MUM KNOWS - NEWBORN CARE

Dear new mothers,

Welcome to the Maternity Department and congratulations on the birth of your baby! With the following text, we would like to help you to go through the first few days of your baby’s life successfully and make the hospitalization period easier for both of you.

The newborn basic care guide has been prepared by the Centre for Integration of Foreigners. We will explain what to expect within the following few days, clarify the basic rules on breastfeeding, point out possible problems and give you some information about a newborn baby. At the end of this text, you will find important laws which need to be followed in the Czech Republic. We believe that this guide will help you to understand the conditions common in this country. If you have any problems or questions, please do not hesitate to contact one of the nurses or doctors who are here to help you 24 hours a day.

Questions regarding foreigner issues can be answered by the staff of the Centre for Integration of Foreigners. The contact details are listed below.

We wish you a pleasant stay at the Maternity Department and all the best for the future.

ROOMING-IN

The effort of the maternity hospital is to allow you to keep your baby with you all the time during your stay in hospital (rooming-in) – if you and your baby’s state of health allow that. This ensures that you will soon learn how your baby behaves when he/she is hungry or upset and how to take care of him/her (changing nappies, bathing, taking care of the skin, cleaning the eyes, bellybuttons, etc.)

BREAST-FEEDING

Exclusive breastfeeding is considered to be the best way of providing babies with all the necessary nutrients until the age of sixth months. Afterward, you can continue to breastfeed while introducing appropriate complementary food up to two years of age or beyond. The longer you breastfeed your baby, the healthier and more resistant against common illnesses he/she should be. That is the reason why you should, from the beginning, learn some simple rules and the right technique of breastfeeding to be able to breastfeed as long as possible without any problems.

Breast-feed your baby whenever he/she shows signs of hunger such as pouting the lips, sticking out the tongue, putting his/her hands to the mouth, etc. Do not wait until your baby starts to cry because after that latching on becomes more difficult. Within the first two or three days after birth, the majority of babies will drink hardly any milk – this is normal. Do not forget that even a very small amount of colostrum (the first milk produced by your breasts) contains a large number of antibodies that the newborn needs the most within the first days after birth.

During the last few months of pregnancy, you have provided your baby with all the necessary nutrients which will give your baby enough energy for the first few days of life. During this time, all newborns lose some weight (so-called Neonatal [Newborn] Weight Loss) – it is a common feature and definitely does not mean that the baby is starving. It only means that the water contents in the baby’s organs and skin are changing so they are more resistant in a dry environment outside the mother’s womb. The weight loss is usually about 10 percent of the birth weight – sometimes more, sometimes less.

Bringing the baby to the breast immediately after birth and as often as possible during the first days of life is very important for early milk production.

The break between two breastfeedings shouldn’t be longer than 4 hours during the first days of life. Place your baby to both of your breasts every time you breastfeed.

Later (after 2 or 3 days), we can roughly weigh the amount of the milk drunk by the baby. This will inform us about the fact that the milk production has already started and the baby is able to suckle successfully. However, the amount of milk is not crucial and it is important to take into account other facts than just the numbers. There are big differences in the amounts of milk drunk by individual babies during the first days after birth. While sucking, the baby rests for about the same time as it suckles – the baby is not asleep! If the baby has drunk enough and falls asleep, it usually releases the nipple. Some babies want to hold the nipple almost constantly – let them do that!

After feeding let your baby burp in a raised position – ideally in bed (bad manipulation right after breastfeeding can cause heaving or make it worse).

In the beginning, breast-feed your baby in a lying position, later it is better to change the positions The nurse will help you to train the position and to find the one which will suit you best. Remember: breastfeeding should not hurt. Your baby needs to have your nipple and a bigger part of the areola in his/her mouth. If breastfeeding hurts, it means that something is wrong (mother’s or baby’s position, technique of breastfeeding), and it is necessary to interrupt the feeding and place your baby to your breast again correctly to avoid sore nipples.

During the first few days, place your baby to your breast with the nurse’s help. If breastfeeding hurts, your baby is sleepy, or does not want to latch on, the nurse will help you.

Your breasts should feel softer after feeding – if not, it is best to express the milk.

Expressing breast milk

When to express breast milk:

During a longer separation of the mother and the baby
In case of breast milk retention
In case of excessive milk production
To shape the nipple and areolas.

You can express your breast milk by hand or with a manual or electric breast pump.

Preparation:

Get ready a sterile container for expressed breast milk
Wash your hands
Apply warm moist washcloths to your breasts or take a warm shower
Massage your breasts in circles from the chest wall to the nipples to stimulate the ejection
reflex
After the massage gently shake your breasts by slightly leaning forward

Procedure:

Place a fingertip of your thumb above the areola and a fingertip of your index finger underneath
the areola so that these two fingers make a shape of the letter C. The fingers and the nipple
have to be in a straight line.
Press the whole breast with your three remaining fingers and your palm to your chest.
Keep pressing the nipple rhythmically till the milk starts to drop.
Repeat this triple rhythm movement and change the position of the fingers on the areola.
The fingers must not pull the nipple out and must not leave the skin to avoid abrading of the
Large or very full breasts can be supported by placing the palm of the other hand under them.
The time of expressing is about 20 to 30 minutes, switch the breasts a few times during the whole procedure.

Problems with breasts

Painful and engorged breasts – what to do:

Before breast-feeding – warming up the breasts with a wet warm washcloth, eventually in the shower followed by a gentle massage of breasts and softening the areolas by expressing breast milk to allow the baby to latch on properly
After breastfeeding – soft massage and expressing breast milk until relief
Between breastfeeding – cold compresses, eventually Paralen tablets

Sore and cracked nipples – result of a wrong breastfeeding technique, position, or suckling. What to do:

Improve the breastfeeding technique
Change the baby’s position during breast-feeding so that the cracked part of the nipple is in the baby’s mouth corner
Keep changing the positions
Stimulate the milk ejection before breast-feeding by applying a warm compress on your breasts
Offer the baby the less painful breast first
Do not reduce the frequency and length of breastfeeding
At the end of the feeding, put your little finger in the corner of the baby’s mouth – this will release the suction
After every breastfeeding, leave a few drops of milk on your nipple to dry up
After every breastfeeding apply a healing ointment Bepanthen as a prevention
Leave your nipples on fresh air as often as possible

BREAST-FEEDING TECHNIQUE

Correct holding of your breast

The fingers should not be touching the areola
The breast is supported from underneath by all the fingers (except the thumb)
The thumb is placed on top of the breast, high above the areola
The pressure of the thumb on the mammary tissue allows the erection of the nipple
The breast has to be offered to the baby in a way so that the baby can latch on to both the nipple and the areola

BREASTFEEDING POSITIONS

Main rules:

To find a comfortable position for both the mother and the baby
The baby has to lie on his/her side with the face, chest, belly, and knees towards the mother
The baby’s ear, shoulders, and hips are in a straight line
The central lines going through the ear, shoulders, and hip joint of the mother and the baby have to be parallel
The mother pulls the baby towards herself with her hand holding the baby’s shoulders and back, not the head
The mother should not touch the baby’s head and face unnecessarily in order not to interfere with the suckling reflex
If touching the baby’s head, the fingers should not cross the ear line
Any obstacles such as the baby’s bottom hand or a knot on the blanket or clothes should not be present between the mother and the baby
The mother should not pull the breast away from the baby’s nose
The mother should bring the baby to her breast instead of bringing the breast to the baby’s mouth
The baby’s chin, cheek, and nose have to touch the breast
The baby’s chin has to sink deeply into the breast
The baby should not cry
Breast-feeding should not be painful for the mother

Signs of a correct mutual position of the mother and the baby

Mother:

Is relaxed
Does not feel any pain (the nipple, shoulders, back, arms)
The mammary tissue does not get tensed under the baby’s mouth
The ejection reflex works properly
The nipple is not sore or flat
The breast is empty after breast-feeding

Baby:

Does not pout his/her lips or suck in the cheeks
Feeds with long slow sucks
Does not slurp while suckling
Can breathe normally by pulling away the breast tissue by the top of his/her nose
Is happy

Side-lying position

Both the mother and the baby are lying on their sides facing each other
The mother places a pillow under her head so that her head is level with her shoulder
The mother bends her back slightly towards the baby
The baby lies in the mother’s arm’s angle
The mother must not be bearing her weight against her elbow, the arm must not be above the shoulder

Sitting position

The baby’s head is placed in the mother’s arm’s angle
The mother’s forearm supports the baby’s back
The mother’s fingers are placed on the baby’s bottom or thigh of the baby’s top leg
The mother holds her breast with the other hand
The baby’s bottom arm is placed around the mother’s waist
The mother’s feet are supported by a stool

Football hold

Suitable for women with large breasts or flat nipples, or after cesarean section
The baby lies on the mother’s forearm, the mother supports the baby’s shoulders with her hand
The fingers support the baby’s head
The baby’s legs are placed alongside the mother’s side
The baby’s feet have to be free, without any support
The mother’s forearm is placed on a pillow

Half sitting position with bent knees

Suitable for women after cesarean section
The baby lies at the angle of the mother’s arm, or on her forearm
A pillow placed on the mother’s abdomen avoids placing the baby straight against the scar and reduces the pressure on it
A pillow placed under the mother’s knees supports her legs

Breastfeeding twins

You can breast-feed both of your babies at the same time
You can choose different positions: football hold, side-lying position, cross position, parallel position
Each baby can have their own breast

Correct latching on

The nipple always has to be level with the baby’s mouth
Touching the nipple to the baby’s lips encourages a searching reflex
The baby’s mouth wide open (like a big yawn) is the right response to this stimulation
The breast has to be offered to the baby in a way so that the baby can latch on to both the nipple and the areola, especially below the nipple
All the fingers, except the thumb, should be placed underneath the breast
!CAUTION! The mother must not pull the breast away from the baby with her fingers

Breast-feeding a sleepy baby

Talk to your baby, use an eye-contact
Hold your baby in an upright position
Move your baby
Unwrap your baby
Take off your baby’s clothes (suckling activity decreases with a temperature above 27 C)
Stroke your baby
Change your baby’s nappy
Wipe your baby’s face with a cool washcloth
Move your finger in circles around your baby’s mouth
Your baby can breathe without any problems if positioned correctly
Do not try to breastfeed your baby if he/she is crying – when crying, the baby’s tongue is placed in the upper part of the mouth which makes it impossible to latch on.

If you are still having problems with breastfeeding despite the help of the nurses and the information given above you can always contact the breastfeeding specialists, i.e. The Lactation League or The National Breastfeeding Line.

COMPLEMENTARY FEEDING

If, for whatever reason, the baby needs complementary foods, everyone taking care of the mother and her baby should know the alternative ways of feeding the baby (you can get more information from the nurses).

For breastfeeding to be successful the baby should not be bottle-fed.

There is a difference between breastfeeding and bottle-feeding; the baby has to learn how to suckle in two different ways which might be confusing for him/her and therefore soon starts to prefer bottle-feeding which is easier.

NAPPY CHANGING

Change the nappy before every breastfeeding (every 2 or 4 hours).

The nurse will give you all the necessary information on nappy changing, bathing, and basic baby care.

TEMPERATURE AND OTHER IMPORTANT INFORMATION

The baby’s temperature is usually measured twice a day (morning and afternoon), or more often if necessary.

A normal baby’s temperature is 36,5°C – 37,5°C.

Information that is important for checking the baby’s health status during the first few days after birth: urination, defecation, temperature, time of breastfeeding, and later also the amount of milk drunk (write this information down in the chart on the baby’s bed following the nurse’s instruction).

NEONATAL JAUNDICE

Most babies with neonatal jaundice are treated with daylight. For that reason, do not close the blinds and put the baby’s bed to the window (caution – the baby must not be placed in a draught or on direct sunlight!

Only babies with severe jaundice are treated with blue light (so-called phototherapy).

GOING HOME

Usually, the mother and her baby leave the hospital the fourth day after spontaneous birth or the sixth day after cesarean section – if the baby is drinking well, putting on weight, and does not have severe jaundice or any other problems.

When leaving the hospital, you will get a Health and Vaccination Card (Zdravotní a očkovací průkaz) and Discharge Report of your baby (Propouštěcí zpráva novorozence).

All the things your baby will go through during his/her stay in hospital

Your baby will be checked by a pediatrician every morning during rounds
Your baby’s hip joints will be examined by an orthopaedist
Your baby’s blood will be tested for congenital metabolic diseases
Your baby will be vaccinated against TBC (in left shoulder)
Your baby will be examined by a pediatrician before leaving the hospital

!DO NOT FORGET!

Immediately after your arrival home, inform the pediatrician you have chosen that you have left the maternity hospital. The doctor will give you a vaccination scheme for your baby.

Pick up personally your baby’s birth certificate at the registry office corresponding to your maternity hospital. The birth certificate should be available within 1 or 2 weeks after birth.

Have the birth certificate officially translated and certified for the embassy of your country. This enables the embassy to issue a personal document for your baby (e.g. a passport) or to enter the baby’s details in the parents’ documents.

Within 60 days after birth apply for a residence status for your baby. The baby has the right to get one of the parents´ residence statuses (you can choose the more convenient one). Please contact regional offices of the Department for Asylum and Migration Policy (Ministry of the Interior) for a residence status application.

Within 8 days after birth, register your baby with a health insurance company. The easiest option is to register your baby with the same health insurance company you were registered with on the day of your baby’s birth (you will need a birth certificate and a personal document). If your baby has Czech nationality, permanent residence status, or asylum, you must register him/her with a health insurance company. Then he/she will have been insured since birth and the insurance will be paid for by the government. If your baby does not have government health insurance (e.g. if you have applied for long-term residence status for him/her) you have to pay for your baby’s commercial insurance. Be careful when choosing commercial health insurance for your baby – it can be comprehensive or can only cover emergency treatment. Find out what exactly the insurance policy is! More information about health insurance can be found on www.cicpraha.org.

!Caution! If the mother does not have health insurance on the day of her baby’s birth, she will be charged all the medical expenses!