Q&A: Know what to expect when your newborn arrives
My first baby is due in two weeks and I would love if you could give me some information on the tests which will be carried out to check the baby's health. Also, my head is racing with a million worries about bringing my newborn home. I went to antenatal classes and found them very beneficial but, to tell you the truth, I focused mostly on labour. Now that D-day is drawing nearer I find my head is in a spin.
It is hard to totally prepare yourself for the arrival of your newborn. It might be overwhelming at first when you realise you are responsible for this little person, and questions run through your head -- how is he doing? Why is he crying? From the moment your baby is born, he will be the centre of attention and will have a series of tests to ensure he is healthy.
Apgar score
This is performed by the midwife straight after birth, then again after five minutes. Your baby will be given a score between zero and two for skin colour, heartbeat, reflex, muscle tone and breathing.
Most newborns score between seven and 10 in total. If he scores between five and seven he may need help to start breathing.
Heart and lungs
Shortly after birth your midwife will observe your baby's breathing pattern and check his heartbeat with a stethoscope.
In the first few days there is a massive change in the workings of your baby's circulation. Murmurs are not uncommon at this stage, however, the majority are nothing to worry about.
Heel prick
This test is also called the Guithre test and is carried out between 72 and 120 hours after birth. The midwife, if taken in the hospital, or your public health nurse, if carried out at home, will collect blood samples from your baby's heel, which will be checked for genetic conditions.
These conditions include Hypothyroidism (an absence or underdevelopment of thyroid gland), Maple syrup Disease, Phenylketonuria, Homocystinuria and Galactosaemia.
Skin
The colour of your baby's skin will be checked and this will vary depending on the ethnic origin. Some newborns develop jaundice, a yellow colouring of the skin. This is generally transient but in some cases a blood test is required to check the exact levels.
Your baby's skin will also be checked for any birthmarks, including stork marks (reddish/purplish marks), strawberry marks (raised red areas) and Mongolian spots (a bluish, darker pigment). These are common skin conditions.
Reflexes
Your baby's reflexes include grasping, sucking and swallowing. Your baby's sucking reflex will be checked by putting your baby to the breast shortly after birth (if considering breastfeeding), or by placing a gloved finger in his mouth. He will also be observed feeding. The midwife or doctor will check your baby's Moro reflex by gently allowing your baby's head to safely fall a short distance. Your newborn should fling out both arms with his fingers spread and stretch his legs.
Your baby's grasp reflex is checked by placing a finger in his palm, and the rooting reflex is observed when your baby's cheek is stroked and he turns his head towards it.
Weight
Your baby will be weighed shortly after birth. His length is measured, as is his head circumference. When you go home your public health nurse will carry out these measurements and graph them on a chart. In the upcoming weeks, your baby's growth will be monitored.
Genitals
A newborn boy's genitals are red and swollen in the early days. This is due to the maternal hormones he was exposed to before birth. These same hormones may also cause baby girls to have a white or slightly bloody vaginal discharge for the first few weeks.
In both sexes, withdrawal of maternal hormones results in breast engorgement, sometimes accompanied by a secretion of 'milk' by the fourth or fifth day. Baby boys' scrotums will be checked after birth for undescended testes and the penis will be checked to ensure the opening is at the tip and not the underside.
Eyes
Your baby's eyes will be looked at shortly after birth to check their appearance and position. Cataracts are checked for by shining a light into the eyes.
Spine
Your baby's spine will be checked for any abnormalities. It will also be observed for the presence of a sacral dimple. This is a dimple just above the buttocks; this may mean a problem with the lower spine. If a dimple is present he will be checked for symptoms like leg weakness and cold feet.
The hips are also checked for dislocation. Each leg will be rotated to see if they click.
Once the birth is over and you bring your baby home, it is perfectly natural to have concerns about this little person, whether it is worrying about sleeping, feeding or winding issues.
Sleep
The first few weeks can be a difficult time, especially if your baby slept well in the hospital but will not sleep at home. It will take time to adjust to the new routine.
Newborn babies need 16-20 hours sleep every day. All babies are different; some wake every two hours for feeds while others will go for four hours. It is important that babies get enough milk in any 24 hours.
Wet nappies
Your baby should have between five and six wet nappies a day. This will mean your baby is getting a good supply of milk.
Milk feeds
During the first few weeks, let your baby feed whenever he wants. Little and often is best.
Babies are pretty clever and will regulate their own intake. If you are bottle feeding and you find your baby is not satisfied with a 90ml feed, make up the next feed to 120ml.
Weight
In the first week your newborn can drop about 10pc of its birth weight. It can take up to three weeks to regain birth weight again.
Dirty Nappies
All babies are different, some babies poo several times a day while others poo only once. Most small babies strain and go red in the face when passing a stool. This is normal and doesn't mean they are constipated, as long as the stools are soft. If you are worried, contact your public health nurse or GP.
Don't panic
Get advice from correct sources -- you can get a lot of conflicting advice from friends and relatives.
Discuss your fears with your partner/close friend/ relative.
Take your time -- don't think you have to master every activity to perfection.
Don't be afraid to ask professionals for help -- midwives, public health nurses or GPs.
Keep a record -- any changes in your baby's habits that concern you can be written down.
Trust your instincts -- you are usually right.
Get rest -- problems will be easier solved with a fresh mind.
- Grainne Ryan
Irish Independent
