Caring For Your Newborn

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– Hello, my name is Doctor Bonny Whalen.
I am the medical director of the Newborn Nursery
here at Dartmouth Hitchcock Medical Center.
Welcome to the Birthing Pavilion
and congratulations on your pregnancy.
And if you've already given birth,
congratulations to you and your new baby.
In this video we would like to share
some important information about the Birthing Pavilion
and the kinds of things you and your new baby
will experience in his or her first few days of life.
We'd also like to offer you some tips and advice
on caring for your new little one.
The Birthing Pavilion is a comfortable, private
and calm place to give birth.
It has it's own operating rooms
and the intensive care nursery is right next door
should you need any special care right after delivery.
The Birthing Pavilion is an especially safe place
for you and your baby.
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The first few minutes and hours after birth
is an important time for a mother
and her new baby to bond.
Spending time together and skin to skin contact
for the first hour of life is especially helpful
in making the transitions after the birth's successful
for you and your baby.
Skin-to-skin contact
means the baby's naked skin comes in direct contact
with the mother's bare skin.
The skin-to-skin contact helps stabilize
the baby's blood sugars and body temperature.
It helps the baby's heart rate and breathing
become more stable and it's very calming for the baby.
This quiet bonding time is also helpful
with the baby's first feeding.
A mother's body benefits from skin-to-skin contact too.
It helps the mother's uterus contract
which helps decrease bleeding
and it also helps stimulate a mother's milk hormones
if she is breast feeding.
– Does he look like your other son?
– We encourage you to hold your baby skin-to-skin
as much as possible in the first few hours
and days of life.
Baby's who are held against their mother's
or father bare skin are often happier and healthier.
There may be times when your baby
might not be able to be placed skin-to-skin
right after birth, due to a medical problem.
If this is the case, we will do our best to let you know
ahead of time and explain why.
After the first hour of life,
we will apply an antibiotic ointment called azithromycin
to your baby's eyes.
This helps prevent eye infections
that can be caused by bacteria in the birth canal.
This ointment should not cause any problems for your baby.
We will also give your baby a shot of vitamin K
soon after birth.
This is a special vitamin that is made by the liver.
Vitamin K helps blood to clot and helps prevent bleeding.
Baby's are born with low levels of vitamin K
and it takes a few weeks for their liver
to start making enough vitamin K to help stop bleeding.
Without the vitamin K shot,
babies can develop serious bleeding in their skin,
intestines and brain.
The shot will cause some brief discomfort at first
but should not cause any other problems for your baby.
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After birth your newborn is given
a foot band and an armband.
These are stamped with your baby's name, date
and time of birth.
Mothers and their significant others
receive a matching band.
Our healthcare staff with check the bands
to identify both the baby and the parents
before any test or procedure is performed
and anytime your baby is returned to you
after spending time outside of your room.
An infant security tag will be attached to your baby's ankle
as a special security measure.
If this tag gets close to
one of the Birthing Pavilion's exits,
it will set off an alarm and lock the door.
To keep from setting this alarm off accidentally,
please try to stay clear of the exits
when you wheel your baby through the hallway
in his bassinet.
The alarm will also trigger if the tag gets wet,
if it falls off or if someone damages it.
Babies often lose weight after birth
so tell your nurse if the tag becomes so loose
that it might fall off.
For safety and security reasons,
when babies are outside of the room,
they must be pushed in their bassinet.
Staff members will questions anyone
carrying a baby in their arms.
Even another staff member.
This is one of the best ways
we can make sure your baby remains safe.
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A day or two after the birth,
we will perform several important procedures
and tests for your newborn.
Sometimes these are done in the Newborn Nursery
and sometimes they are performed in your room.
If your baby needs to go to the nursery,
you are welcome to come along
and help soothe him or her with your voice and your touch.
To help keep your baby healthy
and to identify certain medical conditions
before they become problems,
we will perform a special blood test
called the Newborn Metabolic Screen.
This is sometimes called the PKU test.
We will take a few drops of blood from your baby's foot
to perform this test.
This test can tell us if the newborn has problems
in producing certain types of hormones
such as in hypothyroidism.
It can also detect if a baby will have problems
breaking down food or in using his nutrition
such as with conditions called PKU and Galactosemia.
Without screening,
these problems may not show up
until a baby becomes very sick
or has delays in his development.
If the screening test shows that there may be a problem,
your doctor will do extra testing.
If this follow up testing shows
that there is truly a problem,
a special medicine or diet can be prescribed
to help keep your baby from getting sick.
You will receive results on your baby's newborn screen
at the two week well child visit.
If there is a problem on the newborn screen,
you should hear from your baby's doctor before this visit.
Your baby will also be tested for Jaundice,
a common newborn condition which makes a baby's skin
turn yellow.
Jaundice develops when a yellow chemical called bilirubin
builds up in the body.
Bilirubin is formed when a baby's red blood cells break down
which is a normal process after birth.
Babies get rid of bilirubin through the liver
and then through their stool or poop.
Since a newborn's liver is not very mature at birth
and because babies don't pass a lot of poop
in their first few days of life,
extra bilirubin can build up in the baby's blood.
The bilirubin can then get into the skin
and cause it to look yellow.
Most babies get a little Jaundice
in the first few days of life
and normally this does not cause problems.
But some babies can get so yellow
that they need help getting rid of their Jaundice.
To find out if Jaundice is going to be a problem
for your baby, we will perform a bilirubin blood test.
This will be done at the same time as the newborn screen
to help limit an extra poke for your baby.
Your baby may have a bilirubin test performed earlier
if there are any concerns about her looking too yellow
for her age.
While we perform these tests,
we will give your baby a very small amount of sugar water
to suck on, this helps lower pain.
Breast feeding your baby
and holding her skin-to-skin a little,
just before these tests, can also help to limit pain.
Most new babies hear well at birth, but some do not.
About one to three of every 1000 babies
will have a true hearing loss
We screen your newborn for hearing loss
with a special machine.
The screening test is easy
and is done while your baby is resting or sleeping.
Some babies may not pass on the first try.
This can be due to noise in the room
or because the baby is moving around.
If your baby does not pass on the first try,
we will repeat the hearing screen one more time
before you go home.
If he does not pass on the second try,
we will contact the audiology department
and ask that they call you at home
to schedule an appointment for more testing.
We also recommend that your baby receive
the Hepatitis B Vaccine before going home from the hospital.
The Hepatitis B Vaccine is an important first vaccine
for a baby.
It has been recommended for all newborns
by the American Academy of Pediatrics
and the Centers For Disease Control for almost 20 years.
If a new baby is exposed to the Hepatitis B virus,
a serious infection of the liver can develop.
The vaccine helps to prevent this.
This vaccination is recommended
even if the mother's Hepatitis B test result
is negative during her pregnancy,
because testing is not always accurate
or sometimes the mother can develop
the Hepatitis B infection after her test is done.
The Hepatitis B vaccine is a safe an effective vaccine.
The shot will cause some brief discomfort
to your baby at first, but it should not continue to hurt
and it is unlikely to cause any other problems.
Some babies are born with a dangerous heart condition
that can cause a low level of oxygen in the blood.
For this reason, we will perform a special oxygen test
on your baby before you go home.
This test is painless
and can be done right in your own room.
If this test shows that your baby has a low level of oxygen
in the blood, we will perform extra oxygen testing
to make sure that you baby's heart is healthy.
If the extra testing shows that your baby
may have a heart condition,
we will perform an ultrasound of your baby's heart
called an echocardiogram.
This will look at the structure of your baby's heart
to see if there is a problem.
(pleasant bouncy music)
– [Nurse] Just above it.
– One of the best things a newborn can do
to get the best start in life
is to be a healthy eater.
Babies need to eat often
because their stomachs are very small.
At first they can only eat
about two to three teaspoons at a time.
Sometimes their stomachs are full
of amniotic fluid right after birth.
For this reason some babies are not very hungry at first.
As their stomachs grow
and they get rid of this fluid,
they are able to eat more.
Usually newborns eat about every two to three hours or so
whether it is daytime or night time.
Sometimes they need to eat
only one to one and a half hours after their last feeding.
This pattern is called cluster feeding.
In the first few days of life,
babies often are hungriest at night
and do most of their cluster feeding then.
This can be quite tiring for new parents
so make sure you take every chance to nap during the day
when your baby is sleeping.
Limit visitors during the day
for these first few days to make sure you
and your baby get all the sleep you need.
Babies will show you when they are hungry
by licking their lips, sucking on their hands
or opening their mouths wide
when you touch their lips or cheeks.
Your baby should show you these cues
at least every few hours.
If it has been about two and a half to three hours
since the last feeding,
unwrap your baby down to the diaper
and use skin-to-skin contact to help or her wake up
and get interested in feeding.
Some parents worry that allowing their baby to feed
very frequently will spoil their baby.
You cannot spoil your newborn.
Try to feed your baby whenever he or she shows you
hunger cues and before he or she start to cry.
Crying causes air to enter a babies stomach
leaving less room for milk.
Crying also causes babies to be gassier and fussier.
You will find that your baby is happiest
when you feed her just as she is starting to get hungry.
Brest feeding is the healthiest type of feeding
for new babies and has many benefits
for their new mothers as well.
For newborns, breastfeeding is especially important
in helping fight off infections
because the mother's early milk called colostrum
has a lot of infection fighting properties.
Breastfeeding also helps to lower a baby's chance
of developing asthma, a condition of the lungs
that causes problems with breathing.
Eczema, an itchy skin condition.
Type one and type two diabetes,
childhood leukemia, obesity
and Sudden Infant Death Syndrome.
Babies are born with natural instincts
to help them breastfeed.
Just placing a baby on a mother's chest
whilst she is laying back a little bit
will bring out the baby's natural feeding insticts.
Babies can often find their way to the breast
and latch on without any help at all.
Sometimes babies can have difficulties breastfeeding
just as some babies
can have difficulties with bottle feeding.
Our nurses will help you learn
how to breastfeed your baby.
We also have lactation consultants
or breastfeeding specialists
who can help you if you are having any problems.
Breastfeeding is the healthiest choice
for both moms and their babies.
On rare occasions, some mothers and babies
are not able to directly breastfeed.
If you will be bottle feeding your baby
breast milk or formula, we will also help you learn
how to do this safely.
Whether breast feeding or bottle feeding,
it is important to feed your baby when hungry
and until she or he is content.
Babies show contentment by falling asleep
after a good feeding
or by pushing the nipple out of their mouth.
Babies often pause a little during feeding
to take a rest to decide if they are hungry for more milk.
After you baby has taken this rest,
see if he or she is interested in feeding more
by squeezing your breast to give a little more milk
or by tickling your baby's lip with your nipple.
If you baby doesn't seem interested in feeding anymore,
see if he or she needs to burp.
Most babies will be able to bring up a burp
within a few minutes,
while other babies may not need to burp at all.
An excellent way to judge how well your baby is eating
is by noting the number of wet and dirty diapers each day.
Your baby should have at least one dirty
and one wet diaper in the first day of life.
Then one more of each for each day older.
So on the second day there should be at least two wet
and two dirty diapers
and on the third day three of each and so on.
This starts leveling off to about six to eight
of each wet and dirty diaper per day
when your baby's about one week old.
It is a good idea to buy lots of diapers now.
In the first few days, a baby's poops are very dark
and tarry looking and are very sticky.
These poops are called meconium.
A baby usually passes all of her meconium
in the first two days of life.
Then the stools start to get less sticky and turn green.
Then brown, then yellow.
When you see these changes,
you can feel good knowing that your baby
is feeding very well.
The most exciting events after a birth
is finding out the baby's birth weight.
Your baby will be weighed right after birth
and then early each morning during your hospital stay.
Most babies will lose about 8% of their birth weight
in the first few days of life.
This is because they are born
with extra fluid in their body
to help them stay hydrated
and when they pee they lose this weight.
The first few stools called meconium
also weigh a lot
and this causes babies to lose weight too.
Some babies will lose more than 8% of the birth weight
if their mothers had a lot of fluid during labor
or if their labor was very long.
We will help watch your baby's weight
and make sure he or she
is losing the right amount and not too much.
By about day four,
your newborn will stop losing weight
and then will start gaining about a half an ounce a day.
Babies are usually back to their birth weight
by the time they are two weeks old
and some get there sooner.
Feeding your baby often at his or her early feeding cues
and at least every three hours
helps keep your baby from losing too much weight.
It also helps your baby start gaining weight
and the right amount at the right time.
Remember to feed your baby at the first sign of hunger
and until she or he is totally content.
(soft playful piano notes)
One of the biggest transitions for a new baby
is learning to be away from his or her mother.
While living in your belly,
you held your baby all the time
so it'll be natural for your baby to want to be with you
all the time after birth.
A mother's touch
makes the baby feel safe and secure.
We strongly recommend against falling asleep
in bed with your baby.
Mothers are often very sleepy after labor
and from their pain medicine
as well as from the baby's frequent night time feedings.
Falling asleep in bed with your baby
increases the risk of suffocation
and of falling out of the bed.
Our hospital beds are narrow
so they are especially unsafe for bed sharing.
If you are feeding you baby in bed
and you feel sleepy,
please let your nurse or support person know
so that they can help you hold your baby.
When you are finished feeding,
place your baby into the bassinet
so that you both can have a restful safe sleep.
After the birth it will be helpful
to find ways to make your baby feel comfortable
lying alone in the bassinet,
whether awake or asleep.
While you're in the hospital,
we will teach you how to help your baby feel comfortable
sleeping alone in the bassinet.
We'll also teach you how to make her sleep time
the safest to help prevent a condition called SIDS
or Sudden Infant Death Syndrome.
Having your baby sleep on his or her back
is one of the best ways to prevent SIDS.
It is also really important to make sure
there are no loose blankets, pillows or stuffed animals
in your baby's sleep space.
You and your partner
need to sleep whenever your baby sleeps.
This is especially important during the daytime
so you can be more rested at night
for night time feedings.
(cheerful piano music)
(baby whimpers)
Remember to limit visitors during the daytime
so you can get your sleep.
Please ask visitors not to come in between two and four
in the afternoon so that everyone can have some quiet time
and a nap.
We have signs that you can put up on your door
when you are taking a nap
so that no one interrupts your sleep.
It's a good idea to ask visitors
to wash their hands before they hold your baby.
Baby's immune systems are not well developed yet
so they are at a high risk for getting infections.
As we mentioned earlier,
breastfeeding helps babies develop their immune system
and can help fight off infection
but they are still at risk of getting sick.
We also recommend that you do not allow anyone with a cough,
cold, fever or other contagious illness to visit you
or your baby in the first few months of life.
(gentle piano notes)
One other important thing to know about babies
is that they can cry a lot, this is normal.
Crying is a baby's special way of saying
she or he is hungry, uncomfortable,
or stressed about something.
Sometimes babies seem to cry for no reason at all.
One of the best ways to calm a fussy baby
is to put her skin-to-skin with her mother
or another care giver.
Another way to help calm a fussy baby
is with swaddling.
Swaddling means wrapping a baby in a blanket.
Holding a baby close and gentle swaying, rocking or jiggling
is also very calming.
Having a baby suck on your own hand,
an adults finger or a pacifier
can help calm a crying baby too.
We do recommend waiting on introducing a pacifier however
until you know breastfeeding is going well.
And sometimes sucking on a pacifier can cause problems
with how a baby breastfeeds.
It is also important to see if you baby is hungry first,
anytime it looks like she wants to suck.
Babies like a shushing sound because it sounds like
the noises inside the womb.
You can make a sound like
in your baby's ear to help calm her down.
If you have a very fussy baby
especially one who's hard to calm down,
it is important to have friends or relatives close by
who can help.
If you are feeling overwhelmed with your baby's crying,
gentle place your baby in the bassinet
and ask a friend or family member to help
while you take a break.
If you are alone it is also okay
to put your baby in the bassinet
and walk away for a while to give yourself a little break.
The bassinet is a safe place
and it will be okay for your baby to be on his or her own
for a little while.
Remember that it is normal for babies to cry.
Sometimes babies cry for long periods of time
and sometimes for no reason at all.
It is important to know that you should never ever
shake your baby to stop the crying.
Shaking can be very dangerous
and can cause serious brain damage and other injuries.
(soft cheerful music)
Some parents choose to have their son circumcised
for cultural, religious or personal reasons.
If you would like your son circumcised
you will be asked to sign a consent for
and watch a video that talks about circumcision
and reviews it's risks and benefits.
Your baby's pediatric provider
will make sure your baby's penis and foreskin look healthy
and that he is healthy enough
to have the circumcision performed.
If your pediatric provider does not think your baby is ready
to have a circumcision performed before you go home
or a provider is not available to perform the circumcision,
we will help coordinate this procedure as an out-patient.
Because a circumcision is not medically necessary,
some insurance companies
do not cover the cost of the procedure.
Check your company's policy
before having your baby circumcised
to find out whether or not they will help pay for it.
(soft piano notes)
There are a few other activities that will happen
in the Birthday Pavilion before you go home.
Our secretary will come to your room
to help you fill out a birth certificate.
You will use your baby's name
if you have made a decision.
But a name is not required to complete the form.
You will however need a social security number
for both parents as well as your places of birth.
When it's almost time to bring your baby home,
we will help you set up your first medical appointments
with your baby's primary care provider.
– [Woman Red Top] That's perfect.
– If you have not chosen a primary care provider
for your baby yet,
we can help you pick one soon after birth.
We will need to have a specific provider's name
to set up your baby's first appointments
and to include on the Newborn Metabolic Screening Card,
so the results will go to the right provider.
This is especially important if there are any problems
on this early screening.
Before you go home,
a clinical resource coordinator
will meet with you to help you identify
your discharge needs as well as to talk to you
about any community resources that may be of use to you.
She can help set up a home visit with a visiting nurse
if there are concerns with your baby's feeding,
weight or Jaundice.
Or if you need to have a nurse visit you
for any complications you may have had,
either with the pregnancy or delivery.
The resource coordinator can also help you obtain
a rental breast pump, if that is needed
and a referral to a Good Beginnings volunteer
if one is available in your area.
By law and for safety's sake,
your baby must ride in an approved car seat at all times.
A nurse will look at your car seat
to make sure it is an approved one.
We will help show you how to make sure
your baby fits well in his car seat.
We will also help you learn how to use it properly.
The safest place in your car for your baby's car seat
is in the back middle seat facing to the rear
for his first year of life.
If your baby was born before 37 weeks gestation
we will also perform a special safety test
to make sure that his breathing and heart rate
remain healthy while in the car seat.
Your baby's nurse and doctor will help teach you
how to best care for your baby
and discuss any medical problems
that your baby may have.
As you prepare to go home,
your nurse will also give you some extra discharge teaching.
Much of this information can be found
in our Going Home With Your Newborn booklet,
that we developed especially for new parents
to help them learn how to provide
the very best care for their new babies.
It is helpful to read through this
during your stay here in the Birthing Pavilion
when you have time.
Congratulations again on your pregnancy or birth.
If you have any questions of concerns
regarding any of the information
we have shared in this video,
please be sure to speak with your baby's nurse,
the Birthing Pavilion's resource coordinator
or your baby's pediatric provider.
If at anytime you have questions about your baby,
please ask your nurse or your baby's doctor.
We are happy to answer any questions that you might have.
Welcome to the Birthing Pavilion and Newborn Nursery.
(soft piano notes)

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