Child Birth

Shade was very concerned about the wound on her newborn’s belly button. This umbilical cord stump just wasn’t healing as fast as it should.

Her friend, Fola, wrongly advised her to pull the stump and clean it with alcohol to speed up healing. A few days later, Fola took this advice, and it backfired terribly!

Her baby started bleeding profusely from the stump site and a hospital visit became crucial.

What’s an umbilical cord stump?

The umbilical cord is the connection between the placenta and the baby. The cord transports nutrients and oxygen through from you to you baby.

At birth, your baby’s umbilical cord is clamped and cut close to your baby’s body. It is a painless procedure that leaves an umbilical stump attached to his/her belly button.

A baby’s umbilical cord stump typically falls off within seven days to two weeks after birth. When this happens there may be some raw skin exposed. This is okay. In the meantime, treat your newborn’s umbilical cord stump with great care.

Umbilical Cord Stump: The Do’s & Don’ts

What You Can Do?

• Keep the umbilical cord stump very clean and dry. Wipe with cotton wool and clean water after each diaper change. Fold your newborn’s diaper away from the stump. This exposes the stump to air and prevents contact with urine.
• Secondly, the same way you care for a circumcision, give your baby sponge baths. This is when you apply water to the body using a small wash cloth without actual immersion in water. Although, there is no harm in getting the stump wet, sponge baths make it easier to keep the stump dry.
• Finally, during warm weather, dress your baby in a diaper and loose T-shirt to allow air circulation.

What You Shouldn’t Do?

1. Avoid dressing your baby in tight or full undershirts. This creates a lot of discomfort that slows down the healing process
2. Furthermore, do not attempt to pull off or cut the umbilical cord stump, even if it seems to be hanging by a thread. Doing this will increase bleeding in the newborn.
3. We are currently asked not to use alcohol (methylated spirit etc) to clean the umbilical stump. Studies show that this kills bacteria which keeps the cord dry and help it separate. Instead, expose the stump to air which dries out the base.
4. Don’t put cow dung, latern soot, local herbs potentially unsterile mix on the stump. This can spread germs and lead to an infection.

Signs of Infection of the Umbilical Cord

During the healing process, it is normal to see a little blood near the stump. The tip of the cord stump might bleed a little when it falls off.

However, the obvious signs of infection include:

• Redness or swelling at the base of the stump (where it meets connects to the baby’s tummy)
• Continuous bleeding
• Discharge of yellowish fluid or white pus
• Foul-smelling discharge
• Your baby flinching or crying out when the stump is touched (a sign of pain)

As parents, our babies depend on us to keep the umbilical stump clean to prevent infections which could potentially land baby back in the hospital.

Furthermore, attempts to speed up the drying process such as pulling the stump or applying anything that hasn’t been prescribed by your doctor are dangerous and should be avoided. These tips should be provided during your antenatal visit. However, if you missed the class, this article tells you all you need to know.

ALL YOU NEED TO KNOW ABOUT JAUNDICE

Yemi could notice the yellow discoloration of the eyelid of her first baby 72 hours after his birth. But this didn’t make much sense to her since this was her first child and she felt it was normal.

The discoloration continued slowly up to the point where her baby could not suck as much as he used to, and his cries were becoming uncontrollable. She had no choice than to seek help from her doctor.

And on getting to her doctor, she realized how careless she had being as a mother. Her baby had jaundice!

What Is Jaundice?

When your newborn’s skin and eyes look yellow, it’s possible he may have jaundice. It may seem alarming to you as a mother, but it is a common problem in newborns, and it’s usually harmless. Sometimes it goes away on its own, or your doctor may suggest light therapy or other treatments to take it out.

Jaundice happens when too much of a byproduct of the red blood cell released during their normal breakdown process, builds up in the blood. Close to 60% of babies get it.

Symptoms of Jaundice?

The first sign is the yellowing of a baby’s skin and eyes. The yellowing may begin within 2 to 4 days after birth and may start in the face before spreading down across the body of the baby.

If a finger lightly pressed on a baby’s skin, and it causes that area of skin to become yellow, it’s likely a sign of jaundice.

What Causes Jaundice?

Some of the body’s red blood cells break down every day and produce bilirubin – a by-product of the blood. It’s the liver’s job to remove it out of the body. When your baby is still in your womb, your liver clears out his bilirubin for him or her.

After birth, your newborn’s liver takes over. Sometimes, the baby’s liver is unable to break down bilirubin as quickly as his body makes it, and it starts to build up. As a result of its yellowish color, bilirubin turns your baby’s skin and eyes yellow.

Other Causes….

An underlying disorder or disease may cause infant jaundice. In these cases, jaundice appears much earlier or much later than the more common form of infant jaundice. Diseases or conditions that can cause jaundice include:

• Internal bleeding (hemorrhage)
• Infection in your baby’s blood (sepsis)
• Other viral or bacterial infections
• Amismatch between the mother’s blood and the baby’s blood
• Liver issues
• An abnormality of your baby’s red blood cells that causes them to break down rapidly

What are the risk factors for Jaundice?

The major risk factors, especially for severe jaundice that can cause complications, include:

• Premature birth

 A baby born before due date for delivery may not be able to process the byproduct of the red blood cell (bilirubin’s) as quickly as full-term babies do.

Premature babies also may feed less due to fewer bowel movements, resulting in less bilirubin eliminated through stool.

• Significant bruising during birth

Babies who become bruised during delivery may have higher levels of bilirubin from the breakdown of more red blood cells.

• Blood type

In cases where the mother’s blood type differs from her child’s, he/she may have receive antibodies or proteins through the placenta that cause abnormally rapid breakdown of red blood cells.

• Breast-feeding

Breast-fed babies, particularly those who have difficulty nursing or getting enough fluuids and nutrition from breast-feeding, are at higher risk developing jaundice.

Dehydration and low energy intake may contribute to the onset of jaundice, therefore, your baby must get enough to eat and stay well hydrated.

Complications of Jaundice?

High levels of the by product of blood (bilirubin) that cause severe jaundice can result in serious complications if not treated.

1. Acute Bilirubin Encephalopathy

The byproduct of blood (Bilirubin) is toxic to cells of the brain. If a baby has severe jaundice, there is a risk of bilirubin passing into the brain, a condition called acute bilirubin encephalopathy.

Prompt treatment may prevent significant lasting damage by this condition. Signs of acute bilirubin encephalopathy in a baby with jaundice include:

• Difficulty waking
• High-pitched crying
• Poor sucking or feeding
• Fever

2. Kernicterus

Kernicterus is the syndrome that occurs if excess bilirubin causes permanent damage to the brain.

In most cases, Kernicterus causes:

• Uncontrolled movements
• Constant upward gaze
• Loss of hearing
• Improper development of tooth enamel

How can newborn jaundice be treated?

Mild jaundice will usually resolve on its own as a baby’s liver begins to grow. Frequent feeding (between 8 to 12 times a day) will help babies pass bilirubin through their bodies.

More severe jaundice may require other treatments. A common and highly effective method called, Photo-therapy, uses light to break down bilirubin in your baby’s body.

In conclusion, this condition occurs normally in babies with symptoms of yellow discoloration of the eyelid and body part.

It could last for some couple of days or weeks. Some resolve on their own while other cases require sunlight or photography.

Amaka’s baby boy was circumcised at the hospital a few days after he was born.

During her stay at the hospital she had watched the nurses bathe him and change his diaper. This, she was still trying to get the hang of.

She was full of questions;

• What was the piece of plastic that was used for the procedure?
• When would it come off ?
• He had been a bit fussy after the circumcision but calmed down after he had been fed. She was worried about having to go home alone with him. Without the nurses who had painstaking shown her how to carefully change him during her stay.
• What if she got it wrong?
• How would I handle things if it started hurting him at night?
• What if poo got on the circumcision point?
• How would she know it was healing well ?

How can Amaka look after her circumcised baby?

What Is Circumcision?

This is a surgery to remove the fore skin (outer skin) covering the tip of the penis.  

Why Is It Done?

For some, male circumcision is mainly for religious or cultural reasons. It may also be done to relieve the tip of the penis if the foreskin becomes painful, swollen and inflamed later in life (a condition called phimosis).

On the other hand, circumcision provides health benefits such as; decreased risk of urinary tract infection during the first year of life, and decreased risk of penile cancer and sexually transmitted infections (STIs) later in life.

When Is Circumcision Done?

Circumcision occurs usually before or after the mother and baby are discharged from the hospital. If the baby is healthy, it is usually done 2 days after birth.

When Should It Be Avoided?

Circumcision should be delayed when the baby;

• Is born very early (preterm babies)
• Has problems with his blood (problems with controlling bleeding)
• Possesses a family record of bleeding problems
• Is born with certain abnormalities of the penis (sometimes the foreskin is used to correct these issues during surgery )

What to expect after circumcision

Your infant to be in some discomfort after the procedure. His penis is sore, swollen and bruised; this would make him fussy! A yellow scab may form over the wound.

Get ready for lots of crying, feeding and sleeping problems.  

 No need to be anxious, though. These usually resolve within a day or two.

Caring For A Circumcised Penis

Proper after-care is important for your baby to properly heal. Here are some tips to help you out;

• Keep the site clean and dry to prevent infection. Clean with water daily, just as you’d do with the umbilical cord.
• Use soapy water if the baby stools.
• Change his diapers regularly.
• Always apply antibiotic ointments as prescribed by your doctor or petroleum jelly to avoid discomfort

• If there is bleeding, use a clean cloth or gauze to apply firm but gentle pressure on the tip of the penis for a few minutes to stop the bleeding.
• Ensure he wears underwear that holds the penis in place.
• Pain medication like baby paracetamol will relieve the pain (please follow your doctor’s prescription)

Usually, the doctor applies a bandage or plastic ring around the site during the procedure.

• Replace bandages (with petroleum jelly) during each diaper change for the first 2 days.
• Do not bother about the stitches; they would dissolve on their own.
• Ask your doctor when to remove the dressing
• If it is a plastic ring, it will fall off on its own in 5 to 14 days. 

Whenever the bandage or ring comes off, remember to keep applying petroleum jelly.  

How Long Does It Take for a Circumcision Site to Heal?

Every baby heals differently. It takes about 7-10days to heal on an average. Although, some boys may take up to a month to heal completely.

Do You Have To Call The Doctor?

Circumcisions are usually problem free. Nevertheless, these are some warning signs that you should not ignore;

• Your baby doesn’t pee within 12 hours after the circumcision
• Foul-smelling discharge from the tip of the penis
• The plastic ring remains in place two weeks after the circumcision
• Persistent bleeding or blood on the diaper
• The redness and swelling do not go away after 3 to 5 days
• Your baby has a temperature of 38C or higher.
• Serious pain.
• The head of the penis becoming blue or black.
• The plastic ring used slips downward unto the shaft of the penis

These are likely signs of infection. Call your health care professional immediately if you notice any.

Finally, how do I keep an uncircumcised penis clean though? Clean it as you would clean your finger… just clean only what you can see, no prodding required.

Finally, knowing what to expect empowers you as a parent to nurse your child through the changes that circumcision presents.