Baby's first milk

Liquid Gold

Colostrum or baby’s first milk is quite literally, liquid gold. This precious first-food for baby is proving to be more valuable than we ever imagined now that we understand its composition and function. Can you believe that at one time, mothers were told to express and discard this milk because it was said to be the ‘waste product of pregnancy’?

Ultra-sweet, this thick, yellow creamy milk is all that a baby needs for the first few days of life.

Supplementary water and formula ‘until your milk comes in’ is old-fashioned, incorrect advice. I remember arguing with an older doctor about this once when he asked his patient, who had recently given birth, if the midwives had given her baby water yet. When she said no, he accused me of neglecting my duties as a midwife.

I calmly told him that newborn’s only need colostrum to which he argued: “You drink water don’t you?”

“Yes,” I answered. “I wasn’t born yesterday.”

He thought I was being cheeky, so I elaborated. “Newborn’s don’t need water,” I insisted. “All they need is MOM – Mothers Own Milk.”

This left the mother in a dilemma. Who should she believe? Her (old-fashioned) doctor or the midwife? When the doctor left, she asked me to bring a bottle of water for her baby. Sigh.

Colostrum is coloured yellow because it’s rich in beta-carotene – a type of Vitamin A.

Vitamin A facts:

• Babies and young children need vitamin A for optimal health, growth, and development.
• Almost all children are born with low stores of vitamin A. During the first six months of life, mothers need to breastfeed exclusively to increase their babies’ vitamin A stores.
• After six months, vitamin A comes from breastmilk and vitamin A-rich foods.

Newborn only need to drink one teaspoonful of colostrum to fill their tiny stomachs. 

Five millilitres of colostrum is equal in nutritional value to 30 millilitres of mature breast milk. 

Like puppies or kittens, babies need to be close to their mothers so that they can be given frequent feeds. As often as they need – on average, two hourly. When babies are filled-up with formula, they will sleep for four hours or longer. 

This means that Mom misses out on frequent suckling that not only helps to release hormones to make milk, these hormones also help to keep her womb contracted, and this helps to minimise the risk of haemorrhaging after the birth.   

When baby is late

What to do when you’re overdue

I thought my first baby would never come. He was 16 days late and has been late ever since. My last baby was six weeks early. My second was induced. Only my third baby was born when she was due. On a meniscal statistical scale, therefore, one in four babies are born on their ‘due’ date.

Waiting for your baby’s birth is like waiting for your flight that’s repeatedly delayed. Your bags are packed, baby’s cot and paraphernalia are waiting, you’ve had a few episodes of ‘false labour’ and a day is a very long ‘t-w-e-n-t-y f-o-u-r’ hours when you’re waiting to go into labour. By the time your contractions are coming every five minutes, or your waters have broken, you’ll grab your bags, run out the door and rush to the hospital. This would never have happened just a few months ago when you were terrified to go into labour!

In my books, babies come when they’re ready. As a child, I remember picking ripe peaches off the tree. Sweet, soft and delicious, they would simply fall into my hand. Unripe peaches, however, were really difficult to pick, sometimes taking a piece of the branch with them. These peaches were hard and tangy. When the cervix (mouth of the womb) is soft, flat and opening, that’s when your baby is ready to come.

If this is your first baby, remember that everything is ‘new’ and tight. This means that labour often starts later and takes longer. But don’t stress, your hormones (oxytocin, progesterone and prostaglandin) are already doing their thing.

What can you do?

Keep busy. Do physical things – don’t worry, hanging curtains or scrubbing walls and floors won’t twist the cord around your baby’s neck.

Don’t take castor oil – it will give you the runs and make birth rather messy.

Go to the shops or meet a friend for coffee – it’s unlikely that your waters will break. This mostly happens when you’re having strong, regular contractions. Pregnant women who ‘suddenly’ go into advanced labour in public places only happens in movies or sitcoms.

Your weight will level off. Your health-care provider will keep an eye on your blood pressure and look out for swollen fingers and toes. If your blood pressure goes up, and your fingers and toes swell, you may be admitted. If this gets worse, you may be induced.

Your baby’s position will be checked. If you’re 40+ weeks, the head is not ‘down’ and you're not ‘dropped’, the baby may be too big. If this is the case, you may need a c-section.

You will need to see your health-care provider at least once a week. Please don’t miss these appointments, or ignore advice if induction or even a c-section is recommended. Make sure your baby is moving. If you’re worried, go to the hospital.

Take a deep breath. Don’t panic. Take it easy getting to the hospital – or calling the midwife. Good luck!

Photograph of labour ward: Aloise Ireland

    

How babies develop immunity

When can I take my baby out?

I often see the teeny-tiny newborn’s in shopping malls and I have to resist the urge to make a fuss over them, firstly because I know Mom is protective as a she-bear, and secondly, my person is abuzz with bacteria, viruses and even fungi that could be potentially harmful to a new-born still colonizing microorganisms. In other words, developing their immune system.

I’m often asked when it’s safe to take the baby out for the first time and I like to caution new mothers to avoid people-busy places like malls, church services and even birthday parties for the first four weeks – especially if her baby was born by c-section, was premature and is not breast-fed.

Here’s why.

Newborns have an under-developed immune system. This is because, for the first nine months of life, they were protected by their mother’s immune system, the placenta and her cervix (the doorway to her womb). A baby’s first introduction to microbes and bacteria is through the vagina – and providing the mother is clean and healthy, these ‘harmless’ bacteria help to jump-start the baby’s immune system.

Babies born by c-section don’t have this advantage.

Immediately after birth, a healthy baby is put skin-to-skin between the mother’s breasts. Here the baby is comforted by her smell, the sound of her voice and heart-beat and her body warmth. Over and above this, healthy microbes on mom’s skin are transferred to her baby through suckling, introducing these organisms to her baby’s gut where healthy bacteria are essential for digesting and absorbing nutrients. 

Premature babies are more at risk because they miss out on the last few weeks (even months) of developmental maturity, they’re mostly born by c-section and often put onto antibiotics. This is when kangaroo-mother-care is a big plus and expressed breast-milk (EBM) is a must.

Luckily, babies are incredibly adaptable and within a few short weeks, they’re colonizing microorganisms by the billion. By the time babies are crawling and exposed to dirt on the floor, the dog’s food, and garden snails, their gut microbiota is able to cope with and eliminate most germs.

According to neonatologist Nicholas Embleton, at Newcastle University, UK, “by the age of two or three, the composition of a child’s gut microbiota is very similar to that of an adult’s,” which means, they have a healthy immune system, making it pretty difficult for disease-causing microbes to make them sick.  

Photo from "UNSPLASH"   

Making the most of magic vernix

Protecting your baby’s skin

Coldwater and ocean swimmers will often put fat or Vaseline on their bodies to help retain heat, reduce chaffing from swimsuits, help prevent salt burn and help them through the water.

Vernix, the white, creamy, vaseline-like substance that covers the newborn's skin, protects it from amniotic fluid during pregnancy lubricates their little bodies during the birth and helps to keep babies warm after birth.

We used to wash this valuable natural cream off the baby soon after birth, but this practice is fading fast. The WHO (World Health Organisation) and skin research institute no longer recommend washing new-borns in warm water before the first 24 hours. They recommend that excess amniotic fluid (that makes babies wet and cold) is dried off with a warmed towel and babies are left skin-to-skin between their mother’s breasts for the first ‘magic hour’ after birth.

Thanks to research, we know so much more about the newborn's skin today. We know that the baby’s skin, although fully formed, is still maturing during the first 28 days after birth and that the skin of a premature baby has a few added disadvantages. This maturing process continues throughout their first year. New-borns, in particular, can lose valuable body fluids and heat through their skin, their skin is more easily damaged and because they have less body fat, their natural moisturising factor is missing.

Babies left skin-to-skin with their mothers are more able to colonise microbes (these help to develop their immune systems) and babies who have a natural birth have an advantage over babies who are born by c-section.

What’s ‘magical’ about vernix?

Vernix helps to keep natural moisture in, thereby helping to keep the skin hydrated.

Vernix helps to keep the baby warm by retaining natural warmth. Babies with a temperature below 36°C are considered ‘hypothermic’. Left untreated, hypothermia can deplete sugar reserves and make the baby hypoglycaemic, sleepy and ‘floppy’. This, in turn, can interfere with feeding and the domino effect is that this can increase the risk of ‘baby jaundice’. Left, baby can end up in high-care, and the new mother in tears.

What can you do?

1. Speak to your health-care provider before you go into labour about the possibility of skin-to-skin – even if a c-section is unavoidable.
2. Wait 24 hours before bathing your baby for the first time. Ask your midwife to recommend the best hypoallergenic baby products.
3. Weighing and measuring can wait until the baby’s temperature has stabilised.
4. Cover baby’s head with a beanie to minimise heat-loss.
5. Allow baby to breastfeed when s/he is ready.