Healthy Mom&Baby: Issue 28 by Healthy Mom&Baby

ISSUE 28 / 2020 | $3.95 | health4mom.org

PREGNANCY | BIRTH | PARENTING

GIVING BIRTH DURING COVID-19 Be Prepared

WHEN PREGNANCY IS COMPLICATED What to Expect

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RESPECTFUL CARE

Every Woman Deserves

Health4mom.org POWERED BY THE NURSES OF

POSTPARTUM MOOD DISORDERS

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Issue 28 / 2020

Contents ◆ healthy moms

◆ healthy pregnancy

11 Healthy Eating

31 1st Trimester

What’s the real story on healthy nutrition for pregnancy and breastfeeding?

13 Breastfeeding Success You’ve decided to breastfeed your newborn—a rewarding and challenging experience awaits!

15 Dad and Baby Bonding Dad’s involvement in childbirth and caring for the new baby beneﬁts everyone.

16 Post-Birth Warning Signs Learn these post-birth warning signs.

19 Postpartum Mood Disorders Postpartum mood disorders can occur among women with a healthy pregnancy and birth.

21 Respectful Care Every Woman Deserves It’s your body. It’s your baby. It’s your birth.

24 Caring for Your Perineum You may be surprised about the physical aspects of recovery from a vaginal birth. Here’s what to expect.

27 Postpartum Recovery You may be sore from your birth experience. So now what?

Healthy Eating in Pregnancy

From pregnancy tests to morning sickness, here’s how it all begins.

33 2nd Trimester Welcome to your second trimester—soon you’ll be halfway to term!

34 3rd Trimester The changes to expect as you get closer to giving birth.

◆ healthy babies 53 Your Baby’s Need for Nourishment and Comfort Make the most of your baby’s ﬁrst few months by learning to understand their needs and cues.

37 Understanding Fetal Heart Rate Monitoring Here’s why your care provider regularly checks your baby’s heart rate.

55 Awakening Your Baby’s Senses

39 Emotional Health

Playing with your baby—or infant stimulation—includes activities that arouse or stimulate your baby’s sense of sight, sound, touch, taste and smell.

Tips on how to look after your emotional health during the COVID-19 pandemic.

41 Birth During a Pandemic Giving birth during the COVID-19 pandemic.

57 Safe Sleep Tips for Baby Recommendations to keep your baby safe whenever and wherever.

44 High Blood Pressure Hypertension can pose problems during pregnancy.

60 Navigating Vaccine Decisions Vaccines can help protect you and your family from dangerous diseases during your pregnancy as well as through your child’s frst years of life and beyond.

46 Tobacco During Pregnancy Quitting is one of the most important things you can do to improve your baby’s health.

48 Pregnancy Complications

65 Caring for Baby’s Skin Keeping baby’s skin healthy is a daily job.

What you need to know.

1st Trimester

41 48

Pregnancy Complications

Navigating Vaccine Decisions

60 57

Safe Sleep Tips for Baby

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HEALTHY MOM&BABY EDITORIAL ADVISORY BOARD DANIELLE BEASLEY, PhD, RNC-OB University of South Florida Tampa, FL ROBERTA DURHAM, RN, PhD California State University East Bay Hayward, CA

AWHONN’s mission is to improve and promote the health of women and babies. Healthy Mom&Baby is powered by the nurses of AWHONN.

BY REBECCA CYPHER, MSN, PNNP

Nurses Are at Your Side

JOANNE GOLDBORT, PhD, RN Michigan State University East Lansing, MI HELEN M. HURST, DNP, RNC-OB, APRN-CNM University of Louisiana School of Nursing Lafayette, LA ELIZABETH JORDAN, DNSc, RNC FAAN University of South Florida College of Nursing Tampa, FL SHARON C. HITCHCOCK, DNP, RN-C University of Arizona Tucson, Arizona JENNIFER LEMOINE, DNP, APRN, NNP-BC University of Louisiana at Lafayette Lafayette, LA PARIS MALOOF-BURY, MSN, CNM, RNC-OB, IBCLC Sutter Health Sacramento, CA RACHEL NAPOLI, DNP, CNS, RNC-OB, IBCLC Sonoma State University Rohnert Park, CA RITA NUTT, DNP, RN Salisbury University Salisbury, MD SUSAN A. ANGELICOLA, MSN, APN Summit Medical Group Cedar Knolls, NJ MICHELE K. SAVIN, DNP, APRN, NNP-BC Thomas Jeﬀerson University Philadelphia, PA JAMIE M. VINCENT, MSN, RNC-OB, C-EFM John Muir Medical Center Walnut Creek, CA HEATHER WATSON, PhD, MSN, BSRN Johns Hopkins University Baltimore, MD

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LASHEA WATTIE HAYNES M.ED, MSN, AGCNS-BC, APRN, RNC-OB/EFM Wellstar Health System Atlanta, GA KIMBERLY WILSCHEK, RN, CCE Medical Revenue Solutions Chicago, IL CHARLOTTE WOOL, PhD, RN, CCNS York College of Pennsylvania York, PA

The World Health Organization declared 2020 to be the International Year of the Nurse and Midwife. Nurses across the globe play essential roles to keep people healthy, prevent disease, and involve entire communities to improve their health and wellbeing. In the United States, nurses are the largest group of maternity care professionals that help women during pregnancy, labor, birth and care for their newborns after delivery. Some women receive care from midwives and nurse practitioners, but all women have nurses that will provide the highest levels of care as well as oﬀer ongoing support and encouragement. During your pregnancy, nurses will be with you every step of the way, from the start of prenatal care through labor, birth, and postpartum. Nurses will be at your side, helping to care for your baby and will continue to guide you through your baby’s ﬁrst pediatric visits. Health care doesn’t happen without nurses.

A Holistic Approach

Nurses bring a holistic approach to your care. We know that your physical and mental health is inﬂuenced by the food you eat, your physical activity and the social support you get from family and friends. The work you do, your personal responsibilities and the community you live in all play a role in the wellbeing of you and your baby. Getting to know you as an individual lets

us understand what’s important to you during pregnancy, labor and postpartum, so that we can give you personalized attention and advice. We’ll do the same for your baby as they deserve the same level of individualized care.

Supporting Your Decisions

Nurses are committed to giving you the information you need and want to guide you through the many decisions ahead that you will be making in the future. Whether you’re contemplating genetic screening tests, quitting smoking or where your baby should sleep we want you to conﬁdently make decisions based on the latest guidelines and research so you can decide what’s right for you and your baby. Nurses, nurse practitioners and midwives plan and write the articles in Healthy Mom & Baby. We include the evidence for recommendations and the alternatives to consider. We work with pregnant individuals and their personal support team every day, so whether we’re talking to you in person or through the pages of Healthy Mom & Baby, our goal is to give you the information you can use to make choices or as part of the shared decision-making process that you use with your healthcare provider. Find us anytime at Health4mom.org. Nurses are here to support you and your baby so you can make the most of pregnancy, birth and your little one’s ﬁrst year.

REBECCA CYPHER, MSN, PNNP is the AWHONN 2020 President.

ISSUE 28 / 2020 Healthy Mom&Baby

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IT’S NEVER TOO EARLY to start growing your little reader—

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The Care You Deserve BY CATHERINE RUHL, DNP, CNM

AWHONN AWHONN 2020 President

Rebecca Cypher, MSN, PNNP Interim Chief Executive Oﬃ cer

Kathleen A. Hale, MS, RN, NE-BC Vice President, Strategic Partnerships, Communications & Meetings

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

Carolyn Davis Cockey, MLS, LCCE Director of Patient Education

Catherine Ruhl, DNP, CNM MAITLAND WARNE Group CEO & Publisher

Kevin Harrington Editorial

Elika Roohi Hillary Nguyen-Don Jess Smith Design

Jason Craig Production Director

Jo Harrington

Pregnancy, labor, birth and the months afterwards have always been times of intense change for women and their families. Living through these major life events in the middle of the COVID-19 pandemic means facing unexpected challenges and ﬁguring out how to make the best of a completely new set of circumstances. But pandemic, or not, making decisions based on your values, preferences and evidence is always key. Healthy Mom&Baby is your guide to pregnancy, birth and the early weeks and months settling in with your baby. This issue includes important information to guide you during the pandemic. Find out what to ask your birth setting about their policies in response to COVID-19 on page 41. Your emotional health is just as important as your physical health, now more than ever. Tips for looking after your emotional health during COVID-19 are on page 39. When you get health care, whether during pregnancy or any other time, there are basics you should expect. You should feel: • safe, both in the place of care and with the professionals giving you care. • acknowledged as an individual, not just as a “patient”. • respected, no matter what your lifestyle, beliefs or choices. • at the center of your healthcare team. After all, the nurses, midwives, physicians and other professionals are there to support you. This is your pregnancy, labor, birth and baby, not theirs. Read more about respectful care on page 21.

Production

Adam Linard-Stevens Severine Eidem

Healthy Mom&Baby is published by Maitland Warne in partnership with AWHONN. © AWHONN, 2020. All rights reserved. All material in Healthy Mom&Baby is wholly copyright. Reproduction without the written permission of the publisher 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.

PUBLISHER

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

Part of respectful care is supporting you with fact-based information to make decisions that are right for you and your family. In these pages you’ll find the basics on each trimester of pregnancy (pp. 31-34), tips on quitting smoking (p. 46), what to expect if you have high blood pressure (p. 44) or other complications (p. 48), and a step-by-step guide to safe and restful sleep for you and baby (p. 57). Read about common mood disorders in pregnancy and after birth (p. 19). If you’re not feeling like yourself, it’s important to get help. Don’t miss suggestions for comfort care for you after birth (p. 27) and for baby (p. 53). Dads need encouragement and suggestions for how they can be helpful—we’ve got ideas on page 15. Whether you’re a first-time parent or adding to your family, each new baby brings new joys and new challenges. Give yourself time to get to know your baby, yourself and your partner as you all adjust to new roles. Know that Healthy Mom&Baby’s evidence-based information written by the nurses of AWHONN is always at your fingertips and just a click away on Health4mom.org. Stay strong,

Cathy Catherine Ruhl, DNP, CNM

Editor, Healthy Mom&Baby

AWHONN Catherine Ruhl, DNP, CNM cruhl@awhonn.org 1716 Anderson Pl, SE | Albuquerque, NM 87108 Tel: (202) 255-1172 | www.AWHONN.org

ISSUE 28 / 2020 Healthy Mom&Baby

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Pregnancy and breastfeeding decrease risk of early menopause

healthy

Moms

Exclusive breastfeeding for 7 to 12 months reduced a woman’s chance of having menopause before age 45 by 28% compared to women who breastfed for less than a month, say researchers at the University of Massachusetts, who studied more than 100,000. Pregnancy also decreased the risk of early menopause by 8% for one full term pregnancy, 16% for two and 22% for three. Early menopause has been shown in studies to increase the risk of early death, cognitive decline, osteoporosis and heart disease.

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Breast cancer risk increased with use of hair dyes and straighteners Ever wonder about the risks of using permanent hair dyes or straighteners? A new study from the National Institutes of Health of over 45,000 women found that women who used hair dye in the year before entering the study were 9% more likely to develop breast cancer than women who didn’t use dye. African American women who used hair dye as often as every ﬁ ve to eight weeks had a 60% increased risk; white women had an 8% increased risk with the same frequency of hair dye use. No increased risks were found for semipermanent or temporary hair dye. Women of both races who used chemical straighteners every ﬁ ve to eight weeks were about 30% more likely to develop breast cancer. Prior studies had not found a possible link between breast cancer and straighteners, so more research is needed.

No link found between talcum powder and ovarian cancer Women who use talcum powder in the genital area didn’t have an increased risk of ovarian cancer compared to women who don’t use powder in an analysis of data from four ongoing studies of women’s health practices and outcomes. More than one third of women reported using powder in the genital area, with 10% reporting use for at least 20 years and 22% reporting use at least once weekly. The data from over a quarter million women was analyzed but researchers say still more data is needed to decide this question because ovarian cancer is relatively rare.

ISSUE 28 / 2020 Healthy Mom&Baby

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Discover the power of Prebiotin Prebiotic Fiber before, during and after birth for a stronger immune system.

Prebiotics benefit you and your baby too… Prebiotics aren’t just for parents. A full-spectrum prebiotic can fertilize the good bacteria you pass on to your baby during the birth process. A healthy gut microbiome creates harmony between your probiotic bacteria (live organisms) and the prebiotic bacteria (soluble fiber) that feed them in your colon. Eating nutritious food such as fruits and vegetables, whole grains, lean protein and plain Greek yogurt may help you avoid digestive stress, strengthen your immune system and increase calcium absorption, for both a healthier mom and baby. Breast milk serves as a prebiotic. It contains human milk oligosaccharides or HMOs that can’t be digested in the small intestine. HMOs are the third most abundant ingredient in breast milk after fat and carbohydrates. The HMOs travel intact to the colon, where they stimulate the growth of healthy bacteria that support a baby’s immune system. Since the gut is where 80% of the immune system exists, a baby with a healthy amount of bifidobacteria can have a great start on good health for life!

Don’t Worry if You Can’t Breastfeed or Had a C-section… If you are not able or choose not to breastfeed, or had a C-section, you can still make sure your child has a good balance of microbiome bacteria. Numerous research studies find that children who receive chicory root based inulin and oligofructose (the ingredients in Prebiotin) as a supplement show improvements in growth of healthy bacteria such as bifidocolonies in the gut. With your doctor’s support, an easy solution may be the addition of oligofructose-enriched inulin (Prebiotin Prebiotic Fiber) to your baby’s formula.

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As your child grows, supplementing a healthy diet with Prebiotin may start them on a path to a balanced gut microbiome (the collection of microorganisms living in the gut). These lifelong benefits may include: An improved immune system Improved bowel regularity and decreased constipation Increased calcium absorption for strong bones Better appetite control and less obesity Help with heart and brain health

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24/04/2020 15:37

healthy moms

Healthy Eating in Pregnancy and Beyond You may have heard that “eating for two” is a myth. So what’s the real story on healthy nutrition for pregnancy and breastfeeding? By Susan Angelicola, MSN, APN

ood nutrition promotes a healthy pregnancy and can establish a lifetime of good health for baby. Here’s the latest advice on how to prepare nutritionally for pregnancy, what to eat and to avoid during pregnancy, and how much weight you should aim to gain.

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Before pregnancy

Before you’re pregnant is the ideal time to think about nutrition. Healthy eating habits you start before pregnancy will be hardwired once you’re pregnant. Decide if you can make healthy changes—such as eating more fruits and vegetables. Discuss if your weight is ideal with your nurse or health care provider. If you’re overweight, you’re at increased risk for complications of pregnancy such as gestational diabetes or high blood pressure.

Folic acid

Begin taking a folic acid supplement at least 3 months before pregnancy. Folic acid is a form of the B vitamin folate and can reduce the risk of

birth defects such as spina biﬁda when taken before and during pregnancy. Prenatal vitamins always contain folic acid.

During pregnancy

Even though eating for two is a myth, you do need to increase your calories—but only in the second and third trimesters when it’s recommended to eat an extra 300-400 calories per day. This is easy! Try healthy snacks in between meals, such as fruits, nuts or nut butters or a hard-boiled egg.

Foods to limit or avoid

Some foods should be avoided in pregnancy such as mercurycontaining fish (shark, swordfish, mackerel and tile fish). Your nurse may also recommend that you avoid lunchmeats or soft cheeses to prevent exposure to the Listeria bacteria. Limit caffeine to 2 servings per day. As for alcohol, evidence shows that during pregnancy there is no safe type or amount or a time during pregnancy when your baby won’t potentially be affected if you drink.

During breastfeeding

Congratulations on the decision to breastfeed your new little one! In order to maintain a normal healthy milk supply, you need about 500 extra calories daily—more than during pregnancy! Breastfeeding will dehydrate you, so drink water each time you nurse your baby or use your breast pump. Continue to avoid ﬁsh that contain mercury because they can aﬀect development of baby’s brain. Check with your nurse about whether to continue taking prenatal vitamins during breastfeeding.

Special circumstances If you’re having a multiple gestation (twins or more!), have any dietary restrictions such as being vegetarian or vegan, or have had weight loss surgery, let your nurse know since you may need to follow special instructions.

PREGNANCY WEIGHT GAIN Pre-pregnancy weight Underweight Normal weight Overweight Obese

Weight gain recommendation 28-40 pounds 25-35 pounds 15- 25 pounds 11-20 pounds

SUSAN ANGELICOLA, MSN, APN is an advanced nurse practitioner and an expert adviser to Healthy Mom&Baby. ISSUE 28 / 2020 Healthy Mom&Baby

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healthy pregnancy

Breastfeeding Success in the Early Days By Joanne Goldbort, PhD, MSN, RN

Colostrum—

1 2 3

baby’s ﬁrst food

During the ﬁrst few days after birth, your breasts make colostrum—food so rich in nutrients and infection-ﬁghting antibodies that it’s called liquid gold. It’s all your newborn needs.

The golden hour— the ﬁrst hour post-birth

Healthy babies should be placed on mom’s chest, skin-toskin after birth, to promote bonding and breastfeeding. Babies are most alert and awake in the ﬁrst hour. Your nurse will help you bring baby to your breast so baby can latch onto the areola— the darkened area around the nipple—with a wide-open mouth.

Breastfeeding—

a learned experience

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From the ﬁrst latch you and baby learn about breastfeeding. For many moms and babies, especially ﬁrst-timers, this process takes patience, rest, family support and a healthy diet with plenty of water.

JOANNE GOLDBORT, PHD, MSN, RN, is an assistant professor in the College of Nursing at Michigan State University and an expert nurse adviser to Healthy Mom&Baby.

You’ve decided to breastfeed your newborn—a rewarding and challenging experience awaits!

xclusive breastfeeding is recommended for baby for the ﬁrst 6 months or longer, unless your baby has a medical reason otherwise. This means your baby gets only breastmilk, not other ﬂuids, like formula or water, or foods.

compresses before nursing, gently massaging as you nurse. If baby has diﬃculty latching, express some milk before feeding by placing your thumb above the areola, your ﬁngers below, and gently pressing to release some milk.

The ﬁrst 24 hours of life

How do I know my baby is getting enough?

Babies are often sleepy after the ﬁrst feeding and for the next 24 hours. Keeping baby close-by, even skin-to-skin, as much as possible helps you learn how your baby shows interest in nursing. Crying is a late cue; the crying baby may need calming before latching. Expect your baby to breastfeed at least 8-10 times in a 24 hour period. Let baby nurse “on demand”. You can’t overfeed or spoil your breastfeeding baby. The more baby nurses in the ﬁrst days, the sooner your milk will come in.

When will my milk come in?

Your colostrum will change to milk by around 2 to 5 days postpartum. You may experience engorgement—fullfeeling breasts—when your milk comes in which should resolve in 24-48 hours. For tender breasts apply warm

Baby’s diaper tells all! The ﬁrst day your baby should wet the diaper once and pass one stool, with two of each on day 2, and 3 each on day 3. Stools will be black and tarry the ﬁrst few days and then turn yellow and seedy. By day 4 expect baby to wet the diaper and pass stool each time you nurse. If your baby isn’t producing this much urine and stool talk to baby’s provider right away.

Listen to your intuition!

Mom—you’ve got this! When you need expert advice ask your nurse, healthcare provider and/or a lactation counselor/ consultant. La Leche League USA (lllusa.org) can be a helpful resource. Unsolicited advice from friends and family can be confusing and lead you to second-guess yourself.

ISSUE 28 / 2020 Healthy Mom&Baby

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healthy moms

Dad and Baby Bonding Research shows that a dad’s involvement in childbirth and caring for the new baby beneﬁts everyone—both the parents and baby

erhaps you’re thinking, “Great”, my partner is very involved in my pregnancy and plans to be there at the birth, so we’re good! However, we often expect dads to know what to do once baby is born and the reality is they may never have seen fathers caring for their babies.

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Culture shift for dads The culture shift in the last 3040 years has been from dads not being allowed in the labor room or expected to participate in newborn care, to expecting them to know everything and be good at it. Dads today may or may not have had dads who were involved in baby care. Dads often feel left out if baby is breastfeeding. Happily, today’s dads want to rise to the occasion. Sadly, they don’t always know how. Here are some suggestions to help make the paternal experience a happy and fulﬁlling one.

By Heather Watson, PhD, MSN, BSRN

Create a special time that belongs to dad

Maybe it’s right before bed or bath time. This is a special bonding time for dad and baby, and honestly, moms may not want to admit it, but they need a break.

Share breastfeeding duties

If baby is breastfeeding, dad can be the one who gets baby to mom in the middle of the night and puts baby back to sleep. Dad will share the burden of interrupted sleep and feel part of the feeding process.

Trust your partner

The mothering instinct can be strong, which is usually great, but it can also be “judgey” and “protective”, even toward the baby’s dad. So, relax and let dad help and also allow for mistakes (moms make them too).

Take a newborn class before delivery

This is important for both parents because, even if you have experience with newborns, recommendations change frequently and this ensures mom and dad have the same up-todate information on baby care.

Encourage dad to be part of the record keeping

Taking photos and writing down memories or milestones in a book can be fun, but it’s also a job. It’s more likely to get done with two subject matter experts on the job. Enjoy the newborn experience; it’s special! HEATHER WATSON, PHD, MSN, BSRN is a nurse scientist at Johns Hopkins Health System and expert advisor to Healthy Mom&Baby.

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healthy moms

Post-Birth Warning Signs Learn these Post-Birth Warning Signs

By Lisa Kleppel, MPH, PMP

Know the Post-Birth Warning Signs Do you know the signs of potentially life-threatening complications that could affect you after you give birth? Specific signs you should watch for during the first year after birth include:

arah Duckett had only been home from the hospital for a week with her second baby when she sensed something wasn’t quite right. She didn’t feel like herself; something was off. Her heart was beating rapidly just from walking across a room. It was hard to get a breath in without coughing. She remembered the postbirth warning signs her nurse had discussed with her and wondered if she was experiencing one of these signs. It didn’t make sense—hers had been a perfectly uneventful pregnancy and normal birth. Sarah’s mom took her to the emergency room, where the staff checked her blood pressure, ran several lab tests and did a chest

x-ray and CT scan. They discovered a small blood clot in her lung. Sarah received treatment, and avoided further complications, all because she trusted her instincts, and knew the warning signs to look for.

Reduce your risks for problems in and after pregnancy Many moms return home from the hospital, tired and overwhelmed with the excitement of a new baby. Naturally, you may be more focused on caring for your new baby but pay attention to your own health. Be aware of signs and symptoms that could mean you’re having a complication.

XXPain in your chest XXObstructed breathing or

shortness of breath XXSeizures XXThoughts of hurting yourself or

someone else XXBleeding that is soaking through

one pad/hour, or blood clots the size of an egg or bigger XXIncision that is not healing XXRed or swollen leg that is painful

or warm to touch XXTemperature of 100.4° F or

higher XXHeadache that does not improve,

even after taking medicine, or a bad headache with vision changes

health4mom.org

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healthy moms The mother/baby nurses of AWHONN have created specific instructions for postpartum moms called “SAVE YOUR LIFE: Get Care for these POST-BIRTH Warning Signs”. Learn these post-birth warning signs because knowing how to recognize and respond to these specific signs and symptoms may help save your life.

Act on your instincts; get help!

If you think you are experiencing one of the post-birth warning signs,

act on your instincts. It’s important to get help and let the person responding to your needs know that you’ve just had a baby within the past year. Whether it’s the 911 operator, emergency room or urgent care providers or your own provider, tell them, for example: “I had a baby (give date) and I have a really bad headache that won’t go away.” If you feel something is wrong or you just don’t feel quite right, always call and get evaluated by your healthcare provider. If your

images: shut ter stocK , ge t t Y

Complications and Deaths Among New Mothers Increasing Did you know that according to the CDC: Although still rare, an increasing number of women are dying from pregnancy-related problems before, during and after their baby’s birth, and at least half are preventable. Severe complications of childbirth, such as losing enough blood to need a blood transfusion,

seizures, and life-threatening infections, are 100 times more common than a woman dying from a childbirth related complication. While some women may be at higher risk of developing complications than others, ALL women are at risk of developing post-birth complications. If you are surprised by these facts, you’re not alone.

symptoms worsen or you do not hear back from your healthcare provider, call 911 or go to the nearest emergency room. The sooner your care providers can identify your symptoms, the sooner they can make a diagnosis and provide the necessary care.

Share post-birth warning signs

Just as your nurse will share these instructions with you, please share this same information with your family and friends; you may not be able to act on your own, for example, if you’ve have had a stroke or seizure. Share this information with other pregnant moms you may know. Together, we can help ensure that no mom suffers injury or death because they didn’t recognize the signs of a post-birth problem. Sarah is a living testament to the old saying “Knowledge is a Powerful Thing!” In this case, her knowledge may have saved her life. Lisa KLeppeL, MpH, pMp is a public health researcher and expert advisor to Healthy Mom&Baby.

ISSUE 28 / 2020 Healthy Mom&Baby

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healthy moms

Postpartum Mood Disorders What Moms Need to Know By Danielle Beasley, PhD, RN, RNC-OB

Postpartum mood disorders can occur among women with a healthy pregnancy and birth

very woman transitions to motherhood differently. Up to 80% of new moms suffer from the baby blues, experiencing mild anxiety, crying and restlessness that goes away within the first two weeks after giving birth—once your hormones level out. If these feelings get worse or last longer than a couple of weeks, you may be experiencing a postpartum mood disorder. Talk to your nurse or healthcare provider right away. Seeking help can prevent your symptoms from worsening.

Postpartum anxiety

Postpartum anxiety strikes 1 in 10 women, who feel overly anxious and worried and have trouble sleeping. Postpartum anxiety, left untreated, often turns into postpartum depression.

Postpartum obsessivecompulsive disorder

A form of postpartum anxiety is obsessive compulsive disorder which involves repetitive actions such as exaggerated cleaning and double checking on things that you perceive as a danger to your newborn.

Postpartum depression Risk depression is the most common factors for Postpartum postpartum mood disorder—1 in 7 women postpartum experience it. Symptoms include crying depression more than usual, anger, feeling numb or

XXPrevious history

of depression XXStressful life

events XXLow social

support XXBeing a mom to

multiples, like twins, or triplets XXBeing a teen

mom XXPreterm (before

37 weeks) birth XXPregnancy

and birth complications XXHaving a baby

who has been hospitalized

disconnected from baby, doubting your ability to care for baby, worrying you will hurt baby, and withdrawing from loved ones. Postpartum depression is more severe than the baby blues and postpartum anxiety, lasting beyond a couple of weeks postpartum. Without treatment, it can last for months, even years. You may, or may not, have risk factors for postpartum depression (see box). Most women don’t seek help, but postpartum depression rarely goes away on its own, so it’s important to get help from a healthcare professional.

Postpartum psychosis

Postpartum psychosis, a rare disorder affecting 1 in 1,000 women, usually develops in the first two weeks postpartum. Symptoms include thoughts of harming yourself or baby, hallucinations or delusions, extremely disorganized behavior, confusion or cognitive impairment that may come and go. Risk factors are a past history of a psychotic episode or bipolar disorder. If you feel that you may have postpartum psychosis, seek the help of a healthcare professional immediately.

images: shut ter stock

Helpful resources

Read more about postpartum mood disorders at Postpartum Support International (postpartum.net) and the National Institute of Mental Health (nimh. nih.gov/health/publications/postpartumdepression-facts/index.shtml). Danielle Beasley, PhD, Rn, RNC-OB is a Women’s Health Instructor at the University of South Florida, College of Nursing and an expert advisor to Healthy Mom&Baby.

ISSUE 28 / 2020 Healthy Mom&Baby

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Slow ! down Relax.

Don’t rush me!

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

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

f 40 or !

Download a free copy of

40 Reasons to Go the Full 40

What’s the hurry?

at www.gothefull40.com.

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

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

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healthy moms By Paris Maloof-Bury, CNM, RNC-OB, IBCLC and LaShea Wattie Haynes, M.Ed, MSN, AGCNS-BC, APRN, RNC-OB/EFM

Respectful Care Every Woman Deserves It’s your body. It’s your baby. It’s your birth.

he care you receive during pregnancy, birth and postpartum can aﬀect how you feel about yourself. Sometimes you might feel pressured to “go with the ﬂow” and not complain. A healthy baby is what matters, right? Wrong. Nobody loves your baby more than you do—of course, you want a healthy baby! In the rush of activity during birth, your pregnancy care providers may not stop to listen to you or to ask for your permission to touch and care for your body. You deserve to be treated with kindness, listened to, have your questions answered

and your requests acknowledged. When women receive respectful care, their babies do better. Stress from poor treatment can increase the risk of complications for women and babies. Consider the following tips as you interact with your pregnancy care team.

Choosing your healthcare provider Do your research and read reviews before selecting a healthcare provider for your pregnancy and birth care. Midwives specialize in supporting normal birth; one of

their primary philosophies is “Listen to Women.” Read more about midwives at health4mom.org/birthmidwife. Obstetricians are surgeons and have expertise in managing women with complications during pregnancy and childbirth. Whomever you choose, you should feel respected, comfortable asking questions, and receive timely and appropriate feedback. Often your insurance may determine your range of choices for providers and the provider you choose may determine your birth place.

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healthy moms

Choosing your birth place

Most hospitals offer childbirth classes and tours to provide information on their practices and birth options. Check online for the hospital’s statistics for Cesarean birth , breastfeeding rates, and customer service scores. For more information, go to health4mom. org/choose-birth-environment.

Bodily autonomy

Dignity and modesty

are basic things to ask for and may be as simple as having a blanket to keep you covered. Most of us feel more confident when we wait to undress for an exam until after talking with our healthcare provider, and most of us find that we remember more of what we discussed with our provider if we have our clothes on during the conversation.

Privacy and confidentiality

Your healthcare provider shouldn’t ask you personal questions in front of your family or friends without your permission. Ask your family and friends to step out if you want to keep information confidential.

Racism and bias are real

and can impact your health. If you experience discrimination based on your race, religion, sexual orientation, gender identity or medical philosophies, either choose another provider or tell your provider directly about your concerns.

What’s in a name?

Your name is part of your identity and should be used correctly. If healthcare providers have difficulty pronouncing your name, ask them to write it out phonetically in your chart. Unless you’ve given someone permission to do so, using “terms of endearment” can be belittling. You can correct people if they mispronounce your name or call you “honey” or “dear”. Pregnant women and their families are from many racial, ethnic and cultural backgrounds. Historically, people of some races, ethnic and cultural groups were called disrespectful names in order to belittle them. Women have also been referred to in disrespectful terms. Healthcare professionals should always address you by your preferred name, rather than using casual or slang terms.

Respectful care

means you’re treated with dignity, empathy, and compassion regardless of your race, gender, socioeconomic status or reproductive history (pregnancies, miscarriages, abortions). You’re in charge of your medical care and have the right to informed consent and refusal and autonomy every step of the way. If you ever feel that something isn’t right, speak up! It’s the health professional’s job to listen.

Patient autonomy XXis defined by MedicineNet as

“the right of patients to make decisions about their medical care without their health care provider trying to influence the decision.” You have the right to learn about your care and choose or decline what is recommended, and the right to decline care in one instance but accept it in another. It’s your body, your baby, your birth, and your choice.

Informed consent XXmeans your healthcare provider

reviews the risks, benefits, and alternatives of any treatment or intervention they recommend. This includes even “routine” procedures, like sweeping your membranes, breaking your water, or cutting an episiotomy.

Paris Maloof-Bury, CNM, rNC-oB, iBClC, is a certified nurse-midwife and lactation consultant at Sutter Health in Davis, CA. lashea Wattie hayNes M.ed, MsN, aGCNs-BC, aPrN, rNC-oB/efM, is a system clinical nurse specialist for labor and delivery and mother/ baby for 7 birthing centers in her healthcare system.

images: shut ter stocK

Unless there’s a medical emergency, healthcare providers should ask permission before touching your body, especially before vaginal exams. Vaginal exams can be physically uncomfortable; and for women who’ve experienced sexual abuse, they can also be emotionally triggering. These exams should only happen with your permission. You have the right to stop the exam if you change your mind or it becomes too uncomfortable. Your consent must be continuous, and you can revoke it at any time.

health4mom.org

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m u e in r e P r u o Y r o f g in r a C After Vaginal Birth Recover from Birthing

You may be surprised about the physical aspects of recovery from a vaginal birth. Here’s what to expect

ou just birthed your baby—a baby which took around nine months to grow—so be gentle with yourself and don’t expect your body to feel like it did pre-pregnancy any time soon. One area that needs tender care is your vagina and perineum—areas that stretched a lot to allow your baby to enter the world and may have torn or been cut. If your provider made a small cut, or incision, in your perineum—the area between your vagina and anus—this is called an episiotomy. Episiotomies increase the risk of infection and blood loss; an episiotomy can be more extensive than a natural tear. Tears, if small, typically heal faster than episiotomies. Recovery may take a few weeks. If you had an episiotomy it may feel tender as you walk or sit. Keep your perineal area as clean and dry as possible; change pads every 2-4 hours. Gently pat yourself dry front to back

after urinating to decrease infection risk. Get fresh air to your perineum to speed healing. If lying down to breastfeed or nap, take oﬀ your underwear and pad for a while. No two moms recover the same way, and no one knows your body better than you—so listen to those twinges, pains and sore areas—and be gentle and nurturing with yourself after birthing. Tell your healthcare provider if you experience any of the following in the weeks after a vaginal birth: Perineal

or vaginal pain or swelling that gets worse, not better, in the ﬁrst week

Not

able to control your urine or stool

Pus-like

discharge from the tears or episiotomy

Pain

when you resume sexual intercourse



Common pain relievers— acetaminophen and ibuprofen are safe during breastfeeding



Period pads from heavy to light until your bleeding ends



Witch hazel for vaginal pain or hemorrhoids—soak pads in witch hazel and chill them



Stool softener to help your bowels get moving again post-birth



Sitz bath for soothing pain



Squirt bottle- ﬁll with warm water to rinse during and after urinating for comfort CATHERINE RUHL, DNP, CNM is editor of Healthy Mom&Baby and a certiﬁed nurse-midwife in Albuquerque, New Mexico.

IMAGES: SHUT TER STOCK

Make a recovery care package! Prepare for your body’s recovery by having these supplies ready at home:

By Catherine Ruhl, DNP, CNM

health4mom.org

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PIPs® Panty (Perineal Ice Panty) is an attractive patented boy short underwear designed to ease the swelling, pain and discomfort that many women experience after vaginal birth. THE APPLICATION OF ICE TO THE PERINEUM IN THE

FIRST 24 TO 48 HOURS AFTER DELIVERY IS VERY HELPFUL TO THE HEALING PROCESS. THERE HAS NEVER BEEN A TRULY EFFECTIVE, COMFORTABLE AND DIGNIFIED WAY TO PROVIDE COOLING TO THE PERINEUM FOR WOMEN IN THE FIRST FEW DAYS AFTER BIRTH.

PIPs Panty addresses this problem.

It has a unique design - the crotch has a sewn in pouch with a center opening that holds a re-sealable PIPs ice bag. The ice bag itself also has a center opening that lines up with

the pouch opening. The opening in both the pouch and the PIPs ice bag allows blood from the vagina to ﬂow thru these center channels to the sanitary napkin beneath the pouch. The pouch remains directly against the perineum or vaginal area, providing cooling relief where it is needed unobstructed by the sanitary napkin. The water repellent pouch can be wiped down with a damp washcloth or paper towel when soiled. Your PIPs ice bag can be ﬁlled with ice found on most Maternity Units. There is no need for freezers which are not typically supplied in birthing suites. Best of all, mamas can be up and moving around while wearing PIPs! PIPs Panty and ice bag are washable and reusable.

Coming soon, gel packs for use where freezers are available.

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Comfort, Health, Functionality

Using the bathroom after delivery can be challenging and uncomfortable for many new moms, so we designed the Cascade 3000 bidet seat to help. Its aerated, warm water wash stream is soft enough not to cause discomfort but powerful enough to get you thoroughly clean, leaving you refreshed and ready to go. Best of all, we’ve made the Cascade 3000 intuitive and easy to use so you can enjoy all the beneﬁts of bidet cleansing without the learning curve. With its amazing features and sleek look, the Cascade 3000 will keep you feeling fresh throughout pregnancy, postpartum and beyond!

Cascade 3000 ◆ Replaces your existing toilet seat ◆ Soothes and relaxes sore areas while providing gentle, efﬁcient front and rear cleansing ◆ Warm air dryer reduces the need for abrasive, irritating toilet paper ◆ LED nightlight makes it easy to navigate the bathroom in low light ◆ Nozzles self-rinse before and after each use, and silver nano-technology keeps the interior components sterile, so you can rest easy knowing that you’re getting an exceptionally hygienic cleanse ◆ Versatile unit provides a supremely comfortable, convenient and sanitary cleansing experience regardless of life stage or gender

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healthy moms

Strategies for a Comfortable Postpartum Recovery 5 You may be sore or uncomfortable from your birth experience, whether you had a vaginal birth or a cesarean. So now what?

hen you’re in the hospital or birth center, there will be many options to soothe and comfort soreness. However, you may want to have the following items at the ready for use at home. By Heather Watson, PhD, MSN, BSRN

IMAGES: SHUT TER STOCK

Breast pads. If you’re breastfeeding you may experience some leaking between feedings. Having disposable pads handy to insert into your bra helps you avoid inconvenient trips to the store.

Ice packs. Grab extras from the hospital if you can, but if not use soft gel ice packs to reduce swelling.

Witch hazel medicated pads. These will help with tender and inﬂamed tissues and help cleanse any stiches or minor tears.

Heating pad. Soreness is common after labor or surgery, but baths are usually not an option for several weeks. Helpful alternatives are electric or microwaveable heating pads—just be careful not to apply directly to the skin or an incision.

Sitz bath. Sometimes these go home with you from the hospital, but if not, they’re available at local drug stores, and help to cleanse and provide soothing warmth to the perineum. Feminine hygiene pads of various sizes. Postpartum bleeding can last several weeks but typically reduces over time so having a variety pack is helpful. Remember you don’t want to insert anything vaginally, so tampons are oﬀ limits.

Maternity belt. Perhaps you wore one toward the end of your pregnancy for support, but if not ﬁnd them at drugstores or ask at the hospital. The belt provides extra support, especially if you had a cesarean, while you strengthen your abdominal muscles and return to your pre-pregnancy shape.

Savoy cabbage. When your milk comes in, usually between days 2 and 6 after birth, your breasts may become engorged and feel sore and swollen. The best relief is for your baby to nurse often and empty your breasts. Cabbage leaves are an old, and inexpensive, remedy to soothe breast engorgement. Use green varieties so as not to stain clothes. Apply a washed leaf to each breast and you may ﬁnd some relief. If nothing else, you can take a funny picture for the baby book!

HEATHER WATSON, PHD, MSN, BSRN is a nurse scientist at Johns Hopkins Health System and expert advisor to Healthy Mom&Baby.

ISSUE 28 / 2020 Healthy Mom&Baby

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Join us on Facebook facebook.com/HealthyMomAndBaby

Kombucha: not the drink of choice in pregnancy

pregnancy

Maybe you drink kombucha for the health beneﬁts of the probiotics it contains. Maybe you like its bubbles. During pregnancy think again about drinking kombucha. Kobucha contains alcohol. Although the alcohol content is generally less than 0.5% by volume, kombucha’s alcohol content has been found to vary. Manufacturers aren’t required to label beverages warning pregnant women not to drink alcohol during pregnancy when alcohol content is less than 0.5% by volume. But public health experts at MothertoBaby, the nation’s leading experts on exposures to harmful substances in pregnancy, caution that in some cases kombucha has been found to continue to ferment on store shelves and end up with a higher than 0.5% alcohol content. Homebrewed kombucha has varying amounts of alcohol, sometimes as high at 3%. Furthermore, some kombucha is not pasteurized. When you’re pregnant you’re more at risk for infection from certain food-borne bacteria which can cause pregnancy complications. This is why experts recommend pregnant women avoid unpasteurized products which could contain these harmful bacteria.

SIDS risk increased when moms smoke tobacco and drink during pregnancy

IMAGES © SHUT TER STOCK

Aspirin shown to decrease preterm births for first-time moms A new study of 11,000 women in six countries found that women pregnant with their first baby who took a low-dose aspirin starting as early as the first trimester through the 36th week had fewer babies born before 37 weeks, including fewer early preterm births (births before 34 weeks). The women taking aspirin also had fewer stillbirths and newborn deaths. Women in the U.S. were not included in this study. Aspirin is a low-cost and safe therapy which shows promise to improve pregnancy outcomes.

Pregnant women should know that smoking cigarettes and drinking alcohol during pregnancy increases baby’s risks of SIDS. SIDS is the sudden, unexplained death of a baby less than a year old. Researchers from Boston Children’s tracked over 12,000 pregnancy outcomes of women in the U.S and South Africa. When mothers both smoked and drank beyond the ﬁrst trimester their babies had a 12-fold increase in SIDS compared to women who either gave up both smoking and drinking in the ﬁrst trimester or never drank or smoked.

ISSUE 28 / 2020 Healthy Mom&Baby

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healthy pregnancy

1st Trimester Week 1-12

Early Pregnancy Events From pregnancy tests to morning sickness, here’s how it all begins

By Susan Angelicola, MSN, APN

IMAGES: SHUT TER STOCK

elcome to your 1st and sleepiest trimester; during these 12 weeks your baby will grow from an embryo 1/5th the size of the period at the end of this sentence to a nice juicy plum. Every day, the pregnancy hormone HCG is increasing and it’s what makes your pregnancy test positive. It’s also responsible for feeling tired, tender or sore breasts, frequently needing to pee and for many women—morning sickness. It’s normal to want a nap every day—your body is working hard to grow your baby—it’s exhausting!

Start—or continue—habits that keep your pregnancy as healthy as possible all the way to term: ● Daily prenatal vitamin, especially if you haven’t been taking one ● Make and keep all prenatal appointments ● Healthy food with lots of water ● No, smoking, drinking or using illegal drugs if you have any of these habits ● Caffeine limited to no more than 200mg a day—that’s up to 12 ounces of coffee. ● Foods like chocolate and other beverages have caffeine too Before you knew you were pregnant, baby’s neural tube—

what becomes her brain and spinal cord—formed and closed. The 800 micrograms of folic acid in most prenatal vitamins protect against neural tube birth defects, so it’s important to take a prenatal vitamin before conception and through pregnancy and breastfeeding. Baby ﬁnishes the 1st trimester 10 times bigger than at conception. Your body is changing too: Your breasts are likely bigger and sore, you may have frequent headaches, fatigue and nausea. It’s not unusual to have some spotting or mild cramping and this doesn’t always mean miscarriage. Call your provider right away, especially if the bleeding is heavy or if you’re cramping.

Around week 8, you’ll have your ﬁrst prenatal visit; after that you’ll likely see your provider: Every 4 weeks (until 28 weeks) Every 2 weeks (28-36 weeks) ● Weekly (week 36+) ● ●

You may be oﬀered 1st trimester screening—non-invasive tests done between weeks 11-14 for chromosome disorders like Down Syndrome and genetic testing. Your nurse can talk with you about the risks and beneﬁts of these tests. Bring your questions to every prenatal visit—your care providers expect and welcome them! As you complete week 12, you can relax—all of baby’s organs and bodily systems have formed and the next 28 weeks are all about growing. You’ll be able to hear your baby’s heartbeat and the early symptoms of pregnancy should begin to subside. SUSAN ANGELICOLA, MSN, APN, is an advanced nurse practitioner and expert advisor to Healthy Mom&Baby.

ISSUE 28 / 2020 Healthy Mom&Baby

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2nd Trimester Week 14-27

Enjoy the Energy Burst of the Second Trimester Welcome to your second trimester—soon you’ll be halfway to term! By Susan Angelicola, MSN, APN

What to expect at prenatal visits

Between weeks 24-28, you’ll be checked for the most common pregnancy complication: gestational diabetes. As many as 1 in 10 women develop diabetes in pregnancy. You’ll drink a sweet liquid and have your blood drawn at 1 hour. If your 1-hour test is high, you’ll do a similar 3-hour test, but only 1 in 3 women who need that test will have gestational diabetes. Around 27 weeks, ask for the Tdap vaccine, which protects against pertussis (whooping cough). Newborns can’t get vaccinated against pertussis until they’re 2-3 months old and pertussis can be deadly for babies. Also, get a ﬂu shot in pregnancy before ﬂu season—this vaccine is safe in any trimester. Your baby’s heart is beating

Other changes can include: 

An energy burst—ask your nurse what exercises you can continue or begin in pregnancy

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Lower back pain as your uterus grows and changes your center of gravity

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Heartburn can occur when your growing uterus slows down digestion

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Constipation—your intestines slow down during pregnancy and iron supplements can also contribute

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Soreness or twinges along the sides of your belly as your uterus stretches and moves higher in your abdomen

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Nasal stuffiness or even snoring from increased hormones and blood flow; soothe with saline nose drops and a humidifier

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Varicose veins in your legs—even your vagina, from relaxed blood vessels and slower circulation; elevate your legs or wear support or compression stockings

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Itchy skin or stretch marks; belly butters and balms can ease the itching

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Baby’s first flutters--around weeks 17-20 you may be surprised by flutters in your belly—that’s your baby moving! More exciting is your second trimester ultrasound. Will you try to learn whether you’re having a girl or boy?

fast in the second trimester— about 140-150 beats/minute, which is normal. She’s sucking and swallowing amniotic fluid as she prepares for nursing. Don’t be surprised when you feel her hiccups! Her lungs are exhaling amniotic fluid, preparing for those first breaths after birth. Your baby can recognize your voices and will respond to them at birth.

Weight gain in the second trimester

Many women experience their biggest weight gain during the second trimester and that is normal. Your baby’s growth accelerates and the extra amount of blood in your body needed to sustain your baby peaks at the start of the third trimester. Amniotic ﬂuid, the water around the baby, is also increasing in the second trimester and your breasts continue to prepare to produce milk when baby’s born. The pace of many women’s weight gain slows in the third trimester, which is also normal. Aim to make every calorie you eat a healthy one that is supporting both your body (and mind!) and baby’s. Prioritizing protein, ﬁber and enough liquids (see box) will help you maintain your energy and avoid complications such as low blood sugar, constipation and energy swings.

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uring this trimester, your little one grows from the size of a peach to an eggplant. You’ll have more energy, feel less sick and be hungry! At 13 weeks, your placenta starts producing the hormones that maintain your pregnancy, and it gives baby oxygen and nutrition and removes waste. You begin to ‘show’, happily trading jeans for maternity yoga pants!

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healthy pregnancy

Nutrition know-how 

Hydration is key; drink at least 8, 8-ounce glasses of water a day plus more during exercise

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Minimize heartburn by skipping spicy or heavy meals, acidic fruits like tomatoes or eating late at night

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Take in an extra 250 calories a day in the second trimester—up to 350 calories in the 3rd trimester— to maintain steady weight gain

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Pick high-protein snacks like eggs, nuts, cheese sticks or hummus

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Fill up on ﬁber in beans, bran or berries to keep your bowels regular SUSAN ANGELICOLA, MSN, APN, is an advanced nurse practitioner and expert advisor to Healthy Mom&Baby.

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healthy pregnancy

3rd trimester Week 28-40

Third Trimester Changes By Joanne Goldbort, PhD, MSN, RN

You’re headed into the third trimester (weeks 28-40) of your pregnancy and wonder what changes to expect as you get closer to giving birth

Goodbye, sleep!

As your baby’s body continues to gain weight, develop and mature, you may ﬁnd it diﬃcult to sleep at night, especially during the last few weeks of the pregnancy. Perhaps you’re noticing increased heartburn due to added pressure on your diaphragm. Relief for both of these issues will happen when the baby “drops” or settles into the pelvis around the last few weeks of pregnancy. This is known as “lightening.” You may or may not notice when your baby does this subtle movement but friends and family will, so expect statements, such as, “oh, you’re getting closer as your belly looks lower!” Heartburn may also diminish during this time but be replaced by increased pressure on your bladder

◆ 3rd trimester

warning signs

Call your healthcare provider if any of the following happens:  Your water breaks. This may happen as a trickle of clear fluid that at first may seem like you have to urinate but continues even after you go to the bathroom. Or it may be a gush of fluid. Either way it’s important to get this checked out—you very well could be headed quickly into labor! 

You have vaginal bleeding



You have contractions or tightening of your belly that occur regularly—about 5 minutes apart, lasting for a minute or so and continuing for at least an hour



You have a headache or heartburn that won’t go away after taking over-the-counter medications for the problem JOANNE GOLDBORT, PHD, MSN, RN, is an assistant professor in the College of Nursing at Michigan State University and an expert nurse adviser to Healthy Mom&Baby.

and the urge to use the bathroom more frequently. Even sleeping restfully gets more diﬃcult as you get closer to birthing your baby.

Watch for the mucus plug

When your baby moves into your pelvis, more pressure is put on your cervix, and you may even lose the mucus plug that sits inside the cervix. You may notice this happens when you wipe after urinating—a thick, clear, gloppy substance may appear on the toilet paper. No need to worry; this is normal, and for some women it’s a sign that birth is getting closer.

Prepare for birth

If you haven’t already done so yet, attend childbirth classes to learn more about labor and birth, and meet other women going through the same experiences as you. You’re nearly ﬁnished with pregnancy. In these last weeks, remember to get plenty of rest, drink lots of water, continue to be active, and eat a wellbalanced diet. Soon you will meet your baby!

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he third trimester brings moments of anticipation and excitement as you move away from the more restful past 12 weeks and into a period of increased growth and changes as your body gets ready for birth. Let’s look closer at what some of those changes may be.

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Postpartum Care Meets Sports Science Technology

Mama Strut is an FDA Registered Medical Device which can be billed through most insurance.

www.mamastrut.com

Pelvic birthing injuries are common and look very much like sports injuries. Why arenâ&#x20AC;&#x2122;t we treating them that way? A weak or injured pelvic floor can lead to problems controlling your bladder, organ prolapse, lower back pain and trouble doing every day activities. Icing and compression are proven ways to reduce swelling and relieve pain instantly. Protecting and supporting the pelvis are essential to healing right. Sports medicine is built around these ideas and so is the Mama Strut!

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www.facebook.com/HealthyMomAndBaby

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healthy pregnancy

Understanding Fetal Heart Rate Monitoring Here’s why your care provider regularly checks your baby’s heart rate

◆ Electronic fetal

monitoring devices

By Cynthia Loring, MS, RNC, CLC

ince the 1800s, midwives and obstetricians have listened to baby’s heart rate as one way to check on baby’s wellbeing. Fetoscopes—similar to stethoscopes—were the ﬁrst technology used to listen in on baby’s beating heart. Measuring fetal heartbeats can be a reassuring sign that baby is getting adequate oxygen through their placenta and umbilical cord (normal range for babies is 110160 beats per minute and in this range your baby’s heart can vary by 5 to 25 bpms). Outside of these ranges, baby may not be getting enough oxygen or experiencing other problems.

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Checking baby’s heart rate

During prenatal care, providers typically use a wireless ultrasound device called a Doppler to listen to baby. A fetal Non Stress Test records baby’s heart rate when baby is moving. Late in pregnancy, you may be

asked to have a Contraction Stress Test to measure baby’s heart rate during contractions; you may need to be in the hospital with medication to start contractions for this test. Once you’re in labor, baby’s heart rate is typically checked intermittently unless there are medical reasons to monitor it continuously. The Association of Women’s Health, Obstetric & Neonatal Nurses (AWHONN), which publishes Healthy Mom&Baby, supports fetal heart rate monitoring. AWHONN advises that monitoring should happen in ways that are consistent with a pregnant woman’s preferences and desires, and that unless clinical concerns require more increased monitoring, the least invasive ways for checking on baby’s heart rate should be used to promote normal labor and vaginal birth. CYNTHIA LORING, MS, RNC, CLC, is a nurse expert adviser to Healthy Mom&Baby.

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Electronic fetal monitoring involves two devices strapped to your belly via stretchy belts, and attached to the fetal monitoring device by cables:

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Ultrasound transducer: for tracking baby’s heart rate

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Tocodynamometer: for tracking your contractions and uterine activity

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If the ultrasound transducer doesn’t pick up baby’s heart rate well enough, your provider may recommend placing an internal monitor, called a scalp electrode, on baby’s scalp. This is done during a vaginal exam.



If your pregnancy care provider needs more information about the intensity and frequency of your contractions, you may also receive an internal device (intrauterine pressure catheter) that sits between your baby and uterine wall, with a cable extending out to a fetal monitor.



When your labor is progressing normally, being upright and moving including rocking on a birthing ball, relaxing between contractions, and staying hydrated all support baby’s heart rate.

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It’s all about Immunity for Mom, Baby and Family... One of the most important things you can do to deal with all the influenzas and viruses that threaten us on a daily basis, is strengthen your immune system. During a time of uncertainty, numerous supplements promise virus protection and immune boosting properties. None can make specific claims against the Coronavirus, nor does Prebiotin claim to cure, prevent or treat this virus or other diseases. Look for solutions with scientific support. Prebiotin Prebiotic Fiber is a simple, all-natural, gluten-free solution to address this critical need to strengthen and maintain a healthy immune system. No hype, science based, highest quality prebiotic from Oligofructose-enriched Inulin (OEI). Beneficial to every one of every age, especially our elderly population and those struggling with compromised immunity, as well as for yourself before, during and after your pregnancy. (For more information on Prebiotin see the Trimester by Trimester section in this issue.) As prebiotic pioneer, Dr. Frank Jackson first learned over 20 years ago, “A prebiotic is a food fiber that is present in plants. The very best of these make the good bacteria in the gut grow prodigiously and make good things happen in the gut and body. There is now significant experimental evidence in the medical literature these good bacteria strengthen the immune system by stimulating the immune cells to be resistant to infection.” To learn more about gut immunity, watch Prebiotin founder, Dr. Frank Jackson, gastroenterologist, discuss how your immune system works.

Read a special message from Prebiotin CEO, Ron Walborn, Jr., regarding COVID-19. www.prebiotin.com/ceo-message Click Prebiotin Structure/Function Claim: Support Health and Immunity for more information and research about how Prebiotin supports health and immunity. www.prebiotin.com/immunity-support Check out Prebiotin’s latest blog, Coronavirus and the Importance of a Strong Immune System, with more detailed information and updated statistics. www.prebiotin.com/coronavirus Important Information from the CDC, www.cdc.gov/coronavirus/ 2019-ncov/index.html

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Frequent use of sanitizers and disinfectants will also contribute to less microbiome diversity going forward, which then can weaken our immune system, creating dysbiosis and resulting in increased inflammation and chronic diseases. During this challenging time, when fiber-filled fresh fruits and vegetables may be hard to obtain, shelf-stable Prebiotin will enable you and your family to nurture the beneficial bacteria in your gut microbiome. Prebiotin is the fertilizer for your “inner garden” that is home to 80% of your immune system and can help you to “feel better, do more.”

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healthy pregnancy

Pregnancy during COVID-19 Looking After Your Emotional Health Know your red ﬂags ➌ W

Here are six tips for taking care of yourself during the pandemic.

your expectations ➊ Manage

Don’t underestimate the pandemic’s impact or emotional toll. Adapting to so many disruptions in our daily lives takes time. Go easy on yourself. Set realistic goals for yourself and your family as you settle into new rhythms of daily life and your pregnancy progresses. Look for alternatives when plans you’ve made aren’t workable options. For example, consider asking the friend who wants to throw you a baby shower to plan a virtual event.

manage your stress ➋ Proactively Prioritizing sleep can help you feel emotionally balanced. Set regular times to go to sleep and wake up. Keep healthy treats on hand for you and baby. Stress goes handin-hand with wanting to indulge. Stay active. Exercise is proven to lower stress levels, regulate emotions, and improve sleep.

By Elizabeth T. Jordan, DNSc, RNC, FAAN

Manage stressful moments by identifying the key thoughts and physical sensations that contribute to a cycle of feeling stressed and overwhelmed. Frustration, worry, sadness, physical sensations (tension, upset stomach, jitters) and actions (such as compulsively checking the latest COVID-19 statistics) each feed into and intensify these negative emotional spirals. If you start this cycle, try relaxation breathing. Breathe in for four counts, hold for four, breathe out for four, hold for four, then repeat. This can de-escalate the cycle and help you regain control and feel better. You may also want to listen to relaxing music and lay down, breathing deeply, and slowly tense up a set of muscles and then relax, working from toes to face.

introverted among us need a sense of connection to others for our mental, as well as our physical health. Keep in touch with people you care about and who care about you. Many groups have created virtual forums where you can contribute or just sit back and enjoy the chatter. We may be socially isolated, but we need not feel alone.

uncertainty by staying in the ➏ Manage present

Take each day as it comes and focus on the things you can control. Be positive. Meditation and mindfulness can help. Be intentional about looking after your emotional health and wellbeing. ELIZABETH “BETTY” JORDAN, DNSC, RNC, FAAN is Vice Dean, Undergraduate and Global Programs at the University of South Florida and expert advisor to Healthy Mom&Baby.

a routine ➍ Set

Setting a routine may help you manage anxiety and adapt more quickly to the current reality. Create clear distinctions between work and non-work time, ideally in both your physical workspace and your headspace. Find something to do that isn’t work-related that brings you joy. If you’re working, and it’s possible, work in short bursts with scheduled breaks to keep your thoughts clear.

connections ➎ Maintain

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e’re living through a time of great uncertainty with COVID-19. Being pregnant at this time may make you feel alternately stressed, anxious, helpless, or hopeless. Stay in touch with your pregnancy care provider so they can answer questions and address your concerns. Some of your prenatal visits may be by video conference or on the phone so you can avoid exposures at your provider’s oﬃce. Social distancing can be hard to follow but reduces your chance of exposure to the virus.

Reach out to those who can provide you support. Tell your partner, family, and friends how you’re feeling. Even the most

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What can I do about my Scar? The leader in scar management ™ has been providing treatment to health care professionals and mothers for over 25 years with remarkable results! ReJuveness self-care products help prevent and treat problem scars from surgery incisions, keloid, and stretch marks. Note: C-section wounds have a longer healing time. Confidence in ReJuveness can promote early conversations between clinician and patient, leading to successful scar management. Early intervention is key to successful results, so talk to your doctor, says Tom Fallon, representative to the FDA in classifying silicone for problem scars.

✩ ReJuveness recognizes favorable bio-active healing properties of certain silicones and their design over others. ✩ Attain results with a combination of a rapid regrowth of the top layer of skin, and a balanced remodeling of collagen in the lower levels. ✩ Strategic taping over the silicone sheet is essential. This combination acts as stent lessoning skin tension, keeping incision edges together and promoting an even collagen production. ✩ For a more positive outcome, give the process a boost with our Hyper-Heal cream in combination with our silicone sheeting, which is cost-effective and reusable. Daily use of the non-adhesive silicone sheeting should be started no less than two weeks after surgery. ✩ Derma needling is emerging as an added tool in scar management as well as revision of older scars with unfortunate repercussions. ✩ Just one sheet of ReJuveness can last up to a year. ✩ Scar advisors are available throughout treatment to answer any questions or concerns.

www.rejuveness.com

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GivinG Birth DurinG the COVID-19 PanDemIC By Rachel Napoli, DNP, CNS, PHN, RNC-OB, IBCLC Stay up-to-date. The situation with COVID-19 is changing constantly and so are policies and guidelines. Consult trusted sites such as the Centers for Disease Control and Prevention for the latest advice for pregnant women and new moms. Review your office, clinic, and hospital websites for the most up-to-date information so you can plan for office visits and your stay in the hospital. Know what to expect at the hospital: Hospitals are changing visiting policies to prevent the spread of COVID-19. Review the

website of the hospital where you’re planning to give birth to check their current visitor policies. These are some of the restrictions that may be in place in your hospital: Screening all visitors and patients before they enter the hospital ➤ Hospitals are taking temperatures of every patient and visitor when they arrive. ➤ Patients and visitors will be asked about symptoms of COVID-19, possible exposure to someone with COVID-19, and recent travel.

Visiting policies will vary. You may see these recommendations implemented at your hospital: ➤ One visitor allowed for women to come to the birth unit (labor and delivery unit). This visitor is usually the only visitor allowed for the entire stay. Some hospitals may not allow visitors. ➤ No children are allowed as visitors ➤ Hospitals are limiting visitors from coming and going. Check with your hospital about their policies. ➤ Check on any restrictions about what you can bring with you to the hospital, including food.

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Prior to labor and birth, if you have symptoms of COVID-19 contact your healthcare provider for care and follow guidelines for separating yourself. ➤ At this time there is no recommendation that birth by cesarean or a labor induction is required if you have COVID-19. ➤ Women who have COVID-19 are recommended to wait to give birth, if possible, until a negative test result is obtained or they’re no longer quarantined to avoid transmitting the virus to their newborn. ➤ Check with your hospital if you plan to have a doula or labor coach present in addition to your partner because they may not be allowed under current visiting policies. ➤ Epidural pain management for labor is an option for women with COVID-19. If you planned on using nitrous oxide in labor check with your hospital to find out if it’s still an option or if its use has been suspended during the pandemic. ➤ You may be asked to wear a mask over your mouth and nose even if you have no symptoms of COVID-19 to protect all who you come in contact with at the hospital. People without symptoms can have COVID-19 and spread the virus when they talk, cough or sneeze. If you’re in labor and have COVID-19, or are suspected of having COVID-19 due to symptoms like fever or cough, call your healthcare provider before going to the hospital. Discuss your labor progress and what to expect when you arrive. You’ll be required to wear a mask to limit the spread of the infection and placed in an isolation room when you arrive on the birth unit.

We don’t know at this time whether COVID-19 can cause serious problems for baby. We don’t have much information on whether pregnant women with COVID-19 can transfer the virus to their unborn baby but so far COVID-19 has not been found in amniotic fluid. Right now, the priority is to keep baby from getting COVID-19 after birth. If you’ve tested positive or are suspected of having COVID-19 the recommendation at this time is to temporarily separate you and your baby after birth to keep your baby from getting COVID-19. Discuss the risks and benefits of separation with your healthcare provider taking into consideration the severity of your symptoms. ➤ Your hospital may have a separate isolation room for your baby. If a separate room is not available barriers such as a curtain or room divider can be used to separate your baby by six feet or more. Six feet is recommended to best avoid transmitting the virus. ➤ A healthy adult should stay with you to help to care for your baby. This person should wear gown, gloves, face mask, and eye protection at all times. ➤ Mothers who are separated from their newborn and wish to breastfeed are encouraged to express breast milk to maintain supply and have milk available for a healthy caregiver to feed the newborn. So far, the virus hasn’t been found in breastmilk, but it’s unknown at this time if COVID-19 is spread in breastmilk. ➤ Talk with your healthcare provider about when you’ll no longer need to be separated from your baby. Decisions are made based on your individual case taking into account how your illness has progressed, your symptoms and lab results.

Other points to consider as you prepare for birth ➤ Postpartum follow-up appointments: Many providers are scheduling telephone or video follow-up appointments. When you go home from the hospital confirm your follow-up appointments and if you’ll have an in-person or a telephone or video appointment. ➤ Before you go home: Arrange to have your home well-stocked with food and supplies for you and your baby. ➤ Once you’re home: Let others go shopping for food and any needed supplies. Follow the recommendations for social distancing to decrease your chances of being exposed to COVID-19. Plan virtual visits to introduce your baby to family and friends. Wash hands frequently and disinfect “hightouch” surfaces often. To support your immune system and regain strength, rest as often as you can, drink plenty of fluids, and eat healthy foods. Use your favorite personal strategies to decrease anxiety and stress. Rachel Napoli, DNp, cNS, phN, RNcoB, iBclc is an assistant professor of nursing at Sonoma State University and expert advisor to Healthy Mom&Baby.

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COVID-19 Symptoms

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CHILDREN DIE IN HOT CARS BE ALERT TO THE DANGER OF CHILDREN LEFT IN AUTOMOBILES! Automobile monitors designed for shared child care, designed for the parent whose child is not always in their care. “No matter who is driving you will know that your child is safe.” HYPERTHERMIA DANGER! Every 10 seconds a child is left unattended within an automobile. During the summer months a child dies every 2.5 days from overheating while unattended in an automobile. BE PROACTIVE ABOUT YOUR CHILD’S SAFETY: Always check your back seat before exiting your vehicle. And for peace of mind when your child is not in your personal care use Baby Alert International Inc’s Car Seat Monitor. For more information or to purchase visit:

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Swabbies allows for quick and sanitary diaper changes without all the mess. Each sponge applicator is pre-filled with Swabbies Supreme Diaper Cream for a singlehanded, mess-free application. This new, one-of-a-kind design was created by a mom, for busy bums on-the-go. Swabbies is pediatrician tested and approved.

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High Blood Pressure in Pregnancy

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

High blood pressure, also called “hypertension”, can pose problems during pregnancy whether you had it before pregnancy or it’s new in pregnancy

Complications of high blood pressure for mom and baby Pregnant women with high blood pressure have a higher risk for premature separation of the placenta (placental abruption), cesarean and hemorrhage

Symptoms to Report to your Provider (some women have no symptoms until their blood pressure is dangerously high) XX Headache XX Changes in your vision (spot in eyes, blurry vision etc) XX Puffiness (edema) in your feet, legs, hands or face XX Especially edema that doesn’t resolve with rest XX Sudden weight gain XX New nausea or vomiting in second half of pregnancy XX Difficulty breathing XX Epigastric pain (below ribs in area of upper belly) or shoulder XX Your baby moves less than usual (talk with your nurse about

doing daily fetal “kick counts”)

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igh blood pressure you have before pregnancy is called chronic hypertension. High blood pressure that you develop during pregnancy is gestational hypertension. Both of these conditions can get worse with pregnancy and may progress to a pregnancy-related condition called “preeclampsia”.

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healthy pregnancy after delivery. You have a higher risk of having heart and kidney disease later in life. Your baby is at risk to be born early, grow smaller than normal, be stillborn or die soon after birth. If you have very high blood pressure, as sometimes occurs with preeclampsia, you can have complications including seizures, stroke, kidney or liver complications and even death.

How do I know if I have preeclampsia? Currently, there is no screening method for preeclampsia. If you have chronic or gestational hypertension expect your providers to closely monitor you for symptoms (see box). They’ll check for signs you may be developing preeclampsia, including high blood pressures and changes in laboratory values. Some women who develop preeclampsia have risk factors (see box) but many women with preeclampsia have no risk factors.

Chronic hypertension

Chronic hypertension is high blood pressure diagnosed before pregnancy or before the 20th week of pregnancy. If you have this condition before pregnancy, work with your care providers to treat your blood pressure. Ask for counselling about healthy weight, nutrition, and activity to begin your pregnancy as healthy as possible. Let your provider know you’re thinking about getting pregnant so they can prescribe antihypertensive medications that are safe in pregnancy. Avoid excessive salt and caﬀeine intake and ask for help to stop smoking. After 12 weeks of pregnancy, your provider may recommend you take low-dose aspirin daily to help prevent preeclampsia.

Gestational hypertension

Risk factors for Preeclampsia: 

Preeclampsia in a previous pregnancy



Being pregnant with twins, triplets or more



Chronic hypertension



Type 1 or 2 Diabetes



Kidney disease



Autoimmune diseases



Never being pregnant before (Nulliparity)



Pre-pregnancy body mass index greater than 30



Mother or sister who had preeclampsia



Maternal age 35 years or older



Being African American

your provider may recommend low-dose aspirin daily after 12 weeks of pregnancy to prevent preeclampsia.

Monitoring high blood pressure in pregnancy When you have high blood pressure in pregnancy you’re considered “high-risk”. You and baby will be monitored more often. Your provider will regularly check your blood pressure and order lab tests to measure your kidney and liver function. Your baby’s growth, and well-being will be checked with ultrasounds and fetal heart monitoring. At any time in pregnancy if your blood pressure rises high enough you may be admitted to the hospital for closer monitoring. If needed, your provider may place you on a medication called magnesium sulfate to help prevent you from having a seizure (eclampsia) or other complications. Your provider may recommend delivering your baby early if your condition becomes dangerous for either you or your baby. Remember high blood pressure can be “silent”. You know your body better than anyone else, so if you’re concerned about any symptoms or just don’t feel “right”, let your provider know so you and your baby can be checked.

RACHEL NAPOLI, DNP, RNC-OB, PHN, CNS, IBCLC is an Assistant Professor, Department of Nursing, Sonoma State University and an expert advisor to

Healthy Mom&Baby.

Gestational hypertension is high blood pressure diagnosed after the 20th week of pregnancy. If you have gestational hypertension your provider will check your blood pressure more often and may place you on blood pressure lowering medication if your blood pressure continues to increase. Depending on risk factors,

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healthy pregnancy

Tobacco During Pregnancy Quitting Anytime Helps If you smoke cigarettes, quitting is one of the most important things you can do to improve your baby’s health By Roberta F. Durham, RN, PhD, and Diana Cortez, RN, BSN

Secondhand smoke is also a threat

Never too late to quit smoking or vaping

Even if you don’t smoke, secondhand smoke—other people’s smoke that you inhale—can increase the risk of having a low-birth-weight baby by as much as 20%. Small babies often have complications such as infections, trouble feeding and gaining weight, breathing problems and immature lungs. Babies exposed to secondhand smoke also have an increased risk of SIDS and are more likely to have asthma attacks and ear infections. If you work or live around smokers, take steps to avoid secondhand smoke. All secondhand exposure produced by cigarettes, e-cigarettes and vaping devices, cigars, hookah and marijuana are harmful to your health and your baby’s.

Nearly 16% of women smoke during their pregnancies. Quitting smoking before 15 weeks of gestation will help you and your baby the most; quitting at any point in pregnancy can help. E-cigarettes contain the same chemicals, like nicotine, that can harm both mom and baby. Flavors and other chemicals in e-cigarettes may also be harmful. Recently e-cigarettes (e.g., vaping) have been linked to serious lung complications. If you need help to quit, tell your nurse or provider. If staying smokefree isn’t your goal, you may want to cut down rather than quit smoking altogether. It’s true that the less you smoke, the better for your baby, however quitting is best.

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hen you smoke during pregnancy, your baby is exposed to nicotine, just one of 4,000 toxic chemicals in cigarettes that you can pass to your baby. Nicotine narrows your blood vessels and your baby gets less oxygen and nutrients through the placenta. Nicotine also can damage baby’s brain and lungs. Cigarette smoking doubles your risk of having a small baby, a baby born with birth defects such as a cleft palate, and increases the chance of preterm birth, that is giving birth more than three weeks early. Babies that are born too early may not be fully developed. Other risks include miscarriage, stillbirth and even an increased risk of sudden infant death syndrome (SIDS) once baby is born. Smoking during pregnancy doubles your risk of having a problem with your placenta. An example is placental abruption, where the placenta separates from the wall of the uterus, a dangerous complication for you and your baby. The risks of smoking during pregnancy go beyond problems in pregnancy. Children born to mothers who smoke during pregnancy are at an increased risk of asthma, colic and childhood obesity.

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healthy pregnancy

Make a Quit plaN a quit plan is your personal plan to get ready to quit smoking.

Decide on a quit day. On this day, throw away all your cigarettes or cigars, lighters and ashtrays. Choose a day within the next 2 weeks so you have time to get ready. Put the quit day on your calendar.

2 3

List your reasons for quitting. Look at this list when you think about smoking.

Know triggers that make you want to smoke. Triggers can be emotional, like wanting to smoke when you feel stressed or lonely. Knowing what your triggers are can help you learn ways to manage them so you don’t need to smoke.

Plan ahead for ways to deal with cravings. For example, what can you do instead of smoking when you have a craving to smoke?

5 6

Get rid of smoking reminders, like matches and ashtrays. Wash your clothes and clean your car.

Make use of tools to help you quit. Use apps and quitlines. Smokefree.gov has a free text message program for pregnant women who are trying to quit. It also has a free app you can download to keep you on track. Call 1-800-QUIT-NOW for advice from a quit smoking counselor. Look for programs in your community or where you work, called smoking cessation programs, that can help you stop smoking.

Tell your family, friends and loved ones about your plan to quit smoking. They can help support you.

Smoking Cessation Resources

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Visit smokefree.gov/build-your-quit-plan to get started. Here are some things to include:

XX National Alliance for

Tobacco Cessation (becomeanex.org/ pregnant-smokers.php) XX The American Cancer

Society (cancer.org/quitsmoking) XX March of Dimes

(marchofdimes.org/ pregnancy/smokingduring-pregnancy.aspx) XX National Institutes of

Health (smokefree.gov and 1-800-Quit-Now) XX Centers for Disease

Control and Prevention tips for quitting smoking (CDC.gov/quit)

RobeRTa F. DuRhaM, RN, PhD, is Professor Emeritus at California State University, East Bay, and DiaNa CoRTez, RN, bSN, is a staff nurse at the University of California, Davis Medical Center.

ISSUE 28 / 2020 Healthy Mom&Baby

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healthy pregnancy

What to Know About Pregnancy Complications By Jamie Vincent, mSn, aPRn-cnS, Rnc-OB, c-eFm

Special testing

How often special tests are done depends on your condition or your baby’s, whether the condition remains stable, and the results of the test(s). Some special tests are repeated weekly, or twice a week, starting between 32 and 34 weeks of pregnancy.

Checking baby’s movements

Fetal “kick counts” are a great way to assess your baby’s well-being and can be done at home. a common way to do a “kick count” is by lying on your side and counting each of baby’s movement. If you count 10 separate movements within 2 hours, you can be reassured. check with your provider for specific instructions on how she would like you to monitor your baby’s kick counts.

Non-stress tests

a non-stress test (nST) measures your baby’s heart rate and how

During routine prenatal visits, your health and your baby’s are closely monitored it responds when baby moves. a fetal monitor is placed on your abdomen and your baby’s heart rate is recorded over at least 20 minutes. If two or more increases (accelerations) in the baby’s heart rate occur within a 20-minute period, the results are considered “reactive” or reassuring. additional time may be needed if your baby is asleep when the monitor is placed, or the baby may need to be stimulated to move with sound projected over your abdomen. If the baby’s heart rate does not accelerate twice in 20 minutes, the non-stress test is non-reactive. Further testing may be need to evaluate your baby’s well-being.

Biophysical profiles

A biophysical profile (BPP) may be done when a non-stress test is non-reactive or when other testing is non-reassuring. a BPP includes a non-stress test and an ultrasound to evaluate the amount of amniotic fluid around the baby, the baby’s breathing movements, the baby’s

body movements and the baby’s muscle tone. Each of these five assessments are either present (2 points) or not (0 points). a score of 8-10 is reassuring. a score of 6 is “equivocal” (neither reassuring nor non-reassuring). If the BPP is equivocal, the BPP may be repeated within 12-24 hours or it may be decided your baby should be delivered. a score of 4 or less means that further testing is needed, e.g. “doppler flow studies” or your provider may advise early delivery. Not enough amniotic fluid means that more frequent testing should be done or delivery may be advised.

Modified biophysical profiles

A modified BPP may be done for the same reasons a full BPP is done. A modified BPP includes an NST and an ultrasound to measure the level of amniotic fluid surrounding the baby, i.e. an amniotic fluid index (aFI). an aFI is the total level of amniotic fluid in four areas of your uterus. If you have a normal amount of amniotic fluid and the NST is reactive, the modified BPP is reassuring. If either are not the case, a full BPP or a contraction stress test may be needed.

Contraction stress tests

a contraction stress test (cST) is performed to see how the baby’s heart rate responds to uterine contractions. mild contractions are stimulated by rubbing your

images: shut ter stocK

regnancy can be both an exciting and stressful time. Knowing your baby is growing as expected and that you have a healthy pregnancy can be greatly reassuring. Occasionally, because of a medical condition you had before pregnancy or because of a finding during a prenatal visit, your provider may want to check on your baby more frequently or add some special tests to further check your baby’s well-being.

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nipples through your clothing (your provider will instruct you how to do this) or by giving you oxytocin in an IV. Three contractions in 10 minutes are required to evaluate the test. If the baby’s heart rate

does not decrease (decelerate) after contractions, the result is normal or “negative”. If decelerations are present after most contractions, the CST is “positive” which may indicate a problem with blood flow

Reasons for Special Testing Maternal conditions XX Pre-existing or

gestational diabetes XX Chronic or gestational

hypertension XX Preeclampsia XX Lupus XX Chronic kidney disease XX Blood clotting disorders XX Heart disease

Pregnancy-related conditions XX Decreased fetal movement XX Low amniotic fluid XX Fetal growth problems XX Twins or triplets

(with certain complications) XX Previous history of stillbirth XX Rh sensitization XX Post-term pregnancy

(more than 42 weeks)

in the placenta. Other testing may be needed if the results are unclear or if not enough contractions could be stimulated to complete the CST.

Doppler flow studies

Doppler flow studies are done with an ultrasound to check the blood flow through the umbilical artery, a blood vessel in the baby’s umbilical cord. A normal test shows that there is normal blood flow through the umbilical artery. If there are problems with the blood flow, your baby may not be getting enough oxygen and your provider may advise early delivery. Although no test is 100% accurate, special testing may help reassure you and your provider of your baby’s well-being. Jamie Vincent, mSn, aPRn-cnS, RncOB, c-eFm is a perinatal clinical nurse specialist and an expert advisor to Healthy Mom&Baby.

ISSUE 28 / 2020 Healthy Mom&Baby

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Babies’ screen time increasing Screen time starts early for babies. Researchers from the National Institutes of Health found babies at 12 months averaged just under an hour of screen time daily and by the time they are 3 years old this increased to an average of 150 minutes a day. The American Academy of Pediatrics (AAP) advises against any screen time until 18 months of age and then recommends introducing digital media slowly. The AAP advises no more than an hour daily for children ages 2 to 5 years old. Children followed in the study who logged the most screen time were born to ﬁrst-time mothers and were in home-based care rather than center-based care.

What does it mean when your baby meets developmental milestones? When your baby reaches a milestone like crawling or walking or playing peek-a-boo at the recommended age, what does this mean? A new study from Boston University explored what “most children” meeting milestones by a certain age meant and found that “most” was not deﬁned nor was how often or well a child met the milestone described. The researchers found that over 90% of children in the study met the milestones, based on parental assessments, by the recommended ages. However, having demonstrated the behavior once by a certain age didn’t mean that the child demonstrated it very often. For certain milestones, only about half of children did the behaviors “very much” of the time by the recommended age. The authors of the study conclude that what it means when an individual child meets a milestone, or not, is best discussed with your child’s care provider.

Music soothes babies in neonatal intensive care Music therapy to help improve outcomes for babies born prematurely has been studied for three decades. When these babies are exposed to music in neonatal intensive care units (NICUs) they’ve been found to have shorter hospital stays, improved measures of physical condition, better feeding and fewer re-hospitalizations. A new study found that babies who received music therapy in the NICU had better long-term scores on visual and early learning tests. Not just any music is helpful. Music therapists work with families and the entire care team in the NICU to plan music that is soothing, varied, directed at baby and, if possible, live (not recorded).

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The Problem

Applying diaper cream to a baby can be very messy especially to babies on the move. With most diaper cream this is a very stcky, oily & really messy task which requires two hands to administer. Diaper cream creates a moisture resistant barrier to protect a babies sensitive skin therefore it does not simply wash off with water.

The Solution

Swabbies allows for quick and sanitary diaper changes without all the mess. Each sponge applicator is pre-filled with Swabbies Supreme Diaper Cream for a single-handed, mess-free application. This new, one-of-a-kind design was created by a mom, for busy bums on-the-go. Swabbies is pediatrician tested and approved.

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healthy babies

Your Baby’s Need for Nourishment and Comfort Make the most of your baby’s ﬁrst few months by learning to understand their needs and cues By Paris Maloof-Bury, CNM, RNC-OB, IBCLC



White noise

otherwise soothed. Closeness and comfort are crucial to baby’s brain development and their secure attachment and selfconﬁdence.



Movement (walking, bouncing, swaying)

But I just fed my baby! Can baby really be hungry again?

It’s not colic



Swaddling



Wearing baby (sling or wrapstyle carrier)



Warm bath



Sucking (comfort nursing or paciﬁer)



Position changes (when baby’s awake--upright, side-lying, on tummy)

Baby may be fed, clean and dry, but still cry when laid down, especially during the ﬁrst 3-4 months of life. Some babies are especially “needy” during certain hours of the day, often during the evening. Baby may transform from smiling to being fussy and insatiable—the baby you can’t put down or stop nursing long enough to make dinner. Experts call this the “Period of Purple Crying.” It begins at around 2 weeks of life, reaches its peak between 6-8 weeks, and mellows out by 3-4 months.

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Soothing Techniques

uring pregnancy, babies are held 24 hours a day, rocked with our movements, and soothed by the lullaby of our breath and heartbeat. After they’re born, they ﬁrst experience cold, hunger and silence. No wonder they need almost constant comfort and soothing for the ﬁrst few months.

Will holding my baby all the time or feeding more than every two to three hours spoil baby?

You cannot spoil a baby by loving them too much or by responding to their needs. Babies cry because of a need, be it for nourishment or closeness. Research tells us that it’s normal for newborns to fuss when not being held, rocked, swayed, nursed or

PARIS MALOOFBURY, CNM, RNC-OB, IBCLC, is a certiﬁed nurse-midwife and lactation consultant at Sutter Health in Davis, CA and expert advisor to Healthy Mom&Baby.

Yes, especially if your baby’s only a couple of weeks old. Or having a growth spurt. Or it’s ﬁve o’clock and you thought you’d make dinner. Babies “cluster feed” for both nutritional reasons and for comfort. Either way, frequent nursing can be normal. If you’re feeding your baby on demand and are still concerned about them getting enough milk, talk with your lactation consultant or pediatrician.

Is there anything I can do to make this phase easier for my baby—and for me?

Glad you asked! There are soothing techniques that help most babies most of the time. Not every technique will work every time (see box). Remember, if despite your best eﬀorts baby is still crying and you ﬁnd yourself becoming frustrated, it’s OK to put baby down in a safe place and walk away long enough to calm yourself down. Never, ever shake a baby. For more information on the Period of Purple Crying, please go to www.purplecrying.info.

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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 sheâ&#x20AC;&#x2122;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.

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healthy babies

Awakening Your Baby’s Senses Playing with your baby—or infant stimulation—includes activities that arouse or stimulate your baby’s sense of sight, sound, touch, taste and smell By Elizabeth “Betty” T. Jordan, DNSc, RNC, FAAN

nfant stimulation can improve your baby’s curiosity, attention span, memory and nervous system development. Playing stimulates a newborn’s senses and helps them develop and learn. Activities that arouse or stimulate their sense of sight, sound, touch, taste or smell may help your baby reach developmental milestones faster and have better muscle coordination.

Sight

Babies can tell the difference between light and dark from the moment they are born and see an image that is placed within 10 to 13 inches of their face. Try to always look at baby during feedings. In the first three months, your baby is most easily stimulated by contrasting color patterns and black and white. As babies get older, they’re stimulated by bright colors. Hanging mobiles and choosing toys that are black and white or bright colors will arouse and excite baby. Babies also like looking at themselves in the mirror.

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Sound

Babies learn about their environment through sound. Hearing is well-developed before birth. Holding your baby close to you and near your heart will be comforting and a sound that is familiar to your baby. Your baby will enjoy listening to you tell a story and will listen to your music and recognize your voice. Singing to your baby is great way

to comfort and to connect. Babies may be very sensitive to loud and abrupt noises and these noises may startle them or cause discomfort.

Touch

Touching your baby provides comfort and reassurance. Gently stroking and rocking your baby is a great way to bond with your baby. You may find that your baby responds well to a simple, soft stroke of the head, cheek or chest. Gently exercise your baby’s arms and legs, moving them smoothly and slowly. Babies also love to touch a variety of textures, fabrics and toys. They may be comforted by the feel of a stuffed animal or the corner of a blanket.

Taste and smell

Let your baby taste and smell different things but slowly introduce them in case of allergies. Babies will often know their mother by smell! Reading picture books and playing peek-a-boo with your baby are also great stimulating activities. Stimulation works best when your baby is alert and active. If you notice that your baby becomes irritated or fussy take a break. Keep your baby warm and allow your baby to rest in a quiet and calm environment. ElizabEth “bEtty” t. Jordan, dnSc, rnc, Faan, is Vice Dean, Undergraduate and Global Programs at the University of South Florida and expert advisor to Healthy Mom&Baby.

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Why vitamin D? Vitamin D helps the body use calcium and phosphorus from our diet, which helps support normal bone and teeth development as well as muscle strength. Vitamin D also helps support a healthy immune system.*

Are you and your baby getting enough vitamin D? The American Academy of Pediatrics and The National Academy of Medicine recommend that all breastfed babies receive a daily vitamin D supplement of 400 IU. For adults, including lactating and pregnant women, The Endocrine Society’s Recommended Dietary Allowance (RDA) is 1500-2000 IU of vitamin D daily.

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healthy babies

Safe Sleep Tips for Baby

Follow these recommendations to keep your baby safe whenever and wherever baby’s sleeping, based on American Academy of Pediatrics’ guidelines. By Sharon C. Hitchcock, DNP, RN-C and Melanie Welch, MSN, RN

Babies should sleep on their backs, starting from birth, every time they sleep. Swaddling is calming; make sure to do it properly. Don’t use wedges or positioners.

Share your room— not your bed—with baby. Some babies are especially at risk when they share beds with others. This list includes babies who are less than 4 months old, premature or low birth weight babies, and babies born to moms who smoked during pregnancy. It includes babies bedsharing with siblings, non-parent caregivers and anyone who smokes or has taken sedating substances. Sleeping with baby on a couch or recliner is dangerous.

Use a ﬁrm sleep surface for baby in a safety-approved crib, bassinet or playard. Bedside or “sidecar” sleepers that are government safety-approved are an option. Breastfeeding is protective! Giving baby only breastmilk for the ﬁrst 6 months is best, but any amount of breastmilk helps protect against Sudden Infant Death Syndrome (SIDS). When feeding baby at night, an adult bed with no blankets or pillows is considered safer than on a couch or recliner.

Offer baby a pacifier—it’s protective against SIDS! Wait until breastfeeding is going well (3-4 weeks) to introduce the pacifier and don’t hang it around baby’s neck or attach it to clothes. No need to reinsert if it falls out.

Keep all soft objects out of the crib or basinet, including blankets, pillows, bumper pads or stuﬀed toys. Dress baby in blanket sleepers or a swaddle sack for warmth.

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Let baby breathe clean air. Smoke of any kind around baby in the house or car is a major risk for SIDS. This includes tobacco and marijuana smoked in cigarettes, cigars or vaped.

Don’t expose baby to alcohol, marijuana or street drugs during pregnancy and after birth. The risk of SIDS increases when mom uses any of these during pregnancy or after baby is born, if either parent is using and sleeping with baby.

Don’t overheat baby. Keep room temperature comfortable for an adult and don’t dress baby in more than one additional layer to what you’re wearing. Don’t cover baby’s face or head for sleeping.

Immunizations are protective! Attend all well-baby checks and follow guidelines for baby’s vaccinations.

11 Get regular prenatal care. Going to your visits means your baby will have a lower risk for SIDS.

Don’t let baby routinely sleep in sitting and carrying devices such as car seats, strollers, swings, bouncers, carriers or slings. Babies under 4 months are especially at risk to suﬀocate in these situations.

12 Don’t use monitors marketed to reduce the risk of SIDS. These monitors haven’t been shown to reduce SIDS risk.

Provide lots of “tummy time” when baby is awake and supervised. This helps prevent ﬂat spots on the head and promotes normal shoulder and neck development.

15 Educate everyone who cares for baby about these safe sleep rules, including grandparents, relatives, babysitters, siblings and friends.

SHARON C. HITCHCOCK, DNP, RN-C is a clinical assistant professor at the University of Arizona College of Nursing and an expert nurse adviser to Healthy Mom&Baby. MELANIE WELCH, MSN, RN is a clinical instructor at the University of Arizona College of Nursing and childbirth educator at St. Joseph’s Hospital in Tucson, Arizona.

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healthy babies

health4mom.org

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Worry Less Sleep More!

It is important to understand safe sleep guidelines and how they can help protect against sudden infant death syndrome (SIDS). Setting up a good sleep environment with babies in their own crib, on their back, and with the absence of soft objects will help pave the way to prevention. Investing in reliable brands you can trust will help your child sleep and put your mind to rest.

Baby Shusher uses a real human voice to break the crying cycle and engage baby’s natural calming reflex to lull them to sleep. Used in the home and in Hospital NICUs, the Baby Shusher’s natural, rhythmic shushing sound brings the familiar sounds of a parent in the room when otherwise unable to be there. The 15 and 30 minute timer settings enable long shushing sessions to get even the most resistant sleepers to sleep. www.babyshusher.com/HMBS

As parents, we do everything possible to keep our children safe and while It’s important to remember the risks associated within the crib. We should also be aware of injuries that could occur from an infant’s quick decision to climb-out and potentially face injuries from a fall. The Safell Dream Catcher is an inflatable bumper that surrounds your baby's crib and provides a safe, soft place for your baby to land if they were to decide to climb out. With eight inflatable sections, it can be configured to any nursery layout. www.safell.org/HMBS

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healthy babies

NAVIGATING VACCINE DECISIONS FOR YOU AND YOUR FAMILY By Candice Robinson, MD, MPH

Vaccines During Pregnancy

When you are pregnant, you share everything with your baby. That means that when you get vaccinated, you are not just protecting yourself—you are giving your baby some early protection too. The Centers for Disease Control and Prevention (CDC) recommends the following for pregnant women: ➤ Whooping cough (also called Tdap) vaccine during your 27th through 36th week of pregnancy, preferably during the earlier part of this time period. When you get the Tdap vaccine during pregnancy, your body creates protective antibodies and passes some of them to your baby before birth. These antibodies provide your newborn some short-term, early protection against whooping cough. ➤ Flu (influenza) vaccine any time during pregnancy. Note that pregnant women should get a flu shot, not the nasal spray flu vaccine. 60

Vaccines can help protect you and your family from dangerous diseases during your pregnancy as well as through your child’s ﬁrst years of life and beyond. Here is some information to consider as you navigate making decisions about vaccines CANDICE ROBINSON, MD, MPH, works for the Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases.

Changes in your body during pregnancy make you more likely to get seriously ill from the flu. The flu can also cause serious problems like premature labor and delivery. Get the flu shot if you are pregnant during flu season—it’s the best way to protect yourself and your newborn baby for several months after birth.

Vaccines for Your Baby

Vaccination is one of the best ways you can protect your baby from 14 serious childhood diseases before age 2. The CDC sets the immunization schedule in the United States. It’s a good idea to review this schedule before your baby’s ﬁrst shot visit so you know what to expect and can write down any questions you want to ask at your baby’s next appointment. Diseases that vaccines prevent can be very serious—even deadly—especially for infants and young children. For example, a high number of measles cases and outbreaks have been reported in the U.S. so far in 2019. Measles is very contagious. Anyone who is not vaccinated is at risk of getting infected, including babies who are too young to receive their measlesmumps-rubella (MMR) vaccine (the ﬁrst dose is normally given between 12 and 15 months of age and the second dose is given between 4 and 6 years old). It is very important to stay up to date on your baby’s vaccinations. It can take weeks

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regnancy and parenthood are full of excitement. They can also be challenging as you navigate some new areas, like babyprooﬁng, breastfeeding, sleep routines, and so much more. This may include what to do about vaccines—there is a lot of information out there, and it can be hard to know what to believe.

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healthy babies for a vaccine to start working, and some vaccines require multiple doses. If you wait until you think your baby could be exposed to a serious illness—like when they start childcare or during a disease outbreak— there may not be enough time for the vaccine to provide protection.

Finding Credible Information

It’s normal to have questions about vaccines. If you are already a parent, talk to your child’s nurse or doctor. If you are pregnant, ask your obstetrician or midwife about vaccines during pregnancy. If possible, ﬁnd a doctor for your baby early, so you can schedule a prenatal consultation and ask questions about infant vaccines.

Questions to ask your nurse:

There is a lot of vaccine information online, but not all of it is credible. Here are some sources that you can trust:



Which vaccines do I need during pregnancy?

• Healthy Children—from the American Academy of Pediatrics (healthychildren.org)



Is my child up to date on her shots?

• CDC’s website (cdc.gov/vaccines)



What side eﬀects can I expect after my child gets her shots?

• Vaccine Education Center at the Children’s Hospital of Philadelphia (chop.edu/centers-programs/ vaccine-education-center)



What other shots will my child need as she gets older?



Which diseases are these shots preventing?



Which vaccines are important for my partner and other caregivers?

Part of becoming a mom is learning how to navigate all kinds of important health decisions for your family. Learn more about vaccines so you can keep yourself and your family on track for a long and healthy life.

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Winix 5300-2 An air purifier with the correct filter can help contain allergens and dust to keep your baby breathing purer air, as well as diaper odors or other unpleasant smells. The Winix 5300-2 has carbon filters to capture odors and is fitted with a true HEPA filter for all fine particles.

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NATURELO PRENATAL MULTiviTAMiNs

You want only the best for your baby. NATURELO is a trusted brand of high-quality vitamin supplements than can provide proper nourishment for your growing child. The NATURELO Prenatal Multivitamin contains Folate, Iron, Plant Calcium & DHA to support mom’s health & well-being, as well as, nourish the baby’s developing brain, heart, and bones.

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ISSUE 28 / 2020 Healthy Mom&Baby

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healthy babies

Caring for Baby’s Skin From birth, keeping baby’s skin healthy is a daily job By Catherine M. Hill, MSN, FNP-BC

ISSUE 28 / 2020 Healthy Mom&Baby

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healthy babies told you otherwise, it’s OK to immerse baby’s cord stump in the water when bathing baby in a tub. If your baby was born early (before 37 weeks), consider swaddling baby for bath times, and limit baths to a few minutes as preterm babies struggle to hold a healthy, normal body temperature. Have warmed towels prepared to immediately wrap baby in following the bath.

Skin protection

Choosing a babyfriendly product

Protect baby’s skin from irritation or break down with the following practices: Bathe baby every few days, not daily.  Use skin products that don’t irritate baby’s skin. If you have a family history of skin rashes or infections be especially careful to protect baby’s skin.  Keep the nature-made, white, creamy coating called vernix intact from birth; there’s no need to rub or wash it oﬀ. Vernix protects baby’s skin, acting as baby’s ﬁrst barrier cream; it moisturizes baby’s skin by increasing its ability to hold water, keeping baby’s skin supple and soft. Yes, it’s sticky. Let it absorb naturally into baby’s skin over the early days. 

Bathing baby

Bathe baby about 3 times a week—or every other day—for the ﬁrst month of life if all is healthy and well with baby’s skin; shampoo baby’s hair only once or twice weekly. Bathe baby in a warm room away from drafts. Place tub, towels, blankets and bath products within reach. Keep baths short—5-10 minutes at ﬁrst—so baby doesn’t get cold. Unless your healthcare provider has

Use products designed for baby’s skin only as they can be protective, help baby’s skin retain water, remain soft and supple and improve how baby’s skin barrier works. They’re also less likely to sting baby’s eyes. Adult products aren’t designed for baby’s skin.



Use as few products as possible—more is not better when it comes to baby’s skin.



Choose safe products that contain tested ingredients. “Organic,” “green” or “natural” don’t always mean “safe” when it comes to baby’s skin. These are marketing terms, not deﬁned or regulated by the federal government. Plant-based products aren’t necessarily safe or safer for newborn skin and, in fact, may be allergenic or toxic to baby’s skin.



Keep skin issues at bay, such as eczema (allergic contact dermatitis), which is the most common skin condition resulting from the use of herbal therapies.



CATHERINE M. HILL, MSN, FNP-BC, is Director of Evidence-Based Practice for the Association of Women’s Health, Obstetric and Neonatal Nurses and a family nurse practitioner.

Bath time basics

1 2

Begin by washing your hands

Place baby’s bathtub in a warm room, safe space and on a strong surface

Use warm—never hot—water (100–104°F); check the water temperature with a bath thermometer. Swirl the water to eliminate any hot spots

4 5

Always support baby’s head and neck during bathing

To shampoo, ﬁrst wet baby’s hair, then apply a baby-safe shampoo gently with your hand. Lightly massage baby’s scalp with your hand or a soft baby brush, and rinse with water moving down the back and sides of baby’s head. Don’t put pressure on the soft spot–known as the fontanel–on baby’s head

While holding baby, lower them into the water feet first. Allow baby to rest on your arm or supported by the tub with the water just up to their shoulders. If baby’s tub specifies different instructions, follow the instructions with your baby’s bathtub

Begin with a clean cloth; wash baby’s face ﬁrst, body second and diaper area last. Always wipe away from the eyes and mouth and then into the creases as you go behind their ears, around their neck, into their underarms, between their ﬁngers and toes, and in their diaper area

Gently rinse baby’s body with your hands or a soft cloth, moving from head to feet, ensuring no soap is left behind

Move baby from their bath into a towel or blanket; pat their skin dry rather than rubbing it. Once dry, dress baby to keep them warm

IMAGES: SHUT TER STOCK

aby’s skin protects them from bacteria and germs, and helps them hold a normal temperature. At birth, your baby’s skin is thinner than your’s, and will continue to thicken and change through their ﬁrst birthday. Babies born more than 3 weeks early may need as many as 9 weeks after birth for their skin to fully work as a barrier so they stay warm and hydrated.

health4mom.org

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HEALTHY MOMS. STRONG BABIES.

FIND SUPPORT AND RESOURCES DURING THE COVID-19 PANDEMIC As the country adjusts to new public health guidelines, moms and moms-to-be want to best prepare for childbirth and infant care while optimizing the health and well-being of themselves and their children, including newborns. Whether pregnant, a new mom or looking to get pregnant, March of Dimes is here as a reliable resource and support system during the COVID-19 pandemic so women and their families can: • • • •

Access and share COVID-19 resources and tools online Take action virtually to step up for moms and babies Give voice to honest stories of pregnancy, parenting and loss Support the urgent need for COVID-19 research, advocacy, education, resources and support

LEARN MORE AT MARCHOFDIMES.ORG/COVID19

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

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