HealthyMom&Baby: Issue 16

ISSUE 16 / Spring 2015 | $3.95 | health4mom.org

PREGNANCY | BIRTH | PARENTING

YES, YOU CAN! Breastfeed Your Baby Born Early

SKIN TO SKIN AFTER CESAREAN

DO YOU KNOW PURPLE CRYING?

ESSENTIAL PROBIOTICS & SUPPLEMENTS GUIDE TO BABY’S

MILESTONES MEET THE CAST:

40 WEEKS POWERED BY THE NURSES OF

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healthy babies 50 Sleeping Baby

How much sleep is too much for baby?

Issue 16 / Spring 2015

53 Marking Milestones

( CONTENTS )

Here ’s what baby should be doing, and how you can help

56 Prevent Shaken Baby Syndrome

Act before you ’re at the breaking point with baby

healthy moms

healthy pregnancy

11 Consider Female Condoms

24 Powerhouse Protein in

They can help prevent pregnancy and protect against infection

12 Healthy Celebrations

From baby showers to birthday parties, there ’s always an opportunity to indulge

14 3 Key Supplements

Get nutrients primarily from foods, but also boost with a supplement, say experts

16 Probiotics Promote Your

Health

Pregnancy

This essential nutrient is important for a healthy pregnancy

25 1st Trimester: Weeks 1-12 From pregnancy tests to morning sickness; here ’s how it all begins

26 2nd Trimester: Placenta

Problems

Let nature take over for your easiest birth

This good bacteria protects your health

29 3rd Trimester: Colostrum as

17 Cervical Cancer Screening

Experts call this “liquid gold ” the perfect food for newborns

Get the info on cancer prevention for yourself —and your kids

19Super Sleep in 6 Strategies

Bad sleep zaps more than just your mood —it affects your health too!

20 How We Birth

Baby ’s First Food

57 Purple Crying

Baby ’s incessant crying is normal; learn about this phenomenon

59 My Baby Has Gas

How to help baby pass gas easier

60 Hungry Baby

Your top newborn feeding questions answered

65 Parenting Against Picky Eating Avoid picky eating by following these steps

66 Potty Training 101

With patience your toddler can rule the loo

Potty Training 101 page 66

33Your Changing Breasts

Here ’s what happens to your breasts before baby is born

39 Skin-to-Skin after Cesarean Yes, this is possible —learn how!

From homes to hospitals, here ’s how we ’re striving for full term healthy births

42 Alcohol in Pregnancy How much is safe?

44 Belly Bumps to Baby Mamas Meet some of the moms of 40 Weeks

Belly Bumps to Baby Mamas Meet the Mamas and the babies in 40 Weeks, a new pregnancy documentary now in theaters across the country ASYA REZNIKOV Alcyone, born February 22, 2014

44

FEATURE

ISSUE 16 / Spring 2015 Healthy Mom&Baby

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Hyland’s Baby Diaper Ointment Ok, so what is cuter than your baby’s bottom? Nothing. That’s exactly why diaper rash should be outlawed. It effaces such natural beauty—never mind the fact that it’s irritating and painful to your baby. Our diaper ointment is heroic. It relieves, heals and protects.* It leaps tall changing tables in a single bound. We are so happy to have thousands of tubes in stock for you.

So many little behinds. So little time before they grow big.

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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 Eastbay Hayward, CA JOANNA GOLDBORT, MSN, PhD, RN Union Hospital Health Group Terre Haute, IN HELEN HURST, DNP, RNC, APRN-CNM University of Louisiana School of Nursing Lafayette, LA ELIZABETH JORDAN, DNSc, RNC University of South Florida College of Nursing Tampa, FL CAROLYN “CARRIE” LEE, PhD, 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 Brigham & Women’s Hospital Boston, MA RITA NUTT, DNP, RN Salisbury University Salisbury, MD SUSAN PECK, MSN, APN Robert Wood Johnson Medical School New Brunswick, NJ MICHELE SAVIN, MSN, NNP-BC Christiana Care Health Services Wilmington, DE PAT SCHEANS, MSN, NNP Legacy Health System Portland, OR SHARON JEAN SCOTT, BSN, RN Mary Washington Hospital Fredericksburg, VA KIMBERLY WILSCHEK, RN, CCE Medical Revenue Solutions Chicago, IL CHARLOTTE WOOL, PhD, RN, CCNS York College of Pennsylvania York, PA TAMERA YOUNG, RN, MSN Central Ohio Technical College Zanesville, OH

CONSUMER ADVISORS MARIA OPLT Lafayette, LA

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

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

You’ve Got Questions?

We’ve Got Answers: Ask Our Nurses

BY K AREN T. HARRIS, MSN, RN, WHNP-BC

If you’re pregnant—or simply trying to ask our conceive—you’re probably receiving a lot nurses of unsolicited advice. It’s the top pet peeve of pregnant women and women who are trying to conceive! Your aunts, sisters, cousins and friends all mean well but you SEARCH need information you can trust and act on.

That’s where the nurses behind Healthy Mom&Baby come in. We’ve taken the top questions asked by women in exam and birthing rooms across the country and provided the answers in both videos and written questions and answers with article links. Ask Our Nurses experts answer questions like:  How long should my partner and I try to conceive on our own?  Is it safe to exercise in pregnancy?  What foods can I eat—or should avoid—in pregnancy?  Why is it important to wait for my labor to start on its own?  What’s the “Golden Hour” so many new moms talk about?

In short, these videos that are less than 2 minutes each give you the information you need from the healthcare providers you trust most—nurses. You see your nurse at every prenatal visit; they want to answer your questions and concerns that naturally come up during pregnancy—even if this isn’t your first baby.

Th is is why the mother/baby nurses of the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) produce Healthy Mom&Baby—so women just like you can get health advice and information that’s based on science and is useful and trustworthy.

Begin with the advice from nurses in this issue. Every time you find an Ask Our Nurses icon next to an article, the link published there will lead you to an online video question and answer. Once you’re online, you’ll find even more great advice and articles at Health4Mom.org.

KAREN T. HARRIS, MSN, RN, WHNP-BC, is the AWHONN 2015 President.

ISSUE 16 / Spring 2015 Healthy Mom&Baby

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the new year starting up!

At Healthy Mom&Baby we’ve made it easy to get the health advice you need weekby-week from our nurse experts.

Unlike other pregnancy-by-week offerings, we’ve got you covered

from week 1 all the way through week 42+ because nurses know there’s a lot going on with your baby from the moment he or she is conceived.

Nurses also stress the importance of going all the way with your pregnancy to full-term, even if that means waiting for baby to start labor on her

Printed in the United States on paper made with 30% post-consumer recycled fiber.

Please recycle this magazine!

Healthy Mom&Baby is published by Maitland Warne in partnership with AWHONN. © AWHONN, 2015. All rights reserved. All material in Healthy Mom&Baby is wholly copyright.

Reproduction without the written permission of the publisher is strictly forbidden.

Neither this magazine nor its contents constitute an explicit or implied endorsement by AWHONN or by Maitland Warne of the products or services mentioned in advertising or editorial content.

The editorial content in this publication does not necessarily represent policies or recommendations

by AWHONN. This publication is not intended to be exhaustive. While every effort has been made to ensure accuracy, neither AWHONN nor Maitland Warne shall have any liability for any errors or omissions. Readers who may have questions should consult their healthcare provider.

own—even up to 42 weeks! Check out each week of pregnancy in the Healthy Pregnancy section at Health4Mom.org.

Speaking of new parents, we’d like to introduce you to some of the cast from the 40 WEEKS documentary in this issue, as well as give you some great advice on things you thought might not be possible: breastfeeding your baby born early and going skin-to-skin with your baby after cesarean. Yes, you can do these things; and we’ll show you how.

If you’ve wondered how much alcohol—if any—is safe during pregnancy; we’ve got the answer in this issue. (Hint; if you’re thinking “no amount of alcohol is safe”— you’re right! Read why!).

Enjoy your emerging bump,

PUBLISHER

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

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

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

health4mom.org

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• Use your own suction to remove nasal mucus safely and hygienically.

• More effective than bulb and battery type aspirators.

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Nothing else to buy!

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Available at

Spinning Babies Stretch into your dream birth with companion videos!

In Daily Essentials, experience stretching, sitting, walking, getting in and out of the car and bed can add comfort for your pregnancy. Two 28-min pregnancy yoga stretches for beginner and intermediate. Blooma Yoga’s Sarah Longacre’s moves you through your day. Midwife Gail Tully explains how these moves are a daily essential to your birth.

Spinning Babies; Parent Class goes beyond any childbirth class: How to tell if your baby is engaged after 38 weeks gestation, the Fantastic Four muscle release to free your pelvis and lower back, identifying a normal compared to a stalled labor, and resuming normal labor. Keep your birth as natural and comfortable as you choose. Tips on flipping a breech or sideways baby and ways to ease a posterior, or back labor.

See the trailers, download or get the DVDs at SpinningBabies.com Easier Birth With Fetal Positioning.

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healthy

Join us on Facebook facebook.com/HealthyMomAndBaby

Moms

Questions? Our Nurse Experts Have Answers!

BY SUMMER HUNT

Why wait until your next appointment to get your pregnancy questions answered? Search the Ask Our Nurses feature on the newly redesigned Healthy Mom&Baby website at Health4Mom.org. Who knows? We may already have a video or article that answers your question!

Check out our new “So I Asked My Nurse” video at bit.ly/askanursePSA

ask our nurses

SEARCH

TOP QUESTIONS  Pap Smear  How do I safely store breast milk?  How can I continue to breastfeed after birth if I have to go back to work right away?

Midwives Safer Than Docs?

IMAGES © 123RF

If you’re having a normal pregnancy, a certified nurse midwife (CNM) may very well be a safer, healthier provider choice than doctors, according to a clinical assessment from Britain, where midwives care for most pregnant women. When all is healthy and well, midwives typically do fewer medical interventions into pregnancy, including avoiding labor induction.

In the U.S., most CNMs (75%) work in physician practices or hospital settings, where any unexpected complications can be attended to in a timely manner.

WHAT’S A CERTIFIED NURSE MIDWIFE? A licensed registered nurse who is educated in midwifery and nursing.

Out of the 3.9 million U.S. births in 2013, only 9% were attended by midwives.

Nearly half of all U.S. counties don’t have access to ANY maternity care professional

PAIN MEDICATIONS CONNECTED TO BIRTH DEFECTS Use of opioid pain medications early in pregnancy can cause birth defects, with hydrocodone, codeine and oxycodone being among the most filled prescriptions in women ages 15-44, says the CDC. “Many women of reproductive age are taking these medicines and may not know they are pregnant and therefore may be unknowingly exposing their unborn child,” says CDC director Tom Frieden, MD, MPH. If you are pregnant or trying to conceive, talk to your healthcare provider about alternative pain relievers if necessary.

ISSUE 16 / Spring 2015 Healthy Mom&Baby

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Send us your feedback and comments! health4mom@awhonn.org

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healthy moms

Consider Female Condoms

By Susan Peck, MSN, APN

They can help prevent pregnancy and protect against infections

Are you interested in birth control that protects against infection, doesn’t require a prescription and that also doesn’t involve hormones? Why not consider the female condom—condoms aren’t just for men.

Female Condoms

The female condom is an easy to use, soft, polyurethane (nonlatex) pouch that fits comfortably inside your vagina. There’s a ring at each end of the condom. Before intercourse, insert inner ring/pouch deep into your vagina, leaving the outer open ring covering part of your vulva. This external covering may reduce exposure to sexually transmitted infections that are transmitted from skin-to-skin contact, such as genital herpes or HPV. During intercourse, any pre-ejaculate fluid and semen from your male partner is collected in the pouch, thereby preventing pregnancy and reducing your exposure to sexually transmitted infections transmitted through bodily fluids. After ejaculation, the female condom is removed and discarded. The condom is strong but very thin—like the thinnest male condom.

images © 123rf

Using Female Condoms

Many couples prefer female condoms because they can be used with oil-based lubricants like Vaseline or coconut oil and are latexfree, unlike male condoms. You may find it helpful to insert the female condom as part of foreplay; it may even enhance external clitoral stimulation making sexual activity more pleasurable.

Polyurethane may conduct more body heat between partners, which may also heighten sexual pleasure. Female condoms can also be used safely during anal intercourse.

Some couples may find the condom slips easily into the

vagina or may be awkward to insert, but with very little practice, most couples use it very easily. Adding additional lubricant may help to avoid slippage. Like male condoms, female condoms can only be used once and must be discarded after use. Don’t try to use both a male and female condom at the same time as friction may tear one or both of the condoms.

Effectiveness of Female Condoms

The female condom can be used with other birth control methods including birth control pills or IUDs because of the infection prevention it provides. On it’s own, and when used correctly every time, only 5/100 women will become pregnant after one year of use. If not used correctly every time, 21/100 women will become pregnant. Additionally, spermicide may be applied for extra protection.

In 2009, the FC2 Female Condom was approved for use and sale. You can purchase female condoms online or at local drug stores or health clinics like Planned Parenthood for around $4 each.

Susan Peck, MSN, AP, is a nurse practitioner at the Robert Wood

Johnson Medical School and an expert advisor to Healthy Mom&Baby.

ISSUE 16 / Spring 2015 Healthy Mom&Baby

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BY LYSSIE LAK ATOS, RDN, CDN, CFT AND TAMMY LAK ATOS SHAMES, RDN, CDN, CFT

Healthy Celebrations It’s certainly no secret that you can do a lot of damage to your waistline when it comes to parties and celebrations if you’re not careful.

The temptation to indulge is always there; use our pointers to stay lean and still enjoy yourself.

1

(

FROM BABY SHOWERS TO BIRTHDAY PARTIES, THERE’S ALWAYS AN OPPORTUNIT Y TO INDULGE—HEALTHFULLY!

)

Don’t skip meals in anticipation of...

Sk ipping rty or celebration. overdoing it at a pa when you get ake! This back fires meals is a huge mist ca n’t turn u yo at so ravenous th to the food feeling cluding in s, ng eri off gh ca lorie down any of the hi t’s face Le u like them or not. drinks —whether yo try to do to nt to overeat, you wa the it—if you’re going for it e sav d an at you ca n the lea st da mage th ry hung before s, it’s no fun to go foods you love! Plu ! e for that matter) the event (or anytim

2

Star t with a healthy breakfast, making sure to include fiber to fill yo ur stomach and protein to help to stay satisfied.

Think: oatmeal and a har d-boiled egg or whole gra in toa st with an apple and a nonfat Greek yogurt.

3

Exercise in the morning before the celebration begins.

Whether we go to the gym or run or walk outside, we make sure we do this so we feel better all day. It helps us to stay on the healthy track. Plus, it never hurts anyone to burn a few extra calories.

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4

Wear fitted clothes and snug belts to keep from overeating.

This works beautifully, just don’t loosen your belt or unbutton your pants!

health4mom.org

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Fill up on veggies.

Keep sugar-free gum handy.

It’s always best to ha ve too many veggies than not enough wh en they are raw, steamed or lightly sautéed. And for any of you who pla n to invite us over in the future, you’v e been wa rned. Ha ha! Broccoli, aspara gus, green beans, cauliflower and spin ach all work for us! But please leave off the creamy or buttery sauces; we ’d like to keep our belts intact. Br ing our Sk inny Cauliflower Mash when you’re a guest and wa nt to bring something deliciou s and guilt-free [see recipe].

We chew a piece when we’ve had plenty but still are craving—it distracts our taste buds and saves hundreds of calories. Plus, you can’t really eat something with a piece of gum in your mouth! New research reveals that gum chewers are leaner, plus it gives you fresh breath!

7

Make veggie sides rather than casseroles and instantly save 100-400 calories.

or blend a Stea m carrots or green bea ns seroles Cas . butternut or acorn squash esy che my, crea are often filled with ose cho so s, ient red ing fat or high rie fresh vegetables over high calo with r side dishes and flavo delicious spices— try Herbs de Provence (savory and rich tasting ).

IMAGES © 123RF; ISTOCKPHOTO

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healthy moms

Substitute with seltzer.

A mixed drink will set you back 250 calories while a 5-ounce glass of wine will cost you 120 calories, and we prefer to use our calories on food. If alcohol is your thing, clearly wine is the calorie saving option. Make yours bubbly like a wine spritzer by adding seltzer to thin out the calories even more.

SKINNY CA U

LIFLOWER M ASH

Swap this d elicious side dish for mas you’ll trick e h potatoes— ven the big gest mashe promise!) an d potato fa d save yours ns (we elf hundred 1 head cau s of calorie lif lower or s!

1 (16-ounce caulif lower bag) frozen 1/2 teaspoo n (1 small cl ove) garlic 1/8 cup sk im milk 1 teaspoon dried chive s (optional) Freshly gro und black p e pper, to tast 1/2 teaspoo e n lemon juic e (optional) Directions: 1. Steam ca ulif lower un til ten a fork . If usi ng frozen ca der when poked with ulif lower, d microwave efrost in th or overnigh e t in the refr 2 . Crush ga ig erator. rlic and let sit for 5 min health-prom utes to rele oting prope ase it s rties.

3. Place cau lif lower (pie ces), milk , ga spices (if usi rlic, pepper ng) in a ble and nder or foo 4. Add lemo d processo n juice if usi r. ng and sam more garlic ple for ta st , lemon, ch e . Add ives, or pep Blend until per as desire smooth. Plac d. e mix ture in bak ing dish a small and sprink le with paprik Bake at 350 a, if desired degrees in . oven until b Makes 3 se u b bly. rv ings (abo ut 3/4 cup e ach).

Nutri tion Fact s Pe r Serving: Calories 43 , Total Fat 0 gram, Satu rated Fat 0 gram, Carbohydr ates 8 gram s, Protein 4 grams, Fi ber 0, Sodium 46 milligrams

LYSSIE LAKATOS, RDN, CDN, CFT and TAMMY LAKATOS SHAMES, RDN, CDN, CFT, are The Nutrition Twins, authors of The Nutrition Twins’ Veggie Cure.

ISSUE 16 / Spring 2015 Healthy Mom&Baby

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healthy moms

and expert advisor to Healthy Mom&Baby.

14

BY SHARON SCOT T, RN, MSN

Get these nutrients primarily from foods, but also boost them with a supplement, experts advise

There’s no 1 magic ingredient that completes a perfect pregnancy diet. Eating a healthy, balanced diet high in vegetables, fruits, grains and proteins is important because pregnancy takes a toll on your body, and experts agree that women considering pregnancy, or who

are pregnant or nursing, should take prenatal vitamins and other supplements, to ensure the best nutrition possible.

Here’s a look at the 3 leading supplements recommended during pregnancy: Folate/folic acid, calcium and vitamin D.

FOLATE/FOLIC ACID

CALCIUM

VITAMIN D

Folate, the natural source of this B vitamin, is found in dark leafy greens, citrus fruits and dried beans.

Folic acid, the synthetic form, is in fortified cereals.

Drink your daily calcium in dairy products including milk, creams and Kefir. Cheese and yogurt are also great calcium sources. There’s even calcium hanging out in broccoli, spinach and other greens, shellfish and beans.

Gained primarily from sun exposure, most experts recommend a supplement because vitamin D is in few foods such as salmon and other fatty fishes, or in fortified orange juice or milk.

Folic acid can reduce the risk of your baby having a neural tube defect, which are severe birth defects involving your baby’s brain or spinal cord. It may also protect against cleft lip and cleft palate.

Some research shows it can also reduce preterm birth risk. Begin to take folic acid prior to pregnancy because these birth defects usually occur in the earliest days of development, before you may even know you’re pregnant.

Calcium protects your muscles and nerves in pregnancy, and can help your blood clot. Your baby needs calcium, too, for its teeth and bones, and you will deplete your body’s stores if you don’t consume calcium in pregnancy, putting you at risk for osteoporosis later in life.

Vitamin D (you may see it as D3 on supplements) is a fat-soluble vitamin and hormone that helps your body absorb calcium. Vitamin D helps grow your baby’s bones and teeth; vitamin D deficiencies have been linked to increased risks for gestational diabetes, preeclampsia, vaginal infections and even a greater likelihood of needing a cesarean birth. For babies, D deficiencies have been linked to increased likelihood of cavities, an increase in asthma and respiratory infections, softening of the skull in infancy and decreased bone health by age 9.

Get 800 micrograms daily prior to pregnancy; ask your healthcare provider what your dose is in pregnancy as women with higher BMIs/body weight may need a larger dose to get the protective effects.

Most prenatal vitamins include 800 micrograms of folic acid.

Pregnant adult women need 1,200 milligrams a day; pregnant teens need 1,500 milligrams daily.

Consume calcium with vitamin D, as D helps your body use calcium in supplements and food.

The recommended daily amount of vitamin D during pregnancy is 600 IU/day. Most prenatal vitamins have 400 IU, so you’ll need to get extra elsewhere. But vitamin D can be too much of a good thing—experts have set safe upper daily limits of anywhere from 2,000 IU to 4,000 IU during pregnancy.

IMAGES © 123RF

SHARON SCOTT, RN, MSN, is a nurse educator

Key Supplements

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healthy moms

Probiotics Promote

BY TAMER A (TAMMY) NUT TER, RN, MSN

Your Health

STOP VAGIN AL INFEC TIONS YEAST INFECTIONS: Vaginal yeast infections are an overgrowth of Candida Albicans in the vagina. Usually, these yeast are kept “in check” by the bacteria Lactobacillus. Recent studies have shown that vaginal yeast infections can be largely prevented by taking a daily probiotic supplement containing Lactobacillus. Still, should the tell-tale itching

and burning of a yeast infection emerge, experts recommend seeing your healthcare provider, who can treat your infection with medication.

BACTERIAL VAGINOSIS: Like vaginal yeast infections, bacterial vaginosis is bacterial overgrowth. Like with yeast infections, the bacteria Lactobacillus can be useful in both preventing and even treating bacterial vaginosis when used with an antibiotic.

URINARY TRACT INFECTIONS (UTIS) Thanks to our anatomy, women are more prone to urinary tract infections (UTIs). UTIs happen when certain bacteria overtake the normal, healthy Lactobacillus bacteria in the urinary tract.

Several studies have shown that regularly taking a Lactobacillus probiotic supplement can help reduce UTIs—especially if you have ongoing UTIs; still more research is needed.

IRRITABLE BOWEL SYNDROME Like urinary tract infections, women are more prone to certain bowel issues such as irritable bowel syndrome (IBS). Experts don’t know quite understand what causes IBS; some studies have shown that probiotics can help relieve the symptoms of this disorder. There are also some promising findings related to probiotics and help with the symptoms of ulcerative colitis.

Picking Probiotics Probiotics are in certain foods, particularly yogurt and other fermented yogurt-related products (such as Kefir), sauerkraut, miso and tempeh.

These foods are great for a healthy diet, but most experts suggest adding a probiotic supplement to get the full benefit.

Probiotic supplements contain different bacterial strains, and different concentrations of specific bacterium.

Talk to your healthcare provider about which bacterial strains and supplements may work best of for your health situation. And remember—there’s likely a period of trial and error needed in finding the supplement that works best for you.

Boost the effectiveness of probiotics by taking them with a prebiotics. These prebiotics “feed” the probiotics, and are found in bananas, honey and whole grains.

TAMERA (TAMMY) NUTTER, RN, MSN, is an expert advisor to Healthy Mom&Baby.

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IMAGES © 123RF

Probiotics are the “good” bacteria that live in your intestinal tract and help with digestion, among other basic bodily functions. While probiotics can benefit everyone, they do have specific benefits for women’s health.

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healthy moms

HPV Causes Most Cervical Cancer A virus, the Human Papillomavirus (HPV), causes most cervical cancers. There are many different types of HPV but only a few of them cause cancer.

HPV is easily spread through skin-to-skin sexual contact with someone who has the virus. It’s so common that most adults have been infected with it at some point in their lives.

HPV doesn’t always result in cervical cancer—some forms cause genital warts and others cause no symptoms at all. In many cases, an HPV infection will go away on its own without any treatment. The body’s immune system launches an attack against the virus and wins the battle. However, in some cases the virus wins and will eventually lead to abnormal cell growth and cervical cancer.

Get the info on cancer prevention for yourself—and your adolescent kids

Confused About

Cervical Cancer Screening?

image credits

Rita Nut t, DNP, RN

Cervical cancer was once a leading cause of cancer death for women. Today, it’s less common thanks to Pap testing, which finds abnormal cells on the cervix early when they can effectively be removed. Early detection and treatment is important in reducing your cervical cancer risks.

Shot Against Cancer When it comes to preventing cancer, 2 vaccines—Gardasil and Cervarix—protect against HPV and are now available and recommended for use in adolescent girls at age 11 or 12. Gardasil is also recommended for adolescent boys to protect against anal, penile, throat and mouth cancers, and genital warts.

Both boys and girls need 3 separate injections over a 6-month timeframe. If every boy and girl were vaccinated, cervical cancer could become a thing of the past!

When to Get Checked for Cervical Cancer Annual well-woman visits that include a breast exam, sexually transmitted infection test and external genital exam are important at all ages. The Pap and HPV testing guidelines have changed recently, causing some confusion.

Part of this confusion comes because HPV screening is typically done with your Pap test. When these 2 tests are done together, you can be screened less often. Find your age to see the most updated cervical cancer screening recommendation: Age 20 or younger

No screening required

21-29

Pap test alone every 3 years; no HPV screening

30-65

30-65 screening

66 or older

Screening is no longer required if you’ve had 3 normal Pap tests or 2 normal HPV tests in a row

Rita Nutt, DNP, RN, is a nurse educator and expert advisor to Healthy

Mom&Baby.

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healthy moms Carolyn (Carrie) J. Lee, PhD, CNE, RN

Super Sleep in 6 Strategies (

Bad sleep zaps more than just your mood—it affects your health too!

Think about how you feel after a good night’s sleep—full of energy, ready to perform and take on the day! And after a poor night of sleep?

Sluggish, unable to concentrate and out of energy!

Poor sleep affects more than our mood. Studies show insufficient sleep can bring weight gain, hormonal disturbances, heart health risks and even safety risks. Sleep experts say you need at least 7-8 hours of sleep each night, although there are certainly individual variations. Modern life and plain old bad habits can change your daily sleep.

Try these 6 tips for super sleep:

)

Go to Bed!

Disconnect!

Surveys show most of us sleep with our smartphone within reach. But exposure to their bright light and the mental distractions of social media and email keep us from falling asleep. Does your phone buzz or beep every time you get a text, email or are tagged in a post? Use your phone’s powers for good: Mute it, set “do not disturb” time-frames for nonurgent contacts, and flip it face down on your nightstand to turn off its lights. Have your kids do the same as well to teach them good sleep habits.

Stage your sleep.

Keep your sleep space for just that. Sleep in a dark, cool room—close the shades, turn any lights and blinking devices off, and turn the thermostat down. This also means you’re not using your sleep space for an office or anything else that can clutter your mind when you’re trying to rest.

Set boundaries!

Doesn’t it seem that life and work are getting busier? More people are reporting that work is an increasing intruder on their private time. If possible, have conversations in your workplace about how to create a culture that considers how to get work done while protecting reasonable personal boundaries. Aim for high standards of protected professional and personal time—you just might just inspire others to do the same!

There’s always just one more thing to do—housework, one more email, or things to get a leg-up on tomorrow. If you struggle to stop your day, or you use your late night hours to get stuff done, take a tip from Elsa—let it go! You can’t go to sleep if you don’t go to bed, your productivity and efficiency actually goes up when you’re rested!

Cut the noise!

Noise will keep you from falling and staying asleep. Falling asleep with a TV on is a definite no-no due to the variations in the sound and light. Instead, use a “white” noise device to distract from household sounds. There are apps that will play through the night or for a set period.

Create a sleep pattern.

It’s not easy but setting a pattern for sleep helps. A warm (not hot) bath, light reading, a time for reflective thought or music might be the trick for you. Your routine gives you the message that you value relaxing and resting as an important part of your day.

Carolyn (Carrie) J. Lee, PhD, CNE, RN, is a

professor at the University of Toledo College of Nursing.

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How

BY K AITLYN DIXON

We Birth

(

)

IN MANY WAYS, THE MORE BIRTH CHANGES THE MORE IT STAYS THE SAME

1900: BIRTHING AT HOME Almost all women birthed in their homes. The few (less than 5%) women birthing in hospitals were mostly poor or homeless and couldn’t birth at home. Even with doctors attending most births, 1 in 154 births caused the death of the mother, and 1 in 100 infants died.

1910-1939: IS BIRTH DANGEROUS? Both women and doctors began advocating for birthing in

20

IMAGES © 123RF; THINKSTOCK

How much do you know about birth in the US? At the turn of the last century, most births were at home. When did we shift to birthing in hospitals? How is birth today still like birthing in the 1900s? This short tour through birth in the US may surprise you while also showing why it’s important to advocate for yourself during this important conclusion to your pregnancy.

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healthy moms hospitals. Women wanted painless childbirth via “twilight sleep,” which used drugs to reduce pain as well as drugs that caused memory loss of labor and birth.

At the 1920 meeting of the American Gynecological Society, obstetrician Joseph DeLee argued that birth was inherently dangerous and harmful. He encouraged doctors to intervene before anything had a chance to go wrong. Although some doctors initially objected, his approach caught on and many doctors began to perform surgical birth, use drugs to speed or slow labor, cut episiotomies and use forceps. These interventions were easier and safer, so it seemed, in a hospital. By the 1950s, almost all city dwellers were birthing in hospitals—a huge shift in birthing from just 50 years earlier.

1940-1969: Regaining Trust in Women’s Bodies In the 1940s, improvements in preventing infections and reducing blood-loss in childbirth helped quickly reduce maternal deaths. In reaction to Dr. DeLee, other doctors began to speak against medical interventions into birth. Arguing their case, Dr. Grantly Dick-Reed wrote Childbirth Without Fear, Dr. Lamaze published his research in the 1950s, and by 1958, Dr. Benjamin Bradley introduced husband-coached childbirth. These last 2 doctors are still known for their Lamaze and Bradley birthing methods.

Women were encouraged to trust in their body’s natural ability to give birth. These new ideas helped women relax and give birth normally, without unnecessary medical interventions. These changes were welcomed by women who were disappointed with unconscious, forceps-assisted birth experiences.

KaitLyN Dixon

is a health educator in Silver Spring, MD. Sources: American Journal of Public Health; National Center for Health Statistics, Centers for Disease Control & Prevention; Yale University Press.

1970 - 2000s: Interventions Surge, Midwives Gain Popularity Beginning in the 1970s, epidural pain relief was greatly improved and became more common. Nurses started using electronic fetal monitoring to determine how well baby was tolerating the effects of labor. These were considered great advancements for childbirth, however, science is now questioning the benefit of electronic fetal monitoring among moms and babies at low risk during birth because EFM can sometimes lead to cesarean surgery if baby appears to be in distress—and actually isn’t.

Both epidurals and electronic fetal monitoring lessened the amount of time medical staff needed to directly stay with laboring women, further separating birthing women from the centuries-old traditions of having women to encourage and support them throughout birth.

Midwives, who traditionally provide more hands on support during labor and birth, increased in

independent practice around the 1960s, and have gradually attended more of American births over the decades—from very few births in the 1960s to 12% of vaginal births in 2012.

Now: Advocating for Full Term Birth Having many types of healthcare providers available for wellness care, especially for women with low-risk pregnancies, is a newer development. For example, you may choose to receive prenatal care and birth with the support of an obstetrician, midwife, advanced nurse practitioner in either a hospital (still 98% of all births in the US), or a birthing center, and with or without an epidural or other types of pain relief. Support may also come from a labor assistant called a doula.

These changes bring new meaning to the concept that birth is not one-size-fits-all, and mothers need information and expert care and support for the healthiest outcomes.

Ask about what type of support you want and can expect to receive during labor and birth, and if your healthcare provider will support waiting for labor to start on its own and birthing normally, or if she or he may want to induce labor or augment labor, use EFM, consider a VBAC (vaginal birth after cesarean) or consider scheduling a non-medically indicated cesarean for reasons of convenience, such as scheduling.

One example of how scientific evidence has changed birth has been in the recent decline of inductions prior to 39 weeks gestation, as care providers and families have become more aware of the risks associated with inductions, which had been increasing from 1990-2010.

Be Your Own

cate Birthing Advo

Childbirth looks really different now than it did 100, 50, or even 20 years ago. But our medical model of birth also still carries some similarities to the early 1900s: Birth in the US is still often treated as an illness requiring routine medical intervention instead of a normal (though life-changing) event for most women. So what can you do?

99Advocate for informed choices in childbirth 99Ask friends and family for recommendations for a provider who will listen to you, keep you informed of your risks and your options, and respect your choices in birth 99Ask your care provider about their typical support for full term birth, waiting for labor to start on its own, and use of inductions, cesareans, and other interventions, and ask them about the evidence for these practices 99Make informed choices and be an active part of your health care team. Not only can this improve health outcomes, you will also help shape what childbirth looks like in another 20 years

ISSUE 16 / Spring 2015 Healthy Mom&Baby

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Join us on Facebook facebook.com/HealthyMomAndBaby

BY SUMMER HUNT

Pregnancy

Pump Up the Possibilities!

Only 52% of moms know that they can get free breastpumps through their insurers, says pump manufacturer Medela. Latch onto this great benefit of the Affordable Care Act, and be sure to milk your flexible spending and health savings accounts (FSA/ HSA) for all they’re worth—after all, it’s your money!

KEEP CALM AND AVOID INDUCTION! Unless there’s a medical need, avoid having your labor induced or boosted through the drug Pitocin, says the Association of Women’s Health, Obstetric & Neonatal Nurses (AWHONN), which publishes Healthy Mom&Baby. Inducing labor without a medical need can increase complications for both you and your baby, and raise your risks of cesarean birth, research shows.

Currently, 1 in 4 births is induced—a number that has doubled since 1990. Risks related to induction or boosting labor include: For moms:

 If your preferred pump costs more than the health plan is willing to pay, you can use FSA funds for a pump upgrade, a second pump for work or on the go, milk storage bags, or additional supplies  You can set aside up to $2500 each year—plan ahead in the fall if you know you’ll be pregnant or breastfeeding in the next year  Check with your employer about a 2.5-month grace period to use any remaining funds after the calendar year ends or if you can carry over unused funds to the next year  Keep tabs on your FSA throughout the year—don’t let any precious $$$ go to waste!

 Increased chances of hemorrhage  Risk of cesarean birth, blood transfusion, or a hysterectomy  Potential placenta issues in future pregnancies For babies:

 Chances of fetal distress, respiratory illness  Separation from mother, interrupted bonding

IMAGES © 123RF; ISTOCKPHOTO

 Possible NICU admission

Epidural Timing The best time in labor for an epidural is whenever you want one, say experts from the Cochrane in a review of labor research. Laboring women have been advised to wait until they’ve dilated at least 4cm, but research shows no difference in outcomes for women who received epidurals before or after that time. Contrary to popular belief, epidural timing also didn’t affect how long a woman spends pushing. What remains unknown is whether you may labor longer overall with an epidural.

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healthy pregnancy

Powerhouse

BY MADELINE HURST

PROTEIN IN PREGNANCY

(

)

THIS ESSENTIAL NUTRIENT IS IMPORTANT FOR A HEALTHY PREGNANCY—HERE ARE SOME WAYS TO ENSURE YOU GET ENOUGH EVERY DAY

BEANS

Soybeans are nearly 40% protein and peanuts 25%, which means these beans bring as many as 4-8 grams of protein per ounce.

EGGS

Eggs have more than 6 grams of protein. Make yourself an omelet or add some scrambled eggs to a noodle or rice dish.

24

POULTRY

Turkey and chicken are protein powerhouses, containing anywhere from 24-30 grams per 3.5 ounce servings.

pregnant women the suggested protein intake can be as much as 20-30 grams more. There are many great ways to work protein into your diet.

The best sources for protein during pregnancy, according to the USDA experts at ChooseMyPlate.gov are beans and peas, such as pinto, soy, kidney beans and chickpeas; nuts and seeds, including sunflower, almonds and peanuts, as well as lean meat and fishes and low-fat dairy.

LEAN MEATS

Lean meats like beef, pork and lamb have about 22 grams of protein per 3-ounce serving.

The leaner the cut, the more protein the meat has.

NUTS & SEEDS

FISH

Once per ounce, nuts and seeds provide healthy protein with nuts averaging in around 6 grams per ounce and seeds around 2-4 grams per ounce. Go ahead; dip that spoon in the nut butter jar of your choice!

Fish is right up there with lean meats and poultry, packing 19 to 26 grams per 3-ounce serving so experts advise 2 fish meals a week. But avoid high-mercury fishes, such as shark, swordfish, king mackerel and tilefish, and instead have salmon, sardines, shrimp and pollock.

DAIRY

Milk has 8 grams of protein per cup. Lactose intolerant?

Soy milk has 3-11 grams per cup, depending on the brand.

MADELINE HURST

is a food reviewer and contributor to Healthy Mom&Baby.

IMAGES © 123RF

Vegetables and whole grains may take the main stage in a healthy pregnancy diet, but protein is also important for baby’s growth, particularly in the 2nd and 3rd trimesters. You need more protein, iron, calcium, and folic acid than you did before pregnancy, says the Office of Women’s Health.

Normally, women are supposed to get 46 grams of protein in their daily diet, however for

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healthy moms

Your

st 1

Trimester:

By Susan Peck, MSN, rnc

Weeks 1-12

99 Reason #10: Nourish your body— a healthy diet and breastfeeding will help you lose the baby weight

From pregnancy tests to morning sickness, here’s how it all begins XX Exercise, as it’s safe in pregnancy, ask your nurse if you have questions about what you can do

images: 123rf, thinkstock

XX No, smoking, drinking or using illegal drugs if you have any of these habits

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

Start—or continue—habits that keep your pregnancy as healthy as possible all the way to term: XX Daily prenatal vitamin, especially if you haven’t been taking one XX Make and keep all prenatal appointments XX Healthy food with lots of water

Go Full Term 99 Reason #1: End right by starting right—keeping all of your prenatal appointments helps ensure a healthier ending

XX Caffeine limited to no more than 200mg a day—that’s up to 12 ounces of coffee. Foods like chocolate and other beverages have caffeine too Before you knew you were pregnant, baby’s neural tube—what becomes her brain and spinal cord— formed and closed. The 800 micrograms of folic acid in most prenatal vitamins protect against neural tube birth defects, so it’s important to take a prenatal vitamin before conception and through pregnancy and breastfeeding.

Baby finishes the 1st trimester 10 times bigger than at conception. Your body is changing too: Your breasts are likely bigger and sore, you may have frequent headaches, fatigue and nausea. It’s not unusual to have some spotting or mild cramping and this doesn’t always mean miscarriage. Call your provider right away, especially if the bleeding is heavy or if you’re cramping.

Around week 8, you’ll have your first prenatal visit; after that you’ll likely see your provider: • Every 4 weeks (until 28 weeks) • Every 2 weeks (28-36 weeks) • Weekly (week 36+) You may be offered 1st trimester screening— non-invasive tests done between weeks 11-14 for chromosome disorders like Down Syndrome and genetic testing. Your nurse can talk with you about the risks and benefits of these tests. Bring your questions to every prenatal visit—your care providers expect and welcome them!

As you complete week 12, you can relax—all of baby’s organs and bodily systems have formed and the next 28 weeks are all about growing. You’ll be able to hear your baby’s heartbeat and the early symptoms of pregnancy should begin to subside.

99 Reason # 20: Maximize those little lungs—babies born just 2 weeks or more early can have twice the number of complications with breathing Read all 40 reasons to go to term at GoTheFull40.com

N u tr it io n K n ow-H ow No one food combats morning sickness; smaller meals eaten more frequently seem to help Eat 3 servings of protein daily, such as lean meats, low-mercury fish, nuts, beans, milk or eggs, to support your growing baby Eat no more than an extra 100 calories a day—that’s a small apple and 6 ounces of skim milk Bulk up on fruits, veggies and water to combat constipation

Susan Peck, MSN, RNC

is a nurse practitioner in New Brunswick, NJ.

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healthy pregnancy

The placenta is an amazing organ that’s chiefly responsible for providing your baby with nutrition and oxygen while also removing waste from baby’s blood during pregnancy. Blood flow through your baby’s placenta and its attached umbilical cord are her lifelines.

Most moms will never have issues with baby’s placenta during pregnancy but serious conditions for both you and your baby could arise. The most common placenta problems are placenta previa and placental abruption, which is less common but can be life threatening.

Both can cause bleeding in pregnancy and at birth.

Normal

26

You r 2 nd Tri me s ter

Placenta Previa If you begin bleeding more than 20 weeks into pregnancy, your healthcare provider will suspect placenta previa as this is when the uterus begins to stretch the most as it grows. Placenta previa happens when the placenta covers part or all of your cervix.

Placenta previa is measured in different degrees: marginal, partial or total. You may be told you have a “low-lying” placenta. Often seen on the 20-week ultrasound, a low-lying placenta may be near the cervical opening but not yet covering it. In most cases, this resolves on its own as the uterus grows and your placenta moves away from the cervix.

If you’re diagnosed with a placenta previa you may have multiple ultrasounds during pregnancy so that your healthcare provider can track the position and health of your placenta.

These ultrasounds will also help determine whether you can birth your baby normally or need cesarean, such as with a total placenta previa. With a partial previa, your healthcare provider will discuss the risks of normal versus cesarean birth with you. Together, you will make the best decision for how your baby will

Marginal Placenta previa

Contact your healthcare provider at any time in pregnancy if you have painless, bright red vaginal bleeding. This could be a sign of placenta previa or another problem. You could be at risk for placenta previa if you:

BB Have had several pregnancies BB Are age 40 or older BB Smoke BB Have had placenta previa before BB Are carrying twins or more babies BB Have had a cesarean birth

partial plaCenta previa

images: shut ter stock

Placenta Problems

Pl ac en ta Pr ev ia : Kn ow You r Ri sk s

by Helen M Hurst, DNP, RNC-OB, APRN-CNM

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healthy pregnancy be born—most women who experience placenta previa have an otherwise healthy pregnancy and birth.

MANAGING PLACENTA PREVIA If you have placenta previa, your healthcare providers will likely ask you to avoid putting anything into your vagina, which means avoiding intercourse and vaginal exams during pregnancy. This is to reduce your risks of bleeding.

Complications you can experience in pregnancy if you have placenta previa include:  anemia—if you have frequent episodes of bleeding  intrauterine growth restriction, where your baby doesn’t grow as much as he/she should

IMAGES: 123RF, THINKSTOCK

 early birth, particularly if your baby needs to be born early due to bleeding or growth issues, which may result in baby’s needing to receive care in the neonatal intensive care unit.

If you have a complete placenta previa, or reoccurring bleeding, your healthcare provider may ask you to be on bedrest at home or in the hospital for an extended period of time. You may also need to receive blood if bleeding is excessive. Exactly what you will need to do will depend on the degree of the previa and the symptoms you are having.

The placenta Your nurse midwife or doctor will see you more frequently and continue to monitor the previa by ultrasound. For future pregnancies it will be important to tell your

TOTAL PLACENTA PREVIA

PL ACENTAL ABRUPTION: KNOW YOUR RISKS

healthcare provider that you have had a past placenta previa, as this places you at risk for another.

PLACENTAL ABRUPTION

A placental abruption can be a life-threatening problem for you and your baby. It happens when part or all of your placenta pulls away or separates from the wall of the uterus, often without warning.

Signs of placental abruption are dark or bright-red vaginal bleeding, abdominal pain, and your abdomen feeling tender and very hard to the touch (like a board) or sudden, rapid contractions.

Placental abruption is a medical emergency; get to a hospital immediately by calling 911 and alerting your midwife or doctor on the way.

Depending on your symptoms, baby’s heart rate and the amount of bleeding, you may have an immediate ultrasound or the diagnosis may be made by your symptoms only.

PLACENTAL ABRUPTION IS AN EMERGENCY With abruption, your baby will be delivered immediately by cesarean because once the placenta separates, your baby will no longer be receiving the oxygen and blood flow she needs to survive—no matter baby’s gestational age.

In some situations a very small, isolated abruption may be discovered by ultrasound and not be an immediate risk to your pregnancy. When an abruption is diagnosed and cared for quickly, the outcomes can typically be good for both mom and baby. In this situation, the size of the abruption will be monitored by ultrasound, you will have more frequent office visits, and you will be instructed to watch for bleeding, cramping, back and abdominal pain.

As with a placenta previa, it’s important that if you become pregnant again, you let your healthcare provider know of your history of placental abruption.

While both of these placental conditions sound, and can be, very frightening, you can be proactive in watching for signs of placenta problems— particularly if you’ve had a problem with a placenta in the past, so that you strive toward the healthy best pregnancy and birth for your baby.

You’re most at risk for placental abruption if you:

 Have high blood pressure  Experienced a previous abruption  Use cocaine or smoke  Experience abdominal trauma such as having your abdomen struck in a car accident  Have uterine fibroids or other uterine abnormality  Have an amniotic fluid infection  Are pregnant with twins or more  If your water breaks early

This illustration shows a normal placental attachment.

HELEN M HURST, DNP, RNC-OB, APRNCNM, is a midwife and

expert advisor to Healthy Mom&Baby.

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Byram Healthcare – A Leader in Medical Supply Delivery The Affordable Care Act (ACA) has directly benefited new and expecting moms by providing an electric breast pump that is FULLY paid for through their insurance plan.

This is accomplished by contacting a Durable Medical Equipment (DME) company. Byram Healthcare is one of those companies.

with the majority of insurance plans including Medicare and Medicaid. Their service does not stop there; Byram Healthcare also offers their customers educational and support programs so that individuals may better understand how to effectively use their supplies.

Byram Healthcare began providing medical supplies in 1968 to thousands of customers.

Over the years they have increased their product portfolio to include diabetes (gestational), wound care, urology and incontinence supplies for adults and children.

Prior to the launch of the Affordable Care Act, Byram began supplying breast pumps.

Today, Byram Healthcare is one of the nation’s leading breast pump providers.

What began as a small company located along the Byram River in Connecticut has grown into an organization that employs over 750 people and operates 16 customer service locations and 5 distribution centers across the United States. Byram Healthcare is a Community Health Accreditation Program (CHAP) and HIPAA compliant company.

In 2008, Byram Healthcare was proud to become part of Mediq, an international provider of medical devices, pharmaceuticals and associated care. Mediq has 7,100 employees in 14 countries.

Byram Healthcare continues to attract customers from across the United States by delivering a wide assortment of high quality critical medical supplies in a timely fashion. They possess extensive insurance reimbursement expertise and are contracted

Byram Healthcare continues to fulfill its mission every day by keeping the customer at the center of everything it does.

Byram Healthcare is pleased to offer a selection of breast pumps at no cost* to you by leading manufacturers: Medela, Ameda, Hygeia, Spectra and Freemie We accept hundreds of insurance plans.

Your breast pump will conveniently arrive at your home with no additional shipping charges.

To find out more information or place an order online: www.byramhealthcare.com call: 1-877-773-1972 *Individual must have Byram accepted, valid insurance that covers breast pumps.

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healthy pregnancy

Colostrum

By Michele Savin, MSN, NNP-BC

as Baby’s

First

Expert s ca “ l i qu i d l l t h i s the per gold” fe c for new t food bo r n s Colostrum or “liquid gold” is the first gift you give your baby. Your breasts produce colostrum as early as 16 weeks. This super milk is clear to yellow in color, thick, and sticky. Colostrum is easily digested, and is the perfect first food.

At birth, you already have enough colostrum to nourish your baby. Going skin-to-skin with baby right after birth will help him smell the colostrum and latch on for his first feeding. Your baby is born wanting to suck. Introducing him to the breast within the first hour will encourage his natural desire to breastfeed.

images © 123RF

Baby’s First, Tiny Meals

Since your breasts are not yet full with breastmilk, it’s easier for baby to learn to suck and swallow.

In those first few days it’s more important for babies to feed frequently than to nurse for longer periods of time. It’s tiring but breastfeeding your newborn at least 8-12 times each day will give him all the benefits of colostrum, stimulate production of your mature milk, and get breastfeeding off to the best possible start.

Newborns have small stomachs perfect for tiny meals; colostrum delivers concentrated nutrition. Most healthy babies begin taking in

Food

anything between ½ to 2 teaspoons of colostrum per feeding the first day; this increases to 1-2 ounces per meal by the end of the third day.

Somewhere between days 2 to 5 after birth, colostrum production will give way to a higher volume of what’s called transitional milk, with your mature milk then coming in by 1-2 weeks.

Colostrum’s Nutritional Powerhouse

Compared with mature milk, colostrum is high in Vitamin A, sodium chloride, carbohydrates, protein, and antibodies; it’s also lower in fat, and contains more minerals and amino acids. Colostrum is known to encourage cell growth.

Baby’s digestive system also benefits from colostrum as it promotes normal gut flora, and prevents harmful bacterial growth. Colostrum also helps the small intestine absorb nutrients and helps baby pass his first stool, called meconium.

Colostrum is rich in antibodies, including Immunoglobulin A (IgA), which protects mucous membranes in baby’s throat, lungs, and intestines, and leukocytes that begin protecting the infant from viruses and bacteria. Together, these and other important immune factors that are more highly concentrated in colostrum jump start baby’s immune system. ▶

You r 3 rd Tri me s ter

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healthy pregnancy

Expressing Colostrum During Pregnancy: Pros & Cons

Benefits of Colostrum Expression in Pregnancy 99 May help stabilize baby’s blood sugar 99 May help increase milk supply after birth 99 May help with infant feeding difficulties 99 May reduce risks of dairy allergies (cow’s milk)

Reasons for Moms to Avoid Colostrum Expression in Pregnancy

88 Michele Savin, MSN, NNP-BC, is a neonatal

nurse practitioner at Christiana Health Care Services in Wilmington, DE, and an expert advisor to Healthy Mom&Baby.

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88 History of preterm labor 88 Current Preterm labor Problems with your cervix in pregnancy

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Multiple Pregnancy

images © 123RF

Should You Pump and Store Colostrum?

Some experts are advising that moms pump and store colostrum before baby’s birth but there’s little research that supports this. There is one research trial now ongoing that many are hoping will help answer whether this is helpful for babies. If you’re considering expressing colostrum before birth, discuss your plans with your healthcare provider.

Benefits to expressing colostrum for baby include less formula use, more breastfeeding and increased immunity protection for baby. But it’s not known if the colostrum present in your breasts during pregnancy differs from the colostrum baby gets at birth. If you do express colostrum, it can be kept at room temperature for up to 24 hours, or in the refrigerator for up to 8 days, but ideal use is within 3 days.

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healthy pregnancy

My Breasts

By Charlot te Wool, PhD, RN and K ate Wool

Are Changing

Long before baby is born and breastfeeding begins, your body and your breasts begin to prepare to nourish and sustain your little one!

If you’re a woman, your body is specially designed to nourish and nurture a baby. Just as your baby grew inside of your womb without your prompting, your breasts undergo changes during your pregnancy: XX Often, your breast size changes and goes up a cup size or more XX Your nipples, and the area around them, may get bigger and darker XX Your breast tissue and milk ducts may get bigger XX About halfway through your pregnancy, your breasts start producing colostrum, the extraordinary milk your baby gets in the first few days after birth. Many clinicians call colostrum “baby’s first vaccination” because it is so protective for your baby XX Some women, but not all, may begin to leak some colostrum toward the end of the pregnancy, which may look yellowish and thick Virtually all women can successfully breastfeed, no matter the size and shape of the breasts. Your milk production is triggered by feel-good hormones called oxytocin and prolactin. These hormones work together to stimulate your milk production. But that’s not all. Your baby’s natural suckling reflex is the crucial factor to getting your milk flowing.

Scientists know quite a lot about the unique and amazing properties of breast milk. Scientists know, for instance, that each woman makes just the right amount of nutrients in just the right proportions for her baby. More than 200 ingredients are in breast milk—nutrients like protein, vitamins and minerals.

Scientists understand that breasts can change the amount of milk they make each day based on your baby’s needs. However, what scientists cannot figure out is how your breasts change the composition of your milk based on your baby’s needs. Get this: The breastmilk of a mom with a premature baby has significantly more anti-infective properties than the breastmilk of a mom with a full-term baby. ▶

ISSUE 16 / Spring 2015 Healthy Mom&Baby

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Where did my perfect plan go?

Everyone loves a daily routine, but a new baby can turn everyone’s schedule upside down. For the first 4-6 weeks your baby will eat and sleep at all hours of the day and night. Here are 5 tips for breastfeeding success—even if your plans go awry:

1. Be informed. Don’t be afraid to do your own breastfeeding research; the more you know the more you will understand the changes your body is going through. And you’ll be able to better help baby get used to nursing regularly.

2. Ask for help. Being too proud will

Boosting Breastmilk Production Frequent feeding, and skin-to-skin cuddling results in ample milk production, so your baby should have unrestricted access to your breasts—especially during the first 4-6 weeks of life. If your pregnancy goes full-term, then your baby will be more likely to have a stronger suckling reflex, stay awake longer while feeding, and have the strength to complete a full feeding.

In the first few days after your baby is born your breasts don’t change much. You can get used to feeding your baby and learn how to get into a comfortable position for breastfeeding. Between days 3-4, your breastmilk will come in. This results in feelings of firmness and fullness. Some women find this uncomfortable, but many do not.

Wear a well-fitted maternity bra for support and feed your baby often—at least 8-12 times in 24 hours. As your baby is learning how to breastfeed, your nipples may become sensitive. It’s normal to feel tugging while the baby is feeding and some sensitivity. Pain however, is not normal and needs immediate attention from your nurse.

not help you or your new baby get the support you need in the early weeks. If something is confusing or you experience pain, having someone help will ease your conscience and get you on the right path. While you’re in the hospital, ask the nurse or lactation consultant to watch you feed your baby.

They are trained to help and are the perfect people to help! Also, ask about nursing support groups you can attend once you’re back at home with baby.

3. Create a positive support system.

Access experts: Your nurses, a lactation consultant, and even an experienced mom can be helpful. Finding someone who is willing to be patient with you and your baby as you get underway on your breastfeeding journey will make all of the difference.

4. Write in a journal. Having an outlet

for your thoughts and emotions during the first few weeks is therapeutic. It’s also a great way to put everything in perspective as you return to previous entries in the future to see how far you’ve come.

5. Be patient. Breastfeeding is a new

Charlotte Wool, PhD, RN is an expert advisor to

experience for you and baby. Both of you are learning from one another and it will take time. Be ready to experiment with positioning or try something new. ▶

Healthy Mom&Baby; Kate Wool is Charlotte’s daughter-inlaw and a new mom.

ISSUE 16 / Spring 2015 Healthy Mom&Baby

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healthy pregnancy

Early Birth, Successful Breastfeeding:

Kate’s story

Toward the end of my pregnancy my husband and I relocated to the Midwest because of a change in jobs.

I am not sure if it was the 2 days of driving across the country or the stress of closing on our first house, but our baby decided that the day after moving was the perfect time to be born.

Our beautiful little boy, Luke, arrived just a day shy of being 37 weeks. He was small at 6 pounds and 2 ounces, but healthy and strong. Our breastfeeding journey began with skin-to-skin contact and a very successful first latch. Toward the end of our stay at the birthing center, we were instructed to schedule an appointment with the pediatrician the following day due to Luke’s weight and bilirubin levels.

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Trying New Things We experimented with breastfeeding positions so that Luke could get a deeper latch, we fed him only in a diaper so he would stay awake, we applied some pressure under his chin to increase his suction, and I did breast compressions to help my milk flow more easily.

To help him to gain weight I also pumped after every feeding and fed him any milk he had missed during the feeding. Eventually I ended up supplementing him with 1 ounce of formula after every feeding. Luke is now 5 months old, has strengthened his suckling reflex, and is still breastfed.

He has since had steady, healthy weight gain and is now on the graph for his growth.

I attribute our success with breastfeeding to the support we received and to being an informed, determined mother. I cannot stress enough how important it is to create a strong network of support from the start. My support system included my mother and mother-in-law, the lactation clinic, a pediatrician who supported my determination to breastfeed, and other moms. The encouragement and knowledge gained from them surely made our breastfeeding journey successful.—Kate Wool

images © 40 Weeks;123RF, thinkstock

At this appointment we learned that he had lost 10% of his birth weight without any evidence of gain.

Additionally, his bilirubin levels were too high and he would need phototherapy. This caught me off guard but my pediatrician was very supportive of my choice to breastfeed my son.

This began a long series of weekly visits to the pediatrician for bloodwork and weight checks. I was frustrated and in need of support so I went to the breastfeeding clinic that was offered through our birth center. I was blessed to work with the same lactation consultant that we had following Luke’s birth.

She was very supportive and informed me that my son’s jaundice was what made him sluggish at the breast, and that his suckling reflex was weaker than normal. These hurdles were likely the cause of his slow weight gain, not a lack of supply on my end.

She reassured me that we could get through this, but we might need to try some different strategies first.

health4mom.org

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healthy pregnancy

after birth has been found to help your newborn with her fi rst feeding, and it helps breastfeeding get off to a good start. Skin-to-skin also helps your newborn’s brain and digestive systems develop; it stabilizes her heart rate, breathing, and temperature, and reduces cold stress—helping her sleep better.

Skin-to-skin is very soothing to your newborn, which reduces stress and leads to less crying. A calmer newborn has an easier time latching on and nursing. Th is leads to more efficient breastfeeding and boosts your milk supply.

Skin-to-skin contact with your baby also keeps you calmer and more relaxed, while lowering your blood pressure and reducing postpartum bleeding.

Skin-to-skin has also been found to boost wound healing and decrease pain, which is important for you as a cesarean birth mother.

Skin to Skin CHERYL ROBYN ZAUDERER , PHD, CNM, NPP, IBCLC

Yes, it’s possible and here’s how!

after Cesarean

You’ve likely heard about the amazing benefits of going skin-to-skin with your newborn right after normal birth—but what if you need a cesarean?

Can you and baby still get those many skin-toskin benefits post-surgery?

The answer is yes! Skin-to-skin contact is one of the oldest techniques used to enhance bonding between moms and babies. Its many benefits include boosting breastfeeding, stabilizing baby’s temperature and breathing, and releasing the feelgood hormone, oxytocin, in moms.

BENEFITS OF SKIN-TO-SKIN BONDING Being with your baby for the fi rst time after 9 months of anticipation is a precious moment— and that fi rst hour after birth is so important for you and baby. At birth, your newborn needs to continue to feel close to you, to feel your warmth and to hear your voice.

Skin-to-skin contact within the fi rst hour

SKIN-TO-SKIN AFTER CESAREAN Some hospitals separate newborns from their mothers after cesarean. Mom may be groggy from the anesthesia or in pain; baby may be pulled aside for evaluation. But as experts have learned more about the incredible benefits of skin-to-skin bonding and touch between mom and baby postpartum, they’re starting to change their practices and put moms and babies together immediately following cesarean. Ask your healthcare provider or the nurses where you plan to birth if you and your baby will be able to go skin-to-skin after cesarean.

What’s helping promote this change are the objections by moms who say separation after cesarean interfered with bonding, and new research demonstrating that when moms go skinto-skin with their newborn right after a cesarean they have a better relationship with their baby, and a more positive breastfeeding experience— ▶

ISSUE 16 / Spring 2015 Healthy Mom&Baby

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healthy pregnancy especially when going skin-to-skin with their baby right in the recovery room. Husbands or partners are able to benefit from skin-to-skin contact too.

In fact, some new mothers said they felt as if they had a more natural birthing experience when they went skin-to-skin after cesarean with baby. Moms described the experience as “natural,” “peaceful,” “good,” “important,” “pleasant,” “positive,” “wonderful,” “nice “or “great.” It made these moms feel closer to their newborns from the beginning, and these same moms said it helped them connect with their babies while recovering from surgery.

If you’re uncomfortable after surgery, ask your nurse to help you and your baby reposition yourselves in a way that allows for skin-to-skin bonding. Any amount of skin-to skin contact will give you and your newborn as sense of calm and fulfillment.

For some mo ms, going skin-to -skin post-cesarean removed the “medical feeling” of surgical bir th for them.

Cheryl Robyn Zauderer, PhD, CNM, NPP, IBCLC, is an assistant professor at the New York Institute

of Technology and a nurse practitioner/lactation consultant in private practice in Garden City, NY.

B B Skin-to-skin is exactly as it sounds: You and your baby connecting with nothing in between your bare skin and baby’s bare skin (baby may be wearing a diaper, just in case!)

B B Your nurse will help you place baby on your chest, or between your breasts. Baby should lay face down with her head turned to the side B B Blankets are placed over you both for warmth; you can also blanket baby with your nightgown or robe so that she’s nice and toasty warm B B You can stay like this for as long as you want but try to go skin-to-skin for at least an hour after birth; baby will typically begin breastfeeding within that first hour B B Take advantage of every opportunity you have to go skinto-skin with baby, and have your partner do the same.

This closeness will help you learn each other’s cues so that you better respond to baby’s needs and desires.

B B You don’t have to breastfeed to get the benefits of skinto-skin contact, which is why it’s great for your partner to bond with baby this way too

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1. Skin-to-skin, after birth, your baby will be able to smell your colostrum 2. You will see her newborn head begin to bob up and down, navigating toward your nipple. It’s almost as if she’s crawling towards your nipple to feed 3. Gently guide her to your nipple and help her latch on to nurse

images © 123RF; thinkstock

Going Skin-to-Skin

Beginning Breastfeeding

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healthy pregnancy

Alcohol in Pregnancy:

By Catherine Ruhl, CNM, MS

)

T he amo re’s no s u a in pr nt of alc fe ohol e g na nc y, no o beve ne alco and h o l ic r age a s be t er ve ype, suc h rs i s s a u s w ine , f er

No Safe Amount of Alcohol

First, there’s no safe amount of alcohol in pregnancy, and no one alcoholic beverage type, such as beer versus wine, is safer. The same amount of alcohol is found in a standard serving of beer (12 ounces), wine (4 to 5 ounces) or hard liquor (1.5 ounces).

When you drink alcohol so does your baby as it freely crosses the placenta. Your developing baby’s liver isn’t yet mature, so he can’t process alcohol like you do. He’ll get the full effect of the alcohol you drink. If you drink “just a little” and don’t feel the effects, that doesn’t mean your baby isn’t being affected.

Alcohol-related Brain Damage

Alcohol depresses your central nervous system, and it can directly affect your baby’s brain development throughout pregnancy, not just in the early weeks or months. This is why there’s no time during pregnancy that drinking doesn’t bring 42

the risk of alcohol-related brain damage.

What does alcohol-related brain damage look like? Fetal Alcohol Spectrum Disorder (FASD) is a range of lifelong physical, mental and behavioral disabilities linked to alcohol use in pregnancy.

FASD is thought to affect as many as 1 in 100 babies born in the U.S and often the signs don’t show up until a child is school-aged.

When You Drink, Baby Drinks Alcohol Too

When you drink alcohol, in any amount, at any time during pregnancy, your baby is drinking it, too, and that could cause lifelong problems. If it seems wrong to plan to offer your newborn a few sips of a craft beer, why would you do the same when he’s even smaller and more vulnerable while growing inside you?

Know the Signs: Fetal Alcohol Spectrum Disorder (FASD) FASD may be diagnosed in babies and children by the following when mom has used alcohol in pregnancy: XX Learning problems XX Difficulty with attention XX Hyperactivity XX Slow language development XX Memory and judgment problems

Catherine Ruhl, CNM, MS, is director

of Women’s Health at AWHONN and a certified nurse midwife.

image credits

(

How Much is Safe?

When it comes to drinking in pregnancy, you may be hearing mixed messages.

You may have heard that there’s no safe time during pregnancy to drink, and no safe amount or type of alcohol. But still you wonder, how could a glass of wine every so often really be harmful?

As with all decisions in pregnancy, you should understand the facts behind the advice. Several national studies have shown that the women who are most likely to drink alcohol during pregnancy are age 30 or older, and have higher income and education.

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BellytoBumps Baby Mamas

BY SUMMER HUNT

A 40 Weeks Adventure

Most movies about motherhood take a woman from bump to baby in the blink of an eye, amidst a wardrobe of designer duds and perfectly applied makeup in the delivery room. But pregnancy is so much more than a made-for-movie-length journey.

With 40 Weeks, husband-andwife filmmakers Christopher Henze and Dominique Debroux have created a documentary that covers the full experience, from the positive test to the positively overwhelming joy of welcoming a child into the world—and everything in between.

And that’s what Healthy Mom&Baby heard when we sat down with a few of the moms featured in the film to talk about their experiences.

NATALIA QUINTANA Sofia, born July 11, 2014 “I wasn’t sure if I wanted kids,” says Natalia Quintana. “We had 2 French bulldogs, and I felt like those were our babies!”

But once she and husband Mauricio saw friends starting families and still doing all the things they loved to do—they knew they were ready. “The first time she kicked, that changed everything,” she says. “I knew I was going to do whatever it took to have the best pregnancy.”

While being filmed for 40 Weeks, Natalia decided to explore birthing with a doula. First up: find out what a doula is! “Once it was explained to me, I was like, ‘Can I have 2?!’” she says. “My doula, Corrinne, was amazing. She never pushed me—she made everything my decision.” Midway through her pregnancy, Natalia opted to have a natural water birth. “I realized that I wanted to try to give my daughter the very best entrance into the world,” she says.

With the encouragement of her doula and husband, Natalia gave birth to Sofia on July 11, 2014. “It’s so awesome to look at her and know that she is a part of me, and part of us,” Natalia says. “Sofia is this beautiful thing that we made together, and it will always bind us—no matter what.”

Natalia urges women to be empowered about their choices when it comes to labor and birth, as she was able to do. “It’s your body; it’s your baby,” she says. “Make the best decisions, and don’t let anyone change your mind.”

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healthy moms

ASYA REZNIKOV Alcyone, born February 22, 2014 “They say when you have 2 kids, the work doesn’t just double,” laughs Asya Reznikov. “I say it multiplies to the power of a million.” She and husband Mike Rosenthal welcomed daughter Alcyone on February 22, 2014, approximately 2.5 years after son Ariston was born. “I got into a rhythm with just the one, and now it’s like there’s never enough time.”

Asya began to grow a little anxious as Alcyone’s due date neared… and then passed until she was born a week later. In 40 Weeks,, Asya expresses her jitters: “At one point I was basically like, ‘Is she just going to dissolve into my body? Is she never going to come out?’”

Asya wanted to go into labor on her own, and she decided to forego an induction. Almost everyone she knew who had been induced with Pitocin had to have a C-section, and Asya really didn’t want that—she also wasn’t quite emotionally prepared. “There’s the physical fear, but also the mental fear of letting go,” she says tearfully in the fi lm. “It’s like the fi rst step of them going away from you.”

One bit of advice Asya would give other moms-to-be: “Don’t have too tight of a plan or expectation,” she says. “You can’t put that kind of pressure on yourself and think that if it doesn’t happen the way you want it you’ll be disappointed.”

VICKY VARGAS Josiah, born June 10, 2014 “The morning sickness was consistent… and it wasn’t just in the morning,” says Vicky Vargas. “There were days when I was throwing up under my work desk in the afternoon.” After having experienced a miscarriage in June 2013, Vicky and husband José experienced many mixed emotions when she realized she was pregnant again.

“I was excited, scared, overwhelmed; it was a rollercoaster.” But nothing compared to that 1st ultrasound. “We were so happy when we saw that heartbeat,” she remembers.

Even though she’d made a birth plan, Vicky says that all went out the window: “I had a non-stress test when I was already post-term, and my blood pressure was sky high,” she explains. By mid-afternoon, Vicky was given Pitocin and an epidural; she also had her water broken.

After waiting it out in the hopes of having a vaginal birth, Vicky was not dilating, and the decision was made to birth via cesarean. Then came the important part: “I just remember hearing the doctor say, ‘We got a boy!’ My husband and I were so emotional; we couldn’t wait to hold him in our arms.”

After 41 weeks of pregnancy, baby Josiah was born on June 10, 2014. “I honestly feel like Superwoman because of what my body was able to do!” Vicky says.

The realization that she was fi nally a mom hit her after delivery: “I woke up one morning during my hospital stay and started crying because he was in the nursery, and I missed him,” she says. “It was my motherly instinct that I wanted to be with him 24-7.”

ISSUE 16 / Spring 2015 Healthy Mom&Baby

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healthy moms Phoebe Hamilton Willow, born July 9, 2014 “Before I became a mother, I had no idea what to expect emotionally,” says Phoebe Hamilton. “No one can know until they become a parent.” She gave birth to son Silas in 2010; 4 years later, she and wife Jen were ready to do it all again. However, Phoebe had struggled with a frustrating and exhausting condition in her first (and subsequently, her second) pregnancy: hyperemesis gravidarum, or severe nausea and vomiting.

“My family may not agree, but the hardest part about being pregnant wasn’t just the physical stuff, but the emotional toll it took on me,” Phoebe remembers. She credits her midwife for helping her through the tough times, reminding her that this wasn’t a permanent condition.

Considering her difficult pregnancy, Phoebe says that “labor and birth were amazing”—and she did it all naturally. “I kept changing positions and walking and showering, and it was tolerable.”

Not long after she’d begun laboring, she got a little overwhelmed and became adamant that she “no longer wanted to give birth”—then the nurses knew it was time. Willow was born shortly after, on July 9, 2014. “About an hour or 2 later, I felt like a million bucks,” says Phoebe.

For expecting moms or those trying to conceive, Phoebe encourages building a strong support system.

“Well-wishers are not the same as supporters,” she advises. “You need people on your side who will help you get through it. Relish the rough patches, because there is always tomorrow. We can’t do it all right. But we won’t do it all wrong.”

B “Every time a woman gives birth it ’s a miracle, a magical thing.

You see other women and you think, ‘Could they possibly love their baby as much as I love my baby? Is it even physically possible for another person have this much emotion? ” —Asya Reznikov

R ea d t he 4 0 W e ek s s pe c i Hea lt h al i ssue of y Mom & B a by c reate m o m s 2 d ju s t f o r be a t b hmbm it .ly/ ag

SUMMER HUNT is editorial coordinator at AWHONN and writes for Healthy Mom&Baby.

Find a local screening of 40 Weeks at 40weeksthemovie. com. Read the 40 Weeks special issue of Healthy Mom&Baby created just for moms2be at http://www.health4mom.org/ hmb-magazine.

ISSUE 16 / Spring 2015 Healthy Mom&Baby

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Nobody likes to be rushed, especially babies.

Your baby needs at least a full 40 weeks of pregnancy to grow and develop. Inducing labor even a week or two early is associated with a host of risks, including prematurity, cesarean surgery, hemorrhage and infection.

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

Your baby will let you know when she’s ready to come out, so give her all the time she needs: at least the full 40 weeks.

Download a free copy of

40 Reasons to Go the Full 40 at www.gothefull40.com.

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

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

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BRAIN ABNORMALITY LINKED WITH SIDS

Babies

BY SUMMER HUNT

Many infants who die of Sudden Infant Death Syndrome (SIDS) have abnormalities in the hippocampus—the part of the brain that influences breathing, heart rate and body temperature—say researchers funded by the National Institutes of Health.

Researchers examined sections of the hippocampus from 86 SIDS cases and found that about 43% had the abnormality. The rest of infants without the abnormality suggests that SIDS likely has a number of causes. Previous studies have suggested a link between SIDS and seizures that stop the heart and breathing; a possible connection was also found with serotonin metabolism.

“The hope is that research efforts in this area eventually will provide the means to identify vulnerable infants so that we’ll be able to reduce their risk for SIDS,” says Marian Willinger, PhD. The exact cause of SIDS remains a mystery, but experts have shown SIDS risks can be reduced by following safe sleep recommendations, which include putting baby down on his back at night and for naps in a safe crib—not in a bed with mom and dad.

IMAGES © 123RF

GO SKIN-TO-SKIN Boost breastfeeding when you go skin-to-skin with baby after birth—even after cesarean. Within 30 minutes of birth, baby should be placed against your chest. If there are medical issues that require separation, your partner can also provide skin-to-skin care.

Talk to your care provider about your preferences for skin-to-skin care after birth, especially in the event of a cesarean. There are no negative effects from immediate or very early skin-to-skin contact after birth, but the benefits are bountiful:  More effective breastfeeding  Longer periods of sleep  Improved weight gain  Better brain development  Decreased crying  Longer periods of alertness  Earlier hospital discharge

(VITAL VITAMIN)

Protect against vitamin K deficiency bleeding (VKDB) with a simple shot given to your baby up to 6 hours after birth.

Vitamin K is needed to form clots, and babies are born with very little of the substance as the placenta only passes along small amounts.

Infants can be affected by VKDB until 6 months of age, as they don’t get enough vitamin K from breastmilk, and the good intestinal bacteria that produces vitamin K hasn’t yet developed.

ISSUE 16 / Spring 2015 Healthy Mom&Baby

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healthy babies

Help Baby Stay Awake

Newbo r c a n be n s ver y sleepy how m —but u ch is too m sleep uch?

Baby Sleeping Sharon Scot t, MSN, RN

Too Much?

Wake Your Baby for Breastfeeding If you had a long labor, received pitocin (the medication used to induce labor) or pain medication, or if your baby has molding or bruising of the head—or was born preterm, it’s particularly important to wake your baby for feedings every 2-3 hours during the first few days.

Your baby may be very sleepy in the newborn period but baby should never go more than 4 hours between feedings.

Baby will need to nurse at least 8-12 times a day; and every baby is different. Some may feed less and some more frequently; some may get their days and nights mixed up—keeping you up all night and wanting to sleep through the daylight.

As you learn your baby’s sleep cycles, you’ll feel the most rested—if that’s possible, if you sleep when 50

BB Pick baby up BB Unswaddle

baby so that you can nurse or bond skin-to-skin

BB Lower the temperature in the room BB Dim the lights so that baby can open his or her eyes BB Talk to baby face to face BB Play with baby BB Massage baby’s

feet

baby does and be up and awake when baby is too.

This time won’t last forever, but sleep deprivation is one of the hardest things new moms cope with in those first weeks after birth.

Skip a Schedule Baby is unlikely to keep any kind of schedule; and experts say never put your baby on a schedule.

Rather, baby eats when baby is hungry; sleeps when sleepy. Learn your baby’s hunger cues so that you can rouse her to nurse (see “Baby is Always Hungry!”).

Your baby may not wake up for feedings, and letting baby sleep more than 4 hours at a time can lead to weight loss and dehydration. These problems make baby even sleepier, so you risk beginning a difficult problem if baby doesn’t eat every 2-3 hours.

Talk to your nurse, baby’s healthcare provider or a lactation consultant if your baby seems too sleepy, doesn’t want to nurse as often as expected or falls asleep at the breasts with less than 10 minutes of active sucking and swallowing.

eed s Baby n ment g a e encour if he or e s r s to nu ast feed e r b e s sh e im t n8 less tha ours! h in 24

Sharon Scott, MSN, RN, is an expert advisor to

Healthy Mom&Baby.

images © 123rf

Newborns should sleep for most of their day—just not all at once—and never more than 2-4 hours at one time. Newborns typically sleep 14-18 hours a day after birth, and then between 12-14 hours a day in the first month.

Follow these steps to wake your baby.

As your baby begins to stir or move after sleeping:

health4mom.org

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Peaceful Sleep for Mommy and Me! The most important baby monitoring safety device you can purchase and your first choice is the Babysense 5s… the original Non-Touch Infant Movement Monitor.

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healthy babies

Marking Milestones Elizabeth T. Jordan, DNSc, RNC, FAAN

Here’s what baby may be doing—and how you can help—during her first 4 months

Baby’s First 4 Months Personal & Social Development

Your baby may . . .

Baby might . . .

You can . . .

Express comfort and discomfort, enjoyment and unhappiness

xx Cry, smile, wiggle, fuss and use facial expressions

xx Respond when she cries

Calm herself

xx Learn to close her eyes, suck on a fist or turn head away from distractions

xx Give smiles, hugs, and other warm physical contact to help baby feel secure

xx Enjoy soothing

xx Show baby your face and talk or hum softly xx Place your hand on baby’s stomach or back

xx Be quiet when you rock, sing, talk to her

xx Pick baby up and gently rock

xx Close her eyes when she’s sleepy Show interest in adults she knows

xx Fuss, cry, or coo to initiate interactions

xx Make eye contact with baby regularly

xx Turn to voice that is familiar

xx Use gentle facial expressions and tones

xx Smile when seeing or hearing a person they recognize

xx Play “peek-a-boo” with baby

Show awareness of other children

xx Mimic children he recognizes with facial expressions, noises or body language

xx Place baby near others when awake

Demonstrate attachment to certain people

xx Turn her head toward a familiar caregiver

xx Speak directly to baby

xx Look in the direction of your voice

xx Let baby watch and interact with children of all ages in a supervised setting

xx Make eye contact when talking to baby

images 123RF

Children reach milestones in how they move, play, speak, respond and behave. Skills such as smiling, laughing, playing peek-a-boo, crawling and walking are called “developmental milestones.”

Milestones can occur at different rates and stages in baby’s development. Experts have created guidelines, like the ones in this article, to help you know what to expect of your baby if she or is developing like other babies of a similar age.

You are the most important person when it comes to baby’s learning. There are many things you can do to help your baby grow and learn during each stage of development. The American Academy of Pediatrics recommends that all children be screened for developmental delays and disabilities during regular well-child healthcare visits at 1, 2, 4, 6, 9 and 12 months after baby’s birth. Your baby may need more screening if he’s considered at risk for developmental problems from being born too early or having low birth weight, for example.

As a parent you know your child best. If you have questions about how your baby is behaving or growing, let your baby’s healthcare provider know immediately. Don’t wait—if indeed there is a problem, it’s important to get your baby help as soon as possible.

xx Imitate your smile xx Track your movements

ISSUE 16 / Spring 2015 Healthy Mom&Baby

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healthy babies

Understanding & Communicating Your baby may . . .

Baby might . . .

You can . . .

Listen and express himself

xx React strongly to noise by either being soothed or frightened

xx Talk with baby directly and face-to-face

xx Use sounds and facial expressions of pleasure or displeasure xx Babble or coo when hearing a voice xx Appear to “listen” xx Turn head to look at you Recognize and react to the sounds of language

xx Avoid talking loudly xx Play different kinds of music xx Sing and hum to baby

Your baby may . . .

Baby might . . .

Begin to understand that she can make things happen

xx Play with her hands xx Explore toys with her hands and mouth xx Turn her head to follow objects

xx React to a new nursery rhyme by kicking legs; smile when hearing a familiar nursery rhyme

xx Repeat nursery rhymes, chants and language

xx Turn her head toward loud noises

xx Sing songs

xx Repeat sounds, enjoy and experiment with different sounds

xx Read with baby in your lap

xx Repeat enjoyable actions, such as shaking a rattle

xx Coo to conversation Begin to build a vocabulary

xx Follow her lead, and repeat sounds she is making

Discovering and Learning

xx Show momentary attention to board books with bright colors and simple shapes, especially faces

xx Talk about everyday objects xx Speak to baby xx Read and show baby simple books xx Name objects

xx React to colors and shapes by cooing or moving her hands

You can . . . xx Provide a safe and stimulating environment xx Supervise baby on the floor to promote movement xx Play “peek-a-boo” xx Provide clean, safe toys for baby to hold xx Smile and give baby your complete attention to help her focus and interact

Coordinating Movements Your baby may . . .

Baby might . . .

You can . . .

Use many repetitions to move various body parts

xx Bring hands together to grasp and shake toys

xx Give baby lightweight rattles or soft, bright patterned toys that make soft noise

xx Reach for objects and swipe at dangling objects xx Raise her head, arch her body and flex her legs xx Begin to try and roll over and sometimes kick herself over xx Push up by hands or forearms when on stomach xx Bring her hands to mouth

xx Have daily supervised “tummy time” xx Support baby’s head when holding her xx Frequently change baby’s position when she’s awake Elizabeth T. Jordan, DNSc, RNC, FAAN, is an

expert advisor to Healthy Mom&Baby.

ISSUE 16 / Spring 2015 Healthy Mom&Baby

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healthy babies

Preventing

Shaken Baby Syndrome

By Catherine Ruhl, MS, CNM

Plan to act before you’re at the breaking point with your baby

Holding a crying baby who won’t calm down despite all your efforts to soothe her can seem overwhelming. When you feel at the end of your rope, you could be tempted to move from rocking your baby to shaking her.

Shaken Baby Syndrome happens when a baby’s brain is shocked from being shaken so violently that baby can die or be permanently disabled. This can happen in as little as 5 seconds of shaking.

When baby won’t stop wailing, remember these two things, says the CDC: BBHaving an inconsolable baby doesn’t make you a bad parent BBIt’s normal for babies to cry excessively (see Purple Crying, p.57), particularly between ages 2 weeks to 4 months old Create a care plan for your inconsolable infant before you’re at your wits end: First, assess and meet baby’s needs: BBIs she tired? Hungry? Need a diaper change?

BBIs she showing any signs of illness? Fever? Runny nose?

Tugging at her ears?

BBAre her clothes comfortable—not too warm, entangled?

BBDoes anything help soothe her, like walking, cradling or gently moving?

Second, give yourself a break:

BBAsk your partner or a trusted caregiver to take turns being with baby during the crying

BBCalm your nerves by putting baby in a safe place, such as on her back in her crib or bassinet. Supervise her from another room within ear shot or via a baby monitor BBCheck on baby every 5-10 minutes until the crying subsides BBRemind yourself that baby’s crying is normal; this period will pass

56

Recog nize Sha ken Ba by Syn drom e You may know “never shake your baby”; but it’s also important to watch for signs that a relative or caregiver may have shaken your baby. Alert your baby’s healthcare provider if you notice your baby has any of the following:

XX Acts lethargic or listless XX Head or forehead appears

larger than usual or soft-spot on head is bulging

XX Eating very little or nothing at all XX Struggling to breathe XX Vomiting XX Has pale, bluish skin XX Experiencing convulsions or spasms

Abusive Head Trauma Shaken Baby Syndrome—also called abusive head trauma—happens because a baby’s head is large and heavy but her neck muscles are weak. Shaking moves baby’s brain within the skull, causing bruising, swelling and bleeding, says the National Institutes of Health.

This violent motion damages baby’s brain, eyes, spinal cord and neck—even fracturing bones. Hitting baby’s head against a pillow or mattress can be enough to cause injury or death.

XX Has rigid or poor posture or can’t lift her head

XX Pupils of unequal size; can’t

follow an object with her eyes

XX Has bruising or blemishes

around the head, neck or trunk

Catherine Ruhl, MS, CNM is Director of

Women’s Health Programs at the Association of Women’s Health, Obstetric & Neonatal Nurses (AWHONN).

images: 123rf

le Ba by Ca rin g for an Incon so lab

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healthy babies

(

)

Purple crying is a normal phase for babies that’s of ten hard on parents!

My Baby Cries

Every Night!

images © 123RF, thinkstock

By Jennifer Lemoine, DNP, APRN, NNP-BC

Your baby coos and giggles during the day, but in the late afternoon or early evening he starts crying and nothing you do helps. A baby, who seems to be crying more than they ever have before, especially around just a few weeks of age, is absolutely normal.

All babies go through a period of increased crying, and there’s actually a name for it: the Period of Purple Crying. Experts consider it a normal stage of development for every baby.

The word period is very important to remember because it reminds you that these episodes are temporary and they eventually will stop. Additionally, it’s a relief to know that these extended periods of crying don’t mean that your baby is sick or abnormal.

When you know that these episodes are normal, it becomes easier to deal with the frustration that occurs. Manage your frustrations appropriately—inconsolable crying is the leading reason frustrated caregivers sometimes shake babies, which can lead to brain damage or death.

Jennifer B. Lemoine, DNP, APRN, NNP-BC is a

What is Purple Crying?

Purple crying does not mean that the baby turns “purple” with crying, but stands for an acronym developed to describe the common characteristics.

There is a PEAK to the crying BBBegins at about 2 weeks of age, peaks at around 2 months of age, and then decreases over the next several months.

Crying is UNEXPECTED

BBNo predictable start or stop to the crying episodes.

Baby tends to RESIST calming/soothing

BBBaby is difficult to soothe or console.

No matter what you do, baby doesn’t stop crying.

Baby makes a PAIN-LIKE face

BBAppears to be in pain, when he/she is not.

Crying may be LONG LASTING

BBCan last for several minutes to a few hours a day, OMG!

Crying increases in the EVENING

BBBaby seems fine throughout the day

and then cries without reason in the evening/late afternoon.

Managing Inconsolable Crying Stay calm while trying to soothe your baby; make sure his needs are met: BBIs he hungry? Need a diaper change?

BBBurp baby BBGive baby a lukewarm bath BBGo skin-to-skin with baby while you walk or rock gently BBTake baby on a walk or for a ride in the car BBMake eye contact while smiling or singing softly to baby If all fails, take a 5-10 minute break. If another trusted person isn’t available to hold baby, place him in his crib on his back and walk away.

Check on him every 5-10 minutes until the crying episode passes.

neonatal nurse practitioner for Pediatrix Medical Group of Lafayette, LA.

ISSUE 16 / Spring 2015 Healthy Mom&Baby

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Here are some telltale signs to help diagnose the problem:

IT MAY BE COLIC IF BABY….

 Cries for more than 3 hours a day, 3 days a week for more than 3 weeks  Screams loudly instead of a normal baby cry  Cries for no reason  Can’t be soothed

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healthy babies

Gas d o colic, esn’t cause b babie ut crying more s swallow air them , giving gas.

My Baby Has Gas! Pat Scheans, DNP, NNP-BC

images: 123rf

Men love this fact: it’s normal for babies to pass gas 12 or more times a day!

In fact, babies are quite gassy. Gas happens when air gets trapped in baby’s tummy or gut.

In turn, baby fusses, seems to be in pain, and arches his back or pulls his legs up to move the gas along.

As long as your baby fusses only a moment or two with gas, everything is fine. As he grows, he’ll get better at passing gas.

Pat Scheans, MSN, NNP, is an expert advisor to Healthy

Managing Gas Babies swallow air when they suck and when they cry—here’s how you can help: BBHold baby skin-to-skin when he’s crying. Crying babies like this, as well as being swaddled, or held close and walked.

BBLet baby suck his fingers or a pacifier—this is soothing BBFeed baby with his head higher than his tummy so that air floats to the top and is easier to burp BBBurp your baby frequently. Since babies can’t sit upright or walk around to expel gas like adults. Pat them on the back gently in more than one position: Over the shoulder, sitting up, laying across your knees. Massage or a warm bath might also help.

BBBicycle baby’s legs to move gas out

Fe ed to Pr ev en t Ga s Let baby empty your breast before switching to the other when nursing. Your foremilk (the milk that comes out first) has more milk sugar and your hindmilk has more fat. Too much milk sugar can cause gas and green, foamy stools. Be sure baby drinks until your breast feels empty to ensure he gets both kinds of milk before offering the other breast.

While foods that give you gas don’t necessarily give baby gas (like beans!), you may want to determine whether dairy products bother your baby. Cow’s milk protein can pass into your milk, and it makes some babies gassy.

oduc ts Sk ip Ga s Re lie f Pr You will see products that claim to help with gas, but there’s no research to say they work. Talk to your baby’s healthcare provider before using gas drops or what’s called “gripe water” (herbs and water).

G a s 911 Take baby to his healthcare provider for gas when: BBBaby can’t calm down even with swaddling, sucking and walking BBBaby has a temperature of more than 100.4 ˚ F (fever) BBNo bowel movement in one day (constipation) BBBloody stools BBBaby is sleepy and hard to wake up to feed

Mom&Baby with Legacy Health System in Portland, OR.

ISSUE 16 / Spring 2015 Healthy Mom&Baby

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healthy babies

Baby’s Hungry

BY JOANNE GOLDBORT, PHD, MSN, RN

ALL THE TIME!

Your top newborn feeding questions answered It’s a shock to many new parents that just 48 hours after baby is born, you’re back at home and apart from the safe, secure cocoon of expert nurses at the hospital who stood ready to help and guide.

Don’t worry—you’ve got this, and we’ve got the answers to the top 3 questions most parents have when it comes to feeding a newborn. In these first weeks after birth, you’re creating your milk supply, so rest when baby rests, and keep her close by so that you can catch her feeding cues.

IS IT NORMAL FOR BABY TO SEEM HUNGRY ALL THE TIME? So, you’re home after a busy birthing experience and your baby wants to nurse “all the time.” This is a typical and normal response from your newborn; in fact, your baby will likely want to nurse 10-12 times in those first days!

This may seem too frequent to family and friends who aren’t familiar with what to expect with a breastfeeding infant. But rest assured, most healthy newborns feed “on demand”, which means your baby will be nursing about every 2 hours with unlimited time at the breast each time.

Wake for br baby up east if she feeding s longe leeps r t ha n h ou r s 4 .

1

60

JOANNE GOLDBORT,

PhD, MSN, RN, is an expert advisor to Healthy Mom&Baby.

IMAGES: 123RF

HOW WILL I KNOW IF MY BABY IS HUNGRY OR JUST CRYING? Your baby will give you clues to her hunger: She may smack or lick her lips, open and close her mouth, or suck on her tongue, lips, finger or toes. She may also fidget or “root” by turning her head toward your breast—and her food!

Crying is a late sign when it comes to hunger. Don’t wait for crying or baby may be too upset to relax and latch on to your breast. If you find yourself in this state with baby, be patient, calm her and offer her your breast until she latches on.

2

SHOULD BABY JUST KEEP FEEDING AND FEEDING? Sometimes, often in the evenings when you’re more tired, baby will want to feed more frequently, and for longer periods of time. These are called cluster feedings. The best thing is to fi nd a comfortable place to nurse and let the others take care of the house and you.

Keep baby close to you with a wrap so that she can feed frequently.

How often and for how long baby feeds is her way of helping you produce milk; it also calms baby and makes her feel secure.

She’ll pull off the breast when she’s done nursing. You can always offer her your other breast just in case, but if she’s truly done, start the next feeding with the other breast.

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Parenting against

By Carolyn Davis Cockey, MLS

Picky Eating What to avoid parenting a picky eater?

Start with you own diet, says nurse researcher Mildred Horodynski of Michigan State University’s College of Nursing.

image credits: 123RF

What you eat—and if you see your child as a picky eater—has a huge impact on whether your toddler consumes enough fruits and veggies, according to Horodynski’s research in Public Health Nursing. The findings come out of the eating patterns of children up to age 3 in Head Start programs. The more fruits and veggies moms eat, the more children are likely to eat them too.

“What and how mothers eat is the most direct influence on what toddlers eat,” Horodynski said.

This is important because a healthy diet early on sets the stage for a healthier life, Horodynski says. “Diets low in fruit and vegetables even at young ages pose increased risks for chronic diseases later in life.”

Be Persistent with Picky Eaters Since baby typically eats what you eat, it’s important to introduce fruits and vegetables early. Experts say that can happen any time with pureed first foods after 6 months of breastfeeding. Start slow and don’t be discouraged— research shows you may need to offer your budding gourmand any particular food as many as 15 times before she determines whether she likes it or not.

The AAP recommends baby’s first foods be single-ingredient cereals, like rice cereal, that you can introduce with your breastmilk. Baby’s first solids should be iron-rich single-ingredient foods, such as pureed turkey, chicken or beef.

As baby gets the hang of chowing down on real grub—albeit at a nearly liquid consistency, you can also steam, mash or strain fruits and veggies such as pears, bananas, cooked carrots, peas, and sweet potatoes, for example, while you munch out on the matching solid with her.

To ensure your baby doesn’t have an allergic reaction to her new foods, introduce them 1 at a time, waiting several days before you add another food to baby’s menu.

Prevent Picky Eaters Age:

4-6 Months

6-9 Months

9-12 Months

What she’s eating:

Primarily breastmilk for at least 6 months; you may start single-ingredient pureed foods after 4 months but always nurse first, then offer other foods.

Primarily breastmilk with pureed single-ingredient foods.

Primarily breastmilk with pureed multi-ingredient foods.

Pureed singleingredient foods like bananas, apple sauce, pear, sweet potato, or rice cereal mixed with breastmilk.

Let baby see you eat the solid versions of these foods.

Pureed mixed ingredient foods, like apple-banana sauce or pureed meats; increase the texture as she seems interested in it.

Eat with baby to make it pleasurable.

Pull baby’s high chair up to the dining table to feed her finely chopped finger foods like graham crackers, soft fruits, pasta, cheese, or forkmashed foods from the family’s meal.

What to feed:

ISSUE 16 / Spring 2015 Healthy Mom&Baby

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healthy babies

Potty

AT 18 MONTHS

AT 21 MONTHS

BY SUMMER HUNT

Training 101 It’s easy to get down in the dumps helping your kiddo conquer the commode, but this painstaking process is worth doing right. Experts including the American Academy of Pediatrics agree a positive, gentle approach is best. Follow this ageappropriate guide to potty success.

H E T R A DE TOO L S O F T Potty chair: Your child’s feet should touch the floor when seated.

Training pants: These introduce the idea of underwear while minimizing accidents.

Use the correct words for poop and pee and encourage your child to do the same. Change your child of ten, and encourage him to come to you when he needs a fresh diaper. Avoid referring poop as “yucky”, rather, make diaper changes pleasant.

Introduce a potty chair and toilet by transferring poop from dirty diapers into the toilet. Ask your toddler to sit on the potty chair while you read with or play games with her. Ask her to sit on her potty chair while you use the toilet, or have her observe an older sibling using the toilet.

AT 2+ YEARS

AT 2 YEARS

Underwear: Let your wee one choose their underpants, and use underwear as a treat to encourage him.

Let your child pretend to train a beloved teddy bear or baby doll to use the potty.

Watch educational videos or read helpful books. Introduce wearing underwear as a privilege, and put them somewhere visible. Start practice runs to the potty when you notice your child needs to go.

Once your child has successfully used the potty and understands the process, try what AAP calls “the barebottom weekend.” Commit to several hours with just you and your child—with no interruptions—during which time your child won’t wear any diapers, pull-ups, or underwear—nothing below the waist. This trial-and-error experiment could lead to a major breakthrough for your little one.

DOS AN D DO N’ TS  Do praise your child when she comes to you with a soiled diaper or in anticipation of needing a change.

 Don’t discipline or punish your child if he has an accident.

Say something like, “You’ll get the hang of this! You’re doing a great job!”

SUMMER HUNT is

editorial coordinator at AWHONN and writes for Healthy Mom&Baby.

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stickers—make a little chart to celebrate successes near the potty.

 Don’t get frustrated—children will pick up on your feelings and may become overwhelmed. There’s no need to rush; it will happen will practice and determination.

IMAGES: 123RF

 Do encourage with rewards like animal crackers or

health4mom.org

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06/03/2015 15:19

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!

G me ive tim e

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

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

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

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