Merging Into Life: Preparing for Your First Baby: The Honest Guide

[00:03:46] Sabrina Pierotti: Is there a specific question that you hear on repeat?

[00:03:50] Dr. Carole Keim: I feel like the biggest question while you’re pregnant is like, what do I need to know? What sort of information do I actually need? Because there’s so much information out there, and you don’t know what’s good, what’s not, who to follow, if it’s going to be like a different philosophy or what. I wrote “The Baby Manual” to be for these are the things that are going to happen.

[00:04:09] Sabrina Pierotti: I’m so glad that you wrote that. Like I said, I already know who I’m going to be gifting it to. And reading myself one day. Now, during those nine months, if there were three things that came to mind that would best prepare somebody before having their first baby, what would they be?

[00:04:23] Dr. Carole Keim: I think first of all, relationship, yes, work on the relationship with your partner and talk to them about baby-related things. Make sure you’re on the same page. I love parenting classes. Make sure you and your partner have the same philosophy about a lot of things. Then say, preparing the house and the home for a baby. So, a lot of parents want to set up a nursery. You don’t really need that because your baby is going to be sleeping in a bassinet, and they should be sleeping in a bassinet in your room for the first four to six months, and then, once they’re able to roll or to sit up, then you need to transition them into a crib. But the crib is supposed to be in your room, and at this point, the Academy of Pediatrics recommends until one year of age, and then you move the crib into their own room.

[00:05:07] Sabrina Pierotti: What is the reason for having the baby sleep in your room for up to a year?

[00:05:11] Dr. Carole Keim: So, all of the safe sleep recommendations that we have are to prevent SIDS, which is sudden infant death syndrome, and the other kind of half of that is the ABC of sleep, which is “alone,” on their “back,” in a “crib.” So, the A for alone, meaning nothing else in there, no blankets, no pillows, no toys, no stuffed animals. All they can have is a pacifier and a tight swaddle. I like the ones that Velcro to their body because they can’t come off and get wrapped in them like they can with like a swaddle blanket. B on their backs, so they’re facing up so that their face isn’t down into the mattress. And then C in a crib or a bassinet, something that is meant for infant sleep specifically. It needs to be a hard mattress. It needs to have a tight sheet, if it has a sheet on it that belongs with it or came with it, because babies can get tangled up in bedding and can suffocate. And so, the reason that they should be in your room for that first year is that we think that it will help reduce the risk of SIDS. Moms and babies tend to be in tune with each other, especially if they’re breastfeeding, because your melatonin is going out into your breast milk and your baby’s sleep cycle’s going to be with you. But even if you’re not, moms and baby sleep cycles tend to go together. Dads and babies, not so much. We don’t know why, it just is how it is. But moms will typically wake up when their baby’s waking up. And if the baby’s in the room with you, you’re more likely to just sense if something is wrong and to wake up.

[00:06:27] Sabrina Pierotti: So, let’s say that you’ve welcomed your new baby home, whether through birth, adoption or surrogacy. What should parents expect and do during just the first day and night with their new baby? So, like just starting on Day 1.

[00:06:41] Dr. Carole Keim: For the ones that have their baby in the hospital or birthing center, if you’re there for the night, what to expect at first. So, your baby’s going to come out, there’s a doctor and probably also a nurse there that are going to be checking your baby out, drying them off, making sure everything’s OK. They’re making the transition.

[00:06:58] Dr. Carole Keim: All babies are born a grayish blue. And that’s something that’s really important to know. It’s not like in the movies. So, OK in the movies, it’s like: Your water breaks. It’s always like in a restaurant, right? And then you rush into the hospital. And then, like maybe 20 seconds later, like there’s a bunch of screaming, and then there’s baby, and it’s like beautiful. That’s not exactly what happens. So, what is a lot more typical, if your water breaks, you might feel a gush. It’s not often dramatic. I was sitting at home doing nothing. Then when you get to the hospital, you’re going to start having contractions, and the contractions need to get closer and closer together. You’re probably going to be in labor for a while, like hours. Possibly days of contractions. So, that’s something to just be prepared. Now, if you have a scheduled C-section (cesarean section), that’s different. You do know when your baby’s going to come, and that’s easy peasy. And then, if you end up having an urgent C- section, that might end up happening for a variety of reasons. Regardless, it’s going to take a little while of your baby to come out. And babies are born this grayish blue, and that is because all of their oxygen on the inside is coming through the placenta. So, this is blood that’s already been sort of partially used by mom’s body that finally gets to the placenta gets through the placenta into baby’s body. So, their circulation, their oxygen percentage is only around 70% when they’re first born. And so, they look blue, and that’s normal.

[00:08:16] Dr. Carole Keim: They come out, they should take a big breath and cry. Their lungs fill with air. Their lungs were previously kind of like a wet sponge. They were just filled with fluid, right? So, you know how you have to like squeeze a sponge, and then it opens up, and it fills with air? Babies get that squeeze while they’re going through the birth canal, and then their lungs open up. And they cry, and it opens their lungs out further and pushes air into them. And then their circulation switches over. So, over the first 5 minutes or so, they go from being grayish blue to being pink with like a little bit of bluish-purple hands and feet. So, then babies want to eat pretty much right away. They’ll, a lot of times, latch onto their breasts pretty easily. Or if you’re going to do a bottle, you can give them a bottle right away, and usually, they’ll feed well once or twice. And then they’ll kind of forget what they’re doing, and they’re tired. There’s a lot of adrenaline with the birth, right? And then, I think it just wears off. They’re wiped out, mom and dad are wiped out. So, you’re going to have to feed them for the next 16 to 24 hours, every, at least once every four hours, if not more often. So, the first night in the hospital, definitely ask for help from the nurses. They’re going to pee and or poop probably every time they eat. So, it’ll just be this pattern of like, eat, pee, poop throughout the day, every day, for days on end.

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[00:09:59 ] Sabrina Pierotti: Now, I want to talk about sleep, because now we know that baby needs to eat every two hours, pee, poop, repeat. And sleep is very hard to come by in this early stage of life. So, these questions actually came from my friends. I like texted them, and I was like, I’m hosting a podcast with a pediatrician. What do you want to know about? Just anything, and a lot of it came from sleep. So, the first question, which I think is a great question that came from my friend, is to sleep train or not to sleep train? And I would also love for you to explain first what sleep training even is and then answer that question for me.

[00:10:44] Dr. Carole Keim: So, I feel like the way that we’ve used sleep training in the U.S. here has a lot to do with going back to work, too, and getting into a routine as a family. And we just sort of assume that the majority of people have a 9-to-5 job. They need to get back to that job. They might have between two and six weeks of maternity leave. And then they’re back on this full-time schedule. Plus, there’s also a baby at home. So, ideally, baby needs to be sleeping the same time that the parents are sleeping. And this is not realistic at all. So, when babies are first born, they have no circadian rhythms. They kind of have their nights and days backwards. And that’s because prolactin, which is the hormone that produces milk, is the highest between midnight and 6 a.m. So, babies want to cluster feed at that time, because something biologically, they just know that bodies make the most milk at that time. So, they’re eating a bunch in the middle of the night, and then, they’re sleeping more during the day to kind of make up for it, which is just like a wreck to your schedule. So, the whole idea with sleep training is, it needs to be developmentally appropriate if you’re going to try to teach a baby how to sleep and to try and get them onto a schedule that’s closer to an adult’s schedule. But you can’t do that because even their brainwaves are different as an infant. So, around 4 months of age, there starts to be a change in their brainwave pattern, and they start to have more adult-like sleep and less infant-like sleep. They’re sleeping differently, and it just is harder to fall asleep at night, or they get over tired, and they get overstimulated and kind of worked up, and then it’s hard to wind down again.

[00:12:18] Dr. Carole Keim: When your baby is less than 2 months old, if they’re awake, they need to be fed. That is why they’re awake, you need to feed them. Don’t even think about trying to sleep train. Between 2 and 4 months, they still need to eat a couple of times at night. Their belly’s not big enough, and they’re still on a full liquid diet. So, they cannot and should not be expected to sleep through the night. It’s just not safe. Around the time that you’re starting solids is around 4 to 6 months, which is around the time their sleep is changing anyway. So, they may or may not be sleeping better. What you do consistently is what you teach your children. Somewhere between 4 and 6 months you can start working on it. You can start lengthening the time that you perhaps let them be in their crib alone before you go in and reassure them, if they’re crying. Or maybe you’re sitting in there with a hand on them, and then you’re just sitting next to the crib, and then you’re sitting farther away, and then just outside the door. There’s ways to kind of progressively teach your child that they are safe, but the whole like the cry-it-out sleep method is now definitely not recommended. It’s recommended against, and it can cause problems for children and psychological problems and sleep problems. We don’t just let them cry until they fall asleep.

[00:13:26] Sabrina Pierotti: Now the next question, which I also think is a great sleeping question, your take on co-sleeping, can it be done safely or is it a strict no-no?

[00:13:36] Dr. Carole Keim: Yeah, that’s a sticky question for me, because officially, I’m supposed to say no, no, no, because Academy of Pediatrics says no co-sleeping. However, most parents will co-sleep at some point in their child’s life. And a lot of the time it ends up happening when your child is sick, which is, of course, the least safe time to co-sleep with a child. Like if they have a respiratory infection, and you’re co-sleeping with them, they’re already at increased risk of suffocation. So, things like babies can’t have blankets until a year of life. So, if you’re sleeping with an infant under a year, you can be sleeping on a floor bed, because if they roll off of a floor bed, they’re not going to get severely injured. And like a mattress on the floor is what I’m talking about. And you can’t have any blankets, because they could suffocate from blankets, and you can’t have any pillows. So, no pillows until they turn 2. So, a baby between age 1 and 2, you could have in a bed that’s on the floor with a blanket, but not with any pillows

[00:14:28] Sabrina Pierotti: Now, I want to talk really quick about the parent’s sleep. How can parents focus on their sleep health? I mean this is honestly probably what I am most scared of, because I am truly unwell if I get less than like 7 hours of sleep.

[00:14:44] Dr. Carole Keim: What I like is sort of splitting the night. And that’s, I think what worked best for us is I had a husband that had a job that would come home late at night. And so, he would take over baby care in the evening until about 2 a.m. And then I would take over from 2 a.m. to 6 a.m. So, he had like the 10 to 2, I had the 2 to 6. So, that at least for half of the night, we were guaranteed to get a solid four hours of sleep. And then for the other half of the night, we were just sort of on call for the baby, right? Another thing that I’ve heard of working is one parent feeds the baby. The other parent changes the baby and puts them back in their bed. That’s another thing that can be done. Things like blackout blinds can be really helpful. Red light at night. So, red night lights will not wake up your brain at all. And amber light is the next best. Things that have blue light, so things like screens, any sort of digital device is not great to look at at night and will trick your brain into thinking it’s daytime. And so, if you look at your phone in the middle of the night when you’re taking care of a baby, it’s going to take longer to fall back asleep and to get back into that deep sleep that you really need. White noise machines can sometimes help. You don’t necessarily have to do those things for your baby. I like these more for adults, actually.

[00:15:54] Sabrina Pierotti: I wanted to spend the last part of our conversation really focusing on the parents and the emotional toll that it takes, especially having a newborn. So, let’s dive into postpartum a little bit. And I want to start off with postpartum depression and your experience with it. What are signs of postpartum depression?

[00:16:15] Dr. Carole Keim: One sign was that I didn’t really connect with my baby. And at first, that’s OK. Like, when a baby is first born, I feel like we have this social pressure that you think you’re going to look at the baby and immediately be in love for the whole rest of your life. And that doesn’t always happen right away. You know, thinking, like, I’m just not feeling this. Like, this could be any baby. I don’t feel particularly connected to this baby can be a sign. Now, the official signs of postpartum depression, we have this thing called the Edinburgh Postnatal Depression Scale. It can creep in with this sort of sense of like, I’m not doing a good enough job, which is especially in this day and age with everything, like the pressure to be the perfect parent is so high right now. When’s the last time I laughed at a TV show or a movie, or do they all make me cry? When’s the last time I hung out with my friends? Do I want to hang out with friends? And if you don’t want to do the things that you would normally want to do, that can be a sign of postpartum.

[00:17:13] Sabrina Pierotti: I want to talk about the support system, and a lot of us say it takes a village to raise a child, but what do you say to that person who doesn’t have family close by, or a huge support system.

[00:17:26] Dr. Carole Keim: I’m actually doing a, the season of my podcast is the, it takes a village podcast, where it’s like all the different support networks. So, it’s really just learning like what support is out there that you didn’t even know existed. There are, there’s so much out there that’s not just family. Of course, family is the first that comes to mind, right? You can find middle school, high school age children in your neighborhood that can come over and be mother’s helpers or parent helpers. Right, where you can have them say, baby’s in the playpen or baby’s taking a nap and they just sort of sit nearby, tell you if baby wakes up kind of thing, but you can get something done. You can also have them help you with specific tasks. Like they’re big enough that they could help sweep a kitchen, for example, and load a dishwasher or things like that. So, you can ask neighborhood friends, neighborhood children to help out with that. Then kind of branching out to like paid babysitters, nannies, au pairs, there’s paid childcare help available as well. Some workplaces have childcare built in or have on-site childcare that you can have. If you have any other sort of community, if you have a community through your church or religious organization, or if you a community that, like I do martial arts, like, I had my karate friends, right? My knitting friends. Communities also love to come together and put together things like meal trains and stuff like that and help out, and also, just come over and keep you company. They can body double. They can at least feel like you have someone else there, because it can also, especially if you have a partner that is working or if you’re a single parent, you’re spending all your time with somebody that doesn’t talk, and you kind of feel like you’re going crazy just talking to yourself all the time. So, it can be really helpful to have somebody over just to keep you in company.

[00:19:10] Sabrina Pierotti: Alright, now we are headed into our mailbag segment, and this is an exciting segment where listeners of the podcast and AAA members have a chance to ask their questions. I love this question. This is such a good question, and I’m very curious what you have to say about it. So, our listener said, I’m a new parent to a young baby, and one of the hardest parts of postpartum life has been losing my routines. Before having a baby, I really relied on predictable mornings, getting up, moving my body, showering, making breakfast, and starting the day with some structure. Now, if I’m lucky, I get a few minutes to myself, and even though I know life won’t go back to exactly how it was, I’m struggling to adapt to this new normal. When do routines usually start to feel possible again after having a baby, and how can new parents create a rhythm that feels realistic when every day still feels unpredictable? I love this question.

[00:20:08] Dr. Carole Keim: When babies are very first born, you’re not going to have a routine for the first couple of weeks. It’s just kind of all over the place. It was like a 24/7 routine, where it’s just like feed the baby, change their diaper, make sure I’m also eating and going to the bathroom. And like that’s it. And then you finally get into the swing of that. And then they start being awake during the day, around a month. And you’re like, this is weird. It like it throws you for a loop. It is going to throw you. So, you’re like, what do I do? How do I keep them busy? The short answer is you don’t have to. You just let them look. At 1 month of age, they love to look at things like a window with leaves outside of it or a ceiling fan, like it’s fascinating. Or just sit there and watch you do and just like narrate your day to them. And then everything, they say everything’s a phase, right? And you finally get into a pattern, and you’re like OK, this is easy. And then something else shifts. They start to consolidate their sleep. So, over the first six months or so, sleep is really, really patchy, and you’re working more with like wake windows than like sleep chunks. Whereas between 6 and 12 months (old), it’s more like, OK, now they have like sleep plus naps, and then they’re awake the rest of the time. And so, then I’d say between 6 and 12 months (old) you get a little bit more of a routine because you’re now able to kind of plan around like, I know when they’re going to be sleeping and when they are going to be awake. And that’s a big thing, right? Between 1 and 2 (years old), you’re starting to feel like a human being again. When your child is finally able to start walking a little bit, they can start telling you things with words. And yeah, it’s when you’re really getting back to it. Yeah.

[00:21:34] Sabrina Pierotti: Hang in there, listener, you got this. Carole, this has been, I mean, you are a wealth of knowledge. Thank you so much for everything that you shared. And I just want to ask if there’s one thing that you and our friend listening today to take away from today’s conversation, what would that one thing be?

[00:21:53] Dr. Carole Keim: I’d say that there’s a lot of information out there about health and children and it’s constantly changing. And so, just keep in mind that you can always trust your gut. It’s always OK. It’s OK to ask for help, and also, it’s always OK to filter the information that you get and decide what works best for you and for your family and really just focus on that, because what works for somebody else might not be the best thing for you.

[00:22:19] Sabrina Pierotti: Carole, where can people find you if they want more information about you.

[00:22:22] Dr. Carole Keim: I’ve got my website; it’s carolekeim.com, spelled c-a-r-o-l-e-k-e i-m dot com. There’s also my linktree, which I can send you the linktr.ee/drkeim. I’m also on TikTok and YouTube LinkedIn, Facebook, Instagram, all the things, yeah any of those places. I wrote “The Baby Manual” actually in 2015, and I wrote it because I kept getting calls in the middle of the night for the same kind of things, and I was like, look, if it was just written down and parents knew about it, they wouldn’t be panicked, and they wouldn’t be calling me over these things. I really just wrote it to like give to my patients, and now I’m on the third edition.

[00:23:02] Sabrina Pierotti: This has been awesome. Thank you so much for joining us today. There’s so much information out there for new parents, and one of the biggest takeaways from this conversation is that you do not need to know everything all at once to be a good parent. Preparing for your first baby doesn’t mean having every answer before Day 1. It means knowing where to turn, giving yourself permission to ask the questions that feel silly and remembering that a lot of uncertainty is completely normal. As Dr. Keim reminded us, there really are no stupid questions when you’re learning how to care for a brand-new baby and yourself at the same time.

The views and opinions expressed in this podcast do not constitute medical advice and are not necessarily the views of AAA Northeast, AAA and or its affiliates.