Dr B. J. C. Perera
MBBS(Cey), DCH(Cey), DCH(Eng), MD(Paediatrics), MRCP(UK), FRCP(Edin), FRCP(Lond), FRCPCH(UK), FSLCPaed, FCCP, Hony. FRCPCH(UK), Hony. FCGP(SL)
Specialist Consultant Paediatrician and Honorary Senior Fellow,
Postgraduate Institute of Medicine, University of Colombo, Sri Lanka.An independent freelance medical correspondent.
KEY POINTS
- The foetus lives a pampered existence within the womb of the mother and the birth itself is a bit of a harrowing experience for the baby.
- The most important initial need is to establish normal breathing.
- Exclusive breastfeeding should be commenced within one hour of birth.
- Baby should “bed-in” with the mother and should be fed on demand, day and night.
- The baby needs warmth and to be cuddled.
- The baby should pass urine and stools within the first 24 hours.
The arrival of any newborn baby is certainly a superlatively joyous occasion. The mother has carried this bundle of joy in her womb for just about nine months, and at long last, it will be time for him or her to see the light of day. The foetus in the womb has a pampered existence, with the mother meeting all its needs. Her body provides all the warmth and essential nourishment that the baby needs for growth and development. The baby grows in the protected environment of the womb, floating in a bag of water in completely dark surroundings. Having gone through nine months of such a blissful existence, it must surely be quite a harrowing experience at the time of delivery, either by the natural route or by a Caesarean operation. No small wonder that all of them come out making quite a bit of noise and crying. That noise is music to the ears of the birth attendants, as in the vast majority, it implies that all is generally well with the baby.
First essential requirement
The first essential requirement for the newborn baby, at birth, is to breathe properly. In the womb, the mother’s blood provides the baby with life-giving oxygen through the placenta and umbilical cord. This route is cut off rather suddenly at birth, and the baby has to fend for itself as far as breathing is concerned. The immediate need, after birth, is to initiate and maintain normal breathing. In the vast majority of deliveries, Mother Nature has put in the necessary mechanisms for the baby to start breathing normally, and the baby comes out with a lusty cry, expands the lungs and starts to breathe normally. The life-giving oxygen from the air will be extracted by the lungs and carried to all the tissues by the blood. The skin turns pink, the baby starts to move all four limbs vigorously, keeps on crying, and with some gentle coaxing, settles down to the normal routine of a newborn baby. The umbilical cord is generally secured with a germ-free sterile plastic clamp or tied up with special sterile suture material and cut with a pair of sterile scissors.
Based on scientific evidence, it is now advised to delay the clamping of the cord by 60 seconds or more after the birth of the baby, as it has several benefits for the health of the baby. The total functional dependence on the mother is terminated with the cutting of the cord, but the baby still remains almost totally dependent on the mother for its basic needs.
Yet for all this, in a small minority of babies, breathing problems are encountered, and this situation must be dealt with promptly, imperiously, and with a lion-hearted response by the medical attendants at delivery. Sometimes the possibility of breathing problems could be predicted, but at other times it just happens out of the blue. Inadequate establishment of normal breathing leads to a catastrophic fall in the oxygen content of the blood. One organ that is exquisitely sensitive to a lack of oxygen is the newborn baby’s brain. There is absolutely no time to lose. Every second matters, and resuscitative measures should be instituted immediately. The recovery of the baby will depend on the skills, capability and urgency of the medical response. Happily, such episodes can now be dealt with competently and decisively using the currently available resources in our medical institutions. In many instances, all that is necessary is to take over the baby’s breathing for a couple of minutes with a special bag with a mask attached to it. This type of artificial ventilation automatically induces the baby to breathe normally in most cases. Once a baby has recovered adequately and satisfactorily from such a calamity, there is no looking back, and he or she will be quite normal.
Different treatment modalities
However, if the treatment modalities are delayed, leading to a protracted lack of oxygen to the brain of the newborn, or the baby does not recover well even after adequate efforts at resuscitation, there is a very real risk of permanent brain damage from which he or she will suffer for the rest of his or her life. The damage to the brain can take many forms, but the most common is a disturbance of the ability to move the limbs normally known as Cerebral Palsy. In some instances, it does leave the child severely disabled for the rest of his or her life. Baby brains that are permanently damaged in this fashion do not recover completely, and the child is likely to have enormous problems for his or her life thereafter. This is the reason that training of all personnel and dedication towards the resuscitation of the newborn is such an important aspect of the day-to-day routine in the labour rooms and operating theatres.
While in the womb, the baby is constantly exposed to a surrounding temperature of around 37 degrees Celsius. This is the normal body temperature of the mother. The room temperature in the delivery rooms and operating theatres is much lower than this. Even in non-air-conditioned areas, it may be about 28 to 30 degrees Celsius, while in air-conditioned surroundings it may be as low as 18 – 20 degrees Celsius. The newborn baby needs to be kept warm, particularly because the normal body temperature control mechanisms of the baby are rather immature and not fully developed or sensitised at birth. In many institutions, radiant heaters are used to keep the baby warm, but simple measures like keeping the baby adequately covered in pre-warmed linen are quite effective. The most rational and simplest way of keeping the baby warm is to keep the baby with the mother as soon as feasible, using the body warmth of the mother for the purpose. This is known in medical parlance as ‘Kangaroo Care’.
Food and nourishment
During the time that the baby is in the womb, all the nutrients for the baby are provided by the mother. There is a prime need to provide food and nourishment for the baby after birth. The very best food for the baby is, of course, mother’s milk. Breastfeeding is the natural continuation of the care that has been given to the baby during the months of pregnancy. Breast milk is all the food that the baby needs for the first six months of life, and it is the proverbial elixir of life. The best time to start breastfeeding is right after the baby is born. Babies are born with a sucking reflex, which is most powerful around 30 minutes after birth. Putting the baby to the breast then helps the mother and baby in several ways.
The sucking of the baby releases hormones in the mother’s body which contract the womb and help to control blood loss. The baby gets colostrum, or first milk, which offers proteins and immune protection. The mother responds to successful breastfeeding by making more milk, so that the baby loses less weight after birth. Immediate feeding is also known to initiate and enhance that all-important mother-child bonding, which would last a full lifetime. In scientific circles, this bonding with the mother is considered to be one of the many useful outcomes of early breastfeeding. It has been clearly established that the sooner the baby is started on mother’s milk, the better it is, especially to successfully feed the baby for the first few months of life.
Need to be with mother
The bundle of joy is later cleaned up, washed, dressed in very light clothes and handed over once again to the mother. It is now the usual practice to have the baby bedded in with the mother in the same bed. In the good old days, babies were separated from their mothers and kept in nurseries and cots. Being with the mother at all times helps her to respond to the needs of the baby and particularly to react to demand feeding whenever the need arises. The normal newborn baby is expected to pass urine during the first few hours after birth and to open its bowels during the first 24 hours. The urine is generally very light-coloured, and the stools are dark blackish. Gradually, the stools turn to the normal yellowish brown colour over the first couple of days.
The baby tends to sleep a lot during the first few days and wakes up when he or she is hungry. All that the baby needs in the first few days is for it to be fed adequately with the mother’s milk and kept clean and warm. It is also important to continue to feed the baby whenever the baby wakes up in the night, as there is hormonal stimulation by the suckling process, which increases the supply of milk from the mother. With night feeding, this benefit is carried on even into daytime. The currently advised practice is to exclusively breastfeed the baby for the first six months of life. What is meant by this is to give only mother’s milk to the exclusion of everything else, except medicines and vitamins. The World Health Organisation (WHO) recommendation for exclusive breastfeeding is six months. However, due to social reasons, such as the need for the mother to go back to work and the limitation imposed by the period of maternity leave, it may be necessary to curtail this period to four months. It has been scientifically shown that the baby does not need even additional water, not even in very warm climates. The vast majority of babies do very well on this regime of exclusive breastfeeding, grow and develop satisfactorily. They should be protected from infections by preventing people with other communicable diseases from coming into contact with the baby. It must be remembered that newborn babies have immature defence mechanisms and a still-developing immune system. Therefore, they are that much more vulnerable to many types of infections.
Newborn babies need to be cuddled and comforted. The warmth of the mother is quite soothing and reassuring to the baby. Normal newborn babies thrive extremely well without any further assistance from anything or anyone else, provided adequate nutrition is provided for them. In evolutionary terms, they are born with all the necessary requirements and the potential to grow unhindered into childhood, adolescence and adult life. The vast majority of them will develop and flourish, just like flowers that bloom beautifully in this world.