by JoAnn Lister, FNPC
Contributing Writer

I’m glad to be back to normal activities although I had a really wonderful time between Thanksgiving and Christmas. Paul and I had our first grandchild to be born into the family and we took turns going to Houston to help out our daughter Karen after her Caesarian Section. There were lots of things I could do to help besides cook and do laundry, with my medical background and experience of raising 4 of our own children. But how things have changed in the baby business.

No cloth diapers were to be found in my daughter’s house. We didn’t have to get out any baby bottles since she breastfed the new grandson and that was quite a time-saver for everyone. By the end of the 2 weeks there, 3 of us adults had colds but the antibodies the baby was born with and those he was receiving from the breastmilk kept him very healthy.

I knew babies were to be placed only on their backs for sleep now to prevent sudden infant death syndrome (SIDS) from my practice, research, and from talks I have given day care centers. In the US, the rate of deaths due to SIDS dropped by 50% once new parents were taught to keep infants on their backs only. I soon saw that infants’ strong startle reflex complicates this position. Every time little Ricky moved his foot or hand, he was suddenly awakened, arms and legs spread out and quite frightened.

We didn’t have that problem when I had my babies. We wrapped them up snuggly and laid them on their stomachs or sides and they slept well for hours (if we were lucky). The startle reflex was seldom seen except when tested for in the doctor’s office.

But there is a strategy for this for modern families, my daughter and son-in-law were taught to “swaddle” their newborn really well, so he had limited mobility while lying on his back. Also they bought (on advice from friends with babies) an interesting gadget consisting of 2 plastic lumps covered with flannel material and a space between them big enough for an infant to lie on his back to restrict movement some. You could even buy a pre-made velcro swaddler wrap at “Babies R Us” if you were having difficulty achieving the swaddling skill. Speaking of shopping for the newborn, as I walked through the baby section of Target and Baby’s R Us and saw the array of gadgets, utensils and outfits they were beyond the imagination of a ‘70’s mother.

I looked up more on SIDS prevention and noted that babies shouldn’t even be placed on their sides as mothers in my generation so often placed them. These measures definitely have saved many a life and introduced new ways of baby care. As a student nurse in the ‘60s I was taught to swaddle and place infants on their sides in the hospital nursery. My research chided modern day nurses who were not role-modeling the back-lying position in their nurseries. My daughter vouched for the fact that she saw the nursery nurses positioning infants on their side. These infants are under constant observation however 24 hours a day. I’m sure that is their reasoning.

Another strategy that came up with the back-lying positioning was soon needed. Babies’ neck muscles were not developing very well. It took them longer to control their heads. Thus “tummy time” was invented. New parents are taught to give the baby time on the tummy so he can practice raising his head and strengthen his neck muscles. But this is only done when the infant is awake and someone is with him assuring he does not smother in blankets or cushions that he may inch up to.

Also I read that pacifiers are permissible and even helpful in preventing SIDS. At least I didn’t falter there in telling my daughter to be assured that it was a good thing as babies love to suck and sometimes that can cause sore nipples, especially at first. Breastfeeding up to 20 minutes on each breast per feeding is still recommended, although not inflexible. But as I read further, I saw that pacifiers are to be introduced after the first month so as not to confuse the baby with using different sucking muscles on a different shaped nipple. Well it worked fine with my babies – that is the ones who liked the pacifier. You can only offer it and leave it up to the individual infant. They have their own opinions even in the first few days of life.

We went to see the pediatrician when Ricky was 2 weeks old. He was re-gaining back that weight that babies usually lose right after birth. The doctor advised Karen that when she is breastfeeding, at about 3 months, she needed to add vitamin drops that contained vitamin D, as currently recommended by the American Academy of Pediatrics. Formula contains enough extra vitamin D but apparently breast milk does not. I wondered if she considered the fact that infants that breastfeed tend to absorb a lot more of their nutrients than bottle fed babies. But when I got back home and resumed my professional reading, there was much new material on vitamin D and how it is so much more important than once thought. You may remember when we were young we received lots of vitamin D from sun exposure, but nowadays sun block is in and UVA and UVB sun rays are out! Although about 15 minutes of sun is safe in mid day in the northern states and less in southern states, no one wants to recommend this since there is so much evidence of increasing danger of skin cancer from sun rays and lessening protection by the ozone layer. Although not official, there will be a recommendation soon that we take in 800 IU of Calcium daily instead of the current dietary guidelines for 400 IU daily (Some recommend 1000 IU). There should be lots of information in the news soon about the many benefits of vitamin D other than just to promote bone growth through stimulating absorption of calcium.

Gone are the cotton balls of the past. Now baby wipes are everywhere. Karen told me there are even warmers for the baby wipes to make them more comfortable for baby.

There is an interesting contraption called a “diaper genie.” This was a slender plastic lined disposal unit that you push the disposable diaper through and it seems to compact them and keep the odor from coming back into the room. Once this is full the plastic bag is replaced and all the diapers are neatly smashed together into another plastic bag. No need for a diaper pale or washing out of diapers the old fashioned way.

We used to be aware of “baby blues,” but due to recent national publicity about the horrendous murder of the 5 children in Houston by their mother, everyone is paranoid about postpartum depression and psychosis, probably more so in Houston itself. Karen asked me almost as soon as I arrived what to expect and when it would happen. Even her husband was concerned because she was so worried about it. But 8 of 10 women have a few days of baby blues, a normal hormonal response, and this usually resolves by 2 to 4 weeks after delivery. Postpartum depression, on the other hand, is a medical illness, affecting about 13% of new mothers, who need diagnosis and treatment. Although much more rare than baby blues, there is a new heightened awareness by healthcare providers for this condition. To the extreme is the rarer postpartum psychosis with delusions, hallucinations, and psychotic symptoms, affecting 0.1-0.2% new mothers.

When I went with Karen to see her OB doctor at 2 weeks, he told her the biggest cause of postpartum depression is fatigue. He warned her to get daily naps during this 6 weeks after the delivery, and to be very attentive to the need for rest. He also advised her that the condition is more common in professional women as they are used to being in control of their lives. That definitely changes once the baby enters the picture. Symptoms of postpartum depression include feeling like you are a “bad mother,” feeling hopeless, having no energy to ask for help or to make follow up OB and pediatrician appointments, thoughts of harming self or the infant, not being able to interact with the baby, and general symptoms of major depression. Family members or friends who see these symptoms need to suggest getting help to the mother and even help her make an appointment and get to the healthcare provider.

The condition is very treatable and urgent. Nurse Practitioner Diane Judge suggests that mothers who feel like harming themselves or their baby go to an emergency room or call 1-900-273-TALK (8255). She adds that friends should tell the new mother, “You seem really down and I am concerned about you. You don’t have to feel this way. You might have postpartum depression. Let me help you make an appointment with your health care provider, okay?”

I’m sure Karen will be fine, and will probably feel baby blues at some point. She is just trying to be well informed, is anticipating problems and trying to prevent them. She is interacting very well with little Ricky. It’s wonderful to see as the new grandmother; and it makes me proud, as her mother, to see her tenderness and love for her new baby.