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Part 1: Pregnancy, Childbirth and the Newborn  >  Management of the Newborn in Hospital

PART 1: PREGNANCY, CHILDBIRTH AND THE NEWBORN

MANAGEMENT OF THE NEWBORN IN HOSPITAL

At last, the long awaited moment arrives. The doctor announces your baby’s birth.

The doctor or a paediatrician has a quick look at the baby and places her near your breast. The baby now has direct skin-to-skin contact with your body. The nurse covers both of you to avoid a chill. The little one opens her eyes, manages to turn her head to one side and seems to be searching for your nipple. As the doctor attends to you, your baby succeeds in getting hold of the nipple and starts suckling...


A New Experience
This is an ideal situation and it may be yours — especially in a baby-friendly hospital. In such a hospital, as soon as you deliver, your doctor will probably dim the lights in the room and make sure that the atmosphere is quiet and peaceful. Attendants may avoid any unnecessary talk and noise, trying to create, as far as possible, the same sort of environment that your newborn had inside your womb. There may be an instant bonding between your new daughter and you; you may start talking to her. 

But be prepared for surprises; no two babies or mothers are alike. You may not even feel excited when you see your child for the first time, or you may find her blood-stained face and wrinkled body disconcerting to look at.

It is also possible that you may feel exhausted or sleepy. Don’t feel guilty if you do. Just go with your body. Remember, it is your right to smile, cry, burst out with joy or just go to sleep.

If you were motivated through your pregnancy and if your doctor managed to avoid giving you pain-relieving drugs or sedatives through labour, it is very likely that you and your baby will meet each other as if you have been waiting for this moment for ages.

The baby is wide awake for about 40 minutes after delivery. This is the time to put your arms around her and experience your first moments of bonding with her; this will probably help make her feel secure all her life. (Research by Lynee Murray and Liz Andrews for their book The Social Baby reveals that a baby identifies its mother within a minute of its birth. Within 2 minutes, it may even strain its neck to study her face. Within half an hour, the baby can recognise the form of a human face. Random waving of arms and gurgling among newborns may appear incomprehensible to adults, but is actually a complex system of intelligent communication that the infant possesses. There is a wired-in programme to help babies lock in to those who are caring for them.)

The baby is wide awake for about 40 minutes after delivery
The baby is wide awake for about 40 minutes after delivery

Accept the child —son or daughter —gratefully, as a gift from God. This will help you begin a life-long healthy relationship with your child.

REJOICE IN YOUR DAUGHTER
Once considered almost a misfortune, having a daughter today is more a matter of celebration than grave concern, though exceptions remain. Rita Sawhney interviewed several parents in this connection. What has led to this tilting of the scales in favour of the girl child? The writer also interviewed psychologists, gynaecologists and a teacher of sociology. It seems that the stand is changing because the myth that it is easier and safer to bring up a boy has exploded. Accepting hospitality at a married daughter’s home is no more a taboo. Besides being more reliable, girls continue to maintain emotional ties and provide their parents their much-cherished freedom, whereas a boy means long-term babysitting for the ageing mother. Girls are showing equal and, in many cases, better business acumen than their brothers to carry on the family business. Girls are venturing into many a field that was earlier considered male-dominated. Behaviourists believe that girls are more demonstrative of their feelings. 

Additionally, even health wise, having a baby girl could mean less sleepless nights. Boys outnumber girls 3:l in learning disabilities, and 4:l as stutterers. Haemophilia (a blood disorder) and Duchenne’s Muscular Dystrophy (a serious muscle disease) afflict boys exclusively. Boys are more likely than girls to suffer from Fragile-X Syndrome, one of the causes of mental retardation. The mortality rate of boys is 20% higher than that of girls. This continues as they grow older.


The Kangaroo Position
The kangaroo position is ideal for the newborn. In it, the mother clasps her baby between her breasts, with the baby’s face just below the mother’s chin. The baby stays quiet, possibly hearing the mother’s heartbeat to which she was accustomed while she was in the womb. If the room temperature is low and the baby is premature, the baby’s head may be covered with a cap. This greatly helps to maintain body temperature. 


Apgar Scoring
Doctors and nurses often use the term ‘Apgar scoring’. It is meant to assess the condition of your baby in certain respects at 1 minute and 5 minutes after birth. Sixty seconds after the complete birth of the infant, the 5 objective signs given in the table are evaluated, and each is given a score of 0, 1 or 2. A total score of 10 indicates an infant in the best possible condition. Most normal babies score 7 to 10 points. An infant with a score of 0 to 3 requires immediate attention.

Sign 

1 point  2 points

Heart rate 
100/minute 100/minute

Absent  Less than 100/minute More than 100/minute

Respiration 

Absent 

Slow, gasping 

Good or crying

Muscle tone 

Limp 

Some flexion of limbs 

Active and flexed

Reflex response to catheter placed in the infant’s nose

None  Minimal grimace  Cough sneeze or cry
Colour  Blue or pale  Body pink, extremities blue Completely pink


Normal Reflexes
While examining your newborn baby, the paediatrician will test for certain reflexes like the grasp reflex, the walking and stepping reflex and the Moro reflex.

For the grasp reflex, the doctor places her finger in the palm of the baby, who is expected to grasp it firmly. To test the walking and stepping reflex, the doctor holds the baby upright so that her feet touch a firm surface. The baby takes a few steps as if she were walking. If the baby’s leg comes in contact with the edge of a table, she steps up onto the table.

A newborn baby can see at birth. She can focus at a distance of 15 to 20 cms. Thus, she can see her mother’s face while breastfeeding. She can also hear and can smell her mother’s milk. She likes body contact, especially with her mother. She is alert for 40 to 60 minutes after birth. Then she may go to sleep for a few minutes or for several hours.


Examination Of The Baby
It is not essential that there be a paediatrician at every delivery. However, most babies should be checked by a paediatrician within 24 hours after delivery. Or a paediatrician may be called earlier if any problem is noticed. It is normal to worry about your newborn baby. It helps to remember that many things that may appear abnormal to you are normal variations in a newborn. (See chapter on NORMAL VARIATIONS IN A NEWBORN.) 


Rooming-In
In all baby-friendly hospitals, the baby is given to the mother soon after delivery, and kept in her room; she is not sent to a separate nursery. This is called rooming-in. Normal babies kept in a nursery are more likely to contract infection from the attendants or from other infected babies (if any).

In some hospitals, the baby is unwisely kept in the nursery to allow the mother to rest after the delivery. Experience shows, however, that the average mother would prefer to have her baby with her, especially if she knows that this is the best thing for her and her baby. Unless the mother is heavily sedated, she can keep her baby in her bed (bedding-in).


Immunisation In The Hospital
In some hospitals, it is a routine practice to give BCG (immunisation against tuberculosis) and one dose of hepatitis B vaccine and oral polio vaccine to all newborn babies before they are discharged from the hospital. This dose of oral polio vaccine is called the zero dose. This is an extra dose besides the primary course of 3 to 5 doses about which we shall discuss in detail in the chapter on IMMUNISATION

If your baby is not given these immunisations at the hospital, they can be given at a later date.  

Unless the mother is heavily sedated, she can keep her baby in her bed
Unless the mother is heavily sedated, she can keep her baby in her bed




7 March, 2016

 
Part 1
Pregnancy, Childbirth and the Newborn
Planning A Baby
Pregnancy
Making Preparations
Labour and Delivery
Management of the Newborn
Normal Variations in a Newborn
Care of the Newborn
Holistic Bonding
 
Guide to Child Care
Home
Introduction
1 Pregnancy, Childbirth ...
2 The Growing Years
3 Feeding Infants, ...
4 Keeping Your Child Healthy
5 Keeping Your Child Happy
About Dr. R. K. Anand
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