Changes in the breast

Once the baby is born your body and organs will take another 6 to 18 weeks to return to normal and enable you once again to take up your old responsibilities plus new ones. This period following the delivery is known as puerperium. The changes in the breast are remarkable. Initially they get congested followed on the third day by marked fullness and tenderness. Its initial secretion, as we have learnt elsewhere, is colostrums which is a thick, sticky yellow fluid which is considered the ideal food for the baby at this stage. True milk comes a few days later. Initiation of milk production and the maintenance of lactation remember it depends a great deal on mechanical stimulation by sucking the nipple as also on your will to breast feed the baby and make a success of it. Mind you, the mother’s body does not absolutely have foolproof involution of all the changes that it underwent during pregnancy and labour. The anatomical structure of the wall of the womb, for instance, is likely to remain permanently altered in some way or the other. Also, the vulva remains somewhat enlarged. The striae on the skin also are likely to remain as permanent scars.

How the body changes

A major change is the reduction in the size of womb by a series of process known as involution. During the first week or two, a discharge comes out of the vagina. This is lochia. In the beginning say for 3 or 4 days it is dark red in colour as it is more or less pure blood. Later it becomes pale and then scanty and creamy. Take advice from an expert if it persists after 2 weeks, more so if there is reappearance of blood in it. Remember, other reproductive organs also show involution but the speed is not as fast as in the case of the womb. Following delivery, the temperature is usually a degree higher than normal. Do not worry; it will return to normal within a matter of hours. The pulse behaves a little differently. It is almost always normal as you are over with the labour. In the subsequent week or so it is likely to slow down. Do not panic if it is just 50 or so per minute. That is normal. In the first few days, you may pass a lot of urine. This is called physiological dieresis and need cause no anxiety. Likewise, urine examination may show a little albumin. You may suffer from constipation also.

Discharge of low birth weight babies from hospital and home care

Low birth weight babies are generally discharged from the hospital when they have regained weight. They should also be able to feed satisfactorily, show stable temperature control under normal room temperature and be free from disease. In our overcrowded hospitals and nurseries, it is usually very difficult to fulfill the first criteria. Most babies are generally discharged when they reach 1,600 g to 1,800 g in weight and show evidence of steady weight gain. The mother should, however, make sure that she is fully trained to feed the baby, knows how to maintain aseptic environment around the baby. She should also have learnt the ways and means to keep the baby warm. At home, she must see to it that the handling of the baby by the visitors is discouraged. If home visiting facilities by a doctor, lady health visitor or a public health nurse are available, she must make good use of them to assess the baby’s progress as also for further advice. The low birth weight baby reacts poorly to most of the drugs. Hence the doctor normally avoids medication to him unless it is urgently needed. Administering of drugs like chloramphenicol, sulphonamides and vitamin K must be avoided. The dosage prescribed to a low birth weight baby is usually one half of that recommended for the normal newborn.

Special care for low birth weight babies

First and foremost the babies breathing must not only be established but also well maintained. Secondly, his body heat has got to be maintained. Thirdly, he must be adequately fed. Fourthly, he must be protected against infection. Lastly, any kind of physical tiredness should not be inflicted on him. It is customary for a senior obstetrician and a child specialist to be present in the labour room when such a delivery is anticipated. It is a practice to clamp the low-birth-weight baby’s cord fairly late and to squeeze it to be the baby’s side before it is ligated. This gives the baby a good deal of extra iron stores. Once the doctors are convinced that he is breathing properly and fluid and blood have been sucked out of his throat and mouth, he is immediately removed into a pre warmed incubator in which his body heat can be preserved; he can rest without external disturbance and against infection. Most Centers nurse the incubator babies without clothes so that it is easy to notice development of jaundice, cyanosis etc. Visitors are not allowed. His mother is only permitted to come and touch him. He is not given a bath until he is at least 2 kg in weight. As for feeding, breast-feeding should be the choice.

Vaccination

Vaccination is the process of administration of antigenic material that is a vaccine into the body so as to produce immunity to a disease. Vaccines can prevent or ameliorate the effects of infection by many pathogens. There is strong proof that the influenza vaccine, the HPV vaccine and the chicken pox vaccine among others vaccines have saved many a lives. The most effective and cost-effective medicine available is a vaccine. The vaccine administered can either be live but weakened forms of pathogens like the bacteria or viruses, killed or inactivated forms of these pathogens, or purified material such as proteins. Vaccination should be done for babies against BCG, whooping cough etc. As early as 200 B.C. inoculation was developed in ancient China. In order to eradicate disease Countries all over the world are giving wide publicity in order to motivate the people to inoculate their children. In fact the WHO is also taking an active part in this. The WHO in the year 1988 set a target to eradicate Polio by the end of the year 2000. Even though this did not succeed fully, Polio is almost eradicated. Vaccination is administered orally, by injection (Intramuscular, intradermal or subcutaneous), by puncture or intranasal.

Handicaps in babies

The smaller the baby, the weaker is his hold on life. The immaturity of his brain leads to poor activity and lethargy. Breathing difficulties may cause blue spells. Your doctor may need to resuscitate him. His temperature-regulatory mechanism is inadequate. Subnormal temperature is seen in a majority of such babies and may prove fatal. At times, he may develop high fever too. In coordination in sucking and swallowing causes vomiting and choking. The capacity of the stomach is small and he can tolerate only very small amounts of feeds. Digestive upsets are common. As a result of poor tone of the muscles, abdominal distension is common. Since liver enzymes are rather immature in such a baby, blood bilirubin level is relatively high and stays high for a prolonged time. This will be apparent to the mother as a prolongation of the so-called physiological jaundice over a longer period. Also, high blood bilirubin is more likely to cause damage to his brain than in a healthy baby. Incidence of a particular type of congenital heart disease, patent ductus arteriosus, is higher in preterm babies. He is more prone to develop dehydration and ankle swelling. He may also develop many metabolic disturbances such as hypoglycemia, various nutritional deficiencies such as anemia.

Use of safety pins, Diaper liners and Protective pants

One must take exercise care when you put in the pin. Slip two fingers of your hand between the nappy and the baby’s skin so that the pin does not prick him. Also see that you buy good quality pins, the ones which do not open on their own. Also ensure that the sharp end of the safety pin is away from the infant’s body. All these precautions will help you to prevent accidental hurt to the baby. Diaper liners are of special help during traveling. The paper or treated cloth-made, if available, are certainly of help in protecting the nappy from getting wet. These are placed between baby’s skin and the nappy. There is no truth in the saying that these may harm the baby. Protective pants again are of very special help when you are traveling with the baby. They should not be too tight, should not be used in the presence of nappy rash, should be replaced frequently and should be sterilized in the same way as nappies. These pants are waterproof, made of either rubber or plastic and so it is better if the protective pants are not used when you are not traveling out with your baby.

When to change the nappy and nappy washing

You must change the nappy as soon as you know it is soiled. An exceptional baby may not care if he is wet but most of them become restless and cry. Do not rub the infant’s buttocks with the nappy. Wash it or clean it with cotton soaked in water or baby oil. Dry the area with powder before putting on another nappy. It is good to change the nappy before and after each and every feeding session. Before beginning to wash, remove the loose stools from the dirty nappies. It is a good idea to put the used diapers or nappies in a basin containing water and soap or detergent. It is not necessary to wash the nappies in special washing machine. A wash tub containing water and soap or a detergent will suffice. Repeat rinsing until the water becomes clear. Usually, two rinsing suffice. As an extra precaution, the thus-washed nappies may now be put in the Dettol solution for some 20 to 30 minutes. Squeeze the water out and let the nappies dry before finally ironing them. The use of Dettol helps to prevent occurrence of the so-called nappy or diaper rash, a troublesome problem in some babies.

Nappies and how to fold them

I know that there are two types of nappies available. One is cotton fabric nappies which are washable and ready for use again and again. The second type is the ready made disposable and sterile, available in the markets. You can use any of the two depending on your choice and circumstances. If you opt for first one, see that you buy soft but durable stuff. Frequent laundering will be possible only then.
There are 4 ways of folding a nappy. First is the triangle nappy. Here, fold the nappy into a triangle. Then, put the triangle under baby’s buttocks. One corner should lie between his legs. The other two corners should lie round the baby’s middle. Join the three corners with a safety pin in the front. Second is the oblong nappy in which there are two ends at the back. You should bring the corner of the front up between the legs and then join to the ends of the back with safety pins. Third, the so-called twisted nappy is more or less the same as an oblong nappy. But you are required to twist it before bringing up between the legs and then join the ends of the front with safety pins. In the fourth type, kite nappy, the sides of the nappy are so folded that it becomes wide on the top and narrow at the bottom. Using safety pins join the front and the back ends.

Using the Thermometer

Everyone knows that the thermometer is a device that is used to measures the body temperature. There are many ways of measuring the body temperature using a thermometer. When it comes to measuring the body temperature the procedure that is not preferred by many is the rectal temperature. The procedure for measuring rectal temperature is risky and painful. Unless one is experienced in this procedure it may hurt the rectum. Rectal temperature provided the most accurate body temperature. The mouth temperature procedure cannot be used in the case of new born and little older infants. The best and safest place to record baby’s temperature is the armpit (axilla) or the groin. What is more important is to keep the thermometer in place for at least 3 minutes. The so called half a minute and instant thermometers are misnomers. There are other kinds of medical thermometers such as the tympanic or ear thermometer that measures the temperature of the tympanum by infrared measurement, and the band thermometer that is applied to the patient's brow or forehead. A newer development is the temporal artery thermometer, which uses the infrared principle to accurately report a patient's temperature, with comparable accuracy to rectal thermometer.

Baby Clothing

Clothing is not only to cover the body but also to protect the body from extreme climatic conditions like cold and heat. Clothing also enhances the appearance of an individual. In the case of the new born, the baby has got to be kept rather warm but at same time not too warm. His garments should not make him sweat. Instead it should be soft and thin. Baby clothing should not be too tight as it will not allow free flow of air. Unfortunately, over clothing is practiced far too frequently, covering the baby with layers and layers of woolen clothing even in good weather. This is undesirable and such babies do not suck well. They also become drowsy and show failure to thrive and develop constipation. Over clothing also results in development of prickly heat rash. Woolen clothing is most advisable during very chill weather or during winter season only. Even then it is better to avoid woollies touching the neck and face of the baby. During summer, the best way to dress a baby is to make him wear a vest and a nappies. Avoid using synthetic material to dress up your baby because some babies may develop allergic reaction to the synthetic dress material. So it is best to use pure cotton dress material.