Melomed Articles

14 February 2019 - Dr. Vuyelwa  Singata

Parenthood - A Life Begins...

The experience of childbirth and parenthood is an  unknown adventure ,which results  in major changes  in ones life and family.

All parents worry about the possibility of unexpected outcomes ie birth complications, prematurity , unforeseen abnormalities ,surprise multiple pregnancies.

Many parents are surprised or even alarmed at the sight of  their newborn.

Its  important to understand the effects of birth and that these are usually temporary.

Common concerns are:
*An Abnormally shaped head which can be due to 
Caput medusa or moulding  occurs  as the skull  squeezes through the birthcanal.The pressure can result in  localized swelling  or overlapping of the soft skull bones -resolves within a few days.

Cephalhaematomas  are a collection of blood beneath the scalp usually on one side-may take weeks to resolve.

Fontanelle- commonly reffered to  as soft spots on the head located posteriorly and anteriorly.Triangular and diamond shaped.The former closes around 3months and the latter by 18months.

*Abnormal looking skin or skin colour
Vernix is the waxy white substance that protects and lubricates the babies skin in the womb-comes off easily with wiping.

Puffy eyelids and red marks on eye lids usually due to instruments used to assist during the birth-disappear with a few days.

Milia is a fine white rash over the nose and face due to keratin that is entrapped just below the top layer of the skin-resolves spontaneously.

Birthmarks  are present at birth or are clearly visible within the first month after birth.They are caused by an over growth of melanocytes(pigment cells) eg café au lait spots and Mongolian spots or an over growth of blood vessels eg haemangiomas. Mongolian spots   disappear by the 6th birthday.

Jaundice is the yellowish discoloration of the skin and sclera due to a build up of excess bilirubin .This usually presents a few days after birth. Most babies develop  physiological jaundice which requires no special treatment.Those with pathological jaundice need more investigations to determine the cause and  will require phototherapy .

*Small for Gestational Age  or Low birth weight babies are also  concerning as these babies have not grown adequately in-utero which can be due to internal factors in the womb eg infections,genetic defects or external factors eg maternal smoking ,use of alcohol or poor maternal nutrition.Feeding after delivery is paramount for these babies.

Lastly prematurity remains a major problem for all parents and healthcare providers alike as it is often not preventable.A baby born before 37completed weeks is considered premature.A premature baby is ill-prepared for life outside the womb because all the organs are still growing and not yet functional.Thus they need specialized care  and attention.

There are various causes for prematurity : maternal and infant causes maybe identified .However at times no cause is found.

Most will have difficulty breathing due to premature lungs thus need some  assistance with ventilation.
An under-developed immune system leads to a constant risk of infection.Strict infection control measures are put in place.---HAND WASHING

Temperature regulation is also problematic due to lack of subcutaneous fat ,a relatively large surface area especially the head.

Feeding is also  challenging as in most the sucking reflex is not developed and digestion not yet established in a premature gut.Thus need assisted feeding via  tube or intravenously (parenteral feeds).

Chances of survival  have improved vastly in recent years. The morbidity and long term quality of life of premies  is also much better than it was 20years ago.

The first 6-8weeks after your babies birth is known as the post- partum period.It's a time for re-adjustment for the baby ,parents and the whole family at large.Taking care of your newborn baby does not require any special skills -just some basic knowledge ,a lot  of common sense and willingness to seek help from healthcare providers.

What good parents instinctively do for their babies is usually best after all    -  Benjamin Spock        
Remember nobody has all the answers. Not even Dr Google                                                                                                


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