Homebirth Seven/Baby Care & Breastfeeding

1.  Baby care
1. Newborn decisions within the medical system (in order of hospital routine)--starred items are a concern if you use a licensed midwife also
1. Immediately after birth
1. *Suctioning
1. Often not needed
2. Even if needed, non-medicated baby should need only mild suctioning
2. Cord clamping (not delayed unless parents specifically request it)
3. Warming table
1. Baby will do better on mother's bare chest with warm blanket over both
2. Bright lights may hurt baby's eyes
4. *Antibiotic eye drops
1. Given because state law assumes that every woman having a baby has or is at risk for gonorrhea or other STD's
2. Absolutely unnecessary--studies have shown that treatment of any symptoms is at least as effective as prophylactic eye drops
3. Blurs baby's vision
4. May contribute to later sensitization to erythromycin (if that kind is used)
5. Vitamin K
1. Colostrum is high in this vitamin
2. Shot has been linked to childhood leukemia in preliminary studies
3. Original reason for use was because immediate circumcision of boys puts them at risk for hemorrhage
1. No reason existed(s) for girls
2. Circumcision, if done, should occur on the 8th day (in accordance with OT law), when body's own vitamin K levels are at a peak
4. New reason (now that many boys are not circumcised) is something about brain hemorrhage
2. Within first 24 hours
1. Hepatitus B vaccine
1. Obtained from blood products (carries attendant risks)
2. Vaccines are questionable altogether
3. Disease is only spread through sex, blood sharing (transfusions, blood products, sharing drug needles), maternal transmission)--use of vaccine assumes the child will live unhealthy lifestyle
2. Circumcision
1. Unnecessary, medically and spiritually - Acts 15:23-29
2. Pray about decision
3. If done, consider doing in accordance with Scripture (on 8th day) rather than immediately in hospital nursery
4. Procedure in hospital is rather cruel: baby strapped to board, entire foreskin cut away without benefit of anesthesia (only part of foreskin removed in Jewish ceremony performed by moyel--but many moyels will not do circumcisions for Gentiles)
3. Water bottles
1. Reasons for giving these range from "just because" to making sure that baby can swallow or to remedy low glucose level. Consider:
1. Baby's intestinal tract is sterile until given anything but breastmilk
1. Water interferes with proper gut closure (after birth)
2. Introduces a pathway for bacteria
2. Defect wherein baby doesn't have fully open passages is rare
1. Breastmilk is naturally sterile and organic and will not hurt baby even if aspirated into lungs
2. Swallowing can be observed while baby breastfeeds
3. Low glucose level is usually caused by glucose IV given to mother during labor
1. Baby produces more insulin to deal with extra sugar
2. After birth, glucose level drops dramatically because of extra insulin
3. Proper treatment should be to nurse, not give glucose solution to baby--colostrum is high in glucose and also nourishing, whereas sugar water will only perpetuate the high-low cycle
4. Bath
1. Not necessary; vernix will be absorbed
2. Baby's temperature drops after bath; many nurseries then insist on baby staying in warmer until temp comes back up
5. PKU test (phenylketonuria, galactasemia, congenital hypothyroidism, and other metabolic disorders)
1. "Required" by state law within two weeks of birth
2. Not valid until at least 24 hours after milk comes in (baby must be on milk or formula for that time)
3. Many hospitals will deny that there is a waiver and insist on an invalid test (before you leave hospital, which is usually before mom's milk comes in)
4. Baby will usually have to be retested at two week checkup
5. Less than 1 in 100,000 chance that baby actually has one of these disorders, often hereditary
6. Treatment is controversial
7. Breastfeeding should continue even if baby has the condition
3. Within two weeks
1. Jaundice--yellowish cast to skin, sometimes eyes
1. Normal physiologic jaundice does not show up for 2-4 days and is not dangerous
1. Do not stop nursing; giving water bottles actually aggravates condition
2. Sunlight (short exposures of 5-15 minutes at a time, 2-3 times a day) is very effective treatment
3. May even be beneficial; some sources state that bilirubin acts as an anti-oxidant and antibacterial
2. Pathologic jaundice shows up within 24 hours of birth
1. Can be caused by Rh incompatibility
2. ABO incompatibility also a possible factor
3. Treatment controversial
3. "Breastmilk" jaundice
1. Nobody knows what it is
2. Never shown to be dangerous
3. Temporary cessation of breastfeeding not necessary (but often advised by doctor)
2. Vitamin supplements
1. Many doctors still recommend these
2. Absolutely unnecessary
3. Iron in human milk is almost completely absorbable, unlike artificial supplements
1. Baby has stores of iron in liver
2. Extra iron will upset balance in intestines, causes constipation and internal bleeding, and opens the way for intestinal diseases
4. Fluoride present in minute quantities in breastmilk
1. High doses are toxic
2. Makes many babies vomit
5. Vitamin D is synthesized after exposure to sunlight (a few minutes a couple of times a week is sufficient)
2. The basics in newborn care (at home)
1. Cord stump
1. Disinfect with alcohol immediately after birth
2. Clean with alcohol or dust with goldenseal (may use alternately, or combination of the two) at least 2-3 times a day until it falls off
3. Stump will dry up after birth and fall off anywhere from 4-5 days to three weeks
4. Some seepage, bleeding from navel (afterward) is normal--just keep clean
2. Genitals
1. May be swollen at birth--this is normal, due to effect of mother's hormones
2. Baby girls may have pink discharge in diaper first couple of days
3. Boy babies
1. If circumcised, a soothing ointment and clean gauze at diaper changes are all that is needed till healed; gently pull back remaining foreskin during bathing--should be sufficient to keep separated afterward
2. If intact, DO NOTHING!! Foreskin will spontaneously separate by age 4-5
3. Nail care
1. Baby's nails may be long at birth
2. Baby often scratches himself if not kept short
3. Can tear or bite them off (at first) if you are leery of using clippers (and this is a valid concern!)
4. Bathing
1. As noted before, optional for the first couple of days
2. Sponge bath only until cord falls off and navel heals
3. Use water that is comfortable in temperature to your elbow, not hand
4. Pay attention to folds and creases (especially in neck area when weather is warm)
5. Take care to protect baby from chill during sponge bath (cover head after washing, etc.) and soon after tub bath
6. Everyday bathing optional; only use soap every second or third day
5. Dressing baby (or not)
1. For hot weather, a diaper and onesie are fine
2. For cool, dressing baby to your own comfort level, plus one layer, is a good rule--you can always undress baby if he's overwarm
3. Covering baby's head for the first few days is a good idea, also after baths and when going out
4. Booties or socks rather than shoes are fine till baby starts walking
6. Sleep
1. When
1. At-term or "late" babies seem to need less sleep than premies
2. Babies generally sleep when they need to; different babies have different sleep cycles
3. The need for sleep decreases as baby gets older
2. Where
1. Cribs optional--cradle, bassinet, or simple laundry basket fine for early weeks
2. With mother at night
1. Highly controversial topic!
2. Mother actually gets more sleep this way
1. Mom and baby synchronize sleep cycles
2. Baby does not have to cry to wake mother
3. Neither one has to wake fully for night feedings
3. Mom will not roll on baby unless under the influence of alcohol or drug
3. If baby gets nights and days mixed up
1. Keep baby up as much as possible during day (hard with newborn!)
2. Try to make night feedings a no-nonsense affair--little or no light, whisper to baby or don't talk at all during diaper changes
7. Feeding
1. Nothing but mother's milk is required for at least 4-6 months (see below!)
2. Starting solids
1. When
1. Baby has teeth
2. Baby seems unsatisfied by breastmilk--remember this may also be growth spurt (average times are at 3 weeks, 6 weeks, 3 months, and 6 months) or mother's supply
3. Baby shows interest in food (most often, by reaching for your plate!)
2. What
1. Cereals--rice, wheat (can be an allergen), oats
2. Vegetables--potato, sweet potato, avocado--all easy to cook and puree
3. Fruits--soft, pureed
4. No milk till 1 year (may try white cheese and yogurt a little earlier)
3. Waiting until baby can tolerate table foods (mashed or pureed version of what you eat at a regular meal) is easiest, and probably the healthiest if you eat "whole foods"
4. Ideally, introduce one new food every three or four days, so you can watch for signs of allergy
1. Wheezing or difficulty breathing
2. Dark circles under eyes
3. Skin rashes
4. Unusual fussiness
5. Hyperactivity
6. Cold symptoms
7. Frequent ear infections
8. When baby cries
1. Babies have emotions, just like adults, and different cries have different meanings
2. There is nothing inherently wrong in a baby crying out of boredom or a desire to be held; all human beings need/desire companionship (part of the reason why God gives us the Comforter, and each other)
3. What is "colic"?
1. Generally defined as extended fussiness or crying, especially during a certain time of day
2. Sometimes a sign of intestinal upset
3. Sometimes caused by overstimulation
4. Has been linked to use of medications during labor or other events during birth (thus, part of the reason why home birth babies have a reputation for being calmer)
4. Continuous, sustained crying (not colic), is not good, and can be a sign of some other problem
1. Baby reacting to something mother ate (dairy, caffeine, certain cruciferous vegetables)
2. Baby reacting to formula, if not breastfed (can signal milk or soy allergy)
3. In rare cases, baby could have some more serious medical problem
2. Breastfeeding
1. Why "breast is best"
1. Perfect balance of nutrients (no worries about "something the formula company left out")
2. Easier to digest, causing less stomach upset, diarrhea, and/or intestinal bleeding
3. Always sterile, at the right temperature, and readily available
4. Antibacterial properties, which helps baby fight off illness
5. Mother's immunities transferred to baby (which is born without an immune system of his own)--this translates to fewer colds, ear infections, and other common childhood ailments
6. Closeness required by breastfeeding has several benefits
1. Encourages emotional development of baby
2. Gives mom a chance to rest often during the day
3. Encourages bonding between mother and baby
1. More time spent together
2. Mother's body produces "prolactin" during nursing, a hormone which acts as a natural tranquilizer and helps her to feel more "motherly"
7. Can man ever truly improve on what God has already provided?
2. Importance in the beginning
1. Helps the uterus contract to prevent postpartum hemorrhage--goes hand-in-hand with natural birth
2. Protects the baby from illness, even at first nursing
1. Colostrum (first milk) is rich in antibodies; in nature, this substance is essential for a newborn creature's survival
2. Colostrum coats intestines to close off pathway for bacteria and viruses
3. Ensures perfect nutrition for optimal well-being whether baby is at term or premature (mother's body "knows" and produces just what baby needs)
3. Reward for hard work of labor
1. Mother has satisfaction of knowing that she is still able to be sole provider of baby's nourishment ... after all, your body grew the baby to begin with!
2. Closeness of nursing (both physical and emotional) was ordained by God--transition time from womb to independence in outside world
3. Getting started
1. Easiest with an undrugged baby
1. Medicated baby more likely to be sluggish/sleepy
2. Drugs interfere with sucking reflex
2. Early (if not immediate) skin-to-skin contact between mother and baby helps stimulate baby to nurse
3. Baby may only nuzzle at first; this is normal and still helps stimulate uterus. Most babies are ready to nurse between 10-30 minutes after birth.
4. Best positioning
1. Make sure baby's body is completely facing mother's (tummy to tummy)
2. One hand will be cupping breast ("C" is best, with fingers underneath, thumb on top) and other hand supports baby's bottom (or head if football position is used)
3. Tickle side of baby's mouth with nipple
4. When baby's mouth opens wide, quickly pull baby onto nipple
1. Baby should have entire nipple and preferably about an inch of areola (darker skin around nipple) in mouth (baby's gums should be behind nipple, not on it)
2. If you pull baby's lower lip down, you should see baby's tongue over bottom gums
3. You may be tender at first; but if very painful, baby is probably not latched on properly. DON'T be afraid to take baby off and try again.
5. Importance of proper latch-on
1. Many breastfeeding problems can be traced to baby not latching on properly--plugged milk ducts, cracked and/or bleeding nipples, inadequate milk supply
2. Baby has to nurse harder for milk, does not empty breast properly
3. Intense pain while nursing is one sign of improper latch-on; clicking or popping sound from baby while sucking is another
4. First week
1. Do not restrict time on or off the breast according to the clock
2. Sleepy baby may need to be awakened--baby should be nursed at least every 2-3 hours, or 8-12 times in 24 hours
3. The more often baby nurses, the more quickly the milk will come in
4. Supplemental bottles, whether water or formula, will interfere with milk supply (pacifiers can, too)
1. Formula digests differently than breastmilk--3-4 hours vs. 1 1/2-2 hours, and obviously this changes the baby's hunger cycles
2. Even one feeding of milk-based formula can trigger a lifelong allergy to milk
1. In addition, more than 40% of babies that are allergic to milk are also allergic to soy formulas
2. There is no such thing as "lactose intolerance" in a baby. Breastmilk has higher levels of lactose than cow's milk and there has never been a proven case of a baby being allergic to his own mother's milk. (You can be sure the formula companies would have let us know if this were so!)
3. There is no substitute for God's original provision
5. Nurse often to reduce engorgement (swelling of the breasts when milk comes in)
1. Engorgement is only partially due to the volume of milk; blood rushes to the breasts in the beginning, to provide fluid and nutrients for the milk
2. It is only temporary! Breasts soften again once the milk supply is established
3. Coping measures
1. A bag of frozen peas will help reduce swelling between nursings; wrap them in a hand towel before applying
2. Cabbage leaves (raw) will also help reduce swelling; place them directly on breasts (inside bra) for no more than 15 minutes at a time
3. Warm compresses (towel wrung out in hot water)
4. Express a little milk before nursing if necessary to help baby latch on better
6. In the beginning, offer both breasts at each feeding
1. Allow baby to nurse on first side until sucking slows and baby is taking long pauses
2. Switch to other side (waking baby if necessary) and let baby nurse till asleep or comes off breast alone
3. Start baby on side used last (stimulates more even milk production)
4. Baby may only nurse on one side at a feeding when older
7. Sleeping with baby encourages adequate milk supply
1. Baby nurses more often
1. Promotes optimal growth
2. Extends amenorrhea (no menstrual cycles)
2. Mother gets to sleep more (so there isn't the same temptation to encourage baby to sleep through the night before baby's ready)
8. Many mothers find that wearing a well-fitting bra, even at night for the first week or two, is helpful
9. Some leaking may occur in early weeks of nursing; this will go away eventually
5. How to know baby's getting enough
1. 8-10 really wet diapers a day (5-6 if using disposables)
2. 2-5 bowel movements a day in early weeks, older baby may go several days without a bowel movement
3. Baby gaining weight (about 1 lb. a month or more)
1. It is normal for baby to lose a little weight after the birth
1. More pronounced if IV used during labor
2. More likely if baby separated from mother per hospital routines
3. Will gain back in 1-2 weeks
2. Babies gain at vastly different rates, no matter what the growth charts say
4. Baby alert when awake
1. Newborn babies spend a lot of time sleeping
2. When awake, baby should not be listless
3. Some babies, especially those drugged during labor, will need to be awakened to nurse (again, every 2-3 hours)
6. Several factors affect your milk supply
1. REMEMBER--your breasts operate on supply and demand: MORE NURSINGS = MORE MILK! Fewer nursings = less milk.
2. Stress can inhibit letdown reflex, decrease supply
3. Inadequate water is OFTEN a culprit
1. Liquid intake affects milk production more directly than food, although severe dieting or fasting can be a factor here, also
2. Tea, coffee, and sodas contain caffeine, which is a diuretic--these will actually dehydrate your body (besides very possibly upsetting your baby's tummy)
7. A word about nursing on "demand"
1. Some interpret this to mean that mom offers the breast for baby's every whimper--not so!!
2. It is important to learn to differentiate your baby's cries--hungry is much different than uncomfortable or tired
8. Weaning
1. This technically begins when you start solids
2. In most cultures, complete weaning did/does not take place till after age two, at least
3. A one-year minimum is considered good by the experts; two years is considered best
4. As in other things, a balance should be struck between the baby's needs and your particular situation
9. When to ask for help
1. If baby is nursing often and still shows signs of not getting enough
2. If mom experiences severe, continuous pain even after attempting to correct latch-on (remember, some soreness is normal at first)
3. If mom's nipples become bruised or cracked
4. Any time mom is feeling afraid or uncertain about mothering in general (remember the Titus 2 principle--older women teaching the younger to love their families)
5. Special situations
1. Flat or inverted nipples (you CAN still breastfeed, and it's worth the effort!)
2. Mom needing to go back to work (lots of resources out there on expressing and storing breastmilk to give baby while mom cannot be there)
3. Other medical problems: cleft lip or palate in baby, extreme prematurity, illness in mother (all need to be judged on a case-by-case basis by someone who truly cares about breastfeeding--and this is seldom most of the hospital staff!)
3. Helpful tips
1. Do not take breastfeeding-related advice from anyone who nursed less than 6 months (if it didn't help them, it probably won't help you)
2. Most older women were given very different advice on things like breastfeeding, starting solids, sleeping patterns and arrangements, and the need of baby to be near mother; please take this into account when they are trying to be helpful.
3. Note on relatives: just because you (mother and father) turned out "all right," does not mean it was the best thing to do. Approach this subject with loved ones carefully--hurting one another accomplishes nothing--but you have every right to assert your authority as the baby's parents. God gave this baby to YOU.
4. Please do NOT consider weaning until you've passed the 6-week mark. It sometimes takes this long for everything to smooth out and for baby and mother to get used to each other. You can always reevaluate later if you still feel the need to wean Every day of nursing is beneficial to baby.
5. If you have any questions or concerns, call someone; a truly caring counselor (professional or not) would rather reassure you that something is normal than to first hear from you when everything is falling apart (although that is better than not hearing from you at all because you decided to throw in the towel and wean!).
6. Most of all--enjoy your baby and use this opportunity to grow closer to the Lord for the benefit of you and your family (and to HIS glory)!

© 1999

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