Postnatal care

Key Resources

Discharge Education Video

YOU AND YOUR BABY IN THE POSTNATAL WARD

When the midwives in the delivery suite are happy that all is well following the birth of your baby, they will transfer you and your baby to the postnatal ward.

When you are admitted to the ward, the midwife will check the sex of your baby with you by opening the nappy, the baby’s identification bands and security tag. It is important to remember that if you try to move your baby outside the ward area your baby’s security tag will set off an alarm. To make sure your baby is safe and secure, they must wear the security tag and identification bands at all times while they are in the hospital.  If you notice that a band or the tag has come off please tell a member of the ward staff immediately.  They will re-secure it for you.

You will spend the next couple of days in the ward getting to know your baby and preparing for when you leave the hospital to go home. The midwives, student midwives and care assistants on the ward will guide, teach and help you to care for yourself and your baby.  After nine months of anticipation, excitement and probably some nerves, you and your partner can now start the next stage of a wonderful journey as you discover how to be parents.

During your stay in the postnatal ward you will experience a wide range of emotions.  You will feel wonder as you look at this new little person in the cot beside you.  You may also feel overwhelmed that your baby is completely dependent on you for all their care.  Indeed, it is a time of huge learning, especially if this is your first baby.

PAIN RELIEF AFTER BIRTH

Pain relief medications

Most women will experience some pain after giving birth.  It is very important that your pain is well controlled so you can look after yourself and your new baby.

During your time in the Rotunda you will be offered regular pain relief.  Pain will be better managed if you take the prescribed medication at regular intervals, rather than waiting until the pain is bad.

Pain relief medications work in different ways and one pain medicine alone may not be enough to control your pain. Depending on your level of discomfort you may be offered two or more medications to control your pain. Combining different types of pain relieving medications may give you better pain control and allows lower doses to be used.

To assess your pain, you will be asked to score it from 0 to 10 where 0 is ‘no pain’ and 10 is ‘worst pain you can imagine’.  This will help us to decide which pain medication is best for you, and how much you need.  If your pain is not well controlled, please discuss this with your doctor or midwife.

Most women will experience some pain after giving birth.  It is very important that your pain is well controlled so you can look after yourself and your new baby.

During your time in the Rotunda you will be offered regular pain relief.  Pain will be better managed if you take the prescribed medication at regular intervals, rather than waiting until the pain is bad.

Pain relief medications work in different ways and one pain medicine alone may not be enough to control your pain. Depending on your level of discomfort you may be offered two or more medications to control your pain. Combining different types of pain relieving medications may give you better pain control and allows lower doses to be used.

To assess your pain, you will be asked to score it from 0 to 10 where 0 is ‘no pain’ and 10 is ‘worst pain you can imagine’.  This will help us to decide which pain medication is best for you, and how much you need.  If your pain is not well controlled, please discuss this with your doctor or midwife.

The following types of pain medication work in different ways and are safe to take together:

 – Paracetamol is a very effective pain medication which also reduces fever (high temperature) and inflammation.

– Anti-inflammatories including Ibuprofen or Diclofenac will help reduce levels of chemicals in your body that cause inflammation and pain.

– Opioids such as Oxycodone, Morphine or Codeine are only used if your pain is not well controlled with a combination of other drugs.

Paracetamol

Paracetamol is a very effective pain medication if it is taken at regular intervals.  The adult dose is 1gram (two 500mg tablets) four times a day (maximum dose per day is 4grams or eight tablets).  If you are taking other medications for pain or over the counter cold and flu remedies, always check with you doctor, midwife or pharmacist if these contain Paracetamol. You should only take one Paracetamol containing product at a time.

Ibuprofen

This can be safely taken with Paracetamol.  The usual dose is 400mgs three times a day. Because these tablets can upset your stomach they need to be taken with or soon after food. If you have asthma, Ibuprofen may make it worse. Tell your doctor, midwife or pharmacist if you have asthma or if you are on any other medications as they may interact with Ibuprofen.

Diclofenac

Diclofenac is usually given as a suppository (100mgs once a day).  It provides good control of your pain in the days after vaginal delivery or caesarean section.  After the first two days you will usually be given Ibuprofen tablets which act in a similar way to Diclofenac.  If you have asthma, Diclofenac may make it worse. Tell your doctor, midwife or pharmacist if you have asthma or if you are on any other medications as they may interact with Diclofenac.

Never take Ibuprofen and Diclofenac together.

Opioids

If the above medications do not fully control your pain, stronger Opioid medications will be used.  Opioids provide very good pain relief, but they are not used as first-line pain-relievers due to side effects including nausea, vomiting, itch, confusion or dizziness, sweating and constipation.

As opioids may affect your co-ordination or cause drowsiness, you should be careful handling your baby. If you feel very drowsy or short of breath after taking opioids, contact your midwife immediately.  You may have to take laxatives while taking opioids to avoid constipation.

Pain relief after leaving hospital

On discharge you will either be advised to buy your medications without prescription in your local pharmacy or you will be given a prescription for pain medications.  Bear in mind that pain is much harder to control if you let it build up so please take your medications regularly as recommended at discharge.  Further information on those medications will be available on the patient information leaflet inside the pack or from your pharmacist.

Pain relief medications and breastfeeding

Paracetamol, Ibuprofen and Diclofenac are safe for use during breastfeeding.  Pain relief medications that contain Codeine or Oxycodone are not routinely prescribed if you are breastfeeding.  If you are prescribed these medications and you are breastfeeding you need to tell the midwife or doctor if your baby is difficult to wake, does not feed well, does not gain weight, or appears limp or floppy.

Always be aware when handling your baby that Codeine or Oxycodone can affect your alertness and can make you drowsy which can slow down your movements and reaction times. Take care when standing up from a sitting or lying down position to avoid dizziness.

CARING FOR YOU

After an epidural

If you had an epidural during your labour and birth, you will need to stay in bed for at least four to six hours after the birth. This allows the effects of the drugs used in the epidural to wear off completely.  Do NOT try to get out of bed by yourself. Even if you think your legs feel normal you may become weak when you stand up. You will be given a call bell so please call us for assistance the first time you want to get out of bed.

Lochia

After the birth of your baby you will lose blood from your vagina. This bleeding is normal and is called ‘lochia’.  The lochia can be heavy for a few days but will gradually settle down and usually stops within four to six weeks after the birth. The blood loss is caused by your womb contracting as it returns to the way it was before you were pregnant.

If the bleeding gets very heavy (for example, it soaks a sanitary pad in an hour or less) or if you notice any clots or a bad smell from your lochia please tell the midwife looking after you.  This could be the start of an infection or a sign of ‘retained tissue’, which could need treatment.

Breast changes

You will experience breast changes in the days after the birth of your baby whether you are breastfeeding or not.  This happens as nature prepares to fill your breasts with milk. You will notice your breasts become swollen, hard and sometimes sore.  However, this period is short because once you have established breastfeeding your body will regulate the milk supply.

If you are not breastfeeding you can help reduce the engorgement by wearing a well-fitting bra with the straps pulled up tightly.  It will also help if you avoid stimulating your breasts so don’t put hot water directly on them while in the shower or bath.  Breast engorgement will go after a few days if your baby does not stimulate them by sucking to produce milk.

Care of the perineum

Your perineum is the area between your vagina and back passage. If your baby was born vaginally, you may have stitches that become tighter as the wound begins to heal.  This can make sitting down, walking and passing urine uncomfortable.  Take regular pain relief. You could also try sitting on a cushion to relieve the discomfort. 

Wash the perineal area frequently as this will keep the wound clean.  Remember to dry yourself well after washing. There is no need to add any disinfectant or salt to the bath water as research has found bathing in plain water is much better for the healing process. It is also important to change your sanitary towels frequently.   Do not use tampons as they can cause infection in the early days and weeks after you give birth.

Even if you did not need any stitches after the birth, you may still experience discomfort and heaviness in your vaginal area. This is normal as you are likely to be bruised and swollen around the vagina.  Plenty of rest, warm baths (for 5 to 10 minutes maximum), good hygiene and pelvic floor exercises will all help to heal the area. 

Passing urine

Emptying your bladder completely after giving birth is very important. You will be asked to measure how much urine you pass when you go to the toilet for the first couple of times after birth.  This is so that we know that you are emptying your bladder completely.  You should drink at least 1.5 to 2 litres of fluid a day, or 2 to 3 litres if you are breastfeeding.

Bowel movements

Many women worry about opening their bowels for the first time after the birth. They are scared that their stitches might burst. This will not happen and in fact the sooner you start going to the toilet the better. It may help to place your hand, which is covered with toilet paper, under the vagina to provide some gentle support. If you put this off you may become constipated.  To prevent this happening, drink plenty of water and eat high fibre foods such as fruit and vegetables. Gentle exercise will also help.  The best position to sit on the toilet is pictured below.

  • Use a foot stool or raise your heels so that your knees are higher than your hips
  • Lean forward, with your feet apart and your elbows on your knees
  • Breathe in and let your tummy gently swell out
  • Breathe out as you push down towards your back passage
  • Your tummy should stay braced out and don’t allow your tummy to suck back in again
  • Repeat as necessary
  • Allow yourself time, do not rush
  • If you put this off you may become constipated.  To prevent this happening, drink plenty of water and eat high fibre foods such as fruit and vegetables. Gentle exercise will also help.  The best position to sit on the toilet is pictured below.

Blood tests

If your blood group is rhesus negative you may need an injection called Anti-D. We will give you this injection within 72 hours of your baby being born. 

During your pregnancy your blood will be tested to see if you are immune to rubella (German measles). If you are not immune to rubella, you should attend your GP for the rubella vaccine.  If you were identified as not having immunity to chickenpox in pregnancy, you should also discuss vaccination with your GP after pregnancy.

The midwife's check

The midwife caring for you will carry out a daily postnatal check. They will want to know:

  • how you are feeling;
  • if you are in any pain;
  • if you are experiencing any difficulties with the baby;
  • how much you are bleeding vaginally (lochia); 
  • that you are passing urine without too much discomfort.

The midwife may also check your breasts, your tummy and, if you have stitches, your perineum. She will ask you if you have pain especially in your legs and she may check your haemoglobin (iron) level by taking a blood sample.

If you were taking any medication, for example, blood pressure tablets before the birth, then you will continue to take these while in hospital. During this daily check the midwife will give you information and advice about taking care of yourself. She will happily answer any questions you may have.

The doctor's check

If your baby was born by caesarean section or if you had an instrumental (vacuum or forceps) delivery then a doctor will visit you on the postnatal ward.

They will be happy to answer any questions you have about the birth of your baby. 

Sometimes, the doctor may advise you to return to the hospital for your six-week check if they think they will need to talk to you or examine you again. Otherwise you should visit your GP around this time.

Baby blues

It is common to feel a little low a few days after your baby is born. The ‘baby blues’ describe weepy moments you may have during this time. Feeling overcome, emotional and crying for no apparent reason is a very normal response to the massive change that has happened in your life.  You can feel overjoyed and frightened all at the one time. The tears may start for no reason.  Don’t be frightened by this, just go with it and have a good cry.  As long as every day is not a tearful one you will be fine.

Having support on ‘baby blues’ days can be invaluable.  A partner, mother or friend who will cuddle the baby while you have a bath and a cry will seem like a godsend to you!  (See section on postnatal depression later in this chapter for more information.)

You will be asked to fill out a simple questionnaire called the ‘Edinburgh score’ before leaving the hospital. It will ask you to consider your mood and feelings at the time around the birth of your baby. This is a simple tool we use to identify mothers who are emotionally distressed. When you leave hospital, we pass on the score you received on the questionnaire to your GP and public health nurse (PHN). If you do have negative feelings, talking about them and planning a recovery programme can help prevent postnatal depression.

CARING FOLLOWING CAESAREAN SECTION

Immediately after surgery

Once your baby is born and providing you and your baby are both well, the baby can be placed directly on your chest for skin to skin contact. Your partner can hold your baby skin to skin if you are unable to do so at the time of birth. Skin to skin contact with you can be continued or commenced on the postnatal ward.

When you arrive on the postnatal ward after your caesarean section, you will have a drip in your arm, through which you will be getting intravenous fluids. You will have a catheter which will drain urine from your bladder for the first 24 hours and you will pass urine normally within six hours of the catheter being removed. There will be a wound dressing on your abdomen over the caesarean section scar, which will be removed after 72 hours. The drip will be continued until you are able to drink enough fluids to stay hydrated and we are sure that the bleeding is not excessive.

If you had a spinal or epidural you will feel numb from the waist down for up to six hours after surgery.  After that time, feeling and sensation will gradually come back into your legs. It is important that you do not try to get out of bed on your own during this time. If you had a general anaesthetic, you may feel groggy and sleepy for the first few hours. You may have a special pump attached to the drip through which you receive pain medication.  This is known as patient controlled analgesia and the midwife will show you how to regulate the pump yourself.

During the first few hours after surgery, the midwife will be checking your observations regularly, including your temperature, pulse, blood pressure, respiratory rate and oxygen saturations, the wound dressing for signs of bleeding and your vaginal blood loss. She will encourage you to move your body a little in the bed at least every two hours so that a pressure sore will not develop. You will continue to wear white surgical stockings while in hospital and you will be encouraged to bend and move your legs to help prevent a blood clot developing in your leg.  You will also receive heparin injections to prevent a clot from forming.

Diet after surgery

Once you are fully awake after surgery, you will be offered sips of water. Usually you can have tea/coffee and toast about four hours after surgery. If you are feeling ok after this we can stop the intravenous fluids.  The catering staff will offer you a daily menu choice. If you would like something other than what is on the menu please ask the catering officer. Fruit or nuts can be a good snack especially when you are breastfeeding.  Drink plenty of water to prevent dehydration and constipation.

Care of your wound

The wound dressing is removed 72 hours after surgery. You can then have a shower and you should pat dry the wound rather than rubbing it. The wound must be kept clean and dry to prevent an infection. The midwife will check your wound every day.  You may have dissolvable stitches, or clips or beads, which will be removed after four or five days. Sometimes the doctor may ask that the wound is covered for longer, or that the stitches or clips stay in for a longer period.  Wear panties that come up above your wound, to avoid friction on the wound site. The physiotherapist will visit you after the operation and she will advise you on postnatal exercises.

Caring for your baby

Your baby will stay at your bedside on the postnatal ward, unless your baby needs admission to the neonatal unit.  If you are breastfeeding the midwife will help you and show you different positions to hold your baby so that they will not hurt your wound.   The staff will help you to become confident in caring for your baby.

Preparing for discharge

You will know the evening before your discharge that you will most likely be going home the following day. Ask your partner to bring in your clothes and the baby’s clothes and car seat for going home. We will try to have you ready for home by 11 am. We will advise you where to go for your six week postnatal check up. Try to feed your baby just before going home as this will help to keep your baby settled while you are travelling and will give you some time to get settled in at home.

It is common to feel tired after the operation, so try to get as much rest as possible at home. Don’t be afraid to accept help from family or friends with caring for your baby. Avoid lifting heavy objects and driving for six to eight weeks after the operation.

POSTNATAL EXERCISES

Immediate care following birth

Rest is important to help with your recovery.  Rest on your back or side to minimise discomfort, reduce swelling and to take the weight off your pelvic floor.  If your perineum is sore when sitting, put a rolled towel or small pillow under each thigh and buttock so that your perineum is not in contact with the chair.

Getting out of bed

Gently pull your lower tummy in. Bend your knees and roll onto your side. Slide your feet over the edge of the bed. Push yourself up to sitting using your elbow and hand.

Getting into bed

Gently pull your lower tummy in. Sit your bottom down square on the bed and then lower your head and shoulders onto the pillow. At the same time lift your legs up onto the bed.

Leg exercises

Move your feet forwards and back and around in circles 20 times every hour while resting in bed.

Pelvic floor and deep abdominal exercises

Pelvic floor and deep abdominal exercises help you return to your pre-pregnancy shape and will help with healing of stitches. They can be safely started 1 – 2 days following the birth of your baby, provided there is no increase in your pain.

 

Pelvic floor muscles

Pelvic floor muscles are very important as they control the bladder and bowel. During pregnancy they become weakened due to pregnancy hormones and the extra weight of your baby. It is important for all women whether they have a vaginal or caesarean delivery to strengthen their pelvic floor muscles.

Exercises for your pelvic floor muscles

To begin with, lie on your back with your knees bent and your feet hip width apart or over on your side.

 Long holds
  • Breathe in and let your tummy gently expand and your pelvic floor relax downwards. As you breathe out, squeeze and lift your pelvic floor. Starting at the back passage, squeeze as if you are trying to stop yourself passing wind and then urine. You may feel your lower tummy tighten gently.
  • Hold for 3 seconds; keep your upper tummy, buttocks and thigh muscles relaxed and breathe normally.
  • Relax completely for 3 seconds. Repeat this exercise 5 times. Repeat 3 times a day.
  • As your pelvic floor muscles get stronger, practice in sitting and standing.
  • Gradually increase the length of time and number of repetitions until you can do a 10 second hold, 10 times. Always stop exercising when the muscle gets tired.
 Quick holds
  • Breathe normally as you quickly tighten the pelvic floor muscles and hold for a second before letting go fully.
  • Repeat 5 times in a row. Repeat 3 times a day.
  • Gradually increase your repetitions until you can do 20 quick squeezes in a row; it may take a few months to be able to do this.
 The knack

Quickly squeeze and hold your pelvic floor muscles BEFORE coughing, sneezing, laughing and when lifting your baby. This will give you more control of your bladder and will help to keep your muscles strong.

To be effective you need to do your pelvic floor muscle training 3 times a day.  If you have any concerns or you are unsure what you are doing, you can come to our postnatal class between 6 and 8 weeks after delivery, or you can make an individual appointment for a pelvic floor assessment in the Rotunda up to 6 months after giving birth, by phoning 01 817 1787.

Pelvic floor muscle exercises - information videos

The physiotherapists in the Rotunda Hospital have made five videos on learning about pelvic floor muscles, doing your pelvic floor muscle exercises, leaking urine and doing exercises after you have your baby.

Leaking urine or wetting yourself when you do not mean to (also known as urinary incontinence), can be treated with pelvic floor muscle exercises (PFME). PFME help reduce symptoms of urinary leakage; in some cases leading to temporary or even permanent relief.

We know from research done at the Rotunda Hospital as part of the MAMMI study, that one in three women leak urine occasionally (less than once per month) before their first pregnancy; one in three first time mothers leak urine once a month or more frequently during pregnancy and as many as one in two first time mothers leak urine 3 months after the birth of their first baby. The numbers are higher in women who have had more than one baby.

The videos can be accessed on our website: www.rotunda.ie and each video is just 3-6 minutes long. 

Healthy bladder and bowel habits

You should empty your bladder within 6 hours of your delivery.  If you have difficulty emptying your bladder, talk to your midwife.

Drink 1.5 – 2 litres of fluid during the day (water is preferable to tea and coffee which may irritate your bladder). You need to drink more if you are breastfeeding. 

Don’t ignore urges to empty your bowel in the first few weeks. Eat plenty of high fibre foods (e.g. fruit, vegetables).

For comfort when opening your bowels, hold some folded toilet paper over your stitches in front of your back passage. If you had a caesarean section, support your tummy with your hands or a folded towel.

Avoid straining – take your time. Sit leaning forward, with your elbows on your knees, and let your tummy relax. Use a foot stool or lift your heels up off the floor so that your knees are above your hips.  Don’t hold your breath. 

If you have any leakage from your bladder or bowel, contact the physiotherapy department to make an individual appointment on 01 817 1787.

1. Deep abdominal muscle exercises

Abdominal muscles are important for back support and in maintaining good posture. During pregnancy, your abdominal muscles stretched and became weakened.

Lie on your back, knees bent and feet hip distance apart.

Breathe in: let your tummy rise.                 

Breathe out: gently tighten your lower abdominal muscles by pulling your lower belly in towards your spine (as if getting into tight trousers).  

Keep your upper abdominal muscles relaxed throughout the exercise, breathe normally. Hold the position for 5 seconds.                  

Repeat 5 times, 3 times a day.

Pull in your deep abdominal muscles during activities like lifting your baby and walking.

As you get stronger, you can do the exercise in sitting, on all fours and when standing. Gradually increase the hold time up to 60 seconds.

2. Knee rolls (start as in exercise 1)

Tighten your lower abdominal muscles, slowly lower both knees to the right as far as is comfortable.            

Use your tummy muscles to slowly bring your knees back to the middle and relax there. Repeat to the left.         

Repeat 3 times each side, 3 times a day.             

Slowly increase your repetitions till you can do 10 each side.

3. Pelvic tilts

Tighten your lower tummy and flatten your lower back into the bed.

Hold for 5-10 seconds and let go.

Repeat 10 times.

Exercises following a caesarean section

The above exercises are helpful in relieving wind discomfort.  When coughing firmly support your stitches with your hands or pillow. If you are in bed bend up your knees.

For the first 6 weeks avoid lifting anything heavier than your baby, including doing housework or other strenuous activity.

Sexual intercourse

If you are not experiencing any problems you can start as soon as you feel ready. Choose a comfortable position, use lubrication and start gently. If you have persistent pain or discomfort, contact the physiotherapy department to make an individual appointment by phone 01 817 1787.

Back care

When lifting, bend your knees, keep your back straight and always tighten your pelvic floor and abdominal muscles. Hold the object firmly and close to your body.  Make sure your work surfaces are at waist height (e.g. bathing & changing your baby).  

Create a supportive position for feeding.  Sit well back in the chair, make sure your feet are supported and use pillows help lift the baby up to your breast.

Start gentle walking as pain/discomfort allows; gradually increase your distance and then your speed up to a 30 minute walk each day. You can start swimming when you have had 7 days in a row free from vaginal bleeding or discharge.  Wait 3 months or more to return to heavy exercises, sit ups or weights. If you have any leakage of urine or heaviness into the vagina with a particular exercise it means that your pelvic floor muscles are not strong enough yet and it is too early to do the exercise. 

Postnatal 'core and pelvic floor' exercise class

We recommend that you attend the postnatal exercise class within 6 weeks if you had a vaginal birth and within 8 weeks if you had a caesarean section.  It is very important to attend the class if you are having problems with your bladder or bowel control or with back or pelvic pain. It is an opportunity to learn how and when to return to exercise and to meet other mums. You are welcome to bring your baby with you to the class, which is held every Thursday from 11.30 am to 1.00 pm in the physiotherapy department. Please ring 01 817 1787 to make a booking.

CARING FOR YOUR BABY

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.

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.

Before you go home, either a doctor from the paediatric team or a midwife will carry out a thorough physical examination of your baby.  They will put a probe on your baby’s hand or foot to check their oxygen levels. They 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.

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.

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.

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.

 

BIRTH NOTIFICATION AND REGISTRATION

Please be advised, during your in-patient stay you will NO longer meet with a member of the birth notification team as all required details for birth registration purposes is sent directly to the civil registration services.

However, if there are any details unavailable to us, you will receive a phone call from a member of our team.

To register your baby in Dublin, Wicklow or Kildare you will need an appointment. There is now an online appointment system in place, to avail of this service, please logon to www.HSE.ie Civil Registration Service (births, deaths & marriages) and follow the prompts.

To register baby anywhere else in the country, contact your preferred Civil Registration Office as they may have a walk-in service.

NB: For marriages not registered within the Republic of Ireland, you must provide your original marriage certificate and if necessary a certified translation at the time of registration.

DAHR Registration contact details: dahr@welfare.ie

GOING HOME WITH YOUR BABY

How long you stay in hospital will depend on the type of delivery you had or if you or your baby had any complications following birth. We recommend that you stay in hospital for at least 24 hours unless you are going home under the care of the community midwifery team (DOMINO and ETH). If you are breastfeeding for the first time and are not living within the community midwives’ area, we recommend that you stay in hospital for 48 hours. While in hospital, try to get as much rest as possible.

Guide To You Length Of Stay In Hospital After Birth
 
 If you have access to community midwifery services   6-24 hours
 
 If you don’t have access to community midwifery services
and your baby was born by vaginal delivery and you are:
 Breastfeeding   48-72 hours
 Formula feeding  24-72 hours
 If you had a caesarean section   3-5 days

 

Early Transfer Home (ETH) service

The ETH service is provided by the community midwives who, if all is well, offer women and babies the opportunity to be discharged from hospital within the first 24 hours following birth.

A midwife from the team will then visit you at home for up to a week to provide care, advice and support. The ETH team operates in the local catchment area of the hospital – the north side of Dublin.

The midwives visit the postnatal wards every morning to arrange for suitable women and babies to go home. If you would like to consider ETH, please phone 01 817 6849 or 817 6850. If you are not within the catchment area for the ETH service then your public health nurse (PHN) will visit you within two days of leaving hospital.

Travelling home with your baby

Leaving hospital with your new baby is one of the most exciting and scary parts of the whole pregnancy, birth and baby journey. You and your partner will remember your first night at home with your baby forever.

If you are taking your baby home by car or taxi you must have an appropriate car seat. It is very dangerous and also illegal to travel without a properly fitted car seat.

You should buy your car seat well before your baby is due to be born. You and your partner should become very familiar with the seat and know how to fit it correctly and safely into a car. Babies up to 13 kgs (29 lbs) must be strapped into the seat, which must face the rear of the car – not the front. Never put a rear facing baby seat into the front passenger seat of the car where an airbag is fitted. If the airbag was ever activated, even in a small accident, the airbag could severely injure or even kill your baby. For further information on car safety, please check the website: www.rsa.ie

LOOKING AFTER YOURSELF AT HOME

Travelling home with your baby

As a new mum, it is very important that you take good care of yourself. You should make sure to have someone staying with you for the first few nights. If your partner cannot be there perhaps your mother or a good friend could stay with you. If you have other young children it is often a good idea to let them have sleepovers with your mother or a sister or friend.

Rest and sleep are so important for you and your baby. Try to keep visitors to a minimum until you feel ready to entertain. People who do visit should be encouraged to stay for just a short time. Very often your partner will take charge of organising visitors so he should be aware of your need to sleep.

Stock up your freezer with cooked meals or have family members lined up to provide you with meals for the first week or so. Not having to think about cooking will allow you to spend more time with your new baby. It is important to drink plenty of fluids so have plenty of drinking water easily available.

When breastfeeding you may feel thirsty so keep a drink nearby and avoid very fizzy drinks or drinks with a high caffeine content.

Recovering from the birth

Your body will take time to recover physically from the birth. Your recovery will depend on how your pregnancy and birth went. Recovery will be quicker for some women while others may take a little longer to feel back to themselves. In general, it will take six weeks for a full recovery. You should plan to have at least two weeks dedicated at home to you and your baby. After this you may feel ready to face the world and introduce your new baby to it!

Your bleeding should settle down to a period like bleed over the first three to five days. You may pass the odd small blood clot if you have been lying down for a long time or after you breastfeed. If your bleeding gets heavier and you are soaking pads or passing lots of clots, please ring the emergency and assessment unit for advice – 1800 522 687.

At first, you may experience some stinging when passing urine, but this should ease over the first few days. If you suddenly notice increasing pain when passing urine or severe backache, you should look for medical advice to make sure you don’t have a urinary tract infection.

You may not have a bowel motion for a few days after the birth. This is normal and nothing to worry about. However, it is important not to become constipated so drink plenty of water and eat a varied diet with fruit and vegetables. If you become constipated it will increase the pain and discomfort around your stitches.

You may have pain or discomfort in your vaginal area, particularly if you had stitches. You should try to find the most comfortable position for you when sitting down. Very often it is bruising and swelling that causes the most discomfort. Regular bathing will help. Gentle pelvic floor exercises in the early days encourage the reduction of swelling and are great for easing pain.

Contact the emergency and assessment unit immediately by phoning 1800 522 687, if you have any of the following symptoms:

  • heavy vaginal bleeding, particularly if there are large clots
  • severe pain
  • smelly blood, fluid or pus coming from your vagina
  • red, swollen or painful wound
  • shortness of breath, chest pain or a cough
  • a swelling or pain in your lower leg
  • a temperature, fever or chills
  • feeling generally unwell

The cervical smear test is a screening test, which checks to see if the cells that make up the surface of the cervix are normal. It aims to identify any abnormality which can be simply and effectively treated and therefore prevent long-term problems. You should wait until 12 weeks after giving birth before having a smear test. Cervical screening is free in Ireland with ‘CervicalCheck’. You should register with your GP or Well Woman centre to avail of this service. For further information, check the website: www.cervicalcheck.ie

When to restart your sex life is a very individual decision. Physically, most women will know when their bodies are ready for sex again. Emotionally, it very much depends on how you and your partner are coping with this massive life-changing event. It is important to talk to your partner to make sure you both understand each other’s needs.

METHODS OF CONTRACEPTION

Contraception should involve both partners.  Each couple has to balance the risks and the benefits, bearing in mind their own culture, medical histories and lifestyles. These may change over time and therefore you may choose to use different methods at various stages in your life.

Most contraceptives have very high success rates if they are used carefully and consistently.  Full instructions on using your chosen method should be provided by your GP or family planning clinic.

'Combined' pill

This tablet contains two hormones – oestrogen and progesterone.  It is 99% effective at preventing pregnancy provided you take it correctly.  It is not suitable for women who have a history of a blood clot, high blood pressure or for women over 35 years of age who smoke. 

Progesterone only or 'mini-pill'

This works mainly by preventing sperm getting through the cervix. It is 96 – 98% effective if taken correctly and at the same time every day.  Additional contraceptives are required if the tablet is taken more than three hours late.  It is suitable for breastfeeding mothers and for women who cannot take oestrogen.

Progesterone injection

This works in a similar way to the progesterone only pill and prevents ovulation (99% effective).  The injection is given every 8 – 12 weeks and is effective immediately. It can be safely used while breastfeeding.  It is also suitable for women who do not like or forget to take pills.

Vaginal ring

This is a flexible ring that slowly releases contraceptive hormones into the vagina and is left in place for three weeks and it is then removed. There is a break for one week after which a new ring is inserted.  It is 99% effective.

Patch

The contraceptive patch is worn on the skin.  The hormones are absorbed into the skin and then into the bloodstream.  A new patch is used every week for three weeks.  No patch is worn on the 4th week.  It is 99% effective if it is used correctly. 

Intrauterine contraceptive device (IUCD)

A copper based coil (IUD) or the more popular progesterone containing coil, for example, Mirena is inserted into the womb during a woman’s period and it is effective for 3 – 5 years. Fertility returns quickly after it is removed.  It is suitable for women who want a long term method of contraception or who cannot take oestrogen.  It is also suitable for women who are breastfeeding and it is 98 – 99% effective.

Implants

An implant is a small flexible rod which is placed just under the skin, usually in the upper arm and contains progesterone only.  It is 99% effective and lasts for three years and is suitable while breastfeeding.

Barrier methods

These include spermicidal products, diaphragms, cervical caps and male condoms.  They work by preventing the man’s sperm from entering the womb and are less reliable than hormonal methods.  Diaphragms and caps need to be fitted by a doctor or nurse and require practice to be used effectively.  Condoms are the only method that protect against STIs (sexually transmitted infections).

Natural methods

Natural methods of contraception involve learning how to recognise the fertile and infertile time in your menstrual cycle.  It can be used to achieve or avoid a pregnancy and therefore you can be in control of your own fertility.  It is called ‘natural’ as it does not interfere with any of the normal physiological processes of the body.

Methods include the calendar method, basal body temperature method (BBT), cervical mucus method (Billings Method), muco-thermal method, symptothermal method and ovulation awareness monitors.

The Billings Method can be used while breastfeeding (lactational amenorrhoea) as breastfeeding delays the return of ovulation after birth. The successful use of this method demands full breastfeeding day and night without the addition of other milk, juice, solids or the use of soothers.  It should only be used during the first six months after giving birth, providing that menstrual periods have not returned.

Special instructions should be sought for all natural family planning methods.

Emergency contraception

Usually called the ‘morning after pill’, this prevents pregnancy in the event of unprotected sexual intercourse or failure of a birth control method, such as a condom breaking or slipping or forgetting to take the pill.  It is available over the counter in pharmacies and should be taken as soon as possible after intercourse (up to 120 hours).  It is 75% – 95% effective.  It should not be used regularly as it is only intended for emergency use. 

Remember, women should not wait until the return of their menstrual period before starting contraception as ovulation occurs before menstruation making pregnancy possible. Please discuss with your GP or local family planning clinic.

Surgical methods

These include a vasectomy for men and tubal ligation for women; these must be considered permanent. Therefore, couples should be counselled in all aspects of sterilisation before a final decision is made.

POSTNATAL DEPRESSION

Postnatal depression is common. It can happen to any mother after having a baby, but it is more common if a woman has a previous history of depression. About one in eight women suffer from postnatal depression and many women have had some depressive symptoms during pregnancy.

The suffering caused by postnatal depression is profound and frequently underestimated. Sufferers are robbed of many of the joys that are so commonly written about and portrayed by the media. Women who have always been seen as competent and responsible, leading fulfilling lives, unexpectedly find their lives shaken by this condition that can creep in gradually or strike suddenly without warning.

The negative effects of postnatal depression are often made worse by a delay in diagnosis and treatment. Many women are reluctant to admit to feeling down, as they fear they may be judged ‘bad’ or unfit to care for their baby. Many do not know what is wrong with them or that help is available.

Being a new mother means you can’t do everything you did before the birth. You need to take time to recover from the pregnancy and the birth and adjust to being a mother. Take every chance you get to rest and build up reserves of energy. Your maternity leave is there for your benefit and to benefit the relationship between you and your baby. Involve your partner and people you trust to help with the baby and housework.

 Try also to:

  • Have regular meals; choose nutritious foods that require little cooking. Avoid high sugar snacks and meals, as they tend to increase irritability and reduce energy.
  • Get some physical exercise, as it is a great stress buster and will make you feel better.
  • Be open about your feelings and worries with someone that you trust. This will help them understand what you need. It is not your fault if you are having a hard time. Equally it is most likely not your partner’s fault.
  • Organise a baby sitter and have a ‘date’ every couple of weeks to discuss life and its new challenges.
  • Make a plan to reduce stressors and take time to relax with family and friends.

Signs of postnatal depression

The signs of postnatal depression are very varied and include:

  • feeling irritable, moody and angry;
  • feeling low and unhappy, not really enjoying the baby;
  • feeling sad and lonely even with people around;
  • crying for no reason;
  • feeling inadequate and unable to cope;
  • feeling out of control and as if you are losing your mind;
  • feeling anxious and panicky;
  • worrying about things you would normally take for granted;
  • not sleeping well, difficulty getting to sleep and waking early;
  • feeling exhausted and lacking in energy; and
  • having difficulty in getting motivated to do anything – some days hardly able to get dressed.

It can also be a sign of postnatal depression if you are over-involved with the baby and don’t allow anyone else to help. This can lead to exhaustion and make the condition worse. A small group of women feel they cannot do anything right for the baby and will ask their partner or family friend to care for the baby.

Some mothers with postnatal depression will be reluctant to leave the house to meet friends or take ‘time out’. They may use excuses like “what if the baby needed me” or “I’m too tired”.

 Other signs of postnatal depression include:

  • being over-involved in keeping the house tidy or being too exhausted to do any housework;
  • having poor concentration – unable to focus on what people are saying, often forgetting things and finding it difficult to make decisions;
  • having a disturbed appetite – some mothers forget to eat and others comfort eat or a combination of both;
  • lacking sexual desire – some mothers think “what did I see in him” and another time will think that their partner will meet someone else and leave them;
  • feeling guilty about many things, for things said and things not said; and
  • thinking about running away or harming themselves – “the family would be better off without me”.

Treatment

It’s good to talk – Women who have postnatal depression respond well to treatment. Women who are diagnosed and treated early recover faster than those treated later. The key to prevention and early recovery is extra support and practical help. If you feel that all is not ‘right’ acknowledge this and talk to someone you trust – a friend, your midwife, your public health nurse or your GP. A bad day is normal, a bad week or two is not.

Please speak with your GP or PHN if you are worried that you may be suffering from postnatal depression. Your GP can also make a referral to the Specialist Perinatal Mental Health Service if needed www.rotunda.ie/mental-health 

Sometimes, postnatal depression needs a dual approach. First, talking helps mothers develop a sense of perspective about the situation and allows them to consider what steps they can take to regain a sense of control. Second, about 30% of mothers with postnatal depression will need drug treatments. These drugs are not addictive.  The length of time that mothers need to be on medication varies from six months upwards. Anti-depressants take at least two weeks to begin to work. If you stop taking medication before six months there is a bigger risk of the depression coming back.

Support from family and friends is also crucial to recovering from postnatal depression and therefore should be part of your care plan. Ask for their help and support. Local parenting groups and support groups often help by offering support and understanding. With help all postnatal depression can be overcome. You will enjoy life with your new baby and family again.

EARLY DAYS AT HOME WITH YOUR BABY

The old saying “sleeps like a baby” certainly does not apply to newborns. Caring for your new baby is a 24-hour-a-day seven-days-a-week job. In this section we will look at caring for your baby at home. We will also explain how important it is that your baby has a safe environment and advise you what medical checks your baby should have over the first six weeks.

Going out with your baby

Women often ask how soon is it okay to take a new baby out? The answer actually depends on how you are feeling. While babies have immature immune systems they are actually born with inherited immunity from you. If you feel like going out for a short walk in the first few days after getting home, then the baby is good to go with you. Make sure the baby is well wrapped up for the weather, and protected from the sun, and both of you can enjoy your first venture outside. It is a good idea to have someone with you for support.

What a newborn baby can do

There is one important skill that babies don’t have to learn – they are born knowing how to suck. During the first few days they learn to coordinate their sucking and their breathing. Newborn babies also automatically turn towards a nipple or teat if it is brushed against one cheek, and they will open their mouths if their upper lip is stroked.

They can also grasp things (like your finger) with either hands or feet, and they will make stepping movements if they are held upright on a flat surface. All of these, except sucking will be lost within a few months, when your baby will begin to make controlled movements instead.

Newborn babies can use all their senses. They will look at people and things, especially if they are near, and particularly at people’s faces. They will enjoy gentle touch and the sound of a soothing voice, and they will react to bright light and noise. Very soon they will also know their mother’s special smell.

Baby development

Getting your baby to lie and play on their tummy keeps them active.  Tummy time helps to strengthen their head, neck and back muscles and lets them experience feeling on the front of their body.  For newborn babies, you can start by lying your baby on your chest while you are lying down or in a semi-reclined position.  Hold them safely facing you and encourage them to lift their head to look at you.  As your baby gets older, you can place them on a firm and flat surface with their hands out at either side to support themselves.  You must stay close to your baby while they’re in this position.  Always place your baby on their back if they fall asleep during tummy time, to reduce the risk of cot death.  Remember ʿback to sleep and tummy to playʾ.

When your baby goes to sleep, they will turn their head to look at the right or left because their muscles are not yet strong enough to hold their head in the middle.  Make sure that your baby does not develop a preference to look at one side more than the other; ideally they should spend equal time looking at both sides.

Don’t leave your baby in a restricted position, for example in a swing or bouncer for long periods of time as it restricts their movement and they may miss out on valuable tummy time and time to play on the floor.

Sleeping

It can be difficult to encourage a pattern of sleep in the first few weeks. Newborn babies tend to sleep for two to three hours and then wake for a feed. Newborns like to sleep during the day and are often wide-awake at night. This is normal and the baby will eventually sleep more at night. You must be patient and learn to sleep when your baby sleeps.

Background talking, music or children playing generally do not cause any problems for the baby sleeping, but a sudden loud noise will. As each week progresses the baby will stay awake for longer periods and will settle into a routine of sleeping. By three months your baby will usually wake up for a time before they are due a feed and quite a few will sleep for most of the night.

Tips to help settle baby at night:

  • Bath and feed your baby, change their nappy if needed and dress them in a comfortable babygro.
  • Do not talk out loud while settling your baby as this can encourage the baby to stay awake.
  • Dim the light, as a bright light will keep the baby alert.
  • Make sure the room is not too hot and free from draughts.
  • Do not pick the baby up again once they are settled because this will confuse them.

It is recommended that your baby stays in the same room as you for the first six months, but they should sleep in their own cot.

PREVENTING COT DEATH OR SUDDEN INFANT DEATH (SIDS)

SIDS (sudden infant death syndrome) or cot death is the tragic sudden and unexpected death of a seemingly healthy baby. No cause for death can be found even after a post mortem. Cot death can occur in a cot, pram, bed, car seat or anywhere a baby is resting. The best position for your baby to sleep in is on its back, with the back of their head lying on the mattress.

How to reduce the risk of cot death

  • Always put your baby on their back to sleep in a face up, face clear (nothing blocking their face) position.
  • Place your baby’s feet at the foot of the cot.
  • Do not smoke in the same room as your baby.
  • Do not share a bed with your baby.
  • Keep your baby’s head and shoulders above the blankets.
  • Do not let your baby get too hot or too cold. To check how warm your baby is, feel their tummy, which should feel warm, but not hot.
  • Dress your baby for bed in a nappy, vest and babygro. In hot weather, your baby needs fewer clothes.
  • Use light layers of blankets in an ideal room temperature of 16° – 20°C.
  • Duvets are not recommended for babies under one year of age.
  • Do not put a pillow in your baby’s cot.
  • Take off the dribbling bib before you put your baby down to sleep.
  • Do not have a ‘soother’ (also called a ‘pacifier’ or ‘dummy’) attached to the babygro by a ribbon.
  • Use a cot mattress that is clean, firm, flat (not elevated or tilted) that fits the cot correctly.

IMMUNISING YOUR BABY

Immunisation is a safe and very effective way to protect your baby against certain diseases. These diseases can cause serious illness or even death. Immunisation works by causing the baby’s immune system to produce antibodies to fight these diseases.

Your baby should have their first immunisations when they are around eight weeks old. It is very important that your baby receives the different vaccinations when they are due. Your GP or public health nurse will give you information on the schedule of vaccinations. 

For further information on the childhood immunisation programme, visit the website: www.immunisation.ie

FREQUENTLY ASKED QUESTIONS ABOUT NEWBORN BABIES

How do I know if my baby is getting enough milk?

Some babies will take to feeding without any problems while others need a little bit of encouragement. Your midwife will guide you on feeding; for most babies we recommend that you feed them when they seem to want it -‘demand feeding’. Small or jaundiced babies may require more frequent feeds.

You will recognise when your baby has had enough because they:

  • are happy and active
  • sleep well between feeds and
  • have wet and dirty nappies.

It is common for babies to lose a small amount of weight in the first few days; however, your baby should return to their birth weight by the time they are two weeks old. The midwife will weigh your baby before you go home from hospital. The public health nurse will also check your baby’s weight when she visits you at home. If you have any concerns about your baby’s weight always ask for advice early from your midwife or doctor.

What do I need to know about vomiting?

Young babies frequently bring up some of their feed, which is called ‘posseting’, particularly if they are trying to bring up wind – this is normal. You only need to tell your midwife or doctor if:

  • the vomiting is forceful or repeated effortlessly and
  • occurs after every feed.
My baby has loose stools, why?

Your baby will pass a sticky green-black bowel motion for the first few days. This is called meconium; following this the stools turn yellowish. Formula fed babies commonly pass firmer stools than breastfed babies. However, if you find the baby is constantly passing very runny stools tell the midwife or doctor because a baby can become dehydrated quickly.

My baby has facial spots or a rash – what should I do?

Many babies have milk spots on their nose or face, which usually disappear in a few weeks without treatment. Newborns can develop spots on their bodies as they get used to the outside world. Generally these spots appear for a short time and then disappear. Please consult your midwife, public health nurse or GP if you are concerned about spots on your baby.

What should I do if my baby has trapped wind?

Trapped wind can give rise to tummy pains and the baby will cry and will not settle after the feed. There are simple techniques that usually work to deal with wind, like holding your baby up against your chest as well as gently massaging the baby’s back. Sometimes walking up and down stairs with your baby held against your or your partner’s chest can help to shift the baby’s trapped wind.

Why is my baby crying?

Crying is baby’s natural way of communicating. While you were pregnant your baby let you know they were happy with their movement and kicking; now the baby is more vocal and there are many reasons for crying.

As you get to know your baby you will begin to understand their different cries and what each one means. Reasons for crying can include that your baby:

  • is hungry or thirsty;
  • has a wet or dirty nappy and needs a change;
  • has trapped wind or colic;
  • is either too hot or too cold;
  • is sick or in pain; or
  • is lonely and wants a cuddle and some attention.
How to soothe a crying baby
  • Pick your baby up and hold them close to your body.
  • Talk or sing to your baby and gently massage their back.
  • Feed your baby.
  • Change their nappy.
  • Go for a short walk with your baby.

If your baby continues to cry, ask another member of the family to take over as sometimes the baby can sense if you are under stress. It is best to seek medical advice as soon as possible if:

  • you think the baby is in pain;
  • the type of crying is unusual;
  • the baby is pale
  • the baby has a purple or red rash on its body; or
  • the baby feels hot.

Remember never shake your baby as this can damage the baby’s body and brain

‘Sticky eyes’ – are they a problem?

‘Sticky eyes’ are usually due to a mild eye infection. You can usually solve the problem by gently cleaning the affected eye with a piece of cotton wool dipped in cooled boiled (sterile) water. Use each piece of cotton wool just once and wipe the eyes from the inside (near the nose) to the outside. Sometimes a baby will need an antibiotic depending on the infection.

CARE OF YOUR BABY FOLLOWING DISCHARGE FROM HOSPITAL

The role of the public health nurse (PHN)

Once you have been discharged from our hospital we will pass on your details to your local PHN.  The PHN will contact you and arrange to visit you and your baby at home. This visit will normally take place within 48 hours of you leaving hospital. 

The PHN will arrange to carry out weight and development checks on your baby until school going age. The PHN will give you lots of information about local support groups and services. If you are under the care of our community midwifery services (DOMINO and ETH) then your first visit with the PHN will be after the community midwife has finished caring for you and your baby – usually around seven days after the birth.

The role of the GP

If you attended your GP for ‘combined care’ during your pregnancy, you should take your baby for a health check to your GP at two and at six weeks of age. These visits are part of the combined care service and you will not be charged for them.

Babies who have left hospital in the previous two weeks

Your GP or PHN (public health nurse) or community midwives are available to deal with any medical or other concerns you might have about your baby. Please use these services. The community midwife or PHN will visit you at home shortly after your discharge and will advise you about any questions or problems you may have. They will also arrange to have the baby’s weight checked.

The Department of Paediatrics in the Rotunda offers 24-hour medical emergency services to all babies born in the Rotunda for two weeks after they leave hospital. Between 7.30 am and 3.45 pm Monday to Friday you should bring your baby to paediatric outpatients (POPD). Outside these hours we will treat your baby in the emergency and assessment unit. We strongly advise you to attend POPD during office hours and to phone to arrange an appointment where possible.  If you are not sure whether or not we need to see your baby, please phone 01 817 1728 for advice.

If we need to admit your baby to hospital, we will usually admit them to the Rotunda. However, sometimes we may need to transfer the baby to another hospital.

Emergency services for infants beyond 2 weeks

For emergency services after 2 weeks you should take your baby to your GP or the local paediatric emergency department, as a maternity hospital has no facilities or inpatient cots to meet the needs of your infant. 

Your GP and public health nurse are available to deal with any medical or other concerns you have about your baby. Your local health clinic or your public health nurse can check your baby’s weight. 

We provide an outpatient service for babies who have left the Rotunda between two and six weeks previously by appointment only. The outpatients department is open Monday to Friday from 7.30 am to 3.45 pm. 

Babies who are more than six weeks old will only be seen in the Rotunda if they have an appointment or if it has been arranged in advance. Parents may phone 01 817 1728 for advice.