Excerpt
Baby 411, 11th Edition
3-2-1 Baby!Preparing for the New OneYour baby is here! This section explores your baby’s first few days . . . plus how to survive the first two weeks. I’ll tackle finding a pediatrician, explain newborn screening tests, offer insider tips for scheduling appointments, and advise you on what to do on weekends and holidays when your baby is sick. Also in this section: parenting 101 and navigating the world of childcare.
If your due date hasn’t arrived yet, be sure to flip through these first three chapters for housekeeping items worth tackling before your little one makes their debut.
Chapter 1Birth Day“Giving birth is like taking your lower lip and forcing it over your head.”—Carol BurnettWhat’s in This Chapter• Cutting the cord, literally
• Details of your baby’s first physical examination
• Your baby’s first meal
• The first few days with your newborn
• Tests and procedures
• Situations that weren’t in the birth plan
• Jaundice
• Going home and the two-week survival guide
• Special situations: preterm births and adoption
Birth Day is finally here—the most incredible day of your life. You have prepared the nursery and taken the childbirth class, breastfeeding class, and baby care class. Hopefully, you’ve also met with your pediatrician (see Chapter 2, “You and Your Baby’s Doc”). So, you’re ready, right?
There is no way anyone can prepare you for this, but this chapter will guide you through your baby’s first days of life. Let’s leave the giving birth part to the pregnancy books (see our other book, Expecting 411). Instead, we’ll focus on what happens once your baby is born. This chapter will give you an overview of your newborn, head to toe. It also includes a handy two-week survival guide, which you will want to bookmark!
Many people are not aware of this, but your baby’s healthcare begins with their first checkup right after birth. Why, you may ask? Because entering the world is a big transition. Babies who are still inside the womb may have certain medical problems that do not show themselves until they take their first breath of fresh air. It is very helpful in the world of modern-day medicine to have ultrasounds, lab tests, and amniocentesis to get a glimpse of potential problems in your baby—but they don’t cover every issue.
Also in this chapter, we’ll explain a few decisions you should make before giving birth. You may desire additional tests and procedures for your baby post-delivery, which are only options if you plan ahead. And we will address the unique issues related to having a premature baby or adopting a newborn.
This chapter will also cover things you don’t have in your birth plan, such as delivering a premature baby or one who needs some additional medical attention after delivery.
That is a ton of ground to cover, so let’s start with your baby’s first moment of life.
Cutting the Cord and Your Baby’s To-Do ListQ. Can my partner cut the umbilical cord?Yes. But your partner is also allowed to say no—especially if the sight of blood induces nausea or fainting.
If your partner wants to cut the baby’s cord, this event occurs after the baby has come out and after your practitioner has placed two clamps (about one inch apart) on the cord. (Don’t worry, your doc will give the cue.)
Your partner cuts the cord with a pair of scissors (provided by your practitioner) between the two clamps. The umbilical cord is a little rubbery, so it often takes a few snips to complete the job. It also can spray blood—you’ve been warned!
Q. Should we wait to cut the cord?The American Congress of Obstetricians and Gynecologists (ACOG) advises that for routine deliveries, there is no rush to cut the cord. Studies show that by waiting at least thirty to sixty seconds after delivery to place two clamps (aka medical clothespins) and cut the umbilical cord, more blood flows from the placenta to the newborn. That extra blood boosts a baby’s iron stores for several months, which prevents anemia.
The downsides? Delayed cord clamping and cutting reduces the odds of having enough umbilical cord blood to store. It also increases the chance of a newborn becoming jaundiced in the first few days of life (see jaundice later in this chapter). And if your baby is in distress and there is a concern for their health, the obstetrician (OB) needs to cut the cord right away and hand the baby over to the pediatric team for immediate care.
Bottom line: Wait to cut the cord unless a medical reason requires a quick snip!
Q. When does the OB collect blood for cord blood banking?Within minutes after delivery. So if this is something you want to do (it’s optional), you need to plan ahead for it. We’ll discuss optional tests and procedures later in this chapter.
Here is how it typically goes. The baby comes out, and your practitioner (usually) puts them right on Mom’s chest. If a couple wants to bank their baby’s cord blood, your practitioner places two clamps on the cord right after delivery and the cord is cut (either by your partner or by your practitioner).
Once the cord is cut, your practitioner places a needle into the largest vessel in the umbilical cord to drain as much blood as possible into a bag or syringe. The goal is to get as much blood as possible before the vessels spasm and the placenta begins to separate from the wall of the uterus. Once that happens, no more blood flows through the umbilical cord.
Q. When will I be able to hold the baby for the first time?If the delivery goes smoothly and the baby is doing well, you can hold your baby pretty soon after the big entrance.
Your baby will be covered in blood and white cheesy stuff (vernix) and sometimes poop (meconium). In other words, they are all wet and that means they are going to get cold pretty fast. So the staff needs to vigorously dry your baby off with towels first and either places them skin-to-skin on your chest or puts them on a small exam table that has a heater (warming table). The vigorous rubdown stimulates your baby to breathe and gets their circulation going. The delivery team staff also suctions their mouth and nose to remove thick secretions.
The team will do a quick assessment (see Apgar test below) and then you get to snuggle for the first time together.
Q. Does my baby need to study for the Apgar test?No. They probably won’t score a perfect 10, either—those Olympic judges are so critical of the dismount. Just kidding. The Apgar test determines which babies need extra help adjusting to life outside the womb. They are given a score from 0 to 10. Your baby’s Appearance (color), Pulse (heart rate), Grimace (reaction to stimulation), Activity (tone), and Respiration rate are assessed at one minute of life and again at five minutes. Babies who endure difficult deliveries often have low (less than 5) Apgar scores at one minute, then perk up (greater than 7) at five minutes. The babies whose scores don’t rise may need observation and assistance by medical staff. Rest assured, low Apgar scores do NOT correlate with low standardized test scores and future intelligence.
Reality CheckIf the baby has an immediate problem (such as trouble breathing), they may get whisked over to the warming table in your delivery suite or even off to the neonatal intensive care unit.
If your newborn has an urgent health issue, the hospital may ask a neonatologist (newborn intensive care specialist) or a staff pediatrician in the hospital to care for your baby immediately.
If you deliver at a birthing center or at home and there is a problem, your baby will need to be transported to the nearest medical facility via ambulance.
This is very unsettling if you have a perfect vision planned of those first moments together with your newborn. If this should happen to you, remember that your baby’s health is the utmost priority. Even if you don’t get to bond in those precious minutes right after delivery, you still have time later—and I promise it won’t impact your long-term relationship with your child.
Q. When is my baby examined for the first time?Your baby will be examined several times, so be prepared. If you deliver at a hospital, the delivery healthcare staff performs the first overall exam on your baby after you have a little bonding time. The staff measures the baby’s weight, length, and head circumference. They also place an ID band on the ankle as well as a security clip. Eye ointment and a vitamin K shot are routinely administered at this point. We’ll explain the importance of these two therapies in the section to follow. Your baby will eat a first meal, and then while you are getting cleaned up (childbirth is pretty messy), your baby will be observed for the first couple of hours in the nursery. That is when they will have a complete head-to-toe exam by the nursery staff. Your baby’s heart rate, respiratory rate, body temperature, and oxygen level are monitored. That’s the time your baby also gets any blood drawn for lab tests (blood sugar, blood count, blood culture), should any be necessary. Your baby can get cleaned up after proving they can maintain their body temperature.
After all those hurdles, your baby is ready to join you in your postpartum room.
