Care after leaving the hospital

Care of the baby after leaving the hospital

Chord Care

Care of the baby’s cord should continue as when in hospital. The cord will come loose after 7 – 14 days. The area might bleed slightly. The area should continue to be cleaned with surgical spirits or Hibicol (as directed by the paediatrician) until it is clean and dry.

Remember: If the skin area around the cord base becomes red, the paediatrician should be contacted immediately as the baby may require medication to prevent sepsis.

Feeding

Breast-feeding:
Breast-feeding can take up to three weeks to be properly established. By this time the baby should have settled into a 3 – 4 hourly routine.

Duration of a feed

Breast-feeding should not be assessed according to the amount of time it takes to feed. Babies need different amounts of food at different times of the day. The baby should be allowed to empty the one breast before being offered the next one. The baby should be allowed to decide when it is satisfied.

The baby is getting enough milk if it

  • Gains weight steadily
  • Is content after feeds
  • Sleeps for 2 – 4 hours between feeds
  • Has six or more wet nappies in 24 hours

Bottle Feeding:

At time of discharge from hospital, the volume of a feed needed by a bottle-fed baby is calculated as follows:

Baby’s weight x 150ml amount of feeds in 24 hours i.e. 3kg x 150ml = 450 x 6 = 75ml 

  • Use cooled, previously boiled water to mix the formula
  • Follow the manufacturer’s direction on the tin.
  • After a feed the bottle should be rinsed with cold water.
  • It should then be washed with dishwashing liquid using a bottlebrush.
  • It is then rinsed thoroughly with clean water and placed in a sterilising solution or, if preferred, steamed.
  • The teat should be rubbed with coarse salt before washing.


Mouth Care

The baby’s mouth should be cleaned by wiping it with a piece of wet gauze.
A small amount of glycerine may be used if preferred.

Elimination

It is unnecessary to be concerned about the number of stools a baby passes a day. Breast-fed babies can have up to 13 per day or none at all for a few days.

If baby becomes constipated, the paediatrician should be contacted.

Points to remember when changing the nappy:

  • The nappy should be changed on a regular basis.
  • The baby’s bottom should be cleaned, washed and dried with wet wipes or soap and water.
  • A barrier cream is then applied to the area.
  • Nappy liners should be used if towelling nappies are used.
  • Baby powder is not recommended particularly on babies with respiratory problems.

Should the baby have nappy rash, the affected area should be exposed to the air and zinc and castor oil cream applied. The clinic sister or doctor should be contacted if the problem persists.

In girl babies, a whiteish discharge is sometimes evident. This is a normal occurrence. The area should be cleaned as normal and not over-cleaned.

A baby boy’s foreskin should be washed in the same way as the rest of the body. It should not be pushed back as this might cause cracks in the skin.
 

Circumcision

Should parents wish to have their child circumcised, they are advised to discuss the procedure with the paediatrician who will provide them with the necessary information.

Use of pillows in a newborn baby’s cot
Paediatricians advise against allowing a newborn to sleep on a pillow it may cause the baby to suffocate.

Baby registration
Babies have to be registered at the Home Affairs Department within seven (7) days of birth. It is the parents’ responsibility to register their baby themselves.
 

The following is needed:

  • A registration form (provided by the hospital)
  • Copies of parents ID documents
  • A black pen
  • As per government regulations, the baby registering service is no longer available through the hospital.

N.B. The new baby should be registered on the family’s medical aid as soon as possible.

Immunisation

The baby will receive its first immunisation before being discharged from the hospital, when BCG for prevention of TB and polio drops will be given.

A “Road to Health Card” will be provided. This card should be stored in a safe place as it is to be brought along to all subsequent visits. The card will become a record of the baby’s development as well as immunisations and is required by all schools when enrolling a child.

Clinic Visits

The baby will need to be weighed and immunised at regular intervals at a clinic or by a private nursing practitioner. All relevant information regarding this facility is available from the maternity staff on discharge from the hospital.

Six Week Follow Up Visits

It is routine practise for the paediatrician to see the baby again after six weeks unless any problems were identified in the hospital, in which case the paediatrician will decide on when the baby should next be checked.

The hospital will provide the patient with the paediatrician’s details on discharge. An appointment for the six- week follow-up visit should be made as soon as possible.

Care of the mother after leaving the hospital

Breast-feeding

Once the mother has left the hospital, she should continue feeding the baby on demand. Most babies feed every 2 – 3 hours for the first three weeks. As the baby gets older, it will settle into a routine. No newborn should be left without a feed for longer than 4 – 5 hours.

Tips on Breast-feeding

A mother’s milk cannot be “weak” but problems can occur causing the baby to be undernourished.

Babies sometimes stay hungry and want to suck all the time. Extra breast-feeds for a day or two will stimulate milk supply and thus satisfy the baby. Drugs to increase milk supply are available and can be prescribed by your doctor. Dietary supplements are also readily available from most pharmacies.
It is important to be relaxed whilst breast-feeding. Listening to soothing music and a warm drink will aid relaxation.

The baby is getting enough milk if it:
  • Gains weight steadily
  • Is content after feeds
  • Sleeps for 2 – 4 hours between feeds
  • Has six or more wet nappies in 24 hours
  • Medicines & drugs:
  • Patients must remember to inform their doctors that they are breast-feeding should they require prescription drugs for any reason.

Remember both alcohol and tobacco can be harmful for you and your baby.

Breast-feeding Problems

Engorged breasts

Sometimes babies are not able to feed because the mother’s breasts are too full. The following steps should be taken to alleviate the problem:

Heat should be applied to the breasts before each feed in the following ways:


  • By using a hot towel
  • By taking a hot bath
  • By using an infrared lamp for about 10 minutes.
  • Using the hands, milk can be expressed until the areola around the nipple is soft and then the baby can latch. Allowing the baby to suck on the breast a little longer if possible will also help to alleviate engorgement.
  • Some milk may be expressed to gain some relief but she should not empty the breast completely, as this will increase the milk production.
  • A comfortable, supporting bra should be worn.
  • Cold, not frozen, cabbage leaves can be placed on the breasts. Alternatively, cold cabbage leaves can be placed on the breasts and (with assistance) be bound up with crepe bandage (like a cross-your-heart bra).
  • Painkillers can be used if the breasts are very uncomfortable.
NB: The baby should continue to be fed regularly. Feeds should not be skipped.

Mothers are encouraged to persevere, as this condition normally does not last longer than a few feeds.

Mastitis

If a painful, red, lumpy area develops in the breast and you develop a fever, consult your doctor, as you might need an antibiotic.
However, if you experience any problems beforehand, contact your doctor immediately.

Nipple Care

To prevent cracked nipples, the mother must ensure that the baby latches properly at each feed and use correct method to take the baby off the breast, which staff will demonstrate to her.

A good nipple cream or milk, expressed after a feed, can be used to alleviate soreness. If a blister develops on the nipple, the baby’s position should be changed when it feeds. Exposure to sunlight, a hair drier or red lamp for + 10 minutes after a feed may be useful.

Tips regarding diet

  • Follow a healthy, well balanced diet.
  • Do not go on a strict weight-loss diet especially whilst breast-feeding.
  • There is no need to change your diet if you are breast-feeding.
  • Eat everything in moderation and drink + 2 litres of fluid per day.
  • Foods that might cause discomfort to your baby are:
  • Food containing excessive spices
  • The “cabbage” family
  • Tomatoes, onions, garlic etc
  • Fruit juices in excessive amounts
  • Chocolates


Rest

It is important to rest as much as possible, especially if you are breast-feeding as excessive exercise etc can reduce your milk supply.

Perineal Care:

Sitz-baths should be taken until the episiotomy has healed completely which usually takes about 14 days.  The stitches are dissolvable and will not need to be taken out.

Sexual activities can be resumed when comfortable or on the doctor’s advice.

Caesarean section – general wound care:

The patient should: 

  • Keep the wound clean and dry.
  • Keep the waterproof dressing on for three days.
  • Remove the dressing if the wound becomes wet, burns or any discharge or redness of the area is noted.
  • Clean the wound with surgical spirits or Hibicol.
  • Contact the doctor if any signs of wound infection are noted.
  • The stitches will be removed at the doctor’s rooms 10 – 12 days after the caesarean section or subject to the doctor’s decision.  (See back page for specific doctor’s follow –up procedures)
 

Infection – Danger Signs:

  • If the new mother notices any of the following symptoms, she should consult her doctor immediately.
  • Her temperature is raised and she feels as though she has the flu.
  • Her wound is red and burning.
  • Any offensive yellow discharge from the wound.
  • A sudden, heavy vaginal bleeding.
  • An offensive vaginal discharge.


Exercising

After normal delivery, exercises can be started immediately.The most important exercises are the pelvic floor exercises.  (See information leaflet).

Driving

Most doctors recommend that patients who have had a caesarean section do not drive a car themselves for about 3 weeks. This does not apply to patients who have had a normal delivery.

Family Planning

Contrary to popular belief, it is possible to fall pregnant whilst breast-feeding. The new mother is advised to be aware of this and to discuss contraception with her doctor or clinic sister as soon as possible.

Post-natal examination of the mother:

The post-natal examination is usually done six weeks after giving birth. The doctor should be contacted well in advance to make an appointment. (See follow up visits)