Well Newborn: First Weeks at Home

Preventing Fatigue and Exhaustion

For many mothers the first weeks at home with a new baby are often the hardest in their lives. You will probably feel overworked, maybe even overwhelmed. Inadequate sleep will leave you fatigued. Caring for a baby can be a lonely and stressful responsibility. You may wonder if you will ever catch up on your sleep or work. The solution is asking for help. No one should be expected to care for a young baby alone.

Every baby awakens 2 or more times a night. The way to avoid sleep deprivation is to know the total amount of sleep you need per day and to get that sleep in bits and pieces. Go to bed earlier in the evening after your baby's final feeding of the day. When your baby naps you must also rest or nap. While you are napping take the telephone off the hook and put up a sign on the door saying MOTHER AND BABY SLEEPING. If your total sleep remains inadequate, ask a relative for help or hire a babysitter. If you don't take care of yourself, you won't be able to take care of your baby.

The Postpartum Blues

More than 50% of women experience postpartum blues on the third or fourth day after delivery. The symptoms include tearfulness, tiredness, sadness, and difficulty in thinking clearly. The main cause of this temporary reaction is probably the sudden decrease of maternal hormones. The full impact of being totally responsible for a dependent newborn may also be a contributing factor. Many mothers feel let down and guilty about these symptoms because they have been led to believe they should be overjoyed about caring for their newborn. In any event, these symptoms usually clear in 1 to 3 weeks as the hormone levels return to normal and the mother develops routines and a sense of control over her life.

There are several ways to cope with the postpartum blues. First, acknowledge your feelings. Discuss them with your husband or a close friend as well as your sense of being trapped and that these new responsibilities seem insurmountable. Don't feel you need to suppress crying or put on a "supermom show" for everyone. Second, get adequate rest. Third, get help with all your work. Fourth, renew contact with other people; don't become isolated. Get out of the house at least once a week—go to the gym, go shopping, visit a friend, or see a movie. By the fourth week, setting aside an evening a week for a "date" at home with your husband is also helpful. Take-out food and a rental movie can help you tap back into your marriage. If you don't feel better by the time your baby is 1 month old, see your healthcare provider about the possibility of counseling for depression. If the blues are making it impossible for you to care for yourself and your baby, get help as soon as possible.

Helpers: Relatives, Friends, Sitters

As already emphasized, everyone needs extra help during the first few weeks alone with a new baby. Ideally, you were able to make arrangements for help before your baby was born. The best person to help (if you get along with her) is usually your mother or mother-in-law. If not, teenagers or adults can be hired to come in several times a week to help with housework or look after your baby while you go out or get a nap. If you have other young children, you will need daily help. Clarify that your role is looking after your baby. Your helper's role is to shop, cook, houseclean, and wash clothes and dishes. If your newborn has a medical problem that requires special care, ask for home visits by a public health nurse.

The Father's Role

The father needs to take time off from work to be with his wife during labor and delivery, as well as on the day she and his child come home from the hospital. If the couple has a relative who will temporarily live in and help, the father can continue to work after the baby comes home. However, when the relative leaves, the father can take saved-up vacation time as paternity leave. At a minimum he needs to try to work shorter hours until his wife and baby have settled in.

Not only does the mother need the father to help her with household chores, but the baby also needs to develop a close relationship with the father. Today's father helps with feeding, changing diapers, bathing, putting to bed, and so forth. The father needs to be his wife's support system. He needs to relieve her in the evenings so she can nap or get a brief change of scenery.

A father may avoid interacting with his baby during the first year of life because he is afraid he will hurt his baby or that he won't be able to calm the child when the baby cries. The longer a father goes without learning parenting skills, the harder it becomes to master them. At a minimum, a father should hold and comfort his baby at least once a day.

Visitors

Only close friends and relatives should visit you during your first month at home. They should not visit if they are sick. To prevent unannounced visitors, the parents can put up a sign saying MOTHER AND BABY SLEEPING. NO VISITORS. PLEASE CALL FIRST. Friends without children may not understand your needs. During visits the visitor should also pay special attention to older siblings.

Feeding Your Baby: Achieving Weight Gain

Your main assignments during the early months of life are loving and feeding your baby. All babies lose a few ounces during the first few days after birth. However, they should rarely lose more than 7% of the birth weight (usually about 8 ounces for a 7 pound birth weight). Most bottle-fed babies are back to birth weight by 7 days of age, and breast-fed babies by 10 days of age. Then infants gain approximately an ounce per day during the early months. If milk is provided liberally, the normal newborn's hunger drive ensures appropriate weight gain.

A breast-feeding mother often wonders if her baby is getting enough calories, since she can't see how many ounces the baby takes. Your baby is doing fine if he or she demands to nurse every 1 1/2 to 2 1/2 hours, appears satisfied after feedings, takes both breasts at each nursing, wets 6 or more diapers each day, and passes 3 or more soft stools per day. Whenever you are worried about your baby's weight gain, bring your baby to your healthcare provider's office for a weight check. Feeding problems detected early are much easier to remedy than those of long standing. A special weight check 1 week after birth is a good idea for infants of a first-time breast-feeding mother or a mother concerned about her milk supply.

Dealing with Crying

Crying babies need to be held. They need someone with a soothing voice and a soothing touch. You can't spoil your baby during the early months of life. Overly sensitive babies may need swaddling for comfort.

Sleep Position

Remember to place your baby in his crib on his back. As of 1992, this is the sleep position recommended by the American Academy of Pediatrics for healthy babies. The back (supine) position greatly reduces the risk of Sudden Infant Death Syndrome (crib death).

Taking Your Baby Outdoors

You can take your baby outdoors at any age. You already took your baby outside when you left the hospital, and you will be going outside again when you take him or her for the two-day or two-week checkup.

Dress the baby with as many layers of clothing as an adult would wear for the outdoor temperature. A common mistake is overdressing a baby in summer. In winter, a baby needs a hat because he or she often doesn't have much hair to protect against heat loss. Cold air or winds do not cause ear infections or pneumonia.

The skin of babies is more sensitive to the sun than the skin of older children. Keep sun exposure to small amounts (10 to 15 minutes at a time). Protect your baby's skin from sunburn with longer clothing and a bonnet.

Camping and crowds should probably be avoided during your baby's first month of life. Also, during your baby's first year of life try to avoid close contact with people who have infectious illnesses.

Medical Checkup on the Third or Fourth Day of Life

Early discharge from the newborn nursery has become commonplace for full-term babies. Early discharge means going home in the 24 hours after giving birth. In general this is a safe practice if the baby's hospital stay has been uncomplicated. These newborns all need to be re-checked 2 days after discharge to see how well they are feeding, urinating, producing stools, maintaining weight, and breathing. They will also be checked for jaundice and overall health. In some cases, this special re-check will be provided in your home.

The Two-Week Medical Checkup

This checkup is probably the most important medical visit for your baby during the first year of life. By two weeks of age your baby will usually have developed symptoms of any physical condition that was not detectable during the hospital stay. Your child's healthcare provider will be able to judge how well your baby is growing from his or her height, weight, and head circumference.

Try to develop a habit of jotting down questions about your child's health or behavior at home. Bring this list with you to office visits to discuss with your healthcare provider. Most physicians welcome the opportunity to address your agenda, especially if your questions are not easily answered by reading or talking with other mothers.

If at all possible, both the mother and father should go to these visits. Most physicians prefer to get to know both parents during a checkup rather than during the crisis of an acute illness.

If you think your newborn starts to look or act sick between the routine visits, be sure to call your child's healthcare provider for help.