Caring for your newborn baby

The first few days with your newborn baby are a special time of getting to know each other, while your maternity care team helps you learn how to care for your baby with confidence.

After birth, your baby will receive a range of routine observations, checks and screening tests. These help your midwife, doctor or paediatrician assess your baby’s wellbeing, identify any concerns early and provide appropriate care. You will also have opportunities to learn about everyday newborn care, including bathing, nappy changes, umbilical cord care and feeding.

Some care, such as vitamin K administration and hepatitis B vaccination, requires parental consent. Your healthcare team will explain the options available to you and answer any questions you may have.

APGAR Score

The APGAR score is a standardised assessment used shortly after birth to help your midwife or doctor assess how your newborn is adapting to life outside the uterus and whether they need any additional support.

The assessment is usually performed at one and five minutes after birth and considers five areas:

• Breathing effort
• Heart rate
• Muscle tone
• Reflexes
• Skin colour

The APGAR score is one part of your baby’s overall assessment and helps your healthcare team determine whether any additional care or support is needed.

Newborn observations

Your baby will have regular observations after birth. The frequency will depend on your baby’s individual circumstances and your hospital’s clinical protocols.

Observations may include your baby’s:

• Colour
• Activity and behaviour
• Heart rate
• Breathing rate
• Temperature
• Feeding

Your midwife will explain your baby’s observation schedule and let you know if your baby needs additional monitoring.

Checking your baby’s weight

Your newborn’s weight will be checked during their hospital stay. Babies commonly lose some weight during the first few days after birth as they adjust to feeding and life outside the uterus.

The amount of weight loss will be monitored alongside your baby’s feeding, urine output, bowel movements and overall wellbeing. Babies who are premature, have a low birth weight or have other health concerns may require more frequent weighing.

Your midwife or doctor will discuss your baby’s weight and feeding progress with you and let you know if any additional support is needed.

Your newborn’s urine and bowel movements

Your baby’s wet nappies and bowel movements are useful indicators of feeding and hydration during the early days.

During the first 24 hours, you may see one or two wet nappies. Your baby’s first bowel movements are usually meconium, which is thick and dark green or black.

Over the following days, your baby’s urine output should increase as feeding becomes established. Bowel movements will also change in colour and consistency, eventually becoming yellow and softer.

Your midwife will help you understand what is normal for your baby and how to monitor wet and dirty nappies at home.

Nappies and umbilical cord care

Your midwife will show you how to change your baby’s nappy and can provide assistance whenever you need it during your hospital stay.

The umbilical cord stump will gradually dry out and separate as your baby grows. Keeping the area clean and dry is important. When changing your baby’s nappy, folding the front of the nappy down can allow more air flow and help this process.

Your midwife will explain how to care for your baby’s umbilical cord and what to look for as it heals. Washing with cool, clean water and a cotton bud is recommended, and look out for signs of infection, including a smelly odor, pus, or if the area becomes warm to touch.

Bathing your newborn

Your baby’s first bath will take place once they have been able to maintain a stable body temperature, generally after the first 24 hours. Your midwife can demonstrate how to safely bathe your baby and give you an opportunity to practise while you have support available.

Some babies enjoy a bath before a feed, while others may be more settled having a bath afterwards. As you get to know your baby, you will discover what works best for you both.

Bath time can also be a lovely opportunity for bonding and getting to know your newborn’s cues.

Checking your baby’s hips

Your baby’s hips will be examined after birth as part of their routine newborn checks. This is to look for signs of developmental dysplasia of the hip (DDH), a condition where the hip joint does not develop normally.

Hip dysplasia can occur in any baby, but is more common in babies who were breech, babies with a family history of hip dysplasia and some other groups.

If there is a concern about your baby’s hips, your doctor may recommend further assessment, which can include an ultrasound. Early diagnosis and treatment can help the hip develop normally.

Your child health nurse and GP will continue to monitor your baby’s development as they grow.

Vitamin K for newborn babies

Newborn babies have naturally low levels of vitamin K, which is important for normal blood clotting. Vitamin K deficiency can rarely cause serious bleeding, including bleeding that occurs without an obvious injury.

A vitamin K injection strongly recommended to newborn babies shortly after birth to help prevent vitamin K deficiency bleeding.

Parents will be provided with information about vitamin K and asked to provide consent before it is administered.

Hepatitis B vaccination

Hepatitis B vaccination is part of Australia’s routine childhood immunisation program. A birth dose is recommended for newborn babies, usually as soon as possible after birth and preferably within 24 hours.

You will be provided with information about the vaccination and asked for consent before it is given. Your baby’s ongoing vaccinations will then follow the National Immunisation Program schedule.

Newborn bloodspot screening

The newborn bloodspot screening test, sometimes known as the Guthrie test or heel-prick test, is offered to babies in Australia to screen for a range of rare but serious health conditions.

A midwife or nurse takes a small sample of blood from your baby’s heel, usually between 48 and 72 hours after birth. The sample is sent to a laboratory for testing.

The screening test can identify babies who may have certain genetic, metabolic or other conditions before they develop symptoms. Early identification can allow treatment to begin as soon as possible.

If the screening result is normal, you will not be contacted. If further testing is needed, your healthcare team will contact you and arrange follow-up.

Newborn hearing screening

Newborn hearing screening is offered to all babies born in St John of God Health Care hospitals to identify possible hearing loss as early as possible.

If the screening identifies a possible concern, further testing will be recommended. Early identification of hearing loss allows appropriate support and intervention to be provided as soon as possible.

Newborn congenital heart screening

Newborn screening may also include a simple check for signs of certain serious congenital heart conditions.

Pulse oximetry screening uses a small sensor placed on your baby’s hand and foot to measure the amount of oxygen in their blood. The test is quick and painless and is performed while your baby is settled.

Your midwife or nurse can explain the screening process and what the results mean for your baby.

It is important to remember that screening tests do not diagnose every possible health condition. They are designed to identify babies who may need further assessment.

Paediatric review and discharge

A paediatrician or your obstetrician/GP may review your baby during the first few days after birth, depending on your individual circumstances and the hospital’s care arrangements.

If there are concerns about your baby during pregnancy, labour or after birth, your baby may require an earlier paediatric assessment or additional monitoring in a Special Care Nursery.

Before you go home, your healthcare team will discuss your baby’s health, feeding, weight, screening tests and any follow-up appointments or care that may be required.

This is also an important opportunity to ask questions. Caring for a newborn can feel overwhelming at times, particularly in the early days, and your midwife and healthcare team are there to help you build confidence as you learn about your baby.

Caring for your newborn at home

The first days and weeks with your newborn are a time of learning, for both you and your baby. There is a lot to take in, from feeding and settling to bathing, nappy changes and recognising your baby’s cues.

You do not need to know everything straight away. Your midwife, GP, St John of God Healthcare at Home caregiver, child health nurse and other healthcare professionals can provide guidance and support as you adjust to life with your newborn.

Knowing what newborn checks and tests to expect can help you feel more prepared for those first precious days together.

St John of God Healthcare at Home

Phone: 1300 475 442
Website: https://www.sjog.org.au/healthcare-at-home