Healthy Mom&Baby: Issue 36

ISSUE 36 / 2024 | $3.95 | health4mom.org

PREGNANCY | BIRTH | PARENTING

PREGNANCY WITH A DISABILITY BIRTH PLAN OPTIONS ROCK YOUR BABY SHOWER BUMP! WHEN EVERYTHING ITCHES IN PREGNANCY

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MULTIPLES AND THEIR PERSONALITIES INTRODUCE FINGER FOODS

POWERED BY THE NURSES OF

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Issue 36 / 2024

Contents ◆ healthy moms

◆ healthy pregnancy

◆ healthy babies

12 How Did I Develop Gestational Diabetes?

32 Birth Plan Menu & Options: Explore Your Choices

50 Baby + Brand = Choosing The Right Infant Formula?

All you need to know about taking care of your body while managing gestational diabetes.

This is your journey so you have all the power! Work out what the best options are for you.

14 When Everything Itches in Pregnancy!

36 Prenatal Care Vitamins: Does the Method Matter?

Rest assured, mama! It’s common to itch during pregnancy.

Prenatal vitamins help your beautiful body regain all of the vital nutrients it needs.

16 Shared Decision Making for Healthcare Decisions

39 Mom and Baby Essentials

Establish a positive relationship with your pregnancy care provider.

It is important that you have all the necessary resources to ensure you make a positive transition into motherhood.

18 Navigating Pregnancy with Physical Disabilities

43 How to Find the Right Breast Pump for You!

Many women experience successful pregnancies despite having a disability.

There are a vast number of breast pumps on the market but which model is the one for you?

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20 Angela’s Childbirth Survival Story Meet Angela Sherice Lee as she tells her pregnancy story.

25 Early Postpartum Exercise Get back in the groove after pregnancy with some simple and effective exercises.

28 Rubba Scrub Scrub! 6 Tips or Easier Cleaning Routines with a Baby at Home Create a tidy and well-organized home for your little one to explore.

When Everything Itches in Pregnancy!

46 Ready to Rock Your Bump and be Showered?

Take time to organize a wonderful event for family and friends to celebrate the imminent arrival of your little one.

47 Choosing Childcare You know what they say, moms know best! Pick out a childcare facility that meets all your needs.

Birth Plan Menu & Options: Explore Your Choices

14 32 Angela’s Childbirth Survival Story

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How to Find the Right Breast Pump for You!

Feel confident with your choice. .

51 The When, What, Why, and How of Introducing Foods to Your Baby!

Introducing whole foods to your baby can be an exciting experience.

52 The Ultimate Hospital Bag Checklist: Essentials for Your New Arrival Discover some of the must-have items to bring with you to the hospital.

53 Nursery Décor – Decorating Means Oh So Much More!

Create a space that you and your bundle of joy will love to spend time in.

54 It’s Playtime! Your Children Benefit from Creative Play Encourage baby to enjoy playtime by engaging their imagination.

57 Introducing Finger Foods Explore your creativity when offering nutritious and delicious treats for baby.

58 One Baby, Two Baby, Three Baby, Four! Learning the Individuality of Multiples Mothering more than one child is an experience to cherish.

The When, What, Why, and How of Introducing Foods to Your Baby!

51 43 54

It’s Playtime! Your Children Benefit from Creative Play

ISSUE 36 / 2024

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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

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

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

Support When You Need It: The National Maternal Mental Health Hotline

LAKISA BALLARD, MSN, RN, C-EFM, RNC-OB Holy Cross Hospital Silver Spring, Maryland DANIELLE BEASLEY, PHD, RN, RNC-OB, CNE Excelsior University Tampa, Florida SHABRITTANEY L. CONDOL, BSN, RNCOB Baton Rouge General Medical Center Baton Rouge, Louisiana NIKITA JOHNSON, CPM-S, CBE, COBST, CNA, CD Certified Doula & Professional Nurse Midwife Student Baltimore, Maryland JESSICA MCNEIL-SANTIEL, DNP, APRN, CNM, RNC-OB, C-EFM Baylor University, School of Nursing Dallas, Texas SHAWANA S. MOORE, DNP, APRN, WHNP-BC, PNAP, FAAN Emory University Atlanta, Georgia HOLLY MYERS, BSN, RN Hospice of South Texas Victoria, Texas RACHEL NAPOLI, DNP, PHN, CNS, RNCOB, IBCLC Sonoma State University Petaluma, California JENNIFER PETERMAN, BSN, RN, IBCLC Hospital of the University of Pennsylvania Philadelphia, Pennsylvania DANIELLE RUSH, BSN, RN-C Northwell Health Phelps Hospital Sleepy Hollow, New York NATALIE SHELTON, MSN, APRN, ACNS-C, FNP-C Clinical Nurse Specialist & Nurse Practitioner Atlanta, Georgia KIMBER STOVESAND, RN Nomad Health Charlotte, North Carolina

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ESSENCE SUTHERLAND, MSN, RNCMNN, CBC, LCCE, PMC-NM Southern New Jersey Perinatal Cooperative (SNJPC) Crum Lynne, Pennsylvania ALIAH THOMAS, RNC-OB Wellstar Health System Atlanta, Georgia JAMIE VINCENT, MSN, APRN-CNS, RNCOB, C-EFM, C-ONQS John Muir Health Walnut Creek, California

By Shakira Henderson, PhD, DNP, MS, MPH, EMBA, RNC-NIC, IBCLC Pregnancy and the time following birth are often portrayed as “a beautiful journey,” which candidly ignores all the changes in your body, lack of sleep, and ever-shifting hormones.

Add those seemingly endless trips to the bathroom and the huge shift that comes with caring for a newborn, and you may find yourself asking, “Who am I?” So, I’m not going to mince words as we consider a sobering statistic: Among all pregnancy and postpartum maternal deaths—1 in 5—are by suicide. Your struggles are real and they’re common. The good news is there’s help and support available.

You’re Not Alone in Your Struggles Most pregnant people and new moms experience a mix of emotions and mental challenges. While you’re recovering from birth, be honest with your nurses about how you’re feeling.

New motherhood is often portrayed as a glowing happy mother cradling her infant—the reality could not be farther from the truth. You’re exhausted. Your breasts may be painful and engorged.

Your belly and/or your bottom is sore, and a good night’s sleep is a distant

memory your body is physically craving.

When it seems there’s no hope, and you can’t find the strength to reach out, please: Seek Support: Share your needs and feelings with your partner, friends, and family. Ask them to stay with you to be the alert caregiver you can’t be right now. Join a support group online or in-person to connect with other moms going through similar challenges.

Accept Support: Ask for help if you’re struggling. Give your partner, a relative, or a friend permission to reach out to you—you don’t have to do this alone.

It’s not just the ‘baby blues,’ and it may not go away without support.

Call or text the National Maternal Mental Health Hotline (1-833-TLCMAMA; 1-833-852-6262): It’s a safe space available in more than 60 languages (through interpreters) for confidential conversations for expectant and new moms experiencing maternal depression, anxiety, or other health issues.

Your physical and mental health matters. Expressing your needs is a strength, not a weakness. By sharing, you’re taking a crucial step toward a healthier and happier pregnancy and post-birth recovery.

SHAKIRA HENDERSON, PHD, DNP, MS, MPH, EMBA, RNC-NIC, IBCLC, is the 2023 President of the Association of Women’s Health, Obstetric & Neonatal Nurses (AWHONN), the professional organization of nurses who provide care for women, pregnant persons, and newborns.

ISSUE 36 / 2024

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◆ AWHONN AWHONN 2023 President

Shakira Henderson, PhD, DNP, MS, MPH, EMBA, RNC-NIC, IBCLC Editor in Chief

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

Jonathan Webb, MPH, MBA Senior Vice President, Strategic Partnerships,

The Power of Your Voice

Communications & Meetings

Billie Robinson, MBA, CAE Senior Director, Strategic Partnerships & Publications

Carolyn Davis Cockey, MLS, LCCE, CAE Associate Director of Publications

Brea Onokpise, MPH, LCCE, MCHES® MAITLAND WARNE Group CEO & Publisher

Kevin Harrington Sub Editor

Emmanuel Berhanu Design

Joanna Harrington Production

Ray Walsh Cover image

© Getty Images

Healthy Mom&Baby is published by Maitland Warne in partnership with AWHONN. © AWHONN, 2024. 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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By LaShea Haynes, MEd, MSN, APRN, AGCNS-BC, RNC, C-EFM It’s time for pumpkin spice and everything nice! Enjoy this festive flavor that sends everyone into a frenzy for a limited time. I’m excited to be here throughout your pregnancy journey. There’s so much for me to share with you in this edition. Make a list of the top 5 things you really want to do during your pregnancy. Express your expectations and you’re more likely to have them met. Get creative as you plan your baby’s nursery décor or baby shower theme. Does this sound overwhelming? Don’t worry because we have the deets in this issue to guide you.

Also, in this edition, we dive in on discussing gestational diabetes, cholestasis, and managing any disability with your pregnancy care provider. We share how to select the best childcare. Today is the best time to get on the waiting list at a few of your top choices. How about the inside scoop on mom and baby must-haves—we have information on that too! Please, dig in, and happy reading! Be sure to follow us on Facebook and Instagram for news and updates.

Finally, I want to encourage you. This is your pregnancy journey, and you have POWER! Use it to select the best healthcare provider that meets your individual needs. A bit of advice; ensure they make you feel comfortable and answer all your questions. Ask about their schedule at the facility where you’d like to birth your baby.

Remember, choosing your pregnancy care provider includes choosing the facility where they provide care. Ask if the practice has midwives. Ask who is most likely to actually catch your baby. Your goal is to avoid surprises at your baby’s birth! Take a list of your concerns to each prenatal visit. Ask questions to inform your decisions.

Meantime, if you’ve got questions, post them on our social channels—while we can’t provide patient care online, we’ll share general advice, and you’ll get a lot of feedback from other moms too. Lastly, in this issue, we have a birth story that will keep you on the edge of your seat and ultimately bring joy to your heart. Remember, you’re the expert on your body and everyone else should be grateful for the privilege of assisting in your birthing experience.

Happy baby growing!

LaShea

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

Editor in Chief, Healthy Mom&Baby

EDITORIAL INQUIRIES

AWHONN Health4Mom@awhonn.org www.AWHONN.org

ISSUE 36 / 2024

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hile it is generally understood that the architecture of the human brain is driven by strong genetic influences, many expectant parents are unaware that research has recently revealed these genetic influences are silenced late in pregnancy. More specifically during the third trimester which leaves environmental factors to influence the last phases of prenatal and early postnatal brain development. Your baby’s cognitive development is a complex and orchestrated process that sets the framework for learning and behavior for life. It’s empowering as a parent to know you have access to a safe and effective early intervention tool which utilizes a series of alpha rhythmic and decibel-controlled sounds to spark creativity and early learning during one of the most impactful times of development.

Over the past decades, the plasticity and capacity for adaptation of the human brain has been well documented and offers considerable potential for optimizing outcomes. Noninvasive and time-tested products like The BabyPlus Prenatal Education System® offer expectant parents an opportunity to make the most of this precious time. Researchers think that this memory of the sounds (‘auditory learning’) starts developing from 27 weeks of pregnancy. As the hearing perception develops with advancing pregnancy, babies respond to even lowlevel sound stimulation. The fetal heart rate rises when the mother listens to fast music and likewise drops in response to slow and calming rhythms like those found naturally in the prenatal environment. Studies have also indicated that unborn babies who listened actively or passively to simple and progressive rhythms

while in the womb showed a significant improvement later in life.

Also, important to factor in that rhythmic decibelcontrolled sounds may also have a significant influence on not only the unborn baby but on the pregnant mom as well. The stress hormone cortisol plays a vital role in the body and in fetal development, excessive levels of cortisol can disrupt development of the unborn child’s brain. From improving the unborn baby’s reflexes, responses, movement and mental stimulation, the use of alpha rhythms like those used in the BabyPlus system also can be calming and stress lowering for the expectant mom. “It’s not the cause of the stress, but how the person handles it that matters,” said Catherine Monk, professor of medical psychology and director of Women’s Mental Health @Ob/Gyn at Columbia University Irving Medical Center in New York City. Mindfulness, cognitive behavioral therapy, use of therapeutic sounds and other practices can help pregnant women – lower stress and anxiety.

Few life experiences are as emotional or tumultuous as pregnancy and giving birth. As an expectant mom, it is easy to feel overwhelmed and even helpless at times. It’s empowering to know that a few simple changes in your daily routine can yield big gains for you and your baby. Recognizing your importance as a mom, caregiver, and protector of your child during pregnancy can work wonders toward bonding with your baby and maintaining a feeling of power throughout the birthing journey and beyond. www.babyplus.com

* Monk, C., Feng, T., Lee, S., Krupska, I., Champagne, F. A., & Tycko, B. (2016). Distress During Pregnancy: Epigenetic Regulation of Placenta GlucocorticoidRelated Genes and Fetal Neurobehavior. The American journal of psychiatry, 173(7), 705–713. https://doi.org/10.1176/appi.ajp.2015.15091171 ** Vasung L, Abaci Turk E, Ferradal SL, et al. Exploring early human brain development with structural and physiological neuroimaging. Neuroimage.

2019;187:226-254. doi:10.1016/j.neuroimage.2018.07.041

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Fathers are Key Players in Breastfeeding, Safe Infant Sleep

It’s likely that the father of your baby spends more time in childrearing activities than his father or grandfather did. This is triple the attention dads are giving to their children within the past 50 years, and it’s creating better infant health. With dad involved, research shows moms have an easier time nursing baby and do so for at least 8 weeks, and baby is more likely to be put to sleep in a way that promotes safe infant sleep.

Moms also consider their baby’s father’s opinion about breastfeeding, say experts at the National Institute for Child Health and Human Development. Dads are more encouraging and supportive of their partner nursing their child as compared to their father’s attitudes, according to a survey among 250 dads in Georgia. The survey also discovered that when dad wants their baby’s mother to breastfeed their child, this resulted in more moms nursing their newborns and sustaining breastfeeding for more than 8 weeks.

Additionally, these same fathers also described placing their infants to sleep on their backs as advised by leading sleep experts, including the AAP, making dads great partners you can lean on during those first days and weeks of sleepless newborn care.

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Help for the Blues Following Birth Many new moms experience emotions including being overwhelmed that don’t simply go away after baby’s birth. As you care for your newborn, breastfeeding and pumping around the clock, keeping up with all the appointments, you might wonder, is there anyone I can talk to about how I feel? How I’m coping?

The National Maternal Mental Health Hotline is available 24 hours every day of the year. Calls and texts are free and your personal information is kept private. This service is not only for postpartum mothers; you can call while pregnant too when you need extra support. Even your loved ones can reach out if they need support, too. Counselors communicate in English, Spanish, and 60 on-demand languages. TTY users can use a preferred relay service.

For support, call or text 1-833-TLC-MAMA (1-833-852-6262) to get the help you need, when you need it.

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How Did I Develop

Gestational Diabetes?

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

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our incredible pregnant body adapts in many ways to feed and provide for your growing baby. Your placenta brings nutrition and oxygen to baby while it removes carbon dioxide and waste.

You and your baby receive energy from glucose, what we often think of as “blood sugar,” carried to your body’s cells via insulin. Your pancreas produces insulin and releases it into your bloodstream; still, it doesn’t move through the placenta to baby.

Your baby’s pancreas produces its own insulin. During pregnancy, your body has circulating hormones that resist the effects of insulin, which slows how fast glucose enters your cells, and this helps baby receive glucose for their developing body.

How Does Gestational Diabetes Develop?

Gestational diabetes develops when your pancreas can’t produce the extra insulin needed to balance the insulin resistance created by pregnancy hormones. This leaves more glucose circulating in your blood than normal, which is known as high blood sugar or hyperglycemia. Approximately 2-10% of pregnancies are complicated by gestational diabetes.

How is Gestational Diabetes Diagnosed?

There are two types of laboratory tests used to diagnose gestational diabetes, a screening test, and a confirmation test.

Laboratory Screening Test: Your healthcare provider will likely order a glucose screening test, otherwise known as a glucose challenge test, between 24- and 28-weeks gestation to check for gestational diabetes.

For this test, you’ll be given a flavored glucose drink and then have your blood glucose levels measured one hour later. You don’t need to fast before this test. If your blood glucose level is less than 140, you don’t have gestational diabetes.

If your blood glucose is 140 or more, this is considered a positive screening test, which will compel your pregnancy care provider to request a confirmation test to learn if you have gestational diabetes.

Confirmation Test: For a confirmation test, oral glucose is given after at least 8 hours of fasting. A fasting blood glucose level is drawn first, and then you’ll be given a flavored glucose drink. After finishing the drink, your blood glucose levels will be tested every hour for three hours. High glucose levels for two or more of the blood draws is considered a positive test, and it’s likely your provider will diagnose you with gestational diabetes.

Gestational Diabetes: Am I at Risk?

Federal health experts have developed a short quiz of questions to help you learn if you‘re at risk for developing gestational diabetes.

These questions include: h Are you older than 25? h Are you related to anyone who has or has had diabetes? h Do you have high blood pressure, high cholesterol, or heart disease?

Will I Have to Take Insulin?

If diagnosed with gestational diabetes, your pregnancy care

provider will likely ask you to monitor your blood sugar and your diet. Many pregnant people with gestational diabetes manage their blood sugar by adjusting their diet, increasing physical activity, and reducing stress.

Your healthcare provider may prescribe medication if your blood glucose level remains high despite lifestyle changes. Medication (pill or insulin injection) is typically used as a last option but may be needed to keep your blood sugar in normal range.

Are There Any Complications?

Gestational diabetes can cause preterm birth, kidney infection, and damage to your retinas. Your baby could be affected by neural tube defects, enlarged organs, or abnormal growth. You both will have an increased risk of developing Type 2 diabetes later in life.

Peace of Mind For peace of mind, it’s important to follow your pregnancy care provider’s recommendations to keep your glucose level in a normal range. Ask your provider questions to learn all that you can; you and your baby’s health is worth it.

JAMIE VINCENT, MSN, APRN-CNS, RNC-OB, C-EFM, is a nurse expert advisor to Healthy Mom&Baby.

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When

Everything Itches in Pregnancy!

What is Intrahepatic Cholestasis?

By Danielle Rush, BSN, RN-C

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tching during pregnancy is common—especially for an everexpanding belly. Itching may seem harmless, not something you need to mention to your provider. But severe itching can be a sign of a pregnancy complication, intrahepatic cholestasis of pregnancy (ICP). Here’s why your itching may be more troublesome than bothersome.

What is ICP? ICP is a liver disorder that can begin in the late second or third trimester when estrogen levels peak. What causes ICP isn’t fully understood; some experts think genetics, environment, and hormones may all contribute. ICP isn’t common; it only affects a tiny fraction of pregnancies in the U.S., still, studies show it’s on the increase.

High estrogen levels can cause cholestasis by slowing or stopping the flow of bile in your gallbladder.

Blocked bile acid, usually responsible for fat digestion, builds up in your bloodstream and can cross the bloodplacenta barrier to your baby.

Could You Be at Risk?

You may have a higher chance of developing ICP if you have any of these risk factors:  Prior history of ICP  Chronic liver disease  Chronic Hepatitis C  History of gallstones  Multiple gestation pregnancy: twins, triplets, etc.  Age 35 or older in pregnancy

is most common on your hands and soles of your feet but can be all over; it’s also generally worse at night.

Lab testing may reveal increased bile acid levels and possibly elevated liver function.

Other symptoms associated with ICP include:  Nausea  Decreased appetite  Fatigue  Dark urine  Pale stools  Mild jaundice or yellowing of the skin  Pain near your liver in your abdomen  Insomnia associated with night-time itching

ICP Complications Circulating bile acids cross your placenta and can accumulate in your developing baby’s amniotic fluid, potentially causing severe complications including:  Sudden intrauterine fetal death or stillbirth  Meconium-stained amniotic fluid  Preterm birth  Neonatal ICU admission The higher the bile acid levels, the greater the risk of more severe complications for your developing little one.

ICP also increases your risks for other pregnancy complications, such as:  Gestational diabetes  Preeclampsia  High cholesterol

A few studies have linked ICP with a lack of Vitamin D and selenium, a trace mineral.

It is because of these potentially serious complications that it’s important to begin treatment for ICP immediately.

What Are the Symptoms of ICP?

What to Expect if You Develop ICP

Itch, itchy, and more itchiness! Pruritus or itching, without a rash, is the cardinal symptom of ICP and often begins before any changes in your body.

Starting around the 30th week of pregnancy, moderate to intense itching

When treating ICP, the goal is to decrease the risk of illness and stillbirth for your baby, as well as reduce the itching sensations and improve your liver function.

Testing: Repeat blood lab work to

evaluate serum bile acid levels and liver function.

Medication: Your provider may recommend Ursodiol (UDCA) or Actigall, 300 to 500 milligrams twice daily, until birth to reduce circulating bile acids. This medication can also relieve itching and potentially improve liver function. Research has shown that the use of UDCA improves fetal outcomes too.

Increased surveillance: Your provider may perform weekly biophysical profiles due to the risk of fetal illness and stillbirth. This type of ultrasound evaluates your baby’s heart rate, muscle tone, movement, breathing, and amniotic fluid level.

Weekly non-stress tests, and externally monitoring the baby’s heart rate for a sustained period may also be recommended.

Birthing: Your provider may ask you to consider an early birth or induction of labor to protect your health and baby’s health. Discuss the risks of prematurity with your pregnancy care provider to help your decisionmaking. Depending on the severity of symptoms and bile acid levels, giving birth by 37 weeks gestation, if not earlier, is the current recommendation from The American College of Obstetricians and Gynecologists.

What is the Cure?

Birth! ICP symptoms almost always cease once your baby is born. Further investigation into liver and gallbladder function will be considered if symptoms do not return to normal after the baby is born.

Itchy skin is a nuisance. The unrelenting feelings of ‘bugs crawling under your skin’ could be ICP. Do not hesitate to speak with your pregnancy care provider about any symptoms of ICP. Advocating for yourself will help ensure your baby’s safe passage from your womb into this world.

DANIELLE RUSH, BSN, RN-C, is a labor and delivery nurse at Northwell Health Phelps Hospital in Sleepy Hollow, NY.

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Shared Decision-Making for Healthcare Decisions

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

F

ew things are more frustrating than having a situation planned in your head, just to have absolutely nothing occur as you hoped. When this happens during pregnancy, it often leaves people feeling disappointed, angry, and not heard.

To help establish and set expectations, there’s a push for pregnancy care providers to use what’s called in medical terms, “shared decision-making,” which is where your pregnancy care provider shares information about your pregnancy, and you make decisions together based on your preferences.

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This can help avoid unmet expectations.

Say goodbye to the days when healthcare providers simply told you what to do and you happily comply without question. Today’s technology allows you to access your medical records and review treatment choices. You may then research information that places your personal desires on the opposite side of a care plan that your healthcare provider has outlined for you. And that’s ok.

Here’s how you can engage in shared decision-making with your pregnancy care provider:

Interview Healthcare Providers Most parents would never allow someone to babysit their child without ever meeting them or at least talking to them beforehand.

Selecting a healthcare provider, especially one that will support your baby’s birth, should be no different.

Most providers offer consultation visits. This is a great opportunity to ask questions and get a feel for the provider and their values. Ask your family and friends for referrals. Select a provider that respects you, makes you feel comfortable, and uses shared decision-making.

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healthy moms Tour the Birthing Hospital Who you choose as a pregnancy care provider may also mean you’ve chosen to birth where that provider has access to care for patients in certain hospitals.

Touring hospitals allows you to feel the culture and vibe of the staff and facility. Ask the nurses questions about labor and birth to learn if you have requests that the staff are unable to accommodate. It can be difficult to change providers, so take the time to choose a pregnancy care provider and hospital that works for your desired birth.

Ask About the Visitation Policy The spread of COVID required facilities to alter their visitation policies, limiting the number of visitors. Visitation can also be limited at birthing centers and home births.

Routinely check this policy of the facility where you’ll give birth.

Be Certain That Your Provider & Hospital Accept Your Health Insurance

Remain Flexible

prescribe alternative treatments.

Ask your pregnancy care provider to share more information with you—to watch or read about topics you’re interested in—this is how you can make informed decisions about your care together.

Lastly, flexibility is always required if you experience a health emergency. In circumstances where an emergency occurs, schedule a time to talk with your provider to discuss what occurred, and allow them to explain why certain decisions were made.

It’s important that you feel comfortable with the decisions that are made regarding your care, even when they are not your first choice.

All in all, you should always feel empowered to take an active role in your healthcare decisions.

Remember, your healthcare provider is human and their goal is to ensure that you have the safest possible birth outcome. Some providers

JESSICA MCNEIL-SANTIEL, DNP, APRN, CNM, RNC-OB, C-EFM, is a certified nurse midwife and adjunct professor. Her career focus is on maternal-child health.

Healthcare providers and the facilities at which they practice may take a limited number of health insurance plans. Call your insurance company in advance to ensure that both the provider and the facility where they see patients are within your insurance network.

A great patient experience can be ruined when you receive a large, unexpected bill from an “out of network” plan or a facility that doesn’t accept insurance. Check with your insurance plan to learn specifically what they cover, including discounted medical supplies like breast pumps.

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Feel empower ed in taking an ac tive role in your he althcare decisions, ye t be flexible with alternat ives and during emer gencies.

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Navigating Pregnancy with Physical Disabilities How to Advocate for Your Pregnancy Care

By ShaBrittaney L. Condol, BSN, RNC-OB

I

f you’re an expectant mother living with a physical or limiting disability, the thought of carrying a pregnancy to term may be scary. The key to overcoming this discomfort is gaining knowledge on how to manage your disability in pregnancy, receiving accommodations, making adaptations, and having a plan for when things don’t go as they should. All of these steps should help you feel empowered during pregnancy decision-making.

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Before Pregnancy It’s best to consult with your pregnancy care provider before getting pregnant, particularly if you have a disability that can complicate pregnancy, labor, or birth. You will likely need to find a care provider who is open-minded, supportive, respectful, and has the capacity to learn about your specific disability.

Ensure your healthcare provider’s office/facility can accommodate your accessibility needs and support

your care.

Make a list and arrange a time to ask a nurse or another care provider about how the office is set up to support your needs, such as wheelchair-accessible parking, scales for taking accurate weight in a wheelchair, bathrooms with space to move around with your equipment, and patient rooms with electronic exam tables that are easily lowered and elevated for care. These simple things can reduce the stress of receiving care.

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healthy moms There are additional ways to reduce stress before your first appointment.

Create a list of questions or concerns you’ve been thinking about. Ask your provider to order specific blood or genetic tests related to your condition so you’re informed of any risks to your baby as early as possible. Find out if your provider collaborates through a multi-level healthcare system that offers social services and can provide in-home resources before your baby arrives.

Consider starting care with a behavioral health counselor to discuss any anxieties related to getting pregnant. This relationship can become one of support during your pregnancy and throughout your postpartum recovery.

Finally, gather information early, particularly for mothers with visual, hearing, or intellectual impairments.

Create a customized plan with your pregnancy care provider that centers around challenges of the disability in pregnancy, labor, birth, and during postpartum recovery including medications.

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During Pregnancy Once pregnant, your medications may be altered due to the safety of your unborn baby. Antispastic, anti-depressant, and anti-seizure medications are examples that need to be discussed because certain medications in these categories can be harmful to the growth and development of your baby.

Long-term, chronic pain control medications for certain conditions like cerebral palsy may also need to be changed completely due to any potential risks to your unborn baby.

If your medication has to be adjusted during pregnancy to ensure your growing baby’s health, you can seek out non-drug pain options.

Alternatives include massage and water therapy, heat, ice, acupuncture, meditation, and relaxation techniques.

These are just a few treatments that

can help you cope with the pain you may be enduring from your medical condition. Schedule an appointment with an occupational therapist, physical therapist, and/or pelvic floor therapist. These professionals will customize therapies to help prepare your body for the changes and possible pain or discomfort you may experience during pregnancy, in labor, and/or while giving birth.

If you need a larger wheelchair to accommodate the weight of your growing baby, call your insurance carrier to discuss the options that are available. In the meantime, add a few cushions to your chair; this may help with pain and annoying pressure points.

Near the end of your pregnancy, ask your provider if you should be referred to the anesthesia team early to discuss pain options during labor. It is important to know if certain anesthesia medication used during labor and birth has caused spinal cord abnormalities.

Depending on your condition, one procedure may be better than another to prevent complications of the spinal cord. Finally, for anyone with lower limb contractures, consult with both your healthcare and anesthesia providers about the best form of pain relief and your options for a safe birth experience.

After Pregnancy Setting up a newborn nursery can be fun and exciting but make sure you read reviews and test equipment before buying to ensure items fit your family’s specific needs. A person that uses a wheelchair may need to purchase a crib that opens on the side. Other options are bassinets that connect to the parent’s bed and allow for easy reach to your baby, these can be fantastic. A baby changing table that allows for easy height adjustments from standing to a person who is sitting can be helpful too.

Your Journey The number of women with disabilities has increased over the years and many of these women have successfully become parents. With adequate knowledge and the needed resources, women can advocate for their own health care and experience an amazing pregnancy journey.

Having a team who supports you throughout your journey can make pregnancy enjoyable and healthy and support a safe birth for mom and baby.

SHABRITTANEY L. CONDOL, BSN, RNC-OB, is a labor and delivery nurse at Baton Rouge General Medical Center in Baton Rouge, LA.

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Angela’s Childbirth Survival Story

By Angela Sherice Lee, RN, BSN, C-EFM

I thanked my doctor for saving m y life but couldn’t help thinking that I would never be pregnant ag ain.

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I

was excited to learn I was expecting my first child. As a Labor & Delivery nurse for 8.5 years, I love supporting pregnant patients through birth.

This was my first pregnancy. At an 18-week ultrasound, I was diagnosed with placenta previa, a complication where the placenta attaches lower within the uterus and can cover the cervix and cause bleeding.

When Birth Plans Change I was devastated. I had always wanted to have an unmedicated, vaginal birth. I was now facing the reality of a cesarean birth.

Every 2 weeks, I had an ultrasound check with maternal-fetal specialists.

I was advised against vigorous activities and was asked to notify my pregnancy care provider if I started bleeding.

Being the Patient Where I Worked At 29 weeks, I was admitted to the hospital where I worked. The plan was for me to stay in the hospital until birth at 36 weeks.

I felt depressed being a patient. I couldn’t sleep, and it was hard seeing my co-workers knowing I couldn’t help

them. After a few weeks, I awoke in the hospital bed to a large amount of bleeding. My water had broken.

Within minutes, I was being prepped for an urgent cesarean surgery. I was only 32.3 weeks and scared, anxious, and nervous.

I gave birth to a beautiful, healthy, 4 lb., 12 oz., baby boy, Ethyn. My placenta followed, which removed any concerns I had about continued bleeding. Still, I remained in recovery for more than 3 hours before the bleeding slowed. Only then was I able to go to the neonatal ICU, where I could spend time with Ethyn.

Beginning Recovery I felt good and anticipated pumping milk for my baby. Still, I noticed increased bleeding and felt a gushing sensation when I sat up in bed. I asked the nurse to check the amount of blood on the pad under my body.

“That is not a lot of blood; I don’t want to hurt you by pressing hard.” I told her, “I work in labor and delivery, I know what a lot of bleeding is. I am at high risk of hemorrhaging, please massage my fundus (top of the uterus).”

A co-worker checked the bleeding; and when she pressed on my uterus, multiple clots and gushes emerged. I immediately asked for my doctor.

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Risking Hemorrhage Instead, the nurse refused to call the doctor and threw away the bloody pad. She didn’t take time to determine how much blood I had lost.

A coworker noticed my blood pressure was dropping even as my heart rate was increasing. She continued to massage and we saw more clots and increased bleeding.

Another co-worker called my provider and called out for additional nursing help because I was bleeding out. As the doctor manually pushed the clots from my uterus, I clenched my teeth; what a painful experience!

I received medication to help control bleeding and 2 units of blood.

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healthy moms When Everything Crashed Two hours later, I noticed more bleeding, and a dilation and curettage was ordered to remove tissue from within the uterus. I cried and told the anesthesia team that I was afraid of being put to sleep not knowing if I would wake up. I was reassured and comforted by knowing the staff caring for me.

I was given 22 units of blood to replace the more than 4 liters that I had lost. During the procedure, they placed a device to keep my uterus firm and remove clots. I remained on a breathing tube and was transferred to the ICU. Ultimately, I needed an emergency hysterectomy—the removal of my uterus.

I awoke in the ICU with a breathing tube in my throat. The nurse gave me a pen and paper. I asked about my son, family, and whether I could pump my milk. Soon after the breathing tube was removed, and I could finally speak, my provider came to share the details with me.

I experienced being ignored. Research shows women of color are less likely to be taken seriously or listened to.

My advice to all pregnant persons is to speak up and advocate for yourself, especially if your healthcare provider

is not listening to your concerns.

Escalate the concern until you receive the care you deserve!

ANGELA SHERICE LEE, RN, BSN, C-EFM, is a registered nurse of 15 years, charge nurse, and team lead in labor and delivery.

Losing My Fertility The bleeding slowed after my uterus was removed. I felt gratitude and yet grief and loss from all that happened to me. I thanked my doctor for saving my life. I couldn’t help thinking that I would never be pregnant again. The thought of only having one biological child terrified me as I was just starting my family.

I grieved for the loss of my fertility.

Even now, I experience post-traumatic stress syndrome when I care for a patient hemorrhaging or undergoing a hysterectomy.

Every day, I use my experience to advocate for laboring patients. I recall how I was not listened to, and I validate and reassure every patient I care for. I especially advocate for high-risk patients and women of color.

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Finding Purpose in My Experience

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Early Postpartum Exercise

By Aliah Thomas, RNC-OB

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A

ren’t our bodies amazing?

We can make, birth, and feed a whole new person!

And as such, it’s important to honor ourselves by investing in a full recovery and healing after birth so we can live our best lives with our growing families.

This means taking time to strengthen the pelvic floor and abdominal muscles (core) that have worked hard to support your growing baby. And the earlier you start, the better. While it’s important to wait until about 6 weeks before resuming any intense exercise regimen, here are a few exercises you can resume immediately after giving birth— after you’ve celebrated with lots of snuggles and a good meal, of course!

Strengthening Pelvic Floor Muscles Your pelvic floor muscles form the base of your “core.” Stretching from your pubic bone in the front to your tailbone in the back, and to the sit bones on your right and left sides, these muscles work with your deep abdominal muscles and your back to support your spine and control pressure in your abdomen.

Over the course of your pregnancy, your pelvic floor muscles support the ever-increasing weight of your growing baby. Then during birth, these same muscles stretch to birth your baby. After all this work, if we don’t strengthen them again during postpartum, we’re at increased risk for many common pelvic floor

problems, including loss of bladder or bowel control (incontinence) and either painful or less pleasurable sex.

Abdominal Muscle Exercises Your abdominal muscles (abs) form a corset that stabilizes your pelvis and supports your back; they’re essential to maintaining proper posture. In the same way that pregnancy stretches your pelvic floor muscles, your uterus, growing in size with your growing baby, pushes outward on the vertical abdominal muscles running down the middle of your stomach, making them longer and weaker.

Oftentimes, they will separate and pouch out. This condition is called diastasis recti and affects about

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Pelvic Floor Exercises Pelvic floor exercises, previously known as “Kegels,” can strengthen the pelvic floor muscles around your bladder, vagina, and bottom. These exercises can reduce your risk of incontinence and help to assure that sex (after 6 weeks, of course!) feels satisfying again. Kegels can be done anywhere and anytime, while lying down, sitting, or standing.

1. Find a comfortable position. At first, it may be easier to start lying down.

2. Squeeze the muscles around your bottom as if you’re trying to hold in gas.

3. Squeeze the muscles around your vagina and bladder as if you’re trying to stop the flow of urine.

4. Aim to hold the squeeze for 10 seconds, rest for 10 seconds, and repeat up to 10 times. If this is difficult, perform short squeezes for 1 second, with a 1 second rest.

Repeat 10-15 times.

5. Don’t perform Kegel exercises with a full bladder.

Start gently, stay within your comfort zone, and work up to stronger exercises when you can. Try to do these exercises at least 3-4 times daily. In the beginning you may find it difficult to feel your pelvic floor muscles working. It can take a few weeks to build their strength back up.

But stick with it and soon you’ll notice a difference and feel your pelvic floor muscles contracting and relaxing.

It can be challenging to remember to do pelvic floor exercises at first, so try to make them a part of your daily routine by prioritizing them the same way you prioritize brushing your teeth. Make time while you’re in the car, resting in bed, watching TV, feeding or cuddling your baby, or any other times that work for you.

Gentle Abdominal Exercises These gentle abdominal exercises can reduce the size of the separation of your abdominal muscles to help your body bounce back more quickly and completely and reduce your risk of chronic back pain.

1. Lie down, sit, or stand. Keep your back flat.

2. Take a deep breath in, and on the exhale, pull your lower abdomen in towards your spine. Try not to bear down while you do this.

3. Hold for a count of 10, then gently release.

4. Repeat up to 10 times.

Once the gap in your abdominal muscles has closed and your pregnancy care provider gives you the “all clear” to resume more strenuous exercise, you can progress to more challenging workouts with crunches, sit-ups, planks, or Pilates.

Get Moving Early with Exercise, But Take it Slow Once you feel ready, you can add other very low impact exercises, such as gentle yoga and short daily walks. This can add to your overall sense of wellbeing while improving circulation and helping to stretch out all of the sore spots as you recover from childbirth.

In addition to these exercises, take care to practice good posture, support your lower back with a pillow while sitting, and support yourself with your arm when getting out of bed or off of the floor.

Need More Help? If you still notice a bulge in your stomach, leaking urine, or pain with sex at 8 weeks postbirth, reach out to your provider and ask if you might be a good candidate for pelvic floor physical therapy. You deserve to have an intact body that functions beautifully, especially after all the work you’ve put into bringing your gorgeous baby into the world!

ALIAH THOMAS, RNC-OB, is a perinatal nurse who has worked in women’s health for her entire career. She also serves as a Facilitator in the Nurse Residency Program for new graduates at her hospital and is passionate about patient education and advocacy.

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60% of women during pregnancy and postpartum. Normally, your separated stomach muscles will go back to their pre-pregnancy size within 8 weeks. But when they don’t, you’re more likely to experience longterm back pain and have a harder time getting your pre-pregnancy figure back.

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Rubba Scrub Scrub!

6 Tips for Easier Cleaning Routines with a Baby at Home

By Shawana S. Moore, DNP, APRN, WHNP-BC, PNAP, FAAN

C

leaning with a new baby in the house can be challenging. As a parent, cleaning can seem like a daunting task, but it doesn’t have to be. With preparation and a plan, you can get your home in tip-top shape without sacrificing precious time with your little one. We’ve got ya with six practical strategies: 1. Make a list: Identify all the areas in your home that need to be cleaned.

Break the list into smaller tasks to make it manageable. Instead of “clean the bathroom,” separate the goal into simpler tasks like “clean the toilet,” “wash the sink,” and “scrub the shower.”

2. Set realistic goals: With a baby, your time is limited and energy level may be low. Don’t try to finish everything at once.

Set realistic goals that you can achieve in short bursts.

4. Use safer cleaning products: The safety of your baby is a top priority.

Choose cleaning products that are safe for your little one and the environment. You can also make your own cleaning products using natural ingredients like vinegar and baking soda.

5. Declutter: Sort your belongings and donate or sell items you no longer need or use. Decluttering will not only make your home look neater; it will also make cleaning easier.

6. Get help when needed: Don’t be afraid to ask for help from family and friends. If you need additional support, ask someone to watch your baby while you complete a larger cleaning task. Consider a cleaning service if that’s an option for your family.

Cleaning may seem overwhelming, but with a plan in place and by following these tips, you can achieve a clean and organized home while still enjoying quality time with your little one. So, grab your cleaning supplies and get to work—you’ll feel refreshed, recharged, and ready to make the most of the season ahead!

SHAWANA S. MOORE, DNP, APRN, WHNPBC, PNAP, FAAN, is a women’s health nurse practitioner. She serves as an Associate Professor and the DNP Program Director at Emory University’s Nell Hodgson School of Nursing. She is passionate about equitable, respectful, and inclusive maternal-child care.

With a baby at home, set realistic clea ning goals that yo u can achieve in sh ort bursts .

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3. Involve your baby: If your baby is old enough, get them involved in the fun!

Or, they can lay on a blanket or play with a toy while you clean nearby.

Over time, you’ll learn how to best spend quality time with your little one while getting things done.

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pregnancy

Zurzuvae for Postpartum Depression Giving birth to your first, second, or third baby comes with a mix of powerful emotions each time. If your joy and excitement subside postpartum and you begin to feel anxiety, mood swings, cry with little control, or have difficulty sleeping, you may be experiencing postpartum depression. These feelings can begin during pregnancy and continue long after you’ve given birth.

Postpartum depression is the most common health complication for women who have just had a baby. It’s serious and may affect your baby’s feeding and development, or your bonding and parenting. Talk to your pregnancy care provider about how you’re feeling; ask what you may do or take to help.

The Food and Drug Administration has approved the first oral medication for postpartum depression, Zurzuvae (zuranolone).

Side effects of Zurzuvae include drowsiness, diarrhea, fatigue, and urinary tract infections. However, when taken as directed, the results are promising after just three days. Healthcare providers call the new medication “a game-changer” because of the lack of qualified maternal mental health care providers. Talk with your care provider or baby’s pediatrician to learn if they have any concerns about your use of Zurzuvae while nursing your baby. Ask your care provider if it could help in your circumstance as part of your overall care during postpartum recovery.

Pregnancy Apps and Data Sharing

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Maternity Fashionista!

Stand up mamas! Show off that beautiful bump! Are you gearing up for a friend’s milestone birthday party, weekend getaway, babymoon, or other exciting venture? Try shopping with retailers that offer a variety of sizes and styles that fit every occasion. Spend your dollars with one-stop shops for shapewear, sweaters, shoes, and more.

Do you love discounts? Add up those loyalty points for continued shopping once you’re postpartum. Check when your faves are offering free shipping and definitely read the return policy. Is there potential for another baby in the next few years? Hold on to your prized pieces for future days to go glam!

Most of all have fun! In the distant past maternity dressing was depressing, but now, show off your radiance while you nurture your precious little one growing on the inside.

In our high-tech world, privacy is everything. We use strong passwords to protect our personal information and trust companies to encrypt our data.

Before getting pregnant, did you use an app to track your ovulation? Have you downloaded a pregnancy tracker to get the week-by-week growth of your baby? If so, keep in mind that the tech company may be able to share some of your user data. Take a quick few moments before signing up for the next pregnancy app to be sure you understand what information you’re giving access to by reading the privacy policy.

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healthy pregnancy

Birth Plan Menu Consider Your Options and Choices to Plan Your Best Possible Birth

By Rachel Napoli, DNP, PHN, CNS, RNC-OB, IBCLC and LaShea Haynes M.Ed, MSN, APRN, AGCNS-BC, RNC, C-EFM

Tour Your Birthing Space and Prepare Mentally It’s a good idea to tour the facility where you plan to give birth prior to labor. You’ll pre-register and view the inside of the labor and delivery and postpartum unit rooms. This

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tour gives you a mental picture of the available support equipment and sets your expectations for labor and birth.

Browse online with facilities that offer virtual tours.

Set Your Preferences and Expect the Unexpected Choose the preferences you desire for your birthing experience and share them with your partner or support person. Finish your birth plan at least a month prior to your due date and discuss it with your pregnancy care provider. Share what is important to you and be open to changes or modifications based on you or your baby’s health condition.

Be flexible when birthing. Events may differ from the plan that you originally designed. However, your

provider and nurses understand the goal is for you and your baby to remain healthy. Keep an open mind throughout the process for any changes that may occur during labor, birth, or postpartum. An unpredictable scenario may be lifesaving. Choose what’s important to you:

Birth Location Your choice of pregnancy care provider often will determine where you will give birth. The provider that you choose to support your baby’s birth practices at specific hospitals or birth centers. Most women will birth in the following kinds of facilities: h Hospital h Birthing Center h At home

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P

ositive pregnancy test? Baby’s due date right around the corner? In both situations and everything in between, understanding your options can empower you to give birth to your baby with the plan you confidently desire.

Your choices for your baby’s birth are personal. You can decrease surprises when you create a plan.

We’ve outlined a birth menu just for you—consider these items as you prepare for your baby’s birth.

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healthy pregnancy

Tour the Birthing Facility  Visitor policies will determine how many people can be with you when birthing:  Ask what the policy is and whether there’s any restrictions on visitors after birthing  Know that flu or re-emergence of COVID could change these policies  Are there restrictions on recording videos or snapping photos of my birth?  You may be asked to sign a release form  Ask about electronic fetal monitoring:  Are there opportunities to be monitored from time to time to allow for more movement during labor?

Yes or no  Does the facility have mobile fetal monitoring to support movement while laboring?

Yes or no

 What complications might require me to have continuous fetal monitoring?  How else can my care providers monitor my baby if I do not want continuous electronic fetal monitoring?  Pain management options: Ask what alternative options during labor are available:  Movement, breathing, massage, visualization, counter-pressure, shawl or wrap for comfort  Water therapy, such as sitting in the shower or using a birthing tub  Transcutaneous electrical nerve stimulation (TENS) machine  Intradermal water block  Epidural  Nitrous Oxide  Intravenous medications

Once in Labor  Can I eat and or drink fluids during early labor?

Yes or no  Will this change as my labor progresses?  Can I walk the halls outside of my labor room?

Yes or no  Is there the option to have the IV capped to facilitate moving around?

Yes or no  Can I use low lighting while laboring?

Yes or no  Can I take rest breaks and naps without

 What labor equipment is available?  Birth or peanut ball  Rocking chair  Squat bar  Tub or shower options during labor  Birth stool  Modify the birthing bed to allow for various position changes  Fan  What can be brought from home for use during labor and/or do you have these available for laboring families?  Speaker and playlist  Massage tools or handheld massagers  Aromatherapy, such as essential oils  My own gown, socks, and slippers  Massage tools or handheld massagers  Hot or cold compresses

Pushing  Will my choices be respected during labor, including when I feel like pushing?

Yes or no

interruptions?

Yes or no  Can I opt to have vaginal exams only when essential to reduce risk of infection?

Yes or no  What support options are available to me or my support person when birth doesn’t go as planned?

 Will I be able to change positions while pushing?

Yes or no  Can I watch baby emerge with a mirror?

Yes or no

 Pushing options:  Pushing in upright or side-lying positions  Pushing while on my hands and knees  Pushing while kneeling in bed; leaning into the raised head of the bed

 Can I touch baby’s head while crowning?

Yes or no  Can my partner support my legs while I’m pushing?

Yes or no

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Birth and Bonding

 Can my partner or support person cut the baby’s umbilical cord after delayed cord clamping?

Yes or no  Can baby go immediately skinto-skin to support baby’s recovery and to begin breastfeeding?

Yes or no  Are mental health services available if this birth experience is traumatic?  For what reason(s) would baby ever be separated from me at or after birth?  Can all assessments of baby be done while skin-to-skin with me postbirth?

Yes or no  What procedures and/or medications are typically given to baby after birth?  Can I opt out

of those for the first few hours for bonding?

Yes or no  Can those be delayed until baby has nursed?

Yes or no  Can the baby’s bath be delayed between 8 to 24 hours after birth to allow for infant stabilization?

Yes or no  Will the care team leave the vernix on baby at my request?

Yes or no  Are lactation consultants available to share how beginning breastfeeding will be supported?

Yes or no  Are hospitalgrade breast pumps, milk storage, and bottles available, if needed?

Yes or no  Does the hospital work with a newborn photographer or can I hire my own photographer?

Yes or no

Cesarean Birth After Labor  Will I be asked to consent to cesarean surgery if unable to labor and birth vaginally?

Yes or no  Which preferences from my birth plan menu will be honored when changing how baby will be born?  Do you offer a clear drape or a drape with a window if baby is born surgically?

Yes or no  Can baby be placed skin-to-skin following cesarean birth?

Yes or no  If baby is admitted into the Neonatal Intensive Care Unit will a preference for pumped breastmilk be honored?

RACHEL NAPOLI, DNP, PHN, CNS, RNC-OB, IBCLC, is an Assistant Professor of Nursing at Sonoma State University. She has a passion for expanding breastfeeding. She works clinically as an RN at Providence St. Joseph’s Health in Sonoma County.

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Discuss with Your Birth Provider  How long after my due date can I go before we discuss the use of medications to start or assist labor?  What would cause a provider to strip or sweep membranes?  Can I opt out?

Yes or no  Is artificially breaking the bag of water (amniotic sac) helpful with increasing contractions?

Yes or no  Do I have the option to opt-out to decrease the pain in labor?

Yes or no  Are cultural traditions for saving the placenta or with other aspects of birth honored?

Yes or no  Will you ask for my consent before using forceps, vacuum, or episiotomy?

Yes or no Other important preferences and additional questions to ask (list anything not above)

LASHEA HAYNES M.ED, MSN, APRN, AGCNS-BC, RNC, C-EFM, is the Editor of Healthy Mom&Baby magazine. Her nursing career spans 25 years.

She is the founder and owner of her own nurse mentoring and education company.

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 Can my partner or support person help catch the baby?

Yes or no

health4mom.org

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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!

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healthy pregnancy

Prenatal Care Vitamins: Does the Method Matter?

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By Shawana S. Moore, DNP, APRN, WHNP-BC, PNAP, FAAN

igh-quality prenatal vitamins are an essential part of prenatal care to ensure the health and well-being of you and your developing baby. There are a wide range of available options, including pills, liquids, and chewy gummies.

Prenatal vitamins include higher levels of folate needed for baby to help prevent some birth defects early in pregnancy.

You can also get the nutrition you need from a healthy diet. If you’re already eating nutritious foods, it’s still recommended that you take a daily prenatal vitamin throughout pregnancy and postpartum recovery.

Prenatal vitamins and healthy food choices support the changes in your body and your baby ’s ra pid growth.

Importance of Prenatal Vitamins

Types of Prenatal Vitamins Prenatal Pills, Tablets, or Capsules Prenatal vitamins as pills are widely available. They contain all the necessary nutrients in one dose.

However, if you fi nd it diffi cult to swallow pills, especially if you’re experiencing morning sickness or nausea during pregnancy, perhaps try liquid or gummy prenatals.

Liquid Prenatal Vitamins Liquid prenatal vitamins are a great option if you struggle with

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swallowing pills. They’re easily absorbed by your body but may expire more quickly and may need refrigeration, making them less convenient for travel.

Gummy Prenatal Vitamins Chewy gummy prenatal vitamins are popular for their taste and texture.

Try gummies if you have a hard time swallowing pills or if you have taste versions.

Healthy Foods A healthy diet is essential in pregnancy, yet, relying solely on food for all nutrients may not provide enough vitamins and minerals needed for your baby’s development.

Prenatal vitamins act as a backup to ensure that you and your baby receive plenty of nutrients. They’re also helpful if you’re vegetarian or have food allergies.

It’s important to discuss selecting a prenatal vitamin with your pregnancy care provider. They can review your nutrition needs related to your age, medical history, and food habits.

Your healthcare provider may recommend a specific type or brand of prenatal vitamin.

Ideally, it’s recommended that you begin taking prenatal vitamins before you get pregnant. But as soon as you know you’re little bun is in the oven, taking a prenatal becomes essential.

Prenatal vitamins aren’t a substitute for eating healthy foods from all the food groups, they’re an option to support your pregnancy and the new changes in your body.

SHAWANA S. MOORE, DNP, APRN, WHNPBC, PNAP, FAAN, is a women’s health nurse practitioner. She serves as an Associate Professor and the DNP Program Director at Emory University’s Nell Hodgson School of Nursing. She is passionate about equitable, respectful, and inclusive maternal-child care.

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Pregnancy puts increased nutritional demands on your body. Prenatal vitamins help fi ll nutrient gaps because they typically contain higher doses of folic acid, iron, calcium, vitamin D, iodine, and omega-3 fatty acids. These nutrients play a crucial role in healthy fetal development and help prevent birth defects.

health4mom.org

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Finish Strong A whopping 80% of a full-term baby’s iron needs are accumulated during the mother’s third trimester of pregnancy, making adequate iron intake of most importance.

If you’re concerned you or your baby may be suffering from iron deficiency, talk with your health care provider before taking any iron supplement.

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These products are not intended to diagnose, treat, cure or prevent any disease.

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With the added advantage of six adjustable height settings, allows you to align the bassinet perfectly with your bed, granting easy access for feeding or soothing your baby, day or night.

Embrace the challenges and joys of raising a baby with the Papablic 4-in-1 Baby Bassinet by your side. Let it stand as a testament to the incredible voyage you and your baby are embarking upon – a journey characterized by growth, love, and cherished memories.

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healthy pregnancy

Postpartum depression t 1 in affects abou have ho w 8 women h. It is rt bi n ve gi recently ta trea ble. common and id to Don’t be afra . lp he r ask fo

Mom and Baby Essentials

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elcoming a new member into the family is an exciting and joyful experience. Having the necessary pregnancy and postpartum resources is essential. Here are nurse-approved and mom-favorite resources that can ease the transition into motherhood while also promoting health for you and your baby.

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La Leche League International When you need breastfeeding support, the La Leche League is there connecting mothers with other mothers for encouragement, information, and education. Their online communities and group meetings provide a welcoming environment where you can discuss breastfeeding, and challenges

By Danielle Beasley, PhD, RN, RNC-OB, CNE like establishing a good latch, managing milk supply, and balancing breastfeeding with other aspects of life.

Postpartum Depression Resources Postpartum depression (PPD) is a common condition that affects many new mothers. It’s important to seek support from a healthcare provider if you or someone you know is experiencing PPD. Here are some helpful resources: h Postpartum Support International: A global organization that provides support, education, and resources for individuals and families experiencing perinatal mood and anxiety disorders, including PPD. Resources include a helpline, online

support groups, and a directory of local support coordinators. h Online Communities and Forums: These groups can provide support and a platform for connecting with other individuals who have experienced or are currently experiencing PPD. h In-Person Local Support Groups and Services: Check with hospitals, clinics, community centers, and mental health organizations in your local area. These groups often provide a safe space for sharing experiences and receiving guidance. h Healthcare Providers: Reach out to your pregnancy or primary care provider. Use them as a resource for guidance, support, and referrals to mental health professionals who specialize in PPD.

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healthy pregnancy Belly Band A belly band is a garment worn around the abdomen and lower back during pregnancy. It’s made of soft and stretchy fabric. The band provides support, comfort, and stability to your growing belly and relieves some discomfort associated with pregnancy. It may help reduce back pain and pelvic pressure.

Some moms wear the band after pregnancy because it can support better posture and stability, especially during activities that involve standing or walking for extended periods.

Belly bands also offer relief and support during pregnancy but are not a substitute for medical advice or treatment. Pregnant women should consult with their healthcare

provider to determine if a belly band is suitable for their specific needs, and to address any concerns or complications related to their pregnancy and birth.

Nursing Support Pillows Nursing support pillows are beloved by moms and babies everywhere!

From the wraparound design and adjustable cushions, nursing pillows are designed to provide support and comfort to you and position your baby for a better latch during breastfeeding or bottle feeding.

Look for pillows made from soft, plush fabric with a filling that offers both firmness and flexibility to keep pressure off your tender stomach.

Pillows that come with removable, washable covers are easier to keep

clean and ready for your next nursing session. Additionally, consider using a nursing pillow against your incision when sneezing or coughing to provide abdominal support. You may also want a pillow that provides back and lumbar support, especially after cesarean surgery.

Baby Sound Machine Baby sound machines or white noise machines are devices designed to create soothing sounds and can help your baby relax or sleep. The consistent and calming background noise drowns out disturbances, helping baby relax, fall asleep, or stay asleep longer. Choose from white noise, nature sounds, lullabies, or heartbeat sounds that mimic the comfort of the womb.

A newborn grooming kit is a collection of essential items that can help you take care of your baby’s needs. These kits contain accessories designed specifically for infants.

Store away from baby’s reach to avoid the items becoming a choking hazard.

1. Soft-bristle brush to gently brush their hair 2. Comb to gently untangle any knots in baby’s hair 3. Nail clippers or file to trim baby’s nails safely. They often have rounded edges or guards to prevent accidental cuts 4. Nasal aspirator helps clear a baby’s nasal passages by gently suctioning out mucus or congestion 5. Digital thermometer measures baby’s body temperature. Rectal thermometers for newborns provide the most accurate readings 6. Grooming scissors have round tips for trimming hair or for other needs DANIELLE BEASLEY, PHD, RN, RNC-OB, CNE, is the BSN and MSN Faculty Program Director and Assistant Professor at Excelsior University.

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Newborn Skin, Hair, and Nails Kit

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Keep Baby at the Breast With the Neotech Bridge®

Breastfeeding Assistance Device Many moms face challenges with breastfeeding, including tongue-tie, difficulty with latch, and low milk production. The Bridge was developed by an International Board Certified Lactation Consultant to address these and other common issues.

Use the Bridge in place of a bottle to keep the baby at the breast as much as possible. Can be used to provide colostrum, expressed milk, or fortified human milk.

Continue bonding with your baby while stimulating natural milk production.

LEARN MORE AT neotechnewborn.com

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Advertisement Feature

One Size Breast Pump Will Not Fit All “Pumping while being able to move around and get ready for work in the mornings is such a time saver with my wearable Freemie!” — Barbara B.

Pumping breast milk for your baby shouldn’t be hard. There are more choices than ever before, and you don’t have to confine yourself to a bathroom like in the nineties. Right?

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he reality is that breastfeeding and pumping can be challenging to learn, and there are things no one tells you. For example, are you in the majority of women whose breasts do not fit well into the “one size fits all” flanges offered by most breast pump brands?

Where will you need to pump?

Will you need to pump around other people?

Will you have the necessary time and privacy to pump?

Will you need to be hands free and able to move around while you’re pumping?

As the first commercially successful wearable breast pump in the world, we at Freemie have learned a thing or two as we’ve introduced the tools and ideas that have been an important part of the global transformation of motherhood over the last decade. The most important thing we learned is that every woman faces different challenges and has different needs.

If the convenience of pumping while clothed is essential, then a wearable pump like Freemie may be the way to go. Once you decide on the type of pump you’ll need, try not to blow your budget all at once. Your needs can change over time. You may have to add accessories, switch to a different pump style, or change sizes to make your pump routine more comfortable or practical.

New moms who will pump need to know about their options and resources while also being aware that one size pump won’t necessarily fit every mom. When first getting started selecting a breast pump, new moms will want to consider some basic questions:

If you are prepared to pump whenever and wherever it is necessary, you are more likely to be successful. Being prepared for the unexpected can include simple things like keeping your Freemie Pump fully charged or having extra clean parts on hand.

“Freemie has been a life saver for me. Especially at work. It saves me from being stuck to a wall for numerous hours a day and I can work and walk around freely” — Koree C.

Part of being prepared is also knowing where to turn when you’re having trouble or feeling stressed about feeding your baby. Be sure to get to know what lactation resources are available to you either through your health insurance or through other public or private organizations. Experienced professionals can literally save your lactation journey when you run into obstacles.

Every woman’s body is different, and one size does not fit all. If pumping is painful, it shouldn’t be, and you should consult your healthcare professional. Often the problem is simply the wrong flange size. Freemie has more silicone insert sizes available than any other company so you can adjust the breast flange diameter and dial in an optimal fit.

Freemie Fitmie inserts work with our in-bra Collection Cups that hold 5, 6 or 8 ounces of milk per cup, with styles that range from concealable to ultra-discreet. Our versatile cups work with hospital-grade Freemie pumps, and other compatible Pumps.

Freemie for more style, comfort and fit for all!

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healthy pregnancy

How to Find the Right Breast Pump for You!

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

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reastfeeding is a healthy choice for you and your baby. Once you’ve set a breastfeeding routine, your thoughts may turn to those times when you aren’t able to nurse your baby. You’ll want a reliable breast pump when you return to work, travel, or need to be separated from baby for more than 2-3 hours. Expressing your milk with a pump will keep your breasts from becoming engorged and ensure baby is fed.

So, how do you choose among the wide variety of breast pumps?

First, forget the “one size fits all” approach. Recognize you may need different pumps based on how often you pump, how easy it is to use and

Manual vs. Powered Pumps If you plan to pump breast milk occasionally, a manual (hand) pump can be a good option. They’re portable and easy to clean. Use this pump with only one breast at a time; it can give you a quick 2-4 ounces of milk. We’ve heard moms say they keep one in their purse or diaper bag “just in case.” Some hospitals will provide a free manual pump before you leave to go home with your baby.

A battery-powered or electric pump supports more frequent pumping.

These pumps are usually lightweight, portable, and don’t require hand pumping. The difference is, they require more clean-up. Additionally, electric pumps may not have an adjustable suction or cycle length

like stronger hospital-grade pumps.

Choosing to pump your milk is timeconsuming. Track your time for how long it takes to express the ounces of milk you want; this can help you develop a consistent routine.

Electric and HospitalGrade Pumps If you’re returning to work or need to pump frequently and store milk, electric pumps are great. After hospital-grade pumps, these are the most durable and customizable.

You can find pumps that are able to draw milk from both breasts at the same time. They provide a fast way to express your milk through different cycle lengths and adjustable suctions, which provides maximum comfort. Most models have battery backup available and car adapters for pumping in your vehicle.

Electric pumps have carrying cases, breastmilk cooling and storage equipment, and mobile apps to

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clean, and how effectively it empties your breasts. Many moms have more than one pump for pumping at work, home, or on the go.

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healthy pregnancy

Hands-Free Portable Electric Pumps If you need to use your move around while pumping, then consider a hands-free portable pump. These pumps are small, discrete, and allow you to wear the pump as the milk collects in cups quietly inside your bra or shirt. Keep in mind that some portable pumps may not have the same strong and effective suction as electric pumps, but many moms find them to be useful secondary pumps.

Buyer (or Renter) Beware Most breast pumps are not designed to be used by multiple people as pumps can harbor bacteria or viruses.

Avoid purchasing a used pump and don’t share your breast pump—even

44

with someone you know. Hospitalgrade pumps are manufactured differently and designed to be used by more than one person at a time over the life of the pump.

h Easy to use and clean h Freezer tote for cool milk storage in a fridge h Transport bag h Minimal noise

Does Your Insurance Provide a Pump?

Dress for Pumping

The Affordable Care Act requires most health insurance plans to cover the cost of a breast pump, and some also provide breastfeeding support and counseling. Ask your insurer for the pumps specifically covered by your plan (including Medicaid or WIC).

Most plans provide the pump prior to baby’s birth, if requested.

Key Breast Pump Features These are the most common features of a breast pump: h Double electric that pumps both breasts at once h Memory from the last pump session h Hands-free and portable h Battery backup; plugs into a wall h Simulates the way a baby nurses at your breast

As you begin to fit into your prepregnancy clothes, prioritize nursingfriendly shirts, dresses, and outfits that don’t require undressing to use your pump.

Keep it Clean!

We recommend these steps to keep your pump(s) clean: h Rinse pieces that touch your milk directly after use h Wash pieces separately with dish soap h Replace cloudy or moldy tubes h Sterilize pump parts in boiling water or via steam in an enclosed bowl in the microwave regularly h Allow all parts to air dry JESSICA MCNEIL-SANTIEL, DNP, APRN, CNM, RNC-OB, C-EFM, is a certified nurse midwife and adjunct professor. Her career focus is on maternal-child health and she’s served in positions ranging from perinatal educator to women’s services manager.

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save your pump session data. If needed, rent a hospital-grade electric pump. Check with your hospital or a community lactation consultant for more details. When renting a pump, you’ll receive your own accessory kit to ensure no one else has used the pump parts that will come in contact with your breast or milk.

health4mom.org

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healthy pregnancy

Delight at your baby shower with a location, deco rations, and food that speak to your heart an d turn up the excite ment for your baby ’s arrival!

Ready to Rock Your Bump and be Showered?

A baby shower is one of the most celebrated occasions next to weddings. Everyone is excited to welcome a new life into the world.

Over time, these events have become more elaborate with larger-than-life decorations and more guests, as most showers are now co-ed. Here are 7 tips for hosting a fabulous baby shower.

Step 1: Make your guest list and set a budget. All of your family and friends are welcome to attend, right? Well, if you come from a large family or you have a huge friend circle, this may be overwhelming and expensive. If this is the case, trim your guest list by only inviting adults. Divide your budget into three parts: Venue, decorations, and food. Once you have the number of guests in mind, search for a venue that will accommodate your party.

Step 2: Choose your venue. If you are renting a facility, it is important to reserve well in advance to ensure you get your preferred date. Visit in person to get an idea of how you want the event to flow as well as how to decorate. Check to see that

46

the facilities are working properly and if there is adequate parking for your guests.

If you are entertaining at home, ask your guests to carpool to reduce traffic in your neighborhood. If entertaining outdoors, set up shaded areas and treat the grounds for bugs. Plan to have a tent or alternative location in case of inclement weather.

Step 3: Decide on a theme or color scheme. YouTube and Pinterest are great resources for inspiration.

Once you have a theme in mind, all purchases should correspond with the theme. Now the tone is set for what guests should expect; this may even help them with their gift selection.

Step 4: Select the menu. Now your venue is set and décor confirmed, it’s time to decide if you will cater or enlist family and friends to prepare dishes.

Select a variety of satisfying foods that showcase your theme, meet all your guests’ needs, and don’t break the bank.

Step 5: Delegate. You will need help planning a baby shower. The people

closest to you often love to assist and should be given specific tasks.

If you are making DIY decorations or assembling party favors, invite your helpers over for dessert while you all prepare. These mini parties are also lots of fun as you anticipate the big event.

Step 6: Make a gift registry. Your registry should be at your favorite store or a collection of stores online; be sure that gift cards are an option.

Your choices should range in price so that gifts are affordable for everyone.

Don’t be afraid to put more expensive items like cribs and furniture on your registry since some people will purchase group gifts.

Finally, please remember to send personalized handwritten thank you cards to each guest whether they bought a gift or not. Expressing appreciation over text or social media does not replace the simple gesture of a thank you card. Good manners are never outdated.

STEPH STORM is an event planner, interior decorator and digital artist.

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By Stephanie Storm

health4mom.org

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healthy pregnancy

Choosing Childcare

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

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any parents depend on childcare for their children as they navigate demanding careers with busy schedules.

Enrollment ranges from full-time to part-time, and even “drop-ins” for families with flexible schedules.

Be particular about requirements for the center that cares for your child as it becomes like a second home to them. They should feel safe and spend most of their time learning and developing. Here are 4 strategies to choose great childcare:

information on their mission, services, and background.

Many facilities provide reviews from previous or existing customers. Read all of these reviews carefully and seek out your own recommendations from family, friends, or neighbors who also have children in care.

Get specific when chatting with other parents you know. Before touring a center, make a list of important questions to ask, including a detailed description of the daily activities.

Childcare Near Home

Childcare Tour

Location, location, location. Choose a childcare facility near your home or work. It’s an added convenience in light of your commute, high-traffic areas, and school bus routes. Do a test drive of your commute to learn how much time you’ll need during different times throughout the day.

When choosing childcare, visit the actual facility in which your child will receive care. Consider this meeting their “interview.” Assess the cleanliness, energy, and temperament of the staff and children.

What does your gut say to you about their interactions? Does the reading collection resemble the types of books you read to your child? Is there a warm feeling with creative vibes for kids?

What type of separate learning spaces do they provide? How often are the play areas cleaned? Gather as much information as you can to influence

Ask Around and Read Childcare Reviews

your decision.

Ask if you can meet the actual team members who will be regularly caring for your child. Understand how many children there are and the ratio of children to teachers in your child’s class. Ask the director about safety measures, such as whether staff are trained in basic life support, first aid/CPR, and facility-wide emergency response.

What is the Childcare WOW Factor?

What does this childcare facility provide that goes above and beyond?

Cost, functional space, activities, positive team members or raving reviews, flexible operational hours, live virtual check-ins, lactation space?

Is it close to your home, job, or do you have friends who have children currently enrolled? Choose the place that best meets your family’s needs to find a facility where your child will thrive in their new environment.

LAKISA BALLARD, MSN, RN, C-EFM, RNC-OB, is a Labor and Delivery Clinical Nurse Educator at Holy Cross Hospital in Maryland. She has worked in many high-risk facilities around the country and has a passion for educating future nurses.

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Researching childcare online may be as easy as 1, 2, 3 as facilities pop up one by one in your search results. Some faith-based childcare sites provide

Listen to your gut whe n researching childcare. Yo u know what’s best fo r your child.

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It’s about time!

Sunzeez Baby Sunglasses!

The American Academy of Pediatrics States: Children are at special risk from the harmful effects of the sun since their eyes don’t have the ability to be protected from UV. Babies under 6 months of age should be kept out of direct sunlight.

Babies’ eye protection for the first 12 months

Sunzeez Sunglasses are Designed for Baby’s UV Protection UV rays are strongest between 10:00am and 4:00pm and can bounce back from sand, water, snow or concrete. Any form of exposure can reach the retina and cause damage to baby’s eyes. The highest standard in UV protection for sunglasses is UV 400nm, which blocks 99% to 100% of the sun’s UVA and UVB rays. Sunzeez meets these high standards.

Sunzeez Sunglasses are Designed for Baby’s Comfort Sunzeez featherweight shatter proof lenses are secured to the baby’s temples by memory touch natural rubber edge banding. Sunzeez are easy to use; simply unfurl over your baby’s eyes. Sunzeez can be ordered online.

Three Sunzeez for $24.95 at Sunzeez.net

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Does Your Toddler Need that Nutrition Boost?

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If you’ve been down the infant formula aisle recently, you may have noticed a new line of mixable drinks for infants and toddlers ages 6-36 months. But before you choose between tutti-frutti and vanilla flavor for your growing babe, the American Academy of Pediatrics is cautioning about the need for these new products.

“Products advertised as “follow-up formulas,” “weaning formulas,” or “toddler milks and formulas,” are misleadingly promoted as a necessary part of a healthy child’s diet, said lead author George J. Fuchs, III, MD, FAAP, a member of the Committee on Nutrition, which produced the clinical report. This is especially true for those products directed at young infants in a way that makes them seem equivalent to infant formula.”

“These drinks should not replace a balanced diet and are inferior to standard infant formula in children younger than 12 months of age and offer no benefit over much less expensive cow’s milk, or breast milk, in most children older than age 12 months,” he advised. Baby’s long-term brain development is dependent on getting the right nutrients during the first years of life. Jot down your questions about these ‘drinks’ and discuss with your pediatric care provider at your baby’s next well-child visit.

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8 Actionable Infant Warning Signs Newborns, or babies who are ages 1-28 days old, are constantly adapting to life outside the womb. They’re breathing on their own and learning to nurse at their mother’s breast or bottle feed, and sometimes it’s hard for parents to discern when baby may need extra support to keep them growing day by day.

Use these eight signs from the World Health Organization to assess how your newborn is adapting to life outside of the womb. Call or visit your pediatrician immediately if you observe your newborn doing any of the following: 1. Stops nursing or taking in any nutrition, such as infant formula 2. Starts having convulsions 3. Belly sucks or sinks into their chest 4. Begins breathing fast (two counts of 60 breaths or more in one minute) 5. Has a high temperature of 99.5F or more, or a low temp less than 95.7F 6. Has a yellowish color around their eyes or on their skin 7. Moves only a little or not at all, moves only when stimulated 8. Shows any signs of infection, such as redness around the umbilical cord, open sores, or eyes draining a pus-like fluid You are your baby’s first advocate. If you feel your concerns are dismissed, follow up with a second pediatric care provider until your concerns about your baby are taken seriously. Stand firm in your position as the expert on your baby’s needs.

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Baby + Brand = Choosing the Right Infant Formula?

By Shawana S. Moore, DNP, APRN, WHNP-BC, PNAP, FAAN

Wash your ha nds before prepar ing formul a. Teac h those who will care for your baby how to prepare their formul a correctly.

Consider Your Baby’s Needs Consider your baby’s needs regarding allergies or dietary restrictions. If your child can’t consume cow’s milk, you may need a soy-based formula.

Or, if your baby is lactose intolerant or has a protein allergy, specialized formulas are available without these ingredients.

Age and Stage As your baby grows, their nutritional needs will change. Generally, newborn formula is designed for babies aged six months or younger. It’s essential that you read the labels to understand the differences between the three

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developmental stages: newborn, infant, and toddler formulas.

Check the Ingredients and Expiration Date Read the ingredient list and check the expiration date. Formula should contain essential nutrients like fats, carbohydrates, proteins, vitamins, and minerals.

Consider the Price Formula costs vary widely. What is your budget and how often will you buy this formula? Keep in mind that many name-brand formula companies sell store-brand formulas in retail stores. Consider what brand will work best for your baby and your budget.

Proper Formula Preparation Wash your hands and all feeding parts with soap and water before preparing your baby’s formula. Follow the instructions. Some formulas require boiling water, others are pre-mixed.

Teach those who will care for your baby how to prepare their formula

correctly, and to hold the baby in an upright position when feeding by bottle.

When in Doubt Ask Baby’s Pediatrician Your baby’s pediatric care provider is a great source of information when it comes to choosing baby formula. Ask questions that help you navigate the many different options and discuss any other concerns that you have.

Baby’s provider can also recommend special formula brands if your baby has dietary restrictions. At each wellbaby visit, share with your baby’s healthcare provider how they are adapting to their formula as they grow.

Ensure the formula you choose is made for your baby’s age and development stage; when in doubt, ask your baby’s pediatric care provider for their recommendation.

SHAWANA S. MOORE, DNP, APRN, WHNPBC, PNAP, FAAN, is a women’s health nurse practitioner. She serves as an Associate Professor and the DNP Program Director at Emory University’s Nell Hodgson School of Nursing. She is passionate about equitable, respectful, and inclusive maternal-child care.

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hoosing the right baby formula can be a daunting task for new parents. There are so many different types on the market, each with benefits and drawbacks.

Selecting the right formula can ensure your baby receives proper nutrition for healthy growth and development.

So, how can a parent make the best choice for their child?

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healthy babies

The When, What, Why, and How of

Introducing Foods to Your Baby!

By Danielle Rush, BSN, RN

M

amas, you’ve hit a new milestone… time to start feeding solids to your little one. Introducing your baby to whole foods can be exciting and overwhelming.

Babies eat s small amount te bi y er and ev should count!

When to Introduce Foods?

Most babies start showing signs of interest in food around five to six months. Use this short safety checklist to reduce your anxiety and consider if your baby is ready to start solids: h Sits up independently h Holds up their own head and neck h Swallows food instead of spitting it out h Grasps objects h Opens mouth when others are eating Babies can typically do most of these things by six months of age. If you think your baby is ready sooner, talk with your pediatric care provider.

How to Introduce the First Foods?

Most pediatricians recommend first foods that are high in iron and rich in nutrients. Introducing solid foods is recommended just as baby has used up their iron stores for growth and development around four to six months. It’s then vital that baby gets enough dietary iron to support their fast-paced growth. Breastfed babies are at a higher risk for iron deficiency anemia because breastmilk is low in iron.

The AAP guidelines for best first food experiments: h Expose baby to a variety of tastes and textures h Be prepared, baby may cough, gag, or spit up h Try foods one at a time h Wait three to five days between new foods to see if there is any negative reaction h Introduce foods multiple times h Select initial offerings that can lead to healthy food choices in the future h Make your own baby food designed to baby’s liking

High-Iron First Foods

What About Allergens?

Iron-fortified rice or oatmeal cereal fed by spoon to baby are common first foods. Here are other great high-iron first foods to consider: h Lamb, beef, or goat

Food allergies are on the rise.

Studies have shown that introducing traditionally allergenic foods early and often may decrease the chance of developing allergic reactions. Common

What are the Best First Foods and Why?

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h Chicken and pork h Egg yolks h Beans and lentils h Green veggies like broccoli and string beans

allergens include cow’s milk, eggs, fish, shellfish, tree nuts, peanuts, wheat, soy, and sesame. Drinking cow’s milk is not recommended before 12 months of age, but other products, such as yogurt and cheese, can be started earlier.

Baby Feeding Methods The two most common baby-feeding techniques are: h Pureed baby food that is smooth and soft; feed baby with a spoon to keep track of the amount eaten h Baby-led weaning allows baby to feed themselves. Finger foods are large and soft enough to be grasped, and easily mashed in the mouth.

There’s no wrong way to start feeding your baby. Every baby, parent, and family situation is different.

Since babies eat small amounts, every bite should count! Optimal nutrition is essential for growth and development. Introducing your baby to the wonderful world of food should be fun, intuitive, and, of course, messy!

DANIELLE RUSH, BSN, RN, is a labor and delivery nurse at Northwell Health Phelps Hospital in Sleepy Hollow, NY.

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The Ultimate Hospital Bag Checklist P

Essentials for Your New Arrival

By Shawana S. Moore, DNP, APRN, WHNP-BC, PNAP, FAAN

reparing for your baby’s arrival is an exciting and joyful time.

Pack baby’s hospital bag with the most important must-have items to stay organized and have a smooth transition.

Clothing Choosing baby clothes will pull on your heartstrings but keep it practical.

Baby only needs one outfit per day that includes onesies, cozy socks, and newborn caps to keep them warm.

Baby is likely to be skin-to-skin or swaddled for hours, so they don’t need many layers of clothing until the trip home.

Toiletries

Drinks and Snacks

Wait to bathe and wash your baby’s hair for about 8-24 hours after birth.

Bring along grooming items made specifically for infants: shampoo, body wash, mild moisturizer, nail file, and soft-bristle brush.

It’s good to bring drinks and snacks with you. Non-perishables like crackers and granola bars are great. Fruits like bananas and apples give you a quick fill.

In addition to your water bottle, bring a flavorful, non-alcoholic drink.

Decrease stress by packing a hospital bag with baby essentials about 4 weeks before the big day. Enjoy every precious moment with your bundle of joy.

Nursing Essentials Your favorite nursing supplies can make your hospital experience more comfortable. Pack nursing bras and pads, cream for nipple care, and a water bottle to stay hydrated during birth and feeding sessions.

Paperwork

Add in a lightweight, breathable swaddling blanket to use as a breastfeeding cover or wrap around baby if they’re having their first photoshoot in your hospital room.

A personal ID and your insurance information are needed when you go to the hospital in labor. Ask for copies of any hospital or baby identification documents that you sign before you go home. Bring a folder to keep all these important papers together.

Diapers and Wipes

Electronics

Many hospitals provide newborn-size disposable diapers and wipes upon baby’s arrival. If your family is using cloth diapers, bring enough for about 8 changes per day. Add these items to your baby registry to ensure your supply is full when you first arrive home after baby is born.

Your partner may get a few short moments to indulge while you’re nursing baby or taking a short nap. An e-book, tablet, or phone, loaded with movies or shows makes for a quick, short escape. Remember to bring the charger so you’re ready to capture lots of family memories with your newborn!

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Swaddling Blankets

SHAWANA S. MOORE, DNP, APRN, WHNPBC, PNAP, FAAN, is a women’s health nurse practitioner. She serves as an Associate Professor and the DNP Program Director at Emory University’s Nell Hodgson School of Nursing. She is passionate about equitable, respectful, and inclusive maternal-child care.

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healthy babies

Nursery Décor Decorating Means Oh So Much More!

By Stephanie Storm

Give your ba by ’s nurser y plen ty of personalit y ke eping safety and se renity top of mind.

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here are endless adorable items to fulfill your vision for your baby’s nursery. We’re sharing some practical furniture pieces and accessories that should be kept in mind when decorating. Beauty, comfort, and safety—you and your new baby can really have it all!

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Choosing a Crib Your baby’s crib is the primary furniture piece in the nursery. It needs to be sturdy and contain easily adjustable levers. A mini crib or bassinet may be perfect for small spaces. If your baby is growing fast, it’s likely best to purchase a fullsize crib that can later be converted into a toddler bed. Although this option is more expensive and takes up more space in the nursery, it is a worthwhile investment for your baby’s developmental needs.

Crib Safety Measures Crib sheets should not be fluff y. They should be tight-fitting around the mattress. Similarly, baby should be

put on their back to sleep and plush toys should not be left in the crib.

Otherwise, the risk of suffocation is increased. Hang the crib mobile a safe distance above baby’s reach and secure it tightly. Any artwork or picture frames hanging above or near the crib should not be within reach of the baby and the crib should not be located near a window. If you opt for a second-hand crib, check for any recalls and ensure the bed is not more than 10 years old.

A Chair for Parents Near the Crib Countless hours will be spent feeding your baby, rocking them to sleep, reading bedtime stories, and singing lullabies. A parent’s chair is the second-most important piece of furniture in the nursery. It should be well cushioned, and comfortable with back support and armrests.

Rocking or gliding chairs are excellent options. This chair delivers peace of mind when you need to stay in the baby’s room if they are restless, sick, or uncomfortable.

Practical and Functional Items It may be tempting to bring in lots of toys and decorative items but remember to leave room for a changing table, baby monitor, air purifier, and a play gym for tummy time. Bright lighting is great for playtime and when you are changing and dressing your baby. Use a night light in a baby-proofed outlet for coming and going from baby’s room without disturbing them. Stock up on electrical socket covers for other rooms of your home as your baby becomes more mobile.

Colors Choosing colors and themes you like is so much fun! Understand that some colors can be restful and others stimulating. If you have another room in your home to designate as a playroom, reserve the bright and bold colors for that area. Nursery colors should be peaceful.

STEPH STORM is an event planner, interior decorator, and digital artist.

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It’s Playtime!

Your Children Benefit from Creative Play

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By LaShea Haynes, M.Ed, MSN, APRN, AGCNS-BC, RNC, C-EFM

our toddler has a whole new world to explore, what better way to stimulate their curiosity and imagination than to use creative play? Try this every day: Set aside time for your child to draw (arts and crafts), play make-believe, sing, dance, and/or build blocks of some kind.

What is Creative Play?

Creative play contributes to your child’s physical and mental health development and improves their creativity and social skills. You can also use this time to teach your child group behaviors like sharing, being patient, and getting along with others.

An amazing benefit of creative play is that it builds your child’s confidence through practicing communicating their thoughts and ideas.

Creative Play Benefits

Make Time for Creative Play h Create opportunities for your child to have creative play. Start by simply taking them outdoors to learn about nature, animals, trees, flowers, and much more! h Focus on creative play and decrease the use of electronic devices, tablets, computers, and TVs. One idea is to set a time each day when all electronic devices in your home are quiet so that your child can spend time discovering their creativity. h Schedule a play date for your child and other kids their age who live nearby or attend their school.

Creative pl ay builds yo ur child’s confide nce as they learn to communicat e their though ts and ideas.

Watching your child play will help you see how comfortable they’re becoming with sharing, expressing their feelings to others, and using all their social skills.

Here’s a list of household items to use as you build your child’s creative toolbox: h sponges h paper towel rolls h cardboard boxes h tape h washable paint and markers h crayons These commonly used items allow your child to let their mind wander and enhance fine motor skills and hand-eye coordination.

Let your hair down, relax, and enjoy your child’s “play time”! Your mini-me is on their way to developing into a bright and innovative person with a big personality!

LASHEA HAYNES M.ED, MSN, APRN, AGCNSBC, RNC, C-EFM, is the Editor of Healthy Mom&Baby magazine. Her nursing career spans 25 years. She is the founder and owner of her own nurse mentoring and education company.

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Studies have shown that creative play improves intelligence, learning, and memory. The research results have also shown a significant relationship between play and divergent thinking.

Divergent thinking produces creative

ideas by allowing the brain to explore multiple possible solutions to all the scenarios your child may imagine.

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Promoting Healthy Milk Supply From The Start

Newborn bath time made simple.

Having that unfulfilled sensation when pumping? Baby fussing unhappily during feedings? Here’s a comforting thought: Moms are created to naturally feed their offspring and keep them satisfied.

Mom’s diet plays a huge role in milk supply. Certain herbs (mint, sage) weaken supply.

Other foods are known to boost supply (avocado, brown rice).

With all that, who’s not looking for a quick snack to boost energy and supply… Mommy’s Cookie Jar cookies don’t merely taste great but contain the finest quality of key ingredients known to augment Mom’s milk supply. These include brewer’s yeast, flaxseed and oats.

The New Mom Starter Kit comes with a variety of flavors, such as White Chip Cranberry and Mocha Chip, in convenient packs of two to grab and go.

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In the first few weeks of an infant’s life, it’s critical the umbilical cord stump is protected from moisture until the stump naturally falls off.

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THE IMPORTANCE OF SOUND

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FRESH FEAST

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You go from unboxing to sizzling skillet to dinner table in about 30 minutes or less. www.meezmeals.com

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healthy babies

Introducing Finger Foods

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ating finger foods is another milestone in your toddler’s diet. First, you learned to nurse your baby or how to feed the best formula, then you introduced baby food, and now the time has come for finger foods.

Your baby may be around 9 months or so and begin looking at your plate like they’re waiting for you to share some food. This is normal as your toddler’s growing body requires more calories and in turn, they will demand more options to eat.

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

Creativity is the key to introd ucing finger foods to your toddler a joy you’ll treasu re!

Beginning Finger Foods Does baby need teeth to begin with finger foods? Not necessarily. Teeth help break down food to make swallowing safer and easier. Start with soft finger foods. Your toddler will point at and grab food with two fingers or their whole hand. This is one of the signs that it’s time to introduce finger foods. Introduce these foods in small portions and let your toddler decide on the amount based on their hunger.

Pleasing a Picky Eater

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Will your toddler be picky during this stage? More than likely yes! The good news is that there are many options to choose from.

Stay open to foods that you may have never tried but that will add nutrition to your child’s diet. As toddlers feed themselves finger foods, they’re introduced to new foods and start to get a sense of independence. This is an opportunity for creativity while making fun foods for your toddler.

Best First Finger Foods for Baby What foods could you start with?

Steamed sweet potatoes are soft,

easy to chew and digest, and easily picked up by small fingers and hands.

This potato can also be baked, sliced, and served directly on a plate. Sweet potatoes contain both complex carbohydrates and fiber. Other good finger foods are roasted zucchini, squash, avocado, watermelon, scrambled eggs, and rice.

When introducing finger foods that are fruits and vegetables, cut them into small uneven chunks for increased safety while eating—avoid round or smooth shapes that can increase choking risks. Pay attention to whether your toddler likes or dislikes certain foods, and how much they typically want to eat. For

example, start with a banana and smash it on the plate to create small bites, then progress to cutting it into chunks and larger pieces as your child’s ability to feed themself grows.

Your toddler is growing fast and so is their appetite. This road to independence will be a trial of foods that your child does or doesn’t like.

The encouraging news is your toddler will find foods that they prefer during this stage as you provide a variety of choices. Happy eating!

LAKISA BALLARD, MSN, RN, C-EFM, RNC-OB, is a Labor and Delivery Clinical Nurse Educator at Holy Cross Hospital in Maryland. She has worked in many high-risk facilities around the country and has a passion for educating future nurses.

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ou successfully conquered a highrisk pregnancy with multiples, now what? Parenting one child can be scary and overwhelming. How do you care for two (or more) at the same time?!

When your family doubles within the blink of an eye, your life is more complex than just multiplying what you do for one child. Being the parent of multiples is a unique, rewarding, and yes, exhausting experience. Here are some things to consider as you begin your journey. h Know there are thousands of ways to raise multiples! As with any parenting advice, take it all in and make your own. h Treat your babies as individuals…

Have fun with matching clothes, keeping in mind that each child has a distinct personality. Avoid referring to them as “the twins” or “the triplets;” use their given names. You set the example for others to follow. h Be mindful of your purchases. Teach your children how to share to avoid buying unnecessary items. Add separate and safe sleeping spaces to

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your registry. Rotate which baby will enjoy a toy during playtime. Seek out infant carriers and strollers that are designed for multiples. h Build a special one-to-one relationship with each child. Schedule dedicated time to read a book of your child’s choice or to talk about their favorite topic. This allows each of your children to focus on you as much as you focus on each child. h Take photographs of each child separately. Often, children will ask for a picture of themselves. If your littles are identical, create a system to label their photos. When taken together, one standard could be the oldest is on the right and the youngest is on the left. h Foster privacy. Privacy is especially important if your children share a room. Organize an individual space and offer them some alone time. Give each child their own shelf, drawer, or assigned corner to develop a sense of ownership. Model with them how to share when an item belongs to them. h Focus on their differences rather than their similarities. Your children

Learning the Individuality of Multiples

By Jennifer Peterman, BSN, RN, IBCLC are unique people who deserve to be treated as such. If one or more enjoy sports and the other(s) enjoy music, respect their differences and nurture their preferences.

Praise each one individually. Avoid competition or comparisons. h Allow each child to make choices.

When your family is together and when your children are apart, ask their choice of bedtime story (different nights) or breakfast (different mornings). Do not insist that the vote be unanimous each time.

Parenting multiples is a unique, joyful, and challenging experience. There are community and state resources like clubs, support groups, and books that offer guidance. As you enter the wonderful world of parenting multiples, surround yourself with information and a network that will support you on a continuous basis.

JENNIFER PETERMAN, BSN, RN, IBCLC, is a clinical practice leader on postpartum and well baby hospital units. She is also an international board certified lactation consultant.

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One Baby, Two Baby, Three Baby, Four!

A s a parent of multiples, find joy in learning ab out their individual pe rsonalities and celebrat ing their differences.

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So you can stay comfy, baby.

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