Birth and Postpartum Handbook

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Table of Contents

Teams & Contact Information
Birth & Postpartum Supplies
Prenatal Homeopathic Regimen
Postdates
Prenatal Perineal Massage
What to do When Labour Starts
Sage Quotes
Postpartum Care
Breastfeeding Myths
Breastfeeding
Your Newborn Baby
Newborn Tests

Birth & Postpartum Supplies

Items to assemble for home birth
  • Hand mirror
  • Extra Pillows
  • 6 old cotton towels or large receiving blankets
  • Space heater/fan (seasonal)
  • Thermometer (not ear)
  • Large cookie sheet
  • Large flashlight with extra batteries
  • Small bottle of olive oil
  • Food & drink for Mom & birth assistants
  • 1 package of heavy flow/overnight menstrual pads*
  • Newborn diapers
  • Overnight bag packed for Mom & Baby*
  • Infant car seat (already installed)
  • 1 small bottle of hydrogen peroxide
  • Roll of paper towels
  • 1 pack of baby wipes
  • 2 large ziplock bags for placenta
  • Access to plugs for 2 plug in items or extension cord/power base
You may want to take our home birth kit or you may obtain the items separately. Our kits include:
  • Large plastic sheet (tablecloth)
  • Bendy straws
  • 2 large garbage bags
  • Baby hat
  • 15 disposable blue & green pads
  • 6 cotton wash cloths
  • 2 large immediate post partum pads
  • Peri bottle
  • Instant freeze peri pack
Hospital List for Overnight bag
  • It is helpful to pack 2 bags, 1 for your labour and 1 to leave in the car to bring only if you choose to stay overnight.
  • Money for parking meter
  • toiletries
  • nightgown/pjs
  • robe
  • slippers/slip on shoes
  • 1 pkg overnight menstrual pads (not dry weave)
  • extra pillows
  • food & drink for Mom & birth assistants
  • clothes for baby (at least 3 -4 sets), onesies, sleepers, hats, socks
  • small container of olive oil
  • baby shampoo/wash, comb/brush
Medications to have available for either home or hospital birth:
  • 1 bottle of ibuprofen 400 mg tablets (extra strength) Only for taking after delivery
  • 1 bottle of acetaminophen 500 mg tablets
  • Gravol 50 mg tablets
Suggested preparation of the bed

 To prepare the bed for labour we suggest you use 2 sets of older sheets. Wash & dry them as usual. They need to be clean, not sterile. In early labour, put a clean bottom sheet on the bed and then cover it with a plastic sheet (or tablecloth that comes in the birth kit). Finally, put another clean sheet over the plastic one. After the birth or when you return from the hospital, the soiled and plastic sheets can be removed and a freshly made bed remains.

Prenatal Homeopathic Regimen

Arnica 12C or 30C
  • Relieves bruising and aching from the physical trauma associated with birth
  • Helps maintain the strength needed to birth the baby
Actaea Racemosa 12C or 30C (Cimicifuga, black cohosh)
  • Uterine stimulant and uterine relaxant
  • Ability to stimulate uterine contractions while relaxing the tension and stress that concentrates in the uterine muscle
  • Helps uterus to contract in a coordinated and effective way
  • Used with caulophyllum to help prepare the uterus for childbirth
Caulophyllum 12C or 30C (blue cohosh)
  • Uterine stimulant
  • Caulosaponin, a chemical component of caulophyllum, actively stimulates uterine contractions and promotes blood flow to the pelvic region
  • Cimicifuga and caulophyllum work synergistically with each other

Take these remedies 3 – 4 weeks prior to your due date. Take each remedy once per week, alternating as follows:

  • Cimicifuga: 1 dose on Monday
  • Caulophyllum: 1 dose on Wednesday
  • Arnica: 1 dose on Friday

 Homeopathic remedies should be taken 15 minutes after consuming food or drinks. Do not use metal or skin to touch the pellets, use a plastic spoon. Place the dose under your tongue and let dissolve. Wait at least 15 minutes before consuming any food or drink. Also avoid 15 minutes before and after brushing your teeth.

 Labour remedies you may want to have on hand include Bach Flower Rescue Remedy and Arnica 200C. Rescue remedy helps to promote calmness particularly when labour becomes more intense. Arnica can be used by mom and baby in the immediate postpartum period. It helps reduce bruising and swelling and promote the healing of traumatized tissues.

Postdates Pregnancy

Caulophyllum 200C
  • Uterine stimulant and uterine relaxant
  • Ability to stimulate uterine contractions while relaxing the tension and stress that concentrates in the uterine muscle
  • Helps uterus to contract in a coordinated and effective way
  • Used with caulophyllum to help prepare the uterus for childbirth
Cimicifuga 200C
  • Uterine stimulant and uterine relaxant
  • Ability to stimulate uterine contractions while relaxing the tension and stress that concentrates in the uterine muscle
  • Helps uterus to contract in a coordinated and effective way
  • Used with caulophyllum to help prepare the uterus for childbirth

Alternate 1 dose of Cimicifuga 200C and 1 dose of Caulophyllum 200C every 15 minutes for 2 hours.

These remedies may be taken in conjunction with other non pharmacological methods of induction such as:
  • stripping of the membranes (providing vaginal exam is not contraindicated)
  • castor oil rubbed on the abdomen (cover with plastic wrap to avoid staining fabric)
  • fleet enema or ingestion of foods that irritate the bowel
  • reflexology or massage

Prenatal Perineal Massage

 The perineum, or the perineal area, is the skin located directly between your vagina and your anus. It is composed of skin as well as several muscle layers. During the birth of the baby’s head, these layers stretch and move out of the way to allow for the birth of the baby. For the majority of women, a tear involving the skin only or the skin and some muscle of the perineum is inevitable.

 A tear is preferable to an episiotomy (cutting the perineum) since a tear occurs along the “path of least resistance” whereas an episiotomy may involve some muscle that hasn’t had a chance to thin and move out of the way. Midwives do episiotomies if the birth is imminent but the baby is in distress and needs to be born quickly.

 A recent research study found that women who did routine perineal massage for at least four weeks before labor had fewer tears, episiotomies and instrumental deliveries. It was found to be even more helpful if the woman was over 30 years of age.

 Perineal massage has the additional benefit of preparing the woman for the sensations that occur when the baby’s head is crowning (about to be born). Being familiar with these sensations gives you the advantage of being able to relax—facilitating the birth of your baby.

 You can do the massage yourself, using your thumbs, but it is probably easier in the last six weeks of pregnancy for your partner to do this for you. Make sure your bladder is empty and that you are propped up comfortably. When first starting, you may find that a warm bath softens your tissues. Use a mirror the first few times so you can become thoroughly familiar with the area.

 Massage the oil into the tissue of the perineum and the lower vaginal wall. Pay special attention to any scar tissue from previous episiotomies.

 Then your partner can put both index fingers about 3 inches into the vagina and press downward toward the rectum. While maintaining steady pressure, the fingers can be moved upward along either side of the vagina in a “U” or “sling” type motion.

 As you massage each night, your tissue will relax and stretch. Have your partner gently stretch the vaginal opening as wide as possible each time until you feel a tingling or burning sensation that indicates “far enough”. This will help you recognize the burning sensation, which indicates to stop pushing for the crowning of the head as it slips out. Hold this stretch for a minute or two, then release. Massage with the oil, stretch again to the maximum, hold, then release. By doing this, your perineum becomes more elastic. This assures that your tissues are supple and creates the confidence that a baby’s head can surely fit through.

 Do a “Kegel” (contraction of the vaginal muscles) and feel where the pubo-coccyegeal muscles lie and how strong it is. Feel how difficult the stretching is when you are tensing the muscles of the pelvic floor, and consciously release them as your partner does the stretching (HINT: keep your mouth and throat really loose during the massage). By continuing with Kegel exercises after the birth, your muscles will tone again.

What to do when labour starts

Relax – if you find it hard to relax, it could be helpful to use tension releasing exercises of the neck and shoulders, together with sitting quietly and breathing gently. Back and foot massage may also be relaxing.

Save your energy – don’t waste energy in encounters with people you would chat to in the course of a usual day – this is a special day. Rest, especially if contractions begin in the evening. Try to sleep if it seems likely that you will labour through the night. If contractions make lying on your side uncomfortable, make a pile of cushions at the top of the bed and sleep between contractions, leaning over the cushions.

Daytime – carry on as normal for as long as possible. Try to hold back from contacting relatives and friends at this early stage. Go for a walk or watch a movie.

Eat and drink – something light, plain and nourishing, little amounts and often. Yogurt and honey, soups, eggs, pasta, cheese, cereals are good. Try drinking herbal or fruit teas, diluted juice or water. If labour gets going during the night and you have to get up, eat a light breakfast, even if it is 4 am – you probably won’t feel like eating later and you need energy. Keep your preferred kinds of drinks nearby, taking sips often.

Baths – a long soak in the warm or hot bath can take the edge off mild contractions. Aromatherapy can be very relaxing.

Movement – you may, like most women, prefer to stay upright during labour – standing, swaying, rocking, rotating you hips, walking up and down stairs – try it!

Enjoy your labour at home – make a really nice corner in your home with a pile of cushions, dim lights/candles and everything you need to create a space for you and your labour companion to concentrate of the labour. This is a good idea even if you are going into hospital, as you can choose to stay home while labour is developing a rhythm.

Signs of early labour usually include:
  • bloody show, mucus plug, menstrual like cramps or backache
  • irregular contraction (for example, they come every 4, then 6, then 10 minutes)
  • trickle or gush of fluid
Page your midwife if:
  • you have regular strong contractions, 5 minutes apart or less, lasting 50-60 seconds over the course of 1 hour
  • you think your waters have broke
  • you have bright red bleeding from your vagina
  • you’re anxious and need reassurance

Sage Quotes

 “Most Western women have never been physically tested until we go through labor and birth…haven’t gone eighteen or twenty-four hours without food or sleep…allowed ourselves to go a day or two…without a bath or shower, without brushing our teeth and doing our hair and make-up. Even fewer of us would allow anyone else to see, smell, or touch us, unwashed, sweat-soaked, naked, oozing mucus, blood, and feces from our nether regions. When faced with the forces of labor, we can’t hide the fear, the anxiety, the responses to pain… All the inhibitions and trappings of our social selves are peeled away as our bodies thrust and heave, vomit and grunt, cry and leak. Then animal is there for everyone to see.”

Confronting fear

 Birth is the strongest force a woman normally experiences. If there is harmony with this force, you body and mind with enter into a different state, one that surrenders totally to natural forces. The face loses self-consciousness; it is a quiet state, gentle and profound. Sometimes I think the ease of a birth has to do with complete surrender to nature; an acceptance of being a part of something greater than the individual self. Like a beautiful spring, or the first heavy rains, or the sounds and rhythms of the sea.

 Labor and birth are a matter of believing, trusting and listening to your instincts – a matter of getting close enough to yourself and to the information you are receiving from your body. You must rely on yourself. You can’t rely on anyone else, a coach, teacher, mate, etc. They are not receiving the stimulus or the information you are receiving. I do not think that they can do it for you because they can’t. Their support and love vibrations are invaluable and make it possible for more than just yourself to share in this most beautiful act of love, the joyful bringing forth of life. Tune into labor. Unfold your inherent birth knowledge. Use your own rhythm; get behind it and don’t have your mind someplace else. Most important of all, don’t have your mind in any time dimension except the present. Don’t slip into the past and don’t rush to the future. Accept each contraction one at a time just as you accept the sun rising each morning, without question, one day at a time.

 A factor in labor is the intense sensation. It is beyond the expectations of anyone who has never given birth. This intense sensation is simply a par t of the whole, and when there is no fear, it simple is. It is nothing more, nothing to be afraid of, nothing to waste your time and energy fighting against.

Post-partum care

In the first 24-hours following the birth
It is normal for babies to:
  • breath irregularly
  • spit up mucus, and look as if they’re choking
  • have blue hands and feet, and pink face and body
  • sleep for 4-6 hours and then wake up to nurse every 2-3 hours after that
It is normal for women to:
  • bleed about the same amount as a heavy period
  • pass a clot or two (up to the size of the palm of your hand), provided bleeding is normal
  • void often
  • be exhausted, so rest is so important
Reasons to page in the post-partum period
Baby
  • your baby’s color is blue or gray in the face or chest
  • temperature of 37.4°C/99.3°F or higher
  • your baby is sleepy and has not fed for more than 8 hours
  • your baby has not urinated or passed meconium in the first 24 hours
  • your baby’s skin is yellow in the first 24 hours
  • your baby is vomiting after every feed, or has projectile vomiting
Woman
  • your vaginal bleeding is heavy ( you soak a pad in 12 hour)
  • your bleeding is foul smelling. A strong, fleshy odor, like your period, is normal.
  • temperature of 38°C/100.4°F or higher
  • uterus is painful to touch
  • you are feeling depressed, very anxious or unhappy, crying without reason, cannot sleep or eat
  • sore, red, hot, tender area on your breast or leg

Breastfeeding Myths

Written by Jack Newman, MD, FRCPC
1. Many women do not produce enough milk.

 Not true! The vast majority of women produce more than enough milk. Indeed, an overabundance of milk is common. Most babies that gain too slowly, or lose weight, do so not because the mother does not have enough milk, but because the baby does not get the milk that the mother has. The usual reason that the baby does not get the milk that is available is that he is poorly latched onto the breast. This is why it is so important that the mother be shown, on the first day, how to latch a baby on properly, by someone who knows what they are doing.

2. It is normal for breastfeeding to hurt.

 Not true! Though some tenderness during the first few days is relatively common, this should be a temporary situation which lasts only a few days and should never be so bad that the mother dreads nursing. Any pain that is more than mild is abnormal and is almost always due to the baby latching on poorly. Any nipple pain that is not getting better by day 3 or 4 or lasts beyond 5 or 6 days should not be ignored. A new onset of pain when things have been going well for a while may be due to a yeast infection of the nipples. Limiting feeding time does not prevent soreness.

3. There is no (not enough) milk during the first 3 or 4 days after birth.

 Not true! It often seems like that because the baby is not latched on properly and therefore is unable to get the milk. Once the mother's milk is abundant, a baby can latch on poorly and still may get plenty of milk. However, during the first few days, the baby who is latched on poorly cannot get milk. This accounts for "but he's been on the breast for 2 hours and is still hungry when I take him off". By not latching on well, the baby is unable to get the mother's first milk, called colostrum. Anyone who suggests you pump your milk to know how much colostrum there is, does not understand breastfeeding, and should be politely ignored.

4. A baby should be on the breast 20 (10, 15, 7.6) minutes on each side.

 Not true! However, a distinction needs to be made between "being on the breast" and "breastfeeding". If a baby is actually drinking for most of 15-20 minutes on the first side, he may not want to take the second side at all. If he drinks only a minute on the first side, and then nibbles or sleeps, and does the same on the other, no amount of time will be enough. The baby will breastfeed better and longer if he is latched on properly. He can also be helped to breastfeed longer if the mother compresses the breast to keep the flow of milk going, once he no longer swallows on his own (Handout #15 Breast Compression). Thus it is obvious that the rule of thumb that "the baby gets 90% of the milk in the breast in the first 10 minutes" is equally hopelessly wrong.

5. A breastfeeding baby needs extra water in hot weather.

Not true! Breastmilk contains all the water a baby needs.

6. Breastfeeding babies need extra vitamin D.

 Not true! Except in extraordinary circumstances, ie the mother herself was vitamin D deficient during the pregnancy, the baby stores vitamin D during the pregnancy, and a little outside exposure, on a regular basis, gives the baby all the vitamin D he needs.

7. A mother should wash her nipples each time before feeding the baby.

 Not true! Formula feeding requires careful attention to cleanliness because formula not only does not protect the baby against infection, but also is actually a good breeding ground for bacteria and can also be easily contaminated. On the other hand, breastmilk protects the baby against infection. Washing nipples before each feeding makes breastfeeding unnecessarily complicated and washes away protective oils from the nipple.

8. Pumping is a good way of knowing how much milk the mother has.

 Not true! How much milk can be pumped depends on many factors, including the mother's stress level. The baby who nurses well can get much more milk than his mother can pump. Pumping only tells you have much you can pump.

9. Breastmilk does not contain enough iron for the baby's needs.

 Not true! Breastmilk contains just enough iron for the baby's needs. If the baby is full term he will get enough iron from breastmilk to last him at least the first 6 months. Formulas contain too much iron, but this quantity may be necessary to ensure the baby absorbs enough to prevent iron deficiency. The iron in formula is poorly absorbed, and most of it, the baby poops out. Generally, there is no need to add other foods to breastmilk before about 6 months of age.

10. It is easier to bottle feed than to breastfeed.

 Not true! Or, this should not be true. However, breastfeeding is made difficult because women often do not receive the help they should to get started properly. A poor start can indeed make breastfeeding difficult. But a poor start can also be overcome. Breastfeeding is often more difficult at first, due to a poor start, but usually becomes easier later.

11. Breastfeeding ties the mother down.

 Not true! But it depends how you look at it. A baby can be nursed anywhere, anytime, and thus breastfeeding is liberating for the mother. No need to drag around bottles or formula. No need to worry about where to warm up the milk. No need to worry about sterility. No need to worry about how your baby is, because he is with you.

12. There is no way to know how much breastmilk the baby is getting.

 Not true! There is no easy way to measure how much the baby is getting, but this does not mean that you cannot know if the baby is getting enough. The best way to know is that the baby actually drinks at the breast for several minutes at each feeding (open-pause-close type of suck). Other ways also help show that the baby is getting plenty

13. Modern formulas are almost the same as breastmilk.

 Not true! The same claim was made in 1900 and before. Modern formulas are only superficially similar to breastmilk. Every correction of a deficiency in formulas is advertised as an advance. Fundamentally they are inexact copies based on outdated and incomplete knowledge of what breastmilk is. Formulas contain no antibodies, no living cells, no enzymes, no hormones. They contain much more aluminum, manganese, cadmium and iron than breastmilk. They contain significantly more protein than breastmilk. The proteins and fats are fundamentally different from those in breastmilk. Formulas do not vary from the beginning of the feed to the end of the feed, or from day 1 to day 7 to day 30, or from woman to woman, or from baby to baby... Your breastmilk is made as required to suit your baby. Formulas are made to suit every baby, and thus no baby. Formulas succeed only at making babies grow well, usually, but there is more to breastfeeding than getting the baby to grow quickly.

14. If the mother has an infection she should stop breastfeeding.

 Not true! With very, very few exceptions, the baby will be protected by the mother's continuing to breastfeed. By the time the mother has fever (or cough, vomiting, diarrhea, rash, etc) she has already given the baby the infection, since she has been infectious for several days before she even knew she was sick. The baby's best protection against getting the infection is for the mother to continue breastfeeding. If the baby does get sick, he will be less sick if the mother continues breastfeeding. Besides, maybe it was the baby who gave the infection to the mother, but the baby did not show signs of illness because he was breastfeeding. Also, breast infections, including breast abscess, though painful, are not reasons to stop breastfeeding. Indeed, the infection is likely to settle more quickly if the mother continues breastfeeding on the affected side.

15. If the baby has diarrhea or vomiting, the mother should stop breastfeeding.

 Not true! The best medicine for a baby's gut infection is breastfeeding. Stop other foods for a short time, but continue breastfeeding. Breastmilk is the only fluid your baby requires when he has diarrhea and/or vomiting, except under exceptional circumstances. The push to use "oral rehydrating solutions" is mainly a push by the formula (and oral rehydrating solutions) manufacturers to make even more money. The baby is comforted by the breastfeeding, and the mother is comforted by the baby's breastfeeding.

16. If the mother is taking medicine she should not breastfeed.

 Not true! There are very very few medicines that a mother cannot take safely while breastfeeding. A very small amount of most medicines appears in the milk, but usually in such small quantities that there is no concern. If a medicine is truly of concern, there are usually equally effective, alternative medicines which are safe. The loss of benefit of breastfeeding for both the mother and the baby must be taken into account when weighing if breastfeeding should be continued.

Breastfeeding

Starting Out Right

 Breastfeeding is the natural, physiologic way of feeding infants and young children milk, and human milk is the milk made specifically for human infants. Formulas made from cow's milk or soybeans (most formulas) are only superficially similar, and advertising -- which states otherwise -- is misleading. Breastfeeding should be easy and trouble free for most mothers. A good start helps to assure breastfeeding is a happy experience for both mother and baby.

 The vast majority of mothers are perfectly capable of breastfeeding their babies exclusively for four to six months. In fact, most mothers produce more than enough milk. Unfortunately, outdated hospital routines based on bottle feeding still predominate in too many health care institutions and make breastfeeding difficult, even impossible, for some mothers and babies. For breastfeeding to be well and properly established, a good early few days can be crucial. Admittedly, even with a terrible start, many mothers and babies manage.

 The trick to breastfeeding is getting the baby to latch on well. A baby who latches on well, gets milk well. A baby who latches on poorly has difficulty getting milk, especially if the supply is low. A poor latch is similar to giving a baby a bottle with a nipple hole which is too small-the bottle is full of milk, but the baby will not get much.

 When a baby is latching on poorly, he may also cause the mother nipple pain. And if he does not get milk well, he will usually stay on the breast for long periods, thus aggravating the pain. Unfortunately anyone can say that the baby is latched on well, even if he isn't. Too many people who should know better just don't know what a good latch is.

Here are a few ways breastfeeding can be made easy:

1.  The baby should be at the breast immediately after birth. The vast majority of newborns can be at the breast within minutes of birth. Indeed, research has shown that, given the chance, many babies only minutes old will crawl up to the breast from the mother's abdomen, latch on and start breastfeeding all by themselves. This process may take up to an hour or longer, but the mother and baby should be given this time together to start learning about each other. Babies who "self-attach" run into far fewer breastfeeding problems. This process does not take any effort on the mother's part, and the excuse that it cannot be done because the mother is tired after labour is nonsense, pure and simple. Incidentally, studies have also shown that skin to skin contact between mothers and babies keeps the baby as warm as an incubator.

2.  The mother and baby should room in together. There is absolutely no medial reason for healthy mothers and babies to be separated from each other, even for short periods. Health facilities which have routine separations of mothers and babies after birth are years behind the times, and the reasons for the separation often have to do with letting parents know who is in control (the hospital) and who is not (the parents). Often, bogus reasons are given for separations. One example is the baby passed meconium before birth. A baby who passes meconium and is fine a few minutes after birth will be fine and does not need to be in an incubator for several hours' "observation".

 There is no evidence that mothers who are separated from their babies are better rested. On the contrary, they are more rested and less stressed when they are with their babies. Mothers and babies learn how to sleep in the same rhythm. Thus, when the baby starts waking for a feed, the mother is also starting to wake up naturally. This is not as tiring for the mother as being awakened from deep sleep, as she often is if the baby is elsewhere when he wakes up.

 The baby shows long before he starts crying that he is ready to feed. His breathing may change, for example. Or he may start to stretch. The mother, being in light sleep, will awaken, her milk will start to flow and the calm baby will be content to nurse. A baby who has been crying for some time before being tried on the breast may refuse to take the breast even if he is ravenous. Mothers and babies should be encouraged to sleep side by side in hospital. This is a great way for mothers to rest while the baby nurses. Breastfeeding should be relaxing, not tiring.

3.  Artificial nipples should not be given to the baby. There seems to be some controversy about whether "nipple confusion" exists. Babies will take whatever gives them a rapid flow of fluid and may refuse others that do not. Thus, in the first few days, when the mother is producing only a little milk (as nature intended), and the baby gets a bottle (as nature intended?) from which he gets rapid flow, he will tend to prefer the rapid flow method. You don't have to be a rocket scientist to figure that one out, though many health professionals, who are supposed to be helping you, don't seem to be able to manage it. Nipple confusion includes a range of problems, including the baby not taking the breast as well as he could and thus not getting milk well and/or the mother getting sore nipples. Just because a baby will "take both" does not mean that the bottle is not having a negative effect. Since there are now alternatives available if the baby needs to be supplemented.

4.  No restriction on length or frequency of breastfeedings. A baby who drinks well will not be on the breast for hours at a time. Thus, if he is, it is usually because he is not latching on well and not getting the milk that is available. Get help to fix the baby's latch, and use compression to get the baby more milk. This, not a pacifier, not a bottle, not taking the baby to the nursery, will help.

5.  Supplements of water, sugar water, or formula are rarely needed. Most supplements could be avoided by getting the baby to take the breast properly and get the milk that is available. If you are being told you need to supplement without someone having observed you breastfeeding, ask for someone to help who knows what they are doing. There are rare indications for supplementation, but usually supplements are suggested for the convenience of the hospital staff. If supplements are required, they should be given by lactation aid, not cup, finger feeding, syringe or bottle. The best supplement is your own colostrum. It can be mixed with sugar water if you are not able to express much at first. Formula is hardly ever necessary in the first few days.

6.  A proper latch is crucial to success. This is the key to successful breastfeeding. Unfortunately, too many mothers are being "helped" by people who don't know what a proper latch is. If you are being told your two day old's latch is good despite your having very sore nipples, be skeptical, and ask for help from someone who knows. Before you leave the hospital, you should be shown that your baby is latched on properly, and that he is actually getting milk from the breast and that you know how to know he is getting milk from the breast (open-pause-close type of suck). If you and the baby are leaving hospital not knowing this, get experienced help quickly.

7.  Free formula samples and formula company literature are not gifts. There is only one purpose for these "gifts" and that is to get you to use formula. It is very effective, and very unethical, marketing. If you get any from any health professional, you should be wondering about his/her knowledge of breastfeeding and his/her commitment to breastfeeding. "But I need formula because the baby is not getting enough!". Maybe, but, more likely, you weren't given good help and the baby is simply not getting the milk that is available. Even if you need formula, nobody should be suggesting a particular brand and giving you free samples. Get good help. Formula samples are not help.

 Under some circumstances, it may be impossible to start breastfeeding early. However, most medical reasons (maternal medication, for example) are not true reasons for stopping or delaying breastfeeding, and you are getting misinformation. Get good help. Premature babies can start breastfeeding much, much earlier than they do in many health facilities. In fact, studies are now quite definite that it is less stressful for a premature baby to breastfeed than to bottle feed. Unfortunately, too many health professionals dealing with premature babies do not seem to be aware of this.

Is my baby getting enough milk?

Written by Jack Newman, MD, FRCPC

 Breastfeeding mothers frequently ask how to know their babies are getting enough milk. The breast is not the bottle, and it is not possible to hold the breast up to the light to see how many ounces or milliliters of milk the baby drank. Our number obsessed society makes it difficult for some mothers to accept not seeing exactly how much milk the baby receives. However, there are ways of knowing that the baby is getting enough. In the long run, weight gain is the best indication whether the baby is getting enough, but rules about weight gain appropriate for bottle fed babies may not be appropriate for breastfed babies.

Ways of Knowing:

1.  Baby's nursing is characteristic. A baby who is obtaining lots of milk at the breast sucks in a very characteristic way. The baby generally opens his mouth fairly wide as he sucks and the rhythm is slow and steady. His lips are turned out. At the maximum opening of his mouth, there is a perceptible pause which you can see if you watch his chin. Then, the baby closes his mouth again. This pause does not refer to the pause between suckles, but rather to the pause during one suckle as the baby opens his mouth to its maximum. Each one of these pauses corresponds to a mouthful of milk and the longer the pause, the more milk the baby got. At times, the baby can even be heard to be swallowing, and this is perhaps reassuring, but the baby can be getting lots of milk without making noise. Usually, the baby's suckle will change during the feeding, so that the above type of suck will alternate with sucks that could be described as "nibbling". This is normal.

 The baby who suckles as described above, with several minutes of pausing type sucks at each feeding, and then comes off the breast satisfied, is getting enough. The baby who nibbles only, or has the drinking type of suckle for a short period of time only, is probably not. This is the best way of knowing the baby is getting enough. This type of suckling can be seen on the very first day of life, though it is not as obvious as later when the mother has lots more milk.

2.  Baby's bowel movements. For the first few days after delivery, the baby passes meconium, a dark green, almost black, substance. Meconium accumulates in the baby's gut during pregnancy. Meconium is passed during the first few days, and by the 3rd day, the bowel movements start becoming lighter, as more breast-milk is taken. Usually by the fifth day, the bowel movements have taken on the appearance of the normal breast-milk stool. The normal breast-milk stool is pasty to watery, mustard coloured, and usually has little odour. However, bowel movements may vary considerably from this description. They may be green or orange, may contain curds or mucus, or may resemble shaving lotion in consistency (from air bubbles). The variation in colour does not mean something is wrong. A baby who is breastfeeding only, and is starting to have bowel movements which are becoming lighter by day 3 of life, is doing well.

 Without you becoming obsessive about it, monitoring the frequency and quantity of bowel motions is one of the best ways of knowing if the baby is getting enough milk. After the first 3-4 days, the baby should have increasing bowel movements so that by the end of the first week he should be passing at least 2-3 substantial yellow stools each day. In addition, many infants have a stained diaper with almost each feeding. A baby who is still passing meconium on the fifth day should be seen at the clinic the same day. A baby who is passing only brown bowel movements is probably not getting enough, but this is not yet definite.

 Some breastfed babies, after the first 3-4 weeks of life, may suddenly change their stool pattern from many each day, to one every 3 days or even less. Some babies have gone as long as 15 days or more without a bowel movement. As long as the baby is otherwise well, and the stool is the usual pasty or soft, yellow movement, this is not constipation and is of no concern. No treatment is necessary or desirable, because no treatment is necessary or desirable for something that is normal.

 Any baby between 5 and 21 days of age who does not pass at least one substantial bowel movement within a 24 hour period should be seen at the breastfeeding clinic the same day. Generally, small infrequent bowel movements during this time period means insufficient intake. There are definite exceptions and everything may be fine, but it is better to check.

3.  Urination. With six soaking wet (not just wet) diapers in a 24 hours hour period, after about 4-5 days of life, you can be sure that the baby is getting a lot of milk. Unfortunately, the new super dry "disposable" diapers often do indeed feel dry even when full of urine, but when soaked with urine they are heavy. It should be obvious that this indication of milk intake does not apply if you are giving the baby extra water (which, in any case, is unnecessary for breastfed babies, and if given by bottle, may interfere with breastfeeding). The baby's urine should be clear as water after the first few days, though an occasional darker urine is not of concern.

 During the first 2-3 days of life, some babies pass pink or red urine. This is not a reason to panic and does not mean the baby is dehydrated. No one knows what it means, or even if it is abnormal. It is undoubtedly associated with the lesser intake of the breastfed baby compared with the bottle fed baby during this time, but the bottle feeding baby is not the standard on which to measure breastfeeding. However, the appearance of this colour urine should result in attention to getting the baby well latched on and making sure the baby is drinking at the breast. During the first few days of life, only if the baby is well latched on can he get his mother's milk. Giving water by bottle or cup or finger feeding at this point does not fix the problem. It only gets the baby out of hospital with urine which is not red. If relatching and breast compression do not result in better intake, there are ways of giving extra fluid without giving a bottle directly. Limiting the duration or frequency of feedings can also contribute to decreased intake of milk.

The following are NOT good ways of judging:

1.  Your breasts do not feel full. After the first few days or weeks, it is usual for most mothers not to feel full. Your body adjusts to your baby's requirements. This change may occur quite suddenly. Some mothers breastfeeding perfectly well never feel engorged or full.

2.  The baby sleeps through the night. Not necessarily. A baby who is sleeping through the night at 10 days of age, for example, may, in fact, not be getting enough milk. A baby who is too sleepy and has to be awakened for feeds or who is "too good" may not be getting enough milk. There are many exceptions, but get help quickly.

3.  The baby cries after feeding. Although the baby may cry after feeding because of hunger, there are also many other reasons for crying. Do not limit feeding times.

4.  The baby feeds often and/or for a long time. For one mother every 3 hours or so feedings may be often; for another, 3 hours or so may be a long period between feeds. For one a feeding that lasts for 30 minutes is a long feeding; for another it is a short one. There are no rules how often or for how long a baby should nurse. It is not true that the baby gets 90% of the feed in the first 10 minutes. Let the baby determine his own feeding schedule and things usually come right, if the baby is suckling and drinking at the breast and having at least 2-3 substantial yellow bowel movements each day. If that is the case, feeding on one breast each feeding (or at least finishing on one breast before switching over) will often lengthen the time between feedings.

 Remember, a baby may be on the breast for 2 hours, but if he is actually breastfeeding (open-pause-close type of sucking) for only 2 minutes, he will come off the breast hungry. If the baby falls asleep quickly at the breast, you can compress the breast to continue the flow of milk. Contact the breastfeeding clinic with any concerns, but wait to start supplementing. If supplementation is truly necessary, there are ways of supplementing which do not use an artificial nipple.

5. "I can express only half an ounce of milk". This means nothing and should not influence you. Therefore, you should not pump your breasts "just to know". Most mothers have plenty of milk. The problem usually is that the baby is not getting the milk that is there, either because he is latched on poorly, or the suckle is ineffective or both. These problems can often be fixed easily.

6.  The baby will take a bottle after feeding. This does not necessarily mean that the baby is still hungry. This is not a good test, as bottles may interfere with breastfeeding.

7.  The 5 week old is suddenly pulling away from the breast but still seems hungry. This does not mean your milk has "dried up" or decreased. During the first few weeks of life, babies often fall asleep at the breast when the flow of milk slows down even if they have not had their fill. When they are older (4-6 weeks of age), they no longer are content to fall asleep, but rather start to pull away or get upset. The milk supply has not changed; the baby has. Compress the breast to increase flow.

Notes on scales and weights
  • Scales are all different. We have documented significant differences from one scale to another. Weights have often been written down wrong. A soaked cloth diaper may weigh several hundred grams (half a pound or more), so babies should be weighed naked.

  • Many rules about weight gain are taken from observations of growth of formula feeding babies. They do not necessarily apply to breastfeeding babies. A slow start may be compensated for later, by fixing the breastfeeding. Growth charts are guidelines only.

Sore Nipples

Written by Jack Newman, MD, FRCPC

 Sore nipples are usually due to one or both of two causes. Either the baby is not positioned and latched properly, or the baby is not suckling properly, or both. Incidentally, babies learn to suck properly by getting milk from the breast when they are latched on well. (They learn by doing). Fungal infection (due to Candida albicans), may also cause sore nipples. The soreness caused by poor latching and ineffective suckle hurts most as you latch the baby on and usually improves as the baby nurses. The pain from the fungal infection goes on throughout the feed and may continue even after the feed is over. Women describe knifelike pain from the first two causes. The pain of the fungal infection is often described as burning, but may not have this character. Sudden, unexplained onset of nipple pain when feedings had previously been painless is a tipoff that the pain may be due to a yeast infection, but the pain may come on gradually or may be superimposed on pain due to other causes. Cracks may be due to a yeast infection.

Proper Positioning and Latching

 It is not uncommon for women to experience difficulty positioning and latching the baby on. Proper positioning facilitates a good latch and good latching reduces the baby's chances of becoming "gassy", and also allows the baby to control the flow of milk. Thus, poor latching may also result in the baby not gaining adequately, or feeding frequently, or being colicky.

Positioning

 Good positioning facilitates a good latch. A lot of what follows under latching comes automatically if the baby is well positioned in the first place.

 At first, it may be easiest to use the cross cradle hold to position your baby for latching on. Hold the baby in your right arm, the web between your thumb and index finger behind the nape of his neck (not behind his head) with your fingers (except for the thumb) supporting the baby's face from underneath, and your forearm supporting his back and buttocks. Hold the baby's buttocks between your chest and your forearm-this should give you good control. The baby should be almost horizontal across your body and should be turned so that his chest, belly and thighs are against you with a slight tilt so the baby can look at you. Hold the breast with your left hand, with the thumb on top and the other fingers underneath, fairly far back from the nipple and areola.

 The baby should be approaching the breast with the head just slightly tilted backwards. The nipple then automatically points to the roof of the baby's mouth.

Latching

1.  Now, get the baby to open up their mouth wide. The way to do this is to run your nipple, still pointing to the roof of the baby's mouth, along the baby's mouth, very lightly, from one corner of the mouth to the other. Or you can run the baby along your nipple, something some mothers find easier. Wait for the baby to open up as if yawning. WAIT FOR THEM. As you bring the baby toward the breast, their chin should touch your breast first.

2.  When the baby opens up their mouth, use the arm that is holding them to bring them onto the breast. Don't worry about the baby's breathing. If they are properly positioned and latched on, they will breathe without any problem. If they cannot breathe, they will pull away from the breast. Don't be afraid to be vigorous.

3.  If the nipple still hurts, use your index finger to pull down on the baby's chin in order to bring the lower lip out. You may have to do this for the duration of the feed, but this is usually not necessary.

4.  The same principles apply whether you are sitting or lying down with the baby or using the football hold. Get the baby to open wide, don't let the baby latch onto the nipple, but get as much of the areola (brown part of breast) into the mouth as possible (not necessarily the whole areola).

5.  There is no "normal" length of feeding time. If you have questions, call the clinic.

6.  A baby properly latched on will be covering more of the areola with his lower lip than with the upper lip.

Improving the baby's suckle

 The baby learns to suckle properly by nursing and by getting milk into their mouth. The baby's suckle may be made ineffective or not appropriate for breastfeeding by the early use of artificial nipples or from poor latching on from the beginning. Some babies just seem to take their time developing an effective suckle. Suck training and/or finger feeding may help.

"My nipple turns white after the baby comes off the breast"

 The pain associated with this blanching of the nipple is frequently described by mothers as "burning", but generally begins only after the feeding is over. It may last several minutes or more, after which the nipple returns to its normal colour, but then a new pain develops which is usually described by mothers as "throbbing". The throbbing part of the pain may last for seconds or minutes and may even blanch again. The cause would seem to be a spasm of the blood vessels in the nipple (when the nipple is white), followed by relaxation of these blood vessels (when the nipple returns to its normal colour). Sometimes this pain continues even after the nipple pain during the feeding no longer is a problem, so that the mother has pain only after the feeding, but not during it.

What can be done?

1.  Pay careful attention to getting the baby to latch onto the breast properly. This type of pain is almost always associated with, and probably caused by whatever is causing your pain during the feeding. The best treatment is the treatment of the other causes of nipple pain.

2.  Heat (hot washcloth, hot water bottle, hair dryer) applied to the nipple immediately after nursing may prevent or decrease the reaction. Dry heat is usually better than wet heat, because wet heat may cause further damage to the nipples.

3.  On occasion, we have had to use a medicated paste (nitroglycerin) or an oral medication (nifedipine) to prevent this type of reaction.

General Measures

1.  Nipples can be warmed for short periods of time after each feeding, using a hair dryer on low setting.

2.  Nipples should be exposed to air as much as possible.

3.  When it is not possible to expose nipples to air, plastic dome-shaped breast shells (not nipple shields) can be worn to protect your nipples from rubbing by your clothing. Nursing pads keep moisture against the nipple and may cause damage that way. They also tend to stick to damaged nipples. If you leak a lot you can wear the pad over the breast shell.

4.  Ointments can sometimes be helpful. If you do use an ointment, use just a very small amount after nursing and do not wash it off.

5.  Do not wash your nipples frequently. Daily bathing is more than enough.

6.  If your baby is gaining weight well, there is no good reason the baby must be fed on both breasts at each feeding. It may save you pain, and speed healing if you feed your baby on only one breast each feed. It will help to compress the breast, once the baby is no longer swallowing on his own in order to continue his getting milk. You may be able to manage this some feedings, but not others. In very difficult situations, a lactation aid can be used to supplement (preferably expressed milk), so that the baby will finish the feeding on the first side.

 If you are unable to put the baby to the breast because of pain, in spite of trying all the above measures, it may still be possible to continue breastfeeding after a temporary (3-5 days) cessation to allow the nipples to heal. During this time, it would be better that the baby not be fed with a rubber nipple. Of course it is also best for you and the baby if the baby is fed your expressed milk. Use the technique called "finger feeding" or cup feeding.

 Nipples shields are not recommended for sore nipples, because, although they may help temporarily, they usually do not. They may also cut down the milk supply dramatically, and the baby may become fussy and not gain weight well. Once the baby is used to them, it may be impossible to get the baby back onto the breast. In fact, many women who have tried nipple shields find that they do not help with soreness. Use as a last resort only, but get help first.

Your Newborn Baby

Newborn Behaviours

Sleep patterns – unfortunately or luckily, babies do not sleep as much as the books say they do. Your baby’s sleep pattern should determine your own—that is, you sleep when the baby sleeps. This way you are well rested when your baby wants to nurse all night. Feeding your baby by breast or bottle is very demanding, as well as ensuring your healthy recovery from the birth.

Feeding patterns – breastfeeding is no longer dictated by strict routine. Instead demand feeding is the current recommendation. A baby’s stomach is as small as a kiwi and needs to be filled frequently. This means that the baby will feed every 2-3 hours with only a 4-6 hour stretch of sleep each day. Another way of keeping tract of feedings is to count up to 8-12 feedings per day.

Stooling (poo) – meconium is the baby’s first bowel movement which occurs in the first 24-48 hours of life, it is black and sticky. By day 3-5 post-partum, transitional stool occurs when the breast milk changes from colostrum (high in protein) to milk (high in fat), transitional stool is green. Once the milk has come in, the stool is yellow and seedy and has a sweet smell to it. The number of stools per day varies. A baby stools as little as once a day, and as often as every feeding. Once the baby is 3 weeks or older, the baby may go 5 days without stooling and this is normal—but be prepared for a large, explosive bowel movement!

Voiding (pee) – you can expect one wet diaper for every day of life—that is day 1 = 1 wet diaper, day 2 = 2 wet diapers, and so on. Once the baby is 6 days old, he or she will wet 6-10 wet diapers per day. By keeping track of the number of wet diapers, you can assure yourself that your baby is nursing enough. Commonly, the baby may have some urate crystals in the diaper, this looks like blood or brick dust and is normal.

Weight loss — in the first few days following the birth, babies lose weight. Normal weight loss is less than 10% of birth-weight, occurring around day 3-4 postpartum, and this weight is regained by day 10-14.

Head control – head lag is normal in newborn but a degree of control should be noted in some positions (lifting into sitting position with arms, prone and lifting head from side to side). Head control is gained by 4 mos.

Senses

  • Vision – 20/100-20/400, a baby can focus momentarily on bright or moving objects 20 cm (8") away and in the midline. They have a visual preference of high contrast black-and-white, and shiny.
  • Hearing – mature infants can differentiate between a mother’s voice and another female voice.
  • Smell – mature infants can differentiate between the smell of mother’s milk and another woman’s milk.
  • Taste – taste buds are mostly distributed on the tip of the tongue.
  • Touch – a baby’s face (especially the mouth), hands and feet are most sensitive, touch and motion are essential for normal growth and development.

Signs of over stimulation: a baby can demonstrate when he or she is fed up with the surroundings. They do this by gaze aversion, frowning, sneezing, yawning, hiccuping, vomiting, mottled skin, irregular respirations, heart rate changes, finger spaying, arching stiffening, fussing, or crying.

Signs of attention: a baby can demonstrate interest in his or her surroundings. They do this with a quiet alert gaze, focused gaze, dilated pupils, regular respirations, regular heart beat, rhythmic sucking, reaching or grasping, and hand to mouth movements.

How do I know the baby is getting enough milk?

 You will know that your baby is getting enough by keeping track of the number of diapers. In the first week of life, a baby pees one wet diaper per day, 3 wet diapers on day 3, 4 wet diapers on day 4, etc. after the first week, a breastfed baby is getting enough if he or she is peeing 8-12 wet diapers a day and the poos are yellow.

Normal Newborn Care

 These are our recommendations for newborn care. You will encounter unlimited (and unsolicited) advice on basic, everyday care for your baby. And you will find that other mothers, your mother and women without kids can offer great tips on the care of your baby. Pick and choose to do the things that fit with your family routine and your personality. Be confident in the fact that your baby wants you, the parent, to be close for comfort, warmth, and nourishment. All the other tips and advice are merely guidelines to make things easier or safer—many are common sense.

Bathing — baby’s are not great at maintaining their temperature, so after bathing your baby, dry the baby off so it won’t get cold and avoid drafts. Ways to bath your baby vary from bringing the baby into the bath or shower with you to setting up a “baby-bath”. How often you bath the baby is up to you. In the early post-partum, you may want to bath the baby with you, while you soak in the postpartum herbal bath. Baby soaps and creams to use on the baby’s skin aren’t necessary but not harmful.

Cord care — the umbilical cord stump rots and the cord falls off. It is normal for the cord to weep, have spots of blood, and to smell horrible before it falls off. Caring for the cord involves folding the diaper down so that the cord is not laying against a wet diaper, and patting the area dry after a bath. Some practitioners recommend wiping the base of the cord with an alcohol swab however a large research study showed no difference in the infection rate between alcohol swabs and nothing. Signs of infection are red streaking, and heat on the abdomen. Another concern is if there is bleeding from the stump that is continuing.

Burping — breastfed babies don’t tend to need as much burping as bottle-fed babies—try for 5 minutes.

Mucus — babies spit up mucus in the firsts few days following the birth (they can look like they’re choking but they are just working at clearing the mucus). Babies may spit up a lot as well and this is normal.

Clothing — babies need one more layer of clothing than you. Taking the baby outside is fine provided they have one more layer of clothing than you do.

Sleep position — babies should sleep on their back, not on their stomach. This has shown to reduce the incidence of Sudden Infant Death Syndrome (SIDS). Babies do not choke when they sleep on their backs.

Bed or bassinet? — where your baby sleeps is a personal decision yet seems to elicit a strong reaction in many people. It is safe for your baby to sleep in a crib down the hall from your room and it is also safe for your baby to sleep in your bed.

 As midwives, our preference is for clients to have their baby in bed with them or in a basket next to them for the first week or two postpartum. This is because feeding is easier when you’re close to the baby, when it is easier, you end up getting more sleep and recover faster.

Common variations in the newborn

jaundice – over half of babies become jaundiced after the birth. They do this because they have an abundant amount of red blood cells that they no longer need once born. These extra blood cells are broken down and the by-product is excreted out. The by-product is bilirubin and while waiting to be excreted, it can be absorbed into the fat of the body, such as skin. Babies can get a yellow hue to their skin. In the past, jaundice was over-treated and now, expectant management (wait-and-watch) is the common practice.

A jaundiced baby is healthy provided:

  • the baby is nursing well, wakes-up to feed, and is not lethargic
  • the baby is peeing and pooing normally
  • the baby has alert periods
  • the jaundice appears on day 3-5 postpartum and is gone by day 10

Swollen breasts and genitals – maternal hormones in the baby’s system can cause genitals and breasts to be swollen. Left alone, the swelling subsides. Some baby girls may pass menstrual blood.

Asymmetry of face – the face of newborn babies can be very lopsided because of the molding that took place in the birth canal. This resolves in the first day or so.

Molding – the skull may be extremely elongated as the bones of the skull overlap adjusting to the birth. Resolves in the first day or so.

Caput – a rounded, raised, cap-like swelling on the baby’s head, consisting of fluid which is lying under the skin of the scalp. Resolves in first day or so.

Cephalohematoma – consists of blood gathered under another layer of scalp tissue and has a bruised appearance. This can take several weeks to resolve.

Eye color – grey until about 6 months

Red, bloodshot eyes – the whites of the baby’s eyes may have red areas which are broken capillaries. These are caused by the pressure of contractions on the baby’s head during second stage of labor.

Edema and bruising of the eyes – tear duct blockage is common and unless accompanied by redness in swelling, can be treated by massaging the tear duct and gentle cleansing

Umbilical hernia – the belly button may stick out all the time or only when the baby cries. This is quite common in babies. Usually, there is no treatment and it will heal itself in the first year.

Milia – tiny white pimples on the baby’s nose and face. It is vernix trapped in the pores of the skin. Resolves in the first few weeks.

Birthmarks – these are small or large areas of pigmented skin. Most of these disappear in the first few days or months of life, though some last a lifetime.

Rashes – common in the newborn and usually cause no problem. Red blotches on the baby’s skin is likely due to a baby adapting from the sterile environment inside the mother to the non-sterile environment of the outside world. Another common area for rash is the diaper area. Advise your midwife of this as it could be an common irritation rash or a yeast infection requiring treatment. Leaving the diaper off and letting air get to this area will help it to heal.

Sucking blisters – a benign blister on the upper lip from suckling at the breast, will resolve spontaneously.

Startle reflex – in response to sudden movement or a loud noise the baby throws back its arms and gets a very surprised expression often followed by a cry. This is a normal reflex and happens to all babies.

Newborn Drugs

1.  Vitamin K is required for normal clotting in our blood. Babies are born with a low amount of vitamin K, and produce it once they start eating. For most babies, this low ability to clot is of no concern, however, there is a rare condition called hemorrhagic disease of the newborn. Babies with this condition will begin to spontaneously bleed, both internally and externally. If this occurs in their brain, it can lead to brain damage and death.

 Unfortunately, we have no way of screening which babies may develop hemorrhagic disease of the newborn. Instead babies are routinely given an injection of vitamin K following the birth. Once the baby starts feeding, friendly bacteria in their intestines will produce all vitamin K they will need.

 The babies who are at risk of hemorrhagic disease of the newborn are babies who are breastfed, babies who have had a traumatic delivery, babies whose mothers are taking certain medications and babies with digestive disorders.

 To date, there are no adverse effects from the injection. Currently, an oral preparation of vitamin K is available but more research is needed to determine the dosage.

2.  Erythromycin Eye Ointment is a mandatory treatment for all newborn babies in Canada. It is used to prevent babies from developing an eye infection caused by vaginal infection in the mother. The main infection of concern is gonorrhea and chlamydia, as these can lead to serious eye infections causing blindness. This is one reason why screening for vaginal infections in pregnancy is important.

 The ointment will cause the baby to have blurry vision for a few hours following administration.

3.  Vitamin D oral drops - Vitamin D is responsible for normal absorption of dietary calcium and normal bone and teeth development. Vitamin D comes from a conversion process that occurs on our skin when exposed to sunlight. Fortified cow’s milk, fatty fish oils, liver and eggs contain high levels of vitamin D as well. Breast-milk is considered the perfect food for newborns, according to the World Health Organization. However, for infants who are completely breastfed, there are some things to consider when deciding whether to give your baby vitamin D drops.

 During pregnancy, babies absorb vitamin D through the placenta and store it in their kidneys and liver. Following the birth, the baby can use these stores. When breastfeeding, babies absorb vitamin D in the breast-milk. Both prenatally and postnatally, the level of vitamin D available to the baby is dependent on the mother’s diet.

 Other factors determine the amount of vitamin D available to the baby: sunlight exposure and the amount of pigmentation in the baby’s skin. Researchers found that for a White baby, 30 minutes in the sun wearing clothes and no hat, was found to provide enough vitamin D for one-week. For a Black baby, this time increases because of the darker pigmentation.

 Infants who do not receive sufficient vitamin D in their diet or lack of sun exposure, can develop rickets, which is the formation soft bones in growing children. There is also the risk of too much vitamin D, which can contribute to high calcium in urine leading to kidney stones. It seems that high levels of vitamin D can only occur in supplementation and not from a well-rounded diet or too much sum exposure.

 The Canadian Pediatric Society recommends 400 IU (International Units) of vitamin D for children subject to certain risk factors, such as inner city housing, darkly pigmented skin, multi-layer clothing, and those with low dietary intake of vitamin. They have not made a recommendation of routine supplementation for all newborns.

 Deciding whether to give your baby vitamin D drops is your decision. Determine whether you have a good diet, whether your baby has dark skin, and whether you have a good diet, and whether you are an “outdoors” family. Also, take into consideration if your baby is born in the summer or winter (more or less sun exposure).

 Vitamin D drops for newborns are available at pharmacies, and parents should follow the directions on the label. Parents should also consider whether supplementation is necessary for their baby.

Facts About Vitamin D
  • Vitamin D facilitates the absorption of calcium and together, they help build strong bones in growing children.
  • Vitamin D is found in milk, eggs, liver, and fatty fish.
  • Our skin produces vitamin D when exposed to sunlight.
  • Infants at risk of vitamin D deficiency are those whose mothers have a poor diet, dark pigmentation, and little sun exposure.
  • Vitamin D drops for newborns are commonly recommended by health care providers.

Newborn Tests

Newborn Screening
What is newborn screening (NBS)?
  • NBS is a blood test done shortly after birth to test for treatable diseases that are not usually apparent in the newborn period.
  • Early detection of these diseases is the key to effective treatment and can prevent serious health problems and even save lives.
  • A heel prick allows health care providers to collect a small amount of blood on special filter paper. This blood is sent to Newborn Screening Ontario (NSO) where it is tested for 29 diseases. For a complete list, visit Newborn Screening
Universal Hearing Screening

 The first months and years of a baby's life are very important for developing language. Undetected hearing loss is one of the causes of delayed language development. Delayed language development can lead to behaviour and emotional problems and later, to problems in school.Every year in Ontario, approximately three in 1,000 babies are born deaf or hard of hearing. Through the Ontario Infant Hearing Program these babies can be found very early and given the help they need to develop language.

 Most deaf and hard of hearing children whose hearing loss is identified early, and who receive the support they need, will have the same chance to develop language skills as hearing children. All newborn babies in Ontario can have their hearing screened and there is no charge for the screening. It is a simple, reliable process that is quick, completely safe and comfortable for your baby. The technology used to screen your baby's hearing involves placing a small earphone in the baby's ear. Soft sounds are played through the earphone and the ear's response is measured and recorded. Your baby will probably sleep comfortably through the whole experience, and you will get the results right away.

 When you have your baby, we will submit a form to the Infant Hearing Program and Speech Services. You will get a phone call within 2-4 weeks to arrange an appointment for your baby to be screened. If you do not hear from them by your 4 week postpartum clinic appointment, please let the front desk know so we can follow up on your behalf.