Transcription:
Prepared Childbirth, Part 2: Meeting Your New Baby

Melanie Cole (Host):  Welcome to BayCare HealthChat. I’m Melanie Cole and today, this is prepared childbirth part two, Meeting Your New Baby. Joining me is Judy Trimble. She’s a Perinatal Educator at BayCare. Judy, thanks for coming on with us and in a previous podcast, we spoke about once labor starts and what to expect. And now, our little beautiful bundle is born. So, what should they expect to happen in that first ten minutes after birth?

Judith Trimble BSN, RNC-OB, C-EFM (Guest):  This is an amazing time. It’s difficult sometimes to describe those first moments when you first gaze at your newborn’s face and hear their voice for the first time. Because they take a big breath and then you know, they cry. And it sounds wonderful. Generally, what we do initially is we try to get the baby dried quickly and put skin to skin. Skin to skin with the mom helps to stabilize the baby’s breathing, their temperature, their blood sugar. It’s bonding time. It can be a wonderful time.

In some circumstances, not too many, but some, we may need to assess the baby under the warmer for stimulation or oxygen. So, it would be right there in your room. We may take the baby over, check the baby out and then bring the baby back over as soon as we can. One thing that we look for, we do an assessment at one minute and five minutes that’s called an Apgar score. It doesn’t have anything to do with their overall health, their long-term living; it’s just an assessment specific for one minute and five minutes. We look at their heart rate, respiratory effort, muscle tone, reflex irritation, which is their cry, and their skin color. They get zero, one or two points for each one at one minute and five minutes.

Generally, a first Apgar would be maybe seven or eight, maybe nine. Second Apgar is usually eight or nine. It’s not usually ten. Because their hands and feet do remain a little bit bluish after they are born. Their body is pink, but their hands and feet are a little blue. Usually, anywhere from about one to two minutes after the baby is born, the doctor or midwife will clamp and cut the cord. The reason we wait a minute or two is because the baby’s blood circulates via the umbilical cord to and from the placenta and when the baby is delivered, about a third of their blood is still in the placenta. So, if they wait one to two minutes, that blood will travel over into the baby, then they will clamp and cut the cord.

If you are going to do any kind of cord banking, cord blood banking, if you have read anything about it, it would be done obviously, once the cord is clamped and cut.

Host:  Well thank you for that excellent description. So, newborn appearance. You mentioned that the limbs are not always as pink as the rest of the body. What about the head shape? Because little babies heads come out of very small canal and they can be many shapes when they come out. Women shouldn’t worry about that should they?

Judy:  They should not worry about it. The head can be oddly shaped. It usually looks large in proportion to the rest of their body anyway. But there can be molding or change of shape, sometimes like a little lump like feeling. Usually, it’s going to go away over the next few days and I usually say just go ahead and put a hat on them and then no one will ever know, and you’ll never have to explain why their head was shaped funny. They also will have newborn hair. There are three different kinds. They can be bald, have peach fuzz or thick hair. Usually they are going to lose it and it’s going to grow back as they go into their first year. Some babies are covered with this yellow, creamy, it’s almost like lotion. It’s called vernix. The closer they are to their due date, the less vernix you are going to see. But sometimes babies are born with it like on their face, on their bodies and all we do is just sort of rub it in, wipe it off a little bit. And then the rest of it is washed off when they have their first bath.

Usually the first bath isn’t until around eight hours after they are born. Their eyes can look puffy. Usually that’s just because they’ve been soaking in amniotic fluid for nine months. They were squished on their way out and then we usually put some kind of an antibiotic ointment in. So their eyes can look a little puffy.

The more hair they have on their head, usually, the more they have on their shoulders. They can look like they have sideburns. It’s called lanugo. It’s something that’s going to rub off. You are going to find it in their blankets and on their clothes as the weeks go by. So, lanugo doesn’t stay. They may look like their breasts and genitalia are a little swollen. That’s just the consequence of their mom’s hormones and that does go down on its own.

They are also born with some really amazing reflexes. One is palmar grasp. You can put your finger in your baby’s palm, and they’ll grab right on which is really a fun thing to have happen. They also suck. You can put your finger in their mouth, and they are going to suck on it. They root around. If you brush their cheek, they are going to move towards your finger to maybe suck on something, usually breastfeeding. They have hiccups. And they sneeze and they cough, and these are all totally normal things that a newborn would do.

Host:  It’s so fun to hear you discuss all of this and I’m smiling as even when you are talking about this. But now comes the part that many parents don’t know what to do about and are afraid of is the crying. Babies cry. And usually when they need something, but not always. So, tell us about baby crying and what parents can expect when they get home. How they can cope with that crying and if you can even tell them what it means.

Judy:  It’s interesting that you brought that up. Usually we think babies are going to sleep a lot more than they actually do. And they’re actually going to cry more than their parents are expecting initially. On average, babies sleep 13 to 17 hours a day and may cry from one to four hours a day. It’s not necessarily that you’re doing anything wrong that makes them cry. It’s just their way of communicating. You can’t spoil a baby by responding to their cries. Sometimes the reason they are crying is they do just want to be held. Sometimes, when they cry enough, they need to be held so that you can burp them because they’ve swallowed some air while they were crying. They do have some times during the day where they have awake states and sleep states. They don’t deep sleep very often. They do have a light sleep which is much more common where you watch them and they sort of twitch. It looks like their eyes are moving under their lids. They may make sucking sounds or grimace. They stir, they root around, they make sucking noises. And usually that’s an indication that they are ready to be fed.

If you can catch them right then and pick them up and feed them; then they won’t get into such a cry. They also have a drowsy state, a quiet alert state which is really the most pleasing as the weeks go by. Active alert and then crying. And so, basically, your goal is to try to calm them down and to help them to stop crying. It’s important to remember that sometimes they are just going to cry. You can try every trick you know; they don’t want to be fed, they don’t want to be burped, they don’t need to be changed, they just are crying. It’s okay for you if you are by yourself, and the crying is really getting to you; to put them in their crib, in a safe spot, walk away, shut the door, go make a cup of tea, calm yourself down, come back and then deal with it.

Ideally, you can hand them off to somebody else. But if you are by yourself, don’t be afraid to do that.

Host:  That’s really great advice. Another thing that happens sometimes at the hospital, sometimes depending on religious views, it happens after the hospital. What about circumcision? Do we circumcise our little boys? What do we need to know about that and if we do, what do we need to know about taking care of that?

Judy:  Circumcision really is an individual choice. The American Academy of Pediatrics, their statement is the preventative health benefits of circumcision outweigh the risks but not enough to recommend routine circumcision of all newborn boys. They advise parents to weigh the medical information in the context of their own religious, ethical and cultural beliefs and practices. In 1979, the rate of circumcision was about 65%. In 2010, it was about 58%. The circumcision is usually done by the obstetrician. There’s a special little board that they use that they fit the baby in. They wipe off the penis. They use an anesthetic. And then they remove the foreskin. Either way that you do, if you decide to have a circumcision or not, the nurses that are taking care of you on the maternity unit are going to give you a really good explanation of how to take care of both.

Host:  And Judy, what do new parents need to know before they can take their baby home from the hospital?

Judy:  Okay, there’s a few things that will take place while you are on the maternity floor. They usually give you a list, a checkoff list of the things that you are going to need to get done. One of them is they will fill out the birth certificate information, they’ll bring it back to you and then you’ll sign it. and then it will be sent off. That also includes the social security number application which is important. The discharge coordinator will visit you and also financial services will visit you so if you have any trouble paying your bill, if you need anything more for your baby and you’re having issues with that; they can help take care of that.

There’s helpful videos that are on the hospital TV which they’ll sort of assign you so that you can go through review how to take care of your baby so that basically all of your questions are answered before you leave to go home. They’ll also give you a booklet which will give you a website that you can go to if you have questions after you go home. If you are breastfeeding, the lactation consultant will visit you every single day. The baby will have a discharge physical by the pediatrician or neonatologist before you go home. And then they are going to want you to make an appointment with your pediatrician for the day after you go home or the day after that. So, at least before two days go by, you’ll be taking your baby back to the pediatrician to have them check them out, weigh them and make sure that everything is going okay. They’ll also do baby photos. They take them and then you can decide which ones you want just by going on their website.

They’ll also do some screenings before your baby is ready to leave. One is a hearing screen. Every baby gets one. They do it very quietly. It’s in your room when your baby is sleeping. They’ll do an oxygen saturation test, which sounds kind of complicated but basically, they just put a little sensor on your baby’s wrist or foot and record what their oxygenation saturation is. And they can tell that their circulation is going well. They’ll do a newborn jaundice screening with like a little handheld device where they touch your baby’s forehead and they can see what their bilirubin level is. And they’ll also do a PKU metabolic screening. We’ve been doing them for decades. They are testing for very unusual metabolic disorders and then if there’s any problem with them they will let your pediatrician know. It’s things that hardly ever happen. It’s a little blood test but if your baby does have any of these metabolic disorders, they can take care of it right away instead of letting it go.

Some of the things that they are going to make sure that you know about before you leave the hospital. One of them is how to take care of a circumcision and all the other things that you need to know about taking care of your baby. Diapering, and one of the most important things is a car seat. They are going to want you to bring your car seat in, usually the car seats are the kind that have a base in the car and then you put the seat into it. they’ll want you to bring that in and you’ll need to adjust the straps to fit the baby. That’s one important thing.

They are also going to talk to you about Back to Sleep. Back in 2011, the American Academy of Pediatrics promoted Back to Sleep. They felt like babies were more likely to stop breathing and experience Sudden Infant Death Syndrome if they are laying on their bellies. So, they promoted this. It was a really big thing and it was a huge change. The incidence of Sudden Infant Death Syndrome went down incredibly. But then it sort of plateaued. And so, in 2016, the American Academy of Pediatrics revisited it because they felt like there was a higher incidence of Sudden Unexpected Infant Deaths during sleep related times. This was due to accidental suffocation and strangulation. So, they revised their recommendations and they recommended that baby is Back to Sleep for every sleep using a firm sleep surface. They recommend breastfeeding. They recommend room sharing. The baby would be in your room for the first year, but they don’t recommend bed sharing. They suggest you keep soft objects and loose bedding away from the infant’s sleep area. You consider offering a pacifier at nap time once breastfeeding is established.

You avoid alcohol and drug use during pregnancy and after birth. Avoid overheating. And head covering infants. And avoid the use of commercial devices that are inconsistent with safe sleep recommendations. There’s another thing to keep in mind. A lot of times, our mothers and our grandmothers put their babies on their bellies to sleep. And so, you really need to do some educating of your family and anyone that’s watching your baby to know that this is not a recommendation anymore. It’s not recommended that you put your baby on their belly to sleep. Sometimes it seems like they sleep better that way. But the safest way for your baby to sleep is on their back.

Host:  And in just the last minute, give us your final thoughts and the importance of postnatal care, and what an exciting time it is. Wrap it up with your best advice for new parents.

Judy:  Having a baby presents some of life’s greatest challenges and rewards. It can be an amazing time of wonder, and joy and bewilderment and stress. It’s very important for you to have somebody to talk to about it. Just recently over the last year, on the postpartum floor, when they are doing the last testing on the baby, different blood tests and things that they do before you take your baby home; they’ve been giving the mom like a survey to fill out about how she’s feeling emotionally as far as from having her baby, how she’s coping with it at that point. It’s very, very important to be honest about that. There is help out there for you if you’re feeling overwhelmed, if you are feeling like you can’t handle it. People want to know that. Your obstetrician wants to know that. There are support groups that BayCare has where they definitely want to know and help support you. Don’t let it go. Don’t feel like you’re a bad mother or you are doing anything wrong if you are starting to feel overwhelmed. There’s definitely help out there.

Our goal is that you are a happy mother, happy baby. It’s not going to end when you have your baby. We want to definitely follow-up and make sure that things go for you as best as they can.

Host:  It’s great information and such an exciting time. Thank you so much Judy for joining us today and really sharing your incredible expertise when it comes to babies and delivery. So, thanks again. To learn more about BayCare’s maternity services please visit our website at www.baycarematernity.org for more information. That concludes this episode of BayCare HealthChat. Please remember to subscribe, rate and review this podcast and all the other BayCare podcasts. I’m Melanie Cole.