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.

  

Dads and labour

Preparing Dad for the labour ward

When I trained to become a midwife in the mid-’70s, dads-to-be walked up and down in the corridors or smoked in the waiting room while everything happened behind closed doors in the delivery room. Once mom had recovered and was spruced up and the baby had been bathed and swaddled into a bassinette in the nursery, Dad was given a peek at his offspring through a big glass nursery window and then allowed to give his wife a bunch of flowers. It was all very formal.

Luckily this had all changed by the time I had my first baby, and because I knew what to expect, I could talk my man through what was going to happen next. A few years later when I started giving pre-natal classes, I realised that it was just as important to prepare men for the labour room as it is to prepare women.

I can’t claim to be the instigator of educating couples. This had all started in the early 1940s when Dr Grantly Dick-Read published his book “Childbirth without fear” stressing that childbirth is natural and that pain is minimised when fear is taken away. This research was followed by the French obstetrician, Dr Ferdinand Lamaze and American obstetrician, Dr Robert Bradley. Only then, with much negotiating and the support of midwives and parents, maternity units opened their doors to men who now play ‘doula’ during the first stage, help his woman to focus during the birth and share the joy in the first ‘magic hour’ together. Some private midwife-run facilities go so far as to provide a double-bed for couples in their own private suite where they do everything for themselves with midwives on standby should they need help.

The move towards women choosing to start a family when she is older, escalating fertility treatments plus doctor’s fear of litigation when there are (even minor) complications has meant more c-sections (especially private health care). This also means that women (and their doctors) don’t feel the need for physical preparation before the birth – just as long as she knows how to cope with major abdominal surgery after the birth.

Where does this leave Dad? To be honest – pregnancy, babies and birth belong in the women’s department. Men learn to cope with pregnancy-related outbursts and emotional melt-downs, but when it’s ‘crunch time’ ie time to go to the hospital, reality hits them between the eyes like a punch ball. They’re not quite sure where to look or what to say or do. While some feel like obscure spectator’s, others jabber on with the nervous conversation or get in the way with cameras and video equipment. A few simply pass out. But they all feel drained and exhausted afterwards, wondering what just happened, how their lives have changed and what they can do to cope.

Top tips for dads:

• Join in with prenatal classes where there is an opening for dads
• Go with your partner to the doctor/midwife as often as you can – or at least for the first visit, the first scan, the hospital ‘tour’ and her last few appointments when she really needs your support, and you have the opportunity to ask questions
• Read that parenting and baby magazines she conveniently leaves lying around
• Work on baby’s room together and talk about how you are feeling
• Talk to seasoned dads – and learn from their mistakes.

Like the picture? I found it on “100 powerful photos of dads in the delivery room to celebrate Father’s Day”. Open the website for more.

 

Labour hormones and how they help

Make friends with your ‘labour’ hormones

Last week’s post focused on physical preparation for labour. This post is about making friends with your labour hormones.

The good news is that Mother Nature doesn’t leave you to cope with labour and birth on your own – hormones help you to do this. These are mostly oxytocin, relaxin and endorphins. Unfortunately, fear, stress and pain can block these hormones. Pain can increase fear to the point of panic that can quickly get out of control. That’s why it’s important to minimise fear so that you can make the most of natural hormones.

How can you do this?

• Fear of the unknown – minimise this by reading, learning about childbirth (Lamaze, ante-natal classes) but please don’t google questions – rather ask your doctor/midwife
• Choose a birth-partner: Baby’s dad, mom, gran, best friend, doula
• Stay at home for as long as you can during ‘warm-up’ labour (or until contractions are 5 minutes apart) unless ….. you’re bleeding, your waters have broken or your gut tells you something is wrong
• Fear is made worse by hospital smells and by what we hear and see. To create your own ‘comfort-zone’ – take your own pillows and blanket
• Wear earphones and listen to your favourite music.

Keep comfortable:

• Wear an old pair of loose-fitting pants so that you can walk around for as long as possible in early labour
• Bring snacks and beverages
• Have your birth partner rub your back with ‘smelly’ cream
• Keep a wet face cloth handy and use it to keep feeling cool and fresh
• Bring lip-ice and hairbrush
• You don’t have to have a water-birth, but getting in and out of a warm bath helps
• Squat on a chair or soft exercise ball
• Humm, sing, chant your contractions away!

Something to remember about labour pain:

This type of pain is not destructive pain caused by disease or injury. Labour pain is functional pain mostly caused by resistance. Oxytocin, relaxin and endorphins helps to minimise this resistance and ease the pain. Make sense?

Remember that there is no pain between contractions (not like period pain that just goes on and on …)

How do hormones help?

Oxytocin – also called the ‘love’ or ‘bonding’ hormone activates the ‘reward centre’ of your brain. It also:

• Controls fear, helps you to trust
• Keeps you calm, controls your blood pressure
• Initiates bonding and mothering instincts
• Improves appetite (especially after the birth)
• Helps to make and release breast milk (after the birth)
• NB: Decreases fear
• Helps with healing.

Relaxin:

Besides improving blood flow, this hormone relaxes pelvic ligaments and softens the pubic bone allowing the baby’s head through during the birth.

Endorphins:

This is a ‘natural morphine’ opiate or pain-relieving hormone that comes from the brain. Providing that a woman is relaxed, endorphins are released during contractions in bigger doses as she nears the end of the first stage, goes through ‘transitional’ and ‘second’ or ‘birthing’ stage. Endorphins can even help to put a woman into a trance during this difficult stage so that her only focus is to push her baby out – irrespective of circumstances!

This ‘endorphin’ high also helps a woman cope during the first few days after the birth or until breastfeeding hormones are flowing. Women lucky enough to experience natural birth are often less likely to struggle with the ‘baby blues’.

Picture source: ‘Everything you need to know about a birthing doula’ by Genevieve Howland: https://www.mamanatural.com/birth-doula/