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The Newborn After Delivery

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    vijigermany's Avatar
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    The Newborn After Delivery

    The Newborn After Delivery

    The first day of your baby's life will be a flurry of activity. You will want to spend as much time as possible getting to know your son or daughter, while the baby undergoes a battery of health tests and you make several decisions that affect his or her care. This article will help guide you through these critical hours, including:

    • The Apgar Test The first few minutes of your baby's life are a critical time. The doctor must check his or her breathing, muscle movement, and other vital signs. All these checks are part of the Apgar test, administered twice -- one minute and five minutes -- after birth. Make sure to ask your doctor about the test score, and find out what it all means on this page.

    • Newborn Physical Examination

    • You will want to get to know your new baby right away. But you'll also want to make sure he or she is healthy. After a few hours of time alone with your newborn, the hospital will give him or her a thorough examination. A nurse or doctor will check eyes, ears, nose, size, breathing, organ function, and everything else from head to toe. Find out what they're looking for on this page.
    • Circumcision If your baby is a boy, you will make a decision that will affect him much later in life: whether to have him circumcised. Some experts believe there are health benefits for adult males; others aren't so sure. In either case, if you decide to have the circumcision, it should be on your son's second day. This page will tell you how to care for a newborn's circumcised penis.
    • Postpartum Care of the Umbilical Cord For a few weeks after birth, your baby will have a stump of umbilical cord where the belly button will be. You don't have to worry about this, but you can't ignore it, either. Caring for the cord is an easy thing to do until it dries up and falls off on its own. Learn how on this page.

    The Apgar Test

    Your baby is given the Apgar test immediately after delivery. This test is used to assess whether your baby needs extra medical care right away. Each of five signs is rated on a scale of zero to two, with ten the best possible total score. Babies with breathing problems or nervous system problems may need extra care.

    The Apgar score is determined twice -- one minute after birth and again five minutes after birth -- and gives your caregiver an idea of whether these problems exist. Usually, scores of between seven and ten are signs your baby is in good condition. If his scores are below seven, your baby may be taken to the nursery for observation and care. Be sure to ask about your baby's Apgar scores.

    Within the first hour after birth, most babies receive a medication in their eyes. This might be erythromycin or tetracycline (both antibiotics) or silver nitrate. As required by law in all states and provinces, these medications are given to prevent infections of the eye, which could result in blindness.

    On rare occasions, a mother may have organisms in her vagina which, if picked up by the baby during birth, could cause eye infections. Gonococcus and Chlamydia are two common organisms that can cause serious problems. Because we do not have laboratory tests that are 100 percent accurate in discovering whether a woman has these organisms, laws exist to protect babies who might be infected unknowingly.
    Many parents prefer the antibiotic ointments over silver nitrate since they do not burn or irritate babies' eyes as silver nitrate does. Your baby's vision is blurred until the ointment is absorbed.

    This immediate care can be done with your baby in your arms or very close by. Once these procedures are completed, you may spend some uninterrupted time with your baby. Although your nurse or midwife observes the baby and periodically checks your temperature, your blood pressure, and the condition of your uterus, she should try to stay in the background and disturb you as little as possible.

    This is the time when you and your partner can become acquainted with the baby and start the first feeding if you plan to breast-feed. Most parents describe this as a wonderful time. Usually the baby is alert and calm, very interested in your faces and voices and in the new sounds he hears. When held close to your breast, your baby begins nuzzling and licking, and then takes the nipple in his mouth and begins to suckle.

    Even after a long, tiring labor, you and your baby will probably be wide awake and interested in each other. After spending one or several hours together, both you and the baby will doze off, possibly very soundly.

    The Apgar test is a preliminary check, designed to minimize the intrusion into your getting-to-know-you session. In the next section, find out what takes place in the more detailed examination later in the day.
    Newborn Physical Examination

    Now that your baby has had some time to get used to you, the hospital will want to perform some critical health checks. There are many conditions that can potentially affect a baby's health. These are typically temporary conditions that will cause no lasting damage, but only if they are detected and treated early.

    Besides the Apgar score, which is determined right after birth, a more thorough physical examination of the baby is done a few hours later. The newborn exam is a thorough check of all the baby's systems. A midwife, family physician, pediatrician, or nurse practitioner may carry out this exam. You may ask that it be done in your presence, so you can learn more about your baby.

    From head to toe, the examiner checks such features as the fontanels (soft spots at the top and back of the head); eyes, ears, nose, mouth, and throat; ability to suck and swallow; size of the head; weight and length; breathing pattern; size of the liver and spleen; heart tones and sounds of the lungs; genitals; hip joints; overall appearance of the baby; and the baby's reflexes. The baby's ability to pass urine and move his bowels is also noted.

    Some babies are further assessed for their actual gestational age; a test called the Dubowitz examination helps determine whether your baby was born early, on time, or late.

    In the hospital, babies receive identification bracelets, sometimes on both wrist and ankle, and mothers receive a matching wrist bracelet; this is to prevent mixing up of babies in the nursery. Footprints and handprints are also taken. Immediately after the umbilical cord is cut, a sample of blood is taken from the cord, labeled, and stored, in case it is needed later for blood-typing or other laboratory tests.

    The baby's temperature, feeding patterns, activity levels, breathing and heart rate patterns, and urination and bowel movement patterns are observed for the next several days. If at home, the parents make these observations after receiving instructions from their caregiver. In the hospital, nurses usually make these observations.

    Within an hour or so after birth, your baby receives vitamin K to help prevent bleeding problems. Vitamin K helps in the clotting of blood; since babies do not have vitamin K in their systems for the first few days after birth, its administration is considered an important preventive treatment. Vitamin K can be given by means of injection in the thigh or by mouth. At present, most doctors prefer to give it by injection.

    Your baby undergoes a number of laboratory tests. The skin is also examined for any marks or other important signs. Several days after the baby is born, a sample of blood is drawn from the heel of each newborn.

    The one test given to all newborns is a test for phenylketonuria (PKU). PKU is an inherited disorder that can be very serious if not detected very soon after birth. A baby with PKU cannot properly process protein and needs a special diet low in phenylalanine, the component of protein that she cannot handle well. If PKU is detected and the baby receives this special diet, she will grow up normally. If it is not detected and treated, however, PKU can cause mental retardation.

    Because of the seriousness of PKU, all states and Canadian provinces require that all babies be tested for it. Once performed before the baby left the hospital, the PKU test is now more often performed at a physician's office during the baby's first examination.

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    Re: The Newborn After Delivery

    The same blood sample is checked for another condition, congenital hypothyroidism. Some people do not make enough thyroid hormones for normal development. If this condition is discovered early, a baby can be treated and grow up without any problems.

    Blood may be drawn from newborns for other purposes both during their hospital stay and at other times. Many babies develop jaundice within the first weeks of birth (indicated by yellowing of the skin and the whites of the eyes). Your doctor may draw some blood to analyze your baby's bilirubin level. Bilirubin, a yellow substance, forms when red blood cells break down; the presence of excessive amounts gives a yellow tinge to the baby's skin. If the bilirubin reaches a certain level, your doctor may treat the baby to lessen the jaundice.

    While jaundice in a newborn is rarely a serious condition, it is important to keep track of bilirubin levels in jaundiced babies and to determine the cause. The usual treatment, phototherapy, involves keeping the baby in a brightly lit bassinet, except for feedings. On rare occasions, a blood transfusion is given. Jaundice rarely occurs in the first 24 hours after birth, so blood specimens are obtained after that.

    Blood glucose (a form of sugar) levels are also checked in some babies -- those who are very large or very small, those whose mothers have diabetes, and those with other possible problems.

    Urination and Bowel Movements

    Many babies urinate within minutes after birth. This is an important milestone and is recorded in your baby's medical chart when it happens.
    The first bowel movements of a newborn baby are called meconium, which forms in the intestine long before birth. In fact, some babies pass some meconium while still in the uterus. It mixes with the amniotic fluid.
    While this is usually harmless, when your doctor spots meconium in your amniotic fluid during labor, he or she will be concerned the baby might inhale it deeply with the first breaths after birth. If meconium is breathed deep into the lungs, it can cause breathing problems. If meconium is present, deep suctioning with the mucus trap is done before the baby breathes.
    Many parents are unprepared for their babies' strange bowel movements. Your baby will have a meconium bowel movement within a few hours after birth. Meconium is black and sticky and difficult to clean off. Some parents think ahead and rub olive oil on their new baby's bottom before the bowel movement happens. Meconium is then much easier to clean off.
    As the baby begins to feed, the bowel movements become runny and greenish-brown. Once the colostrum has changed to milk, a breast-fed baby's bowel movements become yellow and liquid (often described as mustardy) and nearly odorless. Breast-fed babies normally move their bowels anywhere from once a week to once each feeding. Formula-fed babies move their bowels less frequently, and their bowel movements are dark, firm, and strong smelling.
    If you've had a boy, you now have a decision to make. See what to do whether or not you choose to circumcise your son in the next section.

    Circumcision can be a controversial procedure, although some experts believe there are health benefits that go along with it. If you decide to go ahead with the circumcision, you will need to be aware of special care that is required for the next couple of weeks.
    In hospitals, circumcision is usually performed on the second day of life, and parents do need to use special care in diaper changes and keeping the area clean for a week or two after surgery. If you decide not to circumcise, there is no special care of the penis.
    It is important to remember that at birth the foreskin of the penis is usually not separate from the end of the penis, as it is in an older uncircumcised boy. Therefore, you should not try to pull the foreskin back. To do so could cause tearing of the skin and scarring, which could be a real problem later in life. The best care for an uncircumcised penis is to leave it alone except to wash and rinse it whenever the baby has a bath.
    Some researchers conclude there are significant health benefits to both the circumcised male and his future sexual partner(s) -- other investigators disagree. Although most men and boys in the United States are circumcised, the circumcision rate in the United States is declining, and the practice of non-religious circumcision remains controversial.
    The remainder of the umbilical cord will fall off soon. In the next section, find out how to care for it.
    Postpartum Care of the Umbilical Cord

    The umbilical cord, all-important in delivering nutrients to the baby in its fetal stage, will gradually go away after birth. Until then, you will need to care for it. It's an easy process, and a temporary one as well.
    Usually shortly after the cord is cut, your doctor applies a special substance called triple dye or some other antiseptic agent to it. This may make the cord appear blue. The clamp that was left on the cord at birth is removed on about the second day.
    For one to three weeks afterwards, your baby will have a black, dry stump of cord where the belly button will be. The stump gradually dries up and falls off. In the meantime, you need to keep the cord clean. The best way to do that is to take a cotton swab, dip it in rubbing alcohol, and gently wipe it around the base of the cord each day.
    Other Considerations

    Other matters become very important in the first hours after birth. During the time when you and your baby can become acquainted with and accustomed to each other, you have many choices.
    For example, it is for you to decide how much time you want to spend with your baby. Studies have shown that being together from birth seems to improve the parent-infant relationship. Bonding (a strong attachment between parent and child) is enhanced by more contact. The only reason your time together might have to be limited is illness in either mother or baby. Hospital routines should not keep you apart. You must also decide how you will feed your baby -- breast or bottle.
    The relief after the delivery is over can quickly be replaced by apprehension. Perhaps you do not know if your baby is healthy or what tests the nurses or doctors might be performing. The key is understanding these postpartum tests and the post-delivery process.



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