Your guide to the first few weeks

You've read everything you can get your hands on about pregnancy, but what really happens in those first few minutes, hours, days, and weeks after your baby's birth? Specialist obstetrician/gynaecologist Dr Anil Sharma reveals some of the things you can expect after the birth of your baby.

Here you are, finally at your destination! All those months of nurturing, nesting, blooming, and expecting are over. Your new baby has arrived, and you feel both elated and exhausted at the same time. The tiredness you feel after labour will likely be the most severe you've ever experienced, and at the end of it, you will be handed your progeny to nurture 24/7. Luckily, nature has a way of making you forget how difficult it all was, so that you are highly likely to be back again for another child one day. But, in the meantime, you might feel a little trepidation and anxiety. What now?

What your baby does on the first day
It really is quite amazing how a newborn adjusts to the major changes that occur at birth. Not only does the baby's circulation start to work independently of mum for the first time, but the way the newborn copes with what must be a massive overload of all the senses is really what the word "awesome" should be reserved for. The true nurturing then starts in earnest with mum and baby (and, to an extent, dad) using all their senses and competing emotions to try to bond with one another. During this time your newborn will cry, sleep, and start to establish feeding.
You might be wondering if your infant can see you once their eyes are open. As newborns, babies are thought to have blurred vision, with the best distance for visualization being around 20-40 cm away.

What are newborn babies like?
Babies are born wet and wizened, and many are covered with a whitish, creamy, waxy coating called vernix all over their bodies (to stop them getting waterlogged while they live in the amniotic fluid of the placenta). Any vernix is washed off with the baby's first bath. Some babies are born looking wrinkled, and others (especially premature babies) may have a slightly furry appearance because of lanugo, a fine hair that develops while in the womb. Wrinkles and lanugo usually resolve in a week or two. Rashes, blotches, or tiny white spots also are also common on newborns, and these usually clear up over the first few weeks after birth.
Your baby's head may be pointy and slightly swollen, which is only natural, as the birth canal has squeezed it on the way out. Remember that the newborn's head is the widest part of its body. If an instrumental delivery was needed,this may accentuate any soft-tissue swelling further. These changes are temporary and will resolve to a lovely, round-headed appearance within a few days.
After months of growing in the foetal position in cramped conditions, it can take time to stretch and straighten those limbs. Your baby's skin may look slightly red, pink, or purple at first.

Newborn tests
Tests are carried out on your newborn soon after birth. Your lead maternity carer, a paediatrician, or a paediatric nurse will undertake an initial physical examination of the baby. In New Zealand, mums usually get to have some skin-on-skin contact before the examination. Since babies can get cold quickly, they are dried off fairly promptly. The physical examination usually consists of a head-to-toe inspection and includes tests for some reflexes, listening to the heart, and an Apgar score (named after Virginia Apgar, the anaesthetist who devised it).
The Apgar score measures a baby's responsiveness and vital signs, and was designed to help healthcare providers to assess the newborn's overall physical condition. This was so that they could quickly determine whether the baby needed immediate medical care. The test does not accurately predict a baby's long-term health, intelligence or outcome. The factors that are checked are heart rate, breathing, colour, activity, and muscle tone, and grimace reflex response. If the baby does need some immediate medical attention, it may be very straightforward: For example, clearing the breathing passages with suction.
This early medical attention is usually undertaken at a Resuscitaire, which is a large, specially equipped trolley. This has a number of features, including a heater to keep the baby warm, and an oxygen supply. The baby also has a number of measurements done and is then finally weighed, which has traditionally become the first question that people will ask you!
If you have decided to have Vitamin K given to protect your baby from bleeding disorders, an injection will be given at this stage. The baby is then wrapped to keep warm.
Before you leave the hospital, a Guthrie test is also offered to look for a number of metabolic diseases that, although uncommon, can have far-reaching consequences for the child. This is done with a heel-prick sample of blood on a special card, which is then sent off to the laboratory. All going well, the approximate stay in hospital after a vaginal birth is two to three days, and around four to five days after a Caesarean birth.

Breast or bottle?
The precursor to breastmilk is called colostrum, and it varies from thin and watery to thick and yellowish. As the baby suckles, a number of hormonally mediated changes take place to produce and release milk in your breasts, which then "comes in" over the next few days.
Some babies (especially premature and small babies) can find it difficult to latch on to the nipples or get enough suction going. The advice of the midwife or a lactation consultant can be invaluable.
This time can be quite frustrating, especially since you will hear multiple opinions from many people. Initially, you will probably be feeding your baby about every two to three hours around the clock. If you will be bottle-feeding your baby, you can usually begin within the first few hours of life.
Choosing whether to breastfeed or formula-feed your baby is one of the first decisions parents will make. Although there are great reasons for breastfeeding, the zeal existing in New Zealand does annoy some couples and puts a few off because they feel so pressured.
Despite the politics, there is overwhelming evidence that if a new mum can and is able to breastfeed (meaning, she has no anatomical problems and is on no medications that prohibit it), then she should seriously consider breastfeeding for at least six months, and possibly 12 months or longer. There are many reasons, including the passage of anti-infection antibodies to the baby, as well as likely protection from childhood asthma, allergies, diabetes, obesity, and cot death. Initially, you will probably be feeding your baby about every two to three hours around the clock.
As a group, formula-fed infants have more infections (40% more ear infections) and more hospitalisations than breastfed babies who have had at least four months of exclusive breast-feeding. Apart from the approximate $2000-a-year cost of formula and its related paraphernalia, there are increased medical costs as well. Breastmilk is also more easily digested by a newborn's immature system. Compared with formula-fed infants, breastfed infants also have fewer incidences of diarrhoea or constipation. And, of course, the recent events in China, where formula has been adulterated with cheap and dangerous additives in the interest of profits, will do nothing to convince new parents that formula is in the best interests of their newborn.
Since a nursing mother needs 500 extra calories per day and should eat a wide variety of foods, this gives babies different tastes through their mothers' breastmilk, not just the same flavour all the time. Also, breastfeeding women who are in employment are less likely to have to take time off from work to care for sick babies. In one American study, infants who were never breastfed would incur additional medical costs of US$331 to US$475 per year. Breastfeeding is also a great aid to burn calories and lose pregnancy weight. It also helps to reduce the risk of premenopausal breast cancer and may help decrease the risk of uterine and ovarian cancer in breastfeeding mothers.
Nevertheless, breastfeeding can be challenging. A postnatal midwife or lactation consultant should be able to help you in a constructive and non-judgmental way. Remember, just like you did with your lead maternity carer, you have a choice, as there are usually a number of lactation consultants available in most public hospitals and also some in private practice. Sometimes, both mother and baby need plenty of patience and persistence to get used to the routine of breastfeeding.
Some women who could breastfeed do choose to formula-feed, and this may be because it is more appropriate for their personal situation. The final decision on breast or bottle rests with the new parents. After an informed choice has been made, healthcare workers and society have no right to be judgmental.

Your emotions
The immediate postnatal period is a rollercoaster ride for new parents. Women will go through elation, exhaustion, and anxiety. Your feelings may change unpredictably and quickly. Sleep deprivation affects us very deeply, and it is important for family and friends to support the new family unit.
Up to 80% of women can go through feeling sad with the "baby blues", which can last from a few days to a week. The "baby blues" are thought to be due to major hormone fluctuations after birth. Whenever you can, take a shower, bath, or nap. Eat well and talk to people close to you and to other new mothers. Don't hold back the tears if you feel the need to cry, as it is highly likely the blues will run their course. If the feelings go on for longer than a week or are much more distressing, please talk to your lead maternity caregiver. Proper rest, nutrition, and support are important, as exhaustion, sleep deprivation, or stress can reinforce and fuel feelings of sadness and depression. Your maternity caregivers should be on the lookout for postnatal depression (PND). To learn more about PND, see "The big, black cloud" in OHbaby! Magazine Issue 2 (Winter 2008). Your loved ones should also be aware of the signs, and ask for advice from healthcare professionals if necessary.

What your body is going through
As a new mum, your breasts may be painfully engorged for several days when milk comes in, and your nipples may be sore from use. The soreness from the birth and any tears can make the first postpartum bowel movement slow and accompanied by pain. Take what is needed to make this easier and less painful. This may mean fruit (especially kiwifruit) and veggies, fruit juice, or even medication.
The pain from your healing vaginal area can be helped by painkillers and sitting on soft cushions. It can be even more painful due to haemorrhoids (piles), which are very common in pregnancy. The good news is that they start to resolve once the baby is born and will continue to do so in most women in the next few weeks to months.
Because of major hormonal changes, it can be fairly common to have some hot and cold flushes, or vaginal dryness. It is also quite common, for the first few months, to have urinary or faecal incontinence due to the stretching of your muscles during delivery, or even the feeling that your vagina or cervix has moved downwards and outwards. These symptoms can cause you to inadvertently pass urine while coughing or laughing. If these continue after three to four months, seek advice from your doctor and then a gynaecologist.
After-pains are due to the uterus contracting down to its initial pre-pregnancy size and are most noticeable when your baby breastfeeds. The natural vaginal discharge you experience after birth is called lochia, and although it is initially heavier than your period, it gradually fades to white or yellow, and then stops within two months.
Exhaustion, vaginal healing and dryness, and the new relationship with your baby may reduce a couple's libido for a few weeks. This is only natural, and in good time, you will recover!

Dr Anil Sharma is a specialist doctor in gynaecology and maternity. He is very involved in lectures and updates for family doctors and frequently takes part in debate regarding women's health and maternity for print media and radio. He believes that anxiety and fear can be conquered by knowledge. Anil immigrated to New Zealand form the UK in 2001 with his wife, Rachel, and he tries hard to be a hands-on and fun father (putting golf and cars on hold for the time being) to their three daughters, who were all born here. For further information about Anil's practice, visit www.dranilsharma.co.nz

As seen in OHbaby! magazine Issue 4: 2009

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