The First Bath
The First Bath

Photo by Marcin Jozwiak on Unsplash

written by Anna Sarreither — Pediatric Nurse

Introduction

For most new parents a newborn’s first bath is something incredibly special, but also a little intimidating. It is a very intimate moment between the one giving the bath and the baby. Additionally it is a brilliant opportunity to get to know a baby and observe how it reacts in different settings. Does it like being undressed? Does it actually like the feeling floating in water? Does it like being washed? From my experience and shown in recent studies bathing has psychological benefits for the baby and parents. (1) Most babies enjoy being in water and floating, it reminds them of the feeling of being back in the womb — it is comforting and warm, and the memory of floating in a protected surrounding comes back to the young baby. Additionally a paper published 2018 in ‚die Hebamme‘, showed that bathing is better for the skin of a baby in the first year of life, than sponge bathing it. (1)

Frist of all, I am going to explain the term ‚swaddle bathing‘, which is often used in this article. The term ‚swaddle bathing‘ is generally understood to mean, that the baby is placed on a muslin, in which its extremities are wrapped, while keeping a flexed and midline position, this helps with the baby’s body perception. While wrapped in the muslin, the baby is immersed into the bathtub. Each extremity is individually ‚unswaddeled‘, washed, rinsed off and recovered, to maintain the flexed midline position during bath time. (2)

Timing of the first bath

The actually timing for a first bath varies between different cultures and religions. Even 24 years ago, when my mother gave birth to me timings were very different to those recommended today. As my mother told me, I was bathed for the first time, by my father, just an hour after being born, without any attention to religious and cultural background. It was hospital policy back in 1997 in Germany, that babies were bathed after birth to wash of the vernix caseosa (white cheesy protective matter, which is unique to humans and protects the baby’s skin inutero and after birth) and blood from birth. It was deemed as the first step in the bonding process between a newborn and its father. There are diverse cultures and religions that bathe a baby straight after birth, because of their beliefs and traditions. For example, in Hinduism it is traditional to bathe a baby for the ceremony known as nwaran (naming ceremony). This usually takes place somewhere between the 3rd and 12th day after birth. Also among Slum Dwellers in Rachna Town, Lahore, Punjab, Pakistan, women reported bathing the babies soon after delivery, with most babies being bathed just after cutting the umbilical cord. Delivery fluids and blood are regarded as polluted (napak) and hence the baby is not perceived to be clean or pure until it has been bathed. (3) To decide when you want to bathe your baby, you have to know two key points in the care of a newborn. There is always the outcome that shows immediate side effects and those that are presented subsequently.

So, to decide whether to bath the baby straight away or delaying it for a few hours or even days, you should know the differences between evidence based outcomes that where shown in studies concerning hypothermia (body temperature drops below 36,5°C in newborns (4)), hypoglycemia (blood glucose <45 mg/dl, varies in literature, this is the average (5)) and results in breastfeeding — these are the immediate side effects and evidence based outcomes concerning hydration of the skin, which are subsequently presented. (6)

In 2017 the World Health Organization published an update to its ‘Guideline for the Newborn Health’ which recommended „Bathing should be delayed to after 24 hours of birth. If this is not possible at all due to cultural reasons, bathing should be delayed for at least 6 hours. Appropriate clothing of the baby for ambient temperature is recommended, this should be 1–2 layers more than adults and a hat. The mother and baby should not be separated and should stay in the same room 24 hours a day.“ (7) Furthermore, a new study by Susan Warren et al, that was published in March 2020, showed that bathing a baby after 24h brings extreme benefits with it (in comparison to bathing the baby in the first 24 h): „Delaying the newborn bath for 24 hours was associated with an increased likelihood of exclusive breastfeeding at discharge and a decreased incidence of hypothermia and hypoglycemia in healthy newborns. The implementation of a delayed bathing policy has the potential to improve breastfeeding rates and reduce the incidence of hypothermia and hypoglycemia.“ (8) One should also keep in mind, that the baby will have its umbilical cord stump until approximately week two too three after birth. (9) There were no signs of increased infection in the study researching ‘taking or not taking a bath’ by the Department of Pediatrics, Aja University of Medical Sciences, Tehran, Iran, but there was however evidence that the stump fell off faster. (10) One should keep in mind that an open wound, such as the navel ground presents, is always an entry point for bacteria which can lead to infections. By reducing the time of the stump to fall off, one also reduces the risk of an entry point for infection. Now that I have explained the choices to be considered in the timing of a first bath, I would like to continue presenting the benefits in different timings of the day.

Timing of the day

A child thrives from rituals and consistency of routine. (11) For example, bathing a baby before bedtime is a very good opportunity to help the newborn to relax. On the other hand, when considering that a baby has no properly developed sleep-awake rhythm in the first three to four month, it will dictate appropriate timing itself. As the sleeping periods during nighttime increase, a bathing routine will be easier to establish. (12) Concerning how often to bathe a baby, dermatologists recommend bathing only 1–3 times a week to keep the physiological skin barrier intact. (13) It is not recommendable to bathe a baby just after being fed. One should always remember the saying ‘Rest and Digest’. (14) Feeding before bathing would stress the baby’s delicate body circulation and due to that, it will most likely vomit. Ideally, one should bathe a newborn when it has woken up but is not yet hungry. One may think this is impossible, but the more one can read the baby, the easier it will be to predict. One should calculate 30 minutes for the whole bathing procedure; this includes dressing and undressing, as well as skin care. It does not include preparation. The actual bathing time of the bath should not exceed 5–10 minutes, with an ideal tendency leaning towards 5 minutes. (15) One should calculate, that the undressing, drying of, skin care and redressing, will take up some time around 20 minutes if one does this in a relaxed manner. It is important to note that bathing makes a baby very tired and hungry. If one stretches the time over 30 minutes it will probably exhaust the baby and it will not drink its usual amount, which will result in it waking up earlier due to hunger.

To get a better understanding why certain methods are recommended, here are some additional informations, which will make it better to understand.

Additional Informations

As already presented in section ‚Timing‘, most baths after birth are carried out to wash of the vernix caseosa. However increasingly studies have show over the years, that the white, cheesy matter, actually bring a lot of benefits with it, such hydration of the skin or barrier function in utero. It has several developmental and protective functions for the unborn as well as the newborn infant. For further informations read the article ‚The Phenomenan Vernix Caseosa‘. In the research paper of Cinar et al, published August 2020, concerning the effect of newborn bathing training with the swaddled and tub bathing methods given to prim parous pregnant women on the mother’s experience, satisfaction and newborn’s stress during the first bathing of the newborn at home, it was shown, that the the training had a positive effect on the mothers satisfaction. A mixed method study was demonstrated and presented that mothers who practiced a newborn bath before birth, were more relaxed in their surrounding, whilst preforming the first bath with their newborn. Additionally there was less mentioning of anxiety concerning drowning or harming the baby, by the new mother. This has also shown that the baby is more relax during bath time. (16) Therefore, it is recommendable to try it once before the baby’s arrival, whilst going through each step. One should prepare everything as listed in article ‚The First Bath II‘ , borrow a doll or offer to bathe a friend’s newborn baby. One should also know that a baby is not able so shiver after birth due to lack sufficiently developed skeletal muscle mass to maintain body temperature. Nevertheless, it possess brown fat, which has tissue that converts chemically stored energy, into heat through the metabolic non-shivering method. This method needs a lot of oxygen, which is why studies have shown, that a stressful, long bath as well as a not warm enough surrounding temperature was detectable in the baby measured oxygen levels afterwards. The non-shivering method can persist up to the age of two. (17) Additionally, the relation to the birth weight, newborns have a big body surface, which also favors heat loss. (18)

Additional Sources
['Anna Sarreither']
['Newborn', 'Baby', 'Motherhood', 'Parenthood', 'Parenting']