Understanding your baby (or trying to!)
By no means am I professing to be an expert on all things baby, but I do have 3 daughters of my own and I do have over 20 years’ experience as a midwife working with women, new parents and babies.
During the pregnancy, many women tend to put most of their focus on actually getting the baby here and through no fault of their own, do not learn a lot about “babies” until they actually have to.
I strongly encourage you to at least learn a bit about feeding, newborn behaviour and what to expect from your baby in the first 6 weeks, before the baby is born, so you have some awareness and some knowledge and it isn’t all foreign information once the Midwives talk about these whilst you’re in the hospital.
The Golden Hour
Once the baby is born, you will notice the baby is wide-eyed, alert, and very active. The baby now has to learn to feed. It is no longer getting a constant flow of nutrients through the placenta from you. It has to survive now. It is important to allow the baby plenty of uninterrupted time on your chest, in direct skin to skin contact with you. This will not only ensure the baby stays warm, but will start to stimulate your hormones, will impregnate your skin with his/her smell to promote bonding, stimulate the breast and encourage the baby to start to search out the breast and start to suckle. The first hour after the birth is the most crucial time, but some babies take a bit longer than others to actually become more alert and then to latch on to the breast.
You may choose not to breastfeed, and that’s ok. It is still important for both you and your baby to have this uninterrupted skin to skin time.
The baby will “paw” at the breast, stroke the breast, bob his/her head around and gradually move his/her body in a way to help it manoeuvre closer to the dark round areola so it can start to smell, lick and taste the colostrum. Try not to rush the baby, let him/her take their time – if they are able to work it out for themselves, it will imprint in his/her brain for future feeds. Try not think the baby will be finished as soon as he/she comes off – the baby will probably attach and re-attach several times in this first feeding session, which may last for up to 2 hours.
Try not to interrupt the process by getting the baby weighed or arranging for the first vaccinations to be given to the baby. There is plenty of time for this after the baby has finished its feed.
The baby may want a few feeds close together during this golden time but will then have a big long recovery sleep for maybe three to four hours. Take this time to snuggle with your baby, breathe in that amazing smell, have something to eat, rest and recover.
What will the baby look like?
You may never have seen a newborn baby. Or if you have, it may have been a couple of days old.
When your baby is first born he/she will be wet, may have a bit (sometimes a lot) of blood covering his/her head or body from the birthing process, the skin may be covered in a white creamy substance called vernix and may look a funny colour – a bit purple, a bit bruised and a bit squashed. The baby’s head may also look to be out of shape – it will look quite elongated and you may notice the skull bones have overlapped each other. This is all very normal – your baby has worked hard to travel through the birth canal and is designed very cleverly to mould and fit but will gradually become a more normal shape over the next couple of days.
The baby’s hands and feet may continue to look purple at times (this is called acrocyanosis) but doesn’t mean the baby is cold. The baby’s circulation is still immature, and this will become more normal over the first couple of weeks.
The baby’s cord will be cut and trimmed soon after the birth and a plastic clamp will remain in place for about 5-10 days when the cord will then “fall off”. Sometimes when the nappy rubs on the base of the cord it may bleed a little bit, but it usually isn’t a concern. You do not need to cleanse the cord with any solution, just wash normally in the bath when the baby has a bath and pat dry with the towel afterwards.
The baby may also develop a common skin rash called erythema toxicum neonatorum in the first few days. This rash is not concerning and not harmful and will disappear as quickly as it arrives. It looks a like red blotchy spots mostly appearing on the baby’s arms, legs and abdomen and it will come and go. You don’t need to do anything for it.
Babies cry for many reasons. It’s normal. They can’t talk so their only form of communication is to cry. It doesn’t always mean something is wrong or concerning.
Generally, they will cry out to know you are there; for comfort; for warmth; to let you know they want their nappy changed; for food; and because they need you. Babies are very expressive when they cry, they use their whole body – head, arms, legs, abdomen. Sometimes, they will be uncomfortable or have a belly ache, sometimes they just need a cuddle.
Most babies will have a period of time during the 24 hours where they will be a bit cranky, unsettled and crying a lot. During the first couple of weeks, this will often be during the early evening or at night. They will often want to feed frequently during this time as well and you might find yourself pacing the floor trying to soothe and settle a crying baby. Try to stay calm, hold the baby in close, and just wait it out – it will eventually ease, and the baby will eventually settle back to sleep. Be consistent and persistent with your approach, try not to chop and change your techniques to often as this can sometimes make things a little worse.
Sometimes new parents worry their baby has terrible gas pain or even use the word “colic”. Newborn babies have a very immature digestive system. Some babies struggle a bit with this process in the first six weeks, until their gut matures and grows to cope with the frequent flow of milk through the bowel.
Newborn babies have very small stomachs that are designed to hold small volumes of milk in the first few days. The stomach will slowly stretch from the size of a small cherry (5ml) in the first couple of days to the size of an apricot at one week (60mls). Keeping in mind this is very general and not all babies are exactly the same, some babies will drink more, and some will drink less. Your baby is supposed to have small amounts of milk frequently. They usually digest their milk very well, but sometimes in the early weeks their gut just needs to get used to digesting the milk after only being exposed to amniotic fluid while in-utero.
It may be helpful to understand a little about how breastmilk is digested. When the baby suckles at the breast, he/she will stimulate the hormone Oxytocin to be released which will cause the breast to contract and eject the milk – called the “Milk Ejection Reflex”. Initially in the first few days after the milk has “come in”, you will have too much milk for what the baby can hold in his/her stomach. The baby’s stomach will stretch very quickly. You may have heard the terms “fore-milk” and “hind-milk”. This relates to the watery milk which is usually taken toward the start of the feed (“fore-milk”) and then the fattier milk(“hind-milk”) towards the end of the feed. In effect, it is not quite so clear cut – but what does happen is, as the breast empties, the fat content increases as the fat is released off the cell walls as the cells become empty of milk. So, it is always a good idea to let the baby suckle for as long as possible on the first breast, before offering the second. Some women only offer one breast per feed – alternating each feed.
When the milk enters the baby’s stomach, the watery part of the milk (called whey) will leave the stomach almost instantly and pass into the small intestine, leaving behind the casein (curd) or fatty part of the milk which will sustain the baby until the next feed. This process of the whey passing into the small intestine is what makes some babies very uncomfortable – it’s a bit like how you might feel if you drink a cold glass of water too quickly.
I often suggest gently massaging the breast at the start of the feed as this will break up some of the fat deposits off the cell walls and release it into the milk ready for the baby, and then allowing the baby to suckle on the first side until the breast feels much softer and much lighter – then you know the baby will be getting a higher fat content feed. This will aide digestion, will reduce some of that digestive pain and hopefully help the baby to settle for a little longer.
Try not to be tempted to keep feeding your baby larger volumes with the idea he/she will sleep for longer – it doesn’t always work and may in fact cause more discomfort.
Your supply will settle down after a couple of weeks, be patient. There is no need to express the milk the baby does not drink, as this will only stimulate your body to keep making that much milk.
Nappies (oh so many!)
When would you ever imagine that talking about someone’s bowel and urinary habits would be so creative and interesting? Only if you have a newborn baby!
Initially in the first couple of days, the baby will not pass very much urine. We would usually expect one wet nappy in the first 24 hours, two in the second 24 hours and maybe three by the third day. This is because the baby is only getting very small amounts to drink from the breast (or by bottle if bottle feeding), the urine will also look very concentrated – so a dark colour, which may also look a little pink or blood stained. It isn’t blood in the urine, but a waste product called urates (very concentrated urine). By the third or fourth day, your milk supply will be starting to increase and hence the urine output will start to increase and become clearer.
The first few poos the baby will pass is called meconium. This is the sterile poo that has built up in the baby’s bowel during the whole pregnancy – it is made up of the amniotic fluid the baby has been floating in and has swallowed, bile, and other gastric secretions. It is a dark green and very sticky substance that surprisingly does not smell. It can sometimes be difficult to clean off the baby’s skin (usually because you don’t want to rub too hard and hurt the baby). Once your milk supply starts to increase, the poo will transition to a lighter greeny brown colour and then to a yellow mustardy colour once the supply has really established.
The baby’s nappies will be your best indicator to tell you he/she is getting plenty of milk. The wet nappies will be heavy and dense and equal the number of feeds the baby has e.g. 8 feeds a day = 8 wet nappies a day. The poo will be squirty, yellow/mustard with plenty of “sesame seeds” or “mustard seed” in it. The “seeds” indicate fat deposits from the milk, so the more seeds, the better. Generally, breastmilk fed babies do not get constipated. This is because there is a natural substance in breastmilk that stimulates the bowel.
Sleep and behaviour
Probably the most talked about topic! All babies are different. All babies have a different personality, different temperament and will have different patterns.
With the exception of having an unsettled period of time at some point in the 24 hour day, most newborns will pretty much feed and sleep for the first week or two. Generally, most babies will have a growth spurt at around the two-week mark and will then become more wakeful, more alert and a bit more interested in what is going on around them.
Many babies tend to be more settled during the first half of the day, they will feed well and settle well. They then tend to become a bit more unsettled as the day goes on and then by the evening or night-time, they become more wakeful and often want to feed a lot. This is normal. This usually happens for a couple of reasons:
1. When they were in-utero, you would rock them to sleep during the day as you were moving around and walking. At night-time when you were sleeping and your muscles were relaxed, the baby would wake up and start moving more.
2. Also, your lactation hormone (Prolactin) is in greater concentration at night-time, therefore producing a higher volume of milk, so the baby feeds more at night-time – initially.
This won’t always be the case. Your baby will gradually feed more during the day and will start to sleep a bit longer at night-time and last longer between feeds at night-time. Be patient. In the early couple of weeks, as you are recovering from the birth of your baby, try to rest as much as you can during the day so you will be able to cope a little better with being up and awake at night-time. Your baby’s circadian rhythm will gradually adjust and become more like yours as time goes on.
Most babies will have a sleep cycle of about 45-50 minutes. They may wake at this moment and become alert, or with a little bit of help from you, they may settle again into a second sleep cycle. Just because they stir or cry out, doesn’t always mean they are hungry and are up ready for another feed. They may just be a little uncomfortable, they may. Just need to know you are close by, or they may have a bit of trapped wind the needs help to come up. Try some settling techniques:
- Turn onto left side
- Pat or rock the bassinette
- Pick up for a cuddle
- Is he/she too hot or too cold
- Does he/she have a dirty/wet nappy
- Give him/her a nice warm bath
If all else fails, offer another feed. It is normal to feed anywhere between 2 to 5 hours. And sometimes, nothing else will work but a feed.
Most breastfed babies will sleep approximately 14-16 hours a day with about 8-10 hours of wakeful time, which includes feed time. Quiet restful sleep plays an important role in memory processing and neurodevelopment for your baby, whilst hormones released in both you and your baby’s body enhance and facilitate bonding and clam, restorative sleep.
They are very noisy when they sleep. A lot of the time, they do not sleep soundly nor stay completely still. They moan and groan. They squirm and wriggle. Many new parents are very surprised by the amount of noise their tiny baby makes and how much they wriggle around when they sleep. Often it may seem like they must be very uncomfortable or have a lot of pain in their belly. They may do, but often they are just helping their body go through the process of digestion. Sometimes turning them onto their left-hand side can help them through this, then once they are settled, put them back onto their back again.
The first six weeks will be the most challenging for you and your partner as you get to know your baby, work out his/her personality and learn how to care for him/her. Every day will possibly be different as you navigate feed times, nappy changes, behaviour and managing to continue your own day to day living.
The raising children’s network has a lot of very helpful information on their website. There are also other resources such as Australian Breastfeeding Association, The Wonder Weeks, and Starting Blocks. Your local Maternal & Child Health nurse will also be a source of helpful professional information relating to the development and care of your baby.
Try not to expect too much. Your main focus is to rest, recover from the labour and birth and nurture your baby.
Call in all your helpers. Ask for and accept all offers of help – meals, cleaning, errands, and try not to feel guilty about it. Somewhere, along the journey, we have lost our villages. We need to get them back again, because it is true, it does take a village to raise a child.