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CHAPTER oneYou and your newborn

THE MOMENT of birth may be exactly that: a moment, a joyous, unforgettable moment, or an unpleasant experience we’d rather forget. Becoming a parent, however, can take a bit of getting used to. Even if your pregnancy was planned, the baby’s room is decorated and the cupboards are well stocked, don’t be surprised if life as a parent isn’t what you thought it would be. There is a word for it: ‘babyshock’.

JOURNEY INTO THE UNKNOWN

The first twenty-four hours

WE CANNOT know what parenthood will be like until it happens. Yet many couples find that the first few months are much harder than they expected. After the elation and excitement of the birth, they are tired, stressed and bewildered. Although you are delighted that your baby is here, even those first twenty-four hours can be more difficult than you envisaged.

Katharine found both her baby and the hospital experience overwhelming: ‘It was dreadful. Max wouldn’t settle and I had a catheter in which was uncomfortable, and the room was hot and stifling and the corridor outside was noisy. I was awake most of the night and so shattered the next day I couldn’t take in all the information that people kept popping in to tell me. The room was like Victoria Station. People were in and out and I didn’t know who half of them were: midwives, paediatrician, someone bringing a bunch of flowers from my mum and then other people looking for a vase to put them in …’

COUPLES OFTEN find that with the demands of a new baby it can take a while to calm down, and discover just what it is that you do feel. Lynn found the first few days of motherhood a real eye-opener: ‘Looking back, I was very naive. I hadn’t a clue what new babies were like: the only babies I’d had much to do with before were older, about nine or ten months old, so I was used to seeing them sitting up and playing, smiling…eating biscuits, for Heaven’s sake. Just to have Adam so completely helpless, so dependent on me, was terrifying.’

Olivia kept being surprised by her daughter: ‘I don’t think I had ever pictured her, physically. I don’t think you do. You picture them more as toddlers and what they’re going to look like when they’re people. For instance, I did think that all babies looked the same and I was amazed in hospital how they didn’t. For a start, mine was the most beautiful on the ward, of course! And Robert kept saying, “You know, even objectively, I’m sure she’s the most beautiful. There’s no doubt. And I’m not just saying this because I’m her father.” And I couldn’t convince him that everyone on the ward thought the same about their own baby. So that was nice, really, that she was so lovely’

CAESAREANS

PARENTS WHOSE baby was delivered by caesarean often find that they have particular problems adjusting to the fact of the baby’s arrival. After all, at the last minute, the decisions were taken out of their hands.

Eileen had a long labour and eventually needed an emergency caesarean: ‘After what seemed like hours they finally wheeled me in to the operating theatre and the anaesthetist said, “You ‘II feel a pressure round your neck now …” and that’s the last thing I can remember before coming round. And when I did come round, neither the baby nor Mick was there, so I thought, “Oh, I haven’t had the baby yet, then,” so when Mick did walk in, I said, “What are you doing here?” Mick said they’d taken the baby up to the Unit as he wasn’t breathing properly, and I said he should be with the baby, so he went, and then the nurse came in when I was awake a bit more and said, “What are you going to call him then?” and I got terrified because I thought it meant that we were going to have to baptise the baby straight away because he was so ill with his breathing and going to die. So I wailed, “Oh, call him Michael after his father.” She looked at me very oddly because I think they just wanted to know what to write on his cot tag up in the Unit.’

Sometimes a caesarean can lessen the feeling of continuity, as it did for Sushma: ‘They brought him in about five o’clock for a feed. He was all washed then and wrapped in a white blanket, very clean, and so calm – big, dark eyes looking round. I felt like I was being introduced to a stranger, though, who had just dropped in. I was very glad to meet him and all of that, but I didn’t get the feeling that this was the little being I had laboured for so many hours to produce. I felt no connection between this baby in a blanket and the pregnancy I’d had. This baby was here, and I wasn’t pregnant any more, but they didn’t seem to coincide, somehow.’

WHEN YOU’RE preparing for the birth, it may be a good idea to read up about caesareans. That way, if things do turn out not quite the way you planned during your labour, you will be better informed to make choices about the sort of caesarean birth you want.

TWINS OR MORE

ONE IN EVERY 90 births in this country is of twins, triplets or more. If this is your situation, you may find many of the problems of adjusting to life as a family doubled (or tripled). In particular, the physical demands can be exhausting, as Dawn and her husband found out: ‘Sometimes we do despair. The sheer volume of work – washing, drying, bottles, nappies – and the effort involved in lifting three of them into the bath, out of the bath, into the highchair, out of the highchair, into the cot, out of the cot … And the noise! Just when you’ve got the last one off, the other two wake up and start shouting.’

STATISTICS SHOW that unfortunately twins, triplets and other higher order births experience medical problems more frequently in the early months of life, and spend more time in special care.

Colin, whose twins did need special care, used to envy parents who only had one: ‘I just seemed to lurch from worry to worry and they had so much more time. So it was useful to be reminded occasionally just how special the twins were. Although I envied parents who only had one, I would never have swapped the twins for just one, or had them one at a time.’

MOST OF US, when we envisage ourselves with a child, envisage exactly that: a one-to-one relationship. Right from the start, therefore, if you’ve given birth to twins, you have to adjust the dream to the reality in a fairly major way.

Jess felt she was giving neither of her children the attention they deserved: ‘Other parents might have time to show their babies a book, or take them for walks, but I hardly had time to smile at them. If one was being quiet, I’d rejoice, because it meant that I could change the other one’s nappy in peace. Most of the time, though, in those first few months, I felt as if I was listening to a constant grizzle, because – except when it came to feeding – whatever I was giving one, it meant I wasn’t giving it to the other.’

PARENTING IN the way or to the standard you’d imagined may not be possible with twins or more, and individual attention may be at a premium, but twins have each other for companionship and, as they grow older, a guaranteed play partner, in ways that singletons can never know.

Widening the circle can be more difficult, however: the efforts involved in getting out and socialising are multiplied more than seems fair when you have more than one. With her triplets, Dawn found it especially complicated: ‘Sometimes it can seem like too much trouble to put on three pairs of shoes and three coats just so you can wheel them all to the corner shop. But I know from experience that if I don’t go, and if I allow Peter to bring things back from work with him at the end of the day, like milk or a loaf of bread, then I might have no reason to go out, and if I don’t have a reason, I won’t go, and if I don’t go, I’ll just stay in and get more and more miserable. So it’s worth the effort.’

HOWEVER, most parents of twins (or triplets) will confirm the old cliché: that even if the demands and problems are doubled (or tripled) so are the joys and delights.

NEWBORN NICETIES

Some of the physical features of newborns that may cause surprise or anxiety include:

 Birth marks (if it’s going to be a mark that’s permanent, someone should come to talk to you about it)

 Heads that are moulded (from labour) so that they look squashed; the bones will return to normal within days

 Spots (usually entirely harmless, however disappointing)

 Hair (either too much or too little, depending on what the parents had thought the baby would have, but any amount is normal)

 The sex organs – those on some little boys can appear out of proportion (he will grow into them), those on some little girls may be red and swollen as a reaction to the hormones in her mother’s body. Swollen breasts and even occasionally small amounts of milk are caused by the mothers’ hormones. Breast size will reduce and milk disappear over the first few days

 A squint (which often disappears as the baby learns to focus her eyes).

LOOKS

HOW MANY of us new parents were prepared for the black umbilical stump? For the blotchy skin which newborns are prone to? For the way our newborn’s hands and feet can turn blue after a long nap, a sign that the circulation is not yet efficient or mature? In fact, in many respects the picturebook baby you were expecting may bear no resemblance to the child you’ve actually got, as Lynn discovered: ‘It was only when I changed Adam’s nappy for the first time that I got a good look at the umbilical cord … which was definitely something I hadn’t been prepared for. There was this black thing, with a clip on it. What was I supposed to do? The nurse had said “Oh, sprinkle on some of this powder when you clean him”, so I stood there with this talcum powder tin trying to guess if I should move the stump to one side, or lift it up, or just sprinkle all around it. I hadn’t a clue. I was petrified of hurting him. I was convinced that whatever I did, it would be wrong: the clamp would come off, it would bleed, I’d knock it off and do him dreadful damage. Then Adam did a wee all over me and I stopped worrying about the cord and started worrying about that instead.’

THERE ARE MANY kinds of marks on your baby’s body that may worry you, although most need no worrying about whatsoever. There are two kinds of birthmarks: vascular, which are to do with the blood vessels, and pigmented, which are to do with skin colouration. Philippa’s daughter, Sophie, was born with a birthmark: ‘Sophie was born with a red mark on her forehead and at first we never gave it a second thought. The midwives said it was probably a pressure mark from the birth and we were quite happy with that explanation – and relieved. At the six- week check, the doctor was more specific: “It’s a strawberry birthmark – my daughter had one. Don’t worry – it’ll go away on its own. “We were due to go back when Sophie was six months old, but we went back long before then as the mark began to get darker and to swell and we were worried it was some sort of tumour. We saw a skin specialist in London when she was three months old. She started on steroids and almost immediately the mark stopped growing. We were lucky, they think there won’t be a permanent mark, but those first months of her life were dreadful. There was all that uncertainty, all that fear for the future, and all that guilt. Even though this wasn’t a life-threatening condition, and it didn’t mean she had any permanent disability, that mark takes away the enjoyment and all the joy of her arrival even now. I look back at photographs of her when she was newly born and I think: “I should be thinking what a beautiful baby she was”, but I’m not. I’m thinking: “Look at that red mark. Little did we know.”’

BIRTHMARKS

 A brown mark – these are present in about ten per cent of babies: sometimes dark brown, sometimes a pale, milky coffee colour. Harmless. May not fade but no treatment necessary.

 Mole – a very few babies are born with a mole; raised, flat, dark or light, of any shape. They are only a cause for concern if they suddenly get larger, itch or bleed. If this happens, see your GP.

 Mongolian blue spot – a large, blue-grey or brown mark which occurs reasonably frequently in dark-skinned babies, usually on their back or bottom. Harmless. Soon fades.

 Port wine stain – a flat, purple-red birthmark caused by blood vessels under the skin; usually harmless but can be distressing for parents, and permanent without treatment. Nowadays, laser treatment can remove these birthmarks safely and effectively in four or five treatments, which can usually be started almost immediately.

 Stork bites – small pink blotches, usually near the eyelid. Harmless. Will fade. No treatment required.

 Strawberry birthmarks – raised, red marks. Usually occur on the face or neck. They eventually stop growing – although they may initially get larger before they shrink again – and usually fade completely during childhood. May need treatment if it is near your baby’s eyes, or in an awkward place where it could cause her discomfort. In these cases, the mark can be removed with laser therapy.

 Tiny brown marks – usually round… stop panicking – it’s a freckle.

DURING THE first 24 hours after the birth, a paediatrician will visit you to check over your baby. The paediatrician will check things like:

 Your baby’s hips – to make sure they are fitting nicely in their socket and have not been slightly dislocated by the birth

 The fontanelles: your baby will have two main fontanelles – soft spots on her head where the skull bones haven’t yet grown over and fused together.

IT’S NORMAL for the fontanelles to appear slightly indented, and you may notice a pulse beating through the skin. You may worry that they are very fragile, but they are covered by toughened membranes. If they do become very sunken or raised, this is a useful warning sign that your baby is unwell, possibly dehydrated and needs medical attention.

All babies, while in the womb, are covered with a fine fuzz of hair called lanugo. Sometimes there will still be a little of this lanugo left when the baby is born – but it will soon rub off.

Some babies may be born with coarse hair, often across the shoulder blades or down the spine, which can alarm parents. Most of this will fall out – it just rubs off.

In fact, the hair your baby is born with on his head may well not last – if you look at new babies a couple of weeks old, you will notice that they have a little bald patch on the back of their heads where the hair has been rubbed away by the mattress. All the hair is gradually replaced, and the colour it will finally be cannot be judged from the colour he started out with – many babies change from fair to dark, and some vice-versa.

A blister on the baby’s upper lip concerns some parents, but it is only a ‘sucking blister’, an indication of your baby’s enthusiasm for feeding. The blister may disappear between feeds, it may not. Babies seem entirely oblivious to the blisters and they soon fade as feeding frequency decreases.

If there’s anything that worries you, ask your midwife or health visitor. They will be visiting you regularly to check things like this. If your baby has a condition which needs further treatment, you will be given further information and often the names and contact numbers of support groups. If in doubt, ask.

VITAMIN K

VITAMIN K has been much in the news the last few years as health authorities and trusts have been rethinking their policies on this issue.

A few years ago, almost every newborn baby in this country was automatically given an injection of vitamin K just after birth with the aim of preventing haemorrhagic disease – a rare but dangerous condition in which the baby’s blood fails to clot in the event of any bleeding. Vitamin K prevents this disease developing and thus the injection programme gained widespread acceptance. No one knows why babies are born with low levels of vitamin K compared to adults, but it may be a safety measure in the womb when cells are dividing very quickly.

Then a study was published which showed a possible link between vitamin K injections and childhood cancer. Although the link was never proven, many health authorities decided to err on the side of caution and replace the routine injection with an oral dose of vitamin K, which was not linked with any problems.

You will find that your baby will be offered a preventive dose of vitamin K shortly after she is born. It is up to you and your partner to decide, well beforehand, whether and how you want her to have this. The disease it prevents is rare, but possibly fatal, and it isn’t possible to predict which babies will develop the disease. Babies who develop bleeding are usually found to have an underlying liver problem. If you want more information before making your decision, discuss it with your midwife.

FIRST ATTEMPTS

THERE ARE many new skills to learn, but all new parents experience this daunting realisation: just how much they have to learn. Rose, like many new mothers, had to start from the beginning: ‘“Have you fed and changed him?” the nurse said to me at six o’clock in the morning, when I’d only had him at ten the night before. And I thought, “What? Me? No.” So I went and looked for the stuff I’d need and I didn’t know where it was, and everyone had just left me. Then this other nurse came round and I was in tears. She said, “Are you alright, love?” I said, “No, I don’t know what I’m doing!” So she showed me. She was really nice. She had two little boys of her own and showed me which bits to wipe and which bits to use where…you know, all that stuff they give you in hospital, all those gauze things…you don’t know which end to use what on. The gauze was for wiping his bottom, apparently and I’d been trying to wash his face with it.’

BEING IN hospital can make things very public, as Hilary found: ‘It was awful, that first time. I felt like I was on show, like everyone was watching me. I’m sure they weren’t, they were all too busy with their own nappies, but it was a very testing time. And I felt like Lucy was made out of china. I didn’t want to fasten the nappy too tight, so it fell off, and then I did it too loose and it leaked. Mind you, you get used to it very quickly.’

Sometimes no knowledge can be a good thing, says Chloë: ‘Nobody ever came along and told us what we had to do or should be doing, because once he was born, they just left us on our own for the rest of the day and then we came home that same evening, so nobody was there to guide us. So that evening we thought we’d better change him and it was … I found it very exciting. It was very frightening, too, that first time, because he had meconium and I was worried in case he was suffering, and I kept thinking, “Is this normal?” But the most important thing was the excitement. I felt very excited to have him home and very happy. I wanted it like that.’

John reckons it’s often the simple tasks that worry you most, in the beginning: ‘There were obvious things I didn’t know. Like, I didn’t know what the cream was for. I didn’t realise it was a barrier cream. It’s obvious now but I didn’t realise then, so I put as little of it as possible on and he got very bad nappy rash. So I could have done with a bit more guidance in those early days.’

YOUR BABY’S TEMPERAMENT

ONE THING that will determine how tough or how easy you find the transition to parenthood is your baby’s temperament. Some are easier than others. Some babies actually seem to like being babies, and thus help make their babyhood a more enjoyable experience for all concerned, too; other babies seem to actively dislike being a baby. There are sighs of relief all round when they sit up, or walk, or turn into a toddler, whichever great achievement they seem to have been pining for.

Wakeful

IF YOU HAVE a baby who seems to need very little sleep – lucky you! You have an intelligent, smart child with great potential who will obviously do very well in life. At least that’s what everyone will tell you. And, if it’s any consolation, they’re probably right. Some babies are born wanting more – more of everything: more colour, more shapes, more talk, more walks in the park, more discussions over whether he’d like his bath now or later, or after the news.

If the wakefulness just lasts during the day, it’s going to mean hard work for you, but parents often find that this sort of baby, hungry for stimulation, is quite happy to be passed from friend to friend and all around the grandparents. Invite round old friends, distant relatives – anyone who’ll dandle the baby on their knee while you get on with calm and relaxing tasks like cooking dinner for 35.