PART 1: PREGNANCY, CHILDBIRTH AND THE NEWBORN
CARE OF THE NEWBORN
In case of a normal delivery, you are likely to be discharged from the hospital after 3 to 5 days. If you had a Caesarean delivery or if you or your baby had any problem, you may have to stay longer. Follow your doctor’s advice.
Given a choice, choose to go home as soon as possible, especially if you have some help at home. In a nuclear family, it is especially important to make sure that the mother has such help— either from a female relative or an experienced midwife. Or hire the services of an efficient maid.
If you are unable to arrange any support, it is best for you that your husband takes ‘paternity’ leave. But if, despite his best efforts, he cannot be around, do not hold it against him.
Once home, do not blindly follow the instructions of any relative or health worker. Do not let them make you anxious that you may not have enough breast milk or have them give your baby water or top feeds. You and your baby share a bond, and your body will produce the nourishment she needs.
Most Indian families employ a maalishwali bai, a traditional massage woman, to massage and bathe the new mother and the newborn, especially in the urban areas. In the rural communities, a senior woman member of the household will do this. The mother herself may like to massage her baby. Since the traditional massage woman will have a great influence on the mother and the other members of the family, her knowledge, attitudes and practices with regard to infant feeding and baby care are of great import. Unfortunately, most of these women have no contact with the medical community and the majority are illiterate. Their knowledge and practices are therefore often suspect.
Oil massage — the traditional way
Taking into consideration the key role played by traditional massage women, a project has been started in North-West Mumbai to give them formal training and to certify them. Certified maalishwali bais are expected to pass correct scientific information and messages on infant feeding (including breastfeeding) and baby care to the mothers under their care. They are also expected to pass on literature in appropriate languages to mothers on these subjects. Carried out under the auspices of the Breastfeeding Promotion Network of India (BPNI), and its Maharashtra state branch, and funded by UNICEF (Mumbai), the project is likely to spread to other regions. Hence we hope that certified maalishwalis will be available all over India in the near future.
For more information about the Trained Maalishwali (TMW) project, you may contact:
Dr. Prashant Gangal, TMW Project Co-ordinator, Flat No. 2B, Rolex Apts., New Era Signal, S. V. Road, Malad (West), Mumbai 400 064.
Email : firstname.lastname@example.org | email@example.com
Tel: +91 93 2231 7556 | +91 98 2006 6028
The Indian Joint Family System
A caring joint family offers you the readymade support of people who are usually knowledgeable about and sensitive to the needs of a new mother and baby, and who will support you through post-partum depression, if any.
Cherish a caring joint family
Accept their help and advice; it works to your benefit to consider all solutions to any problem that arises.
Remember that the child’s grandparents too want the best for their new grandchild. (In a study published in the British Medical Journal, the presence of grand-mothers in the home was seen to be helpful in preventing unnecessary accidents and emergency visits to the hospital.) Listen to their suggestions, but do not follow their advice blindly, especially if it contradicts new knowledge about child care. Most important, do not allow tensions to arise in the family. If you believe that your mother-in-law’s beliefs will clash radically with yours, decide in advance to spend the first couple of weeks after delivery at your parents’ house.
If you are truly confused about what to do in a certain situation, consult your paediatrician. For instance, if elders insist that you give water to your baby, let the doctor convince them that an exclusively breastfed normal baby does not need water in the first 6 months of life, even on a very hot day.
If possible, arrange for them to meet the doctor. If that is not practical, let the doctor give the advice in writing and also, if possible, give you some written material (a book or an article or a pamphlet) to substantiate the given advice.
Finally, of course, it is for you to decide whether you want to spend the time after delivery at your mother’s place or with your in-laws or with just your husband. But before you decide, do keep in mind the fact that there are several benefits of living in a joint family. So do not take a hurried decision to stay alone if adjustment is possible.
If you have an older child, be prepared for the possibility of sibling rivalry.
Be prepared for the possibility of sibling rivalry
Ideally, you should have introduced the baby to her in advance. Let the older child know that you are going to have a little baby. As the baby in your womb starts kicking about, let the older one put her hand on your abdomen and say hello to the ‘little’ one. Let her talk to the baby in her own way.
Encourage the older sibling to make or buy a welcome card to be presented to the newborn on her arrival.
It would please your older child considerably if you have a framed photograph of her on your bedside table in the hospital. It will reassure her that she is still your favourite. Arrange to have your older child brought to see you and the new baby in hospital after you deliver. Ignore the baby for a little while and make a fuss of the older child. Then introduce the older child to the baby and ask her if she would like to hold her. If the older child wants this, make her sit in the middle of the bed and put the baby in her lap. If she decides to kiss the baby, let her do so, as long as she doesn’t have a cold or any other infection. If she does, she should wait at home for the baby’s arrival.
Some amount of jealousy is normal and to be expected, but we must be sensitive and handle it properly. Take the help of your older child in the care of the younger one—getting her clothes, changing her diapers, etc.
If the older child hits or pinches the younger one, by chance or intentionally, remove her from the scene so that no further damage is done. But keep in mind that ‘A child needs love most when she is least lovable’. Hug the older child. Cuddle her and give her a kiss. Do not make an issue of the incident by punishing her for hitting the baby. By your action, the child gets a clear message that hitting others is not allowed, but also that everyone still loves her as before.
A child may feel bad because she is suddenly deprived of her possessions— her cot, her room, her toys, her father’s lap or her mother’s breast— for the sake of the younger one. Assure her of her place in the family. If the older child, on seeing the baby breastfeeding, shows a desire to suckle, she may be allowed an occasional feed.
When parents are unable to handle a child’s jealousy adequately, she may start behaving like a little baby—wetting her bed, sucking her thumb or even speaking like a little baby. Often, the problem resolves on its own. At times, however, the situation worsens, and the child may withdraw and stop communicating. Seek the help of a child psychologist or a family counsellor in such a case.
HANDLING YOUR BABY
Do not hesitate to pick your child up when she cries. It is most important for a baby to have a feeling of security after birth. Crying is often a signal that she needs something. Don’t worry about disciplining the child at this stage. I am all for discipline, but let that come later, when the child is reassured that she is loved and wanted.
Sometimes, a baby who was quite at peace in hospital may start crying unduly on reaching home. Perhaps she needs time to adjust to her new surroundings. She will almost certainly settle in 2 to 3 days.
If you are worried that your baby is crying because you are not producing enough breast milk for her, watch the colour of her urine. If she is getting only your milk (without additional water), and keeps passing a light-coloured urine, that is a sure sign that she is getting enough milk. The crying is then due to other reasons (see Crying in the chapter on THE A-Z OF CHILDHOOD ILLNESSES).
Is Your Milk Suitable For Your Baby?
Your milk —thin, thick, yellowish, bluish or white —is always right for your baby. Breastfeeding is to be continued even if the mother is suffering from asthma, malaria, cold, typhoid or tuberculosis. It is important not to give any glucose water or any other milk for the first few days, because
the first yellowish milk (colostrum) produced then, though small in amount, is enough to meet all the needs of the baby. Even if you have to work outside the home, it is dangerous to start bottle-feeding with the assumption that the baby should get used to it. Working mothers can breastfeed successfully without ever using a bottle.
You can feed in any position— lying down, sitting or reclining, as is convenient for you. The important point is that the position of the baby at the breast should be correct. This is based on the fact that breast milk collects in the dilated ducts that lie underneath the areola, the dark portion behind the nipple of the breast. The breast should be put into the baby’s mouth so that much of the areola—especially the portion below the nipple — is not visible while the baby is suckling. Let the baby keep suckling from one breast even if she seems to have fallen asleep and her eyes are closed. Offer the other breast only when the baby releases the first breast on her own. If the baby is satisfied with only one side, offer her the other breast at the next feed. If you have twins, milk from one breast is enough for one baby.
Some mothers’ breasts feel heavy or congested 3 to 4 days after delivery. This means that the mother is not feeding the baby enough. She should offer the baby frequent feeds or express the milk for the next 2 to 3 feeds. If the heaviness is allowed to remain, the mother will feel more discomfort and the baby will have difficulty in suckling.
If the baby starts sucking her fingers, do not jump to the conclusion that she is not getting enough milk from you. Observe the baby’s urine; its light colour indicates that the baby is getting her required quota of milk. Here, it may be mentioned that a baby may pass yellowish urine if she is given vitamins or if she sweats more because of heavy clothing.
Vitamins For The Baby
Your baby does not need any vitamin drops if you are breastfeeding and eating well. Your diet should include seasonal fruits, vegetables, sprouts, whole grains and nuts.
Babies who are given cow or buffalo milk do need extra vitamins. Formula milk (from baby milk powders) has added vitamins.
Your paediatrician may give your newborn baby a dose of Vitamin K, based on the premise that it takes some time for the newborn to start making this important vitamin in her system. The first milk produced by the mother (colostrum) is rich in this vitamin and all babies should get colostrum.
It has also been seen that the amount of Vitamin K in breast milk can be increased if the mother’s diet includes leafy vegetables.
10 Important Points For The Care Of Your Newborn
- Aim for direct skin-to-skin contact with your baby soon after birth.
- The first yellowish breast milk (colostrum), though produced in small amount, is enough to meet the needs of your baby.
- A crying baby may need body contact. Pick her up; don’t worry about spoiling her.
- Bathe a newborn with plain lukewarm water for the first 7 to 10 days of life. Soap and oil may be used later. There is no need to buy medicated soaps and expensive baby soaps and oils. In fact, some babies may develop skin rash with their use. Any non-scented bath soap and a locally preferred oil like til (sesame) oil, coconut oil, groundnut oil or mustard oil is adequate. Refined groundnut oil, available in most homes, is a possible substitute. There is no need to go in for almond or olive oil. Talcum powder, including special baby powder, irritates a baby’s nostrils and can cause severe lung disease. At times, it gets caked in the skin folds. Avoid using all types of powders. If you feel you must use it, restrict its application to the nappy area or where the skin tends to chafe. Never buy prickly heat powders; they are often medicated and unsafe for babies. Some children get skin rashes with besan (gram flour) or malai (milk cream). In general, we do not recommend their application.
- Relatives should massage or bathe the baby. If a maalishwali is hired, she should be closely supervised to ensure she does not give too vigorous a massage.
- Some newborns may have swollen breasts that subside on their own after a few weeks. Pressing the breasts to squeeze ‘milk’ out of them can be dangerous and should never be done.
- Do not try to push the foreskin of a male child’s penis to separate it from the soft front portion. It is meant to protect the delicate part of the penis.
- Do not put oil into the ears and nostrils of the newborn. Oil, if aspirated into the lungs, can be dangerous. The baby’s nose may sometimes be obstructed by thick secretions. These should be moistened with cotton soaked in water and then removed gently with a clean cloth. Do not clean the tongue and mouth of a baby. Avoid pacifiers (dummies); besides interfering with proper feeding habits, pacifiers increase the risk of infections (including middle ear infection) and malocclusion of the teeth.
Mom’s clean finger may be safer than a pacifier
- Never use earbuds or cotton buds for the baby. After a bath, use a corner of the towel to clean the external ear. The wax normally found in the ear canal protects it. Do not try to remove it. Also, do not blow into the baby’s ears after a bath.
- Never use surma for the baby’s eyes. Quite a few such preparations contain lead, which can be dangerous for the baby.
In most Indian families, it is customary to give the baby an all-body massage with oil or ghee to stimulate the circulation. I support this tradition; it provides extra body contact. But I must add that it is not essential, especially if you do not have extra help.
I recommend a daily bath in normal circumstances. In extremely cold weather, daily sponging and a bath twice a week should be adequate. The face and diaper area need more frequent cleansing.
In the hospital, you may be shown how to bathe your baby in a bath-tub and you may follow the same method. Many Indian women also often bathe babies without a tub. The woman sits comfortably on the floor with her legs stretched out in front of her. The baby is laid, on her back or stomach, between the woman’s bare legs and then massaged or bathed. I find this a very simple and practical method and strongly recommend it.
Never leave the baby alone in water even for a few moments. Negligence can be fatal.
Some people clean the mouth and tongue of the baby with a piece of cloth or with glycerine. This is unnecessary and may damage the delicate mucous membrane of the baby’s mouth and lead to infection.
Cut your baby’s nails while she is sleeping after a bath. Cut the nails straight across with a nail clipper.
To begin with, a newborn baby either feeds or sleeps. She may not yet be aware of the difference between day and night. She may sleep more during the day and feed more often throughout the night, which can be rather annoying. Fortunately, within a couple of weeks, your baby will fall into a routine convenient to you. Till then, try to doze off while she sleeps during the day. As people at home start taking more and more interest in talking to the baby, she may start sleeping less during the day and for longer hours during the night.
Put your baby to sleep on her back. Prone sleeping (on the stomach) has been reported to be a risk for Sudden Infant Death Syndrome (SIDS). However, putting baby to sleep on her side, previously recommended as a safer alternative, also appears to be associated with SIDS, probably because infants placed on their sides tend to roll onto their stomachs.
Additionally, infants who die of SIDS have a more than twofold-increased probability of having been born to smoking mothers. Risk of SIDS specifically attributable to parental smoking (mother or father) was over 61%.
Fan Or Air-Conditioner?
During hot weather, a fan must be used, unless you are
lucky to have a room with cross-ventilation which always remains cool. Do not hesitate to switch on an air-conditioner.
However, make sure that the baby does not sleep directly under the fan. Keep the windows open when the air-conditioner is not in use. Place the baby a little away from the window in order to avoid her being in the draught.
Music And The Baby?
Sing or have her grandmother sing to baby to lull her to sleep. If you want to play recorded music to serve the same purpose, go ahead. Should you listen to music while the baby is asleep? Of course, you should, if you enjoy music. Let the baby also start getting used to your ways of living.
Of course, the music shouldn’t be played too loud; that would not be good even for adult ears.
Should You Use A Cradle Or A Hammock To Rock The Baby To Sleep?
Do not let your child be dependent on being in a cradle or hammock to sleep; you will find it very difficult to put your baby to sleep if you happen to go to a new place, where you do not have such a facility. However, if your baby is already used to it, fold a sari to make a hammock and suspend it securely from both ends of a bed or a table.
Should You Wrap Up Your Baby?
Keep baby warm in cold weather. Some babies sleep better if wrapped up, especially during their first month. Some like to have their hands out. Be flexible; go with what your baby seems to like.
Gradually, the baby should be unwrapped more and more so that she can move her limbs freely. She will start looking at her hands later and get to know the shape of her body better. It was mentioned earlier that most babies tend to sweat profusely on the head. But some tend to sweat a lot all over. Some of these babies, if kept wrapped all the time, may develop fever due to dehydration. This fever will settle down if your baby is kept cool and is given a few sips of boiled and cooled water with a cup or a spoon. Never use a bottle for this purpose. (See chapter on Feeding the Newborn and Infants.)
Wrapping the baby is not difficult. Follow the figures on the next page: (a) fold the upper corner of the sheet. Put the baby on the sheet as shown; (b) straighten the baby’s right arm gently. Wrap the right half of the sheet over the arm and her body. Take the sheet behind her back and tuck it; (c) straighten the left arm and wrap the left half of the sheet over the body as before; (d) lift the lower portion of the sheet upwards over the body. You may secure it with a closed safety pin or just leave it as it is.
Traditionally, an Indian woman stays at home for at least 6 weeks after delivery; it takes about that much time for the woman’s anatomy to return to its previous state. For instance, as the foetus grows bigger, the uterus goes right up to the top of the pregnant woman’s abdomen. This has to come back to its earlier position. The baby suckling at the breast hastens the process of this so-called involution of the uterus. The 6 weeks’ rest also gives the mother and the baby time and opportunity to become familiar with each other’s moods and to continue the on-going process of mothering and motherinfant bonding.
But can you go out — say to a party or for shopping or for a wedding — earlier than this ‘sacred’ period of 6 weeks? Of course you can, and you must if it is important. If you know that you will enjoy going out, go ahead. Whenever possible, take your baby with you. Do not worry that she is not yet immunised. Of course, avoid taking her to crowded places as far as possible. If you are going to a party and you have a maid, take her with you. Let the baby be with her in an adjoining room, join your friends, enjoy the evening and attend to your baby if the need arises.
Avoid sexual intercourse in the first 6 weeks after delivery. Do discuss family planning with your doctor. If you do not believe in modern family planning methods, make sure that you exclusively breastfeed your child for 6 months and after that, add other foods gradually, while breastfeeding is continued and bottle-feeding is avoided.
FREQUENCY OF CHECK-UPS
After seeing the baby at birth, I like to see her 1 and 2 weeks after discharge from the hospital. At around 10 days, the baby is supposed to regain her birth weight. I also like to know how breastfeeding is going and answer any questions that the mother might have forgotten to ask in hospital. I also like to see the condition of the umbilical cord at that time.
I would then like to see the child at 6, 10 and 14 weeks for immunisation (see chapter on IMMUNISATION). I would also check about breastfeeding and see the milestones of development that the child has achieved and record her height, weight and head circumference.
Then I would like to see the child at about 6 months, 9 months, 15 months and 2 years. At 6 months, addition of complementary foods will be discussed. At 9 months, measles vaccine will be advised. I also like to see at that time if the child needs any vitamins, calcium and iron. At 15 months, MMR vaccine will be advised. Through these visits, I would observe the growth and development of the child and advise a booster dose of DPT and OPV at 2 years. At this age, we may also get a rough idea about the height that the child will achieve later in life. Then I like to see the child once a year and guide the parents for a healthy and happy childhood and adolescence. If you would like your paediatrician to see your child every month for the first year or two of her life, discuss it with her and arrange for check-ups accordingly.
7 March, 2016