From a midwife: Caring for a newborn
Our last few blogs have covered labour and birth, which helps to prepare you for your journey into birth and meeting your little one. But now it's time to talk about how to care for that little one; your newborn!
First off, CONGRATULATIONS! Parenthood is the scariest, craziest, best journey I've had the pleasure of embarking on. Welcome to the club of sleepless nights, cold coffees and mountain-sized piles of washing. But being a part of this club also means your heart will double in size from the love you'll feel, you'll have an endless supply of cuddles and kisses, and you will go on to learn what a privilege it is to be someone's Mama or papa bear. But in all honesty, those newborn days are rough. So I hope this blog helps prepare and educate you on caring for your newborn or act as a reminder at 2 am when you can't remember a thing.
Newborns [both breast and formula fed] feed regularly, around every 2-4 hours, including overnight. It's a good thing because your prolactin [a hormone that tells your body to make milk] is highest at night, meaning feeling at night helps to establish and maintain your milk supply. If you're expressing, it's also important to express overnight for the same reasons. If your bub isn't breastfeeding well, try a different position and make sure your attachment is good at every feed, for the whole feed. That's because as bub starts to get sleepy, they may begin to slip off and create nipple damage. If you need help with breastfeeding, contact your Midwife, Hospital, GP, Lactation Consultant or the Australian Breastfeeding Association hotline.
When making up formula, it's important to follow the instructions as per the tin. Avoid adding more water or scoops than specified, as doing this can make your little one unwell. Don't forget to sterilise bottles after use when formula feeding and feed on demand, similar to a breastfed bub.
Newborns don't need any liquids other than breastmilk or formula, including water. From around 6 months of age, you might introduce cool-boiled water when starting solids, but it's not necessary or recommended until this point. Even if it's a hot day, offer them the breast or bottle more frequently instead of giving them water.
The best way to know when your bub is hungry is to watch for their feeding cues, regardless of if they are breast or formula-fed. Newborns will begin to show signs they want to feed quite early, such as starting to stir, opening their mouth and turning their head from side to side. Medium feeding cues that show they are beginning to get really hungry include stretching, sucking on their hands or moving more frequently. Late signs bub is really hungry include crying, agitated movements and turning red. If you feed your bub when they're showing early cues, they're less likely to be distressed and should go on to have a good feed.
Breastfed bubs who are full and have had enough will stop sucking, pull off and go to sleep. When feeding bubs a bottle, keep an eye on their cues that they've had enough, such as no longer sucking, pulling away, spitting up milk, or starting to fall asleep.
From the very beginning, bub should be having lots of wet and dirty nappies. Wet nappies are the best indicator that your little one is getting enough milk. On the first day of life, we expect 1 wet nappy. On day 2, we expect 2 wet nappies. This continues until day 5. From day 5, we expect 6-8 wet disposable nappies in every 24 hour period. If your little one isn't doing this, increase the frequency and length of time they are feeding for. If breastfeeding and bub isn't feeding well, consider expressing and giving that to bub. If this still isn't working or bub is formula-fed and not taking their bottles, get your little one assessed by a doctor in case of dehydration.
In the first 2-3 days of life, you might see urates in your newborn's nappy. These look like little rust-stains and are normal at this age. However, if you still see these after day three, bub needs to be assessed by a doctor. This is also a good time to mention that it's normal for little girls to get periods in their nappy. Don't stress Mama, it's from your hormones being passed to them and will settle on its own.
Your newborn's first poo will be meconium. This is a thick, sticky, tar-like, black substance. As your bub starts to take more milk, their poo will change from meconium to dark green, orange and eventually land somewhere around yellow-orange with mustard seed flecks in it for breastfed bubs. Formula-fed bubs will have more solid poo compared to breastfed babies. However, it should still be very soft and may be yellow, tan or greenish in colour. Your newborn should have at least 1 poo in the first 24 hours, then continue to poo regularly afterwards. If you're ever concerned, contact your Midwife or Doctor, or get bub checked out.
When it comes to nappy changes, wipe front to back for newborn girls. For little boys, don't retract their foreskin.
Within the first ten days, bub's cord will go black/ brown, dry out and drop off. Use a cotton bub and warm water to dab around the bottom of the cord. Alternatively, bub's cord can get wet in the bath, but make sure you dry it really well afterwards. Try and keep bub's cord clean and dry, and always observe for signs of infection, such as redness around the base, pus or offensive discharge coming from the cord, the cord smells, or bub looking generally unwell and/ or having a fever. Keep nappies folded below the cord, and avoid clothing being directly on it or pulling on the cord. If 14 days have passed and bub's cord is still attached, or you're concerned there are signs of infection, ask a Doctor or Midwife to have a look to double-check things look normal.
In the first few weeks, bub can get lots of rashes like newborn rash. Here are some common ones:
- Cradle cap: this is a yellow, oily, scale-like rash that bubs often get on the top of their head. It's usually not itchy, contagious, painful or serious, and will mostly clear up on its own without treatment. If you want to remove it, regularly rub a small amount of baby oil onto the affected area, and brush gently with a baby brush, which should remove them over several treatments.
- Milia: these are little clear or white bumps that pop up on a newborn's skin shortly after birth from their sweat glands becoming blocked. Again, these aren't itchy, painful, contagious or serious and will pass by themselves. If they become red, swollen, hot to touch or form a crust, get your bub seen by a GP.
- Nappy rash: nappy rash is when bub's genital area becomes red, sore, potentially mildly swollen or has broken skin from being exposed to constant moisture, wee or poo. Nappy rash can range from mild to severe and is most commonly uncomfortable, if not painful. Prevention is best, so make sure you're changing bub's nappy regularly, consider using barrier creams like Bepanthen at the first sign of irritation, keep their skin clean and allow some nappy-free time. Mild nappy rash is manageable at home, but again if concerned, get it checked by a GP.
- Newborn rash: sometimes called erythema toxicum, this rash is very common and normal around day 2 to 4 weeks of life. These are flat, red patches or small bumps on the skin, usually located on the cheeks and nose. Newborn rash will pass on its own and doesn't usually need treatment.
A rash that doesn't fade when you press on it is a life-threatening rash and called a 'non-blanching' rash. If you see this in your bub, take them to get medical attention immediately. Rashes are so tricky, so if you're ever unsure, it's best to get it checked by a GP or midwife.
Any fever of 38 or above in a baby under three months needs immediate medical attention. There are no exceptions to this rule because little ones can become very sick quite quickly, and a fever may be their only symptom. So if your newborn has a fever, don't risk it and get them checked out.
As a general rule, dress bub how you'd dress yourself +1 layer. Swaddles and wraps are included as a layer, so consider this when dressing them. Some swaddles, such as Love to Dream, come with a dressing guide based on the room temperature, so this can be a helpful hint for dressing at bedtime.
I always like to remind parents to avoid beanies indoors. The reason is that when bubs are hot, they get rid of the extra heat through their head. If they've got a beanie on, all of this heat gets trapped, leading to an increased risk of overheating, which is a risk factor of SIDS. I also recommend parents avoid beanies, hats, headbands and clips in car seats, prams, when sleeping or when bub is not directly supervised due to the risk of these falling down and covering their mouth and nose.
When packing for the hospital, most bubs will fit into 00000 or 0000. However, big bubs [4.5kg+] may need 000.
Newborns crave closeness and comfort. There may be days where they want nothing more than to be cuddled or held by you, and this is SO NORMAL! If you think that they've spent the last nine months listening to your heartbeat and laugh, being swayed to sleep, not having to wear uncomfortable clothing or a cold nappy and always feeling snug, it's no wonder they want nothing more than to be close to you. More than anything, I want you to know that you can't spoil your baby by responding to them. If you want to look into it more, look up 'The Fourth Trimester".
Being a Mama of three myself, I understand that sometimes a newborn needing you for absolutely everything can get a bit much. If you need a break, put bub in a safe space, take a minute to gather yourself and return when you feel safe to do so or ask someone to come over and help. You don't have to do it alone, Mama.
Newborns typically sleep for 16 of 24 hours and around 2-4 hours at a time. It's NORMAL for bub to wake several times a night to feed regardless of breast or bottle. Regardless of what you see on social media and what all your friends' babies are doing, there is nothing wrong with your bub for not sleeping through the night. Our culture focuses so much on it that it's often forgotten that night waking is normal, SIDS protective, promotes your milk supply and helps bub feed regularly. By around three months, most bub's have one longer stretch overnight [around 5 hours]. I know it's tough to get through, but I promise it doesn't last forever.
Something else that's really important to discuss when it comes to sleep is making sure bub's sleep environment is safe. Red Nose has guidelines around sleep to help reduce the risk of SIDS [suddent infant death syndrome, when healthy bubs pass away in their sleep for no identifiable reason]. Some of the guidelines include:
- Sleep bub on their back from birth.
- Put bub at the bottom of the cot so they can't wriggle down under the blankets.
- Sleep bub in their own sleep space, such as a basinett, in your room for the first 6-12 months of life.
- Keep bub smoke free.
- Avoid sharing a sleep surface. However, if you choose to co-sleep, make sure you do it safely by following the Red Nose guidelines around co-sleeping.
- Avoid overheating.
- Avoid putting any toys, excessive bedding, cot bumpers or pillows in bub's sleep space.
- Keep bub's sleep surface firm [an adult's bed is not a safe sleep space for a newborn].
- Make sure bub's sleep space is safe at every single sleep, including daytime naps.
Before using any devices or products that promote themselves as a "sleep surface", make sure you do your own research.
Newborns love being swaddled. It helps with the startle reflex and makes them feel secure. An alternative to swaddling is Love to Dream swaddle suits, which are similar to a swaddle, except that it zips up at the front and doesn't require you to wrap bub yourself. Swaddling can be a good sleep association tool, but must be stopped once bub starts showing signs of being able to roll [usually around 4 months], and not done when bed-sharing.
Some newborns love bathtime, and some hate it. Thankfully for the ones who hate it, babies only need a bath every 2-3 days. If bub loves water, you can do it up to once a day, but keep an eye out for dry skin. Before putting bub in the bath, gather everything together first. It's not safe to leave your bub in the bath alone, ever. Even if you're just stepping out to grab a towel; even if there's not much water in there; even if a sibling is watching them. Please don't risk it, Mama.
A bath for a newborn should be around 5-10minutes long. If they don't like it, lay a wet washer across their tummy to help them feel secure, and continually wet the washer to keep it warm. The water temp should be around 37-38 degrees. If you don't have a thermometer, the water should feel warm when touched with your wrist or elbow. Start with the face and head, then work your way down, making sure to wash in every crack and crevice. Make sure the environment is warm for when bub gets out, which is often a good time for some nappy-free time or a baby massage. You can bath bub at any time of day that you like, but many Mama's do it at night as part of the bedtime routine.
I often get asked about showering with a newborn. If you're going to put bub in the shower with an adult, make sure the water is warm for them and not hot, that you have a good grip on them [some Mama's start out by sitting on the shower floor holding bub], and that you keep their face out of the direct stream of water. Again, never leave them alone. Even for a second.
There's nothing quite like having a newborn. They grow so quickly, but it's also tough. I often found myself somewhere between wanting bub to need me a bit less, sleep a bit more and have a bit of independence and wishing time would slow down so I could savour every second of my newborn.
Enjoy this special time, Mama, and I hope this post helps you look after your newborn. But most of all, don't forget to look after yourself too.