You and your baby may be discharged from hospital on the third day following the birth if you have had a normal delivery, or on the fifth day if you have had a Caesarean section.

Before leaving the hospital you will be given a date for your baby to have a Guthrie test (metabolic screening) if this has not already been carried out. Your midwife or public health nurse may do this blood test or you may have to return to the hospital to have the test carried out.

If you are travelling by car from the hospital it is important that you have a car seat to strap your baby into. Your baby’s identification bands may have been left on so cut these off when you get home. Your midwife or public health nurse may visit you at home in the first few days.

The first few weeks with a new baby can be very stressful and worrying for new parents so it is important that you ask for assistance from your midwife, public health nurse or doctor if you have any concerns.

Getting to Know Your Baby

There is a common perception that all a baby does is eat, sleep and cry, however, research has shown that babies’ behaviour is more complex than this and can be organised into six states of consciousness.

Quiet alert
When babies are in a quiet alert state they may lie very still and rarely move. They spend all their energy watching with their eyes wide open, usually staring directly at someone or listening intently. This is a particularly good time to interact with your baby.

Active alert
Your baby will be more active with arms waving and legs kicking. Although your baby will do a lot of looking around he/she is more likely to focus on objects rather than on a person. Babies are often in this state prior to being fed.

Crying
Crying usually occurs when your baby is hungry, uncomfortable or just unhappy for some reason. While crying, your baby will contort his/her face, move his/her arms and legs vigorously and shut his/her eyes tightly.

Drowsiness
Babies are drowsy just as they are waking up or drifting off to sleep. Drowsy babies will often stretch as they are waking up and will make a variety of facial gestures. The eyelids will be droopy and the eyes will appear glazed and unfocused.

Quiet sleep
Your baby’s face is relaxed and the eyelids are closed and still. The baby will lie very still with just occasional mouth movements and breathing is regular. Quiet sleep alternates with active sleep every half hour or so.

Active sleep
Half of the time your baby is asleep he/she is in an active sleep. In this restless sleep state the eyes, although closed, can often be seen moving under the lids. This sleep is called rapid eye movement (REM) sleep and is actually a lot more restful for your baby than it looks.

Care of the Umbilical Cord Stump

The cord clamp on your baby’s cord will have been removed on the third day. The cord will turn black a few days after birth and can be expected to drop off between one and four weeks later. You can help speed up the healing process by keeping the area dry and exposed to air. Many mothers are apprehensive about touching the umbilical stump in case it is painful for the baby but the tissue is dead so there is no need to worry.

When putting on your baby’s nappy fold the front of it down below the umbilical stump to let the air in and keep urine away from it. Dry the stump carefully after you have bathed your baby. Swabbing the stump with alcohol was often recommended in the past but recent research has shown that healing is faster without the use of alcohol and there is no increased risk of infection. Do not put any powder on the cord. If the area around the stump turns red, oozes or has a bad odour talk to your midwife, public health nurse or doctor.

Nappy changing
In the early weeks you may need to change your baby’s nappy frequently. Changing before or after feeding and whenever there is a bowel movement, is the best way to prevent your baby from developing nappy rash or skin irritation. Waking your baby to change his/her nappy is hardly ever necessary unless your baby is very wet or has a bowel movement and appears uncomfortable.

The colour and texture of your baby’s stools may change from day to day and from bowel movement to bowel movement so there is no need to worry if this happens. Meconium is a newborn’s first stool and this will be sticky, tar-like, black or dark green. Transitional stools, which usually appear on fourth day, tend to be grainy and greenish-yellow in colour. Babies who are breastfed may have seedy, creamy, light yellow or mustard stools. Frequent, watery, greener than usual stools may mean diarrhoea. Hard, pellet-like stools may indicate that your baby is constipated.

Burping (winding) your baby

Whether bottle- or breastfeeding, your baby may swallow air along with the milk, which may make him/her feel uncomfortably full before he/she has finished the feed. That is why burping or winding your baby to bring up any excess air is important. Burp your baby every 60mls (2ozs) or so when bottle-feeding and between breasts or mid-breast if breastfeeding.

Three methods of winding:

• On your shoulder: Hold your baby firmly against your shoulder, firmly supporting the buttocks with one hand and patting or rubbing your baby’s back with the other.

• Facedown on your lap: Turn your baby face down on your lap, stomach over one leg and head resting on your other leg. Hold your baby securely with one hand and rub or pat his/her back with the other hand.

• Sitting up: Place your baby in a sitting position on your lap, head leaning forward, chest supported by your arm as you hold her/him under the chin with one hand while rubbing or patting his/her back with other hand.

Jaundice
It is quite common for babies to develop jaundice in the early days. Jaundice is a yellowing of the skin that starts at the head and works its way down to the toes, tinting even the white of the eyes yellow. Jaundice is caused by an excess of bilirubin in the blood. Bilirubin is a chemical formed during the normal breakdown of red blood cells and is usually removed from the blood by the liver. Newborn babies often produce more bilirubin than the immature liver can handle. As a result, the bilirubin builds up in the blood causing the yellowish tinge of the skin. This is known as normal, physiological jaundice.

In physiological jaundice the yellowing of the skin of occurs around the third day, peaks around the fifth day and should be gone by the time your baby is a week or ten days old. To check if your baby is jaundiced press his nose, arm or thigh with your thumb. If the area beneath the pressure turns yellowish rather than white, jaundice may be present so contact your midwife, public health nurse or doctor.

Bathing your baby

As long as adequate spot cleaning is done during nappy changes and after feeding you only need to bath your baby three to four times a week. However, many mums find that a bath helps their baby to settle. You can bath your baby at any time of day but bathing before bedtime will make your baby more relaxed and help him/her to sleep better. Avoid baths just before or after a feed. Your baby will not like being handled if his/her tummy is full. Give yourself plenty of time for your baby’s bath and avoid being rushed so that you can enjoy it.

While you are using a portable baby bath, the kitchen or bathroom provides the most suitable setting. Your work surface should be at a level that you can manoeuvre easily and with enough space for all the items it needs to hold. Turn off fans and air conditioners and be sure the room is warm (24-27ºC) and is not draughty, as newborn babies lose body heat quite quickly. Never leave your baby unattended, even for a second, during the bath. Ignore doorbells or the telephone until the bath is finished.

Ear care

The old saying ‘never put anything smaller than your elbow into your’ ear is correct. Cleaning the inside of your baby’s ear is not necessary and can be dangerous. Wipe your baby’s outer ear with a flannel or cotton wool but do not try to enter the ear canal itself with swabs or anything else. The ear is naturally self-cleansing and trying to remove wax by probing could force wax further into the ear.

Nose care

The inside of the nose, like the inside of the ear, does not require any special cleansing. If there is nasal discharge wipe the outside of the nose but do not use cotton swabs, twisted tissues or your finger to try and clean the inside of the nose as you may cause trauma to the delicate tissues.

Nail trimming

An infant’s nails are often quite long at birth and most parents are uneasy about trimming their baby’s nails but it is necessary as babies can scratch themselves quite badly. Cutting the nails is easy because they are so soft but getting your baby to stay still may be a problem. Cutting his/her nails when he/she is asleep maybe an option. Otherwise get your partner to hold your baby’s hand still while you trim the nails. Always use special baby nail scissors or clippers