Labour of Love

The “Labour of Love” Is Here

So, at long last, the “little stranger” – your “labour of love” – has arrived. He has just said goodbye to the comforts of the warm, watery world. With the very first breath and the cry, his struggle in adjusting to the airy world begins. A large majority of these adjustments to an independent life is achieved during the very first week of life or a little later.

Baby’s appearance

Do not raise eyebrows if the new arrival does not exactly turn out to be what you had anticipated or fancied. In the first place, you perhaps wanted to have a boy whereas you got a girl. Or, may be you got a son instead of a daughter. Remember, it’s all Nature’s doing. We cannot do a thing about it. Secondly, you perhaps imagined the “little one” would resemble quite a lot the babies depicted on the picture postcards, glossy advertisements or calendars. Your baby, on the contrary, looks odd with a large head, dome-shaped abdomen, lean and thin buttocks and the skin covered with a waxy material. He looks more of a little monkey. And, that is quite a contrast to the picture in your mind – a lovely, chubby infant who would start playing with you as soon as he is born. Wait, another three or four months and he will in all probability start conforming to your fancied picture. All that you have to do is to give him ample love and bring him up properly.

Let us have some details of how the newborn looks

Skin: The skin is covered with a yellowish-white, greasy (cheese­like) material called vernix caseosa. It was a natural protective covering to safeguard his skin while lying in the amniotic sac within the mother’s womb. After birth, it need not be removed when the baby is cleaned. Let it be there for sometime. It will wash off with the first bath.

If vernix is stained yellow, your doctor will notice it and act promptly to exclude haemolytic disease of the newborn. Incompatibility between mother’s and baby’s blood groups is responsible for this disease.

Once vernix peels off, the underlying skin shows up quite red and rather raw. Some desquamation of the skin may also occur making the raw areas and minor abrasions susceptible to a bacterial infection.

At places, particularly over the buttocks, you may find large bluish spots. These are the monogolian spots which have no significance and will disappear in due course on their own.

“Will my baby continue to be as fair as he seems right away?” – this is an oft-asked question. Remember, absence of enough pigment, melanin, is responsible for baby’s extra-fair colouration at birth. In some weeks it is going to darken as the normal development of the pigment occurs.

Head: Compared to the body it is large and rather odd-looking because of the overriding and moulding it underwent during the birth process. This odd shape need not panic you. In a few days the head will assume its normal rounded appearance. On your part, see that you keep changing its position as the baby is asleep. This will provide the head uniform pressure on all sides and assist it in gaining its normal shape.

At times you may find a soft swelling over the area of the head which came out first. It is very transitory and will last no longer than a couple of days. It is termed caput succedaneum.

Some babies may have one or two longlasting swellings called cephalhaematoma on the top of the head. Cephalhaematoma results from stretching of the veins of the scalp before or during birth and is quite harmless. It needs no treatment and usually disappears within two or three months.

Talking about the mechanical effects on the head – well, the baby may show marks or swelling over the head if forceps had been applied during delivery. Do not bother about these. Their disappearance occurs very fast.

If you run your hand over the head, you will find that the bones of the skull are separated from each other by slight gaps called sutures. If you examine the front of the skull, there is a large gap (diamond-shaped and measuring 3 × 2 cm) at a point where the bones do not meet. This is known as anterior fontanelle which gives very useful information to the doctors. It usually closes between 9 to 18 months of age.

Its patency after 18 months of age usually points to vitamin D deficiency (rickets). Premature closure  of anterior fontanelle along with that of skull sutures is associated with small head (microcephaly). During dehydration, it gets depressed and during raised intracranial pressure (RICP), it starts bulging.

Similarly at the back is a much smaller gap, called posterior fontanelle which usually closes by the age of two months or so. Doctors do not attach as much importance to it as to the anterior one.

Grandmothers are usually fond of putting some vague substance and oily things over the anterior fontanelle (“this will make the child brainy and keep him cool”). Avoid all that. For, that will only lead to accumulation of dirt and formation of a dirty crust over the head.

Hair: Most babies are born with lots of hair on the head. In some, especially in case of a premature baby, hair grows down the back of the neck and across the shoulders. This hair is known as lanugo. It will fall off soon.

Hair on the scalp may also fall off during the first few weeks. This should not be confused with baldness. Hair will regrow. I have come across numerous babies in whom type and colour of hair at this second growth is characteristically different from that of the hair seen at birth.

Eyes: The baby after birth keeps the eyes closed most of the time. All newborns have blue eyes but after the first month change in colour may start occurring. It will be difficult to predict the true permanent colour of the eyes until the baby is at least nine months of age.

Do not be upset if the baby gives an impression of a cross-eye, also called strabismus or squint. It is because of lack of coordination between the eye muscles. It is all normal for a newborn and for several later months.

The baby is capable of differentiating between darkness and light.

Mouth: The baby sometimes may not move his tongue quite a lot. The condition is rare and, in any case, needs no interference until the age of three years. It does not cause speech defects.

You may find pale grey-coloured areas on the roof of the mouth or close to the palate and on the inner surface of the lips. These help the baby to fix his lips tightly around the mother’s nipple during breastfeeding.

Once in a while, a newborn may show eruption of one or two teeth.

Abdomen: The newborn’s belly is round and full, more so after a feed when it feels like a tight little drum. This is perfectly normal.

The stump of the navel does look very odd. It begins to dry up within 24 hours. It will drop off after five to ten days. What it is going to leave as a remainder is the wrinkled “button”, which when inverted will become the navel or the umbilicus. Never pull off the umbilical stump; it will bleed, inviting troubles. Let it fall off on its own.

Breasts: Every other newborn has a swollen breast; even a drop of milk may appear from the nipples. This is the same substance as secreted by the mother and is, in fact, the result of the mother’s hormones passing into the baby’s blood while inside the womb. The swelling and secretion will stop after a few weeks. Make no attempt to squeeze the breasts.

Likewise, some female newborns may have a slight discharge as such or somewhat bloodstained discharge from the vagina a few days following the birth. This again needs no treatment.

In a full-term newborn, the breast nodule measures 5 to 7 mm. If the baby is born before 36 weeks of gestation, its diameter will be just 3 mm. Before a gestation of 33 weeks, it is simply not palpable.

External genitals: The foreskin over the tip of the penis may be tightly overriding the hole through which urine passes, making the latter very tight. This causes difficulty in passing urine. Your doctor may like to give a little surgical cut and correct the minor defect. In case it is gross, called phimosis, the baby may need a small operation in which the foreskin is snipped and pushed back. This is called circumcision. In certain communities, say Mohammedans and Jews, it is performed in each and every child as a “ritual”.

In some babies, testicles, the organs which will be responsible for the production of sperms in later life, are not palpable in the bag of skin behind the penis, the scrotum. Doctors usually do nothing about this problem at this stage. They follow the baby. In many cases, testicles do descend within a month; in others they may take longer. Usually if the testicles have not descended by three years of age, a hormonal or surgical treatment is carried out.

Your may find that the scrotum is quite enlarged. Your doctor will be able to tell you if it is hernia, hydrocele or just normal.

Measurements: On an average a newborn in the Western countries weighs about 3.4 kg, though the variation is considerable.

An average newborn in India and other Asian countries weighs less. Your doctor will give the baby special care in case he is less than

2.5 kgs. He may need to be kept in an incubator, a temperature regulated apparatus in which low birthweight babies can be reared.

In the first seven days after birth, most newborns lose 10 per cent of the birth weight. By the 10th day weight loss is regained. After that a healthy infant gains about 200 gms every week.

The average length of a newborn baby is around 50 cm, most babies falling in the range of 45 to 53 cm.

The average circumference of head is about 35 cm.

Most mothers would be interested in knowing if all low birth-weight babies will grow up to be dull, small and delicate and all hefty newborns would be strong and big. The answer is a plain “no”. Some “big shots”, including Sir Isaac Newton, Sir Winston Churchill and Nobel Laureate Rabindranath Tagore, were born small at birth. Likewise, some big babies at birth have ended up in later years as very small and delicate.

Remember, size at birth has less to do with the eventual outcome; your care has more.

His behaviour and performance

Certain reflexes: If you place an object in his hand, it is at once grasped around fairly firmly. Try your fingers, one for each for his hands.

Once he has held these tightly, you can hold him suspended in the air. This is called grasp reflex.

If you touch the angle of his mouth with your finger, he will immediately turn his head to that side. He will also open his mouth and push his tongue over to the corner of the mouth. This is what is termed rooting reflex. It helps him to root for the nipple and find it during breastfeeding.

If you hold the baby under the arm, raised and made to touch his foot to the edge of a table, he will curl the foot up, raise it and place it on the table. This is called placing reflex.

If your put the flat of the newborn’s foot on a table, he will lift the other foot as well as though he was walking. This is the walking reflex.

On sudden banging of the table on which the newborn is lying awake, he will at once throw out his hands and fingers wide open, pull his legs up and cry. This is followed by his pulling the arms together in a “close embrace”. This is the Moro’s reflex.

When doctors are not certain about a mother’s statement about the duration of pregnancy, they can judge the newborn’s approximate gestational age from these and other reflexes.

Activity: Incoordinate movements of the arms and legs, when he is lying on his back, occur in the newborn as and when he is awake.

Sleep and wakefulness: The baby sleeps a lot, waking up periodically, usually to receive the feed. In the latter half of each span of “sleeping hours”, his sleep is quite deep and he cannot be easily aroused.

Bladder: Do not be panicky if he does not pass urine for 24 to 36 hours. It is not that his kidneys are not yet functioning. They are. What is contributing to the delay in passing urine is the failure on the part of the bladder to empty it.

Bowel: It is different with the bowel. He usually passes his first stool right at birth or sometime during the first 24 hours.

The first stool is black. It is called meconium. In the subsequent bowel movements, especially after three days, black meconium changes colour to brown and then to yellow. The sooner you put him to the breast, the faster the meconium gives way to real stool colour.

Crying: The first thing the newborn learns is to cry. It comes with the very first breath. It is an important means to attract the mother’s attention and to express himself.

You can read a lot in a newborn’s “cry”. If it is choked and gasping (which one does encounter immediately after birth), the baby may be having a breathing difficulty. Its absence in toto indicates extreme distress. A high-pitched, shrill cry resembling the mewing of a cat may mean brain damage.

Feeding: The healthy newborn can suck and swallow well. As I hinted earlier, he nearly masters sucking while in the womb and is well trained after getting born. He is also trained to swallow and digest his natural food, mother’s milk. His body is trained to utilise it for its growth.

The average baby needs to be fed six to eight times every day, taking 90 to 100 ml of milk at every sitting.

Colostrum, the thick yellow milk produced by the mother during the first two or three days after childbirth, is an ideal food for the newborn. It is in fact tailored to his needs. You are advised to let it be fed to the baby. There is nothing more stupid than to say that colostrum will harm the baby. Make sure you give it to the baby.

Other behaviours: All newborns have hiccups, sneezes and yawns. Do not fuss that he has indigestion or wind, a cold or tiredness. These reactions do not mean anything. Nearly all babies have each one of these. None of these appears to do any harm to him.

Likewise, your baby’s jaw may show “trembling” from time to time. This too has no special behavioural importance. A few years back, I had a tough time convincing an anxious mother about the benign nature of “trembling” that her few-day-old baby exhibited. I had to talk to her mother. It was only when the mother of the young lady emphatically told her “O, yes, you too used to have this kind of trembling when you were very small and we had to do nothing for it” that she was satisfied.

Again, the newborn gives a sudden jerk as and when there is sudden noise, a sudden change in his position or when his bedclothes are moved. Ignore it.

A proportion of the newborns develop high fever on second or third day after birth. The baby seems fine. His tongue and mouth are however dry. It is ascribed to the weight loss experienced by nearly every newborn and is termed dehydration fever. Do not panic about it. It does not mean an infection. All that you are supposed to do is to give plenty of boiled water in between the feeds. If fever is too high, you may give paracetamol. Do ask your doctor as to when to give it and in how much dose. Self-medication can prove dangerous, especially when it is the case of a newborn.

Lastly, a newborn can feel pain, thirst, hunger, heat and cold. Not just that, he can have happiness and anxiety. He is a person who can think about them. As a mother you must understand his deepest emotional needs. Your concern should not be just his physical body. You must take care of the little one’s mind, his behaviour and his emotional states as well.