Caring for your newborn baby with jaundice

Newborn Jaundice

Many of us have seen a jaundiced baby with a slight yellowish tinge to the skin in those early weeks. But what is jaundice? What can we do to help reduce jaundice? And when do we need to seek medical advice??

What is Jaundice?                                                                         

Jaundice is caused by the build-up of bilirubin in the blood. Bilirubin is a yellow substance produced when red blood cells are broken down. Jaundice is common in newborn babies because babies have a high level of red blood cells in their blood, which are broken down and replaced frequently. The liver in newborn babies is also not fully developed, so it's less effective at removing the bilirubin from the blood. By the time a baby is about two weeks old, their liver is more effective at processing bilirubin, so jaundice often corrects itself by this age without causing any harm. Of course the amount of bilirubin dictates how yellow/orange your baby is and the higher the level the more noticeable the effects. 

Symptoms of jaundice

Physiological Jaundice; occurs naturally 2 to 4 days after birth. It can last up to 2 weeks.

Skin begins to develop a yellow tinge; beginning from the face and head and often spreading downwards. If your baby has olive or dark skin, the yellow tinge may not be as obvious. The whites of her eyes, inside the mouth, palms of the hands and soles of her feet may also turn yellow.

·         Urine may be dark yellow rather than colourless

·         Pale coloured poo

Pathological jaundice: In a small number of cases, jaundice can be the sign of an underlying health condition. This is often the case if jaundice develops shortly after birth (within the first 24 hours).

How common is it?

Jaundice is one of the most common conditions that can affect newborn babies. It's estimated 6 out of every 10 babies develop jaundice, including 8 out of 10 babies born prematurely (babies born before the 37th week of pregnancy). However, only around 1 in 20 babies has a blood bilirubin level high enough to need treatment. For reasons that are unclear, breastfeeding a baby increases the risk of them developing jaundice, which can often persist for a month or longer, known as breastmilk jaundice! In most cases, the benefits of breastfeeding far outweigh any risks associated with jaundice.

 When to seek medical advice

Your baby will be examined for signs of jaundice within 72 hours of being born, during the newborn physical examination. If your baby develops signs of jaundice after this time, speak to your midwife, Public Health Nurse or GP as soon as possible for advice. While jaundice isn't usually a cause for concern, it's important to determine whether your baby needs treatment.

If your baby has jaundice when you come home, it's also important to contact your Gp urgently if their symptoms quickly get worse or your baby;

·         becomes very sleepy,

·         becomes very reluctant to feed,

·         is difficult to rouse for feeds

·         or the jaundice is getting more yellow and travelling down the body

Treating newborn jaundice

Most cases of jaundice in babies don't need treatment as the symptoms normally pass within 10 to 14 days, although symptoms can last longer in a minority of cases. If your baby has normal physiologic jaundice, there are several things you can do to help your baby’s body clear it more efficiently:

·         Frequent feeding – bilirubin is excreted by your baby’s stools. Breastmilk is an excellent laxative, and breastfed babies tend to poo more frequently, excreting bilirubin faster. All fluid intake will help to flush the bilirubin from your baby’s body.

·         Window therapy – sunlight helps to break down bilirubin in the skin, so the liver can process it more easily. Ten to fifteen minutes of exposure next to a closed window four times a day is enough. Sunburn is possible, so keep an eye on the time and be sure to avoid peak sunlight.

Treating more severe or pathological jaundice

Treatment is usually only recommended if tests show a baby has very high levels of bilirubin in their blood. This is because there is a small risk that the bilirubin could pass into the brain and cause brain damage.

There are two main treatments that can be carried out in hospital to quickly reduce your baby's bilirubin levels. These are:

·         phototherapy – a special type of light shines on the skin, which alters the bilirubin into a form that can be more easily broken down by the liver

·         an exchange transfusion – a type of blood transfusion where a small amount of your baby's blood is removed and replaced with blood from a matching donor

Most babies respond well to treatment and can leave hospital after a few days.

Complications

If a baby has very high levels of bilirubin, which isn't treated, there's a risk they could develop permanent brain damage. This is known as kernicterus.

Kernicterus is very rare in the UK, affecting less than 1 in every 100,000 babies born. (NHS 2015)

 

 

Baby Reflexology; a beautiful therapy to learn with your baby.

Reflexology is a beautiful therapy to enhance nurturing relationships with your little one, developing a sense of security and attachment. You can introduce reflexology to your child at any stage and enjoy the immediate benefits. Reflexology is a safe and effective therapy to use with babies and children, encouraging health and wellbeing, promoting bonding and comforting, soothing digestive complaints, and boosting the immune system. It can be used anywhere and at any time of the day or become part of the bedtime routine encouraging a restful sleep.

So what is Reflexology?

Reflexology is the application of touch and massage to areas of the feet or hands that correspond to specific areas of the body, which are mapped out on the hands and feet.  There are many forms of reflexology with varying styles and pressure, but the pressure applied on babies and children should always be very gentle. Gentle touch Reflexology developed by Sue Ricks of ‘Sue Ricks Clinic & School of Complementary Therapies UK’, is a gentle reflexology therapy suitable for babies and children…

A brief history of Reflexology

Reflexology has been around for thousands of years. It dates back to ancient cultures and had been practised by American-Indians, Chinese and other Asian countries and by African tribes. Dr. William Fitzgerald, an American Ear, Nose and Throat (?) (ENT) surgeon who developed the theory of the link between reflex zones in the feet and hands with corresponding areas and organs of the body, introduced reflexology to the West in the early 20th century. Dr Fitzgerald’s fellow American – Eunice Ingham, a physiotherapist, went on to refine and develop zone therapy.

In 1938, she published her first book: “Stories the Feet Can Tell“, which very quickly spread the word about the benefits of Reflexology. Eunice travelled the world attending health seminars where she spoke with medical practitioners about her therapy.

Reflexology finally arrived in Europe, including mainland Britain, in the 1960s and in Ireland in the 1980s. It is rapidly growing in popularity in Ireland and is becoming firmly established as an effective and gentle complementary therapy, which can be practised on persons of all age groups, even newborn babies! 

Positive touch

There is much research out there supporting how ‘positive touch’ and ‘tactile stimulation’ promote your baby’s brain development, and the strong nurturing bond between parent and baby.  In recent years, a wave of studies has documented some incredible emotional and physical health benefits that come from touch. Dr. Dacher Keltner from the UC Berkeley Department of Psychology, USA, notes that the research is suggesting that “touch is truly fundamental to human communication, bonding, and health. The benefits start from the moment we’re born”.

A review of research, conducted by Dr. Tiffany Field, a leader in the field of touch, found that preterm newborns who received just three 15-minute sessions of touch therapy each day, for 5-10 days, gained 47% more weight than premature infants who had received standard medical treatment. According to Dr Tiffany Field, Director of the Touch Research Institute at the University of Miami, School of Medicine, “a massage before bedtime is more effective than rocking at helping your baby fall asleep and stay asleep.”  The beauty and joy of reflexology is that it is one way to introduce positive and appropriate touch to children to enjoy as they grow up.

Sue Ricks (2009) explains how some children are deprived of touch and this can be attributed to the fact that many adults are too busy or too stressed to relax, or they may find it difficult to offer cuddles, hugs and mini-massages as they were not used to it themselves. Reflexology is a way to introduce positive touch and is a simple therapy for parents and caregivers to learn, which they can then give to their own loved ones.

Reflexology for babies and children

The beauty of reflexology is that it ‘grows’ with your child. You can start reflexology from birth and your child can enjoy it for years to come. In fact often a child as young as one or two will present their feet and ask you to ‘do my feet’. When your child gets older, they simply adore this undisturbed one to one time with you. While doing feet or hands, you are in a great position to chat about the day with your child if you wish, or they can simple close their eyes and RELAX!

Babies

Reflexology can improve bonding between parents and babies, aids restful sleep and boosts the immune system. In particular, reflexology provides a drug free approach to ease complaints such as:

  • Colic;
  • Constipation;
  • Reflux;
  • Teething;
  • Nasal congestion;
  • Eye and ear complaints;
  • Restlessness and sleep issues.

Children (including teenagers!)

Reflexology promotes communication and relationships between a parent and their child. It promotes rest and relaxation, improves concentration, self-confidence and self-esteem and combats complaints such as:

  • Headaches;
  • Anxiety;
  • ‘Tummy’ aches, constipation;
  • Eye, ear and throat congestion;
  • Sleep disturbances ;
  • Behavioural problems.

Babies and children can be taken to a reflexologist for a treatment, or a series of treatments and/or parents/caregivers can learn this beautiful therapy in simple terms to give to their own loved ones.

What Parents say!

I have been practicing reflexology everyday lately, since my baby developed a bunged up nose and cough at the weekend. I found it a great way to connect with him and give him some relief, it was calming and enjoyable for us both as it allowed me time to concentrate on a stress-free method of providing him with care in an acute situation. He loves it! Thanks Marie for sharing all your knowledge on reflexology” – Jacki

I brought my son to baby reflexology classes. I really enjoyed this experience as I got to bond with him while learning how to help him with wind and digestion, etc. I love to practice now whenever I can! It was lovely meeting other mothers too” – Noreen

I would definitely recommend using baby reflexology with your little one. I think it’s a relaxing and soothing experience for both baby and mother” – Sarah

On a personal level, I give all my 4 children reflexology. They ask for it regularly and simply love the ‘feel’ of it and the one-to-one time with Mum. I would always use reflexology to help conditions such as teething, constipation, stuffy noses and so on, and find it definitely works.  My littlest girl has loved reflexology since she was a baby, although, when she got to one, I often had to give it in little short treatments lasting only a couple of minutes as she would not stay still!! Now she is three and presents her feet asking ‘will you do my feet?’ I have found it also a useful way to stay nice and calm during tantrum or crying episodes. Gently holding the solar plexus point in the hands or feet is extremely calming for both giver and receiver. I would highly recommend any parent to learn this beautiful therapy.

Marie, a mother of 4, Public Health Nurse and Reflexologist, delivers baby reflexology classes in her own home outside Bruff, County Limerick. see http://www.mariedrakeboyle.ie/baby-reflexology-classes/

References
Field, Tiffany (2010) Preterm infant massage therapy research: A review In Infant Behaviour and Development Vol 33 issue 2 Pages 115–124
Keltner, D (2010) Hands-On Research: The Science of Touch In Greater Good; the science of a meaningful life
Ricks, Sue (2009) The Gentle Touch of Reflexology for Babies and Children

 

Getting Breastfeeding off to a good start

Breastfeeding has huge benefits for both mum and baby, but it does take time and practice to get established. It is very important to get hands on help in the early days and weeks. The midwives will provide breastfeeding support, but it is also a good idea  to ask for the lactation consultant in your maternity hospital during your stay to get additional help. Arm yourself with good breastfeeding resources and its a good idea to have looked at some breastfeeding videos and look at them again when your baby with with you. See my Breastfeeding Resources page for more info. The following points will help you to get breastfeeding off to a good start; 

 

Skin to skin contact. The more skin to skin contact in the early days and weeks the better, the first 18 hours being crucial. So spend time with your baby lying on your chest skin to skin. Your chest is 2 degrees warmer than the rest of your body at this stage so an ideal place to warm your baby. Your baby has a heightened sense of smell and will make her way to the breast by her sense of smell!!

You will initially produce colostrum, the highly nutritious first milk and then your milk will ‘come in’ around day 3, meaning that the breast milk will be more like the colour of milk and you will feel fuller.

Watch for your baby’s Feeding Cues; such as eyes fluttering before she awakes, smacking her lips and mouth movements, hands to the mouth, turning head towards the breast (rooting)

Comfortable position for you and baby. Hold your baby close, supporting head shoulders and baby’s feet. You can choose whatever position you like most: cradle hold, rugby hold, upright or laid back position. Just ensure that your baby can tilt her head back easily to allow her to lift her chin and latch on to the breast. And also have her positioned in such a way that she does not have to twist her head to reach the breast. A chest to chest position usually enables this.

Attaching your baby to the breast Position your baby nose to nipple to allow your baby to tilt her head to reach the breast. (Remember if you want to take a drink yourself you would tilt your head back!) When your baby tilts back her top lip will brush off your nipple stimulating her to open her mouth wide. When she opens wide, bring her closer to the breast allowing her to take your nipple and surrounding areola deep into her mouth, leading with her chin. To help her, guide your nipple towards the roof of her mouth. (You need a deep latch to avoid your nipple being pinched by the ridge along your baby’s hard pallet. The tip of the nipple needs to extend beyond this point!)

Checking the latch Check your baby is latched on well and ask the following questions.

  •   Mouth open wide
  •  A large portion of areola in her mouth especially near her chin with a little visible above her upper lip?
  • Lower lip flanged out
  • Nose clear of breast
  • Head tilted back
  • No continuous pain after initial pinch
  • Sucking quickly at first but now slowing to longer sucks and pauses allowing her to swallow ( you may hear her swallowing when her chin drops)
  • Jaw is moving up near the ears while sucking
  •  Cheeks are rounded
  • No clicking or smacking sounds
  • If your baby does not appear to be latched on correctly, take her off the breast by placing a clean finger into the side of her mouth to break the ‘suction’ and start over.

Your baby will come off the breast herself when she has had enough. Although we do not time feeds as such, 20 to 40 minutes is a rough guide as to how long your newborn baby should be feeding. You can offer the second breast if you feel she is not satisfied. She may only take a little but you can start with that breast on the next feed.

Feed on demand. Your baby will need 8 to 12 feeds in the 24 hours. Sometimes newborn babies ‘cluster feed’ at some stage during the day where they will feed several times over a few hours. Feed on demand and let your baby take the lead.

Relax while feeding. It is important to make yourself comfortable while feeding, as this helps your ‘let down reflex’, allowing your milk to flow. Breastfeeding triggers excessive thirst while feeding. Try keeping your shoulders down and relaxed (your partner could also give you a shoulder massage!!), having a glass of water and a good book or the TV remote to hand!!   

It takes 3 to 4 weeks to get established at breastfeeding. It’s important to prioritise breastfeeding in the first few weeks, to give yourself and your baby time to learn this new skill. Once established, breastfeeding will become so easy and convenient.  

Note your baby’s wet and dirty nappies.

  • Day 1 to 2    Wet: 1-2                        Dirty: 1 or more Black tarry meconium
  • Day 3 to 4    Wet: 3 or more           Dirty: 2 or more greenish stool
  • Day 5            Wet: 5-6 or more       Dirty: 2 or more yellow seedy
  • Day 7+          Wet: 6 or more           Dirty: 2 or more yellow seedy

Positive breastfeeding support is vital. One to one support from lactation consultants and your PHN should available to you in the early days. Check out details before you leave the maternity hospital. Join a breastfeeding support group near you and/or join a breastfeeding Facebook support group, where you will get the much needed mother to mother support and some expert advice also.   (see http://www.mariedrakeboyle.ie/breastfeeding-resources-and-support/ for more details..

 

 

 

6 Effective Ways to cope with Labour

We all worry about how we are going to cope with labour and it is daunting the first time around. Of course each labour is different so there is always some apprehension, even for mums heading into their second or subsequent labour. If you feel prepared and understand labour, it somehow helps you and your partner to cope more effectively. Here are my top tips for coping in labour once you get their!

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Positive affirmations for Pregnancy, Birth and New Baby

Positive affirmations are positive words, phrases or sentences said repeatedly with conviction and attention. Rather than blanket positive thinking, affirmations are simply a way for you to take the steering wheel on your thoughts, and therefore have a huge effect on the way you feel and the experiences you have.

Positive affirmations can have a dramatic effect on one’s outlook towards any situation! It is a simple and very effective way to boost self-esteem, self-confidence and our overall positivity, ideal for use in pregnancy and facing birth and new parenthood.

Read More

5 Top tips for Coping with Labour

It is a really good idea to prepare yourself for labour and birth, both physically and emotionally. Whether it's your first or subsequent baby, it is so important to head into this life changing event, relaxed, confident and informed. Here are my top 5 tips on preparing for and coping with labour!

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Loving your little one!

The early weeks and months of your baby's life are particularly special. So much change, all so new if its your first little one, a huge transition from the life you once knew. But with each addition to your family this is a very special time of change and readjustment. So how do you adjust? Being prepared helps of course. Knowing a little of what to expect takes the fear away. But yes, once you come home from hospital with your little bundle of joy, the reality hits you. Your life changes and suddenly (after many months of anticipation!!) you are responsible for this new little being. 

So what can I tell you? You love this little person. You begin to bond, some immediately, some take little more time (that's OK). You are apprehensive about feeding, changing, bathing, settling your little one, but, in a short time, you will learn and become an expert in all those fields! You need support (everyone needs support!), supporting each other, seeking out support from family, friends, health professionals, groups, is essential. You are sleep deprived! But you will find ways to carry on regardless, and let me assure you, you will get a nights sleep again in the future!!  You do worry!! Is your baby hungry, tired, windy... Soon you will get to know your baby. You will decipher their needs and will recognise feeding cues, discomforts, tiredness. You are on an emotional rollercoaster!! You will never have experienced so many emotions all at the same time. Love, excitement, euphoria, relief, joy, pride, apprehension, anxiety, panic; the highs and lows of the emotional rollercoaster for both parents. 

How can I advise you? Cherish the moment. Spend time enjoying your baby. Skin to skin contact as much as possible in the early weeks. Look at your baby, make eye contact, smile, chat, sing. Kiss, cuddle, hold, rock, comfort your little one. Forget routines for the early days and weeks. Feed on demand, whether breast or bottle. Observe their tiny hands and feet, little facial expressions, little noises and funny quirks... Take lots of photos and videos!!

Yes, there will be hard days and better days. Although, it is a huge transition, parenthood is wonderful, fulfilling and overwhelmingly rewarding! 




Birth plan? Do I need one? YES!!

"Do i need a birth plan?", I hear you ask! Who will read it? Sure will I just go with the flow as labour can be so unpredictable? 

If it was this easy.....!!  :-)

If it was this easy.....!!  :-)

YES, you do need a birth plan, whether you actually write it down or not, is up to you. It is very important to discuss this with your partner.  There is no right or wrong way to approach labour. Each one of us have different ambitions, hopes and expectations of labour and birth. Let your midwife know what kind of a labour you are hoping for and she will endeavour to assist you, while informing you of any need to deviate from your wishes. 

To make that plan you need to be informed! Here are some of the many considerations, but don't feel too daunted. If you go down through the list, you will be able to answer most of the questions without too much thought. Other areas need a little research to make that decision easier. There are hospital policies in place also, which may influence some decisions, but if you have a particular concern, routine policies can be discussed with your midwife and doctor. 

  • Birth partner; who will accompany me in labour?
  • Where do I wish to have my baby; hospital, home birthing room (hosp), at home? 
  • Atmosphere?; lights low, calm surroundings, music can enhance your labour hormones
  • Upright and mobile for as long as possible? (even with fetal heart monitor attached, if possible)
  • What natural pain relief method do I want to use? Breathing and relaxation techniques, meditation, visualisation, acupressure, TENs, affirmations
  • What pharmacological pain relief methods do I wish to use? Entonox Gas, pethidine, epidural.
  • Would I prefer to be offered pain relief or do I want to ask for it when I feel I need it?
  • Would I prefer my baby delivered straight onto my chest? Routinely done in most cases. 
  • Would I prefer to have delayed cord clamping? Usual practice but sometimes could do with a mention in labour!
  • Would my birth partner or I wish to cut the umbilical cord? Nice little ritual for birth partner or indeed Mum.
  • Would I prefer active management or physiological management of the third stage of labour (delivery of placenta)? Active management is standard hospital practice so research this if you want very 'natural' labour!
  • Have I plans to use my placenta afterwards? Placenta encapsulation or otherwise, you need to know if you need to save your placenta for this and if so tell your midwife. 
  • Would I prefer to continue skin to skin contact for as long as possible? I would advocate for this!!
  • Would I like to breastfeed my baby?

Again,  there is no right or wrong approach, but going into labour blindly just adds to the stress and fear of the unknown. And yes of course labour is unpredictable, but there are many elements within your control and, if you and your birth partner keep communicating with your midwife and doctor, you will have a more positive overall experience. Enjoy this journey, it is not one to be feared. It is empowering and overwhelmingly beautiful!!

If you have any considerations to add, I would love to hear them!

 

(all topics above are explored in my antenatal classes) 

 

 

Loving Tummy Time

I just love tummy time! Although it sometimes takes a while for your baby to love it too. The key is to start early and be consistent! Ok, from the moment after the birth of your beautiful baby, tummy time begins, with placing your baby on your chest, skin to skin, chest to chest. It would surprise you how many babies will lift their heads!! This is a lovely position for Mum and Dad to use in the early days, slouched back on the couch enjoying tummy time. From then on, you can give your baby small periods of tummy time, like a minute or so, a few times a day, nappy changing time is ideal, I find. Ensure this is a relaxed time for your baby and not when your baby is tired or hungry for example.

So how does it help your baby’s motor and physical development? Spending time on the tummy encourages the development of your baby’s head, preventing ‘flathead’ and misshapen heads. It is also fantastic for strengthening back and shoulder muscles. Fine motor skills are enhanced too, with your baby reaching and grasping little toys, blankets etc.

As your baby grows, he or she will get more proficient at tummy time and will enjoy this fun time. You can place toys within reach, different textures to touch, put him in front of a mirror to see his reflection! Soon he will be up taking his weight on his forearms (3-4 months), reaching out to grasp objects (4-5 months) and will be moving about and rolling before long (5-6 months)!!  

Enjoy!!

 

Excitement Building...1st Coffee Morning!

It is with great excitement I am hosting the first of many coffee mornings here in Baggotstown, Bruff, next Thursday. Over the last 6 months, I have had the pleasure of meeting the most wonderful, enthusiastic and committed parents-to-be, some first-time and some having their second or third babies.

Although I have worked with mothers, fathers, their babies and older children for almost 15 years, this is the first time I have really had the opportunity to support parents from pregnancy through to established parenthood, so to speak. As a midwife, I encountered many pregnant mothers and had the pleasure of delivering many new babies, and indeed met many babies and mothers in the first few days of motherhood. But, of course in the hospital setting, I could care for and support these parents at only one particular stage in the journey. As a Public Health Nurse, I now support mothers and fathers in the early days, weeks and years of parenthood, with great pleasure I might add! So this is why I am delighted to reunite with the new families, I had contact with during their pregnancy and since! 

The coffee morning will give parents a chance to reunite with those they met here at the antenatal classes, but will also offer a support network to each other, having babies of similar age! I will be their, of course, to offer support and advice of various elements of early parenthood challenges. But above all, we will have a cup of tea and chats and admire and enjoy all the little newbies!!