Newborn Care

Newborn Jaundice

What it is, why it happens and how to treat it at home

Have you ever noticed how newborn babies often have a really healthy glowing tan? It’s as if they went on holiday to the south of France without you before they arrived. This glowing tan is often a sign of jaundice and whilst jaundice in adults is a sign of ill-health, in newborn babies it is very normal.

Ok. Are you ready for the science?

Cast your mind back to those school day science lessons. While the dreary teacher drones on in the background, you doodle love hearts and flowers in your notebook. (Just me? Oh well, never mind.)

Your teacher probably mentioned that the air that we breathe is made up of lots of gases. Oxygen is the essential one that we all need to provide energy for all our cells and organs. Air has about 21% oxygen in it. This is a perfect amount for our bodies to function well.

So, pregnant women breathe that 21% oxygen and the oxygen is absorbed by their bloodstream which then delivers the oxygen to all their organs. Because of that, by the time the blood reaches the placenta, it has about 16% oxygen in it. The placenta is where the oxygen in the mother’s blood gets passed over to the baby for him or her to use to power their own cells and organs.

Babies handle this lower level of oxygen really well because they have unique red blood cells with fetal haemoglobin molecules. Don’t worry, I’m not going to start an in-depth atom by atom description of haemoglobin. All you need to know is that fetal haemoglobin molecules are extra sticky when it comes to oxygen. That means that although there is only 16% oxygen passing over to the baby, the baby picks up all of it. They can make it work just as well as we do with our 21%.

What happens once a baby is born

As babies are born, they begin to breathe the air around them. They can use the 21% oxygen in that normal air, rather than relying on the oxygen in the bloodstream of their mum. This means they don’t need that extra sticky type of haemoglobin molecule. Because of that, their body starts to change from using fetal haemoglobin to creating adult haemoglobin molecules.

Being excellent at recycling from the start, their bodies break down the fetal haemoglobin into its various parts like iron and lots of proteins. Most of these parts are reused by the baby to create adult haemoglobin molecules. However, there is one part which is not reused, the yellow pigment called Bilirubin.

Bilirubin

Bilirubin is the cause of babies’ yellow skin. As the baby doesn’t need it, it gets rid of it. Some of the bilirubin will come out in the baby’s nappy. You may have noticed the transition in colour of your baby’s poo from sticky black tar, through various mixes of brown and green and on to a chicken korma or mustard-like colour. You can take this change as a very good sign that your baby is feeding well and adapting perfectly to life outside the womb.

The tan on your baby’s face, torso, and even limbs is caused by extra bilirubin that hasn’t exited via their nappy. You can tell if it is jaundice by pressing lightly on their nose. As you release the pressure the skin underneath will show the yellow more clearly.

As I’ve already said, jaundice is a normal reaction to being born, so in the majority of babies, it is nothing to be worried about. However, sometimes bilirubin levels can rise to such an extent that they can cause the baby problems.

When jaundice is a problem

Babies who are struggling to get rid of the bilirubin levels in their body can start to seem extra sleepy or lethargic. They often aren’t pooing or still have dark poos rather than yellow ones. They may not seem all that interested in eating and you may have trouble waking them up enough to feed.

If your baby has any of these symptoms, please contact your midwife or GP as soon as possible

Very few babies need extra treatment to help them reduce their bilirubin levels. The usual treatment is phototherapy, where they get to lie under a mattress which gives out UV light. You may have seen photos of this or noticed babies on the TV having this treatment. They are surrounded by a blue light source and often wear cute little sunglasses! The UV light helps to break down the bilirubin lying under the skin. Once it is broken down, the baby can poo it out.

Treating Jaundice at home

The good news is that just two minor alterations in your baby’s routine can reduce the risk of him or her needing hospital treatment.

First of all, make sure your baby is feeding regularly. As they feed, their body will move the bilirubin out of their system with the waste products. You’ll see it in the nappy!

Secondly, keep your baby in bright rooms during daylight hours. Natural daylight contains UV light, so you have your own free source of phototherapy! If you set the baby’s cot, pram or Moses basket next to a window, the daylight will help break down the bilirubin under the baby’s skin. Please don’t think that it needs to be direct sunlight as too much direct sunlight may cause the baby to overheat. We also live in the UK, where actual sunlight isn’t always available! Don’t worry, just keeping little one near the window will make a difference.

The key is to avoid putting your baby in a dark inner corner of the room far from the windows. You also don’t need to expose lots of the baby’s skin to the daylight. Their face will be enough surface area if it is cold, although if it is warm you can certainly take off their baby grow. Leave them with their vest on and arms out, but put a blanket over their bodies to keep them cosy.

So there you have it. A simple explanation of newborn jaundice and how to treat it yourself so that you don’t need to go back into hospital.

For more information on Jaundice, you can visit the NHS website here

You can also find information on charities and organisations which can help you with feeding problems on my useful links page.

 

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Pregnancy

What to expect at a pregnancy booking appointment

First Impressions

So you’ve made it to 8 weeks or thereabouts! Well done to you and to little one! Now you get to meet your community midwife for your pregnancy booking and it all feels a little more real.

 

 

First things first – don’t be scared!

Community midwives are a great support during your pregnancy and they are all well trained in being lovely. She will know that you might be feeling anxious and will be keen to put you at ease and get excited with you about your pregnancy.

 

Take someone with you.

You don’t have to take anyone with you, especially if your appointment is at a time that only just fits in with your job. However, if you are apprehensive then taking a friend along is perfectly ok with us! The friend might be your partner or a family member or just a friend who has been through it before themselves.

 

It takes a little while. 

This is not a quick appointment where you’ll be in and out in 10 minutes. Be prepared for it to take up to or even slightly more than an hour. You may need to consider this when paying for parking or considering taking children with you. Bring a drink and snacks for yourself if you need to, we understand how hungry pregnant ladies get!

 

Brush up on your family history.

Part of the booking appointment involves taking a detailed history of your health. However, we will also want to know about your partner’s medical history and any medical issues on both sides of the family. If you aren’t sure, chat to your parents and your partner’s parents. Ask about their health, their brothers and sisters and their parents. Do they take any regular medication? Was anyone born with problems with their eyes, hearing or hearts? Does anyone have to eat special diets or are there any twins in the family?

 

 

Check local maternity unit options.

Depending on where you live, there may be several options for where you can have your baby. You can discuss this with your community midwife. Have a look at the Birth Choices website which provides information on the size of maternity units close to you, as well as available facilities and user feedback.

 

Planning your care. 

Once your midwife has taken your history and recorded details of any medical issues or past pregnancies, she’ll be able to give you an idea of your individual pregnancy care plan. That includes when you will have a scan and whether you will need to see a doctor who specialises in pregnancy (an obstetrician). You’ll have a clearer idea of when your next appointment is and you’ll get your own copy of your pregnancy notes.

 

Your notes – becoming attached to them.

The booking appointment enables us to create a set of pregnancy notes for you. These notes include all the information you have provided and gives you other information about your local maternity services. They also include telephone numbers to use if you have any concerns and are therefore useful for you and us! If you go anywhere while you are pregnant – abroad, just within the UK or just 20 miles down the road, take them with you. Should you need urgent care, the notes provide any maternity unit with important information about you and your pregnancy. Don’t leave the house without them!

 

Blood tests.

You will probably need to have some blood taken for various tests at the beginning of your pregnancy. I will write another post about the tests themselves later on. Just be warned that your community midwife will likely be eyeing up your veins at some point during the booking appointment. Don’t worry if you are scared of having your blood taken. Midwives do it every day and are very good at it. We will do our best to put you at ease, letting you sit or lie down. Calm, gentle conversation can also be wonderfully distracting. If your partner is with you, this could be a perfect time for them to practice helping you stay calm!

 

Meeting your midwife
What happens at your first appointment in pregnancy

 

So there you have it, a general guide to your first appointment with your midwife. It seems like a lot to fit into just one hour. Your head will definitely be bursting with information by the end. You can ask any questions you can think of before you leave. Don’t worry if some pop up in the following days. Make a note of them and when you see your midwife again you’ll be ready to find out the answers.

 

Most midwives will have several booklets and leaflets to give you. This is great as you can read the information in your own time at home. You can also find helpful information on the NHS Pregnancy pages or by downloading one of the many available pregnancy smartphone apps. My recommendation for the smartphone app would be Baby Buddy, which is a UK based app run by a charity, so they aren’t trying to sell you anything or get your name on a mailing list. They just want to give you accurate up-to-date information to help you have a healthy pregnancy.

For further reading around pregnancy care, see my useful links page

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Labour and Birth, Pregnancy

5 Pro tips for surviving early labour

So, the time has arrived.

Baby is now past 37 weeks and could arrive at any time.

You’ve had some tightenings and even very painful Braxton Hicks contractions but then everything stops.

Your hopes are dashed.

The following night, things start up again.

Painful tightenings get closer and closer, sometimes taking your breath away.

You’re up pacing the house in the wee small hours but then morning comes and the contractions fade as the sun rises above the horizon.

You can feel like you’re going crazy. No sleep and no progress can really bring you down.

What do midwives recommend for those long relentless hours?

  • Rest:

This is really really important. There is no easy way to tell how long this will last but in the worst case scenario, you may still have some days to wait until labour becomes consistent. Take whatever rest you can, in large and small amounts spread throughout the day. If you have older children, enlist family and friends to entertain them for a while so you can nap. It’s not easy, but perhaps it is mother nature’s way of preparing you for the sleepless nights to come when baby arrives!

  • Eat:

Get plenty of good nutrition on board. Labour is extremely hard work and you need to have a good supply of energy to help keep your contractions strong and effective. When labour really kicks in, you might not feel like eating so think like a marathon runner and eat as preparation.

  • Try out your pain relief strategies:

Some people go into labour knowing exactly how they will cope with the pain. Others have no idea what they want to try or what will or won’t work. There are so many strategies to choose from, it’s an entire post of its own (coming soon). However, these early painful episodes can be useful in figuring out whether your partner is any good at massaging, or whether the TENS machine you hired online is just going to drive you crazy.

  • Bathe or shower:

Water is well known to relieve labour pain, although you may have to wait until you get to hospital to try out the wonderful wide, deep birthing pool. Luckily, you can definitely try a comforting bath or stand under a cozy warm shower at home at this early point. For some, this may settle the pains down, which will give you a chance to rest. For others, the warm soothing waters can relax them enough to help the contractions get stronger.

  • Check your bags are packed and ready:

Another good idea is to take the time to make sure you’ve got everything packed ready for the hospital. There are tons of great lists online of what to pack and my own list is on its way. While the pains are reminding you of their purpose in bringing baby ever closer, use that focus to ensure nothing gets left behind.

However long these times last, please remember that the baby at the end is definitely worth everything you’re going through. You are stronger and fiercer than you know and you can do this!

Are you worried that the pains are too early or might be real labour pains? Please contact your local maternity unit as soon as possible.

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Pregnancy

You’re pregnant!

Is it really true?

Maybe you’re feeling a little sick, perhaps your boobs are incredibly sensitive or maybe your period just hasn’t arrived. You’re incredibly tired or constantly on the loo or unable to stomach your usual morning coffee. Perhaps you’ve got all these symptoms or perhaps you have none.

Whatever makes you suspect pregnancy, you potter off to your local supermarket or pharmacy and head for the aisle with the pregnancy tests. Some people may hide under an impressive sunhat and dark glasses, paying via the self-checkouts and praying to whoever that they don’t run into someone they know. For others, its a team trip. Your best friend, partner or mum comes along, and you discuss the pros and cons of each type of test.  You then proudly take it to the staffed checkouts and smile broadly at the cashier.

 

Test Options

Tests come in many different packages and seem to offer a myriad of different options. Some proclaim they can tell you incredibly early on, whilst others tell you in words instead of faint lines, to avoid confusion.

Whichever test you choose, they are all looking for the same thing: human chorionic gonadotropin (hCG). This hormone is produced by the growing embryo and is, therefore, a good indicator of pregnancy. The levels being produced by the embryo increase steadily in the first few weeks of pregnancy. If you are using a pregnancy test in the very early weeks of pregnancy (2 – 4 weeks) it is better to use the first urine passed in the morning. This will have higher levels of the hormone and therefore give a more accurate result.

Pregnancy tests these days are very reliable. Most GPs and midwives will not require a laboratory test to confirm what your home test has told you. However, it is worth waiting until you are at least 6 weeks pregnant before you book an appointment with your GP or midwife. This is because there is a higher risk of miscarriage around the time your next period is due. Hopefully this little one will cling on and keep growing well. Good luck!

Did you know?

Before the wide availability of over the counter pregnancy tests, you had to provide a urine sample to your GP. That urine was sent to a hospital laboratory where there were lots of frogs sitting around in cages. A small amount of the urine was injected into a frog and if you were pregnant, the hCG in your urine would cause the frog to produce eggs within 24 hours! Congratulations!

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