Post Natal Care

This page contains general and Christchurch, New Zealand specific information about post natal care.

Newborn Hearing Screening

Up to 170 babies are born each year in New Zealand with significant hearing loss. Picking up hearing difficulties early in life is very important as early intervention can make a significant difference to how your baby’s brain develops.

You will be offered to have this non-invasive screening test for your baby. It is either done before discharge if you are staying in hospital, or an appointment can be arranged for later in the first weeks of your baby’s life. Some babies will be offered further testing.

Information about the test

http://www.nsu.govt.nz/files/ANNB/HE1921_Your_Babys_Hearing_Screening.pdf

Newborn Hearing Screening Website

http://www.nsu.govt.nz/current-nsu-programmes/newborn-hearing-screening.aspx

Signs your baby can hear

http://www.nsu.govt.nz/current-nsu-programmes/2281.aspx

Note that it is very difficult to determine if babies can hear properly until they develop speech and language skills. Screening enables treatment to occur long before this point.

Metabolic Screening

Metabolic Screening is also called the Heel Prick Test, and the Guthrie’s test. This test is done as soon as possible after your baby is 48 hours old.

The test involves pricking the baby’s heel and taking four samples of blood as spots on a card. Often feeding your baby will help distract them during the test, and most babies are more frustrated by the midwife holding their foot than by any pain!

The blood samples are used to screen for evidence of metabolic disorders, which are mostly enzyme deficiencies. Most of these enzymes are for processing food. If they are missing, toxic substances can build up in your baby’s body and cause permanent health problems. Picking up these deficiencies early in life enables changes in diet to be made and early treatment to begin, which can make a significant difference to your baby’s health.

The test currently screens for 28 different disorders. Some babies will be offered further testing.

Many disorders do not show symptoms until damage has already occurred, so screening enables intervention before this point.

Information about the test

http://www.nsu.govt.nz/files/ANNB/Your_newborn_babys_blood_test.pdf

Metabolic Screening Website

http://www.nsu.govt.nz/current-nsu-programmes/newborn-metabolic-screening.aspx

If you wish, you can request for your babies test card to be returned to you after testing

http://www.nsu.govt.nz/files/ANNB/Guthrie_card_return_july_09.pdf

Vitamin K

Vitamin K is a blood clotting factor. It is produced by bacteria in the gut. Newborns have a lower level of Vitamin K since they initially have very little gut bacteria. A very small number of babies can develop severe internal bleeds due to this. Although this is uncommon (2-10 cases per 100 000 births), the consequences can be severe – leading to blood transfusions, brain damage, and death.

An injection of Vitamin K into the baby’s thigh soon after birth has been shown to reduce the incidence of this kind of bleeding dramatically. Three oral doses can be given instead over the course of six weeks, although this is not as effective as an injection.

It is your choice whether or not your baby has Vitamin K at birth. In some cases, Vitamin K would be more strongly recommended as the baby may be at higher risk. For example, premature babies (who have even lower levels of Vitamin K), babies of mothers on certain medications, sick babies, and those born by instrumental birth or a long labour where there is an increased chance of bruising.

More information including signs of Vitamin K Deficiency Bleeding

http://www.patient.co.uk/doctor/Haemorrhagic-Disease-of-Newborn.htm

Consensus statement from Paediatricians, Midwives, and Obstetric organisations

http://www.medsafe.govt.nz/profs/puarticles/vitk.htm

Immunisation / Vaccinations

Several vaccines are part of the National Immunisation Schedule offered to all babies. In most cases, the first round of vaccines can be given at about 6 weeks of age through your local doctor’s surgery.

Extra vaccinations are offered at birth in some cases, for example if the mother has Hepatitis B.

Vaccination against tuberculosis is not routine in New Zealand. This vaccination can be added if your baby is deemed at higher risk or you are planning to visit countries with a high incidence of tuberculosis.

All vaccinations that are part of the schedule are free. Some vaccinations come in combination, so if you choose to only use some a cost for the individual vaccine may apply.

A National Immunisation Register (NIR) maintains a record of which vaccines your child has had. Your baby is entered into the register at birth. Reminder letters can be sent to you if you miss part of the schedule, although you are not obliged to vaccinate if you choose not to. You can choose to opt off this register if you wish.

Excellent information on how the immune system and vaccinations work

http://www.immune.org.nz/immunisation

Online booklet about the vaccinations offered

https://www.healthed.govt.nz/resource/childhood-immunisation

Information about the National Immunisation Register

http://www.health.govt.nz/our-work/preventative-health-wellness/immunisation/national-immunisation-register

Well Child / Tamariki Ora

Your midwife or Lead Maternity Carer (LMC) will visit you up until 4-6 weeks after birth, providing care for you and your baby. Before discharge, your baby can be referred to a Well Child Provider. Visits may start at about 5 weeks and so overlap with your midwifery care. The Well Child visits are less frequent but continue until your child goes to school. The Well Child visits are for ensuring your child is growing well, and include discussions about introducing solids, dental hygiene, vaccinations, and development as appropriate to the child’s age.

Well Child visits are free. They are not compulsory, and you can change your provider or stop care if you wish at any time.

You will be given a Well Child book at your baby’s birth. This book contains information on child development, sickness warning signs, and first aid. There are expected weight and height charts for your child, and checklists for development for you to fill in. The book also contains records of any immunisations, hearing screening, and metabolic screening.

In Christchurch there are several Well Child Providers to choose from:

General information about well child services

http://www.wellchild.org.nz

Breast Feeding

Breastfeeding is often more of a challenge than anticipated. A little prior learning can make a big difference in establishing breastfeeding with your baby. Your midwife will provide lots of support and advice with this (as will much of the community!). You can also:

If you are having ongoing difficulties with breastfeeding, your midwife can arrange for you to meet a specialist Lactation Consultant, either in hospital or at your home.

Expressing and Storing Milk + Breast Pump Hire

Pumps come in many shapes and forms. Whether or not you need one, whether to rent or buy one, and which suits best, depends on how often you intend to pump and for how long. Discuss options with your midwife.

Expressing milk by hand is an important skill – as well as being a free way to express milk, it is also useful for expressing lumps and thus minimising risk of mastitis.

For a video about hand expressing: http://breastfeeding.about.com/video/

For information about expressing and storing expressed milk: http://www.kiwifamilies.co.nz/articles/expressing-your-milk/

Bottle Feeding

For advice on preparing formula feeds:

http://www.kiwifamilies.co.nz/articles/bottle-feeding-your-baby/

https://www.healthed.govt.nz/resource/feeding-your-baby-infant-formula

How much formula and when?

For information on formula feeding ‘on demand’: http://www.babycentre.co.uk/baby/formula/howmuchmilk/

Pelvic Floor Exercises

As many as you can every day forever!

How and why: http://www.thewomens.org.au/Pelvicfloorexercises

Unwell Baby

You will receive a Well Child Book from your midwife at the birth of your baby. This contains good information on warning signs that your baby is unwell, and what to do in emergencies.

For the Well Child website: https://www.healthed.govt.nz/resource/well-child-tamariki-ora-my-health-book

To download a pdf version of the book: https://www.healthed.govt.nz/resource/well-childtamariki-ora-health-book

You can also attend first aid courses for infants and children: http://yellow.co.nz/yellow+pages/First+Aid+Training/Christchurch

If you have emergency concerns, call an ambulance by dialling 111.

If not urgent, contact your midwife or doctor.

Once discharged from your midwife (after 6 weeks) you can contact your doctor – some are free for babies and children up to school age.

You can call Healthline 24hrs a day for free advice: 0800 611 116, see http://www.health.govt.nz/yourhealth-topics/health-care-services/healthline

You can also call Plunketline 24hrs a day for free advice: 0800 933 922, see http://www.plunket.org.nz/what-we-do/what-we-offer/plunketline/

Brainwave Trust / Child Development

Babies and children are not little adults – learning a bit about their differences and how they develop can be fascinating, rewarding, and explain away many frustrations of parenting!

An excellent organisation called the Brainwave Trust is dedicated to translating the latest findings in infant development (fetus to age three) and brain development into practical tips and explanations. Check out their website and look out for their regular talks around Christchurch:

http://www.brainwave.org.nz/

The Centre for Attachment also discusses child development: http://www.centreforattachment.com/index.php?option=com_frontpage&Itemid=1

Another great website with lots of tips and explanations is Dr Sears: http://www.askdrsears.com/

Sleep Issues / Soothing Babies

Ask Dr Sears: http://www.askdrsears.com/topics/sleep-problems/31-ways-get-your-baby-sleep-and-stay-asleep

Wind / Colic / Reflux

Winding – ask Dr Sears: http://www.askdrsears.com/topics/feeding-infants-toddlers/burping-baby

For support when you have a baby with reflux: http://www.cryingoverspiltmilk.co.nz/

Postnatal Depression + Post Traumatic Stress Disorder

Please talk with your midwife if you are feeling down or have postnatal depression. There is lots of support out there and we can help you get in contact with it.

If you are not sure if you have postnatal depression, try the following short quiz: http://www.mothersmatter.co.nz/epds.htm

Depression.org: http://www.depression.org.nz/ContentFiles/Media/PDF/Depression_and_pregnancy.pdf

Explanation of postnatal depression and support available: http://www.everybody.co.nz/page-5e0a04d5-df69-4be3-bc11-9d8a54a86378.aspx

Trauma and Birth Support website: http://www.tabs.org.nz/

If you are lucky enough to live in or near Rangiora, we highly recommend the following support group:

http://www.motherssupportingmothers.org.nz/index.php

Community Supports

There are dozens of great support organisations in Christchurch.

Please discuss options with your midwife if you have particular needs or concerns.

Also check out the links amongst other postnatal topics.

Pregnancy Help

http://www.pregnancyhelp.org.nz/canterbury/ Provide unbiased information, free equipment and clothing, counselling and advice for women who are pregnant.

Birthright

http://www.birthright.org.nz/What+we+do/Regional+Societies/Christchurch/Christchurch+Resources.html

An excellent list of Christchurch resources and organisations.

Birthright focuses on single parent families.

Father and Child New Zealand: http://fatherandchild.org.nz/christchurch/

A resource for young parents with links to many support agencies in Christchurch. http://thepulse.org.nz/Life/Relationships/Parenting/Directory/Futures.pdf

Another great list of Christchurch resources – Mothers Matter: http://www.mothersmatter.co.nz/support/South-Island/Canterbury/default.asp