The First 48 Hours of Life

 
The birth of a child and the first 48 hours spent with it are awakening experiences. For most parents this is a time of fulfillment - the culmination of nine months of labor, and for many, numerous months of trying to conceive and readying their lives, homes, and bodies. For others, particularly fathers, it is a time of epiphany and realization. The pregnancy and child that they had perhaps felt so distant from and unattached to, is suddenly the center of their lives and focus of attention. These factors, compounded by uncertainty and anxiety surrounding the times ahead can make these first couple of days of parenthood a whirlwind of overwhelming emotion and confusion.

This section will help provide some clarity regarding this tumultuous time. It will explore what the baby will look like, what his senses will be like, what sorts of test will be run on him, and what his hospital stay will be like. The mother's physical and emotional state and recovery during the first days after birth will also be discussed.

What does the baby Look Like?

Most new parents take careful time to inspect their children from top to bottom after birth. They take the opportunity to inspect their child, ensuring that there is nothing wrong, and acquainting themselves with their child's body.

On average, a newborn should be between 18 and 22 inches long, and weight between seven and nine pounds. There are also a number of traits characteristic of newborns that may be noticeable in the baby:

· the baby's Head - Most notable about the baby's head will be its proportionately large size compared to his body. At birth, his head comprises 25% of his body. While his body did grow a lot in the last few months of gestation, it has not completely caught up to his head.

Also, the baby's head may look vaguely malformed, either with a cone-shaped look or a caved appearance. This misshapenness occurs in one of two ways: 1) because the soft, and yet unattached bones of the skull change shape in order to move through the birth canal and pelvis; and 2) the soft head's shape is altered by forceps or vacuum extraction that is sometimes used when labor is not progressing or the mother is unable to actively deliver. The baby's head will return to its normal shape within a couple of days.

The baby also has two soft spots on his head, one on the top and one at the back, known as fontanels. These spots are covered by thick membranes that will eventually grow over with skull bone. The fontanel at the back of the head will have closed by the baby's second month, and the one on top will have closed by the time the baby is eighteen months. It is alright to gently touch the fontanels, no harm can be done.

The baby's Head

The baby's forehead and crown may appear, swollen, lumpy, and/or bruised or red. This is known as a caput and is caused by the pressure placed on the baby's head by the mother's cervix and birth canal during birth. The caput will disappear with in days.

The color of the baby's hair may be shocking. Some babies, will be born with very blond, dark, or red hair that is completely opposite of both their parents. This hair is not usually permanent, and does change as soon as more long-term hair grows.

The mother will notice that the baby is not yet able to hold his own head up. His neck muscles are not developed enough to be able to hold up his heavy head. It is likely that not until the fourth month will the baby be able to support his own head.

· the baby's Face - the baby's face may appear swollen and slightly off center, as if it is being pulled up or down. His nose may be askew and/or flat, and his chin may seem out of place. The baby may also have some bruises on his face from the birth and his eyes may be swollen and blood shot. Also, the skin on his forehead may look loose and wrinkled.

The baby's eyes will either be quite dark, blue, or grey in color. This coloration will not likely last and their true, permanent color will emerge in about two weeks. The baby may appear cross-eyed because he has trouble focusing on distant objects. He will quickly learn to focus and his cross-eyed appearance will disappear.

The mother may be worried that the baby's ears stick out too far or are too large. Because of the head's disproportions the ears may seem too big; if this is the case, the baby will grow into them. However, the baby may just have naturally big ears. In this case, nothing can be done to remedy them without surgery. This should not be a large concern though. If the baby and the mother have both emerged healthy, as has the mother, ear size should be a trivial matter.

· the baby's Legs - It is unlikely that the baby will emerge with straight legs. His positioning in the womb will have made his legs slightly curved or bowed. The baby's legs will straighten out as he spends more time out of the womb and as he grows.

· the baby's Skin - the baby's skin may appear quite translucent and veins may be readily visible. The skin on his hands and feet may be peeling, and birthmarks may be obvious.

Caucasian babies may have a pinkish or purplish pigmentation during the first few days. Non-Caucasian babies may not have obvious pigmentation for hours or even days after birth. Some are born with rather light pigmentation and gradually darken during their first days of life. Some babies may have a bluish pigmentation, typically signaling that they have a build up of mucus in their lungs. This mucus is suctioned out immediately after birth and much is coughed up by the baby in the days to follow. The baby's skin may develop a yellow or orange pigmentation two or three days after birth. This signifies a mild case of jaundice, which half of all newborns experience. The liver should begin to function properly and the jaundice disappears in seven to 10 days.

The baby's skin should feel tender, soft, and smooth. The mother must ensure that his skin stays warm and does not chap. Birthmarks and delivery marks are also very common among newborns. The mother should not worry about these; they are not the result of anything that she did or ate during pregnancy. Birthmarks and delivery marks are perfectly natural.

Delivery marks can be caused in the womb or during delivery, and are common in most births. The marks should fade or disappear within a few housr or a few days of delivery. If, however, they do not, and instead they grow, change color, or remain, contact the baby's physician.

There are numerous different types of birthmarks. Newborns may display many different types of them. The more common birthmarks include:

- Café au Lait spots: tan or light brown in color, appearing anywhere on the body. These birth marks are typically permanent.

- Hemangiomas (a. k. a strawberry marks): these are very common, appearing in 10% of births. They are pink or red and can appear anywhere on the body. Typically, they will disappear by the age of ten.

- Moles: can appear anywhere on the body and range in color from light brown to black. They are permanent unless removed.

- Mongolian Spots: flat, blue marks that are found most commonly on the back and buttocks. They will usually fade or disappear by age three, but can be a permanent fixture on the body. Darker skinned and Asian babies, seem more susceptible to these spots.

- Stork Bites (a. k. a. salmon patches): are pink spots that typically appear on the face and head. They are caused by blood vessels, and usually disappear; some are however permanent.

The mother should monitor any birthmarks that are found on the baby. If they change color or shape, or begin to bleed, a physician should be contacted. Most birthmarks are harmless, but others will be removed surgically for precautionary reasons.

· Other Parts of the baby's Appearance - the baby's hands and feet will be very small. He will likely keep his hands clenched in fists and his legs will be pulled up to his stomach, resting in the fetal position. The nails on his fingers and toes will be very thin and may already need to be carefully trimmed. His feet are void of all bones expect a heel bone. The cartilage that will later form bones is present, and his feet are likely turned inward.

The baby's stomach is probably frighteningly prominent. However, this should not be a cause for alarm. The baby has a lack of muscle tone in his abdominals, which allows his stomach to bulge. It is not an excess of fat or a medical problem. It will disappear as he gains strength and tone through his greater mobility in the upcoming months.

The mother may also notice that the baby's genitals are swollen and perhaps discolored. This again is normal and should not be a cause for concern. Swollen genitals are common among both sexes of newborns. Females may also be displaying vaginal discharge as well as inflammation. In both sexes, swelling is the result of maternal hormones which have crossed the placenta. The condition should fade in a couple of days after birth.

The mother may also notice that the baby's breasts become slightly swollen and may leak some fluid in the first couple of days after birth. This is a normal occurrence. The mother must avoid squeezing or rubbing them. This could harm them and/or cause infection. The swelling should subside in a matter of days.

The baby's bowel movements in the first few days will appear very dark - ranging from black to green to yellow. This first bowel movement is known as meconium. It is composed of cellular material and other substances that have accumulated in the baby's intestines while in the womb. Before normal digestion can begin, the baby must rid himself of this waste. If the baby has not expelled the meconium within 48 hours after birth, his physician will be concerned that the baby has a bowel obstruction. Within a couple days of passing the meconium, the baby's stool should turn to a light yellow or green color, with a granulated texture.

What are the baby's Senses Like?

Most new parents wonder what their newborn child is able to sense. Can the baby see? Can he hear? Can he taste? Can he smell? It may be hard to believe, but soon after birth, the baby's senses are developing quickly. In fact, he can recognize the voice and sight of the mother almost immediately. All of the baby's senses are functioning within the first couple of days after birth. This is not to say however, that they are well-developed.

· the baby's Sense of Hearing - the baby is able to hear at birth, but his hearing is not fully developed. Crucial parts of the baby's ear are not mature and he is only capable of hearing a small range of sounds - particularly lower sounds such as the human voice. The mother can play a vital role in helping the baby's hearing further develop by talking to him in a slow and exaggerated voice.

· the baby's Sense of Sight - the baby's eyes are perhaps the most developed of his sense organs. He is capable of seeing a wide range of things. What hampers the baby's vision is his underdeveloped brain. The baby will have trouble seeing distant objects, and his optimal line of vision is about one foot in front of him. He has the easiest time distinguishing between light and dark patterns.

· the baby's Sense of Smell - It is believed that infant's sense of smell is very well-developed at birth. Almost immediately the baby will be able to guide himself to the mother's nipple through his sense of smell. The baby will learn quickly to associate smells with their various sources, and whether they are good or bad.

· the baby's Sense of Taste - the baby is born with a relatively undeveloped sense of taste. He is however, born with a craving for sweet foods which makes him readily take breast milk and formula. At birth he is able to distinguish between bitter and sour tastes, but those areas, as well as salty, are quite undeveloped.

· the baby's Sense of Touch - the baby's sense of touch will be well-developed and sensitive from birth. He will quickly become accustomed to the mother's touch, and it will soothe and comfort him. The baby will like a firm touch - it will give him a feeling of security. He will also respond favorably to stroking and gentle massaging.

What Tests will be performed on the baby after Birth?

Immediately after birth, and usually once again shortly after, the baby will have a number of tests performed on him. These tests are meant to assess his health and indicate any potential problems or conditions. The following are some of the more common and more significant tests that will be performed:

· APGAR Score - This health assessment test is administered immediately after birth. It is not a prediction of future health, merely an indicator of the baby's current condition. The baby will be evaluated one and five minutes after birth. He will be graded a 0, 1, or 2 in five different categories: color, heart rate, breathing, movement, and reflexes. The individual scores are added together - the highest possible score being a ten. On average, newborns receive scores between seven and nine. Typically the APGAR score of the second test will have increased as the baby's breathing begins to become normal and his color changes. If however, the score is lower or remains low, something may be wrong and doctors will have to further examine the baby.

· Blood Tests - Blood is taken from the baby's heel in order to test for various diseases. The blood screen looks for anemia, blood-glucose levels, hyperphenylketonuria, hypothyroidism, and sickle-cell anemia. The results will inform doctors of whether the baby needs any special care or further evaluation.

· Brazelton Neonatal Behavioral Assessment - The test examines and evaluates a wide degree of the baby's behaviors in order to provide information on how he responds to his surroundings. Many hospitals perform this test on all newborns, but it is most often used only when physicians suspect that there are health problems.

· Coombs Test - Blood is taken from the umbilical cord in order to test whether the mother's blood is Rh-negative or Type O. This is meant to discover whether Rh-antibodies have been created in the mother's body.

· Neonatal Maturity Test - This test is meant to assess the baby's neuromuscular and physical maturity at birth. Various aspects of the baby are assessed and given a numbered score which are then summed. The final gives a relative measure of the baby's maturity.

· Reflex Assessment - Several of the baby's reflexes are tested. The reflexes typically tested included:

- Sucking Reflex: Placing one of the baby's fingers, or the mother's fingers, in the baby's mouth will cause him to suck with surprising force.

- Rooting Reflex: If one of the baby's cheeks are touched he will turn his head, open his mouth, and root for the nipple.

- Grasping Reflex: If a finger or object in placed in or touches the palm of the baby's hand, he will grasp the object tightly.

- Babinski Reflex: Stoking the bottom of the baby's foot will cause his toes to fan out and curl up.

- Moro Reflex: This reflex is a startle response. If provided with the feeling of falling, the baby will outstretch his arms and legs and then make an embracing motion as if trying to grab something to prevent falling.

Greater evaluations will be done if certain reflexes are not observed.

· Hearing and Vision Testing - More and more hospitals are beginning to test vision and hearing of newborns, especially if there is a familial history of related problems. The baby's eyes will be tested for various diseases and proper functioning. Hearing is tested by listening for an inner-ear echo, or by monitoring electrical brain activity in response to noise. If a problem is found with either hearing or sight, further steps will be taken.

Beyond these immediate tests, a routine examine of newborns is typically performed by their pediatrician with in the first two days after birth. The physician will:

- Listen to the baby's heartbeat and lungs.

- Feel the baby's abdomen to check for any abnormalities in the internal organs.

- Test the baby's reflexes to ensure that his nervous system has developed properly.

- Test the baby's hips to ensure that he does not have 'clicky hips' - where the sockets of the hip are too shallow allowing the legs to slide out of place. If this is found, there are a number of solutions such as splints and braces that are usually worn for approximately two to four weeks while the hip sockets mature. If untreated, 'clicky hips' can cause the baby problems in walking and crawling.

- Measure the baby's head.

- Check the baby's genitals.

- Check the baby's palate.

- Check the baby's spine.

The baby's Hospital Care

Beyond these initial tests and the follow up tests performed by the baby's pediatrician, the baby's hospital care will be minimally intrusive as long as he is healthy and normal. The baby's pediatrician will make regular visits to check on him and answer any questions or concerns that the mother may have. If requested, the pediatrician will perform a circumcision, and further acquaint himself with the parents of his patient. The pediatrician will then schedule regular follow-up examines for the baby at which his growth, development, and health will be tested.

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