POSTNATAL DEPRESSION AND ANTIDEPRESSANTS

Down but Not Out

The Experts Answer Your Questions About Postnatal Depression and Antidepressants I am on an eight-month course of the postnatal depression medication, Aropax, and am weaning myself off it slowly over the next four weeks. (My original dose was one tablet per day; I’m now on a quarter per day.) My daughter is almost a year old and, even though I have found her easier to look after as she has grown out of that newborn stage, I am still worried about how I will cope after the effects of my medication have worn off. Are there any strategies I should be following to help myself adjust? AUCKLAND PSYCHIATRIST SARA WEEKS REPLIES: For a single episode of postnatal depression, antidepressant medication such as Aropax (paroxetine) is usually prescribed for between six months and a year, depending on the severity of the depression and how long it took to recover once the medication was started. The usual dose range is between 20mg (one tablet) and 60mg (three tablets). Because you have already weaned down to a quarter of a tablet (5mg) of Aropax, you have already started to adjust to being on less medication. Taking antidepressant medication is like having a plaster cast on a broken leg. The pain (depression) goes fairly quickly, but you have to keep the plaster on (or keep taking the medication) to allow the bone (or brain) to heal underneath. While we can x-ray bones, there is no comparable test to see whether you have built up stores of serotonin in your brain again. This is one reason why we suggest gradually weaning off medication, so that if symptoms are going to return, they are likely to do so while you are still weaning off the medication, and will not be as bad. If depressive symptoms such as increased anxiety, sleep problems, irritability, poor energy or low mood return during the reduction stage, then the medication can be increased slightly, to the point where you are no longer experiencing these symptoms. After a couple of months you can try to reduce again slowly. If you have had a previous episode of depression, or the PND was severe, you may need to take the medication for a couple of years. Another reason for weaning off this sort of medication slowly is that some people (about 30 per cent) experience what is called a discontinuation syndrome. This includes symptoms such as dizziness, nausea, and a flu-like feeling when this type of antidepressant medication is stopped too suddenly. Some people experience buzzing in their ears or a vague electric shock-like feeling. While these symptoms can be disconcerting and upsetting, they are not actually harmful, and can usually be avoided by weaning off the medication very slowly. Some people, however, find these symptoms impossible to manage, and no matter how slowly they wean the medication, the symptoms do occur when medication is stopped altogether. Sometimes changing onto a very low dose of a similar medication, which has a longer clearance time from your system, can help. And then when that is stopped, you are far less likely to experience discontinuation symptoms. With regard to strategies to help yourself adjust, eating well, regular exercise and plenty of sleep help you make sure your brain is producing enough serotonin. Talking over problems before they grow, having some achievable goals, and keeping an eye on the amount of stress you are under are all likely to be helpful. You may notice that you feel more sensitive or irritable before your periods, even if you did not suffer premenstrual syndrome (PMS) before your pregnancy. It is relatively common for the degree of PMS to change after pregnancies, and the Aropax will have been dealing in a minor way with this.

I have been on antidepressants for several months. My partner and I would like to have another baby. Do I need to come off my medication before I get pregnant or can I continue taking antidepressants during my pregnancy? AUCKLAND OBSTETRICIAN MARTIN SOWTER REPLIES: Depression in pregnant women is relatively common, with about 10 per cent of pregnant women describing symptoms of depression. Up to five per cent of women take antidepressants while pregnant. Reassuringly, there doesn’t appear to be an increased incidence of fetal abnormality associated with taking these drugs. Some studies have suggested there may be a small increase in the risk of pre-term delivery, or that some newborn babies may show signs of a short-lived withdrawal syndrome, but recent studies are reassuring. If you are planning to conceive and are taking antidepressants, review with your doctor whether they are still needed, and continue to take them if they are. If you conceive unexpectedly, continue to take your prescribed antidepressants. Untreated depression in pregnancy, apart from being unpleasant for the woman affected, may also be detrimental to her pregnancy. Women with a past or current history of depression may be at increased risk of PND. It is important to discuss this with your LMC and partner to develop a strategy for reducing this risk.

I suffered from postnatal depression after the birth of my first child. My partner and I are thinking about having a second child. Am I likely to suffer from PND again? AUCKLAND PSYCHIATRIST SARA WEEKS REPLIES: If you have a second child your chances of suffering PND are increased. Rather than being about one in seven, the risk increases to about one in three. Being prepared is an important factor in reducing the likelihood of postnatal depression, depending on its severity. Ensuring you have enough help around, and that you are not undertaking any big projects such as moving house or renovating your home (during pregnancy as well as afterwards) helps. I also suggest you try to sleep, or at least rest, when your baby sleeps. When women have suffered fairly severe postnatal depression, doctors will often recommend that they start on an antidepressant medication, which has previously worked for them, as soon as they have had the baby. This makes it very unlikely that the depression will recur, and, even if it does, it is likely to be less severe. It is also important to keep an eye on your mood during pregnancy, because if you start to become depressed or highly anxious during pregnancy this further raises your risk of postnatal depression. It may be recommended that you start antidepressant treatment during the pregnancy. Make sure you let your Plunked nurse, midwife, or doctor know you have previously suffered postnatal depression so they will be able to intervene promptly if there are any problems.

HOW TO CHANGE A NAPPY

Six simple steps to help you to get the best out of your Treasures nappy:

Step 1

Open your Treasures nappy and check that the leak guards are sitting up. If they are lying flat, run your finger lightly down the elasticized leak guard join, see picture at right, so it springs up off the surface of the nappy. This is one of the most common causes of nappy leakage, so it’s worth getting into the habit of checking the leak guards every time.

Step 2

Place the opened nappy under the baby with the front tape closest to you. Bring the front of the nappy up between the baby’s legs and spread it over his tummy.

Step 3

With one hand on the nappy and baby, open grip tabs and attach it to the frontal tapes by pressing firmly. Repeat on the other side.

Step 4

All done! Because both Treasures Ultra and Treasures Giggles have refastened able grip tabs you can refasten or reposition tabs as often as required.

Step 5

It’s a good idea to flush any excess soiling down the toilet. But never flush your Treasures nappy away. Roll into a tight ball and use the tabs to seal. Please always throw your nappy in the rubbish.

Tips:

For novice nappy users, particularly grandparents who have never used nappy, it may be worth telling them that the pictures go at the front. We have heard of the occasional person trying to put them on backwards! Some bigger babies learn how to take off their nappies when their parents aren’t looking, with very messy consequences. You may find that if you put them on backwards for a couple of days, your baby will find it so difficult to get them off that he’ll stop trying. Many mums find if they tuck their son’s penis down, their nappies are less prone to leak.

Are you ready to go up a size?

Your baby’s nappy is more likely to leak when you are ready to go up a size. How do you tell? Keep an eye on the weight range on the packs and watch for tell-tale red marks left around your baby’s legs or tummy from nappies that are just a little too tight. Remember the weight is only a guide. The correct size will also depend on the ‘shape’ of your baby.

How to avoid Nappy Rash

However careful you are to keep your baby’s skin clean and dry, most babies will get nappy rash at some stage. Most nappy rash is caused by the breakdown of urine and faces into ammonia, which irritates the skin. It’s less common in newborns, as their nappies are changed often, but can become a problem when babies start sleeping longer at night. Disposable nappies have been shown to be the best for avoiding nappy rash. Treasures Ultra nappies are highly absorbent and quickly draw moisture away from the skin. Even if your baby is in a disposable nappy, it’s important to change your baby as soon as you can after he’s had a bowel motion. Treasures Ultra Newborn nappies have a specially designed Air Cell Absorption System, a soft woven layer that draws, disperses and contains a newborn’s runny pools. When you change your baby, gently clean and dry the skin, wiping from front to back for girls. Always clean in all the little creases. Letting your baby air her bottom once or twice a day will also help prevent nappy rash. Barrier creams, powders and ointments are the best first line of defense against nappy rash. Before applying them, make sure the skin is clean and dry. If nappy rash persists talk to your pharmacist, GP or Plunked nurse. Your baby may have thrush or a bacterial infection.

BOUNCING BACK!

IT HAS BEEN A LONG-HELD BELIEF that beauty comes from within. If you feel good about yourself, and are happy and relaxed, you’ll look radiant and healthy. But that doesn’t help much straight after childbirth – when sleep deprivation fogs your brain, your stomach still resembles a pregnant woman and you’re clutching a delicate little bundle who only knows how to do three things – drink, squawk and fill his nappies. But there is hope. Physiotherapists Jill Wood and Vicki Holmes, who have spent more than 10 years working in maternal health, have a motto: “Form follows function.” If you get your body doing what it used to be able to do before you became pregnant, you’ll feel a lot better about yourself – and ultimately look a lot better. However it’s important to take it easy on your body for the first three months, when the hormone relaxing (which softens connective tissues as your body prepares for birth) is still having an effect, but there are exercises that will have you feeling good before you know it. The most common physical problems women face after childbirth are perinea discomfort, incontinence, sore back, bad posture, a floppy stomach that keeps moving long after you’ve stopped, exhaustion and stress. Wood and Holmes say there are simple exercises that, in most cases, will cure problems such as incontinence and restore a woman’s dignity. And while it takes six to 24 weeks to get the body’s muscles back to pre-pregnancy condition, that isn’t too bad given that it took 40 weeks to get them that way. On the following pages are their strategies for getting back into top health following the birth of your baby. The first two weeks Pelvic floor exercises: You can begin these from day two. It helps if you already know how they should feel. If you have stitches or are still sore, lie on your tummy with a pillow under your hips, and practice gentle pelvic floor contractions. Simply squeeze and relax, squeeze and relax. Don’t worry if you “can’t find” your muscles in these early days. They will return! As well as strengthening your pelvic floor, these exercises help “pump away” any swelling and make your bottom feel more comfortable. They will most probably be good for hemorrhoids as well. - While you are squeezing and lifting, it’s important to keep breathing normally, so don’t hold your breath (this may take practice). Breathing also helps with relaxation. - Hold for three to five counts (if you can). For many women, it’s a case of becoming familiar again with the sensation of squeezing and “deciding” to let go. For some, that might initially be after the count of one, but it will improve. Repeat the squeeze and hold three to five times. Do it three times a day. As comfort allows, do more repetitions and for longer, aiming for six times a day. It takes three to six months for the muscles to recover. Quick flicks: When comfort allows (and this will vary from woman to woman), work on “three flicks”. This uses the same group of pelvic floor muscles in a fast, powerful way. It’s as much a mental thing as physical. You need to tell your brain to tell your pelvic floor to work hard and fast. “The muscles need to be able to do two things,” explains Holmes. “They need to be able to hold on for a long period of time to keep the urine in the bladder and they also need to be able to cope if there’s any increase in abdominal pressure – like with a jump, a lift, a walk, cough or sneeze.” If you’ve had a vaginal delivery, your reaction time will be slower, so practicing quick flicks helps speed it up. Transverse Abdominal Exercises: These exercises work the deep abdominal muscles. Using a chair sit up tall with your feet flat on the ground and slightly apart. Place your hands on your hips, think of an imaginary piece of string that’s attached to the muscles just below your belly button. Then visualize someone is behind you pulling the string (very gently) so that your tummy is being drawn towards your spine. Then hold is there gently. Whilst keeping your tummy in; lift your right foot 12cm off the ground. At the same time, lift your left arm and hold for five counts. Repeat with the opposite arm and leg. If you’ve had a Caesarean, ensure you do these exercises very gently and always within your pain tolerance. NOTE: Don’t do crunches (sit ups) initially as these only work the outer layers of the abdominals and increase pressure on already weakened pelvic floor muscles. Two to four weeks Posture exercises: Posture is very important at this time. After standing with stretched abdominal muscles and with your weight propelling your body forward for nine months, getting yourself back to an upright position with your tummy tucked in will take some conscious effort. Whenever you’re standing, it’s good to take the time to think about your posture and basically “tuck yourself in” – simply by pulling in your tummy muscles, straightening your knees and pull back your shoulder blades you will automatically assist in correcting your posture. Stepping out: If you feel up to it and are starting to feel your pelvic floor muscles strengthening, it’s time to get out for a short walk once or twice a week. Walking is low-impact, time efficient, and you can take the baby. Take a friend along, too. Walking and talking is a great combination and you should not be so puffed that you can’t talk. But don’t just walk! While you are walking use the times to do both your pelvic floor exercises and your transverse abdominals. It’s good to do at the same time as the two have a natural connection and work together to improve incontinence, posture and back strength. Note: If you had a Caesarean, avoid pushing a buggy up hills for the first three to four weeks. Rectos Abdominals Muscles: During pregnancy, the outer shield of this muscle separates, leaving a gap but it should be coming together by now. To test this: Lie on your back with your knees bent and your feet flat on the floor. - Place your fingers just above your tummy button and push your fingertips firmly down into your abdomen. - - Lift your head and shoulders off the floor and feel for a gap. You’ll If the gap is more than two fingers wide, feel the ridges of the - left to right, and then you need to do more transverse abdominals to bring the muscles in and back together. - If the gap is large, consult a women’s health physiotherapist. Check the gap weekly, working towards having it closed by six weeks. Four weeks to six months Walking programmed Walking is great for reducing stress – a good blast in the fresh air may help you cope with the demands of your new baby. It may even help you sleep better, too. To use walking as a means to improve your fitness, set specific walking goals. Aim to walk for 45 minutes, three times a week. Vary your routine Keep up pelvic floor exercises and transverse abdominals, which you should do for the rest of your life – but are especially important for the first 24 weeks after giving birth. After six weeks you can do other sorts of exercises for your stomach too, but make sure your transverse abdominals and pelvic floor are working while you do them. By three months, you should hope to have a good body awareness of pelvic floor and lower abdominal muscles and you should be able to work them both individually and together. If you want to take your exercise further, you could now join a gym, if you’ve been a runner before you became pregnant, you could try some gentle running at around six weeks, but only if you have full bladder control. If you’ve never been a runner, don’t attempt such a high-impact activity for three months, and make sure you wear shoes with good support that are the right fit (remember, your feet can change size after pregnancy!). Instead, you could look at doing some low-impact exercise that will build up your cardiovascular fitness. Go for a power walk, swim, or ride a bike.

BABY SLEEP

If you want your baby to get into good sleep habits, you need to do your bit, too. There’s an old joke: “Anyone who says they slept like a baby has obviously never had one.” But, as I well recall, it’s no joke when you’re grappling with a baby who seems to think a decent sleep is 40 minutes long.

Plunked family centers report that about half the new mothers coming to see them are there because of problems with their babies’ sleeping patterns. Kay Morgan, Plunked nurse and unit manager for the Grey Lynn family centre, says the problems usually fall into two areas – the baby who will fall asleep in your arms but wakes the instant she reaches the cot, and the baby who snacks and snoozes, and so rarely sleeps for long. In both cases, of course, it’s actually both baby and mother who have a sleep problem, as mothers get more and more worn out.

It helps to know a bit of the theory about sleep before tackling some practical solutions. The textbooks tell us that in babies there is a developmental progression of sleep behavior. Newborns alternate between sleep and wakefulness every three to four hours, in response to hunger. As the baby grows this should shift to a diurnal pattern with longer periods of sustained sleep at night – up to eight hours. That’s the theory.

Patricia Aley is a former Plunked nurse who specializes in treating sleep problems for young babies. After years working as a psychiatric nurse and then a Plunked nurse, she says she became aware that new mothers were often missing the cues that their babies needed sleep. Her guidelines for settling a young baby are straightforward. “First, sleeping and feeding can’t be separated. You have to be sure that the feed has been an efficient feed, and if the baby is dozing off on the breast, take her off, start her again and make sure she’s feeding efficiently. “The next step can be scary for many mothers – you have to put the baby down to sleep, awake. So, you give the baby a play period at the end of each feed, and babies of three weeks and older will happily manage that. “Then you have to be alert for the baby’s tired signs – she may be grizzly, or she may start making jerky movements, opening and closing fists, yawning or crying. You have to be attuned to your baby’s individual signs. “Then put the baby – awake – into her bed, and let her fall asleep by herself.”

Patricia says that when you hear a tired cry from the cot, it’s a legitimate sign in its own right, not a signal for mum to go in and comfort rock or pick up the child. “Nine times out of 10, the child will be asleep in 10 minutes, and it’s important that they learn to do it themselves.” Kay Morgan agrees, and says it’s important to know that while some babies naturally get into a good sleep rhythm, most have to learn it. “It’s a learned practice. People think if a baby is tired they will fall asleep anywhere, but that’s just plain exhaustion.” A big part of the work of Plunked nurses is showing new mothers how to recognize those sometimes subtle “tired signs” in their own babies.

Kay says getting a baby into a regular routine means they will often start extending their sleeps longer at night. Again, feeding can’t be separated from sleeping, so the aim is to ensure the baby has a good, efficient feed before they go to bed for the night. It’s a case of “baby rarely knows best”, Patricia Aley says. “Sometimes people will tell you that the baby will stop feeding when he’s had enough, but that’s not always true. And people say the baby knows when it needs to sleep, but that’s no truer of babies than it is of adults. Just as we’re able to delay sleep with distractions, so can the baby distract itself with all the things going on around him.”

Be aware also that babies will go through growth spurts, typically at six weeks, three months and five months. The baby will be hungrier and so will increase the amount of feeds, and shorten his sleep times, but it’s usually a temporary hurdle. While both Kay Morgan and Patricia Aley say regularity and routine is important, they’re not in favor of totally rigid routines.

“We are creatures of habit, but we’re all capable of varying our routines, and so if you have to take the baby out, then you just have to,” says Patricia. Kay says: “You have to decide what you’re comfortable doing. We’re not suggesting a crying contest, as some programmers do, and we like to look at every individual situation. We look at what’s age appropriate, whether there are any other factors such as a baby with reflux, but mostly it’s just learning to recognize the tired signs in a baby, and then getting them into bed.”

You can start to teach a baby the difference between day and night even from a young age by keeping playtime, talking and cuddling to the day, and at night keeping noise and lights low, and talking to a minimum. And as for sleeping like a baby – well, babies do have different sleep patterns to adults. They spend more time in REM (rapid eye movement) sleep in which dreams occur, which means they have more transitions between light and deep sleep. That, in turn, is why they wake up more often. Until they learn to soothe themselves back to sleep, that may mean more interrupted nights. Children don’t have truly adult sleep patterns until the age of three or four.

POST-NATAL DEPRESSION

Feeling down?

Can't stop crying? Worried that you don't love your baby? It's normal to feel emotional in the days and weeks after you have a baby, as your hormones are still settling down after a tumultuous few months. There's even a phenomenon known as the baby blues, which causes up to 80 per cent of new mothers to feel teary and tired for a couple of days about three or four days after the birth. But there's another kind of blues that affects about one in every 10 new mums. It's called post-natal depression (or postpartum depression), and it usually strikes between one and three months after the birth, sometimes lasting for months. Much less common is a third type of depression, called post-natal psychosis. This is a serious medical disorder characterized by psychotic behavior such as delusions, hallucinations and even a desire to harm yourself or your baby. It requires immediate medical diagnosis and treatment, but has a very good recovery rate. It's not known exactly why some mothers suffer from post-natal depression, although statistics show that you're more likely to experience it if you had a difficult birth experience, if you haven't got much support with your new baby, if you've previously had an abortion or stillbirth, if the pregnancy was unplanned, if you and your partner are having relationship problems or if you've previously experienced depression. It's likely that the demands and stresses of new parenthood, including broken sleep and a new sense of responsibility, also contribute.

Warning Signs

Here are some warning signs to watch out for: You feel sad or miserable You cry a lot You have lost your self-confidence and blame yourself when things go wrong, even when they're not your fault You feel ugly or boring You feel anxious and tense You feel confused and can't make simple decisions You feel tired and irritable, but have trouble sleeping Your are either frenzied with energy or lethargic (or you alternate between the two) You feel like you've lost your sense of humor You've lost your appetite and your interest in sex You find yourself withdrawing from friends and family You worry about your baby and about being a good mother, or you simply don't feel interested in your baby You have thoughts of hurting yourself If any of these sound familiar to you, see your doctor as soon as you can - and not just for your own benefit. Some research suggests that children of mothers with post-natal depression may suffer from delayed mental and emotional development. But the good news is that treatment is available and is usually highly successful. It is likely to include counseling and psychotherapy, and in some cases may also include antidepressant drugs. In the meantime, tell your friends and family how you're feeling and don't be afraid to ask them for help so you can get some time to yourself and rest as much as possible. Sharing your experiences with a support group, whether online or in person, may also help.

BABY SHOWER IDEAS

How to throw a perfect baby shower

Cups of tea, hand-knitted booties, and definitely ladies only – the baby showers of old were pretty tame affairs and for a while went completely out of fashion. But they seem to be climbing again in popularity. And why not? The birth of a baby is a fantastic thing to celebrate with friends and it’s great for a mum to receive a few little nick-knacks for the nursery.

The right food and drink

Some expectant mums won’t mind sipping grape juice while everyone else has a few wines, others might feel left out. Check with the guest of honor what drinks she’d prefer to have on offer. Make sure any food is safe for pregnant mums – lay off the pate and soft cheeses.

Thoughtful gifts

Quite often first-time parents don’t know about all those useful little items that will make their lives easier: muslin wraps; head smugglers for the car seat or buggy; a tri-pillow for feeding or propping up baby when they get a bit older; snuggle rugs for covering baby, your shoulder, the change mat, or the mattress to catch dribbles; papaya cream or bee balm for bottoms; bibs, bibs and more bibs – buy them big. Second, third (or more) time around parents will have a lot of the basics but will probably appreciate a few new and special bits and pieces, especially if they are having a baby of the opposite sex. If you are set on buying gorgeous clothes, buy them a bit bigger as all parents appreciate having some lovely outfits waiting in the drawer in the next size up. Pop in an exchange card as well – it’s amazing how many bright minds think alike when it comes to presents. Make up a mum’s pamper box: bath bombs, hand cream, toenail polish for when she can again reach her toes, a lip gloss, a good magazine. Make the expectant parents a housecleaning and babysitting coupon book. Include vouchers for doing the groceries; making some meals and taking the baby for a long walk so the new mum can have a sleep. Or go in with friends and buy the services of a housecleaner for a month. Older siblings will feel left out with all the attention that’s given to the new baby, so take a little something for them if you can. New parents can never have too many nappies – bigger sizes come in handy if they already have a good supply of newborn ones. And of course joining your friend to the Little Treasures Baby Club is always a fail-safe gift idea. You can join online now - see link below.

Lighten up with a game

Ask guests to cut a piece of string to the length they think would fit exactly around the expectant mum’s middle. The closest wins. Play blindfolded “put the nappy on the cardboard baby”. Hold “waters breaking” races holding full water balloons between your knees.

BABY TIRED SIGNS

How recognizing tired signs helps you get your baby to sleep

“I know my baby gets really tired, but I can’t get her to sleep easily. I’ve tried everything to settle her but we’re both feeling tired and grizzly.” It’s important to learn to recognize signs of tiredness in your newborn. Usually feeding and playtime can be finished within an hour. By then your baby will be giving you signs of being ready to go back to bed: a change from being relaxed to clenching of fists, yawning, and rubbing of the eyes, jerky movements, facial contortions and frizzling. If you put your baby down as soon as you notice these signs and if you stick to a routine, keeping everything the same every day, your baby will find it easier to self-settle. Put your baby into her cot while she is still awake. If she cries, that’s okay. You can visit and soothe her by rocking or patting, but try not to pick her up. Babies should trust that mum will come, but they should also learn that they can put themselves to sleep. And remember, whatever your baby or child goes to sleep with is what they will need when they wake in the night. Make sure it's something such as a cuddly blanket or a soft toy -- that doesn't require you to be there. Dummies fall out and can't be found. If babies fall asleep at the breast, they will wake demanding to suckle.

Sleep them safe

Most cot death rate has fallen dramatically since parents started following recommendations to sleep babies on their backs. But there’s more you can do to cut the risk for your baby. Here’s the latest advice on how to avoid sudden infant death syndrome (SIDS).

No smoking during pregnancy

Smoking during pregnancy is an important cause of sudden unexpected death in infancy because it damages babies before birth. Many women find that it is easier to give up smoking when they are pregnant. It is important to stop smoking as soon as possible after a pregnancy has been confirmed. A midwife or health practitioner can help pregnant women and other household members to quit smoking.

Sleeping position – “Back to sleep”

Babies should be put down to sleep on their backs. Babies who sleep on their backs are less likely to get their faces accidentally covered by sheets or bedding.

Sleeping environment

The recommended sleeping environment is having baby sleeping in a cot or bassinette near the parents’ bed. Co-sleeping (a parent who sleeps with their baby in bed) is dangerous when: the baby’s mother has smoked during pregnancy, or … the adult in bed with the baby has been drinking, or taking drugs or medicines that might reduce their awareness of the baby, or …the co-sleeping adult is excessively tired. A small increase in SIDS risk from co-sleeping is also present for babies less than three months old, whether or not the mother smoked during pregnancy.

Room sharing

Babies who sleep in the same room as parents for the first six months are at lower risk of SIDS.

Breastfeeding – ‘Breast is best’

Breastfeeding has many benefits for mothers and babies. It helps to keep babies healthy and well.

SHOULD I CALL THE DOCTOR?

Most parents feel anxious when their baby gets sick. Often your intuition will tell you when something’s not right, but any of the following signs shows that you must get help from a doctor quickly: • Difficulty breathing, breathing rapidly or grunting. If your baby’s chest and shoulders lift with each intake of breath, they may be having breathing problems. • Coughing or wheezing • Stopping breathing, even briefly • Difficult to wake for feeds or is unusually sleepy, floppy or listless • Any change in skin color, like turning blue, or very pale • Blotchy skin or a rash, particularly if it’s red or purple • Crying or screaming more than usual or on a high pitch. • Obviously experiencing pain while feeding or refusing to feed at all (this often happens when your baby has an ear infection). • Crying and pulling at an ear. Is the ear discharging? Look at the head sheet in your baby’s bed. • Waking in a distressed state during the night when they have been in a regular sleep pattern previously. • Fussing during feeding when previously they fed quite happily. • Refuses three consecutive milk feeds or has trouble swallowing. • Vomiting for more than six hours or continual, severe vomiting. • There is a change in bowel motions; for example, a loose, smelly, runny pool that is green or contain blood, and is frequent at every feed. Is your baby vomiting as well? If so, you need to take your baby to the doctor immediately. • Convulsion or fit • Swelling in the groin area or swelling or redness in the testes • A bulging fontanels when not crying • If your baby has been hurt (especially on the head), or has fallen off a bed, table or couch, they should also see a doctor. If you are not sure if your baby needs to see a doctor, it is better to be safe and get your baby checked out. If there is no improvement, or your baby gets worse, see the doctor again or, if you cannot see a doctor, take your baby to the nearest hospital. If your baby is having breathing problems, ask for an ambulance immediately. If it is not urgent, you can call into a Plunked clinic and ask the nurse to look at your baby. Be assertive when it comes to your baby’s health. No one knows your baby better than you do and if you are anxious about your baby, follow through on your gut instinct. Be persistent until your baby gets the treatment they need and begins to improve.

ACING A BABIES TEMPERATURE

Babies and Temperatures

A normal temperature is around 37ºC. A fever (a temperature higher than this) shows that the body is fighting an infection. It’s not an illness in itself, but an important symptom. Because they have little resistance to infection, a baby under two months with a raised temperature should be seen by a doctor immediately. You may decide to wait a little longer to see if more signs and symptoms develop before going to the doctor with an older baby who is in no distress and who is otherwise feeding, sleeping and behaving normally. Don’t ignore the fever, but look for other clues to determine if your child is seriously ill. You can measure a temperature inside the mouth, under the arm, in the outer ear canal or rectally. What kind of thermometer you use depends on the age of your child: • Digital thermometers can be used at any age from birth. They are easy to read and accurate, and are usually the cheapest. Place it in your child’s armpit; a beep will sound when it has finished taking the temperature. • Ear thermometers are more expensive. When placing the probe into the ear, be careful not to push it too far into the ear canal. Be gentle; place it just at the entrance. Ear thermometers are not generally recommended for use in young babies. • Plastic strip thermometers use plastic strips placed on the baby’s forehead to read temperature. Although easy to use, they do not give as accurate a reading as a digital thermometer. • Some homes still have Mercury thermometers, which are put under the armpit for three minutes. These are old-style thermometers and potentially dangerous, as mercury vapor can be toxic if the thermometer breaks. If you have one, do consider replacing it. .

To cool down a feverish baby or child:

• Remove heavy blankets or clothing and cover with a light sheet only • Sponge the child with lukewarm water (not cold) • Open windows or increase circulation of air in the room with a fan • Give a dose of paracetamol • Give plenty of fluids. Older children might like a lemonade ice block

DIRTY NAPPIES - WHAT TO EXPECT

Your baby’s first bowel motion can give you something of a shock. It’s called me conium – and it’s a greenish-black substance that fills your baby’s intestines before he’s born. Your baby will usually pass this in the first 24 hours or so. Over the next couple of weeks your baby will pass what are sometimes referred to as “changing stools” as his body gets used to milk. These early pools are often runny and expelled with some violence, so don’t assume your baby has diarrhea – it’s quite normal. Green poor in an otherwise healthy baby is fine too. Once this stage has passed, a breastfed baby’s pools are generally like mustard in color and consistency. They don’t usually smell offensive. A bottle-fed baby’s pools are often more solid, smelly and a pale brown color. Babies vary a lot in how often those poor, but one thing they should always do is pass urine. The average healthy newborn should have five or six wet nappies a day.

CORD CARE

At birth, the umbilical cord is clamped firmly to prevent bleeding. The stump gradually shrinks and dries until it falls off between five to fourteen days after birth. Before the stump falls off, it needs to be cleaned every day to prevent infection. This can be done by dipping a cotton wool in cooled boiled water and gently wipe around the skin – check with your LMC that you are doing it correctly. Some babies develop a bulge from the umbilical area which is known as an umbilical hernia. Don’t worry, these are very common, are harmless and don’t cause any discomfort. They usually disappear as the baby gets older.

MENINGITIS AND BABIES

All babies are now offered the meningococcal vaccination free of charge as part of the routine vaccination schedule. Meningococcal disease is a serious bacterial infection caused by a bacterium (germ) known as a meningococcal. More commonly referred as ‘meningitis’; the infection occurs when these particular germs break down the body’s defenses. Many of these germs live naturally in the nose and throat and can be spread by coughing and sneezing, kissing or sharing food, drinks or utensils. Meningitis can be life-threatening or leave a child with brain damage that can include physical disabilities, mental retardation and hearing loss. Early detection is vital as some forms of meningitis can kill in 24-48 hours in if not treated. There are several symptoms that may appear, however not all at once nor all together – some may not show at first whereas some may only experience only a few. And aside from that someone with bacterial meningitis may become very ill over a few days while others may become seriously ill in just a few hours. Therefore it is very important that if feel your child may be a risk or have meningitis don’t wait - see your doctor straight away! And as time is of the essence don’t be afraid to be back if you’re worried:

What to look for in babies:

Fever Refusing feeds or vomiting Fretfulness In a deep sleep and not easy to wake High-pitched or moaning cry Pale or blotchy skin Rash of red-purple spots or bruises

What to look for in adults and older children:

Headache Fever Vomiting Neck stiffness, joint pain Drowsiness or confusion Coma Dislike of bright lights Rash of red-purple spots or bruises

BATHING BABY

Bathing your baby can seem like a major logistical nightmare for new parents – especially if your baby is not too thrilled about the prospect. Rest assured, it will become second nature and in most cases enjoyable as your wee one learns to love a good kick and splash. 1) Before you start, make sure the bathroom/room is warm – this should be no less than 22 degrees C, and make sure there are no cold draughts. 2) Ensure you have everything on hand before you begin – cotton wool, baby soap, baby liquid (your baby’s skin is sensitive so don’t use adult cleaning products in the bath), towels, baby cream, nappies and clean clothing 3) Run cold water in the bath first, then hot. If using a baby bath place on the floor first. Make sure you thoroughly mix the hot and cold water before you test the temperature. The water should be about 32C, and no more than 10cm deep. 4) Undress your baby and wrap her in a soft clean towel, leaving her head free. Its best to wash your baby’s hair first before you put her in the bath. To clean her hair, securely hold her body with your arm and support her head with your hand and gently squeeze a little water from a flannel on to her hair, then gently wash with plain water or baby shampoo, then pat dry with a dry flannel or towel. 5) Unwrap the towel, and gently lower your baby into the bath while holding her firmly under her shoulders and cradling her neck in the crook of your elbow. Then use your other hand to support her legs and buttocks which your lower her into bath. Once your baby is touching the bottom of the bath you can remove your lower hand so it’s free to wash her gently using a soft flannel and baby soap. Gently swish water over your baby’s body while talking to her and smiling so she feels secure. 6) After a few minutes, lift your baby out of the bath. Hold her firmly as her skin will be slippery. Wrap her in a towel and lie her down so you gently pat her dry, pay close attention to the nooks and crannies, like those behind the ears, in the elbows, knees and groin. It’s amazing how quickly a little moisture left behind in the body creases can develop a sore red patch. Apply nappy cream or baby lotion followed by clean clothes.

BABY'S SKIN

Baby’s Skin

As newborns skin is particularly delicate, most babies develop some form of skin rash within their first year. Common skin complaints in newborns:

Acne-type face Rash

Spotty red facial rash caused by hormones passed on to the baby in late pregnancy. It usually disappears after two or three weeks and requires no treatment.

Prickly Heat

Tiny red spots may appear if the skin is overheated – commonly caused by overdressing or using to many blankets. These rashes generally disappear as the baby cools down.

Dry Skin

Common in winter or with overdue babies. Try to use a non-perfumed soap at bath time (aqueous cream is a good alternative) and avoid scented baby powders.

Nappy Rash

No matter how careful you are, some babies will get nappy rashes because of their sensitive skin. Frequent changing and washing the urine and bowel motion off the skin is really important, as the combination of urine and faces against the skin can cause nappy rash. Exposing the baby’s skin to the air helps, so leave baby with her nappy off as much as possible.

BABY'S HEAD

Fontanels

The soft spot on top of a baby’s head is the area where the skull bones have not yet fused together. The little gap, which varies in size with all babies, allows the rapidly growing brain to expand during the first 18 months, which time it will gradually close. The soft spot is not delicate or painful to touch. The brain is well protected by a tough membrane, so it is impossible to cause any injury with you are bathing or brushing your baby’s hair.

Baby’s Head

Your baby’s head may appear a slightly unusual shape due to the pressure caused in the birth canal – don’t worry as this is quite normal and only temporary. Also your baby’s head will be quire heavy in proportion to the rest of its body and their neck muscles will have very little strength so their head will be appear rather wobbly. It’s therefore very important to remember to support your baby’s head carefully when you are carrying her in your arms or when using a baby carrier.

Cradle Cap

Also known as infantile seborrhea dermatitis, cradle cap appears as dry white or yellow scales that form a hard crusty cap on your baby’s scalp. It happens because young babies can regulate oil secretion. When to much oil is produced it dries and flakes off. Cradle cap shampoos are available from the chemist, but a little baby oil or cooking oil applied to the scalp overnight, then gently scarped off with a comb and washed thoroughly the next day will usually shift the scaly area.

Baby's Eyes

Many babies often develop ‘sticky eye’ after birth, often seen as thick mucus material around the eye. Caused by a blockage of the tear duct, sticky eye can be generally cleared by keeping the eye area clean. Dip a piece of cotton wool into cooled boiled water and gently wipe your baby’s eye from the inner corner outward. Ensure to use a different piece of cotton wool for each eye. If the eyes become red and the problem persists consult with your doctor.

NAPPY CHANGING

Challenging times

AS ANY NEW MOTHER OR FATHER QUICKLY LEARNS, newborn babies are genetically programmed to save up their number twos until they've been dressed in their best outfit and buckled in the car seat in preparation for an outing. And more than one mother has wondered whether the baby's father has trained his offspring to hold on tight until the minute Mum walks back in the door from the shops.

By the time your baby is three or four months old, you'll have become intimately acquainted with his by-products in a manner that would have sent you squeamish before you became a parent. What's even more frightening is that you really won't mind - in a bizarre way an energetic digestive system becomes a source of pride for parents fascinated with the minutiae of their baby's bodily functions. Eavesdrop on any coffee-group and you'll hear plenty of "my daughter's more prolific than your daughter" one-penmanship from all the doting mums.

From the terrifyingly black, sticky me conium that passes during the first few days to the lurid, curdled liquid of a breast-fed newborn, the variations you'll be faced with are as unique and creative as a toddler's imagination. If you'd ever wondered where the color keratin yellow got its name, you won't be wondering for long. Just wait until you start your baby on solids such as carrots, spinach, blueberries and beetroot - the rainbow hues he comes out with will rival any finger-painting he performs up top.

If you're breastfeeding, it's natural for your baby to bless you with a small gift at every nappy change, and it's equally natural for him to evacuate violently only once every few days. Every-nappy mums might wish they didn't have to face the daily lottery of when to risk bare-bottom time, but once-a-week mums know that the payoff for several days off is that when it arrives it is explosive.

If you're left holding a leaky baby, make sure the waistband is fastened securely and the little leak guards around the legs are in place. Try using a larger size, or swapping to a more absorbent brand of nappies.

Rest assured that, despite your fumbling efforts in these early weeks, you'll soon have the technique down pat, planned like a military operation with wipes on hand and the new nappy unfolded at the ready. You'll be able to do it with your eyes closed - a not-unlikely scenario at three in the morning.

Take heart, also, that the entire business will get easier (or should that be harder?) as your baby starts on solids or formula. This is a source of great relief to some parents, until the awful truth dawns on them that the more adult consistency is unfailingly accompanied by a more adult odor.

By the time your little angel is rolling and crawling, your parenting skills will be finely honed to the point at which you can simultaneously hold up his wiggly little legs, bat his inquisitive little hands away from the danger zone, wipe his bottom, whip the old nappy away, slide a fresh one into place, rattle a distracting device in his face - oh, and fend off the older sibling who's decided to investigate the dirty nappy in the meantime. Give it a few more weeks and you'll probably be able to talk on the phone at the same time.

At this stage safety is paramount, and the best place to change a squirming six-month-old is on the floor. If you find it easier to wedge him into a changing table, make sure you use the belt every time.

If you find yourself chasing your little adventurer around the house, waving a nappy at his half-wiped bottom, try distracting him with a special toy or a colorful poster on the wall during those crucial between-nappy seconds. Pull funny faces, sing a song or play peek-a-boo games. If all else fails, co-opt someone else, such as an older child, to distract the head while you deal with the working end. And remember, as messy as it will undoubtedly get, it's only a stage you're going through!

TIPS FOR HANDLING TWINS

Eek, I'm pregnant with twins!

When your first ultrasound reveals you’re carrying twins nothing will ever be the same again. You may have had an inkling that something different was going on or it may have come as a complete surprise, but either way the news is likely to take a little while to sink in and it’s OK to feel daunted. The good news is you’re not alone. Close to 900 women give birth to twins in New Zealand each year – if they can cope, so can you! The trick is to take extra efforts to look after yourself – and your babies – right from early on in your pregnancy, and be as organized as possible.

Before the birth:

Mothers of multiples not only need to gain more weight but more importantly, they need to gain it quicker. Research shows that the weight gained by a mother in the first 24 weeks of a multiple pregnancy influences the babies significantly more than the weight gained in following weeks. If this is your first birth, book in for antenatal classes early – later on, enforced bed rest or early delivery may mean you miss out. Consider giving up work early if it’s financially viable – every moment of rest will count. Be aware that for multiple pregnancies, early delivery is normal. The combined weight of babies, placentas and fluids on a uterus that can only stretch so far is a common factor in early labor. Statistics also show that a higher percentage of multiples are delivered by Caesarean. Talk to Work and Income to see whether you qualify for any extra help (with twins you usually only qualify if you have another child under five). Do your research and avoid impulse buying. Make sure your choice of a double pushchair will fit in your car and through your front door.

When the twins arrive:

Increased sleep deprivation and workload caused by twins puts mothers at increased risk of depression and stress illnesses. You need to become a sleep hog and snatch every moment of rest you can. Make a roster of those who offer to help with meals, shopping and housework. Encourage Dad to look after the babies on his own, so you can get some valuable time out. Breastfeeding is still possible. Sticking to a routine will keep you sane in the early days. At night, if one twin wakes up, wake and feed the other at the same time to minimize the amount of time you’re spending out of bed. Loads of advice will be dished your way, but the most helpful tips will come from the parents of other twins.