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Caring For Your Newborn



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- Hello, my name is Doctor Bonny Whalen.

I am the medical director of the Newborn Nursery

here at Dartmouth Hitchcock Medical Center.

Welcome to the Birthing Pavilion

and congratulations on your pregnancy.

And if you've already given birth,

congratulations to you and your new baby.

In this video we would like to share

some important information about the Birthing Pavilion

and the kinds of things you and your new baby

will experience in his or her first few days of life.

We'd also like to offer you some tips and advice

on caring for your new little one.

The Birthing Pavilion is a comfortable, private

and calm place to give birth.

It has it's own operating rooms

and the intensive care nursery is right next door

should you need any special care right after delivery.

The Birthing Pavilion is an especially safe place

for you and your baby.

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The first few minutes and hours after birth

is an important time for a mother

and her new baby to bond.

Spending time together and skin to skin contact

for the first hour of life is especially helpful

in making the transitions after the birth's successful

for you and your baby.

Skin-to-skin contact

means the baby's naked skin comes in direct contact

with the mother's bare skin.

The skin-to-skin contact helps stabilize

the baby's blood sugars and body temperature.

It helps the baby's heart rate and breathing

become more stable and it's very calming for the baby.

This quiet bonding time is also helpful

with the baby's first feeding.

A mother's body benefits from skin-to-skin contact too.

It helps the mother's uterus contract

which helps decrease bleeding

and it also helps stimulate a mother's milk hormones

if she is breast feeding.

- Does he look like your other son?

- We encourage you to hold your baby skin-to-skin

as much as possible in the first few hours

and days of life.

Baby's who are held against their mother's

or father bare skin are often happier and healthier.

There may be times when your baby

might not be able to be placed skin-to-skin

right after birth, due to a medical problem.

If this is the case, we will do our best to let you know

ahead of time and explain why.

After the first hour of life,

we will apply an antibiotic ointment called azithromycin

to your baby's eyes.

This helps prevent eye infections

that can be caused by bacteria in the birth canal.

This ointment should not cause any problems for your baby.

We will also give your baby a shot of vitamin K

soon after birth.

This is a special vitamin that is made by the liver.

Vitamin K helps blood to clot and helps prevent bleeding.

Baby's are born with low levels of vitamin K

and it takes a few weeks for their liver

to start making enough vitamin K to help stop bleeding.

Without the vitamin K shot,

babies can develop serious bleeding in their skin,

intestines and brain.

The shot will cause some brief discomfort at first

but should not cause any other problems for your baby.

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After birth your newborn is given

a foot band and an armband.

These are stamped with your baby's name, date

and time of birth.

Mothers and their significant others

receive a matching band.

Our healthcare staff with check the bands

to identify both the baby and the parents

before any test or procedure is performed

and anytime your baby is returned to you

after spending time outside of your room.

An infant security tag will be attached to your baby's ankle

as a special security measure.

If this tag gets close to

one of the Birthing Pavilion's exits,

it will set off an alarm and lock the door.

To keep from setting this alarm off accidentally,

please try to stay clear of the exits

when you wheel your baby through the hallway

in his bassinet.

The alarm will also trigger if the tag gets wet,

if it falls off or if someone damages it.

Babies often lose weight after birth

so tell your nurse if the tag becomes so loose

that it might fall off.

For safety and security reasons,

when babies are outside of the room,

they must be pushed in their bassinet.

Staff members will questions anyone

carrying a baby in their arms.

Even another staff member.

This is one of the best ways

we can make sure your baby remains safe.

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A day or two after the birth,

we will perform several important procedures

and tests for your newborn.

Sometimes these are done in the Newborn Nursery

and sometimes they are performed in your room.

If your baby needs to go to the nursery,

you are welcome to come along

and help soothe him or her with your voice and your touch.

To help keep your baby healthy

and to identify certain medical conditions

before they become problems,

we will perform a special blood test

called the Newborn Metabolic Screen.

This is sometimes called the PKU test.

We will take a few drops of blood from your baby's foot

to perform this test.

This test can tell us if the newborn has problems

in producing certain types of hormones

such as in hypothyroidism.

It can also detect if a baby will have problems

breaking down food or in using his nutrition

such as with conditions called PKU and Galactosemia.

Without screening,

these problems may not show up

until a baby becomes very sick

or has delays in his development.

If the screening test shows that there may be a problem,

your doctor will do extra testing.

If this follow up testing shows

that there is truly a problem,

a special medicine or diet can be prescribed

to help keep your baby from getting sick.

You will receive results on your baby's newborn screen

at the two week well child visit.

If there is a problem on the newborn screen,

you should hear from your baby's doctor before this visit.

Your baby will also be tested for Jaundice,

a common newborn condition which makes a baby's skin

turn yellow.

Jaundice develops when a yellow chemical called bilirubin

builds up in the body.

Bilirubin is formed when a baby's red blood cells break down

which is a normal process after birth.

Babies get rid of bilirubin through the liver

and then through their stool or poop.

Since a newborn's liver is not very mature at birth

and because babies don't pass a lot of poop

in their first few days of life,

extra bilirubin can build up in the baby's blood.

The bilirubin can then get into the skin

and cause it to look yellow.

Most babies get a little Jaundice

in the first few days of life

and normally this does not cause problems.

But some babies can get so yellow

that they need help getting rid of their Jaundice.

To find out if Jaundice is going to be a problem

for your baby, we will perform a bilirubin blood test.

This will be done at the same time as the newborn screen

to help limit an extra poke for your baby.

Your baby may have a bilirubin test performed earlier

if there are any concerns about her looking too yellow

for her age.

While we perform these tests,

we will give your baby a very small amount of sugar water

to suck on, this helps lower pain.

Breast feeding your baby

and holding her skin-to-skin a little,

just before these tests, can also help to limit pain.

Most new babies hear well at birth, but some do not.

About one to three of every 1000 babies

will have a true hearing loss

We screen your newborn for hearing loss

with a special machine.

The screening test is easy

and is done while your baby is resting or sleeping.

Some babies may not pass on the first try.

This can be due to noise in the room

or because the baby is moving around.

If your baby does not pass on the first try,

we will repeat the hearing screen one more time

before you go home.

If he does not pass on the second try,

we will contact the audiology department

and ask that they call you at home

to schedule an appointment for more testing.

We also recommend that your baby receive

the Hepatitis B Vaccine before going home from the hospital.

The Hepatitis B Vaccine is an important first vaccine

for a baby.

It has been recommended for all newborns

by the American Academy of Pediatrics

and the Centers For Disease Control for almost 20 years.

If a new baby is exposed to the Hepatitis B virus,

a serious infection of the liver can develop.

The vaccine helps to prevent this.

This vaccination is recommended

even if the mother's Hepatitis B test result

is negative during her pregnancy,

because testing is not always accurate

or sometimes the mother can develop

the Hepatitis B infection after her test is done.

The Hepatitis B vaccine is a safe an effective vaccine.

The shot will cause some brief discomfort

to your baby at first, but it should not continue to hurt

and it is unlikely to cause any other problems.

Some babies are born with a dangerous heart condition

that can cause a low level of oxygen in the blood.

For this reason, we will perform a special oxygen test

on your baby before you go home.

This test is painless

and can be done right in your own room.

If this test shows that your baby has a low level of oxygen

in the blood, we will perform extra oxygen testing

to make sure that you baby's heart is healthy.

If the extra testing shows that your baby

may have a heart condition,

we will perform an ultrasound of your baby's heart

called an echocardiogram.

This will look at the structure of your baby's heart

to see if there is a problem.

(pleasant bouncy music)

- [Nurse] Just above it.

- One of the best things a newborn can do

to get the best start in life

is to be a healthy eater.

Babies need to eat often

because their stomachs are very small.

At first they can only eat

about two to three teaspoons at a time.

Sometimes their stomachs are full

of amniotic fluid right after birth.

For this reason some babies are not very hungry at first.

As their stomachs grow

and they get rid of this fluid,

they are able to eat more.

Usually newborns eat about every two to three hours or so

whether it is daytime or night time.

Sometimes they need to eat

only one to one and a half hours after their last feeding.

This pattern is called cluster feeding.

In the first few days of life,

babies often are hungriest at night

and do most of their cluster feeding then.

This can be quite tiring for new parents

so make sure you take every chance to nap during the day

when your baby is sleeping.

Limit visitors during the day

for these first few days to make sure you

and your baby get all the sleep you need.

Babies will show you when they are hungry

by licking their lips, sucking on their hands

or opening their mouths wide

when you touch their lips or cheeks.

Your baby should show you these cues

at least every few hours.

If it has been about two and a half to three hours

since the last feeding,

unwrap your baby down to the diaper

and use skin-to-skin contact to help or her wake up

and get interested in feeding.

Some parents worry that allowing their baby to feed

very frequently will spoil their baby.

You cannot spoil your newborn.

Try to feed your baby whenever he or she shows you

hunger cues and before he or she start to cry.

Crying causes air to enter a babies stomach

leaving less room for milk.

Crying also causes babies to be gassier and fussier.

You will find that your baby is happiest

when you feed her just as she is starting to get hungry.

Brest feeding is the healthiest type of feeding

for new babies and has many benefits

for their new mothers as well.

For newborns, breastfeeding is especially important

in helping fight off infections

because the mother's early milk called colostrum

has a lot of infection fighting properties.

Breastfeeding also helps to lower a baby's chance

of developing asthma, a condition of the lungs

that causes problems with breathing.

Eczema, an itchy skin condition.

Type one and type two diabetes,

childhood leukemia, obesity

and Sudden Infant Death Syndrome.

Babies are born with natural instincts

to help them breastfeed.

Just placing a baby on a mother's chest

whilst she is laying back a little bit

will bring out the baby's natural feeding insticts.

Babies can often find their way to the breast

and latch on without any help at all.

Sometimes babies can have difficulties breastfeeding

just as some babies

can have difficulties with bottle feeding.

Our nurses will help you learn

how to breastfeed your baby.

We also have lactation consultants

or breastfeeding specialists

who can help you if you are having any problems.

Breastfeeding is the healthiest choice

for both moms and their babies.

On rare occasions, some mothers and babies

are not able to directly breastfeed.

If you will be bottle feeding your baby

breast milk or formula, we will also help you learn

how to do this safely.

Whether breast feeding or bottle feeding,

it is important to feed your baby when hungry

and until she or he is content.

Babies show contentment by falling asleep

after a good feeding

or by pushing the nipple out of their mouth.

Babies often pause a little during feeding

to take a rest to decide if they are hungry for more milk.

After you baby has taken this rest,

see if he or she is interested in feeding more

by squeezing your breast to give a little more milk

or by tickling your baby's lip with your nipple.

If you baby doesn't seem interested in feeding anymore,

see if he or she needs to burp.

Most babies will be able to bring up a burp

within a few minutes,

while other babies may not need to burp at all.

An excellent way to judge how well your baby is eating

is by noting the number of wet and dirty diapers each day.

Your baby should have at least one dirty

and one wet diaper in the first day of life.

Then one more of each for each day older.

So on the second day there should be at least two wet

and two dirty diapers

and on the third day three of each and so on.

This starts leveling off to about six to eight

of each wet and dirty diaper per day

when your baby's about one week old.

It is a good idea to buy lots of diapers now.

In the first few days, a baby's poops are very dark

and tarry looking and are very sticky.

These poops are called meconium.

A baby usually passes all of her meconium

in the first two days of life.

Then the stools start to get less sticky and turn green.

Then brown, then yellow.

When you see these changes,

you can feel good knowing that your baby

is feeding very well.

The most exciting events after a birth

is finding out the baby's birth weight.

Your baby will be weighed right after birth

and then early each morning during your hospital stay.

Most babies will lose about 8% of their birth weight

in the first few days of life.

This is because they are born

with extra fluid in their body

to help them stay hydrated

and when they pee they lose this weight.

The first few stools called meconium

also weigh a lot

and this causes babies to lose weight too.

Some babies will lose more than 8% of the birth weight

if their mothers had a lot of fluid during labor

or if their labor was very long.

We will help watch your baby's weight

and make sure he or she

is losing the right amount and not too much.

By about day four,

your newborn will stop losing weight

and then will start gaining about a half an ounce a day.

Babies are usually back to their birth weight

by the time they are two weeks old

and some get there sooner.

Feeding your baby often at his or her early feeding cues

and at least every three hours

helps keep your baby from losing too much weight.

It also helps your baby start gaining weight

and the right amount at the right time.

Remember to feed your baby at the first sign of hunger

and until she or he is totally content.

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One of the biggest transitions for a new baby

is learning to be away from his or her mother.

While living in your belly,

you held your baby all the time

so it'll be natural for your baby to want to be with you

all the time after birth.

A mother's touch

makes the baby feel safe and secure.

We strongly recommend against falling asleep

in bed with your baby.

Mothers are often very sleepy after labor

and from their pain medicine

as well as from the baby's frequent night time feedings.

Falling asleep in bed with your baby

increases the risk of suffocation

and of falling out of the bed.

Our hospital beds are narrow

so they are especially unsafe for bed sharing.

If you are feeding you baby in bed

and you feel sleepy,

please let your nurse or support person know

so that they can help you hold your baby.

When you are finished feeding,

place your baby into the bassinet

so that you both can have a restful safe sleep.

After the birth it will be helpful

to find ways to make your baby feel comfortable

lying alone in the bassinet,

whether awake or asleep.

While you're in the hospital,

we will teach you how to help your baby feel comfortable

sleeping alone in the bassinet.

We'll also teach you how to make her sleep time

the safest to help prevent a condition called SIDS

or Sudden Infant Death Syndrome.

Having your baby sleep on his or her back

is one of the best ways to prevent SIDS.

It is also really important to make sure

there are no loose blankets, pillows or stuffed animals

in your baby's sleep space.

You and your partner

need to sleep whenever your baby sleeps.

This is especially important during the daytime

so you can be more rested at night

for night time feedings.

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(baby whimpers)

Remember to limit visitors during the daytime

so you can get your sleep.

Please ask visitors not to come in between two and four

in the afternoon so that everyone can have some quiet time

and a nap.

We have signs that you can put up on your door

when you are taking a nap

so that no one interrupts your sleep.

It's a good idea to ask visitors

to wash their hands before they hold your baby.

Baby's immune systems are not well developed yet

so they are at a high risk for getting infections.

As we mentioned earlier,

breastfeeding helps babies develop their immune system

and can help fight off infection

but they are still at risk of getting sick.

We also recommend that you do not allow anyone with a cough,

cold, fever or other contagious illness to visit you

or your baby in the first few months of life.

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One other important thing to know about babies

is that they can cry a lot, this is normal.

Crying is a baby's special way of saying

she or he is hungry, uncomfortable,

or stressed about something.

Sometimes babies seem to cry for no reason at all.

One of the best ways to calm a fussy baby

is to put her skin-to-skin with her mother

or another care giver.

Another way to help calm a fussy baby

is with swaddling.

Swaddling means wrapping a baby in a blanket.

Holding a baby close and gentle swaying, rocking or jiggling

is also very calming.

Having a baby suck on your own hand,

an adults finger or a pacifier

can help calm a crying baby too.

We do recommend waiting on introducing a pacifier however

until you know breastfeeding is going well.

And sometimes sucking on a pacifier can cause problems

with how a baby breastfeeds.

It is also important to see if you baby is hungry first,

anytime it looks like she wants to suck.

Babies like a shushing sound because it sounds like

the noises inside the womb.

You can make a sound like

(shushes)

in your baby's ear to help calm her down.

If you have a very fussy baby

especially one who's hard to calm down,

it is important to have friends or relatives close by

who can help.

If you are feeling overwhelmed with your baby's crying,

gentle place your baby in the bassinet

and ask a friend or family member to help

while you take a break.

If you are alone it is also okay

to put your baby in the bassinet

and walk away for a while to give yourself a little break.

The bassinet is a safe place

and it will be okay for your baby to be on his or her own

for a little while.

Remember that it is normal for babies to cry.

Sometimes babies cry for long periods of time

and sometimes for no reason at all.

It is important to know that you should never ever

shake your baby to stop the crying.

Shaking can be very dangerous

and can cause serious brain damage and other injuries.

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Some parents choose to have their son circumcised

for cultural, religious or personal reasons.

If you would like your son circumcised

you will be asked to sign a consent for

and watch a video that talks about circumcision

and reviews it's risks and benefits.

Your baby's pediatric provider

will make sure your baby's penis and foreskin look healthy

and that he is healthy enough

to have the circumcision performed.

If your pediatric provider does not think your baby is ready

to have a circumcision performed before you go home

or a provider is not available to perform the circumcision,

we will help coordinate this procedure as an out-patient.

Because a circumcision is not medically necessary,

some insurance companies

do not cover the cost of the procedure.

Check your company's policy

before having your baby circumcised

to find out whether or not they will help pay for it.

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There are a few other activities that will happen

in the Birthday Pavilion before you go home.

Our secretary will come to your room

to help you fill out a birth certificate.

You will use your baby's name

if you have made a decision.

But a name is not required to complete the form.

You will however need a social security number

for both parents as well as your places of birth.

When it's almost time to bring your baby home,

we will help you set up your first medical appointments

with your baby's primary care provider.

- [Woman Red Top] That's perfect.

- If you have not chosen a primary care provider

for your baby yet,

we can help you pick one soon after birth.

We will need to have a specific provider's name

to set up your baby's first appointments

and to include on the Newborn Metabolic Screening Card,

so the results will go to the right provider.

This is especially important if there are any problems

on this early screening.

Before you go home,

a clinical resource coordinator

will meet with you to help you identify

your discharge needs as well as to talk to you

about any community resources that may be of use to you.

She can help set up a home visit with a visiting nurse

if there are concerns with your baby's feeding,

weight or Jaundice.

Or if you need to have a nurse visit you

for any complications you may have had,

either with the pregnancy or delivery.

The resource coordinator can also help you obtain

a rental breast pump, if that is needed

and a referral to a Good Beginnings volunteer

if one is available in your area.

By law and for safety's sake,

your baby must ride in an approved car seat at all times.

A nurse will look at your car seat

to make sure it is an approved one.

We will help show you how to make sure

your baby fits well in his car seat.

We will also help you learn how to use it properly.

The safest place in your car for your baby's car seat

is in the back middle seat facing to the rear

for his first year of life.

If your baby was born before 37 weeks gestation

we will also perform a special safety test

to make sure that his breathing and heart rate

remain healthy while in the car seat.

Your baby's nurse and doctor will help teach you

how to best care for your baby

and discuss any medical problems

that your baby may have.

As you prepare to go home,

your nurse will also give you some extra discharge teaching.

Much of this information can be found

in our Going Home With Your Newborn booklet,

that we developed especially for new parents

to help them learn how to provide

the very best care for their new babies.

It is helpful to read through this

during your stay here in the Birthing Pavilion

when you have time.

Congratulations again on your pregnancy or birth.

If you have any questions of concerns

regarding any of the information

we have shared in this video,

please be sure to speak with your baby's nurse,

the Birthing Pavilion's resource coordinator

or your baby's pediatric provider.

If at anytime you have questions about your baby,

please ask your nurse or your baby's doctor.

We are happy to answer any questions that you might have.

Welcome to the Birthing Pavilion and Newborn Nursery.

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