For Expectant Mothers

Information for Expectant Mothers or What Care We Provide

Dear Expectant Mothers,

We would like to give you some information about what you can expect from pediatric point of view if you decide to deliver your baby in our hospital.  We hope that by providing this information we will dispel any fears you might have, which are absolutely natural, and each member of our team is aware of them and will try to help you alleviate them. So do not be afraid to ask if you have any questions or need advice.  We often receive mothers who have a very clear idea about their delivery, but they may not realize that their requests are already common part of our work. Therefore we want to explain to you some basic terms and their definitions and at the same time describe how we work.  

 

Bonding:

A healthy and ready baby is put on the mother’s chest after a standard normal delivery with umbilical cord still uninterrupted. There the baby is dried and covered to keep normal temperature, the failure of which could be dangerous to the baby. After the umbilical cord stops pulsating, but after at least 1minute, the cord is clamped. It is a standard procedure that the father or another accompanying person is asked to cut the cord.  The baby stays with the mother in the delivery room for two hours. Then the mother and the baby are transferred to a postnatal ward. 

 

Situations in which bonding is not done:

1: The mother does not want to bond or her health condition does not allow her to. Her role can be taken over by her accompanying person.

2: The baby does not adapt well, and it needs our help.

3: There were problems in the second phase of delivery, especially weak heart sounds and/or meconium stained amniotic fluid. Therefore, we are worried that the baby does not have sufficient oxygen supply.

4: Baby is born sooner than expected (premature newborn, gestational age below 37 weeks).

In all the above mentioned cases a pediatrician-neonatologist is present at the delivery. He or she helps the baby to adapt and also decides about the next step. If the baby’s health condition requires the care of a neonatologist, the baby is transferred to a baby box at the delivery room, where the appropriate support ca be given. The father may join the baby as soon as its condition has improved. The doctor needs to work in peace to stabilize the health condition of your baby. As soon as the baby is all right, it is returned to the mother.

First breastfeeding attachment:

We try to put the baby to the breast as early as possible in the delivery room and it is facilitated by midwives. Do not expect that the baby when in contact with the breast will immediately start to suck. However, even skin-to-skin contact is pleasant for both of you and also helps to start lactation. If your health condition does not enable you to have this first contact with the baby, a person close to you can provide this contact.

Bonding after Caesarean section:

If you know already that you will deliver by Caesarean section, you will be given one of the following two types of anesthesiology.

General anesthesia, when you sleep during the operation and you only see the baby and it is first put to your breast after the operation, after you wake up, at the operating theatre. During this time the baby can be held in the arms of the father or another accompanying person.

If you opt for epidural or spinal anesthesia, it means that you will be conscious during the operation but you will not feel any pain in the area of the section. The baby can be, if your health condition allows it and the anesthesiologist and obstetrician agree, put to your breast immediately after it is checked and dried immediately at the operating theatre and so you can enjoy the first moments with the baby similarly as in spontaneous deliveries.  

If the Caesarean section is acute, which means that complications occurred during labor, the operation is usually done in general anesthesia. Bonding is done after the baby´s and mother´s conditions are stabilized.

 

Care for the baby after Caesarean section:

After you are transferred to the obstetric Intensive care unit, the baby is taken by a pediatric nurse to a neonatal ward. Here it is taken care of by nurses first on a heated bed, then in a cot. Every three to four hours including nighttime, the baby is brought to be breastfed after agreement with the intensive care unit staff. If the baby is all right, a pediatrician does not come to see the mother at the ICU. The mother can, however, request it. It is not possible to have the father or any other accompanying person at the ICU. Your accompanying person can see the baby in the neonatal ward, where he/she also receives all the necessary information about the baby’s health condition. 

Supplemental feeding:

Overall, infants are not given supplemental food. The baby can manage the first 24-48 hours with very little intake of fluids. Reasons for supplemental feeding of a healthy baby include (1) a big weight loss (over 10% of the birth weight), (2) if the baby shows signs of distress and has an increased temperature, or (3) it is the mother’s wish. It is necessary to realize that except for the above mentioned situations this “starving” is natural for the baby and they do not suffer in any way. Each supplemental feeding is done with the mother´s consent and at best administered by the mother herself (after she is advised how to do so by the nurse). It is also possible to feed the baby donor breast milk, your own breast milk or milk formula. Some babies do not manage to drink enough milk when breastfed and the mother then expresses some milk and feeds the baby alternatively (usually using a finger-feeding method).

Cases in which early supplemental feeding is required:

Ad 1: The baby is too small (small for gestational age, SGA)

Ad 2: The baby is too big (hypertrophical)

Ad 3: The baby’s mother suffers from gestational or another type of diabetes

In all these cases the baby is at risk of having a low level of blood sugar – hypoglycemia. Blood sugar levels (glycemia) is checked 2-3 hours after birth from a drop of blood. If it is low, the baby is given supplemental food. The mother is always informed in advance about the situation and can choose between pasteurized breast milk from our donor mothers and/or milk formula. The same procedure is required every time hypoglycemia is found.


Vitamin K:

Vitamin K is given to infants to prevent hemorrhagic disease of newborns, which is a condition caused by lack of blood clotting factors, whose production depends on vitamin K. Its shortage can lead to bleeding. This doesn’t involve vaccination and the baby is not weakened by the administration of the vitamin. It is usually injected into a muscle. If you do not find this method acceptable, we recommend administration by drops. There is, however, a risk that the baby will vomit them and thus will not be protected; also, you will need to give the baby the drops until the completion of its third month of age. But it is a possible and safe method.


Pulse oximeter:

A machine which monitors oxygen saturation levels in your baby’s blood using a small sensor attached mostly to the right hand and enables us to immediately recognize if there is a problem. The machine is used in the delivery/infant box if the baby stays with the parents by themselves after the delivery.

 

First bath:

At the delivery room babies are not washed, they are just dried. After transfer to postnatal unit, the baby is wiped with oil to remove any blood and vernix1. The first bath is given to the baby in the room the following day in your presence.

 

Breastfeeding support – lactation consultant:

All nurses (postnatal and delivery assistants) in our ward are trained lactation consultants. There is always one nurse, who is specifically assigned to give you help and support during initial problems with breastfeeding. She goes to see all mothers in the morning and tries to discover the problem and helps you solve it. She then continues to provide systematic help to those mothers who have difficulty in breastfeeding. You can contact her with your questions even during your pregnancy and make an appointment, if, for instance, you want to find out if you should use nipple formers. You can contact her by email at  petra.poddana@ftn.cz

 

Nipple formers:

One of the most frequent problems which make breastfeeding difficult is inverted nipples. Every mother should have her breasts examined by her gynecologist during pregnancy, or at the latest in prenatal clinic. If the above problem is found, it can successfully be solved by wearing nipple formers from approximately 35-36 week of pregnancy and hence avoid problems later in hospital after the delivery. Every mother can also contact a lactation consultant.

Screening:

During the stay in the postnatal unit, a baby undergoes several examinations whose aim is to find any possible congenital defects or diseases. The only examination which is invasive is taking a dried blood sample from the baby’s heel between the 48th to- 72 nd  hour of the baby’s life. Other examinations which are totally noninvasive are a hearing examination by measuring OAC (otoacustic emissions), eye examination to rule out congenital cataract, examination of hip joints and ultrasound screening of kidneys. The mother is thoroughly informed about each examination and will be given an informed consent form to sign.

1Vernix is a waxy or cheese-like white substance found coating the skin of newborns.