Birthweight of a Baby

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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.

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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.

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In these first days

wrap her warmly,

hold her closely,

handle her slowly . . .