hunger cues.
Q. How do you check if the baby is receiving enough breast milk?
A. Babies tend to lose up to 10% of their birth weight (300g weight loss in a 3.0kg baby) within the first few days and regain the birth weight within 10-14 days. However, babies who lose more than 5% of their birth weight on day 1-2 have been shown to be at risk of losing more than 10% of their birth weight later.
The most sensitive indicator of adequate breastfeeding is weight change in the baby. A baby receiving adequate amounts of breast milk is expected to lose less than 5% of their birth weight. If a baby loses more than 5% of the birth weight on day one they will be given additional support to breast feed while monitoring their weight. Therefore, weight is checked daily in the postnatal ward and also before discharge to ensure that the baby is receiving enough milk at the time of discharge.
The breastfeeding technique is checked in every mother by a nursing officer / midwife trained in lactation and assistance is provided when needed. Those babies who have a satisfactory breastfeeding technique are more likely to be having minimum weight loss and are likely to have established breastfeeding.
Q. How many times should the baby pass urine ?
A. Baby is expected to pass urine only once on day one, twice on day two, thrice on day three, etc and six or more times after five-six days of life. Urine should be colourless indicating that he/she is well hydrated. Dark colour urine may indicate that the baby is not receiving adequate fluids. Passing urine after every feed is normal for newborn babies.
Urine colour and frequency is also helpful in assessing the adequacy of breast milk, especially, after the first week of life.
Q. What about stools? How frequently should baby pass stools? What colour will they be?
A. The baby is expected to open bowel and pass meconium (green-black stool in the first few days) on day one or latest by day two of life. If the baby does not open bowel by the end of day two he/she should be investigated for a lower intestinal obstruction like Hirschprung Disease. Therefore, a baby is not discharged from the hospital until he/she has passed stool.
The frequency of passing stool can vary greatly in breastfed babies. It is normal for a baby to pass stool during/after each feed – this is not diarrhoea. Stools will be watery with particulate matter. It is extremely unlikely for an exclusively breastfed baby to develop an infective diarrhoea.
It is also normal for a baby not to pass stool every day even up-to 10 days provided the baby is otherwise well. Laxatives are not indicated and injudicious use may be harmful. However, if the baby is passing hard stool and is finding it difficult to pass stool he/she should be investigated for a lower intestinal pathology like Hirschprung Disease. Please note that formula milk causes constipation.
Q. When can you bathe the baby ?
A. Baby should be bathed daily after the first 24 hours. You must take precautions that the baby does not get cold after a bath. Prepare a baby bath / small basin inside the house / away from a window/ fan/ air condition with tepid water. Get baby’s clothes and towel ready on a nearby bed. Slowly emerge the baby into the water and wash for 5-10 minutes with soap and water. Dry immediately, dress in new clothes and offer a breastfeed to keep the baby warm.
Q. Danger signs in the baby that would necessitate returning to the hospital?
A. If your baby is behaving differently or is not responding to you as usual seek medical advice. Bleeding, yellow discoloration, poor feeding, not being active, fever, abnormal movement are indications to seek medical attention urgently. The best thing is to plan ahead and organize a method of transport to a hospital with a paediatrician / neonatologist in case the baby becomes unwell. You should not wait until your husband returns home from work, as the delay may be detrimental to your baby as they deteriorate very rapidly.
Q. Any advice summing up what you have already said to enable maximum benefits to newborns?
A. Breastfeed your baby exclusively for six months, continue to breastfeed for two years and beyond until the baby wants to stop. Breastfeeding has been proven to improve IQ by 7-10 points, improve immunity and reduce respiratory infection, diarrhoea, ear infections etc, improve long term health with reduced risk of allergy, diabetes, heart disease, obesity, immune mediated disease, leukemia, etc.
Finally, spend time with your baby. Talk to baby, sing to baby, hug and kiss the baby, read to your baby and play with your baby when he/she is awake. Get to know your baby and identify and enhance his/her strengths as each baby is unique. As he grows, invest in books for the child. Start with “0+” mentioned at the back of books, with one picture in one page and then gradually advance. Listen to classical music. Early stimulation improves brain growth and improve synaptic formation. Take the child to the garden and enjoy nature together. Enjoy your baby, they grow up very fast. Also stay away from computers, televisions, to soothe the baby. Screen time is harmful to babies and results in damage to the brain also resulting in speech delay and poor vocabulary. The World Health Organization has released guidelines on screen time in 2019 which states that children under the age of two should have ZERO screen time.