Amniocentesis is a proceedure done usually by a specialist obstetrician or Expert Radiologist at about the 15th or 16th week of gestation.
Your baby is swimming in a pool of fluid called liquor.
This liquoir is made from fetal urine and pulmonary lung fluid and secretions from the Anmiotic Membranes..
This fluid also contains skin cells from your baby.
A small amount of the amniotic fluid is withdrawn by a needle(it doesn’t hurt), it is then cultured in a special nutrient broth that allows the cells to grow.
After 5 to 7 days of growing these cells are harvested and the chromosomes are analised under a microscope.
The Chromosomes are studied by genetecists and they are able to diagnose that the baby is normal or they can also detect many abnormalities such as tris
Chorionic Villus Sampling: CVS
CVS is a simpler method of assessing the babies Chromosomes.
A small amount of tissue is taken from the Membranes of the baby through the cervix.
CVS can be done at about the 12th week of Gestation , therefore providing a much earlier diagnosis than an Amniocentesis.
Both Amniocentesis and CVS carry a risk to the baby.
However in expert hands the probably of complications of fetal loss is less than 1 in 400.
The risk benefit ratio must always be assessed prior to any medical intervention.
This will be explained to you by your obstetrician.
Reasons for chromosome analysis include :
- High risk pregnacies associated with known genetic syndromes associated specifically in males or females.
- Advanded Maternal Age (Association With Trisomy 21)
- Previous Genetic Abnormality
Pregnancy is the pediod that it takes for a human baby to form and develop into an indepent being.
This is called the gestation period.
The human gestation period is approximately 40 weeks.
This is calculated from the beginning of the last menstrual cycle.
Most babies are born naturally between 38 and 41 weeks gestation.
A baby is considered mature at 36 completeted weeks.
Occasionally babies need to be delivered early either because of growth problems with the baby or a medical complication with the mother.
Up to 10% of babies are born prematurely,that is less than 37 weeks ,often without any underlying cause.
Modern neonatology is able to care for most of the problems associated with prematurity.
Babies as early as 25 weeks now survive and are normal.
The more mature your baby is in terms of weeks gestation,the less medical problems of prematurity are likely.
Method or Mode of Delivery:
Vaginal: the birth canal
Most babies are born naturally, that is through the Pelvis and Vagina.
Occasionally the baby needs to be assisted by the midwife or doctor.
Methods include Forceps and Ventouse-Suction.
There are different types of Forceps.
The Forceps forms a cage around the babies head and if applied correctly do not harm the baby.
The suction device commonly used is a Ventouse.
A small plastic cup is applied to the very top of the babies head attached to a suction device to assist its passage through the Pelvis.
There are often bruises on the scalp or face associated with this proceedure. However the bruising quickly subsides.
Caesarian is an abdominal operation on the mother to deliver the baby.
Caesarian section is becoming a more common mode of delivery.
Once used to deliver babies urgently because of fetal(baby) distress or for a previous caesarian section we now do elective caesarian sections to minimise any possible trauma.
Some babies are delivered more safely if delivered by caesarin section,
Examles of this situation are if the baby is a breech presentation.this means that the baby is bottom first.
It is now well documented that a caesarian section is the preferred method of delivery.
Another example is a repeat caesarian section because of previous caesarian section.
Once the uterus has a scar on it,it is more likely to rupture during a normal delivery.(risk about 1 in 200)
Some women are successful with Vaginal Birth After Caesarin section (VBAC).
Every situation is different and the pros and cons need to be discussed with your doctor.
Some couples are requesting elective caesarian sections.
This is definately becoming more commonplace.
Basically an elective ceasarian section removes any possible physical trauma to the baby, particularly brain damage during the birth process.
Modern Anaesthetic agents have made it safer for mothers and babies to choose this mode of delivery.
Head Moulding or Head Shape:
Many babies develop a funny head shape during delivery.
This is referred to as moulding.
A babies head has soft movable bones in order to fit through the pelvis .
The skull bones overlap,this gives the baby the Conehead appearance.
Quickly aftter birth the skull returns to its normal shape.
Babies that are in the breech position often have a rounded head shape that is pointy at the back of the skull.
This is because the babies head is resting at the top of the rounded uterus.
This shape too resolves within a short time after delivery.
Skull moulding can be alarming to parents at first.
However it always resolves and usually quickly.
A Cephalohematoma is a bruise usually on the side of the babies skull.
It is due to Haemorrhage on the outside of the skull but under the scalp.
Cephalohematoms are more often associated with instrument deliveries, but not necessarily so.
These swellings may be large but they are not painful.
They usually resolve within weeks after birth.
Cephalohematomas always heal perfectly.
Fortunately the newborn scalp is quite insensitive to pain.
This is a soft swelling in the babies scalp over the point of the skull that is the presenting part.
It is due to pressure on the scalp as it squeeses through the Cervix and Pelvis.
This caput is painless and resolves within a day or two after delivery.
At birth the Umbilical cord is cut, usually by dad.
There is a small residual piece of cord on the babies abdomen,about 2 centimeters.
We place a plastic clamp on the cord to stop it bleeding.
The cord quickly dries up and becomes small and hard.
We remove the plastic clamp on about day 3 .
The Cord stump falls off about day 10 to 14.
Alcohol used to be applied to the base of the cord,however this no longer practised,
A clean cotton bud is usually run around the base of the cord on a daily basis to remove debris .
A good idea is to keep the cord stump clean and dry.
This can be achieved by folding the nappy down below the cord.
Newborns often develop a creamy discharge from one or both eyes.
This is referred to as a sticky eye.
This is usually due to a blocked tear duct.
Babies actually make tears all the time to lubricate their eyes.
The tear fluid then flows down the tear((lacrimal)duct into the babies nose.
Babies nose can get blocked with mucus and sometimes milk due to regurgitation.
Parents often notice that their baby is sneezing,
This is how babies clear their nose.
Babies breathe almost exclusively through their nose,and therefore have to remove any mucus ,
They do this by sneezing,
The tear duct in a newborn is as thin as a hair so it’s easy to imagine how easy it is to get blocked.
Once the duct is blocked the tears spill over and dry as slimey, creamy discharge.
Sometimes as the mothers milk begins to let down the milk refluxes up the back of the babies nose.this may also contributes to nasal congestion.
Sticky eyes will respond to washing with saline and lacrimal duct massage.
This is done with vertical motion downwards along thre side of babies nasal bone . 6 to 10 rubs 3 times a day.
It may also help to breast feed the baby in a more head upright posture.
The eyes can be irrigated with saline frequently to remove mucus and crusting.
This is usually not an infective process and usually does not require antibiotic drops .
If ,however there is evidence of redness around the eyelids or the conjunctiva ,an antibiotic such as chloramphenicol may be prescribed by your doctor.
There is a myth that breast milk squirted into the babies eye is helpful,because of its antibacterial qualities.
I don’t think so!
Much debate has occurred about the use of dummies.basically all babies love to suck.
Presumably the act of rhythmical sucking stimulates rhythmical peristalsis in the babies bowels,
When babies cry and are placed on the breast they stop crying immediately.
Obviously no food can get into their blood stream immediately and it takes a time to actually fill their stomach,yet they stop crying immediately!
In other words sucking is soothing!!
Some babies respond to a dummy others reject them.
Whatever the case if your baby is unsettled and wants to suck constantly it may be worth trying a dummy.
No particular brand or type is recommended.
If one type doesn’t work another probably wont either.
Orthodontic specialists do not claim an increase in abnormal dentition due to dummies.
Most cosmetic dental abnormalities are genetic rather than acquired.
Many babies are happy with a dummy.
That makes mothers happy and that makes dads happy.
Some concern has been raised about dummies interfering with breast feeding.
In clinical practice i have never seen a baby reject the breast after being given a dummy.
A contented baby will usually make a mother more relaxed and therefore improve her milk supply.
A crying baby is always stressful.
A recent clinical trial of a large number of babies using and not using pasifiers showed no difference in the incidence of breast feeding at 6 monthhs.
Sleeping and Temperature
The recommended position for sleeping your baby is on the back.
Babies sleep patterns vary a great deal in the first few months.
In the first 6 to 8 weeks most babies feed for about an hour then sleeep for 2 to 3 hours.
Some babies that are unsettled tend not to sleep during the day.
This causes concern to parents that is may cause trouble with the baby’s development.
This is not the case .although the baby is not sleeping constantly they are good at taking short naps that regenerate their energy.
Healthy babies get as much sleep as they need.
This phase is only temporary and usually settles by 6 to 10 weeks.
If your baby is unsettled it’s a good idea for parents to take turns at looking after the baby.
No point in both of you being sleep deprived.
Sometimes babies will respond to a good walk with dad in a baby pouch.this gives mom a chance to catch up on an hours sleep.
If the unsettled pattern persists it’s a good idea to see your local well baby clinic or your family doctor.
Everybody realises babies can become cold easily however they can also become overheated.
It important to to have good ventilation around the baby and an even environmental temperature - 21 to 22 degrees celsius.
Babies loose heat through their their scalp , so it is important to leave their head exposed to allow them to control their body temperature.
On very hot days it may be necessary to have a gentle fan in the vicinity of your baby.
Also during feeding there is a great amount of skin to skin contact that provides heat to the baby.
The main thing is to be comfortable.
If it is hot take some clothes off and consider a fan.
If it is cold put on another layer of clothes.
Cotton is generally preferred on babies skin.
The general rule is babies require one layer more than you.
Hugging and kissing is very important, but keep cool in hot summer months.
Drinks: usually breast milk or infant formula is adequate fluid for your new baby.
Milk is 95% water.however on extremely hot days it is resonable to offer your baby cooled sterile water.
Babies do not need extra milk on hot days as this may cause overstimulation of the breat milk production that often causes a crampy baby and engorged breasts in mom.
It is safe to offer your baby 20 to 30 millilitres of sterile water once or twice a day.
If baby is interested great, if not no problem.
Sudden Infant Death:
Sudden infant death occurs in less than 1 in a 1000 live births.
Overheating is implicated as a an association as is cigarette smoking.
There is no identifable cause.
- Sleeep Baby on back
- Breast Milk is preferred
- Avoid over Heating
- Avoid Cigarette smoke
- Sleep on a firm flat matress.
Jaundice is a yellow colour that occurs commonly in newborn babies.
Babies are not born with jaundice,they may develop it on day one , two or three.
Most babies will develop some degree of Jaundice .
Upt0 90 % of newborns will develop some degree of Jaundice in the first week of life.
Basically Jaundice is due to the accumulation of a pigment called Bilirubin.
Most Jaundice is physiological and harmless.
When a baby is born their blood is totally different to adults.
This is called foetal Haemoglobin.
Baby has a thick rich blood that enabled the growing baby to extract oxygen from the placenta.
A babies Haemaglobin is almost twice as high as the mothers.
When your baby is born there is no need for all that rich blood,so it begins to dissolve.
As the haemaglobin breaks down it produces a substance called Bilirubin.
Bilirubin is the chemical in the blood that makes your baby look jaundiced or yellow.
Bilirubin is eventually broken down by your babies liver and excreted into the bowel.
Upto 90% of all healthy babies develop some degree of Jaundice.
Some Jaundice is indeed good for you as Bilirubin is an anti oxidant and is capable of mopping up oxygen radicles.
Physiological Jaundice normally comes on day 2 to 3 , reaches a peak on day 5 to 6 then abates over the next couple of weeks.
Natural light modifies natural Jaundice.
Never direct sunlight but filtered light will keep your babies jaundice at normal levels.
Isn’t nature wonderful!
Some types of jaundice are due to pathological causes.
Probably the commonest cause is when the mother and babies blood group are different.
This is referred to as a b o incompatability.
This occurs when the mother is group o and the baby is either group a or b.
This type of Jaundice often begins on day 1 .
The levels of Bilirubin may become very high very quickly.
Jaundice on day 1 is always a cause for assessment by your midwife or doctor.
If bilirubin becomes too high it may cause damage to the hearing nerve and in extremely high levels even cause brain damage.
We use a treatment called phototherapy or light therapy.
Your baby is placed under a bank of normal neon lights. Not ultra violet or infra-red.
Light causes the bilirubin to change its chemical structure and be passed out in the babies urine.
How clever is that!
The Apgar score is a number estimated by the person delivering your baby at the time of delivery.
The Apgar score was invented by a Dr.Virginia Apgar,
A pediatrician in the USA.
It is a method of assessing the well being of your baby in the first 5 minutes after delivery.
Your baby is assigned a score of zero ,one or two depending on various parameters.
The score is assessed on :
The score is assigned at one and five minutes
If your baby is active ,alert ,pink and crying your baby will score 8 to 10. This is a normal score.
If the score is less than that it predicts that your baby may require assistance.
The five minute apgar score reflects how well your baby is progressing compared to the one minute score if it was low.
This is the process of removing the foreskin of the male penis.
This proceedure has been practised for thousands of years. Circumcision is still a ritual proceedure in those of the Jewish Faith.
The present role of Circumcision is contraversial.
30 years ago circumcision was almost a routine proceedure in all males in the newborn period prior to discharge home.
Now about 25 -30% of male babies are Circumcised in the newborn period.
Another 5 to 10% of babies require Circumcision for medical reasons.
Circumcision is no longer routinely done in Australia.
Parents elect to have a Circumcision based on their religeous or medical beliefs.
Positive medical facts associated with Circumcision include:
- Less Urinary tract infection in the first year of life
- Less Sexually transmitted disease in Adult life
- Less Foreskin infection throughout life
Circumcision is the surgical removal of the foreskin of the penis.
The Foreskin is adherent to the penis for the first 2 to 3 years of life.
The Fforeskin is peeled of the penis to expose the glans and the redundant skin is cut off.
This proceedure is best done under a local anaesthetic in the first 6 weeks of life.
Parents should discuss the options with their paediatrician.
There are definite advantages to Circumcision however it is not routinely recommended.
Parents must make their own decision based on their information.
The correct decision is the one you make.
Approximately 10% of babies are born bottom first=breech.
The recommended mode of delivery for breech babies is caesarian section to minimise trauma to the baby.
Breech babies tend to have a higher incidence of hip dislocation and dysplasia.
This probably is due to the compressive force of the uterus on the developing hip joints.
During pregnancy the mother has hormones that make her ligaments elastic in order to deliver the baby.
These same hormones allow the baby to be elastic as well.
Therfore if there are stress forces on the hips they may become hypermobile and even dislocatable.
All babies hips should be examined in the first week of life.
Particularly breech babies.
Female breech babies have a slightly increased risk of problems compared to males.
If the hips are unstable it is best to treat baby with a harness to stabilise the hip joints for 6 to 12 weeks.
Most breech babies do not require treatment but all babies hips should be examined .
Developmental Hip Dysplasia - CDH
CDH is the underdevelopment of the hip joint.this occurs in babies particularly with a family history of the condition.
The examination of the hips may be normal at birth but as the baby grows the hip joint or acetabulum fails to mould into a cup shape.
This makes the hip joint very unstable.
It not painful and therefore parents do not suspect a problem.
CDH is often detected by a health professional between 4 and 6 months of age.
These babies also require harnessing to immobilise the hip joint to allow it to develop normally.
The earlier the detection, the quicker the treatment, the better the outcome.
All babies with a family history of CDH shoild have an ultrasound at 3 to 4 months to assess hip growth and development.
If the problem is not detected until later the babies often require corrective surgery.
This a waxy build up on the baby's scalp.
Just as adults do babies have oil or sebacious glands in their scalp.
This oily/waxy secretion accumulates and forms an adherent layer of wax on your baby's scalp.
Wash the scalp with warm water and a gentle shampoo such as "no more tears "or the" ego "shampoo for babies.
To avoid recurrent build up of wax gently shampoo your baby's scalp 2 to 3 times per week.
This is a pilmply eruption on the cheeks of the face.
It is due stimulation of the sebaceous glands in the skin by hormones in the breast milk.the Skin appears roughened and spotty.
There is no infection ,simply overstimulations of the glands.
A simple application of a moisturiser such as sorbolene or dermeze 2 to 3 time a day will calm it down.
Saliva or Dribble Rash
Most babies if not all tend to dribble and drule.
Most babies also tend to regurgitate a small amount of milk after a feed.
Once the milk is in the stomach it is now mixed with acid !!
Therefore when baby regurgitates, the acid in the milk irritates the skin of the face.
The areas affected are the cheeks,neck creases,behind the ears and the top part of the chest.(the dribble area)
This rash nis also treated with a moisturiser such as sorbolene or dermeze 2 to 3 times a day plus a mild hydrocortisone such as :
1/2% aqueous hydrocortisone availableas: dermaid or sigmacort from the chemist.
If the skin is irritated by saliva or stomach acid the normal barriers are removed and a subsequent infection may ensue.
This rash is usually red and angry and often weepy.
It is important to moisturise the skin with sorbolene or dermeze and pat dry the skin... do not rub!
This rash may often need an antibiotic to clear it up.
Your family doctor will prescribe this.
Eczema is inflammation of the skin often associated with allergy.
The face rash is often asssociaed with eczema elsewhereon the body.particularly in the creases behind the knees and in the elbow creases.
The rash is usually red and weepy.
It is best to keep the skin clean with water and use a moisturiser such as sorbolene or dermese several time a day.
A steroid cream such as dermaid or sigmacort is good for the face however a stronger steroids cream may need to be prescribed by your family doctor.
General Skin Care:
Water is best for washing.
Sorbolene Cream may be used as a moisturiser all over the body after a bath.
Cotton is by far the best fabric to have on the babies skin.
Avoid Polyester and synthetic fabrics as they do not allow air circulation over the skin to let the skin breathe.
In winter months wool clothes are fine but not directly on your babies skin.
- Stork Marks Naevus Flamus
- Strawberry Haemangioma
- Pigmented Naevus
- Hairy Naevus
- Café au Lait Patch
- Salmon Patch
- Mongolian Patch or Spot