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
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
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
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
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?
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
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
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
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
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