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newborns

what support to expect during the first few weeks with your newborn.

11 mins

10/07/2020

Health visitor Victoria Jackson outlines the help & support parents will receive from health professionals during the weeks after your new baby's arrival.

Taking your new baby home can be daunting, but don’t worry, even within the current situation you still have a team of local community healthcare professionals and resources ready to support you as you adjust to being parents.

Health visitor, Victoria Jackson, explains what support you can expect to receive from your community midwife and health visiting team in the UK during the weeks after your baby arrives. Please note this may vary depending on where you are in the UK so it’s best to consult with your local NHS for more detailed guidance.

Due to COVID-19 and current NHS and UK Government guidance on social distancing and social isolation, services are not running as normal and there are a number of changes to all aspects of health care. Your health visitor service is still in place and available to support you and your family. If you have any questions or concerns, please see our advice page, contact your local health visiting team or go to the following sites for more information:

discharge from hospital

Following a straight forward natural birth, often you can expect to be discharged from your local hospital or midwifery unit after around four hours. If the birth occurs at home, the first contact with a qualified healthcare professional should be as early as possible within the first 24 hours of birth.1

If you or your baby need ongoing care after the birth, you’ll be admitted to a postnatal ward at a local hospital. This may involve at least one night at the hospital if you had: a c-section, either elective or emergency, an assisted birth with forceps or ventouse which can cause extensive tearing and requires stitching in theatre, or monitoring of a pregnancy condition, e.g. pre-eclampsia, or if baby needs monitoring due to trouble feeding.1

what to expect in week 1

continued care from your local midwifery team

Typically, a community midwife will visit you at home the day after your baby is born; this is usually followed by subsequent appointments when the baby is 3 days and 5 days old, with a final visit at around 10-14 days of age, unless there are ongoing needs, in which case this can be extended until the baby is up to 28 days old.2 These visits may take place either at home or at a clinic, in a hospital or community setting.

During these appointments, the midwife can provide information and support with:3

  • Your recovery after birth

  • Your family’s general health and well-being, including supporting with anxiety and or low mood.

  • Your baby’s health and development

  • Feeding your baby

  • Coping as a new parent/s

Helpful Tip – try to make the most of your midwife appointments:

  • Write down any questions or concerns you have when you think of them, so that you’re prepared when the midwife arrives

  • Make sure someone is there with you to offer additional support – your partner, friend or family member

  • Ask for explanations if there is anything you don’t understand

  • Don’t be afraid to take notes or ask questions

  • Find out where you can receive additional support (i.e. local groups or online forums)

Midwives are there to support and reassure you, provide useful information, and help you cope in these exciting but often challenging early days. If needed, you can arrange to see your midwife up to day 28.

If you or your baby are still in hospital at these times, the care will be provided by hospital staff.

new-born physical examination

Within 3 days (72 hours) of you giving birth, your baby will also be given a newborn physical examination. This is usually carried out just after your baby is born, but sometimes it's done at a hospital or community clinic, GP surgery, children's centre or at home. The examination includes checking the baby’s:3

  • General appearance including colour, breathing, behaviour, activity and posture

  • Head (including fontanelles), face, nose, mouth, ears, neck and general symmetry of head and facial features

  • Eyes; to check opacities and reflex

  • Neck and clavicles, limbs, hands, feet and digits; to assess proportions and symmetry

  • Heart; heart rate, rhythm and sounds, murmurs and femoral pulse volume

  • Lungs; to check effort, rate and lung sounds

  • Abdomen; to check shape and palpate (examining the body by touch) to identify any organomegaly (abnormal enlargement of the organs); also check condition of umbilical cord

  • Genitalia and anus; to check for completeness and undescended testes in males

  • Spine; to inspect bony structures and check integrity of the skin

  • Skin; to note colour and texture as well as any birthmarks or rashes

  • Central nervous system; to observe tone, behaviour, movements and posture

  • Hips; to check symmetry of the limbs and skin folds

  • Cry; to note the sound

  • Weight; to measure and plot in your baby’s Red Book

blood spot test

Finally, towards the end of your first week with your newborn (around day 5 – 8), your baby will have a blood spot (heel prick) test. This screens for several rare diseases , including cystic fibrosis and sickle cell disease. This may take place in the community setting or at home and involves a healthcare professional pricking your baby’s heel and collecting drops of blood on a special card.

You should receive the results by the time your baby is 6 – 8 weeks old, ask your health visitor if you have not received the results.

A midwife looks on as two parents hold their newborn baby

neonatal hearing test

This is usually done within the first 3 weeks, and if you give birth in a hospital it is often completed before you are discharged5. If you have a home birth or you go home before this is done, then an appointment will be made for it to be carried out. You will be given the results as soon as the test is completed. It's not always possible to get clear responses from the first test. This happens with lots of babies and doesn't always mean your baby has a permanent hearing loss.

It could mean:

  • your baby was unsettled when the test was done

  • there was background noise

  • your baby has fluid or a temporary blockage in their ear

In these cases, your baby will be offered a second test.

what to expect in weeks 2-3

support from your local health visiting team

As your midwifery care finishes, around 10 – 14 days of age, you will be discharged into the care of your health visiting team, who will support your care – and that of your baby until they are 5 years of age. You may see the health visitors and midwife jointly at times, either within the same visit or within these first 2 weeks.

Health visitors are qualified nurses or midwives who have undertaken further training and qualifications in child health, health promotion, public health and education. Your health visitor is there to help you and your family navigate the first few years of your child’s life, supporting you and your family in raising happy and healthy children. They can visit you at home or you can see them at your child health clinic, GP surgery or health centre and you can contact them in a variety of ways including e-mail, telephone, texting and even video calling in some areas. Ask your health visitor about the different ways you can contact/visit them.

You might have been contacted by a health visitor around the 32-week mark to discuss how life may change post-birth, for example, what to expect in terms of feeding, caring for a newborn, the immunisations schedule, your expectations of becoming a parent, as well as discussing your emotional wellbeing.

During your first postnatal visit the health visitor will:

  • Review your general health and well-being, as well as that of your baby

  • Ask how you're coping as a new parent

    • they will discuss infant feeding

    • advise on any difficulties you might be facing

    • advise you on how to manage crying and colic

    • advise on any other concerns you may have

    • discuss your wellbeing, and how to support you with any postnatal anxiety or depression

  • Put you in touch with groups where you can meet other parents

  • Provide useful information on safe sleeping, immunisations, bonding, along with healthy eating and safe post-partum physical activity and more

  • Talk you through the process for registering your baby

  • Explain what happens at your six-week postnatal check with the GP and 6-8-week review with the health visitors

  • Advise what family services you can access (for example child health clinics at family centres)

Helpful Tip – Beyond your recovery and your baby’s physical well-being, consider how else your healthcare team might be able to support you. Here are some questions you might like to ask them:

  • Are there any playgroups or other social activities for parents and babies in my area?

  • What are the opening times of my baby clinic?

  • How do I contact you or another healthcare professional or get advice in the evening or at the weekend?

  • What can I do to look after my own health and recovery?

  • When can I take up physical activity?

  • Is it normal to feel tearful, anxious or sad?

  • Where can I get support from people in a similar situation?

  • Can you give me information in my own language?

  • How can I access an interpreter to help me understand my care and the care of my baby?

what to expect beyond week 3

continued care from your local health visiting team

By week 3, it’s likely that the frequency of your health visitor appointments will have reduced, but don’t forget – you can speak to a health visitor at your local family centre or baby clinic outside of these set appointments. You can also call your health visitor if you have any questions or concerns, some health visitors may also provide the opportunity for you to text or video call them. Be sure to ask your health visitor about the different ways you can contact them.

Beyond week 3, your health visitor will likely contact you to arrange the following appointments:

  • 6 – 8-week review – you will have 3 different appointments at this time:

    • 6 weeks: you will see the GP for an examination similar to that of the new birth examination

    • 8 weeks: your baby will have their 1st set of immunisations

    • You will also have an appointment with your health visitor. This appointment usually takes place at your home, in a family centre or the GP practice. Your health visitor will follow up on a lot of the same topics covered in your first review, as well as: weighing your baby and plotting his or her growth in the Red Book: explaining what happens in your 1st year review; how to contact them and seek support outside of the normal reviews, and, connecting you with groups where you can meet other new parents

family mental health and wellbeing

It may not be surprising to learn that mood changes, irritability and episodes of tearfulness are common after giving birth. This is all very normal and such symptoms are often referred to as the “baby blues”, which affect around half of new mothers and lasts 5 to 10 days.7 Sometimes these symptoms may persist, and it could be postnatal depression or anxiety. It is important to recognise that fathers and partners may also experience depression and or anxiety. Your health visitor is trained to assess for postnatal depression and anxiety and to support you with this, referring to other services if needed, but if you ever feel that you or your partner need support or have any questions between your appointments, please do get in touch with your health visitor who can advise on support available to you.

bonding with your baby

It may seem like your newborn mostly just sleeps and feeds but believe it or not, they’re already developing their social skills from birth. Research has shown that even at a few days old, babies have a preference for face-like patterns over any other pattern. It’s not unusual to see a newborn mimic people’s facial expressions too! In the meantime, the natural chemicals in your baby’s brain are helping them to form a social bond and attachment to you and their other caregivers. Both mums and newborns have these chemicals, including the hormone oxytocin. Holding, cuddling and talking to your baby helps promote this hormone, in turn stimulating brain growth and emotional development. Being kept close to you and being responsive to your baby’s needs means that your baby feels a sense of emotional security.8,9

Did you know?

Children’s brains develop fastest and are at their most ‘plastic’ in the womb and early years of life. During this period, the brain is primed for learning and growing; it is a time of rapid cognitive, linguistic, social, emotional and motor development.

Although your newborn can’t really talk to you, there are other ways they will communicate with you. At around 6-8 weeks, babies will change their cries to indicate different needs. This shows their new ability to express different feelings. For example, one cry is more likely to mean ‘I’m hungry’ and another ‘I’m bored or tired’. After 12 weeks, babies’ social signals become more varied as they continue to develop. They may even be able to pick up on clues from people’s faces and voices, this helps them to distinguish different emotions, such as happiness and sadness. At the same time, babies will also begin to recognise their own name.10

Did you know?

A baby’s first smile typically happens by six to eight weeks but may happen much earlier if you smile, talk to them a lot and hold them close, but don’t worry if they don’t meet this timeline as not all babies are the same!

You are a critical part of your baby’s social and emotional development but forming a bond doesn’t always happen overnight and that’s ok. Over time, you’ll start to interpret their different cries and signals as well as learning how to respond to their needs. Just be patient with yourself and your baby as you get to know each other. You can read more about enjoying the first week with your newborn here . And remember, your health visitor is always there to answer any questions too.

Healthcare professionals are available to support new parents when it comes to providing help and advice relating to their babies, or that of the parents themselves. If you have any questions or concerns at any time, please make contact with your local healthcare support team for advice.

references:

  1. Which? Postnatal Care: What happens after you give birth? https://www.which.co.uk/reviews/scans-appointments-and-classes/article/appointments/your-postnatal-appointments, last accessed 18 March 2020

  2. Community midwife visits. Cambridge University Hospitals. Available at: https://www.cuh.nhs.uk/rosie-hospital/pregnancy-labour-and-birth/going-home/community-midwife-visits Accessed February 2020

  3. Postnatal care up to 8 weeks after birth; Guidance; Recommendations. NICE. Available at: https://www.nice.org.uk/guidance/cg37/chapter/1-Recommendations Accessed February 2020

  4. Newborn blood spot test. NHS UK. Available at: https://www.nhs.uk/conditions/pregnancy-and-baby/newborn-blood-spot-test/ [last accessed February 2020]

  5. Newborn hearing test. NHS UK https://www.nhs.uk/conditions/pregnancy-and-baby/newborn-hearing-test/ [last accessed March 2020]

  6. Postnatal care up to 8 weeks after birth; Information for the public; Every postnatal contact. NICE. Available at: https://www.nice.org.uk/guidance/cg37/ifp/chapter/Every-postnatal-contact [last accessed February 2020]

  7. Institute of Health Visiting, Understanding Mothers’ Mental Health & Wellbeing during their transition to motherhood (2009) https://ihv.org.uk/for-health-visitors/resources/resource-library-a-z/understanding-mothers-mental-health-wellbeing/ [last accessed March 2020]

  8. Zero To Three, Nurturing Your Child's Development from Birth to 2 Months (2003) https://www.zerotothree.org/resources/321-nurturing-your-child-s-development-from-birth-to-2-months [last accessed March 2020]

  9. Wave Trust, Conception to age 2 – the age of opportunity (2013) https://maternalmentalhealthalliance.org/wp-content/uploads/conception-to-age-2-full-report_waveTrust.pdf [last accessed March 2020]

  10. Ronald, A. 2019. How and when do babies develop social skills? NCT https://www.nct.org.uk/baby-toddler/emotional-and-social-development/how-and-when-do-babies-develop-social-skills [last accessed March 2020]

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