Healthy Mom&Baby: Issue 20 by Healthy Mom&Baby

ISSUE 20 / Summer 2016 | $3.95 | health4mom.org

PREGNANCY | BIRTH | PARENTING

PREPARE FOR ZIKA SAFE BABY SOOTHING

Support Our Diaper Drive

5.3 million children need your help at DiaperDrive.org

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Probiotics Can Improve Your Newborn’s Health Feel your best and give your baby a healthy start at life with probiotics The key to finding radiant health during pregnancy (and beyond) may start with the presence of good bacteria that live in your gut environment. Scientific research confirms that not only does maternal gut flora influence our overall health, but it establishes the foundation of health for our children as well.* Because babies are nearly sterile in utero, as much as 90% of the beneficial bacteria that supports a child’s health throughout his or her life stems from what we, as mothers, pass Did you know? on to them during birth and through breast milk.

Babies get their good bacteria from mom during birth and through breast milk.

The problem? Many factors can signiﬁcantly impact our good gut ﬂora such as age, stress, diet, certain medicines, and overzealous hygiene habits.

That’s why midwives and practitioners around the country are recommending probiotics as one of the top supplements to take to encourage healthy, happy pregnancies and the best beginnings for little ones. Created for expecting and nursing mothers, Hyperbiotics PRO-Moms can help naturally restore beneﬁcial ﬂora and encourage optimal health and wellness for both mom and baby. *Mueller, N., Bakacs, E., Combellick, J., Grigoryan, Z. and Dominguez-Bello, M., 2015. The infant microbiome development: mom matters. Trends in Molecular Medicine 21: 109-117.

Collado, M.C., Rautava, S., Isolauri, E. and Salminen, S., 2015. Gut microbiota: a source of novel tools to reduce the risk of human disease? Pediatric Research 77: 182-188.

Santacruz, A., Collado, M.C., García-Valdés, L., Segura, M.T., Martín-Lagos, J.A., Anjos, T., Martí-Romero, M., Lopez, R.M., Florido, J., Campoy, C. and Sanz, Y., 2010. Gut microbiota composition is associated with body weight, weight gain and biochemical parameters in pregnant women. British Journal of Nutrition 104: 83-92.

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PRO-Moms provides the targeted strains moms need along with kiwifruit powder, a natural superfood ingredient that nourishes the good bacteria in your system so it can get to work beneﬁting you and your child at the microbial level. Our little ones deserve only the best. PRO-Moms can give you the tools you need so that you can focus on what matters - enjoying your pregnancy and your new baby. Probiotics can support expectant and nursing moms by: • Promoting optimal immune response of mother and child • Supporting healthy glucose levels • Reducing the dreaded pregnancy-related constipation • Producing folate (the non-synthetic version of folic acid) • Encouraging shedding of the baby weight • Promoting proper nutrient absorption • Supporting balanced mental and emotional function • Increasing the odds of successful breastfeeding

Enjoy $10 off PRO-Moms by entering checkout code:

HEALTHYMOM www.hyperbiotics.com Important Notice: Hyperbiotics’s products are not meant to diagnose, treat or cure any disease or medical condition. These statements have not been evaluated by the Food and Drug Administration. Please consult your doctor before starting ANY exercise or nutritional supplement program or before using these or any product during pregnancy or if you have a serious medical condition.

23/02/2016 14:40

S u p po r t Our Diap er Drive! Page 52

( CONTENTS )

50 5.3 Million Children Need Diaper Donations

Support our Healthy Mom&Baby Diaper Drive for families who can’t afford enough diapers

healthy moms

healthy pregnancy

11 Fight the Mosquito Bite!

29 Healthy Pregnancy Foods

13 Conceiving After Birth Control

Optimal nutrition is the goal as you’re eating for baby’s growth and development

31 Pilates in Pregnancy

Here’s when most women are able to conceive after stopping birth control

This popular exercise also helps you recover post-birth

14 Yikes—A Yeast Infection!

34 Will I Poop in Labor?

They’re so uncomfortable yet so treatable with this advice

17 Create Lasting

Relationships

Emotional intimacy is critical to building deep relationships

49 Explore Baby Sign Language You can start communicating long before baby’s first words

Issue 20 / Summer 2016

Protect yourself and your family from diseases mosquitoes carry

healthy babies

Birthing is messy; here’s what might happen

36 These Tests Screen Baby in Pregnancy

52 Diapers Make a Difference

Meet two moms who are working through diaper need for their families

58 Nursing Through Nipple Pain

Stop nipple pain before it starts with these simple steps

61 Safely Soothe Your Baby

Dozens of ways to shush and calm a fussy baby

66 Daddy & Baby Time

These bonding tips are perfect for guy time

Learn about these common tests and screens for your baby in pregnancy

39 Alternative & Homeopathic Remedies

Explore options for all that ails you week by week as baby grows

42 Pain Killers in Pregnancy If you’re using pain killers, so is baby; here’s how opioids affect you both

45 Delay Clamping Baby’s Umbilical Cord

Why it’s best to wait before clamping and cutting baby’s cord at birth

Work. Pump. Repeat. Here’s Your Plan.

Latch on to Jessica Shortall’s book Work. Pump. Repeat.; it’s empowering breastfeeding moms as they return to work post-birth with a pumping plan in hand.

FEATURE

ISSUE 20 / Summer 2016 Healthy Mom&Baby

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Join us on Facebook facebook.com/HealthyMomAndBaby

HEALTHY MOM&BABY EXPERT ADVISORY BOARD CANDACE ANN CAMPBELL, DNP, RN, CNL University of San Francisco Concord, CA ROBERTA DURHAM, RN, PhD California State University East Bay Hayward, CA JOANNE GOLDBORT, PhD, RN Michigan State University East Lansing, MI HELEN M. HURST, DNP, RNC-OB, APRN-CNM University of Louisiana School of Nursing Lafayette, LA ELIZABETH JORDAN, DNSc, RNC, FAAN University of South Florida College of Nursing Tampa, FL CAROLYN “CARRIE” LEE, PhD, MSN, CNE, RN University of Toledo College of Nursing Toledo, OH JENNIFER LEMOINE, DNP, APRN, NNP-BC University of Louisiana at Lafayette Lafayette, LA CYNTHIA LORING, MS, RNC, CLC Perinatal Consultant Enf ield, NH RITA NUTT, DNP, RN Salisbury University Salisbury, MD SUSAN PECK, MSN, APN Summit Medical Group Cedar Knolls, NJ MICHELE SAVIN, MSN, NNP-BC Christiana Health Services Wilmington, DE PAT SCHEANS, MSN, NNP Legacy Health System Portland, OR SHARON JEAN SCOTT, DNP, MSN, RN Germanna Community College Locust Grove, VA JAMIE M. VINCENT, MSN, RNC-OB, C-EFM John Muir Medical Center Walnut Creek, CA KIMBERLY WILSCHEK, RN, CCE Medical Revenue Solutions Chicago, IL CHARLOTTE WOOL, PhD, RN, CCNS York College of Pennsylvania York, PA

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TAMERA YOUNG, RN, MSN Central Ohio Technical College Zanesville, OH

CONSUMER ADVISORS MARIA OPLT Lafayette, LA

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 SUZANNE “SUZE” KETCHEM, MSN, RNC-OB, CNS

Help Nurses Ensure Every Baby Has

Enough Diapers

In downtown Cincinnati, a mom chooses between paying the electricity bill or buying enough diapers to keep her infant in childcare so that she can go to work. Across the country, two new parents are anxious to take their newborn home. Before leaving the hospital, they ask their nurse if she has any extra diapers they can take with them—diapers are expensive, they say, and they’re worried about having enough in the coming weeks. Nurses see families in need every day—1 in 3 American families struggle to buy all of the diapers they need for their youngest children. And every day, throughout the country, nurses are involved in collecting and donating infant essentials, like diapers, that help their tiniest patients stay clean, dry and healthy. In a recent survey, mother/baby nurses told AWHONN that they’re actively involved in collecting and donating diapers, wipes, clothes, food and car seats for families in need in their communities. In response to their efforts, AWHONN last year started the Healthy Mom&Baby Diaper Drive—which counts and shares the stories of nurses meeting needs across the country. To date, more than 230,000 diapers have been donated to our partner, the National Diaper Bank Network, with the support and help of our sponsor, Huggies®.

How You Can Help Helping families in your community is as simple as 1-2-3: 1 Purchase and donate diapers to a diaper bank near you; find one at DiaperDrive.org 2 Make a $10 donation to buy a week’s worth of diapers at DiaperDrive.org 3 Make your donation count—share what you’re doing in your own community to help families around you; for a list of tweets and posts, go to DiaperDrive.org.

Share The Need Share what you’re doing in your own community to motivate others to help. Popular tweets and posts include: • 5.3 million babies in America are aﬀected by diaper need. Help end this now by donating at DiaperDrive.org! • Toddlers-in-need can’t go to preschool without a “diaper stash.” Your $20 donation=2 weeks of diapers needed to attend at DiaperDrive.org. • 1/3 of American families can’t aﬀord enough diapers. Join Healthy Mom&Baby to end diaper need at DiaperDrive.org. Tag your efforts with #DiaperNeed and #Nurses4Babies. Diaper Need Awareness Week begins the last week of September every year. But nurses are actively giving diapers to families in need year-round, right where they live and provide care. Please join in our efforts; together, we can Wipe Out Diaper Need.

{ } SUPPORT THE HEALTHY MOM&BABY DIAPER DRIVE AT DIAPERDRIVE.ORG.

SUZANNE “SUZE” KETCHEM, MSN, RNC-OB, CNS, is the AWHONN 2016 President.

ISSUE 20 / Summer 2016 Healthy Mom&Baby

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Protect Your Baby from Zika

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By now you know Zika is spreading through the US, and mosquitoes are their most active during the summer. You may be wondering how you can protect your baby from Zika if you’re already pregnant or if you’re trying to

Senior Editor: Hannah Guinness Editor: Jess Smith Junior Editor: Kayley Loveridge

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for 4 issues! Go to health4mom.org/magazinesubscription or fill out the form below: Please send me 4 issues of Healthy Mom&Baby for $13.95. Name: Address:

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Suzanne “Suze” Ketchem, MSN, RNCOB, CNS Chief Executive Offi cer:

Lynn Erdman, MN, RN, FAAN Vice President; Marketing, Communication & Publications:

Tom Quash, CAE

Editor & Director of Publications:

Carolyn Davis Cockey, MLS Director of Women’s Health:

Catherine Ruhl, CNM, MS Editorial Coordinator & Writer:

Summer Hunt

Printed in the United States on paper made with 30% post-consumer recycled fiber. Please recycle this magazine!

City: State/Zip: Check One: Credit Card Card Type: Name on card: Credit Card No: Exp. Date: Signature:

Healthy Mom&Baby is published by Maitland Warne in partnership with AWHONN. © AWHONN, 2016. 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

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conceive. As of this note on the first day of summer, there were 3 babies born with the devastating birth defects caused by Zika in the US; 3 pregnancy losses have also been attributed to Zika. In sum, more than 234 women have tested positive for Zika in the US. Keep up with the latest information from the Centers for Disease Control and Prevention at cdc.gov/zika. And follow these simple tips from the CDC to ensure you create the safest possible environment for your baby away from the harmful effects of the Zika virus:  Talk to your healthcare provider if you’re pregnant now or thinking about becoming pregnant; together, you can come up with all of the situations in which you’ll need to prevent coming into contact with the virus  Protect yourself from mosquitoes; we’ve got the latest tips on p. 13, and you can always find the most current advice at bit.ly/zikaupdate  Know you can become infected with Zika virus through sex: Use condoms every time you have sex, or avoid sex altogether during pregnancy. The virus lives longer in semen than blood, and experts are unsure for how long the virus can infect people. If your partner has traveled to an area with a Zika outbreak, avoid sex for at least 8 weeks; avoid unprotected sex for at least 6 months if your partner has been diagnosed with or has symptoms of Zika. Keeping you healthy and safe through conception, pregnancy, labor and birth is the goal of the AWHONN nurses who write Healthy Mom&Baby. Find more advice from nurses online at Health4Mom.org. Until next time,

EDITOR IAL

AWHONN Carolyn Davis Cockey, MLS carolyndc@awhonn.org 1208 Western Pine Circle Sarasota, FL 34240 Tel: (877) 377-5326 www.AWHONN.org

Carolyn Davis Cockey, MLS Editor & AWHONN Director of Publications Health4Mom@AWHONN.org

ISSUE 20 / Summer 2016 Healthy Mom&Baby

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Join us on Facebook facebook.com/HealthyMomAndBaby

Moms BY SUMMER HUNT

Periods—end of story? Tired of your monthly visitor? Experts say there’s no medical need to have a period when you’re on contraception. In fact, the bleeding you experience while on the pill isn’t really a period at all; you’re just shedding the lining of your uterus. To send Aunt Flo on an extended vacation, skip the “placebo” pills in your birth control pack, or consider a hormone shot, a hormonal IUD, or an implant in your arm. These aren’t necessarily guaranteed to help you send Aunt Flo packing for good, though. You may still experience spotting or unscheduled bleeding when you begin one of these methods. Right now, there’s no evidence that skipping your time of the month will af fect your future fertility; research still needs to be done on long-term ef fects of stopping menstruation. If you’re still full of question marks about your period, talk to your nurse or other care provider.

As a w oma n , you’ll s 6 yearpend s of your li fe hav ing period s.

Weight loss and PCOSrelated infertility

IMAGES © 123RF

Women struggling to get pregnant while battling polycystic ovarian syndrome (PCOS) may have better odds if they lose weight before beginning infertility treatments, say researchers at the National Institutes of Health. In a review of two studies, women who started a weight loss program before clomiphene to induce ovulation were 2.5 times more likely to have a baby.

BREATHE EASIER WITH YOGA! If you’re already bending over backward to balance your asthma issues, you could breathe a little easier with a regular yoga regimen. A team of Cochrane researchers found evidence that yoga reduces the effects of asthma on your quality of life. But don’t toss that inhaler in favor of more downward dog just yet—the study’s lead author says it’s unclear if yoga has a consistent impact on lung function, or if it can reduce people’s medication usage.

TS 5-10% OF PCOS AFFEC GES 18-44 WOMEN A

ISSUE 20 / Summer 2016 Healthy Mom&Baby

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ZIKA WHAT YOU NEED TO KNOW ABOUT REPELLENTS To protect you and your family from the Zika Virus, the CDC recommends using DEET or Picaridin on exposed skin, and Permethrin on clothing and fabric, all of which are safe and approved by the EPA for use by pregnant women. Sawyer’s line of family friendly* insect repellents are all compatible with sunscreen and help provide the best protection from disease carrying mosquitoes.

PERMETHRIN Sawyer’s pharmaceutical grade permethrin is the synthetic version of naturally occurring Pyrethrum from the chrysanthemum flower. • Treat you and your child’s clothing, strollers, blankets, and any other fabric for protection from disease carrying mosquitoes and ticks. • Odorless after it dries. • One treatment lasts 6 washings on clothing or 6 weeks of sun exposure. PICARIDIN The new gold standard for topical insect repellents, available in both lotion and spray. • Effective on mosquitoes and ticks as well as biting flies, gnats, chiggers, fleas, and more. • Won’t damage plastics or materials. • Comfortable lotion which offers 14 hours of protection with a mild citrus scent. DEET If you prefer DEET over Picaridin, use Sawyer’s Controlled Release Family Formula. • The only DEET formula proven to reduce the absorption of DEET into the skin. • Reduces DEET absorption in the skin by 67% per application. • Comfortable, odorless lotion which protects up to 11 hours. * Protect infants aged <2 months from mosquitoes by using an infant carrier draped with mosquito netting with an elastic edge for a tight fit (CDC).

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healthy moms

prevent

Mosquito Bites By Carolyn Davis CoCkey, Mls

While the headlines may have you concerned about Zika virus, did you know you can also contract other diseases including West Nile virus, malaria, dengue fever, chikungunya and Eastern equine encephalitis from mosquitoes and their bite? Avoiding mosquito bites is best prevented through insect repellents, experts say, and the most effective products for the longest period of time typically contain either DEET, icaridin or lemon-eucalyptus oil containing p-menthane-3,8-diol, say researchers who compared the effectiveness of popular products last fall and published their work in the Journal of Insect Science. You probably already know it’s best to avoid the outdoors at dawn and dusk, when mosquitoes are most active. But did you know that the Aedes mosquito that carries Zika virus is active throughout the day? This makes wearing insect repellent and light, layered and loose clothing a must anytime it’s mosquito season. Home and HealtH protection Minimize your exposure to mosquitoes by keeping them away from your home. Mosquitoes lay eggs in standing water, so change the water in your pots and birdbaths at least weekly, and empty any other containers of standing water—such as your little ones’ swimming pool—at least weekly as well. Use sunscreen daily but skip products that include insect repellent— add that only after you’ve applied your sunscreen. Shower or bathe to remove insect repellent as soon as you’re done being outdoors for the day.

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mosquito Bite Warning signs Most mosquito bites emerge as the common puffy, reddish bump with a raised fluid-filled center that itches like crazy, even more so if you scratch it—so don’t. Scratching a bite can lead to infection. Seek health care if mosquitoes have bitten you and you’re having any of the following symptoms: B Increasing swelling and redness around the bite B Red streaks near the bite B Fever of 100 degrees or more B Headache B Feelings of flu or tiredness B Hives treating mosquito Bites Most bites will clear on their own in time, but if the symptoms are too bothersome, try: B Over-the-counter antihistamine, like Benadryl® B Anti-itch lotion or ointment, or over-the-counter hydrocortisone cream B Homemade paste of baking soda and water B A cold compress or ice pack applied for a few minutes

mosquito safet y do’s and don’ts

Use insect repellent—as directed on packaging; use permethrin only on your clothing, not your skin

Don’t use DEET on an infant age 2 months or younger

Avoid the outdoors at dawn and dusk

Avoid lemon eucalyptus oil on children ages 3 and younger

Wear loose, lightcolored protective clothing

Avoid getting insect repellent on children’s hands and faces

Don’t apply insect repellent under your clothing, or on wounds or cuts in your skin

Drain standing water around your house— clear the gutters, downspouts, pots and birdbaths at least weekly

Use mosquito netting over car seats,strollers

Repair all screens so they’re bug tight Source: CDC, Mayo Clinic

CARolyn DAvis CoCkEy, Mls, is editor of Healthy Mom&Baby.

ISSUE 20 / Summer 2016 Healthy Mom&Baby

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CONCEIVING

After Birth Control BY SUSAN PECK, MSN, APN

So, you’ve made the decision to stop birth control in hopes of starting or expanding your family. The good news is that having been on birth control doesn’t create problems for women who want to conceive.

IMAGES © THINKSTOCK

Most women fi nd that their menstrual periods return to what they were like before birth control and that their fertility returns to allow them to conceive within a year when trying to do so. Contraceptive Pills, Rings and Patches Contraceptive pills, rings and patches stop ovulation so that you don’t release an egg. Once you stop these contraceptives, your ovaries become active again and work to mature and release an egg. You can begin trying to conceive as soon as you stop these contraceptives. Typically, within 3 months of stopping, most women have had a spontaneous period, and many are pregnant already! It’s defi nitely a myth that you need to stop these contraceptives for any period of time before trying to conceive. If you’ve had a history of irregular periods or are age 35 or older, conceiving may take longer because of the age of your ovaries and overall health—not the use of contraceptives. In rare cases, “post-pill amenorrhea” may happen; this means your menstrual period doesn’t return after the use of the pill. See your healthcare provider if you stopped the pill, patch or ring and your period doesn’t return within 3 months. It may necessary to check your hormone levels or perform other tests. Depo-Provera Injection Similar to the pill, patch or ring, Depo-Provera stops ovulation. Depo-Provera is injected every 3 months but the eff ects on your body last longer. After your last injection, it will take at least 12 weeks

for your ovaries to become active again. And for most women, it takes 4-5 months for ovulation to return. The average length of time to conception after the last injection is 10 months but could be as long as 18-24 months. If you’re on Depo-Provera now, take these timeframes into consideration as you’re thinking about conceiving. IUDs The copper IUD, ParaGard, doesn’t contain any hormones, so ovulation still happens. If your menstrual periods are regular each month, you should assume that your fertility has returned and pregnancy can happen after this IUD is removed. The IUDs Mirena, Skyla and Liletta suppress but don’t entirely stop ovulation as they contain the hormone progestin. This is why your monthly periods may or may not happen even though ovulation is still occurring most months. After these IUDs are removed, most women who are trying to conceive (77% or more) will become pregnant within 1 year. Contraceptive Implant Nexplanon, the contraceptive implant that’s inserted into your upper arm, works by preventing ovulation most months. Regular ovulation restarts and pregnancy can occur typically right after it’s removed. In fact, the hormone from the implant may be gone as soon as 7-14 days after removal. SUSAN PECK, MSN, APN, is an expert adviser to Healthy Mom&Baby.

ISSUE 20 / Summer 2016 Healthy Mom&Baby

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healthy moms

! s e k Yi

is it a yeast infection?

Most of us don’t think about our vaginas during our busy days; however, when it starts to feel just plain angry, you can’t help but stop and notice! Did you know that 75% of women will experience a yeast infection? That means, gentle reader, you likely already know all too well how irritating and distracting this infection can feel. The remedy? Understand yeast infections and what you can do to keep your vagina happy and healthy.

Vaginal infections in Pregnancy If you’re having symptoms of a vaginal infection during pregnancy, contact your healthcare provider before self-treating. Yeast infections are common during pregnancy because high estrogen levels promote the growth of yeast. While you may not be comfortable, these infections won’t harm your baby. Most treatments are even safe during pregnancy, but please check with your care provider before using any treatment during pregnancy.

Why the itch?

Your vagina is home to yeast, which is technically a fungus. In fact, yeast and bacteria live together in the vagina preventing infections and keeping you comfortable by maintaining a normal pH, which is a technical term to say that yeast and bacteria are in harmony—not too much of one or too little of the other. When that balance is disrupted and yeast overgrows, symptoms like itching, burning, soreness and swelling can happen. You may also see vaginal discharge that looks like cottage cheese—and it should be odorless. If it has a foul, fishy odor, you’re more likely to have a bacterial infection. Many things can upset the yeast-bacteria balance: B Antibiotics B Over-cleaning the vagina (especially on the inside with a douche) B Pregnancy B Birth control pills (because of higher estrogen levels) B Uncontrolled diabetes B Lingering in wet bathing suits or wet underwear after exercise B Impaired immune system

images: 123RF

BY SuSan Peck, MSn, aPn

health4mom.org

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healthy moms Some women notice yeast symptoms after sex, especially after receiving oral sex, but don’t worry—this doesn’t mean you’ve gotten this infection from your partner. Oftentimes, a yeast infection just happens without a specific cause.

Yeast or Bacterial infection?

If you’ve had a yeast infection before and are certain your symptoms are similar, you can try using an over-the-counter remedy. See your healthcare provider if you’ve never had a yeast infection before, or if you suspect it may be something else. Most women’s health care providers can diagnose a yeast infection just by looking at and in your vagina. Sometimes, a sample for testing is needed to confirm the type of infection. This involves a swab inside your vagina, which may be uncomfortable because your vagina is already irritated but shouldn’t hurt. Most healthcare practices can examine the sample under a microscope while you’re there, but it may need to be sent to a lab for diagnosis. Maybe you’ve considered using one of the home test kits that can measure the pH of the vagina. These can be problematic because even if you find changes in your vaginal pH, it doesn’t always mean you have an infection. Semen and blood can change your vagina’s pH. As possible, see your healthcare provider for a certain diagnosis and the best treatment for you.

treating Vaginal infections

There are lots of drugstore and prescription options for treating a yeast infection: B Creams B Suppositories B Vaginal tablets B Medications If you’re certain you have a yeast infection, and it’s not one that keeps repeating itself in your vagina and you have no other health issues going on, try an over-the-counter yeast infection kit, which usually come in 1-, 3- or 7-day dose packages. Use these treatments at bedtime; they can be messy and leak out of your vagina. Some common treatment options also come with a topical vaginal cream to use outside your vagina to soothe the itch. Prescription creams are very similar to the options you can get in most stores but may be stronger or contain a steroid to help resolve the itch and burning more quickly. Protect yourself from pregnancy if you’re using a cream to treat a yeast infection as the cream can damage latex condoms or diaphragms. For severe infections, or if you’re sensitive to creams, your healthcare provider may prescribe a single-dose pill you take with water called fluconazole. This medicine kills fungus throughout your body, including your vagina. You should, know, though that the FDA is currently evaluating data that suggests that oral fluconazole taken during pregnancy may increase the risk of miscarriage.

Home remedies

Some blogs and websites suggest tea tree oil, yogurt-soaked tampons, garlicky vaginal suppositories, douching with vinegar, coconut oil or oregano oil to cure a yeast infection. Do they work? While they’re

PreVenting Yeast infections Maintaining a perfectly balanced vaginal pH is the best way to keep yeast infections away. Simple ways to promote a healthy pH include: B Wear cotton underwear not nylon underwear and thongs B Avoid using panty liners every day B Never douche or use scented “feminine hygiene products” B Change out of wet clothes, such as swimsuits or exercise shorts, as soon as you can B Avoid unnecessary antibiotics B Don’t “over-clean” the vagina Your vagina is self-cleaning! Cleanse around the vagina with just warm water and a mild unscented soap on the outside only. No internal cleansing is necessary—in fact, it can disrupt that important pH! Researchers are currently studying whether probiotics can help maintain the right vaginal pH and prevent yeast infections, but the evidence is still being collected as to whether probiotics are useful in this way.

unlikely to harm you, they simply haven’t proven to help. Once you agree on a treatment with you healthcare provider, always finish the entire treatment and be patient—it can take several days before you’re feeling better!

reoccurring infections

For most women, yeast infections will go away as quickly as they started. But sometimes, an infection comes back over and over again. If this happens, it’s important to be examined by your care provider to make sure your immune system is healthy and that you don’t have diabetes. You may need special tests and an extended treatment, such as a weekly prescription vaginal cream or oral tablet for 4-8 weeks; another option is treatment with a boric acid suppository. Boric acid is an antiviral/antifungal crystalline powder that is placed in a gelatin capsule and inserted into the vagina. In rare cases, if all treatments fail, you may need to be evaluated by a vaginitis specialist, a healthcare provider who focuses on severe recurrent infections.

SuSan Peck, MSn, aPn, is an expert adviser to Healthy Mom&Baby.

ISSUE 20 / Summer 2016 Healthy Mom&Baby

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ACTIONS TOWARD DEEPER RELATIONSHIPS BY STEVEN DESALVO

healthy moms

BE PRESENT When we’re completely present, we value our relationship and our time together. Intimacy is single-tasking, not multitasking.

LIMIT DISTRACTIONS Turn off your mobile and other devices and give your full undivided attention. Interruptions and distractions break the connection that only your undivided attention can bring.

SHARE YOUR TRUTH Bring as much truth and honesty as your relationships will allow. Gradually shared truth over time develops even deeper levels of intimacy in our relationships.

4. BEGIN WITH LISTENING Allow a person to speak uninterrupted. Listening allows you a deeper understanding of what is being said and strengthens your connection.

5. BE AUTHENTIC Trying to please other people when it goes against who we are, or what we believe, eventually hurts us in relationships. Speak and behave from your authentic self. It’s better to be disliked for who you truly are than liked for who you are not.

LIVE YOUR WORDS We betray others when we say one thing and then do another. Align your words with your actions for deeper trust and intimacy.

COMMUNICATE FEELINGS What you feel communicates more about you and builds deeper intimacy versus sharing your thoughts alone. When we communicate our feelings with others, they feel it, and we feel it, and together we develop deeper, more intimate connections.

Intimacy in our relationships occurs when we’re able to be honest with ourselves and others and express our vulnerability. You may think intimacy is just for couples or romantic relationships, but all of our relationships have some level of intimacy as it’s the fiber that connects us to others. It takes time to develop intimacy; you can’t force it. What most of us regularly feel is the very human desire to connect with and be accepted by others. Feeling disconnected? Follow these 10 tips to cultivate closeness and connection in all of your relationships: Life coach STEVEN DESALVO is the author of Relationship Dynamics.

RESOLVE CONFLICTS Take responsibility for your part in any conflict and watch your actions build deeper intimacy in relationships, particularly if both sides in a conflict are willing to serve the needs of the relationship. Apologize and agree on how to go forward.

KEEP COMMITMENTS Keeping commitments builds trust and sustains our relationships; breaking commitments erodes trust and hurts feelings. Apologize when you fail to maintain your relationship.

10.

CHERISH YOUR RELATIONSHIPS Regularly express your gratitude for those you cherish and for all they bring to your life. Never take for granted the love, kindness, care, and support of others. Regular words or acts of gratitude show we value our relationships.

ISSUE 20 / Summer 2016 Healthy Mom&Baby

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feature

: S M O M g n i BreastfeedHas Your Back, Jessica Shor tall ights S r e H in e if L k r o W and Your

She’s not politically correct, falls short of espousing standard breastfeeding recommendations and pedagogies, still lactivist Jessica Shortall is blowing up breastfeeding in the workplace, one Viking warrior at a time— and women and companies are listening, and acting.

IMAGES: DAWN REED; SHUT TER STOCK

BY CAROLYN DAVIS COCKEY, MLS

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feature Jessica Shortall knows breastfeeding and she knows shoes—two topics near and dear to almost any mom’s heart. She was director of giving for TOMS Shoes when she circled the globe pumping for her two children. Her experiences since that time and her quest to bring a voice to the sisterhood of moms are rolled into a new book: Work. Pump. Repeat: The New Mom’s Survival Guide to Breastfeeding and Going Back to Work. Here’s why she wrote it, the hacks that will help you persevere when it’s your turn to pump, and the support every lactating mom needs when she feels her loneliest. Your TED talk on paid family leave is a jaw dropper. When it comes to the consequences of birthing without paid parental leave, you describe an all-out assault on parents—especially moms who return to work so quickly after birth and who try to pump breastmilk for their babies. Into this morass you penned Work. Pump. Repeat. What did you want to see happen when your book hit the streets?

Pumping at work is one of the loneliest experiences; you’re literally hiding yourself away. Women are all over the spectrum on breastfeeding—and have the right to be. It’s their bodies, their lives, and they don’t need to be uncomfortable about breastfeeding. I have no tolerance for people who try to shame women either for breastfeeding in public or for deciding that’s not for them; it’s your body, your baby, your family, you decide. I wrote Work. Pump. Repeat. because I wanted to collect advice and tips from parents who have been around the block a few times. I wanted other moms to know there’s a sisterhood of women who have gone through this who will have your back; you’ll get through it.

say “breast is best,” because, first of all, you bought it – I assume you get that breastfeeding has benefits. Second of all, this is a book for working mothers, and our work culture is often not compatible with pumping. Breastmilk is wonderful, and great, but it’s not possible for every woman. Yes, some women muscle through it and accomplish breastfeeding, but not nursing doesn’t make you a failure. Every woman is entitled to her own approach. Some women will say, “I want to exclusively provide breastmilk to my baby and I’m going to do that come hell or high water,” and that works for them. Then there are women who say that but it doesn’t work for them, and they feel horrible. And there we find so many women, alone in their struggles.

That was the case with my first child. I couldn’t keep up. I was having so much anxiety; I suffered from really horrible postpartum anxiety after he was born. It’s really scary and I talk about it a lot because I really want to help normalize it. With my second child, when I started to feel that anxiety coming back I knew that I had to protect my health for my own sake, and because I matter—period—to my family. I started supplementing with formula when my daughter was probably 6 months old. That decision extended breastfeeding for me and my daughter because I didn’t spiral into horrific anxiety. I felt like, ok, I’m not the only one shouldering the nutrition burden, and for me, that helped me breastfeed her far longer than I breastfed my son. I want women to know it’s not always about just trying harder—which is what women hear a lot. Our lives are complex and we should respect that. Healthy Mom&Baby magazine is written by the nurses who are right at mom’s side in the hospital when baby enters

Alone, pumping breastmilk for 15-20 minutes at a time hardly feels like a revolution.

I have yet to meet a pumping mom who relishes the idea of pumping while on a conference call, but it happens. When you’re pumping at work, you’re hiding yourself away. I did a piece for ELLE where women sent me photos of their lactation spaces: They’re pumping in server rooms, bathrooms, closets, cubicles. It’s lonely and isolating. You don’t want to talk about it with your coworkers; you just want to get it done. You’re stressed the whole time and that’s where I say to these women: You’re not alone. Don’t say you failed at breastfeeding when you went back to work because you failed at pumping and providing enough milk for your baby. No; you did not fail. The system failed you. The system is not set up to support you. If you got even a drop of breastmilk out of that pump at work then you’re a Viking. You beat the odds; you beat the system, even for that minute. Our country is the only industrialized country that doesn’t have paid parental leave.

We send women back to work while they’re still bleeding, their nipples are cracked, and their breasts are engorged with mastitis. The system says to them while they’re slipping away to pump throughout the day: You have to be totally ‘back’ at work because we’re watching to see if you really are back; if you really can handle your responsibilities now that you have a baby. You’re trying to pump even while most workplaces aren’t set up for it. You’re financially vulnerable because you have a new baby. If you file a complaint, and you get fired, even though they’re not supposed to fire you—who will pay the mortgage? The rent? The whole system is set up against you. So if you get any amount of breastfeeding done, you’re a Viking in my eyes. You should be super proud of yourself for managing work and new parenthood. Mine is probably the first breastfeeding book that doesn’t

In her massively popular TED Talk, “The US needs paid family leave — for the sake of its future,” Jessica Shortall unpacks the harsh realities of parenting in the US.

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feature the world. That first hour after birth is important—baby will be hungry and in a quiet, alert state. That’s the best time to begin breastfeeding. Yet, where’s the support for mom when we send her home into a world that’s not set up to support lactation and continued breastfeeding?

Right! This is another crisis point. You’ve just had that baby. You’re learning to breastfeed; that tiny mouth is trying to find its way. And then so quickly after birthing we’re sending you back to work without the same kind of “all hands on deck” type of support you received in the hospital. It’s a scary, lonely time; there’s really no network of support around breastfeeding women returning to work. There’s just pressure. And dads are working people too, but have you ever noticed that we use the term “working mom” but we never say “working dad?” Dad is just a guy at work; being pegged as a “working mom” contextualizes us and it makes women understandably afraid to be visible about being a working mother. But new motherhood is a time when we need a lot of support. Working moms are in their own category; their own herd—if there is a herd where you work.

You should never apologize for being a working mother. Not apologizing sets a precedence in the work environment that “yes, I’m a working mother and I can do my job. And for this limited time period I’m going to be making food for my baby at work.”

I know it’s really hard to say this; and it’s really hard not to say sorry. Just say thank you if people are helpful to you. You are setting the precedent for others. Any woman who’s pumping at work feels like she is always asking to leave a meeting early, always asking to borrow an office, always late to something or always wondering in the back of her mind whether everyone thinks she’s not working hard enough. “They already call my maternity leave my vacation; and now they think I’m taking all of these breaks during the day.” There’s this constant ticker—like the headlines that run across the bottoms of your screen on the news channels—“Where am I going to pump?” You want to find someone and say, “Hey, if we’re together in a meeting and I make this little signal, can you be the one who will say, ‘we’ve been meeting for an hour—I could really use a 15 minute break’ so that it’s not me all of the time?” Just shouldering some of that load for these women who are just barely keeping it together can be an enormous mental relief. A breastfeeding woman who has just returned to work is very vulnerable physically, emotionally and financially. She now has a baby to support. She doesn’t want to be mommy-tracked. She doesn’t want to fight the battles when people are inappropriate or rude. She just needs another person to step in, have her back, and take some of the awkwardness out of the situation. It’s really, really hard to explain this to the person who signs your paycheck. So, into this harsh environment your book is like a best friend and toolkit of sorts to help women navigate this new territory.

The temptation for new moms going back to work is to dance around the situation, “Oh, I have a new baby now, and I’m going to have this thing that I’m going to need to do a few times a day . . .” So you tiptoe around pumping when talking with your coworkers. Have you ever noticed when you go to the bathroom, you don’t tell others where you’re going, and you don’t spend all of your time worrying, “What if they wonder where I’m going all of this time?” It’s culturally accepted that I’m going to have to step away from my work duties a few times a day to go into the bathroom to do a thing we don’t need to talk about all the time. So you have to normalize pumping at work in the same way. Before you go on maternity leave you just have to have this awkward conversation with your boss—I call it ripping off the Band-Aid®: “Look, this is a really awkward conversation. When I come back to work, I’m going to be breastfeeding and that means that I’m going to have to go into privacy with a breast pump. I’m going to pump breast milk for my baby a few times a day. I’ ll put together a plan and present it to you on how I plan to make that work, and what kind of support I will need.” Where are dads in this? They may take some scheduled vacation or unpaid leave at baby’s birth or later on, and dads are also some of those bosses. How do you talk to a male boss about a dad’s role?

Because this is an issue that almost exclusively affects women—although there are transgender dads who nurse their babies and who pump at work—it gets treated like a women’s thing that people have to tolerate. Men in any managerial position, or any position having a voice in the workplace, should reflect: You’re going to see your wife going through this. You’re going to see a superhuman in a number of ways creating a baby, birthing a baby and then pumping at work to provide food for her baby. Dads should tell their stories in their own workplace. Go into HR and say, “Hey, you know my wife works in a totally different company, and she’s pumping at work. It made me wonder, ‘what’s our lactation policy?” Stepping up as a man and advocating for women to be able to do that at work is powerful. It’s not viewed as a woman coming with her hand out asking for something, which is not what it is, but unfortunately some people see it that way. Men bringing their own experiences to work and telling their stories

ISSUE 20 / Summer 2016 Healthy Mom&Baby

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[ [ A Smarter Way to Pump NEW

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feature can go a long way to normalizing parenthood in the workplace. In my book, there are templates an individual employee can use to figure out her own pumping plan, with sample emails to send to HR. Millennials will be 75% of our workforce by 2030, and at the corporate level, companies are slowly starting to realize that they need to fight for Millennial talent, and that women make up 47% of the American workforce. Some are starting to add paid leave. Still, many women are silent about their lactation struggles at work; they’re just getting through their day because they’re overwhelmed. There are only so many battles you can fight when you’re doing three jobs at once: being a new parent, working and making milk all day for your baby. But supporting lactation is part of having a human workforce, which means saying “we support you, and we don’t want this to be hard for you.” It doesn’t take that much to bring a working mother to tears of gratitude when an employer is supportive. I believe lactation support is the next frontier for corporate culture. How would you describe your own evolution as a working mom? From breastfeeding your own children to advocating for other moms to be able to do the same?

With my first baby, I never wanted anyone to tell me that I had to breastfeed my kid for ‘X’ amount of months. That is too prescriptive and fails to take into account so many dynamics that are unique to each individual family. But I was also super judgy about people who breastfed their kids for what I thought was ‘too long’; I was that person. And then I went, “wait a second; this goes both ways. This is a family decision and there’s no such thing as too long. We don’t have an epidemic in this country, or anywhere else in the world, of un-weaned 10-year-olds. This is something that has always worked itself out in human history.” I had to check myself and say: Support all families and all mothers, and their choices and their approaches. That’s been a big evolution for me. I’ve also evolved ng f eed i to making sure I’m thinking about all parents – re a s t B a l e ve pumping and lack of paid leave are hard enough pa i d l y d n a in an office environment; we need to think about eep a re d d . So blue- and pink-collar workers, about teachers and c e te nurses and others who often have even less support. con n omic

I always tell myself “ dig deeper, below ground.” Breastfeeding and paid leave are deeply connected. So are economic health and paid leave. American pediatricians tell us that we should breastfeed our babies for at least a year. But we don’t hear ‘should,’ we interpret this as ‘you have to or you’re a total failure as a mother.’ World Health Organization has their own recommendations about breastfeeding, so does the CDC. And yet our government’s rejection of paid leave as an economic and social necessity tells us “go back to work within two weeks of giving birth,” which is true for almost 25% of working mothers in this country. And women are managing more than breastfeeding; they’re managing postpartum mood disorders when their bodies and minds should be healing. Families are more likely to be on public assistance in the first year of parenthood when they don’t have paid family leave. Babies are less likely to have their well-checks and vaccinations on time if mom has returned to work within a few weeks. The public health, economic, financial and mental health impacts are astonishing. And that also includes affording dads the right to be equal partners to help raise their kids. If you had 3 wishes for mothering in the US, what would those wishes be?

First, paid family leave for all. Our workforce is made up of humans and human lives are messy. Our economy requires both men and women to

work; paid family leave is good for the economy by keeping people in the work force so they don’t drop out, which results in lower lifetime earnings and savings, more families on public assistance, and health problems for parents and for babies. Wish two would be that working mothers wouldn’t feel like they have to hide or over-compensate for being working mothers. 43% of households are headed by a woman bread-earner. Being a working mother should be woven throughout the fabric of our economy and culture in ways that are celebrated as women have babies, go back to work, and are honored for raising families. They’re contributing to the economy of our future. Children are our most valuable renewable resource; we need children to continue to be born and raised, be educated and become healthy adults with the ability to do all of our jobs when we’re old and need care. Parents produce our future generation; we should respect that. My third wish is for a public health imperative that supports breastfeeding for the full 47% of women who make up the workforce. Th is isn’t a niche activity, but right now we have a patchwork of laws that apply to different groups, with different rights in different states, so that women can’t fully know and understand their rights regarding breastfeeding. We need to fully make room for breastfeeding in our society if we’re going to thrive economically.

CAROLYN DAVIS COCKEY, MLS, is director of publications for AWHONN and editor of Healthy Mom&Baby.

IMAGES: W W W.WORKPUMPREPE AT.COM

You’ve always been fighting for social justice in one way or another. And now the case is about paid family leave.

con a re e n d pa i d ha h e a l t ave . le

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www.MyBrestFriend.com 415-785-3890

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Pregnancy

BY SUMMER HUNT

FLU VACCINES SAFEGUARD PREGNANT WOMEN, THEIR INFANTS

IVF

resulting in fewer multiples, healthier pregnancies If you’ve shied away from in vitro fertilization (IVF) out of fear of having twins or triplets, or you might have heard that there could be complications, there’s good news. The latest IVF is resulting in healthier pregnancies and babies, thanks to new technologies in reproductive medicine, says Elena Trukhacheva MD, MSCI, medical director of Chicago’s Reproductive Medicine Institute. More and more of ten, IVF is being combined with single embryo transfers (SET) and preimplantation genetic screening (PGS), which make it possible to control the number of healthy embryos that are implanted, researchers say.

Here’s just one more reason to get your flu shot: Babies born to women who receive the flu vaccine during pregnancy are much less likely to have flu-like illnesses, say experts at the American Academy of Pediatrics. In a study of more than 249,000 infants, researchers reported a 70% risk reduction in confirmed cases of the flu. Incidentally, 97% of all confirmed cases of the flu occurred in infants born to women who did not report getting the flu vaccine while pregnant.



IMAGES © 123RF

MORNING SICKNESS? THERE’S AN APP FOR THAT It’s no one’s favorite part of pregnancy; rather morning sickness is often seen as a rite of passage for the more than 3.4 million women who struggle with it. The Managing NVP (nausea and vomiting of pregnancy) app offers information, nutrition and lifestyle tips, and other tools designed to help manage morning sickness. Use the app to track symptoms and notes to discuss with your care providers, who can then monitor the severity of the symptoms. Download the app in iTunes or Google Play stores, or visit www.wellmomapp.com.

ISSUE 20 / Summer 2016 Healthy Mom&Baby

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Trimester

Healthy Foods BY TAMER A L. YOUNG, RN, MSN

Your pregnant plate is all about optimal nutrition as baby grows!

(FOR PREGNANCY) Lean Proteins

Your baby relies on you to provide the nutrition necessary for healthy growth and development. And what you eat also keeps you healthy. Lean proteins, fruits, vegetables, dairy and whole grains are your best bets for more energy, to feel better and be healthier during and after pregnancy. Take in at least 400 micrograms of folic acid each day to prevent the most common spinal cord birth defects—you can get this through the foods you choose, like leafy greens, and daily prenatal vitamins. For constipation, try increasing the fiber in your diet through more leafy greens, vegetables and whole grains. Experts at the USDA’s “ChooseMyPlate.gov” recommend the following foods especially during pregnancy for the healthiest diet possible:

Beans and peas • Nuts and seeds • Salmon, trout, herring, sardines and pollock • Lean beef, lamb and pork • Shellfish

Fruits

Cantaloupe • Honeydew melon • Mangoes • Prunes • Bananas • A pricots • Oranges • Red or pink grapefruit • 100% prune juice or orange juice

Dairy • F at-free o r l ow-fat y ogurt • F at-free m ilk ( skim m ilk) • L ow-fat m ilk (1% m ilk) • Calcium-fortified soy milk

Vegetables Greens, including spinach, kale, collards, turnip greens and beet greens • Sweet potatoes • Squash • Pumpkin • Tomatoes and tomato sauces • Sweet peppers

Whole Grains

Fortified ready-to-eat cereals and breads • Fortified cooked cereals

IMAGE CREDITS

Avoid These Foods in Pregnancy

TAMERA L. YOUNG, RN, MSN, is an expert adviser to

  

Alcohol—there is no safe limit in pregnancy

    

Fish high in mercury—shark, swordfish, king mackerel and tilefish

Limit caffeine—some experts say up to 12 ounces may be ok Cold cuts and soft cheese—these can contain the bacteria listeria that can harm your pregnancy

Limit white albacore tuna to no more than 6 ounces a week because of mercury High-fat, sugary and junk foods and drinks Unpasteurized foods Undercooked meats and eggs

Healthy Mom&Baby.

ISSUE 20 / Summer 2016 Healthy Mom&Baby

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Sleep in with with every every Sleep

Our unique accordion style nipple provides a Our unique accordion style nipple provides a continuous latch, easing the transition from continuous latch, and easing theAllowing transition breast to bottle back. youfrom to go breast to bottle and back. Allowing you to go to work, exercise, or simply….sleep in. to work, exercise, or simply….sleep in.

Preferred 2 to 1 over Dr. Brown’s® for ease Preferred 2 to 1 over Dr. Brown’s ® for ease of use in an in-home study of 100 moms.* of use in an in-home study of 100 moms.* munchkin.com munchkin.com PRODUCT AND DESIGN ARE TM & ©2016 MUNCHKIN, INC. MUNCHKIN, IT’S THE LITTLE THINGS, THE HEART LOGO AND LATCH ARE TRADEMARKS OR REGISTERED TRADEMARKS OF MUNCHKIN, INC. PRODUCT AND DESIGN TM & ©2016 MUNCHKIN, INC. MUNCHKIN, IT’S THE LITTLE THINGS, THE * when tested againstARE Dr. Brown’s ® standard bottles. HEART LOGO AND LATCH ARE TRADEMARKS OR REGISTERED TRADEMARKS OF MUNCHKIN, INC.

* when tested against Dr. Brown’s® standard bottles.

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2nd

Trimester

healthy pregnancy

Considering

Pilates in Pregnancy By Lauren MccLerkin, PMa®-cPT, TPi

Pregnancy is a time of extraordinary changes for your body. Taking control through exercise empowers you to feel stronger, be more capable. Pilates connects you more deeply to your body while it makes you stronger, more flexible. You can find Pilates classes particularly for pregnant women so that you can benefit from the strengthening and conditioning benefits of Pilates from pregnancy, through labor, birth and recovery. How Pilates affects Your PregnancY Six things happen when you practice Pilates during pregnancy:

easier breatHing As the baby gets bigger, you’ll find it harder to breathe, especially to take a deep breath. Your lung capacity hasn’t changed; baby is exerting upward pressure on your diaphragm. Pilates breathing techniques pull your rib cage out, letting your lungs expand sideways, allowing you a deeper, fuller breath. Breath is also important during labor; Pilates breathing will help you when the time comes for baby’s birth.

images: 123rf

less discomfort Pregnancy is uncomfortable! From indigestion, backaches and the emotional highs and lows, discomfort can be eased by Pilates with its focus on posture and alignment. As baby grows, your muscles are taxed to support your belly and hold you upright. Pilates strengthens your hips, core and pelvis, stabilizing your lower back and improving posture. Ah, relief!

ISSUE 20 / Summer 2016 Healthy Mom&Baby

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healthy pregnancy

Pelvic floor strengthening Pelvic floor exercises are essential in pregnancy. The pelvic floor and core muscles strengthened during Pilates support your lower abdominal organs. More pressure is put on the pelvic floor as baby grows. Moms who practice Pilates in pregnancy say the exercises helped them feel both the contraction and release of the pelvic floor muscles during birth and postpartum.

suPPorts birth There comes a point for most women late in pregnancy when they realize that baby has got to come out somehow, and it’s not going to be easy. Being physically fit is going to make it easier, whether you birth normally or have to recover following cesarean. Birth requires stamina, which Pilates builds for the hours of labor ahead. Every single workout that you do before labor and birth is one that you’ll thank yourself for!

B Know your limits Your body has limits during pregnancy to keep you and baby safe:

B avoid lying on your back—this puts undue pressure on your spine, back and blood vessels

B always stand on both legs—your risk of falling increases as your balance is challenged

B avoid putting your weight on your wrists and hands—use an exercise ball or other tool to support your weight

B Move slowly through stretches in your normal range of

motion—during pregnancy, the hormone relaxin makes ligaments looser and more f lexible, putting you at risk for taking stretches and movements too far, and risking injury

faster recovery This is more than just “getting your body back.” What’s most important is that your body is healthy in recovery. You need strength and endurance even more so in recovery as you’re also caring for your newborn. That care requires bending and lifting with strong shoulders, arms and core muscles; it requires flexibility.

Each pregnancy is different, so whether this is your first baby or your fifth, being strong and physically fit before and during pregnancy is going to make the whole process easier and get you to feeling great faster so that you can take care of that little one.

Lauren MccLerkin is a PMA® certified Pilates instructor and mom of five. Her program, the 100s to Happiness™, is available via app and online at 100stohappiness.com.

images: 123rf; THiNKsTOCK

PrePare for childcare Because Pilates is a dynamic workout system, you get stronger in movement rather than in held positions. This means you’ll be prepared and have the strength to go through the moves and motions needed to carry, lift, hold and care for your new baby. It’s important to note here that Pilates helps to prevent diastasis recti by improving the strength and tone of the transverse abdominis muscle. Unlike other workout regimens that focus on your “six pack,” Pilates works your entire core, helping to prevent this potentially serious postpartum complication in which the abdominal muscles don’t fully come back together.

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FREE! Online Pilates training by one of today’s leading instructors.

PilatesLessons.org

Don’t miss out

 www.facebook.com/HealthyMomAndBaby

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healthy pregnancy

3rd

Trimester

WHAT IF YOU POOP DURING LABOR? BY JOANNE GOLDBORT, PHD, RN

It’s every woman’s most feared and most unspoken question: What if I poop when I push my baby out? Vomit? Urinate? Do other embarrassing bodily things? First, stop freaking out—your healthcare team has seen it all. Birth is a messy business! As a former labor and delivery nurse with more than 35 years of experience, and a mother of 4 children, let me just reassure you that your healthcare team is prepared for just about anything that might happen.

NATURE WILL PREPARE YOU Your body is already one step ahead of you. A few days before birth, you’re likely to experience a mild case of diarrhea and or vomiting. Th is is nature’s way of preparing you for birth. Don’t try to help nature—avoid the outdated practice of having an enema or taking laxatives before birth. Experts now know it’s risky at best. To minimize your risks of vomiting in pregnancy, stick to light foods and snacks in small amounts and drink plenty of fluids. PICK YOUR WITNESSES Healthcare providers know what to expect during birth but your friends and family may be surprised at what you experience. Discuss any fears you have with your partner; together you can be certain your thoughts and feelings on these delicate matters are observed and honored when the time comes.

Bir thingy is mess — s busines will

s r n u r se and you o ou n! c hee r y

GIVE IN TO LOSING CONTROL There is no shame in your body doing what it’s naturally designed to do. Birth is a time when you learn to give up control for the beautiful end results of bringing a new life into the world. As my mother Mabel always jokingly said (and she birthed 13 children!) “When you go to the hospital to have a baby, you leave your modesty at the front desk; don’t forget to pick it back up on the way out!” Ultimately, you will be so involved in the demanding work that is birth that any “embarrassing” moment is soon forgotten. Relax, give birth all your energy, and don’t hold back! JOANNE GOLDBORT, PHD, RN, is an expert adviser to Healthy

Mom&Baby.

IMAGES © 123RF

POOP HAPPENS, AND A WHOLE LOT MORE Should your body do something you didn’t plan, something you fi nd embarrassing, your healthcare team will just take it in stride—we know you feel embarrassed and are uncomfortable. Did you know that your nurses consider a bowel movement a good sign that you’re pushing correctly? And by correctly, we mean you’re using the muscles that help bring baby down the birth canal. When women don’t know quite how to push, we’ll often say, “push like you’re having a bowel movement” or “ bear down!” If it happens, your nurse will discreetly clean the area and dispose of the soiled pad. Plus she will continue to encourage the good pushing that you’re doing! Th is is especially important when you have an epidural as you may not feel any sensation during labor, and may only feel slight rectal pressure. Birthing without an epidural, you’ll feel a lot of pressure on your rectum that will give you an uncontrollable urge to push. Just go with it—holding back on pushing out of fear of having a bowel movement will only lead to pushing for longer periods of time and delay baby’s birth. Passing stool during birth is quite common—don’t fear it; many women experience it.

health4mom.org

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Baby Steps (to ZAP Zika)

Zika virus can cause serious health problems for your unborn baby. Take these simple steps during pregnancy to help protect your baby when she needs you most.

USE MOSQUITO REPELLANT

COVER UP EXPOSED SKIN

USE CONDOMS OR ABSTAIN FROM SEX

USE NETTING & WINDOW SCREENS

REMOVE STANDING WATER

#ZAPZIKA MAIN BRANDING

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OPTIONS FOR SOCIAL MEDIA

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healthy pregnancy

Screens

Tests

IN PREGNANCY Here’s what tests you can expect when you’re expecting! Could your baby have Down syndrome? How is baby doing the last few weeks of pregnancy? Pregnancy tests can detect problems when things aren’t normal. No two pregnancies are the same; tests and screening tools help you learn what risks and problems could affect your baby. Health issues before pregnancy or that occur during pregnancy can affect your baby’s health. Knowing your risks means you and your healthcare provider can manage those risks together for the best possible outcome in your unique situation.

Most of the tests offered can be done in your provider’s office, or at a lab or the hospital where you plan to birth. Know that any screen, test or procedure is always your choice. For those screens or tests that carry risks with the procedure, ask yourself what you might do with the information—if you’re not sure you would act on the information, you may not want to undergo that test. Discuss your questions and concerns with your nurse so that you’re comfortable with your screening and testing decisions.

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healthy pregnancy geTTing ScreeneD in Pregnancy Screening tests measure your baby’s risks for a problem. As you learn about any risks, you learn how to manage those risks or get extra help. For example: Knowing if your baby has a birth defect may help you to prepare for having a child with a particular problem. Maybe you’ll need specialists who work with these disorders present at baby’s birth. Screening tests are actually better at identifying when there’s not a problem with your baby. Still these tests can be “false positive”—meaning they can show positive when the truth is that there isn’t a problem or risk. If the screening test identifies there is a problem with your baby additional testing will need to be done to actually confirm if there is a problem.

Screening TeSTS ThaT Show riSk amniotic fluid index measures how much amniotic fluid you have in your sac—or bag as some people say—using ultrasound. How well your baby is doing and how well your placenta is working is evaluated with this test. Most pregnant women have between 8–24 cm of amniotic fluid; less than 5 cm means you don’t have enough amniotic fluid.

Biophysical profile uses ultrasound and fetal monitoring to assess baby’s well-being in high-risk pregnancies. Baby’s heart rate, breathing, movements, tone, and measurement of amniotic fluid level are scored among the 5 components; a total score of 8-10 is considered normal.

iDenTiFying ProBleMS in Pregnancy Diagnostic tests help detect a specific problem or provide information that helps your healthcare provider make a diagnosis—which is an explanation of the issue or problem. Diagnostic tests determine if you have or are at risk for a disease. Prenatal diagnostic tests can identify certain disorders before a baby is born. Sometimes diagnostic tests are used to confirm or identify risks from screening tests. You’re likely to have both types of tests in pregnancy.

DiagnoSTic TeSTS ThaT Show SiTuaTionS amniocentesis is used between weeks 15-20 to check for genetic disorders common in families, birth defects like chromosomal problems. A very thin needle is inserted to withdraw a small amount of amniotic fluid for testing. This test carries a small miscarriage risk (1 miscarriage in every 300-500 procedures).

chorionic villus sampling (cVS) is performed between weeks 10-13 to test for any fetal problems caused by genetic disorders. In CVS, a sample of tissue is taken from the placenta for testing. The risk of miscarriage with CVS is about the same as the risk with amniocentesis.

ultrasound uses sound waves to visualize baby in your womb. This is where you’ll “see” baby for the first time before birth. It’s the most common diagnostic test in pregnancy. During an ultrasound, your baby will be measured to make sure baby is the normal size for the particular week of your pregnancy, if baby is developing well and moving or functioning well, and if your amniotic fluids are normal and your placenta is functioning well.

contraction stress test may be suggested at term to check baby’s well-being. Baby’s heart rate is measured during a contraction to see if there’s enough blood flowing from the uterus and placenta to baby. Typically, the test will observe baby’s heart rate through 3 contractions that are at least 40 seconds long. If baby’s heart range doesn’t decrease during the test it’s considered “negative” or normal.

kick counts are an important screen you can do any time from 28 weeks on. You simply count how many movements, or kicks, baby is making in a specific period of time. Put your hands on your abdomen and count baby’s movements during a 1-2 hour timeframe. Note how many times baby moves. Ideally, as many as 10 movements can be felt in a 2-hour period. If at any time you don’t think your baby is moving, try drinking a glass of cold water and focus on kick counting for the next 2 hours. You can stop when you get to 10 kicks in less than 2 hours. Call your healthcare provider anytime baby’s movements get less frequent.

Maternal serum alpha-fetoprotein (aFP) multiple marker screening is a blood test to measure AFP in your bloodstream as increased levels can be a sign of neural tube defects like spina bifida, Down syndrome or other chromosomal abnormalities, carrying multiple babies, or an incorrect gestational age as levels vary throughout pregnancy. A “triple marker screening” combines AFP, human chorionic gonadotropin (hCG), and estriol and compares the numbers with risks associated with your age at pregnancy to detect some genetic disorders and neural tube defects. The quad screen adds inhibin-A to the triple marker screen to increase detection of Down syndrome to 80%. These screens are done between weeks 15-16.

nonstress test uses electronic fetal monitoring to check on baby’s heart rate and rhythm and whether baby is getting enough blood and oxygen from the placenta based on how baby’s heart rate increases as baby moves. It’s the most common screen for checking on baby, especially in high-risk pregnancies.

RobeRta F. DuRham RN, PhD, is a professor at California State University in East Bay and an expert adviser to Healthy Mom&Baby.

hallie K. tayloR is a neurobiology student at the University of Nevada, Reno, and SaRa olDeRShaw is a nursing student at the California State

University in East Bay.

ISSUE 20 / Summer 2016 Healthy Mom&Baby

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Brain, EyE and nEuropathway dEvElopmEnt starts with mom! Many studies confirm the importance of DHA, and how critical it is in pre- and post-natal care for both Mom and Baby. Supplementing with DHA during pregnancy and after in breast feeding is important for healthy brain, eye and neuropathway development of the baby. ChildLife Prenatal DHA contains 500mg per one soft gel. Dr. Murray C. Clarke, founder of Childlife essentials, who formulates the entire ChildLife line, focuses on purity—with no detectable levels of heavy metals, mercury, aluminum, PCB’s, Dioxins or other contaminants. A clinical report carried out by the American Academy of Pediatrics suggests children with higher levels of DHA could show 4 to 5 IQ points higher by age 4. The American Academy of Pediatrics found 7 of 10 kids deficient in Vitamin D and recommends 400 IUs of Vitamin D3 per day for babies and infants from BIRTH.* Vitamin D3 supports healthy, immune, respiratory and bone development. *Based on findings from a study by Juhi Kumar, MD, MPH, of Montefiore Medical Center; Michal Melamed, MD, of Albert Einstein College of Medicine and colleagues.

Important Notice: Childlife Essentials’ products are not meant to diagnose, treat or cure any disease or medical condition. These statements have not been evaluated by the Food and Drug Administration. Please consult your doctor before starting ANY exercise or nutritional supplement program or before using these or any product during pregnancy or if you have a serious medical condition.

Natural health for Every Stage Specially formulated and carefully crafted by natural health experts Recommended by health practitioners across the world Safe for moms and babies*

of Development

Understanding the safety of a medicine while pregnant or nursing can be confusing and even a little scary for moms. While a qualified health provider can provide of knowledge and recommendations, it is understandable why many women are still left concerned about the potential side effects and how they may impact the health of their baby. Homeopathic medicines have been proven as a natural and remarkably effective option for treating many symptoms and conditions that arise during pregnancy and labor*. They are made exclusively from ingredients found in nature. Native Remedies specializes in providing the highest quality of herbal supplements and homeopathic medicines formulated to support vital stages of life for the entire family.

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*Homeopathic product uses are based on Homeopathic Materia Medica. These 'Uses' have not been evaluated by the Food and Drug Administration. The products have not been clinically tested by Native Remedies. These statements have not been evaluated by Food and Drug Administration. These product are not intended to diagnose, treat, cure or prevent any disease. The information in this advertisement is designed for educational purposes only. It is not intended to be a substitute for informed medical advice or care. You should not use this information to diagnose or treat any health problems or illnesses without consulting your health professional. Native Remedies bases these statements on the historically established and widely acknowledged traditional uses of natural ingredients

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healthy pregnancy

Alternative & Homeopathic Remedies in Pregnancy: What’S SaFe, What’S nOt? By Jamie Vincent, mSn, Rnc-OB, c-eFm

From morning sickness to nausea, back pain, heartburn and constipation, we’ve got alternative recommendations for your top pregnancy complaints. You’re eating clean, organic food, taking prenatal vitamins, avoiding raw fish, drinking plenty of water and you gave up alcohol, but what can you do about the morning sickness that plagues you morning, noon and night? Do you need a prescription for an anti-nausea medicine, such as Zofran®, or are there safe, non-prescription alternatives that will work, including homeopathic treatments? Homeopathic or alternative treatments have been used during pregnancy and birth for centuries. There isn’t always research to measure their effectiveness, so like many pregnant women, you may be wondering—what works? What’s safe? And what should you avoid? Alternative medicine includes treatments such as acupuncture, chiropractic medicine and herbal remedies. Homeopathic remedies are based on the principle that “like cures like.” Remedies are made from very minute amounts of the same substances that might cause the symptom or illness, but in these minute amounts the substance stimulates the body to heal itself. Holistic medicine begins with the basic philosophy that mind, body and spirit work together. Homeopathic remedies are usually very individualized treatments, and for this reason it’s best to find an experienced homeopathic

provider who has experience in working with pregnant women. These treatments aren’t regulated by the FDA, unlike prescription medications; they’re generally recommended as directed by the Homeopathic Pharmacopoeia of the U.S. And although your cousin may swear ginger root tea cured her morning sickness, you may need to try more than one remedy to learn what works best for you. Always tell your healthcare provider what medications, over-thecounter products and alternative or homeopathic therapies you’re using; you may even be surprised if they recommend some of these from our list of popular therapies for you to try as well. Although complementary and alternative remedies and medicines may be available without a referral from your provider, it’s important that your pregnancy care provider is also aware of what you’re taking so that information can be included in your medical record, and to ensure they don’t conflict with other medicines or treatments you might receive.

Jamie Vincent, mSn, Rnc-OB, c-eFm, is an expert adviser to Healthy

Mom&Baby.

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healthy pregnancy Your SYMptoMS: Morning sickness, nausea, vomiting

You MigHt trY: Eating small frequent meals with Vitamin B-rich foods, for example whole grains, nuts, avocados, liver, fish and chicken Vitamin B6 supplements

You MaY want to avoid: Strong foods, strong smells Having a prolonged empty stomach

Fresh ginger root tea or dried gingerroot capsules Sea bands (acupressure bands placed around the wrist)

CaLL Your HeaLtHCare provider: Persistent nausea and vomiting is known as hyperemesis gravidarum. You may be prescribed an antinausea medication such as Reglan ® or Zofran ® or receive IV fluids if you’re severely dehydrated.

Taking prenatal vitamins with food; switch to smaller capsules if the larger pill is difficult or ask for a liquid prenatal Heartburn and indigestion

Eating small frequent meals and drink between meals, rather than with meals

Lying down right after eating

Taking an antacid

Greasy or spicy foods

Marshmallow tea that contains mucilage, one cup up to 4 times a day (avoid if you are diabetic or have gestational diabetes as it may increase your blood sugar)

Over-the-counter (OTC) drugs such as Zantac®, unless otherwise directed by your provider

Slippery elm (Ulmus fulva), which also contains mucilage, as a lozenge, powder or tea Meadowsweet (Filipendula) in a tincture or tea up to 3 times daily Back pain or sciatica

Stretching Maintaining good posture

Prolonged standing or sitting, or exercising on concrete or pavement

Wearing supportive, comfortable shoes

Lower back pain may be a sign of preterm labor. Contact your provider if the pain is rhythmic, persistent or worsening.

Exercise, such as yoga or swimming Warm baths, hot and cold compresses Sleeping with a pillow between your legs Acupuncture by an acupuncturist experienced with pregnant women Chiropractic adjustment by a chiropractor experienced in treating pregnancy-related back pain Massage by a massage therapist experienced with prenatal massage Valerian (Valeriana of f icinalis) tincture in hot water Constipation

Drinking plenty of water Eating high fiber foods such as vegetables and fruit, e.g. prunes, dates, figs, freshly ground flaxseed Exercise

Binding foods such as bananas Mineral oil as it can deplete vitamins A, D and E

Using a fiber supplement, such as Metamucil ® or Docusate Sodium (Colace ® ) Hemorrhoids

Applying arnica gel every time you go to the bathroom

Bearing down and constipation (see remedies above for constipation)

Leg cramps

Calcium, magnesium and potassium-rich foods and supplements

Moderate or strenuous exercise right before bedtime

Stretching, rotating your ankles, and staying hydrated

Severely painful hemorrhoids may be thrombosed (have a blood clot within the vein)

Red raspberry leaf tea as a source of calcium and other nutrients; up to 4 eight-ounce cups a day

health4mom.org

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Nobody likes to be rushed, especially babies. Your baby needs at least a full 40 weeks of pregnancy to grow and develop. Inducing labor even a week or two early is associated with a host of risks, including prematurity, cesarean surgery, hemorrhage and infection. While it may seem convenient for you or your health care provider, labor should only be induced for medical reasons. Your baby will let you know when 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.

The nurses of AWHONN remind you not to rush your babyâ&#x20AC;&#x201D;give her at least a full 40 weeks!

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

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healthy pregnancy

Pain Killers in Pregnancy OPIOIDS CAN BE ADDICTIVE FOR YOU AND YOUR BABY

Can you take pain killers in pregnancy? Nearly all moms question whether it’s safe to take medication during pregnancy: “Can I continue to take my allergy medication? Should I take medication if I experience nausea and vomiting during the first trimester?” 9 out of 10 moms take some type of prescription or over-the-counter medicine while pregnant. While many are safe for both you and your baby, some can create serious problems or harms. With more women than ever before using opioid pain killers, there are more pregnant women than ever before potentially using these drugs—and they’re not without problems for you or your baby. Opioids are the most commonly abused prescription drugs. Opioid pain relievers (analgesics) include codeine and hydrocodone—you may know them as Vicodin®. Morphine is also an opioid, as is oxycodone, also known as OxyContin® or Percocet®. The most commonly used opioid however is heroin. Opioids are also found in some cough syrups, are prescribed for pain and often provided to women after surgery or dental procedures. Maybe you have received a prescription for opioid painkillers for short-term or ongoing pain. If you were abusing opioid pain killers before you got pregnant, talk to your care provider to learn if you can get treatment for your addiction during pregnancy. The typical treatment is to use other drugs such as methadone or buprenorphine. These drugs help you stop using opioids until you can quit them. Never quit suddenly on your own, especially if you’re pregnant as this could also cause problems for your baby, including death. OPIOIDS IN PREGNANCY Experts think opioids for a very short-time use in pregnancy are probably ok and don’t cause any long-term problems for you or your baby. For example, if you have a tooth removed, and you take an opioid medication for two to three days, you’ll likely be fine.

BY JENNIFER LEMOINE, DNP, APRN, NNP-BC

BREASTFEEDING & OPIOID USE Plan to breastfeed your baby even if you’re using opioids or undergoing opioid treatment with methadone, say the experts at ACOG. This is true if you don’t have HIV or any other reasons that you shouldn’t nurse your baby. Minimal levels of the drugs will pass through to baby in your milk but the benefits of nursing and of breastmilk outweigh the risks. For example, the closeness and swaddling that comes with breastfeeding may even reduce neonatal abstinence syndrome symptoms in your baby. Nursing helps you and baby bond and baby receives additional immunity from you in your milk during those important first months of life. Ask your nurses about the challenges you may face nursing your baby. Babies with neonatal abstinence syndrome (NAS) may struggle to coordinate sucking and swallowing, frustrating your baby while feeding, and making baby irritable. Don’t be surprised if baby cries uncontrollably. Withdrawal symptoms can begin anytime in the first 2 weeks of life but usually start within 72 hours of birth. Symptoms may last for days or weeks. Your labor and birth nurses, and lactation consultants who specialize in helping mothers breastfeed, are ready to help you begin breastfeeding your newborn right from birth. They will guide you through any nursing challenges. Many hospitals and birthing centers also have a phone number—sometimes called a “warm line” you can reach night or day for advice and support. Ask your nurse for these resources before you go home with baby. Your baby’s healthcare provider may recommend treatment during your baby’s withdrawal if baby has NAS. You’ll know your baby is doing well when he or she is able to nurse, sleep for longer periods of time like babies who don’t have NAS, and is regularly gaining weight.

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healthy pregnancy Problems begin to arise if you need to take one of these medications for weeks or months—or take them in increasing doses. Opioids can increase your risks for miscarriage or preterm labor or birth and put your baby at risk for defects, including heart and spinal problems. Even if your healthcare provider has prescribed these medications, take only take the recommended dose for the shortest period of time. SIDE EFFECTS OF PAIN KILLERS FOR YOU AND BABY Opioids affect your body in many ways; some of the most common side effects include drowsiness, nausea and vomiting, and constipation. Longer term use of these drugs can cause sleep apnea, in which your body stops breathing for short periods of time during sleep. Opioid pain killers can also create: • Irregular breathing • Tolerance, so that you need stronger doses to get the same pain relief • Addiction—where you physically crave and need to take the drugs • Withdrawal symptoms

IMAGES: 123RF

In pregnancy, research shows opioid pain killers can cause: • Stomach cramps • Uterine contractions • Miscarriage • Problems with the placenta • Less oxygen flow to baby • Fetal growth restriction • Low birth weight • Preterm labor and preterm birth • Baby passing its first stool while still in your womb (meconium) • Stillbirth (baby’s death in your womb from age 20 weeks on) PAIN KILLERS & YOUR DEVELOPING BABY As with any medication, opioid use during pregnancy can affect your baby. Using these pain killers early in pregnancy has been shown to increase your chances of your baby having spina bifida, a serious birth defect of the spine, and other birth defects including heart defects, hydrocephaly (fluid in the brain), glaucoma (eye problems), and cleft lip and palate, say experts at the CDC. Just as you experience withdrawal symptoms when you stop taking pain killers, so do babies. In babies, this is called “neonatal abstinence syndrome,” (NAS), which is a big medical phrase that basically means baby has stopped using narcotics. Babies also go through withdrawal if their moms use other drugs including heroin, methadone and buprenorphine when stepping down from stronger opioids. These medications can also lead to NAS in your baby. If you have been using opioids before pregnancy, and continue to use them in pregnancy, your baby is likely to have NAS at birth. The longer you have taken opioids, the greater baby’s risk is for NAS. Almost all infants who have been exposed to opioids for greater than a few weeks will be born with some of the symptoms of NAS. This puts your baby at risk for breathing problems and most likely your baby will need high-level medical care in the neonatal intensive care unit (NICU). Baby’s withdrawal symptoms will peak anywhere from 72-96 hours after birth; the severity of the baby’s withdrawal symptoms are typically related to the strength and amount of the pain killer used, as well as the last time mom took a dose before baby was born.



WITHDRAWING FROM OPIOID USE It’s not easy to quit opioids, and you may crave the drugs for years af ter you’ve stopped using them. According to the experts at the American College of Obstetricians and Gynecologists (ACOG) withdrawal symptoms from short-acting opioids, such as heroin, typically develop within 4–6 hours of use, and may progress up to 72 hours, and then subside within a week. For longer-acting opioids, such as methadone, withdrawal symptoms usually begin within 24 hours af ter last use and may last for several weeks. Even af ter quitting, obsessive thinking and drug cravings may persist for years, putting you at risk to start using pain killers again, ACOG cautions.

HOW DO I KNOW WHAT MEDICATION IS SAFE IN PREGNANCY? Typically, if your pregnancy care provider has prescribed a particular medication for you, it’s considered safe for your pregnancy—but don’t just take our word for it—ask your provider why the medicine is considered safe, and how it may affect your pregnancy, if at all. Always take medications exactly as instructed on the label. If you need to take opioid medications in pregnancy, talk to your care provider to make the best choices and decisions possible for you and your baby.

OPIOID WITHDRAWAL SYMPTOMS IN BABIES                 

Excessive signs of hunger, including sucking Problems breastfeeding or bottle-feeding Irritability, jitters, tremors Fever Problems sleeping Excessive crying, high-pitched cry Vomiting Diarrhea Slow or no weight gain Excessive sweating Mottling (lacy appearance) Faster breathing Nasal congestion Sneezing Hiccupping Hyperactive reflexes Seizures

JENNIFER LEMOINE, DNP, APRN, NNP-BC, is an expert advisor to Healthy

Mom&Baby.

ISSUE 20 / Summer 2016 Healthy Mom&Baby

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Don’t Clamp—and Cut— That Cord Just Yet! BY MAYRI SAGADY LESLIE, EDD, MSN, CNM

In most birth settings, just as soon as a baby is born the umbilical cord is clamped and a parent or nurse typically cuts it. But what if this isn’t the healthiest option for your newborn? What if there are reasons to delay clamping, and then cutting, baby’s cord?

IMAGES © 123RF

KEEP THAT CORD FLOWING The real story isn’t about the cord alone. It’s about allowing the cord to remain connected and pulsing while baby’s own blood supply finishes transferring from the placenta into their body. Simply waiting gives your baby important blood volume, red blood cells, more iron and has protective benefits for both full-term and premature babies. In your baby’s cord blood are millions of specialized stem cells essential to his or her organ development. In preemies, these stem cells are even more concentrated. Because experts know baby’s organs continue to grow and mature after birth, losing these stem cells by clamping and cutting baby’s cord too early may increase baby’s risk for diseases later in life including asthma, diabetes, epilepsy, and Parkinson’s disease, to name a few. If you’re interested in storing baby’s cord blood, this can still be done with delayed cord clamping. Many of the cord blood collection companies provide information about how to do this. For most moms and babies, there are no real risks in delaying cord clamping and cutting, research shows. Baby can still go skinto-skin with you and begin bonding even as the cord continues to transfer blood. It’s best if baby remains at the level of your abdomen during this time. In 2014, in response to research, the World Health Organization recommended delayed cord clamping for at least 1-3 three minutes after birth for all mothers and babies, calling it a “best practice” at birth. These same experts specifically recommend against early cord clamping (less than 1 minute), unless there is an urgent medical need to move baby to another location. Your nurses can do routine newborn care right at your bedside with the cord intact.

cord at birth. You may find, however, your nurses will be your greatest champions when it comes to delayed clamping and cutting as they’re the care experts observing and noting whether baby is receiving blood from the placenta at birth.

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BOOSTING YOUR PREEMIE BABY’S BLOOD VOLUME For babies born premature, delaying clamping and cutting the cord is even more important. Delaying cord clamping boosts baby’s blood volume by 30% in babies born at term, and up to 50% more for preemies. Research shows that particularly for babies born premature, waiting to clamp baby’s cord: 

improves baby’s blood pressure



boosts baby’s oxygen

 reduces the risk or need for blood transfusions in the NICU 

reduces the risk of developing one of the most common and serious intestinal diseases in premature babies, necrotizing enterocolitis



reduces baby’s risk for internal bleeding (hemorrhage)

THE BEST START IN LIFE Delaying cord clamping boosts red blood cells, iron and proteins needed to transport oxygen in red blood cells by as much as 60%. And baby’s iron levels remain boosted for as long as 6 months after birth. Th is reduces your baby’s risk of not having enough iron (anemia) in the first year of life. In contrast, babies whose cords are clamped and cut right after birth are twice as likely to be iron deficient in their first year when critical brain development occurs. Anemia during baby’s first year can cause lasting developmental delays. REQUEST DELAYED CORD CLAMPING Talk to your healthcare provider about delaying clamping and cutting your baby’s

MAYRI SAGADY LESLIE, EDD, MSN, CNM, is director of the

Concentration in Nurse-Midwifery for the Masters in Nursing Program at George Washington University in Washington, DC.

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ÒB ecause every birth defect has a causeÓ ÒW hy My Child?Ó ItÕ s the question every family asks when they have a child with a birth defect. We help to answer that question and support the family with speciﬁc information about their childÕ s birth defects. We also connect families who have children with similar problems. And provide referrals to support groups and resources their child may need. BDRC also sponsors the National Birth Defect Registry, a research project designed by prominent scientists to collect data for studies of the unknown causes of birthFOR CWF LOGO (W/ TYPE) GUIDELINES defects. No Smaller Than 1.5”

SPOT COLOR

PMS 541 PMS 194 OR PROCESS COLOR

www.birthdefects.org

C M Y K

100 57 0 38

C M Y K

0 100 64 33

A Mess a g e fr o m H a p p i T u m m i® F o u n d e r . . . ! ) Health4mom.org m is the premier site for moms-to-be

mo o amoms. a l snew ( w h o ’ s and It provides a host of features, covering everything from proper nutrition to best birthing options, promoting the optimal health and wellness for mom and baby. Visit Health4mom.org often to get news and articles covering the health topics that moms-to-be and new moms care about.

Exclusively on the Web Experts: Ask one of our nurses a health question and get an expert answer

Recalls: The latest product safety information, updated daily Shopping: All the products from the magazine are available to buy through our website

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healthy

Babies

Join us on Facebook facebook.com/HealthyMomAndBaby BY SUMMER HUNT

Should Your NICU Baby Take Acid-Suppressing Medication? As many as 1 in 4 babies in the NICU may be receiving an acid-suppressing medication and may even continue to take them after leaving the hospital, but researchers at Nationwide Children’s Hospital are warning against the risks in the absence of testing—and they’re asking parents to speak up. “There’s actually little evidence that acid suppression helps in the NICU at all,” says neonatologist Jonathan L. Slaughter, MD, MPH, lead author of the study in Pediatrics. “Parents are right to ask questions and voice concerns about starting the drugs or about the timetable for stopping. [They] should not be afraid to ask about evidence for the medications working or about possible side effects.” Some of the drugs used to treat NICU infants with GERD (gastroesophageal reflux disease); congenital heart disease; and ear, nose and throat conditions may be doing more harm than good. These medications, used to reduce stomach acid, were originally approved by the FDA for use in adults and older kids and have been associated with infections and increased risk of death in babies. “It’s encouraging that doctors are starting to pay attention to the warnings and decrease usage,” Dr. Slaughter says. “In the small premature babies who are prescribed acid suppressive medications, doctors are waiting longer, until they are a little older. That’s promising. But I think the numbers should be declining faster.”

WHAT’S YOUR GUT TELLING YOU? How you give birth and what you feed your baby can have a major influence on his future health, say experts in JAMA Pediatrics. At 6 weeks old, breastfed babies who were born vaginally had dramatically different “gut” bacteria when compared to those fed formula (or a combination of formula and breastmilk) and born via cesarean. Cesarean birth is linked to increased obesity and asthma risks as well as type 1 diabetes risks later in life. Breastfeeding can reduce asthma, obesity and metabolic syndrome risks, as well as reduce the risks of infection in babies. Experts believe a baby’s exposure to microflora during vaginal birth is related to healthy microbiome patterns in infants, but how this happens and how it protects a baby’s health remains unclear.

(

FROM DIAPERS AND WIPES TO TOUCHSCREEN SWIPES

)

Forget “goo goo ga ga”—your youngster’s first words might be more like “Google” and “WiFi.” In a recent survey of parets with kids ages 3 and younger, 3 out of 5 parents said that their youngster was operating a touchscreen before they could talk. Additionally, 47% said that their child likes taking selfies, which makes it no surprise to find that most parents admit to running out of storage on their phones from too many photos and videos of their kids.

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healthy babies

BY CAROLYN DAVIS COCKEY, MLS

Start Talking with Baby through

Sign Language

REPEAT AFTER ME: WHAT’S YOUR SIGN? Language is taught through repetition; so are baby signs. As early as age 6 months, babies can understand simple signs including their desire for milk, food, sleep—even a pacifier, says Joseph Garcia, an American Sign Language (ASL) interpreter. His research shows that babies ages 6-7 months who watch their parents sign can begin to use those signs by their 8th or 9th month. If you’re concerned that learning signs will delay baby’s talking, push that fear aside. Research shows baby sees your signs more so as gestures—movements that go with your sounds and actions. Babies who are consistently exposed to infant signs tend to speak earlier and develop a larger vocabulary. Having a physical way to express a need can calm baby once they start to use simple sign language. READY TO SEE SIGNS? Does baby follow your gestures with their eyes? Try to move their hands and arms like you do? Your baby may be ready to learn to sign. Simply do a sign with your hands as you say the word and do the action. Use the same sign with the same word and action every time. More is typically baby’s first learned sign, parents say. Tap your fingers together in front of your body and ask if baby wants more. Speak the word as you do the sign. Whether your baby picks signing up right away or simply seems entertained, just have fun with it. Each baby will learns on their own schedule; you may need to make signs for quite some time (months!) before you see baby trying to mimic your actions.



BABY’S FIRST SIGNS More: With both hands, tap your pinched fingers together in front of you Eat: With one hand, bring your pinched fingers to your mouth Drink: Cup a hand as if making the letter “C;” raise your cupped hand to your lips and down again, repeat Milk: Hold your fist up, as if grasping a mug. As you raise it up and down, open and close your fingers, as if milking a cow All done: Hold both hands in front of you, palms facing out and move them in opposite directions out and in again, repeat Yes: Hold one fist up, knuckles level on top of your hand; rock your fist up and down Book: Hold your hands palms together, fingers pointing to baby; let your hands fall open while the bottoms of your hands remain touching, as if opening a book Thank you: Place your hand, f ingers closed and palm down on your lips, let your hand fall naturally forward from your mouth until your f ingers are pointing at baby Sleep: Place your whole hand, fingers splayed, over your face— covering your eyes. Pull your fingers together in a pinch as you drag your hand down your face, ending with your fingertips on your chin. I Love You: Hold your hand in front of you, f ingers open and thumb extended; fold down the two f ingers between your index and pinky f ingers

CAROLYN DAVIS COCKEY, MLS, is director of publications for AWHONN and editor of Healthy Mom&Baby.

IMAGE: THINKSTOCK

Muhh muhh muhh. Da da da. You anxiously await baby’s first words. Yet there’s no reason to wait. Start communicating with American Sign Language, adapted for babies and toddlers, before baby’s first birthday.

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She was listening long before this moment... ...even in the womb. Play something that will matter. To learn more about the

natural, simple, impactful sounds of BabyPlus Prenatal, go to www.babyplus.com.

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Nurses Make Change Possible for Babies BY HEATHER QUAILE, DNP, APRN, NP-C

Join with nurses so 5.3 million children in low-income families have enough diapers to stay clean and dry.

NURSES DIAPER THEIR TINIEST PATIENTS But there’s hope: For as long as families have struggled with diaper need, nurses have stood in the gap by providing extra resources for the families they serve. Nurses teach parents how to change baby’s fi rst diaper. FOOD. SHELTER. DIAPERS. And nurses regularly collect and give out diapers, wipes, For babies, diapers are essential like food and shelter. Yet 1 in 3 clothes and car seats to their tiniest patients, according to a families in the US don’t have enough diapers for their youngest survey from the Association of Women’s Health, Obstetric children, with low-income families hit the hardest. “Diaper need” & Neonatal Nurses, (AWHONN), which publishes Healthy is not being able to afford enough diapers to keep a child clean Mom&Baby magazine. and dry. At local AWHONN meetings, nurses collect infant care items and then give them to families in need during HEALTH RISKS OF DIAPER NEED baby showers and educational events at their hospitals and Babies risk severe rash and infection when a parent leaves a dirty diaper clinics. Nurses also connect families to social services for on for too long, or dries out and reuses diapers. Babies can’t attend even more help. childcare or preschool unless families can maintain a “stash” of extra diapers on hand. When babies can’t go to childcare or preschool, a parent may be forced to give up a job and a paycheck to care for baby. It’s a vicious cycle that holds families back when trying to break out of poverty. Did you know:  Diapers can’t be purchased with WIC or food stamps  Diapers are classified with cigarettes, alcohol and pet food and excluded from public assistance  Diapers cost upwards of $80 month for most families but a $10 donation through the Healthy Mom&Baby Diaper Drive diapers a baby for a week through our partner, the non-profit National Diaper Bank Network

HEALTHY MOM&BABY DIAPER DRIVE So it was only natural that the magazine that nurses write for pregnant women would be the same magazine to create a national diaper drive to share the stories of nurses meeting diaper need in their communities all across the country. Working with partners Huggies® and the non-profit National Diaper Bank Network, the Healthy Mom&Baby Diaper Drive makes sure nurses get the credit and recognition they deserve for helping families combatting diaper need. Every year, you can join with nurses in the bid to make a difference for families in your community. It’s time to end diaper need for families in your community—here’s how:

PER NEE D HELP NU RSE S WIPE OU T DIA

WHAT IT IS: Nurses and families across the U.S. donating diapers to diaper banks and pantries in their communities in partnership with Huggies® and the non-profit National Diaper Bank Network. GET INVOLVED: Donate diapers at a bank near you, and then

2016 GOAL: More than 250,000 diapers donated at diaper banks and pantries throughout the country. Disposable, cloth, and hybrid diapers are all needed. GIVE A DONATION: $10 buys a week’s worth of diapers--$20 buys two weeks’ worth—at wholesale prices through the National Diaper Bank Network. Donate today at DiaperDrive.org.

report how many diapers and where you donated at DiaperDrive.org to have your efforts counted in our national total. Reporting your donation helps those who would “match” our efforts have the greatest impact on diaper need.

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feature MANY PARENTS ARE FORCED TO CHOOSE BET WEEN

FOOD AND

DIAPERS

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Chanelle plays in the park on a sunny day with Z’amir (1) and Da’Marko (3).

s r e p a i D

Make a Difference

Until you become a mother, you never quite realize the sacrifices you’re willing to make for your family. For these two moms, that commitment means doing what’s necessary to take care of their little ones. 52

You may have heard people talk about diaper need in the news lately, but what exactly does that mean? Simply put, diaper need is not having enough diapers to keep your baby clean, dry and healthy. Evidence shows that not having enough diapers stresses moms more than anything else, including not having enough food or a stable place to live. The two moms profi led here are very different, but they share a common thread: They both know what it’s like to manage the delicate balancing act of keeping their babies happy and healthy while juggling other personal responsibilities.

IMAGES: DAWN REED

BY SUMMER HUNT

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IMAGES: DAWN REED

Chanelle Hensler: A voice for the silent majorit y “I felt like a failure as a mother diapers and how diaper banks because I couldn’t provide such a have made it so that I don’t have basic necessity for my son,” says mom to choose between going to school Chanelle Hensler, speaking of her and providing for my children,” she experience with diaper need. She has says. “He’s very understanding and one son of her own, Z’amir (1), and is really trying to make a difference.” a godson, Da’Marko (3), who she After their fi rst phone meeting, has raised since he was only 3 weeks Rep. Ellison hosted Chanelle, old. “They are why I work so hard, Da’Marko, and Z’amir at his office in and they have shown me how strong Washington, DC, where he offered her a huge I truly am as a mother,” she You shouldn’t be ashamed opportunity to have her says. to ask for help when you voice heard: Originally an internship from Nashville, need it. I know I’m not the in his office. Chanelle attended high only mom out there trying “Obviously, I took it!” she school in to make ends meet. says excitedly. Front Royal, To g e t h e r VA, before —Chanelle Hensler with Rep. Rosa moving to DeLauro (CT) and others, Rep. Ashburn, VA, to be with Z’amir’s Ellison is working to pass legislation father. When they broke up, she and to provide diapers for needy families. the boys came to Arlington, VA, “[They] should not have to choose where she participates in a program between diapers, food, or rent,” says that provides safe housing and Rep. Ellison. “We all benefit when educational opportunities for young children are healthy and families are mothers. “When we fi rst moved, it was really not worried about how they will care tough,” she remembers. “We had no for their infant or toddler.” Chanelle and her two kids love money, and I had to use Da’Marko’s underwear as diapers for Z’amir until visiting the zoo and playing at the we were able to get assistance from park. They love to climb and run, and the DC Diaper Bank.” While she the slide is a favorite. Books are also wasn’t thrilled at the idea of having to popular with the boys. Right now, The ask for help, Chanelle knew that her Itsy Bitsy Spider and The Very Hungry kids’ needs were more important than Caterpillar top Da’Marko’s must-read dwelling on pride. “You shouldn’t be list. “While I’m in school, I read them ashamed to ask for help when you my homework out loud,” Chanelle need it. I know I’m not the only mom laughs. “I don’t know who really enjoys that more, them or me.” out there trying to make ends meet.” As a part of the housing program, Chanelle is right: Her story reflects that of the 1 in 3 families struggling Chanelle is currently enrolled in to afford enough diapers. The executive college and is considering a career director of Chanelle’s housing program in nursing or psychology. Over presented her with the opportunity her summer break, she’s looking to invoke real change by connecting forward to affecting change during her to Congressman Keith Ellison, a her internship. “People are so quick representative from Minnesota who is to judge. I feel like sharing my story passionate about improving the lives of shows how vital diapers are, and also how hard I work to provide for my low-income families. family,” she says. “I love my kids, and “I told him my story, and we I just want to be a good mother.” spoke about my troubles of getting

Da’Marko, Chanelle and Z’amir enjoy a good book.

Da’Marko shows off his current favorite.

Da’Marko climbs at the park, along with Z’amir and Chanelle.

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When it comes to taking your little one’s temperature, you need the thermometer that’s accurate, convenient, trusted by moms, and backed by pediatricians and nurses everywhere. With the Exergen SmartGlow TemporalScanner™, gently swipe the temporal artery thermometer across the forehead to get an accurate reading in just two seconds. It features patented, infrared technology with accuracy supported by more than 60 clinical studies. The TemporalScanner™ is used in thousands of hospitals, clinics and pediatricians’ ofﬁces across the country, in millions of homes, and made in the USA from components sourced worldwide. Here’s what sets the Exergen TemporalScanner™ apart from other thermometers: • Use – By millions of physicians and nurses. • Proven Accuracy – By more than 60 published clinical studies. • SmartGlow Feature – A softly illuminated display for easy reading in any light – perfect for checking the temperature of your baby in a darkened room • 8 Temperature Memory – Automatically retains the last eight temperature readings for instant recall to check on fever progression • Silent Mode – Beeping sound indicating scanning can be turned off or on to avoid waking up your baby • °F or °C Mode – Ability to switch between Fahrenheit and Celsius Available at Wal-Mart, Target, Walgreens, Costco, Babies “R” Us, and Toys “R” Us, the TemporalScanner™’s suggested retail price is $49.99. For more information, visit www.exergen.com/hmb

What’s OsoCozy is New Again: Cloth Diaper Resurgence! The demand for diapers is great – and the resurgence in popularity of the ‘traditional’ earth-friendly cloth diaper should not be over-looked in your choice for your diapering preference they can and do work. OsoCosy® Cloth Diapers and Accessories are designed with sustainable, renewable 100% cotton – which remains the most economical and environmentally conscious way to safely and comfortably diaper your baby. (Unlike disposables, whose synthetic oil based fibers made them the 3rd largest consumer item in landfills.) OsoCosy® Cloth Diaper Packages start at under $200 – about the same cost as 3 months of disposables – and can be safely washed manually. Even Day Care facilities are getting on board with earth-friendly diapering at these locations: http://daycare.realdiaperindustry.org. As landfills grow, and the costs of waste disposal rise (affecting all our futures), remember: If your diaper isn’t cloth, it’s refuse thats costs all of us.

www.osocozy.com

OsoCosy® Better for your Baby. Better for our Earth.

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Marina Kearney: Not a handout, but a hand up

IMAGES: STEPHANIE ZURN, E ASTSIDE BABY CORNER

“I don’t really even know how I can express how I feel, to the food bank, which he didn’t like, but it was reassuring to explain what it means to have the support of the diaper bank,” know that there was somewhere I could go if I was hungry.” says Marina Kearney. Her voice breaks as she considers her Marina eventually saved enough to get her own apartment, next words. “I don’t think people realize how something like and the people at the food bank helped her to get on her feet diapers can make a difference in a person’s life. It means so after her marriage ended. “They gave me diapers, wipes, a much to feel like I’m in a place where I don’t have to beg, but table, spoons, forks… things that you don’t really think about I can get what I need.” needing until you don’t have them.” Hailing from Ivory Coast, Marina Following her divorce, Marina wanted to It feels selfish, to receive fell in love with an American man who go back to school. Unfortunately, struggles this wonderful gift and was an international teacher in Africa. with her ex-husband over custody of their son The pair were married and lived abroad became too much to bear, and she found it to not do something to in Mexico and Colombia, among other difficult to stay af loat financially. She began to better myself. places, before settling in the United explore other opportunities, including working States. They welcomed their first as a translator. In addition to her native —Marina Kearney French, Marina speaks 4 other languages; her child, Patrick, and it wasn’t long before Marina felt the stresses of raising a little one in a foreign land. f luency made her a perfect candidate. But it wasn’t as easy as it She and her husband experienced financial troubles, and the sounds. “The work paid well,” she says, “but it was often very marriage began to crumble beneath the weight of it all. far from home. By the time I got a sitter and put gas in my car, “I found a job at a restaurant, because I knew I wanted a I was barely breaking even.” divorce,” she explains. “He told me I would never be able to As she thought about how to take care of her kids and best make it on my own, but I knew I had to try. I also went to use her skills, including a college degree in marketing and

Marina watches her son Frederick (2) play in their neighborhood.

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strong work ethic, Marina earned also works crossing-guard duty at money by doing odd jobs. She his school; Marina feels strongly was also able to secure financial about learning a service of giving assistance with rent and and being self less. “I tell him, ‘I some bills, and getting want you to live your life diapers, wipes, and giving back and helping food from Eastside others.’” On! r e Baby Corner in By addressing p a Di diapers in Issaquah, WA, her physical needs, e t a ! Do n ni t y allowed her to Eastside Baby mmu o c r you o t save her earnings Corner has also e lin to Go on g r to start her given Marina .o e r Dr i v ce . D i a pe own business. “I something more feren f i d a e k a m started cooking than diapers: selffor people in the respect, confidence, neighborhood and and dignity. “I came to delivering meals,” she says. America to be more than just Marina and Frederick outside of Marina’s days typically start at 4:30 a beggar,” she says, the passion and their house in Snoqualmie, WA. a.m., when her fiancé comes home determination radiating from her from the graveyard shift and she as she speaks. “I am confident that goes to work at a daycare. When this will not be my life forever. The she returns at 8 a.m. and the kids support I’ve gotten from the Baby are off to school, she starts cooking. Corner has empowered me so much. Even at 9 months pregnant, she They give women like me a voice. is constantly working to provide. I’m an educated, strong, fierce, “I don’t want to take a break,” she smart woman—and I know that says. “It feels selfish, to receive one day, I’m going to be the one this wonderful gift and to not do donating diapers to another woman something to better myself.” While in my shoes.” Marina has been living in the states for more than a decade, she still has SUMMER HUNT is a writer and editorial ties back in Africa. “I know how coordinator at AWHONN in Washington, DC. Marina cooks in the afternoons lucky I am to be in America, a place for her food delivery business. so many people dream to be. I’ve experienced tough times, but I have poor family in Africa,” she says. “They are dying; they are hungry. I worry and want to do for them as well, but it’s not always possible.” Marina has three boys—Patrick (11), Dominick (5), Frederick (2)— and one on the way. “I’m not sure on the name yet, but I’ve stuck to a theme so far: They all end in ‘ick’!” she laughs. They spend a lot of time together as a family, reading books, going to the park, and riding bikes in their home of Snoqualmie, WA. Her oldest, Patrick, plays the piano, and he earns money in the summer from a lemonade stand to pay for lessons as well as soccer equipment. “I want my children to grow up understanding the importance of Marina encourages Frederick on his tricycle, a gift from Eastside Baby Corner. working hard,” she says. Patrick

IMAGES: STEPHANIE ZURN, E ASTSIDE BABY CORNER

feature

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Donat eD for Fam iapers Your C ilies In Join th ommunity e dia Diaper per drive at Drive.o rg

1 in 3 Babies

Don’t Have all the Diapers They Need

You Can Change That!

Help Healthy Mom&Baby Wipe Out Diaper Need! When babies don’t have enough diapers:  They can’t go to childcare  Mom or dad can’t go to work You can’t buy diapers with food stamps. Childcare and laundromats won’t allow cloth diapers. It’s a vicious cycle. You can help make change possible! Join with AWHONN nurses in your community to help families in need where you live:

Our Partners:

 Donate diapers at a diaper bank near you  Donate dollars to help diaper banks buy diapers at wholesale  Report your efforts at DiaperDrive.org to be included in our national total of diapers raised! Together, nurses and families can help wipe out diaper need. Get involved at DiaperDrive.org

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Act Today at

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healthy babies BY CAROLYN “CARRIE” LEE, PHD, MSN, CNE, RN

Managing Nipple Pain DURING BREASTFEEDING After birth, you’ll find your nurses are very interested in your nipples, asking about them and checking them. What’s up with that? Almost all moms experience some nipple sensitivity when starting breastfeeding, but severe nipple pain isn’t normal. It’s important to get help if your nipples become sore, and before that soreness becomes painful. Left untreated, it’s a leading reason many new moms stop breastfeeding even when they have a strong desire to nurse their new baby. Nipple soreness is typical the first couple of days of breastfeeding; see your healthcare provider or a lactation consultant if nipple pain remains after your first week of nursing. Keep nipple pain at bay by ensuring baby is nursing the best possible way at your breast— here’s how:

YOUR NURSES ARE READY TO PROVIDE BREASTFEEDING CARE

AVOIDING NIPPLE PAIN Watch baby for his or her early hunger cues, such as wiggling or smacking their lips, or rooting around your breast with their mouth. Try to begin when baby seems to be getting hungry to minimize the impact of nursing to your nipples. Some babies will get pretty fired up to start sucking vigorously if they’re overly hungry. You’ll feel

A shallow latch can cause nipple pain.

more relaxed in working through a feeding with sore nipples if you can nurse before baby gets too aggressive in how they feed at your breast.

HELP BABY LATCH WELL A baby’s “latch” at your breast is simply how well baby takes in your nipple and areola to nurse at your breast. The best latch happens when baby’s mouth is wide and placed beyond the nipple and grasping breast tissue. If baby sucks only on your nipple, you’ll get sore nipples very quickly. As baby approaches your breast, tickle his or her lips so that they open

IMAGES: 123RF

Your nurses are there to help you begin breastfeeding right after birth if all is well; you should expect support with breastfeeding as a normal part of your care during your hospital or birth center stay. Your nurses will even note in your medical record as to how your breastfeeding is progressing, including the condition of your skin, so that you can get continuous support even as your nurses change shifts. You can also ask to work with a lactation consultant if you have any questions about how breastfeeding is going, including what feels normal and what’s not normal. Maybe you attended a breastfeeding class during pregnancy where you were told to ask to see a lactation consultant as part of your care and recovery after you birth baby. That’s pretty typical now. Make note of the names and numbers of the lactation consultants who help you after birth; you’re free to call them after you go home should questions or concerns come up. Nipple pain can also come from too much milk in your breasts (engorgement) or poor positioning with a breast pump—ask a lactation consultant to observe your positioning with a breast pump if you experience pain with pumping.

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healthy babies

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COULD NIPPLE PAIN BE FROM TONGUE-TIE OR SOMETHING ELSE? You may have heard that some babies can’t nurse well because of something called “tongue-tie.” This uncommon condition, called ankylglossia, happens when a cord-like tissue under baby’s tongue, called the frenulum, restricts baby from freely moving his or her tongue. This restriction affects baby’s ability to properly latch and suck at your breast. Your baby’s pediatrician can usually assist with tongue-tie through a surgical snip of the shortened tissue. If your nipple looks blanched and devoid of color and feels painful following feeding, you may have Raynaud’s phenomenon of the nipple. This happens when your blood vessels spasm during nursing. Warm showers, without water beating on the breasts, or anti-inflammatory medication may help. With thrush, which is a fungal infection, your nipples can seem to turn white-pink with redness in the areola. Check baby’s tongue—if you see a thick white coating on his or her tongue or cheeks, you both need to see your healthcare providers for an anti-fungal treatment. Find a Lactation Consultant Near You La Leche League International is home to lactation consultants across the globe: http://www.llli.org/

wide and evenly across the areola, the circular tissue beyond your actual nipple. Early in breastfeeding you may feel a twinge when feeding begins; that should diminish quickly as baby learns the best way to nurse at your breast. Some babies want to suck on the first thing that comes their way. If baby’s latch isn’t quite right, or comfortable, you can try shifting baby without stopping nursing by bringing baby further onto your breast, or by using your index finger to tug the baby’s chin down to help get more of the breast into their mouth. Try these things first. If those step, gently break the suction by inserting your smallest finger gently inside their cheek and try again. Trust your instincts— it will feel right when baby is properly positioned and latched well. Sometimes it takes some effort to get this right, but it’s so important! Soon, proper latching will become second nature to you both and these early efforts will be rewarded.

FIND THE BEST POSITION The right position is the position that feels best for both you and baby. Some babies do better with different positions during nursing, others find a position they like and want to feed that way each time. Pay attention to those feeding positions that don’t cause nipple soreness—you might find you need to alternate positions if you have sore nipples. You can switch positions between cradle, cross cradle, a ‘football’ hold, and side-lying in bed, which can feel particularly good when you are really tired. No matter what position you’re using, have baby’s mouth lined up well to your nipple so that baby can open wide as you draw him or her into the breast. This will keep baby from improperly ‘going for it,’ which can hurt your breast tissue and your nipples.

latch, A great by’s lips with ba ou t , f langed e r vent helps p oreness nipple s . and pain

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PRACTICE GOOD NIPPLE CARE A few simple steps with each feeding will minimize or help cure nipple pain:  Air-dry your nipples after each feeding  Avoid nursing pads or bras that keep moisture on your nipples  Dab a little milk across your nipples after each feeding and allow to air-dry—your breastmilk has antibacterial properties to keep infection away. Some women like lanolin for painful or cracked nipples. Warm compresses or warm tea bags may feel soothing, but research has shown they don’t help healing—use only as a comfort measure and then air-dry before covering your nipples  Gently soak your nipples with a warm water compress if your nipples ever “stick” to a breast pad, your bra or clothing—never pull fabric or pad directly off of a nipple if it seems stuck  Wear breast shells between feedings—not pads or shields—if your pain is severe

CAROLYN “CARRIE” LEE, PHD, MSN, CNE, RN, is an expert advisor to

Healthy Mom&Baby.

ISSUE 20 / Summer 2016 Healthy Mom&Baby

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Shoosha Baby Truly Organic is an entire line of USDA Certiﬁed Organic products so pure, you could eat anything in the line. We chose this standard because what you feed your baby’s skin is as important as what you feed your baby’s tummy. All of our products are free from any synthetic fragrances and ingredients. We have carefully hand picked each ingredient for their gentle, safe and nourishing attributes. Our ingredients are simple to understand and we strive to take the guesswork out of picking a natural product. Shoosha’s Rescue Nipple Balm is our star product for nursing Moms. It has been referred to as a “little pot of gold”. It is packed with 8 simple therapeutic ingredients, including soothing Calendula, nourishing Sea Buckthorn Berry Oil and protective Cocoa Butter. Sore nipples are one of the most common reasons new mothers give up on breastfeeding. Our Rescue Nipple Balm is made with ingredients that work together to help provide fast relief from sore, cracked and chaffed nipples. It is safe enough for baby to ingest, and does not need to be washed off prior to breastfeeding. Shoosha’s Rescue Nipple Balm is also Lanolin, Gluten, GMO, Gelatin and synthetic ingredient free.

Coupon code for 20% off HEALTHY20

www.shooshatrue.com

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healthy babies BY CYNTHIA LORING, MS, RNC, CLC

Safe Baby Soothing Parents:

y Your bab r u o y wants nd a e v gentle lo ! g in h soot

We know you need more than one way to safely shush your fussy baby— learn safe soothing techniques to keep stress at a minimum for you and your baby Parents seem to fear a fussy baby almost more than any other part of parenting. And baby boot camp begins the moment you hold your little one in your arms for the first time. Babies cry because they don’t yet talk—it’s your job to learn does that crying mean “I’m uncomfortable” or “I need a change” or “I need to be held.” Decoding babies’ cries is step one in becoming an expert soother. As the parent, you’ve got the advantage. Your baby loves to be with you, and she or he wants your help navigating this new world. Even during pregnancy babies are comforted by the sounds of their parents talking. They know mom’s heartbeat and will quickly get to know dad’s.

There are many reasons babies cry, and usually it’s to express a need. Babies rarely cry when they’re sick— they tend to withdraw and be quieter. See baby’s healthcare provider if crying is prolonged and if baby has been vomiting, has diarrhea, is refusing to eat or is running a fever. BABIES AND STRESS When you’re stressed, it’s very difficult to calm a fussy baby. You need to calm yourself first! This means taking a break and letting someone else care for baby. If you’re alone, this means putting baby safely in the crib and going into another room where you can still hear or see him or her while you take a break. Some states even have parent hotlines if you need a break but have no one to call.

WHY BABIES GET FUSSY  Crying is normal; it’s your baby’s only way of communicating a need  Babies fuss and cry a lot in the f irst 4 months of life; infant crying peeks between ages 6-8 weeks  Check the basics for a quick f ix to meet baby’s needs; is baby:



Hungry

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Needing a diaper change

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Too hot; too cold

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Bored; needing af fection or attention

 Try a womb-like f ix; many babies are soothed by things that remind them of being in the womb, such as being swaddled or held close in a warm, dark space as you gently rock in a chair or back and forth  Crying it out with supervision is OK; there are times when soothing is just impossible and your baby just needs to fuss or cry for a while. Experts call this a period of “purple crying” and nearly all babies seem to go through it  Find the techniques that work for you baby; well-meaning advice from others is only good if it works for you and your baby  What calms babies at 3 weeks may not work at 3 months; keep trying new techniques and retry older ones that worked when baby was younger

ISSUE 20 / Summer 2016 Healthy Mom&Baby

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healthy babies

Safe SOOThiNG TeChNiqueS ThaT WORk

Cynthia Loring, MS, rnC, CLC, is is an expert

adviser to Healthy Mom&Baby.

a Ba By, e v e R ! N e v e R Sh a k e By the time your baby is born, hopefully you will have been educated about the dangers of shaking a baby. it is never oK to shake an infant. Even one episode of brief shaking can lead to permanent changes in the baby’s delicate brain. Situations that lead to a parent or other caregiver shaking a baby are a crying infant combined with a caregiver who is feeling very stressed and angry about the crying. If you ever feel that you are in such a situation, place your baby in a safe position on his or her back in the crib, remove yourself from the baby’s room, and call for help (a parent hotline or a friend who can help you).

Safe POSiTiONS fOR BaBy

Your newborn doesn’t have the muscle strength to hold or move his or her head; baby depends on you to position her or his head so that the airway is always clear. This is important when you’re putting baby to sleep on his or her back in a crib and when you’re holding baby. To safely position baby so that his or her chin doesn’t press down on the chest: » Keep baby’s head in the same direction as his or her chest; if baby’s face is turned to the side—like when you are holding the baby on your shoulder—make sure you have a clear view of baby’s face so you can see baby breathing normally » Keep baby’s nose turned upward—like baby’s sniffing the wind— and don’t let baby’s face fall forward or to one side » always place baby on his or her back for sleeping—never on the tummy or side » Baby should only be put to sleep on his or her back on a firm surface, such as an approved crib or bassinet. No bumpers, pillows, toys— just a firm, tight-fitted mattress with a fitted sheet and baby » never put baby to sleep on a sofa, stuffed chair or pillow; it’s just as dangerous to baby if you fall asleep while holding baby on a sofa, stuffed chair or pillow

Call one of these hotlines when you just need someone to talk to or a break from your crying baby:

B 24-hour Parent helpline: 888-435-7553 B Crying Baby hotline: 866-243-2229 B fussy Baby Warmline: 888-431-2229

T h e re’s He lp W h e n Y o u N e ed It

images © 123RF

1. Cradle baby in your arms against your chest or shoulder, with baby’s face turned to the side 2. Cradle and sway or walk with baby 3. Gently glide or rock with baby 4. Swaddle, re-swaddle or unwrap the swaddle 5. Gently bounce on an exercise ball with baby 6. Lay baby across your forearm on on your knees; this really helps babies with gassy tummies 7. Massage baby’s back, legs, arms and tummy; pure coconut oil is a safe, gentle product for baby’s skin 8. Give baby a warm bath; cover baby’s body with a warm washcloth or towel while in the bath for even more warmth and comfort 9. Whisper into baby’s ears 10. Sing, hum, chant or shush—repetitive words or sounds are soothing 11. Play calming music or white noise like ocean waves, rain or a shushing sound 12. Take baby to a quiet, dimly lit room away from other people and noise 13. Turn off all noise, such as T V or stereos 14. Roll baby in a stroller around the house or neighborhood 15. Go outside for a change of scenery and environment 16. Take baby for a car ride in an approved rear-facing infant car seat 17. Nurse baby or feed baby breastmilk from a bottle 18. Let baby suck your clean fingers, pinky f inger nail-side down works great 19. Try a pacifier 20. Cradle baby with mom’s pillowcase or pajama top; baby may be missing mom’s scent 21. Tag team soothing baby; switch of f with your partner or another adult every 15-30 minutes so that no one loses their cool with baby—soothing takes patience and energy! 22. Stick with a technique; it may take a few minutes before baby responds, especially during hard crying periods 23. Offer a frozen teether or washcloth

health4mom.org

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marketplace

Babytime! by Episencial makes baby-safe, all-natural skincare products that support skin immunity and help treat common skin conditions, like eczema, cradle cap and common dehydration. With clinically effective formulas designed to support the health and development of both the skin and body, Babytime! provides a protective barrier to insulate vulnerable skin, offset environmental contaminants, and help keep children safe. By virtue of using all natural ingredients, Babytime! products reduce exposure to unnecessary and potentially harmful chemicals prevalent in baby skincare products; even those made for babies and children. Doctors and medical professionals throughout North America use Babytime!â&#x20AC;&#x2122;s skincare products in their hospitals. Our unique probiotics formulation helps to enhance skin immunity, with organic ingredients as high as 95% to ensure the highest quality.

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health4mom.org

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The Milk SnobÂŽ Cover is a must have for every new mom. Our silky soft and breathable covers give you true 360 coverage while breastfeeding. They fit on any infant car seat within seconds, and will protect your precious baby from the elements.

www.milksnob.com

ISSUE 15 Healthy Mom&Baby

07/09/2016 21/09/2016 09:22 09:07 11/10/2016 08:45

Baby Gear ADVERTISING

PRODUCT GUIDE

Che these pcak out approvrentfavorit ed es!

BabyPlusÂŽ The BabyPlus Prenatal Education System is a sound producing device that stimulates development as the baby continues to grow inside its mother. BabyPlus contains a set of patented sounds making up 16 lessons. Parents who use BabyPlus report seeing better sleeping habits, ease of nursing, longer attention spans, early or improved verbal skills and improved school readiness. BabyPlus retails for $199. Get more info: http://babyplus.com/why-use-it/

Ez Pz As baby grows more independent, proper eating techniques are important to achieve. Ez Pz products are designed with your child in mind assisting with food allergies and fussy eating habits. Our products cater to both neuro-typical children and those with special needs; many children with autism, Down Syndrome and cerebral palsy are eating independently for the first time! Find out more at www.ezpzfun.com.

New England Cord Blood Bank Stem cell research has proved vital for developing and expanding available treatments for illnesses and diseases. Banking cord blood with us helps to ensure these treatments and therapies can be available for our clients. We deliver quality expertise to your family at an affordable price. Get more information at www.cordbloodbank.com.

Revolution Foods Revolution Foods brings ethically sourced and organic food to expecting mothers. We pride ourselves on developing a unique blend of whole and super foods to increase energy aiding new mothers as they grow baby. Revolution Foods deliver packs of food designed especially for your needs, from smoothies to protein rich foods. Available at www.revolutionfoods. com and www.amazon.com.

ISSUE 20 / Summer 2016 Healthy Mom&Baby

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healthy babies BY RITA NUT T, DNP, RN

Dad & Baby Time There’s no need to leave dad out of the adventure once baby is here! Dad, you’re not alone if you’re feeling out of bounds. Life with a new baby can be overwhelming, especially for dads. There’s no need to stay out in the cold—you can have a strong bond with your new little one, too. In fact, your daddy-baby bond is just as important as mommy’s. Start with these best bonding tips: JUMP RIGHT IN Don’t be afraid to jump right in and start caring for and loving on your baby. Your bigger arms and hands will make baby feel secure. The more you hold baby, the more comfortable and natural it will feel. TAKE A NIGHT SHIFT As mom and baby get the hang of nursing, be there to change diapers before and after feedings and burp baby. Once breastfeeding is going well, mom may want to pump breastmilk and let you give baby a nighttime meal so that she can get a longer stretch of much-needed sleep. HUSH LITTLE BABY, DON’T YOU CRY If your first approach to a crying baby is a quick handoff to mom, hold on. Your partner doesn’t have any magical shushing powers—she simply has had more practice at it! Find your own groove when it comes to calming baby: try swaddling, rocking, singing, gently bouncing, shushing or wearing baby in a front carrier. READ HIM A BOOK Cuddle up in a cozy spot and read something—anything, really—to your baby. Your newborn will enjoy the rhythm and pace of your voice as you read a children’s book, a fairy tale, the sports pages or even your favorite car magazine. In these early months, it’s not about what you’re reading; it’s about reading itself.

BEDTIME Bedtime rituals will help baby drift off to sleep more easily. Whatever you choose to do, the key is to make bedtime a predictable, quiet sequence of events that your baby will come to learn leads to bedtime. Mom may ultimately be the one to tuck baby into bed after a last feeding, but you can set the stage for a great night ahead of time. RITA NUTT, DNP, RN, is an educator in Salisbury, MD, and an expert adviser to Healthy Mom&Baby.

IMAGE: 123RF

BATHING BEAUTY Bath time may seem scary, but it’s a great time for fun with baby. Yes, there’s soap, water and a slippery baby, but bathing is quite easy once you get the hang of it. You’ll enjoy it as much as your baby!

health4mom.org

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Bella the Bunny

Portable Bluetooth Speaker and Soother VoiceShare mobile app is an open invitation for loved ones to connect with baby. A personal playlist, a favorite story read by Daddy while heâ&#x20AC;&#x2122;s on the road or even just soothing white noise: all can come from a chew-safe, fuzzy friend.

by WavHello Learn more at: wavhello.com/soundbub

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The power of hugs.

What hugs mean to baby. Over 600 medical studies on the effects of human touch prove what moms have always known: Hugs are important. In fact, more and more hospitals state that they are vital to the healthy development of a child. And the beneﬁts of human touch for babies often extend throughout childhood.

The beneﬁts of hugging. Every hug sets off cascades of hormones that beneﬁt health and help regulate body temperature. Oxytocin, the hormone released by touch, is even nicknamed the “bonding hormone.” A hug can stabilize heart rate, increase oxygen levels, strengthen the immune system, and reduce crying and stress.

How will you greet your babies? After the ﬁrst hug, let the second thing that touches baby’s skin feel just as good. Huggies® Little Snugglers Diapers and Huggies Natural Care® Wipes provide our best care to help keep their skin clean and healthy. And as perfect as the day they were born. www.huggieshealthcare.com ® Registered Trademark and * Trademark of Kimberly-Clark Worldwide, Inc. © KCWW. © Disney. Based on the “Winnie the Pooh” works by A.A. Milne and E.H. Shepard.

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