NGU5404 Session 22: Domiciliary care of the mother and neonate

Session 22
Domiciliary care of the mother and
neonate

Contents
Introduction, p31
22.1 Domiciliary care of the mother, p31
22.2 Domiciliary care of the neonate, p36
Summary, p39
Objectives, p40

Introduction
The care and help given to new born babies and mothers in the first few days after birth
are critical in maintaining the normality and preventing any complications in them.
First time mothers often need more help and support for the proper care of their
infants, as well as for the care of themselves. From the moment of birth, each newborn
is a separate individual with needs that may depend not only on the mother, but also
may require special attention.
It is very important for the health care providers to help the mothers in this crucial time
period. Therefore the mother should make aware the Public Health Midwife in her
home area regarding her delivery. The mother should attend the post-natal clinics
regularly.

22.1 Domiciliary care of the mother

After discharging from the hospital, the mother recovers from the changes caused by
delivery. The mother should get some rest throughout the day because the child will
change the previous routine of the home with respect to normal sleeping patterns. It is

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NGU5404 Session 22: Domiciliary care of the mother and neonate

important to take regular exercise and fresh air outside to improve the condition and
normalize the weight of the mother.

22.1.1 Physical changes and personal hygiene

Lochia will normally last for 4-6 weeks. The discharge will diminish gradually, turning
light and mucousy. Continuous bloody discharge, an unusual smell or high temperature
are not normal signs. So if mothers are experiencing any of these, they should contact
the doctor.
The start of the first period after childbirth depends on the individual. Some women do
not start their period until 4-8 months after childbirth, depending on breast feeding and
other factors.
Pregnant women store lots of fluid in their bodies. After baby is born, mother’s body
needs to get rid of this extra fluid and does so by sweating and passing urine often. It is
normal to perspire more than usual during the first several weeks after giving birth.
Mothers may pass large amounts of urine 2-5 days after the delivery. Some mothers
have trouble passing urine, due to soreness and/or swelling of the perineum. It is better
to pass urine often to avoid overfilling of the bladder.
The perineum often receives small tears or sometimes it is cut (an episiotomy) during
childbirth. If stitches were used to repair the episiotomy site, they would absorb on
their own. and not need to be taken out. An episiotomy including stitches will usually
heal within 3-5 weeks. To avoid infection and heal the perineum, it should be kept
clean and dry.
The mother must take good care of her personal hygiene. The best way to have a wash
is to take a shower. Perineum should be gently wiped from front to back after going to
the toilet or having a shower. This prevents germs from the anus being wiped toward
the vaginal opening and urethra. The sanitary pad should be changed often and always
after using the toilet. Perineum should be exposed to air.

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NGU5404 Session 22: Domiciliary care of the mother and neonate

22.1.2 Care after Caesarean birth

When a mother is undergone a caesarean section, mother’s belly has been closed with
either sutures or staples. If they do not dissolve on their own, they have to be removed
5-7 days after the caesarean birth.
The dressing over the abdominal incision is usually removed on the day two after the
surgery and then mother has to get a shower. After the shower, the surgical wound
should be dried with a clean towel gently. Leaving the wound site uncovered helps it
to heal. The incision site takes a few weeks to heal; over time it will shrink and
become paler in colour.
The mother should contact the doctor if the site of surgical incision;
-opens
-is swollen and red
-becomes more painful
-has fluid (blood/pus) coming from it
-starts to have a bad smell

22.1.3 Care of the breasts

When the mother get first started to breastfeed the baby, her nipples may become sore
and red. Nipples are often at their most sensitive stage on the third day from starting
breastfeeding, but the soreness usually improves over the course of a week. A good
feeding position and the correct latching position of the baby will prevent or at least
reduce nipple soreness. Mother can take care of her sore and ulcerated nipples by
squeezing out a drop of milk onto the nipples after feeding, by applying some
ointments and by giving a warm water bath to nipples.
A few days after childbirth, mother’s breasts may become engorged along with
increased milk production. In normal physiological engorgement, full breasts are hot,
heavy and the milk flows freely. When the breasts become so engorged, they are
painful and swollen. Mother cannot breastfeed properly and it is difficult for the baby
to latch onto the breast and suckle. There may also be a slight increase in mother’s
body temperature. Frequent feeds are important when treating engorged breasts.

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NGU5404 Session 22: Domiciliary care of the mother and neonate

Later on during breastfeeding, mother may feel a pain-free, small and hard lump in her
breast. This kind of blockage of the milk duct is usually caused by the breast or part of
it not emptying properly. A blocked milk duct is treated by emptying the breast
throughout the day and night. Breast feeding should be started with the blocked breast
and if necessary, mother can have mild analgesics
The most common reason for breast infection, i.e. mastitis, is blockage of a mil duct.
A breast infection usually appears in the first few weeks of feeding. Symptoms may
include warmth and redness in the breast and high temperature (over 38.50C). If mother
is experiencing such symptoms, she should contact the doctor. Breast infection
requires a course of antibiotics and during that course, it is necessary to breastfeed
frequently. Other treatments according to symptoms include rest, taking plenty of
fluids, and medication by antipyretics and analgesics.

22.1.4 Nutrition
The quality and quantity of the food that the mother eats are important after giving
birth. She needs more protein, iron and vitamins in her diet as the production of breast
milk increases their need. Dairy products, eggs, low-fat meat, fish and vegetables are
good basic foodstuffs. Fish is a good source of omega-3 fatty acids which is important
in the baby’s growth and development.
Mother should drink plenty of fluids including milk, fruit juice and water. But it is
better to limit tea, coffee and some soft drinks those contain caffeine. It is important to
have a diet high in fibre content to avoid constipation.
Most babies enjoy and tolerate the taste of different foods in breast milk. The only food
stuff, a breast feeding mother needs to avoid are those to which she has known
allergies. Breast feeding requires extra energy, some of which will be taken from the
fat content that the mother gained during her pregnancy.

22.1.5 Emotional aspect

Being a mother
Getting used to being a mother takes time. Some new mothers feel love for their baby
right after birth. To build up the bond, mother should spend lots of time with the baby,

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NGU5404 Session 22: Domiciliary care of the mother and neonate

holding the baby close to her, looking at the baby’s eyes, talking to the baby, and
touching and stroking the baby’s skin.
Many women have a lack of confidence about their ability in nurturing newborns and
doubt whether they possess essential skills and knowledge for becoming a mother.
Mothers may feel anxious about how to feed, bath, diaper, and comfort the baby.
Feeling anxious may affect her sleep pattern also.
Following strategies will help women get used to motherhood;
-rest when baby sleeps
-be real in own expectations
-set aside time to relax by her own
- spend time with the partner and/or other family members

How to involve the family?

The family goes through a lot of changes with the arrival of the newbaby. The partner
may miss the attention mother given him before the baby came. If the mother has
other children, they may also have a hard time accepting the new baby because they
feel uncared for and think the mother is more interested in the new baby.
To overcome the above matters mother should;
-ask the partner, other children and family members to help with the baby’s care
-set aside time to be with the partner and family
-take time to be with other children and do the special things that they enjoy
-talk about the changes in own life, and be open about own feelings, fears and
concerns, so that the partner can understand and help accordingly.

Postpartum emotional changes

New mothers often expect to feel very happy about the baby and the other hand they
are upset feeling sad, angry, fearful or anxious. Up to 75% of women have “baby
blues” that may begin within a few days after giving birth. These sad feelings often go
away on their own within 14 days after delivery.
“Baby blues” are due to the sudden change in hormones after delivery, combined with
stress, isolation, sleep deprivation, and fatigue.. Signs of this condition include;
-crying often and not always for a reason
-feeling very tired

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NGU5404 Session 22: Domiciliary care of the mother and neonate

-having trouble falling asleep

-having trouble thinking clearly of feel out of touch
-feeling very nervous about baby
-feeling annoyed, angry and not understanding why
-feeling that nothing will ever be the same.
Taking care of the mother is the best way to decrease the symptoms of the “baby
blues.”
If the symptoms last longer than fourteen days it could be an indication of a more
serious condition, such as postpartum depression. Therefore it is required to seek
medical advice immediately.

22.2 Domiciliary care of the neonate

22.2.1 Breast feeding

Exclusive breast feeding is recommended for the first 6 months of the baby At six
months, introduction of nutritionally-adequate and safe complementary (solid) foods
together with continued breastfeeding up to 2 years of age or beyond is
recommended(WHO, 2020).Breast milk is the best food for baby. Continuous breast
feeding makes a big difference to baby’s health as well as mother’s health.
Breast milk is easily digested, so baby will suck often. Mother should watch for signs
that baby is getting hungry. These include;
-waking, stretching and stirring from sleep
-sucking on fingers or hands
-clicking or sucking on tongue
-opening mouth and looking for the breast

The breast milk in the first few days, colostrum, is usually fairly thick and its colour
may vary from creamy yellow to transparent. The neonate should be fed at the breast
8-12 times in 24 hours. When the baby is feeding at frequent intervals, the amount of
milk starts to increase and the actual milk usually starts to come in after 2-5 days from
birth.

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NGU5404 Session 22: Domiciliary care of the mother and neonate

When the mother is producing enough milk, she can hear the sound that baby swallows
milk and the baby is satisfied at the end of feed. Mother can also estimate if a new born
baby is getting enough milk from wetting of the nappy and the amount of stools; the
baby should produce an average of 5-7 clearly wet nappies per 24 hours after coming
home.
A steady weight increase is the most reliable sign of a sufficient milk supply. The
baby’s weight will fall in the first days by an average of 7%, but it will usually start to
rise at the age of 4-5 days if the baby is getting enough food. The birth weight is
regained by the age of 7-10 days.
Mother should let the baby feed on the first breast until it stops sucking and
swallowing. Then should try to burp the baby and offer the second breast. If baby feeds
on only one side, should start on the other side at the next feeding. If baby is sleepy
and has not fed often enough, should wake up. Feeding time is usually 20-30 min, but
can be shorter or longer.

Insufficient supply of breast milk

If there is a reason to suspect that the baby is not getting enough milk, it may be
because the milk has not started to come in properly or the baby is not suckling the
milk offered, to him/her. Mother can help the baby suckle the available milk from the
breast by improving the latching-on and nursing technique, by increasing the number
of feeds and by having plenty of skin contact.
The baby must be breastfed whenever he/she is showing signs of need to nurse. These
signs indicate that the baby is hungry even before crying.
Breast feeding positions include sitting down, lying down or the under arm position.
To start nursing, the mother positions the baby on his/her side against herself so that
nipple is clearly above the baby’s upper lip, almost by the nose. When latching-on to
the breast, the baby lifts the head back and opens the mouth so that the nipple is just in
front of the mouth.
The mother can encourage the baby to suckle by touching the baby’s lips with her
nipple or by squeezing a few drops of milk on to the baby’s lips. When properly
latched on to the breast, the baby’s mouth is fully open and mother’s nipple and most
of the areola are in its mouth. The baby’s chin touches the breast, keeping the nose
clear. With the correct latching position, the baby will suckle efficiently.

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NGU5404 Session 22: Domiciliary care of the mother and neonate

If the mother has plenty of milk but the baby is unable to suckle, the mother can
express milk and feed the baby from a bottle. If mother is concerned that she is not
producing enough milk, she should inform the PHM in this regard and get help from
her.

22.2.2 Skin care

The baby can be bathed 1-2 times a week. If necessary, can add a few drops of baby oil
to the bath water if the baby’s skin is dry. The baby’s face and eyes should be cleaned
using a damp washcloth rinsed in soap-free water every day. Pay special attention to
creases under the arms, behind the ears, around the neck, and, especially with a girl, in
the genital area.. Baby powder can be used to relieve irritated skin. Newborn babies
have a sensitive skin and therefore they may get spots or red blotches that do not need
any special treatment.
When bath is given to the baby, mother should consider the following ;
-ensure the room is warm and there is no draught while changing clothes, washing and
bathing
-use warm water for bathing
-During the bath, wrap the baby in a dry towel and expose only the parts of the body
which are going to be washed
-thoroughly but gently dry the baby, dress and cover immediately after bath
-wash the buttocks when soiled and dry thoroughly

22.2.3 Cord care

After cutting, the umbilical cord will be clamped. The clamp closes the belly button
safely and effectively and will not open by itself. If the clamp is still in place when the
baby is taken to the home, it should be removed on the third day from birth by
squeezing the clamp lengthways with the thumb and forefinger.
The umbilical stump normally takes about 4-14 days to fall out, depending on its
thickness. At home, the base of the umbilical stump should be cleaned every day with
clean water and cotton buds. Then it should be carefully dried with a dry cotton bud.
After the umbilical stump has dropped off, should carefully clean and dry inside the
belly button once a day for a few days, and should dry it after every wash.

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NGU5404 Session 22: Domiciliary care of the mother and neonate

If the belly button is red or if it smells, it can be cleaned with an antiseptic, non-sting
preparation on several occasions, when the nappies are changed. If a red, flame-like
pattern appears on the skin above the belly button, should contact the doctor as the
baby may have an infection that requires treatment.

22.2.4 Immunization
New born babies should be given the BCG vaccination to prevent tuberculosis.
Normally it is given within 24 hours after birth, but if there is any problem with the
baby like low birth weight, it can be given within the first month of age.

Activity 22.1

Explain the main factors that the mother of a new born baby should concern on her
personal hygiene and nutrition at the home.
Describe the methods that can use to prevent the postpartum emotional changes of a
mother.
Explain the factors that should concern by a mother when she is breast feeding her new
born baby at home.

Summary
• Care of the newborns and mothers at home is very important to maintain the
normal conditions and prevent the complications of them.
• The mother who has given birth to a baby should pay much attention on her
physical changes, personal hygiene, nutrition, rest and emotional aspect.
• The most important aspects that should concern on caring the neonate at home
are ensuring safety, thermal protection,breast feeding, skin care and cord care.

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NGU5404 Session 22: Domiciliary care of the mother and neonate

Objectives

Now you will be able to;

To describe the importance of home care of the mother and neonate.

To explain the factors that mothers should concern on her care at home, after
giving birth to a baby.
To explain the factors that should concern on caring a new born baby at home.
To describe the warning signs that need immediate attention which may occur at
home, in mother and neonate.

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