The first few hours after your baby’s birth are very busy ones for him. His lungs fill with air in order to supply his body tissues with the oxygen they need. If he has any trouble breathing because of mucus in his lungs, throat, or nose, the doctor or nurse will help him get rid of this.
The umbilical cord is cut and clamped or tied off. Some doctors put a dressing on the small piece of cord that remains attached to the baby’s navel, some do not. This remnant of cord dries up within a few days and drops off after about a week.
In some hospitals, drops are put in the baby’s eyes. The medicine is usually either a 1-percent solution of silver nitrate or penicillin. This is a precaution against certain types of eye infection and is required by law in most States.
While these things are being attended to, the doctor makes a quick examination of the baby and the nurse starts his record by writing down his birth weight, length, sex, and other important facts about his delivery.
For legal reasons, as well as for your own peace of mind, your baby has some form of identification attached to him before either of you leaves the delivery room. Some hospitals use adhestive tape; others put beads, metal bracelets, or tags on wrists or ankles. Sometimes there are two markers for each baby, exactly alike; the hospital keeps one and the other goes home with the mother. The fingerprints, footprints, and palm-prints of your baby may be taken and your fingerprints may be recorded with his as an extra precaution.
Wrapped warmly in a cotton blanket, your baby will be taken from the delivery room to a nursery. If there is any special need for close supervision, he may be placed in a special nursing unit. Wherever he goes, he is given the closest attention and protected in every way from any chance of infection.
Your baby at birth
You may be surprised when you look at your newborn baby for the first time. Chances are that he will seem red, and his hands and feet may appear bluish. He may be wrinkled and scrawny. If he is full-term, his weight will be somewhere between 5 1/2 and 10 pounds. If he is “average,” he will weigh between 7 and 8 pounds and be 19 to 22 inches long. He may be covered with a white, creamy substance called vernix and he may have a lot of fine, soft hair on his scalp.
The baby’s head may be a bit out of shape, at first, because of the molding it received during birth. Don’t let this bother you. The bones of his head are soft and flexible, with spaces in between called fontanels. The soft place between the bones on top of his head is one of these. Because of these spaces, the head of a child about to be born can be safely compressed quite a little as it goes through the birth canal. It will usually go back into proper shape within a few days.
All newborn babies have arms and legs that seem much too small for the size of their heads. They wave their arms wildly about and kick aimlessly with their tiny bowed legs. Your baby’s eyelashes and eyebrows will be so fine you can hardly see them. He will not be able to focus his eyes. He will cry without tears, for his tear glands are not yet working. He will not know how to smile or respond to you in any other ways. He will want to sleep most of the time.
Most little babies cry when they are hungry. Some cry when they are wet or otherwise uncomfortable; some do not. Some cry more than others. Most of them seem to get a lot of comfort from being held and cuddled, rocked and sung to. It is so natural to give babies this kind of attention that you may be tempted to pick yours up more often than is necessary after you get him home. During most of the day, newborns need to sleep quietly in their bassinets. You will probably be handling yours enough, at first, if you play with him only when you pick him up to feed him, change his diapers, or put on his outdoor clothes.
Some babies seem to be more comfortable in the first few weeks if they are snugly wrapped in a small thin cotton blanket. If this is the procedure in your hospital, the nurse will show you how to fold the blanket around the baby so that the wrapping stays in place and is not too tight.
Whether your baby is rooming with you or is in a nursery for newborns, you will be surprised to find out how much you can learn about him and his care during the few days you are in the hospital.
Feeding your baby
Your baby is brought to you for his first meal sometime between 12 and 24 hours after birth. Whether you plan to breast or bottle feed him, you will need to help him learn how to use a nipple.
How your baby gets his nourishment will depend on a number of things—your ability to produce a good supply of milk, your health, your way of living, your preferences for breast or bottle feeding. Breast milk is a natural food. It has in it most of the food elements a newborn baby needs for growth, combined in ways that make it easy for him to use them. Even if you cannot continue nursing, it is good to start your baby at the breast because of the benefit he gets from the colostrum.
Many mothers want very much to nurse their babies, and get great satisfaction from doing so. If you prefer to bottle feed your baby you have every right to make this decision and be happy with it. As yet, there is no proof that breast feeding is always better for children than bottle feeding. Either method can be good for your baby under the right conditions. Breast feeding does have the advantage of immunizing a baby against certain infectious diseases through the action of the antibodies he gets in his mother’s milk.
One of the important reasons for breast feeding is the contact with his mother’s arms and body, the feeling of warmth, closeness and security a baby gets from being held while he takes his food. Your bottle fed baby can have this security if you hold him in your arms to feed him just as you would do if you were offering him your breast.
During early breast feedings, the nurse will help you show the baby how to get your milk. He is born knowing how to suck but he needs help in finding the nipple. He roots around for this, and will find it, if it is anywhere near his mouth. Let his cheek touch your breast. Then, when he does find the nipple, see that he gets his mouth completely over it and over the darkened circle around it, the aureola. Hold the top of your breast away from his nose with the tip of one finger, so that he can breathe easily.
Some babies want to be put to the breast frequently during the first few days, at fairly short intervals. This seems to help the milk to come in. While the milk is forming, let the baby suck a short time on each breast; ten good sucks on each one may be enough at first. After the milk begins to flow, a baby will suck longer. The breast you start with is usually the one that is most thoroughly emptied. For this reason, it is customary to begin each feeding with the breast you gave second the last time you nursed. If you do this, each breast is emptied regularly every 8 hours or so, but is also stimulated at each feeding. It is this frequent stimulation that increases the milk supply to give the baby more and more milk as he grows older.
A baby usually learns to suck well from the breast within the first few days, although some need more time. He will do better at it if he is hungry. For this reason, the only supplementary nourishment most babies get while they are learning to nurse is boiled water cooled to room temperature.
There are so many individual differences in the nursing behavior of infants that you will have to find out for yourself how your baby likes to take his food. You and he have to get used to each other. If you particularly want to nurse him, don’t give up too soon. You probably will not be able to tell before you leave the hospital whether or not you are going to have enough milk for him. Completely satisfactory nursing is often not established until late in the second week.
Once breast feeding is going well, the usual total nursing time at any one feeding is 15 to 20 minutes. The baby may get all the milk he is going to drink in 8 or 10 minutes but he will suck for several minutes longer. He needs the satisfaction he gets from sucking just as much as he needs the milk he drinks, although for different reasons.
As a baby drinks, bubbles form in his stomach. This is a normal part of his digestion, but it can make him uncomfortable. That is why you need to “burp” him. Hold him up against your shoulder or ask the nurse to do so, then pat his back gently, so he can bring his bubbles up. Another way of “burping” is to sit him in your lap, his stomach resting against your forearm. With the other hand, you can stroke upward on his back to help him push the air out of his stomach. In either case, protect your dress with a soft cloth, in case he spits up more than air or gas bubbles.
If your nipples are unusually tender, your doctor may advise you to put something on them between feedings. Be sure to wash this off before you put the baby to your breast again. The doctor may also suggest that when you are not nursing, you protect your nipples with a clean pad of gauze or soft cotton cloth, using a cream if necessary.
After the milk has started, it will continue to form as the baby sucks. On the other hand, if you are not nursing your baby, your milk supply will not be needed and will gradually dry up. Your doctor will tell you what, if anything, to do about this.
Bottle feeding can be a very satisfying experience for you and your baby if you do it in a way that is comfortable for both of you. Hold the baby in your arms when you feed him, so that he feels the warmth and closeness of your body as he sucks. It is better, for several reasons, not to prop the bottle in the crib; while he is eating, your newborn needs all of your love and attention.
Tilt the bottle so that the neck of it is always full of milk when the baby is sucking. This prevents air bubbles from getting into the milk. Check frequently on the size of the holes in the nipples. If the holes are too big, the flow of milk will be more than the baby can manage. If they are too small, he will not get enough milk and will have to work too hard for what does come through. In the Children’s Bureau pamphlet Infant Care (also the book, Infant Care, Child Care Publishers, Inc.) you will find much more information and many more suggestions about baby feeding than can be given here. This booklet can help you in many ways even before your baby is born.
Whether you breast or bottle feed your baby, you will have to work out a timetable for his meals that suits you both. There are no hard and fast rules about this. The time between feedings may depend upon several things: the size and weight of the baby, how often he seems to need food, and whether you and your doctor want to try letting him make his own schedule. A cry you will soon learn to recognize will be his way of telling you when he is hungry. At first, his signals may come at irregular intervals but he will probably soon fall into a rhythm of his own on which he will thrive.
To feed your baby, take a position that is relaxing. If you are up, sit in a comfortable chair. Don’t perch on the edge of the bed. As a precaution against possible infection, wash your hands thoroughly with soap and water and be sure that your nails are clean.
The baby’s bath
Most hospitals no longer give sponge baths with soap and water to new babies. In fact, your baby may not be bathed at all for several days, although the folds of his skin may be cleansed with mineral or baby oil on cotton balls. Surgical gauze is not used for sponging the skin of a newborn. It is rough in texture and apt to be irritating.
Most babies get their first real baths on the seventh or eighth day. Tub baths are delayed until the stump of the cord has fallen off and the navel is healed. Whenever the diaper is changed, the region around the genitals and buttocks should be carefully cleaned with baby oil or warm water and mild soap. Your baby’s skin may become dry and scaly, but this is nothing to worry about. It is a condition that usually corrects itself as the baby gets older.
Clothing for the newborn
Nowadays most babies start off with a minimum of clothing. When yours is brought to you in the hospital he will probably be wearing only a diaper and little cotton shirt and perhaps a short gown. He will be wrapped loosely in a soft, warm blanket. This is about all the clothing he will need indoors for several weeks.
Babies do not like to be either too warm or too cold. They will fuss if their clothing is too heavy, too hot or too tight. They need to be able to move their bodies freely, especially their arms and legs. You will not need to cover your baby’s head, unless you are taking him outdoors on a cool or windy day. A padding around the sides of his bassinet, carriage or crib will usually be enough to keep off a draft.
If your baby is a boy and is to be circumcised while you are still in the hospital, you will be asked to sign a permission slip for this. It is a very common and very simple operation. What the doctor does is to remove part of the fold of skin (the foreskin or prepuce) that covers the tip of the penis. When this is too large or too tight, it interferes with urination and personal cleanliness.
Babies who need it are usually circumcised before the second week of life, preferably within the first four days. This may be done in the delivery room at birth, with the parents’ consent. It is often more convenient and more economical to have the operation take place then, and there is the added advantage of having the baby under hospital supervision for a day or two afterwards. The wound is small, heals in a few days and does not usually require any special care after you go home. A little petroleum jelly will keep the diaper from sticking to it.
If your baby is to be circumcised for religious reasons, there will be more formality. Find out what the ritual is, if you do not already know, so that you can make the necessary arrangements with the hospital and the doctor.
The first few days
Tiny babies need to be protected against infection. This is why hospitals take very possible precaution to keep newborns away from people with colds, sore throats, intestinal upsets, or skin infections. If the baby is born at home, try to be just as careful.
Most new babies lose weight at first and may not begin to regain it until they are about a week old. This weight loss is due to loss of water from their bodies, to the passing of materials that gather in their intestines before they are born and to lack of nourishment during the first two or three days of life. If your baby does not begin to gain by the end of the first week, let your doctor know.
You may notice that your baby’s breasts get a little red and seem to grow bigger the first few days. Drops of milk may even ooze out of the tiny nipples. This can happen with either a boy or a girl, but is not very common. It just means that some of the internal substances that were getting your breasts ready for nursing also passed into the baby’s body from your blood before he was born. As these substances are carried off, the swelling will subside. Be careful not to press or rub the baby’s breasts while they are in this condition.
If yours is a girl baby, a few drops of blood may come from the vagina for a few days after birth. This bleeding is usually caused in much the same way as the breast enlargement. It will disappear shortly.
Care of premature babies
If your baby weighs less than 5 1/2 pounds when he is born, he is considered premature. His body is not quite ready to adjust to life in the outside world so he is placed in an incubator, if this is necessary. Temperature and humidity are carefully controlled in the incubator and extra oxygen is supplied if needed. Special precautions are taken to keep infection away from the baby when he is fed or changed. This is why you may not be able to have him with you while you are in the hospital.
Although your premature baby may not be strong enough to nurse for a while the doctor may want your milk for him. In that case, the nurse will show you how to express it by hand or with a breast pump, so that it can be fed to the baby. Doing this helps to keep up the milk supply, an important consideration if you are going to try to breast feed your baby when you get him home.
The kind of care a small premature baby needs can usually be given only in a hospital. If yours, by any chance, is born at home, make every effort to get him at once to a hospital that has a staff trained to look after premature babies and equipment for their care. Your doctor or a public health nurse will help you make the arrangements. In an emergency, the police will help you get transportation.
How long a premature infant stays in the hospital depends on his progress. A baby who weights almost 5 1/2 pounds at birth may need very little special care. The smaller ones are usually kept in the hospital until they weigh at least 5 pounds and show in other ways that they are strong enough to get along without hospital care.
The public health nurse who visits in your neighborhood will know about the birth of your premature baby, and will help you get ready for his return from the hospital. After he comes home, she will visit you from time to time. She can help you in a number of ways to carry out your doctor’s recommendations for his care. He will not be returned to you until he is sturdy enough to be at home.
The baby’s name
It may save much trouble later if your baby’s name can be entered on the original birth certificate. Try to decide upon it before you go to the hospital. Since you will not know in advance whether you are going to have a boy or a girl, it is a good idea to have names in mind for either one. If a name cannot be entered when your baby’s birth is first registered, be sure that it is added to the official record later.
The birth certificate
A birth certificate, properly filled out and filed, is the legal record of your child’s birth and will be recognized as such in any court of law. One of the most important things you have to do before you leave the hospital is to make sure that your baby’s birth certificate has been completed and sent to the proper authorities.
You probably know from experience how often your child will need this proof of his identity during his life. He will use it as proof of age when he enters school, when he applies for his first work permit and his first driver’s license. He may have to have it to prove his right to vote, to marry, to draw social security benefits, to hold certain kinds of jobs. It can help to settle insurance claims, and questions of parentage, inheritance and citizenship. Without a birth certificate, for example, it is hard to get a passport for travel in foreign countries.
The hospital will take the main responsibility for seeing that your baby’s birth certificate is completed and sent to the registrar of births in your community. If a baby is not born in a hospital, the doctor or midwife in attendance is responsible for making out the certificate and filing it with the registrar.
If there is time when you are admitted, the hospital will get from you then the information that has to go on the certificate: the names, addresses, ages, and occupations of you and your husband. If this information is not obtained when you enter, a nurse will get it from you later. The date and other necessary facts about the baby’s birth are added by the hospital or the doctor after the child is born. The certificate must be signed by the doctor and the hospital superintendent.
The local registrar will be the local health officer or someone on his staff. When he receives the birth certificate he goes over it very carefully for mistakes and if necessary sends it back for corrections. When everything is in order, he makes a copy for his own files and sends the original to the State office of vital statistics, which is a part of the State health department in most States and is usually located in the State capital.
You will be officially notified when the record of your baby’s birth is on file. In some States, this notice will be mailed by the local registrar; in others by the State office. It may be a photostat of the original, except for the medical information; or it may be a short form containing only the baby’s name, date and place of birth and his parents’ names. If your baby’s certificate is in any way incorrect, see that it is corrected immediately. In some States, the birth certificate is sent only on request and for a fee. There is practically always a charge for second copies. The personal information on all birth certificates is confidential.
Getting to know your baby
Although your stay in the hospital will probably be short, these few days have a lot to offer you and your family. During this time, you will be with people who are especially prepared to help you with your own after care and the care of the baby. You will be protected from having to do too much too soon. Above all, you will have a chance to get to know your new baby in a quiet and peaceful atmosphere.
This last point is in some ways the most important. At first, you may not feel the outpouring of love for your new baby that you expected. You may be disappointed because he isn’t as pretty as you thought he would be, or because he doesn’t respond to you when you first talk to him or fondle him. His first attempts to nurse may be uncomfortable for you. You may be afraid of him because he is so small and fragile looking.
As a rule, none of these feelings mean much in the long run. The babies who are homeliest at birth are often the prettiest later. Gradually they “wake up” and begin to notice the people who look after them. The nursing smooths out and the little bodies become sturdy. Mothers and babies have to learn to know and enjoy each other, and this takes time. Love will grow between you and your baby as you make him comfortable and he begins to show signs of personality.
Your family doctor or your pediatrician will be getting to know your child at the same time you are. While you are in the hospital, he and the nurses can be of much help to you in this “getting to know you, getting to like you,” process.