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Growing Healthy podcast


May 31, 2018

Welcome back, folks!

MK - After we talked about the top 5 things I wish I knew about the post-partum period...that glorious time in every glowing mother's life, we also wanted to cover the top 5 things that I wish I had known about that little wrinkled being that just came out of me!

I'll never forget when my husband and I watched the birthing video at our prenatal class and he's like, "what's wrong with that baby".

I'm like, "yeah, babies come out blue"

Info bit #1:  Babies are blue at birth.

AP: yes they will be, as you can imagine, goes through quite a journey both physically and physiologically during the delivery process.  They go from getting all they need to survive through the umbilical cord, to needing to breath and manage all their needs on their own.  This transition goes surprisingly well and quickly for most babies....but they do come out a bit blue to start off, and as their lungs start to fill with air, and it gets pumped around their body they start to pink up.  In some baby's for a variety of reasons, this transition from inside to outside takes a little longer and they need more support, sometimes we need to help them to breathe a bit while they are figuring it out, and the vast majority of time they are doing it all on their own by 10 minutes of life.  So don't be too worried if we need to help your baby out a bit, we will keep you informed and get them back to you, where they belong, as soon as it is safe for both of you to do this!

AP - Info bit #2:  Your baby will lose weight...and then regain it.

MK: it is normal for you baby to lose up to 10% of their birth weight in the first few days of life.  We generally expect them to gain back this lost weight, and be at their birth weight by 10-14 days of age.  

AP - Info bit #3:  Your baby will be jaundiced, but you may not recognize it.  Maria, can you describe jaundice to us?

MK: Yes, ALL babies get jaundiced, it just depends on how jaundice they get as to whether we need to treat them.  Jaundice is that yellow tinge to skin and eyes that babies get.  It is caused by the breakdown products of the red blood cells of babies, as they are transitioning from their baby hemoglobin, or red blood cells, to their adult hemoglobin.  This product is then broken down in the liver and transferred out of the body in the baby's pees and poops.  There are a number of reasons why this may not happen as efficiently as it could, which would then cause higher bilirubin levels and more jaundice.  

AP: why do we care if baby's are a bit jaundiced? can it cause them any harm?

MK: Well we definitely care, because once the bilirubin gets to a certain level, it can cross what we call the blood brain barrier and cause irreversible damage to your baby's brain.  

AP: are there any risk factors that we can watch out for in babies to predict a higher risk of getting jaundice? 

MK

a) gestational age - the younger a baby is the less mature their liver is and therefore the less capable it is at keeping up with the need to breakdown these products quickly, and therefore levels can rise in the blood.  So this is premature babies.

b) Ethnicity - Babies of east asia ethnicity (including china, japan, korea, taiwan etc) are at a higher risk for jaundice requiring therapy.  The bilirubin levels are often higher, and peak a bit later, and take longer to resolve. This is due to a decrease in the enzyme which helps breakdown the bilirubin in baby's blood. About 1/5 baby's of this ethnicity will require treatment to bring their bilirubin down. 

c) Blood type - If baby has a different blood type than mom, and mom has created antibodies against this blood type, then baby will often be born with these immune cells from mom which will break down the baby's red blood cells more quickly.  This occurs with mom's who are RH - and baby is RH +, or if mom has blood type O and baby is a different blood type (A, B or AB)

d) There are certain genetic causes that can increase baby's risk of being jaundiced, these can be as a result of the shape of the blood cells, or red blood cells are broken down more quickly leading to more bilirubin in baby's blood, or because the enzymes that help to break down bilirubin don't work as well.  

d) If you had a previous baby with jaundice requiring treatment under the phototherapy lights, then we are much more cautious with subsequent babies, as they are at a higher risk of needing treatment generally because of one of the above reasons.

AP: how do we monitor for jaundice?

MK: here in Victoria, we have recently started a program where we can take a skin measurement of baby's bilirubin levels.

I actually really love this little gadget because it's very Star Trek.

We do this multiple times over the first few days of life.  If your baby's bilirubin levels are high on this skin test, we need to confirm with a blood test.  On discharge from the hospital, if your baby's jaundice level is not too high, but not too low, we get your baby to go to public health and have these skin checks done until we know it is improving.  If your baby has a high blood level, then we either have to monitor closely with more blood tests or start treatment. 

AP: How do we treat Jaundice? 

MK: The treatment of jaundice is by keeping your baby hydrated, as the broken down bilirubin is excreted through your baby's pee and poo, and by using ultraviolet light to help breakdown the bilirubin.  This looks like a little tanning booth for your baby.  We put them into this, in a diaper with eye protection and leave as much skin exposed to the lights.  It is important for your baby to be under this as much as possible, so other than breastfeeding your baby should be under the lights...which is hard because it decreases the snuggle time with your baby.  But we do have a "bili blanket" which wraps around your baby so you can continue to snuggle and feed while receiving treatment.  However, sometimes, your baby will still need to go under the tanning bed.

Very rarely your baby's bilirubin is so high that we have to do more invasive treatment which requires what we call exchange transfusions, but this rare. 

If we need to treat your baby, we will need to follow up with bloodwork to ensure that the levels stay on the lower side and don't bounce back up. 

Info bit #4:  One of the things that new parents in particular are always asking me is "how much do baby's need to eat" and "how to know if they are getting enough"?

AP:  When babies are born, their stomachs are just wee, and that is normal.  As we discussed previously mom produces just small amounts of colostrum for the first few days before her milk comes in, and mom and baby are designed to work together.  So baby will feed often and get little amounts over the first couple of days of life.  This allows your babies stomach size to slowly increase with mom's milk production, and also gets that frequent feeding and skin to skin time, which is so important for both revving up mom's milk supply and for baby's attachment to mom to start forming and regulating temperature.  So trust yourself and your body!  If you are in the hospital, we make sure that your baby has not lost too much weight.   Also to make sure your baby is getting enough, check the wet diapers.  Over the first few days to a week they should be having as many wet diapers as they are days old...ie 2 wet diapers on day two of life, 4 on day four of life etc!  

 AP: Speaking of diapers....make sure you are well prepared, because in those first few weeks of life you are going to go through a lot!!! your baby will pee 5-10 times a day, and although poo varies from every feed to once a week expect more than less at the beginning...and you want to get that poo away from their skin as it can cause the skin to break down and get raw and irritated....poor little bums...so frequent bum changes and if the skin starts to break down...using a barrier cream such as vaseline petroleum jelly, penetin etc will help.  If it gets really bad go see your health care provider because they may need a prescription cream to help it heal. 

MK: I love Vaseline.  Not just because it's cheap, easy and effective, but because it was a staple of my childhood.  I have numerous photos of me with very shiny chubby cheeks.

Alicia, Do you find some baby's are more prone to diaper rashes:

AP: Yes! like us adults,  some babies have very sensitive skin, and if that is your baby you will want to consider not using the "big brand" diapers that have been bleached, scented etc.  I usually recommend the seventh generation or Earth's best.  Also take a look at your wipes, some people have to use just warm water on a cloth to clean their baby's bums!  For prevention cloth diapering is an option in those very sensitive baby's, but this is not for every family!  

MK - Info bit #5:  Your baby will fool you by sleeping so soundly and beautifully for the first few weeks.....during the day anyways!! 

AP: They sure will!  babies sleep lots in the first month of life.  Unfortunately for us adults that is usually more during the day and less at night!  This often starts to transition over around 6 weeks of age, when they will have more awake periods during the day, and sleep longer chunks at night.  So be prepared!!! and try to get a nap in during the day, or tag team with your partner/support person at night the best you can.  Try to encourage sleep at night by not reacting every time your baby makes a peep.  The nature of sleep is that baby's and adults come to the edge of waking and then sometimes will go back into a deeper sleep, unless they are disturbed by a well meaning parent!  so if your baby is not crying, give them a minute or two to see if they will settle.  And some baby's are just noisy sleepers...don't worry...if they are hungry they will call for you.  But...during the first few weeks, until you know your baby is gaining well, you should be feeding them at least every 3 hours during the day and  4 hours from start to start at night, in reality it will probably be more often than this!

MK:  So there's our Top 5 things to know about your baby in the post partum period.  I'm sure there are so many more questions and helpful advice that many of you have, so please give us some feedback through youtube, facebook, apple iTunes, or even in person.  We love hearing helpful feedback.

AK:  Thanks again for listening, folks and keep on Growing healthy!