start

RCH Discharge Teaching Class

I'd like to welcome you to the newborn

baby class the first 4 to 6 weeks is

going to be somewhat overwhelming and

this is something that all first-time

parents go through first of all it's a

big change in your lifestyle you go from

people that if you slept in for work

it's amazing how quick you can get out

the door but once you have children your

life is going to take a lot more

planning and the other thing that you're

going to find overwhelming is the sleep

deprivation at the beginning for the

first 4 to 6 weeks it's very normal for

babies to be up a lot during the night

time so it's really really important

that when you go home with your babies

that do not rely on getting sleep at

night because quite often that won't

happen so when your little baby sleeps

during the daytime forget about

everything else your house is going to

be there forever right now this little

baby needs you so just go and get your

rest and that will make the transition

to being new parents it will go much

smoother for you so congratulations to

all of you and my name is Jeanie and I

have met some of you and some of you I'm

sure I will be meeting ok so if

everybody in the group is breastfeeding

or practicing breastfeeding I just like

to let you know I say about 35% of our

families do have some trouble with

breastfeeding initially so if you are

having some trouble with breastfeeding

please don't feel like you're the only

one ok

breastfeeding is actually a learning

process for both the mummies and the

babies and sometimes it can take a good

6 weeks to get breastfeeding really well

established where you feel a lot more

comfortable with it now colostrum is

considered the perfect food for your

baby in the first couple of days it does

come in very small amounts but it is

very high in colostrum we really

encourage you to try to weight your baby

up at least every three hours sometimes

the first 24 hours some of these little

babies can be very sleepy some of them

could have swallowed a lot of stuff

during the delivery and their mucousy

spitting up a lot of stuff and they're

not that interested in feeding so if

your baby has gone over that three-hour

period

we really do encourage you to wake them

up get them skin-to-skin and attempt to

breastfeed them you also want to be

watching your little babies for the

feeding cues now the kind of feeding

cues we're talking about their little

hands going up to their lips licking at

their lips turning their little heads

looking for something that's called the

rooting reflex that's the baby's feeding

cues they're showing you they want to

eat now if your little baby is too tired

or too mucusy and you can't get your

baby to the breast then you want to get

your nurse in and you want to get her to

get you to start hand expressing she can

teach you how to hand expression to be

stimulating your breasts at least every

three hours the more often your baby is

at the breast and the earlier right

after birth that will help bring your

milk in much quicker okay

so there's all different kinds of

positions that you can feed your little

babies in and when you go home with your

baby I really encourage you to do some

experimenting at home and find your

favorite little spot for feeding your

baby and don't be afraid to try some

different positions there's one common

thing though about all these positions

and that's the baby's body alignment

okay now we all love to hold little

babies like this and I go in to help

mums with breast feeding a lot and I see

these little babies they're lying in the

crook of mummys arms and mummys trying

to get the baby to the breast when a

little baby's lying like this what is

this baby having to do with their head

to get latched to the breast they have

to turn their head now if you turn your

head sideways try swallowing when your

head is turned to the side it's like

there's a big lump in your throat so if

you notice with all these little babies

body alignment is very very important so

you take this little baby and baby's

tummy mummys tummy you want to take this

baby that's lying on their back turn

that baby and bring the baby right to

you

okay and whether you hold your baby this

way or whether you've got your baby

supported this way

of a look at the ear the shoulder and

the hip joint see how you could draw a

line right down the baby so it's body

alignment that you're looking for in

this football hold if you decide to use

this football hold just have a look at

your baby and you want to make sure that

that baby is not having to turn their

head over their shoulder trying to get

latched onto the breast okay

so tips for comfort

first of all we want to get these little

babies as close as we can to their

mummies if they're wrapped up in several

blankets it's very hard for their little

bodies to get close into mummy your body

temperature is the perfect temperature

for them okay so best way to feed your

babies is the babies in their diapers

okay so remember the tummy to tell me

with my mummy so you bring this baby

tummy to tummy you want to keep this

little bottom end tucked in nice and

close to your body whether you're

holding the baby this way or whether

you've got the baby supported this way

their little bottom end needs to be

tucked in nice and close now when you're

trying to latch your baby we don't

encourage you to grab your baby's head

and bring into the breast this way

because this type of motion when you do

that you're actually pushing the baby's

nose right in to the breast okay so and

the other thing is little babies they

don't like to have their heads grabbed

either so what you want to do is to

support the baby's head with a couple of

your fingers and where you want that

little bit of pressure is right in

between their shoulder blades that is

going to tip their chin into the breast

and bury it well into the breast and it

also tips their head back slightly into

a sniffing position and what do we do

when we drink a glass of water we take

that glass of water and we tip our head

back slightly it's easier to drink that

way and it's easier for your baby to

drink that way if their head is in a

sniffing position also that will help

free up your nose or the baby's nose at

the breast okay

now I've got a couple of really nice

slides here that shows a little baby

that's trying to get latched on to the

Mummy's breasts now you might look at

this picture and say well why is the

mummy aiming the nipple I'll put the

nose instead of having this baby hoisted

up and aiming that nipple straight into

the mouth this way when we latch a baby

where the nipples going straight in the

baby would have the same amount of the

areola all the way around in their mouth

that would be called a symmetrical latch

but an actual fact for better milk

transfer for your baby and a more

comfortable latch for money the baby

should have more of this part of the

breast in their mouth than what sits up

at the nose so it's actually an

asymmetrical latch so if you can just

remember when you're trying to latch

your baby you want to tip up your breast

and when you get that big wide-open

mouth you want to flip the nipple into

the back as far as you can so if you can

just remember tip and flip now this was

a picture of a little baby that was

trying to get latched and as you can see

in the previous picture baby had that

nice big wide-open mouth

but boy oh boy can they ever close that

mouth quickly so right now this may take

you several tries to get your baby

latched and that's normal at this stage

you're going to find your little babies

learn very very quickly

in order to get fed they have to get

latched and to get latched they have to

keep their mouths open longer so it's

going to get much easier in the next

couple of weeks now this is a picture of

a little baby that is well latched to

the breast and as you can see see that

little chin how it's really well buried

into the breast and see how the nose is

slightly away okay so that's what your

little baby should look like at the

breast you might wonder what does it

feel like and what should I look for to

see if I have a good latch when your

baby goes to the breast you should be

feeling a tugging sensation and at the

beginning for the first couple of weeks

some mums find

uncomfortable it shouldn't be painful

shouldn't be pinching pain but strong

tugging is normal and some women do find

that uncomfortable your little baby's

chin should be really well buries into

the breasts and the nose slightly away

and then you want to have a look at your

little baby's cheeks they should be nice

and full and round

they shouldn't be sucking in at the

sides nice full round cheeks when your

baby starts nursing at the breast and

you might not hear a lot of swallows the

first couple of days because the

colostrum comes in very small amounts

and it's usually thicker but as your

milk starts coming in you're going to

start to listen to those swallows at the

at the breast so what it sounds like

it's a little cuff sound every second

2/3 suck so you want to start listening

for that there shouldn't be any clicking

or smacking sounds and one thing that's

really really important that can tell

you a lot about how your baby is latched

is what your nipple looks like after

that baby comes off the breast so

basically it should just be round but

more elongated if it looks like a brand

new lipstick then that showing it is

compressing one side of the nipple or if

there's a white line right across your

nipple that shows that the baby is

compressing your nipple between the

tongue and the roof of the mouth and

pretty soon that white line is going to

start to break down it will start to

bleed and you're going to end up with a

very sore nipple cracks blisters

bleeding that should not be happening if

that starts to happen you want to get in

contact with your public health nurse

right away okay let's just take a look

at tummy size it always amazes me to see

that babies start out with very tiny

tummies but look what happens by one

week the change in the tummy size

because they start out with such tiny

tummies their little tummies are going

to fill up very quickly and breast mouth

is very easily digested so therefore

it's going to leave the tummy quickly

these little babies will need to get in

at least eight feedings in a 24-hour

period but it's very normal for babies

to feed anywhere from 8 to 12 times

24-hour period all babies do lose some

weight the first few days but right

around day four is when that weight

should stabilize and then start to go up

check inside your little baby's mouth

inside the mouth should be nice and wet

and shiny and it shouldn't be dry and

sticky in there and just remember when

your little baby is at the breast you do

want to start listening for those

swallows all right challenges are common

okay so if you're having problems after

you leave the hospital really really

important to get in contact with your

public health nurse right away don't

leave it because it's only going to get

worse and get in and get the help

cluster feeding now usually around the

second night these little babies all of

a sudden wake up they'll have a great

feed this is probably about 11 o'clock

at night and then you'll think to

yourself oh good we're going to get a

couple of hours sleep

15 minutes later baby wakes up again and

they want to eat again and this can go

on for like a five-hour stretch they go

on a feeding frenzy

it's called cluster feeding and now if

it hasn't happened to you yet

be prepared it will happen tonight or

tomorrow night okay and that is

completely normal your little baby is

working really hard to get your milk in

as quickly as possible so just feed your

baby babies will feed more frequently

during growth spurts so around ten days

and then again around a month and then

around three months your baby may go on

little feeding frenzies that's going to

bring the volume of your milk up your

nighttime feeding is really really

important right now now remember I said

at the beginning of the class that

little babies are up a lot during the

night time and the reason that is it's

all connected to the mummy the hormone

for milk production is called prolactin

and it peaks in the night time so when

these little babies are up in the night

feeding they are stimulating that

hormone to all the receptors and mummys

breaths not only to bring in that good

supply but to help maintain that supply

for

many months down the road it's nature's

way of protecting a baby's food source

so your nighttime feeding is really

really important right now

all right so let's just do some breast

feeding basics here your breast milk is

made by supply and demand so when you

are feeding your little baby at the

breast you're actually making the food

for the next feed that's the way the

body works baby should finish the first

breast on their own and then you burp

the baby and always offer the second

side and at your next feeding you are

going to start on the side that you left

off on because they always take more

from the first breast breast milk is

considered the perfect food for the

first six months for your baby and then

you're going to start adding solids to

their diet now you can go down to the

Public Health Unit or you can go to the

best beginnings website because they

have some very current helpful

information on introducing solids to

your baby which can be very helpful and

it has really changed since your parents

started feeding solids to you

so Health Canada the World Health

Organization and the Canadian pediatric

Society they recommend exclusive

breastfeeding for the first six months

then the introduction of solids and

they're really trying to encourage

people to breastfeed their children

longer now you might wonder who came up

with that number - why isn't it one year

of age why isn't it three years of age

what's so magic about - these are all

toddler aged children they may only

breastfeed once or twice in a 24-hour

period so if they're in the age group

thirteen months to about two and a half

years of age okay so it's not for the

calories anymore they're eating lots of

solid food for their calories but what

they've been doing a lot of research in

the last five years is this age group

and their immune systems okay through

their research they found that the

toddler age group does not get up to the

adult levels of immunity until they hit

in the range anywhere from 22 months to

26 months

beige is when it's boosted up and one or

two breast feedings in a 24-hour period

brought those levels up to the adult

levels to help protect this age groups

from infection this age group is at very

risk for contacting a lot of infections

because toddlers are little explorers

and they go around their whole world is

explore explore touch everything and

their hands are always in their mouths

so this is a way that you can help

protect your toddlers from infection

okay if for some reason you're needing

to supplement your baby with some

formula some of our babies for medical

reasons or if you need to go home doing

this while you're waiting for your milk

supply to get established it's very

important that you get the correct

information on doing this in a safe way

there are two sheets that we need to

give you so you would want to ask your

nurse for those and also just to be very

very careful what you're buying out

there and make sure you read the

directions very carefully there are two

types of liquid formula on the market

one of them is a ready to give so you

don't do anything with it the other

liquid formula is a concentrated liquid

where you have to bring it home boil a

certain amount of water cool the water

and then add it to it and there has been

a few cases in the last year where

parents have gone home and they're tired

and run out and bought the formula and

accidentally bought the concentrated

formula thinking it was the ready to

give and given their babies concentrated

formula without mixing it with the water

and that can cause kidney damage to your

babies so please be very careful that

you read the directions very very

carefully okay burping your baby there's

lots of different ways that you can burp

your baby I really like this way when

they're little or supporting the baby on

your chest this way here and this way

here is great for when the babies are a

little bit older so if you're using this

way I'll just demonstrate with my little

baby here

you just sit the baby on your lap and

you want to take the baby with your

thumb and first finger and just put them

right around the baby's jaw not

around their necks but right around

their jaw and let the baby fall into the

palm of your hand because right about

where the palm of your hand sits is

right about where that little baby's

tummy is and that provides a little bit

of pressure on the baby's tummy to help

bring up the burp and then you just do

some gentle passing you should get into

the habit of trying to burp your little

baby after each breath now in the early

days your baby might not do a lot of

burping because they're taking very

small volumes but as the volume starts

to increase then you're going to find

that your babies are going to start

burping a lot more okay

all right you've been keeping track of

your baby's feeds and the wet diapers

and the bowel movements on those little

sheets that we have given you now we've

got a different version of the sheets

that you've been using right over here

and I really encourage you to come and

collect three or four of these sheets to

take home with you and you're going to

put these by your change table at home

you're going to keep the record for 24

hours and then you're going to add it up

and on the back of these sheets it's

going to give you ideas what to look for

because another way of assessing how

your baby is transferring milk with the

breast is what goes in needs to come out

so if your baby is not meeting these

guidelines then you know you need to get

some help right away so as you look at

this okay you can see the first couple

of days babies might not have a lot of

wet diapers and sometimes you open up

that day for it's just got a very little

bit of urine in it and it can be really

dark strong smelling urine but right

around day four or five all of a sudden

you're going to start increasing you're

going to start noticing that those wet

diapers are increasing the diapers are

getting heavier and the urine should

almost get to be a pale very light

colored urine with very little smell to

it so it shouldn't be strong smelling so

that by one week your baby should be

having at least six to eight good wet

diapers in a 24

our period that's what you want to look

for okay

some little babies in the first few days

of their life may pass Ricki colored

crystals in their urine

now that baby's diaper has a lot of

Ricky colored crystals in the urine

sometimes you just open up a diaper and

there's just a little trace that you see

basically it's just telling us the urine

is quite concentrated now that is normal

up to about day four day form beyond

your baby should not be passing bricky

colored crystals in the urine the urine

should get to be a lot more dilute the

diapers should start to feel heavier

okay have you all changed that really

black sticky stool now that is called

the meconium and that is what built up

in the baby system over the past nine

months when they were growing in money

okay so once the babies get rid of that

meconium you're going to find that your

baby's bowel movements are going to have

a lot of changes in this next week so I

will warn you this next slide has a lot

of poopy diapers on it so this is the

meconium so that's the first stool

that's what built up in the baby system

over the past nine months and then this

is what we call a transitional stool

okay it turns to sort of brownie green

now this is quite green it usually isn't

quite that green it's usually more

brownie green but it gets a lot runny

err when your breast milk is completely

and this is the color you're going to be

looking for it's like a mustard yellow

now some little babies it's kinda Kirti

some little babies it's more seedy then

we get the other little babies where

it's very watery now that is not

diarrhea in a breastfed baby that is

completely normal

if you ever see blood in your baby's

bowel movement that is of a concern you

should take your baby into the doctor

and have your baby seen right away now

all of you should have received one of

these little charts here now the nursing

staff we all call them the poop charts

okay so this condition is known as

billary atresia and just to let you all

know this is not something that

is common but if it's caught early these

babies are very treatable but if it's

not caught early these little babies can

go into complete liver failure and

require a liver transplant so this is

why we are educating all families on

this because if we can prevent just one

case of this it's worth it to educate

everybody your nurse will be going over

this little chart with you but basically

it's these top three boxes here that is

of concern and you don't wait till their

bowel movements are completely like that

if you see traces of colored bowel

movement that looks like those colors

you would want to take your baby into

the doctor right away and have your baby

assess the first two months are the

critical period but your nurse will be

going over this with you

before you get discharged and if you

didn't get one of these little charts

please ask your nurse for one of those

all right

newborn jaundice this is quite common in

our babies and this can happen anytime

after your baby is born up to about 10

to 12 days when babies can develop what

we call newborn jaundice and so this is

why we tell you about it because it

could actually happen after you you

leave the hospital so this is a little

baby that's jaundice can you see how

that little baby's skin looks kind of

yellow it looks like you snuck outside

and got a little suntan without you the

whites of the baby's eyes can even get

yellow and generally speaking when these

little babies get jaundice they tend to

get quite sleepy and they don't feed

very well now all of your little babies

are going to have a Billy meter test

done before they go home so the nurse

will be coming in with this level meter

she'll do these little flashes on the

forehead or flashes on the chest that

gives us a readout number okay and if

that number is too high we will order a

blood test for your baby because it's

much more accurate now if that test came

back to high your baby might require

some help

to get rid of that jaundice okay so what

we do is we put them under a special

light it's called a photo therapy light

or you might hear it called a billy lie

eight and then sometimes we lay them on

a little blanket called a billy blanket

and the treatment is usually about 24

hours and if you're in the hospital here

and that happens we set up that

treatment in your room we teach you how

to look after the baby end of the light

and you just stay an extra 24 hours

while your baby's having that treatment

if you've gone home and you need to

bring your baby back

you would go next door to Pediatrics and

the baby would go under photo therapy

there and mummy would come in so she can

continue to feed the baby now you might

wonder what would cause my baby to be

jaundiced and somebody else's baby

didn't get jaundiced

little babies are born with a lot of

extra red blood cells their hemoglobin

that's the red blood cells is way higher

than ours and the reason that they're

born with that extra hemoglobin and all

those extra red blood cells is when they

were in their mummies they had to get

their oxygen from their mummies red

blood cells so in order to get enough

from their mummy

they had way more so they're born with

all those extra red blood cells but once

they're born and they're transferring

their own air they don't need all those

extra red blood cells so they get sent

off to the liver to get broken down and

one of the byproducts that's released

during that break down is called

bilirubin and it's washed out through

the baby's urine and the baby's bowel

movements okay now some little babies

their livers are just a little bit in

the cheer they can't process it quick

enough and get it through the system so

it backs up into the liver then it backs

up into the bloodstream and that's what

causes these little babies to get

jaundiced so this is just something you

do have to watch for it because it could

happen after you go home okay so things

that you can do to help if your baby

slightly jaundice trying to encourage

the baby frequently will help the more

the baby is peeing and pooping that is

going to help clear the system of that

extra bilirubin that they are carrying

around but like I say if you get home

with your baby your baby's looking

yellow or the baby's sleepy and not

feeding as well please make sure you

take your baby back to the doctor

and have your baby checked ok passing

your baby I understand all of you I've

got to see your baby bath so that's

great they do have little bathtubs like

this for babies it's a very cute picture

but these little bathtubs or $85.00

believe it or not and I just think well

why couldn't we just buy a nice little

bucket to put the baby in but I thought

it was a cute picture just remember you

can buy all kinds of support systems to

put babies on in bathtubs remember don't

ever ever turn your back on a baby

that's around any kind of water source

because these little babies they start

moving around very very quickly and also

remember your little baby does not need

a bath every day there are going to be

days when you are overwhelmed the main

thing is keeping their bottom ends

really clean and under their chins where

they might get milk is really really

important but they do not need to be

backed every day please do not be using

powders around your babies when you are

putting powder baby powder on bond a

little babies bottoms those little

babies are inhaling all that powder and

please stay away from perfumed products

babies smell absolutely wonderful just

the way they are your little baby's cord

it should fall off anywhere in about 5

to 15 days now that we leave them alone

we're finding that they fall off much

quicker now a lot of your little babies

cords will have the cord clamp still on

them if that cord clamp is down really

close to the baby's skin you might want

to ask your nurse to take that off for

you if it's going to be interfering with

cleaning around your baby's court okay

we are asking you to fold the diaper

down below the cord and the reason that

we asked you to do that is so that the

air can circulate around the cord your

little baby's cord has no feeling in it

so it's not that the diaper is hurting

the cord it's like your fingernails or

your hair so it's no feeling but we want

it folded down so that the air can

circulate around it now as far as

cleaning the baby's cord we just

recommend good old soaking water when

you bath your baby we're going to get

you to wash the cord

when you take the baby out of the tub

you want to dry it really well where

it's going into the body we don't care

about the end of it here it's where it

meets the body so you can take the

corner of the towel dry it really well

and then have some q-tips at your change

table and three or four times during the

day any little bits that start to slough

off it because that will happen take a

q-tip and just clean them away okay now

this is a picture of a little baby's

cord that has just fallen off you might

get a little bit of old dark spotting

that's normal

bright red bleeding is not normal bright

red bleeding you would want to take the

baby into the doctor now have a look at

this little baby's cord here do you see

how it's very red and swollen and it

probably has a mucky smelly yellow

discharge as well that little baby has a

Corden section cord infections are very

serious in the newborn so if you see

anything like that with your baby's cord

you would want to take your baby into

the doctor immediately please don't

leave that okay sleeping positions what

do we notice about all of these little

babies they're all sleeping on their

backs another thing that we notice all

the baby's arms are free none of them

are swaddled like tight little mummies

and then the other thing all these

sleeping places they look very bare

there's no bumper pads in them there's

no quilts there's no pillows there's no

big stuffed animals back in 2004 and for

the sudden infant death syndrome society

started asking us to put babies on a

firm flat surface on their backs to

sleep and take all that stuff out of the

crib bumper pads quilts pillows big

stuffed animals the incidence of sudden

infant death syndrome went down

significantly so this is why we're

asking you to do this as far as loose

bedding in the crib babies when they get

a little older they can pull that right

over their head so that can interfere

with the air that circulates around

their face they don't think that these

little babies got into the bumper pads

or the little stuffed animals and

suffocated but what they think happens

is when they get in close to surfaces

like that it does interfere with the air

that circulates around the baby space so

if you're going to be using bedding in

the crib you would want to make sure

that that's well tucked under the

mattress so that the baby can't get it

anywhere around their face okay this is

a little sleep sack these things I find

worked really well you can get summer

weight winter weight sleep sacks and if

it's the winter time you put them in an

undershirt you put them in a winter

weight sleeper and then you just pop

them in a winter weight sleep sack that

keeps all the heat in there their arms

are free they can move around they can't

pull anything up over their head so

these little things work very well when

little babies are sleeping on their

backs if they need to bring anything up

the baby needs to be able to move around

freely in order to do that so if you've

got your baby swaddled so tightly that

they can't move the baby could actually

choke so arms should always be free okay

newborns love to be swaddled so if you

have your baby and you're holding your

baby swaddling is great or if you've got

your baby right beside you watching your

baby that's fine but if you're putting

your baby down to sleep and you're going

to sleep please make sure they're on a

firm flat surface on their backs with

their arms free okay how can we keep

these little babies safe just to review

firm flat surface on their backs to

sleep with their arms free have the baby

sleep in very close proximity with the

parent so in other words in the parents

room for the first six months

maintaining babies at comfortable

temperatures an overheated baby is at

more risk so if you pick up the baby

from their sleeping spots and they're

sweating behind the near ears or they're

sweating behind the neck that shows that

the baby's too hot okay

breastfeeding decreases the risk now if

you were your partner or smokers even if

you only smoke outside that little baby

should not be sleeping in the same room

with you

and they are greater risk of dying from

sudden infant death syndrome so we

really encourage you to get the help to

quit smoking not only for yourselves

for your children as well any use of

alcohol or drugs of course is going to

increase the risk of sudden infant death

syndrome okay okay so you might want to

know what you should look for when you

think you need to take your baby to the

doctor or signs that your baby might be

sick now not all babies display the same

kind of sign so first of all we've gone

over a lot of these already if your baby

is not having enough wet diapers or

bowel movements or showing no interest

in feeding well then of course you would

want to call and get some help for it

away don't leave it we've already gone

over cord infections if your little baby

has a fever you would want to take your

baby into the doctor now some little

babies when they get sick they'll get

extremely fussy now those little babies

tend to get seen sooner than these

little babies the little baby that goes

to sleep they start sleeping more and

more the parents have to go in every

time to waste them up for a feed baby

gets two breaths they have a five minute

feed and then they want to go right back

to sleep now sometimes first-time

parents confuse that very sleepy

behavior with they thought oh we've got

such a Content baby as all the baby does

asleep when in actual fact the baby was

sick we call that kind of behavior

shutting down behavior if you have a

preterm baby a little baby that we call

preterm or a near term baby that's

thirty five thirty six even 37 weeks

those little babies we are going to be

giving you feeding plans where you're

going to go in wake them up and ensure

that they are eating at least every

three hours okay if your baby has any

breathing problems skin color gray dusky

undertones

those are 9-1-1 calls this is going to

be your very best guideline trusting

your instincts as parents when people

bring their babies into the hospital or

into the doctor thinking that there's

something wrong with them

ninety nine percent of the time the

parents are absolutely right you'll you

have that inner connection to your

babies so always

go by your instincts don't ever ever

leave your baby if you think that

there's something wrong all right

skin-to-skin contact if you do lots of

this in the next couple of weeks when

you go home with your baby you're going

to find your babies are going to be a

lot more content it does all these

wonderful things you've got to remember

that that baby was in the perfect spot

for nine months and then all of a sudden

they're born out into this world and

that can be very stressful for them so

first of all your body temperature is

the perfect temperature for them so that

stabilizes their temperature it

stabilizes their heart rate and when

they're lying on your chest skin-to-skin

that whole sensation of you breathing

encourages them to stabilize their

breathing a breathing rate also it

increases a baby's blood sugar now you

might wonder how could it increase a

baby's blood sugar even if the baby

wasn't eating when a baby is warm and

cozy and feeling really secure their

blood sugars actually go up but when a

baby gets cold and they're stressed

their blood sugar drops quite quickly

this is great for bonding as well and it

also helps to promote breastfeeding

because baby is in the right place and

you've got to remember that little baby

was in the perfect place so this is

going to really ease that transition

from that intrauterine life to the extra

uterine life by spending lots of

skin-to-skin time with their mommies and

daddies and dads if mummys gone off to

take a nap you just get that little baby

skin-to-skin with you and put a little

blanket over the baby the babies

absolutely love it and dads you don't

have to shave off your hairy chest

babies love a hairy chest they're very

tactile they just love that tummy time

how many times really important in our

babies because they spend so much time

on their backs when they're sleeping

they're lying on their backs traveling

around in a car where is their little

head pressed it's pressed to the back of

the car seat and right now the bones in

your baby's skull are quite soft so if

you don't get them down on their tummies

enough they can start developing a flat

spot on the

their head that does not cause brain

damage but if you don't take care of it

quickly it actually could become

permanent and there are people out there

that are walking around that have these

very flat heads at the back and that's

very preventable the other thing that is

really important about tummy time it

gets the baby developing the muscles

their neck and shoulders by lifting up

their own heads and if they're not ever

on their tummies they don't have the

opportunity to do that so you can start

this right away you don't have to wait

till the cord falls off some of these

babies are very young babies this is a

set of twins they're very new there's a

little baby and there's a newborn on his

daddy's chest so there's lots of

different ways of doing tummy time you

should try and do tummy time

approximately 10 minutes 3 or 4 times a

day and you want to do the tummy time

when the baby's in that nice awake alert

state where they're just kind of looking

around and this is supervised tummy time

it's not time for you to run off and get

your dishes done or get the laundry done

this is the time you're going to spend

and join your baby talking to your baby

singing to your baby playing lots of

music to your baby and also very very

important we want you to start reading

to your little babies right away don't

even wait three or four weeks down the

road if you start reading to these

little ones right away and right now you

would want to choose two very simple

books and you want to try and get the

books that rhyme because at this age

little babies they love repetition and

they love rhyme and yes you will get

sick and tired of reading those same

little stories over and over again but

if you start this right away within

about five or six weeks when you pull

that little book out and you start

reading you want to pay attention to

your baby's eyes it's just like the

light bulb goes off it's just amazing to

watch so this is going to really help

your children in their later years so

taking care of yourself like I said at

the beginning of the class it's really

important to sleep when your baby sleep

okay

don't rely on getting sleep at night and

try not to have too

many visitors at the beginning the best

kind of visitors are the ones that knock

on the door pass you a casserole and say

we're going to leave you you call us

when you want us to come and visit ok

because you're going to find you're very

tired when you feel ready try to get

involved in your baby groups out in the

community this can be a huge support

network they do have them through the

public libraries and they also have them

through the Public Health Unit and they

have groups right from newborns all the

way up to 18 months of age and you're

going to be there to support new mummies

coming into the group when you go into

the group there's going to be mummies

there that are going to be there to

support you it's really nice to be able

to talk to somebody that's had a bad

night just like you've had a bad night

and you can share that with somebody now

as far as the healing process goes we

really encourage you to take that little

plastic wash ball that we've given you

we want you to take that home and you

just use warm water in it just like

you've been using here and you should

use that bottle until your flow has

completely gone now your show your flow

should be gone by around a 15 to 20 you

are going to find your flow does

increase when you're breastfeeding and

the reason that that happens is the

hormone that ejects the milk when you're

breastfeeding is also the same hormone

that clamps your uterus back down to

that too little outside that was before

you got pregnant change your pads very

frequently because blood is the perfect

breeding ground for bacteria and if you

sit in those pads for long hours you're

putting yourself at risk of developing a

nasty infection okay for those of you

that have had a cesarean section you

want to keep your incision nice and

clean and dry as well and you shouldn't

be lifting anything heavier than your

little baby for the first four to six

weeks and that does not mean your baby

in a car seat car seats with babies in

them that is way too heavy remember to

take your pain relievers as you need

them so that you're able to care for

your baby and the other thing is it's

really important that you check with

your doctor or with your obstetrician

when you are allowed to draw

okay okay so let's look at nipple care

care as you can see from this mummy's

nipple the front of this nipple the skin

has come right off and now she is

developed a scab over that that's

extremely painful

so nipple tenderness is normal you have

to expect some nipple tenderness but

excruciating pain is not normal so

cracking bleeding scabbing blistering

that is not normal so this type of thing

starts to happen to you

you do not want to leave that you want

to get into your public health nurse as

quickly as possible because you need to

find out why that is happening to you

there's something about the latch that

is causing that kind of damage to a

nipple now hopefully you will not get

engorged this can happen sometimes with

mummies when their milk all of a sudden

comes in quite quickly by frequent

feeding okay you don't want to go long

periods between feedings if you

breastfeed your baby frequently

hopefully you won't get engorged but if

you do get engorged where the breasts

get very very hard and firm and it might

be difficult for the milk to let down

you want to call your public health

nurse and get the help the use of cold

compresses can really help take that

swelling down but call the public house

nurse get in to get the help to help so

that you can get the help to resolve

that engorgement and it can take three

or four days for that to go down now all

of you should have received this little

pamphlet in your packages that you got

during your pregnancy so you might want

to just get this out and review it and

it's pretty well the same guidelines for

pregnancy as it is for breastfeeding

except you're going to find you're

really really hungry and you need to eat

more food now please don't worry that

you're going to gain weight because

you're eating more food

breastfeeding is the most wonderful diet

of all you get to eat lots of food

because the weight just falls right off

you so enjoy it while you can but just

remember whatever you're eating your

baby is eating four or five hours later

you do want to stick to that really nice

healthy well-balanced diet you're going

to find your release thirsty when you're

breastfeeding so you do need to drink

extra fluids you don't need to over

drink there used to be an old wives tale

out there that if you drink lots and

lots of fluids you'd make more milk well

that's not true but you need to drink

too thirst foods that you should avoid

fishtest high in mercury so you wouldn't

want to be choosing a lot of tuna fish

halibut is not a good choice as well

salmon is fine you can eat salmon foods

that are contaminated with Listeria okay

the deli luncheon meats while they're

not good for you anyway

okay please don't ever diet while you're

breastfeeding you're going to find just

with breastfeeding and eating a healthy

diet you will lose weight you want to

expose your baby to lots of flavors

quite often I get asked questions Oh

should I avoid cauliflower or am I

allowed to have chocolate well who could

I couldn't live without my piece of

chocolate every day it's everything in

moderation so yes you can have a piece

of chocolate you can have broccoli you

can have cauliflower spicy food your

baby loves spicy food the research shows

babies that have been exposed to a lot

of different flavors while they were

breastfeeding are less picky toddler

eaters okay we really encourage you to

continue taking your prenatal vitamins

for as long as you're breastfeeding and

also make sure that your calcium intake

is good okay for the coffee drinkers

that just can't give up their coffee one

cup of coffee a day is okay for the two

tea drinkers 2 to 3 cups of tea a day is

okay but if you're drinking massive

amounts of coffee and tea your baby is

going to be like this and your milk

supply could take a little bit of a dip

okay so vitamin D for our babies it is

recommended that all breastfeeding

babies be supplemented with vitamin D so

we would like you to speak to your

Midwife or your doctor and you can do

this before you go home or you can do it

on the first visit that you take the

baby to and they will recommend

there's a couple different products out

there there's a D drop product where

it's just a drop which provides four

hundred national international units or

sometimes you can buy the vitamin D

liquid form and they get a little half a

dropper full but you would want to

discuss this with your doctor or your

Midwife and they will let you know the

dosage that they would like you to give

to your baby and when to start it

all right the baby blues we all go

through the baby blues after we've had a

baby and it's not just the mummy that

goes through the baby blues it's the dad

as well and dads usually go through the

baby blues a little bit later than mummy

first of all the birth experience is

overwhelming for both parents and then

you're both going through that sleep

deprivation which you're not used to and

then on top of that Mommy goes through

this huge hormonal shift really really

quickly in her body so you might come

into the room mums crying her eyes out

she has no idea why she's crying okay

this can go on for a couple of weeks and

dads I will let you know when it's going

to happen to you usually it's after you

go home you've been home for three or

four days and mum says you know what you

got to go out and get some diapers and

some milk and all kinds of groceries

daddy comes back into the house with all

the groceries mums crying her eyes out

baby screaming the little head off and

dad just wants to throw his hands up in

the air and start crying too like what

happened to us and I always say dads

have a good cry with mom everybody's

going to feel a whole lot better okay so

this is normal this can go on for a

couple of weeks but unfortunately

postpartum depression has increased

significantly over the last five years

and quite often when a mummy goes into a

postpartum depression she doesn't see it

happening to herself you can say to her

well how's everything going you know how

is it with the baby she'll have this

great big plastered smile on her face

oh yes everything's fine because isn't

that what you're supposed to say after

you've got this beautiful little baby

isn't that what it's supposed to be all

about but for many women once dad has

gone back to work especially if they

they

used to having their career where

they're around people talking to people

all of a sudden they're at home with

this little baby and sometimes that can

be very lonely for a lot of women and

they may not even recognize it in

themselves so we really encourage

partners family members to watch mummy

very carefully for the first few months

after she's had a baby and sometimes

they pick up on it quicker

so if you notice mums just not herself

she's not sleeping even when the baby

sleeps you can just tell something's

wrong she said she's not enjoying the

things that she used to enjoy please

make sure that you get her in and get

her the help as soon as possible

that first year of your baby's lives are

the most incredible journeys you're

going to go through with your children

they go from being these little babies

like this one year of age a lot of them

are running around all over the place

it's just an amazing year and mummies

that go through postpartum depression

they don't enjoy that year at all in

fact it's a huge struggle for them to

get through that every mummy has the

right to enjoy that special year with

her baby so please get mum in and get

the help this specific postpartum

support society is a wonderful society

that you can get in touch with that is

very supportive of the entire family of

somebody that's going to postpartum

depression the period of purple crying

you should have all received one of

those little DVDs the little purple DVD

and we really encourage you to watch

this probably before your baby hits

about two weeks of age would be a good

time now the reason that they call it

purple crying is they found through

their 25 year study all over the world

that babies cried the most around 2 to 3

months it was unpredictable resisted

soothing pain like look long bouts of

crime generally happening late afternoon

evening time when the parents were

getting really tired so that's what the

purple stands for now back in my day we

used to call these babies colicky babies

you might have heard your parents say oh

you were such a colicky baby you cried a

lot so if your baby does start this

behavior you would want to take your

baby into the doc

to make sure there's nothing wrong with

them now if we just take a look at this

graph here as you can see all babies

start crying more around two weeks it

peaks between two to three months and

look what happens here it drops down

significantly by four to five months

look at that little group of babies

there they could cry for five to six

hours in a 24-hour period generally

happening all together late afternoon

evening time when the parents are

getting tired and some of them can be

very difficult to consult but they

studied these babies for many years

after and they found this group of

babies that went through this 99% of

them turned out to be perfectly happy

healthy children because if you have one

of these little babies that screams and

screams and screams for hours on end and

you're walking the floor and they're so

you start to wonder is there something

wrong with my baby that they could cry

like that and I can't console them

also the other nice things for parents

to realize there is light at the end of

the tunnel it's going to get better so

parents find that very helpful as well

okay so things you can do to help soothe

your baby and every baby is different so

you will have to do some experimenting

first of all try putting the baby back

on the breast several times in a row

sometimes that can interrupt a crying

cycle now a breastfed baby will not

overfeed you can't do that with a bottle

fed baby because they will over feed

some babies responded really well to

motion so the little baby swings were

well or in a rocking chair going out for

a stroller ride hopefully you won't have

to drive around for two or three hours

every night at the cost of the gas but

some babies respond well to that as well

putting on a vacuum or putting on a

dishwasher now I always find that

amazing all of a sudden the baby stops

crying it's very very strange but some

babies it just interrupts that cycle

some babies have been overstimulated

they need to get into a quiet spot like

a bedroom maybe with a rocking chair

could help try taking warm

with your baby holding a baby in

different positions now if you're going

through this with your baby and your

partner works afternoon shift nobody

should have to go through this

themselves it's very stressful on the

parents so please make sure you do get

some help into the house and always know

it is okay to take a break from a crying

baby

quite often parents feel very guilty

about putting a baby down that's crying

because as humans when you hear a baby

cry you want to pick the baby up and you

want to control the baby and I don't

care who you are you can have the

patience of a saint when you're dealing

with this night after night it wears you

down and your little clue that you will

need to take a break you'll be walking

that baby and all of a sudden you might

not say it out loud but inside you'll

say I just can't take this any longer

that's your - you need to take a break

and the best thing to do put your baby

in a safe place

safest place is the crib shut the door

and walk away and don't be afraid to do

that your baby's not going to hurt

themselves crying in a crib get on the

phone if you're by yourself and see if

you can get somebody to come over and

help you but even if they can't come

immediately they say that little 5-10

minutes telephone conversation with

another album helps to bring down the

stress level so that you're able to go

back and try and console your baby again

okay all right car seats we would like

you to bring your car seat up to the

unit we don't want you to bring the base

the base should already be properly

installed in your motor vehicle and then

we are going to ask you to put your baby

in the car seat and we're going to come

and check it and if there's any advice

we can give you we will now it is the

law that babies are in the rear-facing

position for one full year now okay but

the new recommendation out there is

keeping these little babies rear-facing

for at least two years so the law is one

year but the new recommendation which

will become the law

is at least two years and beyond these

little babies do way better when they're

involved in a motor vehicle accident

when they're in the rear-facing position

okay very important that your babies are

put in their car seats properly with

every car trip baby should not be

traveling around in cars where they're

slumped all over this way they're

slumped all over this way this can

interfere with the baby's airway if

they're they're not positioned properly

in the car seat if your baby does need

positioning in the car seat with

rolled-up blankets your nurse will show

you how to do this and please do not be

bringing your babies into the house if

they've fallen asleep in their little

infant car seat you do not bring the

baby into the house drop them down in

the hallway and then go about your

business and just leave them coming back

when they wake up car seats are not

meant for that there has been two

tragedies in the last year where babies

have succumbed in car seats that were

not positioned properly in the car seat

all slumped over and it interfered with

their airway so please do not do that

okay on the day that you go home we are

going to be giving you this little

pamphlet your nurse will give it to you

and we fax the public health nurse all

the information about your babies births

so this program is called the best

beginnings program and it's run through

the Public Health Unit you will receive

a phone call from one of the public

health nurses 24 to 48 hours after you

go home now they are there to follow you

up for a six to eight week period after

you've had your baby I cannot promise

that they will come to see you in your

home they will come out to see some of

you but they may not come out to see

everybody but you can go into the public

health unit for that full six to eight

weeks you can call them seven days a

week

8:30 to 4:30 if you want any information

if you have questions regarding yourself

or your baby so they are there for

follow-up care so you will all receive

this little pamphlet on the day that you

go home do you all

of this little book called babies best

chance this is a wonderful resource it's

also on the internet so you can pull it

up on the internet if you like that's a

great resource for all the way up to six

months that we encourage you to go to

and the other thing is this little best

beginnings website now if you would like

you can come and tear one of these

little sheets off because this gives you

all the information that's on this

website and this website is very current

it was put out by Frazer health and it

goes all the way from preparing for

pregnancy all the way up to children 2

years of age so if you're looking on how

to introduce solids to a baby there's

lots of very good information on

breastfeeding you can try looking up

this website it's very very helpful

alright now I know this is a little bit

early to be talking to you about milk

donation but we are always looking for

milk donors in Frazer health we have a

level-3 nursery at Royal Columbian

Hospital here and we have some very

fragile babies down in our NICU that are

sometimes born 24 weeks 25 weeks 26

weeks 27 weeks and sometimes for one

reason or another their mummies may not

be able to produce breast milk or they

could be on some kind of medication that

is contraindicated with breastfeeding

and it is critical that these very

fragile babies receive breast milk so if

you go home in the next six to eight

weeks and you find that you have an

abundant milk supply you could become a

milk donor the screening process is very

easy you will get a telephone call if

you decide to do this you will get a

telephone call from one of the lactation

consultants down at BC women's and

children so it's just a telephone

interview then you have to go for a

blood test which is paid for by the

donor around clinic and then your milk

that you collect once you've been

screened can be dropped off at any of

the pub

health units and Fraser health so it's

very convenient and then what they do

they take that donor milk it's sent down

to BC women's and children's where it's

pasteurized and it does retain many of

its very very beneficial products for

these very fragile babies and then we

get that melt back into our NICU for

these very fragile babies so if you do

find you have an abundant milk supply we

would really appreciate you becoming a

milk donor so questions when you go home

please make sure that you have a piece

of paper and a pen that's handy in your

house because a lot of questions are

going to come up about yourself and

about your babies and when the public

health nurse calls you or when you take

your baby to the doctor or the Midwife

comes over all the questions that you

were going to ask are going to fly right

out of your head so please make sure

that you write your questions down thank

you very much for coming to the class