The nurses in the postpartum ward taught me how to change diapers. Surprisingly, none of the first page or so of google results has all of these tips. So I will type up my notes in case they are useful to anyone else.
Change immediately if you see a stool or if the baby seems unhappy. If the baby is not unhappy, it is okay to leave a wet diaper for a few hours. If the baby is having trouble sleeping, it may be better to leave the diaper wet than to wake the baby for the diaper change.
To check for stool, pull back the leg cuff behind the baby’s butt and look inside. Large stools may be visible from the outside: the diaper will distend.
To check for urine on a disposable diaper with a moisture-sensitive strip, look for a change in the color of the strip. The color may change only in the back.
To check for urine on a diaper with no such strip, feel for dampness.
People develop their own workflows. The nurses I asked all demonstrated slightly different techniques. Here’s the basic idea:
- Lay down a changing pad or towel if necessary to protect the surface.
- If using a dry wipe or cloth, moisten it with some water. If using pre-moistened wipes, open the packet and draw one out. Use ones moistened with water only. It was previously common to moisten wipes with an alcohol solution, but that dries and irritates the skin.
- Lay the baby on the surface, feet toward the dominant hand and head toward the non-dominant hand.
- Expose the diaper. Swaddling cloths need to be removed. For onesies and similar garments, undress the legs and flip the fabric up behind the baby’s back.
- Unfold the new diaper. Disposable diapers have their sticky tabs on the posterior panel. The leg cuffs should be unfolded to point distally down the legs.
- Slide the new diaper underneath the baby, still in its old diaper. It’s easier to position the diaper now when both hands are available. The new diaper also helps catch drips.
- Grip both ankles with the non-dominant hand, with a finger between the two legs.
- Open the old diaper.
- Flex the baby at the hips to expose the bottom. Fold the legs down toward the chest, rather than hoisting the baby up by its ankles.
- For stool, use the old diaper to wipe the bottom. Make one motion from front to back to avoid contaminating the urinary tract with stool.
- Fold the old diaper underneath the baby’s bottom.
- Use the moistened wipe to clean away the stool. This is a surprisingly complicated operation. See detailed description.
- Put the wipe on top of the dirty diaper.
- Pull the dirty diaper away from the baby.
- Roll the dirty diaper into a tight wad containing all the stool and the wipe. Leave one sticky tab exposed and use that to secure the roll.
- Push the anterior panel of the new diaper between the baby’s legs.
- Using the dominant hand to stabilize the head and neck, rotate the baby a quarter-turn so its feet point toward you and its head away.
- Lay the legs down, and pin them to the table with the heels of your hands.
- If the umbilical stump is still present, fold the top edge of the diaper down to leave the stump uncovered.
- Tape the posterior panel onto the anterior panel, probably tighter than you expect. See details below.
- Clean the changing pad, throw away the dirty diaper, close the packet of wet wipes, etc.
- If you wore gloves, discard them. If you didn’t, wash your hands! And then moisturize them, because you’ll be doing this about a dozen times a day for a while. See details.
Make two passes over the baby’s bottom, first to clean away the gross stool and then again to clean all the folds more carefully. Each pass is from the front to the back, to avoid contaminating the urinary tract with stool.
For the second pass, you might need to do something complicated with your hand to separate the baby’s legs while still restraining them. The specific technique here is hard to describe and apparently varies a lot from person to person based on factors like hand size, so I won’t try to give any more detail.
In each pass, use short dabbing motions with the wipe. Use a corner of the wipe for the first dab, then fold it down to conceal the soiled part. Rotate the wipe a little and dab again with a spot a little farther along the edge of the wipe. Proceed around and around the wipe, rolling it in from the edges to keep the soiled areas covered, until you have it in a wad.
At first, you need to use a finger behind the wipe to apply pressure. As the wipe becomes more wad-like, you can use it more like a cotton ball. It’ll also get easier to get into the creases that way.
The diaper is tensioned correctly around the baby when there is a little resistance and only a little resistance when you put two fingers into the waistband. Most new parents under-tension the diaper, even when informed that most new parents under-tension the diaper.
Signs the diaper was too tight:
- The baby has a red mark across the belly at the next diaper change.
- The baby tugs at the waistband, cries, or otherwise seems unhappy.
- The baby struggles to feed or need more frequent burping. (Apparently, you can fasten it so tightly that it compresses the baby’s stomach.)
Signs the diaper was too loose:
- It slides down.
- The stool is not contained.
This is another area where I was surprised by how much the nurses had to say.
In addition to the obvious stuff labeled for moisturizing hands, they pointed out that diaper cream was usually petroleum jelly and worked fine for hands. Chapstick and cooking oil work too. In a pinch, you can even scavenge oils off other parts of your body by running your fingers through your hair or rubbing your face.
Bottom line: always moisturize after washing, because you’ll be washing as many as a dozen times a day.
I was surprised by how much there turned out to be. I guess they try to downplay the learning curve in order to reassure people that they’ll be able to learn it. But it turns out that if you ask six or seven people to explain something they’ve done a dozen times a day for a decade, you get a lot of information.
Also, they’re really fast. I glanced at the clock before asking one of them to show me, because I wasn’t sure if she had time. Shift change was a bit over a quarter hour away. She changed the diaper in a quite leisurely fashion, stopping several times to point out various details, let me look at her hand positions, and answer questions. She left about two minutes later.