What I would like you to Remember From Your Hospital Stay with Your Newborn©
There is nothing, nothing, more special for me as a physician than to meet a family and their brand new baby. Every morning when I round, meeting my new patients, I love seeing all sorts of families of whatever composition, background, philosophy, or geography because they are all excited to share their stories, to tell me how their little one came into the world, to share little details they have already observed. Those moments give me my psychic income.
I want to protect that. I don’t want that happy family dazed and confused a few days later. Those first days should be filled with joy, not angst. The key to angst-avoidance is education and preparation. I usually teach and prepare during that first hospital visit. However, too many studies have told us that new mothers do not remember much of what is said during those first days for me to think that even my stellar advice sticks. Here is what I would like new families to remember:
Jennifer Thomas, MD,MPH, IBCLC, FAAP, FABM
4202 West Oakwood Park Court, Suite 200, Franklin, WI 53132 414.423.5250
What I would like you
to remember about your hospital stay ©
1. I was in the room. I was in the room, examining your baby with you watching me, answering questions because that is the right thing to do. Mothers who are breastfeeding make a special antibody called secretory IgA. Secretory IgA is made in response to a signal from a cell in your gut alerting your body to a potential infectious invader. That signal subsequently travels to the breast and shares its message. That results in the production of a highly specialized, very cool protein called secretory IgA that purposefully gets into breastmilk to keep the baby safe from that invader. If I take your baby to the nursery and do my exam, I expose your baby to all sorts of people, many of whom will never have contact with you. If you have no contact with these people, but they have contact with your baby for whatever reason, you cannot make secretory IgA to whatever infections they may be carrying. I have joked (half-heartedly) that we should have all mothers who have their baby in the nursery go lick the caretakers (I used to say “kiss” but “lick” is a better visual) so that the baby can be protected through this amazing IgA mechanism. This is one crucial reason we encourage you to to keep the baby with you in a process called “rooming in.” Another reason to practice rooming in is that you will probably sleep better. We are a complicated species, but in general a new mother is looking to see that her baby is safe. We as new mothers instinctively need to know where our newborn is so you will likely not sleep better if the baby is away from you. In addition, you have the right to ask for procedures to be done in your room, including the first newborn exam. I did my exam in your room because I know how important it is that healthy, term newborn babies and their mothers stay together.
2. The clock is not important: We may ask you to record how many minutes you fed on the left breast or right breast, what time the baby went to breast and how many diapers you have changed and when. The AAP policy statement on “Breastfeeding and the Use of Human Milk” says that the babies should go to breast 8-12 times a day. I get that doing math is tempting but 8-12 times per day is not equal to every 2 to 3 hours. You do not need a clock to find out if you’ve fed your baby 8-12 times a day. You could make an “x’ each time you fed the baby, or draw a smiley face, or stack Oreos, but you do not need to be a slave to the clock. When we say “feed on cue” we can hardly justify “as long as it is every 2-3 hours.”
3. Poop is important: When your baby is latched well, transferring milk, they are getting all sorts of crucial components that are designed to create a healthy immune system and develop their brain and lungs. One ingredient found in very high amounts in the first milk you make, called oligosaccharides, are instrumental in keeping the baby free from infection. Oligosaccharides are not digested and help the baby poop. The more milk the baby gets, the more oligosaccharides they get, the more poop we have and the more we can be assured that the baby is getting enough milk. The poop will transition from black and tarry and sticky to just black and tarry to brown to yellow. We are looking for yellow poop at about day 4-5 of life.
4. Urine output is deceptive: You may have noticed that you received a lot of IV fluids during the course of your labor. Your baby got some of those IV fluids and will be peeing them away in the first days after birth. No matter how great or lousy your baby is breastfeeding, they might be peeing really well. That probably has nothing to do with breastfeeding, because your baby’s stomach only can handle a teaspoon or two of breastmilk, and the urine output they have will be more than that. We don’t need to watch urine output as much as we need to watch for poop.
5. Your baby will lose weight: As I just mentioned, you may have gotten a bunch of IV fluids during your delivery. We know that the amount of IV fluids you get during the course of your labor, especially in the hour before you give birth, is directly correlated with how much weight your baby will lose. Most babies normally lose about 7% of birth weight but some can lose more. Weight loss can be quite distressing, but we are not watching weight, or urine output, because we are watching poop. If we have poop, the other numbers are less important. If we do not have poop, we need to help you with breastfeeding.
6. Your milk is in- you have enough: the newborn stomach can only handle about a teaspoon or two. The milk you make in the first couple of days is really not designed as food: it has ingredients, not really for nutrition, but for immune system development, brain development, lung development and contains components that affect so many things it would make your head spin. We call it “colostrum” but that is the name we give the recipe it contains. Make no mistake, it is milk. You have enough.
7. Your baby will always act “hungry” when away from you: Your baby was born with adult senses of hearing, taste and smell. Vision is developing, but not quite there. The baby hears voices all through pregnancy, so fathers, siblings and other people who were talking during that time are familiar voices. Those members of the baby’s life who have familiar voices can use them to soothe the baby. Often, we just hold them, but familiar voices are soothing, so talk to the new little one. When the baby hears an unfamiliar voice, one way to get back to safety is to look hungry. When I am doing my exam, I expose the baby to an unfamiliar voice and smell. That may provoke a response in the baby which looks a lot like hunger: licking hands, rooting. A reasonable person sees those cues and says “I think somebody’s hungry” and gives the baby to you. The baby is safe and near protection, away from unfamiliar smells and sounds and may breastfeed or may to go sleep. Both results are fine. This also explains why when you put the baby down, they may cry and when you pick them up, they stop. That is not spoiling, it is your baby being smart. With you your baby is safe, somewhere familiar, surviving infancy. ( I think of a baby, safe on your chest, as being at Target. When you put them down, they are at Home Depot. There's nothing really wrong about Home Depot, but I would cry, loudly, if I was in Target, with everything I needed, plus some stuff I didn't know I needed until I was there, and somebody moved me to Home Depot.) My preference is for you to hold the baby as much as your heart desires.
8. Your baby will turn yellow: Jaundice, or the yellow color the baby turns after birth, is very common and likely serves and important role in providing important antioxidants to your baby. The pigment, bilirubin, which causes jaundice, is pooped out. As we are seeing a theme here, we need poop. If your baby was born at term, is pooping, the latch does not hurt, and you and your baby have similar blood types, we do not need to worry. If any of those things are not true, we need a different approach and you should ask (please!) for help with breastfeeding.
9. Watch out for the second night: Babies tend to be pretty “good” during those first hours. By the second 24 hours, they are transitioning to life outside the womb. Our babies ask us to help them survive infancy. We do that by preventing disease, and by protecting them from things that may harm them. They do not know that the predators we have are not going to be a real threat; they act on survival instinct, staying with familiar people, mainly mom. Our babies do not have their days and night mixed up. They know exactly when the threat is greatest- at night. And they are up at night, with mom, probably breastfeeding. This is normal and expected. That means, if you can, please try to rest during the day. While you cannot really control the amount of interruptions for things like my exam and the need to take your vital signs, you can control the amount of visitors you have. Please realize that when the baby is not around familiar scents and voices, they shut down and usually sleep. What that means is that after labor, birth, breastfeeding, entertaining guests and little sleep for a myriad of reasons, you may find yourself overwhelmed that second night. Be prepared: ask visitors to wait until you are home and settled, or at least give them visiting hours. Sleep when you can and enjoy your time as a new family. That way, when the “second night” comes, you are ready.
10. You need to promise me that you will seek help if you have questions. I do not want you dazed and confused. I have a great team ready to help; we just need to know you need help. We promise you will not be one of “those” parents if you have questions about your baby. My website is www.drjen4kids.com and anything that is underlined in blue on here means that there is more information available on the website. My phone number is 414.423.5250. Use them. Use the Facebook pages and Twitter accounts connected to them. You have hired me for this journey and I want you to have access to good information when you need it. Call the office and make an appointment for 2-3 days after you are discharged and we’ll discuss all of this again, and it will be my pleasure to help.
Jenny Thomas, MD, MPH, IBCLC, FAAP, FABM
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