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Childhood Diagnosis of Diabetes
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Feeding Your Kids
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Family Health Magazine - CHILDBIRTH

When Baby Comes Home
Looking After Baby; Taking Care of Mom

Soon your baby will arrive and you will start a new life together. Will you be ready? The truth is, even if you have checked everything twice, it is still hard to be totally prepared. Questions pop up in the early days, both for first-time parents and with second, third and fourth babies. Most of the concerns new parents have are similar, and revolve around feeding, sleeping and general care.

Looking After Baby

Getting ready

As your due date approaches, be ready to leave at any time. Pack a suitcase with diapers, blankets, and clothes for you and baby to wear in hospital. This will make departure less hectic. If the weather is cold, include appropriate outer clothing for baby. Include a housecoat, slippers and nightgown for yourself. If you plan to breastfeed, the nightgown should have a front opening. You will also need a nursing bra. Remember to have the car seat ready for the trip home.

Long before you arrive home with your baby, you will need to plan sleeping arrangements. Many people like to have a nursery set up and decorated, but this is not necessary or always practical. It is not unusual for a baby to sleep in the parents' bedroom for the first several weeks. Being close allows parents to respond quickly to a baby's (often frequent) needs.

Always consider safety first. Your baby may be safe in a cradle for the first few weeks. However, once she begins to move around there is a danger of tipping a rocking bed. It is then time to switch to a modern safety-approved crib. Do not use a crib manufactured before 1986, when strict safety regulations were passed.

You will need comfortable places to feed and change your baby. To feed baby, place a comfortable chair in a draft-free, quiet area. You may find using a chair without arms makes it easiest to position baby for breastfeeding. To change diapers, use a solid and secure surface high enough that you do not have to bend down. Keep in mind that it is easy for a squirming baby to roll off.

These days, much thought goes into the type of diapers to use. The number of choices, from various styles of cloth through to disposable, is almost overwhelming. Base the choice on your lifestyle, finances and philosophy. Remember to set up storage space, along with a laundry hamper, diaper pail and wastebasket.

A car seat is an absolute necessity and required by law. Many hospitals will not allow you to leave with your baby unless you have a properly restrained infant seat. Studies have shown that very often infant seats are not used properly. Be sure to read all of the directions. Have the seat installed professionally if necessary. Nothing is more tragic than having an infant killed or injured in a crash for lack of this precaution.

Feeding baby

While other needs must be met, perhaps preparing to feed and care for your baby is most important. Breastfeeding is natural and is definitely the best option, but it takes some work. Attend breastfeeding classes, find community resources, read about breastfeeding, and discuss it with your family doctor. The more you know, the better your chances of being successful. Your family's attitude makes a difference, so talk about it during pregnancy.

While in hospital, learn as much as you can to avoid breastfeeding problems. Your doctor, hospital nurses and community health nurses can help you deal with feeding concerns. You may also wish to see a lactation consultant. Check with your local health centre. In many communities, special breastfeeding clinics are available.

A mother may not able to breastfeed for a variety of reasons, including adoption or being on certain medications. If this is true for you, talk to your doctor about using infant formula.

After your baby is born, it will take two to three days for your milk to come in, and possibly a day longer if you have had a caesarean section delivery. Until that time, your breasts produce a very important substance called colostrum. An infant may not be very hungry on the first day of life, but needs the colostrum. Your baby must learn how to latch on to your breast, and you need to learn how to help.

On the second day, you will have a very hungry baby who will want to feed often. It now becomes essential to latch on well. An improper latch will damage your nipples and make them painful.

On the third day, your milk will probably come in, and you will know it! The most common problem at this time is that the breasts become so swollen that baby cannot latch on. In this case, use your fingers or a good breast pump to release some milk from your breasts. This softens them enough for your baby to take hold and feed. Electric breast pumps can be rented from many pharmacies and hospitals. You may want to add this item to your list of things to have ready.

A baby who is not feeding well, or sleeping too long and not feeding often enough, can become dehydrated with serious results. Generally, babies should be fed on demand, meaning as often as they wake and appear hungry. This may be as frequently as every two to three hours.

For the first several days, feed your baby at least every four hours, even if it means waking the baby. You can feel confident that a baby who is wetting six times a day, with pale clear urine, is getting enough to eat.

You may see a rust-coloured stain, known as 'brick dust,' on your baby's diaper on the second to fourth day of life. Brick dust indicates that your baby may not be getting enough fluids. Simply feed more often until the urine becomes colourless. Get help quickly if the baby is getting more and more sleepy, wetting fewer diapers, or is noticeably jaundiced (with yellow colour in the skin, especially the face and the whites of the eyes).

For the first several months of life, your baby does not need food or fluid other than breast milk (or formula). Water, juice and baby cereal are not necessary. In fact, they may upset your baby's digestion, or provide calories that take away from those needed for good nutrition.

Vitamin D is the only vitamin supplement recommended for breastfed babies. It is only needed in countries like Canada with very low levels of sunlight during parts of the year. Some mothers begin giving vitamin D after the baby is three weeks of age, to reduce the chances of the baby spitting it up. Formula-fed babies need iron in the form of iron-fortified formula.

Your baby's stools are an important indicator of how well your baby is feeding. First, the tarry greenish black meconium clears out of the bowel, around the second or third day of life. A breastfed baby will then begin to pass bright yellow, mustard coloured, 'seedy' stools. Each child is different, so the frequency may be anywhere from every diaper change to once every five to seven days. As long as your baby is healthy, active, seems comfortable and is feeding regularly, this is likely normal.

A formula-fed infant will often have a pasty pale yellow stool, which may seem hard to pass, but is also normal.

It is essential that you take care of yourself so you can care for your baby. This is especially true if you are breastfeeding. You must be rested to provide quality milk. If possible, spend the first two weeks of your baby's life concentrating on yourself, your baby and feeding. This includes getting rest when your baby is sleeping, especially during the day, to keep up your strength and endurance for the night feedings.

Try to have someone provide meals, clean house and look after your other children. This is not the time to have lots of friends and family visiting, or to do any entertaining.

LOOKING AFTER MOM

If you are pregnant, chances are you are doing everything you can to guarantee that you will have a healthy baby. How do you make the transition from healthy expectant mom to healthy mom and baby? Begin by taking care of yourself. The first week or so at home is critical to the health and wellbeing of both you and your newborn. You need rest and time with your new baby. While it may sound selfish, face it – giving birth is hard work, both physically and emotionally. By making sure you stay strong and rested, you can give better care to your newborn baby.

Rest

Eight hours of interrupted sleep is not enough. You must sleep during the day to meet the needs of new motherhood. Do not feel guilty about taking naps. If you have older children, consider having friends or relatives care for them for a few days, either part or full time. A good rule is 'sleep when your baby sleeps!' If this is not possible, take short naps when you can.

If you do not get enough sleep, it is hard to cope with increased demands. As well, your milk production will suffer if you are breastfeeding. This can turn into a vicious cycle. Too little sleep reduces milk production so baby must feed more often. This means extra night feedings, which lead back to less sleep for mother. All new mothers, nursing or not, need enough sleep.

To adapt to your new role, you need one-on-one time with your baby. Set your priorities. This is not the time to keep a spotless house or have gourmet meals unless someone else is willing to do it for you. Other members of your family may have to fend for themselves for a few days. Enlist the help of friends and family to accomplish daily chores.

While visitors are often glad to help, some may not recognize your need to rest and be with your baby. Arrange to have family and friends visit only by appointment. Otherwise they may drop in without warning just as you are getting to sleep. When guests ask what they can do, suggest that they bring a meal or do dishes or a load of laundry during the visit.

Baby blues

Often new mothers are tearful at some point during that first week. This is very normal. Hormone changes and the emotional nature of childbirth both contribute to these feelings. Most mothers recover from these up-and-down mood swings on their own. However, some have more severe emotional upset that lasts weeks to months. If you feel depressed or angry and the feeling is not going away, see your doctor.

Breast care

New moms who are breastfeeding will find it takes two to three days for milk to come in, and possibly a day longer after a caesarean section delivery. Until that time, your breasts produce a greasy but very important substance called colostrum. Your baby may not be very hungry on the first day of life, but needs colustrum. Learning how to latch baby on to the breast is also key. Both in hospital and at home, get as much help as you can from a lactation consultant. This is essential if you have any difficulty or special conditions such as inverted nipples.

Once your milk comes in, the most common problem is that the breasts become engorged, and must release their build-up of milk. Nursing relieves it, but your baby may have trouble latching on well. In this case, use a good breast pump or your fingers to release some milk from your breasts.

It is not unusual to have sore nipples until they toughen up. Nipple shields or hard plastic caps can protect nipples from clothing and dampness. Changing breast pads often will save your clothes and prevent nipple infections that come from constant moisture.

Watch for signs of mastitis (bacterial infection of your breasts). Here, red or hard areas appear in the breasts, and are accompanied by high fevers or sweats. Antibiotics are needed immediately. Scaly or patchy redness on nipples and the surrounding skin are a sign of yeast infection, and are often linked to thrush in the baby's mouth. Both can cause nursing problems.

Women who are not breastfeeding will want to prevent the breasts from filling and becoming engorged. Medications may be prescribed immediately after delivery to prevent milk from coming in. Wearing a snug bra all the time (even when sleeping), and avoiding warm water flowing onto your breasts will also help.

Perineal care

After a vaginal delivery, it is likely that your bottom end (perineum) will be sore. You must keep this area clean to allow healing and reduce your chances of infection. Even if you don't have stitches, use a squirt bottle to spray warm water over your perineum every time you visit the bathroom.
If there is swelling or bruising, you may apply ice packs wrapped in a clean tea towel a few times a day for several minutes. You can also make ice packs by spraying a sanitary pad with water to make it slightly damp and placing it in the freezer. For comfort and hygiene, some women like to use sitz baths, sitting and soaking in lukewarm water. Add salt or epsom salts if you like.

The amount of bleeding you have will vary. Your flow is likely to start like a very heavy period and taper off over one to three weeks. Some women find they need to wear a panty liner for a few weeks longer. If your flow becomes heavy or smells bad, talk to your doctor within 24 hours.

Infections after childbirth

Some vaginal deliveries are complicated by endometritis, an infection of the uterine lining. How do you know if you are developing an infection?

Watch for:

If you have these symptoms, see your doctor right away. Ignoring infection can allow it to become much worse. Usually an antibiotic will get you back on your feet.

Bowel function

Regular bowel movements are important. The first bowel movement after delivery can be scary due to your tender bottom, but you need to go when your body says to and avoid straining. Even if you don't usually get constipated, consider adding extra fibre and fluid to your diet to prevent straining. If hemorrhoids are a problem, try hemorrhoid ointments and TUCKS™ pads.

Postpartum exercises

Vaginal delivery

To get the most benefit from exercise after birth, start as soon as you can comfortably walk. Walking will be your most important exercise in the first few days and weeks – which is good because you can do it with your baby in a 'snuggle' pack or a stroller. Your doctor, birth attendant or health nurse can advise you on exercises that help regain tone in your pelvic floor, abdomen and leg muscles.

Many women already know about Kegels, the exercise that strengthens the perineum. To do this, tighten thigh and buttock muscles, while pulling the perineum upwards as if trying hard not to pass urine or gas. Hold for 10 seconds. To get the most benefit, repeat it often throughout the day. Try doing three Kegels each time the baby's diaper is changed.

Caesarean birth

It is natural to have a sore abdomen after a surgery such as caesarean birth. Talk to your doctor about pain medication before going home. You can expect to be able to reduce the amount you need quite quickly over the first week or two.

You may need to arrange to have the dressing changed on the incision and the sutures or staples removed. Talk with the community health nurse or your family doctor's office. At home, keep the area clean. Use basic hygiene, cleaning with soap and water and drying it on a regular basis.

Even after a caesarean, you need to do Kegels (see above section) to strengthen your perineum. Some exercises designed to improve your abdominal tone may be all right as long as there is no straining of the muscles involved. Avoid lifting anything heavier than 10 pounds (such as grocery bags, and baby carriers) and doing exercises such as sit-ups. You can do more after you have been told your incision is healed, usually about six weeks after birth. It is best to ask your doctor which exercises you may do, and when you can increase your lifting. Remember – any physical activity you do at this time should not hurt. If it does, stop until you are sure it is not doing harm.

Intimacy after childbirth

At some point after delivery you will consider sexual intimacy. Remember that you can become pregnant while breastfeeding, even before your first period. You must use some form of birth control. Talk to your doctor during your first visit after delivery (usually six weeks) about the most appropriate form of contraception for you. In the meantime, protect yourself from an unplanned pregnancy by using condoms.

You may be a little worried about resuming intercourse after delivery. Most women have a bloody discharge called lochia for up to six weeks after delivery, which may be distracting. You may also be concerned about pain with intercourse, whether a tear or episiotomy occurred during delivery or not.

Give yourself control by lying on top of your partner. This makes it easier to relax, knowing that if it doesn't feel right you can stop. Your hormones will reduce the natural lubrication of your vagina. Use a lubricating jelly like K-Y® Jelly. In contrast, Vaseline is petroleum-based, and can increase irritation and make condoms ineffective.

Enjoyment after childbirth

Most of all, remember that childbirth has been a natural event since the beginning of humanity. Babies and their mothers thrive in many different situations. Once you have the basics in place, do not worry about having everything just right. Relax, marvel at this miracle of life, and trust your own instincts. You deserve all the joys of motherhood. Take care of yourself and your baby, and both of you will do fine.

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FAMILY HEALTH is written with the assistance of
Alberta College of Family Physicians
FAMILY HEALTH is written
with the assistance of
The College of Family Physicans of Canada
Alberta College of Family Physicians
While effort is made to reflect accepted medical knowledge and practice, articles in Family Health Online should not be relied upon for the treatment or management of any specified medical problem or concern and Family Health accepts no liability for reliance on the articles. For proper diagnosis and care, you should always consult your family physician promptly. © Copyright 2015, Family Health Magazine, a special publication of the Edmonton Journal, a division of Postmedia Network Inc., 10006 - 101 Street, Edmonton, AB T5J 2S6    [CB_FHb11]
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