Embracing Your New Role

Being a new parent is the most important job anyone could have. You now have total responsibility for another human being. There is no formal education to prepare one to be a parent.

Traditionally, culturally accepted parenting skills were handed down from generation to generation, but the skills were not necessarily scientifically based. Today, there is a great deal of information available that provides training and information for new parents that is based on scientific research.

This article will address the typical challenges and adjustments that will help parents cope during the normal but complex life stage of being a new parent. This article will also address issues such as when it is appropriate to call the doctor for either baby or parenting concerns and answer questions about baby blues and post partum depression.

The information presented has been approved by the Academy of Pediatrics and is being provided for post partum moms and their newborns. It is a guide to help answer some of the most common questions related to postpartum and newborn care.

PART I – TAKING CARE OF YOU

When to Call your Obstetrician (OB)

Your postpartum period is the six weeks after the birth of your baby. During this time, any health problems that occur should be called to your OB first. If the problem is not OB-related, you may be instructed to contact your primary care provider or a specialist.

Women who have experienced high-risk pregnancies such as gestational diabetes, gestational hypertension, or depression may have a continuation of problems during the postpartum period. Therefore, it is important to know when to call the doctor to report any new or continued signs and symptoms of your illness.

Gestational Diabetes

Most of the time, the cure for Gestational Diabetes is delivery of the baby. You will no longer need to test your blood sugars; however, you should have a blood test called hemoglobin A1C about 6 weeks after delivery to let your doctor see if your sugars remained within normal limits after delivery.

Any signs of diabetes that occur after delivery should be reported immediately to your doctor. Examples of this would be excessive thirst, increased urination, dry itchy skin, blurred vision, excessive drowsiness, extreme hunger, and sudden unexplained weight loss.

Women who have experienced gestational diabetes have a greater chance of developing overt diabetes later in life and should remain cognizant of their weight, nutrition and exercise regimes. It is also a good idea to notify any other health care providers you have about the gestational diabetes.

Gestational Hypertension

Gestational Hypertension or pregnancy-induced hypertension can also have postpartum complications. Therefore, postpartum control of your blood pressure is very important so as not to damage your heart, blood vessels, eyes, brain, and kidneys. A follow-up with your OB and then your primary care physician is important for anyone diagnosed with a hypertensive issue because often the signs and symptoms are obscure and not experienced until your blood pressure is very high.

Women who have signs and symptoms such as nausea, headaches, dizziness, weakness of the arms or legs, extreme tiredness, confusion, difficulty breathing, nosebleeds, blurred vision, and palpitations need to contact their doctor right away.

Ways to help keep your blood pressure within normal values are to exercise regularly, eat a healthy diet with decreased processed foods and low salt, take medications as ordered, stop smoking and have your blood pressure checked regularly.

Diabetes and hypertension symptoms seem similar, but remember, if you have been diagnosed with either or both, you need to call your doctor if your symptoms worsen or if you have new symptoms.

Post-Partum Depression

Postpartum Depression has received a lot of attention in the last few years. Some well-known movie stars have scoffed at the diagnosis, saying it is not a real illness. However, those who have suffered from postpartum depression know how real and frightening it can be.

Some form of Postpartum Depression affects 3% to 30% of women. Most postpartum women experience some type of blues, but most do not develop into full-blown depression.

Common signs of postpartum depression include:

Crying
poor appetite
feelings of despair
loneliness

feelings of inadequacy

feelings of failure

These signs of the ‘baby blues’ may be apparent off and on for the 3 to 6 days after delivery. It is important to share these feelings with a loved one, close friend, or your OB.

If these feelings continue past two weeks or worsen at any time, you need to call either your physician or go to the ER, especially if you feel as though you want to hurt yourself or the baby.

A more serious form of Postpartum Depression is a postpartum psychosis, which can occur within 1-2 days after delivery. The signs and symptoms are:

sleep disturbances
confusion
agitation
irritability
hallucinations
delusions
suicide
infanticide/p>

Immediate hospitalization is needed along with aggressive treatment so that a complete recovery can occur.

Postpartum Depression is a complex range of disorders that vary from baby blues to psychosis and includes panic or anxiety attacks. Those who suffer pre-baby from panic attacks often find the attacks become exacerbated during the postpartum period.

Women may begin to experience frequent unprecedented episodes of physical symptoms such as palpitations, shortness of breath, chest pain, nausea, and lightheadedness, numbness of the fingers, and a feeling of doom. This often interferes with the new mother’s activities of daily life.

There can also be mental distress which includes such symptoms as repetitive thoughts and behaviors that the women have no control over. They are well aware that these thoughts and behaviors are bizarre and become fearful that they may act on them, thus increasing their anxiety and leading to depression.

The cause for this disorder is not scientifically proven but has been theorized to be correlated with the rapid drop of estrogen and oxytocin in the brain immediately after delivery. Treatment consists of antidepressants, anti-anxiety meds, counseling, and behavioral therapy.

New parents experience psychological and physiological changes in a very short period. Adapting to their new roles can be overwhelming. Having a good support system and recognizing the changes in their lifestyles are critical for new parents. This may help decrease the anxiety and frustration they feel.

What you can do to help yourself

The following recommendations are important for new moms to review and try to follow in an effort to make the post-partum period go as smoothly as possible. Well-mom care consists of:

resting when your baby rests;
eating a well balanced diet;
drinking lots of water (2 quarts daily);
taking vitamins and medications as directed;
limiting the stairs;
avoiding carrying anything heavier than your baby (not in a carrier);
limiting your visitors;
washing hands before and after touching your baby and encouraging others to do the same;
accepting or asking for help with meals, laundry, child care and driving responsibilities.

The preceding instructions are easier said than done and they may lead to more anxiety for some women. Recognizing in advance that having a baby changes your daily life and your relationships with your partner and family and knowing having a baby is one of the top life-changing events in a person’s life may help to decrease the stress and anxiety you feel.

Therefore, women need to discuss some of their fears with their health care providers so they can refer you to support groups that will link you to other parents facing the same challenges, especially if your own personal support systems are not nearby.

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PART II – TAKING CARE OF BABY

At last, you and your newborn are home. You may have been to parenting classes and you received your discharge information packet from the pediatrician. You feel armed with all the information you need to care for your new baby.

However, the first night home is a disaster and you are panic-stricken as the realization sets in that this baby is totally your responsibility.

The baby was up all night and never seemed satisfied with breastfeeding or slept too much after bottle-feeding.
The baby did not burp after feeding, you were not sure how many times you changed the diaper or did not notice if it was wet or dirty or both.
If it is a boy, how were you supposed to care for the circumcision?
You frantically try to remember what you did in the hospital and what you learned in the class. However, due to lack of sleep, you cannot seem to remember and neither can your partner.

Welcome to parenthood! Unbelievably, this is all very normal. You have joined all new parents that experience this traumatic discovery.

The following information is meant to relieve some of the fears and anxiety related to this normal phenomenon.

Feeding your baby

Breastfeed or bottle-feed your baby every 2 to 4 hours and wake him or her up to feed. It is an old wives tale to leave a sleeping baby lie.

Breastfeeding

Breastfed babies can nurse every 30 minutes to 4 hours and this is normal. Your milk may not come in until the third or fourth day postpartum but that does not mean you should not nurse; nursing frequently increases your milk supply.

You may experience some engorgement at first that could last a day or two. Expressing a little milk prior to feeding may alleviate latching problems at this time, and using warm compresses before a feeding will soften the breast to allow for latching.

If you are concerned that the baby isn’t getting enough to eat while breastfeeding, attempt to feed 8 to 12 times a day and look for 6 to 8 wet diapers and 3 or more bowel movements by the fourth day of life.

If you have any doubts the baby is not growing or feeding well, seek help from your pediatrician or a lactation consultant. Remember that all newborns have their own feeding style and elimination pattern, so keep a close watch to learn your baby’s style.

For some this process goes quite smoothly; for others, there are hurdles to overcome. Remember, there are people available to assist you if you are having trouble. Do not hesitate to call your pediatrician’s office or your local breastfeeding resource group to help you.

Bottlefeeding

Bottlefed babies will sometimes sleep longer than breastfed babies because it takes longer to digest formula, but they still need to be fed every 4 hours in the first week or two.

You will gradually need to increase the formula amount, as the baby will soon not be satisfied after the four hours. Increase the amount by ½-ounce increments. Never switch formulas unless you check with the pediatrician first. They are just a phone call away.

You may sterilize your bottles and nipples before the first use, then always rinse in cool water and wash in hot soapy water or place in the dishwasher.

Safety issues for bottle-fed babies

Bottles are considered contaminated once they have been in the baby’s mouth and can only be re-refrigerated for 8-12 hours. If the bottle is not finished at a feeding, it is only good for 2-4 hours and must be discarded depending on the temperature of the room.
Never microwave a bottle as this may cause “hot spots” that could burn the baby.
Formula and breast milk do not need to be heated. They can be given at room temperature. If you prefer to warm the bottles, place them in a bowl of warm water to heat.
It is important for bonding, as well as to avoid choking, to hold your baby to feed.
Elimination patterns for formula-fed infants consist of a bowel movement every 1 to 3 days and six wet diapers daily. Again, it is important to notice your own baby’s regular pattern.

Burping and Spitting

Burping in-between breasts and at the end of the feeding or after each half ounce of formula allows your baby to digest his or her feeding well and helps prevent too much air in the tummy, causing gas pains.

Burping can be done by placing the baby over your shoulder and gently patting the back or rubbing up towards their shoulder. You can also hold the baby on your lap and support their chin with one hand while leaning them slightly over while patting gently as above.

Spitting is common among babies but should never be more than a mouthful or two and should never be with every feeding. Excessive spitting up can come from the baby gulping or eating too fast, too much, or too often, and from not burping.

With bottle-fed babies, spitting can also happen when the wrong nipple is being used. You might need to try several different bottles and nipples before finding the right one for your baby. In the meantime try to sit the baby up for 20 to 30 minutes in a car seat or baby seat after feedings.

Circumcision Care

It is a familial choice whether to have a boy circumcised; your obstetrician in the hospital can perform the procedure if you do choose to have your son circumcised.

Care of the circumcision consists of keeping the penis clean by gently cleansing with warm mild soap and water and coating the penis with Vaseline or A+D ointment at every diaper change. As the circumcision heals there will be a yellow coating over the tip of the penis. Do not try to wipe this off, as it is a normal healing process.

The circumcision will take about a week or two to heal. Call the pediatrician if the penis becomes red, swollen or blistered, or has a foul odor.

Vaginal Discharge

Little girls will have a white or bloody vaginal discharge caused by the hormones passed on by mom. This is normal and need only be wiped away gently from front to back.

Umbilical Care

Historically, the umbilical cord was cleansed with alcohol at every diaper change and some families placed a bellyband over the cord to prevent it from sticking out. Recently, that care has changed.

Pediatricians recommend cleaning the cord with warm water or using nothing at all, and they do not recommend the bellyband as it will prevent air from getting to the cord and prevent it from drying out and falling off.

It will take about two weeks for the cord to fall off. Occasionally, there may be a little bleeding when it is cleaned or when it falls off. This is normal, just like when a scab falls off a cut. Should there be redness around the cord or a foul smell, call the pediatrician.

Jaundice

Jaundice is a yellow coloring of the skin that happens when a chemical in the blood called bilirubin is not excreted by the liver. It begins at the face and works its way down the body, and is common in more than half of all newborns no matter color or race. There are several causes for jaundice but mainly, it comes from an immature liver and is called physiologic jaundice.

Treatment is at your pediatrician’s discretion and it is important that the baby be followed up with medical care within 2 to 4 days after delivery. If the baby appears sleepy, has a decrease in appetite and elimination, and appears more yellow or very red, call the pediatrician.

Jaundice is easily treated once bilirubin levels are obtained via a blood test taken from the baby’s heel. Most of the time jaundice requires no treatment but if it is necessary your baby will be placed under special lights and checked daily until the levels are within a normal range.

Bathing your baby

Babies need a bath about every 2 to 3 days until about 1 year old; if done more often, their skin can become too dry.

A sponge bath is sufficient until the cord falls off and the circumcision has healed.

Use only warm tepid water to avoid burns and never leave your baby unattended near water. A mild soap such as Dove or fragrance-free baby wash is best to use to prevent drying out the skin.

Sleep Patterns

The American Academy of Pediatrics recommendations to prevent SIDS are to have babies sleep on their backs.

Since newborns do not instinctively know day from night you can help them learn this difference by keeping your daytime noise routine normal, such as vacuuming, opening the blinds, letting the phone ring etc.; and by being quiet at night and keeping the baby’s environment dark and quiet.

Exposure to the Elements

Babies are very sensitive to sun and cold.

Never use sunscreen on an infant and check with your pediatrician as to when you should begin. Avoid exposing babies to direct sunlight to prevent sunburn and overheating, which can lead to dehydration very quickly.

Babies lose heat through their heads and skin so keep an extra layer and a hat on them during the winter months.

Rashes

Diaper rash is a common irritation most babies develop at some time. Keep the diaper area clean and dry and coat the area with a petroleum-based ointment unless it is an open rash; then use a zinc oxide-based cream. If it persists or worsens after treatment for 3 or 4 days, call the pediatrician.

Some babies develop newborn rash or baby acne; while it may appear ugly, it will go away on its own; never try to pop the blemish or treat with medications. Most babies will have dry skin; using a light moisturizing cream such as Eucerin will help. Use of a dandruff shampoo will help if the baby’s scalp appears dry; this is commonly known as “cradle cap”.

Some Normal Behaviors

The following behaviors are considered normal for a newborn and new parents need not panic when they are exhibited:

sneezing
occasional crossed eyes
restless sleeping
hiccups
yawning
passing gas
a startle reflex with an abrupt noise
trembling chin when crying
a quivering upper lip.

It is also important for parents to remember that crying is the only way babies can communicate their needs. They cry to say they are hungry, have a messy diaper, and are bored, tired or lonely. As the baby grows, parents will begin to know and understand their baby’s cries and learn how to calm and soothe them.

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CONCLUSION

You are at the beginning of a remarkable journey. As you start out, it can feel overwhelming and you may be filled with many questions and some anxiety. Hopefully, this article will have armed you with the information you need.

If you are still unsure or if something “just doesn’t feel right” to you, remember it is okay to ask your family, friends, doctors, and other medical professionals, even if the questions seem “silly.”

Reaching out for support and information is a smart and recommended thing to do since it is the quickest way to learn what you need to do.

This very complex and life-changing event of having a new baby will become routine and eventually parents will look back at this time as another learning experience in their lives that has helped them to grow and become responsible adults who raise responsible children.

While exhausting and stressful, this is also a time of wonder and awe as you welcome your baby into your family, learn to care for him or her, begin to develop a relationship with your baby, and experience the magic and mystery of birth and an infant’s development.

By Regina Diamond RN MCHClinical Manager at AMH Home Care

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