About Postpartum Care




The First 48 Hours

You have given birth and now is the time to pamper yourself. This page includes the directions for the first twenty-four hours. We will review these things with you before we leave, but this is your back up in case your memory fails!

For mom:

1. Massage your uterus when the baby is not nursing and make sure that it is:

2. Your bleeding should never exceed 2 pads in 30 minutes and there should be no clots bigger than the size of a woman's fist. If there is heavy bleeding, massage your uterus, nurse your baby and give us a call. If we have left you medication in case of heavy bleeding, take it.

3. Take your temperature at least once daily. It should never rise about 100 degrees, if it does give us a call.

4. Afterpains can be normal, but they should fade within 2-3 days. If they don't or are accompanied by a fever, give us a call.

5. When you get up to use the bathroom, please have someone there with you in case you would feel dizzy. Take your shower when you feel up to it but do not use very hot water as this can also make you feel dizzy.

For baby:

1. Take the baby's temperature once a day.

2. Babies should nurse no less than every 3-4 hours and some like to nurse every hour! Alternate sides to avoid nipple soreness, remembering to break suction.

3. The baby should have 4 to 5 wet diapers per day, but may only make a bowel movement once a day.

4. Place the baby on its side or back to sleep.

5. Things to call us about:


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Cleanliness

Use your peri bottle every time you urinate. Fill it with warm water and add a small squirt of your antiseptic solution to the bottle. Rinse with it after going to the bathroom or while urinating otherwise the urine may sting your bottom. Blot yourself gently with toilet paper or diaper wipes and change your pad. As always, be sure to wipe from front to back. You should take showers until your discharge has ended. Please wait until your last postpartum visit before resuming swimming or wading in a public facility.


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After Pains

For a few days following the birth, the uterus contracts strongly when the baby nurses. It is trying to return to its previous size, cut down on your blood loss and help you to heal as quickly as possible. These contractions can cause fairly severe cramping in some women, usually intensifying with each birth. Try doing your breathing exercises. A hot water bottle and the knee-chest position may also help. You can try one or two Ibuprofen (e.g. Advil) thirty minutes before nursing. Ibuprofen is better than aspirin or Tylenol for this situation. Aspirin can cause you to bleed more and possibly contribute to jaundice in the baby. Take no more than 2400 mg. of Ibuprofen in 24 hours.


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Care of Your Perineum

You will probably be sore for a few days, especially if this is your first birth. Bones, muscles, and tissues have been stretched open. If you tore or had an episiotomy, then you must give your bottom extra time and care to heal. Stitches dissolve on their own in ten to fourteen days. We recommend ice packs for the first few hours after the birth to minimize swelling. The day after the birth you can start taking sitz baths. The sitz bath is a device that rests on your toilet and is available from the pharmacy. You can make your own sitz bath solution by boiling a bulb of garlic in a large pot of water for twenty minutes than adding 1 oz. each of: comfrey, uva ursi, and shepherd's purse. Let this steep for another twenty minutes. Strain the concentrate into a clean milk jug and keep in the refrigerator to be heated up and diluted at a later time. Sit in the sitz bath solution until it cools. Other things that may feel good to your perineum include: the heat of a light bulb or hair dryer, warm herbal compresses, aloe vera, or Dermoplast (found in the pharmacy).


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Food and Fluids

You will find yourself urinating quite a bit in the first few days after the birth as your body rids itself of all the extra fluid needed to maintain the pregnancy. Make sure you drink lots of fluid so you don't get dehydrated. Dehydration will make you feverish, headachy, and inhibit your milk production. Some good fluids to take include electrolyte solutions, prune juice (to ease the first bowel movement), herbal teas and clear juices. Eat foods high in iron and protein to build your strength back up. You should continue with your prenatal vitamins and extra calcium and Vitamin C for the entire time you are nursing.


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First Bowel Movement

The fear of the first stool is always greater than the reality regarding discomfort. Pressing against the perineum with a pad of clean toilet paper can help to support that area during the first bowel movements. If you haven't had a bowel movement by the third day following the birth, drink a cup of Flax tea that acts as an effective stool softener. You need to make sure you are getting enough good oils in your diet as well. Drink lots of fluids! If all else fails, you can use Milk of Magnesia or Per Diem found at the pharmacy. These will get things moving and not hurt the baby either if you are breastfeeding.


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Hemorrhoids

It is quite common to have some problem with hemorrhoids after the birth. A hemorrhoid is a swollen varicose vein in the rectum. "Tucks" pads can help quite a bit, or you can simply apply their main ingredient, chilled witch hazel to a gauze square and make your own. Vitamin E suppositories can help hemorrhoids heal as well. The hemorrhoids will disappear most rapidly if you prevent constipation by drinking lots of fluids, eating roughage and avoid straining or prolonged sitting on the toilet.


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Kegels and Exercising

You can start doing Kegels again right after the birth, although it is usually hard to tell if you are really doing them for awhile. By two weeks postpartum, you should be doing 50-100 Kegels per day. These muscles contract the perineal floor and are especially important in restoring vaginal tone after having a baby. If you do your Kegels faithfully, you can help prevent uterine prolapse and incontinence later in life. Kegels should be a lifelong habit! Incontinence during jumping, jogging, coughing or strenuous exercise may occur for up to six months after birth. Keep doing your Kegels, try doing ten every time you nurse the baby. Two to five days postpartum you can start doing some very light stretching exercises and gradually increase these after two to three weeks postpartum. Please wait until the bleeding has stopped completely and your cervix is closed before starting any strenuous activity.


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Resting

We can't stress enough how important rest is after giving birth. It is very easy in the surge of energy after the birth to overdo. Even if you feel great and are anxious to return to your routine, resist! Women who overdo are the ones who will most likely bleed longer, develop breast infections, or are prone to catching whatever is going around. Remember that your resistance is lowered after you have a baby, so take good care of yourself. Please try to wait until your bleeding has completely stopped before you resume heavier housework like shopping, vacuuming and scrubbing. You can start driving a car around two weeks postpartum. Spend the first week after your birth just resting and caring for the baby. You are not on complete bedrest, but avoid taking the stairs more than once a day.

The second week you can start light activities like cooking and washing dishes. Use this special six-week period to get to know your baby. This is the beginning of a bond that will last a lifetime, so don't be too anxious to let these precious moments slip by. Siblings will also need some consideration as they adjust to this new person as well. Gone are the days of eight solid hours of sleep, so nap when your baby naps during the day. Make a sign to hang on your door that says, "Mother and Baby resting. Please come another time." Ask people to call before they come to visit and leave your phone on voice mail or the answering machine. Let your family and friends take care of you. When someone says, "If there's anything I can do..." tell them! Have them run errands, do shopping, laundry and bring meals. If you don't have the extended network of family and friends in this area or would like to hire help, ask us for information regarding these services.


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Emotions

It is common for emotions to fluctuate wildly after birth. Fears and sadness, as well as joy and relief, are experienced by many women. The overwhelming newness of the baby and the attendant feelings of responsibility, combined with fatigue and hormonal changes, affect your emotional status. Don't worry about crying, just cry if you feel like it. Normal postpartum "blues" usually last no more than a week or two and are helped by adequate nutrition and rest. Severe depression that continues beyond this requires consultation. If you had a difficult birth, there are usually some feelings to work through. Even under the best of circumstances, the birth and the baby are often not what you had hoped and dreamed about. There is a period of adjustment as you accept how your birth actually happened and the realities of parenting your new child. We are always available to discuss these things with you.


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Your Body Size and Shape

At the birth one loses around 10 to 15 pounds from the baby, placenta, water weight, etc. This leaves another 10 to 20 pounds above your prepregnant weight. You will probably think your belly has turned to Jell-O. Don't be discouraged. Right after the birth you still look like you are five months pregnant, but this extra flabbiness will soon disappear. While nursing, you should remain 10 pounds above a normal weight. The extra weight from pregnancy serves as an essential cushion of nutrients and calories that will help ensure adequate milk supply for breastfeeding. Remember that your body is still serving as this infant's sole source of nutrition, and the baby is a lot bigger now than when he/she was inside of you. While nursing, many women have a ravenous appetite. Trust the messages from your body. You will find that the demands of nursing and caring for an infant will gradually take off your extra weight. Most women lose it all between nine and twelve months. Remember - it took nine months for it to go on and it will take at least nine months for it to come off! Do no dieting at this time; the nutrients you consume are too important for your strength and your baby's growth. Continue with a high protein diet along with your prenatal vitamins and extra calcium. Every time you nurse, consume an 8oz. glass of fluids.


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Intercourse

In order to minimize the chance of uterine infection, it is important not to resume intercourse until all bleeding has stopped and the cervix is closed. Your final appointment will determine if this has happened. The first time you have intercourse needs to be particularly gentle, and many women find they need extra lubrication. The K-Y jelly left over from the birth can be useful for this. The most important thing during this period is to communicate. Be easy and sensitive with each other and discuss levels of desire. Many women find that it takes a little while before sexual desire returns. This occurs for a number of reasons: lack of sleep, fear of pain, demands of the baby, doubting attractiveness, etc. The father, on the other hand, may be tired from trying to work, do extra things around the house and take care of the other children. It's important to be sensitive to one another's needs and moods, focusing on how the baby has enhanced your relationship. Commitment to the relationship is usually deeper, and all of life takes on a richer and fuller meaning.


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Family Planning

The return of regular periods varies from woman to woman and depends to a large extent upon how frequently and how long you breastfeed. Often periods will not return until you wean your baby. Remember that it is possible to ovulate before the return of your period. Women usually do not ovulate while totally breastfeeding on demand without supplementation, but we certainly know of plenty of women who got pregnant while doing this. Breastfeeding produces an average of 2 to 21/2 years between children according to the research, but you have to be willing to end up on the short side of the average. Natural child spacing using the temperature and mucous method may be difficult to depend on while breastfeeding. It would be possible to use this if you had already gained extensive experience with it before becoming pregnant. There are now special oral contraceptive pills (progestin only) that are suitable for breastfeeding women. These prevent ovulation from occurring. Many women choose barrier and spermicidal methods of birth control while they are nursing. There are no known harmful effects of these methods on the quantity or content of your breastmilk. The options in this category include: spermicidal foam, suppositories, gels or creams; the diaphragm; the cervical cap; condoms and combinations of barrier and spermicidal methods. If you have any questions about any of these methods or how to use them, please ask us. If you want to resume using the diaphragm or cervical cap that you used before you were pregnant, please bring it with you to your last postpartum checkup and we will refit it. A diaphragm must also be refitted if you lose or gain ten pounds.


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The Last Visit

At the final visit, we will do a complete well-woman check-up including a Pap smear. We can also discuss with you any questions that have come up about parenting, breastfeeding or family health. We'd like to know if you have any suggestions for us in caring for other patients. It's always nice if the father can attend this visit, since it is our last routine contact with you and it is always hard to say goodbye (even if it's only for awhile).


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The Kegel Exercise

Every woman, pregnant or not, should do this exercise regularly, every day. During birth a woman with a well-toned pubococcygeus muscle (PCG) will give birth more easily with less chance of tearing. What is generally called the PCG muscle is actually a band or hammock of muscle in the pelvic floor. It extends from the pubic bone in front to the coccyx (tailbone) behind. In good tone, it is about 3/4 of an inch thick and extends about 1/3 of the way up encircling the vaginal walls and supports the pelvic organs. During pregnancy, it acts as a support for the uterus and during birth it must be completely relaxed to allow the baby to pass easily through the vagina without damage to the muscle. A flaccid PCG muscle cannot support the pelvic organs correctly. Eventually the uterus or bladder may prolapse into the vagina, causing incontinence (leaking of urine) and uterine infections. This simple exercise done daily can help prevent these problems. It is especially important if you have been given an episiotomy or tear during the birth. Steps to follow:

  1. To identify this muscle try squeezing your vagina together when urinating. When the urine stops flowing, your are using the right muscle. (Do not practice this routinely while urinating, only to identify the muscle the first time.)
  2. Now try to squeeze the sides of the vagina together from the bottom up, not using your abdominal muscles at all this time.
  3. You can use the analogy of an elevator. Slowly tighten this muscle up to the fifth floor and then relax it slowly down to the basement.
  4. Do this five times in a row about 20 times a day. You can remember to do this every time you answer the phone, open the refrigerator door, or any other activity that happens a lot in your life. After a week of doing 100 Kegels a day, increase the amount in each set to 10 times. This way you can maintain an exercise pattern of 200 Kegels per day.
  5. It may take up to six weeks before you notice a difference. So don't despair if things don't change in two weeks!

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Breastfeeding - Getting Started

Your breasts had colostrum in them while you were pregnant. It may have even started leaking out as you approached your due date. This is what the baby drinks until your "true milk" comes in. Colostrum has antibodies that help your immunities to be temporarily passed along to your baby. It is a wonderful substance to nourish your baby! Even though you may think there isn't much there, your baby is getting exactly what is needed.

Milk can begin to come in within the first 24 hours, but the most usual time frame is on the second or third day. It looks thin and watery, very much like skim milk. The first part may even appear a little bluish, but the fat content increases in the "hind" milk and then will appear creamier.

Many substances besides foods can be transmitted in the breast milk. It is wise to check with your midwife or doctor before taking any medicine while lactating. Blessed thistle, hops and borage herbs help to increase your milk supply. Traditional Medicinals makes a Mother's Milk tea that you might enjoy drinking either hot or cold. We have found over the years that women who consistently drink large quantities of grape juice may reduce their milk supply.

When the milk does come in, your breasts may swell slightly and get lumpy and hard. You need to nurse the baby very frequently to keep the breasts empty. You may run a slight fever and feel fatigued. Rest during this time and drink 2 qt. of fluids during the day. Warm compresses may help the discomfort, or the warm running water of a shower. The swelling will normally go down in a few days. If engorgement becomes enough of a problem that the baby can only grasp the tip of the nipple or not be able to grasp anything at all, the baby may become frustrated and cry. Try hand expressing some milk out of the breast and then re-offering the breast to the baby. One old remedy for extreme engorgement is the application of cold cabbage leaves to the breast. The cabbage can be refrigerated and the leaves peeled off and inserted into the bra. The leaves are molded just right and often feel good on engorged breasts.

You may breastfeed either lying down or sitting. The baby's head should be slightly higher than the stomach. Make sure your nipples are easy to grasp. Express a bit of milk or colostrum and leave it on the nipple. Hold the area behind the nipple in a v or c-grip using the first two fingers, and touch it to the baby's cheek. This will stimulate the rooting reflex and the baby will turn to the nipple. Try to hold the nipple so that most all of the areola (the darker part around the nipple) goes into the baby's mouth. The nipple should be aimed slightly upward so that the tip touches the roof of the baby's mouth. This stimulates the sucking reflex. Alternate the starting breast and offer both breasts at each feeding.

It's all right to nurse as long as ten minutes on each breast during each feeding at the beginning. After this time, you can work up to 20 minutes on the second side. A breast is usually cleared of milk in five to eight minutes of concentrated sucking, but production of milk operates on a supply and demand basis. The more the baby sucks the more milk you will make. There will be days when the baby seems to nurse all the time, so your body will increase the milk supply and it will even out again. The most common times for these "nursing spurts" occur between 2-3 weeks, 5-6 weeks, and again at 8-10 weeks. Nursing frequently is very important in the first week of life. It will help to flush the baby's intestines of meconium and prevent jaundice. It will also help prevent engorgement.

Try to nurse your baby every two to three hours during the daytime. You want the baby to understand that the daytime is for waking and nursing a lot and that nighttime is for a snack and sleeping. At night, let your baby sleep up to four hours without a feeding. It is important to give them at least one feeding a night to maintain blood sugar levels. You may need to encourage the baby to stay awake during nursing for the first several days. Try changing the diaper between breasts, rubbing the baby's head or back, or massaging the soles of the feet. Many babies become much more interested in nursing when your milk comes in and the "let down" reflex occurs. This reflex is not felt by every mother but often feels like a full tingling sensation in the breasts as the "hind" milk comes forward. If your baby likes to suck for more than just eating purposes, that is fine. Babies have a powerful urgeto suck and this action promotes brain development. A newborn silicone pacifier can be used if your breasts are sore or you need a break.


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Sore Nipples

Most women experience some soreness for the first week to ten days. Try to start the baby nursing on the least sore side, so that the let-down will have occurred and the baby will not have to suck as hard on the sore nipple. You can even encourage let-down before the baby starts to nurse by using a warm washcloth on the breast and massaging it. You can use Vitamin E drops or purified Lanolin on nipples to help keep them supple and avoid cracking. If nipples do crack, you can use a breast shield found at the pharmacy. These protect the nipples from further contact with the baby until they heal. We suggest you cut these away slowly so that toughening of the nipple can occur gradually.


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Burping

Nursing babies do not always need to be burped, as opposed to bottle-feeding babies who should be burped after every ounce of formula or so. Noisy or fast eaters usually need burping more than slow quiet ones. There are three different ways to burp a baby, and you will find which one works best for your baby:

  1. Hold the baby on your shoulder over a diaper and pat on the back
  2. Support the baby sitting in your lap and pat the back
  3. Lay the baby on his/her stomach and gently pat the back

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Expressing and Storing Breastmilk

Many women find they can manually express milk easily and do not need a breast pump. Others prefer the breast pump that can pump both sides at the same time. We recommend a battery or electric dual breast pump; it seems to work the best for the money. You can store expressed breastmilk directly into Playtex Nurser bags. Refrigerate the milk immediately. If you are not going to use it within 24 hours, put it in the freezer. Milk will keep in the freezer compartment of a two-door refrigerator for several months, and a year in the bottom of a deep-freezer. Label the date you expressed it.


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Mastitis

A plugged milk duct will usually be tender, reddened or hardened. Try massaging it and putting on hot packs. Nurse the baby frequently on that breast. Push fluids and rest! If you develop a fever of over 100 degrees you will need antibiotics.


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Breastfeeding Resources

La Leche League's nursing mothers group is the main resource for breastfeeding in the area. We will try to answer any questions we can, but we may sometimes have to refer you to a lactation consultant. These specialized nurses are happy to help you and have enormous resources with which to draw from. We recommend that you purchase La Leche League's famous book, The Womanly Art of Breastfeeding.


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Temperature

Newborns are unable to regulate their own temperature for the first 24 to 48 hours so they rapidly take on the temperature of their environment. It is very important to keep them warm. A chilled baby will breathe fast and increase its heartbeat to try and stay warm. This leads to respiratory distress and depletion of the baby's sugar stores, resulting in many serious problems for the baby. The temperature taken under the arm should be between 97 and 99 degrees. Any warmer than this may cause the baby to sweat and become dehydrated. After a few days the baby can regulate his/her own temperature more easily. A general rule of thumb is put one more layer on the baby than you require for comfort in the same environment. The hands and feet may feel a little cool, so the best place to check for being overly warm or chilled is the back of the neck.


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Airway

Many babies swallow amniotic fluid and mucus at the birth. If they have a lot of this in their stomach, it may prevent them for nursing well the first few days. They may also have some in their respiratory passages. Sneezing, coughing and spitting up are normal attempts of the baby to clear this material. You may want to help by using the bulb syringe when the baby has mucus in the mouth or nose. Just be sure to squeeze the bulb first, then put it in the mouth or nose and release the bulb. Babies must breathe through their noses while nursing. Removing the mucus may be necessary to keep the baby nursing well. If the mucus is very thick, it may need to be liquefied before it can be sucked out. Use a humidifier in the room where the baby spends the most time. This will help keep these secretions manageable, as well as preventing the baby's skin from becoming dry. You can use some saline solution in an eyedropper to moisten dry secretions in the nose and then suction.


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Cord Care

The umbilical cord begins to dry up soon after it's clamped and cut. Fold the diaper down so it does not rub and irritate the cord while allowing air to circulate to promote drying. Clean with alcohol and a Q-tip in the folds around the cord as well as over the cord itself each time you change the diaper. This does not hurt the baby but may startle him/her with its coldness. We can guarantee you the baby will not deflate. The alcohol prevents infection and helps the drying process. The cord will probably drop off between one and three weeks and may ooze a little blood towards the end. After it has dropped off, you will still want to keep the area clean. Call us if the cord area ever develops red streaks, a pus discharge, or a bad odor. A little bit of yellow discharge can be normal. Do not immerse the baby in a bath until the cord is healed because water can lead to infection.


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Urination and Bowel Movements

All babies should urinate within 12 to 24 hours of birth. Their bladders are so small that it can be easy to miss that amount of urine on a disposable diaper. We suggest you cut up some of the leftover gauze squares from your birth kit and place inside the diaper. This will help you keep a lookout for signs of urination. Call us if the baby has not urinated within 24 hours. You can check to make sure the baby isn't dehydrated by pinching (gently) a fold of skin on the arm; if it springs back as soon as you release it, then the baby has adequate water in his/her system.

After your milk comes in, you can expect at least five to six wet diapers in a day. All babies should pass their first stool within 24 to 48 hours of birth. Many babies do this at the birth. For the first several days, the stool will be meconium, a sticky greenish-black substance that was inside the baby's intestines while in the uterus. Meconium is very hard to clean after it has dried, so try to change the baby as soon after a bowel movement as is possible. You may need to put the baby's bottom under running water to get it to loosen up. Meconium is also difficult to get out of cloth diapers, so you may want to use disposables or a diaper service until this period passes.

Make sure you pick disposable diapers that are not scented because these can cause rashes for some infants. Within several days, especially after your milk comes in, the baby's stool will change to a transitional green color and then become yellow. It may have small white curds in it that look like cottage cheese. A good healthy stool of a breastfed baby looks like yellow mustard and has almost no odor. It is normal for it to be very soft and liquid. Breastfed babies may have anywhere from one stool every other day to one after every nursing or to one stool per week. The main thing is that the stool looks normal. Your baby doesn't have diarrhea unless there are flecks of stool and mucus surrounded by a large watery stain (often green).


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Jaundice

Eighty percent of all newborn infants after 24 hours of age show some degree of jaundice, or yellowing of the skin. The yellow color is caused by the breakdown of extra Red Blood Cells in the baby's system that causes the bilirubin level to rise. To get rid of the excess bilirubin, you will need to do two things. First, nurse your baby frequently, about every two hours during the daytime. This binds the excess bilirubin to breast milk protein so that the baby can get rid of it. It also promotes bowel movements that contain the unwanted bilirubin. Second, expose your baby's skin to the daylight as much as possible. This also helps break down the bilirubin for excretion. Most jaundice resolves by the second week of life. If you notice:

  1. the baby becoming a "sleepy" nurser and/or sleeping for longer than four hours
  2. the whites of the eyes becoming yellow

call us right away. This may mean the level of bilirubin is increasing and phototherapy may need to be ordered. We can order from the medical equipment supplier a biliblanket that will give concentrated light therapy to the baby. If jaundice levels become too high, hospitalization may be necessary. We like to nip jaundice in the bud!


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Circumcision

There is no medical reason to circumcise your son. There are no unbiased accurate medical studies that indicate circumcised men fare better than uncircumcised men. The only valid reasons to circumcise are the ones you feel are religiously and socially important to you. It is a decision you will have to make. You should be aware, however, that the percentage of uncircumcised infants is changing rapidly. It is down to about 50% now and is expected to decrease further within 15 years. In families where the father is circumcised and the son is not report that this difference is accepted in a very matter-of-fact way. If you do want to have your son circumcised, it is important that he is in good health and that his blood clotting factors are functioning well. If there is any doubt about this, he may need a shot of Vitamin K. You can stay with him throughout the surgery so as to comfort him immediately afterwards. If you do not want a circumcision performed, there is no special care you need to give your son's penis. The foreskin will eventually and gradually retract with time. As he grows, just teach him to clean it like any other part of the body, making sure to retract the foreskin and clean under it if he can. It is similar information that is given to female children about cleaning inside the folds of the vagina.


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Sleeping with Your Baby

It is perfectly all right to have your baby in bed with you. You will not roll over on the baby, and it allows you to nurse and sleep at the same time. While you're first learning to nurse, you may need some light to get the baby positioned correctly, but try to use a night light or other dim source so that the baby will be able to tell night from day. We want the baby to get the message that night is for sleeping! Babies should sleep on their sides or backs in case they spit up and to avoid pressure on the cord clamp. You can put a rolled baby blanket behind the baby's back to support a side-lying position.


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Keeping the Baby Clean

Sponge baths are recommended for the newborn until after the cord heals, usually between one and three weeks. A washcloth with warm water works fine. If you wish to moisturize the baby's skin after the bath, please use a natural baby product other than baby oil. Baby oil contains mineral oil which robs your baby's skin of vitamins. Avoid regular soap because it is drying to the skin. Usually washing the bottom and the face are the most important parts, and you would want to make sure the folds of skin at the neck and behind the ears stay clean too. You can wash the baby's hair with baby bath keeping an eye out for "cradle cap." If you notice scaling in patches on the baby's scalp, try rubbing some Vitamin E oil or olive oil on the scalp and gently massaging with an extra soft toothbrush. This will work the scales off of the scalp and then use a fine baby comb to comb them out.


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Your Baby's Skin

Many babies have "milia," tiny white spots on the nose or face. These are clogged pores that will clear up within a few weeks. "Stork bites" are also quite common. These are light red areas most commonly seen on the eyelids, between the eyebrows, and at the base of the neck. They are caused by a patch of capillaries that are close to the skin. They will fade over a period of months, although they may be visible for several years when the child cries or exerts himself. Another common newborn skin condition is "newborn rash." Up to half of all newborns develop these red splotches that come and go rapidly. Many infants develop newborn "acne," small pimples on the face that almost always disappear by six months. Many newborns, especially overdue ones, have peeling skin around the crease marks, particularly in the hands and feet. Use a good oil or lotion to keep the skin moist. If your baby develops diaper rash, try exposing the sore area to air and sunlight. If you are using disposable diapers, make sure they are the unscented kind. Try leaving rubber pants off when you can, and change the baby more frequently. Desitin clears up most rashes in short order and is a reasonably natural product. Vitamin E and aloe vera are also healing. If your baby's bottom turns bright red all over, think what you may have eaten in the past day or so that might be causing your baby to have an acidic stool. If you are using a diaper service, many times they will test your baby's diapers for you and alter the pH to help you out until the problem clears up.


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Taking Your Baby Out

Fresh air is good for your baby, so feel free to take short walks when you are well rested and feeling up to it. Just keep the baby a comfortable temperature, small babies are quite portable! Most will go easily into new situations and go to sleep to shut out any over-stimulation. You may find them particularly fussy later though if they have been passed from person to person at a gathering. It is usually best to avoid large groups of people for the first six weeks to give your baby a chance to develop an immune system before being exposed to different germs. After six weeks, you can usually take your baby anywhere, although you would always want to avoid letting anyone who is obviously ill too close. We recommend waiting at least six weeks, if possible, to do any major traveling with your baby. This gives you both a chance to recover from the birth and get to know each other.


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Newborn Screening

State law requires that all babies be tested by a heelstick to screen for metabolic disorders, thyroid function, and blood diseases. Most of these conditions are rare but are curable with proper care and have serious consequences if left untreated. Your baby has to have been feeding for at least 24 hours, so we do the test after this time period. At this visit we remove the cord clamp, do the heelstick and the doctor will do a newborn check up and circumcision if appropriate.


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Birth Certificate

As midwives registered with the State Health Department, we are obligated under law to register an infant's birth within four weeks of the event. The social security card will come with the birth certificate if you sign the release statement on the side of the form. Otherwise, you will need to apply for a social security number separately after you receive the birth certificate. Your child will need a birth certificate for a passport, to register for school and as a form of identification.


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Parenting Concerns

If parenting is new to you, it involves a radical change in self-image. Trust that you can do what your baby needs you to do. They really aren't as mysterious or fragile as they seem at first. Their patterns change so rapidly that something that concerns you one week about crying, digesting, or sleeping may be completely gone by next week. Feel free to call us and ask questions or vent concerns. Even if it were 2 a.m., we would rather hear from you than find out later that you were upset all night long. Remember that the baby's crying is the only way he/she knows to communicate and make sure that you are still there. Get some good books on baby care and parenting and have them at home for resources.


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Spitting up

Some babies spit up after almost every feeding. It is nothing to worry about unless it is "projectile" vomiting. This is more than spitting up, under these circumstances the baby vomits with such force that it lands several feet in front of you. Be sure to burp the baby between switching breasts if spitting up becomes a problem. Sometimes babies will even spit up after sneezing or hiccuping. Neither are any causes for concern.


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Colic

Many babies have a fussy period in the evening. Eating a good breakfast in the morning and not overdoing it during the day may help prevent these episodes. Try to keep that time as peaceful as possible, and don't take the baby's crying personally. A baby with an upset stomach usually holds his/her knees tightly drawn up into the stomach area and has a very tense abdomen. Try gentle massage of the abdomen up the baby's right side, across the top and down the left side. This follows the pathway of the large intestine and can encourage air bubbles to pass. Carrying the baby over your forearm face down sometimes helps, as does catnip or fennel tea. Think if you have eaten anything unusual in the last 12 hours. Traditional offending foods include nightshade vegetables, beans, chocolate and apple juice. Volatile oils, such as garlic and onion, do pass through breast milk, but babies don't seem to mind the added flavor. By far the most common offender in your diet is cow's milk. Many babies are allergic to the proteins in cow's milk or find them difficult to digest and these pass into your milk. Try omitting all dairy products from your diet for one week and see if the baby improves. If so, you can try gradually reintroducing milk products into your diet starting with natural yogurt. If all else fails, jump in the shower or the bathtub with the baby and let the warm water soothe you both.


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Giving the Baby Water

Most breastfed babies do not need water. They get all the fluids they need from the breastmilk. The only two exceptions to this might be before the milk comes in or if the baby is dehydrated. Dehydrated babies often run a slight temperature and have dry limp skin. If the baby seems especially hungry before the milk comes in or is exposed to hot weather, the baby may need extra fluids. A jaundiced baby would need to be supplemented with formula and not water. To give the baby a bottle of water, use a bottle with a physiological silicone nipple. This will minimize the baby swallowing air. Boil spring water for 20 minutes and then allow it to cool. Chlorinated "city water" or well water that has not been tested is not recommended. The bottle, rings and nipples should be boiled as well or washed in a hot dishwasher.


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