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.
Get Help
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.
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.
Sibling Rivalry 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
Crying
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 Cryingin 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.
Skin Massage
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.
Bath 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.
Sleep 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.
Going Out
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.
Resuming Sex
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.
