Healthy Mom&Baby: Issue 30

ISSUE 30 / 2021 | $3.95 | health4mom.org

PREGNANCY | BIRTH | PARENTING

40 REASONS TO GO THE FULL 40 WEEKS UPDATED! WHY YOU NEED PRE- AND PROBIOTICS SAFER INFANT SLEEP TIPS HEY MOM, VACCINATIONS PROTECT YOU & BABY DURING COVID-19

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Issue 30 / 2021

Contents ◆ healthy moms

◆ healthy pregnancy

◆ healthy babies

10 Balancing Family and Work

32 COVID 19 Vaccine During Pregnancy

49 Diapering Decisions

The demands of modern life leave many of us juggling competing priorities.

13 You Deserve Respectful Care Begin prenatal care by choosing a supportive pregnancy care provider.

34 Folic Acid and Birth Defects

Pregnancy stresses your pelvic floor; here’s how to recover well.

How folic acid cuts the risk of having a baby with a spinal or brain birth defect.

19 Pumping for Your Premature Baby

35 Choosing a Natural Birth

Use these simple strategies to help support your milk supply.

Planning to birth without medication is becoming increasingly popular.

21 Breastfeeding and Working

36 40 Reasons to Go the Full 40

Returning to work while nursing is a huge milestone in your parenting journey.

Here are fi ve keys to supporting a lasting relationship after baby comes home.

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27 Five Fertility Tips

33 Losing Weight in the Fourth Trimester Trim those extra pregnancy pounds the healthy way with these proven strategies.

16 Pelvic Floor and Perineal Health

25 Keeping the Romance Alive

Studies show that pregnant women are more likely to have severe COVID disease.

Here are 40 reasons to go at least the full 40 weeks of pregnancy!

39 Birth Settings You’ve got options when it comes to choosing where you want to birth your baby.

42 Consider These Classes

You don’t have to face challenges in conceiving on your own.

29 Lines, Pigment and Stretch marks What is going on with your body during pregnancy—we know and we’re sharing!

An overview of classes available and how they help you prepare for your new baby.

44 Pre-term Labor Most moms expect to complete pregnancy around their due date, so what if you go into labor prematurely?

51 Teething Time!

These teething time tips will help your baby cut their chompers with as little pain as possible.

55 Prevent Mosquito Bites Using insect repellent and wearing light, layered and loose clothing are a must anytime it’s mosquito season.

56 Sun Protection For Baby New FDA sunscreen guidelines should help address some of the confusion over what suncare is best for baby.

57 Bathing and Moisturizing From birth, protecting and promoting baby’s healthy skin is a daily job for parents and caregivers.

61 Infant Sleep Safety Babies need their own space to sleep, but it can be super confusing figuring out what product is safe and what’s not.

66 Visitors During COVID-19 Everybody wants to meet the new baby, but during pandemic, it’s important to keep baby and parents safe and healthy.

Keeping the Romance Alive After Baby

COVID 19 Vaccine During Pregnancy

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Bathing and Moisturizing Baby’s Skin

25 Pelvic Floor and Perineal Health

Diapering decisions are easy when you act on advice from nurses who have evaluated all of the options.

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Teething Time!

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40 Reasons to Go the Full 40 3

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HEALTHY MOM&BABY EDITORIAL ADVISORY BOARD LASHEA HAYNES MED, MSN, APRN, AGCNS-BC, RNC,C-EFM Editor Perinatal Potpourri, LLC Nurse Mentoring & Consulting Atlanta, Georgia PARIS MALOOF-BURY, MSN, CNM, RNCOB, IBCLC Associate Editor Sutter Women’s Health Davis, California MICHELE KACMARCIK SAVIN DNP, APRN, NNP-BC Thomas Jefferson University Philadelphia, PA JAMIE VINCENT, MSN, APRN-CNS, RNCOB, C-EFM, C-ONQS John Muir Health Walnut Creek, California JOANNE GOLDBORT, PHD, RN Michigan State University College of NursingEast Lansing, Michigan ALIAH THOMAS, RNC-OB Wellstar Health System Atlanta, Georgia ESSENCE WILLIAMS, MSN, BSN, RNCMNN, CCB, LCCE Southern New Jersey Perinatal Cooperative (SNJPC) Crum Lynne, Pennsylvania KIMBER STOVESAND, RN Nomad Health Charlotte, North Carolina LAKISA BALLARD, MSN, RN, C-EFM, RNC-OB Perinatal Travel Nurse Charlotte, NC SHAWANA S. MOORE, DNP, MSN, CRNP, WHNP-BC Thomas Jefferson University, College of Nursing Philadelphia, PA RACHEL NAPOLI, DNP, PHN, CNS, RNCOB, IBCLC Sonoma State University Petaluma, CA JESSICA MCNEIL, DNP, APRN, CNM, RNCOB, C-EFM Parkland Health & Hospital System Baylor University, School of Nursing Dallas, TX HEATHER WATSON, PHD, MSN, RN Johns Hopkins Health System Baltimore, MD DANIELLE BEASLEY, PHD, RN, RNC-OB, CNE University of South Florida Tampa, FL CHARLOTTE WOOL, PHD, RN, FAAN York College of Pennsylvania York, PA JENNIFER LEMOINE, DNP, APRN, NNPBC Southeastern Louisiana University Hammond, LA RITA NUTT, DNP, RNC-OB Salisbury University Salisbury, MD SHARON HITCHCOCK, DNP, RNC-MNN University of Arizona College of Nursing Tucson, Arizona

AWHONN’s mission is to improve and promote the health of women and babies.

Healthy Mom&Baby is powered by the nurses of AWHONN.

Get Vaccinated to Protect Yourself & Your Baby during COVID-19

By Cyndy Krening, MS, CNS, RNC-OB, C-EFM

If you’re pregnant during the COVID-19 pandemic, you’re likely concerned about the safety of the vaccines available.

What experts and healthcare providers know to be true thus far is that getting a COVID-19 vaccine during pregnancy can protect you and your developing baby.

Being pregnant puts you at increased risk for severe illness from COVID-19 as compared to people who aren’t pregnant. Severe illness means you may need to be hospitalized, receive intensive care, or even breathing support on a ventilator or other equipment. There is also evidence that pregnant people who contract COVID-19 are at increased risk of preterm birth, and may also be at greater risk for other adverse outcomes during pregnancy.

Get Vaccinated

Getting vaccinated during pregnancy is generally believed safe and protective for you and your baby. Experts acknowledge that there’s limited but increasing research about the safety of COVID vaccination during pregnancy, and based on how these vaccines work in the body, healthcare and public health experts believe they’re unlikely to put you and your baby at risk.

Currently, there are clinical trials of the safety of COVID-19 vaccines ongoing in people who were pregnant when they got vaccinated, and people who became pregnant after they got vaccinated. To date, none of the safety monitoring systems used to gather information

about the effects of the COVID-19 vaccine have shown predictable adverse outcomes of COVID-19 vaccination in pregnancy. The early data are what’s called “preliminary but reassuring” as they didn’t identify any concerns for pregnant people or for their babies.

Because most of the pregnancies reported in these studies are still ongoing, more follow-up data is needed for people vaccinated just before or early in pregnancy.

Side effects can occur after receiving any of the available COVID-19 vaccines, especially after the second dose for vaccines that require two doses. The side effects reported by pregnant people haven’t varied from those reported by other people. Although rare, some people have had allergic reactions after receiving a COVID-19 vaccine. Talk with your healthcare provider if you have a history of allergic reaction to any other vaccine or to a medication.

Get Involved

If you are pregnant and receive a COVID-19 vaccine, consider participating in the CDC’s v-safe pregnancy registry.

If you’re pregnancy and have received a COVID-19 vaccine, we encourage you to enroll in v-safe. Download the app in any of the app stores; v-safe is CDC’s smartphone-based tool that uses text messaging and web surveys to provide personalized health check-ins after vaccination. Participation is voluntary, and participants may opt out at any time.

CYNDY KRENING, MS, CNS, RNC-OB, C-EFM is the 2021 AWHONN president.

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AWHONN AWHONN 2021 President

Cyndy Krening, MS, CNS, RNC-OB, C-EFM Chief Executive Officer

Improving Outcomes For All Moms

By LaShea Haynes MEd, MSN, APRN, AGCNS-BC, RNC, C-EFM

Jonathan Webb, MPH, MBA Senior Vice President, Strategic Partnerships, Communications & Meetings

Billie Robinson, MBA, CAE Editor-in-Chief & Senior Director, Strategic Partnerships & Publications

Carolyn Davis Cockey, MLS, LCCE Editor

LaShea Haynes MEd, MSN, APRN, AGCNS-BC, RNC,C-EFM Associate Editor

Paris Maloof-Bury, MSN, CNM, RNC-OB, IBCLC Assistant Managing Editor

Sofia Navard MAITLAND WARNE Group CEO & Publisher

Kevin Harrington Editorial

Chris Jenkins Design

Friyan Mehta Production Director

Joanna Harrington Production

Adam Linard-Stevens

Pregnancy, labor and birth should be one of the happiest moments of a birthing person’s life. For some, they have dreamed of starting a family their entire lives. This time for you and your partner’s life should be filled with excitement, anticipation and euphoria. But with the COVID-19 pandemic and recent headlines sharing the risks of poor outcomes for moms of color in this country, birth may seem scary, unpredictable, and even life-risking for some.

My dedication to you as the Healthy Mom&Baby editor is to provide articles and resources that can keep you and your new baby safe from pregnancy through birth, and into parenting. The advice from mother/baby nurses in our articles give you suggestions, guidance, and information to discuss with your partner, healthcare providers, doula, and nurses to make your baby’s birth the safest and memorable laboring experience you and your family can have.

Cover image

© michaeljung | Getty Images Healthy Mom&Baby is published by Maitland Warne in partnership with AWHONN. © AWHONN, 2021. 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.

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PUBLISHER

MAITLAND WARNE 29 East Madison Street, Suite 809, Chicago, IL 60602, USA Tel: (312) 572 7729 www.maitlandwarne.com

Please use these articles as a guidebook for the safety and protection of you and your baby. Take comfort in knowing our articles are based in the latest scientific evidence, and written by the highly educated, professional and passionate nurses of AWHONN, the Association of Women’s Health, Obstetric & Neonatal Nurses.

AWHONN’s members will be with you to support you through labor, birth and recovery. We are dedicated to providing you with timely advice.

For the latest information, follow us on Facebook, Pinterest, Instagram, and YouTube. There you will find even more exciting interviews, information and announcements related to improving care, improving maternal outcomes, and ways to improve your overall health, well-being, pregnancy and birth!

Let’s enjoy this journey together!

Yours Truly,

LaShea

LaShea Haynes, MEd, MSN, APRN, AGCNS-BC, RNC, C-EFM

Editor, Healthy Mom&Baby

EDITOR IAL INQUIR IES

AWHONN Sofia Navard snavard@awhonn.org www.AWHONN.org

ISSUE 30 / 2021 Healthy Mom&Baby

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Prevent Diabetes to Add Years to Your Life Researchers from the West Virginia University School of Public Health have stumbled upon a ‘Holy Grail’ of sorts that promises to add quality years to your lifespan simply by living a lifestyle that prevents diabetes from ever developing.

For most women who are overweight or obese, that means abandoning the typical low-exercise, low-quality Western diet in favor of being more active and eating healthfully.

Researchers suggested you could add at least four or more “quality” disease-free years to an average lifespan just by: hh Losing 5%-7% of your weight—which is about 10 pounds if you’re tipping the scale near 200 hh Healthy eating and getting more active hh Managing stress and solving problems that hinder progress

images: dreamstime

Can Aspirin Help with Pregnancy Loss?

Repeated early pregnancy loss is hard on women eager to start or add children to their family. Because aspirin can boost your immune and circulatory systems, researchers at Emory University and the National Institutes of Health asked whether aspirin can help reduce early pregnancy loss.

Trialing low-dose (81 mg) aspirin in 1,227 women with previous first trimester pregnancy loss, researchers observed that low-dose aspirin prior to conception and through week 36 of pregnancy for at least 5 of 7 days per week led to 8 more pregnancies, 15 more live births, and 6 fewer pregnancy losses for every 100 women in the trial.

Also, the benefit of aspirin was stronger if women began taking it before pregnancy, and of less benefit if they started it after the 6th gestational week.

hh Getting support from people with goals like yours Avoiding diabetes means slowing the effects of the burden of living with diabetes, the complications of which include stroke, neuropathy (loss of feeling/sensation) and even amputation, say CDC experts.

Mindfulness Training for ADHD Children with ADHD are generally treated with medication, yet this tactic alone doesn’t work for as many as one-third of those kids. This led experts to speculate what might happen if mindfulness training was added as a behavioral treatment.

After an eight-week “MYmind” intervention with at least one parent, there were improvements in focus among both kids with ADHD and their parents.

“A striking result was that parents especially benefited from this training,” researchers wrote, after observing an increase in mindful parenting, selfcompassion and an improvement in mental health among the parents. These effects were still measurable six months after the end of the training. As for the kids in the study, 1-in-3 children improved self-control following MYmind, whereas only 1-in-10 improved when following only regular care.

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Balancing Work, School & Family

By Jessica McNeil, DNP, APRN, CNM, RNC-OB, C-EFM

T

he high-paced demands of modern life leave many of us juggling competing priorities while struggling to maintain a sense of work-life balance. And when Super Mom (or Dad!) goes back to school, finding more hours in an already long day can seem impossible.

According to the Center for Economic and Policy Research, the U.S. is one of the top 10 worst countries for work-life balance. Especially during the COVID-19 pandemic, the neverending Zoom meetings have blurred the lines between time spent working and relaxing. Juggling family, work, and school can feel exhausting for even

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the most organized and dedicated parent. But with a little planning and prioritization, you can find that balance we all crave.

help secure that time, but it can help you live that core value of “Family First,” scheduling everything else around that precious time.

Schedule “family only” days

Dedicate an hour “me time”

You may be thinking, “my schedule is already full, and now you want me to schedule something else?” However, if you’re the type who thrives on organization and follows your schedule religiously, you might benefit from dedicating some time each week just for your family.

Not only will calendaring your activities at the beginning of the month

Dedicating at least one hour each day to something you truly enjoy is not only good for your mental health, but it can also help you be more productive at work and school. Spend that time working out, going for a walk, reading, meditating, watching TV, or even taking a nap.

The key is to do something you enjoy that allows you to break away

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healthy moms While it can feel uncomfortable at first, saying “no” to things that aren’t essential can help you create boundaries and find balance. The truth is, people who love and respect you will understand and will still be there when you’re ready to take on more responsibilities again.

Ask for help

from your daily responsibilities. You can even consider incorporating family time into that break--turn that morning walk into a family walk.

images: Dreamstime

Eliminate extracurricular activities Let’s face it, juggling work and school is enough of a challenge. Add time for family and friends, and this act can send even the most energized parent over the edge. To maintain some balance, reexamine your priorities and temporarily take a few things off your schedule.

Make a list of your activities in order from the most essential to the least important. This exercise can help you determine which activities to clear from your schedule--at least for now. Keep your goals in mind and remember this season of school won’t last forever. After graduation, you can return to those activities if they still feel important to you. In the meantime, thinning out your schedule may be the very thing you need to succeed, while creating the balance that you want.

Redefine success Have you ever heard the phrase “C’s get degrees”? There’s wisdom here! There are seasons in everyone’s life when in order to succeed we need to adjust our standards and expectations. According to a survey by Grand Canyon University, the biggest barrier to work-life balance for most of us is perfectionism. The need to consistently maintain peak performance, make the highest grades, and remain in the running for employee, partner or parent of the year can be overwhelming and unhealthy.

Let go of the need to “be the best,’’ and recognize that sometimes a “C” performance is good enough. This allows you to achieve your goals while sustaining your own well-being and staying present for loved ones.

Learn to say no If you’ve spent your entire life saying yes to every request and filling each hour with activities, now might be the time for a change. If the need to “people-please” has left you feeling overextended, saying “no” can be liberating!

If you feel it’s all too much to manage, be honest about how you’re feeling.

Most employers and professors understand that “life happens,” and we all need help sometimes. It’s ok to ask for an extension on an assignment, or to even take an occasional “mental health day.” Not only will you feel a sense of relief when you allow people to help you, but you’ll be more productive without the added stress of taking on more than you can handle (Karambelas, 2019).

Successfully juggling family, work, and school requires you to prioritize your mental and physical health.

Failing to prioritize yourself can lead to failing at all those other things that are important to you. Schools and businesses are finally starting to recognize the importance of student and employee mental health.

Eliminating the stress of an impossible deadline and, even better, getting it done without having to pull off an allnighter, can be a game changer. Sleep and stress relief might just be the catalyst you need to find the energy to thrive during this intense chapter.

If 2020 has taught us anything, it’s that there’s no promise of tomorrow and we must cherish our loved ones while we can. Work and school will always be there, but family time is precious. Take the time to value your loved ones, maintain your mental health, and have some fun along the way!

Jessica McNeil, DNP, APRN, CNM, RNC-OB, C-EFM, is a certified nurse midwife at Parkland Hospital in Dallas, TX, an adjunct professor at Baylor University, and an expert advisor to Healthy Mom&Baby.

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You Deserve Respectful Maternity Care— Here’s What That Looks Like It’s your body. It’s your baby. It’s your birth.

By LaShea Haynes MEd, MSN, AGCNS-BC, APRN, RNC, C-EFM

Choose your healthcare provider After you have done some thorough research, select a healthcare provider that meets your standards and aligns with your philosophy for birth. Write down your questions so that at each visit you are able to have your questions answered. Ask how many practitioners are in the practice, and if they may be on call to attend your baby’s birth.

Choose your birth place

Patient autonomy You have a right to make your own choices about your birth. Birth planning should be based on shared decision making between you and your pregnancy care team. You always have the right to ask for several options when it comes to labor positions, with movement (getting out of the bed, walking, laboring in the bathroom, birthing or using a peanut ball).

Any healthcare professional who gets upset when you ask questions or ask for alternative options during your birthing experience is not OK! Be sure to discuss what is most important to you with your support person

images: Dreamstime

Most hospitals offer childbirth classes and tours to provide information on their practices and birth options.

With the current COVID-19 pandemic, many facilities have transitioned their prenatal education to online classes and virtual tours. Ask your healthcare providers at your next visit what educational opportunities they may have prepared just for you.

Ask your friends and family, people you have met on social media, and others for their reviews of the facility you’re choosing for birth. Do they have good customer service scores and a reputation for excellence in serving the community you represent? Remember the more you know, and the more you ask questions, the more you can be an active participant in your care!

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healthy moms and doula so they can participate in advocating for a positive healthcare experience for you.

Are they Listening?

Privacy and confidentiality Your privacy is important. Your healthcare provider shouldn’t ask personal questions of you in front of your family members and friends without your permission.

Also, you have a right to ask if any of your personal information will be reported to any outside agencies or organizations. Healthcare providers want what is best for you and your baby. As healthcare workers there are certain types of information they

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are required to report, but you have a right to know to whom and where that information will go. Ask questions!

Racism and bias are real and can impact your health If you feel you have experienced discrimination based on your race, ethnicity, primary language, or any other reason, SPEAK UP! It is OK to tell someone when they have offended you and respectfully explain why that comment was hurtful or inappropriate. These conversations may not be easy, but they are necessary to improve communication between you and your healthcare team.

The healthcare team you have selected to take care of you should feel

honored and excited about being a part of your birthing experience. If you don’t feel that the care you’re receiving makes you and your family feel that way, it’s OK to SPEAK UP about that!

Respectful care Respectful care means you’re treated with dignity, empathy, and compassion, regardless of your race, gender, socioeconomic status, or reproductive history (pregnancies, miscarriages, abortions). Your life is valuable and so is the life of your unborn baby. The words and actions of everyone taking care of you should demonstrate they feel the same way.

LaShea Haynes, MEd, MSN, AGCNS-BC, APRN, RNC, C-EFM is founder of the perinatal company, Perinatal Potpourri, LLC, and editor of Healthy Mom&Baby.

images: Dreamstime

It’s been well documented in science that patients don’t feel “heard” by their healthcare providers. Is this happening to you? How can you ensure that your voice matters?

For example, if you’re taking a new medication and you’re having side effects that make it difficult for you to drive, sleep or function in any way, your medication may need to be adjusted: either the dose or type. Call your healthcare provider to speak with the nurse, midwife, or doctor; or call your local pharmacist to describe your symptoms and ask questions.

You are your BEST advocate. Keep asking questions and calling your healthcare team until you feel that you have received a good resolution to your concerns.

If you are admitted to a healthcare facility and feel as though you’re not being heard, ask for the charge nurse, manager, or director of that unit. Your voice counts, you matter, and your healthcare concerns should be taken seriously by everyone caring for you!

If you feel your concerns aren’t being addressed, or that information is not being explained in a way you can understand, you have a right to ask for the leadership team to escalate any concerns you have about your stay.

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Pelvic Floor & Perineal Health During Pregnancy

By Danielle Beasley, PhD, RN, RNC-OB, CNE

M

aintaining your pelvic floor and perineal health during pregnancy is so important as you prepare to give birth. Putting in the time now to strengthen your pelvic floor can help shorten the amount of time you spend pushing during labor, and even prevent urinary incontinence (which is far too common after childbirth).

Adding a few simple stretches and massage techniques to your daily routine in the third trimester can help prevent perineal and vaginal pain, episiotomy, tearing, and scarring. It’s worth the work—so let’s get started!

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Pelvic floor exercises The pelvic floor is the base of a group of muscles called your core. These muscles are in your pelvis and stretch like a hammock from your pubic bone (in the front) to your tailbone (in the back), and from side to side.

Pelvic floor muscles support the bladder, bowel, and uterus in women.

They help maintain bladder and bowel control and play an important role in sexual sensation and function.

Your vagina is designed to stretch and accommodate your baby during childbirth. We recommend starting daily pelvic floor exercises right away in

the second trimester, and starting them again once you’re cleared to resume exercise in the postpartum period.

Pelvic floor exercises Squeeze the muscles around your vagina as if you are stopping the flow of urine; hold for ten seconds, breathing normally, then slowly release. Do 20 reps five times a day.

Pelvic floor holds Sit or lie down in a comfortable position. Slowly draw up through your pelvic floor muscles and hold the contraction for five seconds. Then

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healthy moms slowly relax, and rest for five seconds.

Repeat 10 times. Remember to breathe!

Basic hip twist Lie on your back with your knees bent and your feet shoulder-width apart.

With your hips into a neutral position, draw in your pelvic floor muscles and engage your core. Rest your fingertips on your hip bones and gently lift one knee out to the side – but only by a few centimeters. If you lift your hip too far, your hip bones will push into your hands, so watch out for that sensation and bring your hip back. Repeat 10 times on each leg.

Coffee table lift Get onto all fours with your hands shoulder-width apart and your knees hip-width apart. Make sure your hips are in a neutral position and your back is flat. Curl your toes under. Breathe in, and then breathe out, drawing in your tummy and pelvic floor muscles, and then lift your knees off the floor. As you breathe in, lower your knees back down. Repeat ten times.

Perineal massage

images: Dreamstime

Your perineum is the pelvic floor tissue between your vagina and rectum. It

is slightly elastic, but can sometimes tear during birth--and we want to help prevent that!

We recommend beginning a routine of perineal massage at around 34 weeks, and continuing until you go into labor. You can start off slowly, performing this technique once to twice a week at first, and then work your way up to daily massage. Remember to keep the massage gentle; if the massage is too forceful it can cause swelling, irritation, discomfort, and pain. hh Wash your hands with soap and water. Be sure your nails are short. hh Find a comfortable position that allows you to reach your perineum, either by reaching your hands in front of you or behind you. You might feel comfortable sitting propped up in bed with your knees bent, or you may prefer raising one leg in the shower or on the toilet. If you decide to stand, make sure to change positions if you become tired or uncomfortable. hh Apply a couple of drops of a natural oil, like organic sunflower, grapeseed, coconut, almond, or olive oil, to your thumb and perineum. Personal lubricants like K-Y Jelly are also good. hh Insert your thumb into your vagina approximately 1-2 inches. hh Apply gentle pressure in your vagina downwards toward your rectum. hh Maintain the pressure as you move your thumb from back and forth in a U shape (from about 3 to 9 o’clock if you can imagine the face of a clock). hh You should feel a stretch and a bit of stinging or burning but it should never be painful. hh Continue massaging for three to five minutes as tolerated.

As always, remember to check with your own healthcare provider before starting any new exercise routine in pregnancy.

And happy pushing!

Danielle Beasley, PhD, RN, is Associate Professor of Nursing at York College of Pennsylvania and an expert adviser to Healthy Mom&Baby.

ISSUE 30 / 2021 Healthy Mom&Baby

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07/06/2021 16:06

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018_HMB30.indd 1

08/06/2021 10:05

healthy moms

Pumping for Your Premature Baby

by Candace Campbell, DNP, RN, CNL

A

re you the mom of a preemie who dreads pumping milk at night while the baby is in the NICU? You’re not alone. Who can blame you? It’s inconvenient. It interrupts your sleep. And perhaps you’re discouraged that even though you are pumping for your premature baby every 2-3 hours during the day, your milk supply is also dwindling.

While there is no solution to the fact that your milk supply follows the simple principle of supply and demand (i.e., if the demand exists, the supply will follow), there are a few simple strategies you can use to help support your milk supply.

images: Dreamstime

Set Up A Pumping Station This would be ideally placed in a comfortable, well-lit area away from your partner (no need for you both to lose sleep). Before you retire for the evening, cover a plate of healthy snacks (e.g., celery and peanut butter,

apples and cheese, or any protein/ fruit/veggie combo that doesn’t require refrigeration) and place it at your cozy spot. Add a pitcher of iced water (or water plus juice), a photo of your newborn, headphone access to soothing music, and you’ll be good to go when the alarm clock buzzes.

Pump Efficiently Try to limit the whole pumping routine to less than 30 minutes. Sit comfortably upright at your prepared place (good lung expansion increases milk flow), attach the pump on both sides simultaneously (you can rent or buy a dual electronic breast pump), and start snacking. Then rise, empty your bladder and wash your hands. You may be tempted to skip this step, but omit it at your peril—breast infection, or mastitis, may be the painful result.

Pump for 20 minutes, refrigerate or freeze your milk, rinse your equipment and head back to bed.

Making Milk Research shows there are five simple prerequisites for making milk: hh Increase nutrition: 500 calories a day is recommended hh Increase fluid intake: 10-12 glasses of water or other non‑caffeinated and non-sugary drinks are best hh Decrease stress: this is hard; your baby is in the NICU! hh Get lots of sleep: another hard one! hh Stay on schedule: pump milk every 2-4 hours round the clock hh Related articles on breastfeeding: Sustaining breastfeeding & Boost breastfeeding

Tempted to skip the snack?

Don’t—it will help keep your blood sugar level in a more even state, which in turn serves to increase estrogen and prolactin levels that help elevate both your mood and your lactation supply.

You should see improved milk results in a day or two.

Candace Campbell, DNP, RN, CNL

ISSUE 30 / 2021 Healthy Mom&Baby

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07/06/2021 14:38

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Operating The BabyBuddha couldn’t be easier! Don’t burden yourself with complex controls or tie yourself down with cords. Simply use the trackball to navigate through the various modes, and land on the perfect one with a simple swivel of your thumb. We’ve taken a multipronged approach to make every pumping session as comfortable as possible. The BabyBuddha pump has an extra-soft cushion to prevent nipple soreness, multiple expression and stimulation modes to suit your preference, and an anti-backflow design to eliminate the need to uncomfortably lean forward as other pumps require. Additionally, our unique suction pattern in stimulation mode mimics a baby’s suction pattern to increase milk production.

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020_HMB30.indd 1

08/06/2021 10:20

healthy moms

Babies, Breastfeeding & Pumping at Work Joanne Goldbort, PhD, RN

R

eturning to work while nursing is a huge milestone in your parenting journey. Get ready before the big day comes with these action steps designed to help you meet your breastfeeding goals.

Know your rights

images: Dreamstime

Workplaces vary in size, number of employees, and types of business. No matter where you work, it’s important to know your rights as a nursing parent, and what workplace accommodation laws apply to help you maintain your milk supply and feed your baby.

The Fair Labor Standards Act (2010) requires businesses with more than 50 employees to: hh Provide time to express milk for at least the first year of your child’s life

(up to age one). You can use your standard breaks or schedule breaks ahead of time. hh Provide space for pumping that is not a bathroom. The space must be “shielded from view and free from intrusion from coworkers and the public.”

Talk with your employer before returning to work and make a plan together that checks all the boxes (time, space, and privacy to express your milk).

You are part of a growing number of the two-thirds of women who work full-time with children under the age of 3.

Supplies Start to gather your supplies to breastfeed/chestfeed long before giving birth. At minimum, you’ll need:

hh Breast pump: While some parents receive an electric breast pump as a gift, you can also receive one through your health insurance company under the Affordable Care Act or Medicaid. Each state has their own policies on exact coverage for a breast pump so be sure to check what your state will cover. hh Milk storage containers: You’ll need several bottles or disposable milk storage bags to store your milk. hh Cooler or refrigerator: If your workplace has a refrigerator, learn if it’s okay to store your milk there.

If not, be sure to get a few ice packs and a thermal container to keep the milk cold.

Technique hh Practice using the pump a few times

ISSUE 30 / 2021 Healthy Mom&Baby

HMB9_Breastfeeding.indd 21

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07/06/2021 15:49

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022_HMB30.indd 1 Sugarpod Naturals.indd 1

(Breastfeeding mom for 4 years and counting)

100%L

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甀猀攀 䠀䔀䄀䰀吀䠀㐀䴀伀䴀 昀漀爀 ㄀㔀─ 漀û

Jenny Tamas

䴀漀椀猀琀 䠀攀愀琀 吀栀攀爀愀瀀礀

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08/06/2021 14:55 10:34 30/04/2021

healthy moms evening before so that you don’t have to multitask in the morning, especially if you’ll be taking baby to daycare on your way to work hh When at work, make sure you have plenty of water to drink while you’re pumping hh If possible, look at photos of your baby, listen to their recorded coos and cries, or play some music or white noise on your phone to help you to relax hh Keep a clean hand towel or paper towels available for possible spills hh Be sure to keep your pumping space clean and wash the equipment after each use

images: Dreamstime

Keep going!

prior to returning to work. It will give you confidence and give your partner a chance to introduce a bottle of expressed milk to your baby. hh Make sure the flanges of the breast pump fit properly: a . the nipple moves freely in the tunnel of the pump b. there is little or no areola in the tunnel of the pump c. there should be no pain in your nipple while pumping hh Hand expression is another great way to keep your milk flowing hh Some women prefer to double pump (both sides at the same time) or pump one side after the other. Double pumping will reduce pumping time and may increase the total volume of milk you express.

You can purchase a pumping bra designed to hold the flanges in place for you while you pump, or you can make a DIY version yourself by cutting two holes in a sports bra to accommodate the pump flanges. hh Generally, the more relaxed you are during the pumping process the

more milk you will express. But each nursing person is unique—and milk production is too. Some may only get an ounce per pumping per side, and others will get several ounces. hh Prior to returning to work, practice pumping first thing in the morning when you have the largest volume of milk. Then store that milk in the freezer for future feedings.

Introduce a bottle hh If possible, introduce a bottle of pumped milk a couple weeks before returning to work hh Some babies have no problem going from breast to bottle, while others will put up quite a fuss, and may even refuse altogether. It’s a learning process hh Make sure someone other than you offers baby the bottle. Your baby knows your smell and might not accept a bottle when they can know the real thing is right there!

The big day hh Gather all your equipment the

hh Eat a healthy diet and continue to take your prenatal vitamins hh To help increase milk production, consume these foods: oatmeal, barley, spinach, carrots, hummus, brown rice, and apricots hh The most effective way to maintain a healthy milk supply is to pump or nurse frequently. The more milk you remove, the more you’ll make!

The research on the benefits of breastfeeding is growing, for both the nursing parent and the infant. The American Academy of Pediatrics, the World Health Organization, the CDC, the Association of Women’s Health and Neonatal Nurses, and many other organizations recommend exclusive breastfeeding/chestfeeding until 6 months of age, and continued nursing through the first year - and beyond!

This means the baby is only fed human milk for the first six months (no other liquids or solids are given--not even water), and then continues to nurse after starting solids. This may seem like a lofty goal, but with good support and a little planning, you can do it!

Joanne Goldbort, PhD, RN, is an assistant professor at Michgian State University and an expert adviser to Healthy Mom&Baby.

ISSUE 30 / 2021 Healthy Mom&Baby

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07/06/2021 15:49

Your Ultimate Feminine Care Routine

"The Signature Feminine Care collection was born after years of struggling with popular store-bought feminine care products, for Founder Jasmine. She was left discouraged and eventually began researching ingredients to truly understand what was failing her. Through this research, she began to create her own recipes for a feminine care routine that supported, versus hindered her feminine health.

At INMYHEALS, we believe that feminine care is of the utmost importance for women, and especially for moms, because the womb and reproductive organs, are the most vulnerable and sacred parts of a woman. The vagina represents the sacred opening that leads to the womb. Ultimately this means that it is the Source; where new life is created, held and brought forth into the world. For this reason alone, we believe that with a proper diet and feminine care routine, it is possible to maintain hygiene that is healthy and balanced.

What we value even more than the routine, is the intention behind it.

With the Signature Feminine Care collection, it is our mission to inspire every woman to enjoy that routine as one of her favorite parts of the day. Our collection supports a 3-step daily routine that keeps the vagina pH-balanced for a happy, healthy flora. Step 1 of that routine is the Signature Feminine Wash - a gentle, yet effective sulfate-free cleanser that is anti-bacterial, pH-balancing and moisturizing. We encourage you to use this 1-2 times daily, as well after any exercise or sexual intercourse.

Last but not least, drink plenty of water!"

www.inmyheals.com

024_HMB30.indd 1

08/06/2021 10:25

healthy moms

Keeping the Romance Alive After Baby

By LaShea Haynes MEd, MSN, AGCNS-BC, APRN, RNC, C-EFM

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Waiting six weeks after having a baby can feel awfully long. But even after much time, you may not feel ready for sex. Sometimes it takes a little longer to heal, while other times we can’t wait to get back to business.

The key is keeping communication lines open and letting your partner know what you need. Whether you desperately miss being held and touched, or are afraid that penetration might be painful, it’s important to tell each other what’s going on.

Meeting each other’s sexual needs is a relationship essential. You may find you both miss some aspects of that spontaneous and unscheduled routine you shared before parenthood.

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images: Dreamstime

re you wondering how your sex life may change after baby? It’s typical to question whether sex will be the same again. All these emotions and questions are normal and expected as couples grow their families. Here are five keys to creating, protecting, and supporting a lasting relationship that can survive any situation you and your mate face.

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The first of these is love.

Love is a verb; it’s how we show our care for another person.

Love solidifies the intense bond you have with your partner, allowing you both to weather any storm or trial.

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The next key is respect.

This means being considerate of the other person’s needs and wishes.

Respect helps partners acknowledge each other’s differing views without hurting each other’s feelings.

Parenting is stressful, and individuals may vary greatly in their parenting styles--and that’s OK! Learning to respect and support each other’s attempts at getting it right with the new baby can go a long way in helping to build each other’s confidence. And let’s face it: confidence is sexy!

The third key is communication.

The fourth key is flexibility.

Pre-baby, many couples go to bed together each night, allowing them to reconnect intimately and sexually.

But after children are born, your old bedtime routine might be dictated by when that little bundle of joy finally falls asleep.

If intimacy is impossible in the evenings, why not give a mid-day lovemaking session a try? Perhaps while the kids are down for an afternoon nap on a Saturday? You’ll have more energy in the afternoon anyway without having to battle that nighttime exhaustion!

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The fifth key is lubrication!

Don’t be afraid to ask your partner to take it slow, especially the first time. If you’re feeling nervous, invest in a little extra foreplay to get the juices going.

Even still, you may need a little lube.

For best results, choose something water based and unscented (e.g., Good Clean Love).

LaShea Haynes, MEd, MSN, AGCNS-BC, APRN, RNC, C-EFM is founder of the perinatal company, Perinatal Potpourri, LLC, and editor of Healthy Mom&Baby.

ISSUE 30 / 2021 Healthy Mom&Baby

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healthy moms

Five Tips to Help

Increase Fertility

By Lakisa Ballard, MSN, RN, C-EFM, RNC-OB

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ertility is the quality or state of being fertile, or having the ability to conceive and bear children.

We know that some women who have successfully conceived and delivered children may have struggled in the beginning.

Women have been waiting longer to have children, perhaps for careers, finances, or for simply not being ready.

Often, when women face challenges in conceiving, it’s because they haven’t asked the right questions, let alone asked the right professionals. So, how can you increase your fertility? Here are fi ve key strategies to increase your chances of becoming pregnant.

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Consult a Fertility Specialist

Obstetricians are doctors who provide pregnancy care from conception through birth; reproductive endocrinologists specialize in fertility and infertility. Choosing the right healthcare provider is essential to evaluating your fertility. You need a provider with whom you can have honest and vulnerable conversations.

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Harness Nutrition

Food is medicine, right?

Evaluating and improving your diet can play a big role in improving physiological function.

Obesity rates are on the rise, and this factor alone can decrease fertility. An honest evaluation of our eating habits can help address the hormonal impact of being overweight. Take a prenatal vitamin daily.

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Exercise Exercise is important to fertility. Bringing conscious

movement to your schedule promotes physical and mental well-being. Choose activities you enjoy. Balance that new doable diet plan with exercise to achieve healthy weight loss goals, or to simply maintain fitness. Walking, tennis, swimming, yoga, dancing, and running are just a few examples of ways we can jumpstart a new routine.

And of course, before you commit to any new exercise regimen, always consult your provider.

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Communication with your Partner

Our partners are an equally valuable part of the fertility process.

Unless you plan to conceive through sperm donation, it’s important to have an honest and clear understanding of each other’s health history. Talk about your goals and desires with your partner, and don’t hold back when it comes to tracking your cycles.

Intimacy is integral to the process, and working with your ovulation peak times is key. Not only will the

awareness of timing increase your fertility, it brings mindfulness to the process. And it gives your partner a chance to ask questions, give insight, and share their encouragement.

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Alcohol and Drug Use

Alcohol and drug use are harmful in pregnancy. Did you know they can also impact your fertility?

Excessive alcohol use can affect ovulation; and other drugs, such as nicotine, marijuana, cocaine, and heroin, can be even more harmful.

These can cause organ damage not only for you, but for your developing fetus. Some of these substances can cause health issues that have severe consequences beyond conception and pregnancy. If you need help quitting any kind of substance, talk with your provider - we’re here to help, not to judge!

LAKISA BALLARD, MSN, RN, C-EFM, RNC-OB specializes in perinatal nursing, and is an expert adviser to Healthy Mom&Baby.

ISSUE 30 / 2021 Healthy Mom&Baby

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healthy moms

Lines, Pigment and Stretch Marks

By Catie Chung, RN, MA

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ike the rest of your body, your skin during pregnancy changes a lot. The causes of these changes are increased blood circulation, and blood vessel and hormonal changes.

Although this sounds like a lot of drama for your skin, there is one major plus: the pregnancy glow.

Never fear—most of these changes you can manage, and the good news is that not everyone gets every single skin change!

images: Dreamstime

That pregnant glow Increased circulation gives you that beautiful pregnancy glow, but it also creates more sweat and oil on your skin’s surface. So in addition to your glow, you might have a few more zits!

Maintain a normal morning and night skin care regime; these problems will go away after you birth your baby.

Oh, mama, those raging hormones!

In addition to affecting all the other parts of your body, they zap your skin, too. Hyperpigmentation, or increased darkening of the skin, can happen on your face, your belly, and

even the areolas around your nipples.

Brownish patches on your face are called melasma or chloasma. Sunlight exposure tends to worsen these patches, so always wear sunscreen.

A brown line that suddenly emerges down the middle of your belly is the linea nigra; don’t worry, that’s normal too. The only place you may keep the extra pigment is the areolas around your nipples; all of the other colors will fade after delivery. Don’t waste any time or money on bleaching or fading creams; they won’t work!

Seeing red All of the increased circulation becomes obvious when little red “webs” of veins called vascular spider nevi show up. Usually these happen on your legs, but they can be on your arms, chest, or face. The palms of your hands or soles of your feet might look red as well. While the redness on palms and soles will go away after delivery, the spider veins don’t always leave. If they really bother you, there are injectable treatments that can

be done through a dermatologist or cosmetic surgeon to make them go away after baby is born.

And stretch marks—you either get them, or you don’t. Stretch marks are a result of the way the collagen in your skin, well, stretches! There are no creams, lotions, oils or vitamins that have been proven effective in preventing or treating stretch marks; but lotion can help with the itching that comes along in the process.

Stretch marks will fade after your baby is born, but they don’t disappear.

The only proven method of reducing stretch marks is laser therapy. Really though, what a badge of honor to show your baby how much they stretched your belly as they get older!

Did you know?

About 90% of women experience hyperpigmentation during pregnancy, according to the American Academy of Dermatology. This means a darkening of the skin.

Catie Chung, RN, MA, is a perinatal nurse in Las Vegas, NV.

ISSUE 30 / 2021 Healthy Mom&Baby

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P O RTA B L E F E TA L H E A RT M O N I TO R I N G Wh at i s a fet a l Do p p l e r ? A fe t a l Do p p l e r i s a p o r t a b l e , h a n d h e l d fe t a l m o n i t o r i n g d ev i ce t h at u s e s a n u l t ra s o n i c p ro b e t o d e t e c t yo u r b a by ’s h e a r t rat e . Do p p l e r s a re n o n i nva s i ve a n d h ave a b u i l t i n s p e a ke r t h at a m p l i fi e s t h e h e a r t b e at . S o m e a l s o co m e w i t h a d i g i t a l s c re e n t o d i s p l ay t h e h e a r t rat e i n a n u m e r i c v i ew.

C a s c a d e He a l t h C a re h a s b e e n s e l l i n g Do p p l e r s fo r ove r 3 0 ye a r s a n d we c a r r y h i g h q u a l i t y, d u ra b l e Do p p l e r s f ro m t r u s t e d b ra n d s i n c l u d i n g Hu nt l e i g h , Su m m i t L i feDo p , Ni co l e t El i t e , Im exDo p a n d New m a n Di g iDo p . Do p p l e r s a re a n i m p o r t a nt a n d f u n c ti o n a l t o o l fo r m i d w i ve s a n d ot h e r p re g n a n c y c a re p rov i d e r s , a n d c a n b e u s e d i n n e a r l y a ny b i r t h e nv i ro n m e nt . W i t h s e n s i ti ve p ro b e s fo r d i ffe re nt s t a ge s of p re g n a n c y, fe t a l Do p p l e r s d et e c t fe t a l h e a r t t o n e s a s e a r l y a s 8 we e k s a n d c a n b e u s e d t h ro u g h o u t l a b o r. Wat e r p ro of o pti o n s m a ke t h e s e a g re at t o o l fo r wat e r births too!

C a s c a d e c a r r i e s t h e e s s e nti a l e q u i p m e nt n u r s e s , m i d w i ve s , a n d ot h e r c a re p rov i d e r s n e e d fo r t h e b e s t p re n at a l a n d n ew b o r n c a re . Fro m o u r p rofe s s i o n a l Do p p l e r ra n ge t o n ew b o r n p u l s e ox i m e t e r s , we h ave w h at yo u n e e d t o p e r fo r m re l i a b l e , e a sy a s s e s s m e nt s .

Fo r m ot h e r s , C a s c a d e offe r s c u s t o m b i r t h k i t s , wat e r b i r t h p ro d u c t s a n d p o s t p a r t u m c a re s u p p l i e s . Sh o p o u r c a ref u l l y c u rat e d s e l e c ti o n of h e a l t h c a re p ro d u c t s t o d ay !

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healthy

pregnancy Catch the Latest Fish Oil Benefits

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Mom’s Blood Pressure Affects Baby’s Future Stroke Risk

Children born to mothers who took fish oil in pregnancy have been shown to have faster problem-solving skills and better attention focus at age 10, according to findings from a study presented at the 6th World Congress of Pediatric Gastroenterology, Hepatology and Nutrition.

This is the first study to examine the long-term effect of maternal supplementation with fish oil and/or 5-MTHF (folic acid) on the resting brain activity of children at school age.

The study was funded by the European Union. The children were assessed at age 10 using MRI brain scanning alongside neuropsychological testing. The results of all groups were then compared for differences.

Researchers stated, “Maternal nutrient supply during the period of rapid early brain development in the second half of pregnancy has a lasting impact on later brain function at school age,” while advising that pregnant women be educated about the importance of a good quality diet and fish oil supplementation.” Researchers also noted that folic acid supplementation, which can prevent birth defects, didn’t create the same lasting effects on brain function.

A study in 5.8 million children has found a higher incidence of stroke four decades later in those whose mother had high blood pressure or pre-eclampsia while pregnant, according to recent research presented at the European Society of Cardiology.

Previous research suggested a link between maternal hypertensive disorders and preterm birth, fetal growth restriction, high blood pressure, obesity and diabetes in baby’s later life. These recent findings showed that hypertensive disorders during pregnancy are associated with increased risks of stroke and potentially heart disease in off spring up to the age of 41 years, researchers wrote, while advising they still don’t fully understand the cause and how it changes baby’s later-life cardiovascular risks.

Babies exposed to maternal hypertensive pregnancy disorders during gestation had 29% and 33% increased risks of ischemic heart disease and stroke, respectively. The associations were independent of preterm birth and fetal growth restriction. In the sibling analyses, the association remained for stroke but not for ischemic heart disease.

If future studies have similar findings, researchers said steps could be taken to prevent later-life heart disease in babies by focusing on maternal health including high blood pressure early in life.

ISSUE 30 / 2021 Healthy Mom&Baby

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healthy pregnancy

Covid 19 Vaccine During Pregnancy & Lactation

By Jamie Vincent, MSN, APRN-CNS, RNC-OB, C-EFM, C-ONQS

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Reduce Your Risk of COVID-19 If you don’t get vaccinated, be sure to reduce your risk of exposure to the COVID-19 virus by following the following guidelines:  stay home as much as possible  stay at least 6 feet away from other people if you need to go out  avoid people who are sick  wash your hands often with soap and water for at least 20 seconds  clean your hands with a hand sanitizer that contains at least 60% alcohol if you can’t wash them (rub until your hands feel dry)  avoid touching your eyes, nose, and mouth

and the birth of the baby, the higher the level of antibodies present in the umbilical cord. This means getting the vaccine earlier in pregnancy may offer greater protection to your baby after they’re born.

Side effects from the vaccine were similar for pregnant and non-pregnant women. For most women, the risk of becoming sick with the COVID-19 infection during pregnancy and suffering severe illness will outweigh the potential risk of side effects from the vaccine.

Recent studies have shown that pregnant women are more likely to have severe COVID disease, especially if they are older, have a higher body mass index (BMI), or have other health issues like diabetes, high blood pressure, asthma, or chronic kidney disease. People of color, especially Latina and Black women, continue to have disproportionately higher rates of COVID-19 infection and death. There also seems to be a higher rate of preterm birth and stillbirth among pregnant women with COVID-19 infection, whether they have symptoms or not.

JAMIE VINCENT, MSN, APRN-CNS, RNC-OB, C-EFM, C-ONQS, is a clinical nurse specialist and an expert adviser to Healthy Mom&Baby.

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his past year has taught us so much about navigating a pandemic. As news of a COVID-19 vaccine surfaced, we began to wonder whether vaccination could be safe and effective for pregnant and lactating women.

Initially, very little information existed on the safety of the COVID-19 vaccine in pregnant and lactating women because they were not part of testing. Still, experts strongly recommended that pregnant and breastfeeding women have access to the COVID-19 vaccines. And now that recommendation is even stronger.

In March 2021, a study of pregnant and lactating women who received the COVID-19 vaccine found that the current COVID-19 vaccines stimulate more antibodies than are produced by getting the infection.

In addition, antibodies that were produced after the women were vaccinated were found in umbilical cord blood and in breastmilk, allowing mothers to “share” immunity with their baby through the placenta and when breastfeeding their baby.

While experts haven’t yet determined the very best time to get the vaccine during pregnancy, the study seems to suggest that the more time between the second dose of the vaccine

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healthy pregnancy

Losing Weight in the Fourth Trimester

By Kimber Stovesand, RN

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our body is going to be different after developing and growing a new person and that’s OK. Just because your body doesn’t look exactly the same doesn’t mean that you can’t love it. It’s common to retain about 10 pounds of “baby fat.” But if you’re determined to get back in shape, here are some tips to help you get to a healthier you!

Breastfeed/Chestfeed We’ve all heard the old saying, “breast is best,” but did you know that nursing is just as good for us as it is for our babies? Breastfeeding/chestfeeding can help you lose weight more quickly by burning an extra 500 calories a day.

And because it increases oxytocin, it helps your uterus quickly shrink.

Exercise In those first weeks post-birth, most recovering moms can safely get in a little exercise by incorporating a daily walk. Put your sweet newborn in the stroller or wear them in a sling or wrap while you get some gentle physical activity and some fresh air. The new sights, sounds, and sensations are great for your little one’s development as well.

Love Yourself Many of us want to lose weight during the fourth trimester, and that’s a

healthy, normal goal. Just be sure to keep your expectations reasonable.

It took nine long months to grow your little miracle, so give yourself some duly earned grace. Your body has done some amazing work and it will take time to recover. The most important goal is to ensure that you are caring for yourself by giving your body what it needs: love, grace, patience and time.

Happy parenting!

Kimber Stovesand , RN, is a travel nurse who specializes in perinatal nursing, and an expert adviser to Healthy Mom&Baby.

images: Dreamstime

Diet A balanced and healthy diet is essential after giving birth. A diet that includes healthy amounts of protein, calcium, iron, and other nutrients not only help moms to thrive through the healing process of the postpartum period, but can also stave off unhealthier urges to snack on less nourishing foods. The goal is to fill your body with the good stuff that keeps you feeling energized, strong, and ready to tackle the new experiences that motherhood brings.

Keep healthy snacks on hand as a good-for-you go-to when temptation strikes. Options like nuts, fresh or dried fruit, vegetable crudité, and protein bars within easy reach will ensure you feel full and satiated. And always have a water bottle close by to ensure you stay hydrated.

ISSUE 30 / 2021 Healthy Mom&Baby

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healthy pregnancy

Folic Acid Helps Prevent Birth Defects

by Catherine Ruhl, CNM, MS

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s you contemplate having a baby, you need adequate levels of folic acid in your body both before and during your pregnancy.

Folic acid is a B vitamin that helps the body make new cells. Having folic acid in your body before and during the first month or so of pregnancy slashes your risks of having a baby with a serious spinal or brain birth defect.

These defects are called neural tube defects (NTD) and folic acid has been shown to prevent up to 70 percent of NTDs. Spina bifida, a type of NTD, is the most common permanently disabling birth defect diagnosed in babies in the U.S.

acid in your daily diet promotes normal development of the brain and spine in the first month of pregnancy.

When you’re pregnant, the easiest way to make sure you are getting enough folic acid is by taking a prenatal vitamin. Prenatal vitamins generally contain between 400 to 1,000 micrograms of folic acid, which will meet most women’s requirement in pregnancy. The folic acid in a vitamin supplement is better absorbed by the body than the folic acid that occurs naturally in food, which is called folate.

Foods such as leafy greens, dried beans, and oranges contain folate, but only about 50 percent of this folate is absorbed by the body. Foods fortified with folic acid, such as grains, breads, and cereals are also a good choice and this added folic acid is better absorbed than folate. But read the labels. While some breakfast cereals contain the recommended daily 400 micrograms of folic acid in one serving, many contain only 100 micrograms.

Catherine Ruhl, CNM, MS is a certified nurse-midwife in Albuquerque, New Mexico.

Important role Folic acid plays an important role during the entire nine months of pregnancy. It contributes to the growth of your baby and placenta, helps your body make the extra red blood cells you need during pregnancy, and helps with production of DNA as your baby’s cells multiply.

Recent research done in Britain shows that inadequate levels of folic acid in pregnancy were associated with hyperactivity during childhood, and it’s also thought that folic acid contributes to normal brain development.

All women of childbearing age should take at least 400 micrograms of folic acid every day through supplements or food sources. This is especially important since many pregnancies are unplanned and NTDs often form in the earliest days of pregnancy, long before you may even miss a period and suspect you are pregnant. Having folic

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How much is needed?

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healthy pregnancy

Choosing an Unmedicated, Natural Birth Paris Maloof-Bury, CNM, RNC-OB, IBCLC

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lanning to birth without medication or unnecessary interventions is becoming increasingly popular. To plan a natural birth, surround yourself with pregnancy care providers who support your goal. This means a midwife or physician who is experienced and comfortable with natural birth. Let them know you want to give birth in whatever position is most comfortable. Ask if they require patients in their care to receive IV fl uids? What about their episiotomy and cesarean section rates?

Who you choose to attend your birth will probably determine where you give birth, so research your options for birthing facilities. Ask about their policies for continuous versus intermittent fetal monitoring, freedom to move in labor, access to showers and tubs, and their cesarean section rates.

If your birthing facility doesn’t provide a doula, consider hiring one.

These labor support experts provide emotional, physical, and informational support. Receiving continuous labor

support by a trained doula typically results in using less if any pain medication, lower cesarean risk, and greater satisfaction with birth.

Preparing Yourself Birth is physically demanding; it requires strength and endurance.

Thirty minutes of daily exercise can improve your energy levels, decrease the risk of pregnancy complications, and increase your endurance.

A daily practice of pelvic fl oor exercises throughout pregnancy along with perineal massage during the last few weeks will give you greater control during pushing.

Prepare mentally to embrace the discomforts of contractions as the good work of birth and surrender to the pain, trust your body, and know that you are safe.

Giving Birth If contractions begin at night, try to sleep in between them. Rest as much as you can. Stay hydrated, and stick to easy-to-digest foods. Spend the early part of labor at home as long as you’re

full term, baby is moving normally, and your bag of water is intact.

As you labor, create a calming environment. Ask those around you to keep their voices soft and respect your space. Dim lights, candles (electric if you’re in a hospital), essential oils, and music all help you focus on birthing.

Practice the comfort techniques from childbirth classes: breathing, relaxation, visualization, and position changes. Get out of bed and onto an exercise ball or into the shower; spend time upright and change positions to help labor progress. Ask your partner, doula, or nurse to support you with massage, counter pressure, a heating pad for back labor, and cool washcloths for your neck or forehead.

If a tub is available, getting into the water can help relieve the intensity of the contractions.

The experience of giving birth is intense and like nothing else, but the key is to simply allow it to happen.

PARIS MALOOF-BURY, CNM, RNC-OB, IBCLC, is a certified nurse midwife,lactation consultant, and associate editor of Healthy Mom&Baby.

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healthy pregnancy

Keep Calm and Wait for Labor!

Don’t mess with Mother Nature; Moms and Babies don’t like to be rushed!

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GoTheFull40.com

our baby needs a full-term pregnancy to grow and develop, and you both benefit from the natural hormones of spontaneous labor! While it may feel tempting to induce labor early, especially during those last few weeks, keep in mind that inducing labor is associated with increased risks, including prematurity, cesarean surgery, hemorrhage, postpartum depression, and infection. Give yourself the gift of a smoother labor by avoiding an early induction. Once baby is born, you’ll enjoy better bonding, attachment, and breastfeeding, with a faster recovery, too!

Labor should only be induced for medical reasons—not for convenience or scheduling concerns. Baby will let you know when they’re ready to be born. Until then, here are 40 reasons to go at least the full 40 weeks of pregnancy:

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healthy pregnancy Better Outcomes with Spontaneous Labor

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Let nature take over—there are fewer complications and risks for both you and baby when labor starts on its own Delight in those kicks and flips—marvel at the miracle of the life inside Birth a brainier baby—at 35 weeks your baby’s brain is only 2/3 the size it will be at term Build a love connection—that brainier baby born full term has had time to build the connections they need for interaction, balance, coordination and learning Enjoy the excuse to “eat for two”—occasionally indulge those cravings without feeling guilty Why ruin the surprise? The excitement of waiting for labor keeps your partner on their toes!

Make more milk—your natural hormones help your milk come in sooner and more abundantly when labor starts on its own Boost baby’s breastfeeding skills—babies born full term latch more easily and suck and swallow more effectively than babies born earlier Help baby make muscles—they need the whole pregnancy to develop strong jaw and cheek muscles to breastfeed well Give baby’s development the benefit of time—especially since you may not know exactly when you got pregnant Let baby pick their birthday—if they decide to make their debut after 37 weeks, there’s no need to stop your spontaneous labor Harness your natural hormones—the hormones of spontaneous labor and vaginal birth promote long-term breastfeeding, bonding, and create attachment Labor your way—feel free to eat, drink, and move freely during early labor in the comfort of your own home

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Lower your stress—laboring at home keeps you in control and lowers your stress and risk for complications Set their thermostat—baby will better regulate their temperature when born at term Slow dance your way through labor—groove your baby down through birth rather than laying strapped in a hospital bed Forget labor pain—don’t miss out on the euphoria and amnesia of your body’s natural labor hormones just in case your baby wants a little brother or sister

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Manage Your Risks

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Protect your vulnerable baby—fewer unnecessary interventions and less stress in labor means better blood flow to your uterus and a healthier baby and birth Recover faster and easier from natural labor—including a shorter hospital stay Reduce baby’s risks—jaundice, low blood sugar, and infection— by waiting until baby’s ready to emerge Maximize those little lungs— babies born just 2 or more weeks early can have twice the number of complications with breathing Ignore people who tell you an induction is more convenient—nothing is convenient about prolonging labor and increasing your risk of cesarean surgery or NICU admission Respond to requests to speed baby’s birth with the facts —inductions often create more painful labors as the hormones of spontaneous labor make it easier to cope with contractions Set baby up for success— babies born early are at greater risk for learning and behavioral issues than those who are born full term Help baby begin to breathe— the hormones of spontaneous labor help clear fluid from baby’s lungs so they’re less likely to need extra help with those first breaths

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Keep baby by your side—NICU nurses are happy not to meet you and your baby Finish well—more time in the womb usually means less time in the hospital

Enjoy This Time

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Relax—babies are usually so much easier to care for in the womb Splurge on pedicures—or ask your partner or a friend to do them for you, especially when you can’t reach your feet Relish in the fact that right now you’re the perfect mom— your healthy pregnancy habits are growing baby in the best possible way Shamelessly wear comfy, stretchy clothes—delight in your gorgeous, growing baby bump Wear your most stylish purses—especially the ones too small to carry diapers, wipes, and baby gear Perfectly parent—right now you know exactly where baby is and what they’re doing at all times Sleep while you can— nighttime parenting is no joke Massage remains a must—ask your partner to help ease the aches and pains Prop up your paperback—your beautiful belly peaks at just the right height for reading books on normal childbirth Don’t rush it—create the safest and best birth experience possible Go those extra weeks— that’s more time to complete childbirth and breastfeeding classes before you’re also caring for baby Gather with your girlfriends— share baby and mommy secrets while they stock your freezer with healthy meals you’ll enjoy when you bring baby home Write your own healthy reason—if it gets baby a full 40 weeks of pregnancy it deserves to be on this list!

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healthy pregnancy

Birth Settings

Where to Have Your Baby?

By Heather Watson, PhD, MSN, RN

images: Dreamstime

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erhaps you always assumed you’d just go to a hospital to have your baby. Most people associate hospital births with safety, but that may be changing, depending on your level of risk during pregnancy. Where to give birth is a very personal and multifacetted decision, and it is important to make an informed choice.

Until the last century, most people gave birth at home with a midwife. The transition of birth to the hospital setting from the 1920s on has had both positive and negative effects. Most importantly, the overall rate of maternal and infant death has decreased significantly due to increased infection control and access to medical care. Unfortunately, racial disparities have increased during that

time, along with an increase in the use of medical interventions such as episiotomies and cesarean surgery.

Out of Hospital Birth Increasing While out-of-hospital birth is still uncommon, it is increasing in popularity, nearly doubling from 2004 to 2017. The rate of out-of-hospital birth increased even faster during the COVID-19 pandemic. As out-of-hospital births have increased, so have rates of breastfeeding among mothers birthing at home or in birthing facilities in communities rather than hospitals.

Birth Place Options There are four main birth place options: a community hospital, a teaching

hospital (associated with a university), a freestanding birth center or home birth. Where you live may limit your options. When making this choice, ask yourself: hh Do I want pregnancy and birth care from an obstetrician, a family doctor, or a midwife? hh Do I want pain medicine during labor? hh How many people, if any, do I want to have with me during labor and birth? hh Where do I want my baby to be cared for? hh How many days do I want to be away from home at a birthing facility? hh Do I have a high risk pregnancy?

Heather Watson, PhD, MSN, RN, is a nurse scientist in the Johns Hopkins Health System.

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Birthing Facility Pros & Cons With proper planning, birthing people can receive safe and supportive care in each type of birthing environment. Each type has benefits and drawbacks, depending on your personal preferences. So let’s take a look at the features of each option, and you can decide which feature is a “pro” or a “con”.

Community Hospital

Teaching Hospital

hh Access to emergency interventions hh May have limited abilities to manage certain types of emergencies hh Your pregnancy care provider may not be on-call when you are in labor hh Pain management options include epidural anesthesia and opioids hh Increased use of medical interventions (IVs, monitors, catheters, labor induction, artificial rupture of membranes, cesarean surgery) hh Limited freedom of movement during labor or birth hh Restricted eating and drinking hh Restricted visitors/birth support persons hh 1-4 day hospital stay hh May not have choice of provider hh You are one of multiple patients hh Higher costs hh Insurance usually covers cost

hh Access to emergency interventions hh Able to manage unusual and high risk emergencies hh Increased providers may increase attentive care hh Students may be present (interns, residents or medical and nursing students) hh Sleep may be more disrupted by increased interactions with providers hh Your pregnancy care provider may not be on-call when you are in labor hh Pain management options include epidural anesthesia and opioids hh Increased use of medical interventions (IVs, monitors, catheters, labor induction, artificial rupture of membranes, cesarean section) hh Limited freedom of movement during labor or birth hh Restricted eating and drinking hh Restricted visitors/birth support persons hh 1-4 day hospital stay hh May not have choice of provider hh You are one of multiple patients hh Higher costs hh Insurance usually covers cost

Home Birth hh No need to travel; children and pets can remain in the home hh Lower risk of infection hh 1:1 care from your pregnancy provider, typically a midwife hh Privacy hh You choose who is present without restriction or limitation hh Decreased use of medical intervention (cesarean surgery, IV, episiotomy) hh Midwifery care hh You follow your own birth plan hh Freedom to eat and move as desired hh Access to bath or shower hh Baby remains with you as desired hh Consistent presence of a healthcare provider as desired hh If there are complications, you may need emergency transport for urgent care hh Limited pain management options hh Lower costs hh Insurance coverage varies

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Freestanding Birth Center hh Better outcomes for low-risk pregnancies hh Shorter facility stay - you can return home as soon as you and baby are stable hh Decreased use of medical interventions (cesarean surgery, IV, episiotomy) hh Midwifery care hh Embrace birth plans hh Freedom to eat and move as desired hh Access to bath or shower hh Baby stays with you as desired hh Consistent presence of a healthcare provider as desired hh If there are complications, you may need emergency transport for urgent care hh Limited pain management options hh Number of support persons during birth may be limited hh Lower costs hh Insurance coverage varies

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healthy pregnancy

Consider These Classes During Pregnancy

By Rachel Napoli, DNP, RNC-OB, PHN, CNS, IBCLC

about normal newborn behavior and how to read your infant’s cues.

To ensure you’re getting the most accurate information, take a class that’s taught by a board certified lactation consultant or lactation educator. You can also check with your healthcare provider, the local breastfeeding coalition, La Leche League, or WIC.

Daddy Classes

Exercise Classes Exercise is one of the best things you can do for yourself during pregnancy.

It soothes swollen ankles, prevents pain, relieves stress and anxiety, takes the edge off depression, improves circulation, and can help prevent or manage diabetes. Plus, it’s good for your growing baby!

If you were already active in an exercise program before becoming pregnant, you can usually continue with that same routine throughout pregnancy. Some exercises may need to be modified, and you should always listen to your body. Check with your healthcare provider before starting any new exercise program -- especially in pregnancy.

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Childbirth Classes: A childbirth class can help you learn or recall preparing for labor and birth ahead. Find a class that aligns with your birthing goals. Most provide an overview of labor, coping techniques (relaxation, breathing, massage, position changes), medications, and warning signs. Involve your partner or labor coach. You can also find these classes online or at the facility where you plan to birth.

Breastfeeding/ Chestfeeding Classes and Support Groups: They say breastfeeding/chestfeeding is natural, and it is! But there’s definitely a learning curve, and it’s normal to face challenges at first while you and your baby are learning. Taking a breastfeeding/chestfeeding class prior to giving birth is a great way to set yourself up for success. Not only will you learn the skills needed to latch and nurse your baby, you’ll also learn

Newborn Classes There is so much to learn about your baby in the days, weeks, and months after you bring them home.

There are classes on baby care and safety, as well as classes that focus on normal baby behavior, cues, infant development, soothing techniques, and infant massage.

Child and Infant CPR Before bringing baby home, be sure to take an Infant CPR class. In the event of an emergency, the skills you learn could mean life or death for your growing baby. The American Heart Association and the American Red Cross offer CPR classes.

Rachel Napoli, DNP, RNC-OB, PHN, CNS, IBCLC, is an assistant professor of Nursing at Sonoma State University (SSU), and an expert adviser to Healthy Mom&Baby.

images: Dreamstime

P

lanning to add a tiny new member to the family? Here’s an overview of the different types of classes available and how they can help you and your partner prepare for your new baby.

New father classes are a great place for dads-to-be to learn with other men including veteran dads in a supportive environment. Dads learn what to expect with a new baby, and develop the skills and confidence they’ll need to dive right into fatherhood.

health4mom.org

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www.nuexpectations.com Virtual Childbirth, Breastfeeding and Newborn Classes

How Do I Prepare for Childbirth in the Age of COVID? In these uncertain times, keeping yourself and your baby-to-be

safe and healthy is more important yet more challenging than ever. Expectant parents are faced with the difficult dilemma of balancing the need to prepare for labor and delivery while staying safe.

privacy, and safety of home. Registration is quick and easy.

Video classes are just no substitute for a live learning experience where you can have your questions answered and your concerns addressed. Get the skills, knowledge, and tools to have peace of mind and confidence for your labor and delivery.

Nu Expectations LLC, an online prenatal education company, is here to help. Under the direction of Elizabeth Gillen, RNC, MPA, a Labor and Delivery nurse and certified Childbirth Educator, Nu Expectations offers comprehensive prenatal classes including Lamaze, Newborn Care and Breastfeeding. Employing a variety of best practice teaching methodologies, you and your birth partner will be informed, prepared, and confident as you embark on this exciting new chapter in your life.

Every course offers:

Nu Expectations offers you access to virtual prenatal courses from the comfort,

• Relevant handouts and resources to help guide your birth experience

• The expertise of a certified Childbirth Educator with more than 30 years of experience • Small class sizes that allow personalized attention for interactive dialogue • The latest evidence-based education on birth and newborn care • Live interactive and engaging activities • Meaningful connections with other expectant parents

Empowering women and their birth partners on their pregnancy journey through education

REDEFINING YOUR BABY BODY Online Pilates-based exercise programs created by an expert women’s health physical therapist & trusted by obstetricians.

After having twins, Jackie Steele worked with Women’s Health Physical Therapist, Becky Dyer, to get back into shape and heal her 3 inch abdominal separation. After developing a physical therapist-safe Pilates exercise program together, Jackie and Becky realised they were onto something worth sharing with moms everywhere – and Body Beyond Birth was born. With 20 minute Pilates workouts, it’s a short, sweet online program offering moms and moms-to-be skills for a healthier life complemented with physical therapy advice.

Member love…

“It is the only online pregnancy Pilates and physical therapy exercise program I feel like I can trust absolutely and I sure have done my research!”

Caroline, mother of 4, Olympic triathlete

Body Beyond Birth: designed for moms by moms (one being a Women’s Health Physical Therapist). ✔ Physical therapist designed pregnancy and postpartum Pilates programs for injury-free results ✔ Obstetrician endorsed ✔ Safe during pregnancy and for women with pelvic instability ✔ Safe after C-section, with abdominal separation, pelvic floor dysfunction and for women with pelvis pain ✔ Pilates-based workouts to retrain core abdominals, tone abs and to heal abdominal separation and pelvic floor ✔ Physical therapy tutorials, yoga, nutrition advice and recipes

“I instantly fell in love with the BBB program – and I’ve lost 26 pounds!”

Marnie, mother of 3

“Jackie and Becky are very knowledgeable about these delicate stages of a postpartum woman’s life.”

www.bodybeyondbirth.com

Adele, mother of 2

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healthy pregnancy

What You Need to Know About Preterm Labor Is there something you can do?

By LaShea Haynes, MEd, MSN, APRN, AGCNS, RNC, C-EFM

Questions you can ask your healthcare team hh What may be causing preterm labor in my pregnancy? Every mother’s pregnancy history, risk factors, and other health concerns can differ. hh What activities can I safely do during my pregnancy if I’m at risk for preterm labor? hh Is my job putting me at risk for preterm labor? Let your healthcare provider know what you do for a living, and ask if your job is potentially putting additional strain on your pregnant body? Some jobs are considered strenuous enough to be considered high energy exercise.

For example, are you lifting objects all day? Standing on your feet with only a few breaks? This type of work may cause a birthing mother to have Braxton Hicks contractions or other signs and symptoms of preterm labor. hh Are there tests we can perform to determine my risks for preterm labor? For example, an ultrasound of the cervical length and/or a Rapid Fetal Fibronectin test can assist your

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Fetal Fibronectin Testing Fetal fibronectin is a glycoprotein that functions like a glue to hold the baby to the uterus during development. fFN in your vaginal discharge is one of the most powerful predictors of preterm birth. A swab test can be done between 22-34 weeks gestation. hh Most patients (80%) will test negative hh A negative result means that you have less than 1% chance of giving birth in the next 2 weeks hh A positive result doesn’t mean you’re in preterm labor, but it may signal you’re at risk for labor hh The test can be repeated every 2 weeks to monitor your ongoing risk

providers with determining your risks.

Ask what a shortened cervical length or fFN test result can mean for your pregnancy.

Help Prevent Preterm Labor Know the signs and symptoms of preterm labor so you can notify your healthcare team right away if you experience any of them: hh Contractions (your abdomen tightens like a fist) every 10 minutes or more often hh Change in vaginal discharge (leaking fluid or bleeding from your vagina) hh Pelvic pressure (feeling that your baby is pushing down) hh Low, dull backache hh Cramps that feel like your period hh Abdominal cramps, with or without diarrhea.

LaShea Haynes, MEd, MSN, APRN, AGCNS, RNC, C-EFM, is editor of Healthy Mom&Baby.

images: Getty images

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ost moms expect to complete pregnancy around their due date. So what if you go into labor long before baby’s expected birthday?

Preterm labor is defined as babies born before 37 weeks gestation. This can be a scary and unpredictable time in your pregnancy, but there are things you can do, questions you can ask, and procedures that may help you and your healthcare provider develop the best plan of care for you and your baby.

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Complete Infant Support System Even the best baby car seats and baby carriers may not position or support your baby, or premature baby properly—it can take 3-5 months before babies grow into their infant car seats. To assure safety and comfort, Hug Me Joey™ Complete Infant Support System snugly fills all empty gaps between the baby and the infant carrier.

Developed by a medical professional, Hug Me Joey Complete Infant Support System is the only patented (two-piece unit) comes with a therapeutic insert and whole body roll that fills the empty recesses between the baby and the infant carrier.

www.hugmejoey.com

Let us know your thoughts and comments on the Healthy Mom&Baby magazine and website.

What do you like?

What do you dislike?

What subjects would you like to read more about?

Email your feedback to: health4mom@ awhonn.org

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Skin-to-Skin Contact at Birth Reduces Infant Deaths mothers and babies are looked after together without having to be separated, researchers concluded.

For their study, participating hospitals were trained in safe skin-to-skin contact for unstable infants. During the first 72 hours, infants in the skin-to-skin group received 17 hours of skin-to-skin contact per day, compared with 1.5 hours in the control group. Mortality during the first 28 days was 12% for those who went skin-to-skin to stabilize compared to 15.7% in the control group, which corresponds to a death reduction of 25%. Researchers also observed fewer babies with low body temperatures with continuous skin-to-skin care.

“Keeping the mother and baby together right from birth, with zero separation, will revolutionize the way neonatal intensive care is practiced for babies born early or small,” says Dr Rajiv Bahl, Head of Maternal and Newborn Health Research and Development at the World Health Organization, (WHO). Bahl added, “this study illustrates that kangaroo mother care has the potential to save many more lives if it is started immediately after birth . . . for infants in countries of all income levels.”

WHO is in the process of reviewing its current recommendations on kangaroo mother care, published in 2015, in light of this new evidence.

images: dreamstime

Going skin-to-skin with your baby immediately after birth, even before baby has stabilized, can reduce their risk of dying by 25%­— especially if baby is born with a very low birth weight, say researchers writing in the New England Journal of Medicine.

Continuous skin-to-skin contact between newborn and mom, or “Kangaroo Mother Care” (KMC), is an effective way to reduce infant mortality globally. The World Health Organization had recommended babies go skin-to-skin after they’re stabilized—but the results show that even if baby isn’t stable, skin-to-skin is the best place for even very low birth weight babies.

“Giving skin-to-skin contact immediately after delivery to very small, unstable babies has encountered quite strong resistance, but 75% of deaths occur before the infant has been judged sufficiently stable,” says Nils Bergman, doctor and researcher at the Department of Women’s and Children’s Health, Karolinska Institutet, in Sweden. The study was conducted at five university hospitals in Ghana, India, Malawi, Nigeria and Tanzania, where mortality for these babies, prior to the study, varied between 20%-30%.

The main message is that low weight newborns should receive skin-to-skin contact immediately after birth and subsequently at a mother-infant couplet care unit, where

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Nobody likes to be rushed, especially babies.

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.

Download a free copy of

40 Reasons to Go the Full 40 at www.gothefull40.com.

The nurses of AWHONN remind you not to rush your baby—give her at least a full 40 weeks!

AWHONN PROMO T I NG T H E H E A LT H OF WOMEN A ND NE W BOR NS

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healthy babies

Diapering Decisions

By Aliah Thomas, RNC-OB

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loth diapers or disposables?

Many new parents have debated this question, as we all want what’s best for our little ones. When it comes to the environmental effects of disposable diapers in comparison to cloth, the evidence shows that there isn’t much difference between the two.

The goal of diapering is to contain baby’s waste while also preventing rash. Experts agree that disposable diapers are most effective in preventing rash because of their super absorbent ability to hold urine and stool away from baby’s skin, due to their highly absorbent properties.

Most newborns go through about ten diapers a day, so be sure to stock up well before the baby arrives!

infection has pink or red patches like an irritant diaper rash, but will also include small bumps.

to remove any diaper cream during each chance; simply wipe away any soiled cream as needed.

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Prevent Diaper Rash Change soiled diapers as soon as possible to reduce moisture on baby’s skin.

Cleanse the area gently with wipes designed to remove urine or stool from baby’s skin.

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Give your baby diaper-free time as much as possible.

Apply a thick layer of diaper cream containing zinc oxide at each diaper change. It’s not necessary

Use superabsorbent, disposable diapers to keep the skin under the diaper as dry as possible.

Call your baby’s pediatrician if the rash has not improved after a few days or if you notice blisters, a worsening rash, pus coming from the rash, or if your baby develops a fever. These are all possible signs of an infection.

ALIAH THOMAS, RNC-OB, is a perinatal nurse and facilitator in the Nurse Residency Program at a hospital in Atlanta, Georgia. She is an expert adviser to Healthy Mom&Baby.

Diaper Rash Basics

IMAGES: DREAMSTIME

Diaper rash is most commonly seen in infants age 9 to 12 months. Exposure to urine or feces, mixed with friction, can cause skin irritation leading to rash.

The American Academy of Pediatrics (AAP) advises that irritant diaper dermatitis can occur from constant and prolonged contact with urine and stool. Irritant diaper rash looks like a pink or reddened area of skin on baby’s bottom or genital area.

Yeast diaper rash is caused by an overgrowth of yeast, a type of fungus found naturally in the baby’s digestive tract. This yeast overgrows and presents itself around the diaper area most commonly when the baby has taken antibiotics. A diaper yeast

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Teething Time!

by Carolyn Davis Cockey, MLS, LCCE

These teething time tips will help your baby cut their chompers with as little pain as possible.

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First Tooth Long before you ever see the first edge of a tooth pushing its way into your baby’s mouth, you may notice that they are a lot more fussy than usual, they may be drooling, want to nurse or feed more often and may have a low-grade fever (up to 100.9⁰F). Your baby may also want to put everything in their mouth and chew with their gums. Excess saliva may cause a rash around the face and they may refuse to nurse although they seem interested in feeding.

Contrary to popular beliefs, teething doesn’t give your baby a high fever (101⁰F or more) or diarrhea. When these symptoms are present, it’s time to see your pediatrician.

Although babies can even be born with a tooth or two already in, they will get their two bottom and two top front teeth in that order before their molars and side teeth emerge. By their third birthday, babies should have 20 teeth in total. As their teeth debut, you may see small cysts on the gums where the tooth below is breaking through.

images: Dreamstime

here’s not a mom out there who hasn’t gazed down at their infant and wondered with a mix of curiosity and fear, “when will my baby get their first tooth?”

Teething ranks right up there among the highest stressors infants face, experts know, because along with the new pearly whites comes loads of fussiness as they cut through your little one’s gums. Do you know that your baby was born with their tooth buds already embedded in their gums?

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healthy babies Easing Teething You can help your baby ease into their teeth with minimal discomfort by practicing good gum care from birth.

Ask your dentist for or purchase a finger-sock-like baby toothbrush or use a washcloth and begin massaging their gums with cool water on a regular basis. Skip the toothpaste until they’re age three and can swish and spit it out, say experts at the American Dental Association.

It’s time for your baby’s first visit to a pediatric dentist when they have eight teeth in their mouth, which is typically around age one. Starting early with good dental care will not only help your baby with their first set of teeth but will also protect permanent teeth from bacteria and decay as they’re forming in the gums, and until they begin to

make their first appearances around age six.

Give your baby something cold to mash their gums against to reduce pain and swelling while teething. Avoid pain medications (infant Tylenol is OK) unless nothing else soothes them.

How to Discourage Thumb Sucking

Natural Teething Strategies  A cold or frozen clean washcloth  A silicone or natural teether (avoid ones with liquids as they can leak or be bitten through)  Soft baby foods, like applesauce or yogurt  Frozen fruit safely contained in a “mashing” bag designed for babies to chew on  Teething crackers

Sucking is a reflex action in infants.

Babies naturally bring their hands to their mouth and suck on their fingers or thumbs as a way to soothe themselves. As your child gets older, you may want to help them find other ways to relax.

Here’s advice from the American Academy of Pediatrics on breaking the thumb-sucking habit:  Look for all of the ways your toddler deals with stress, and suggest cuddling a blanket or stuffed toy instead  Praise your little one when they manage a difficult activity or emotion in a positive way  Reward new behaviors that show growth—some parents use “star charts” or even daily rewards to reinforce good habits The good news is that you rarely, if ever, see an adult sucking or chewing on their fingers!

IMAGES: DREAMSTIME

CAROLYN DAVIS COCKEY, MLS, LCCE, is the founding editor of Healthy Mom&Baby, senior director of Partnerships & Publications at AWHONN, and a Lamaze-Certified Childbirth Educator.

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Prevent Mosquito Bites

by Carolyn Davis Cockey, MLS, LCCE

W

hile swarming mosquitoes may have you concerned about Zika virus, did you know you can also contract other diseases including West Nile virus, malaria, dengue fever, chikungunya and Eastern equine encephalitis from these biting bugs?

Avoiding mosquito bites is best prevented through insect repellents, experts say. The most effective among these products for the longest period of time typically contain either DEET, icaridin or lemon-eucalyptus oil containing p-menthane-3,8-diol, say researchers who compared the effectiveness of popular products in the Journal of Insect Science.

You probably already know it’s best to avoid the outdoors at dawn and dusk, when mosquitos are most active. But did you know that the Aedes mosquito that carries Zika virus is active throughout the day? This makes wearing insect repellent and light, layered and loose clothing a must anytime it’s mosquito season.

IMAGES: DREAMSTIME

Home and health protection Minimize your exposure to mosquitos by keeping them away from your home.

Mosquitos lay eggs in standing water, so change the water in your pots and birdbaths at least weekly, and empty any other containers of standing water—such as your little ones’

swimming pool—at least weekly as well.

Use sunscreen daily, but skip products that include insect repellent— add that only after you’ve applied your sunscreen. Shower or bathe to remove insect repellent as soon as you’re done being outdoors for the day.

Mosquito Bite Warning Signs Most mosquito bites emerge as a puff y, reddish bump with a raised fluid-filled center that itches like crazy, even more so if you scratch it—so don’t. Scratching a bite can lead to infection. Seek health care if mosquitos have bitten you and you’re having any of the following symptoms:  Increasing swelling and redness around the bite  Red streaks near the bite  Fever of 100 degrees or more  Headache  Feelings of flu or tiredness  Hives

Treating Mosquito Bites Most bites will clear on their own in time, but if the symptoms are too bothersome, try:  Over-the-counter antihistamine  Anti-itch lotion or ointment, or overthe-counter hydrocortisone cream  Homemade paste of baking soda and water  A cold compress or ice pack applied for a few minutes

Mosquito Safety Do’s and Don’ts DO: ✔ Use insect repellent—as directed on packaging; use permethrin only on your clothing, not your skin ✔ Avoid the outdoors at dawn and dusk ✔ Wear loose, light-colored protective clothing ✔ Use mosquito netting over car seats, strollers ✔ Repair all screens so they’re bug tight DON’T: ✘ Use DEET on an infant age two months or younger ✘ Use oil of lemon eucalyptus on children ages three and younger ✘ Let children get insect repellent on their hands and faces ✘ Apply insect repellent under your clothing, or on wounds or cuts in your skin ✘ Leave standing water around your house—clear the gutters, downspouts, pots and birdbaths at least weekly CAROLYN DAVIS COCKEY, MLS, LCCE, is the founding editor of Healthy Mom&Baby, senior director of Partnerships & Publications at AWHONN, and a Lamaze-Certified Childbirth Educator.

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Sun Protection For Your Baby f you’ve ever stood in a big box store staring down an abundance of sunscreen products, trying to figure out which one to buy, you’re not alone.

Let’s take a look at sun protection for your baby.

What SPF is needed? What is broad-spectrum protection? Are these scientific-sounding ingredients safe?

These are the questions that race through your mind as you try to figure out which sunscreen is best for your family, especially for your baby.

The FDA has put new sunscreen guidelines into place and they’ll help address some of the confusion by adding a star-based rating system to help you choose the sunscreens with the most sun protection for your baby.

Understand three things As a parent, there are three key things to understand when choosing sun protection:  All the ways you can protect your skin from sun exposure.  Getting protection from both UVA and UVB rays.  Buying a protective sunscreen and safely using it.

Start with prevention Your infant’s skin is 20% thinner than your skin, which means it dries out and sunburns easier. Babies six months old and younger don’t yet have protective melanin in their skin and can burn easily. Sunburns in the early part of life are a leading risk factor for skin cancer.

You may be surprised to learn that skin cancer is five times more common than breast or prostate cancer, and experts agree that severe sunburns during childhood are the greatest risks for developing melanoma—skin cancer.

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Protecting baby’s skin and teaching them to use sunscreen as they get older is one of the most important health habits you can give them.

UVB vs. UVA rays

Buy A Good Sunscreen

The sun emits both UVB and UVA radiation. Traditional SPF ratings on sunscreen products only address protecting from the rays that cause sunburn—UVB rays. However, UVA radiation is also dangerous because it contributes to premature aging and the most dangerous forms of skin cancer.

The FDA is requiring sunscreen manufacturers to apply ratings of 1 to 4 stars, with 4 providing the greatest protection, to help you choose a safe sunscreen that has the broadest protection. Sunscreens that protect against both UVA and UVB rays will be labeled as “broad spectrum.”

Lotion or stick? Spray or powder? Sheer or waterproof? There are lots of choices when it comes to sun protection for your baby. Most people buy on SPF factor alone—and the higher the better, they assume. Yet experts agree that anything more than SPF 50 may not actually provide extra protection. Buy wise:  Always read the label—not just the advertising language on the package’s front.  Choose one with the fewest ingredients possible—mineral-based sunscreens are the safest and are easy to find.  Pick a lotion—sprays and powders can be unsafe.  Use a minimal SPF from 15 to 50; there’s no evidence that anything higher than SPF 50 adds extra protection.  Choose SPF 30 to 50 for beach play, swimming, and outdoor activities.  Choose “broad spectrum protection” to minimize both UVA and UVB rays.  Check the product’s water resistance—no product is really waterproof.  Research safer choices online at the Environmental Working Group’s Skin Deep database at www.ewg.org or download their free Sunscreen Buyer’s Guide app.  For the broadest sun protection possible for your baby, look for the new UVA “star” rating system on sunscreen labels. The more stars, the better.

Use sunscreen safely Always apply sunscreen at least 15 minutes before sun exposure. Most people don’t apply enough, so cover your skin liberally to prevent sunburn and free radical production that comes from sun exposure, which can prematurely age skin. Reapply sunscreen at least every two hours when outdoors; reapply more often if you’re getting in water or sweating a lot.

Protect Baby’s Skin in the Sun Most experts agree it’s best to keep babies up to age six months out of direct sunlight for prolonged periods.

When clothing and shade aren’t enough, add a safe sunscreen on small areas of the body, such as the face and backs of the hands, say experts at the AAP. Don’t apply sunscreen near baby’s eyes.

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By AWHONN

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healthy babies

Bathing & Moisturizing Baby’s Skin

By Carolyn Davis Cockey, MLS, LCCE

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rom birth, protecting and promoting baby’s healthy skin is a daily job for parents and caregivers. Baby’s skin protects them from bacteria and germs, and helps them hold a normal temperature. At birth, your baby’s skin is thinner than yours. It will continue to thicken and change through their first birthday.

Babies born before term (37+ weeks) may need as many as nine weeks after birth for their skin to fully work as a barrier, keeping moisture, so they stay warm and hydrated.

images: Dreamstime

Caring for Baby’s Skin From bathing and moisturizing to product selection, you can trust you’re doing the very best every day for your baby when you follow the advice from your nurses. First, protect baby’s skin from things that can cause break down or irritation, including:

hh Bathing baby too frequently; bathe every few days, not daily hh Using skin products that can irritate baby’s skin hh Having a family history of skin rashes or infections (dermatitis) Protecting baby’s skin begins with keeping the nature-made, white, creamy coating called vernix intact from birth; there’s no need to rub or wash it off. Vernix protects baby’s skin, keeping it soft. It’s your baby’s first barrier cream; it moisturizes baby’s skin by increasing its ability to hold water, keeping baby’s skin supple and soft. Yes, it’s sticky, just let it absorb naturally into baby’s skin over time.

Bathing Baby Bathe baby about 3 times a week—or every other day—for the first month

of life if all is healthy and well with their skin; shampoo baby’s hair only once or twice a week.

Bath time begins with preparation: Arrange baby’s tub, washcloth and towels or blankets, and products all within reach. Bathe baby in a warm room away from drafts. Keep baths short—about 5-10 minutes at first—so that baby doesn’t get cold. Unless your healthcare provider has told you otherwise, it’s OK to immerse baby’s cord stump in the water when bathing baby in a tub.

If your baby was born early (before 37+ weeks), consider swaddling baby for bath times, and keep baths short—just a few minutes at most, as preterm babies struggle to hold a healthy, normal body temperature.

Have warmed towels prepared to immediately wrap baby following the bath.

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healthy babies Bath Time Basics

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Begin by washing your hands

Place baby’s bathtub in a warm room, safe space and on a strong surface Use warm—never hot—water (100–104°F); check the water temperature with a bath thermometer. Swirl the water to eliminate any hot spots Always support baby’s head and neck during bathing To shampoo, first wet baby’s hair, then apply a baby-safe shampoo gently with your hand.

Lightly massage baby’s scalp with your hand or a soft baby brush, and rinse with water moving down the back and sides of baby’s head.

Don’t put pressure on the soft spot–known as the fontanel–on baby’s head While holding baby, lower them into the water feet first.

Allow baby to rest on your arm or supported by the tub with the water just up to their shoulders.

If baby’s tub specifies different instructions, follow the instructions with your baby’s bathtub Begin with a clean cloth; wash baby’s face first, body second and diaper area last. Always wipe away from the eyes and mouth and then into the creases as you go behind their ears, around their neck, into their underarms, between their fingers and toes, and in their diaper area Gently rinse baby’s body with your hands or a soft cloth, moving from head to feet, ensuring no soap is left behind Move baby from their bath into a towel or blanket; pat their skin dry rather than rubbing it. Once dry, dress baby to keep them warm

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Choosing Infant Skin Care Products Follow these tips to choose an infant-friendly product for moisturizing your baby’s skin: hh Use products designed and made for infant skin only as they can be protective, help baby’s skin retain water, remain soft and supple, and improve how baby’s skin barrier works. They’re also less likely to sting baby’s eyes. Adult products aren’t designed for infant skin. hh Use as few products as possible—more is not better when it comes to infant skin— use only the specific products needed for baby’s skin care issues at that moment

hh Choose safe products that contain tested ingredients; natural and organic don’t always mean “safe” when it comes to infant skin. “Organic,” “green” or “natural” are marketing terms that aren’t defined or regulated by the federal government. Plant-based products aren’t necessarily safe or safer for newborn skin and, in fact, maybe allergenic or toxic to infant skin hh Keep skin issues at bay, such as eczema (allergic contact dermatitis), which is the most common skin rashspot–known as the fontanel–in baby’s head

Carolyn Davis Cockey, MLS, LCCE, is the founding editor of Healthy Mom&Baby, senior director of Partnerships & Publications at AWHONN, and a Lamaze-Certified Childbirth Educator.

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Both night light and sound machine, Rest is designed using scientifically proven light colors that promote healthy circadian rhythms and melatonin production with white noise to aid sleep. Rest is fully customizable, programmable, and controlled from your smartphone. As your child moves from bassinet to big kid bed, Rest grows with your needs - first providing soft light for middle of the night diaper changes and nursing sessions, then alerting your toddler when it is ok to get out of bed in the morning.

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★ MULTI-FUNCTIONAL: Rest combines nightlight, sound machine, and time-to-rise alert in one easy-to-use device that you can control from your phone! Customize color, brightness, sound, and volume level. Set programs to turn off and on automatically based on your family’s sleep schedule. ★ EASY TO USE: Rest can be programmed to turn on automatically, can be adjusted remotely via phone, or can be tapped on manually as needed.

Control remotely via easy-to-use Hatch Sleep app. No need to disrupt a sleeping baby! ★ GROWS WITH YOUR CHILD: Rest grows with your child’s needs - providing soft light and white noise for midnight newborn feeding sessions, the comfort of a nightlight for a preschooler, plus a time-to-rise setting for your older child! Includes toddler lock feature and stays cool throughout the night for safety. ★ ENCOURAGES BETTER SLEEP: Create the ideal sleep environment for your child. Choose from preset sound and color combinations recommended by sleep experts!

Learn more at www.hatch.co

ABCs of Safe Sleep should sleep by himself.

Alone - Baby No blankets, no pillows, no loveys, no people.

Back -

Baby should be placed on her back for every sleep for the first year of life.

Crib -

Baby should be placed in their crib (or bassinet or play yard) that meets federal safety standards for every sleep.

Safe Infant Sleep Safe sleep. Every sleep.

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Infant Sleep Safety Babies Need Their Own Space

By Sharon C. Hitchcock, DNP, RNC-MNN

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he safest place for your baby to sleep is in their own crib or bassinet, free of any bumpers, blankets, loose bedding or toys that could impede their breathing. With so many cribs, bassinets, bedside sleepers, and other products out there, it can be super confusing figuring out what’s safe and what’s not.

The Consumer Product Safety Commission (CPSC) is the governmental organization dedicated to consumer product safety and standards. CPSP.gov is a great place to check for recalls on specific baby products, though not all products have been evaluated or have safety standards.

Protect Baby from SIDS hh Room-share without bedsharing (up to 50% reduction) hh Breastfeed baby (up to 50% reduction) hh Pacifiers, after breastfeeding is established! (between 50-90% reduction) hh Well-baby checks; make sure baby gets all of their recommended vaccines hh Don’t smoke during pregnancy, and don’t allow anyone to smoke around baby

Second, the American Academy of Pediatrics (AAP) offers general guidelines on crib and “sleep space” safety, which is a great place to start, so we’ll summarize their recommendations here.

When deciding where your baby will sleep, keep the following in mind: hh Place baby on their back in a sleep product that meets CPSC safety standards for sleep (cribs, bassinets, pack-n-plays, or bedside sleepers) hh Use a firm mattress that fits the crib (no gaps) with a tight-fitting sheet hh The crib should be empty

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healthy babies nests, docks, loungers, rockers, or nappers as these devices can be dangerous. There have been many reports of injuries and deaths associated with these products, and the AAP is urging they be removed from the infant marketplace hh Keep sleep products out of baby’s crib—that includes pillows, breathing (apnea) monitors, positioners, and hammocks that may even be marketed as safety items. These haven’t been studied enough to be recommended, and some items, like positioners and pillows, are just plain dangerous hh Move baby to their crib if they fall sleep in their car seat or stroller, or other baby gear not designed for sleep. These items should not be used for routine sleep Finally, a shout-out about where to put your crib: Researchers have noted that infants who sleep in the same room with their parents, but not in the

same bed, have a decreased risk of Sudden Infant Death Syndrome (SIDS).

The AAP recommends “room-sharing” for at least 6 months­— and a year is even better!

Sharon Hitchcock, DNP, RNC-MNN, teaches nursing at the University of Arizona in Tucson, AZ. She is an expert adviser to Healthy Mom&Baby.

Keep these Products Away from Your Sleeping Baby hh Baby nests, pods, or docks hh Baby loungers hh Sleep positioners, wedges, or aids hh Inclined sleepers hh Nursing pillows hh Baby hammocks hh Bumper pads hh Monitors to prevent SIDS (there is no evidence these work)

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except for baby, which means no blankets, pillows, stuffed animals or bumper pads hh Dress baby in a sleeper or wearable blanket when needed for warmth hh In-bed sleepers are not recommended; these small portable devices are placed on an adult bed but there are no safety standards for these devices, and there is reason for concern that babies could accidentally get covered, overheated, or rolled onto by a sleeping adult hh The safest place for baby to sleep is alone in an infant bed—never on a couch, sofa, or armchair. These are the very riskiest places for baby, and where accidental suffocation is most likely to happen hh Bring your baby into your bed to breastfeed/chestfeed—just put them in their crib when they’ve finished nursing hh DO NOT USE inclined sleepers— which are sometimes called pods,

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Nobody likes to be rushed, especially babies.

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.

Slow ! down Relax.

Don’t rush me!

While it may seem convenient for you or your health care provider, labor should only be induced for medical reasons.

G me ive tim e

Go

Your baby will let you know when he’s ready to come out, so give him at least a full 40 weeks.

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f 40 or !

Download a free copy of

40 Reasons to Go the Full 40

What’s the hurry?

at www.gothefull40.com.

The nurses of AWHONN remind you not to rush your baby—give him at least a full 40 weeks!

AWHONN PROMO T I NG T H E H E A LT H OF WOMEN A ND NE W BOR NS

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ADVERTISING PROMOTION

PRODUCT GUIDE Check out these parent-approved favorites!

TEETHING PAIN

Camilia is a mess-free solution designed for teething pain and irritability.* It comes in hygienic, pre-measured liquid doses you don’t need to rub into gums. The liquid dose vials are also sterile, recyclable, and small enough to carry anywhere. *Claims based on traditional homeopathic practice, not accepted medical evidence. Not FDA evaluated.

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BODY BEYOND BIRTH

A safe, obstetrician-endorsed online Pilates program for pregnant and postpartum women designed by a Women’s Health Physical Therapist. These Pilates workouts retrain core abdominals, tone abs, heal abdominal separations and pelvic floor. Also includes physical therapy tutorials, yoga, nutrition.

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NUNA® CUDL™ BABY CARRIER

CUDL makes it easy to keep baby close and secure, while keeping your hands free. Magnetic buckles make securing quick and simple, and every position in CUDL offers your growing child ergonomic positioning to keep spine and hip development healthy.

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POSTPARTUM ICE PANTY ● ● ● ● ●

Relieves after birth swelling, discomfort Crotch pouch has two pockets that hold a PIPs ice bag and sanitary napkin Stays cold longer giving cooling relief Mama stays clean, comfy, and able to move around Goodbye ice filled diapers and gloves!

pipscomfortcare.com ISSUE 30 / 2021 Healthy Mom&Baby

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Managing Family & Visitors During COVID-19

By Paris Maloof-Bury, CNM, RNC-OB, IBCLC

Pre-COVID Visitor Advice But during pandemic, it’s important to keep baby and their parents safe and healthy. Even before COVID-19, experts advised limiting the number of visitors baby is exposed to for the first couple of months—and at least until baby’s first round of vaccines. This was especially important during cold or flu season.

Newborn immune systems are immature, so babies are extra susceptible to all germs. Babies with stuff y noses or ear infections struggle more with nursing. When babies have a hard time eating, their risk goes up for things like dehydration and jaundice.

And if there’s any sign of a fever, your healthcare provider will have to

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take every precaution to rule out a bacterial infection, which means blood draws at the very least. All of this can be extremely stressful, and better avoided in the first place.

COVID-Era Visitor Advice Now that we’re in a pandemic, we recommend applying the CDC’s general recommendations for preventing spread of COVID-19 to your newborn:  Avoid indoor exposures to people not in your household  Keep your baby at least 6 feet away from people not in your household  If you take your baby outside of your home, insist that others near you wear a mask When introducing your baby to family members, hold these visits outdoors, when possible, and everyone gets to mask up and keep their appropriate distance. Encourage your loved ones to help by dropping off meals and groceries, and by Zooming with your older children.

For families who can’t follow these recommendations, the next best thing would be to minimize the likelihood

of spreading infection by using any combination of the following:  Keep visits outdoors  Limit indoor visits to 15 minutes  Ask visitors to stay six feet from baby  Ask everyone to wear a mask  Everyone should wear a mask and wash their hands or use hand sanitizer before touching baby Absolutely ban any visitors who:  Have symptoms of illness (even mild symptoms)  Have been exposed to someone who is ill  Have been exposed to someone who is COVID+ Hey parents, there’s a silver lining in these challenging times: Many moms and dads have discovered that sheltering in place with a newborn offers privacy, opportunities to learn how to breastfeed, and time to “sleep when baby sleeps.” Enjoy this special time.

PARIS MALOOF-BURY, CNM, RNC-OB, IBCLC, is a certified nurse midwife, lactation consultant, and associate editor of Healthy Mom&Baby.

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verybody wants to meet the new baby! There’s something so special about a fresh, squishy baby and the miracle of new life.

Plus, family and friends are a serious source of wisdom, guidance, love, and support—and if they help with household chores and meals, what could be better?

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Keep them close

The International Hip Dysplasia Institute acknowledges this baby carrier as a hip healthy product.

Parenting can be intimidating—wearing a carrier shouldn’t be.

CUDL™ 4-in-1 makes it easy to keep baby close and secure, all while keeping your hands free. Say hello to four magnetic buckles that make securing on-the-go quick and simple. And just like that you are ready in a snap.

It’s comfortable and customizable with breathable mesh fabric and padded shoulder and waist straps. CUDL 4-in-1 offers your growing child ergonomic positioning to keep spine and hip development healthy. Keep baby facing in and snuggled up starting with an integrated infant booster for newborns, which then easily unzips as your child grows.

CUDL 4-in-1 is designed so you can adjust and put it on alone, no helpers needed. When baby wants to sightsee their world, have them face out or switch to back carry mode for growing toddlers.

Find out more at www.nunababy.com

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T H I S WA S N ' T I N A N Y O F T H O S E 25 BABY BOOKS YOU READ...

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