ISSUE 22 / 2017 | $3.95 | health4mom.org
PREGNANCY | BIRTH | PARENTING
Breastfeeding
TIPS GALORE
JANA KR AMER Sings the Morning Sickness Blues HEALTHY HAIR DOWN THERE
RISKS OF EXTREME EXERCISE DIAPERING GUIDE INSIDE!
POWERED BY THE NURSES OF
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Creating Moments of Joy Congratulations! We wish you the best as you prepare for your baby’s arrival and hope Lamaze can be part of your special journey.
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Lamaze® is a registered trademark of Lamaze International, Inc. Infant Development System® is a registered trademark of TOMY International, Inc.
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Lamaze International Lamaze is a nonprofit organization that promotes a natural, healthy and safe approach to pregnancy, childbirth and early parenting. Your purchase supports education and advocacy for safe and healthy pregnancy, birth and early parenting around the world. Learn more at lamaze.org.
Learn more at lamazetoys.com
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Issue 22 / 2017
( CONTENTS ) healthy moms 11 Start Your Day Spiraling Up To create happiness, build positive emotions one by one, in “upward spirals”
12 Protect Your Oral Health
Add an oral health self-check to your morning routine—here’s how
15 Hair Today, Gone Tomorrow!
healthy pregnancy
healthy babies
25 Probiotics & Your Health, Including During Pregnancy
53 Traveling With Tots
27 Birth Plans 101
55 Breastfeeding Your NICU Baby and Tracking Milestones
Probiotics boast of improving your overall health—learn the best way to gain their benefits
Craft realistic preferences for your baby’s birth with these tips
28 Will I Need an Episiotomy? You may know that an episiotomy is a possibility with a vaginal birth—but what exactly is it?
31 It Ain’t Easy Bein’ Queasy
Here’s how to enjoy pregnancy when you’re not feeling well
32 Jana Kramer Sings the Morning Sickness Blues
If you decide to remove your hair down there, what method should you use?
Award-winning actress and singer recalls her morning sickness experience
17 Experiencing Endometriosis
34 Fill up on Fish for a Brainier Baby
Painful periods with heavy bleeding and unbearable cramps could mean endometriosis
18 What Is Multiple Sclerosis? Multiple sclerosis is a condition most of us have heard of, but what exactly is it?
20 Workout Woes
Exercise is good for your heart and selfconfidence, but too much of a good thing could actually be unhealthy
There’s an easy way to potentially boost your baby’s brain development before your little one is even born
Looking to get away with your little ones? Be prepared when you plan ahead—then relax and enjoy the journey!
Our nurses answer your questions
57 Tips for Bottle-feeding Breastmilk
With some patience and these expert tips you can help your baby learn to consume breastmilk from a bottle, cup, spoon or dropper
58 DIY Baby Food
Making your baby’s food might seem intimidating, but it doesn’t have to be!
63 Does My Baby Have Hand, Foot & Mouth Disease?
Your little one has a fever, painful blisters and a rash… what could it be?
66 Let’s Play!
Through play, children learn to develop their minds and bodies and their sense of fun
39 Pumping Breastmilk
Expert guidance to help you continue to nurse your baby as you return to work
42 Exploring Nipple Shields for Breastfeeding Challenges
Nipple shields can help ensure baby’s proper latch for successful breastfeeding
44 Milk Banks
Your questions answered about sharing breastmilk and donating your milk to local banks
Prevent Diaper Rash Your baby needs their diaper regularly checked and changed—don’t miss this opportunity to make a special connection with your little one
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FEATURE
ISSUE 22 / 2017 Healthy Mom&Baby
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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 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 EMILY DR AKE PHD, RN, FA AN
New Diaper Guide Helps You Prevent Rash, Improve Bonding with Baby Finding a red, rashy bottom on your baby is among the top fears and concerns of parents. Was it something baby ate? The detergent you washed their onesie in? Or something else? Sleuthing the causes of diaper rash is important, but even more helpful is diapering to prevent rash altogether. The mother/baby nurses of the Association of Women’s Health, Obstetric & Neonatal Nurses (AWHONN)—the nurses who write Healthy Mom&Baby magazine—want you to know there are specific steps you can take as a parent to prevent diaper rash: ABCDEs of Diapering to Prevent Diaper Rash • AIR: Allow baby’s skin to air-dry for as long as possible between changes and regularly give baby some diaper-free time. • BARRIER: Zinc-oxide diaper cream and petroleum jelly provide a barrier between the diaper and urine or stool while your baby’s damaged skin heals. Use at every diaper change if your baby develops rash frequently, and speak to baby’s healthcare provider about baby’s reoccurring rash. • CLEANSE: Always wipe gently and pat when cleaning baby’s diaper area—never rub while cleansing baby’s skin. Irritant-free wipes may actually be more effective than warm water when cleaning stool. • DIAPER: Change your baby’s diaper as soon as it’s soiled or at least every 1-3 hours during the day, and once during the night. • EDUCATION: Take note when and how your baby experiences diaper rash and ask your nurses for their advice on preventing diaper rash for your baby. With newer, higher-tech diapers and diaper inserts, it’s possible to help prevent some forms of diaper rash, particularly contact dermatitis, which develops when baby’s skin reacts to urine or stool, or sometimes to ingredients in products you’re using on their skin or clothes, such as alcohol, dyes or perfumes. Even baby-specific products can cause reactions in some infants. Download Our Diapering Guide Diaper time is also a wonderful time to bond and elevate an ordinary interaction with your little one. AWHONN nurses have a new diapering guide you can download at bit.ly/mindfuldiapering. It unpacks the research and science of attentive care and interaction that transforms diaper time into an activity that can help promote your baby’s overall health, well-being, growth and development. EMILY DRAKE PHD, RN, FAAN, is the 2017 President of AWHONN.
ISSUE 22 / 2017 Healthy Mom&Baby
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Editor & Director of Publications:
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Address: 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, 2017. 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
Check Money Order Call us at 312-572-7729 or mail payment to: Maitland Warne, 123 W. Madison St. Suite 1600, Chicago, IL 60602, USA. Make checks payable to Maitland Warne.
Traveling with Your Baby Perhaps nothing strikes fear in the heart of a frequent flier more than to see a fussy baby headed through security at the airport. I know—as a working mom who often traveled with her newborns in tow (after all, I was committed to nursing them for the first full year of their life or more!), I saw the look of panic firsthand in the eyes of my seatmates. To make traveling a little easier, I would ship extra clothes, care items, diapers and wipes— baby food, too—ahead to my destination. Booking flights, I might splurge on the extra seat so that my baby could be strapped securely in their car seat, facing me, for care, comfort and fun on the flight. It also gave me an “extra” under-seat compartment for the baby bag so that all of baby’s essentials like toys, extra clothes, diapers and wipes were right at hand. Since most airlines will gate-check strollers, we have typically rolled through security screening all the way to the gate and dropped the tagged stroller at the plane’s door on the jetway, where it would again be waiting for us when we got to our destination. Carrying baby on board in their car seat often gained me early boarding at the gate, which was always appreciated. I also paid close attention to when my baby was most likely to nurse or eat if they were already on to some solids as well as breastmilk. I tried to plan a flight taking off near a mealtime so that my child would board as their hunger was starting but be satisfied with nursing on takeoff, and often nap afterward. These are the things that work for me when traveling with little ones. We’ve got more tips on Traveling with Tots on p. 53. What will you use from our lists to make travel easier for you and your family? Follow us on Facebook and share where you’re going next with your family—and what you will do that will make your travel easier this time. Until next time,
MAITLAND WARNE 123 W Madison Street, Suite 1600, Chicago, IL 60602, USA Tel: (312) 572-7727 Fax: (312) 284-5864 www.maitlandwarne.com EDITOR IAL
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Carolyn Davis Cockey, MLS, LCCE Editor & AWHONN Director of Publications Health4Mom@AWHONN.org
ISSUE 22 / 2017 Healthy Mom&Baby
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ALL YOU NEED IS Munchkin has been the world’s most trusted baby products company for over 25 years by driving innovation that is fueled by love.
www.munchkin.com
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Join us on Facebook facebook.com/HealthyMomAndBaby
Moms
BY SUMMER HUNT
Build Your Mom Squad Having a social life as a new parent used to be a tough nut to crack. Make new mom-friends and come out of your shell with Peanut. This new meet-up app connects you with likeminded mamas (and moms-to-be) in your area. Personalized settings showcase your interests and make it easier to f ind sister preggos or moms with kids the same age as yours. Sync your account with Facebook, check out other prof iles, and swipe up to “wave” at moms you want to connect with. As your mom-squad grows, you can start group chats to organize cof fee or play dates—or maybe a moms’ night out instead. Other popular meet-up apps for moms include MomCo, Smile Mom, and Mom Meet Mom.
COULD YOU HAVE AN EATING DISORDER?
IMAGES © 123RF
Eating disorders are common among people of all ages and genders in the US and include anorexia, bulimia and binge eating among others. Worried if you or someone in your family may have an eating disorder? Watch for these warning signs, say experts: Constant dieting Obsession with weight, food, calories and fat grams Laxative use/overuse Poor body image Eating rituals Fear/discomfort eating in public Talk to your nurse if you’re struggling with any of these signs.
ANOREXIA hest has the hig te ra y mortalit l ta en m y of an . er disord
SHOP SMART FOR SUNSCREEN About 90% of non-melanoma skin cancers are caused by exposure to UV radiation from the sun. Shop smart for protective sunscreens with this advice from the FDA: Buy “broad spectrum” sunscreen with an SPF of 15 or more to protect against the full spectrum of the sun’s UV rays Walk away from exaggerated claims: There is no sunscreen that is “waterproof,” “sweat proof ” or a “sunblock,” says the FDA Use sunscreen effectively: Regardless of the SPF, reapply at least every 2 hours; more of ten if you’re sweating or getting in/out of water
ISSUE 22 / 2017 Healthy Mom&Baby
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Only the best for you and your baby During pregnancy, a portion of the chemicals and toxins in your skin care products are absorbed into your bloodstream, and also through the umbilical cord, exposing the fetus to these toxins and synthetics. Research has revealed that almost 300 toxic chemicals have been found in the blood of newborns. For your sake and your baby’s, go to EWG’s database and type in the brands that you use and see how many, and which toxins they contain. Even many of the “organic”, “natural” and/or “pediatrician recommended” products contain ingredients that are rated high on the toxin/hazard scale. Every ingredient used by Finally Pure is rated a “1” (safe and non-toxic).
Use Discount Code: HEALTHYBABY during checkout to save 10% off your first purchase. www.finallypure.com
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healthy moms
Ways to Start
Your Day Spiraling Up BY REBECCA SCRITCHFIELD, MA, RDN, HFS
To create happiness, build positive emotions one by one, on top of one another in “upward spirals,” says positive psychology researcher Barbara Fredrickson. You can exponentially grow your health and happiness by layering positive choices on top of one another. The upward spiral you create pulls energy into your life, and your positive thoughts, feelings and choices fuel one another, keeping this powerful energy spiraling up. If you feel your energy depleting, make restorative choices.
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If you don’t have a morning ritual you love, try one of these 7 ideas or create your own. Practice the daily rituals for a month to see for yourself if they help you start—and stay—positive. REBECCA SCRITCHFIELD, MA, RDN, HFS, is a nutritionist in Washington,
DC. This article was excerpted from her latest book, Body Kindness: Transform Your Health from the Inside Out—and Never Say Diet Again (Workman Publishing).
STRIKE A “POWER POSE” Stand in front of the mirror, smile and raise your arms over your head like Wonder Woman. Say something positive like, “I am strong!” or “I will be kind to my body today!” 3 times. Change up the poses if you feel like it. Amy Cuddy, PhD, suggests power poses flip a switch in your brain to positive thinking. Your body stances can change your mind.
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TAKE DEEP BREATHS Find a comfortable spot to sit, then close your eyes. Inhale deeply, allowing your chest and abdomen to expand. Imagine the day’s new, fresh sunlight filling each of your cells. As you exhale completely and fully, imagine yourself cleansing within, creating space for whatever the day brings. Focused breathing elicits relaxation, impacting your heart, brain, digestive system and immunity.
SPREAD GRATITUDE Thank your daily helpers—your childcare provider, the bus driver, your barista—for their hard work. Make a new friend while you’re in line for coffee. Say good morning to a stranger. Surprise the person behind you by buying their coffee. Human connections make everyone feel good.
TAKE 10 MINUTES OF STILLNESS Snuggle with your partner or your pet, or relax by yourself. Breathe calmly, notice things. When you practice directing your mind in a relaxed state, you strengthen your awareness, which can save you from downward spirals.
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LET THE SUN SHINE IN Eat breakfast by a window or outside to boost your brain’s serotonin, which is linked with improved mood. Listen to the birds chirping or other signs of an energetic, living world just outside your door.
SEEK TO BE INSPIRED Start each morning with a quote or meditation that sets the tone for your day. The power of our thoughts leads to physical manifestations. Spend a few moments clearly deciding how you wish to shape your day, and then act as if your intention has already come true.
INVERSION THERAPY Doing a headstand, handstand or forward bend—even hanging your head off the side of your bed—gives an invigorating, healthy head rush. Remember to get up slowly!
ISSUE 22 / 2017 Healthy Mom&Baby
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healthy moms
Protect Your
Oral with Health a Regular Self-Exam
The Surgeon General is asking healthcare providers including nurses to do an oral health exam during routine care. Poor oral health puts you at risk for problems in pregnancy including preterm birth, diabetes and respiratory and cardiovascular diseases, say experts at the Institute of Medicine. Oral cancer is also a top concern: One of the most common cancers, oral cancer typically grows painlessly and spreads quickly before it’s found. Most oral cancers can be treated if caught early enough. UNDERSTAND ORAL HEALTH PROBLEMS Your mouth’s mucous membrane protects you from bacteria, viruses and infections. You’re at a greater risk for infection and other complications if you don’t have strong and healthy mucous membranes, which can be damaged by periodontal disease. Almost half of all people age 30 and older have periodontal disease—a deep inflammation of the gums that damages the structures that support your teeth. It starts as gingivitis and progresses to periodontitis, which puts you at risk for bone or tooth loss. Periodontitis also makes a pathway for the more than 150 bacteria that live in your mouth to enter your bloodstream.
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QUICK OR AL HEALTH CHECK Just like with breast self-exam, your oral health self-check takes 2 minutes once a month. Get care if you can answer yes to any of these questions:
Check your face first: Is it symmetrical? Look different since your last check? Feel along your neck and jaw: is there any swelling, tenderness, discoloration, lumps or bumps?
Look inside and out including the tissue around your lips and gums. Are there any sores or growths inside or near your mouth? Sores that have changed or that don’t heal?
Open your mouth: Are there any sores or white, gray or red patches anywhere inside your cheeks or on your lips, gums, tongue or the roof (palate) of your mouth? Feel any bumps, lumps, sores or tenderness along your upper hard and soft palates? White sores in your mouth need evaluation to rule out cancer.
ORAL HEALTH WARNING SIGNS
Feeling as if something is caught in your throat
Numbness in any part of your mouth
Trouble chewing or swallowing, or moving your jaw or tongue Ear pain without hearing loss
CAROLYN DAVIS COCKEY, MLS, LCCE, is editor of
Healthy Mom&Baby.
PROTECT YOUR ORAL HEALTH Floss a nd b rush d t eeth a nd g ums x regularly with a fluoride toothpaste Receive regular dc dental care, especially during pregnancy Do an oral exam once a month Eat a healthy diet Never smoke or use tobacco, and limit alcohol Use sunscreen
IMAGES © 123RF
Don’t be surprised if your nurse or primary care provider wants to take a look in your mouth at your next visit— your mouth can be a picture of your overall health.
health4mom.org
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GRAVUR GRAVUR CONDENSED BLACK CO NDENSED BLACK
WE HELP MOMS RULE.
WIC is the nation’s most successful public health nutrition program. We provide healthy food, nutrition education, and breastfeeding support to 8 million income-eligible pregnant women, moms of infants, and kids up to 5 years old.
YOUR PATIENTS MAY QUALIFY FOR WIC BENEFITS. Ask them to visit us online, call, or text to find out.
SignUpWIC.com/healthy
1-833-387-6460 Text healthymom + your zip code to 67076 (example: healthymom 12345)
USDA is an equal opportunity provider, employer, and lender.© 2016 National WIC Association. “WIC” is a registered trademark of the U.S. Department of Agriculture. All rights reserved.
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healthy moms
Hair Today,
Gone Tomorrow BY SUSAN PECK, MSN, APN
To shave or not to shave, that is the question! Should you remove your hair down there? There’s a good chance you’ve thought about whether to take the razor to your pubic region—or you may have wondered what other women are doing but didn’t want to ask. And if you do decide to go bare, what method should you choose? PURPOSE OF PUBIC HAIR First, let’s set the record straight: Pubic hair does have a purpose. It cushions and protects the vulva and prevents irritations and abrasions. Pubic hair may also help prevent infection-causing bacteria from getting close to the vagina. Hair-free down there is the preference for half of college-aged women, a recent study found. Women who remove their pubic hair say it makes them feel cleaner and sexier; they’re also bare because their friends are going bare, too.
Never shar e razor. Shav your in create tiny g can your skin. tears in This makes pathways for bacteri a and viruse s from perso to pass n to perso n via the razo r.
OPTIONS FOR REMOVING PUBIC HAIR Ultimately, you should manage your pubic hair for your personal comfort and preference. Whether you decide to just take a little off the top or dare to go bare, know the risks and be safe. METHOD
Shaving, blade or electric trimmer: cuts hair at the skin’s surface
PROS Easiest Cheapest Electric trimmer may be better than blade
Doesn’t last long Hair regrowth may be itchy May cut yourself
Longer lasting than shaving
May be painful—burns possible Could trigger outbreak in those with genital herpes
Waxing: removes hair at the root
Sugaring: gel made from sugar, lemon & hot water; pulls hair out at the root
Results similar to waxing Sticks only to hair, not skin May be less painful; more natural than wax
May be painful—burns possible
Longer lasting than waxing Most effective for those with light skin and dark hair
Hair regrowth Pain, redness and swelling possible Temporary changes in skin pigment may occur More expensive
Permanent
More expensive Time-intensive to treat each individual hair
IMAGES: 123RF
Laser: concentrated light damages hair follicles
Electrolysis: electric current via fine needle in hair follicle destroys hair growth cells
CONS
I’M PREGNANT— DO I NEED TO REMOVE MY PUBIC HAIR BEFORE MY BABY IS BORN? Absolutely not! However, if you’re having a cesarean, many doctors will make sure your belly is trimmed or shaved where the incision will be made.
SUSAN PECK, MSN, APN, is an expert adviser
to Healthy Mom&Baby
ISSUE 22 / 2017 Healthy Mom&Baby
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Nobody likes to be rushed, especially babies. Your baby needs at least a full 40 weeks of pregnancy to grow and develop. Inducing labor even a week or two early is associated with a host of risks, including prematurity, cesarean surgery, hemorrhage and infection. While it may seem convenient for you or your health care provider, labor should only be induced for medical reasons. Your baby will let you know when she’s ready to come out, so give her all the time she needs: at least the full 40 weeks.
Download a free copy of
40 Reasons to Go the Full 40 at www.gothefull40.com.
The nurses of AWHONN remind you not to rush your baby—give her at least a full 40 weeks!
AWHONN PROMO T I NG T H E H E A LT H OF WOMEN A ND NE W BOR NS
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healthy moms
Experiencing
endometriosis By SuSan Peck, MSn, aPn
Terribly intense menstrual cramps, heavy flow, pain during sex: Are these just period pains, or could it be endometriosis? Endometriosis occurs when the type of tissue that normally lines your uterus grows in your body where it doesn’t belong, like on your ovaries or fallopian tubes, bladder or bowels—even in your abdomen. During your period, you shed the lining that has built up since your last bleed. When endometrial tissue grows outside of your uterus, it reacts to the same hormonal changes as the tissue of your uterine lining—shedding and bleeding. Your body absorbs this small amount of blood, and you feel it as severe cramping, inflammation and other symptoms. Women describe the pain as severe cramps, inflammation or painful bowel movements or urination. Endometriosis can make sex during your period painful. Women living with endometriosis may have heavy periods, heavy bleeding between periods, and cramps that can get more painful over the months and years.
What Causes endometriosis? No one knows for sure what causes endometriosis. Some think it may be caused by what’s called backward menstruation, where menstrual blood containing endometrial cells flows through the fallopian tubes into the pelvis, causing cells to grow outside the uterus. Endometriosis may also be an immune or lymphatic system disorder. image: 123rf
B
diagnosing endometriosis Unfortunately, endometriosis is pretty hard to diagnose. You’ll need to track your period dates, bleeding patterns and symptoms
to discuss with your care provider. They may want you to have a pelvic ultrasound to look for cysts. The only way to diagnose endometriosis for sure is with a surgical procedure called a laparoscopy. Your care provider will insert a small camera-like scope through tiny incisions on your abdomen to look for lesions or scar tissue, which may be removed via laser during this time.
risk faCtors Endometriosis can happen to any woman, but you may be more at risk for developing endometriosis if you: B Drink alcohol B Had your first period before age 12 B Have never been pregnant B Experience short cycles (less than every 25 days) B Have low body mass index or are underweight B Have a uterine problem, such as an abnormal shape B Have a family history of endometriosis
treating endometriosis Mild pain symptoms may be managed with ibuprofen or naproxen. In many cases, though, hormones are needed to improve the severe pain. Your care provider may suggest hormonal contraceptives, such as the patch, pill or ring to make periods shorter, lighter or less crampy. IUDs may stop periods, eliminating the pain of menstruation. One drug blocks ovulation. In severe cases, surgery may be the best option. Not every woman who has painful periods has endometriosis. But if your periods are making you miss work, school or other activities, have a dedicated discussion with your healthcare provider about endometriosis. SuSan Peck, MSn, aPn, is an expert adviser for Healthy Mom&Baby.
ISSUE 22 / 2017 Healthy Mom&Baby
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healthy moms
What Is
Multiple Sclerosis? By SuSan Peck, MSn, aPn
Multiple sclerosis is a condition most of us have heard of, but what is it exactly?
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Multiple sclerosis (MS) is an autoimmune disease in which the body’s own immune system attacks myelin, the fatty substance that surrounds and insulates nerves and nerve fibers in our central nervous system (i.e., the brain and spinal cord). The damaged myelin forms scar tissue (sclerosis). When the myelin sheath and/or nerves are damaged, normal communication between the brain and spinal cord is disrupted. Although MS can affect children and older adults, most people are between the ages of 20 and 50 when diagnosed. MS is 2 to 3 times more common in women than men. This means many women learn they have MS when they may be trying to start a family. MS can occur in any race or ethnic group, but it’s more common in white people (particularly those of Northern European ancestry) and in Europe, United States, Canada, New Zealand and some parts of Australia. There’s still a lot unknown about who develops MS, but family history and genetics can play a part. Having low levels of vitamin D and being a cigarette smoker have been shown to increase MS risks. SymptomS MS can cause symptoms like blurred vision, loss of balance, poor coordination, tingling, slurred speech, tremors, numbness, extreme fatigue, problems with memory and concentration, depression, paralysis and blindness. These vary from person to person and may come and go, or persist and worsen over time. One person with MS may not have any visibly
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mS & pregnancy MS doesn’t cause infertility or affect your fertility—women with MS can have healthy pregnancies, labor and birth and healthy babies. If a woman with MS doesn’t have a significant disability, her childbirth experience should be no different from a woman without MS. All forms of anesthesia (including an epidural) are safe for women with MS. Until you’re ready to start a family, discuss family planning or contraception with your neurologist, obstetrician or nurse. Most neurologists will recommend that medications for MS be stopped when trying to get pregnant. If there are relapses, these are usually treated with steroids, which are allowed during pregnancy. As with many other autoimmune diseases, most women with MS feel very well when they’re pregnant—some even better than before! The suspicion is that MS symptoms are improved or affected by hormones; however, the risk of a relapse in the postpartum period is estimated to be 20%–40%. In long-term studies, though, women with MS who had children didn’t have any increased disability because of pregnancy. Disease-modifying drugs are not recommended for breastfeeding moms, as these could hurt the baby. A woman with MS may need to consider holding off on restarting these medicines. Another option is donor breastmilk. Regardless, she should discuss these issues with her nurse and primary care provider during her pregnancy, before her baby is born.
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healthy moms noticeable symptoms, and another person may lose their ability to walk. GETTING TO A DIAGNOSIS Like many other autoimmune diseases, MS is often hard to diagnose. It’s not unusual for it to take months or even years to gain an accurate diagnosis. Still today, there are no specific symptoms, physical findings or one special laboratory test that can confirm for sure that a person has MS. Care providers may perform tests like a neurological exam, an MRI (to look for damage and inflammation) or a spinal tap (to test the fluid around the spinal cord). Blood tests can also be used to rule out other conditions, such as Lyme disease or a severe vitamin B12 deficiency.
Most pe ople with MS don’t become se disabled verely , and life expec ta n for peop cies le living with MS are increasin g.
TREATMENT Most people who have MS are cared for by a neurologist, a physician specializing in diseases affecting the central nervous system. Fortunately, there are many treatments available today that can prevent disability and keep a person quite well while living with MS. But since every person’s experience with MS is unique, there are still many people who will need the help of a cane or a wheelchair. Managing MS may include getting enough rest, reducing stress, exercise, physical therapy, vitamin supplementation and prescription medications. There is no cure for MS, so medications are used to modify the course of the disease (and prevent disability), treat relapses and make symptoms easier to live with. If you have MS, it’s critical to stay strong and healthy—eating well, resting and listening to your body when it says to slow down!
THE 4 TYPES OF MS Clinically Isolated Syndrome (CIS) is a first episode of neurologic symptoms caused by inflammation and myelin damage. A person who has a CIS may or may not develop MS. Relapsing-Remitting MS (RRMS) is the most common, characterized by clearly defined attacks and partial or complete recovery after an attack. Approximately 85% of people with MS are initially diagnosed with RRMS. Primary Progressive MS (PPMS) is a worsening disability over time from the beginning, without early relapses or remissions. Approximately 15% of people with MS are diagnosed with PPMS.
IMAGES: 123RF
Secondary Progressive MS (SPMS) starts as RRMS but worsens over time.
SUSAN PECK, MSN, APN, is an expert adviser to Healthy
Mom&Baby.
ISSUE 22 / 2017 Healthy Mom&Baby
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Workout Woes
(
)
the DaNgeRs of ex tReme exeRcise By Rita Nut t, DNP, RN
Exercise is good for your heart and self-confidence, but too much of a good thing can actually be unhealthy. Extreme exercise programs are all the rage—heavy weightlifting, intense cardio workouts, aggressive cycling. They’re fun to watch and participate in, but do you know the hidden dangers of excessive exercise at such high intensity? HealtHy Habit or obsessive beHavior? Exercise becomes unhealthy if your habits become excessive or obsessive—and yes, you risk developing an exercise addiction. Extreme exercise classes attract people who may encourage each other to lift more, run faster and cycle harder. Friendly competition is typically a good thing, but
this can become a problem when you push yourself beyond your body’s signals to stop. Keep exercise in balance with the rest of your life—it shouldn’t replace family time, intimate relationships and work or leisure activities. If you find yourself repeatedly turning down opportunities to hang out with family and friends to exercise instead, you may be crossing the line from healthy to obsessive. rest time is non-negotiable Don’t ignore cues from your body to slow down or stop. Exercising despite pain and fatigue increases your risk for injuries. Allow your muscles to recover from the physical demands of an intense workout. Refusing your body’s need for rest can actually decrease your overall physical performance and have long-term consequences and risks for injury. WHere’d ya go, Flo? Excessive exercising can throw your periods out of whack, especially if you’re not eating well. Below normal levels of body fat affects your hormone production and can cause consecutive missed periods, which is called amenorrhea. This could lead to temporary (and possibly permanent) issues with fertility. If you miss 3 or more periods in a row, ask your nurse or midwife about the cause and how to proceed. eFFects on bone HealtH Estrogen is crucial for healthy bones, and excessive exercising can decrease estrogen production, putting your bones at risk for losing density and getting weak. This increases your risks of serious fractures and decreases your endurance and overall strength. If you’re older, bone density loss may be permanent, and you may be at risk for osteoporosis. Keep your Kidneys in cHecK Perhaps the most serious risk of excessive exercise is exertional rhabdomyolysis, which occurs when muscle tissue breaks
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healthy moms down and releases fiber into your blood. Your kidneys can suffer damage as they try to filter the fibers out. Symptoms can mimic normal muscle aches; however, the pain from rhabdomyolysis intensifies with time, and you can also feel weak and stiff and have tender muscles and dark or cola-colored urine. This is a serious condition that requires urgent medical treatment to prevent kidney failure. Prevent rhabdomyolysis by gradually increasing physical activity, especially if you’re new to intense exercise. Hydrate with plenty of f luids and avoid activities that overwork a particular muscle group. Prioritize your health Exercise is important for your overall health. Take caution with very vigorous or intense exercise—especially when you’re just getting started.
Get ready; Get sweaty! “No pain, no gain” is an outdated cliché: B Know how your current health affects your ability to exercise B Ramp up into exercising by starting out no more than 3 to 4 times a week B Try starting with 30 minutes a session and increasing from there B Start with low-impact, low-intensity activities and gradually increase your intensity B Don’t exercise solely as a means to losing weight B Set attainable and reasonable goals B Listen to your body: Not being able to catch your breath, pain, and dizziness or fatigue aren’t normal
Rita Nutt, DNP, RN, is an expert adviser to Healthy Mom&Baby.
IMAGES: thInkStock
rself nd you If you fi urning down dly t out repeate ities to hang to n s u d t n r oppo d frie mily an , you may fa h t i d w om e instea exercis ing the line fr s . s e o v r i s c s e e s b to ob y h lt a e h
ISSUE 22 / 2017 Healthy Mom&Baby
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Protect your unborn baby while driving
Car crashes are the number one risk of injury to an unborn baby.* Tummy Shield™ is a safe & simple solution for directing seat belt pressure away from your tummy while driving.
Fits in Seconds Fits all Cars Crash Tested Firefighter & Healthcare Provider Recommended *US Library of Medicine
SafeRide4Kids.com $10 off with code TS-HMB217
Brands Four Kids / Safe Ride.indd 1
SAFE RIDE
4KIDS 21/07/2017 10:36
healthy
Join us on Facebook facebook.com/HealthyMomAndBaby
Pregnancy Accide nt risks from d river e r ror a re high er during the
2 nd trimes ter.
BY SUMMER HUNT
A Bump on the Road Driving is a daily task you may not even think twice about. But if you’re driving for 2, follow these tips when you’re behind the wheel: ALWAYS wear your seat belt—you’ll reduce the risk of harm to you and your baby in a crash Place the top strap across the middle of your chest between your breasts and to the side of your belly. Never place it behind your back or under your arm
LICORICE
could prove to be lico-risky
Slide the lap belt low across your hips under your bump Slide your seat for extra space between your belly and the steering wheel, which should be angled up Never drive tired or nauseous DON’T DRIVE if you’re in labor! There’s no telling what could happen when a contraction hits
Help Prevent
IMAGES © 123RF, THINKSTOCK
Preeclampsia Listen up, licorice lovers: Researchers in Finland have linked the rope-like candy to lower IQ scores. The problem comes from glycyrrhizin, the sweetener found in pure licorice. In the study, pregnant women who ate the most pure licorice per week had children who averaged about 7 points lower on IQ tests at age 13 (when compared to those whose moms ate little or none). These children also had triple the risk for attention deficit disorder problems. The girls in this group of kids were taller, heavier and entered puberty sooner. Bottom line: You may want to lay off the licorice until your 9 months are up.
Preeclampsia is the leading cause of medically necessary preterm births in the US. You can help prevent preeclampsia by keeping all of your prenatal appointments and having your blood pressure checked at every visit, according to updated guidelines from the US Preventive Services Task Force. Increased screening via blood pressure monitoring helps your care provider catch this dangerous complication that can harm your kidneys, liver, brain and eyes. For example, if your provider thinks you may be at high risk for preeclampsia, they may ask you to take a low-dose of aspirin (81 mg).
ISSUE 22 / 2017 Healthy Mom&Baby
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The only clinically proven protein drink for pregnancy, delivery and recovery A published clinical study* showed that 98% of pregnant women had below normal protein levels 100% of women who took Protiva improved their protein levels to normal and demonstrated better recovery following delivery Order online at: www.protivamom.com /protivamom
protivamom.com
* Published - September 2016
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.
www.childlife.net *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.
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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.
21/07/2017 09:32
1st
healthy pregnancy
Trimester:
Probiotics
BY CATHERINE RUHL, CNM, MS
Your Health
INCLUDING DURING PREGNANCY
(
PROBIOTICS BOAST OF IMPROVING YOUR OVER ALL HEALTH. BUT WHAT’S THE BEST WAY TO GAIN THEIR BENEFITS—AND ARE THEY SAFE DURING PREGNANCY?
IMAGES © 123RF
If your goal is to maintain a healthy digestion and enough “good” bacteria and other microbes in your intestinal tract (intestinal microbiome), prebiotics and probiotics can help with that. Your intestinal microbiome is a control center for your body’s immune system, brain function and metabolism. So it seems smart that you might want to take steps to keep the trillions of microbes in your microbiome in good shape. Prebiotics are non-digestible ingredients in food that promote healthy microbes in your intestines. Probiotics are living microbes (including many bacteria and yeasts) that provide health benefits to your body. HOW PROBIOTICS HELP Research has shown that probiotics are helpful in treating diarrhea and bacterial vaginosis (a common vaginal infection). They also support the microbes in your intestines when you take antibiotics, which can kill off good microbes. Th is is why it’s important to take probiotics with an antibiotic, which can upset your digestion and the bacterial balance in your reproductive tract. There’s also evidence that probiotics can stabilize blood sugar. If you’re at risk of developing gestational diabetes during pregnancy, or have already been diagnosed with it, eat more
high-fiber foods rich in prebiotics and probiotics. In one study, women with gestational diabetes improved their fasting blood sugars and slowed their pregnancy weight gain by taking probiotics for 6 weeks. HIT THE FRIDGE Since the FDA doesn’t evaluate the effectiveness or safety of pre- or probiotic supplements, it may be safest to get your pre- and probiotics through your diet versus supplements during pregnancy. Begin with enough fiber in your diet to improve your digestion. Fiber helps the prebiotics or probiotics you ingest work better. Prebiotics are found in foods such as raw onions, leeks, garlic and Jerusalem artichokes. Probiotics are in fermented foods such as yogurt with live active cultures, kefi r, miso, kimchi, kombucha, tempeh, sauerkraut and pickles. Variety is key: Your gut microbes feed off of prebiotics; fermented foods with probiotics replenish microbes in your intestines. Even when you’re not pregnant, it’s healthy best to clearly read ingredients and choose supplements from brands known to test for consistent potency and safety. Talk with your nurse about pre- and probiotics, especially if you’re considering pregnancy or are pregnant.
)
Babie s their gain f micr irst ob t h ro ug h v e s bir th aginal an b r ea s t f ee d ding.
FIBER-RICH FOODS Raspberries Apple or pear (with skin) Prunes Black beans Lentils Artichokes Whole wheat pasta Green peas Oatmeal
CATHERINE RUHL, CNM, MS, is an expert adviser to
Healthy Mom&Baby.
Almonds Pistachios
ISSUE 22 / 2017 Healthy Mom&Baby
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Share the sound of your love. Hearing begins at 20 weeks. Memory at 30. Give your baby something memorable to listen to in the womb with BellyBuds by WavHello. Your music. Dad’s voice. A story with funny voices. Later your child can dance, recognize or be soothed by familiar beats and voices. It’s all about planning ahead. Start planning now at wavhello.com
Use code BBHMOM for 5% OFF BellyBuds
Look for the new VoiceShare 2.0 launch this summer.
wavhello.com
Snuza’s Newest Wearable Monitor Connects Parents to Baby While They Sleep us.snuza.com
The revolutionary new Snuza Pico wearable baby monitor attaches directly to your baby’s diaper and alarms if no abdominal movement is detected. If there is no abdominal movement detected after 15 seconds, the device will vibrate in an effort to rouse your baby awake. After 20 seconds of no abdominal movement, the Pico will alarm. The Snuza Pico is the first wearable baby movement monitor in the Snuza line that allows parents to directly connect to a smartphone or tablet via a Bluetooth App. The App, which is Apple and Android compatible, also monitors your baby’s skin temperature, sleeping position (side, face-down, face up) and is a fall detector.
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healthy pregnancy 2nd
Trimester:
Birth Plans 101: Realistic Choices for Your Baby’s Birth By Rita Nut t, DNP, RN
iMagES: 123RF
Birth plans let you describe how you want to experience your baby’s big event. Begin with these tips to craft realistic preferences for your baby’s birth. Create your own plan: Skip preprinted plans—your healthcare team will appreciate seeing your personal thoughts and desires. Include any health conditions you’re concerned about or special requests about baby’s labor and birth. Write it down: Make a list of everything you want to discuss at your next prenatal visit. Be short and direct: The clearer your plan is, the easier it will be to follow. Think beyond birth: Include your desires for labor, birth, the first hour after birth, beginning breastfeeding and your baby’s post-birth care. Have a backup plan: Labor can be unpredictable! Describe what’s important to you, for example, if you’ve planned for a normal birth and cesarean becomes medically necessary. Plan early: Discuss your plan with your pregnancy provider sooner than later; they’ll be able to tell you if something in your plan isn’t possible or is in conflict with hospital policy. Be flexible: You can always change your mind once you’re in labor—nurses see this frequently. Maybe you thought you wanted an epidural but in labor you find you can manage the waves of contractions on your own. Relax: The goal of every birth plan is a healthy mom and baby.
birth PLan Considerations Here are some elements you may want to consider in your birth plan: Labor
Cesarean
PostPartum
neWborn Care
Consider how you feel about Wearing your own clothes or gown Eating or drinking interventions, including iV, induction, drugs designed to stimulate contractions, episiotomy, electronic fetal monitoring Being able to move, walk around Having support persons with you taking photos or video
Having support persons with you
Delaying routine baby care for the first hour or first feeding
anesthesia options
Having support persons with you
Watching the procedure
Managing recovery pain
taking photos or video
Wearing your own clothes or gown
Who may accompany baby for procedures apart from you
Beginning breastfeeding
Breastfeeding goals
Having visitors
Pacifier use
Skin-toskin at birth (either you or a designated person) Keeping you and baby together
Pain medication
Keeping baby on your body for procedures
Supplementing with formula Newborn screening
Check ou L a ma z t e’s birt h p la bit .ly/L n at amaze B i r t hP l an
Having your waters broken Delaying cord clamping Who cuts the cord Cord blood banking Skin-to-skin at birth
Keeping baby with you
Rita Nutt, DNP, RN, is an expert adviser to Healthy
Mom&Baby.
ISSUE 22 / 2017 Healthy Mom&Baby
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healthy pregnancy
3rd
Trimester
BY SHARON SCOT T, DNP, MSN, RN
WILL I NEED AN
Episiotomy?
You may have heard that an episiotomy is a possibility with a vaginal birth—but what exactly is it? And is it necessary?
An episiotomy is a surgical cut during the pushing stage of labor between the vagina and rectum (the perineum) to enlarge the vaginal opening. It’s rarely necessary, which is why routine episiotomies—once common—are no longer recommended by the American College of Obstetricians and Gynecologists (ACOG) and the World Health Organization. Episiotomies increase the risk of infection and blood loss; an incision could be more extensive than a natural tear. Natural tears typically heal better than incisions. An episiotomy may be needed if your baby is in true fetal distress, such as if baby’s cord is compressed during birth.
WHAT CAN I EXPECT IF I NEED AN EPISIOTOMY? Your doctor will ensure your perineum is numbed and make either a vertical (midline) or angled (mediolateral) incision. After baby’s birth, your provider will close the cut with stitches. Recovery may take a few weeks. The incision may feel tender as you walk or sit. Keep your perineal area as clean and dry as possible; change sanitary pads every 2-4 hours. Pat yourself dry front to back to decrease infection risk. Recommended comfort measures include using: Ice packs Chilled witch hazel pads
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In 2012 , of vagin al bir t hs involve d episiot omy — t hat ’s d ow n f r om 33% in 20 0 0 .
12%
Warm-water rinse bottle sprayed toward the incision during or after urination Sitz bath: soak your perineum in warm water with either Epsom salt or tea bags Stool softeners to prevent constipation CAN I REFUSE AN EPISIOTOMY? Ask your healthcare provider if or when they would do an episiotomy and include your thoughts about episiotomy in your birth plan. SHARON SCOTT, DNP, MSN, RN, is an expert adviser to Healthy Mom&Baby.
EPISIOTOMY: Watch for these complications Tell your healthcare provider if you experience any of the following after episiotomy: Fever Painful sexual intercourse Infection Swelling Bleeding from the incision Leaking gas or stool if you have cut rectal tissue Pus-like discharge If the incision opens
IMAGES © THINKSTOCK
HOW TO AVOID EPISIOTOMY Follow your body’s instincts by pushing only when you have the urge to push. Your midwife or nurse may recommend performing perineal massage during pushing. Avoid birthing while lying on your back. Birth in an upright or sidesitting position and change positions frequently. Ask for a warm compress to be placed against your perineum during pushing.
health4mom.org
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healthy pregnancy BY SUSAN PECK, MSN, APN
It Ain’t Easy
Bein’ Queasy Do you consider morning sickness a pregnancy “rite of passage?” Here’s how to enjoy pregnancy when you’re not feeling well.
Could it be hyperemesis gravidarum?
amins tal vit Prena ld add to cou aking t a—tr y nause efore bed b m t he t he d of in instea rning. mo
IMAGES 123RF
It’s no secret that nausea and vomiting in pregnancy is very common—and it can be morning-noon-and-night sickness that lasts the whole pregnancy! Most pregnant women (50%–80%) experience nausea, and half experience vomiting. Maybe you take this as a good sign as some studies associate morning sickness with a healthy pregnancy—but that’s not always a comforting thought in the heat of the heaving. Typically, nausea and vomiting in pregnancy isn’t dangerous for your baby. Even with the most extreme form of nausea and vomiting, as long as it’s treated early, most babies have no problems. However, some studies show that if a pregnant woman has hyperemesis gravidarum, her baby could be born earlier or may be smaller overall. WHAT CAUSES MORNING SICKNESS? It’s not exactly known, but the hormones hCG (the pregnancy hormone that makes pregnancy tests positive) and estrogen are said to trigger it. Stress doesn’t help, either. If your mother, sister or grandmother had morning sickness, you might, too.
HOW LONG DOES IT L AST ? Nausea and vomiting can begin as early as 4 weeks of pregnancy; it usually peaks around 8 weeks. For most women, it subsides after the end of the 1st trimester (about 14 weeks). But for 10% of unlucky moms-to-be, it can last the whole pregnancy. Let your healthcare provider know when you’re experiencing the symptoms; it may well begin before you have your first appointment. HOW CAN I COPE WITH MORNING SICKNESS? Avoid tastes or smells that may trigger your reaction. Try eating small, frequent meals and bland, dry foods and high-protein snacks. Ginger (in all forms) may help nausea. Your healthcare provider may prescribe a medicine called Diclegis®. This is a Pregnancy Category A drug, which means it’s been studied in pregnant women with no increase in birth defects or pregnancy problems. SUSAN PECK, MSN, APN, is an expert adviser to Healthy Mom&Baby.
If nothing relieves your symptoms and you aren’t able to even eat or drink, you may have hyperemesis gravidarum. Signs include severe nausea and vomiting several times a day, dehydration and dangerous weight loss. This extreme form of morning sickness happens in up to 3% of pregnancies, but it’s the most common reason for hospitalization in early pregnancy. Women with twins or triplets or who have had hyperemesis gravidarum before and first-time mothers are more likely to have HG. Just like nausea and vomiting, hyperemesis gravidarum usually goes away after the 1st trimester but may continue for a very small number of pregnant women. If you think you may have this extreme form, let your nurse know right away. You may need IV fluids and anti-vomiting medications.
ISSUE 22 / 2017 Healthy Mom&Baby
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r il l e d h t o s s “I w a o u n d o u t I f w he n I n ant . I ha ve a eg wa s pr an t e d t o be e l w e a l w a y s w a s l ik e , ‘I f e d r I m om . ’ m a l it t l e t i I g r e a t ! I fe e l go o d ! ’ ” but Jana Kramer performs while pregnant with daughter Jolie at the 2015 CMA Music Festival in Nashville, TN.
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r e m a r K Jana
SINGS THE MORNING SICKNESS BLUES BY CAROLYN DAVIS COCKEY, MLS, LCCE
“I was so thrilled when I found out I was pregnant. I have always wanted to be a mom. I was like, ‘I feel great! I’m a little tired but I feel good!’” recalls award-winning actress and singer Jana Kramer. Then, 6 weeks in, morning sickness stopped her cold. “Why do they call it morning sickness because I’m sick in the morning; I’m sick in the afternoon; I’m sick at night! I’m sick all the time!” Kramer changed her diet and activity—adding ginger, going outside for fresh air and a walk, but she “just felt like crud. I was touring and promoting my single, ‘I Got the Boy,’ throwing up into a bucket side stage in between songs. It was really difficult.”
IMAGES: MARCEL THOMAS/ZUMA WIRE/AL AMY LIVE NE WS
FINDING RELIEF Jana toughed it out to 12 weeks before she asked her healthcare provider for help. “I said, ‘I’ve changed my lifestyle, my diet, and it’s still not going away.” The solution came in the only FDAapproved medication for use in pregnancy for morning sickness, Diclegis®. “Knowing it’s not going to hurt me or my baby was a huge relief; I’m constantly on Google researching what’s safe for me and for my baby.” Morning sickness typically resolves for most pregnant moms by 12-14 weeks, but Kramer needed the medication throughout her pregnancy. “I stopped taking it around 32 weeks, and I started to throw up again. I was like, ‘Oh man I have to stay on this the entire time,’ and so I did. I was able to enjoy my pregnancy and continue touring without running to the toilet every 2 seconds. I was able to enjoy meals; I was able to enjoy the process.”
“When I started talking about morning sickness, it was like a waterfall eff ect. Another girlfriend of mine shared that the medication worked for her, and it spilled over to others as well.” AVOIDING MOMMY SHAMERS Kramer hopes to be a voice for other moms struggling with nausea and vomiting. “There are so many ‘mommy shamers’ out there that shame you for doing certain things, or shame you for taking medicine. It was almost like I had to keep saying ‘This is safe,’ or like I had to keep a printout that this is FDA approved. I had to keep being that voice, and at the same time I was glad I could be. I
When Jana Kramer found a solution for the nausea and vomiting that plague d her pregnancy, she knew she had to share her story wit h other expect ant moms .
don’t want any woman to feel like they have to suffer, to not tell anybody what they’re going through and go without help.” FINDING HER CHAMPIONS “My family, and my band of course, is so there for me. My family is fantastic. It was such a personal struggle—you just want to get through it and have a healthy baby,” she says. “When I started talking about morning sickness, it was like a waterfall eff ect. Another girlfriend of mine shared that the medication worked for her, and it spilled over to others as well. Now I have all of these mommy group texts where we reach out to each other for support as we navigate motherhood.” CAROLYN DAVIS COCKEY, MLS, LCCE, is editor of Healthy Mom&Baby.
ISSUE 22 / 2017 Healthy Mom&Baby
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feature
Fill Up on Fish
for a brainier baby! By Summer Hunt, eLS
There’s an easy—and delicious!—way to potentially boost your baby’s brain development before your little one is even born. Are you avoiding fish in pregnancy because of concerns about mercury or confusing advice? It’s time to cast a second look at seafood—especially since it contains omega-3 fatty acids including DHA known to help your baby’s brain development. In fact, federal health experts say pregnant women and children need to eat more fish—not less! Seafood iS brain food A 2014 report from the Food and Drug Administration (FDA) indicates that babies born to women who eat more seafood during pregnancy tend to have higher IQs—potentially 3.3 points higher—than those born to women who ate no fish. Brain-boosting DHA is found in high amounts in oily fish like salmon, herring and sardines. That’s why the Dietary Guidelines
for Americans recommends that pregnant women regularly eat at least some fish that are high in DHA. How mucH fiSH SHould i eat during pregnancy and breaStfeeding? Women and children should eat 8-12 ounces of lower-mercury fish a week, according to new FDA guidelines. That’s several 4-ounce servings a week. The American Academy of Pediatrics has also given women the thumbs-up to eat 12 ounces of lower-mercury fish while pregnant. Many pregnant women eat less than 2 ounces of fish per week. If 12 ounces sounds like a lot, increase your fish intake over time and eat the most you can. Every little bit helps, says Philip Spiller, former director of the seafood program in the FDA’s Center for Food Safety and Applied Nutrition. “Eating 8-12 ounces weekly
neceSSary nutrientS Fish pack a boatload of nutritional benef its that are particularly important during pregnancy. reel in these valuable nutrients in seafood: B Omega-3 DHA: salmon, tuna, sardines, trout and anchovies B Calcium: canned sardines and salmon B Vitamin D: salmon, shrimp and tuna B Iron: clams, halibut, crab, shrimp and cooked oysters
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fIsh = Good mood food “The nutrients in seafood are associated with less depression,” says Tom Brenna, PhD, a nutrition researcher and professor of Pediatrics and of Chemistry at the University of Texas at Austin.
DH A
images: 123rf; thinkstock
will help you get the most possible benefits for your baby’s brain development,” Spiller explains. “But less than 8 ounces can still be pretty good. So even if you can’t regularly eat 8-12 ounces, don’t give up on fish.” But whAt ABout mErcury In fIsh? Mercury in fish is often a concern of pregnant women. However, risk in the range of 8-12 ounces a week and even higher is very low, so you can feel confident eating the FDA-recommended amount. There are some fish to avoid during pregnancy (see below), but many of these aren’t typically eaten frequently. When putting fish on your pregnancy plate: B Eat a variety of seafood, and make sure some of your selections are high in DHA. B Avoid shark, swordfish, marlin, orange roughy, tilefish from the Gulf of Mexico, king mackerel and bigeye tuna (used in sushi)—these are higher in mercury, and some are very low in DHA. B Check local advisories when eating seafood caught by family and friends. If there is no advisory, limit these selections to once a week. B Cook seafood thoroughly—fish should be opaque, flake with a fork and have an internal temp of 145°F. Clams, mussels and oysters are fully cooked when their shells open. Summer Hunt, eLS, is a writer and editorial coordinator
m a k es fi sh ba b y’s b ra in fo o d
As k An Ex pE rt : tA kE A dh A su sh o u ld I pp lE m En t? “Food is always going to be the best source for nutrients,” says Rima Kleiner, MS, RD, LDN, a registered dietitian. “But if a woman can’t eat seafood because of allergies or dietary preferences, she can talk to her provider about an omega-3 supplement. She might also consider plant-based sources, like f lax seed.” Also, “the research that has consistently shown brainbuilding benef its has all focused on f ish consumption, which naturally includes DHA in addition to the other important nutrients in f ish,” says Philip Spiller, former director of the seafood program in FDA’s Center for Food Safety and Applied Nutrition.
omG, omEGA-3!
The omega-3 fatty acid DHA is crucial for baby’s eyes and brain. One way to get your f ill— and give baby theirs, too—is to include some f ish that are high in omega-3s in the variety of seafood you eat, like these:
Salmon Whitef ish Anchovy Herring Trout, fresh and saltwater Bass (saltwater) Halibut Sardines Pollock Oysters Mussels Squid
at AWHONN in Washington, DC.
ISSUE 22 / 2017 Healthy Mom&Baby
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Farro, Tuna anD Fennel salaD wiTh crumbled FeTA Makes 4-6 servings
Ahoy there, tasty!
“Pregnant women should feel confident incorporating the recommended amount of seafood into their diets,” says Rima Kleiner, MS, RD, LDN, a registered dietitian (and mom of 2!). “It’s always good to eat a variety of foods, and your baby gets the brain-boosting bonus of DHA.” Rima offers up some yummy and easy recipes to help you slide seafood into your weekly rotation.
Ingredients: 1½ cup farro, uncooked 1 (5-oz.) canned tuna, drained 1 cup canned chickpeas, drained and rinsed ½ large bulb fennel, cut in half, cored and sliced very thin 2 generous handfuls baby arugula 2 Tbsp. extra-virgin olive oil 2 Tbsp. fresh lemon juice Zest of ½ lemon ¼ tsp. ground cumin 13 / cup crumbled feta cheese Salt and pepper, to taste Directions: X Cook farro according to package directions. Drain any remaining cooking water and transfer farro to a large bowl. X Flake tuna with a fork and add to bowl, along with chickpeas, fennel, arugula, olive oil, lemon juice, lemon zest, cumin and salt. Toss well. X Spoon into a shallow serving bowl or small platter and sprinkle feta over the top. Serves 4 as a lunch entrée or 6 as a side dish.
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GrIlleD FIsh & AvocAdo TAcos Makes 4 servings
These tacos practically cook themselves. Grill the fish and the avocados; top with broccoli slaw and a light lime-yogurt sauce. Ingredients: 1 lb. cod (mahi-mahi and tilapia also work well) 2½ Tbsp. olive oil, divided 2½ Tbsp. lime juice, divided 1 garlic clove, minced 1 tsp. chili powder 1 tsp. ground cumin 1 large avocado, cut in half with pit removed 6 Tbsp. nonfat plain Greek yogurt 3-4 cups ready-to-eat broccoli slaw ½ jalapeno pepper, finely chopped ¼ cup cilantro, finely chopped 8 corn tortillas
Directions: X Preheat grill. X In a large plastic baggie, mix 1 Tbsp. olive oil, 1 Tbsp. lime juice, garlic, chili powder and cumin. Add cod and mix until fish is coated. X Grill fish about 3 minutes per side, or until it flakes with a fork (internal temp of 145°F). X Mix ½ Tbsp. olive oil and ½ Tbsp. lemon juice in a small bowl. Rub onto avocado halves and place face down on grill. Grill for about 2-3 minutes. Remove and cut in slices. X In a medium bowl, combine remaining oil, lime juice and yogurt. Mix well. Add broccoli slaw, jalapeno and cilantro and combine until coated with yogurt-lime sauce. X Top corn tortillas with grilled fish, slaw mixture and avocado slices.
IMAgeS: NAtIoNAL FISHeRIeS INStItute/DISH oN FISH; KeLLI BoyD PHotogR APHy/DISH oN FISH
Tuna gets a Mediterranean makeover in this hearty whole-grain salad! If you don’t have farro, sub in 1½ cups cooked brown rice, barley, Israeli couscous or a different whole grain of your choice.
health4mom.org
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Can Eating Seafood Make Your Baby Smarter? The FDA recently changed its recommendations for pregnant women to encourage expecting mothers to eat more seafood. They recommend two to three servings of seafood per week for healthy brain and eye development. It turns out that eating seafood, especially certain types like wild salmon, will actually make your baby smarter. A recent study with 2000 mother-child pairs showed that when mothers eat 3 sizeable servings of fish each week during pregnancy it may benefit children’s brains for years to come.* The link between higher maternal seafood consumption and improved brain development in children is significant. Children were tested at ages 14 months and 5 years to assess their cognitive abilities and to monitor their neuropsychological development. The study found improved brain function in kids whose mothers ate the most fish while pregnant. The researchers also saw a consistent reduction in autism-spectrum traits with increased maternal seafood consumption. For years, common wisdom held that expecting mothers should limit seafood consumption. Many pregnant women chose to completely exclude seafood from their diets. However, emerging research suggests that reduced seafood intake is very likely increasing the risk of complications and limiting brain development in children! Fish from the cold waters of Alaska, like our wild salmon, are particularly loaded with the omega-3s that are believed to be good for you and your baby’s brains. See more on our Alaska Gold Seafood and why it’s good for expecting moms here (https://goo.gl/AbPnIa) or at our website: www.AlaskaGoldSeafood.com *Julvez, Jordi. Center for Research in Environmental Epidemiology in Barcelona, Spanish Childhood and Environment Project, 2004-2008.
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If You’re Going to Pump, You Need More Choices The affordable Freemie cups convert most popular breast pumps into hands free, concealable systems that can be used just about anytime, anywhere, and around anyone. The naturally shaped Freemie cups are used in place of the traditional horns and bottles, attach to your pump and fit right inside your bra to collect your milk. Freemie cups are designed to operate in the background of your life, so you can take care of other important business at the same time you're pumping milk for the baby. And with a new baby at home, sometimes that important business is just closing your eyes for a few minutes... Check for a Freemie Compatible Set (between $59.95-$79.95) for your pump at www.freemie.com
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21/07/2017 10:26
healthy pregnancy
Tips for
&
Pumping Storing Breastmilk at Work By Glenda M. adaMs, Rn, Msn, IBClC
images: 123RF
It seems like most new moms are just getting the hang of motherhood and breastfeeding when it’s time for many of them to return to work. Your nurses and breastfeeding experts known as lactation consultants can help you craft a plan for your unique workplace. Use these expert tips to help you figure out where, when and how you’re going to continue to nurse, pump and store your breastmilk and maintain a good milk supply. Choose Your supplies Many working moms depend on breast pumps for expressing breastmilk at work. First you need to figure out what supplies you need, including a breast pump, a cooler bag and such. Start with your health insurance provider—many plans provide pumps for moms but coverage varies from plan to plan. Many moms find it helpful to have an extra set of pump parts to save time pumping at work. Some moms simply seal pump parts after use into a plastic bag for washing later. Decide if you will use storage bottles or storage bags for your milk. Both work; often what you choose is just a matter of preference, storage capacity and cost. A cooler or insulated bag with a reusable ice pack can keep your milk chilled until you can store it at home. Nursing bras are helpful; hands-free nursing bras
can give extra privacy and save time. You may or may not need nursing pads depending on if you’re leaking breastmilk. Washable or disposable pads are both useful. DisCover Where You’ll pump Next, figure out where you will pump—does your workplace have a dedicated lactation space? Skip the bathroom stall (it’s against the law for workplaces to allow this) and get creative in finding a location if you don’t have a dedicated pumping room. Talk to others who have pumped at work: Are there rooms where you can lock the door, or rooms with running water? Can you hang a sign on the door if the room doesn’t lock? If you have your own office or cubicle, can you pump privately there? Will your supervisor allow you to use their office for pumping, or a conference room? Is there a private break room? Talk with your human resources office to learn what options are in your workplace and what other moms may have successfully done. put pumping into Your WorkDaY Now it’s time to plan your nursing and pumping schedule. When will you nurse or feed baby breastmilk before and after work? How many times should you pump throughout the day to maintain
supplies fo r pum ping & stor ing Br e a stm il k XXDouble electric
pump
XXExtra pump
parts
XXStorage bags or
bottles
XXCooler or
insulated bag
XXReusable ice
pack
XXNursing bra
(consider a hands-free nursing bra)
XXReusable or
disposable nursing pads
ISSUE 22 / 2017 Healthy Mom&Baby
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healthy pregnancy baby’s nursing routine? Most women need at least 20 minutes or more to express their breastmilk, and that doesn’t include your time spent getting to and from where you will pump, setting up and storing your pumped breastmilk. Save yourself some time by assembling your pump and its parts before you leave home; carry extra assembled parts if you’ll pump more than once during your work day. If your workplace has a locker or cabinet/drawer, keep your pump, pump parts, extra nursing pads and storage bottles/bags at work so you won’t accidentally forget them at home. As possible, block or set an appointment to pump on your calendar, or use your lunch break and/or combine shorter breaks to gain at least a 20-minute pumping window in your work day. Doublepumping can save at least 10 minutes per session; a hands-free bra makes it easier to continue working at a desk while you’re pumping. Some moms find it helpful to look at a picture of their baby while they’re pumping. Try to relax and think about your baby to help your milk flow. Safely Store your BreaStmilk Learn where you may have access to refrigerators or where you can safely keep a cooler for storing your breastmilk at work. Storing your breastmilk in a refrigerator is preferred, but if that’s not possible, store your milk in a cooler or insulated bag. Use reusable ice packs to keep your milk chilled. If you are unable to chill your breastmilk, it can be stored at room temperature for 6 to 8 hours depending on how cool your workplace temperature is.
gLenda m. adamS, rn, mSn, iBcLc, is a lactation consultant and assistant professor and clinical instructor for mother/baby nurses at the University of Louisville School of Nursing.
Workplace BreaStmilk pumping optionS Use this list to determine what may help you maintain your breastfeeding goals as you return to work: Location: Where can you pump?
B Dedicated pump room B Your office/work station/cubicle B Boss/supervisor’s office B Conference room B Break room B Private room
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StrategieS and tooLS: What will help you achieve your goals to pump your breastmilk at work? B Breastfeed baby or pump before B B B B B
and/or after work Extra pump parts Wash pump parts after work Double electric pump Hands-free nursing bra Pump while working
Storing YoUr BreaStmiLk: What will help you pump, store and transport your breastmilk? B B B B B B B
Storage bottles or bags Refrigerator Cooler or insulated bag Reusable ice pack Room temperature Locker for supplies/pump storage Drawer/cabinet for supplies/pump storage
health4mom.org
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Are your ready to pump at work? Going back to work can be a difficult adjustment for a new mom and baby, both emotionally and physically. Moms want to ensure they can still provide nourishment for their little one even if they can’t be there to breastfeed. Fortunately, pumping innovation is helping bridge the gap for nursing moms, giving them the tools they need to make sure their baby is getting the best nourishment 24/7. Preparation is key to ensuring you have a comfortable pumping experience. Here are a few tips to help ease into this new routine: PRE-PUMP | Pumping a bit before you head out for the day will help with the uptake later!
At Bravado Designs, we’re always looking for ways to make breastfeeding the best experience it can be. That’s why we created the Clip and Pump™ Hands-Free Nursing Bra Accessory. Its innovative design offers moms the convenience, ease and discretion they’ve been asking for, and its unique figure-8 opening holds bottles in an upright position so that you can go hands-free wherever you are! So whether you’re heading back to work, or looking for a product to support you on-the-go, the Clip and Pump™ is proving to be your newest best friend! - STEP 1 -
CLIP
- STEP 2 -
INSERT
- STEP 3 -
PUMP
PREP | Deciphering what you’ll need to nurse comfortably at work, and where you’ll want to nurse, is beneficial to think about before heading into the office. GEAR | A good nursing bra that gives you options. You want to ensure you have one that is comfortable, supportive and gives you easy access to your breasts for all your nursing needs!
Bravado / Neb Medical.indd 1
SHOP ONLINE AT BRAVADODESIGNS.COM
21/07/2017 10:27
healthy pregnancy
By Cynthia Loring, MS, rnC, CLC
Exploring
Nipple
Shields for
Breastfeeding Challenges
Why might i try a nipple shield? Establishing breastfeeding during baby’s first days of life is important to starting and sustaining nursing. Sometimes nipple shields can help promote your baby’s nursing if you have flat or inverted nipples. A federal review of the research found that nipple shields can also help babies nurse even if they’re not quite ready to do so or if they fall asleep quickly at the breast, particularly premature infants. Your nurse or lactation specialist can teach you how to correctly place a nipple shield on your breast and how to position baby for a deep latch. They’ll likely also watch and evaluate baby’s latch once baby is feeding at your breast.
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Most experts recommend talking with your nurse or lactation consultant before trying a nipple shield on your own, as using a nipple shield inappropriately can create more problems than it was meant to solve! First, work with your nurse or lactation consultant to help baby get a deep, effective latch. Sometimes, all you need is a little time and patience to learn a technique that helps baby latch and nurse effectively. hoW long should i use a shield? While a nipple shield might improve milk transfer from the breast to the baby at first, it’s typically a temporary fix. Long-term continued use of a nipple shield can decrease your milk supply, create nipple discomfort or damage, and make it hard to transition baby to nursing directly at the breast without the shield. Once babies have experienced breastfeeding with a nipple shield, it can be tough to stop—even when the original reason for using it no longer exists! In these situations, you may need the help of a lactation specialist to wean baby from nursing with the shield to nursing directly on your areola and nipple. CyNthia LoriNg, MS, rNC, CLC, is an expert
adviser to Healthy Mom&Baby.
nipple shields through the ages The f irst nipple shields date back more than 500 years ago. They were made from a variety of materials including silver, wood, lead, pewter and animal skins—can you imagine? By the second half of 20th century, rubber nipple shields were in use, followed by latex, and f inally the silicone shields we use today.
iMageS © Shut ter StoCk; By t yLer oLSon
Baby’s proper latch is essential to successful breastfeeding—yet sometimes it can be the trickiest to achieve. If your baby has trouble latching on, your nurse or lactation consultant might suggest trying breastfeeding with the aid of a nipple shield. Nipple shields are made of thin, flexible silicone and shaped like—surprise!—human nipples, covering the areola and nipple, with holes at the tip for breastmilk to pass through. They’re washable and reusable.
health4mom.org
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Luxurious Pain Relief for Breastfeeding Mothers Lil’buds® Breast Comfort Packs are designed to ease and prevent pains associated with breastfeeding. If you’re planning to breastfeed, or currently breastfeeding, you might be aware that breastfeeding comes with its own share of struggles. From initial engorgement, to a recurring clogged duct, mastitis, or even painful let-down, some days aren’t easy. That’s why lil’buds® were created; to help every mother overcome any discomforts to achieve her breastfeeding goals. Lil’buds® earth friendly and innovative design makes them the #1 comfort pack on the market for breast pain relief, and here’s why. - Lil’buds® have a slim profile enabling you to wear them comfortably and discretely inside a nursing bra or nursing tank. - Lil’buds® arc shape allows you to wear them in any orientation, whether it’s across the top, bottom or side of the beast, you can get relief exactly where you need it most. - Lil’buds® all natural filling means you can use them hot or cold; place in the microwave to heat quickly, or cool in the freezer. - Lil’buds® are made with soft cotton flannel making them comfortable to wear directly on skin. No plastic, no chemicals, no messy cloths, lil’buds® are easy to use and a must-have for any breastfeeding or pumping mother. Not to mention, the chic fabric styles and additional option for lavender scent sets lil’buds® apart from any other breast comfort pack available.
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According to a recent study, the #1 reason moms stop breastfeeding is the pain. Don't let that be the reason you stop. Here are some tips for helping to avoid the pain and keep you as comfortable as possible. A main reason for nipple pain is latching issues and a good lactation consultant can help correct. Speak with a lactation consultant you feel comfortable with. Second, try healthy mama's Soothe those Suckers! Soothing Nipple Spray. It's OB/GYN and Pediatrician Recommended. It's the first spray available to provide relief and convenience. A spray application helps you avoid the mess of balms and butters and the need to dip your finger in and rub it on your sore nipples. No fingers, no mess. It instantly cools, soothes, moisturizes and promotes healing while reducing instance of mastitis, so you can continue breastfeeding mama! It's lanolin free, hypoallergenic and safe for mom & baby. Purchase at: http://amzn.to/2qc5lGV ENTER CODE: BCKRBTK8 for 20% Off
#HappierNipples healthymamabrand.com
21/07/2017 10:28
healthy pregnancy By Summer Hunt, eLS
(
Milk Banks your queStionS anSwered aBout SHaring BreaStmiLk and donating your miLk to LocaL BankS
)
Breastmilk is the perfect nutrition for all newborns. If your baby was born early or is in a NICU, it’s especially important for them to receive the super nutrition in breastmilk.
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healthy pregnancy
Maybe you’ve heard about human milk banks or you know someone who donated their breastmilk to a friend or to a bank. Whether you have extra milk and would like to help other babies or are concerned about your own baby’s nutrition, it’s important to learn who is eligible to give and receive donor breastmilk—and the critical role milk banks play particularly for vulnerable babies. Is donor breastmIlk safe? When all the right precautions are taken, yes! Pasteurized donor human milk is the next best food for high-risk preterm infants when a baby’s own mother’s milk isn’t available, says the American Academy of Pediatrics (AAP). Specifically, the AAP recommends that hospitals and individuals receive donor milk only from milk banks within the Human Milk Banking Association of North America (HMBNA) as well as commercial milk banks that identify and screen donors, pasteurize milk and culture post-pasteurization milk according to quality-control guidelines. What’s not considered safe are the casual online networks where moms offer their own breastmilk to other individuals, whether for free or a fee, say experts at the FDA and AAP—primarily for infection control reasons.
IMAGES: PhAnIE/Al AMy Stock Photo
What are the benefIts of donor breastmIlk? Not only does breastmilk provide the right nutrients and calories that babies need, it also has substances that protect newborns from infections and diseases. One such disease is necrotizing enterocolitis (NEC), which can damage or destroy a newborn’s delicate intestinal tract. The risk of NEC goes down significantly when babies are given breastmilk, especially when compared to infant formula. hoW can I get donated breastmIlk? You’ll need a prescription from your healthcare provider to receive donor breastmilk for your baby. Milk banks prioritize who gets donated human milk as follows: X High-risk and premature newborns who are hospitalized X Hospitalized or sick newborns
Some organizations will provide donor breastmilk for feeding an infant not hospitalized. hoW can I donate breastmIlk? There are a number of options for lactating moms who want to help babies in need: B HMBANA is the professional association for supporters of nonprofit donor human milk banking. With 18 member banks in the US and Canada, they provide breastmilk for vulnerable infants and other babies who may need it for health reasons. NICUs get first priority and typically acquire donated milk from the HMBANA in the US. In some cases, though, there are HMBANA banks that may provide donor milk for home use. B Prolacta Bioscience is a for-profit company that creates and supplies NICUs across the country with specialty formulations made from human milk. They work with a network of affiliated milk collection organizations that send all milk to Prolacta for processing. Depending on which bank milk is donated to, moms can be compensated $1/ ounce for their breastmilk or have $1/ounce donated to Susan G. Komen. B Medolac Laboratories is a forprofit company that specializes in humanmilk products for clinical use. Medolac acquires donor milk through the nationwide Mothers Milk Cooperative (MMC), which pays cooperative member moms $1/ounce for breastmilk received through their Milk Money program. MMC also offers a Pay It Forward program in which moms can donate their milk without compensation, if desired. There are no fees to be a donor/member of the co-op, but they do request a commitment of 100 ounces. All HMBANA member banks must adhere to the national standards for screening and processing milk set forth by the association. Both Prolacta and Medolac require donors to undergo an application/screening process, and milk undergoes a variety of testing for safety and quality. You can find more information about each organization’s practices and apply to be a donor online.
avoid donated or breastmilk offered for sale apart from reputable human milk banks It’s dangerous to go against recommendations and gain breastmilk from a trusted friend or informal milk sharing site. Buying breastmilk on the Internet can be dangerous and even deadly—especially for your baby. How will you verify you’re receiving pure, uncontaminated breastmilk free of drugs, medications, and other harmful substances? How will you verify it’s even breastmilk? Scientists at a children’s hospital in Ohio analyzed more than 100 samples ordered online and found that about 10% contained cow’s milk. Not only is this dangerous for babies with milk allergies, it also means that the breastmilk is diluted and not nutrient-rich. Researchers also found high levels of bacterial contamination or detectable levels of disease-causing pathogens, making the samples unsuitable for a baby to drink.
Summer Hunt, eLS, is the editorial coordinator at AWHONN and writes for Healthy Mom&Baby.
ISSUE 22 / 2017 Healthy Mom&Baby
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OUR DIAPER PHILOSOPHY
• founded by a mom for her baby • used by nurses on newborns in hospitals • used in leading pediatricians’ offices
We believe that protection is the best prevention. It’s easier and better on Baby to prevent a rash rather than to treat one. We created our Daily Protection Diaper Balm to keep Baby’s skin healthy and protected. Use our Rescue Diaper Cream with Zinc Oxide willingly but sparingly to work on rashes just when you need. HAPPY & SAFE DIAPERING! Moms are in love with Lil ’O’ Blossom’s Diaper Care ‘hero trio’ of safe and nurturing products. Gentle, calming formulations hydrate, moisturize and nourish to effectively protect and treat Baby’s tender skin. Our ‘hero trio’ features Moringa Oil and Shea Butter.
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IT’S EASY AS ABC! A. Cleanse B. Protect C. Treat
See our complete Lil ’O’ Blossom Luxury Collection of Baby Bath and Body Care products at www.liloblossom.com
E.R.A Organics / Lil 'O' Blossom.indd 1
21/07/2017 10:30
healthy
Babies
Join us on Facebook facebook.com/HealthyMomAndBaby
Nurses know what babies want— now everyone else can, too! What Does Baby Want? presents breastfeeding as the natural, normal way babies feed and grow on breastmilk—it’s what babies want! Read this unique circle-shaped book to your little ones and f ind humor moms can appreciate, too. Sharing What Does Baby Want? with older siblings may help them adjust to a new baby and understand breastfeeding. Don’t miss the charming illustrations and a fun surprise at the end!
BY SUMMER HUNT
BABY BOOK
CELEBRATES BREASTFEEDING (MAKE HEALTHY SKIN A TOP PRIORITY) Your skin works overtime to keep you safe and healthy—show it some love!
IMAGES © 123RF; PHAIDON.COM
DANGERS OF 3RD-HAND SMOKE Your children may get nicotine exposure even if you don’t smoke around them, say researchers at Cincinnati Children’s Hospital Medical Center and San Diego State University, who found significantly high levels of nicotine on kids’ hands if their parents were smokers. When parents light up, tobacco smoke leaves a residue that collects in dust and on household items including rugs, walls, clothes and toys. Little ones explore with their hands, absorbing contaminants from the residue, called 3rd-hand smoke, long after the cigarette is out. Third-hand smoke is even more dangerous for babies and toddlers, who tend to put their hands in their mouths. Smoke residue is hard to clean completely since you can’t really see it. Your best option for protecting others? Find a strategy to quit smoking for good.
FOR MOMS:
FOR BABIES:
Choose fragrance- and dye-free non-soap cleansers
Only use age-appropriate products for infant skin
Tepid showers and baths keep skin from drying out
Limit baths (2-3 weekly) for newborns; use a gentle baby wash
Moisturize your skin after bathing
Test new products 1 at a time, on inside of baby’s forearm
Wear sunscreen every day—SPF 30+ for adults
Keep diaper area clean and dry; for rash, use a cream with zinc oxide Protect from sun with clothing; SPF 15 after 6 months
ISSUE 22 / 2017 Healthy Mom&Baby
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Keep them
SMILING from
DAY ONE. Get answers to the most common diaper rash questions – and learn how you can treat and prevent it – from the experts at Dr. Smith’s.®
Q. How can diaper rash be prevented? A: Keep the diaper area as clean and dry as possible by changing wet or soiled diapers right away, and thoroughly drying baby’s bottom. After every diaper change, apply a layer of Dr. Smith’s® Diaper Rash Ointment to help create a protective barrier.
Q. What My baby has diaper rash. should I do? A: Try cleaning baby’s diaper area with warm water or mild diaper wipes, then allow the area to dry before liberally applying Dr. Smith’s Diaper Rash Ointment. To help treat stubborn diaper rash, let your baby roam free without a diaper at home when possible.
Q. What causes diaper rash? A: There are lots of causes for that red, angry rash on baby’s bottom: leaving a wet or dirty diaper on for too long, chafing from a too-small diaper, or even taking antibiotics. Sometimes, babies can have an allergic reaction to diaper materials, or, if you use cloth diapers, to the laundry detergent. In more severe cases, a yeast or bacterial infection may be the culprit.
Q. When should we see a doctor? A: Most cases of diaper rash can be treated at home. But if your baby has bleeding, swelling, fluid-raised bumps and/or intense redness over a large area, contact your pediatrician.
Visit us at DrSmiths.com #ReachfortheDoctor Copyright © 2017 Mission Pharmacal Company. All Rights Reserved. DSO-P179106
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Check & Change BABY’S DIAPER TO PREVENT RASH BY CHARLOT TE WOOL, PHD, RN
Your baby needs their diaper regularly checked and changed—don’t miss this opportunity to make a special connection with your little one as you lovingly work to protect their skin and prevent diaper rash! Your newborn’s skin is soft and sensitive, and from birth on it needs special care and attention— particularly during diapering. Your skin is one of your body’s largest organs, and it’s remarkable in that in addition to protecting all of your insides it can also regenerate itself—how cool is that!
IMAGES: 123RF, THINKSTOCK
Among the many things it does, your baby’s skin: Offers protection against environmental stressors, irritants and infection Prevents excess water loss Regulates baby’s body temperature Responds to sensations including touch and pain DIAPERING THAT PROMOTES HEALTH AND WELLNESS Maybe diapering feels like a routine task. At each change, you do your best to quickly clean and change your baby and prevent or manage diaper rash. You will change thousands of diapers before you can depend on your little one to use a potty for their needs. So you may not have given much thought as to how a simple diaper change can protect and enhance baby’s skin as well as prevent diaper rash. The diapers and products you choose to use can have an effect on baby’s skin and overall health. Diaper rash is physically uncomfortable—and can be stressful—for even the tiniest of babies. Rash can escalate to infection if not caught early and treated. Keeping baby’s skin clean and dry is the first important step in protecting baby’s skin from diaper rash. Because urine and stool can degrade baby’s skin, most experts recommend opting for the modern diaper technologies found in disposable and hybrid diapers that are made with breathable outer wrappers and superabsorbent materials—some even have wetness meters to eliminate the guesswork as to
Download our Diaper Guide! bit.ly/mindfuldiapering
POINTERS FOR PREEMIES Babies born prematurely, before 37 weeks, have thinner skin with fewer layers. Being gentle is essential: Preemies are more prone to skin tears and more susceptible to irritants and infections. Depending on how early your baby was born, it may take 2-9 weeks for their skin to mature. Babies have what experts call an “acid mantle” to their skin. The acid mantle is a very fine layer on the surface that protects against bacteria, viruses and other contaminants. Premature babies who don’t have a well-formed acid mantle need extra-special attention during diaper time. In the early weeks, it’s especially important to avoid soaps, fragrances and other perfumed products that may irritate baby’s skin. Avoid long exposure
to stool or urine with frequent diaper changes to keep your baby’s skin as healthy as possible. If your baby’s diaper area does get irritated, try short intervals of diaperfree time so skin is exposed to air; this will also reduce friction and skin wetness. Depending on how early your baby was born, ask the nurses if you should take special care in lifting baby’s legs for diapering. They may advise that you lift baby’s legs as little as possible—just enough to slide a new diaper underneath. Your nurse may also advise that you keep baby’s hips aligned and use diapers that are flexible and thin between the legs.
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healthy babies DIAPERING THAT NURTURES YOUR BABY Your baby benefits from every diaper change when you practice these 5 habits shown in research to benefit baby’s growth and development: Create a calm and clean diapering environment through good hygiene with supplies at the ready Change and check baby regularly, such as every 1–3 hours during the day and at every feeding Comfort baby by moving slowly through the diaper change to minimize any stress or discomfort Champion sleep by practicing skin-to-skin care at bedtime and using diapers with wetness indicators to avoid disturbing baby’s snoozing Cherish confidence and closeness that come from learning your baby’s cues and responding to baby’s needs, such as for a clean, dry diaper Source: Adapted from Huggies® Every Change Matters: A Guide to Developmental Diapering Care
whether baby needs changing! Experts also favor cleansing wipes made to match the pH of your baby’s skin over warm-water washing alone because of their gentleness on skin. The nurses of the Association of Women’s Health, Obstetric & Neonatal Nurses (AWHONN) recommend changing baby’s diaper at least every 1-3 hours during the day and with each feeding at night—or at least once during the night. Diapers that don’t contain superabsorbent materials should be changed more frequently. Also, carefully and gently cleansing baby’s diaper area with a skin-friendly wipe is a best practice noted by AWHONN in its newborn skin care guidelines. Choosing diapers with superabsorbent gel will keep moisture off your newborn’s delicate skin and reduce your baby’s chances of developing the type of diaper rash (contact dermatitis) caused by urine or stool lingering on baby’s skin. Fragrances may contribute to diaper rash, so if your baby has sensitive skin, avoid wipes with perfumes or fragrances. Find some time each day for baby to go diaper-free. Finally, fit is everything when it comes to protection and avoiding leaks. Your baby’s diaper should be snug but not so tight it pinches their skin. A poor-fitting diaper can cause irritation and rash by excess chafing. Loose-fitting diapers can also lead to a leaky mess—something all parents would like to avoid. As you fasten baby’s diaper, check for and fi x gaps at baby’s waist and legs and any diaper material folded in to create a leak-proof fit. DIAPERING STEP-BY-STEP Each diaper change brings the opportunity to enhance baby’s development through your presence, touch and care. 1. Gather your materials and prepare a firm, safe diaper surface for baby. 2. Use a changing pad or waterproof liner under baby. 3. Begin with a loving hug or gentle pat. 4. Gently undress baby, removing the soiled diaper and carefully wiping away any excess stool as needed with the diaper from front to back. 5. Cleanse baby’s full diaper area with a pH-appropriate wipe or cloth with warm water, including all skin folds. 6. For girls, wipe from front to back and use a different, clean part of the wipe with each motion. 50
7. Allow the diaper area to fully dry—pat dry if need be but never rub baby’s skin in this area. 8. Apply barrier cream if you note signs of redness or rash anywhere in baby’s diaper area. 9. As you put on the clean diaper, check the material around the legs, making sure there are no gaps and baby’s skin isn’t pinched. 10. Maintain eye contact with baby and follow their cues regarding their stress, comfort and contentment. 11. Touch and talk or sing to your baby. 12. Pull baby up into your arms for another sweet hug after each diaper change; this simple act promotes emotional connection and a surge of good feelings in both you and your baby.
THE DREADED DIAPER RASH Your baby may experience a diaper rash in the first year or 2 of life. Diaper rash is common and typically begins with redness and warmth, followed by raised bumps and sometimes skin breakdown. It can be caused by leaving a wet or soiled diaper on for too long, which irritates your baby’s skin. Other causes include chafing or rubbing, sensitive skin, irritation from a new product, or infection. At times, new foods in your baby’s diet can change the makeup of their stool and cause diaper rash. Experts recommend barrier creams containing zinc for treating and preventing diaper rash. If your baby has a rash, or is prone to rash: Gently cleanse your baby’s diaper area, removing all stool or urine at each change Thoroughly dry the diaper area by patting it dry, never rubbing Apply a thick layer of cream or ointment to the affected area Finish diapering as normal, making sure the diaper fits well With subsequent diaper changes, it’s not necessary to completely remove all of the barrier cream or ointment. The key is to remove all the stool and urine. When your little one has a rash, attempting to remove all the barrier cream at each change may cause irritation and disrupt the healing process. CHARLOTTE WOOL, PHD, RN, is a nurse educator and an expert
adviser to Healthy Mom&Baby. Development of this article was supported with funding from Huggies®.
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Newborn Skin Care
Confidence Advice from nurses on everything you need to care for your little one’s delicate skin in our expert-authored Newborn Skin Care Zone at bit.ly/newbornskin: Your Baby’s Skin Mindful Diapering Guide What’s that Rash? Ask Our Nurses Parent Pages Quiz Polls And More!
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Tips for Traveling with Tots Looking to get away with your little ones? Be prepared when you plan ahead—then relax and enjoy the journey! BY RITA NUT T, DNP, RN
FLYI N G TH E FR IE N DLY SK IE S Children younger than 2 typically fly free in your lap; ask what documentation you need, such as a birth certificate Most airlines will ship a car seat or stroller free Consider a redeye flight to travel during your child’s normal sleeping hours Nurse your baby, or give them a bottle or pacifier, to help equalize ear pressure during takeoff and landing
IMAGES: 123RF
When you’re traveling with young children, you might think taking a trip sounds like the opposite of fun. With these tips, you’ll be prepared for the twists and turns that are family adventures! MAKE TRAVEL CHECKLISTS Preparation is key and nothing makes you feel more organized than a list to check yourself again and tasks to be crossed off as accomplishments toward your vacation dreams. List the big things first: destination; sights to see; accommodations; f lights, train tickets or driving routes/times. Then work on more detailed lists: baby gear you’ll bring or rent at your destination, and what you can order and have waiting for you, such as extra diapers, wipes, sunscreen and pool toys. Prioritize your packing list: It’s your to-do list going and returning home. It will keep you from feeling overwhelmed and calm those last-minute fears that you’ve left something essential at home.
GETTING THERE AND BACK Don’t over-plan. Choose 1 or 2 activities per day. Your baby may get overwhelmed from all of the stimulation, and toddlers and preschoolers want to touch and explore everything, so each outing will take longer than you think. Include downtime for naps and free playtime. Bring along comfort objects, like a security blanket, stuffed animal or doll for your child. (But whatever you do, don’t leave it behind!) Your child will feel safer and more comfortable snuggled up with something from home. Pack light when possible. Ship extra clothes, diapers and wipes to your destination. Be fl exible. A vacation is supposed to be about rest and relaxation! Accept that there may be meltdowns and temper tantrums—but there will also be lots of laughter and joy, too. RITA NUTT, DNP, RN, is an expert adviser to Healthy Mom&Baby.
The 3.4-oz. liquid rule doesn’t apply to breastmilk, formula, juice, ice packs or gel teething rings; keep these separate from your other liquids
HAVE A STRESS-FREE ROAD TRIP Consider
driving through the night to avoid sleep disruptions Plan stops for
nursing, diaper changes and relaxing outside the car
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Before bedtime stories, preschool, and music lessons...
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ask our nurses Your questions answered by our expert mother/ baby nurses at health4mom.org/ ask-our-nurses.
Ask Our Nurses:
IMAGE © 123RF
Breastfeeding Your NICU Baby & Tracking Developmental Milestones CAN I BREASTFEED OR FEED BREASTMILK TO MY BABY IN THE NICU? Yes, you absolutely can. Depending on your baby’s unique health circumstances, your nurses will do everything they can to help you nurse or pump breastmilk for your baby in the NICU. It can be hard and frustrating for moms if they can’t put their baby to breast right away. Babies who have an extremely low birth weight or are born with complications often can’t nurse at the breast right away. If you’re pumping breastmilk for your baby in the NICU, try pumping where you can see your baby, or nearby if you prefer more privacy. If your nurses advise, put your baby skin-to-skin with you in the NICU; this will improve your breastmilk and bring your breastmilk in sooner. If you’re pumping breastmilk at home for your baby in the NICU, we want you to pump at least every 2 hours during the day and plan to get up at least once or twice during the night to pump— this mimics a normal newborn feeding pattern. When you can’t be with your baby, look at your baby’s photograph. Imagine your baby in the NICU being well-cared for by their nurses and physicians. As you start feeding your baby at your breast, don’t worry if you don’t feel like you’re pumping enough milk—your baby is getting more from you when nursing. Putting baby to your breast more often and pumping more often will ensure baby has all of the milk they need to get through a growth spurt.
What’s important to remember is that milestones provide a general snapshot. No one knows your baby better than you— if you think your baby isn’t developing quite right, speak up! Your baby’s healthcare provider can help you make decisions about testing or additional care so that baby develops the best way possible.
—Michele Savin, MSN, NNP-BC
—Jennifer B. Lemoine, DNP, APRN, NNP-BC
WHAT IF MY BABY ISN’T MAKING THEIR MILESTONES? How your baby develops from birth through preschool is remarkable. So many physical, cognitive and emotional changes will occur that experts have put them on a timeline to help parents and providers alike ensure baby is growing and developing appropriately—these are the approximate ages your baby should be able to do new things that demonstrate their growth and development are on track with other young ones their age. Warning signs 2 months: 4 months: 6 months: 9 months:
for babies during the first year include: Doesn’t fixate or stare at an object Doesn’t visually track an object with their eyes Doesn’t turn toward sounds or your voice Doesn’t babble (da-da, ba-ba)
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TRAVELING without baby WHILE NURSING Pumping & traveling can be a stressful combination! But Moms don’t have to pump & dump, stock the freezer for weeks ahead of time, or get nervous about TSA.
6 WAYS TO MAKE TRAVEL EASIER FOR PUMPING MOMS 1. Call your hotel ahead of time to request a fridge. Most hotels have fridges available for medical purposes. 2. Don’t forget to pack your favorite travel pump, travel cooler for airport pumping, & pump cleaning supplies. 3. Plan for extra time at the airport for security. 4. Tell TSA that you are traveling with a breast milk pump. 5. Avoid security hassles by using TSA-friendly foam “ice” packs. 6. On work trips, ask your employer if they will pay for breast milk shipping.
Conception? Pregnancy? BIRTH! You’ve got questions but you’re between appointments—what should you do? Ask a friend? Wait it out? Ask an AWHONN Nurse? Yes! Visit Health4Mom.org, post your question and an AWHONN Nurse will answer. You’ve got questions. We’ve got expert answers.
Milk Expressed BREAST MILK SHIPPING FOR NURSING MOMS
DOMESTIC TRIPS Ship back refrigerated breast milk for baby. Breast Milk Shipping Kits start at $165.
INTERNATIONAL TRIPS Freeze & Check Travel Kits keep breast milk frozen while avoiding customs & security issues.
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BOTTLE-FEEDING BREASTMILK Don’t begin a bottle too soon: Baby’s still learning how to coordinate sucking and swallowing during nursing. Wait at least 4 weeks or more and until breastfeeding is going well before trying other feeding devices. Give yourself at least 4 weeks for baby to learn new feeding methods before you return to work, school or activities that take you away from baby. Begin with fresh breastmilk: Your milk is always ready and the perfect temperature. Pump an ounce or 2 for baby’s first bottle; use less for a cup, spoon or dropper.
10 Tips
for Bottle-feeding Breastmilk BY CYNTHIA LORING, MS, RNC, CLC
Not all breastfed babies want to feed from a bottle, but with some patience and these expert tips you can help your baby learn to consume breastmilk from a bottle, cup, spoon or dropper. Your continued nursing will reassure baby your closeness isn’t at risk even as they eat breastmilk in different ways.
FEEDING BABY FROM CUPS, SPOONS AND DROPPERS
IMAGES: THINKSTOCK
Baby should sit more upright when you’re using these devices: FOR CUPS: Use a small cup from shatterproof materials Start with a half-ounce of warm breastmilk Tilt the cup’s rim lightly along baby’s lower lip Let baby suck, slurp, lap or sip the breastmilk at their pace
FOR SPOONS: Most small spoons will work if the edges are smooth Fill the spoon with warm breastmilk and raise it to the baby’s lower lip Let baby suck, slurp, lap or sip the breastmilk at their pace
FOR DROPPERS: Use a clean, sterile dropper Place the dropper inside baby’s lower lip and feed just a few drops of warm breastmilk Watch for baby to swallow before providing more
When you start bottle-feeding, mimic nursing. Have someone else hold the bottle of warm breastmilk as when nursing. Press a little of the milk through the bottle’s nipple and press it lightly against baby’s lips to promote a latch. Try different bottles and nipples. Bottles and nipples vary in sizes, shapes and flow rates (how much milk flows through the opening). Learn what works best for your baby.
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Be patient with your baby born early: If your little one was born at 37 weeks or earlier, they may need more time to learn nursing.
Wait for baby’s early hunger cues to start something new; stop and offer the breast if baby is struggling and their hunger is increasing.
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Have your partner or another loved one offer baby a bottle of warm breastmilk first and choose a time when baby is just starting to show early hunger cues.
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Never force baby to feed. If baby refuses, try once or twice more every 30 minutes. Offer the breast after each attempt; this is both comfort and nutrition for baby.
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Engage baby. Relax, talk, sing, hum, play and soothe. Make new feeding objects—bottles, cups, spoons and droppers—fun and interesting.
CYNTHIA LORING, MS, RNC, CLC, is an expert adviser to Healthy Mom&Baby.
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healthy babies By Cynthia Loring, MS, rnC, CLC
Baby Food:
Economical, Easy & nutritious Making your baby’s food might seem intimidating, but it doesn’t have to be! Stumped where to begin when baby’s ready for their first foods? Wondering if you should buy organic prepared foods? Focused on popular brands but worried about recalls? Making your own baby food is an excellent choice when baby reaches 6 months of age. If you’ve never made your own baby food or known anyone who has, it probably sounds overwhelming. But it’s actually very easy! True, it takes more time than popping open a jar of the store-bought stuff, but not as much as you think. Most foods can be made ahead and frozen. Necessary equipmeNt You probably have everything you need in your kitchen already: a saucepan, something for pureeing food (blender or food processor), an ice cube tray and a fork. And to top it off, the only cooking skill you’ll need is knowing how to boil water. Get started Before introducing your child to the world of flavors in fruits and veggies, experts recommend an iron-fortified baby cereal. Thin it with breastmilk and serve it with a spoon, gradually using less liquid as baby adjusts to a thicker consistency. Don’t be surprised when baby pushes it right back out of their mouth on their tongue—nursing is a different way of eating. Don’t give up; just be patient and give baby very small and liquid-like bites to begin. Fruits and vegetables blended into a puree are baby’s best beginner foods. Most will need to be boiled or steamed until they’re fork tender and mashable. Once you’ve boiled or steamed a batch of baby food, let it cool. Then place the cooked food in a blender or food processor and blend it into a puree.
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Add a little of the cooking water as needed to get it to the right consistency. It should be very smooth (no lumps!) but thicker than a liquid. Done! store baby’s food Once you’ve finished a batch, store up to 1-2 days worth into a covered container in the refrigerator and freeze the rest in meal-sized batches for up to 2 months. Many moms spoon purees into ice cube trays and freeze for use later. Once baby’s food is frozen, transfer the cubes of food into a freezer storage bag, squeezing any air out as you seal it closed. Write the food and the date it was frozen on the bag. Defrost frozen baby food cubes in your refrigerator, placing as many cubes as desired into a smaller, sealable plastic bag until thawed. Or defrost in your microwave, stirring and checking the temperature to ensure no hot spots are in baby’s food. Never serve piping-hot food to a baby— room temperature or slightly warmer is best. best food choices Some tasty cooked options include carrots, butternut squash, broccoli, potato, apple, pear and spinach. Ripe bananas and avocados are yummy choices that don’t require cooking—just mash up with a fork. When preparing baby food, never add salt, sugar or honey. (Note: Babies shouldn’t have any honey until they are at least 1 year old.) Start with single foods, such as squash, and serve the same food for 3-5 days before trying a different food. This will help you learn what food baby likes and if baby reacts to any foods. If you have a family history of certain food allergies, check with baby’s healthcare provider before introducing those particular foods.
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ISSUE 22 / 2017 Healthy Mom&Baby
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healthy babies Babies typically learn to eat pureed foods slowly—coordinating their tongue and gums is a new skill baby is developing! Give tiny tastes, increasing the amount on baby’s spoon as they get the hang of eating. Once your little one has mastered the art of eating pureed foods, you can gradually add texture by mashing baby’s food as you then progress to grinding or chopping baby’s foods. Between 7-9 months, most babies will develop the finger-thumb pincer grasp; this is your cue to start giving baby bite-sized chunks (odd shapes, never fully round, which can be a choking hazard).
Cookin g Baby’s Fruits & Veggies 1. Wash and trim as needed; remove peels, stems, seeds, etc. 2. Cut into small pieces and boil or steam as follows in #3 or #4 3. Boil food in a saucepan with water that just covers the food; reduce the temperature to simmer once water boils until food is fork-mashable 4. Steam food in saucepan in a basket that sits just above the water until fork-mashable 5. Save a little of the water to thin the puree as needed
KEEP NURSING BABY Even as you introduce baby to their first foods at 6 months of age, the AAP recommends continuing to breastfeed as solid foods are introduced, up to at least baby’s first birthday and longer, as desired. Nursing before each meal and then introducing first foods is a recommended best practice to ensure baby gets the vital nutrition from breastmilk first and primarily as baby’s palate expands to also include other foods. CYNTHIA LORING, MS, RNC, CLC, is an expert adviser to Healthy Mom&Baby.
Practice Food Sa fety
Thaw only the amount you plan to feed to baby, and toss any leftovers Toss any food prepared for baby after 2 hours at room temperature Always thaw food in a refrigerator or microwave— never refreeze or place leftovers back into a refrigerator When in doubt, throw it out
Beyon d Fruits & Veggies Once baby has mastered purees, try any of the following, continuing to introduce 1 new food at a time: Yogurt, full-fat, plain and unsweetened (regular or Greek) Regular or silken tofu, pureed (do not give to babies with soy allergies) Lean, boneless and skinless chicken or turkey, cooked to an internal temperature of 165° and then finely chopped; add a little breastmilk or water to drier foods to achieve a moist consistency Beans and legumes, cooked and mashed; rinse and drain particularly if using canned foods
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Nobody likes to be rushed, especially babies. Your baby needs at least a full 40 weeks of pregnancy to grow and develop. Inducing labor even a week or two early is associated with a host of risks, including prematurity, cesarean surgery, hemorrhage and infection.
Slow ! down Relax.
Don’t rush me!
While it may seem convenient for you or your health care provider, labor should only be induced for medical reasons. G me ive tim e
Go
Your baby will let you know when he’s ready to come out, so give him at least a full 40 weeks.
.
f 40 or !
Download a free copy of
40 Reasons to Go the Full 40
What’s the hurry?
at www.gothefull40.com.
The nurses of AWHONN remind you not to rush your baby—give him at least a full 40 weeks!
AWHONN PROMO T I NG T H E H E A LT H OF WOMEN A ND NE W BOR NS
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A n ad u hand lt with a n d , f o ot disea mouth conta se can be g no sy ious with mpto ms .
Does My Baby Have
Hand, Foot & Mouth Disease? BY MICHELE SAVIN, MSN, NNP-BC
Your little one has a fever, painful blisters and a rash… what could it be?
IMAGE 123RF
Yesterday your toddler had a mild fever, and today it’s gone—relief! Th at is until they start to cry and refuse to drink anything. Upon closer inspection, you notice painful red blisters in their mouth. Th is could be a common virus known as hand, foot and mouth disease (HFMD), caused by coxsackievirus. WHAT IS HAND, FOOT & MOUTH DISEASE? The name for this viral infection comes from the painful red rash and blisters often noticed in those exact places; it can also show up in the
diaper area, knees and elbows. With HFMD, your child will also seem very tired and may not want to eat or drink. It’s easily spread through spit (saliva), coughing or sneezing, broken blisters or stool. It’s common in day cares and places where children play, especially where they touch or put their mouths on things. A child is typically infected with the virus 3-6 days before they start having symptoms. First signs are overall sleepiness and not feeling well, followed by fever, rash and blisters. Your little one is contagious for up to a week, even after they’re feeling better; they can also pass the virus through stools for several weeks. HFMD usually passes in a week or so; keep your little one home until their fever and mouth sores are gone to avoid making others sick. HOW DO YOU PREVENT HAND, FOOT & MOUTH DISEASE? The best prevention is good handwashing with soap and water! There are no vaccines for HFMD. The virus can live on hard surfaces for several days, so keep toys and play areas clean and don’t share food or drink. TREATING HAND, FOOT & MOUTH DISEASE Your little one should drink plenty of fluids to stay hydrated and can have acetaminophen (Tylenol) or ibuprofen (Motrin, Advil) for pain—but not aspirin. Keep rash and blisters on the skin clean and uncovered; use an antibiotic cream to prevent a skin infection. Avoid spicy or acidic foods and drinks, which can irritate mouth blisters. Cold drinks or popsicles may help. Rinsing your child’s mouth with lukewarm water after eating may provide some relief. Very rarely, irritation and swelling can occur in the heart (myocarditis), the brain (encephalitis) or the membranes around the brain (meningitis). These are serious side effects that require immediate medical attention. If your child’s condition worsens, call your provider. MICHELE SAVIN, MSN, NNP-BC, is an expert adviser to Healthy
Mom&Baby.
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Use coupon code “HealthyMom” to receive 10% off your purchase
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Protect your baby from the effects of GERD reflux, flat head syndrome and LM (laryngomalacia) The Snuggle Pod by Chibebe is the original baby bean bag! The amazing design of the Snuggle Pod has been proven, through in home use, to help your baby get needed relief from Gerd Reflux and LM during their awake times. It also molds to your baby’s head preventing flat head syndrome. It is easy to clean by simply removing the inner bag liner and washing the rest. You can even add accessories such as the Pod Warmer and Pod Rocker when they need that extra warmth and movement. Your baby will get the comfort and relief they deserve while you get the amazing styles, ease of use, and security of knowing your baby is safe. Get yours today at www.chibebe.com.
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Baby Gear ADVERTISING
Che these pcak out approvrentfavorit ed es!
PRODUCT GUIDE
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1 lil’buds ® Breast Comfort Packs Made to slip discretely into your nursing bra or tank, lil’buds® Breast Comfort Packs provide luxurious, all natural, hot or cold pain relief for engorgement, clogged ducts and mastitis in breastfeeding mothers. They come unscented or lavender scented for additional relief. Shop now at www.lillemer.com
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Baby Plus
Sparkling Mama
Freemie
Wink Shapewear
BabyPlus is a developmentally appropriate set of sounds that introduce patterns to the prenatal child in the only language he/ she understands—the maternal heartbeat. As a baby compares the simple rhythmic sounds of BabyPlus from those of the mother, learning and enrichment begin. To learn about the remarkable benefits, go to
Fizzelixir is an effervescent supplement powder that dissolves easily into any hot or cold beverage to help relieve Morning Sickness. It is packed with proven nausea reducing vitamins and extracts, but free of dyes, caffeine and artif icial sweeteners. Created by a mama and her naturopath, Fizzelixir’s effervescent nature allows for quick absorption and fast relief.
The affordable Freemie cups allow you the freedom to pump in just about any situation. Freemie cups can connect to most popular breast pumps, are supported by a regular bra, and are worn underneath regular clothing. Learn more at
Wink’s Ultra bikini’s double layer of compression material helps the stomach compress for a f latter stomach. 3 layers of adjustable hook and eye closures at the crotch and side allows for the adjustment of waist and torso length.
www.freemie.com
www.winkshapewear.com
www.babyplus.com
Lamaze Waddling Wade Lamaze Clip & Go features collections of loveable characters that encourage learning through play. Waddling Wade has bright colors, multiple textures and satin ribbons for baby to explore. Baby can hear Wade quack when his tail is squeezed and a chime when shaken. Pull down to see Wade’s feet waddle! www.lamazetoys.com
www.sparklingmama.com
ISSUE 22 / 2017 Healthy Mom&Baby
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healthy babies
Let’s Play! BY CAROLYN “CARRIE” J. LEE, PHD, MSN, CNE, RN
Through play, children learn to develop their minds and bodies and their sense of fun.
As an adult, don’t you wish some days someone would tell you to just go out and play? The joys of simply having fun, being with others and learning are the reasons that childhood experts endorse the importance of play.
Balance your little one’s organized activities and free playtime to avoid burnout for you both! No need to rush from Mommy & Me homeward for one more session of tummy time. Let play happen naturally, too—it keeps things fresh and allows little ones to be creative. What matters most is that your infant or toddler is engaged and feels rewarded in what they’re doing. And don’t forget to join in—peek-a-boo, anyone?
“Play is a fundame right for ntal children every wh ere.”
—United Nations’ H u man R ights Commis sion
1 Y o u r Ro le in P la yti m e Park it, helicopter parents! Try to be more of a hummingbird: Watch and encourage your baby or toddler to play independently and don’t rush in to help even when you know that block tower is going to tumble every time. Your little one will gravitate to what’s suited for their developmental age. Watch as they struggle, learn and have fun in all types of activities—and join in when it’s just too irresistible to sit on the sidelines!
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2 F re e Pla y This is a time for children to explore, invent and imagine to their hearts’ content. Pillows and blankets become forts, and cardboard boxes become rocket ships and racecars! A backyard, open beach or park lets kids be physically active and exercise. Imagination is the king of free play, whether in a group or alone.
Stru ctu red Pla y
CAROLYN “CARRIE” J. LEE, PHD, MSN, CNE, RN, is an expert adviser to
Healthy Mom&Baby.
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Mommy & Me classes, Baby Yogis and play dates are all examples of structured play. Simple games like a bean bag or ring toss teach that there can be structure, order, rules and results.
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#1 Choice Nursing Pillow by Lactation Consultants and millions of moms for 20 years
My Brest Friend is the only nursing pillow designed to perfectly position baby for latch-on while supporting mom’s body where she needs it most. Mom is comfortable and at ease, while breastfeeding. Baby is nursing, healthy and happy.
Arm and Elbow Rests
Firm, Flat Front Cushion
BackRest
Eliminates the gap between you and baby and keeps the baby from rolling in or away during breastfeeding
Helps you maintain good posture during feeding to prevent sore backs and necks
Adjustable Strap with Silent Release
Eliminate shoulder stress
Wrap Around Design Secures to the body, helping mom and baby maintain positioning and latch-on
One-handed velcro* adjustment. Silent release clip lets you remove the pillow without waking baby *Velcro adjustment feature available on Deluxe and Twin pillows only.
Convenient Pocket Deluxe Plush Cover 100% baby soft
For nursing and other accessories
Nurses: Contact us for a free professional Pillow New LC distributors receive 30% off wholesale prices
www.mybrestfriend.com info@zenoffprod.com | (415) 785-3890 Zenoff - Alturnative.indd 1
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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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