This leaflet provides information about our ‘keeping mothers and babies together’ pathway. If you have any questions or concerns, please speak to your midwife.

What is the aim of the keeping mothers and babies together pathway?

Most babies stay with their mothers on the postnatal ward after birth. Some babies require extra support and monitoring on the ward, including:

  • babies born four to five weeks early who are less than 2.5kg
  • babies requiring antibiotics
  • babies requiring phototherapy
  • babies requiring extra observations including blood sugar monitoring.

The keeping mothers and babies together pathway allows the medical and midwifery teams to easily identify these more vulnerable babies and support families in looking after them, so that mother and baby can stay together and mother can be the primary carer for her baby.

Why does my baby have an orange hat?

All babies identified as needing additional care should wear an orange hat for the first 12 hours of life. This helps the team easily identify which babies need extra care and allows the team to take timely observations, blood sugar tests and provide extra support to establish feeding.

You don’t have to use the orange hat on your baby. If you prefer to use your own hat, ask for the orange hat to be taped to your baby’s cot so that it is still visible to the team to highlight that your baby needs extra attention. After 12 hours the orange hat will be removed as your baby will no longer need it, but if you would like to keep it as a memento, please ask the midwife.

In hospital, hats are often advised as baby adapts to life. However once home your baby should not wear a hat indoors. If returning home from a trip outside with your baby, please remove their hat.

What additional care on the ward will my baby be given?

Babies identified as needing extra support will be given:

  • An orange hat.
  • Monitoring of baby’s temperature, breathing and heart rate: every two hours for at least 12 hours. Some babies (for example babies receiving antibiotics or phototherapy treatment for jaundice) will continue to have their observations monitored every four hours thereafter.
  • Feeding support: You will be given a feed chart so that we can monitor how well your baby is feeding and whether extra support is needed. Your baby should feed at least every three hours but this can be more frequent if your baby is shows feeding cues (mouthing, murmuring and getting fidgety).
  • Temperature monitoring: Premature and small babies can sometimes find it difficult to maintain their body temperature. Your baby’s temperature will be monitored regularly, and support will be given to maintain their body temperature within normal levels.
  • Blood sugar monitoring: This will be done for some babies including premature babies, small babies, and babies at risk of low blood sugars. We check blood sugar levels by taking a drop of blood from your baby’s heel. This is done prior to feeding your baby, and with regular feeding, the level usually stabilises quite quickly, and monitoring can soon stop.
  • Weighing: If you are still on the postnatal ward, your baby will be weighed on day three of its life. If you have gone home, a midwife will visit you and your baby and weigh your baby on day three if they weighed less than 2.5kg at birth. All other babies are weighed on day five.
  • Newborn check: All babies will have a complete newborn head-to-toe check within the first three days after birth. Please ask a member of the team if you are not sure whether this has been done.

Does this mean my baby will not go to the neonatal unit?

Our aim is to give you the support that you need so that your baby can always remain with you. Sometimes, however, there may be a need for your baby to be admitted to the neonatal unit. If this happens it will be fully discussed with you with one of the paediatric doctors, as well as the midwives looking after you.

When can I go home?

Babies will be discharged once all the observations are stable, feeding is well established and other treatments such as antibiotics or phototherapy for jaundice have been completed. The length of time is different for each baby. The midwife or paediatric doctor looking after your baby will be able to discuss this with you.

Once I am at home:

Signs of a well-baby: feeding  

Baby is waking for feeds and is having between 8-12 feeds in 24 hours.

Baby should be having wet and dirty nappies as follows:

 

Day

Wet nappies

Type of poo

1

1-2

Meconium (black sticky poo)

2

2-3

Brownish green (becoming lighter in colour)

3

3-4

Becoming lighter in colour

4

4-5

Yellow coloured poo

5

6+

Yellow poo

Jaundice

Jaundice is when your baby`s skin and white of the eye may show a yellowish colour and can be a normal process if more than 24 hours old.   If your baby is less than 24 hours old and you notice this, please alert your midwife or other health care professional on the numbers provided to you or the numbers below.

Jaundice usually presents after day three and may last as long 14 days. Jaundice is one of the most common conditions that can affect newborn babies. It is estimated that six out of every 10 babies will develop jaundice.

While this is often a normal event, there are times that your baby may require extra observation.  It is important that your baby is passing urine, poo and is waking for feeds and having between 8 to 12 feeds in 24 hours.

Reasons to seek advice

  • Your baby`s skin or white of their eyes is visibly yellow either on the face, body or legs

  • If they are not waking for feeds or difficult to wake

  • If your baby is not passing urine or poo

Please contact your community midwife or triage:

Royal Free Hospital

Tel: 020 7433 2957 (direct line).

Barnet Hospital

Tel: 020 8216 4408 (direct line).