Newborn Nursery

When I first started in the Newborn Nursery I felt totally inadequate. I've been around sick kids, sick adults, tired interns, etc. Everyone needing fixing in some way.

With the newborn nursery the babies are (mostly) perfect and the parents are tired but have this excited wondering glow about them. It is a moment that does not need fixing or meddling or doctoring. They are moments of the most pure wonder and love.

And yet, there I am. Trying to "fix" this? "Seriously," I thought on the first day, "there's nothing I can possibly do to help this situation. How do you improve on perfection?"

By the second day I'd semi-sorted it out. I was there not to add to (or subtract from, mind you) the emotion of the moments, but I could add to the logistics of the new little life now in permenant tow.

1. "Back to Sleep" Boca arriba--head up. Put your baby to sleep on his or her back to help reduce the chance of Sudden Infant Death Syndrome (SIDS). Do not have extra blankets or pillows or that cute stuffed bear from Aunt Margaret adorning the crib. A single blanket not by the face is appropriate.

2. Keep in mind, however that on her back is not a position of comfort for your newborn. It makes them feel like they are falling. So when soothing them, they prefer to be on their side usually; you can pat them or make soothing noises to calm her down.

3. "Fourth Trimester" I know, it literally makes no sense, but teleologically this one does make some sense. As humans developed, their brains continued to get proportionally bigger in comparison with their bodies. And therefore, gestations had to become shorter or else mom was never going to be able to push that big head out of her small (but thankfully stretchy) opening. So there is the concept of the "fourth trimester"--the idea that for the first two to three months of life, babies like to have their environment simulate the womb. Because, if their heads weren't so big, they'd still likely be in there. So your newborn will like things like:

• Being "burrito" wrapped snuggly in blankets that contain their limbs in flexed positions. It is not too tight if you can still comfortably fit two finger between the blanket and the baby. I've learned a couple burrito wrap methods. It's easier to have shown then to explain here, but maybe I'll try later with pictures if I get ambitious.
• White noise; quiet swishing like the blood circulating through the placenta and around the baby.
• This is also why they like to be on their side; more like the womb
• And other stuff that I will hopefully learn over the next three weeks. I guess there's a book called "Happiest Baby on the Block" that is good at explaining these sort of things.

4. Jaundice --many babies will have high bilirubin at their 24 hour of life check, usually not dangerously high, but we check just in case. Their livers don't process the bilirubin very effeciently yet so it gets high. With premies it doesn't peak until the fourth to fifth day of life. If it's high, we start "bili lights"--these really cool blue suntanning looking lights--or a "bili blanket." Babies who breast feed or are of certain ethnic backgrounds or have blood type incompatibilites or bruising during birth are at higher risk.

5. Breast Feeding--breast milk is BY FAR the best thing for your baby (except in rare cases when you have to take medicine that is not good for the baby or you are HIV positive). Breast milk, and I didn't really know this, is a dynamic substance that changes through the course of one nursing and changes from the first nursing to the later nursings. It imparts immunity and the perfect mix of enzymes and electrolytes and proteins to your growing baby. Remember, "breast is best." If you're having trouble breast feeding, lactation consultants are great. The nipple should fall into the baby's mouth comfortably. You can massage the upper breast to encourage the milk to come down. Milk will not fully "come in" for at least a couple days.

6. Weight loss--we expect babies to lose weight over the first few days of life. By one week of age they should be back up to their birth weight.

7. Car seats--be sure you know the proper way to strap them into your car. Your baby's shoulders should not be below the level of the top restraints. That is, the restraints need to insert into the seat either at or below the level of the baby's shoulders.

8. Cord Care--just leave it open to the air and let it dry out and fall off. Doctors used to recommend cleaning it with alcohol but that isn't really necessary and is one more discomort for your newborn. The cords will fall off on their own, so just let them.

9. Pediatrician--be sure to have a pediatrician picked out and then you can make your first post hospital check up appointment with him or her before you even go home from the hospital. Everyone will want to be sure you have good follow up care.

Etc. etc. I guess I'm not totally useless, even if everyone is happy and healthy.