Home again with a newborn

Advice and guidance for parents during the first period of time at home with a newborn.

Advice and guidance for parents during the first period of time at home with a newborn.

Picture of a mom, dad and baby

Congratulations

We hope this information will help you find answers to some of your doubts during the first couple of days after the delivery.

Best regards
The staff at the Department of Obstetrics, Rigshospitalet

Birth registration

The birth registration is electronic and happens automatically from the maternity ward. If you and your partner are not married but you wish to take care of your child together, you can declare so by visiting www.personregistrering.dk and print out their form called ”Omsorgs- og ansvarserklæring”.

The form needs to be filled out and sent to your parish. You can find the address of your parish on www.sogn.dk or ask the staff for help.

Maternity offer

After home birth

If you have given birth at home, an offer exists in terms of a visit to your home the day after birth. On the third day after birth, you are offered to visit the Postnatal Ward at the Maternity hotel. During this visit, you talk to a midwife about breastfeeding, the child’s well-being, jaundice, etc., and the mother is offered to have possible rupture of skin from childbirth attended to. PKU and hearing screening are offered for the child. If you live more than 15 km from Rigshospitalet, you are offered a visit to the Postnatal Ward on the first and third day after birth.

After outpatient birth
Offer for first-time mothers

If you have given birth on an outpatient basis, an offer exists in terms of a visit to your home the day after birth. On the third day after birth, you are offered to visit the Postnatal Ward at the Maternity hotel. During this visit, you talk to a midwife about breastfeeding, the child’s wellbeing, jaundice, etc., and the mother is offered to have possible rupture of skin from childbirth attended to. PKU and a hearing screening are offered for the child. If you live more than 15 km from Rigshospitalet, you are offered a visit to the Postnatal Ward on the first and on the third day after birth.

Offer for multiparas

If you have given birth on an outpatient basis, you are given a call by a midwife the day after birth. During the call you talk to a midwife about how the mother, child and family are doing, and if you wish, a meeting will be scheduled at the Postnatal Ward on the third day after birth. During this visit, you have the possibility to talk to a midwife about breastfeeding, the child’s well-being, jaundice, etc., and you are offered a possibility to have any rupture of skin from childbirth attended to. PKU and hearing screening are offered for the child.

After maternity at the Maternity Hotel, Dept. 1002

On the third day after birth, you are offered a visit to the Postnatal Ward at the Maternity Hotel. During this visit, you talk to a midwife about breastfeeding, the child’s well-being, jaundice, etc., and the mother is offered to have possible rupture of skin from childbirth attended to. PKU and hearing screening are offered for the child.

After maternity at maternity department 4021 or 5033/5034 at Rigshospitalet

We offer a PKU and hearing screening for the child. The hearing can be performed three days after the birth and until the child is two months old. – We recommend performing the hearing screening before the child is 14 days old. If you accept the offer, you have to call the Postnatal Ward yourself to schedule a hearing screening appointment. Call (+45) 35 45 37 75

Visit from the health visitor in your home

The midwife will inform your health visitor about your delivery, and the health visitor will contact you for scheduling when he/she can visit you in your home. If you wish, you can contact the health visitor yourselves through your municipality.

Postnatal consultation with midwife

The postnatal consultation is an offer of an in-depth conversation based on the individual’s experience in connection with pregnancy, birth and maternity leave. During the consultation, we will review the birth process and your experiences
along the way. You can get answers to potential questions about this birth and the whole process.

The postnatal consultation is conducted by a midwife with extensive experience. If after the consultation, there are still unanswered questions or need for further follow-up, we will ensure that contact is made with the midwife or doctor present during the birth. The need for a postnatal consultation can occur long after birth, so you always have the opportunity to contact us and get
a time for a postnatal consultation. Contact us tel. (+45) 35 45 37 75, weekdays at. 8:30 to 11:00

General practitioner

Eight weeks after your delivery you will be offered a gynecological examination and a conversation about birth control by your general practitioner.

Birth control

You can get advice and guidance on birth control at: The Danish Family Planning Association www.sexogsamfund.dk/the-danish-family-planning-association

Examinations:
Blood test (PKU) 48-72 hours after delivery

We recommend that every child gets a blood test to search for two metabolic disorders:

  • Phenylketonuric (PKU)
  • Myxedema – low metabolism

The blood test will also be examined for other rare metabolic disorders. The blood test must be taken from the childs heel within 48 - 72 hours after birth. It is done quickly and you can be present during the test.

If you have delivered outpatient, or have had a maternity stay at the Maternity Hotel, you must schedule an appointment for PKU test at the Postnatal Ward at the Maternity Hotel.

If you have been admitted to one of or maternity wards at Rigshospitalet, the PKU test will be carried out during the admittance, or we will help you book an appointment at the Postnatal Ward at the Maternity Hotel three days after the birth.

Hearing screening

All parents are offered to get their child hearing screened. The screening will be done when the child is 3 days old, or before it is 2 months old. The hearing screening can be done during your visit at the Maternity Hotel, or at the Postnatal Ward on the third day after birth in continuation with the PKU test.

Examination of your child

The first examination of your child will be at the age of 5 weeks. You must contact your general practitioner by yourself to make an appointment.

Well-being

All parents wish the best for their child and it is easy to doubt whether or not your child is thriving.

Some good signs of the well-being of the child during the first month are:

  • Your child has a healthy and natural skin color
  • Your child has bowel movements every day, several times a day
  • Your child has wet diapers
  • Your child awakes and shows interest in eating
  • Your child is attentive and comfortable when awake
  • Your child eats at least 8 times a day.

Breastfeeding

One of the most important prerequisites for successful breastfeeding is that you wish to breastfeed.

The child’s needs

During the first couple of days after birth your child will get colostrums (the first milk) when sucking. There is not a lot, but the colostrum is highly concentrated and full of antibodies, so the baby will get exactly what it needs.

Put your baby to your breast when it needs to suck. Your nipples can get sore until they have gotten used to breastfeeding.

You may get a lot of advice from friends and family about breastfeeding, which can be difficult to process because it may contradict what you knew beforehand, or what someone else advised you to do. There are a lot of myths and misconceptions about breastfeeding.
Trust that you and your child will find the rhythm that suits you, and use the staff when you are in doubt, either by phone or when you are
admitted.
If you have already decided not to breastfeed or if you do not have the opportunity to breastfeed your baby, you can contact the staff for advice on
nutrition.
Your child’s need for food, bodily contact and physical closeness can also be fulfilled without breastfeeding.

Sucking technique and breastfeeding

  • Make sure that you sit or lie relaxed and comfortable. You can use pillows for support.
  • Help your child to your breast and bring it close to you so that your child’s stomach
  • is facing your own stomach. This way your baby does not need to move its head to reach your nipple, and you will not get wounds and cracks as easily.
  • If you are breastfeeding lying down, your baby must also lie close to you with its stomach facing yours.
  • Your child will probably sleep a lot during the first day of living. This is completely normal.
  • After the first day the child should suck at least 8 times per day. The intervals can be both short and long.
  • If your child is sucking less than 8 good meals a day, you should contact the Postnatal Ward.
  • If your child is more than a week old, you should contact the health visitor.

How to check if your child lies correctly and sucks well:

  • Your child tilts its head a bit backwards so its nose becomes free
  • Your child has the entire nipple and a part of the brown area around the nipple in its mouth
  • Your child’s lower jaw and the muscles around its ears are active, when it sucks
  • You can hear swallowing noises when the milk supply has been established.

Breast tenderness – establishing milk supply

It is not possible to predict when your milk supply is fully established. Most often it will happen within two, three or four days after birth. For some women it will be a smooth transition, for others it will be a whole day of experiencing a
sore, hard or tender breast.

Breast tenderness occurs in many but it is often experienced individually. The area around the nipple can be so tense, that the child may experience difficulty grasping the nipple.

Advice

Here are some advices to help you in case of breast tenderness:

Take a hot shower

Let the hot water massage your breasts. Use your hands to gently massage your breasts by moving them from the inner side, out towards the nipple. Gently press on the nipple so milk will come out. This way the tense area will soften up a little and it will be easier for the baby to grip the nipple.

Let the baby suck

Let the baby suck as long and as often as it likes. This might ease the pain and the tenderness will decrease.

Hot towels

You might ease the pain by putting a hot towel on the breast.

Massage

If you experience hard and painful areas on the breast after breastfeeding, you can try to massage these areas until they feel soft and not so tender.

Staying warm

To prevent milk knots and blocked milk ducts in the breast you should avoid draughts, keep your feet warm, and keep your breasts warm. You might do this by using woolen padding in your bra.

Fever and breast tenderness

In case of fever over 38,5 degrees Celsius or red marked areas on the breast, you must contact the Postnatal Ward, your health visitor or general practitioner (local doctor).

Let the baby finish sucking

During the first days, the child will get all it needs from the colostrums. When your milk ’comes in’ the consistency of the milk will change.

During the first part of breastfeeding, the milk, called foremilk is thin and watery like skim milk. During the last part of the breastfeeding comes the hind milk, which is thick and rich like cream.

The proteins and fat that makes the child satisfied are in the hind milk. Therefore it is important that the baby finishes sucking from one breast before starting on the other. Changing breast several times during breastfeeding will result in the baby is not fed enough because it doesn’t get a perfect balance of foremilk and hind milk.

Dummy/pacifier

It is recommended that you wait giving your baby a dummy/pacifier until the breastfeeding is going well, and the milk supply has been established. If you choose to use a dummy/pacifier before, be aware that the baby might skip meals as the dummy can create a false sense of satisfaction.

Urination and stools

A newborn does not urinate much, but should at least urinate once in his or her first 24 hours. This shows that the kidneys are functioning normally. As the infant feeds more, it will urinate many times during the day. Occurrence of small
pinkish crystals in the baby’s diaper is completely normal. It is called urate and is a waste product from the kidneys and it looks like bright blood. This will end within a couple of days.

During the first 36-48 hours after birth the newborn should have its first stool. In the first couple of days, where the milk supply is not yet established, the stools will be greenish/black and sticky. During the next 2-4 days the stool changes color and consistency to a yellowish, grainy soft stool. This is a sign that the milk production is full and the baby is feeding well.Infants who are breastfed needs to have bowel movements every day during the first month. The pattern changes afterwards.

Genitals

Newborn girls might have a little bit of bleeding from their vagina, and some vaginal mucus. This is perfectly normal and is caused by the withdrawal of the hormones of the mother.

Some newborn boys’ testicles are swollen and red after birth. This is also perfectly normal and is due to fluids. The swelling is harmless and will
disappear by itself.

Newborns, male and female, can have swollen breasts and secrete a small amount of fluid from them. This is called witch’s milk and is due to the mother’s hormones. It is perfectly normal and will disappear by itself.

Caring for the child:
The navel

After the birth some smell, blood or fluid might come from the navel. This is perfectly normal. You do not have to wash the navel, but the area needs to be kept dry. If the navel secretes a lot of fluid or smells a lot, you can wash the area in cooled boiled water once a day. It does not hurt the baby to get its navel cleaned.
The navel stump will fall off within 1-2 weeks. If the area round the navel turns red, contact the general practitioner or health visitor.

Eyes

The baby’s eyelids may be a bit swollen the first couple of days. If the baby has sleep in its eyes, you can wash it off with cooled boiled water on cotton wool. Use a new piece of cotton wool on each eye to avoid spreading bacteria. If the baby still has green/yellow pus in the eyes after a day, or the eye has turned red, you should contact the local practitioner.

Skin

Different kinds of spots can occur in the skin of newborns. Some of them occur because the baby is feeling too hot, others will occur without an explanation. The spots will disappear quickly. If the spots look like acne (mainly small, red bumps with yellow puss) and do not change appearance within a couple of days, you should contact the general practitioner, health visitor or the Maternity
Hotel if it is within the baby’s first 8 days.
A lot of babies’ skin reacts after they’re born. They can get dry skin that peels off, because they have been used to lying in the amniotic fluid and now they have come out in the fresh air and are wearing clothes. This usually starts around the ankles, wrists and stomach. For the most part it is unnecessary to take action, but contact your health visitor if you are in doubt.

Some babies’ skin are reddish the first couple of days, where other babies’ skin appear brighter. Both are completely normal. Hands and feet can appear blue and feel cold compared to the rest of the body. This is completely normal and is due to the blood flow being concentrated around the central parts of the body at the beginning.

Bath

A bath once or twice a week during the first time after birth is sufficient. The bath should take place at times where the baby is at ease. Wash the baby from the head and downwards. Soap is not necessary. Be attentive to drying the skin creases to ensure that the skin does not get red and irritated.

Temperature

The temperature of newborn babies’ is easily affected by the surroundings. This means the baby is quick to become cold, but also that it is quick to become heated. If the baby lies close to you wearing both clothes and duvet, it can get
too warm. Infants emit heat through the scalp which becomes moisty when the baby is feeling too hot. It is a good idea to feel the baby’s skin underneath the clothes to see if the temperature is right. Check with a finger underneath the
undershirt. If the skin feels right, and is neither cool nor moistly warm, the baby’s temperature is right. It is not necessary for the baby to wear a beanie inside, but it is a good idea when you are outdoors.

You can go for a walk with the baby in a baby carriage. Walk for a short time in the beginning and feel the baby during the walking to see how it keeps its temperature. Depending on the seasons and the weather, you can lengthen or shorten the walks. Ask the health visitor if you are in doubt.

Fever

Any temperature over 37,5 degrees Celsius with a rectal thermometer is considered a fever, nevertheless, you do not need to rush the baby to the
clinic because of fever, if the child is alert, active and playful. If your baby has a temperature over 37,5 degrees Celsius, you can try to take of some off the child’s clothes and measure the temperature again ½-1 hour later. You should contact the general practitioner or health visitor if the baby still has a temperature over 37,5 degrees Celsius and is crying, acting uninterested, inactive/sleepy and does not want to be breastfed.

Jaundice

Jaundice is the yellow color seen in the skin of many newborns. Everyone’s blood contains bilirubin, which is removed by the liver. Before birth, the mother’s liver does this for the baby. Most babies develop jaundice in the first few days after birth, because it takes a few days for the baby’s liver to get better at removing bilirubin.

Most infants have mild jaundice that is harmless. Some infants get drowsy and do not want to eat because of the jaundice. In this case the child must be woken and laid at the breast every third or fourth hour. If your baby’s skin turns very yellow, contact the general practitioner or the Maternity Hotel.

Sleeping positions

A lot of parents are concerned of Sudden Infant Death Syndrome (SIDS). The Board of Health has some advice for reducing the risk of a sudden and unexpected infant death:

  • Always put your baby to sleep on its back. As soon as the baby is able to roll over by itself you do not need to worry if the baby sleeps on its stomach.
  • Avoid exposing the baby to cigarette, cigar or pipe smoke.
  • Avoid the baby getting too hot while it sleeps.

The child needs to be warm but not sweaty. If your child feels sweaty on its back or its chest, it is too hot. The child should not sleep inside on a lambskin. The temperature in the room should be between 18 and 20 degrees Celsius. Always remove outdoor clothing from the child when being indoors as it gets too hot for the child.

If your child is sick or has a fever, it only needs a light layer of clothing and a sheet when sleeping to lose heat.

The safest place for an infant to sleep is in its own bed in the same room as its parents.

The Board of Health advice against sleeping in the same room as your child, if one or both of you:

  • Are smokers
  • Have been drinking alcohol
  • Are overly obese
  • Take slowing medication
  • Furthermore it is discouraged to sleep with the infant on a water bed, a sofa or a sofabed.

If the child is laid to sleep in the parents’ bed, it is recommended that:

  • The child does not lie between the parents
  • The child does not have a pillow
  • The child has a light baby duvet
  • You do not smoke in the room
  • The mattress is not too soft
  • There are no pets or loose blankets in the bed
  • There is not too hot.

Furthermore it is recommended that the child, if lying in bed with its parents, wears his or her own duvet and is placed in the head end of the bed, lying on its back on a solid support.
If you understand Danish, you can read more in the Health Board’s (Sundhedsstyrelsen) information pamphlet ”Forebyg vuggedød – og undgå skæv hovedfacon og fladt baghoved”.

Head positions

Some children prefer to lie with their heads on the same side. This can cause the child’s head to become wry and the muscles in the neck to tighten in one side.

Some advice to prevent this:

  • When your child is asleep, make sure that it does not always lie with its head turned toward the same side.
  • When you carry the child against your stomach, make sure that it does not always have its head turned toward the same side.
  • When you change the baby’s diapers, make sure that it does not look to one side only.
  • If the baby always wants to look to the same side, try making it turn its head
  • in the other direction – for example by talking to it from the other side. If further,action is needed, contact a chiropractor that specializes in infants.

The family:
Smoking

Newborns are very sensitive to smoke in the lungs. If you smoke, your child has a 5 times bigger chance of getting asthmatic bronchitis, inflammation of the middle ear other respiratory infections than if you do not smoke. Nicotine is excreted in the breast milk. If you or your partner smokes, we recommend that you avoid smoking close to the child. Go outside instead.

Siblings

Having a baby in the house can be a big change for the entire family. Everyone has been looking forward to it, not least the big brother or big sister has waited a very long time for the new status. This is why it can be hard at times when the new baby gets a lot attention.

Here is some advice:

  • Be aware of giving big brother/big sister positive attention.
  • Always listen to the elder sibling and take it seriously, if he or she expresses jealousy.
  • Let big brother or big sister’s everyday life continue like it used to before the baby arrived, for example by continuing to attend the nursery or kindergarten, and do things together as you normally would.
  • Remember to be parents for the bigger child as well.
  • Tell friends and family to give the elder sibling attention when maternity visiting.
  • Think of big brother or big sister when purchasing maternity presents.
  • Do not expect big brother or big sister to love the baby at all times. It can be a disappointment for the elder sibling when realizing how much time mom and dad spend on the baby, and finding out that a baby is not a play mate.

Becoming parents

To become a mom and or a dad is a big change in your lives and it can make you both vulnerable and strong. When you share experiences and responsibility for the child, your relationship is likely to grow stronger.

Your responsibilities and priorities in your everyday life is not the same as they used to be. It takes energy to overcome the change and the new
reality.

Men cannot breastfeed, however they can do a lot of other things: Walk with or sit with the baby after breastfeeding, comfort, change diapers, bathe the child, play with and show the child new perspectives on the world.

The baby knows your voices and feels safe in your presence, and in time you will learn to understand the child’s signals and needs. Becoming parents is a process and emotional ties gradually evolve between you and your child.

Reactions after birth

Adjusting to a new baby can be an overwhelming task. As a parent you are still recovering from the birth. The baby requires ”24 hour-around-theclock care”, and you may be exhausted, sensitive and vulnerable from late night feedings, a crying baby, not enough sleep and so on.

Around 80 % of new mothers experience crying spells – also known as the baby blues, during the first 1-2 weeks after birth. The crying spells are usually quickly done, and it is a completely normal reaction.

Talking to your relatives and closest friends about how you feel is the best thing to do. Men too can get affected by the new situation and may need to talk to someone about how it is to become a father.

If one of you feel sad for a longer period of time, cannot grasp the new reality, do not want to eat, cannot sleep or maybe feel an unexplainable anxiety, you might suffer from postpartum depression. Postpartum depressions exist in a
variety of severities and can happen for both mom and dad.

Talk to your loved ones, the health visitor or your practitioner, where you can get help dealing with and overcoming a postpartum depression, so your maternity can be a pleasant time for you and your family. Your practitioner can also refer you to a psychologist or psychiatrist.

Sleep and rest

A delivery and breastfeeding takes a lot of energy. This is why it is important that you rest and relax the first couple of days after the birth. You can set up an agreement with family and friends regarding when and how long you want visitors. It is a good idea to take a nap during the day – every day.

Postpartum bleeding

After birth your bleeding is heavier than a heavy menstruation. After a couple of days the bleeding will decrease and become bloody vaginal discharge with varying appearance. The discharge will decrease within 6-8 weeks. You may see blood clumps the first couple of days, which is completely normal.

As long as your vaginal discharge is bloody, you still have a wound surface in your abdomen where the placenta was. We advise against using bath tubs, swimming in the ocean and in swimming pools due to the high risks of infections in your uterus. For the same reasons we advise against using tampons the first couple of months after birth.

If you experience pain in your abdomen or if your vaginal discharge changes smell, appearance or volume, or if you get a fever, contact the general
practitioner.

Stitches

Maybe you were sewn up after birth. The threads will dissolve and disappear by themselves after 2-3 weeks – for some it will take up to 5 weeks.

The rupture can hurt, sting or itch the first couple of days. If you after a week still experience strong pain or the stitches are bothering you, you can get the general practitioner to take a look at them or have them removed.

Here is some advice, if you are sore:

  • A soft pillow to sit on. It is not a good idea to use a bathing ring as the tissue will be pressed together and the blood flow, and healing of the wound, becomes bad.
  • Put an ice pad on the swelling (pour water on a sanitary pad, put it in a plastic bag and put it in the freezer).
  • Painkillers.

Personal hygiene

To avoid infection in the stitches or in the uterus, you should wash or rinse with water each time you use the toilet. Wash your perineum daily with soap and water during your shower. Change sanitary pads often during the first couple of days.

After birth pain

After birth the uterus begins to return to its prepregnancy size. The shrinking can be painful and is called after-pain. After-pain will be triggered especially by breastfeeding because a hormone is released from the pituitary in the brain, when the baby is sucking on the breast. The hormone acts contractive on the muscle tissue around the mammary glands and on the muscles in the uterus. During the first couple of days with after-pain, it can be necessary to use painkillers (analgesic drugs). This will not hurt your baby.

Urination

It can be difficult to feel if your bladder is full during the first day after the delivery. You should urinate 4 hours after the delivery at the latest. Even if you do not feel the need to urinate you should go to the toilet each 4th-5th hour during the first day, when you are awake.
The uterus will retract better and the bleedings will become less heavy, when your bladder is empty. You should contact the general practitioner if you are unable to urinate or if you get the sense of being unable to empty your bladder.

Bowel movements

If you have had lavement during birth, you will not necessarily have bowel movements the first couple of days after birth. During the first couple of days your abdomen and bowel function usually normalizes by itself. You can prevent
constipation by eating whole grain bread, raw vegetables, prunes and fruit. Remember to drink plenty of fluids.

You may try a mild laxative if the constipation continues for four or five days. Laxatives should only be taken in shorter periods of time. Otherwise your abdomen will get used to need help to function normally.

Fiber products can be used to prevent constipation. You can sprinkle it on sour milk or yoghurt. Remember to drink plenty of fluids when using fiber products, as the fibers occupy liquid.

If you are having trouble withholding bowel movements more than one week after giving birth, you should contact the general practitioner.

Maternity gymnastic

It is important that you perform pelvic floor exercises several times daily the rest of your life to avoid a sunken uterus, urination problems and difficulties during sex. Ask the general practitioner to check if you are using the right muscles when doing pelvic floor exercises when consulting him/her eight weeks after birth.

Food and drink

Vary your food and don’t hesitate to eat different kinds of foods. The baby will not be affected by any kind of food – not even spicy food – if you eat normal portions.
You should take calcium tablets daily if you do not eat or drink milk products. Iron supplements are recommended if you have experienced heavy bleeding during birth.

Alcohol is excreted in breast milk and the infant is more sensitive to alcohol than adults. We therefore recommend that you do not drink alcohol
while breastfeeding.

Sex after the birth

After birth you might feel tired and exhausted and do not feel like having sex. This is normal for the first few weeks, at least sex should be approached gently and tentatively for a while. It’s important for you and your partner to discuss
your feelings to avoid frustrations.

The child gets all the attention and it’s hard to imagine all the work and responsibilities that comes along with being a mother or a father.

You might experience some pain while having sex for weeks or months afterwards, even after your incisions or tears have healed.

Your vagina may hurt a bit or be drier than normal because of hormone change. Use a waterbased lubricant, such as K-Y, until your hormone levels are back to normal and your vagina lubricates.

Don’t forget to use some kind of birth control. Breastfeeding will not protect you against being pregnant again.

You can read more on The Danish Family Planning Association:
www.sexogsamfund.dk/the-danish-family-planning-association.aspx

Accessing your medical record

If you are a Danish citizen, you can read your medical record online 14 days after it has been written.

Log in to www.sundhed.dk with NemID. Go to ”Mine sundhedsdata” in the menu ”Min sundhed.dk”. Choose ”Min e-journal” and click on the link ”forløb”.

Useful phone numbers and homepages

The health visitor
You can contact your health visitor through your municipality – they can provide you with a phone number.

Links
Tryg med barn/Safe with children – short films for new parents
www.trygmedbarn.dk/en/

Redaktør