Childbirth & Parenting Education

Week 4

Created by Katherine Aquilina (RM & accredited

Childbirth and Parenting Educator for BDH WHC)
RECAP FROM LAST WEEK
 The First Hour

Neonatal Assessment

Routine Checks for the Baby

Injections And Screening Tools

This session Newborn Characteristics
will cover: Caring for the Baby

Where To Get Help At Home

Contraception

Postnatal Feelings
THE FIRST HOUR
The First Hour
Baby:
• Keep baby in skin to skin contact

• Baby may attach to the breast

themselves or with some support

Mother:
• Skin to skin contact

• Fundal massage

• Monitoring bleeding

• Attending to any immediate needs.

• Hand expressing may be useful

 NEONATAL ASSESSMENT
& THE ROUTINE CHECKS FOR BABY
Neonatal Assessment

• APGARS

• After the first breast feed.

• Weight, height and head circumference

• Checking the baby physically head to toe

• Checking the baby neurologically through

reflexes

Routine Checks for Baby

• Observations (temp, resp & heart rate)

• Feeding discussion

• Umbilical site inspection

• The importance of wee’s and poo’s!

• ID bands x 2
INJECTIONS AND SCREENING TESTS

All tests and injections are done
only with permission from the
parents. Written consent is
required.
Your midwife can provide you with
more information.
Vitamin K
• Needed to help the blood clot and to prevent bleeding.
• Babies do not get enough v itamin K from their mothers
during pregnancy or from breast milk.
• Newborns can be deficient in v itamin K for the first eight
days of life.
• Without enough v itamin K a baby is at risk of dev eloping a
rare disorder called Vitamin K Deficiency Bleeding or
VKDB,
• VKDB can cause babies to bleed into their brain. This
condition can also lead to death.
• Babies can be giv en an injection with a single dose of
v itamin K within a few hours of birth.
Hepatitis B vaccine
• The hepatitis B v irus can lead to chronic liv er problems
and liv er cancers.
• It is spread by infected blood and other body fluids such
as saliv a.
• First dose giv en within a few hours/days after birth. Repeat
doses giv en within the 4 years.
Newborn Screening Test

• A screening test that looks for rare but serious diseases

that if found allow treatment to start early and help baby
liv e a happy and healthy life.
• Looks for: congenital hypothyroidism
• cystic fibrosis
• amino acid disorders e.g. Phenylketonuria (PKU)
• other rare metabolic disorders.
• Heel pick to produce a small amount of blood; this is
usually done when baby is between 48 and 72 hours old
• >99% of the time the results are normal, and parents will
not be contacted.

Hearing Screen

• A small number of babies are born with a hearing loss,

which could affect their speech and language skills.

• Hearing loss may not be obv ious in the first few weeks of
life but can be detected by a hearing screen.

• You will be giv en the results as soon as the screen is

completed.
NEWBORN CHARACTERISTICS
Fontanelles

• Soft spaces between the bones of the skull

where bone formation isn't complete. This
allows the skull to be moulded during birth

• Anterior fontanelle (12-18 months)

• Posterior fontanelle (2-4 months)

• Sunken fontanelle, likely dehydration, seek

medical support

Moulding

• Caused by pressure on the head in the birth

canal – very normal!

• Self resolving, may take 24 hours or a few

days.
Telangiectatic Nevi (stork bites)
• About 30-50% of newborns have flat, pink spots on their
skin.

• Appear on the face and neck, eyelids, upper lip, back of

the neck, and forehead.

• Caused by a thickening of immature blood v essels and

may be the most v isible when the baby is crying

• Most self-resolv e between the ages of 1 and 3 years

• No treatment needed

Nevus Flammeus (port wine stains)

• Permanent red or blue-coloured birthmarks that are

present from birth

• Most often appear on the face, neck, arms, legs and

scalp and can grow larger

• Caused by irregularity of the blood v essels

• No treatment necessary, but if required laser therapy

treatment is av ailable.
Mongolian Spots

• Birthmarks that are flat blue or blue/grey spots in v arious

shapes/sizes that commonly appear at birth or soon after.
• Most common at the base of the spine, on the buttocks,
back and shoulders
• Most common among Asian children, as well as children
with dark skin, including people of Polynesian, Indian and
African descent.
• Not associated with any other medical symptoms or
illnesses, and do not cause any pain.
• Most self resolv e between the ages of 1 and 5 years
• No treatment needed

Nevus Vasculosus (strawberry marks)

• Birthmarks that are bright red, strawberry in colour
• Most often appear on the head and neck but can
appear anywhere.
• Caused by an ov ergrowth of the cells that line blood
v essels and effects 1 in 15 babies.
• No treatment necessary, will shrink ov er time.
Occasionally may require laser therapy treatment.
Milia

• Milia are tiny lumps or blisters that sometimes come up on

babies’ faces soon after birth.
• Caused by blocked sweat glands. The glands get
blocked because they aren’t yet fully dev eloped.
• Most common on the nose and cheeks, but they can
appear anywhere on the face.
• The blisters can break easily and can leav e a scaly lump.
Do not scratch or pick.
• Self-resolv ing within a few weeks or months after birth.
• No treatment needed

Erythema Toxicum (Newborn rash)

• a harmless rash, which many newborns get. It happens in

up to half of all term babies
• Appears like a combination of flat patches, tiny bumps
and pus-filled bumps 1-3 days after birth
• Self resolv es and no treatment required.

◦ What rash is concerning: a rash that’s spreading and if

baby is fussy, not feeding well, has a fev er, isn’t producing
wet nappies or seems generally unwell
Vernix
• Protective coating that forms on baby's skin in the
womb
• It is a thick, greasy substance made of water, fatty
acids, and proteins, and it creates a moisturizing
barrier for your baby's skin.
• Helps to fight off bacteria, keep babies warm and
moisturises baby’s skin.
• Rub into skin and avoid bathing baby for 24 hours.

Genitalia

• Both female and male genitals may appear swollen

due to mothers' hormones, pressure at birth and
normal development.
• Newborn girls may have a vaginal discharge of
mucus and perhaps some blood that lasts for a few
days. Normal menstrual-type bleeding from the
infant's uterus that occurs due to mothers' hormones.
• Hydrocele is a collection of fluid in the scrotum of
infant boys that usually disappears during the first 3 to
6 months.
• Testicles should be descended.
BREAK
CARING FOR YOUR NEWBORN BABY
Signs of a well-baby
• baby appears healthy - normal colour,
alert and active when awake, and is
waking for feeds
• 2-3 wet nappies a day in the first 3-4
days, then at least 5 wet nappies a
day
• 1 - 2 soft bowel motions/day
• baby is feeding at least six times/day,
most will feed at least 8 -12 times a
day
• baby is gaining weight. Most babies
are back to their birth weight by 2
weeks of age
• baby is breathing easily, about 40 – 60
times a minute.
Signs of an unwell Baby
Hav e you noticed a change in baby's behav iour?
• is sleeping a lot, not waking and demanding feeds
• may wake for feeds but tires easily
• is not as activ e and alert as usual when awake or
feeding
• is unusually irritable.
• may hav e a dry mouth and skin
• may hav e fewer wet and dirty nappies
• urine may appear as a dark yellow staining on the
nappy
• skin colour may change and become pale or
mottled ov er the baby’s body (not just hands and
feet)
• Temperature is higher than 37.4C or less than 36.0C
• may appear to hav e difficulty breathing:
• panting,
• make grunting noises or
• chest wall appears to be sucked in with each
breath
• abdominal distension or excessiv e v omiting.
Cord Care
• After birth, the cord is clamped and cut.
• Over the first few days, the stump gets darker
and shrivels
• Eventually falls off to become your baby’s
belly button – this takes up to 10 days
• Its best to keep the site clean and dry to
minimise infection.
• Use clean hands when cleaning the stump.
• Use clean water only to gently clean around
the stump.
• Dry gently and well after the bath, air drying
helps the stump to fall off faster.
• Keep the stump outside of the nappy, this will
prevent wee and poo from sitting around the
site.
• Signs of infection: the area around the cord is
red, has a bad smell and/or is warm and
tender to touch. Seek support.
Newborn sleep cycles
◦ Newborns have two different kinds of
sleep – active sleep and quiet sleep.
◦ During active sleep, newborns move
around a lot and make noises. They can
be woken easily during active sleep.
◦ During quiet sleep, newborns are still.
Their breathing is deep and regular.
They’re less likely to wake during quiet
sleep.
◦ Each newborn sleep cycle has both
active sleep and quiet sleep and takes
about 40 minutes.
◦ At the end of each cycle, newborns
wake up for a little while. When they
wake, they might grizzle or cry.
◦ If your baby wakes at the end of a sleep
cycle, you might need to help baby
settle for the next sleep cycle.
 How would you settle Settling Tips!
your baby? • Newborns wake frequently to feed because they hav e
tiny tummies.
• Newborns usually sleep in short bursts of 2-3 hours each.
• If my baby is unsettled - Check some reasons off:
• Is my baby hungry?
• Is my baby’s nappy dirty?
• Is my baby too hot or too cold?
• Is my baby tired?
• Is my baby unwell?
• Is my baby looking for comfort and reassurance?

• Gently touching your baby, patting, stroking, rocking

• Gentle shushing noises, settling music or white noise.
• Soft lighting, warm space

Responsive settling is responding to • Wrapping

babies’ comfort needs while helping • Babywearing

them settle and sleep. • Walk in the pram/ being outside

• Bathing baby

Responsive settling helps babies feel • Baby massage

safe and secure. • Ask for help

 Safe Baby wearing
• Pick a suitable carrier – consultations av ailable
• allows healthy hip positioning for your baby
• is safe to use
• is comfortable for you to wear.
• The carrier should allow your baby’s hips to
• spread so their legs are straddling your body,
• knees should be spread apart,
• thighs should be supported,
• hips should be bent.
T.I.C.K.S. rule :
• Tight: the sling should be tight, with the baby positioned
high and upright with head support.
• In v iew at all times: you should always be able to see your
baby’s face by simply looking down.
• Close enough to kiss: your baby should be close enough to
your chin that by tipping their head forward you can easily
kiss their head.
• Keep chin off the chest: ensure your baby’s chin is up and
away from their body. Regularly check your baby. Babies
can be in distress without making any noise or mov ement.
• Supported back: your baby’s back should be supported in
a natural position with their tummy and chest against you.
Bend at the knees, not at the waist.
Shaken Baby Syndrome
• Shaken baby syndrome is a serious brain injury
resulting from forcefully shaking an infant or toddler.
• Infants have poor neck strength, and their heads
are large compared with the size of their bodies.
• When the head moves around, the baby or child's
brain moves back and forth inside the skull.
• This can tear blood vessels and nerves inside or
around the brain, causing bleeding and nerve
damage.
• These injuries can cause permanent brain damage
or death
• If you feel overwhelmed, put the baby in a safe
sleeping space, and remove yourself from the
situation until you have gained control.
• Phone a friend, family member or helpline.
Sudden Infant Death Syndrome
• the sudden and unexpected death of an
infant under one year of age with an onset
of a fatal episode occurring during sleep,
that remains unexplained after a thorough
investigation.
• Follow the principles of safe sleeping to keep
your baby safe.
• Sleep baby on the back from birth, not on the
tummy or side
• Sleep baby with head and face uncovered
• Provide a safe sleeping environment night and
day
• Keep baby smoke free before and after birth.
• Sleep baby in their own safe sleeping place in
the same room as an adult care giver for the
first 6-12 months
• Breastfeed baby.
WHERE TO GET HELP
Also:
• Child & Family Health Nurse
• Your family doctor
• Family and friends
• Parenting groups
• Social connection groups
CONTRACEPTION AND SEX
Sex
• Returning to sexual intercourse and activity when you
feel ready to do so.
• Timing in completely up to the woman
• Women can become pregnant again any time after
giving birth and returning to sexual intercourse.
• Lubricant can be helpful
• If you are experiencing significant pain and discomfort,
seek support.

Contraception
• Have a conversation with your partner about
contraception if you are not planning another
pregnancy
• Let's review the options
• Breastfeeding can help reduce the chances of
becoming pregnant if
• exclusively breastfeeding day and night
• baby isn’t receiving any other food or drink (just
breastmilk)
• baby is under six months old
• The woman hasn’t had a period since giving birth.
POSTNATAL FEELINGS
Baby Blues
• A period of mood swings which you can
experience after your baby is born.
• Between 60 to 80% of women experience the
baby blues, which generally last a few days.
◦ May be caused by sudden changes in your
hormone levels around the time of baby’s
birth or by the anticipation and physical
exhaustion of birth.
◦ You could feel
◦ emotional and burst into tears for no reason
◦ very tense and anxious
◦ worry about minor problems and often have
trouble sleeping
◦ generally unwell and excessively tired
◦ irritable and overly sensitive in their interactions
with others.
 Postnatal Depression
You are not alone! • Is common, but debilitating condition that affects 1 in 7
women following the birth of their baby
Support is available. • Can be long-lasting, and affect your ability to cope with
a new baby
You just need to ask for • You could feel
help. • feeling low or numb
• lack of interest and/or pleasure in life, yourself
and/or the baby
• no energy – difficultly coping throughout the day
(may also be attributed to lack of sleep)
• loss of confidence, feeling helpless, hopeless and
worthless
• often feeling close to tears, highly sensitive to
other’s comments or emotional
• feeling angry, irritable or resentful towards others
• changes in sleep – not being able to sleep even
when you have the opportunity, or conversely,
wanting to sleep all the time
• changes in appetite – accompanied by weight
loss or weight gain
• difficulties concentrating, thinking clearly or
making decisions
• feeling isolated, alone and disconnected from
others
• having thoughts of harming yourself, baby
QUESTIONS