Tips For Changing a Newborn's Nappy

Changing those first nappies can be very daunting, but remember you will soon be a total pro at the quick change! Don't forget the contents of the nappy in these first days will be the tar-like meconium.  

Here are just a few of our tips. 

• Open the nappy and wipe any faeces with a clean part of the nappy. Discard the nappy (or fold it under the baby while you clean his bottom, as he is very likely to wee as you change him).
• Clean the bottom using pieces of cotton wool wet with warm water. (If you are going to use wipes use fragrance free)
• If the bum is really dirty it can be as easy to pop him into a bowl of warm water for a bottom bath
• Always wipe girl babies from their front to the back. 
• Be gentle around a boy’s penis. Do not pull the foreskin back.
• Always pat dry or allow air dry.
• Using a little petroleum jelly on the bottom can make cleaning the meconium a little easier.  You only need to use nappy cream, medicated powders or creams if he develops a rash or a sore bottom. 
•  Lay the new nappy flat under your baby- tabs to the back - with the top of the nappy-back in line with your baby’s waist. Bring up the nappy between his legs, peel back the tabs and fasten. (Make sure you clean your hands of petroleum jelly if the tabs are sticky-back – otherwise they won’t stick)
•  Make sure you leave boys with their penis down before you close the nappy. This is to prevent urine leaking up and over the top of the nappy, and to stop it going on the umbilical cord area.
• Keep nappy folded below umbilical cord stump. This helps the stump dry out and keeps urine away from the area.
• Nappies will often leak on newborn babies. This is not due to any inefficiency on your part, but because even the smallest nappies may be too big for your baby.  NB: If poo leaks out of the nappy (and it will!) avoid taking the dirty vest or body suit over his head. Envelope necks allow you to pull the soiled clothes down along his body And over his feet.

Mums’ Tips 

“If it’s a boy it needs to point down in the nappy!! We couldn’t understand why our 1st boy was always getting wet even though nappies were on securely.

 “I was told to always keep a soft cloth or towel under your baby when changing your baby on a plastic mat or hard surface. They do not like the sensation of cold or hard surfaces and will usually respond by crying. It seems to work.”

Tips for "Tummy Time"

“Tummy Time” helps your baby to strengthen the muscles in his neck, arms and shoulders, and it apparently also helps brain development.

Begin to give your newborn “tummy time” for a minute or two even in his first days.  When he is awake place him on his stomach on your chest or lap, with his arms forward so he can lean on them. Stroke the back of his neck and talk or sing to encourage him to lift his head.

As your child’s strength increases begin to give him “tummy time” on the floor.  Wooden floors often don’t allow babies to get enough of a grip so use a mat or rug. Try not to over stimulate babies too much during “tummy time” initially. Cover brightly coloured play-mats with a plain sheet for the first couple of weeks and just place one or two toys in eye range.”

Get on the floor beside him and play and sing to keep him distracted. Rolling a towel to support under his arms and shoulders may make him more comfortable. 

Don’t give babies tummy time on a full stomach, or when they are tired or hungry.

Use the three cry rule: 1. If he cries or shows that he wants to change position distract him with a toy; 2. If he cries a second time distract again with a different toy and move her so she faces a different direction but is still on her tummy; 3. After the third cry pick up, but try again later if she has only spent a couple of minutes on their tummy.

The aim is to build up to about 10 minutes - or five minutes twice a day - and eventually to leave your baby to play on her tummy for as long as she is comfortable. 

Remember your baby must always be supervised during “tummy time”. Always stay with him when he is on his tummy and turn him on to his back if he falls asleep.

Apgar Scores

The Apgar score is a way of checking the baby's well-being at one and five minutes after birth. It includes the following five tests: heart rate, breathing, muscle tone, skin colour, and reaction to physical stimulation. It is named after Dr Virginia Apgar, who developed the scoring system using her own name as an acronym. 

    A = Activity

    P = Pulse

    G = Grimace

    A = Appearance

    R = Respiration  

Each test is scored 0, 1 or 2 and the scores are added together.

If your baby gets 9 at one minute and 9 at five minutes this is regarded as a top score.  Most babies lose a point because of bluish/greyish hands, feet, lips etc.

Most babies score between 7 and 9. Babies with low scores might need extra care, such as help with breathing. A paediatrician is usually called if the Apgar score is low. A baby may be placed "skin-to-skin" on you or your partner, or put in an incubator in the room beside you, to keep them warm; this allows them to concentrate on their breathing. Sick babies, or those needing additional monitoring, will go to the special-care baby unit for observation and treatment. Often low Apgar scores occur because of the circumstances of the birth – e.g. they may have become briefly distressed, or even because of an extremely fast delivery. 

Activity - Muscle tone

This test tells the midwife about your baby's muscle tone. A lot of activity and movement scores 2. Some movement of the arms and legs scores 1. Limpness and little or no activity scores 0.

Pulse - Heart rate

The midwife will check the rate of your baby's heartbeat by placing her fingers on the baby’s chest or cord. Over 100 beats per minute scores 2. Less than 100 beats per minutes scores 1.

Grimace - Response to physical stimulation

This test shows how well the baby responds to a stimulus. A cough or a sneeze scores 2, grimacing and whimpering scores 1, silence and no facial response scores 0.

Appearance - Skin colour

The appearance of the skin shows how well the lungs are working and if the blood is getting enough oxygen. In Caucasian babies, the skin should be pink all over to get a full two points. . When checking over Black and Asian babies, the colour of the inside of the mouth, the lips, palms and soles of the feet will also be examined. . Newborn skin is thin, so these babies often look paler and pinker than expected.  A point is deducted if the skin is bluish/grey at the hands or feet, or 2 if the skin is bluish or pale all over.

Respiration - Breathing

Regular breathing (and crying) is a sign that the baby has strong, healthy lungs and scores 2. Slow, irregular breathing scores 1.

(An extract from our ebook "Bump to Birth to Baby")

Post-Birth Tips From Midwives & Mums

"In order not to startle your baby leave your hands underneath her for a few seconds before you lift her up, or put her down. Talk to her as you are doing this.  Holding your baby firmly, but gently, close to your body(most of them seem to love shoulders) will also reassure her."

"Most mothers will experience afterbirth pains, but if you are breastfeeding they are likely to be more pronounced.  These pains are contractions of your womb caused by the release of oxytocin.  They may be uncomfortable, or even extremely painful, especially for the first 24-48 hours. You may feel that you need extra pain relief, in particular during or after feeding so it is best to take pain relief 30 minutes before feeding (if you can estimate when that will be!). They usually subside by day 3. It can help to heat a hot water bottle or heat pack before you sit down to feed and place it at your back or on your tummy."

"You will find that on the second and third night after birth your baby may want to feed continuously – even those being bottle-fed. These are the nights that most parents find most difficult after the birth of a baby, so take heart; things will improve. If possible nap – or at least rest with your feet up - whenever the baby sleeps.  Try to get your 7- 8 hours sleep over 24 hours, even if it is broken between day and night."

"The night before the Newborn Screening/Guthrie heel test is due (usually day 4 or 5) put an extra pair of socks on your baby. This will help warm up her feet and make the test easier and quicker to perform, decreasing any stress for baby, and you!"

Don't attempt to scrape cradle cap off with your fingernails. It can take a little persistence to remove. Rub in a little olive oil, coconut oil or emulsifying ointment to soften it overnight, then rub gently in a circular motion with cotton wool, or with a baby brush to lift the scales. Comb out, or if you have used emulsifying ointment wash out when giving a bath.

”Back home, in the days after the birth you may find yourself veering back towards your birthing ball to take pressure off your sore bottom bits. And your new baby will also enjoy the motion of being rocked back and forward while you both sit on it.

"Stay in your pajamas for two weeks. When you are dressed you are considered to be back to normal by visitors, partner and your other children!"

 “I attended water exercise classes run by a physiotherapist, which were great. She kept stressing the importance of pelvic floor exercises, and warned that it took doing the exercises 9 times a day for nine months after the birth to re-tone the muscles. She recommended putting a P on the fridge door as a reminder, and to do one every time the car was stopped at a red light. I did them religiously – and I can now cough without fear when I have a full bladder. I couldn’t do that before the baby!”

Tips for A Sore Bottom After Birth!

If you have had a vaginal birth your bum may be sore — back and front! — and there will a lot of bloody discharge (even if you have had a C-Section) . You will now see why you need those giant maternity pads!

Tips For A Sore Bum:

• NB: While it is often recommended, some carers, including the early-discharge home team at Ireland’s National Maternity Hospital, now advise against using tea tree oil when you have stitches. Instead, mothers are advised to bathe daily in warm tap water, change pads regularly, and begin pelvic floor exercises
• If you do not have stitches try and make sure that you have two warm baths a day containing a few drops of tea tree oil if you wish. This keeps any grazes clean and prevents infection; it soothes the area so that it feels less painful; and even more important it gives you 15 minutes for yourself during these first few days which will seem to be a constant round of feeding and changing. Unfortunately this may not be possible in some hospitals, so start when you get home.  
• What you can do, in hospital or at home, is to get a mineral water bottle with a sports-top (squirty top) and leave it in your toilet bag, or on the cistern. Fill this with warm water (and a drops of tea tree oil if you wish) and wash yourself down each time you use the toilet.  Make sure you circulate the water around your bottom. If you find your bum becomes excoriated or feels scalded stop using the tea tree oil, as you may be having a reaction to it, or are using too much.
• If you do not have a bath at home pharmacies in many countries stock “Sitz baths” which sit on top of your toilet so you can bath your perineum. Ensure that you keep this meticulously clean.
• Your perineum may be swollen after the birth. To soothe it tear open one end of a maternity pad and thread a frozen (and unopened) “Mr. Freeze” cool pop into the pad. Place it against your bum. For added comfort keep your maternity pads in the freezer. You can now also buy gel packs designed for soothing the perineum area.
• If you have stitches ensure you keep your bottom dry in between washing. Either pat it gently with a soft towel or dry it with a hairdryer on a cool setting. A wet scar will take longer to heal.
• Arnica is a homeopathic remedy used for bruising, which a lot of women seem to find helpful after birth. Tablets are available in most pharmacies.
• Do not be afraid of sitting on your bum.  Sitting on your stitches will not harm them. You may find the pain increasing up to day 5 as the tissues heal, but it should lessen after that.  Don’t forget to take pain relief.
• Some women prefer to sit on a swimming ring or breastfeeding cushion, so as not to sit directly on the perineum. You can also buy or hire“donut” or “valley” cushions especially designed to ease a sore perineum.
• If the pain in your perineum increases after day 5 or you begin to get a bad odour from the area, then this may signal an infection. Contact your hospital or doctor, as you may need antibiotics.  If after a week to 10 days your bottom seems slow to heal“go commando” - sleep without underwear to allow air at the vaginal area – and seek advice from your midwife or doctor.

Mums’ Tips

“Back home, in the days after the birth I found myself getting back on my birthing ball to take pressure off my sore bottom. And my baby also enjoyed the motion of being rocked back and forward.”

“I had an epidural and delivered on my back. My coccyx was bruised during labour and I found it very difficult to sit down. My husband came home with an inflatable child’s swimming ring as a joke — but it actually meant I could sit without putting any pressure on my tailbone. What a relief”

“I had a lot of stitches. My partner got me a wheelchair cushion from a medical suppliers. It was the only thing I could sit on for weeks.”

How Your New Baby Looks

Newborn babies often look strange and oddly proportioned – though he or she is likely to seem gorgeous to you.  It is good to know that what seems strange is in fact“normal”.

• Most babies look wrinkled when they are born. This is because they have been curled up in fluid for a long time – you know how your hands get if you stay too long in the bath. If they are overdue their skin may be very dry, and even peeling. In addition to the goo and blood of childbirth your baby may also be covered in a mixture of a whitish, greasy, waxy substance (vernix) that babies produce to protect their skin inside a fluid-filled womb.
• The average weight of a baby is 3.4kg, but varies from 2.5-4.2kg for a full-term baby. As with height, your baby might be bigger or smaller than these weights. However, if your baby has a low birth weight (less than 2.5kg), he/she may need special care.
• It is normal for babies' heads to be very large compared with the size of their bodies.  In an adult, the length of the head is about one-eighth of the length of the whole body, but the length of a baby's head is one-quarter the overall body length. Even perfectly formed heads will be out of proportion with the rest of the body.   
• The head may also be an odd shape. The bones of the head are in such a position that they can slide over each other to aid birth, and if this has happened the baby may appear to have a “cone head”, but the shape returns to normal very quickly. If you have had a forceps delivery there may be indentations on the head, or bruises caused from an instrumental delivery.  
• The vacuum suction cup of a ventouse birth can give babies a “skull cap” that is purple in colour –like a large “love-bite” on the head, where the blood has been drawn up to the top of the skin by suction.  These will usually subside within days.  
• Some babies have patches of downy body hair (lanugo), particularly premature babies. It is most obvious across the back and shoulders and will rubs off within a few weeks.
• The skin of the hands and feet may also look bluish in colour for the first few days.
• You may notice blisters, or bruised looking broken skin on your baby's hands or wrists.  These are a result of the baby sucking on these areas while in the womb.
• Eyes are likely to be puffy for a few days because of the pressure from a vaginal birth. Small veins in the eyes may also have burst during birth, and this will give your baby’s eyes a bloodshot look. It will clear up in a few days.
• Both boys and girls often have swollen breasts. They are swollen because your hormones that are high in order to prepare you for breastfeeding have stimulated them. Occasionally, these hormones cross to the baby during birth.  Some babies even produce small droplets of milk from their nipples. (Do not try and squeeze it out).
• If you notice anything that is worrying you, ask your midwife or doctor about it.

Tips To Soothe A Crying Baby

Some ways to soothe a crying baby that does not want to be fed/changed:

• Curl up together bare tummy to bare tummy for maximum skin contact. Don’t mask your scent with perfumes in the first weeks.
• Try a warm bath and a gentle baby massage (though some babies hate both until they are a few weeks old);
• Rock with your baby in a chair;
• Play soothing music; 
• Walk up and down the stairs holding him;
• Try and distract your baby by holding him up to your face and nodding your head; Looking into his eyes may distract and calm him as he can focus on you at this distance.
• Go about your day carrying him in a sling;
• Sing and talk to him with exaggerated facial expressions;
• Try swaddling;
• Put his bassinet/bouncer beside the washing machine.

If you have a pre-term baby the methods used to calm a full-term baby, such as back-patting and rocking, may not work as well.  A gentler approach is usually needed, such as sitting still and holding your baby close. They may only like one thing happening to them at a time, such as soft singing or gentle patting.

Unfortunately there are times when some babies just cannot be comforted, and this is where the pressure really starts. The sound of a baby crying is designed to be difficult to listen to – it’s a survival technique – so when it goes on, and on, and on it can become unbearable.   Usually with most babies this is a relatively infrequent occurrence, or may only last an hour or two. However, parents whose babies have colic or reflux may experience hours of non-stop crying on a daily basis. If this is the case seek advice and support and bring in friends and family to give you regular breaks.

Look What I Can Do (Aside From Feed, Cry, Pee & Poo!)

Here are just some of your newborn's amazing skills:

• Your baby has a keen sense of smell, and will recognise you by your smell, rather than sight in these first days.
• Your baby already has a keen sense of hearing and will probably move her head in response to noise.  She will love to hear you talk, and will especially like high-pitched voices – and that "goo goo ga ga" baby talk you swore you would never use. She can soon begin to distinguish her parents’ voices from others.  Babies seem to respond to music and sounds they heard while in the womb – and may even be calmed by music played while their mothers relaxed during pregnancy.  Try it and see.
• He can see (in black and white), but may look as if he is squinting or cross-eyed because the muscles of the eyes are not strong enough yet. Within a few days he can focus on objects and faces about 8-inches/20 cm away (the distance from her face to yours during breastfeeding).
• She will particularly like to look at faces and patterns. So put mobiles and toys with strong black and white patterns (remember she hasn’t yet got full colour vision yet) in her sight range. Don’t worry too much about expensive fal-de-las, you can always draw your own patterns with a thick black marker on white card and secure them using the side of the mattress in his cot or crib.
• He can respond to your smiles and chat by nodding, sticking out his tongue, and moving his body.
• She will firmly grasp anything that touches the palm of her hand. And if you stroke the sole of her foot, the foot will also curl around, as if trying to grasp on to something.
• Babies have a very strong sucking reflex so that they can feed.  Just putting pressure on the palate with a finger will make him start sucking strongly.
• If a baby feels like she is falling, or is startled by a loud noise she will throw out his arms and legs and arch her back. She will then curl back inwards. This is called the “Moro” or startle reflex.
• After a few days if you hold your baby upright and touch his feet against a flat surface he will start to move his legs in a stepping motion.

Tips for Breastfeeding

Having been convinced of all the benefits of breastfeeding many new mothers are surprised to discover just how challenging it can be during the first week or two. It can be sore – very sore! Learning how to “latch on” can be very tricky; and your breasts may be on demand just when you need to sleep.  It can also be very confusing if you are getting lots of varying advice. However, it really will be worth the effort once you and your baby have learnt the necessary skills.   And remember your baby hasn’t done it before either.  Get as much help as you possibly can in the early days, and here are just some of the tips from our ebook "After Birth".

• FInd a position that is comfortable for you and baby. Side-lying or "laid-back" positions are often easiest at first. 
• Bring your baby to the breast and not the breast to the baby.
• Make sure baby is comfortable and warm and place“tummy to Mummy”, so that the baby is looking at the breast.   Position the baby so its nose is approximately opposite your nipple.
• Newborn babies have a “rooting” reflex. A baby does this when she is looking for the breast to start feeding. Stroking the cheek will make her turn towards the side being touched, and stroking the lips with your nipple will help the baby to open her mouth ready to feed.
• Gently support her head with one hand and cup your breast with the other. Narrow the nipple by holding the thumb above and fingers underneath, making a C shape so that the baby can get more of the breast into her mouth.  Allow the baby to latch on herself.
• In the first weeks of feeding there may be a moment of slight discomfort, as she draws the nipple in (breath in deeply and it will pass). Once the nipple is completely in, the sensation should be ‘strong’ or ‘dragging’ but not painful. 
• It is very difficult to describe the sensation of a properly attached baby, but if she is attached correctly, the sensation you feel in your nipple should not be described as painful – remember this is ‘breast’ not ‘nipple’ feeding.  If it is painful, place your little finger inside the corner of the baby’s mouth to ‘break the seal’ and remove her from the breast. It is better to have to put her on a few times and get the latch correct, rather than damage the nipple by leaving her suck on the nipple incorrectly attached. 
• A baby needs to have a good mouthful of her mother’s breast tissue so that the tongue is flat and able to “milk” the breast effectively.  If the baby is latched correctly, most of the areola (the dark skin around the nipple) will be inside the baby’s mouth. The baby’s lips should be wide, in a K-like shape, bottom lip rolled out, and the nose should press against the breast.  The baby should be looking slightly upwards, and be content. If your baby seems unable to latch on and seems to be constantly chewing on your nipples check that he is not tongue-tied.
• The cheeks should remain full and round and the jaw muscle around the bottom of the ear should be seen moving as she feeds. You shouldn’t be able to hear a noisy “kissing” sound, but you should hear her swallowing.
• Make sure you are comfortable; support your back with cushions and pillows; prop up the baby if necessary on a cushion; and use a footstool (even a few books will do). Sit up straight. Do not keep leaning forward pushing your breast to baby – sit upright and bring baby to you.
• You will get very thirsty.  Ensure you have a drink of water or juice beside you prior to starting each feed.  At night keep a glass of water AND a glass of ice beside the bed. This will mean you have a cold glass of water at hand during night feeds.
• At the end of each feed gently squeeze out a few drops of breast milk – packed with antiseptic qualities – and rub it back into your tender nipples.
• Chilled green cabbage leaves will soothe hot, engorged breasts, particularly as the milk comes in. Change them regularly, about every 20 minutes. Time is up when the room begins to smell like cooked cabbage soup! Only do this for 12-24 hours. 
• Grated carrot (yes you have the makings of coleslaw if you are also using the cabbage for engorgement!) will soothe sore and cracked nipples. Just place on a breast pad against your nipple and remember to clean off before feeding
• Coconut oil also seems to help many women with cracked and sore nipples. Use breast pads when you apply it as it may stain.

If you find breastfeeding difficult, there are many people who can help and reassure you:  Most hospitals have midwives who are dedicated to giving breastfeeding support; and there are antenatal and postnatal support groups for women wishing to breast-feed. Check your local phone directory, or national breastfeeding websites. 

Breastfeeding Tips from Mums

It gets much easier after day 3. "

“Get help with every single latch on in the first few days to avoid sore nipples. If you get them the best cures are fresh air and a little expressed milk rubbed in.”

“If it really hurts you are doing something wrong

“Give it two weeks – it can be painful at the beginning but it is worth it.  Only latch on when babies mouth is wide open!”

“One midwife told me that when a baby is latched on properly, their lips should form a shape on your breast that looks like the ‘special K’ K. This was a brilliant way to remember what it should look like when looking down at the baby”

“Buy or borrow a comfortable chair that allows you to sit up straight and doesn’t have arms that get in the way of you feeding, and join a local breastfeeding support group.”

“Feed on one breast at each sitting, and then swap over a bracelet to show which boob you’ve just fed from.”

“If you are engorged alternate with hot and cold compresses - a flannel or wash cloth will do."

“When my nipples were sore I used to numb them with an ice-block for a few seconds before latching the baby on.”

“I found my upper back got very sore from feeding. I realised I was holding it tensed almost all the time while she was latched on. So I decided that every time she latched on I would do some deep breathing to relax and remind myself to drop my shoulders down……it worked."

“Feed lying down, it is less exhausting.”

“I found breast milk to be the best medicine! Put it on skin if it is a bit rashy, on the eye if it is a bit sticky, and up the nose if the baby has a cold!”z

Tips for Winding/Gas

Most babies can ‘burp’ louder than Shrek, and pass wind so loud that everyone will look at dad or the dog!  Both breast and bottle fed babies can be windy, though it is less likely with breastfeeding.
Babies swallow air when they are feeding – and crying. Too much air and he gets what we call “wind”/"gas" which can make him uncomfortable, cause him to cry and pull his legs up to his chest. (This is not colic, which is persistent daily crying over a number of hours which winding will not alleviate)
With good feeding technique it is possible to reduce the amount of air – and therefore wind – that your baby takes in. When breastfeeding ensure your baby is latching on in such a way that he is not taking in to much air. Seek advice if you baby seems to be constantly windy, or you may need to look at your own diet. When bottle-feeding try keeping him in a more upright position- so that the air rises above the milk - and check that the teat and neck of the bottle are filled with milk when you are feeding. There should be no air visible.
Babies usually need to be winded after each feed until they can sit up themselves. You can try and wind before you switch breasts when feeding yourself, or after a few ounces if you are bottle-feeding. Try and keep him as upright as possiblefor a few minutes following a feed. Sometimes if your baby has settled or slept without being winded he may wake up crying. Pick him up and he may air his grievances from both ends.

• To wind a baby there should be a straight line between the stomach and mouth. One good way is to sit the baby up with her head extended (by placing your hand under her jawbone) and a hand on her back to keep it straight. There is no necessity to rub, thought some people find this can have a comforting effect.
• Another option is to lay her against your shoulder. Aim to get her tummy flat against you by stroking down her back and legs to straighten out her body. A few light pats usually is enough to produce results.
• It is always a good idea to place a bib, towel or muslin square on your shoulder, or under the baby’s chin, as you are winding in case baby possets (vomits a little).

Margaret’s Tips
“Always wind… but if the wind is not up in 10 minutes chances are it's not coming. You don’t need to walk the floor all night waiting for it. “

Mums’ Talk
“Hold baby in a semi-upright position when you are bottle-feeding, and stop half-way to wind.”

“I breastfed on both babies. The first was a permanent bag of wind. I cannot recall the second bringing up wind even after she went on to formula.”

“Mums - wear white and light coloured clothes when feeding. It doesn’t show up the little pukes and possets as much!”