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Paula M. Elbirt, M.D.

More than once in my 18 years of practice as a pediatrician, a mother has called and introduced herself by saying,"Hello, I'm a new born mother," when of course what she meant to say was, "I'm the mother of a newborn." But there's truth in this slip of the tongue. In what I call the tenth month — those weeks after her baby's birth — a woman is reborn into her new role as mother. She is still a wife, friend, daughter, daughter-in-law, but even those roles are changed forever. As one mom said to me, "I'm not who I used to be, but I'm not exactly who I expected to be either." I tell mothers there is life after childbirth, but it's not the same one. The transformation into the mother-role eclipses all of the others at least for a time.

Not surprisingly, new moms have questions and concerns about caring for their babies. In the first few hours and days, the concerns are fundamental: "Is my baby normal?" "Is she healthy?" Then come all the questions about taking care of the baby, which are asked with incredible predictability. Most new mothers need information on how to deal with the reality and responsibility of the small bundle of joy nestled in their arms.

Moms frequently experience what I have come to call "mother muddle" — a state of neediness and confusion. Nothing quite prepares mothers for this new fact of life: you are now totally responsible for another human being. New mothers need to understand what has happened to them and what will happen to them in the weeks to come.

New mothers also have many questions about caring for themselves. When I do the routine two-week checkup of the baby, I always ask the mother, "How are you?" And they tell me. (As the mother of three children, I understand what they are going through.) Often after we've met I get calls from these same mothers with questions not only about their babies, but more commonly, they ask me about concerns they have about themselves as well. ("When I pass the mirror, I don't recognize myself" or "I know I'm supposed to be happy, but all I do is cry" or "I feel so dumb. I thought breast feeding was supposed to be so easy.") They ask, "Should I be calling you?" and I invariably answer, "Who else would you call?" After an intense nine month relationship, their obstetrician/gynecologist has often faded from the picture, and the pediatrician is now clearly in the spotlight. You could say that pediatricians really have two "patients": mother and baby. We cannot separate the two. I wouldn't want to.

The Delivery Room Experience

The baby emerges with a final push. In a vaginal delivery what you see first is a lot of bloody fluid. Very soon afterwards you will see your glistening, sparkling, shiny wet baby being slid up and over your pelvis and onto your belly. She is still attached to the winding umbilical cord emerging from between your legs. As she is handed up to you, the cord lengthens along with her. Most mothers are so relieved and dazzled by the baby that they don't pay much attention to the cord or for that matter to most of what is happening at their pelvis. In a Caesarian-section, if you are awake (and the majority of women are) then the baby will be lifted up into the air still attached to the cord and placed in your arms at your chest. (In emergency C-sections, the baby will first be quickly examined and then shown to you when everything is determined to be "okay.")

At the moment of birth you will hear someone announce the exact time of birth, but you won't see a nurse turn the baby upside down and slap her like in old movies.

When the baby's head first appears or just when the baby is put on your stomach, you will probably hear odd "gurgling" noises as the doctors and nurses suction from your baby's mouth and nose the amniotic fluid she swallowed in her passage through the birth canal. (Amniotic fluid is the clear pinkish liquid in which the baby floated while in utero.) Some babies, particularly in vaginal deliveries, need extra suctioning, so you may hear slurping sounds, a lot like a vacuum cleaner makes, as the nurse uses a flexible tube in the baby's mouth to suction out amniotic fluid and blood to help your baby breathe more easily.

Once the baby is brought to your chest, you may feel a tugging on your uterus which may be painful, but at this moment it seems largely irrelevant when compared to the precious baby in your arms.

Babies get cold quickly. The nurses will put little blankets over the baby while she is still connected to you by the umbilical cord. Unless you have pre-arranged with your obstetrician to have your partner participate in the cutting of the cord, the doctor will snip and clamp it with a special plastic device. Instead of a clamp, some hospitals now use "triple-dye" -- a chemical which dries up the cord -- and the cord will look like it's been dyed purple. You may see some of what's going on at your pelvis and feel discomfort or even sharp pain while the placenta (the so-called afterbirth) is coming out but again your focus will still be on your newborn.

Most parents confide that the newborn looked less than beautiful but actually quite wrinkled and purple — and that was just fine! There is no other moment to rival this one. It's special even for the staff in the delivery room. When I was a pediatric resident I was often in the delivery room, and never saw anyone connected with a birth respond casually to this truly blessed event. This is actually the bonding period researchers referred to when they originally described the need for mothers to bond with their babies. Some babies alternately cry and then calm in your arms. This is a wonderful opportunity to help the baby to suck on your breast: if you place the newborn at your nipple she will usually suck even though there is no milk. (In fact she may not suck again this calmly until many hours later.)

This magic moment actually lasts for just a few minutes which is usually long enough. As exhaustion sets in, especially in your arms and legs, a nurse will take your baby just a few feet away and put her on a warmer. This is a specially built infant-sized bed where heat lamps radiate down from the top. A small probe, which doesn't hurt or burn, will be taped to your baby's body to monitor her temperature so that the warmer is always at the correct setting.

Your natural instinct will be to follow the baby. If you turn and look to your side you may see the nurse cleaning and drying her on the warmer. Then you'll see the nurse with a stethoscope listening intently to the baby's chest, flicking the baby's heels, picking up her arms and letting them drop in what appears to you to be a rather abrupt manner. It's all routine. The nurse is making a determination of your baby's Apgar score.

This is baby's first test. Apgar scores are universally given at 1 minute, 5 minutes and in some cases 10 minutes to evaluate, or measure the baby in five areas: respiration, heart rate, muscle tone, reflexes and color.) The baby isn't put through any specific tests but rather is observed, and is given a 0, l, or 2 in each area. In the best circumstances the total score would be 10 (which is where the expression "a perfect 10" originally came from). Rarely if ever can a baby get a 10 at the first minute of life because they are "less than pink" at birth. (Variations in color from slightly pale to rosy are perfectly normal.) Generally speaking you are not told the score, unless you ask, but typically a healthy baby gets at least a 7. C-section babies tend to have slightly higher Apgar scores, because they don't have much difficulty coming out and their color is usually better.

You will also see the nurse putting ointment in the eyes to protect the baby from a variety of infections that could occur during the birth process. You may also hear the baby cry as she is given a shot of vitamin K in her thigh to prevent a rare cause of bleeding in newborns. In some hospitals the baby is also given a shot of penicillin to prevent a specific type of infection caused by a vaginal bacteria.

In the delivery room your baby will be registered and a tag put on her ankle. The baby will be footprinted and you will be fingerprinted right onto the birth certificate, so that for all time it's clear that you are this baby's mommy.

The nurses will wrap up the baby after the five-minute Apgar and give you back your dried, tested, registered, and quite wonderful baby. This is the perfect moment to meet your baby. This is often when I see new mothers peek carefully under the blankets — almost as if they are afraid to mess them up. The need to count fingers and toes and really look at this baby is overwhelming. Both parents will start to exclaim: "Oh my God, he looks just like ..." or "Who does he look like?" Parents will joyfully respond when they see what they "like": "Oh, look, he has beautiful blue eyes," and occasionally also be taken aback at what appears to be less than perfect: "What's this bruise, this bump, this red mark?" Most of these birth marks are just that— the result of the process of birth and fade away in just a matter of hours. (More about these marks later.)

After you've held, and examined this nicely wrapped baby (who may now be slightly unwrapped by you) there will come a time — anywhere from fifteen minutes to an hour and a half later — when the nurses take the baby to the nursery and you to the recovery room. (In some hospitals the baby will be wheeled with you to the recovery room and then taken to the nursery.) You may feel a little sad to let her go so soon or you might just be relieved. The clerk in the delivery room will call up to the nursery and announce: "Baby coming up."

SCENE 2: THE NURSERY

Your baby is now in the nursery — a glass enclosed room where there is a lot of contact between the staff and the babies. Your baby is the "new kid on the nursery block" which alerts the staff to keep an eye on her. A nurse will completely unwrap the baby and put her on the scale to determine her birth weight. Then her measurements will be taken: length, size of head, chest and abdomen. She will be placed once again on a warmer where she will be observed naked for the next two to three hours.

While she is on the warmer her temperature will again be monitored by a probe which is attached to her by tape. The nurse will do a full examination of the baby, listening to the heart and making sure the lungs are clear. (I often see the daddy outside the nursery window watching all the goings on.)

During this period, the baby often appears to be very calm and peaceful. If you could peek in to the nursery you would see her lying very quietly making some smooth movements and occasionally jerky ones — very similar to what she was like in the womb. She may even curl into a fetal position. If you've had anesthesia, the baby has gotten some of it too through the umbilical cord and could be a little groggy. Your baby needs to slowly recover from the experience of child birth. (I'm often reminded of the "talking" newborn in the movie LOOK WHO'S TALKING who, immediately after birth, keeps repeating: "Put me back.")

After a few hours of observation, the baby will be dressed in hospital clothing. Most hospitals use loosely cuffed t-shirts with strings or snaps, a baby diaper and a little "sock hat" on her head to keep her warm: the head is such a large part of her overall body that a lot of heat can be lost through it. If baby has long nails, which is the case for many post-mature babies (those babies who were born after 40 weeks of gestation), then she will be dressed in a long sleeved t-shirt which has cuffs that can be pulled down over her fingers so that she can't scratch herself. To prevent the accidental nipping of the skin, nurses are instructed to leave the nails unclipped. Finally baby will be wrapped in a square cotton swaddling blanket. It's been observed that babies are usually much happier when they are swaddled— that is, wrapped in snug fitting clothes and blanket. (Remember your baby has been in pretty tight quarters for the last nine months.) The reason behind swaddling is that babies are subject to the Moro or startle reflex which causes their limbs to flail out and back at random times. They have no control over this neurological event which momentarily upsets them. It can be somewhat reduced by swaddling.

Your baby is almost ready for the journey to your room. She will be put into a crib with a label attached to it listing vital information — such as her last name, your name, time of birth, and birth weight. The nurse keeps track of events as they happen to your baby, such as "first urination" and "first stools", often by recording them on the chart on the crib.

GETTING TO KNOW YOUR NEWBORN

Once your baby has been brought to your room and the distractions of the delivery room are gone, it is the perfect opportunity for the two of you to get to know each other. Take a moment to undress your baby completely and just look at her, a new little person in her own right.

Babies change a great deal the first few days. The baby handed to you on the delivery table may in fact look very little like the one you see now only a few hours later. Her head may still be very pointy, odd, or misshapen, but less so than at birth. If you had a C-section, she will appear to look more like what you expect a baby to look like because she hasn't traveled through the vaginal canal. (Her face is less flattened and the head is rounder.) A four-hour-old baby rarely resembles those perfect infants who reside on detergent boxes and baby formula cans.

I tell all new mothers: Think of your newborn as a work in progress. Babies are unfinished from their GI tract to the muscular system. Few of the many functions of the body are working at complete capacity yet. There is a lot of fine tuning which will develop with usage. (For example, the signals from the brain which tell the two eyes to focus together on the same thing aren't coordinated yet so newborns are often described as "cockeyed.") Control of body temperature is uneven so she may easily overheat or chill. Everything inside your baby is developing in fits and starts. You could say that what you are holding is just a sketch of your baby — the entire picture will be slowly and brightly colored in.

As you look at her you will notice that the baby's body is still in a fetal position. The newborn maintains this position for many weeks after birth. It serves a purpose: Babies aren't born with the best temperature regulation and this position helps keep the warmth and heat closer to their bodies. Her shoulders are hunched up, arms are flexed and her hands are fisted. If the baby was born in a breech position, and her buttocks emerged first, you may find her sucking on her toes for a few days. In the womb, her hips were flexed and her knees held high up on her chest. As her ability to move develops and her body grows she will gradually begin to unfold out of these positions.

You may notice lots of little marks and blemishes. I like to think of it this way: your baby is like a little prize fighter. She's survived for nine months underwater and then gone "10 rounds" through the birth canal. She's emerged the "winner" with all the bumps and bruises to prove it. She may have a little scab on her head from the fetal monitor. She may have pimples on her body (erythema toxicum) as a result of your hormones, and her fingers and toes may be a little purple. (Babies are often accused of looking like little old men — that's because there are a lot of wrinkles and folds all over them as the result of having soaked in an amniotic fluid bath for nine months and then retaining some of that fluid after birth.)

She may in fact have a variety of birth related marks. At the base of the neck you may see "stork" bites so named because that is supposedly where the stork carries the baby with its beak! The official name is nevus flameus which simply means red mark and is a collection of tiny blood vessels under the skin. They may also be present between the eyebrows, under the nostrils or on the eyelids. These irregularly shaped marks are flat and have no special texture. There may also be a bluish discoloration at the base of the spine or over the buttocks. No one knows why any of these marks appear, but almost universally all of them fade by the time the baby celebrates her first birthday.

FROM HEAD TO TOE: INSIDE AND OUT

• The head makes up about one third of the surface area and is almost huge in relation to the rest of their bodies. Babies appear to have large foreheads because they have so little hair. Everybody has heard about the "soft" spot or fontanelle, but there are actually two soft spots. One is right smack at the top of the head, and the second smaller one is slightly toward the back. Although perfectly normal, this second one is the cause of some phone calls to me in the middle of the night. So that the skull can accommodate the baby's brain as it grows, the head is made up of six overlapping flat bones. As needed these bones slide apart to give the growing brain more room. Run your hand gently over her head and you'll feel many irregularities or ridges. These are all normal and are the edges of these skull bones as they override each other.
• The eyes may cross. Most are a grey-slate color which will change by six months.
• The lids are puffy and don't stay open long.
• The eyebrows and lashes are faint and not easy to see.
• The ears may appear not to match. One may be curled forward and one back.

The newborn's head has two small openings called fontanelles. The smaller posterior fontanelle closes soon after birth, while the anterior one, known as the "soft spot", is open into the second year of life.

• The nose has a flat, wide bridge.
• The tongue may stick out.
• The inside of the mouth has ridges and may have several white bumps.
• The cheeks are puffy and very strong.
• The chin recedes.
• The skin will begin to exfoliate, flake. It is often driest at the ankles and wrists.
• The nipples may be hard and knobby and may even leak a clear fluid.
• The belly button has a one or two-inch long yellowish, plastic looking stump.
• The hands and feet may be purplish in color.
• The nails are long, thin, transparent, and are often quite sharp.
• The genitalia of babies are enlarged by the pressure on them during a vaginal birth and the large quantity of hormones transferred from the mother. The vulva and labia in girls and the scrotum in boys all appear quite large in comparison to the rest of the body. Your new daughter may have a vaginal discharge, which is quite normal. In most boys, when the scrotum is relaxed, you can see and feel two marble-sized testicles. Some boys are born with one or both testicles not yet in the scrotum. (Often this condition resolves within a year. The pediatrician should discuss this with you.) The penis has a covering of skin, known as the foreskin, which extends over the top of the penis and narrows a bit — a little like a sock that is pulled too long on a foot. If the penis is left uncircumcised this foreskin will remain. If the baby is circumcised the foreskin will be removed.

WHAT CAN MY BABY DO?

A lot of research has been done trying to figure out just what a newborn is capable of. The noted child researcher Dr. Michael Lewis, and his teams, have thousands of hours of tapes of new babies. His aim is to document what a baby can do. It is clear from the research that rather than being a blank slate which needs to be filled in with information, babies already have a considerable repertoire. All of her senses are operating — she can smell; taste (babies reject formula they don't like and although they are toothless we know they are born with a "sweet tooth"); feel (in fact they have a highly developed sense of touch and will often soothe when you hold them. And we know they can feel pain); hear and see.

What Lewis, and other researchers such as Dr. Stanley Greenspan have discovered is that even newborns try to communicate with us. Babies are really half of a communicating team from the moment of birth. Your daughter can "talk" to you if only you know how to translate. For instance, it's been noted that almost from birth, a baby will look to catch your eye. She can't focus on you for long, and she can only see well about a foot or so away; but if you smile when she catches your eye, she will catch your eye for longer periods. You may even be rewarded with a rudimentary smile. It won't be a full blown grin, of course, but the corners of her mouth will curl up a little bit. (Try it. Smile repeatedly when she looks at you.) A newborn can see best at about six to 12 inches away—the rest is fuzzy. She blinks her eyes open and shut as you get closer to her and flutters her eyelids when you withdraw.

Your baby can make sounds. She can make high and low pitched cries, but she can't modulate very well. Mostly she makes soft squeaks, tweaks and grunts — - sounds which are produced in the voicebox but which seems to come from deep within her chest.

Baby can hear at birth but they don't always respond to sounds. (Don't test your baby's hearing by clapping your hands around her head — her lack of an immediate response may disappoint or even alarm you.) Babies have the ability to selectively inhibit noises: sometimes they respond, even in their sleep to soft noises; and sometimes they don't respond to loud ones even when they are awake. They do seem to have a preference for soft sounds —possibly because for nine months they listened to the world through several layers of your body — and repetitious sounds, perhaps reminiscent of the sound of your heart beat.

In terms of motor skills, you will see that she can move her arms, kick her feet, cry, blink her eyes, open and close her mouth, suck, and grasp — she may even tug on your hair or your finger. She can move her head around but she doesn't have strong neck muscle control yet -- so she can only lift it briefly. The head appears to be in a lot of motion as she twists it from side to side. If you put the baby on your shoulders she may stretch her neck out momentarily and seem to be craning.

Some of baby's movements are out of her control and governed by reflexes: her "strings" are being pulled by Mother Nature. If you want to bring your baby's mouth into a sucking mode, stroke the side of the face near the mouth and baby will begin to purse her mouth as if to suck. This "rooting" reflex is helpful in getting baby to the nipple. The whole upper body may jerk (the "Moro reflex" or the "startle reflex") -- the arms and fingers may flail outwards and then return towards the body and relax. The baby is not nervous, but it often looks that way. (If your baby turns her head to the left, her left arm will extend and her right arm flexes up to her head. This posture, officially known as Tonic Neck Reflex is also called the "fencer's stance" because that's just what it looks like!) These are all normal neurological reflexes. Your baby's movements will gradually become more deliberate; she'll be able to coordinate the use of parts of her body which now move fitfully or in response to these reflexes.

Your baby breathes irregularly - it could be quickly for a period of 15 seconds, followed by a slow shallow period for 5-10 seconds. The normal breathing pattern for baby in the first 24 hours is about 3 or 4 times the rate of adults. (Even her heart rate is naturally almost twice yours and will slow down in about two months.) Newborns periodically cough and sneeze in order to keep their airway clear. BABY CARE The baby will be examined by a pediatrician within 24 hours of birth. He or she will then visit you on a daily basis after seeing the baby and answer any questions or concerns you may have. For example, if you have a boy you have to decide whether to have him circumcised. (See Box) Sometimes the doctor will share some of his own philosophy about baby care with you. (You may have chosen your pediatrician before the baby's birth, but if not your obstetrician will assign one to your baby for the hospital stay.)

CIRCUMCISION

Circumcision is done in the hospital, usually on the second or third day. You must give your permission in writing in order to have it done. In some religions, it is done at home on the 8th day by a person trained in the religious rituals of circumcision.

This has become a controversial issue, but it is currently more "fashionable" to circumcise boys. (In urban centers at least 70% of all infant boys are circumcised.) There are some health benefits associated with being circumcised: research shows that circumcision reduces the incidence of urinary tract infections and may even reduce the incidence of cancer of the penis and cervical cancer in his future partners.

On the other hand, there are risks associated with any operative procedure -- there is always a small risk of bleeding or infection -- and you are making a decision for your baby which is life long. There is also the issue of pain. (The logical assumption is that babies do feel pain much as adults do. Anybody who ever accidentally hurt a baby knows that by the baby's instant cry.) It is difficult to give anesthesia around the penis without creating risks just from doing so, so no pain medication is given -- and alternate means of pain relief are currently being sought.

The procedure is routinely performed by the obstetrician, who is a surgeon, and not by a pediatrician. The foreskin, which is the long tube of skin that covers the head of the penis, is first carefully stretched by the obstetrician and separated from the head of the penis by gentle probing and removed with a scalpel. A clamp is left on the cut end for a few minutes so that there is no need for stitches and so that when the clamp is removed the bleeding has already stopped.

After circumcision, your baby may go home with you only after he has urinated. In general, the circumcised penis requires very little aftercare. Usually a strip of gauze saturated with vaseline is wrapped around the head of the penis so that it doesn't stick to the wound as it heals. Usually the gauze falls off after 24 hours; if not, you will be advised to carefully remove it. After that, apply more vaseline to either a gauze pad or directly on to the inside of the diaper where it will come in contact with the penis while it completely heals over the next 2-4 days. This will protect the penis from rubbing against a dry surface. (Note: the head of a circumcised penis often has a purple-blue color which is normal. Uncircumcised penises are also bluish at the tip, but you don't see it because the foreskin covers it.) While the circumcision is healing, the tissue around where the cut was made may become yellow-green in color, and might easily be mistaken for infected skin. It's normal and to be expected.

The nurses, too, will be routinely checking on and taking care of your baby — doing some of the routine care (diapering, bathing, feeding) that will be taken over by you very soon. Generally the baby resides in the nursery and visits you every 4 hours. Your newborn will be experiencing many "firsts" in her young life.

For at least four hours after her birth, the baby will be on the warmer being observed and will not be fed anything. For their first feed and sometimes the second feed as well, all babies are routinely given water. Generally it's plain sterile water followed by glucose water. At birth there is sometimes a dramatic decrease in baby's glucose level. You may not like the idea of baby getting sugar water (it sounds as if your child is being given Kool-aid), but glucose is part of what naturally runs through our veins. (As a matter of fact in some cultures, shortly after birth, the midwife will prepare a solution using whatever sugar source is on hand — maybe beet sugar - and mix it with boiled water and then use some kind of sponge to squeeze it directly into the baby's mouth. This is done to prevent hypoglycemic tremors.)

At the end of the first day your baby will get her first bath. This is often not done in front of you, unless the baby is rooming-in with you (See Chapter 2), and is usually done by a nurse. A basin is filled with warm soapy water and the baby is placed in the tub. She will vigorously wash the baby from top to bottom with a wash cloth. During this first bath the nurse will wipe off what is left of the vernex — that is, the white sticky material which is protective of the baby in utero. Vernex seems to be a natural moisturizer and protects the skin from the fluid the baby has been floating in. It may also have anti-bacterial properties which is why the vernex is not completely wiped off in the delivery room. After the baby is cleaned she is taken to a second basin containing fresh water or over to a big sink in the nursery to be rinsed off. She will get a bath every day that she is in the nursery.

The nurse will pay special attention to your baby's eyes. You will recall that ointment is put in her eyes at birth to prevent infection, but this ointment can cause the lids to become puffy and she may even develop an eye discharge. The nurses will soon wipe this material off the eyes and use warm water to keep the eyes clean and clear.

Before she goes home, the plastic clamp that was put on the cord in the delivery room will be removed. The one inch dry, twisted stump which remains will fall off in a couple of weeks.

During the baby's stay she will also be subjected to a variety of tests. There are a series of very routine blood tests, for example, which are done on your baby in most hospitals. In addition, some states require free screening tests which look for metabolic disorders that are detectable and treatable in newborns. These tests are done by the nurse or technician by drawing blood from the baby's heel — this is why you may see a Band-aid there on your baby. You can remove the Band-aid after an hour or so.

One routine test is to measure the bilirubin level which, if elevated, is a sign of jaundice. (Bilirubin is a yellow substance produced by the body when breaking down red blood cells.)

JAUNDICE

About one third of all newborns develop a yellow tinge to their skin by the third day of life. Sometimes doctors can predict which babies are more likely to develop jaundice by knowing your blood type and the baby's blood type.(In the delivery room blood is routinely taken from the umbilical cord: A test called a Coombs is done which determines whether your blood and your baby's blood antibodies are compatible. If the results are positive then it means you and the baby's blood are incompatible and jaundice is likely.) When you and your baby's blood pass each other in utero some of your antibodies pass to the baby; if your blood types are not compatible a reaction may occur that causes the red blood cells to break and release a substance called bilirubin. If the baby's liver is overwhelmed with a lot of this substance jaundice occurs because bilirubin is yellow and it accumulates in the skin.

Don't be alarmed if you are told your baby is a little jaundiced. It's not a disease. The nurses will draw small samples of blood from your baby's heel 2-3 times a day. Usually no treatment is necessary unless the bilirubin is over 20 milligrams per deciliter of blood (20mg/dl).

Although jaundice is not remedied by giving excess amounts of water, the doctor may ask you to nurse and feed the baby more often hoping bowel movements will soon follow so that some of the bilirubin can be excreted that way.

The treatment for jaundice is based on the fact that a certain wave length of light which is found naturally in sunlight can help to eliminate bilirubin from the skin by breaking it down so it can excreted in the urine and feces. Unfortunately real sunlight also has ultra-violet radiation and can burn the baby.

To treat jaundice we use "sunlight" created by special artificial lights that break down the bilirubin so that the baby's liver doesn't have to do all the work.

For these treatments the baby is undressed except for a mini-diaper so that almost the entire body is available for exposure to the light. She is placed in an incubator which has clear plastic sides so that the special light can shine through. Her eyes are covered so that the light won't annoy her. Babies stay in their little "sun tan parlor" except for feedings so they can spend the maximum time under these lights. The nurses will come in and turn the baby from front to back and then later from back to front. When you look in it does appear that your baby is happily sunbathing. For reasons which are not clear, babies seem to be very calm under the lights and rarely cry. It could be because of the warmth. This is baby's home until the bilirubin is at an acceptable level -- usually under 12.

Babies with jaundice are often kept in the hospital an extra day or two because most cases don't begin until the third day. It takes that long for the bilirubin to collect in the skin. It's also possible that jaundice may not be discovered until after discharge: this will easily be handled by your pediatrician. If your baby appears yellow anytime before her two week check-up, call the doctor.

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