Healthy Mom&Baby Issue 19

ISSUE 19 / Spring 2016 | $3.95 | health4mom.org

PREGNANCY | BIRTH | PARENTING

KICKS COUNT

Here ’s how and why

MARIJUANA PREGNANCY

Legal or Not, It ’s Bad for Baby

ZIKA ALERT

Are You & Baby At Risk?

Ouch!

Quick Fixes For Breastfeeding Pains

EMOTIONAL EATING MYTHS

POWERED BY THE NURSES OF

PRENATAL CARE ESSENTIALS Our Guide to Every Check Up

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healthy babies 49 Understanding Moro Reflex Why does baby startle suddenly?

Issue 19 / Spring 2016

51 Exploring Hemangiomas

( CONTENTS )

What is this birthmark and what does it mean?

52 Dealing With Breastfeeding Pains

healthy moms

healthy pregnancy

13 Emotional Eating Myths

33 Mapping Your 40 Weeks With

Here are the truths and myths about emotional overeating

A step-by-step guide on your prenatal visits during pregnancy

17 Long-Acting Birth Control

37 Sex During Pregnancy

Busted

Prenatal Care

From engorgement to soreness, reduce breastfeeding pain

55 Eating For Successful Breastfeeding

What foods are best while breastfeeding?

58 What to Do When Your Baby Is Choking

What is safe during pregnancy?

Infant CPR basics and frequently asked questions

20 Vaccinations For a

39 Safe Exercise for Expecting Moms

61 My Baby Has Jaundice

Here ’s why vaccines are important to sustain a long healthy life

40 Find Out Why Kicks Count

66 Splish, Splash in a Safe Baby Bath

Options

Here ’s when to seek help and what to expect

Healthy Life

21 Dealing With Inferitlity

When will you be able to get pregnant?

23 Violence in Pregnancy

How to recognize violent relationships and how to get out of them

Break a sweat safely with these tips

Understand baby by movement in your belly

42 Understanding the Zika Virus

What pregnant women need to know about Zika

44 Marijuana Use in Pregnancy

An in-depth look at the condition

Make bath time good; clean (and safe!) fun for you and baby Safe Baby Bath! p.66

It may be legal some place, but it is not good for you and baby

24 Vaginal Birth After Cesarean

Pam Lawrence talks about her personal VBAC experience

28 Recognizing Autoimmune Disorders

Find out the facts about autoimmune disorders

I Had A Vaginal Birth After Cesarean Persistent mama Pam Lawrence wasn ’t going to let a complicated cesarean birth with twins keep her from having “the birth experience of her dreams ” with her 2nd pregnancy.

24

The Lawre nce Family rela xe with book s s in the nurse ry

FEATURE

ISSUE 19 / Spring 2016 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

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

CONSUMER ADVISORS MARIA OPLT Lafayette, LA

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

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

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

Prenatal Care

Is Your Best Strategy for a Healthy Pregnancy, Birth

You’re pregnant, now what? This is often the first question on many women’s minds once they receive a positive pregnancy test, unless of course they’ve been seeing a healthcare provider while trying to conceive.

What’s next is actually a series of scheduled healthcare appointments with your pregnancy care provider to ensure that both you and your baby have the healthiest and safest possible pregnancy journey. You’ll experience what healthcare experts call “prenatal care” which entails 10-12 appointments that begin monthly and get more frequent as you approach your estimated due date.

At each appointment, your provider will check your health, and your baby’s. She or he will scan for any emerging risk factors and monitor how your body is coping with pregnancy. Your provider will listen to baby’s heartbeat, check his or her movement, and monitor baby’s growth from month to month.

Prenatal Care Keeps You & Baby Healthy The goal of prenatal care is to keep you and baby as healthy as possible through the 40 weeks of pregnancy. Research from the Office of Women’s Health proves that babies of mothers who don’t receive prenatal care are 3 times more likely to have a low birth weight and five times more likely to die than those born to mothers who do get care.

Your partner or a family member or friend is welcome to join you at all prenatal visits.

Many moms and their partners find it helpful to keep a list of concerns or questions on their mobile devices or notepad and to bring that list to each visit.

Your healthcare provider will also help you make choices regarding the birthing experience you desire. You’ll receive helpful advice on where you will birth baby, and your provider will likely encourage you to breastfeed baby and recommend classes on childbirth, breastfeeding and other prenatal topics.

Your 40 Weeks of Pregnancy To help you learn what to expect from each prenatal visit, the nurses of AWHONN have created a chart that maps all 40 weeks of pregnancy for you, and what to expect from each prenatal visit. You’ll find it in this issue, along with the best advice from nurses for the healthiest pregnancy journey possible.

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

ISSUE 19 / Spring 2016 Healthy Mom&Baby

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Advertorial

Guidance For Your Breastfeeding Journey Breastfeeding is one of the many new activities you’re likely to begin in [OL ÄYZ[ KH`Z VM `V\Y IHI`»Z SPML 0TWVY[HU[ [V Z[HY[PUN IYLHZ[MLLKPUN PZ [OL Z\WWVY[ HUK JV\UZLS [OH[ `V\ YLJLP]L HSVUN `V\Y IYLHZ[MLLKPUN QV\YUL` ;OHURM\SS` [OLYL HYL THU` [PWZ LX\PWTLU[ HUK ZLY]PJLZ [OH[ HYL H]HPSHISL [V OLSW `V\ Z[HY[ HUK JVU[PU\L IYLHZ[MLLKPUN BREASTFEEDING TIPS More Comfort, More Milk – Did you know that pumping is easier when you are relaxed and comfortable? Set up a “mom cave” filled with comfy pillows, a supportive armchair, glasses of water and snacks where you can retreat and nurse or express milk for baby.

In the Zone – When you are breastfeeding or pumping, it’s tempting to multitask on your cell phone or do work.

However, if you are having trouble expressing breastmilk, it’s helpful to stay focused on your baby. Even if you are expressing away from your little one, having photos or videos of your baby is a great way to stay relaxed and stimulate milk flow.

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Pump It Up! – Every mom deserves an effective, comfortable breast pump. When considering your purchase, keep an eye out for one like the Philips Avent Comfort Breast Pump which allows you to express breastmilk while sitting upright – rather than needing to lean over. Other details to consider include soft, silicone breast shields and customizable settings for more comfortable sessions.

Hi Ho, Hi Ho! – You can continue feeding baby breastmilk when you head back to work. Before you return to the office, speak with your employer about its policies for accommodating breastfeeding, such as break time and a private space to express milk.

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Advertorial

Many moms often have questions or specific needs as they embark on their breastfeeding journey. The following tips will help you better understand the support, services and equipment that you may be eligible for through your insurance provider, under the Affordable Care Act (ACA) or through your state. There are differences in insurance coverage, so check with your insurance provider to understand your benefits.

Did You Know: Breastfeeding services are one of many preventative care offerings moms may have access to. In addition to well-woman visits, health screenings and immunizations, many healthcare providers now offer breastfeeding support, supplies and counseling without “cost-sharing.” This means that private insurance plans must cover these costs without copayment, coinsurance or deductibles, although other restrictions may apply. If you do not have private insurance, you may still be eligible to receive breastfeeding services under your state’s Medicaid plan or through your local Women, Infant, and Children’s Office.

weigh each option in terms of size, portability, customizable suction modes, ability to express into bottles as well as warranties and recommendations.

Setting Up for Success: Breastfeeding is not always easy or instinctual. In fact, it is a learned skill for most new mothers and support is helpful in order to have a successful transition. Luckily, more breastfeeding support and counseling services are now available in different settings including the hospital, in a clinic or at your home. Contact your insurance provider to find services near you.

We’re here to help and guide you throughout your breastfeeding journey. To learn more about breastfeeding techniques and supplies, visit Philips.com/Avent or Health4Mom.org/breastfeeding.

I Choose You!: There are many different types of breast pumps so ask your insurance provider for their list of breast pump options. Then, work with your healthcare provider to 1 National Women’s Law Center. 2014. New benefits for breastfeeding moms: Facts and tools to understand your coverage under the health care law. Retrieved on September 1, 2015 from http://www. nwlc.org/sites/default/files/pdfs/final_nwlcbreastfeedingtoolkit2014_edit.pdf. Page 1-2.

2 National Women’s Law Center. 2014. New benefits for breastfeeding moms: Facts and tools to understand your coverage under the health care law. Retrieved on September 1, 2015 from http://www. nwlc.org/sites/default/files/pdfs/final_nwlcbreastfeedingtoolkit2014_edit.pdf. Page 1-2.

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Healthy Mom&Baby is published by Maitland Warne in partnership with AWHONN. © AWHONN, 2016. All rights reserved. All material in Healthy Mom&Baby is wholly copyright.

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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.

Zika & Pregnancy Moving into spring, with longer, warmer days ahead the chances of encountering mosquitoes grow greater. You may be wondering if Zika could be a threat to your pregnancy if you ’re pregnant now —or trying to conceive.

The Zika virus continues to emerge in the U.S., as travelers come back with infections from having visited where Zika is active, chiefly the Caribbean and Latin America. If you live in southern U.S., such as Texas or Florida, the CDC estimates your region may be affected first by Zika.

Zika can cause neurological problems and birth defects in developing babies, including microcephaly. We ’ve got the basics on Zika and pregnancy in this issue, and you can stay upto-date with the latest recommendations for women and infants online at bit.ly/ZikaUpdate.

At Healthy Mom&Baby we ’re all about helping you stay safe and healthy through pregnancy. In this issue we share tips for getting the most out of your prenatal care visits, how to practice safe sex in pregnancy, and what to do if your baby chokes on food or an object.

We ’re also all about helping you choose the safest way to birth your baby. Meet a southern couple who risked it all when hemorrhage threatened their twin pregnancy, and learn how this strong mama opted for a natural birth af ter cesarean with pregnancy #2. Her advice and wisdom are worth a second read if you ’re unsure of how you want to birth your baby.

Also, check our tips for overcoming emotional eating. Who hasn ’t munched or crunched their way through a stressful time?

These tips will put your reactions on a healthier plane going forward.

Until next time,

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MAITLAND WARNE 730 North Franklin street, Suite 604, Chicago, IL 60654, USA Tel: (312) 701-0000 Fax: (312) 284-5864 www.maitlandwarne.com EDITOR IAL

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

ISSUE 19 / Spring 2016 Healthy Mom&Baby

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Moms

Vaccinate Against HPV

BY SUMMER HUNT

You and your daughters need the HPV vaccine, say the docs at the American College of Obstetricians and Gynecologists. HPV, or the human papillomavirus, is extremely common and can cause cancer and genital warts.

Cervical cancer rates have been cut by half thanks to recommendations that females ages 9-26 get the vaccine, and through screening ef forts in the last 30 years. HPV vaccination is now the key to preventing cervical cancer.

Still, screening remains an important tool for catching cancer: You need a Pap test every 2 years between ages 21-30; you can be screened every 3 years af ter age 30 as long as you ’ve had 3 normal Pap tests. Discuss cervical cancer screening and prevention at your next yearly well-woman visit, which includes a pelvic exam, breast exam and other healthy checks.

IMAGES © 123RF

NO SHADES OF GREY WHEN SAYING NO TO SEX

For as popular as the novel and movie Fifty Shades of Grey are, a survey of college-aged women say the relationship and sexual messages portrayed are unhealthy, and even include warning signs that could signal a partner prone to violence. Christian ’s use of control, manipulation, and emotional abuse are warning flags, and Anastasia ’s role demonstrates how difficult it is for some women to speak up in an unhealthy scenario.

When it comes to healthy relationships, there are no shades of grey when saying “no ” to sexual activity or violence, they told researchers in the Journal of Women ’s Health.

Only 30% of eligible women get the HPV vaccine

You’re a little piece of my heart now, baby

You may see little bits of yourself or your partner in your baby: Maybe he has your eyes, or his dad ’s nose. But did you know that that your little babe is also a part of you?

Scientists have found fetal cells in mothers ’ bodies post-birth, including fetal cells in a mother ’s brain, heart and kidneys. While this has been confirmed in humans, studies that began in female mice showed that the fetal cells that ended up in mothers ’ hearts developed into cardiac tissue — and became actual beating heart cells.

ISSUE 19 / Spring 2016 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.

Now in English and Spanish.

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

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healthy moms

Emotional Eating Myths Busted

BY SUSAN ALBERS BOWLING, PSYD

If you’re an emotional overeater, you may eat to cope with stress and sadness, enhance joy, and bring a sense of comfort.

But over time, overeating causes weight gain, heart disease, diabetes, and many other health problems. Here are 15 myths and facts about emotional eating that will help you take a new look at how you’re coping with the stressors, disappointments and other emotions in life.

1.

EATING IS A “FEEL GOOD ” ACTIVITY

TRUE: BUT YOU ONLY GET A THREE-MINUTE FIX.

A study in the journal Appetite tested how long the “feel good” feeling from chocolate lasts. It turns out that comfort and bliss only last 3 minutes. 3 minutes! Isn’t it a surprise how short-lived comfort eating can be?

2.

FEELING GUILTY FOR EATING CAKE AFFECTS WEIGHT LOSS TRUE: CAKE PLUS GUILT EQUALS LESS WEIGHT LOSS. Cake is a comfort food that’s often associated with either guilt and worry or pleasure and enjoyment. In one study, dieters who associated cake with “guilt” vs. “celebration” were less likely to lose weight. Dieters who felt positive feelings, such as celebration with cake as a comfort food, were more likely to lose weight. Guilt can derail your efforts.

3.

EVERYONE STRUGGLES WITH THE SAME CRAVINGS

FALSE: COMFORT FOODS AREN ’T CROSS-CULTURAL. Think chocolate is the global go-to feel-better food? It’s not. People in different countries crave comfort from different foods. In Japan, miso soup, okayu (rice porridge that’s served when children are sick), and ramen are popular comfort foods. In India, it’s samosas, potato-stuffed crisps served with spicy green chutney. In Italy, it’s fresh pasta or potato gnocchi.

4.

MEN AND WOMEN CRAVE DIFFERENT COMFORT FOODS TRUE: THERE ’S A GENDER DIFFERENCE.

Research shows males prefer warm, hearty, meal-related comfort foods (think steak, casseroles, and soup), while females prefer snack foods (think chocolate and ice cream).

5.

WE CRAVE FAMILIAR COMFORT FOODS

TRUE: WE CHOOSE COMFORT FOODS OUT OF HABIT.

When we’re stressed out, we revert back to the foods we frequently eat— healthy or not. Researchers who followed the eating habits of college students during midterm exams noted that during peak stress times, students were more likely to choose the snacks they eat most frequently.

It takes less thought and effort to choose familiar foods.

ISSUE 19 / Spring 2016 Healthy Mom&Baby

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6.

HORMONES TRIGGER CHOCOLATE CRAVINGS

FALSE: PMS DOESN ’T TRIGGER HORMONAL CHOCOLATE CRAVINGS.

You may say your hormones make you crave chocolate during that time of the month, but 80% of menopausal women still report chocolate cravings despite no longer having cycles. Experts believe our desire for comfort combined with stress about our cycle compel us to turn to a culturally reinforced way of coping. In other words, we expect that chocolate will help, so we begin to crave it, not because hormones are driving us to it.

7.

RITUAL IS COMFORTING

TRUE: RITUAL CREATES COMFORT AND ENJOYMENT.

Do you eat comfort foods in a certain way? For example, do you eat the icing off your cupcake first or cut your peanut butter sandwich in half every time? Most of us have particular ways in which we eat food, and there’s science behind the good feelings we derive from these little rituals. A study in the journal Psychological Science discovered that not only did eaters who made a ritual out of unwrapping and slowing breaking pieces of a chocolate bar feel those good comfort feelings, but they also enjoyed it more than the folks who simply unwrapped and ate the chocolate.

8.

EATING IS EMOTION

TRUE: IT ’S NOT JUST THE TASTE.

We often think that comfort foods make us feel better because of how good they taste, or how good eating feels. Ironically, researchers in the Journal of Clinical Investigation were able to elicit those same feelings and memories by injecting a fat-based solution right into the participants’ stomachs. Then, the researchers induced sadness and found that the group who received the fat-based solution actually had a reduced brain response of sadness on MRI studies than the group that received the dummy or placebo solution. Those injected with the “comfort” solution just didn’t feel as bad. This compelled the researchers to conclude that something biological is actually triggered in the stomach that sends signals to the brain to make us feel good.

9.

HAPPY PEOPLE OVEREAT, TOO

TRUE: BOTH GOOD AND BAD FEELINGS TRIGGER EMOTIONAL EATING. Even good feelings bring on comfort-food cravings, according to the journal Appetite. In fact, happier people are more likely to overeat as compared to unhappy people—a fact that’s not well-known.

10.

CHICKEN SOUP IS GOOD COMPANY

12.

FAMILIAR FOODS ARE COMFORTING FAR FROM HOME TRUE: YOU CRAVE WHAT YOU KNOW.

A study of students studying abroad in England found that eating familiar comfort foods provided emotional support, bringing a “taste of home” comfort. Live abroad for long and researchers caution you’ll eventually begin to crave the new foods in your acculturated diet the same way you craved the comfort foods of your native land.

13.

MONEY DOESN ’T MATTER WHEN IT COMES TO COMFORT FOODS

FALSE: KRAFT MACARONI IS NO COMFORT FOR THOSE ON PUBLIC ASSISTANCE.

Middle income folks who don’t struggle with paying for food often list the popular Kraft macaroni and cheese dinner as a comfort food. But it’s quite the opposite for those who aren’t sure how they’ll pay for their next meal. This cheesy boxed meal is so frequently donated to food pantries it risks becoming a monotonous staple for recipients, reinforcing their lack of economic power and choice in their meals.

14.

DIETERS ARE THE MOST PRONE TO COMFORT EATING TRUE: DIETERS ARE MOST PRONE TO EMOTIONAL EATING.

Researchers believe that people who are at risk for emotional eating during stress have a high body mass index (BMI), express “low” or “moody” feelings and have high cortisol reactivity (your body’s reaction to stress). But research shows that trying to pull back and practice restraint typically backfires!.

15.

COMFORT IS DOSE DEPENDENT

TRUE: MORE MAKES YOU FEEL BETTER.

When emotional eaters were given chocolate, those who had a low dose (about one-ninth of a Hershey’s bar) had no changes in mood. Sadly, it actually took very large quantities of chocolate to make even a dent in mood, and as we learned in #1, it’s a short-lived “feel good” activity!

SUSAN ALBERS BOWLING, PSYD, is a

psychologist with the Cleveland Clinic. Her newest book is 50 More Ways to Soothe Yourself Without Food: Mindfulness Strategies to Cope with Stress and End Emotional Eating.

TRUE: CHICKEN SOUP IS COMFORTING AND REDUCES FEELINGS OF LONELINESS.

11.

WE ALWAYS WANT COMFORT FOOD

TRUE: COMFORT IS DESIRED TO THE END.

Just look at the typical “last meals” ordered by inmates on death row: 67% chose fried foods, 66% picked desserts. Honestly, is anyone surprised they want calorie-dense comfort foods?

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Here’s why: A study in Psychological Science found that people who ate chicken noodle soup felt less lonely while eating it; they were even able to come up with more relational words about their feelings while eating it.

In other words, if you eat the soup while talking to someone, you’re more successful in connecting with them. Comfort foods = comforting feelings = comfort around others.

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Love is in a pump this comfortable Lots of new mothers told us expressing milk isn’t always easy. So we made comfort a priority. Our breast pumps let you sit upright and relax as soft massage petals gently stimulate milk flow.

Breast pumps may be available through your health insurance providers. Learn more at philips.com/Avent.

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healthy moms

LONG-ACTING

Birth Control Choices

BY SUSAN PECK, MSN, APN

When you think about birth control, do you think about pills or condoms—or getting your “tubes tied?” Hey, it’s 2016! There are many other effective options.

Whether you want to delay or space your pregnancies or you just aren’t ready to do something permanent with your fertility, consider long-acting reversible contraception, or LARC. Intrauterine devices (IUDs) and implants are LARCs. Most health insurance plans cover LARC and permanent birth control. In some states, a LARC can be inserted following your baby’s birth before you leave the hospital or birthing center; in most states, providers wait 6 weeks or more after a birth before inserting this contraceptive. LARCs are safe while nursing; your milk won’t be affected.

With so many choices, picking the best one may feel difficult.

Learning about each method may help to make your decision easier.

INTRAUTERINE DEVICES (IUDS) In the ’70s, the earliest IUD proved problematic and unsafe due to its design. Women developed uterine

infections and had problems getting pregnant after its use. That was then—now, IUDs are very different and safe.

IUDs are T-shaped and inserted into your uterus by a healthcare provider. Because an IUD is placed into your uterus through the vagina and cervix, insertion can feel crampy and sometimes painful. For most women, this feels like period cramps.

Ibuprofen and relaxation techniques can help. IUDs are more than 99% effective, which makes them much more effective than birth control pills or condoms. There are some differences, though, among the 4 IUDs currently available: ParaGard®, Mirena®, Skyla® and Liletta™.

ParaGard ParaGard is copper and plastic. Rather than using hormones, ParaGard works by preventing sperm from meeting up with an egg to make an embryo. It’s effective for up to 10 years and can be used by women ages 17 to menopause. Because ParaGard doesn’t contain hormones, it won’t change your cycle. IUDs don’t cause abortion, in case you’ve heard that false rumor. With ParaGard, you may have periods that are longer, heavier and crampier,

ISSUE 19 / Spring 2016 Healthy Mom&Baby

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healthy moms particularly during the first 6 months of use.

Sometimes, taking ibuprofen can make the flow lighter.

Skyla Available since 2013, Skyla is made with the same hormone and plastic as Mirena, but it’s smaller and narrower with less hormone.

This means it lasts for only 3 years. It works the same way to prevent pregnancy, but since it’s smaller and has less hormone, you’re more likely to have a monthly period with this IUD. It’s approved for all women regardless of pregnancy history.

Liletta The newest of the bunch, Liletta debuted in 2015 and is made of the same plastic and hormone as Mirena and Skyla. Liletta is a “hybrid” between the two: It has the same amount of hormone as Mirena but is effective for 3 years like Skyla. It works the same way and can be used by all women regardless of pregnancy history. Depending on insurance benefits, this IUD may be less expensive.

THE CONTRACEPTIVE IMPLANT Nexplanon Implants are the second type of LARC. Nexplanon® is a single, very small rod—it’s only 4cm long and 2mm wide—that’s inserted underneath your upper arm in a relatively painless procedure. First, numbing medicine is inserted into your arm—just a pinch!—so that it doesn’t hurt when the implant goes in. Nexplanon contains etonogestrel (a progestin hormone) that is similar to the hormone in Mirena, Skyla, and Liletta. It’s effective for 3 years and prevents pregnancy by preventing ovulation, forming the thick mucus plug in the cervix and making the inside of the uterus very thin.

Nexplanon is approved for all women regardless of whether they’ve had a baby. Some women who use the implant have irregular, frequent menstrual bleeding. Sometimes this bleeding can last for the whole 3 years and may be a reason you would want to stop using it. However, many women have light, normal periods, and some women have no bleeding at all.

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PERMANENT OPTIONS If you’re looking for permanent birth control, you can choose to have your “tubes tied” (tubal ligation), but there’s also a non-surgical option called Essure®.

Either option is a permanent decision about your fertility.

Both tubal ligation and Essure are sterilization meaning you can’t ever become pregnant once you do either. These options aren’t reversible. Some research shows if you’re 30 or younger and choose sterilization, you may regret it later in life.

Tubal ligation This is a surgical procedure usually performed in a hospital operating room. It can be done any time; some women plan to have tubal ligation right after the birth of a baby, before going home from the hospital. With traditional tubal ligation, the surgeon cuts the fallopian tubes and then ties them off, which prevents an egg from entering a tube to meet up with sperm. Other methods include burning the ends of the tubes or using clips or rings to clamp them shut. Sometimes the fallopian tubes are completely removed, called a salpingectomy. Some studies have shown tubal ligation may lower your risks of ever having ovarian cancer.

Essure This is permanent—sterilization: two small metal and fiber coils are placed into your fallopian tubes through the cervix. After insertion, scar tissue forms around the coils, blocking the tubes and preventing sperm from reaching an egg. This isn’t surgery; it can be done by a healthcare provider in an office. It takes 3 months for Essure to work – and you’ll need a special test 3 months after it’s been inserted to make sure it has worked. Use to use another birth control method until you have your 3-month post-insertion check up. Essure has been available since 2002, but since 2013 there has been concern that it might cause long-term pelvic pain or other complications, so talk to your nurse or doctor about this. Even though Essure is considered safe and effective, the FDA has asked for more research to ensure there are no harms associated with this permanent birth control method.

The best birth control method is different for each woman. It’s important to learn about the benefits and risks of all methods so that whatever you choose in discussion with your healthcare provider is most effective for how you want to manage your fertility.

SUSAN PECK, MSN, APN, is a nurse practitioner in Cedar Knolls, NJ and an expert adviser to Healthy Mom&Baby.

IMAGES © 123RF

Mirena Mirena has been available since 2000 and is made of levonorgestrel (a progestin hormone) and plastic. Mirena works by creating a mucus plug in your cervix to block sperm from meeting up with an egg. It also thins your uterine lining, impeding how sperm move and sometimes—but not always—preventing ovulation.

Effective for up to 5 years, it’s an option for women who have had a baby; still, many women who have never been pregnant use Mirena. With this IUD, your period is likely to change. Expect spotting or light bleeds after insertion. This can happen unexpectedly and frequently—how annoying! For most women, the bleeding is light and gets better with time. As many as 30% of women who use Mirena don’t have any bleeding at all.

health4mom.org

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Vaccinate FOR A HEALTHY LIFE

BY CATHERINE RUHL, MS, CNM

You may think vaccines are just for babies and children, but vaccines are an important strategy for staying healthy your whole life

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VACCINES & PREGNANCY If you ’re planning to get pregnant, make sure you ’re up-to-date on your vaccines. The flu vaccine is recommended for everyone ages 6 months and older every flu season.

There are certain vaccines you should have before you become pregnant because they aren ’t safe to have during pregnancy, like the measles, mumps and rubella (MMR) and the chickenpox (varicella) vaccines.

CATHERINE RUHL, MS, CNM, is director of women ’s health at AWHONN in Washington, DC.

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Protect Your Health; Protect Your Family When you ’re up-to-date on all of your vaccines, you can feel confident you ’ve decreased your chances of getting sick or passing on illness to family, friends and co-workers. Plus, you ’ll have less chance of missing work or school due to illness. After all, who has time to get sick?

Ask your nurse or healthcare provider about these vaccines: X Flu (inf luenza) —recommended annually for everyone, very important to get this during pregnancy X Tetanus, Diphtheria and Pertussis (Td/Tdap) —Tdap is recommended with every pregnancy; otherwise, once as an adult (Tdap), and a Td booster every 10 years The following vaccines are recommended if you didn ’t receive them as a child: X Human papillomavirus (HPV) —prevents cervical cancer and genital warts; recommended for women ages 9-26 X Measles, Mumps & Rubella (MMR) X Chickenpox (varicella) These vaccines are recommended for adults with certain risks due to their occupations, health conditions or lifestyles: X Hepatitis A and Hepatitis B —recommended particularly for people with specific risk factors for exposure to these viral diseases, such as if you travel where the disease is prevalent, have a blood clotting disorder, work in health care or an environment where you ’re exposed to bodily fluids, or have HIV or chronic liver or kidney disease X Haemophilus influenza type B (HIB) X Pneumococcal vaccines —recommended at age 65 and older and at younger ages with certain risks factors X Shingles —one dose is recommended at age 60 or greater, possibly recommended younger than age 60 for certain risk factors X Meningococcal —particularly recommended if you ’re age 21 or under and a first-year college student living in a residence hall and you either have never been vaccinated or were vaccinated before age 16

IMAGES © 123RF

Vaccines stimulate our immune system to create antibodies against diseases that can cause serious illness, especially at certain times of our lives—like pregnancy and as we age.

As adults, we need vaccines, especially if we didn’t get all of them as children. We may need to repeat some vaccines because immunity can fade over time. And, we may get updated vaccines because the vaccines available today may give better protection than ones we may have received 20 or more years ago.

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DEALING WITH

Infertility

BY PEC INDMAN, EDD, MFT

It seems that when you want to get pregnant, every woman you see is pregnant or has kids.

Even the guy with the beer belly looks like he’s expecting!

Maybe you’ve been told, “Don’t stress, just relax and it will happen.” But each month brings anxiety; every period means another failed attempt. Stress turns to distress and your worries may only further decrease the likelihood of conceiving.

Finding Control To relax, it’s helpful to first clarify what is in your control. For example, you can take prenatal vitamins with folic acid, eat healthy food, stop smoking, and adopt other healthy habits.

It’s in your control to make sure you are getting regular healthcare for any ongoing problems and that you check with your care provider about how any medications you’re taking may affect your pregnancy.

It’s also in your control to monitor your ovulation and learn when best to have intercourse to increase your likelihood of conceiving. Actually conceiving? Well that part, unfortunately, isn’t in your control.

If you’ve been trying to conceive for at least 6 months, ask your healthcare provider about when it would be appropriate to take “next steps,” and what those would look like for you and your partner.

PEC INDMAN, EDD, MFT is a psychotherapist specializing in

reproductive health and the Chair of Education and Training for Postpartum Support International. She is co-author of Beyond the Blues: Understanding and Treating Prenatal and Postpartum Depression & Anxiety.

YOUR POSITIVE ANSWERS

YOUR CONCERNS “What if I never get pregnant? ”

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Just because I haven ’t gotten pregnant yet, is there any evidence or reason to believe I will never get pregnant?

There are a number of different ways to be a mom.

“I feel angry at my body; it ’s letting me down. ”

V V

My body is doing the best it can. This is a very complicated process. We may need a little more practice, more fun, and time to get it right.

“How can I not be stressed —everyone else can get pregnant! ”

V V V V V V

I am not everyone else. I don ’t know every pregnant person ’s story. I don ’t have to compare myself to anyone else.

“The stress is getting to be too much! ” “I feel so out of control. ”

I can go to yoga, a mindfulness class, acupuncture or see a healthcare expert for advice.

Yup, much of conception is out of my control. But, I am doing well with that which is in my control. I can continue to do that well, and acknowledge what is out of my hands.

ISSUE 19 / Spring 2016 Healthy Mom&Baby

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healthy moms

Violence in Pregnancy

BY BREA ONOKPISE, MPH, CHES

Janie is 24 weeks pregnant and lives with her boyfriend, Roy. She’s excited about the arrival of her baby girl but worries when Roy pushes her, shouts and calls her names. She knows Roy is happy about the baby—he’s just under a lot of stress. She hopes everything will be OK once the baby arrives.

Janie is not alone: 1 in 4 women in the U.S. experiences some form of sexual or physical abuse at some point in her life, estimates the National Violence Against Women Survey.

Has your partner ever stalked you?

Isolated you from family and friends?

Prevented you from taking birth control?

Or forced you to have sex when you didn’t want to (rape)? These are all forms of control and aggression.

Sadly, pregnancy is a common time when violence can begin in a relationship.

Although you feel joy, your partner may feel he’s losing control over you due to your baby’s needs. He may continue or begin to yell, call you hurtful names, hit, push, kick, or slap you. If you’re being abused, you’re not alone, and it’s not your fault. You and your baby have a right to be safe.

depression, which often affects moms who are abused before, during or after pregnancy.

Protect yourself and your baby If your partner is abusive before or during pregnancy, you may delay seeking early prenatal care or not gain enough weight.

Your partner’s hits and pushes could cause your baby to be born preterm or have a low birth weight. Unfortunately, the abuse may continue after your baby’s birth.

Postpartum, your partner may break condoms or stop you from using contraception in order to control you and get you pregnant again. This abuse can affect your mental health in the form of posttraumatic stress disorder and postpartum

Make a safety plan Experts advise: t 5FMM TPNFPOF ZPV USVTU UIBU ZPVS QBSUOFS hurts you and ask if you can stay with them in an emergency. Pack a bag with cash, important documents (driver’s license, Social Security and health insurance cards, etc.) keys, clothes and medications. Leave it at their home. t .BLF B DPOUBDU MJTU UIBU JODMVEFT ZPVS healthcare provider, close family and friends whom you can trust, but call 911 if you’re in an emergency. t "U ZPVS OFYU BQQPJOUNFOU UFMM ZPVS OVSTF

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RECOGNIZE AN ABUSIVE SITUATION Are any of the following true for you?

Ask yourself: Does my partner …

B Make me feel unsafe?

B Repeatedly suggest abortion?

B Call me hurtful names?

B Keep me from friends and family?

B Accuse me of sleeping around?

B Prevent me from earning my own money?

B Shove, slap, hit, kick, or push me?

B Threaten me with weapons?

B Use illegal drugs?

B Drink to get drunk?

B Destroy my belongings?

If you answered yes to just one of these questions, you ’re in a potentially abusive relationship. The more yes answers, the greater your risk. Your partner ’s behaviors aren ’t your fault; he ’s choosing to harm you and you don ’t deserve to be abused.

in private that you’re being abused. Your nurse has resources in your community such as social support programs, crisis hotlines, shelters, or home health providers who can help keep you safe. Know that in most states, healthcare providers are required to report any suspected child abuse to social services or law enforcement. t 4FFL QSJWBUF PS HSPVQ DPVOTFMJOH UP DPQF with stress and depression.

Know that leaving can be dangerous You can create some distance between you and your partner by filing an order of protection or restraining order with the court. This action can put your life and your baby’s life at risk because you expose his abuse to others and he may want revenge.

However, as you grow less fearful of your partner, he loses control of you.

There are advocates in your community who will help you understand what your legal rights are. If your partner breaks the rules, he can be arrested by the police. Ask family, friends, and community advocates to help you make decisions so that you can begin to live safely with your newborn.

Remember that no one deserves to be abused. You have the right to protect yourself and your baby.

Get support No matter where you are in these steps, if you are not in immediate danger but need advice or support, there are organizations to turn to. The National Domestic Violence Hotline, for example, is open 24/7 and is toll-free, confidential and anonymous. Call 800-799-7233.

BREA ONOKPISE, MPH, CHES, is a research project manager at AWHONN in Washington, DC.

ISSUE 19 / Spring 2016 Healthy Mom&Baby

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MY STORY:

I Had a Vaginal Birth After Cesarean

The Lawrence Family

After 6 years of trying to conceive, Georgia native Pam Lawrence didn’t think she and her husband Will were going to be parents—it seemed to be one negative pregnancy test after another. “They were the saddest negatives ever,” she says. “It felt like I was never going to see that second little line.” But Pam was not prepared to admit defeat: She sought out support from a local nonprofit that helps couples with in vitro fertilization (IVF), and shortly after, she got a big fat positive (pregnancy test).

“I couldn’t believe it. When the doctor called me back, I asked, ‘Ok, but just exactly how pregnant am I?’” she laughs. They reassured her she was “really pregnant”— the ultrasound confirmed twins!

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TWO COMPLICATED LITTLE LINES Pam’s pregnancy progressed smoothly until the end of her 2nd trimester, when she began experiencing what she thought were Braxton Hicks contractions. In reality, her cervix was starting to open prematurely and her doctor admitted her to the hospital on strict bed rest.

Nearing her 35th week of pregnancy, Pam was growing restless and wanted to return home for Will’s 30th birthday party. She was excited to celebrate with her husband, but at 5’6” and 100 pounds pre-pregnancy, Pam was beginning to feel the full weight of carrying twins. “I was all puff y and swollen, and I started having blood pressure issues,” Pam explains. “At this

point, I was so uncomfortable that I didn’t care if they pulled them out of my nose!”

Soon after, she headed back to the hospital.

A few days after being readmitted, Pam woke up in the middle of the night to what she thought was her labor starting.

“I assumed my water had broken,” she remembers. “But when the nurse came in to check on me, I was gushing blood.”

Pam’s placenta had separated from the uterus (placental abruption), and she was hemorrhaging. By the time the babies were born via emergency cesarean, Pam had lost 60% of her blood volume. Her quick-acting medical team was able to save Pam—and twins David and Jacob—from a potentially deadly outcome.

IMAGES © PAM L AWRENCE

THE SOUTHERN TRUNK | HT TP:// THESOUTHERNTRUNK .COM

BY SUMMER HUNT

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“And I know that giving birth where I did undeniably saved my life. But after such a stressful birth experience, I just wanted to be treated like a normal person. ”

FOR E VERY LIFE PHOTOGR APHY | HT TP:// W W W.FORE VERYLIFE.COM

SECOND TIME ’S A CHARM Shortly after weaning the boys, Pam had a peculiar feeling. “I don’t know how to explain it,” she says, “other than I thought, ‘Dang, if I don’t feel pregnant!’ I think I honestly knew right then, before any test.

But I took one anyway, and boom—there it was!”

As Pam began pondering how the next several months would progress, she knew this pregnancy would be different. “Not to detract from how precious David and Jacob are to me, but everything about their conception and entrance into the world was so medical and scientific,” she explains.

David, Charlotte, and Jacob

FINDING HER VOICE At 12 weeks, Pam decided to find a new practice—one where she could have a vaginal birth after cesarean (VBAC). “My friend is a doula and was in school at the time to become a midwife,” Pam says.

“She encouraged me to get familiar with doctors in the area who had experience with VBACs.” With this vision of a calmer, more natural experience in her mind, Pam also began toying with the idea of an un-medicated birth; a video of a home water birth sealed the deal. “Here I was, pregnant and hormonal and watching this woman go through this, and I got really emotional,” she explains. “I knew that was what I wanted. I felt like it was a rite of passage, and I started to feel very empowered at that moment. This time, I was going to call the shots. It was very, ‘I am woman—hear me roar!’”

BELL A BABY PHOTOGR APHY | HT TPS:// W W W.BELL ABABYPHOTOGR APHY.COM

After a few appointments with her previous provider, Pam didn’t feel like it was the right fit this time around. “I felt like I was being treated like a hazard, even though I wasn’t exhibiting any high-risk signs,” she says. “Pregnancy nowadays is so tampered with, and while a lot of women are afraid to speak up, I knew that this was not how I wanted my daughter to enter the world. There had to be another option.”

Pam (pregnant with twins!) and husband Will

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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.

Slow ! down

Relax.

Don’t rush me!

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

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Download a free copy of

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THE SOUTHERN TRUNK | HT TP:// THESOUTHERNTRUNK .COM

In the end, Pam chose a midwifery practice that worked in collaboration with a top perinatologist in Atlanta. “I knew there was a chance I might need a repeat cesarean,” she says. “This was one of the few places in the area that specialized in family-centered cesareans: I would be able to move my arms, the lights would be dimmed, and I would get to nurse immediately with my baby skin-toskin as I was being stitched up.”

David, Pam and Jacob

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WORDS OF WISDOM For any women considering a VBAC or natural birth —or any mom-tobe, really —Pam gives this advice: DO THE RESEARCH. “I studied up on the possibilities and tried to educate myself and my husband along the way. I knew the risks, and I knew the benefits, too —which made me even more unwavering in my decision. ” SEEK OUT WHAT ’S RIGHT FOR YOU. “You ’re hiring your healthcare provider —not the other way around. If you don ’t have those warm fuzzies, find someone who is willing to give you the birth experience of your dreams. ” BELIEVE IN YOURSELF —and know what you ’re capable of. “My experience was life changing; I wanted to shout about it from the rooftops! I want mamas out there to take the bull by the horns and show labor who ’s boss —know your options and know that you are stronger than you realize. ”

LIKE NIGHT AND DAY Ultimately, her birthing experiences couldn’t have been more different. For example, Pam was able to go the full 40— and then some. “Labor with my daughter, Charlotte, was a very gradual process,” she says. “I woke up 40 weeks and 5 days pregnant and knew it was starting.”

After her mom picked up the twins, Pam was able to labor at home, spending time with her husband. “We went on walks to get things rolling, talking about what was about to happen, and then I laid down to get some rest—that’s when it kicked into high gear,” she says. The couple made the hour-long drive to Atlanta as her contractions grew stronger.

At the hospital, Pam was able to be up and move around during labor. “It was nice not being tethered to anything,” she says.

“They gave me the option of getting in the shower if I wanted, and I spent some time using a birthing ball, too. And while the contractions were painful, it was great to let my body do its job.”

Pam pushed for several hours before it became obvious that Charlotte was a bit stubborn: “She was wedged up under my tailbone and sunny side-up,” she laughs.

“Very true to the person she is today: strong-willed and tough as nails.” Her perinatologist was able to get Charlotte out safely—and Pam still achieved her goal of an un-medicated vaginal birth.

“I think if I had birthed with any other practice or in any other hospital, I would have ended up with a repeat cesarean,” she says. “But my care team was amazing, so knowledgeable and patient. They really listened to my wants and needs, and I think that finding a team you trust is key to being confident about your choices. Never hesitate to speak up about what you want.”

SUMMER HUNT is editorial coordinator at AWHONN in Washington, DC.

ISSUE 19 / Spring 2016 Healthy Mom&Baby

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BY SUSAN PECK, MSN, APN

Could I Have An

Autoimmune Disorder?

So, chances are you may have wondered if the way you feel could mean you have an autoimmune disorder (AD). There are more than 75 different ADs that affect close to 50 million Americans. More than 75% of people with ADs are women – mostly ages 18-40s.

The challenge with ADs are that their symptoms are vague and come from inflammation, such as fatigue and muscle aches. Sadly, with many ADs, there’s not 1 test that will say “yes or no.” So, getting out a diagnosis can be as frustrating for you and your family as it is for your healthcare provider.

On average, it takes most AD patients 4.6 years and 5 healthcare providers before they get a correct diagnosis! Symptoms can come and go, which also makes diagnosis tricky.

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UNDERSTANDING AUTOIMMUNE DISORDERS ADs are chronic diseases; there’s no cure. With treatment, many people with these disorders live healthy, happy lives. Perhaps you’ve heard of some of the more common ADs: X Lupus X Multiple Sclerosis X Fibromyalgia X Rheumatoid Arthritis Others include Type 1 diabetes, psoriasis, chronic fatigue syndrome, celiac disease, Sjögren’s syndrome, and Hashimoto’s thyroiditis (thyroid gland inflammation). If you think you may have an AD, see your healthcare provider right away. They may refer you to a specialist like a rheumatologist or neurologist.

IMAGES: 123RF

Our immune system keeps us healthy and fights off viruses and bacteria so we don’t get sick. But with autoimmune disorders (ADs), the immune system does quite the opposite—it attacks and damages the body itself.

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RHEUMATOID ARTHRITIS Rheumatoid arthritis (RA) is an AD in which the immune system attacks the tissue that lines the joints. RA affects 1.3 million people worldwide and women ages 30-60 are 2.5 times more likely to have RA then men.

Symptoms of RA include: B Redness B Warmth B Swelling B Pain in your joints; more likely to start in the hands and toes B Bumps under the skin B Severe fatigue B Morning stiffness Like other ADs, symptoms can also come and go with RA. A rheumatologist is needed to manage RA; blood tests and X-rays help diagnose this condition.

Treatments for RA include anti-inflammatory drugs, steroids, biologic drugs and disease modifying drugs such as methotrexate. If you have RA and are planning a pregnancy, talk to your healthcare provider about any drugs you may be using as many can’t be taken in pregnancy and may harm your baby. Like MS, RA symptoms may improve in the 2nd and 3rd trimester, but may worsen in the postpartum period. Like MS and fibromyalgia, RA will not harm your baby.

B

B

LUPUS Lupus is an AD that can damage many different parts of your body including skin, kidneys, blood vessels, joints, lungs, and heart. It affects more than 5 million people worldwide; there are about 16,000 new cases diagnosed each year—most of whom (9 out of 10) are women ages 15-44. Women of color are more commonly affected.

The most common type of lupus is SLE, systemic lupus erythematosus, which affects many parts of the body. Other types include discoid, which affects the skin; drug-induced; and the more rarely seen neonatal lupus. Symptoms of lupus include: B Severe muscle and/or joint pain B Red butterfly rash on the face that covers the nose and cheeks B Feeling very tired B Swollen glands Lupus is usually managed by a rheumatologist. Because lupus differs for each person, it’s hard to diagnose. Your care provider may order blood tests, X-rays and/or a biopsy.

Treatments include anti-inflammatory drugs such as Aleve or Advil, steroids, anti-malarial drugs such as Plaquenil, and in severe cases, drugs that suppress your immune system. If you have lupus and are planning a pregnancy, make sure your lupus is under control, such as checking that your kidneys and heart are working properly.

Also, you may not be able to use certain drugs to treat lupus during pregnancy. You’ll want to consult with a high-risk obstetrician because lupus can put you at risk for pregnancy complications such as pregnancy-induced high blood pressure, fetal growth restriction, and preterm labor and preterm birth.

MULTIPLE SCLEROSIS Multiple sclerosis (MS) is a disease in which the immune system affects the central nervous system: your brain, spinal cord and optic nerve. Myelin, the insulation of our nerves, is attacked and becomes scarred and damaged. This prevents the normal operation of your nervous system and produces many different symptoms.

MS affects more than 400,000 people in the U.S. and about 2.5 million worldwide. Like lupus and fibromyalgia, MS affects more women than men, and rates are higher in Caucasian and Northern Europeans.

There are 4 types of MS: relapsing-remitting, primary progressive, secondary progressive and progressive relapsing. Symptoms of MS include: B Tingling B Severe fatigue B Numbness B Walking problems B Vision changes B Bladder and bowel problems B Depression Like other ADs, symptoms may be mild or severe, may come and go, and are different for each person. MS may also be hard to diagnose— usually blood tests, MRIs of the brain and spine and spinal taps are needed.

MS is usually managed by a neurologist. Treatments for MS include disease-modifying injections and pills, medications to manage pain or fatigue, steroids, exercise and stress reduction. If you have MS and want to start a family, the great news is that your MS symptoms will probably get better during pregnancy, especially in the 2nd and 3rd trimesters.

In the first 6 months postpartum, there is an increased risk of relapse, so talk to your neurologist about this transition. None of the standard MS medications are approved for use in pregnancy or lactation. Like fibromyalgia, MS will not harm your baby.

B

FIBROMYALGIA Fibromyalgia is the most common musculoskeletal disorder after osteoarthritis. This AD affects more than 12 million people and, like lupus, most often affects women ages 25-60. It’s poorly understood, but may be a nerve disorder. Symptoms of fibromyalgia include: B Severe muscle aches and pain—your muscles often feel very tender to touch B Feeling very tired B Problems sleeping B Morning stiffness B Tingling in the hands and feet B Memory loss B Depression Fibromyalgia is usually managed by a primary care provider, rheumatologist, neurologist or pain management specialist. There’s no one test to diagnose fibromyalgia; as a result, it may take a long time to diagnose, especially while other diseases are excluded.

Treatments for fibromyalgia include medications that help with nerve pain, anti-depressants, anti-inflammatory drugs, sleep aids, exercise and stress reduction.

If you have fibromyalgia and are planning a pregnancy, manage your pain and fatigue well and check with your care provider about any medications you’re taking. Pain and fatigue may increase in pregnancy, especially if you’re stressed. The good news is that fibromyalgia will not harm your baby.

SUSAN PECK, MSN, APN is a nurse practitioner in Cedar Knolls, NJ and an expert adviser to Healthy Mom&Baby.

ISSUE 19 / Spring 2016 Healthy Mom&Baby

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Join us on Facebook facebook.com/HealthyMomAndBaby

BY SUMMER HUNT

Why You Need

Pregnancy

Centering Pregnancy Want to reduce your baby ’s risks for low birth weight or preterm birth, or your own risks for getting pregnant again too soon af ter this baby? Join a Centering Pregnancy Plus program, say experts in the American Journal of Public Health .

Centering Pregnancy is a group prenatal care program where you join other mamas-to-be with similar due dates for conversations about pregnancy, birth and newborn care, overall health and more. This type of prenatal care is proven to improve your baby ’s chances for the best outcome possible, and it ’s good for your health and recovery, too. In Centering Pregnancy Plus, there ’s an added focus on your sexual health, safe sex and preventing sexually transmitted infections. Find a Centering Pregnancy program near you at centeringhealthcare.org.

B

BUSTING THE BIG BABY MYTH

Food for You During Labor

Don ’t jump to the conclusion that you may need a cesarean if you ’ve been told your baby is measuring big. In fact, only 9.9% of moms who are told their babies are getting quite large actually give birth to a baby weighing more than 8 pounds and 13 ounces —the weight your baby would have to exceed to be a “big ” baby, say researchers who combed the responses of more than 2,400 moms in the recent Listening to Mothers III survey.

IMAGES © 123RF

Macrosomia —the technical word for a big baby —compels women to ask for a planned cesarean or induction, as well as an epidural. While these procedures may be needed for some moms and their babies, they can also put women at risk for things like hemorrhage or infection.

Estimating a baby ’s weight before birth isn ’t always accurate — estimates can often be off by as much as a pound or more.

Research shows birthing normally is usually safest and healthiest for both mom and baby when everything else in the pregnancy is otherwise healthy and well. Talk to your healthcare provider if she or he thinks baby is measuring big and discuss what may be best for you and your baby ’s labor and birth overall.

Forget the old advice to forgo food and drink during labor. You may actually benef it from a light meal if all is going well with your pregnancy and labor, says the American Societ y of Anesthesiologists. Hold the cheeseburger and fries, though —think more along the lines of fruit, soups, toast, light sandwiches, juice and water.

ISSUE 19 / Spring 2016 Healthy Mom&Baby

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healthy pregnancy

Prenatal Care Mapping Your 40 Weeks

BY HELEN M HURST, DNP, RNC-OB, APRN-CNM

Regular prenatal care is important for you and your baby to have the healthiest pregnancy and birth possible. At each visit, your healthcare provider checks the health and progress of your pregnancy for both you and your baby, and you get your questions answered.

You’ll likely have 10-12 prenatal visits during which you’ll learn about any risks that could affect your pregnancy, watch how your baby is growing, get screened for any medical issues that could arise such as gestational diabetes or high blood pressure (preeclampsia), and plan for baby’s birth. Your healthcare provider will also calculate your estimated due date, which will be set at 40 completed weeks from the first day of your last menstrual period.

Hearing baby’s heart beat at each visit is exciting, second only to seeing baby via ultrasound. Many women and their partners feel like they bond with their babies when they can hear his or her heartbeat and see baby in the womb.

IMAGES: 123RF

PRENATAL CARE SCHEDULE

Call your healthcare provider when you first become pregnant but don’t be surprised if they don’t schedule your first prenatal visit until you’re 7-8 weeks along. You’ll get that first visit earlier, though, if you have had issues in previous pregnancies, such as previous preterm labor or repeat miscarriages, or if you have an

existing health problem like high blood pressure or diabetes.

If you’re unsure of the first day of your last menstrual period, your provider may want to see you earlier to get a more accurate estimate of baby’s gestational age by ultrasound.

Whether you choose to have individual or group care, such as Centering Pregnancy, your prenatal visits will be scheduled: t 6Q UP XFFLT NPOUIMZ t XFFLT FWFSZ XFFLT t XFFLT CJSUI XFFLMZ If you choose group prenatal care, you’ll receive the same care at each visit. Bring your partner to each prenatal care visit, as possible, so that together, you can both learn about baby’s growth and development and make decisions about your care.

Nothing is more important than your health and baby’s health. Keep all of your appointments, and jot a list of questions on your cell phone that you’d like to ask your healthcare provider so that you don’t forget. Encourage your partner to do the same; it’s a great way for him or her to be involved in your care.

HELEN M HURST, DNP, RNC-OB, APRN-CNM, is a midwife in Lafayette, LA and an expert adviser to Healthy Mom&Baby.

ISSUE 19 / Spring 2016 Healthy Mom&Baby

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healthy pregnancy

WEEKS

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First Visit 7-8 weeks Health history Family and personal medical, genetic history Pregnancy history to identify any risk factors Complete physical examination Lifestyle assessment (tobacco, alcohol, drugs, intimate partner violence, depression/mental health issues, stress) Determine estimated due date Review vaccinations; recommendations if any are needed (e.g. flu in flu season) Discuss current medications (prescription, over-the counter, supplements) Receive prescriptions/recommendations for prenatal vitamins, iron supplements (if needed)

o o o o o o o o o

10-12 weeks

o Routine checks ** o Listen for baby ’s heart rate o Review lab results o Assess for any new symptoms, medications or lifestyle changes 16 weeks

o Routine checks ** 20 weeks

o Routine checks ** o Discuss any previous test results o Assess for any new symptoms, medications or lifestyle changes o Depression/anxiety and intimate partner violence screening

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Weekly

After 40 weeks

Twice a week or more often

o Routine checks ** o Depression/anxiety and intimate partner violence screening as needed o Review fetal movements o Assess for any signs and symptoms of preterm labor o Assess for any new symptoms, medications or lifestyle changes

o Routine checks ** o Assess for any new symptoms, medications or lifestyle changes o Review fetal movements o Assess for any signs of labor o Results of GBS and other tests o If GBS positive, discuss management during labor o Vaginal examination, as needed, to check for cervical change if you ’re having contractions o Routine checks ** o Assess for any new symptoms, medications or lifestyle changes o Assess for any signs of labor o Review fetal movements o Vaginal examination to check for cervical effacement and/or dilation

**Routine checks at all subsequent visits: Vital signs (blood pressure, pulse, breathing), weight, baby ’s heart rate, uterine size, urine dipstick for protein and glucose (sugar) ***A vaginal/cervical exam may be done anytime preterm labor is suspected.

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o Blood and urine: blood type, protein or glucose (sugar) in your urine o Pap smear o Vaginal and cervical cultures to check for sexually transmitted infections(STIs) o Gestational diabetes screening, if high risk o Ultrasound, if unsure of last period and physical exam raises gestational age questions o Other blood tests for anemia, rubella immunity, STIs,

o Your/your partner ’s questions or concerns about your physical and emotional health, your baby, diet, physical activity, sexual activity; anything else that concerns you o Normal pregnancy discomforts; how to manage (e.g. nausea, vomiting, frequent urination, breast tenderness, tiredness, headaches) o Signs and symptoms of spontaneous miscarriage o Your plans/desires for birth including where you want to birth (e.g., hospital, birth center); where your provider practices will limit your choices o When to call your healthcare provider

o Genetic screening and counseling; usually offered in 1st

o Your/your partner ’s questions or concerns o Normal pregnancy discomforts; how to manage o Signs and symptoms of spontaneous miscarriage o When to call your healthcare provider o Importance of breastfeeding

o Genetic screening tests (MSAFP/multiple marker screening) o Explanation of MSAFP checking for neural tube defects and

o Your/your partner ’s questions or concerns o Normal pregnancy discomforts; how to manage o Signs and symptoms of spontaneous miscarriage o When to call your healthcare provider o Questions or concerns of you or your partner o Discuss genetic screening results o Review of normal discomforts of pregnancy and how to manage them (e.g. constipation, tiredness) o Review signs and symptoms of preterm labor o Potential pregnancy complications and their signs and symptoms: preeclampsia, embolism and postpartum hemorrhage o When to call your healthcare provider

inherited disorders

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multiple markers screening for NTD and trisomy

o Ultrasound to look at fetal anatomy: brain, heart, lungs,

spine, hands and feet, face, sex (if you don ’t want to know your baby ’s sex, ask them not to tell you before the ultrasound starts)

o Glucose screening for gestational diabetes o Repeat blood work o Hematocrit and hemoglobin, to check for anemia o Antibody screen (if RH-blood type) o Administration of RH Immunglobulin (if RH negative and antibody screen negative) o TDap vaccination at between 27 and 36 weeks

o Your/your partner ’s questions or concerns o Normal pregnancy discomforts; how to manage (e.g. constipation, heartburn, difficulty sleeping, frequent urination, changes in vaginal discharge) o Signs and symptoms of preterm labor o Lab results, as needed o When to call your healthcare provider o Potential pregnancy complications and their signs and symptoms: preeclampsia, embolism and postpartum hemorrhage o Childbirth, breastfeeding and other prenatal classes o Options for baby ’s healthcare provider o Normal fetal movement, kick counts o Birth plans and labor expectations, including your provider ’s recommendations about waiting for labor versus induction if all is healthy, including if you go past your due date o Postpartum contraception

o Screening for GBS (group beta strep) o Repeat screening cervical and vaginal cultures (gonorrhea and chlamydia) if high risk for STIs o Blood tests (if high risk for certain STIs)

o Your/your partner ’s questions or concerns o Normal pregnancy discomforts; how to manage (e.g. shortness of breath, frequent urination, heartburn, constipation, Braxton-Hicks contractions, backache, difficulty sleeping) o Preterm labor signs and symptoms o True labor signs and symptoms o Potential pregnancy complications and their signs and symptoms: preeclampsia, embolism and postpartum hemorrhage o Birth plans o Postpartum support at home o When to call your healthcare provider

One or a combination of the following: Non-stress test Contraction stress test Ultrasound (biophysical profile) IMAGES: 123RF

o o o

o Your/your partner ’s questions or concerns o Review of normal discomforts of pregnancy and how to manage them (e.g. frequent urination, heartburn, constipation, Braxton-Hicks contractions, backache, difficulty sleeping) o Labor signs and symptoms o Potential pregnancy complications and their signs and symptoms: preeclampsia, embolism and postpartum hemorrhage o When to call your healthcare provider

ISSUE 19 / Spring 2016 Healthy Mom&Baby

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healthy pregnancy 1st

Trimester:

What’s safe about in Pregnancy?

IMAGE: 123RF

Sex

“Is it safe to have sex while I’m pregnant?”

As nurses, we hear this question all of the time. The good news is that most women have sex throughout pregnancy.

Everything that’s great about sex, arousal, intercourse and orgasm is safe for you and baby unless there are any risks with your pregnancy. Baby is well cushioned by your tissues and amniotic fluid. Simple activities like walking or doing laundry likely jostle baby more than intercourse.

There are circumstances, however, when sex is off-limits in pregnancy, such as: B If you’ve had past miscarriages, preterm labor or bleeding in pregnancy B After your water breaks as participating in penetration could increase the risk of an infection B Sex with a partner who has an active or recently diagnosed sexually transmitted infection Ask your healthcare provider: “Is there anything about sex that I should avoid during pregnancy? Is there anything offlimits?” Your healthcare provider might advise that limitations around penetration mean nothing should go in your vagina,

BY VICKI A ABERG, PHD, BSN, RNC

like a finger or penis. Limitations around orgasm may mean no intercourse, masturbation or any activity that brings you to orgasm.

WILL I WANT TO HAVE SEX DURING PREGNANCY? You may not feel like having sex. Breast tenderness may make breast or nipple stimulation uncomfortable (but this may also be more pleasurable than normal).

In the 2nd and 3rd trimesters, you’re more likely to experience heartburn, excess gas and backache, all of which may make it difficult to find an enjoyable and comfortable way to have sex.

WHAT CHANGES SHOULD I EXPECT? You and your partner may need to find different positions as your growing belly is increasingly in the way. Try side-lying, spooning or woman-on-top. Use a waterbased lubricant for comfort, if necessary.

Oral sex is OK in pregnancy, but your partner should never blow air into your vagina; this could cause an air embolism that could be dangerous for you and baby.

There are many non-sexual ways to show your love and care for your partner.

Consider taking a bath together, sharing a massage or foot rub, cuddling and kissing, and sharing your hopes and dreams for your baby. Take advantage of other ways to stay physically close during this pregnancy.

Potential Warning Signs with Sex in Pregnancy You may notice vaginal spotting after intercourse, and this is typically normal.

If the bleeding is bright red or anything more than a small amount, or you think you might be leaking amniotic fluid, call your healthcare provider as soon as possible. You may also experience contraction-like cramps. This is normal, too, but notify your healthcare provider if these are painful or don ’t go away.

VICKI AABERG, PHD, BSN, RNC, is an assistant professor at Seattle Pacif ic University.

ISSUE 19 / Spring 2016 Healthy Mom&Baby

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17/03/2016 16/02/2016 16:23 14:57 15:36

2nd

Trimester:

healthy pregnancy

Get Your Sweat On,

Mama

BY SUSAN PECK, MSN, APN

If you’re like many expectant moms, exercise during pregnancy seems like a scary, potentially dangerous activity. You may wonder, “Will I hurt my baby or my body?” Friends or family might tell you it’s unsafe, that pregnancy should be a time of rest and relaxation. However, the facts show that pregnancy is a great time to be active, even if you haven’t exercised before.

HOW MUCH ACTIVITY IS SAFE IN PREGNANCY? Unless your healthcare provider has said otherwise, try to get 20-30 minutes of moderate activity most days of the week, say updated guidelines from the American College of Obstetricians & Gynecologists. This is dedicated time for activity; it doesn’t include the time you’ll also spend working or taking care of your home or family.

IMAGES: 123RF

STARTING EXERCISE IN PREGNANCY If you’re not active now, start gradually and increase your time and effort as you go. Discuss your activity with your nurse at each prenatal visit. Regular exercise may help prevent gestational diabetes, which is one of the most common health complications of pregnancy. If you’re overweight or obese, your risks for this complication are greater than if you started pregnancy at a healthy weight as it helps you control how fast you gain weight. Plus, exercise promotes good heart health and normal blood sugar levels, and it helps you gain pregnancy weight gradually, as recommended.

Physical activity helps to maintain and even lower your blood sugar levels. If you already have diabetes or are overweight, it is safe and important to exercise to lower your risk of diabetes-related complications. Strengthening your core and back muscles may also help with lower back pain, a common complaint among mamas-to-be. And did you know that exercise in pregnancy might determine how you deliver your baby? Research shows that moms who exercise throughout their pregnancy have up to a 15% lower chance of needing to have a cesarean.

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SAFE EXERCISES FOR PREGNANCY Walking fast, jogging, using a stationary bike, weight training, low-impact aerobics, yoga and swimming are safe for expecting moms. Avoid contact sports like karate, ice hockey and soccer, as well as activities where you could experience trauma or risk falling, such as horseback riding, skiing or surfing.

Modified yoga and stretching are acceptable, but skip the hot yoga or hot Pilates. Stay hydrated during all activities, avoid long periods of lying on your back, and stop exercising immediately if you experience any of these warning signs: vaginal bleeding, dizziness, headache, chest pain, muscle weakness or calf pain or swelling.

SUSAN PECK, MSN, APN, is a nurse practitioner in Cedar Knolls, NJ and is an expert adviser to Healthy Mom&Baby.

ISSUE 19 / Spring 2016 Healthy Mom&Baby

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healthy pregnancy 3rd

Trimester:

Kick Counts HELP YOU KNOW YOUR BABY

BY MICHELE SAVIN, MSN, NNP-BC

40

9:10pm

8 8 8 8 8 8 8 8 8 8

Start Time: ________

7:50pm

DAY 2

End Time: ________

End Time: ________

8 8 8 8 8 8 8 End Time: ________

DAY 3

Start Time: ________

End Time: ________

DAY 4

Start Time: ________

End Time: ________

DAY 5

Start Time: ________

Start Time: ________

End Time: ________

Start Time: ________

End Time: ________

SOURCE: DEL AWARE DEPARTMENT OF HE ALTH

Kick counts are easy; they just take a few minutes during which time you’re bonding with your baby.

After a few sessions, you’ll get to know what’s normal—and not—for your little one.

KICK COUNTS BOOST CONFIDENCE Research shows that pregnant women who chart their baby’s movements feel more confident and have fewer concerns with their pregnancy when compared to women who don’t track their baby’s movements.

There’s science to back their confidence: Recent studies in Norway and Canada found that when a mom expressed concern about reduced movement from her baby, healthcare providers could intervene earlier, reducing the number of stillbirths.

Why these babies begin to move less than other babies isn’t clear but experts think that less fetal movement may be a sign that the placenta isn’t meeting baby’s needs.

HOW TO DO KICK COUNTS Do kick counts every day when your baby is active.

In your womb, your baby will have sleep cycles of up to 40 minutes. She’ll usually be most active after you eat, when you exercise or move around and in the late evening.

Find that time each day when baby seems most

IMAGES © 123RF

DAY 1

8:00pm

DAY 6

WHY COUNT KICKS It’s typical for healthcare providers to ask women with high-risk pregnancies to spend some time each day, usually just a few minutes, counting their baby’s movements. Kick counts help you and your healthcare provider look for the first signs of problems, even as early as 24 weeks. In a normal pregnancy, kick counts are a great way to check in with your baby and reassure yourself that everything seems fine.

Your healthcare provider may ask you to do this, and for good reason: Decreased fetal movement has been associated with developmental delays in children and even stillbirth.

WEEK 24 Start Time: ________

DAY 7

Your pregnant friend tells you she’s taking time each day to count the number of movements or “kicks” her baby makes. She says she feels closer to her baby; she loves this quiet time together. Now you’re wondering if you should do kick counts, too?

The answer is why not! How often your baby moves is a window into how she’s doing; it tells you about her overall health. Every baby is different, and if you spend time getting to know your baby and her habits, including when she’s awake and active and when she seems to prefer to sleep, you’re more likely to know if something suddenly changes or seems different.

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IMAGES © 123RF

healthy pregnancy active. Stop what you’re doing, sit down, relax and pay attention to her. With your hands on your growing belly, start counting each fetal movement. You should feel at least 10 movements within 2 hours, say experts at the American College of Obstetricians and Gynecologists.

Of course, most babies will have 10 movements in a much shorter time. In fact, it may only take about 30 minutes to get to 10 movements. In 1 study, mothers counted 10 movements in an average of 10 minutes—those babies were on the move!

Even the busiest woman can find 10 minutes to sit quietly and get to know her growing baby. Once you reach 10, you’re done!

EVERY MOVEMENT COUNTS While this activity is often called kick counting, it actually includes any movement your baby makes, such as rolling, kicking, stretching or the like.

Hiccups don’t count, though.

You may have heard that babies move less the closer they are to their due date, but this isn’t true. As your pregnancy approaches term baby has less room to move around but research shows us babies don’t move any less.

And this is true regardless of your own body size, how close to your due date you are or where the placenta is attached to your uterus.

What you feel may change but you should always feel movement, even if it is different from what you felt in your 2nd trimester. In fact, counting kicks regularly means you’ll know your baby’s habits, such as when she sleeps and when she’s typically active.

If your baby’s movements change, particularly if they’re not typical, as frequent or as strong, let your healthcare provider know immediately. If your healthcare provider doesn’t take your observation seriously, ask to speak to another provider on call or go to your hospital’s emergency department or birthing center. Tell them your baby’s movements have changed, slowed down or stopped—whatever the situation may be.

If you’re concerned or you can’t reach your provider, never hesitate to act on your baby’s behalf by going to your local hospital’s emergency room or birthing center and tell them, “My baby isn’t moving.” Don’t be concerned about false alarms.

Research is telling us that in parts of the country, and indeed in parts of the world, where healthcare providers asking moms to do kick counts, there’s no spike in office visits. Instead, mothers actually report decreased movement faster, which has helped reduce the number of babies dying in the womb (stillbirth).

PARTNER WITH YOUR HEALTHCARE PROVIDER If your provider has asked you to keep track of kick counts, ask her or him how you should track them—whether to include the

time of day, type of movements and how long it takes to achieve 10 moves counted, for example.

You know your own body and your baby best. Work with your provider to create a plan that works for you both. Enlist family and friends for support—do kick counts while your partner cleans up after a meal, or have your friend watch your other children while you put your feet up, relax, and bond with your baby.

Putting aside some quiet time each day getting to check in with your growing baby may seem like a challenge, but it’s time well spent.

MICHELE SAVIN, MSN, NNP-BC, is a neonatal nurse practitioner in Wilmington, DE and an expert adviser to Healthy Mom&Baby.

WHEN YOU CAN ’T FEEL MOVEMENT If you can’t feel your baby move, don’t panic; drink a glass of juice or ice cold water (some moms swear by this to get baby moving!) and walk around a little. Then, try again.

Never hesitate to call your provider if you haven’t felt your baby move recently. He or she will want to take a closer look at and listen to your baby.

ISSUE 19 / Spring 2016 Healthy Mom&Baby

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healthy pregnancy

BY HELEN M HURST, DNP, RNC-OB, APRN-CNM

What Pregnant Women Need to Know ZIKA VIRUS:

Stay upda ted on Zika virus at bit .ly/zika update

Zika virus is news all over the globe, so you may be concerned about how the virus may affect your pregnancy and baby, particularly if your baby could be born with a small head, and subsequently, a smaller brain. This is a birth defect and neurological problem called microcephaly.

Experts have observed more babies being born with microcephaly in countries where there has been a large number of Zika infections, such as Brazil. More research needs to be done to know if the virus causes microcephaly.

So far, most of the people diagnosed with Zika in the U.S. have recently traveled to one of the known Zika outbreak areas. If you or someone you know hasn’t been to these countries, your risk of Zika affecting your pregnancy is very low. Keep up to date on Zika at CDC.gov/zika.

CAN ZIKA AFFECT ME OR MY BABY? Zika is spread through mosquito bites. Zika is transmitted particularly by the Aedes mosquito, which bites mostly during the day. Aedes mosquitoes are found in the U.S. but don’t carry Zika virus here; at least not yet.

IMAGES © 123RF

CAN I PREVENT ZIKA? Protecting yourself against mosquitoes is the best way to prevent Zika. Depending on how you react to mosquitoes, you may not even realize you’ve been bitten.

WHAT ARE ZIKA ’S SYMPTOMS? Zika infection usually appears as red eyes (conjunctivitis), pain in your joints, fever and rash. The symptoms usually start 2-7 days after

you’ve been bitten and the symptoms may be so mild you may not realize you have been infected.

CAN ZIKA BE TREATED? Currently there is no vaccine to prevent Zika and no treatment once you have it. Avoiding mosquito bites is your best protection.

I ’M PREGNANT, HOW DO I PROTECT MYSELF FROM ZIKA? If you’re pregnant in any trimester—or trying to get pregnant—avoid traveling to where the virus is active, advises the Centers for Disease Control and Prevention (CDC). Check the most recent advisories at bit.ly/zika_advisories.

If you must travel to one of these areas, talk with your healthcare provider before you go. CDC recommends that if you’re trying to get pregnant and are planning to travel to these areas, consider postponing your trip.

If you’re pregnant and have travelled to one of these areas in the past 2 weeks, notify your healthcare provider, particularly if you have a visible bite or symptoms. Your healthcare provider may want to do a blood test to look for the virus or an ultrasound to check on your pregnancy.

CAN ZIKA AFFECT MY BABY AT BIRTH? If you have Zika, your baby can contract the virus during pregnancy or birth, although experts don’t know how often this may happen. It’s unknown if Zika infection can affect future pregnancies.

HELEN M HURST, DNP, RNC-OB, APRN-CNM is a midwife in Lafayette, LA and an expert adviser to Healthy Mom&Baby.

ISSUE 19 / Spring 2016 Healthy Mom&Baby

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healthy pregnancy

How Marijuana Affects You, Your Pregnancy & Your Baby

BY CHERYL K. ROTH, PHD, WHNP-BC, RNC-OB, RNFA; LORI A. SATR AN, RN, MS-L, IBCLCE; AND SHAUNA M. SMITH, RN

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Do you know how marijuana can affect your pregnancy and your baby?

Marijuana (cannabis) is the most commonly used substance in pregnancy, according to the National Survey on Drug Use and Health from the National Institute on Drug Abuse. Experts estimate that as many as 10% of pregnant women in both the US and in Europe use marijuana at some point or in some form in pregnancy.

Healthcare providers are advised by the American College of Obstetricians and Gynecologists (ACOG) to not prescribe medical marijuana in the preconception, pregnancy, postpartum or breastfeeding periods. Medical marijuana is now legal in 19 states, and legislation is pending in multiple other states. None of these states recommend or approve cannabis use during pregnancy, and some states have considered passing laws that include penalties up

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to incarceration for pregnant women who drug screen positive at birth. In 2014, Tennessee became the first state to pass legislation that criminalizes drug use during pregnancy.

Marijuana is still considered an illegal drug at the federal level and it’s not regulated by the Food and Drug Administration (FDA).

If You Use Marijuana, Baby Uses Marijuana The major active compound in all cannabis products is commonly known as THC. This compound quickly crosses your placenta, meaning if you’re using marijuana, your baby is also using marijuana— only baby receives a blood-level concentration of an equivalent or higher dose of THC than you’ve received. Cannabis can be detected in both

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healthy pregnancy your baby’s cord and urine or stool after birth, and while in your womb, it continues to circulate in your baby’s blood for up to a full month.

Marijuana affects your nervous system in 2 ways: In low doses, it increases your heart rate; at higher doses it induces low blood pressure and a slowed heart rate.

At smaller doses, marijuana can make you feel euphoric, detached and relaxed. At larger doses, you risk a racing heart rate, anxiety, paranoia, confusion, panic and even hallucinations.

One of the biggest challenge marijuana users face is not knowing how much THC they’re taking in as it varies widely from plant to plant, or even on different parts of the plant. Cannabis sold in the US can be highly potent.

Synthetic Cannabis (Spice) Synthetic cannabis, known as “Spice,” contains a similar THC that is as much as 600 times more potent than traditional THC. Because Spice may not show up in standard urine drug screens, it’s often called a “legal” high and cannabis of choice, particularly among younger users.

Using Spice significantly compounds the risks associated with using marijuana. Pregnant women who have used Spice have experienced health emergencies including heart palpitations, an abnormally fast heart rate—even seizures.

Risking Preterm Birth?

If you’re using Spice and have these health complications, your symptoms can easily look like a dangerous form of high blood pressure in pregnancy called preeclampsia or eclampsia, which also have the side effects of seizures, say the obstetricians at ACOG. How Cannabis Affects Baby Research shows cannabis can cross both the placenta and the bloodbrain barrier; although most of this evidence comes from research in animals as it’s nearly impossible to do this type of research in pregnant women. In animals, offspring exposed to cannabis showed long-term negative emotional, thinking and behavioral problems.

When it comes to pregnancy, experts think THC may change certain receptors in baby’s brain leading to problems with attention, memory and problem solving. Alarmingly, increasing evidence has shown that both natural and synthetic THC are harmful to a developing embryo as early as 2 weeks after conception—and that THC can affect your baby’s brain long before you skip a period or get those first symptoms that alert you to the fact that you’re pregnant.

When a baby is exposed to THC exposure in pregnancy weeks 1-4, the risk is increased for a rare and dangerous birth defect called anencephaly where a baby is born without parts of his or her brain and skull. Some research shows the risk of this birth defect—while rare—is nearly double among pregnant women who use marijuana.

Sadly, almost all babies born with anencephaly die shortly after birth.

B

B

CANNABIS WITHDR AWAL SYNDROME After you quit marijuana, cannabis withdrawal syndrome may start within 10 hours and increase in intensity up through 48 hours. You may feel restless, anxious or irritable; have trouble falling asleep; or experience muscle tremors. You may also experience changes in your heart rate, blood pressure, begin sweating and experience diarrhea.

Consequences for Baby When researchers follow infants who were exposed to marijuana during pregnancy, they’ve linked the effects of that to lower birth weight, decreased height, early birth and increased risk for preterm labor. Mothers who used marijuana had more difficult and rapid labor, and often the baby was exposed to meconium while in the womb, raising baby’s risks for breathing problems at birth.

As these babies go through their toddler and early childhood years, researchers have documented both learning and behavior problems related to impaired mental development, hyperactivity, inattention and impulsivity.

One study in particular demonstrated that first trimester exposure to marijuana resulted in problems with reading, spelling and overall educational scores at age 10. The same problems were also linked to second trimester exposure to marijuana.

Quit Marijuana for You & Your Baby If you’re using marijuana now and aren’t doing anything to prevent pregnancy, or are actively trying to conceive a pregnancy, it’s important that you stop using cannabis for your health and your baby’s shortand long-term health and development. What drug use healthcare providers are required to report by law varies from state to state, with some states having mandatory reporting of cannabis use.

Breastfeeding & Marijuana THC can accumulate in your breastmilk in high enough concentrations that your baby will pass THC in his or her urine during the first 2 to 3 weeks after birth. Your baby may also show the effects of the marijuana, including being quiet and sleepy, poor muscle tone and ineffective nursing at your breast. Experts advise that if you’re going to use marijuana after baby’s birth that you should avoid breastfeeding altogether, which robs both you and baby of the many protective and developmental benefits of lactation.

Talk to your nurse about why you use marijuana—is it for a healthor medical related reason? Ask about other options to manage any problems you’re trying to aid with marijuana.

IMAGES © 123RF

CANNABINOID HYPEREMESIS SYNDROME Using marijuana can put you at risk for a rare complication called cannabinoid hyperemesis syndrome, where you experience intense abdominal pain, unrelenting nausea and intractable vomiting that typical anti-nausea therapy won ’t help.

CHERYL K. ROTH, PHD, WHNP-BC, RNC-OB, RNFA is a nurse practitioner at HonorHealth Scottsdale Shea Medical Center in Scottsdale, AZ. LORI A. SATRAN, RN, MS-L, IBCLCE is a clinical director of couplet care at HonorHealth Scottsdale Shea Medical Center in Scottsdale, AZ. SHAUNA M. SMITH, RN is a doctoral nursing student at Arizona State University in Scottsdale, AZ.

ISSUE 19 / Spring 2016 Healthy Mom&Baby

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17/03/2016 10/03/2016 16:26 03/03/2016 15:23 09:12

healthy

Babies

Join us on Facebook facebook.com/HealthyMomAndBaby

BY SUMMER HUNT

HOW YOUR BABY MAKES YOU

Sing, Smile and Just Act Goofy Your baby’s smile can light up a room, but you can’t always make her grin. Is it the silly songs that do it, the goofy faces—or maybe it’s just gas? Surprise! It’s not you at all: Babies smile to make us smile, say a team of computer scientists, roboticists and developmental psychologists. And babies can get us to smile, sing and cajole them while smiling as little as possible.

Researchers compared face-to-face interactions between

IMAGES © 123RF

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ACCIDENTAL MEDICATION POISONING

Put P oison Cont rol in you r cell p hone : 8 0 0 -2 2 2 -12 22

Acetaminophen dosing tops the list as the most common medication mistake for infants, followed by H2-blockers (for acid reflux), gastrointestinal medications, combination cough/cold products, antibiotics and ibuprofen (which is not recommended for infants under 6 months old; likewise, the American Academy of Pediatrics doesn’t recommend cough/cold meds for children younger than 6 years).

A study in Pediatrics found that one-third of poison control calls for infants ages 6 months and younger are for medication errors, including dosing mistakes, giving a medication twice or too soon or giving the wrong medication, among other errors. Double-check the dose at: bit.ly/acetaminophendosagetable.

mothers and their babies with those of undergraduate students and a toddler-like robot named Diego San. When Diego San behaved like babies do, the students responded like mothers, smiling more even when Diego San didn’t smile as frequently.

“Infants have their own goals in [interacting], even before 4 months of age,” said University of California, San Diego study coauthor Dan Messinger. The study is published in PLOS ONE.

HEAD INJURIES, CONCUSSIONS COMMON SHOPPING CART INJURIES An average of 66 children are treated each day in emergency departments for shopping cart-related injuries, typically from falls or the cart tipping over. Head and neck injuries are the most common; other injuries include concussions and broken bones.

Shop safely by bringing another adult to watch your young one, using a stroller or wagon instead of a cart, wearing your baby in a carrier, or having your child toddle beside you if he’s old enough. Stay safe when using carts: B Choose a stable cart that doesn’t wobble B Always use child safety straps B Keep your child seated B Place infant carriers inside the basket, not on the sides or seat

ISSUE 19 / Spring 2016 Healthy Mom&Baby

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17/03/2016 16/02/2016 16:27 14:46 16:11

healthy babies

My Baby

Startles Suddenly!

BY JENNIFER B. LEMOINE, DNP, APRN, NNP-BC

Why does my baby startle or suddenly flail his arms? Is this normal?

All babies are born with innate reflexes. For example, when baby is placed skin-to-skin after birth, baby will crawl toward the breast and begin nursing all on his own—he knows just what to do! Another example is the Moro reflex, which may puzzles parents at first. No worries, though; this is totally normal.

WHY IS MY BABY FLAILING? When a baby exhibits the Moro reflex, his body will tighten, his arms will move sideways palms up, and his thumbs will jut out. It looks like flailing—and for a second, baby is flailing! He may cry or not. And then, just as quickly as it happened, baby will relax and fold his arms back to his body.

WHAT STARTLES BABY? Some babies will startle for no apparent reason. Most babies, however, will startle in response to a loud noise, a change in body position, a sudden movement, a change in environmental temperature, or an unexpected touch.

Babies should exhibit the Moro reflex from birth through age 5 weeks, at which point you may notice baby startles less frequently. This reflex diminishes through time and should completely disappear by 4-6 months of age.

IMAGE CREDITS: 123RF

CREATING THE MORO REFLEX During baby’s 1st physical exam, his healthcare provider will seek to create the Moro reflex by placing baby face up on a soft, padded surface, such as a crib. She will then extend baby’s arms above his torso while holding his hands, support baby’s weight just enough to lift his head gently, and then suddenly release it, allowing baby to fall backward—just for a split second! Don’t worry; this is perfectly safe with an experienced healthcare provider.

What baby’s healthcare provider wants to see is whether he exhibits the Moro reflex on only one side of his body, which could mean baby may have a broken shoulder (clavicle) bone or an injury to the group of nerves running from the lower neck and upper shoulder areas (brachial nerves). These injuries usually occur during birth, particularly with fullterm babies weighing more than 8 pounds.

The lack of a Moro reflex, or an abnormal Moro reflex, is more worrisome as it could mean that there could be damage to baby’s brain or spinal cord.

WHAT IF I SEE A CHANGE IN MY BABY ’S MORO REFLEX? If you notice a change in baby’s Moro reflex, contact baby’s healthcare provider immediately. She will likely want to perform tests to determine the cause and may also want to know: B If there were any problems or events that happened during labor and birth B Detailed family history B Any other new or unusual infant behaviors

JENNIFER B. LEMOINE, DNP, APRN, NNP-BC is a neonatal nurse practitioner in

Lafayette, LA and an expert adviser to Healthy Mom&Baby.

ISSUE 19 / Spring 2016 Healthy Mom&Baby

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healthy babies

Exploring Hemangiomas

BY SHARON SCOT T, DNP, MSN, RN

What are hemangiomas?

These strawberry bursts are a noncancerous birthmark that develops after birth, but one-third may develop in the womb and be present at birth.

These clusters of excess blood vessels may grow close to the surface or deeper below the skin.

IMAGES: 123RF

1 in 10 babies will have a birthmark called a hemangioma, which appears and feels like a rubbery, fluid-filled bump most likely on a baby’s face, head, chest or back. This micro-collection of extra blood vessels can appear during the first few days post birth and grow for up to 12 months, say experts at Boston Children’s Hospital.

The most common are infantile hemangiomas that peak around 3-4 months of age in a baby and then eventually go away on their own. Some grow rapidly for up to a year.

By age 5, about half of hemangiomas have gone away on their own meaning they start to shrink and may leave only a slight discoloration in the skin that shows where they once were. Typically by age 7 almost all hemangiomas will shrink on their own.

Most babies will have only 1 hemangioma, although they can have more.

IS MY BABY AT RISK FOR A HEMANGIOMA? Researchers led by Joyce Bischoff, PhD, at Boston Children’s Vascular Biology program, recently

discovered that hemangiomas appear to originate from stem cells. So far, research has also determined that these tumors aren’t hereditary, and no known activity, action or substance during pregnancy can cause a baby to be born with a hemangioma, say experts at Boston Children’s. They’re more common in girls than boys, and also more common in Caucasian babies and premature babies.

TREATMENT For larger hemangiomas that may not resolve on their own, your healthcare provider may advise corticosteroids to help shrink the hemangioma.

Excess skin or fat left where the hemangioma was can be removed surgically, if desired. Extra blood vessels in the area can also be eliminated through pulsed-dye laser therapy.

Since hemangiomas are blood vessels, you should seek care if your child’s hemangioma bursts open or begins to bleed. You may need to take your child either to your healthcare provider’s office or a local emergency room, particularly if the bleeding is severe.

Although most hemangiomas cause no problems, rare complications that can happen include: X a hemangioma near a child ’s eye or throat that can affect vision or breathing X a large facial hemangioma that can disfigure a child ’s face X a hemangioma on an internal organ that could cause internal bleeding (exceedingly rare)

SHARON SCOTT, DNP, MSN, RN, is a clinical

and lab nurse educator in Locust Grove, VA and an expert adviser to Healthy Mom&Baby.

ISSUE 19 / Spring 2016 Healthy Mom&Baby

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healthy babies

Ouch!

BY JOANNE GOLDBORT, PHD, RN

When Breastfeeding Is Painful SORE NIPPLES WHEN NURSING Many moms experience soreness or pain in one or both nipples at some point with breastfeeding. Nipple soreness is often related to how well your baby is latching and maintaining a latched position during nursing.

Begin by being in a comfortable position, and help baby latch correctly.

Don’t be shy about trying different positions with breastfeeding—what’s comfortable for both you and baby may change from day to day. Plus, changing positions with each feeding will give your baby different pressure points when sucking.

Having a bad latch is a common reason for nipple pain; this is caused by baby’s improper sucking. Some women may experience a wince of pain when nursing begins, but it should never last for more than a second or two.

To break baby’s latch, gently place your finger in her mouth to break the suction. If your baby isn’t latched correctly, she’ll suck improperly causing painful nipples. Make sure your baby is opening her mouth wide enough, with her tongue down, and that she’s bringing the full nipple and a large part of the areola into her mouth. Until the soreness subsides, start the feeding on the least sore nipple and air-dry your breast after each feeding.

B

MANAGE BREASTFEEDING PAIN Promote pain relief and healing to sore, cracked, blistered or even bleeding nipples with the following proven strategies: B Warm, moist compress or tea bags B Breast shells or shields go inside your bra when you’re not nursing; they let air circulate and keep your clothing from irritating your nipples B Hydrogel pads in your bra between feedings create a soothing, moist healing B Purified lanolin on your nipples between and with each feeding; it helps your skin retain its moisture and protects it from further breakdown B Massage a little of your milk into your nipples after each feeding to promote nipple health and help speed cure the soreness Talk to your nurse or baby’s healthcare provider if soreness and tenderness persist. You can also find a breastfeeding specialist (lactation consultant) through your healthcare providers.

If you simply need to give your nipples “time off” to heal, pump and feed baby breastmilk from a bottle for 24-48 hours. Let dad or your partner help give baby pumped milk so that you can also rest and relax.

TOO MUCH MILK Your milk typically comes in around the 3rd-5th day after giving birth, depending on how often and effectively baby nurses in those first few days.

You may find your breasts feel full and firm; this is normal.

The good news is that “your milk is in!” However, the discomfort (if

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any) is due to a combination of factors: B Hormonal changes B Increase in milk production B Increase of water, blood, and lymphatic fluid that helps prepare your breasts for feeding your baby Frequent nursing will help reduce the fullness and discomfort. Typically, your areola remains soft and pliable and your newborn should be able to latch on without difficulty. Continue nursing and the fullness will decrease in about 24 hours. Take note: This does not mean your milk supply has diminished but that the swelling has.

ENGORGEMENT ISSUES Experiencing engorgement is different; it usually occurs as a result of receiving extra IV fluids during labor and birth. As the days and weeks of nursing roll by, you may also experience engorgement when your baby starts sleeping through the night for the first time and skips a feeding or two or when baby goes through a growth spurt and eats more frequently, stimulating your body to make more milk. Engorgement can also occur when you return to work or if you don’t have enough time to pump.

With engorgement, your breasts can feel firm, hard, lumpy, tender or painful—even the areola can be hard and taut. Your baby will struggle to latch on. Pumping some milk will assist in making the areola supple.

PLUGGED MILK DUCTS You may feel a swollen, tender spot in your breast and that could be a plugged milk duct. These happen when your baby isn’t taking enough milk out of your breasts. Using the same position for each feeding, wearing a tight or underwire bra or tight clothing can also cause plugged ducts.

This is one problem where a warm compress helps. Apply it gently to the area before a nursing session; you may want to also gently massage the area to get the milk moving again. Continue with frequent feedings, changing your position with each new feeding and try to spend some time not wearing a bra, or get fitted for the right-sized nursing bra or support top.

BREAST INFECTION Mastitis begins as an inflamed milk duct and can develop into an infection.

Mastitis can develop from plugged milk ducts or pores, sore or cracked nipples, not alternating breasts at each feeding, missed feedings, poor latch, not emptying the breasts at each feeding, or your own illness or stress.

Signs of mastitis include a hot, reddened area on the upper and outer part of one or both breasts. You will likely also have the sudden onset of fever, chills, body aches and a headache.

See your healthcare provider to treat mastitis; antibiotics are usually prescribed for 10-14 days, and you may want to take an anti-inflammatory like ibuprofen for pain and discomfort relief. You may find applying moist heat to your breasts before a feeding helps with discomfort. Always begin each feeding with the least painful breast. It’s important for you to rest when baby rests; continue with frequent feedings or pumping and use a warm compress before feedings.

TAKE CARE OF YOURSELF You’re so busy taking care of baby, particularly in those first few weeks and months, you may forget to also take care of yourself. It’s so important

IMAGES: 123RF

So you got off to a great start with baby, but now breastfeeding isn’t quite as comfortable as it used to be. Let’s take a closer look at what is normal, what is not, and how to treat and manage these concerns.

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healthy babies throughout your breastfeeding journey with baby to get rest when baby sleeps; drink plenty of fluids; eat a healthy, balanced diet; and ask for support from your partner, family, and friends.

Find a local breastfeeding support group and never hesitate to call your nurse or baby’s healthcare provider if you have any questions or concerns about nursing.

B

PREVENT ENGORGEMENT To help prevent engorgement, make sure your baby fully empties at least one breast during each nursing session. If baby leaves milk behind, you can pump it off to ensure your breasts remain soft and comfortable.

These strategies will help you remedy or keep engorgement at bay: B Feed your baby at least every 2 hours B Cover both breasts with ice packs (or bags of frozen peas or corn that can be refrozen) in a “20-minute on, 45-minute off” rotation between feedings B Place fresh, frozen washed cabbage leaves over the breasts for 15 to 20 minutes between feedings and repeat for 2 or 3 sessions; skip this strategy if you’re allergic to cabbage or if a rash develops B Take an anti-inflammatory like ibuprofen; taking these medications right after nursing will reduce the chance they’ll reach baby B Use a warm compress before nursing to stimulate milk let-down; this is a good time to manually express a small amount of milk, leaving some on the nipple and areola to stimulate baby’s nursing

JOANNE GOLDBORT, PHD, RN, is an assistant professor in East Lansing, MI and an expert adviser to Healthy Mom&Baby.

ISSUE 19 / Spring 2016 Healthy Mom&Baby

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healthy babies

BY CYNTHIA LORING, MS, RNC, CLC

Eat Your Way Through Successful Breastfeeding

Breastfeeding moms often have questions about what they eat and how it could affect their babies. It’s natural to be concerned, but no need to panic!

Mother Nature designed the female body to make producing breastmilk a high priority! It’s fairly easy to make sure your breastmilk is safe and nutritious for your baby. All you really need is a healthy diet to maintain your own health and energy and meet the nutritional needs of your baby’s 1st year.

WHAT SHOULD I EAT? Aim for a well-balanced diet that includes a variety of proteins (think lean meats, nuts, eggs, dairy, beans, soy); vegetables (especially dark leafy greens and yellow and orange veggies); fruit (dried fruits and juice are good, but whole fruits are best); and wholegrain bread, cereal, pasta, oatmeal and brown rice.

As a breastfeeding mom, you need about 500 more calories per day. If you still have extra pregnancy weight, you may not need the additional calories until your weight returns to normal; ask your nurse if you’re not sure.

WHAT SHOULD I DRINK? Drinking extra fluids doesn’t increase your milk supply, but you should stay hydrated. Skip sugary

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DO I NEED TO GIVE UP CERTAIN FOOD? The old saying is that baby eats what you eat—but most babies tolerate the spicy or gas-producing foods that you enjoy! If you notice that your baby is gassy, fussy or having looser stools after you eat a certain food, try avoiding it for 1-2 weeks to see if the symptoms go away. However, check for other causes before blaming it on what you ate.

Keep in mind that while baby might be sensitive to a food at a point in time, you may still re-introduce

that food again later—baby’s little digestive system will mature gradually during the 1st year of life.

COULD MY BABY HAVE ALLERGIES? It’s rare for your baby to have true allergies to the foods you’re eating. Dairy, soy, wheat, egg whites, tree nuts, and fish are foods that are known to cause allergies. Symptoms of allergic reaction are skin rashes, mucousy or bloody stools and breathing changes.

Since 2008, there has been a lot more research on the subject of allergies in the 1st year of life. Studies are showing that babies exclusively breastfed for the first 4-6 months actually have fewer allergies, regardless of the mother’s diet. Don’t restrict your diet to try to prevent allergies, says the American Academy of Pediatrics.

If you or your partner has a history of food allergies, though, it would be wise to eat those foods in small amounts since larger amounts can be more likely to cause allergic reactions.

CYNTHIA LORING, MS, RNC, CLC is a clinical

educator in Enfield, NH and an expert adviser to Healthy Mom&Baby.

OOS E — FOO D TO C H E A N D R E FU S make it a habit to eat processed or sugary foods—like hot dogs, sweetened cereals and juices, soft drinks, pastries, etc.

D O N’ T

DO

choose low-fat or fat-free milk, yogurt and cheeses.

eat fish with high levels of mercury, like swordfish, shark, tilefish and king mackerel.

D O N’ T

eat fish 2-3 times per week to provide omega 3 fatty acids for baby’s brain development. Best sources are salmon, bass, bluefish, trout, flounder and tuna.

DO

D O N’ T

eat large quantities of fried foods.

opt for proteinD O rich foods and lean cuts of meat. If you are a vegetarian or vegan, eat foods rich in iron, protein and calcium and consult your healthcare provider for advice on whether or not you should take vitamins B-12 and D.

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soft drinks and reach for milk and water when you’re thirsty, and keep a drink nearby when you breastfeed.

Coffee and tea are OK, but caffeinated drinks are best in moderation. Most babies aren’t sensitive to caffeine, but it can cause sleeping problems or fussiness for some.

If you drink alcohol, wait 2-3 hours after 1 serving (12 ounces of beer, 5 ounces of wine, and 1.5 ounces of liquor) before breastfeeding or pumping. Alcohol doesn’t stay in your breastmilk; it’s removed as your blood alcohol level goes down. When you’re sober, your breastmilk is free from alcohol. If you need to pump while alcohol is still in your system, discard that milk after pumping (though “pumping and dumping” will not speed up eliminating milk from your body that may have alcohol in it).

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healthy babies

BY CYNTHIA LORING, MS, RNC, CLC

What to Do

WHEN YOUR BABY IS CHOKING You may be horrified at the thought of having to perform life-saving skills on your own baby, but fact is there’s a small risk that cardiac arrest can occur if your baby ever chokes on an object.

Unlike adults, cardiac arrest in infants almost always begins with respiratory arrest from a blocked airway. As soon as your baby is old enough to grab an object and bring it to his mouth, he’s at risk for choking on toys or any tiny item that can block his airway.

Many parents take a basic CPR course from a local hospital or Red Cross. Here’s a basic guide on how to prevent choking and react when your child is choking, and a review of the main steps you would learn and practice in a CPR course.

B Check labels and packaging on new toys to ensure they’re baby-safe B Always check play areas for small objects, especially under furniture B Remind family members to pick up dropped items (coins, pens, paperclips, etc.)

B Keep trash out of reach B Don’t leave unsafe items within baby’s reach B Periodically check toys and baby furniture for broken parts B Never let baby play with or chew on balloons, especially rubber ones B Follow safe eating guidelines for 1st foods and never leave baby unattended at meal or snack time B Discourage baby from playing or talking with food in his mouth B Always feed baby while he is sitting

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STEP 1

If your baby cannot cry or cough, go to Step 2

STEP 2

Give 5 back blows: y Turn baby head down and place his stomach on your forearm or thigh with his head lower than the rest of his body y With one hand, hold baby ’s jaw, and with the heel of the other hand, slap the baby firmly between the shoulder blades 5 times y If this fails, go to Step 3

STEP 3

Give 5 chest thrusts: y Rotate baby face up again, using one hand to support the head y With your other hand, place 2 or 3 fingers in the center of the chest slightly below the nipple line and compress the chest rapidly and firmly 5 times y If this fails, go to Step 4

STEP 4

Keep repeating steps 2 and 3 until the item is dislodged from the airway or the baby becomes unconscious. y If baby becomes unconscious, begin CPR protocol y If at any time you see an object in baby ’s mouth, remove it y Never put your fingers down baby ’s throat as this could lodge the item even more firmly

IMAGES: 123RF

B

PREVENT INFANT CHOKING

WHAT TO DO IF YOUR BABY IS CHOKING (INFANTS 0-12 MONTHS OLD)

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B

CPR FAQS What is CPR? Cardiopulmonary resuscitation. If you’re trained in CPR, you have the skills to compress a person’s heart (creating a “heartbeat”) and blow air into a person’s lungs (creating “breaths”) in the event of a heart attack. For the average person, CPR is a way to keep a person alive until healthcare professionals can take over.

Why should I learn CPR when I can call 911?

Research shows that with cardiac or respiratory arrest, the first few minutes are critical to survival. Beginning CPR immediately after arrest saves lives!

Do I have to take a class?

Ideally every new parent should know how to perform basic infant CPR. You can sign up for a CPR class, take an online course, take infant CPR training through your local hospital (where available) or purchase an instructional video. If you choose an online course or purchase a DVD, see if you can arrange to practice your skills under the guidance of a CPR instructor.

How do I find a CPR class?

Two organizations that have long histories of providing excellent research-based classes are American Heart Association (AHA) and American Red Cross (ARC). Both have courses for non-healthcare professionals. Check their websites or contact your local healthcare facility or fire department to find a class.

Are all the courses and instructional materials that I find on my computer search OK to use?

No. Be sure to look for instructional information that follows the current 2015 AHA guidelines.

Protocols change every few years based on current research. One example: You should now start compressions 1st during initial resuscitation instead of breaths, a change made in 2010. You should be recertified every 2 years.

BASIC STEPS IN CPR FOR INFANTS 0-12 MONTHS OLD

STEP 1

Shout & tap: Shout and gently tap the baby ’s shoulder or the bottom of his foot. If there is no response and no breathing, go to step 2.

STEP 2

Yell for help: If there is another person nearby, ask them to call 911. If you ’re alone, don ’t leave baby to call or get help until you have completed 2 minutes of CPR. The first few minutes of CPR are crucial to recovery.

STEP 3

Move baby to flat, firm surface like a table top or the floor (a crib or changing pad is not firm enough) and lay him on his back.

STEP 4

Give 30 compressions: Place 2 fingers on the middle of the chest just below the nipple line. Compress the chest about 1½ inches deep. Compressions must be given very rapidly (100-120 per minute or almost 2 compressions per second).

STEP 5

Open baby ’s airway: Gently tilt baby ’s chin upward to lengthen his airway. With one hand on baby ’s head and the other on his chin, recheck see if the baby is breathing. Only take a few seconds to do this! If there is no breathing or abnormal breathing, go to step 6.

STEP 6

Give 2 gentle breaths: Cover the baby ’s nose and mouth with your mouth and blow a puff of air into the baby. His chest should rise gently with each breath. If it doesn ’t, reposition his head and try again.

STEP 7

Continue alternating compressions and breaths (steps 5 and 6): If the baby shows signs of life (breathing on his own or crying), you may stop CPR, but observe closely until healthcare professionals arrive in case you need to restart CPR.

CYNTHIA LORING, MS, RNC, CLC, is a clinical educator in Enflied, NH and an expert adviser to Healthy Mom&Baby.

ISSUE 19 / Spring 2016 Healthy Mom&Baby

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healthy babies

BY MICHELE SAVIN, MSN, NNP-BC

MY BABY HAS JAUNDICE Baby ’s eyes and skin appear to be yellowed; what could that be?

Congratulations on the new baby! Labor and birth are over, and you’re settling in with your new little one. Th ings are going great; he took to nursing at your breast like a pro and has the sweetest temperament.

You can’t quite figure out just who he looks like, but his skin looks… yellow! Wait, yellow? A nurse comes in with a strangelooking machine. She holds it to his forehead and a few beeps and clicks later the verdict is in: Your baby has jaundice. But what exactly does that mean?

WHAT IS JAUNDICE? Jaundice is seen as a yellowing of the eyes and skin. It’s caused by a buildup of bilirubin, which is a normal result of the breakdown of red blood cells. Red blood cells are created and destroyed in our bodies every day.

While baby was in your belly, your placenta carried away bilirubin for baby. As we grow, we produce enzymes in our liver that help rid our bodies of bilirubin, mainly through stool.

However, it takes a few days for your baby’s system to get that going. The immediate side effect is a short-term condition known as hyperbilirubinemia—or too much bilirubin in the bloodstream.

HYPERBILI-WHAT? Hyperbilirubinemia (pronounced hyper-billy-rūhbah-nee-mee-ah)

is a common and typically harmless condition called jaundice in babies. Each year, slightly more than 50-60% of babies born at term, and most (80%) of preterm babies become jaundiced. Th is usually starts by the 2nd or 3rd day, so every baby gets his or her bilirubin levels checked by either a screening meter that scans baby’s skin or a blood test from a heel stick before they go home.

In babies born at term, jaundice peaks about day 4, and by the 9th day in preterm babies. It’s usually over by 2 weeks.

WHO ’S AT RISK FOR JAUNDICE? Boys are more prone to jaundice than girls. Race also plays a role: Asian babies are more likely to develop jaundice, followed by Native American, Caucasian, and African American babies.

If mom has type O or negative type blood, baby is more likely to develop jaundice. Th is is because cells from mom’s body may cross over into baby’s body, causing an increase in red blood cell destruction, which increases bilirubin in baby’s blood. Babies whose mothers have diabetes are also at risk because they may have extra red blood cells.

Jaundice is also more common in breastfed babies—but contrary to what you might think, there’s no need to stop breastfeeding if your baby has jaundice. There are 2 ways that breastfeeding affects bilirubin. First, your baby may be slightly dehydrated so bilirubin gets more concentrated in baby’s blood. To solve this problem, nurse

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PROBLEMS CAUSED BY JAUNDICE Jaundice is typically harmless. In rare cases, it can lead to bilirubin encephalopathy, also called kernicterus. Th is form of severe hyperbilirubinemia is a rare neurological condition that happens when bilirubin levels get too high and move out of the blood and into baby’s brain tissue, causing irreversible brain damage. Approximately half of babies who suffer kernicterus don’t survive; those who do have lifelong issues with hearing, speech and movement.

Other rare but serious side effects of too much bilirubin in baby’s bloodstream include cerebral palsy and deafness. Healthcare providers take jaundice very seriously and treat it at levels well below the amount of bilirubin that causes these serious neurological problems.

Before your baby leaves the hospital or birthing center, his or her bilirubin level may be checked several times as needed

to determine how fast the level is rising in baby’s blood. If your provider asks you to bring baby back after going home to have baby’s bilirubin level rechecked, it’s absolutely critical to do so.

HOW IS JAUNDICE TREATED? Jaundice can make babies sleepier and feed less yet keeping baby well fed and hydrated is a large part of the treatment for jaundice.

Other than increased breastfeeding, the most common treatment for jaundice is via blue phototherapy lights, which help baby’s body break down and eliminate bilirubin in the skin.

With phototherapy, your baby may be dressed in only a diaper to expose as much of his or her skin as possible to the blue light.

Eyes are covered for comfort and safety. Most babies who require phototherapy only need it for a few days; it’s usually done in the hospital but may be offered to you at home.

With phototherapy treatment, it’s a good idea track the number of wet diapers and stools each day. Your baby may experience more frequent or watery stools, and it’s important to keep baby’s sensitive skin clean and dry. Diaper changes can be done while the lights remain on.

Continue breastfeeding; however, be mindful of and limit time spent apart from phototherapy to keep bilirubin levels from rising again. Follow your healthcare professionals’ recommendations regarding how long baby should receive phototherapy, and keep all appointments for rechecks and testing that may be needed.

If excessive jaundice occurs from maternal antibodies that have crossed into the baby’s system, a protein called an immunoglobulin (IVIG) can be given to baby intravenously to decrease the levels of these maternal antibodies.

In rare instances when jaundice isn’t responding to other treatments, a baby may need to have a transfusion where part of his blood volume is exchanged with fresh blood to quickly lower the bilirubin level. These specialized treatments happen in a neonatal intensive care unit.

Jaund ice comm is more o breas tfed b n in abi it’s no reason es, but to sto p

MANAGING JAUNDICE Every newborn experiences some level of jaundice, and rising bilirubin and jaundice are part of an infant’s natural transition from the womb into the world. Any time you think your baby is “looking yellow” or something seems a little off, ask to have baby’s bilirubin level tested.

Don’t be afraid to ask questions, and know that the nurses caring for you will support you and your baby every step of the way.

MICHELE SAVIN, MSN, NNP-BC is a neonatal nurse practitioner in Wilmington, DE and an expert adviser to Healthy Mom&Baby.

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your baby more frequently. In rare cases, your healthcare provider may want baby to receive IV fluids.

Secondly, a few babies are affected by breastmilk jaundice, which is thought to result from substances in the breastmilk preventing liver enzymes from effectively packaging and removing bilirubin. This occurs in up to 5% of breastfed infants and is a f lag for healthcare providers to closely watch any future siblings for the same.

Other things can cause jaundice in newborns, including problems that create more bilirubin—such as bruising or bleeding that destroys more red blood cells. There are also problems with the liver or intestines that can interfere with picking up bilirubin and packaging it for removal out of the body. Infections, inherited blood disorders and biochemical or metabolic diseases can also increase bilirubin in infants; however, these last few occurrences are rare.

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BY RITA NUT T, DNP, RN

Every parent has questions about bathing their baby—you’re not alone. Here are the most common questions nurses receive—suds up!

HOW OFTEN SHOULD I BATHE MY BABY?

Daily bathing isn’t recommended as it can dry delicate skin; research shows 2-3 times a week is best. Once your baby starts crawling, playing outside and feeding herself, more frequent baths will likely be needed.

WHAT ’S THE BEST WAY TO BATHE MY NEWBORN?

The first step in baby’s bath routine is always to get everything ready for the bath, including an infant tub or basin, warm bathing and warm rinse water, towels and any other items you want at hand.

Go ahead and immerse baby from birth into a tub filled with warm water just deep enough to cover her shoulders: B Use a baby washcloth to avoid irritating her skin B Support her head and neck with your hand and forearm while you wash with your other hand B Keep a warm washcloth over her body to warm baby throughout the bath

BATHING BASICS

Wash from the cleanest areas to the dirtiest: Start with the face using water alone; end with the diaper area. Don’t forget those sneaky spots around her neck, underarms, and groin—babies love to hide dirt in those folds!

Remember to rinse! Always use rinse water you’ve prepared and that is warm; never use running water from a faucet or sprayer as water coming out of your sink can vary in temperature.

WHAT KIND OF CLEANSERS SHOULD I USE?

Prevent irritation by using a mild preservative- and fragrance-free cleanser with a neutral pH designed specifically for baby’s delicate skin. For your baby’s face, water alone is enough. Use a clean washcloth for her eyes: Gently wipe from the inside to the outside, using a clean part of the washcloth for each eye.

POST-BATH POINTERS: B B B B

Pat baby dry with a soft, warm towel rather than rubbing vigorously.

Lotions aren’t really necessary and can actually lead to more drying of the skin.

Never use powders on your baby, which can be inhaled and lead to breathing problems.

Skip cotton swabs, which can damage the ear canal and eardrum.

RITA NUTT, DNP, RN is a nurse educator in Salisbury, MD and an expert

IMAGE: 123RF

No need to feel anxious—follow these tips for a fun, low-stress time to play and bond with baby!

adviser to Healthy Mom&Baby.

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