We all look at our baby at birth to count his/her toes and fingers, looking over the precious little one to be sure that everything is 'normal'. The following is what is important to be done during the prenatal period to comfort you as the parent that your baby is going fine.
Importance of Prenatal CareYour blood pressure tells your care giver how your body is handling the pregnancy. A rise in your blood pressure over a number of weeks would tell me a lot about your diet. It is important that you eat healthy. I want the women that choose my care to eat the following diet. blueribbonbaby.org
Your urine will be checked for sugar and protein. Your care giver may check for other items also, but these are the main two. If you are spilling sugar or protein in your urine, this tells your midwife that your diet needs to be adjusted. You may be required to have other tests done.
This test is done by giving your midwife a urine sample and she uses a special test strip to check the urine.
You will gain between 20-40 pounds (average) with your pregnancy. If you gain too much in a short time, your midwife will check to see if you have any swelling. Your blood pressure may be up also if you have gained weight fast. This problem is controlled by your diet; again your diet is very important.
Your abdomen grows about 1 centimeter for each week of your pregnancy. A sudden growth that continues could mean there is more than one baby, a slow growth that is not corresponding with the weeks you are pregnant, could mean perhaps you are not as far along as you have thought. Your dates will be checked, and rechecked.
Any other possibilities will be discussed with your midwife.
This is a way to tell that your baby is ok.
If you are not sure that you are feeling your baby move as normal, you should go relax and pay attention to your baby. Get something to drink, such as orange juice, and relax. Now write the time you feel the baby move, and do this for ½ hour. Record each time the baby moves. Contact your midwife with this information, and she will discuss the ´results´ with you.
Each day if you sit down for ½ hour, (do it the same time each day) you will notice a pattern. You will be able to tell if your baby is moving well or not.
Color: Babies have a grayish-blue color when they are first born. They pink up quickly as they begin breathing. The feet and hands may stay pale or blue (cyanotic) especially when they are cold or crying. This should not last too long, maybe a day or two.
Fontanels (soft spots): The skull bones are separate to allow for the baby to 'fit' thru the birth canal. It also allows for rapid brain growth that occurs in the first year of life. Between these bones, the 'soft' spots are actually a tough membrane. As the child ages, bone grows here.
Puffy Eyes: the babies eyes may be puffy, this is from pressure on the head and face during the birth. If you choose to have the eye medication in your babies eyes, that can also cause this.
Lanugo: This is a fine soft hair over the baby , esp. on large parts of their bodies. It will fall out over the next few weeks.
Milia: Your baby's face, nose and sometimes the arms, may have a white pimple like bumps They are not pimples! Don't squeeze them or pinch them! They will go away on their own. It shows your baby's skin is working ok.
Birth marks: There are some called 'stork' bites. They are red marks on areas such as the face, bridge of the nose, or back of the neck. They will fade over the next year or so. Babies with darker skin pigmentation may have blue to gray patches over the lower back and buttocks. They can look like a bruise. They are called Mongolian spots and usually fade over a few years.
This is often called a substance that is used to 'grease' your baby to make it easier for the baby to be born. This is not true. It disappears as the child is closer to the 40 weeks gestation period. Premature babies often have a lot of this. It is actually a protectant for the infants skin. It is white, like cream cheese consistency. It should be rubbed into the skin if any is on your baby at birth. It should not be bathed off, as done in the hospital.
The skull bones have not fused together yet. This allows for the head to 'mold' during the birth. The bones will 'over lap' as they move to let the baby fit thru the birth canal. Some people joke that their baby has a cone head or foot ball shaped head at the birth. This is normal and will 're-shape' with in 24 hours.
![[Molding of babys head]](../images/Molding_3.jpg)
This is a way that we 'grade' your baby at one minute and five minutes of age. We give a score for how the baby is breathing, muscle tone, heart rate, the color of the baby, and reflexes. The best score is a 10, and the average is a 7-8 or 9. A 6 or lower and the baby is getting a LOT of our attention!
After the baby is born, the cord is clamped and cut. In hospitals they clamp and cut the cord right away. We do not. Often we wait until the placenta is out, then clamp and cut it. If we do clamp and cut it before the placenta is birthed, then we do wait until it has stopped pulsating. (see cord clamping for more information).
![[Babys cord]](../images/Umbilical_cord_care.jpg)
Your hormones may cause your baby's genitals to be fuller or have swelling. This is normal. Also sometimes the baby girl may have some white to slightly blood tinged discharge from her vagina. A baby boy may have what appears to be a drop of blood that is on his diaper. (it almost looks more red-orange in color than a deep red) this is normal. This is from uric acid crystals, the normal breakdown product of protein. If you are not sure about something, save the diaper to show to your midwife or the baby's doctor.
Your baby should not be bathed before 48 hours except for the herbal baths. Give your baby time for his/her skin to adjust to being out here in 'the air'. You should ask your midwife to do a demonstration bath if you have never bathed a baby. Your baby does not need to be bathed daily. They do not get that dirty. The genitals, face and neck area should be washed daily.
A new born baby sleeps about 22-23 hours out of 24. (usually) Some do not sleep as much. If you have trouble keeping your baby sleeping in the bassinet or what ever you choose beside your bed, try placing a baby blanket or small sheet on your pillow case for 24 hours, as you lay on it, then place it in your baby's crib. Your scent will be comforting to your baby. This is why they sleep better in your bed, during the day even when your are not in the bed.
If your baby cries, first check if they baby is cold, hungry, wet or had a BM. If not, they maybe the baby is just lonely. Remember that this child has been growing under your heart for 9 months, and is use to you as the mother. When you are not right there, the baby knows this. Try the following: offer the baby a feeding, offer the baby something to suck, rock the baby, swaddle the baby, hold the baby, walk with the baby, talk to the baby, just spend some time with the baby. If you have done all of these and the baby is still crying, sometimes the baby needs to cry. If you can't sit with the baby as she cries, then place her safely in the middle of your bed, and go out of the room, just for a few minutes. The baby may cry her self to sleep, maybe she is over stimulated. If after a short break for you, she has not stopped crying, then go to her again after you are calm. Always remain calm with your baby.
I am not saying to let your baby cry itself to sleep, so please understand me here. I believe that your baby needs something even if it is just being held. Sometimes mothers get stressed, and rather than respond to your infant in a negative way from the crying, I am saying to leave baby in a safe spot, and get out of the room for a few minutes. Calm yourself, then go back. Baby will cry, that is hard, but if you are that close to responding in a bad way... take time out. MOST important - get help!!! Post part. Depression is real! Don't go at it alone. Tell your midwife!
The first bowel movement that your baby will have is a very dark sticky stool, called meconium, This is what is left over from making the intestinal tract. The stool will go then to a dark green color, still sticky, and then to a yellow color. Looking like you mix mustard with cottage cheese. Because the breast milk is so easily digested, the baby may have a BM each time he eats. The stool smells sweet, cheese like.
Also called the PKU test. This is when your baby's heel is poked and blood drops are placed on circles on a test card. They are filled. This is then sent into the state lab. The test is only accurate when your baby has been receiving a diet containing phenylalanine, found in both human milk and infant formula, for a period of at least 24 hours. For this reason a breast fed baby should not be tested until at least seven days after the birth to give enough time for the milk to come in and the baby to get enough. If the baby has not had enough milk, then the test may not be valid, and will need to be repeated.
For more information go to :"Why is a newborn hearing screen important? Without a hearing screen an infant with a hearing loss is usually identified later in childhood, usually around 24-30 months of age. Infants learn a great amount during the first months of life even though they will not typically speak their first words until 12 months of age. Identifying hearing loss and providing early intervention improves a child's language development."
"Can I wait to have my infant's hearing tested? The younger the infant, the more likely the infant will sleep during the test. As infants get older (three to four months), they are more alert and restless. It is also important that your infant does not miss out on early language development. Infants begin learning language during the first months of life. An infant with hearing loss needs extra help in communicating and understanding language. If an infant needs extra help, you want to start as early as possible."
"What if I cannot afford to pay for the evaluation? If your insurance company does not cover a referral for a hearing evaluation, children's " Special Health Care Services (CSHCS) is a program that may be able to help. (Assess if the family needs help getting in touch with CSHCS. Have local telephone number available to facilitate contact. Also give out 1-800-359-3722 for CSHCS. The operator can connect family to local CSHCS if long distance toll is a factor.)
Hospitals usually fill this out for you before you leave. They also require you to have your baby named before you leave the hospital. For most people this is ok. For some, you may not have decided yet what you want to name the baby. When I had my children, (in the hospital) I was told that I HAD to name my baby before I could be discharged. That was a LIE. You have up to one year to name your baby (in most states, check your local state law). You also have (again in most states) up to a year to file the birth certificate. Some counties want you to file right away, and will tell you that you have a time limit of about 30 days. Again, check with your state, not local, representative.
There is a work sheet that you will fill out, with the help of the midwife, and mail it to your local health department vital statistics. Check before the baby is born for how to obtain a copy of the birth certificate. Some counties will have you mail in for one, others will have you get one at the time you file. You have to pay for a copy. It is usually less expensive to get an extra copy at the time you do the first one. You will need copies for your child's school enrollment, work permit, drivers license, social security number, and in the future, a marriage license. Some counties only hold the information for 3-4 years, and after that you will need to contact your state department of vital statistics. Other counties will hold the information for 'ever'. The county that my children were born, I can go to and still get a copy, even for myself (and I am over 40).
Usually no, but then there are those few counties that may give you a hard time. If you are given a hard time, ask to speak with the supervisor. Sometimes clerks are unaware of your rights as a parent, and will try to bully you. They may try to tell you that home birth is illegal, and so you are breaking the law. Remember that you have the legal right to have your birth anywhere you want to in this country. They can NEVER regulate where you have your baby, (although many are trying), they can only regulate who helps you with your home birth (the midwife). Sometimes in allegal states (states where the law is not in favor of the midwife) the father may sign the birth certificate as verifier and attendant. According to the law in Indiana, the person who delivers the baby is defined as the person who cuts the cord. (although some other midwives and doctors will try to tell you other wise). This is usually the father of the baby.
You may need special information to take with you to identify yourself, so plan ahead. If you do not want to call when you are pregnant, and want to wait until after the baby is born. You may need to also wait to file for about 6 months. Some counties require you to have a piece of mail with a post mark date on it as one piece of identifying paper. You may need one from when you are pregnant. You midwife may be able to tell you what you will need to have.
1 When you give information for the birth certificate, there is a place that asks "do you want a social security number for your baby?" If you do, check yes. That is it. You will need to provide both the mother and father's social security numbers for this also. (not all counties give this service)
2 The second way is to wait and apply later at a Social Security Administration Office.
Young children need a SSN for opening a bank account, to buy a savings bond, obtain medical coverage, obtain any government assistance such as WIC, Food stamps, or other services.
No.
Keep the card in a safe place. If you need a second one, for any reason, it is provided free of charge. But you will need to contact your SS office for assistance.
This varies. For the Amish families in the area, they have had to take their bishop in to state who they are! (they do not have photo ID's)
You will need at least two documents of evidence of your age, identity, and U.S. citizenship or lawful alien status.
They can not accept photo copies or notarized copies, only original documents can be used.
It would be best to contact the SS office you plan on working with to be sure what they want for you to bring in.
The United States is the only country to practice non-religious circumcision almost routinely. About 80% of males are circumcised.
![[Circumcision]](../images/Circumcision_3.jpg)
![[Circumcision-Surgery]](../images/Circumcision_3-a.jpg)
The following is taken from the ICEA paper "When Your Baby Boy Is Not Circumcised"
Circumcision is the cutting away of the foreskin on the penis. At birth, the penis consists of a cylindrical shaft with a rounded end called the glans. The shaft and glans are separated by a groove called the sulcus. The entire penis-shaft and glans- is covered by a continuous layer of skin. The section of the penile skin that covers the glans is called the foreskin or prepuce. The foreskin consists of two layers, the router foreskin and the inner lining similar to a mucous membrane.
During fetal life (before birth), the foreskin and glans develop as one tissue. That is, the foreskin is firmly attached-really fused- to the glans. Over time, this fusion of the inner surface of the prepuce with the glans skin begins to separate by shedding the cells from the surface of each layer. This is not difficult to understand. Virtually all body cells are continuously discarded and replaced by regenerated cells. For example, the skin surgace of the entire body is normally replaced every 30 days. So too are the epithelial layers of the glans and the inner foreskin lining-not only in infancy, but regularly throughout life. The discarded cells accumulate as white, waxy "pearls" which gradually work their way out via the tip of the foreskin.
Eventually, sometimes as long as 5 or even 10 years after birth, full separation occurs and the foreskin may then be pushed back from the glans toward the abdomen. This is called foreskin retraction. The foreskin may retract spontaneously with erections which occur normally from birth on and even occur in fetal life. Also, all infants "discover" their genitals as they become more aware of their bodies and may retract the foreskin themselves. If the foreskin does not seem to retract easily early in life, it is important to realize that this is not abnormal and that it will eventually do so.
The glans at birth is delicate and easily irritated by urine and feces. The foreskin shields the glans. With circumcision, this protection is lost. In such cases, the glans and especially the urinary opening (meatus) may become irritated or infected, causing ulcers, meatitis (inflammation of the meatus) and meatal stenosis (a narrowing of the urinary opening). Such problems virtually never occur in uncircumcised penises. The foreskin protects the glans throughout life,. In addition, it is erogenous tissue serving a sexual function. The sexual benefit claimed for circumcision, namely the reduction or elimination of premature ejaculation, is totally without basis; witness the fact that at sexual dysfunction clinics, premature ejaculation is the most common presenting symptom among young men, of whom perhaps 75% are circumcised.
The claims that the presence of the foreskin causes cancer, VD, masturbation and a host of others problems are unfounded. While it is true that penile cancer is more often found in uncircumcised males, it is occasionally found in males circumcised in infancy. The penile cancer rate in non-circumcising countries, such as Japan and Scandinavia, is no higher than the US, where circumcision is virtually done routinely. This exceedingly rare cancer may be effectively prevented by good hygiene.
The foreskin is helpful, not harmful. This does not mean that the foreskin will never develop any problems. Things can go wrong with any body tissue, including the foreskin. Infections of the skin, ears, eyes, throat and dozens of other body parts are well known; they are rarely a cause for alarm and rarer still a cause for surgical intervention. The foreskin is the only tissue considered dangerous enough to warrant preventive surgery-circumcision.
Parents are warned that foregoing newborn circumcision will only mean postponing the surgery until later in life when it will be more troublesome. This attitude is found only in the US. Foreskin problems are not very common. When problems such as infection arise, they usually respond to simple medical treatment. Surgery is rarely necessary. This is the experience in all medically advanced countries where circumcison is not practiced routinely, e.g. France, Japan, Scandinavia, Germany, etc.
What about smegma? Isn't it dirty and disease-producing? The answer is NO! Smegma is probably the most maligned body substance. It is normal, natural body product, no more harmful that ear wax. It is definitely not a carcinogen (cancer-causing).
What then is smegma? It is the material produced under the foreskin. The term has been used incorrectly for generations. There are two types of smegma: infant smegma and adult smegma.
Infant snegma: As noted above, the entire body skin is shed every 30 days. The shed skin rubs off on clothing, in bathing and in a thoroughly unnoticed fashion, unless there is a special skin shedding such as sunburn.
Skin cells from the glans of the penis ans the inner foreskin are also shed throughout life. This is especially true in childhood, copious skin shedding serves to separate the foreskin from the glans. Since this shedding takes place in a relatively closed space-beneath the foreskin-the shed skin cannot escape in the usual manner. It escapes by working its way to the tip of the foreskin. These escaping discarded skin cells constitute infant smegma.
Adult Smegma: Everyone is familiar with the enormous changes that occur at puberty-menses, breast development. Hair distribution, voice change,. Etc. There are also noticeable skin changes. At birth, there are millions of skin glands whose function it is to produce an oily substance called sebum. These are the sebaceous glands. In early childhood, they are largely inactive. At puberty, hormones stimulate their development.
Sebaceous glands do not produce an odor; most are associated with hair follicles. There are also specialized sebaceous glands "Tyson's Glands" located on the glans under the foreskin. Tyson's Glands produce an oily substance which, when mixed with shed skin cells, constitute adult smegma. Adult smegma serves a protective, lubricating function for the glans, just as adult smegma in women protects the clitoris.
With the foregoing as background, we can now discuss foreskin hygiene. Despite the myths, the foreskin is easy to care for. The newborn or infant of either sex should be bathed or sponged frequently, and all parts should be washed, including the genitals. The external penile skin is soft and pliable and easy to wash. It is not necessary to retract any part of the skin in order to wash under it. In the newborn, the uncircumcised penis is quite easy to keep clean. NO special care is required! Leave the benis alone. The body provides its own protection of the glans area, because the foreskin is fused to it. As the shed ejpithelial cells (infant smegma) ooze from underneath the foreskin, cleaning away the material is logical. No other manipulation is necessary. There should be no use of Q-tips, irrigation or antiseptics. Good old soap and water is perfect. The same hold true for the newborn girl's clitoral foreskin-leave it alone except for external soap and water.
Mothers are told that the circumcised penis is easier to keep clean,. The implication is that the uncircumcised penis is difficult to keep clean. This is obviously untrue!
The biggest circumcision bugaboo is the issue of foreskin retraction. Unfortunately, many parents have been warned by some physicians and nurses that parents must retract the foreskin daily from birth on, to avoid the "devastating effect" of foreskin retention and inadequate hygiene. Some "authorities" go so far as to urge that retraction be done rapidly so as not to "over-stimulate" (masturbate) the child. THIS IS INCORRECT ADVICE, described by one pediatric urologist as "cruel and inhuman, unfounded medically and physiologically." Many physicians have written that mothers often shirk the task of foreskin retraction, thus making circumcision an absolute necessity. But the mothers were correct in their reluctance to retract and the physicians were incorrect in urging such retraction.
Two questions should be addressed. Should the foreskin be retracted, and if so, when?
THE INFANT FORESKIN NEED NOT BE RETRACTEDBear in mind that in the newborn, the foreskin is NORMALLY attached to the glans. Retracting the foreskin from the glans means forcibly tearing the foreskin from the glans. This is a painful process and will likely leave the underside of the foreskin and the surgace of the glans raw. Bleeding may occur, leaving the area open to urine and local irritation and infection.
It is easy to understand why premature retraction needs to be avoided. No body organ or tissue should be put to use before its time. For example, solid food should not be given until the infant is able to chew, swallow and digest it. It is, by the same token, ill-advised to forcefully retract the normally fused foreskin.
This is the key element of penile hygiene. As noted, the foreskin and the glans develop as one tissue. Separation will evolve over time. It should not be forced. When will separation occur? Each child is different. Separation may occur before birth, this is rare, occurring in perhaps 5% of newborns. It may take a few days, weeks, months, or even years. THIS IS NORMAL. Although most foreskins are retractable by age 5, there is no need for concern even after a longer period. No harm will come in leaving the foreskin alone.
For the parent who is caring for a newborn male for the first time, handling the penis may seem strange. This is why the concept of "leave it alone" is sound advice. As parents become more comfortable in handling the penis, they may be curious to determine the degree of foreskin retraction in their son. Although unnecessary, this is simple to do.
The parents may have had the opportunity to observe a newborn's erection. If full erection has occurred, full retraction may also have occurred. If partial erection has occurred, partial retraction may have occurred. If no erection has been observed, this does not mean that foreskin retraction is not possible. Some newborns do not experience erections; this is not unusual.
To test retraction occasionally, hold the penile shaft with one hand and with the other hand, push the foreskin back GENTLY-NEVER FORCIBLY-perhaps 1/8 of an inch. Retraction may also be done with one hand, pushing the shaft skin gently toward the abdomen. This will automatically retract the foreskin. If there is ANY DISCOMFORT in your baby, or if you feel resistance, stop. Try again in a few months. If the retraction is easy for both the child and the parent, further retraction may be attempted in due time. There should be no rush to retract. Eventually, the foreskin will retract completely, exposing the entire glans. This may take several years.
Is "Leave It Alone" Good Advice?
Yes!Jaundice is when the skin of the newborn appears to be yellow in color. Any jaundice that occurs with in the first 24 hours should be checked by a doctor. This could indicate a more serious problem.
Most jaundice will occur after the second day of life. Between day 2 to 5 is the most common time. The cause is from a increase amount of bilirubin in the baby. The baby is unable to process it fast enough, so becomes yellow form the excess.
As long as baby is healthy, nursing effectively (10-12 times/24 hours and stooling 2-5 times a day) and not showing exaggerated levels of bilirubin, no treatment is necessary. The American Academy of Pediatrics suggests for Jaundice occurring at this point in the baby's life that phototherapy be considered at bilirubin levels of 15 mg/dl, photo therapy be started at 18 mg/dl, exchange transfusion be done at 25 mg/dl and both exchange transfusion and intensive phototherapy are indicated at 30 mg/dl.
Remember placing baby in in-direct sunlight will help the infants body process the bilirubin.
