Birthweight
[picture]
Birthweight . . . his
personal
starting point
for growth
Babies come in a large variety
of shapes and sizes. It does matter to everybody how exactly
one weighs. Because the birthweight, whatever it may be, is
your baby's own personal starting point for growth.
Average Babies
The average birthweight for babies is
just over 7lbs. (3.2kg). But that average conceals many
variations. Boys are usually a little heavier than girls;
first babies are usually rather lighter than their younger
brothers and sisters, while on the whole large parents have
large babies and small parents have smaller ones. So your
baby can be exactly the right size for him without being
average.
Heavy Babies
If you give birth to a 10lb (4.5kg) baby,
you will be rightly proud of yourself for having delivered
him. And he will probably look more beautiful and seem more
mature than most of the other newborn babies in the nursery
as he will be well covered with fat. A very few
exceptionally heavy babies are the result of the mother
having diabetes or pre-diabetes. It is important if the
hospital staff keep a special eye on him for a few days to
be sure that this particular one is just a well-grown baby
whom nature meant to be large, rather than a baby whose
metabolism has been disturbed in the womb and whose
exceptional weight comes from excess water which has been
retained in his body after birth.
Lighter Babies
If your baby is below average birthweight
but weighs more than 5-1/2lbs (2.5kg), he will be treated
like an average birthweight baby except that he will
probably be encouraged to feed more often. The chances are
that you are smaller than average too and that this is a
healthy baby who is meant to be small.
If the
baby weighs 5 to 5-1/2lbs (2.2 to 2.5kg), he will probably
be put in an isolette, however healthy and lively he seems
to be. This is because some babies who are born weighing
less than 5 to 5-1/2lbs (2.2 to 2.5kg) have trouble with
breathing, with keeping warm and with sucking. So to play
safe, all babies who are under this weight
are started off with special care. Look upon it as a
precaution only. If there are no problems, he will probably
be allowed to come out of the isolette and be returned to a
crib by your bed within a few
hours. Small babies
used to kept in the hospital until they had regained
their birthweights or until they had tipped the
scales at a particular weight. Nowadays the decision
to let you take your baby home is more likely to be
based on how he is managing his new way of life and,
above all, on how quickly he settles to
feeding.
If your
baby is born weighing less than 5lbs (2.2kg) then he
probably is lighter than nature meant him to be. The
lighter he is the more special the care he will need. The
particular kind of care will depend partly on whether he is
light because he is premature or because he is
small-for-dates.
Premature Babies
Most very small babies are small for the
simple reason that they have been born prematurely - before
the completion of the usual 40 weeks in the womb. Missing
time in the womb means that the baby has missed out on some
growing time. It also means that he has missed out on some
getting-ready-for-independent-life time. The more weeks
inside the womb he has missed, the more difficulties he is
likely to face. A baby born after 36 to 38 weeks gestation
will probably only need to have things made very easy for
him, by being kept in an isolette with extra warmth, extra
oxygen and tiny feeds of a very easily digested mixture at
frequent intervals. A "younger" baby may need more help
than that. He may need to have some of the responsibilities
of independent life taken right off him for a while. He may
be fed, for example, by a tube passed down his nose into
his stomach because he is not yet able to suck or swallow
for himself.
Small-for-Dates
Babies
Small-for-dates or dismature babies have
not grown as much as they are expected to during their time
in the womb. They may have spent the full 40 weeks in the
womb but still be very small at birth. Or they may have
been born prematurely but be even smaller at birth than
they ought to be after that period of
gestation.
The immediate treatment given to a
small-for-dates baby will be similar to that given to a
premature one, but the hospital staff will be anxious to
find out just how long he did spend growing in the womb and
therefore just how small-for-dates he really is. They willl
probably question you closely about the exact dates of your
last menstrual period before the pregnancy began and check
back on any ultrasound scans. After all, you might have
made a mistake. If your baby was born weighing 4lbs (1.8kg)
after 40 weeks in the womb, then he really is
small-for-dates, but if your calculations were one cycle
wrong, and the baby has actually only been growing for 36
weeks, he is premature.
A baby who really is small-for-dates has
usually been short of nourishment in the womb. The placenta
may have been inadequate or you may have had problems with
your health which prevented the baby from getting all he
needed for optimal growth. The more the hospital staff can
discover about the reasons for your baby's small size, the
more they can do help him catch himself
up.
Isolettes
An isolette or incubator is the nearest
equivalent we have to an artificial womb. The baby has
emerged from inside you so he can no longer rely on your
body to operate his. The isolette acts as a half-way house
between total physical dependence and being a completely
independent physical entity. If the baby is managing
reasonably well immediately after delivery, it may be used
only to give him steady warmth, peaceful isolation,
controlled humidity and perhaps a little extra oxygen. If
he is having problems, it can be used to help him with the
functioning of almost all his body systems. Whether it is
used to give your baby a great deal of help or only a
little, the isolette is a very safe place for him to be.
Specialist doctors will keep a careful eye on his progress,
while the highly sophisticated machinery of the isolette
itself will record any changes in his condition, and set
off warning signals whenever he needs
attention.
Accept the isolette as
your friend because your baby needs it. This machine-womb
is not as good as yours, but it is safer for him than the
outside world while he catches himself up.
The period while your baby is in an
isolette is going to be a difficult one for you, but there
is quite a lot that you can do to make it
easier:
Talk to the nurse or the
pediatrician.
Tell them that you want to know
everything there is to know about your baby's
condition. Once you understand exactly what problems he
is having and the purpose of any tubes or gadgets which
are attached to him, he will stop seeming like the
hospital's baby and start seeming more like yours to
take care of.
Make it clear that you
want to be with the baby as much as possible.
If
the isolette is in the nursery on your maternity floor,
you will probably be allowed to go in whenever you
like. If the isolette is in a "special care" unit
separate from the maternity floor but in the same
hospital, the nurse will arrange a wheelchair for you
until you are fit to walk.
If
your baby has had to be transferred to another hospital
because the one you are in does not have the facilities
he needs, it may be possible for you to go too. If not,
you should still be allowed to visit as soon as you are
well enough to travel.
Explain that you want to
help.
Unless your baby is very fragile
indeed and being stimulated as little as possible, you
will be encouraged to touch him through the glove-holes
of the isolette. Soon you will be able to help with his
physical care, perhaps by changing his diaper inside
the isolette. If he is in reasonably good shape you may
even be allowed to take him out and hold him for a
minute or two.
Perhaps, the most important thing you
can do to help the baby, yourself and the hospital is
to get your breast milk supply going. Very small babies
really need to have breast milk as soon as they are
ready for any milk at all. Often the milk is given by
tube or dropper until the baby is strong enough to suck
for himself. Even if your baby is not ready for milk
yet, he will need to be breast-fed when he is stronger.
You can get the supply established while you are
waiting for him. The hospital staff will show you how
to use a breast pump to express your milk. This is much
easier than expressing by hand.
If
you have to go home leaving the baby still in special
care, you may be able to spend your days in the
hospital and express your milk for him there. Even if
you cannot be at the
hosipital every day, it will still be
worthwhile expressing your milk. Only by continuing to
empty your breasts can you be sure of having a good
supply for him when he joins you at
home.
Look on this time as an
extra bit of pregnancy.
Once you are over the shock and
disappointment of not having your baby with you
immediately, you may be able to look on the
waiting-time as a sort of hiatus between the birth and
starting to be a mother.
Although his birthday is the day he
was born, just as it is for any other child, try to get
used to the idea that his real starting point will be
the day the hospital declares him large and fit enough
to come home. If he was born after only 34 weeks inside
you and you compare him to full-term babies who were
born in the same week, he will always seem to be behind
them in development. He has a lot of catching up to
do.
The
"Blues"
"Baby blues," or "fourth-day blues," or
postpartum depression are not an inevitable part of
the post-natal days, but they are very common; affects
anywhere from 15 to 80 percent of women. It usually
lasts 1 to 7 days and is marked by tearfulness, anxiety,
depression, restlessness and
irritability.
If your baby has to be in an isolette
away from you, or has even the mildest problem - such as
jaundice - that will probably be the focus of your
misery. But even if you had an easy delivery, have a
beautiful, healthy baby and cannot think of any reason for
being miserable, you can suddenly find yourself in floods
of tears. Don't let those tears frighten you. Tears of this
sort spring partly from physical and emotional anti-climax
after the birth, and from hormonal chaos as your body
struggles to adapt to not being pregnant any more and to
making milk. If you can calmly let them flow - they will
probably stop as suddenly as they
begin.
[picture]
In these first days
wrap her
warmly,
hold her
closely,
handle her slowly . . .
Going
Home
Going home may be more of an effort and
less of a thrill than you expected. However eager you were
to leave the hospital it can seem like a haven of
safety once you are out on your own. Your body is
tired after labor and the stress of pregnancy. Your
hormones are working overtime. With all that physical
upheaval, you are also up against the emotional turmoil of
introducing a new person into your life and your family.
Depression, with its dragging tiredness and pointless
tears, may take the shine off these first days at
home.
But however peculiar you feel now, your
new self, new family and new resposibilities will seem
quite ordinary and easy in a few weeks. Try to be patient
and gentle with yourself. Lean, heavily, on your partner or
anyone else who offers support. Let them look after you
while you look after the baby. In the meantime don't try to
accomplish anything practical. This is a time for people
and their feelings. Talk out your own and your partner's;
play out your toddler's, and keep that baby
close.
Post-Natal
Depression
Post-natal depression is not at all the
same as the temporary mood-swings of the first days after
birth. It can overwhelm you at any stage in
your baby's first months and last for a long time.
Depression is a real illness. Any major upheaval can touch
it off: a bereavement or divorce, moving or a job change.
In the end people almost always recover on their own. But
when the upheaval is a birth, there's a baby to think
about. Your baby needs your loving care and if you're
depressed you cannot give it.
Depression drains everything of joy and
color, saps your self-confidence and energy and turns you
in upon yourself. Even if you can find the drive to meet
your baby's physical needs, depression will deny you your
pleasure in him and therefore deprive him of being your joy
as well as your responsibility. So, if you should suffer
from post-natal depression, you will need medical,
practical and emotional help, and
quickly.
The question is: will you get it? If you
are feeling utterly worthless, you probably will not feel
worthy of your doctor's time. If putting on your clothes
takes superhuman effort, telling somebody how you are
feeling will probably be beyond you. Partners, grandmothers
and friends should all be alert to the possibility of
post-natal depression so that the second time they find
themselves saying "do pull yourself together" they
bite it back and suggest help instead. And if a mother
cannot find the energy to seek help for herself, somebody
must do it for her. Community health services and family
doctors all respond sympathetically.
[picture]
In these first
days
wrap her
warmly,
hold her
closely,
handle her slowly . .
.
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