From black and white contrast patterns for visual stimulation to crinkle sounds to spark auditory development, Lamaze toys are “Baby Loved, Science Proven”. Our award-winning toys are created through dedicated research with the help of child development experts, focused on designing The Right Toy at The Right Time.
Lamaze is a nonprofit organization that promotes a natural, healthy and safe approach to pregnancy, childbirth and early parenting. Your purchase supports education and advocacy for safe and healthy pregnancy, birth and early parenting around the world. Learn more at lamaze.org.
Congratulations! We wish you the best as you prepare for your baby’s arrival and hope Lamaze can be part of your special journey.Christy Carlson Romano, brand ambassador for Lamaze toys, is the beloved star of Disney Channel and ABC Family hit shows including: Cadet Kelly, The Even Stevens franchise, Campus Confidential, Taking Five, The Cutting Edge 2: Going for the Gold, and The Cutting Edge 3: Chasing the Dream. She also voiced the title character in the animated Kim Possible, which earned her a Daytime Emmy nomination, and has starred in Broadway productions of Beauty and the Beast and Avenue Q.
For years you may have had Pap smears at your well-woman visit. But recommendations have changed
Supporting women through miscarriage is possible with advice from those who have been through pregnancy loss
Here’s the basics on the latest in babymaking
When your thyroid gland is working as it should, your metabolism is steady
Are you bleeding between periods? Feeling full? Ask whether uterine fibroids could be to blame
Here’s what makes birth more positive and safe when all is healthy and well with mom and baby
Have you ever noticed a fishy smell coming from ‘down there’? This sign could indicate a vaginal infection
Prenatal visits, marijuana and baby, and probiotics in pregnancy
This optional screening can provide genetic and other information about baby; learn about its uses and risks
Pregnancy brings changes to your skin through each trimester
Labor isn’t the most comfortable thing you’ll ever do, but when you prepare to use the power of your contractions working with your body to birth baby, you’ll begin to see the pains of labor in a whole new way
Here’s why your care provider regularly checks on baby’s heart rate and rhythm
You and your baby both benefit from the nutritional support of prenatal vitamins
Your baby has hemophilia—what is that? Learn more about this genetic bleeding disorder and how it may affect your child
Experts agree that there are no safe levels, or safe times to drink alcohol during pregnancy—but what about after baby is born?
Breastfeeding with flat or inverted nipples may seem like a challenge, but with these strategies, success is still possible
Sleep is vital to your baby’s health and growth—even their ability to think and learn
What our kids really need from us
Who doesn’t look forward to the day when diaper changes become a distant memory?
When Alison’s son was first diagnosed, she felt guilty and sad for her baby boy. But by processing her emotions through a creative outlet, she found a wealth of support
The latest safe infant sleep recommendations are based on what experts have learned and are known risk-factors for sleep-related infant deaths
Dozens of young children die every year after being forgotten in a car that heats up as temperatures rise
Into a growing family comes the challenge of introducing siblings to your newborn
How you engage with your baby during diapering can promote their development, growth, well-being, family bond and sleep. Learn more in our Parent Booklet.
CANDACE ANN CAMPBELL , DNP, RN, CNL
University of San Francisco Concord, CA
ROBERTA DURHAM, RN, PhD California State University East Bay Hayward, CA
JOANNE GOLDBORT, PhD, RN Michigan State University East Lansing, MI
HELEN M. HURST, DNP, RNC-OB, APRN-CNM University of Louisiana School of Nursing Lafayette, LA
ELIZABETH JORDAN, DNSc, RNC FAAN
University of South Florida College of Nursing Tampa, FL
CAROLYN “CARRIE” LEE, PhD, MSN, CNE, RN
University of Toledo College of Nursing Toledo, OH
JENNIFER LEMOINE, DNP, APRN, NNP-BC University of Louisiana at Lafayette Lafayette, LA
RITA NUTT, DNP, RN Salisbury University Salisbury, MD
SUSAN PECK, MSN, APN Summit Medical Group Cedar Knolls, NJ
MICHELE SAVIN, MSN, NNP-BC Christiana Health Services Wilmington, DE
PAT SCHEANS, MSN, NNP Legacy Health System Portland, OR
SHARON JEAN SCOTT, DNP, MSN, RN Germanna Community College Locust Grove, VA
JAMIE M. VINCENT, MSN, RNC-OB, C-EFM John Muir Medical Center Walnut Creek, CA
KIMBERLY WILSCHEK, RN, CCE Medical Revenue Solutions Chicago, IL
CHARLOTTE WOOL, PhD, RN, CCNS York College of Pennsylvania York, PA
TAMERA YOUNG, RN, MSN
Central Ohio Technical College Zanesville, OH
MARIA OPLT
Lafayette, LA
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AWHONN’s mission is to improve and promote the health of women and babies. Healthy Mom&Baby is powered by the nurses of AWHONN.
BY JENNIFER L. DOYLE, MSN, WHNP-BC
Daily, nurses guide and provide expert care for the 4 million women who will give birth in our country each year. Whether this is your fi rst pregnancy, or second or third, you may have already realized during pregnancy that the journey to childbirth can be intense, emotional and a time in your life you’ll always remember and reflect on.
As you consider your impending labor, have you given any thought to who will be with you as you birth your baby? Pregnant women who have continuous support from their care providers such as their midwife or nurses, from doulas, and family or friends trend toward better outcomes, including:
Birth baby vaginally after spontaneous labor
Experience a shorter labor
Have baby better cope with labor and birth
Retain positive feelings about labor and birthing
Birth via cesarean
Require birth interventions, such as the use of forceps
Need pain medications to cope with labor
e nurses who provide care for moms and babies combine nursing expertise and clinical knowledge to create an individualized, personalized healthcare experience for each mom and baby. Your nurses provide the care that you and your baby need, and they also coordinate the care you’ll receive from other healthcare team members, including doctors, midwives, anesthesiologists, and lactation consultants, to name a few. eir goal for every mother and baby is to ensure a safe and healthy labor, birth and recovery.
Your nurses will be with you during labor and birth to:
Support and help you understand your progress in labor
Help you change positions, move, walk or rock on a birthing ball to provide movement during labor
Tune in to your needs for physical and emotional comfort, share information and advocate with the rest of the healthcare team for your wishes and desires regarding labor and birth
Monitor your health and progress in labor, as well as baby’s
Keep you updated on labor progress and offer support in coping with the waves of labor
Show your support persons how they can help and support you during baby’s labor and birth
Support you through the recovery process, including going skin-to-skin with baby and beginning breastfeeding at birth
Your nurses are eager to provide the expert care, emotional support and physical comfort you desire as you bring your baby into the world. Don’t hesitate to partner with your nurses for the best possible labor and birth journey possible.
JENNIFER L. DOYLE, MSN, WHNP-BC, is the AWHONN 2018 President.
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© AWHONN, 2018. All rights reserved. All material in Healthy Mom&Baby is wholly copyright. Reproduction without the written permission of AWHONN is strictly forbidden.
Neither this magazine nor its contents constitute an explicit or implied endorsement by AWHONN or by Maitland Warne of the products or services mentioned in advertising or editorial content. The editorial content in this publication does not necessarily represent policies or recommendations by AWHONN. This publication is not intended to be exhaustive. While every effort has been made to ensure accuracy, neither AWHONN nor Maitland Warne shall have any liability for any errors or omissions. Readers who may have questions should consult their healthcare provider.
As moms, we’re hard on ourselves. Every decision, every interaction with our child is weighed and judged as if it could have lifelong, irreversible effects! Did we eat and do the right things in pregnancy? Do other moms nap when baby naps? Is it really OK to take an afternoon away at the salon and leave baby with your partner or a trusted friend? (It is!)
In this issue, we’re kicking mommy guilt to the curb. While you’re pregnant, it’s all about your bump and due date. Once baby arrives, it’s all about them! Are they eating? Sleeping? Nursing? Following your gaze? Cooing and babbling? We scrutinize every moment. Where does this leave you, gentle reader?
Moms, you need as much attention and care—if not more!—before and after baby’s birth. Doting on you starts with exploring Where Birth Is Best (p. 20) so that both you and baby get a healthy 4th trimester. For your labor support needs, have you considered a doula? We’re huge fans; let our nurses tell you why.
Pampering you, mom, means addressing the little, if any, sleep you’ll have once baby is home. You likely know experts want your little to one to share your room—not your bed—until their 1st birthday. We’ve got tips to grab that needed rest, especially when baby snoozes (p. 61).
Lastly, we can’t promise everything will be perfect for your little one, yet we have confidence that you’ll face any challenges that come your way as only moms intuitively know how to do. Meet one mom whose baby developed flat head syndrome, oh my! Be inspired by how this photographer supported her son and shattered her mom guilt through her creativity and care (p. 57).
We’re here for you mom! Until next time,
MAITLAND WARNE
123 W Madison Street, Suite 1600, Chicago, IL 60602, USA Tel: (312) 572-7727 Fax: (312) 284-5864 www.maitlandwarne.com
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Carolyn Davis Cockey, MLS, LCCE
Editor-in-Chief & AWHONN Director of Publications
Health4Mom@AWHONN.org
Most parents understand babies sleep better and longer when swaddled. It is important for parents to know when and how to transition from a swaddle to a wearable blanket. The American Academy of Pediatrics urges parents to stop restraining baby’s arms in a swaddle at three months or when baby shows signs of attempting to roll over, and to start using a wearable blanket. However, many parents feel their baby is not ready and they continue to swaddle, which increases risk of suffocation if baby was to roll over when swaddled. To bridge the gap from swaddle to sleeping sack there is a new option - the Swaddle Sack with Arms Up and Mitten Cuffs.
The Swaddle Sack with Arms Up design supports multiple natural sleep positions and partially suppresses the Moro (Startle) Reflex while providing swaddle comfort and support, and if baby rolls over, the design allows baby to use his or her arms to lift baby’s torso and reposition his or her head to get access to air. The mitten cuffs allow parents to open the cuffs, so baby can self-soothe, or close the cuffs to protect baby from facial scratches. The Swaddle Sack is the perfect transitional swaddle and the missing step in current safe sleep programs.
Swaddle Sack with Wings 0 - 3 months
• Arms Up Sleeves & Mitten Cuffs
• Keeps arms close to body
• Suppresses Moro Reflex
• Snug Fit & Hip Healthy
• Baby Can Self Soothe
• Breathable Cotton
• 2-way Zipper
Swaddle Sack® 3 - 6 months
• Arms Up Sleeves & Mitten Cuffs
• Use of Arms (if baby rolls over)
• Partially Suppresses Moro Reflex
• Snug Fit & Hip Healthy
• Baby Can Self Soothe
• Breathable Cotton
• 2-way Zipper
Sleeping Sack 6 - 12 months
• Sleeveless Wearable Blanket
• Use of Arms (if baby rolls over)
• No Suppression of Moro Reflex
• Ample Leg Room & Hip Healthy
• Baby Can Self Soothe
• Multiple Fabric Options
• 2-way Zipper
Every baby has unique sleep preferences that change as they grow and develop. The Swaddle Sack with Wings is convertible and designed to provide flexibility, comfort, and support. For babies who prefer one arm out when swaddled, the sleeve will help keep baby’s arm warm and the mitten cuff may be worn open or closed. For babies who enjoy sucking on their hand, parents can open one or both mittens to allow baby to self-soothe. The cuffs may be closed if the caregiver is concerned about facial scratches. When transitioning from a swaddle, many babies sleep better with the snugness and unique sleeve design of the Swaddle Sack, while other babies prefer a traditional wearable blanket. It is important for parents to consider both options, so they can make the best choice for their baby. The goal is Better Sleep and Safer Sleep.
LYNETTE DAMIR, RN, CEO & FOUNDER OF SWADDLEDESIGNS, is known for her stylish, functional & innovative designs to help parents care for and comfort their baby. Please visit SwaddleDesigns.com to learn more.
You’ve got questions but you’re between appointments—what should you do?
Ask a friend?
Wait it out?
Ask an AWHONN Nurse?
Yes! Visit Health4Mom.org, post your question and an AWHONN Nurse will answer.
You’ve got questions. We’ve got expert answers.
*These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.
Trying to conceive (TTC) got you stressed? You’re not alone: 80% of women TTC say hearing about other people getting pregnant caused them stress and depression, according to an international survey by fertility solutions manufacturer Ava. Most people would likely never know that because 61% of respondents said they don’t feel comfortable talking about fertility other than with close friends and family.
The survey also revealed other fertility issues women struggle with:
83%
49%
of US women underestimated how long it takes to get pregnant
didn’t know about the importance of timing cycles to conceive
More than half the women polled said they have had “inconvenient” or “unromantic” sex in order to try to conceive
Cheese, cow’s milk, eggs, ice cream, saltwater fish, shellfish and yogurt are rich in iodine.
Your baby cries, and you immediately comfort them. It’s like you’re hard-wired to respond—and researchers say you may actually be! Infant cries activate specific parts of your brain related to movement and speech, say researchers at the National Institutes of Health (NIH). Responding to a crying baby is universal: Among 684 new mothers in the US and 10 other countries, researchers observed similar reactions to crying babies regardless of where the mothers were from. Their work matched responses of new and experienced moms in other studies regarding infant crying.
Women with iodine deficiency may take longer to get pregnant, say NIH researchers, reducing their chances of conceiving by as much as 46% during each menstrual cycle. Iodine is commonly found in seafood, iodized salt and other foods; it helps your body to regulate metabolism. It’s also important for bone growth and brain development in children. Ask your provider about checking your levels if you’re struggling to conceive.
Women are more likely than men to feel sympathy for an infant cry.
So, what’s a Pap test and why would I need one? With a Pap, your healthcare provider takes a small collection of cells from your cervix to screen for precancerous cells or cervical cancer. You don’t need a Pap smear screening until age 21, even if you’ve been sexually active for years (see Why Wait).
A normal Pap result means there are no abnormal cells. An unclear result means your cervical cells could be abnormal, but it could also be the result of an infection or pregnancy. An abnormal result means that cell changes were found, which are likely caused by human papilloma virus (HPV)— this doesn’t necessarily mean that you have cervical cancer.
There’s been a lot of chatter lately about how often you should have a Pap test. Here are some basic guidelines:
B If your first Pap smear at age 21 is normal, it’s only necessary for it to be repeated every 3 years until age 30. During ages 30-65, experts recommend a Pap plus HPV screening every 5 years. It’s also acceptable to have a Pap every 3 years, although experts prefer the Pap-plus-HPV screening.
B If it’s not normal and you’re 24 years old or younger, there’s a good chance you won’t need any other testing or biopsies—just another Pap smear in 12 months, not 3 years.
B If your result is abnormal again or if you’re over age 24, you’ll probably need more testing with a special microscope exam of your cervix and maybe a biopsy test called a colposcopy.
For women between ages 30 and 65 years, your healthcare provider will do the Pap smear and also test separately for HPV. If both tests are negative, your risk of cervical cancer and pre-cancer is very low, and it’s safe to extend your screening interval. Talk to your provider and see what they recommend for you.
The reason for waiting until age 21 to get a Pap smear—and yes, it’s safe to wait—is because cervical cancer is rare in healthy, young women. They often get exposed to human papilloma virus (HPV), the virus that causes cervical cancer, but it typically goes away on its own. HPV can cause cancer when it remains in the cervical cells for many years.
age 20 or younger 30-65
21-29 66 or older
Source: cDc
no screening required
Pap test every 3 years; no HPV screening
Pap test every 3 years, or a Pap test and HPV test together every 5 years
no more screening needed if you’ve had 3 normal Pap tests or 2 normal HPV tests in a row
The Pap test is named after its creator, George N. Papanicolaou.Su S an Peck, MS n , a P n , is an expert adviser to Healthy Mom&Baby.
Pap smears screen for cervical cancer. Here’s why and how often you need a Pap.
Designed to spark cognitive development at the earliest time. Only BabyPlus® offers this unique opportunity for bonding between mom and baby.
Learn more now about the lifelong developmental benefits at babyplus.com
AWHONN members and all prenatal caregivers, Please send us an email at prenatalcare@babyplus.com to receive our complimentary educational brochures.
Alexa, ask BabyPlus ® Prenatal! for more information
Supporting women through miscarriage is possible with advice from those who have been through pregnancy loss.
I had a miscarriage with my first pregnancy. It was 1974. I was barely used to the idea of being pregnant when it all changed. On a Friday afternoon, I felt cramping. I went to the bathroom; blood and a clot came out.
I called the doctor. The next afternoon, the doctor delivered the stillborn fetus. My husband wasn’t allowed in the room, and I wasn’t allowed to see the baby. The doctor performed a D&C (dilation and curettage) to “make sure the whole placenta came out.”
That evening, I awoke in a hospital room without a telephone, alone. I rang for the nurse. “Where’s my husband?” “Oh, we told him you probably wouldn’t be awake until morning. He’ll be back then.” I broke down in tears. I felt so alone, so broken, so heartsick.
The nurse sat with me for a few minutes. She meant to be kind: “You’re young. You’ll have another,” she opined. That didn’t help.
When my husband arrived, he tried to be positive. “Let’s not talk about it. You just take it easy and heal.”
That was the last time we spoke of it. And like my wedding dress, which I put away in a cedar trunk, I wrapped that memory in tears, put it away in a mental trunk and locked it.
Many years later, I was in training as a neonatal nurse in a grief counseling course with a dozen other nurses. I was a happy mom of three children, and fatefully, the only woman in the room who had suff ered neonatal loss. e instructor asked me to “role play” the part of a new mom who had lost a baby to demonstrate therapeutic communication techniques.
“I’m sorry for your loss,” she began. “How far along were you?” I responded, “About 16 weeks.”
“How did that make you feel?” she asked. Silence. I felt a slow eruption as the lock popped off that trunk where the memory remained unresolved for so long. It surprised and embarrassed me as I swam in tears.
Studies show that 1 in 4 pregnancies end in a miscarriage. Use these tips to support a mom experiencing miscarriage:
Be patient with her; grieving takes time. Death and grief comes in waves
Suggest talking about it; ask her how she feels
Share information for local miscarriage support groups
Give her permission to call and reach out—anytime
Give her a reflective journal; encourage her to write her thoughts
Keep checking in with her
Check in with her significant other, the father or partner, as they likely grieve the loss, too
CANDACE “CANDY” CAMPBELL, DNP, MSN-HCSM, RN, CNL, FNAP, is an expert adviser to Healthy Mom&Baby.
“Losing a child at any age of a pregnancy is a difficult thing. Without Heavens Gain, I don’t know how we would have gotten through it. I was comforted by their lovely caskets and urns and they gave great advice so I knew what to expect! We ordered a wood casket, and it was beautiful. Everyone commented how much it looked like a grown-up casket only smaller. I appreciate all your help and would recommend Heaven’s Gain to anyone experiencing a loss.” ~ Kim
Only Ava tells you your 5.3 most fertile days in real time to give you and your partner more time for babymaking. Wear the Ava bracelet at night for effortless insight about your fertility, pregnancy, and your health.
Getting pregnant may seem like a simple process but conceiving a baby involves a delicate orchestration of your hormones, ovaries, uterus, fallopian tubes plus sperm! Knowing when you’re ovulating—the process of maturing and releasing an egg (ovum) from one of your ovaries into an adjacent fallopian tube for the journey to your uterus—can help you discover when you’re most fertile and likely to conceive.
It takes sperm to fertilize an egg, and because sperm live for about 5 days once inside a woman’s body, a typical fertile period would be the 5 days before you may ovulate through to the day following ovulation. Predicting that window across several menstrual cycles will help you learn how long your cycles are, and when your typical fertile periods occur.
Your menstrual cycle is measured as the first day of your period until the beginning of your next bleed. For most women, ovulation occurs in
i ncrease in your basal body temperature
cervical mucus becomes clear, stretchy, eggwhite-like
breast tenderness
bloating
spotting
cramping on one side of your lower abdomen
the middle of the cycle, or about 14 days before your next period begins.
Those are probabilities; your actual cycle may vary, which is why it’s important to use cues and signs from your body to determine when you’re ovulating in each cycle. Most experts recommend intercourse every other day during the 5 days before and the day of ovulation for the greatest chances of conceiving during a cycle.
B Increase in your body’s basal temperature: This is your body’s lowest temperature, which typically occurs during sleep. Track this on a paper or in an app by taking your temperature with a thermometer that’s specific to tenths of a degree at the same time each morning before you get out of bed. You should see a specific trend in your basal temps across several cycles.
Basal body temperature is lower in the first half of your cycle; it increases after ovulation. Experts believe ovulation has just occurred
when you observe an increase of 0.5-1 degree in your basal body temp for 2 days or more. Some women may also see a slight drop in their basal temperature before ovulation.
Changes in your cervical mucus: Ovulation is likely to be occurring when cervical mucus, or vaginal discharge, appears cloudy or clearer, thinner, and stretchier, like raw egg whites. Some women also notice an increase in the amount of this type of mucus.
Changes throughout your body: Breast tenderness, bloating, light spotting and a slight pain or cramping in your side are other signs associated with ovulation.
If your cycles vary in length, or you don’t see a definite trend or pattern in your cycles, you may want to try a more specific, high-tech way to predict when you’re most fertile. Ovulation prediction kits (OPKs) track and measure the luteinizing hormone (LH), the hormone that your body releases to trigger the release of a mature egg from an ovary— voilà! —to identify when ovulation will happen or has occurred.
Used over several cycles, digital OPKs will begin to predict when the best times to conceive are based on LH trends in your specific data. OPKs can be as simple as urinating on a test strip each morning to track hormonal changes or as techy as wearing a bracelet that tracks and transmits changes in your body to an app or device.
OPKs can be inexpensive or more costly depending on the technology. Some kits also track changes in estrogen in addition to LH. There are also OPKs that include digital monitors that give you data about your cycles over time, changes in your hormones and may suggest days when you should have the greatest chances of conceiving.
Confused by all of the options? If predicting ovulation seems too complicated, research shows having sex every 2-3 days will generally cover your “fertility window” without getting too specific about timing when you will conceive.
Most fertility experts say a woman in her 20s who is actively trying to conceive should be able to do so within 6 months; that timeframe stretches to a year if you’re in your 30s. Beyond these suggested timeframes, follow up with your healthcare provider if you’re tracking your ovulation and trying to conceive but not having success in baby-making.
PREDICTING OVULATION BY CYCLE LENGTHOvulation typically occurs mid-cycle or 14 days before your next period. If your cycles are typically:
24 days: your most fertile period is likely days 8-10
28 days: your most fertile period is likely days 12-14
35 days: your most fertile period is likely days 19-21
JAMIE VINCENT, MSN, RNC-OB, C-EFM, is an expert adviser to Healthy Mom&Baby.
OvuSense™ is a smartphone App and medical-grade Sensor that fits comfortably in your vagina like a tampon.
The Sensor records your core temperature while you sleep. In the morning you remove the Sensor and download its data to the OvuSense™ App.
The thyroid gland makes, stores, and releases two hormones called T4 (thyroxine) and T3 (triiodothyronine). Thyroid hormones control your metabolism—the rate at which every part of your body works, like how fast you burn calories or how rapidly your heart beats. You will find your thyroid at the base of your neck, in front of your windpipe; some say it’s shaped like a butterfly.
When your thyroid gland is working as it should, your metabolism is steady. The brain-based pituitary gland controls your thyroid by producing thyroid-stimulating hormone (TSH). TSH signals the thyroid to make more hormones if needed. Not enough thyroid hormones circulating and your metabolism slows down (hypothyroidism); too much thyroid hormones and your metabolism increases (hyperthyroidism).
Hypothyroidism is the 2nd-most common endocrine disorder in women; it affects more women than men. This disorder can be easily overlooked because its symptoms are similar to aging and depression. With hypothyroidism, you may feel fatigued, gain weight, have fuzzy thinking, and experience infertility or changes in menstruation. Chronic inflammation caused by your immune system can damage your thyroid gland, triggering the most common cause of hypothyroidism, a condition called Hashimoto’s thyroiditis. Your care provider will want to measure your levels of TSH to make a diagnosis; treatment typically consists of thyroid hormone replacement therapy.
Hyperthyroidism occurs when your thyroid makes too much TSH. Hyperthyroidism speeds your metabolism up causing symptoms like nervousness, tremors, abnormally rapid heartbeat (tachycardia), frequent stools, excessive sweating, heat intolerance, weight loss, goiter, insomnia, palpitations and high blood pressure (hypertension).
The most common cause of hyperthyroidism is a disorder known as Grave’s disease, but it may also result from taking too much thyroid hormone
when being treated for hypothyroidism. Grave’s disease most often affects women between ages 20-40. Changes in how quickly your eyelids close and open, as well as skin changes, are distinctive symptoms of Grave’s disease. Lumps (nodules) in your thyroid can also produce excess thyroid hormones.
Anti-thyroid medication can be used to reduce how much thyroid hormones your body makes. If medications don’t help, your healthcare provider may suggest treatment with high-dose radioactive iodine to destroy parts of the thyroid gland. In some cases, surgery may be needed to remove the thyroid gland completely.
RobeRta F Du R ham, RN, PhD, is a professor at California State University, East Bay and an expert adviser to Healthy Mom&Baby
Rachael m illeR , RN, bSN, is a labor & delivery nurse at the University of California, San Diego Medical Center.
h allie tayloR , bS, is a medical student at Touro University Nevada College of Osteopathic Medicine.
By R OBERTa F. D URH a M , RN, P H D; Ra CH a E l Mill ER , RN, BSN; a ND Halli E TaylOR , BSAre you bleeding between periods? Feeling full? Ask whether uterine fibroids could be to blame.
Maybe it’s a lower backache without explanation, bleeding between periods or heavier cramping that has you wondering if something has changed in your gynecological health. Symptoms like these can signal the presence of growths called uterine fibroids, which are the most common non-cancerous tumors among young women (99% of these tumors are non-cancerous).
These tumors form from muscle and other tissue that grows in and around your uterus. These tumors can range in size from nearly too tiny to be seen (think apple seed) to large enough to distort your uterus (think grapefruit). Typically, your healthcare provider can feel them with their fingertips when they examine your uterus.
Many women have no symptoms at all, but others describe symptoms and signs including:
B Heavier or painful periods
B Increased cramping with periods
B Bleeding or spotting between periods
B Bloating or feeling “full” in your lower abdomen
B Needing to urinate more often
B Pain during sex
B Lower back pain
When fibroids are found, if they’re small and aren’t bothersome, there’s probably no need for treatment. If you’re having pain or heavy bleeding or if it’s questionable whether the tumor could be cancerous, treatment may be recommended.
Treatments include hormones, birth control pills or an IUD to decrease pain and heavy bleeding with periods, or drugs that can stop your menstrual cycle and shrink the tumor. Laser or ultrasound procedures can also be used. Surgery may be needed for larger or multiple tumors. In severe cases, hysterectomy may be necessary.
Carolyn (Carrie) J. lee, PhD, MSn , rn , is an expert adviser to Healthy Mom&BabyFibroids can complicate your pregnancy— especially labor and birth. Experts at the National Institutes of Health say the most common problems include:
B Baby illpositioned for a vaginal birth, such as in breech position
B Labor stalling or failing to progress normally
B p reterm birth
B p lacenta breaking away from the uterine wall before birth (placental abruption)
B Increased likelihood of cesarean— this risk is 6-times greater among women with fibroids
All young women are at risk for fibroids but there’s a greater chance you’ll develop them if your mom or sister did. Black women are likely to have more or larger fibroids and at a younger age. Other risk factors include:
B Getting your period at a younger age
B Using birth control
B Being obese
B Having a vitamin D deficiency
B Eating a poorly balanced diet high in red meat
B Drinking alcohol
F IB ro I d S and p regnancyFrom the World Health Organization and the nurses who’ll attend your birth, here’s evidence-based advice for a safe and healthy delivery.
How you may experience labor and birth can be influenced by choices you make long before you’re pregnant. From choosing a pregnancy care provider to whether you’ll have support from those earliest contractions can affect your labor and baby’s birth.
After all, once spontaneous labor begins, it’s important that you feel honored, safe, trusted, respected, protected and comfortable with your care providers and the place where you’re birthing. You’ve got good mothering work to do in birthing baby.
Individualized, supportive care is key to positive childbirth experiences, say experts at the World Health Organization (WHO), in releasing new global care standards for healthy pregnant women.
Childbirth is a normal activity without complications for most women and babies; still, every labor is unique and progresses differently. “Many women want a natural birth and prefer to
rely on their bodies to give birth to their baby without the aid of medical intervention,” says Ian Askew, WHO Director of Reproductive Health and Research.
For expectant moms, there are tools for best birth practices including the 6 Healthy Birth Practices developed by the childbirth educators at Lamaze International and advice for avoiding the most common interventions that raise risks, such as the Don’t Rush Me—Go e Full 40 weeks of pregnancy, developed by AWHONN, the mother/baby nursing organization that publishes this magazine.
“We want women to give birth in a safe environment with skilled birth attendants in well-equipped facilities. However, the increasing medicalization of normal childbirth processes are undermining a woman’s own capability to give birth and negatively impacting her birth experience,” says Dr. Princess Nothemba Simelela, WHO Assistant Director-General for Family, Women, Children and Adolescents.
First, pick a pregnancy care provider who understands and honors practices that support normal birth. Ask them if most women receiving care in their practice are upright and moving around during labor. Ask if the nurses where you’re birthing will help you to remain out of bed while laboring.
Gravity is your best friend for healthy labor and birth. Laboring upright while walking or moving around helps baby move down and out. Gravity works with your body’s natural efforts to open your pelvic bones as much as possible.
Research shows that our bodies were meant to move in labor, to change positions as labor progresses, and that movement along with continuous labor support from someone like a doula brings particular benefits:
More positive feelings about childbirth
More likely to birth vaginally following spontaneous labor
Shorter labor
Better Apgar scores for baby
Reduced need for cesarean birth
Less likely to involve vacuum or forceps during birth
Less likely to require pain medication, such as an epidural
Hospitals dedicated to supporting moms through breastfeeding can achieve a “Baby-Friendly™” designation, which means they follow the WHO’s advice regarding breastfeeding, skin-to-skin bonding, and keeping mom and baby together.
Aren’t all hospitals baby friendly, you might ask? Well, yes— especially those with birthing centers. But there’s a difference between being baby friendly and Baby-Friendly with a capital B, that is. Here’s what a baby-friendly hospital with or without the designation does when they get it right:
In choosing a pregnancy care provider who supports your birthing desires—whether that’s a certified nurse midwife or obstetrician— do you know whether you want to birth vaginally? Go skin-toskin at birth? Labor can be unpredictable. Creating a birth plan with a supportive provider provides some reassurances that your preferences will be considered as possible should complications arise.
Here are a handful of the 10 recommendations:
1. Respectful care that ensures informed choice, continuous support
2. Companion of choice through labor and birth
3. Midwifery-led care through pregnancy and birth
4. At admission, assessing fetal well-being via Doppler ultrasound at regular intervals—not continuous monitoring—when all is well
5. Low-tech relaxation activities, e.g., progressive muscle relaxation, massage, breathing, music, mindfulness, and warm packs for labor pain
6. Light food and drinks through labor
7. R emaining upright and active through labor
8. Upright birthing positions
9. Following your body’s natural urges to push and rest
10. For 24 hours after birth, regular assessment by care providers of vaginal bleeding, uterine contraction, fundal height, temperature and heart rate (pulse), blood pressure at birth and 6 hours later, and voiding within 6 hours of birthing
1. Let labor begin on its own
2. Walk, move around and change positions throughout labor
3. Bring a loved one, friend or doula for continuous support
4. Avoid interventions that aren’t medically necessary
5. Avoid giving birth on your back; follow your body’s urges to push
6. Request to be kept together with your baby at all times; it’s best for you, baby and breastfeeding
Source: Lamaze International
At birth, baby should be placed immediately on your bare chest. Skin-to-skin care helps baby transition to life outside the womb. Baby’s body temperature, blood sugars and heart rate stabilize. You’re set to begin breastfeeding as soon as baby is ready, which is typically within the first hour of birthing.
Nurses who support moms in birth have extensive training on breastfeeding. They’re ready to discuss the benefits of breastfeeding, support your nursing efforts and troubleshoot issues you and baby may experience. Their goal is to get you both off to the best possible start.
You and baby should remain together until you return home. Rooming together promotes bonding, breastfeeding, and familiarity. Rooming together means you’re always ready to nurse and learn baby’s hunger cues when they’re ready to feed.
Before you return home ask your nurses about support groups with lactation consultants available for advice and phone support—something many facilities call a “warm line.”
Doulas specialize in pregnancy, labor, birth and postpartum support for moms and their families. Some hospitals and birthing centers provide doula services; more typically you hire a doula for support when and where you want it.
A certified doula advocates for you during labor and birth, provides emotional and physical support, shares coping techniques and information, and assists in communicating your choices and preferences to care providers where you’re birthing.
Doulas typically aren’t healthcare professionals but can become certified, meaning they’ve received evidence-based training to support you before, during and after labor and birth. DONA International is the largest doula certifying organization.
Typically, moms hire a doula for the support while laboring at home, during birth, and in recovery. Many doulas also provide breastfeeding care. Fees for doula support can range from a few hundred dollars to more than $1,000, depending on your location and services desired.
Fin D the best D oula F or you by asking about:
B Their practices and birthing philosophies
B How they will support your birthing preferences and goals
B Whether they’ll also support your partner or family present
B How many births they’ve supported
B Cost of services and what’s covered in those charges
B Whether they’ve received doula training and certification
Nobody likes to be rushed—especially babies! Your baby needs a full 40 weeks of pregnancy to grow and develop. While being done with pregnancy may seem tempting, especially during those last few weeks, inducing labor is associated with increased risks including prematurity, cesarean surgery, hemorrhage, and infection.
Labor should only be induced for medical reasons—not for convenience or scheduling. Baby will let you know when they’re ready to emerge. Until then, the nurses of AWHONN give you 40 reasons to wait for spontaneous labor during the full 40 weeks of pregnancy at GoTheFull40.com.
Source: AWHONN
A NNIE EvANS , BSN, RNC-OB, is the clinical services program manager of women’s health at Spectrum Health. J A m IE vINCENT, m SN, RNC-OB, C-EF m , is an expert adviser to Healthy Mom&Baby C AROLYN DAv IS COC k EY, m LS, LCCE, is editor of Healthy Mom&Baby and a Lamaze-certified childbirth educator.Have you ever noticed a fishy smell coming from “down there”? This sign could indicate a vaginal infection.
All women experience vaginal discharge, even more so in pregnancy, thanks to hormonal changes. However, bad bacteria can sometimes overwhelm the good kind, creating an infection.
The most common vaginal infection is bacterial vaginosis (BV), most often characterized by a thin, off-white/grey discharge with a “fishy smell” that you might notice more after you’ve had sex. Other BV symptoms include vaginal itching or burning around the vagina, or pain with urination, although many women with BV don’t have any symptoms.
What causes BV?
Although it mostly occurs in women who are sexually active, recurrent episodes of BV are not associated with sexual activity, and there are no recommendations that your partner should be treated if you have BV. You’re at higher risk for BV if you smoke, have multiple sexual partners or douche. You may think that douching keeps the vagina “clean” but it actually can wash away the good bacteria and can promote an infection!
BV can increase your risk of becoming infected with HIV and other STDs like chlamydia or gonorrhea, especially if you have recurrent or untreated infections.
h oW is BV diagnosed, treated?
Your doctor or nurse midwife will ask questions about your symptoms and perform a painless, vaginal examination to look at and test the
vaginal discharge. BV is treated easily with a week’s course of prescription oral antibiotics or that same medicine in a vaginal gel; avoid home remedies and over-the-counter options. In pregnant women, the oral medication is preferred, but can leave a metallic taste in your mouth and cause some nausea. If you have frequent BV episodes, you may need a longer course of treatment. No amount of alcohol is safe during pregnancy, and it is especially important to avoid drinking alcohol while taking this medication as the combination of the medication and alcohol can result in severe nausea, palpatations and chest pain, and other serious problems.
Experts don’t know what causes BV, but there are ways you can help lower your risk:
B Don’t douche —it upsets the balance of normal, healthy bacteria
B Limit your number of sexual partners multiple partners = higher risk
B Take the full course of medication to treat BV—this will make sure the infection is resolved and prevent further infection Let your healthcare provider know about any vaginal discharge that’s different from what you normally experience. Vaginal discharge is a normal part of being female. Knowing what’s normal and what’s not can lead to quicker
BV in pregnancy increases your risk of premature birth and baby has a higher risk of being born at a low birth weight. BV can be diagnosed and treated quickly. Many women have one infectious episode and don’t experience it again. your care provider will ask about your symptoms, perform a vaginal exam and test your vaginal discharge.
HeleN M. Hurst, DNP, r NC, APr N-CNM, is an expert adviser to Healthy Mom&Baby
Could BV affeCt my pregnanCy?
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Moms with obesity may birth bigger babies, say researchers at the National Institutes of Health. This is also a risk for pregnant moms with gestational diabetes. Having a big baby can increase your chances for cesarean and excessive bleeding, and potential bone fractures for baby. Being big at birth ups baby’s risks for obesity and heart disease later in life. Starting pregnancy at a healthy weight and keeping pregnancy weight gain within current recommendations gives you and baby the best chances for a healthy birth.
Mom’s flu and pertussis vaccination in pregnancy doesn’t increase risks for babies, say experts at the CDC, who looked at infant hospitalization or death rates in a study of more than 400,000 babies between 2004-2014. Both vaccines are recommended during pregnancy; researchers particularly looked at flu and the Tdap (tetanus, diphtheria and pertussis) vaccines and the risks, if any, for baby in the first 6 months of life. They concluded that the study reinforces the safety of receiving these vaccines in pregnancy.
Families with access to midwifery care may experience better outcomes for mom and baby, suggest researchers. Ranking outcomes by state, they found that communities with midwiferyfriendly laws and regulations tend to be associated with lower rates of premature birth, cesarean and newborn death. Best outcomes were seen in states like Washington and Oregon, with strong connections between midwives and the healthcare system. See how your state ranks: bit.ly/midwiferybystate.
Your baby needs at least a full 40 weeks of pregnancy to grow and develop. Inducing labor even a week or two early is associated with a host of risks, including prematurity, cesarean surgery, hemorrhage and infection.
While it may seem convenient for you or your health care provider, labor should only be induced for medical reasons.
Your baby will let you know when she’s ready to come out, so give her all the time she needs: at least the full 40 weeks.
Your questions answered by our expert mother/ baby nurses at Health4mom.org/ ask-our-nurses.
I’VE HAD A HEALTHY BABY BEFORE; DO I STILL NEED TO GO TO EVERY PRENATAL VISIT WITH MY SECOND PREGNANCY?
Regular prenatal care, including screens and exams throughout your 40 weeks, is important for you and your baby to have the healthiest pregnancy and birth possible. At each visit, your healthcare provider checks the health and progress of your pregnancy for both you and baby. Your care provider will likely want to see you as follows throughout your pregnancy if all is healthy and well:
Up to 28 weeks: Monthly
28-36 weeks: Every 2 weeks
36 weeks-birth: Weekly
Research shows keeping all of your prenatal care appointments can help ensure this pregnancy will be as healthy as your first.
—Helen M. Hurst DNP, RNC-OB, APRN-CNM
If you use marijuana, baby uses it too. While its effects on baby may not always be immediately obvious at birth, when researchers followed infants whose mothers used marijuana during pregnancy, they linked pot in pregnancy to lower birth weights, decreased height, early birth and increased risk for preterm labor. Moms who used marijuana had more difficult and rapid labors, and more often than typical, baby
was exposed to meconium in the womb, raising baby’s risks for breathing problems at birth.
As these babies go through their toddler and early childhood years, researchers have documented both learning and behavior problems related to impaired mental development, hyperactivity, inattention and impulsivity. One study in particular demonstrated that fi rst trimester exposure to marijuana resulted in problems with reading, spelling and overall educational scores at age 10.
e same problems were also linked to second trimester exposure to marijuana. If you’re using marijuana now, it’s important that you stop using cannabis for your health and your baby’s short and long-term health and development.
—Cheryl K. Roth, PhD, WHNP-BC, RNC-OB, RNFA
Lori A. Satran, RN, MS-L, IBCLCE
Shauna M. Smith, RN
Research shows probiotics are helpful in treating diarrhea and bacterial vaginosis (a common vaginal infection). There’s also evidence that probiotics can stabilize blood sugar. If you’re at risk of developing gestational diabetes during pregnancy, or have already been diagnosed with it, eat more high-fiber foods rich in prebiotics and probiotics. In one study, women with gestational diabetes improved their fasting blood sugars and slowed their pregnancy weight gain by taking probiotics for 6 weeks.
—Catherine Ruhl, CNM, MS
This optional screening can provide genetic and other information about baby; learn about its uses and risks.
Your baby develops in a warm fluid-filled sac, and that amniotic fluid can provide information during the 2nd trimester about whether baby may have increased risks for birth or chromosomal defects like neural tube defects or Down syndrome.
Later in pregnancy, amniocentesis can be used to check if baby’s lungs are mature enough for early birth if mom is having pregnancy complications that require baby’s birth, or to learn whether baby may have an infection. If you have too much amniotic fluid, some can be drained with amniocentesis.
When screening for potential birth defects or chromosomal problems, amniocentesis is performed between 15 and 20 weeks.
Amniocentesis may be recommended for any of the following:
B Prenatal screening test needing further follow-up
B Previous pregnancy with or a family history of birth defects or chromosomal abnormalities
B Abnormal ultrasound requiring follow-up, such as a suspected problem with baby’s development,
or later in pregnancy, the presence of too much amniotic fluid
B To assess baby’s lung maturity when mom develops pregnancy complications requiring baby be born early
B To drain excessive amniotic fluid later
Amniocentesis isn’t without risks. Miscarriage is a very serious risk, although studies have determined this risk is relatively rare at less than 1%. Other risks include leaking amniotic fluid, needle injury, and Rh sensitization wherein some of the baby’s blood cells enter mom’s bloodstream during the procedure and she may begin to make antibodies that can harm baby’s red blood cells. A blood test is needed to learn if mom has begun to produce antibodies.
Infection is also a risk, including needle transmission of an infection in mom to baby such as HIV or hepatitis C, or a subsequent uterine infection.
Using ultrasound, your provider will locate baby and the placenta and then find a pocket of fluid away from them where the needle can be placed. Ultrasound will also guide the thin, hollow needle through your abdomen and into the amniotic sac to withdraw the fluid. a small sample—less than an ounce—is sent for analysis.
m any women describe the procedure as more uncomfortable rather than painful. you may feel the needle going in and coming out, similar to having your blood drawn. you and your baby will be monitored by ultrasound after the procedure, and baby also may be followed by electronic fetal monitoring. you may feel cramps or leak a small amount of vaginal fluid immediately after the procedure.
c all your provider if you continue to leak fluid or have bleeding, uterine cramping lasting for several hours or fever, or if baby is moving less than before the procedure.
J A mie Vincent, m Sn , R nc-OB, c eFm , is an expert adviser to Healthy Mom&Baby.When it’s red and sore from diaper rash, irritated from chafing or damp and uncomfortable it can seem like nothing helps. When your baby’s skin suffers you suffer with them, but Aunt K’s is here to help. For nearly thirty years Aunt K’s Comfy Bottoms Powder has been soothing skin, healing diaper rash and preventing chafing, and doing it naturally. No chemicals. No complicated formula. No harmful talc. Created by a mother desperate to heal her daughter’s severe diaper rash when nothing else worked, Aunt K’s Comfy Bottoms is a 100% safe treatment for all manner of issues that can affect your baby’s delicate and sensitive skin. Shared as a family remedy between friends and neighbors in the community, Aunt K’s has made Comfy Bottoms available to the public.
Avoid exposing your child to harmful chemicals by choosing something natural. We’re all tired of using products with ingredients that we can’t identify or even pronounce. Sometimes the simplest solutions are the best, and you can trust Aunt K’s to care for your baby’s most sensitive areas. When you use Aunt K’s you can rest easy knowing you’re not exposing you or your little one to harmful talc or other harsh additives. You can reach for it knowing that it’s safe, effective recipe wasn’t concocted in a lab but originally created in a kitchen using basic, natural ingredients by a parent just like you- a parent who just wanted to help their child feel better naturally. Aunt K’s is right for your child because, quite simply, it works!
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Pregnancy brings changes to your skin through each trimester. ose long, hot baths you soothe yourself with can strip your skin of its natural oils, leaving your skin feeling dry and itchy. Fight back by cleansing, nourishing and protecting your skin.
Soaps include detergents that strip the oils from your skin. Degreasing is great for dirty dishes but not so great for your soft skin. Choose non-soap body washes that are fragrance- and dye-free. Keep your shower and bath water tepid. If you’re going to soak for more than 10 minutes, add bath oils to help retain moisture.
Moisturizers soothe and lubricate. Some even have extra “active ingredients” that make your skin appear tanned or claim to fi ght wrinkles. Choose creams designed to help you retain your skin’s natural moisture, such as healing balms or ointments, which can be more difficult to spread. Warm them by putting a dollop in your palms and rubbing your hands together, and enjoy as you massage them into your skin.
Don’t be discouraged when your moisturizer fails to prevent stretch marks—these can’t be prevented. Stretch marks are scar-like skin changes that happen during hormone-surged life stages, such as the teen years or pregnancy. Sorry, there’s no medically proven way to prevent stretch marks.
Whether it’s sunny outside or not, don’t be fooled by cloudy skies—you need sunscreen year-round. All moms need a daily SPF of 30+, especially at high altitudes. Reapply often when you may sweat your sunscreen off, such as during exercise or a day at the beach or pool.
DR. ALICIA ZALKA, MD, is a Yale-affiliated dermatologist in private practice in Connecticut. She’s also the founder of surface-deep.com.Labor isn’t the most comfortable thing you’ll ever do, but when you prepare to use the power of your contractions working with your body to birth baby, you’ll begin to see the pains of labor in a whole new way.
Every mom hopes for a healthy baby and easy labor and birth. But you may have questions even if this isn’t your first pregnancy: How will labor feel? How will I cope with the intensity of the contractions? What’s the “ring of fire” some moms describe?
To prepare, begin with the idea that labor is a process. Contractions help you move your baby into birth. Yes, labor gets more intense as it progresses—this allows you to build your coping skills and responses over time. Preparing for labor is more than just opting in for medical pain relief (epidural) or going it naturally (no medications); it’s preparing your mind for what your body knows how to do. With each wave of contractions, each increase in intensity, your body releases its own endorphins to help you move closer to meeting your baby.
You wouldn’t sign up for a marathon without taking a few laps around a track. For labor, childbirth classes provide an in-depth look at the stages of labor and how you may choose to be supported, coached, and assisted during labor.
Coping with labor pain naturally increases the likelihood of having a faster, easier birth. ere are so many things you and your partner can practice before labor begins so that you have a few “goto favorites” for when you’re in the midst of contractions. e good thing about these methods is that they are simple, readily available, inexpensive and low-risk.
Continuous labor support with a partner, family member, coach, nurse or doula
Movement, like swaying side to side or rocking in a chair or on a birthing ball
Hydrotherapy, such as with a shower or bath
Touch and massage, or application of cold or heat
Aromatherapy or music to set a calming mood
Breathing, relaxation, and meditation
In some facilities, you may also have experts such as certified nurse-midwives support you with acupressure or acupuncture, transcutaneous electrical nerve stimulation (TENS) or intradermal sterile water injections for lower back pain (or back labor).
Counter-pressure, through the embrace of a shawl such as a rebozo wrapped and pulled tightly around your body as the contractions peak, or skillful hands on your lower back as pressure builds
Relax, you have many options. Take a childbirth class and work with your partner to practice different coping strategies for the various stages of labor. en let your pregnancy care provider know what your preferences are so that they’re prepared to support you when the realities of contractions begin.
JAMIE VINCENT, MSN, RNC-OB, C-EFM, is an expert adviser to Healthy Mom&Baby.Medication pain management is either analgesic (less pain without loss of feeling or movement) or anesthetic (relieve pain by blocking most feeling, including pain). Medications can and do bring different risks and side effects.
The obstetricians of the American College of Obstetricians & Gynecologists explain pain relief medication options typically available, all of which are ordered by your healthcare provider at your request and given by your care provider or your nurse.
Nitrous oxide (known as “laughing gas”)
IV narcotics/systemic analgesics (opioids)
Local anesthetics
Inhaled through a mask; works best when inhaled 30 seconds before contraction
As a shot or through an IV
Relieves anxiety; some women say it “takes the edge off” contractions
Almost immediate relief; mom stays awake
May feel dizzy or nauseated; safe for mom and baby
Itching, nausea, vomiting, drowsiness; may also affect breastfeeding and baby’s breathing and heart rate (short-term)
Numbs particular area of the body; often used during tissue repair
Epidural (most common)
Through a tube in your lower back
Spinal block
Combined spinal-epidural block (CSE)
Single shot into spinal cord fluid
Tube and injection
Some loss of feeling in the lower body, but you should still be able to push
Works quickly to relieve pain but lasts only an hour or 2
Quick pain relief of spinal block with longer-lasting relief of epidural
The so-called “ring of fire” refers to the intense warmth or sensation some moms feel as baby stretches the vaginal canal and perineum (soft tissue between your vagina and anus) at birth. Some birth providers will offer numbing medicine (typically lidocaine) as an injection close to the time of birth. The feeling is fleeting as baby slips from your body.
Very rarely a woman may have an allergic reaction; rarely affects baby
May not be able to walk; similar risks to narcotics
Same as epidural
Same as epidural
MEDICATIONS FOR LABOR PAIN MANAGEMENT
Here’s why your care provider regularly checks on baby’s heart rate and rhythm.
Since the 1800s, midwives and obstetricians have listened to baby’s heart rate as one way to check on baby’s wellbeing. Fetoscopes—similar to stethoscopes—were the first technology used to listen in on baby’s beating heart.
Measuring fetal heartbeats can be a reassuring sign that baby is getting adequate oxygen through their placenta and umbilical cord (normal range for babies is 110-160 beats per minute and in this range your baby’s heart can vary by 5 to 25 bpms). Outside of these ranges, baby may not be getting enough oxygen or experiencing other problems.
During prenatal care, providers typically use a wireless ultrasound device called a Doppler to listen to baby. A fetal Non Stress Test records baby’s heart rate when baby is moving. Late in pregnancy, you may be asked to have a Contraction Stress Test to measure baby’s heart rate during contractions; you may need to be in the hospital with medication to start contractions for this test.
Once you’re in labor, baby’s heart rate is typically checked intermittently unless there are medical reasons to monitor it continuously. The Association of Women’s Health, Obstetric & Neonatal Nurses (AWHONN), which publishes Healthy Mom&Baby, supports fetal heart rate monitoring (FHM). AWHONN advises that FHM should happen in ways that are consistent with a pregnant woman’s preferences and desires, and that unless clinical concerns require more increased
monitoring, the least invasive ways for checking on baby’s heart rate should be used to promote normal, vaginal labor and birth.
Electronic fetal monitoring involves two devices strapped to your belly via stretchy belts, and attached to the fetal monitoring device by cables: Ultrasound transducer: for tracking baby’s heart rate Tocodynamometer: for tracking your contractions and uterine activity
If baby’s heart rate can’t adequately be tracked externally, your care provider may want to insert an internal fetal scalp electrode on baby’s head. To put this into place, you lay back in a position similar to a vaginal exam and the tiny scalp electrode is inserted into your uterus and attached to baby’s scalp via a cable extended to the fetal monitoring device.
If your pregnancy care provider needs more information about the intensity and frequency of your contractions, you may also receive an internal device (intrauterine pressure catheter) that sits between your baby and uterine wall, with a cable extending out to a fetal monitor.
When your labor is progressing normally, being upright and moving including rocking on a birthing ball, relaxing between contractions, and staying hydrated all support baby’s heart rate.
CYNTHIA LORING, MS, RNC, CLC, is an expert adviser to Healthy Mom&Baby.
The beautifully designed, compact and lightweight digital heartbeat monitor is a baby heartbeat monitor, sound amplifier and recorder that helps to encourage bonding during early pregnancy. As a new parent, hearing your baby’s heartbeat and sounds can make you feel closer to your little one as they grow in the womb
You can conveniently hear the baby’s sounds at any desired time in the comfort of your own home, which can give comfort and assurance, particularly for women who have previously experienced a difficult pregnancy
Unique manufacturing technology is adopted to generate clear fetal heart sound by minimizing ultrasound noise. This battery-operated device runs on very low levels of power, making it safe to use over the entire length of a pregnancy when used properly and in line with product guidelines.
Notes: The heartbeat monitor device is a listening system to hear the sounds your baby makes and cannot be used for diagnostic or medical purposes and is not to be used as a substitute for regular prenatal care by a licensed doctor.
https://upandraise.com/products/fetaldoppler
Pregnancy can take a toll on your body, and research demonstrates that if you’re considering getting pregnant, or if you are pregnant, you and your baby both benefit from the nutritional boost and support of prenatal vitamins.
Specifically, not having enough of some nutrients and vitamins, including folic acid, can put your developing baby at risk for neural tube birth defects that can occur in the earliest weeks of pregnancy, while low iron is associated with fatigue and anemia.
Customize your vitamin: Does your throat close at the thought of swallowing a capsule? Look for a chewable, liquid or gummy prenatal. Vitamin B6 can help ease nausea and morning sickness. Most experts advise 50 mg of B6 daily for morning sickness.
If you’re prone to iron deficiencies, look for a higher level of iron in your prenatal vitamin, but be aware that iron supplements can cause nausea and constipation. If you’re not anemic, pick a prenatal vitamin without iron.
For a healthy pregnancy, you need about an extra 300 calories a day, and adding a supplement ensures that whatever you’re eating—or not, depending on your level of nausea—you get the nutrition you need each day.
Not all prenatal vitamins are created equal. And because not all supplements have been tested for safety in pregnant women, just stick to meeting your basic needs. For example, too much vitamin A can be harmful to your baby, so this vitamin is often reduced in prenatal vitamins, which is one reason why a regular multivitamin just won’t work during and after pregnancy.
Skip herbal supplements altogether—most have not been studied in pregnant women and many are considered too risky for your baby; discuss any herbs or other supplements with your healthcare provider before you take them.
Lastly, a prenatal vitamin isn’t an excuse for poor eating—strive to get the nutrition you and your baby need each day through your food.
Here’s a look at the leading supplements recommended during pregnancy.
shutterstock
Vitamin A, D, E and K are stored in the liver, and you should know that too much vitamin A can cause problems for your baby’s bones, urinary tract, and the central nervous system. This is why it’s important to take a prenatal vitamin instead of a general multi-vitamin, which could contain too much vitamin A.
The recommended daily amount of vitamin D during pregnancy is 600 IU/day. Most prenatals have 400 IU, so you’ll need to get extra elsewhere. But high levels of vitamin D can be too much of a good thing—safe upper daily limits are 2,000 IU to 4,000 IU during pregnancy.
Postpartum, when you’re a nursing mom, your baby will receive these vitamins through your breastmilk, except perhaps enough vitamin D. Most infant care providers recommend that both mom and baby take vitamin D supplements.
Folic acid (the synthetic form of the B vitamin folate) is important because it can reduce the risk of your baby having a neural tube birth defect (NTD), and it may also protect against cleft lip and cleft palate. Folate is found in leafy greens and other foods.
Experts suggest that as many as two-thirds of neural tube defects could be avoided if women consume adequate folic acid prior to getting pregnant. This is why you should begin to take folic acid—400 micrograms daily—before conceiving because these defects occur in the earliest days of development, before you may even know you’re pregnant.
Some prenatals have as much as 800 micrograms of folic acid, which is safe and helps prevent birth
defects. If you’ve had a pregnancy affected by a neural tube defect, you may need even more folic acid.
Want to nourish a smarter baby? Many prenatal vitamins now include omega-3 fatty acids in the form of DHA (docosahexaenoic acid). This healthy fat promotes baby’s brain and eye development, and it has been linked to potential reductions in birthing prematurely.
Coldwater fish, such as wild-caught salmon, is a good source of omega-3s, as are walnuts and flax seeds. Experts recommend eating 12 ounces of seafood (low-mercury fish) across several meals a week during pregnancy. You can also get omega-3 and omega-6 fatty acids via pure quality fish oil capsules. This is particularly beneficial to avoid any mercury in acquiring essential fatty acids from fish.
Prenatal vitamins contain iron, which increases blood production and prevents anemia. Extra iron should be used only under your healthcare provider’s recommendation. Your care provider will order blood work to check your iron levels.
If your care provider has recommended an iron supplement, take it between meals or at bedtime with orange juice or another source of vitamin C if you experience nausea, heartburn, constipation, or diarrhea with it. Don’t take iron with calcium, milk, tea, or coffee, because those substances can decrease its absorption.
Choose a prenatal vitamin with at least the following:
B 400 mcg of folic acid
B 600 IU of vitamin D
B 70 mg of vitamin C
B 6 mcg of vitamin B12
B 10 mg of vitamin E
B 3 mg of thiamine
B 2 mg of riboflavin
B 20 mg of niacin
B 15 mg of zinc
B 200 to 300 mg of calcium
Source: National Institutes of Health
Sharon Scott, MS n , rn , is an expert adviser to Healthy Mom&Baby
From birth on, here’s how baby’s vision and sense of color comes into focus, say experts at the American Optometric Association:
From birth: Faces and objects up to 10” away are in focus; baby sees high-contrast pictures or shapes easiest. Don’t be surprised by sometimes crossed or wandering eyes; this is normal as baby’s eye muscles are developing.
5-8 months: All those ill-coordinated glances and grasps begin to appear a lot more intentional and on target as eye control and eye-body coordination improves. Color vision is good by 5 months, and babies who crawl a lot—versus walking early—use their eyes better together, research shows.
9-12 months: All that eye-body coordination should be practice-made-perfect by baby’s 1st birthday. Baby is now reaching for and picking toys and other objects up. Depth perception is stronger; baby is tossing toys with intention!
While colorful laundry detergent pods are convenient for parents, they pose serious risks to babies and toddlers. These squishy, vibrant pods appeal to curious little ones, who explore using their hands and mouths.
In 2017, poison centers received more than 10,500 reports of exposures to highly concentrated pods by children 5 and under. If swallowed, detergent packets can cause vomiting, wheezing, gasping, excessive sleepiness, breathing trouble requiring intubation and even death.
Experts at poison control centers say:
Keep detergent containers sealed and stored up high, out of reach
Follow the instructions on the product label
Call poison control at 1-800-222-1222 immediately if you suspect your child has been exposed
Even after years of safety standards and product recalls, window blind cords still remain a hazard for young children, particularly toddlers, say experts in Pediatrics. They estimate 1 child a month dies from blind entrapment with its cords. Children can get tangled up in inner cords, as well as those that raise or lower blinds—even in loops tied up out of a child’s reach.
The US Consumer Product Safety Commission and Window Covering Safety Council recommend taking steps to safeguard your home:
Use cordless blinds
Keep cribs and all furniture away from windows
Examine all window coverings for accessible cords on front, side and back
Anchor continuous loop cords to the floor or wall
Corded blinds are safer with a free retrofit kit from the Window Covering Safety Council: 800.506.4636 or windowcoverings.org.
Kepi Support Swaddle + Lounger's patented design provides your baby the head, neck, and spine support it needs. The only swaddle that reduces the risk of Flat Head Syndrome, Hip Dysplasia, and unnecessary anxiety in parents and newborns. The Kepi allows the whole family - parents, siblings, and grandparents - to hold and pass the baby with confidence.
Your baby has hemophilia—what is that? Learn more about this genetic bleeding disorder and how it may affect your child.
Your blood has proteins called clotting factors that help stop bleeding. There are 13 unique clotting factors. Hemophilia is a condition whereby your blood doesn’t have enough of a particular factor. A person with hemophilia may bleed more profusely after an injury or even without an obvious cause.
B Hemophilia A: factor 8 (VIII) deficiency; occurs in up to 1 in every 5,000 boys
B Hemophilia B: factor 9 (IX) deficiency; occurs in about 1 in 20,000 boys
Girls can inherit a gene that causes hemophilia from either their father who has hemophilia or their mother who is a carrier. However, girls usually don’t have severe bleeding like boys because they also get an unaffected gene from their other parent and can usually make 50% or more of the needed factor, which keeps their chances of bleeding small.
Hemophilia isn’t usually diagnosed until ages 1 to 3, though parents with a family history of the condition may request testing. If your child bleeds
a lot or bruises easily, their healthcare provider may do blood and genetic tests. Family history is important, but 30% of babies born with hemophilia don’t have family with hemophilia.
Hemophilia is managed by replacing the clotting factor via IV blood treatments. When hemophilia is severe, regular IV treatments may be needed.
If your child is diagnosed with a bleeding problem, keep them safer by adding pads to furniture, gates and other items they might bump into or trip on. Take extra caution when your baby is learning to crawl and walk; keep hard toys at a distance.
If your baby gets hurt and is bruised or bleeding, call your healthcare provider—likewise if you notice a new area of bruising or swelling in a joint. Head to the emergency room if your child sustains any injury to their head, neck or abdomen; complains of severe pain; or has bleeding in their urine or stool.
Michele Savin, Dn P, MSn , nn P-Bc is an expert adviser to Healthy Mom&Baby.
i t’s very rare that females will have hemophilia, but they have a 50/50 chance of passing the hemophilia gene mutation on to their children (regardless of whether the child is a boy or girl). i f a man has hemophilia, his daughter will get the gene and be a carrier, but boys cannot get the gene from their dads.
Factor X i deficiency, sometimes called hemophilia c , is a severe form that occurs in about 1 in 100 million people. i t occurs more frequently among people of a shkenazi Jewish descent. Unlike hemophilia types a and B, it affects males and females equally.
tH ey g et i t fro M tH eir Ma M as faC tor X i D efi C ien C y
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*This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease. Please consult your doctor or healthcare professional before consuming any dietary supplement.
Experts agree that there are no safe levels or safe times to drink alcohol during pregnancy because of the risks for fetal alcohol spectrum disorders. But what about after baby is born? 1 in 4 care providers may say the occasional beer is ok, especially if it helps with the let-down reflex. But what’s the truth?
Myth #1
Alcohol is A nutritious supplement for l ActAting moms
Busted! There’s no evidence that beer, from light to stout, is beneficial for either you or your baby during breastfeeding. Increase milk production through a healthy diet including plenty of non-alcoholic fluids.
Myth # 2
Busted! Alcohol blocks the release of oxytocin and further reduces it in your body, resulting in less milk and a diminished let-down. Alcohol’s negative effects on breastfeeding are present up to 2 hours after your last drink. In
one study, babies consumed 20% less breastmilk in the 4 hours after their mother’s imbibing.
Busted! Your baby may doze sooner but shorter after nursing if you’ve been drinking. Babies exposed to alcohol in breastmilk experience reduced active sleep periods by as much as 25%. Your sleep is affected too, including a decrease in important REM (rapid eye movement) sleep, a critical sleep period essential to helping you manage your moods and stress.
Alcohol doesn’t pA ss to bA by
Busted! Alcohol is a water-soluble substance that flows quickly into breastmilk. And because breastmilk contains lots of water, alcohol concentrates in your milk. If you’re an average 5’4” woman, it takes 2-3 hours to clear 1 ounce of alcohol from your system.
Busted! Research shows that moms who consume 2+ alcoholic drinks a day wean their babies earlier than moms who drank less or none at all. Moms who don’t drink alcohol nurse their babies more often, and through a longer period of time, than moms who drink alcohol.
Busted! The CDC measures a drink as a half-ounce of pure alcohol, 12 oz. of beer, 8 oz. of malt liquor, 5 oz. of wine or 1.5 oz. of liquor. In reality, people rarely measure their drinks, and there’s a tendency to use larger glasses that hold far more than one drink.
Don’t give up breastfeeding even if you occasionally drink. Best practices are to pump and store milk prior to drinking alcohol. limit your drinking as much as possible and wait at least 2 hours before nursing your baby. Pump and discard any alcohol-tainted milk and serve your baby alcohol-free milk only, whether from the breast or stored breastmilk.
Breastfeeding with flat or inverted nipples may seem like a challenge, but with these strategies success is still possible!
Myths about flat or inverted nipples may leave you wondering if you’ll be able to breastfeed your baby. While you may need the assistance of your nurse or a lactation consultant, most women can overcome common breastfeeding challenges—including flat or inverted nipples.
Successful breastfeeding with flat or inverted nipples depends on 3 factors:
B Anatomy: how flat or inverted the nipple is
B Baby: whether baby can latch successfully
B Support: gaining help when needed from a nurse or lactation consultant
Nipples come in all sizes and shapes and are designed for nursing your baby. A nipple may look flat, but work just fine! Nipples, when stimulated by touch or cold, protrude from the breast as a guide or landmark for baby’s latch.
1 in 10 women may have tissue behind 1 or both nipples that prevent nipple erection. These adhesions cause flat or inverted nipples.
So, how do you know if you have adhesions? A simple test will tell: Place your fingers on the top and bottom of your areola (the darker skin around your nipple). Begin about 1 inch back from
your nipple, and gently pinch. The nipple should protrude and become erect. If it doesn’t, there may be adhesions holding it back.
A flat nipple looks flat and won’t protrude with the pinch test. If the pinch test causes your nipple to move inward or even disappear into the areola, this is an inverted nipple.
Your next exploration is to learn if baby has any trouble latching on to your breast and nursing. A healthy baby born at term has an excellent rooting reflex and a strong suck and may be able to latch on with minimal assistance, even with nipple adhesions. If your nipple is severely inverted, even the most vigorous nursing baby may need extra support to latch on—but it’s not impossible.
Lactation consultants are breastfeeding specialists who will help you from birth through weaning, as desired. As you near the end of your pregnancy, talk with your healthcare provider about working with a lactation consultant from birth on, especially if you know you have flat or inverted nipples.
The mother/baby nurses of AWHONN, who publish this magazine, are experts in breastfeeding and work closely with lactation specialists. Your nurses are eager to support breastfeeding from those first moments after baby’s birth until you’re discharged and sent home.
The Breast Sandwich Method uses the idea of squishing or flattening a large sandwich so you can properly chow down. Grasp your breast, making a “C” shape with your hand, and flatten it (behind your areola) to make a “sandwich.” This helps baby achieve a deep latch so they can fully take in the nipple and as much of your areola as possible.
If you have flat or inverted nipples, ask about:
B Gently releasing adhesions that may be holding the nipple back
B Beginning breastfeeding at birth directly from your breasts
B Strategies to ensure that your baby gets enough of your colostrum and breastmilk to stay healthy even if they don’t immediately nurse from your breasts at birth
Nipple shields can help with latching problems but they’re rarely a permanent solution. With flat or inverted nipples, use shields only assistance from a lactation specialist.
Be flexible! What worked in the first 12-24 hours may need to change as baby adapts their feeding style to their new skills.
B Put your baby to breast and see what happens. Immediate, uninterrupted skin-to-skin contact is so vital at birth. Your baby will smell your colostrum and breastmilk and will be eager to scoot to your breast
B Hold baby in a laid back nursing position, skin to skin, to encourage nursing. Ask your nurse if baby has a proper latch and position. Your nurse will also teach you how to gently break baby’s latch and begin again if it’s not quite right
B Stimulate your nipples before bringing baby to your breast. Roll your nipple with your fingers, or use a manual or electric breast pump just to the point of nipple erection, then start nursing. A cold compress can help nipples emerge
B Hold your breast so that your nipple naturally remains erect, helping baby get a deep latch. It’s important that their mouth is taking in the areola, not just the nipple.
B Use an electric or manual breast pump and feed your colostrum or milk to your baby using a spoon, dropper or cup
Cynthia Loring, MS, rn C, CLC, is an expert adviser to Healthy Mom&BabyAWHONN nurses know these success strategies can overcome breastfeeding challenges:
*These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.
Sleep is vital to your baby’s health and growth—even their ability to think and learn. Help your baby get all the sleep they need by learning when to let sleeping babies keep sleeping.
BY CHARLOTTE WOOL, PHD, RNSleep should beprotected wheneverpossible because itplays a major rolein brain growthanddevelopment.temperament
Your baby benefits from every diaper change when you practice these 5 habits shown in research to benefit baby’s growth and development:
Create a calm and clean diapering environment through good hygiene and supplies at the ready
Change and check baby regularly, such as every 1–3 hours during the day and at every feeding
Healthy food. Vigorous exercise. Restorative sleep. These are essential to all human health— but did you know that babies have very different sleep patterns to adults?
We adults need 7-8 hours of uninterrupted snoozing every 24 hours. On a good night, we go through 4 sleep cycles of some 90-100 minutes each. At the end of each cycle, we either wake up or drift back to an earlier sleep stage and repeat the cycle.
Babies have only 2 sleep cycles, active sleep and quiet sleep. These cycles are short—only 5060 minutes for the first 9 months of life before their sleep begins to change to be more like ours.
Babies first drift into an active sleep cycle. As baby begins to snooze you may see baby moving their body, fluttering eyelids or hear baby making gentle noises. About half-way through one cycle, babies begin to transition to another. In quiet sleep, you’ll see baby’s breathing drop into a
slower, rhythmic pattern, and they’ll have less body movement.
In quiet sleep, babies are less likely to be disturbed by noises. Baby either wakes up from a quiet sleep cycle or transitions back to active sleep.
The benefits of adequate sleep for your baby are nearly boundless, says the American Academy of Pediatrics. Sleep is essential for baby’s:
Growth
Weight gain
Brain development
Increased immunity
Stress reduction
Self-control
Language
Learning
Higher-level thinking like problemsolving, to name but a few!
Comfort baby by moving slowly through the diaper change to minimize any stress or discomfort
Champion sleep by practicing skin-to-skin care at bedtime and using diapers with wetness indicators to avoid disturbing baby’s snoozing
Have confidence and closeness that come from learning your baby’s cues and responding to baby’s needs, such as for a clean, dry diaper
Source: Adapted from Huggies® Every Change Matters: A Guide to Developmental Diapering Care.
In between sleepcycles, give your babysome time to fall backasleep on their own.
Sometimes babiesfuss but are able toget back to sleep bythemselves, especiallyas they get older.
Skills where movement and thinking are combined, like coordination and balance, are also affected by sleep. This includes both active and quiet sleep, which is why it’s important to protect baby’s sleep as much as possible.
You may have heard the phrase, “Never wake a sleeping baby.” Science has confirmed this is a good rule of thumb! Think about protecting your baby’s sleep in 2 ways:
surface, such as a crib or bassinet on a tight-fitting sheet
X Don’t use soft bedding or put any other items in the bed—it should be bare and free of things like blankets and stuffed animals (no crib bumpers!)
X Share a room, but not a bed, with your baby for at least their first 6 months and up to 1 year. Room-sharing decreases the risk of sudden infant death syndrome (SIDS) by 50%
X Never expose your baby to smoke, alcohol or illicit drugs
Protect your baby from interruptions when they’re already asleep.
1.
Avoid waking your baby unnecessarily. For example, put your baby to bed in a clean, dry and super-absorbent diaper. Only disturb baby if you need to change a soiled diaper; diapers with wetness indicators can help you avoid waking your baby needlessly.
Protect baby’s sleeping environment so that noise doesn’t startle them awake. Some babies seemingly sleep through anything, while those who are light sleepers may need more support to block disturbances.
Because babies have unique sleep cycles, it can take months for them to begin sleeping through the night. The first 6-8 weeks are often the most difficult; some parents are convinced that baby has night and day mixed up. This is an exhausting and overwhelming time in any parent’s life.
Promoting sleep takes time and patience as you discover your baby’s preferences and what works in your family. Avoid “sleep training” advice and systems—these are ineffective and some are downright dangerous for baby because they ignore the developmental aspects of baby’s sleep cycles with the goal of mimicking adult sleep.
2.
Protect your baby from sleep-related risks. The American Academy of Pediatrics’ updated recommendations (2016) for a safe infant sleep environment include:
X Placing baby on their back on a firm infant-safe sleep
Your baby will naturally begin sleeping for longer periods— and yes, eventually through the night!—as they develop and grow.
After baby’s first 6-8 weeks, during which time baby will
Premature babies (born before 37 weeks) need extra sleep support. Sleep-deprived preemies may have more difficulty regulating their emotions and grow and learn at a slower rate.
Research shows that parents and caregivers are key to helping preemie babies get good quality sleep. Watch for those things that help baby drift off to sleep. Some babies need a little time to soothe themselves; others need your help to calm down, relax and drift into sleep.
Your baby may like sucking their thumb or need help finding and using their pacifier. The American Academy of Pediatrics recommends using pacifiers in all babies to reduce risks of sudden infant death syndrome (SIDS). If your baby’s pacifier falls out of their mouth after they’ve drifted to sleep, there’s no need to replace it.
Protect your preemie’s sleep by helping them relax and fall asleep with:
B Gentle touch
B Skin-to-skin snuggling
B Relaxing, low music or singing and humming
B Resting baby’s head on your chest near your heartbeat
B A super-absorbent diaper with a wetness indicator so that you don’t disturb baby’s sleep to check or change a dry diaper
B Appropriate dim lighting to promote sleep
If your baby is in a NICU, your nurses will work with you to help cluster their needed care for baby during awake cycles, when possible, to protect baby’s precious sleep.
As you tune in to your baby and respond to their needs, trust builds in your relationship and everyday actions. Protecting your preemie baby’s sleep helps optimize their growth and health for the long term.
Ch AR lotte Wool, PhD, RN, is a nurse educator and an expert adviser to healthy mom&Baby. Development of this article was supported with funding from h uggies®
likely be nursing or needing to feed every 2-4 hours through the night, begin to support a predictable but personalized bedtime ritual. This will help your baby begin to recognize patterns, begin to create expectations and process information in an organized way. For example, to help baby recognize the difference between daytime and nighttime:
X Minimize noise during sleep time, especially at night
X Sing, hum or play special music that is used only at nighttime as a cue that it’s time to sleep
X Use light to emphasize the difference: During awake times, the lights can be on and sunshine can stream through the window. During sleep times, lights should be dimmed or off
X Practice rituals, such as rocking, cuddling skin-to-skin or swaddling, to cue baby that it’s time to doze off
Avoid playing with or talking to your baby during sleep time; shushing sounds are OK and relaxing. Diaper changes can also cue baby toward relaxation and sleep. During the day, when baby is awake and active, use a more lively approach to each diaper change; soften your tone and touch as nap time nears.
Developing a sleep routine is just one part of your baby’s development; don’t rush it or stress over it. You’ll both make it through those earliest weeks and benefit from the restorative sleep you both deserve once baby’s old enough and developed enough to sleep through the night.
It’s every parent’s dream: Reacting to conflict with confidence and curiosity. Reacting less and connecting more with your kids. Finding ease among family mayhem.
Indeed, this is possible if you take a fresh look at the sense of rush that pervades our lives, and consciously choose to give your kids your full attention—this is the one thing they crave and need the most from us.
First, being mindful does not mean that you are calm all the time. You can just as easily be aware of your anxiety, anger or fear, as you can be all zen and relaxed. Don’t get me wrong, I love it when practicing meditation or mindfulness brings me to a state of calm, but I don’t at all expect that to be the case, nor should we expect constant calm and bliss while weaving in and out of family life.
Our family has a gratitude jar on the kitchen counter with some little pieces of paper and pens in a bowl right next to it. We often stop during the day to write a few things down we appreciate about each other or our lives.
As a mom, I use my journal to jot down reflections from the day, or better yet tell my children what I appreciated about them that day as they fall asleep at night. Humans have a serious negativity bias, so it’s super easy to start feeling like your children are a total disaster and your relationship with them stinks.
Being specific is helpful. For example, instead of sharing, “You were really kind today,” you might say, “I noticed how
you helped your brother find his shoes this morning when he was running late. That was really kind.” Catch them being good whenever you can.
Use ordinary moments to connect with your children. Don’t wait for that perfect moment on vacation or when the house is quiet (which may never happen). Use the everyday moments to connect. I call these “I see you” moments, where, for just a second, you catch each other’s eyes and feel a moment of connection.
Create and foster fun and unique family rituals. One such ritual I enjoy with our family is kitchen dance parties. Michael Jackson or 90s hip hop is a family favorite of ours. And it’s something we enjoy not only as a family, but also when we have friends over.
Life can become so dang serious, so we find it’s important to take time as a family to play. We use dance parties when everyone is stressed, and when the household has become grumpy. Above all, rituals should be all about enjoying life together.
Mindfulness educator Michelle Gale’s latest book is Mindful Parenting in a Messy World—Living with Presence and Parenting with Purpose.
This the first time there’s ever been you, so I wonder what wonderful things you will do. . . .
Your baby’s doctor knows what is best for their health, but only you know what is best for their heart and mind. In the #l New York Times bestselling picture book, Emily Winfield Martin celebrates every individual child and the infinite possibilities ahead of them.
Art © 2015 Emily Winfield Martin
Retired Entrepreneur/Interior Designer turned Inventor, Janet DeMaria, developed a NO SNAPS! Infant Bodysuit called a SKADOOSIE®. She took up babysitting to give that extra helping hand to parents with infants and small children soon after her husband’s passing. Upon realizing the bodysuit hadn’t changed in 20 years since her son was a baby....she turned a 139-year-old idea into a more viable product for today’s busy working Moms, Dads & Grandparents.
Who doesn’t look forward to the day when diaper changes become a distant memory?
Until then, you may struggle with the same questions other parents ask:
Do boys potty train later than girls? (Typically, yes)
Is there a right age to toilet train? (No)
How will I know my toddler is ready to use a potty? (Read on!)
Before your child can transition to a toddler potty, they have to be able to do 3 things, say experts at the American Academy of Pediatrics:
1. 2. 3.
Know they need to go—feel the ‘urge’
Tell someone they need to go Get to a potty before they actually go
Waiting until they’re ready and able to do these 3 things can turn toilet training from a chore to a choice.
None of these things are likely to happen before baby’s 1st birthday—or even before baby’s 2nd birthday—so there’s no need to rush what may be exasperating for you and your child if potty training begins too early.
Experts agree that the older the child is when toilet training begins, the more quickly they may be able to transition to using a potty. In the meantime, you can watch for signs of readiness that your child is moving toward being able to learn how to relieve themselves in a potty. e more signs you see, the more likely your child is becoming ready for their own potty:
Taking off their clothes or diaper on their own
Pretending they’re using the potty
CAROLYN DAVIS COCKEY, MLS, LCCE, is editor of Healthy Mom&Baby.Watching you or their siblings use the toilet
Unfastening a wet or soiled diaper
Keeping a diaper dry for longer periods of time
Telling you that they’re going, or have just gone, in their diaper
Waking up dry from sleeping or napping
When Alison’s son was first diagnosed, she felt guilty and sad for her baby boy. But, by processing her emotions through a creative outlet, she found a wealth of support.
BY ALISON BURDETT & SUMMER HUNT, ELS
Jack was barely 2 months old when I started to notice the fl atness on his head. When my husband, Ben, noticed it too, I still didn’t want to acknowledge it. I was in denial. Had I neglected him? Not given him all the focus and attention I gave our fi rst child, 2-year-old Eleanor? e “mom guilt” was strong. I blamed myself: I should have held him more, or given him more tummy time. I didn’t want anyone to know about that fl at spot. What would they think of my parenting?
At Jack’s next checkup, his healthcare provider confi rmed our suspicions that something wasn’t quite right with Jack’s head. en he asked if Jack was always looking to the left. While we hadn’t noticed that before, it became impossible to overlook— he never turned his head to the right. Jack was born with a tightening in his neck muscles. at was when we learned a new word: torticollis.
I remember having that word written on a Post-It® note with a phone number for a pediatric physical therapist (PT). I wasn’t sure what to think. But at least I had a word to use, even if I didn’t know what it meant—a word to use so I didn’t have to give details about what my baby’s head looked like over the phone to a stranger. e PT explained that Jack had tightness in his neck muscles, which is why he couldn’t turn his head to the right.
en we got another new word: plagiocephaly. Put simply, it’s a misshapen head. e torticollis meant Jack was constantly lying on the left side of his head, causing the asymmetry. Jack’s case was rated “severe” by a cranial technologist we were referred to. ey recommended he wear a custom-made cranial helmet called a DOC Band® that would reshape his head as he grew.
After doing some research, we decided to proceed with this treatment. Jack’s pediatrician was also very supportive of our decision.
During physical therapy, Jack’s PT put a lot of emphasis on tummy time so that Jack would not be resting on his head. She used toys to get his attention and help him look in different directions. She worked on his range of motion and showed us exercises we could do at home, including how to hold him so that his neck got a nice, gentle stretch.
After 1½ months of physical therapy, the torticollis was gone. About the same time, he began treatment with the helmet. He wears it for 23 hours a day; we take it off to give him a bath and kiss all over his adorable fuzzy head. So far, he’s been wearing the
Alison, Ben, Eleanor and baby Jack enjoy a sunny day outdoors.helmet for 8 weeks. Now that he’s 6 months old and his growth has slowed, the cranial technologist is recommending a second DOC Band for up to an additional 12 weeks.
When Jack fi rst began treatment for plagiocephaly, I resisted posting pictures of him in his helmet on social media, mostly because I didn’t want to deal with questions. But I knew there was no way I could resist posting pictures of my adorable baby on social media for the duration of his treatment. So as a photographer, I decided to process my feelings the only way I know how—by creating around them.
I painted a beautiful blue-sky background, inspired by the movie Up —with a vision of Jack as an aviator and his journey through plagiocephaly as an adventure. And then I posted it on Facebook, because that’s what millennial moms do. I was overwhelmed and pleasantly surprised to see all the sweet comments from my friends, including some who had the exact same experience.
To moms dealing with a plagiocephaly diagnosis: Don’t blame yourself. Don’t be afraid of what people might say, and know it won’t be as bad as you fear. Occasionally I hear, “What happened to him?” and I can fi nally relax and even chuckle at that question.
Also, join a support group. e online group of other parents whose children are using the DOC Band was helpful for specific questions I had, but my in-person breastfeeding group also offered me the immeasurable support of other moms who love and care about me and my baby. Know you are not alone. You have a lifetime to be hard on yourself as a parent—this is not one of those times. Trust yourself. Everyone knows you’re a good mom who will do whatever it takes to care for your baby.
ALISON BURDETT is a multimedia producer, graphic designer, and photographer in Montgomery County, MD. SUMMER HUNT, ELS, is assistant managing editor of Healthy Mom&Baby.
Avoid prolonged time (especially sleeping!) in a car seat, swing, bouncy chair or carrier
Alternate arms when you hold or feed baby
Hold your baby upright out from your body and engage them with their surroundings
Switch up baby’s view at bedtime by placing them to sleep at alternate ends of the crib; always place baby to sleep in their crib or bassinet on a firm, flat surface on their back
“Tummy time” is supervised playtime with your baby lying on their stomach—typically on a floor where baby can’t roll off or fall. Because babies sleep on their backs for long periods, tummy time is essential from birth to ensure their head and neck develops normally. Tummy time helps baby’s neck and shoulder muscles get stronger so that baby can begin to sit up, crawl, roll over and eventually walk. Tummy time that includes toys also helps babies to start organizing their motor skills.
Start with 3-5 minutes in several short sessions and lengthen the sessions as baby gets stronger. Never leave your baby unsupervised on their tummy. And tummy time doesn’t always mean getting on the floor; try these tips from experts at the American Academy of Pediatrics:
Place your newborn on your stomach or chest while you’re awake and in a reclined position; engage with them and encourage eye contact
Lay baby across your lap lengthwise, supporting their head and keeping it aligned with their body; if they fall asleep, carefully move them to their crib, laying baby on their back
Lay baby on their side under an arched toy for exploration, or on a blanket, with their arms and legs forward from their trunk. Add a rolled-up towel behind their back and a folded washcloth under their head to provide more comfort
With his special helmet and aviator gear, Jack soars through the sky.designed by doctors double sided 100 x 150cm surface area 5cm of thick soft padding multi sensory toys
water resistant machine washable plastic detachable sheet for messy play folds for storage
Your baby needs at least a full 40 weeks of pregnancy to grow and develop. Inducing labor even a week or two early is associated with a host of risks, including prematurity, cesarean surgery, hemorrhage and infection.
While it may seem convenient for you or your health care provider, labor should only be induced for medical reasons.
Your baby will let you know when he’s ready to come out, so give him at least a full 40 weeks.
As a nurse, I am all about prevention. e latest safe infant sleep recommendations are based on what experts have learned and are known risk factors for sleep-related infant deaths. As a mom, I also get the need for sleep.
During my second pregnancy, I worked full time, chased around a 2-year-old, and developed insomnia! Prior to going into labor, I was exhausted. I went home with my newborn even more exhausted, and I stayed that way for a long time. I understand the desperate need for sleep parents feel.
Always lay baby on their back for all sleep times—nighttime and naps, and if baby dozes off in your arms
Meaning no blankets, toys, pillows, bumpers, plushies or any other objects or soft items in baby’s sleep area
Every year in the United States, 3,500 infants die suddenly and unexpectedly while sleeping. Many of these deaths are due to sudden infant death syndrome (SIDS), accidental suffocation, entrapment, and strangulation. is is almost 10 babies a day!
While some SIDS cases can’t be prevented, most sleep-related deaths occur in unsafe sleep environments—and these deaths are preventable. As a parent, there’s so much you can do to help your baby sleep safely. e CDC recommends these top 4 actions to keep your infant’s sleep as safe as possible:
Baby only sleeps in an infant-safe crib or bassinet, with a properly fitted infant mattress and a tight-fitted sheet on top—nothing else
Baby sleeps in your room for the first year but not in your bed; baby sleeps in their own bed only
SHARON HITCHCOCK, MSN, RNC, is faculty for the University of Arizona College of Nursing in Tucson, AZ and an expert adviser to Healthy Mom&Baby.
Hospitals and nurses make great efforts to ensure that each baby receives the best possible care. Similar efforts should continue when the baby leaves the hospital.
The Baby Safety Snap lanyard (patent pending) helps drivers remember that they have a “BABY IN CAR”. Attached to the highly visible lanyard is a baby seat metal tab that fits all baby seat buckles. The lanyard’s metal tab is snapped into the baby seat buckle when the seat is not occupied. When the baby is placed in the seat, the driver removes the tab from the buckle and places the
lanyard around their neck. The baby is then buckled into the seat.
The driver wears the lanyard until they reach their destination. The driver then removes the lanyard, unbuckles the baby, and snaps the lanyard tab back into the buckle for the next driver. The baby is safe and leaves the vehicle with the driver.
If the baby is forgotten, the visible Baby Safety Snap lanyard worn by the driver will remind the driver, family members, coworkers and even strangers on the street that there is a “BABY IN CAR”.
The Baby Safety Snap can also be customized to include a logo for a healthcare enterprise, professional organization or any other business to show the community that they care about the safety of their children.
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Every ten days, a baby dies in a hot car.
One in four parents has forgotten a young child or baby in a car.
Dozens of young children die every year after being forgotten in a car that heats up as temperatures rise.
As summer approaches each year, you may begin to worry about storm season. What you’re least likely to think about, experts say, is whether you may one day absent-mindedly leave your child in your car. Sadly, more kids die after being left and locked into a hot car every summer than from severe storms, including tornadoes.
Each year, an average of 37 kids die in hot cars, say experts at the National Safety Council. Between Memorial and Labor days as many as 2-3 kids per week die in hot cars when their parent or care provider forgetfully leaves them there, typically strapped into their car seat.
It seems incomprehensible, but a change in a morning schedule, an incoming phone call or rushing to get to work can make any parent forgetful.
Temperatures inside a car on a sunny day can spike by as much as 20 degrees in just 10 minutes— that’s a 1-degree increase every 30 seconds, and temps climb even on mild days. Young kids are at risk because their body heats up 3-5 times more quickly than does an adult’s body. As their body temperature rises, heat stroke can set in, especially at 104 degrees or more. Temperatures of 107+ can permanently damage organs and cause death, says the American Academy of Pediatrics.
Leave your car locked at all times to ensure young children can’t climb in to play and get trapped
Never leave children alone in your car— not even for a minute
Create a need to go to your child when leaving your car: leave one or both of your shoes, wallet, purse, or cell phone next to your child
Set electronic reminders like scheduled text messages or calendar alerts to prompt you to take your child to their babysitter or daycare; ask baby’s care provider to call if you don’t arrive as scheduled
Use technology— newer cars can display messages to check the backseat if you’ve opened/closed a rear door before your trip. Car seat alarms work with car seat clips to alert you if you’re leaving a child strapped in a car seat
87%
are age 3 or younger 54% are forgotten in a vehicle 27% are playing in an unattended vehicle
18% are intentionally left in a vehicle by an adult
Call 911if you see achild alonein a car.
CAROLYN DAVIS COCKEY, MLS, LCCE, is editor of Healthy Mom&Baby.
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West 4th Wraps are soft and mould to your body to give you support and comfort during pregnancy, and to carry your baby until they are a toddler and beyond.
Our wraps are used for comfort measures during pregnancy, for temporary support of mom’s belly, to apply counter pressure in a hip squeeze, and for partner for assisted squats.
Carrying your baby in a West 4th Wrap or RingSling allows for skin to skin contact, that develops an amazing bond between baby and mom and other members of the family.
In the #1 New York Times bestselling picture book, The Wonderful Things You Will Be, Emily Winfield Martin celebrates every individual child and the infinite possibilities ahead of them. It’s the perfect addition to any nursery library with its loving and inspiring message. penguinrandomhouse. com
Grab Green’s Newborn Baby Laundry Detergent leaves virtually no residue on clothing, preventing irritation on baby’s delicate skin. The detergent is formulated to remove newborn stains like milk, spit up, and diaper disasters and is made with more than 94% naturallyderived ingredients.
Grab a FREE sample pouch at grabgreenhome.com/ newborn
Only Ava tells you your 5.3 most fertile days in real time and doubles your chances of conceiving. Wear the Ava bracelet at night for effortless insight about your fertility, pregnancy, and your health. Use code HEALTHYMOM for $20 off.
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Skadoosie is a USA-made and patented product with a unique rear diaper check slot. Made with USA 100% cotton fabric and baby soft Velcro fasteners.
Skadoosie goes on like a blouse with no overhead application fastening at the center of the chest.
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The Spin and Explore Garden Gym puts a unique spin on tummy time play, an important developmental phase for all newborns. Babies gently and comfortably spin around on their tummies, stretching and building upper bodies while exploring squeaky, crinkly and tactile fun.
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The world’s first supportive swaddle. Shop Kepi’s patented design provides your baby’s head, neck, and spine with the support it needs.
Reduces the risk of flat head syndrome, hip dysplasia, and unnecessary anxiety in parents and newborns.
Allows parents, siblings, and grandparents to hold and pass the baby with confidence.
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The beautifully designed, compact and lightweight digital heartbeat monitor is a baby heartbeat sound amplifier that helps to encourage bonding during early pregnancy.
As a new parent, hearing your baby’s heartbeat and sounds can make you feel closer to your little one as they grow in the womb. You can conveniently hear the baby’s sounds at any desired time in the comfort of your own home, which can give comfort and assurance, particularly for women who have previously experienced a difficult pregnancy.
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You may wonder how your other children will react to a new sibling. Anticipate some jealousy—this is a normal reaction that children of all ages experience to some degree. Preparing your child for a new baby can help minimize jealousy and create a transition with (hopefully) minimal tears.
To begin, be sure that your little ones learn about your pregnancy from you, rather than from others. Once the secret’s out, consider these tips to support your growing family:
Share pictures and stories with your child from when you were pregnant with them; describe how much they were loved as a baby
Discuss what life with a new baby will be like; children may expect an instant playmate and be disappointed
Read books and watch shows that address siblings in a kid-friendly way
Visit friends or relatives who have a new baby; hold their new baby so that your child gets accustomed to seeing you with a baby
Let your children pick out something special to give the baby
Consider sibling preparation classes ; find these where you attend childbirth education or where you plan to give birth
Make any changes to your child’s room well before your due date, particularly if you’re moving an older sibling to a toddler bed
Avoid major life changes for your little ones— this probably isn’t the best time to try potty-training
Give your child a realistic-looking baby doll; address the doll as “baby brother” or “baby sister” and encourage loving behaviors like kissing, rocking and snuggling
Share who will provide care for your children while you’re in the hospital
Buy a small gift for your older child from their new baby brother or sister; surprise them with it when they visit you in the hospital
Let your child know you’ll stay in the hospital for a few days after they visit; toddlers can get upset when mom isn’t at home with them
RITA NUTT, DNP, RN, is an expert adviser to Healthy Mom&Baby.
When it comes to siblings and a new baby, don’t:
1. Punish your child for acting out to get attention
2. Hide away from your child when breastfeeding
3. Insist that they help with the new baby
At Milkbe Strollers, we design an innovative line of baby strollers and products that are effortlessly adaptive for you and your baby. Since our inception, we’ve passionately designed strollers that are unmatched in style, comfort, and our number one top priority: safety. From our hardware to tailoring, we have manufactured high-end strollers and products that are top quality. Milkbe focuses on delivering a powerhouse ergonomic structure that is flexible for parents’ everyday life. We strive to meet the needs of your new life as a parent through our easy-to-use and minimal instruction products. Our strollers provide comfort, convenience and protection.
A new baby often means a new set of strollers. We know how stressful life as a new parent can be. We see it as our duty to create the safest and most modern stroller on the market today. Milkbe Strollers has strived to meet the needs of your family by taking key factors into consideration, such as accommodating a newborn, five-point harness that’s easy to buckle and adjust, versatility and much more. Through patent-pending auto brake and hand sensor B technology built right into our strollers, you never have to worry about your stroller moving—even if you forget to set the brake. It’s designed with your needs and those of your baby in mind.
At Milkbe, our mission is to develop modern yet safe strollers and products. Ideal for infants and toddlers, we keep your family safe and comfortable anywhere you go. A sweet set of wheels perfect for you and your little one.
Your family’s health and happiness are always our top priority which is why we live and work with these values:
Our number one concern is safety. That’s why our patent hand auto brake sensor is designed to stop our stroller from moving even when you forget to set the brake. We’ve thought of everything, so you don’t have to.
Although we pride ourselves on developing an attractive and innovative stroller, we also know how important it is for our stroller to be easy to use on the go. We’re confident you’ll find our stroller the perfect combination for all your needs.
Over 600 medical studies on the effects of human touch prove what moms have always known: Hugs are important.
In fact, more and more hospitals state that they are vital to the healthy development of a child. And the benefits of human touch for babies often extend throughout childhood.
The benefits of hugging.
Every hug sets off cascades of hormones that benefit health and help regulate body temperature. Oxytocin, the hormone released by touch, is even nicknamed the “bonding hormone.” A hug can stabilize heart rate, increase oxygen levels, strengthen the immune system, and reduce crying and stress.
After the first hug, let the second thing that touches baby’s skin feel just as good. Huggies® Little Snugglers Diapers and Huggies Natural Care® Wipes provide our best care to help keep their skin clean and healthy. And as perfect as the day they were born.
