Care on the Postnatal Ward
You will spend the first few days looking at your baby. You will notice every detail – the colour and texture of their hair, the shape of their hands and feet, and the different expressions on their face. The final colour of your baby’s eyes will not be clear until they are six months old or more. You may notice that your baby’s head appears pointed. This is because while your baby is being born their skull bones overlap.
If you had a vacuum delivery, you may also notice a soft round cup mark on top of the baby’s head. Overlapping or a cup-mark are both normal. Don’t worry; by the end of a week your baby’s head will regain the normal round shape.
Your baby needs a really clean environment, as they have not yet developed immunity to the many germs in our environment. Always wash your hands after changing your baby’s nappy. Discourage visitors from holding your baby unless their hands are very clean. Babies do not like to be handled by lots of people so ask visitors to look but not to lift your baby.
During your stay in hospital, your baby will stay in the cot by your bed. It is best if you use the cot as your baby’s ‘house’. Keep your baby in the cot when changing nappies or dressing them. Do not put your baby on your bed at any time, as there is a risk of the baby falling off.
The midwife’s check
While you are in hospital, the midwives and doctors will check your baby’s health and wellbeing. Like you, your baby will have a daily check with the midwife. She will ask you about your baby’s feeding pattern and whether they are having wet and dirty nappies. The midwife will also check the colour of your baby’s skin for a yellow discolouration called jaundice. She will discuss your baby’s sleeping pattern with you. The midwife will examine the umbilical cord to make sure it is clean and dry. The midwife or care assistant will show you how to bath your baby, change the nappy, care for baby’s delicate skin and how to look after the umbilical cord.
We will give you advice and support about aspects of feeding while in hospital. If you are formula feeding the midwife will show you how to sterilise bottles and how to safely make up feeds.
The doctor’s check
A doctor from the paediatric team will carry out a thorough physical examination of your baby before you both go home. They will put a probe on your baby’s hand or foot to check their oxygen levels. This will not hurt or disturb your baby in any way. A specially trained doctor will check your baby’s hips by gently bending the legs upwards and then rotating the hips outwards; this test will detect a dislocated or ‘clicky hip’. Clicky hips are a common problem that can be corrected easily while the baby is young and therefore prevent long-term damage.
Care of umbilical cord stump
The umbilical cord stump and clamp usually stay in place for about eight to 10 days after birth. Keep the cord area clean and dry – no special cleaning is recommended. After seven to 10 days the stump will simply fall off, leaving the ‘tummy button’ in its place.
If you notice the stump is moist, dirty with an unpleasant smell or if the area around it is red you should tell the midwife, as it could be a sign of infection.
Jaundice
Jaundice is very common, occurring in as many as 60% of all newborns and is called ‘physiological jaundice’. The baby’s skin and whites of their eyes take on a yellow tinge due to excess levels of bilirubin. This type of jaundice is visible within the first few days of life and usually disappears within 10 days without any treatment. A baby with jaundice may be sleepier and we will encourage you to make sure that your baby is waking up regularly for their feeds.
If the jaundice levels are rising and the midwife is concerned, she may use a skin probe (bilimeter) on the baby’s forehead to test the skin level of jaundice. If the level is high, a paediatric doctor will review the baby.
The doctor may take a small blood sample from your baby to be tested in the laboratory. If your baby needs treatment for jaundice, we will use phototherapy. Phototherapy (light treatment) is the process of using light to eliminate bilirubin from the blood, which can then be excreted through the urine. We will also encourage you to feed your baby regularly as increasing the amount of fluid will help to resolve the problem.
Breast milk jaundice is another common form, usually occurring four to seven days after birth and can last for three to six weeks. This is not harmful to your baby.
Sometimes jaundice can be a sign of a serious problem, for example, if jaundice appears within 24 hours of birth. It can also occur in a baby that is premature or it could be a sign of infection or when the baby’s body is unable to process and remove bilirubin.
Signs of significant jaundice include when:
- baby’s skin takes on a yellow colour beginning on the face and then moving down to the chest and body;
- baby is tired and sleeps most of the time;
- baby is slow to feed and does not feed well;
- baby’s nappies are dry; and
- baby appears to have a fever and appears sick or off-form.
If these signs are present it is important that you get medical advice and treatment immediately.
Newborn bloodspot screening test
This test is also known as the ‘heel-prick test’. It identifies babies who may have rare but serious inherited conditions, which are treatable if detected early in life. Early treatment can improve their health and prevent severe disability and even death. The conditions are phenylketonuria (PKU), maple syrup urine disease, homocystinuria, classical galactosaemia, cystic fibrosis and congenital hypothyroidism.
When your baby is due to have the heel prick test, you will be given information and asked to sign the newborn screening card to confirm that you have received information about the programme, that the information about your baby is correct and that you consent to the test being done.
Screening your baby for these conditions is strongly recommended, however it is not compulsory. The test is done between 72 and 120 hours after your baby is born, so it may be done by a midwife or else by the public health nurse. The midwife will prick your baby’s heel using a special device to collect some drops of blood onto a special card, which is then sent away for testing. Occasionally a second blood sample from your baby’s heel will be required. If the test results show that your baby does not have any of the conditions, you will not be contacted.
Newborn hearing screening
All babies born in the Rotunda are offered newborn hearing screening before they are discharged. This will screen for congenital nerve deafness. The test takes place at the bedside for well babies and in the neonatal unit for babies admitted there for more than 48 hours. The test takes just a few minutes. A failed test in either or both ears does not necessarily mean your baby has a serious hearing loss, but may be due to the ear canals being full of fluid following birth. If your baby fails three tests they will be referred for a more advanced specialist hearing assessment.
If you are discharged home before the screening test an outpatient appointment will be arranged for your baby to have the test. For the small number of babies who have nerve deafness, early detection means they can be fitted with hearing aids as early as three months. This reduces the long-term speech and social interaction difficulties that come from not having hearing in the normal range. Without newborn hearing screening most of these babies would not be detected until close to three years of age. If your baby passes the test but there is a strong family history of nerve deafness or you have concerns regarding your baby’s ability to hear you will be offered specialist screening around nine months of age.
Bathing your baby
The skin on a newborn baby is delicate and needs to be treated with care. It is not recommended to bath babies for the first 24 hours after they are born. This allows the baby’s natural oils to soak into the skin. If your baby’s hair is bloodstained following the birth, you can use warm wet cotton wool to gently loosen and remove the blood. The midwife or care assistant will show you how to hold and support your baby as you wash them. You need to get everything together before you start. This is because the baby can get cold very quickly so it is very important to organise yourself before you take off your baby’s clothes. A baby does not need a bath every day, two to three times a week is enough to keep baby fresh in the first few weeks. On the days that you do not bath your baby you can ‘top and tail’ by washing your baby’s face, the folds under the neck and arms and bottom.
Most newborn babies will cry with great gusto during their first few baths. This does not mean that your baby is distressed, it is just something new and very soon your baby will learn to love bath time.
Preparing for bath time
- Collect clean bath towel, clothes, nappy, cotton wool or wipes and place them beside the bath.
- Close any windows near you to prevent a draught.
- Put the cold water into the bath first, then the warm water.
- Fill the bath just high enough to cover the baby’s tummy. Four inches (10 cms) is usually enough for a newborn.
- Spread the hot water around the bath evenly with your hand.
- Check the temperature of the water with your elbow – it should feel nice and warm but not too hot.
- Undress your baby and with both hands gently lower the baby into the bath.
- While washing the baby with one hand support their back and head with the other hand.
- Make sure you use both hands to lift your baby out of the bath.
- Lay the baby flat on the towel and cover and dry all the skin folds gently.
Do’s and don’ts when bathing your baby:
- do choose a quiet time when you are not too tired;
- don’t be tempted to answer the phone;
- don’t ever leave your baby alone even for a second;
- don’t leave an older brother or sister to watch over your baby in a bath;
- don’t add any bath products to the water for the first month; and
- don’t bath your baby directly after a feed, as they could get sick.