Doctor in the House: Heading Home with your newborn? Here’s a checklist of dos and don’ts

Now that you have gone through a vigorous and a slightly prolonged labour or you have had a caesarean section, there are things you need to know or learn before you go home. Motherhood can be joyous and equally stressful and now you are responsible for this little person lying in the cot beside you for 24 hours of the day, 7 days a week, with no time off. In some ways, this is the most demanding job that you would have ever taken on. Just that thought can be daunting. It takes times to get to know your baby and you may get a few things wrong, but that’s no cause for concern: it is part of the learning curve.

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Feeding
Ideally (I say ideally for this may not work for all) babies should only be breast-fed and both you and your doctor should give it your best shot to breast-feed. There may be some occasions when your baby is sick and has to be in the ICU that you may not be able to breast-feed right away. In such cases, you can spend as much time with your baby in the ICU as may be permitted and even pump milk that can be fed to the baby. Sometimes, after a caesarean you may be in the recovery area for a couple of hours, but you can always ask the nurse assigned to you to bring the baby to you so that you can feed the baby.

Initially, you may have to feed the baby very frequently, which helps in the production of breast milk, but by the time you are ready to leave the hospital, most babies will be feeding one- to two-hourly. It’s important to see that your baby has learned to latch properly as an improper latch is the main reason for sore nipples. For some women, breast-feeding may not be possible all the time, in such cases, it may be supplemented by formula.

Sleep
It is always best for baby to sleep in a cot by your side. The mattress should be firm and the cot should not  have any loose bedding or toys in it. New borns can sleep up to 20 hours in a day and only wake up to feed. Initially, can you try and wake them up when they sleep for more than three hours. They need to get in at least eight to 10 feeds in a day in the first week for you body to be stimulated to produce milk.

The amount of urine they pass will tell you how well they are feeding. A good thumb rule in the first week is if your baby is 5 days old then baby needs to pee at least 5 times a day.

If you keep the room too warm or over-clothe the baby, then there is a likelihood of your baby sleeping for longer periods. While this doesn’t sound like a problem, if your infant does not feed enough and are kept too warm they can get dehydrated and develop a fever. The ideal temperature should be between 24 -26 centigrade and the baby should have only one layer more than what you are wearing.

new borns New borns can sleep up to 20 hours in a day (Source: Pexels)

Bathing
If you don’t feel confident in the beginning, that’s fine, you don’t need to give them a bath every day, but you should definitely sponge your baby. It is perfectly fine to bathe your baby in lukewarm water. You do not need to use any soap at this age as it can dry out the skin. Their hair can be washed with water but if you think your baby smells of sweat or there is still some dried blood in the hair you can use a mild shampoo to wash it off.

Just wash the baby clothes with a gentle detergent; there is no need to use an antiseptic. Dry the clothes in the sun and use a hot iron on the clothes.

Ask for help
The first few days of parenthood can be extremely overwhelming and exhausting. Do not hesitate to ask for help. You need your rest as well, especially after the draining experience of giving birth. While in hospital, ask the nursing staff for help. If you want some sleep, you can pump and the sister can feed the baby with a special cup called the “nifty cup”. Once you are home, get family and friends to watch over the baby while you get some shuteye.

Jaundice
Nearly all babies develop some degree of jaundice in the first week of life. Most of the time it is physiological and settles down by seven to 10 days. You can make sure it does not reach levels that need treatment by making sure baby is getting milk and passing enough urine. While in hospital, they will check the jaundice level with a machine called a bilirubin meter, but once you are home, if your baby is looking very yellow and is sleepy and not feeding, you need to speak to your doctor.

Some babies who have a blood-group incompatibility with the mother, known as ABO incompatibility or RH incompatibility. It may develop early jaundice and prolonged jaundice that will need treatment with special white lights.

When to speak to your doctor
* If you newborn develops a fever, don’t self medicate, babies can have serious infection and can deteriorate fast and must be carefully monitored by your doctor in case of a fever at this age

* Baby has not passed urine for more than 12 hours

* Blood in the stool

* Lethargic and refusing feed

* Vomitting, especially if yellow in colour

Postpartum Depression
The first couple of weeks of motherhood can frequently be extremely overwhelming and tiring, and, in some women, can lead to a sense of hopelessness. Postpartum depression is a form of depression seen in new mothers after having a baby. It affects up to 15 per cent of people. People with postpartum depression can experience emotional highs and lows, frequent crying, fatigue, guilt, anxiety and may even have trouble caring for their baby. The condition is very treatable with medical and psychological intervention.

It is important to watch for certain common signs, which while are not exhaustive are indicative –

*Your “baby blues” don’t subside: It’s common to have a dip in mood during your baby’s first two weeks, after which the feeling should subside. If you’re still sad or even hopeless weeks later, and the feelings are only getting more intense, that’s more than the blues.

*Overwhelming sadness or guilt: Feeling upset once in a while is normal. But if your days are filled with frequent crying spells, or you often feel unhappy about being a parent, or you constantly feel inadequate as a parent, these may be among the first signs of postpartum depression.

*Losing interest in things you enjoy

*You have trouble making decisions: Maybe you’re too tired to think straight. Maybe you just don’t care. If you can’t decide whether or not to get out of bed, take a shower, change your baby’s diaper, or take them for a walk, these may be early signs of postpartum depression.

*Your mind is subsumed by thoughts of whether you’ll be a good mom or not: While such thoughts are common to new moms, if the feeling is constant doubts about yourself as a mother which do not subside, this could indicate postpartum depression.

*You think about harming yourself: Thoughts of suicide, or hurting yourself or your baby, are advanced signs of postpartum depression and even postpartum psychosis, a rare and serious mental illness that happens with postpartum depression. If you’re having any kind of suicidal thoughts, you’re in crisis and need to call your doctor immediately to get help.

Being a new parent is both joyful and stressful at times, but with patience and lots of help from your family and friends, parenthood is a joyful and rewarding experience.

(Dr. Saroja Balan is consultant neonatologist and paediatrician at Indraprastha Apollo Hospital. Her column appears every fortnight.)

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