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Chapter 47 Caring for Mothers and Newborns LEARNING OUTCOMES: Define the key terms and key abbreviations listed in this chapter Describe how to meet an infant’s safety and security needs Identify the signs and symptoms of illness in infants Explain how to help mothers with breast-feeding Describe three forms of baby formulas Explain how to bottle-feed babies Explain how to burp a baby Describe how to give cord care Describe the purposes of circumcision, needed observations, and the required care Explain how to bathe infants Explain why infants are weighed Describe the care needed by mothers after childbirth Mothers and newborns usually have short hospital stays. Common reasons for home care after discharge include that the mother: •Has complications before or after childbirth •Has health problems •Needs help with other young children in the home •Had a multiple birth •Needs help with meals and housekeeping INFANT SAFETY AND SECURITY cannot protect themselves. cry: •To communicate •When wet, hungry, hot or cold, tired, uncomfortable, or in pain Babies Babies To promote safety and security: •Respond to their cries. •Feed them when hungry. •Change diapers as needed. •Comfort them. •Talk to them. Nursery equipment must be safe and in good repair. Babies can become ill quickly. •Signs and symptoms may be sudden. Be alert to any change in the baby’s behavior. Tell the nurse when a sign or symptom began. HELPING MOTHERS BREAST-FEED (nursing) is feeding a baby milk from the mother’s breasts. •The baby can feed at the mother’s breast. •The mother can pump milk from her breasts. Breast-fed babies are fed on demand. Nurses help new mothers learn to breast-feed. Tell the nurse if the mother or baby is having problems breast-feeding. Breast-feeding BOTTLE-FEEDING BABIES Formula comes in three forms. •Ready-to-feed •Powdered •Liquid concentrate Bottles are prepared one at a time, or in batches for the whole day. •Follow the container directions carefully. •Use bottles stored in the refrigerator within 24 hours. Protect the baby from infection. •Wash formula containers before opening them. •Baby bottles, caps, nipples, and other items must be as clean as possible. Feeding the baby •Bottle-fed babies are fed on demand. •Most babies do not like cold formula out of the refrigerator. •To warm a bottle before the feeding, do one of the following: Warm it in a pan of water on the stove. Use low heat. Turn the bottle often. Hold the bottle under warm running tap water. •To test the temperature, sprinkle a few drops on the inside of your wrist. The formula should feel warm. BURPING THE BABY take in air during feedings. •Air in the stomach and intestines causes cramping and discomfort. This can lead to vomiting. •Burping helps to get rid of the air. Most babies burp mid-way and after a feeding. •You pat or rub the baby’s back with circular motions. Do this for 2 or 3 minutes. Babies Position the baby for burping in one of the following ways: •Over your shoulder First, place a clean diaper or towel over your shoulder. •Support the baby in a sitting position on your lap. Hold the towel or diaper in front of the baby. Remember to support the infant’s head and neck for the first 3 months after birth. •Position the baby on your lap with his or her stomach down. First, place a clean diaper or towel on your lap where the baby’s head will be. DIAPERING In breast-fed babies, stools are yellow and seedy-looking. •They are soft or runny. In bottle-fed babies, stools are yellow to brown. •Their stools are firmer. Over time, an elimination pattern develops. Stools are usually soft and unformed. •Hard, formed stools signal constipation. •Watery stools mean diarrhea. Diarrhea is very serious in infants. •Tell the nurse at once if you suspect constipation or diarrhea. Diapers are changed when To care for cloth diapers: wet or when stools are present. •Rinse a soiled cloth diaper in the toilet. •Store soiled diapers in a diaper pail. •Wash them daily or every 2 days. •Do not wash them with other laundry items. •Wash them in hot water. Use a baby laundry detergent. •Put them through the wash cycle a second time without detergent. •Hang them outside to dry if possible. Otherwise, dry them in the dryer. Disposable diapers are secured with Velcro or tape strips. •Fold soiled diapers so the soiled area is on the inside. •Discard the diaper in the trash container. Do not flush it down the toilet. Changing diapers often helps prevent diaper rash. •When changing diapers, make sure the baby is clean and dry before applying a clean diaper. •If a diaper rash develops, tell the nurse at once. CARE OF THE UMBILICAL CORD The umbilical cord connects the mother and the fetus (unborn baby). Shortly after delivery, the doctor clamps and cuts the cord. •A cord stump is left on the baby. The stump dries up and falls off about 2 weeks after birth. The cord provides a place for microbes to grow. •You need to keep it clean and dry. Cord care is done at each diaper change. Cord care involves the following: •Keep the stump clean and dry. Do not get the stump wet. •Keep the diaper below the cord. •Give sponge baths until the cord falls off. •Do not pull the cord off. •Report the following to the nurse: Swelling, redness, odor, or drainage from the stump Bleeding from the cord or navel area Fever CARE OF THE CIRCUMCISION surgical removal of foreskin from the penis is called a circumcision. •The procedure is thought to: Prevent urinary tract infections in infants Lower the risk of cancer of the penis Decrease the risk of sexually transmitted diseases Circumcision is a religious ceremony in the Jewish faith. Circumcision should not interfere with voiding. The Carefully observe for signs of bleeding and Check the diaper for bleeding. Report any concerns to the nurse at once. The area should heal in 7 to 10 days. Circumcision care involves the following: infection. •Clean the penis at each diaper change. Use mild soap and water, plain water, or commercial wipes as the nurse directs. •Apply a petrolatum gauze dressing. Or use a cotton swab to apply petrolatum jelly to the penis. •Apply the diaper loosely. BATHING AN INFANT bath is important for: •Hygiene •Good skin care •Comfort and to relax babies •Time to hold, touch, and talk to the baby •Stimulation Being touched and held helps babies learn safety, security, and love and belonging. A Planning for the bath is important. •You cannot leave the baby alone if you forget something. There are two bath procedures for babies. •Sponge baths are given: Until the cord stump falls off Until the umbilicus and circumcision heal •The tub bath is given after the cord site and circumcision heal. NAIL CARE The baby’s fingernails and toenails are kept short. Nails are best cut when the baby is sleeping. Use infant nail clippers and a soft emery board. •For fingernails, clip following the natural shape of the nail. •For toenails, clip straight across as for an adult. •Smooth rough or sharp edges with a soft emery board. WEIGHING INFANTS The infant’s birth weight is the baseline for measuring growth. The nurse uses weight measurements: •In the assessment step of the nursing process •To measure the amount of breast milk taken during breast-feeding The baby is weighed before and after breast-feeding. CARE OF THE MOTHER means after childbirth. •The postpartum period starts with birth of the baby. It ends 6 weeks later. The mother adjusts physically and emotionally to childbirth. Postpartum A vaginal discharge occurs after childbirth. •It is called lochia. Lochia consists of blood and other matter left in the uterus from childbirth. •Lochia rubra is dark or bright red discharge. Mainly blood, it is seen during the first 3 to 4 days. •Lochia serosa is pinkish brown drainage. It lasts until about 10 days after birth. •Lochia alba is whitish drainage. It continues for 2 to 6 weeks after birth. •Normally, lochia smells like menstrual flow. Foul-smelling lochia signals an infection. Good perineal care is important. •Sanitary pads are changed often. •When wiping after elimination, the mother wipes from front to back. •Sanitary napkins are applied and removed from front to back. •Good hand washing is essential: After perineal care After changing sanitary napkins After elimination •Standard Precautions and the Bloodborne Pathogen Standard are followed. Some mothers have episiotomies. •The doctor performs this procedure during childbirth to increase the size of the vaginal opening for the baby. •The doctor may order sitz baths for comfort and hygiene. •Complications can develop. These include infection and wound separation (dehiscence). •Tell the nurse at once if the mother complains of: Pain Discomfort Discharge Some mothers deliver by cesarean section (C-section). •The baby is delivered through an incision in the abdominal wall. •A C-section is done when: The baby must be delivered to save the baby’s or mother’s life. The baby is too large to pass through the birth canal. The mother has a vaginal infection that could be transmitted to the baby. A normal vaginal delivery will be difficult for the baby or mother. The mother has emotional reactions after childbirth. •Causes include: Hormone changes Lifestyle changes Lack of sleep Frequent visits and telephone calls Advice and opinions about parenting •The mother can help herself by: Resting when the baby sleeps Taking time for herself and her partner Complications can occur: •During pregnancy, labor, and delivery •In the postpartum period