Baby's survival immediately after birth

 

Babies are smart!

The first ‘magic hour’ after birth

 

I only need to look at my grandchildren to marvel how true this is. I studied paediatrics to learn about developmental milestones, yet, they (like babies all over the world) know, exactly what to do, when and how - without opening a book!   

 

Newborns are programmed to survive. They’re little ‘toughies’ and yes, there may be times when they need a bit of help, but generally speaking, just about all babies manage to get through the first critical hour after birth on their own.

 

More and more, doctors and midwives are learning the value of not interfering, and giving newborn’s the chance to recover from birth and adapt to living in the air on their own. Just like baby turtles paddling their way down the beach towards the sea, a newborn’s first mission is to ‘crawl’ over the contours of mom’s body to find their way to her nipple where they’re rewarded with their first suckle at the breast.

 

Why is this so important and how can it be achieved?

 

It’s not that babies have to eat as soon as they are born. On the contrary. They simply suckle at the breast to connect with mom, absorb microbiomes (good bacteria) from her skin and find comfort hearing her heartbeat.

 

In the first hour after birth, the baby is adapting from living like a little fish in the water to living on land and breathing oxygen. It took land-creatures millions of years to learn how to do this – newborn’s do it in the first few minutes after birth!

 

Breathing is their first step to independence. After this comes suckling – not only for nourishment, but also to self-soothe. Remember that when we were primitive babies, we were at risk from predators, and incessant crying could attract unwanted attention. * Babies need to find comfort from their mothers to overcome the shock of birth, to be reassured by her beating heart, and nourished by precious colostrum – baby’s first food.

 

During the first hour after birth, mom and baby are at their peak of ‘alertness’. The baby, once patted dry, is covered with a cloth, and left naked, skin-to-skin on mom’s flattened tummy where s/he is free to ‘crawl’ toward the target – her nipple – that's been darkened by pregnancy.

 

Babies are instinctively drawn to mom’s left breast where her heartbeat is strongest. This very first ‘tummy-time’, reconnects mom and baby like a magnet. Mom’s sense of relief and elation now that her ordeal is over, pumps up hormones like endorphins (happiness) dopamine (motivation), and oxytocin (the love hormone) that, in turn, help her to adjust over the next few critical days to her new role as mom. A glut of these hormones also helps to minimise ‘baby blues.’

 

We would be blown away if we could zoom onto the surface of mom’s skin to see what’s happening. Thanks to research, the microbiome (good bacteria) and its benefits are in the spotlight. These ‘healthy’ micro bacteria are passed from mom to baby during the birth, skin-to-skin contact, and breastfeeding. When the baby swallows these microbiomes, they’re colonised in the baby’s gut, helping the baby to digest milk and initiating immunity. It's nothing short of a miracle.

 

We’ve learned that babies don’t need to be taught how to breastfeed. All they need is time and patience and ‘hands-off’ from doctors and midwives. Left alone, the baby’s senses (sight, sound, smell, touch and taste) along with the sucking and rooting reflexes help to jumpstart breastfeeding.

* More about this in my next blog.

A treat for the weekend.

 

Quick apple pudding/cake

If you want something tasty and different, here’s a quick and easy apple recipe that can be served with cream, ice cream, custard, or on its own.

You need about 6 apples (or a tin of apples), 1½ tsp cinnamon, and about 2 tablespoons brown sugar. While the apples are cooking, grease a dish (15 X 20 cms) then add the cooked apples and sprinkle them with cinnamon and brown sugar.

   

Next, mix ½ cup sugar with 1 egg till its light in colour and creamy. Add 1 cup flour, 1 tsp baking powder, ½ cup milk, 2tsp cooking oil and 1 tsp essence (I used almond – gave the mixture a lovely nutty flavour). Mix it all up, pop into the oven (180°C) for about 30 mins. Decorate with a few raisins. Serve and enjoy the compliments.

     

Baby Jaundice, what is it and can it be prevented?

 

Why is my baby yellow?

Mother and author, Martha Beck writes in her book, ‘Expecting Adam’ * “There has been the second phase of my education, the one that followed all those years of school. In it, I have had to unlearn virtually everything Harvard taught me.”

In many ways, I feel the same way about my midwifery training. I’ve had to ‘unlearn’ so much I was taught. Baby jaundice – also known as new-born or physiological jaundice – is one example.

I left nursing college practically expecting every new-born to become jaundiced (yellow) after the first 24 hours of birth. This is because when red blood cells are broken down (new-borns have too many of these), the iron is stored to make new red blood cells (in about 100 days’ time). The yellow-coloured waste is called bilirubin and sent to the skin. This gives a baby that tanned, yellowish look. The skin is the biggest organ in the body, and sunlight helps to break-down the bilirubin so that they can be eliminated by the bowel and bladder.

How does nature deal with this problem?

Colostrum or baby’s first milk (read more about this in my previous blog) is a natural laxative that helps to empty the bowel of baby’s first poo called meconium. Meconium is a thick, gooey, sticky mucous so dark green it’s practically black. A tip here for new moms is to smear Vaseline from the nape of your baby’s neck, down his back and all over his little bottom in preparation for this. The Vaseline helps to stop the meconium from sticking. If this happens, it takes quite some scrubbing to clean it off.

It makes sense then that the more often a baby feeds, the more colostrum there is available in the bowel to act as a laxative. I’m talking about two-hourly feeds for the first 24-hours. These are quick ‘top-up’ feeds that shouldn’t take more than five minutes at each breast. Freebies for doing this includes bundles of bonding and stimulating important breastfeeding hormones like oxytocin and prolactin. The new-born also learns to latch onto the nipple while the breast is soft and Mom gets used to the sensation of being suctioned.

How do you know that bilirubin levels are going down?

Firstly, the baby’s skin colour improves. Then there’s baby’s changing poo – from black meconium, to green slimy poop that changes to dark mustard yellow to Colemans Yellow Mustard that’s slightly frothy. After about five to 10 days your baby will produce normal, yellowish-brownish sweet-smelling breastmilk poop. Voila!

What did we go wrong ‘back in the day’?

1.       It wasn’t standard to put baby skin-to-skin with Mom during the first ‘magic hour’ after birth**

2.       Babies were whipped out of the delivery room.  A lucky few moms were given the chance to have a brief squiz of their new-borns, but dads were allowed in the labour room. I squirm to recall that the babies were put into an incubator to 'warm-up' where they cried their little hearts out, believing they've been abandoned. Its no wonder that psychiatrists today are raking in the bucks – but that’s another topic and another blog.

3.       Then, (I kid you not) babies were given their first drink of sterile water (about 20 mls) from a bottle! Yip!

4.       While mothers were in hospital (five days for normal deliveries and 10 days for c/sections) babies were trained (I blush just writing about it) to feed four-hourly. This was to make life convenient for the nursing staff, and ‘easier’ on the new mother when she went home

5.       During the night it was deemed essential that new mothers were left to sleep, and ALL babies were swept into the nursery and bottle-fed by nurse assistants or student nurses.

Sadly, some older-generation midwives still swear by these methods and impose them whenever they can.

What can you do to avoid baby-jaundice?

1.       Learn as much as you can about breastfeeding while you’re pregnant. The breastfeeding “Bible” I recommend (published by the breastfeeding support group called La Leche League International) is called “The Womanly Art of Breastfeeding”. The title sounds horribly old fashioned, but believe me, it’s regularly updated and is very interesting reading – besides being a useful reference

2.       Find out about a lactation consultant in your area, phone her and introduce yourself

3.       Learn about breastfeeding support groups in your area. You could even go to one of their meetings if you have the privilege of maternity leave before you give birth

4.       Speak to your doctor / midwife / about breastfeeding – especially when you go on your ‘hospital tour’

5.       Some women insist on “No Bottle / No Water” instructions attached to their baby’s bassinette and 24-hour ‘rooming in’

6.       Put your baby to the breast as soon after birth as possible, insisting on skin-to-skin – providing there are no medical complications

7.       Breast-feed as often as possible – especially during the first 24 hours while colostrum is still available. This will also guard against hypoglycaemia

8.       Luckily, most mothers go home (all being well) on their second or third day (after a c-section). During Covid this may be as soon as a few hours after birth. If this is the case, make sure that you have dependable home-care e.g. an experienced mom (mom-in-law), friend or if necessary, a midwife in private-practice who is prepared to come to your home.   

 *  Judy Paitkus publishers 2000. Highly recommended especially if you are expecting a ‘different’ child.    

** More about this in my next blog

 

Covid in 2021

Coping with Covid in 2021

We survived the first wave of Covid-19 in 2020. For the last two weeks, I’ve sat perched like a cat on the windowsill, simply watching the world go by, recollecting my thoughts, reading and crocheting yet another blanket and trying to build up the courage to jump back into the living room and re-connect with the ‘real’ world.

I told my grown-up kids: “Brace yourselves. 2020 was a practice run. 2021 is the real deal.”

Here’s why.

Since the day we heard rumours about this nasty virus that jumped species in Wuhan in November, 2019, we have been inundated with conflicting information that’s kept us glued to our TV sets and rooted to our couches where we consumed mountains of potato chips and grew enormously fat and lazy. Well … maybe not everybody did this.

While it all seems so unfair, we have no choice but to come to terms with the situation. How we do this differs from person to person, but there are more or less the same stages to acceptance that we all go through. These are (in no specific order) denial, grief, anger, bargaining and depression. Sometimes we simply go backwards and forwards between stages, never really making any progress. Optimists may hit a double-six more often than pessimists, while extraverts may struggle more than introverts.

Be that as it may, leaders, decision-makers, trend-setters and you and I need to seriously think about planning for the long-term effects of Covid.

1.       Covid will be with us for a l-o-n-g time. It will ravage society for many years to come before it ‘burns itself out’.

2.       Developing a vaccine is not the only answer.

a.       Viruses mutate (change their appearance like chameleons do) getting stronger before growing weaker when they mutate too often and too quickly

b.       The current vaccine will not cover all these mutations

c.       People will need at least 2 vaccinations for these to be effective, increasing costs

d.       Can governments (especially third world) afford these? Will donations be ‘left-overs’? Will private health-care costs soar?

e.       Do we honestly know the side-effects?

3.       Coping with the aftermath. Training people like doctors, pilots, engineers – even post-office workers and traffic officers takes money and time. These people need to be dedicated and passionate about their work, enjoy good health and have years of experience under their belts before they can get to grips with the task at hand. Already we have lost too many qualified people to Covid. Who will replace these vital people we rely so much on? Inevitable this will lead to:

a.       Food shortages

b.       Baby shortages. Infertility has been a pressing problem for years. The new strain of Covid is affecting younger people – those in the childbearing age bracket.

c.       Unhealthy life-styles has led to widespread health problems and obesity – even in children.

Before you slit your wrists or curl up into the foetal position on the window-sill, there’s hope. Yes, there is. And it’s quite simple really.

·         Stick to the original non-pharmaceutical precautions: Social distancing, wearing a mask (washing it at least every day) and washing your hands every time you’re out, sanitising them as often as you can while you’re out

·         Eat healthy. If necessary, grow your own vegetables, or at least herbs in flower-pots on your balcony.

·         Teach what you know to others. Share what you have learned in your lifetime with others so that they too can learn skills.

·         Teach yourself something new, a new language or a new career with an online course. Some of these are free.

·         Support child-rearing families. Give them hope. Encourage them to be prepared. Don’t waste. Learn to minimalize. Use what you’ve got.

·         Cherish people. Take nothing for granted. Celebrate life.   

 

What is colostrum or baby's first milk?

 

From MOM – with love

Today’s post is about magic colostrum or baby’s first milk. This ‘liquid gold’ can be compared to condensed milk. Do you remember sucking this super sweet, ultra-thick yellow liquid straight from a tin when you were a kid? Growing up, eating mielie pap smothered in condensed milk for breakfast was a super-special treat. Today I keep a tin or two in the cupboard for emergencies, puddings or making a sweet and creamy cup of coffee.

Condensed milk was developed in the 1820’s as a way of preserving then reconstructing milk. Vacuum pans had been developed to concentrate orange juice. This method was used with milk, and the trick was concentrating it without curdling the milk. Tinned, this new innovation was an invaluable source of energy for troops during the world wars, and no doubt will be more in demand as fresh milk supplies dwindle as a consequence of Covid.

But I digress.

When I had my first baby, my gynaecologist pooh-poohed colostrum, calling it the ‘waste product’ of pregnancy. Some cultures even insist on emptying the breast of colostrum and discarding it. Thumbs up to research that has taught us more about this golden liquid and how important it is for new-borns. When you understand this, you’ll appreciate why your baby, whenever possible shouldn’t be deprived of MOM (Mother’s Own Milk).

What’s packed into colostrum?

Colostrum is easily digested and perfectly designed for a newborn’s unique inexperienced digestion and metabolism. Colostrum has a way of preventing the ‘overloading’ of this system during those very important first few days of life when a baby is adjusting to 'extra-uterine' life.   

Sugar: Newborn’s need energy to survive (keep breathing on their own) and stay warm. Colostrum contains four times as much energy (or calories) as a 5% glucose solution (sugar water). When paediatricians worry about low blood sugar levels, they sometimes insist on giving babies glucose water – but this can cause ‘reactive hypoglycaemia’. Besides, higher protein levels in colostrum have a stabilising effect on blood glucose levels.

Colostrum contains the right proportions of proteins, healthy cholesterol and carotene (that’s where it gets its yellow colour) – helping to make Vitamin A.

Nature’s natural vaccine: Colostrum is rich in antibodies. These are especially helpful because they can be absorbed directly into the body from the stomach. This means that a mother is literally immunising her baby with antibodies like lactalbumin, lactoferrin and IgA every time she breastfeeds. Wow! This also helps to protect her baby from bacteria and viruses associated with her own body as well as from people and the environment. The concentration of antibodies in colostrum is at its peak in the first few hours after birth.

Understanding your baby’s gut: Colostrum helps to establish the natural flora in the digestive tract. Lactobacillus Bifidus helps to establish your baby’s immune system, teaches the gut to absorb nutrients and guards against allergies. This is especially helpful in allergy-prone families. Another plus is that colostrum has a laxative effect and helps the baby to poo. The first stool is called meconium – a thick, sticky, blackish slug-looking substance that is the waste collected in the intestines during pregnancy. Cleaning this out quickly helps to prevent ‘baby jaundice’*

 Your baby’s marble-size stomach: Just think about it, your baby’s tiny little stomach is about the capacity of a small marble – or the equivalent of one teaspoonful of liquid. Feeding a new-born with 20 MLS of formula will make him uncomfortable – or feeling as full as a tick, like he has eaten a six-course meal. This also means that the baby will sleep for 4 hours or longer (once considered ideal). But today we know that it’s normal for a new-born to have quick, short feed every 2 hours. Not only does this help with skin-to-skin bonding, it tops up baby’s sugar levels AND stimulates hormone production in the mother (see my previous blog) that boosts milk production and helps to minimise blood loss after the birth by helping the womb to contract.   

Where to from here? Colostrum collects from about 20 weeks of the pregnancy. From the moment of birth, the breasts start making transitional milk that the baby will drink as soon as the breasts have been emptied of colostrum. We used to say this was three days, but we know today that the more often a baby is put to the breast, the sooner he will consume the colostrum, then transitional milk that is the very early mature milk, that quickly advances to mature milk.

A mother’s breasts change when her milk ‘comes in’. When this happens, it’s important that her baby has learned to latch correctly because most breastfeeding problems start with incorrect latching.

                 

* More about this in my next blog.