The current practice of handling newborns contributes to the high incidence of neonatal death and illnesses in the country. Doctors are introducing a new way of caring for newborns in the first few minutes of life, which could cut by almost half the number of newborn deaths estimated at 40,000 each year according to this report.

Important points in the new program of the Department of Health (DOH) and World Health Organization that should be imposed are as follows: 1) dry the newborn immediately after birth (instead of washing) to prevent hypothermia and the risks related to it, 2) initiate skin contact with the mother by placing the baby on the mother’s chest or abdomen to provide warmth, increase the duration of breastfeeding, and allow the “good bacteria” from the mother’s skin to infiltrate the newborn, and 3) delay the cord clamping by two to three minutes after birth (or wait until the umbilical cord has stopped pulsing) to increase the baby’s iron reserves, reduce the risk of iron-deficiency anemia and improve blood circulation. These are basically in line with the Essential Newborn Care (ENC) protocol.



When I read about this, I had mixed emotions. On one hand, I got disappointed for I know it was not strictly observed when I gave birth to my 4 children. On the other hand, I felt grateful that an effort is being directed towards its strict implementation. There are only three hospitals in the Philippines currently subscribing to the ENC protocol so far—Quirino Memorial Medical Center in Quezon City, and Fabella Memorial Medical Center and Philippine General Hospital in Manila.

In all of my childbirth experiences, the umbilical cord was immediately cut before the baby is placed on my tummy or my breast. Then my baby was only allowed to ‘kiss’ my nipple because we were not given long enough time for the baby to latch on. They wash the baby and when they bring the baby to the room to be with me (room-in as we always specify), I usually notice red spots are on my baby’s face. They said that it is the result of the cotton rubbed on my baby’s face and will wear away in time. True enough the spots were gone in few days. But with the ENC protocol this should not happen to newborn babies in the future.

Most babies do not experience hypothermia even when washed immediately after birth, but a lot end up staying in the nursery for days just to be heated by lamps. Isn’t it because they were washed even before they get acclimatized in their new environment? I am just wondering. When this happens initiation of breastfeeding is delayed, making the situation worse for both mother and baby. Delaying the start of breastfeeding by one day could make the newborn 2.6 times more prone to infection as also mentioned in that report.

I am posting this to help spread the information about the ENC Protocol. To those who are about to give birth, discuss this with your Obstetrician-Gynecologist (OB). Know the hospital policy on this as suggested in my previous blog on childbirth preparation. If they are not yet implementing the ENC protocol and you want it for your child, ask if they will accommodate your request.

This is also a good chance for me to highlight the various practices beneficial to the health and well-being of the child with less emphasis on cleanliness: (1) passing through the birth canal to get in contact with microorganisms necessary to prime his/her immune system and (2) allowing the child to play and get dirty as explained in my previous blog on natural immunity builders, (3) skin contact with mother for the good bacteria to infiltrate newborn, (4) delaying washing of the new born to prevent hypothermia as washing removes the vernix or baby’s skin protection. Apparently, too much emphasis on cleanliness is also detrimental to your child.

Director Honorata Catibog, head of the DOH task force on the rapid reduction of maternal and neonatal mortality, describes the new program to implement the ENC protocol as “paradigm shift”. I call it going back to basics...our natural survival strategy.

photo courtesy of stockvault.net

Now that the shopping galore for baby things is over and you have prepared your hospital bags, you might ask, what else do you need to do before your baby arrives? Actually, a lot needs to be done to make the baby’s arrival as smooth as possible. Here are some suggestions.

1. Decide your birthing option. By this time you should have an idea on how you want to deliver your baby. If not, educate yourself on the pros and cons of the various birthing options by reading books and magazines, searching from the internet and talking to experienced mothers. You might also want to consider watching videos of child deliveries employing the various options.
   
   There are lots of birthing options to choose from. You can have it the natural way without any drugs (Lamaze, Bradley, Birthworks, etc.), natural with anesthetic pain management, or C-section. If you have made the decision, then preparations toward that option should be made, like enrollment and attendance to birthing classes when applicable. Discuss this fully with your obstetrician-gynecologist (OB).
   

2. Tour the birthing site. Go to where you want to deliver your baby and have a nice tour to familiarize yourself with the place and with the procedure. Inquire on the process/requirements for hospital admission. In some hospitals, you will not be allowed to see the inside of the delivery room but at least you would know where the rooms and other facilities are. Find out if the hospital is Mother-Baby friendly that would allow rooming-in and would support breastfeeding if those are your preferences.

3. Prepare yourself physically and emotionally. At this point, your OB might advise you to increase intake of foods rich in iron and prescribe iron supplement if she has not done before. Towards the end of pregnancy, it is advisable for you to have lots of restful sleep but remain active during most parts of the day. Regular prenatal exercise is preferable as discussed in blissful pregnancy tip #5. Active mom’s usually have relatively easier and uncomplicated natural deliveries.

Enhance emotional connection between you and your baby. Caress your tummy and talk to your baby. In all my pregnancies, I usually talk to my baby about childbirth few weeks from my due date, asking for his/her cooperation and giving my assurance that anytime he/she is ready, I am, for childbirth should be a team effort and the two of us are part of the team. I also tell how excited I am to see him/her and that I will continue to provide for his/her needs even outside my womb.

While you are still waiting for the big day, try envisioning the thrill of having your child on you hands, looking at his/her tiny lips that greet you with a smile. The joy will be far greater than the fears and anxiety of childbirth and will make you endure all discomforts. While I was on the delivery table, my focal point was the wall clock, I was keeping track of my contractions, and around it was a bare wall which I filled with nice pictures of me, my husband and my baby, together as a happy family. These were the visions that I've been keeping in my mind and heart since early in my pregnancy.

4. Arrange Domestic Matters. If you have other children, start thinking about sibling care. Arrange for who’s going to be there for them, who will be in-charge of food preparation and other domestic concerns while you are in the hospital. You might want to stock up on easy-to-prepare food in your freezer. If you are a working mom and needs to go back to work after your maternity leave, then now is the time to arrange for child care. Make sure the area where you are going to receive the baby in the house is clean and tidy.

5. Start a hobby. Despite the many things you need to do to prepare for childbirth, you might still find yourself spending time on futile musings about labor pain and blood, and even death from complications. These are normal and to a certain extent reasonable thoughts, but instead of feeding your worries, why not start a hobby that will keep your mind away from all those fears. Try embroidery on your baby clothes, or crochet a pair of booties or cross stitch a symbol of happiness. Regardless of your choice, or you might choose not to do it at all, remember that your baby is worth much much more than the entire wait.
   

6. Select your Baby's Name. This is a fun part that could also alleviate the discomforts and impatience while waiting for the big day. My husband and I had many enjoyable discussions while trying to come up with our baby's name. These are the moments when we share and (re)define our hopes and dreams for our baby and the family. Each of the names of our children were picked for a reason and has special meaning to us. Baby naming sites like this one was useful to us when we were deciding.
7. Plan the Announcement. After the long wait is the big day of your baby’s arrival. It is yours and your husband’s duty to announce the arrival of your bundle of joy so that he/she can be properly welcomed by your family and friends who are one with you in anticipating the newest addition to your family. Decide on the list of people whom you want to send the announcement to. Examples of announcement ideas include a simple text message with the child’s photo, a card bearing your child’s foot prints, a mass offering, an envelope with tobacco stick for a baby boy and a chocolate bar for a baby girl, a photo or video of you child posted on the home page of your social network account and many more. You can also be creative like this overzealous father.

This stage of your parenting journey would require you to prepare two bags: one for you and the other one for your baby. These bags should be prepared on the seventh month of your pregnancy. In case of unexpected delivery, at least the bags are ready. Whenever you feel that it’s time to go to the hospital, then you can just lift your bags without any hassle. Like the checklist of baby things I posted in the previous blog, I am sharing here the checklist of items you should consider bringing to the hospital with you. These are the items that my hospital bags contained.

Mom’s Bag

• Adult Diapers (2)
• Maternity Sanitary Pads (4)
• Regular Sanitary Pads (8)
• Pajamas/Night Gown with front opening for easy breastfeeding (2)
• Panties (4)
• Nursing Bra (1)
• Set of Clothes for going home (1)
• Something to tie your hair with, if you have a long hair
• Bath towel and face towel
• Toiletries
• Candies, crackers and bottled drinking water
• Extra pillow

Putting on adult diaper immediately after birth is preferable because bleeding is more profuse. The first one is usually provided by the hospital. Bleeding should lessen the following day so you can switch to using maternity sanitary pads instead. Maternity pad absorbs more fluids, but it is very thick and wide. When bleeding is less heavy and you are up and about to do frequent pad change, then switch to your regular sanitary pad. The crackers, candies and bottled drinking water are particularly useful when you arrive at the hospital while still on early labor but advised not to go back home. Candies and water will work well for dry mouth. But once you’re done with enema procedure, you cannot take anything anymore. Labor is expected to progress after this procedure because of stimulated uterine contractions.

Baby’s Bag

• Baby Vests (4)
• Mittens (2)
• Booties (2)
• Bonnets (2)
• Wash cloth/bibs (4)
• Receiving blankets (2)
• Waterproof sheet (1)
• Cloth diapers (12)
• Diaper clips (2)
• Disposable diapers (6)
• Petroleum jelly (1)
• Cotton balls (1)
• Bath towel (1)
• Baby liquid soap (1)
• Ethyl Alcohol, 70% (1)

If you intend to breastfeed your baby, don’t bring feeding bottles and formula milk for fear of your baby getting hungry if breast milk doesn’t come at once. Mother-baby friendly hospitals do not allow these items as well. Having feeding bottles and formula milk available won’t do you any good in terms of inducing milk let down. More info on breastfeeding will be provided in a later blog.

During your blissful last two trimesters of pregnancy, you would be thinking of what your baby needs in its first months after birth. Completing these needs is an exciting part of childbirth preparations. It is a logical goal to accomplish this task before you reach your 7th month of pregnancy. Though shopping for baby things is definitely fun…fun…fun, this activity is also tiring and so you should not wait until the end of pregnancy as you would need a lot of rest by then.

Knowing the gender of your baby ahead is a real advantage that would help you on deciding for colors and motif when you shop (normally shades of blue for boys, and pink for girls). But if you prefer to leave it as a surprise until the baby is born or when the baby’s position does not allow for clear determination of the baby’s gender, go for neutral colors (i.e. generally white or green).

Baby showers should preferably be done earlier for you to consider the gifts received when you make your shopping list. Also consider hand-me-downs from older siblings and cousins. It is also advisable not to have too many clothes of the same size for the baby will surely grow fast and it will be a waste if clothes will only be worn once or never at all.

The following is a sample checklist of basic items that your baby would need after birth with suggested quantities in parentheses. This is basically the list I used to prepare for my four children. I took into consideration that cloth diapers were to be used during the day whenever the baby is at home for its first two months. You can revise this list depending on your preference but having a checklist to refer to is indeed valuable.

Beddings

• Baby Cot (1)
• Cot Mattress (1)
• Cot Sheets (2)
• Waterproof sheet (1)

Baby’s Layette

• Vest, Size M (3) & Size L (3)
• Wash Cloth (6)
• Mittens (6)
• Booties/Socks (6)
• Bonnet (3)
• Long Pants (3)
• Panty (3)
• Cloth Diaper (24)
• Disposable Diaper (24)
• Receiving Blanket (2)

Baby Toiletries and Others

• Bath Tub or Large Basin (1)
• Bath Towel (2)
• Petroleum Jelly (1)
• Diaper Clip/Safety Pins (2)
• Ethyl Alcohol, 70% (1)
• Baby Lotion (1)
• Baby Bath or Liquid Soap (Lactacyd Blue/J&J Top to Toe Wash) (1)
• Cotton Balls (1)
• Baby Oil and Baby Powder (not advisable for babies with allergies or asthmatic family line)

If you intend to fully breastfeed your baby, the following are not immediate requirements unless you need to pump and store your breast milk:

• Feeding Bottles
• Bottle Brush
• Breast Pump
• Bottle Sterilizer

You definitely would need a baby bag so please add that to your list. I choose a medium size bag with enough compartments so it is easy to carry and organize things that the baby would need when going out of the house. It should also be durable to last at least a couple of years or until both you and the baby outgrow the need.

All cloth should be made of pure cotton or cotton-mix especially in humid areas. Wash baby clothes with mild detergent without chlorine. Do not let your baby wear clothes directly from the department store. Enjoy your shopping but control the urge to buy things you and your baby don’t really need. As your baby grows, you can continuously add to his/her wardrobe plus accessories of course. You don’t have to purchase everything all at once. Prepare ahead and take it slow. Shop but don’t drop.

Having a sick child is one of the most unwelcomed occurrences in every parenting journey. The sound of your child’s coughing; complaints of body pain, chills, or high fever; and vomiting are all heartbreaking for parents. If only you can take all these on your child’s behalf…too bad you can’t, but you can do a lot to prevent him/her from becoming sickly. Though sickness in growing children is normal, its frequency and severity affect the overall wellbeing of your child. Yes, you can help him/her so that he/she seldom gets sick or can easily recover if ever he/she does.

The following are natural immunity builders that parents and would-be parents should know about. I strongly recommend that you consider these when deciding what’s best for your child. Nothing compares to the peace of mind in knowing that your child has all the necessary natural defenses to common diseases.

1. Normal Child Delivery. Your role in building you child’s immunity to sickness starts even before he/she is born because you will have to decide on how you will deliver your baby. Studies have shown how birthing options tremendously affect our child’s future health. When a child is born through the natural/vaginal delivery, he/she passes through the birth canal and thus gets in contact with microorganisms necessary to ‘prime’ his/her immune system. In contrast, a baby born via Cesarean operation bypasses this natural provision for the development of a strong immune system and thus, it is delayed. An article I read from the Lifestyle section of a newspaper talked about this in detail.

There are clinical conditions when a mother is left with no choice but to undergo Cesarean operation. But for those who can choose, complete and accurate information on advantages and disadvantages of each alternative should be made available before the mother decides. A well thought of decision on this matter should have taken the baby’s best interest as the number one consideration. And I did…four times.

2. Breastfeeding. To those who had or about to deliver their babies via Cesarean operation, don’t despair. There’s another effective and natural way of boosting your child’s immune system….nourish them with your breast milk. Actually, if you missed the chance to start developing your child’s immune system at birth, the more that you need to breastfeed your baby. Aside from nutritional superiority of breast milk, colostrum (produced during the first three days) is loaded with antibodies that help develop your child’s immune system and immediately fight off early ailments.

The advantages of breastfeeding are very well documented, but still a relatively lower proportion of mothers do so for a variety of reasons. The most common are dread of pain and high demand for mother’s time and attention. It is true that the first few feedings will bring unexplainable discomfort to a point of being painful especially when the baby is not properly latched on. This is another case of ‘sacrifice’ of the mother for her child. The loss of a mother’s freedom from discomfort/pain and the necessary deviation from her usual life focus and activities will never outweigh the benefits that a mother and her child can get from breastfeeding. After this period of adjustment, every feeding time will surely be a delightful bonding moment for you and your baby.

The first two weeks I breastfed my eldest child was so unforgettable. I cried every time she cries because I knew it would surely be another toe-twisting experience; and she fed every half an hour! To make matters worse, she had a tongue-tie that made latching difficult. But I endured, for I was confident even then that I was giving one of the best gifts a mother can give her child. I breastfed all my kids and I always grin from ear to ear when their pediatricians say, ‘Hey you guys, you only visit me for immunization shots…your babies don’t get sick, that’s good… I miss you though.’ It’s all worth it! And I am a proud breastfeeding advocate.

3. Adequate Fluid Intake. How much then is adequate for a child? Fluid requirement depends on your child’s age and weight. For some idea on how to determine your child’s daily fluid requirement, signs that a child needs more, and good fluid sources, you can access this factsheet. Proper hydration is necessary to maintain normal body functions and to eliminate toxins.

As for my school-age kids, we determined that they need to drink six glasses of water a day, on top of other fluid sources like milk and juice (note that we are using 150 ml glasses to make it easier for a child to finish a glass). Coffee is prohibited in the house (ooh I miss coffee), and soft drinks are only allowed on occasions. We are experimenting on a way for our kids (and us parents) to reach the above requirement. I’ll tell you about it in a separate blog.

Part of the fluid intake regimen I recently included is Lemon Grass Tea every morning. Lemon grass is a good immune system booster from what I read. When there is an impending throat infection in anyone of us, I just add ginger. Details on preparation and other benefits from this concoction will be posted soon.

4. Proper Diet and Vitamin Supplement. There’s no substitute for proper, balanced diet. Vitamin C and E and carotenoids are probably the best immune system boosters that can be found in our diet. Vitamin C increases infection-fighting white blood cells, vitamin E reinforce the production of B-cells, which are immune cells that produce antibodies that destroy bacteria, while carotenoids increase T-cells that can also fight cancer cells.

Though we provide daily vitamin C supplement for the children, the kind of food they take in is of utmost importance. You can never go wrong with fruits, vegetables, and grains. Consciously, veggie soup with squash and malunggay (Moringa oleifera) is included at least twice in our weekly menu (Malunggay soup used to be a daily entry when my baby was still fully breastfed). We have mixed vegetables or veggie salad paired with fish very often. Meat and poultry are served from time to time, also with vegetables. Mangoes, bananas and pineapples are regulars from the market, while calamansi, guava and papaya are harvested from our yard.

The kids are allowed to have candies and chocolates…hey they are kids!!! This is done in moderation and my school kids have been trained not to overeat. Even if a friend or relative gives them a whole bag, they will only try one piece or two for they know that too much of anything is bad. It is always their Mama who finishes the sweets in the house (good for me!). Now it is my toddler’s turn to get disciplined in this aspect (too bad for him).

Our second child is the most voracious veggie eater in the family and so he has the strongest immune system. He is the least likely to get sick, and if ever he catches one, he gets well fast with just an additional dose of vitamin C, more fluids, touch therapy and rest. He doesn’t need to take in antibiotics.

5. Restful Sleep. I cannot provide a concrete recommendation as to how much time a child should sleep. Even the experts don’t know for sure. To understand why, this page is worth reading. The emphasis should be that sleep be restful regardless of duration. Not having a full rest will make one feel fatigued and also weaken immunity, thus predisposes him/her to infection. Inadequate sleep is also linked to irritability, attention deficiency and obesity in kids.

The regular nightly routine for my three oldest kids is: after they freshen up, the school kids each get hold of a book while the toddler gets hold of his feeding bottle and then asks me to sing ‘Are You Sleeping Brother John?’ for nth times. My children love to read. My seven-year-old son is already reading illustrated classic novels (He wants to finish Robinson Crusoe over this weeklong semester break). By 9 pm, my kids are sound asleep. They wake up at 5 am if there is school and I would know if they had a restful night based on how quick they move to prepare their clothes and ready their own selves. They are cheerful and attentive even if it is still dark outside. The relaxing sleep time routine probably helps them plus the positive impact of ‘no TV on school days’ policy. On weekends, they get an additional hour of sleep.

Whenever stress is emergent, usually in very few occasions when there is much work in school or anxiety over a major performance, touch therapy before bedtime works wonders.

6. Get Them Dirty. Allowing children to play outside to touch the plants and even the soil, to run around and sweat will not only enrich their learning and childhood experience but also make them stronger physically and boost their immunity to many ailments. I have to warn to not overdo this, of course, and to take precautions regarding exposure to perils in the environment (e.g. deep waters, falling branches, wild animals). What we want is to let them enjoy and at the same time expose them to both good and bad microbes to develop the natural immunity they need as they grow. Overdoing this may make them sick.

Being overprotective to your children is also a health risk in itself. As a first time mom, an Aunt kept the whole house so clean and disinfected (she was studying Medical Technology back then) to prevent my cousin from getting sick. But what happened was the opposite. My cousin had frequent visits to the doctor due to various illnesses. Doctor’s advise? Get him dirty!


I hope you find what I shared above useful. I subscribe to Benjamin Franklin’s “an ounce of prevention is worth a pound of cure”, so let us boost our children’s immune system and give them the best gift of health and wellness. It benefits us as well in terms of lower stress associated with taking care of a sick child and reduced medical bills.

photos courtesy of stockvault.net, except when labeled otherwise