Healthy Mom&Baby: Issue 12 by Healthy Mom&Baby

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PREGNANCY | BIRTH | LIFE

Healthy Eats For Every Trimester BYE, BYE BACK PAIN

7 Fitness Moves Anywhere, Anytime YOU DON’T KNOW THIS ABOUT BREASTFEEDING

The ONLY Diet You Ever Need

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Bumpalicious Liz Lange

Danger!

Learn the Risks of Early, Elective Births Waiting for Labor Healthiest 30/10/2013 16:37

Discover Diclegis® Now available for Nausea and Vomiting of Pregnancy (NVP), commonly called morning sickness1

Indication

Diclegis® is indicated for the treatment of nausea and vomiting of pregnancy in women who do not respond to conservative management.

Limitations of Use

antihistamines (present in some cough and cold medications), opiates, or sleep aids, because severe drowsiness can happen or become worse, causing falls or accidents.

Diclegis should be used with caution in Diclegis has not been studied in women women who have: (1) asthma, (2) increased with hyperemesis gravidarum. pressure in the eye, (3) an eye problem Important Safety Information called narrow angle glaucoma, (4) a Do not take Diclegis if you are allergic to stomach problem called stenosing peptic doxylamine succinate, other ethanolamine ulcer, (5) pyloroduodenal obstruction, or derivative antihistamines, pyridoxine (6) a bladder problem called bladderhydrochloride, or any of the ingredients neck obstruction. in Diclegis. You should also not take Diclegis in combination with medicines Fatalities have been reported from called monoamine oxidase inhibitors doxylamine overdose in children. Chil(MAOIs), as these medicines can intensify dren appear to be at a high risk for and prolong the adverse CNS effects of cardiorespiratory arrest. However, the Diclegis. Use of MAOIs may also prolong safety and effectiveness of Diclegis in and intensify the anticholinergic (drying) children younger than 18 years have not effects of antihistamines. been established. The most common side effect of Diclegis is drowsiness. You should avoid Diclegis is a delayed-release formulation; engaging in activities requiring complete therefore, signs and symptoms of intoximental alertness, such as driving or cation may not be apparent immeoperating heavy machinery, while using diately. Signs and symptoms of overdose Diclegis until cleared to do so by your may include restlessness, dryness of healthcare provider. mouth, dilated pupils, sleepiness, vertigo, Do not take Diclegis with alcohol or mental confusion, and tachycardia. If sedating medicines, including other you suspect an overdose or seek additional

overdose information, you can contact a poison control center at 1-800-222-1222. The FDA granted Diclegis Pregnancy Category A status, which means that the results of controlled studies have not shown increased risk to an unborn baby during pregnancy. Women should not breast-feed while using Diclegis because the antihistamine component (doxylamine succinate) in Diclegis can pass into breast milk. Excitement, irritability, and sedation have been reported in nursing infants presumably exposed to doxylamine succinate through breast milk. Infants with apnea or other respiratory syndromes may be particularly vulnerable to the sedative eﬀects of Diclegis resulting in worsening of their apnea or respiratory conditions. You are encouraged to report negative side eﬀects of prescription drugs to the FDA. Visit www.fda.gov/ medwatch or call 1-800-FDA-1088. Please see Patient Information on adjacent page. Please see full Prescribing Information at www.Diclegis.com. Tablet(s) shown are not actual size.

Reference: 1. ACOG Committee on Practice Bulletins – Obstetrics. ACOG practice bulletin. Clinical management guidelines for obstetrician-gynecologists. Number 52, April 2004. Nausea and vomiting of pregnancy. Obstet Gynecol. 2004;103(4):803-815.

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2013-0094-01 Jun 2013

Printed in the USA.

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Patient Information DICLEGIS (dye-CLEE-gis) (doxylamine succinate and pyridoxine hydrochloride) delayed-release tablets What is DICLEGIS? • DICLEGIS is a prescription medicine used to treat nausea and vomiting of pregnancy in women who have not improved with change in diet or other non-medicine treatments. • It is not known if DICLEGIS is safe and effective in children under 18 years of age. Who should not take DICLEGIS? Do not take DICLEGIS if you: • are allergic to doxylamine succinate, other ethanolamine derivative antihistamines, pyridoxine hydrochloride or any of the ingredients in DICLEGIS. See below for a complete list of ingredients in DICLEGIS. • take monoamine oxidase inhibitors (MAOIs) (Marplan, Nardil, Emsam, Eldepryl, Zelapar, Parnate) Before taking DICLEGIS, tell your healthcare provider about all of your medical conditions, including; • if you are breastfeeding or plan to breastfeed. DICLEGIS can pass into your breast milk and may harm your baby. You should not breastfeed while using DICLEGIS. Tell your healthcare provider about all the medicines you take, including prescription or over-the-counter medicines, vitamins, or herbal supplements. How should I take DICLEGIS? • Talk to your healthcare provider about how much DICLEGIS to take and when to take it. • Take DICLEGIS every day as prescribed by your healthcare provider. Do not stop taking DICLEGIS without talking to your healthcare provider first. • See the following schedule for the usual way you should start taking DICLEGIS: • Day 1- Take 2 tablets, by mouth at bedtime. • Day 2- Take 2 tablets at bedtime. If your nausea and vomiting is better or controlled on Day 2, continue to take 2 tablets every night at bedtime. This will be your usual dose unless your healthcare provider tells you otherwise. • Day 3- If you still had nausea and vomiting on Day 2, take 3 tablets on Day 3 (1 tablet in the morning and 2 tablets at bedtime). • Day 4- If your nausea and vomiting was better or controlled on Day 3, continue to take 3 tablets each day (1 tablet in the morning and 2 tablets at bedtime). If you still had nausea and vomiting on Day 3, start taking 4 tablets each day (1 tablet in the morning, 1 tablet in the afternoon, and 2 tablets at bedtime). • Do not take more than 4 tablets (1 in the morning, 1 in the mid-afternoon, and 2 at bedtime) in 1 day. • Take DICLEGIS on an empty stomach with a glass of water. • Take DICLEGIS tablets whole. Do not crush, chew, or break DICLEGIS tablets before swallowing. If you cannot swallow DICLEGIS tablets whole, tell your healthcare provider. • If you take too much DICLEGIS (overdose), you may have the following symptoms: restlessness, dry mouth, the pupils of your eyes become larger (dilated), sleepiness, dizziness, confusion, fast heart rate, seizures, muscle pain or weakness, and sudden and severe kidney problems. If you have these symptoms

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and they are severe, they may lead to death. Stop taking DICLEGIS, call your healthcare provider or go to the nearest hospital emergency room right away. For more information about overdose treatment, call your poison control center at 1-800-222-1222. What are the possible side effects of DICLEGIS? DICLEGIS may cause serious side effects, including drowsiness. • Do not drive, operate heavy machinery, or other activities that need your full attention unless your healthcare provider says that you may do so. • Do not drink alcohol, or take other central nervous system depressants such as cough and cold medicines, certain pain medicines, and medicines that help you sleep while you take DICLEGIS. Severe drowsiness can happen or become worse causing falls or accidents. These are not all the possible side effects of DICLEGIS. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. How should I store DICLEGIS? • Store DICLEGIS between 68°F to 77°F (20°C to 25°C). • Keep DICLEGIS tablets dry, in a tightly closed container, and out of the light. • Safely throw away medicine that is out of date or no longer needed. Keep DICLEGIS and all medicines out of the reach of children. General information about the safe and effective use of DICLEGIS. Medicines are sometimes prescribed for purposes other than those listed in a Patient Information leaflet.You can ask your pharmacist or healthcare provider for information about DICLEGIS that is written for health professionals. Do not use DICLEGIS for a condition for which it was not prescribed. Do not give DICLEGIS to other people, even if they have the same symptoms that you have. It may harm them. What are the ingredients in DICLEGIS? Active ingredient: doxylamine succinate (an antihistamine) and pyridoxine hydrochloride (vitamin B6). Inactive ingredients: ammonium hydroxide, n-butanol, carnauba wax powder, colloidal silicon dioxide, croscarmellose sodium, D&C Red#27, denatured alcohol, FD&C Blue #2, hypromellose, isopropyl alcohol, magnesium stearate, magnesium trisilicate, methacrylic acid copolymer, microcrystalline cellulose 102, PEG 400, PEG 8000, polysorbate 80, propylene glycol, shellac glaze, simethicone, talc, titanium dioxide. Distributed by: Duchesnay USA, Inc., Bryn Mawr, PA, 19010, www.duchesnayusa.com or call 1-855-722-7734. Visit www.Diclegis.com for full Prescribing Information and additional information.

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incredible prizes we’re offering in the sweepstakes, including a Graco Travel System worth more than $300! And that’s just to start; see additional prizes on page 58. The official drawing is January 15, 2014. Survey ends at the stroke of midnight on New Year’s Eve. Make sure you fill out and mail in the survey in this issue, or take the survey online at http://bit.ly/hmbsurvey. Go ahead, turn the tables on us—this time YOU give us YOUR best advice! Until next time,

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ISSUE 12 / Fall 2013 Healthy Mom&Baby

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Do You See What I See?

page 18

page 49

7 Steps to Save Your Back

Manage this leading pregnancy pain

Issue 12 / Fall 2013

Induction Decisions

Unless there’s a medical reason,

( CONTENTS )

it’s best to wait for labor to start on its own

Avoid Constipation in Pregnancy

Constipation is common in pregnancy but you can

healthy moms

healthy pregnancy

Water Works

7 Fast Moves

Staying hydrated is key to feeling great

Finding time to exercise can be a challenge

Exercise Realities as a Mom

Sara Haley shares her story

This Diet Won’t Fail

Satisfy Pregnancy Cravings

Fuel up; learn to eat for 1.1

Drs Roizen and Oz share the only diet plan

26 Antidepressants in Pregnancy

you’ll ever need

Learn what medications are safe when the bump

Improve your purchase with the latest in labeling

Long-lasting Contraceptives

Pregnancy planning gets a new IUD option

Baby Spacing

When is the right time for another baby?

healthy babies 49

Do You See What I See?

Vision assessment is an essential infant health check

Burping! Spitting! Oh My!

may have reflux?

Busting The Top 10 Myths About Breastfeeding

Separate fact from fiction to meet your

Could it be that your gurgling, bubbling fussy eater

accompanies the blues

New Sunscreen Strategies

manage its discomforts

52 Does My Baby Have An Ear Infection? 2 of out of 3 kiddos have ear pain that could signal

breastfeeding goals

infection before their second birthday

Avoiding Early, Elective Deliveries

Melissa D’Arabian serves up the secrets to

Could where you plan to birth put you and baby

Shop with safety in mind for baby’s top gear

lasting weight loss

at risk for delivering early?

Drop 5 Pounds

Oh, So Very Bumpalicious Fashion designer Liz Lange pioneers pregnancy style

FEATURE

Baby’s Essential 6 Conquer Colic

It is colic or something else?

Mom v Dad

Baby loves you both, even though you parent differently!

Healthy Mom&Baby Reader Survey Tell us what you think about the magazine, its website, iPad app and more. Complete our reader survey on pages 59-60 for a chance to win this Graco Travel System among other prizes.

ISSUE 12 / Fall 2013 Healthy Mom&Baby

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HEALTHY MOM&BABY EXPERT ADVISORY BOARD CANDACE ANN CAMPBELL, MSN-HCSM, RN, CNL University of San Francisco Concord, CA CATHERINE CHUNG, PhD, RN National University Nevada Henderson, NV 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 Johns Hopkins School of Nursing Baltimore, MD CAROLYN “CARRIE” LEE, PhD, CNE, RN University of Toledo College of Nursing Toledo, OH JACQUELINE MCGRATH, PhD, NNP Virginia Commonwealth University School of Nursing Richmond, VA 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 ANJANA ALI SOLAIMAN, MS, RNC, IBCLC University of Maryland School of Nursing Rockville, MD KIMBERLY WILSCHEK, RN, CCE Medical Revenue Solutions Chicago, IL CHARLOTTE WOOL, MSN, RN, CCNS Dillsburg, PA TAMERA YOUNG, RN, MSN Central Ohio Technical College Zanesville, OH

IMAGE © 123RF

CONSUMER ADVISORS MARIA OPLT Lafayette, LA

AWHONN’s mission is to improve and promote the health of women and babies. We accomplish this through education, research and advocacy that is focused on the unique needs of women, babies and the health care providers who care for them.

Don’t Give Away the Benefits of Spontaneous Labor, Normal Birth We rush through everything. When we’re little, we rush to grow up. We can’t wait to leapfrog from primary to middle school, and then on to high school and college. Then, when we get there, we wonder what the big rush was? When it comes to labor and birth, it’s best for moms and babies not to rush into labor when all is well. It may seem that medical procedures such as inductions or cesarean can make life easier by your choosing when baby may be born; it’s far more important when all is healthy to not lose the benefits of spontaneous labor and normal birth. BENEFITS FOR YOU & BABY Mom, your body was made to grow a baby, labor, birth and breastfeed. You and baby both benefit by waiting for labor to start on its own. Or as we nurses like to say in our “Don’t Rush Me . . . Go the Full 40” campaign: “Let baby pick her birthday!” FOR MOM: Waiting for the hormonal cascade that starts labor means: • Your body floods with the natural hormone oxytocin, called the feel-good hormone, so that your contractions are strong enough to push baby out, but not so strong as to stress baby This feel-good effect remains after birth helping you relax and bond with baby • As baby breastfeeds, oxytocin increases, helping shrink your uterus and prevent hemorrhage • Recovery begins; your body bounces back faster and easier from normal birth than from cesarean, which is major abdominal surgery • Your hospital stay will likely to be shorter, allowing you to return home with baby to recover where you’re most comfortable FOR BABY: Waiting for labor provides essential development and growth,

which means baby: • Puts on weight and increases her iron stores • Maximizes her brain and lung maturity and development • Gets ready to suck and swallow so that she can nurse • Receives a big boost of antibodies to protect her post-birth (between 36 and 40 weeks) • Emerges better ready to feed, maintain her body temperature and bond with you Often, we focus on the risks of choosing an induction or cesarean without a medical reason. It’s time to start thinking of the benefits we lose when we don’t finish pregnancy the way nature intended when all is healthy. Go the full 40; allow spontaneous birth to maximize health benefits for you and your baby! Mimi Pomerleau, DNP, RNC-OB, WHNP-BC, CNE, is the AWHONN 2013 President.

ISSUE 12 / Fall 2013 Healthy Mom&Baby

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Moms

Fit for Travel BY SUMMER HUNT

ring n? u t n e V catio r a v r o out f ’t lose you Don hy habits healt the way. alongch day: Ea 1.

Jump-start your heart with swimming, hiking, or walking.

Carry a water bottle; slurp 64 ounces per day.

Top off your tank with nutritious snacks such as fruit, nuts, or granola bars.

Skip the excuses; pack a jump rope or resistance bands to work out anywhere.

Blinded by the Light

IMAGES © 123RF; GR ACO

Slathering on sunscreen saves skin, but failing to protect your precious peepers could leave you with lingering vision problems. Harmful UV rays can injure corneas, cause growths on your eyes, and contribute to issues like macular degeneration and cataracts. Stay eye-wise in the sun when you:  Slip on UV-blocking sunglasses—even when it’s cloudy out.  Don a wide-brimmed hat for additional shade.  Stay inside during peak UV hours—typically 10am to 2pm.

Take frequent stretch breaks.

6. Arrive home feeling wellrested and still on track.

COMPLETE OUR READER SURVEY! Enter our drawing for a Graco Travel System and more by sharing your opinions of Healthy Mom&Baby with us! Complete the Reader Survey on pages 59-60 or complete the survey online at http://bit.ly/hmbsurvey. Good luck—you could win this stroller set, diaper bags and more! to Enter is th N I W l Trave ! m Sy s te

ISSUE 12 / Fall 2013 Healthy Mom&Baby

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healthy moms

Water

STAYING HYDRATED IS KEY TO FEELING GREAT BY SUSAN PECK, MSN, APN

Have you had enough to drink today? Are you feeling sluggish, lightheaded or have a headache? Are you struggling with constipation? If so, you may be dehydrated. FLUID CHECK

Your body needs adequate fluids to carry out normal functions. So, how much water should we drink every day? This is a topic of debate. According to the Institute of Medicine and the Mayo Clinic, a good rule of thumb is 9 cups of fluid daily for women. Caffeine robs you of hydration because it can cause you to lose fluids, so your morning coffee won’t count! Keep your fluid intake simple with water,

Don’t wai tu you’re thir ntil st y to get the 9 cups of water wo me n need eac h day.

flavored water, or decaffeinated tea. Remember that you may require more than 9 cups with illness or strenuous exercise. DEALING WITH DEHYDRATION

Dehydration happens when you lose more fluids than you are drinking. You probably already know the most basic way to tell if you’re drinking enough: Your urine will be light or clear in color. Don’t trust your thirst as a sign—it’s usually not a good indicator until you’re really dehydrated, and it’s especially not reliable in young children or the elderly. Rather, says the Mayo Clinic, look for these signs of dehydration:  Fatigue  Headache  Constipation  Dry mouth or dry skin  Decreased urine output  Dark or concentrated urine After not drinking enough fluids, diarrhea and vomiting are the most common causes of dehydration. Fever also causes dehydration, especially high fever. Excessive sweating and increased urination can also put you at risk. Living higher than 8,000 feet in elevation can also make you more susceptible to dehydration. SERIOUS DEHYDRATION

Left unchecked, dehydration can lead to serious consequences, including low blood volume and a drop in blood pressure, what experts call hypovolemic shock. Dehydration can also lead to kidney failure, seizures due to electrolyte imbalance, and even coma or death. In severe cases, it’s possible to lose large amounts of fluids and electrolytes in a very short time. Infants, young children and the elderly are more at risk than others for the effects of dehydration. 12

Rehydrate with water or other drinks that contain electrolytes Avoid milk, sodas, caffeinated beverages or fruit juices as these don’t replenish your fluids and may make symptoms worse Seek treatment if you can’t keep any liquids down Nurse your baby often if she is sick to keep her hydrated

DEHYDR ATION IN PREGNANCY Kate Middleton put the spotlight on a rare and risky form of severe nausea and vomiting in early pregnancy: Hyperemesis Gravidarum. While 90% of pregnant women experience morning sickness, which can cause vomiting, only 2% experience HG, which is so severe medical intervention is required.

SUSAN PECK, MSN, APN, is a women’s health

nurse practitioner in a busy OB/GYN Practice in New Jersey.

IMAGES © 123RF; RE X FE ATURES

works

IF YOU O R YOU R C H IL D IS DE H Y DR A T E D:

health4mom.org

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30/10/2013 15:44

Exercise Realities BY SAR A HALEY

WHEN YOU’RE A MOM

I remember a time when I could decide when I wanted to work out, how often I wanted to work out, and how long I wanted to work out. If I’d had any idea how drastically that would change once I had a child, I probably would have savored it a bit more. In hindsight, I clearly had absolutely no idea. I’m a fitness expert. I’ve consulted for fitness companies including Reebok, Gaiam, and UltraSlide. I’ve taught thousands of fitness classes around the world, trained celebrities, starred in more than a dozen fitness DVDs, and even created my own fitness brand, The Daily Sweat®. So you would think with all of that, I’d have been prepared for how to continue my work outs as mom. To be honest, I couldn’t have been less prepared.

IMAGES COURTESY OF SAR A HALE Y

FINDING THE DESIRE

After having my son in 2011, I was not only unprepared for the lack of time to work out but moreover, I was not also expecting the lack of desire. This creature I created was so much cooler and more important than any work out, so trying to carve out some “me time” to go get my sweat on at times no longer felt important. It still feels that way. To get motivated, I had to take a step back and look at the big picture. Staying fit and taking the time to exercise isn’t selfish; it’s actually a necessity: To be strong for my child—literally; he’s 30 pounds now! To feel happy about fitting in my clothes and looking good For an emotional outlet on the days I need to blow off some steam For overall health To live a long healthy life REWORKING WORKING OUT

Here is the truth: If you work hard enough, you don’t need an hour! We’ve had it engrained in our heads that we need an hour because most training

bir th giving n, A f te r on L a ndo e rs im e t h e h o t ked t work c la a to Sa r esire red and d t discove of u b es out— n 5 minut han t ve r e e t t t a e th e is b all! is c r e at ex none

sessions and group exercise classes are an hour. When I started working out again after birthing my son, I would head to the gym and pretty much have no idea how much time I would have to work out. That’s when I created my second Daily Sweat® exercise DVD, Sweat UNLIMITED, based on my new work-out method: segments that are 5, 15, 30 or 45 minutes, depending on how much time I have in the day. With that kind of strategy I can be assured that at least 5 minutes is better than no minutes at all. SARA HALEY is a fitness expert and contributor to Healthy Mom&Baby.

Find 7 of Sara’s new Daily Sweat® strategies on pages 22-23 in this issue.

ISSUE 12 / Fall 2013 Healthy Mom&Baby

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For You

BY DR . MEHMET OZ AND DR . MICHAEL ROIZEN

This Diet Won’t Fail Interested in getting into your prebaby jeans? Noshing extra calories while nursing a baby? Fighting fat and just want to become and stay thin? For whatever reason you want to lose weight, you want a diet that won’t fail. We have the answer. TIGHT PANTS PROBLEMS

Most diets promise common sense solutions to tight-pants problems: Eat less; weigh less. Keep your mouth closed; you’ll keep the pounds off. Sweat like a sauna-dwelling sumo and you’ll wind up thinner than a sheet of paper. But if diets really worked that way, we wouldn’t be showing up on Google Earth. If it were really that easy, most diets wouldn’t fail. Maybe most diets have it wrong. Should you simply tackle the corn chips, croissants and cheesecake with brute force? It’s you versus food in a lifetime heavyweight fight. But this fight is always fi xed—and not in your favor. When it comes to dieting, trying to whip fat with willpower is the food equivalent of holding your breath underwater. You can do it for a while, but no matter how psyched you get, at some point your body—your biology—forces you to the surface gasping for air. So it goes with diets: At some point, your body forces you to gasp (or gulp) for food. No matter how hard you try not to eat, some hidden force deep inside is always prying your mouth back open, making it impossible for willpower to win. Instead of sparring with your waistline, make your body your ally in the fat fight. It’s time to win with elegance, with smarts, and with healthy choices that become as automatic as a Simon Cowell barb. 14

(

PUSH ASIDE DISAPPOINTMENTS—THIS IS THE ONLY HEALTHY EATING PL AN YOU’LL EVER NEED

)

Y ou r L atest Diet: T he Pla n Get Active Get a buddy Hardly anyone accomplishes anything alone—so the first thing you need is a buddy. She or he can be a committed spouse or an exercise friend who has your back and cheers you on to great healthful food choices and will not sabotage your plan, no matter what.

Walk Your ultimate goal is 10,000 steps every day—NO EXCUSES! Your buddy or we (EnforcerECoaching.com) can help you build up to 10,000 daily steps. Walking improves all of your body’s systems and builds the habit and motivation you need for ongoing success. It’s THE most important thing you can do to affect weight loss.

Stretch Do 3 to 5 minutes of stretching after your walk. While it keeps your muscles limber and flexible, which helps prevent injury, stretching also has a meditative element that helps you refocus and cope with cravings. Be gentle— “no pain, no gain” doesn’t apply here.

Eat for Life Dump your fridge Read the ingredient labels on everything in your kitchen cupboards, refrigerator, breadbox and everywhere else you stash food. TRASH any of the 5 Food Felons® listed herein.

Go food shopping The first week, you’ll have a larger-than-normal shopping list because you’ll stock up on essentials as well as ingredients you’ll need for this week’s recipes. We want to turn your kitchen into a nutritional honor society so that it’s filled with good-for-your-waist foods that make it easy (and automatic!) to eat right.

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healthy moms  Walk  Trash the fridge  Call or email your buddy with your steps, food diary, weight and waist measurements each week! If you do, this diet will be a lifestyle that will never fail you.

Achieve your own before & after with this fail-safe diet!

LOSE THE WEIGHT FOREVER Science has just started to unlock the biological mysteries that explain why we store fat and gain weight. Having the medical evidence about food, appetite and satiety (satisfaction, that’s right!) means you can tackle your weight problem with the only weapon that works: knowledge. You can reprogram your body so that you can keep off extra weight forever. Work smarter, not harder. On our plan, you can expect to drop up to 2 inches from your waist (or a dress size) within 2 weeks. You’ll continue to see results steadily after that. You may be focused on the end goal, but we believe the path you choose to get there is what really determines whether you’ll make it or not. AUTOMATIC WAIST MANAGEMENT

Avoid the 5 Food Felons Map your meal strategy Eat 3 main meals plus snacks, so you’re never hungry. No eating within 3 hours of bedtime. Consider dessert an every-otherday treat at most. By incorporating snacks, you avoid hunger emergencies, for which apples, almonds, walnuts and edamame (soybeans) are good choices.

IMAGES © 123RF; ISTOCKPHOTO

Automate 2 meals & 2 snacks each day To help make eating automatic, pick at least 1 meal a day to alter and have the same few food choices every day for all other meals and snacks—alternate 1 or 2 breakfasts, 1 or 2 sets of snacks, and 1 or 2 lunches. Then, spice up dinner time with varied and interesting meal choices.

Simple sugars, syrups This includes brown sugar, dextrose, corn sweetener, fructose (as in high-fructose corn syrup), glucose, corn syrup, invert sugar, maltose, lactose, malt syrup, molasses, evaporated cane sugar, raw sugar, and sucrose. Keep a little table sugar, honey and maple syrup handy, because you’ll use them for recipes.

Saturated fats This includes most 4-legged animal fat, milk fat, butter or lard, 2-legged animal skin and tropical oils, such as palm and coconut.

Trans fats This includes partially hydrogenated fats, vegetable oil blends that are hydrogenated and many margarines and cooking blends. (If you must, use cholesterol-fighting sterol spreads, such as Promise and Benecol.)

Enriched flours and all flours other than 100% whole grain or 100% whole wheat This includes enriched white flour, semolina, durum wheat and any of the acronyms for flour that is not whole wheat—they should not be in your kitchen.

Think of your waist management plan a little like the way you’d drive to work. Maybe the first day on a new job in a new city, you took the highway. But then you found out it was more clogged than Rapunzel’s shower drain. So you experimented with a few back roads, shortcuts and bypasses until you found the very best way to get to work. Now you don’t need a map; you do it automatically and don’t spend a single nanosecond worrying about what turn to take. It’s automatic—just the way your approach to eating should be. When you’re starting out on this plan, you’ll experiment with different routes, get stuck in a few traffic jams, and maybe even get a little lost along the way. But if you stick with it and find the right course, you’ll automate your habits, regulate your body’s hormones, and make healthy eating the easiest trip you’ve ever made. It will take some effort at the start to retrain your habits, palate and muscles, but this program is a lifelong eating, activity and behavior plan that will become as routine as going to the bathroom before bed.

MICHAEL F. ROIZEN, MD, is chief wellness officer and chair of the Wellness Institute at the Cleveland Clinic. MEHMET C. OZ, MD, is the host and executive producer of the Dr Oz TV show. He is also a professor and vice chairman of surgery, as well as director of the Cardiovascular Institute and Integrated Medical Center, at New York’s PresbyterianColumbia University.

ISSUE 12 / Fall 2013 Healthy Mom&Baby

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Don’t days let cloudy t into rick you you d thinking o sunsc n’t need re you d en— o.

New Sunscreen Strategies BY AWHONN EDITORIAL STAFF

We’re smarter than ever about using sunscreen to protect our precious skin. Yet, even as sunscreen use increases, so do skin cancer rates. In fact, skin cancer rates have tripled in the last 35 years, says the National Cancer Institute. As if skin cancer isn’t scary enough, who wants the other effect of too much sun exposure: early skin aging. The only way to reduce skin damage and cancer risks from too much sun exposure is to manage the factors that you can—largely avoiding UV rays and sunburns. 16

SAFE SUN STRATEGIES

 Use SPF 15+ sunscreen and lots of it.  Reapply sunscreen every 2 hours

jumping in and out of the water.

or more if you’re sweating or

when the rays are most intense. Cover up with shirts, pants, sunglasses and hats.

 Stay out of the sun between 10am and 2pm 

3. MANAGE YOUR SKIN CANCER RISKS Sunscreen alone can’t reduce your skin cancer risks. Your lifetime exposure to the sun and UV rays matters. Using sunscreen to prevent sunburn is just the first step, say experts at the National Cancer Institute and the CDC: Controllable risk factors   

Never use tanning beds Protect against UV exposure Avoid sunburns

Non-controllable risk factors   

Family history of skin cancer Having a lot of moles on your skin Having fair or freckled skin

IMAGE © 123RF

IMPROVE YOUR PURCHASE WITH THE LATEST IN LABELING

SHOP SMART About 90% of non-melanoma skin cancers are caused by 1. exposure to UV radiation from the sun. The FDA recently made sunscreen manufacturers clarify their labels:  New warning: Sunscreens that aren’t “broad spectrum” (considered protective against the full spectrum of the sun’s UV rays) now warn: “Skin Cancer/Skin Aging Alert: Spending time in the sun increases your risk of skin cancer and early skin aging. This product has been shown only to help prevent sunburn, not skin cancer or early skin aging.”  Time limits: If the product claims water resistance for either 40 or 80 minutes, it’s a water-resistant product. Without this claim and either of these times, the product is not proven water resistant.  No exaggerated claims: There is no sunscreen that is “waterproof,” “sweat proof ” or is a “sunblock,” the FDA says.

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healthy moms

Long-lasting

Contraceptives

By Susan Peck, MSN, APN

This increasingly popular contraception helps you avoid or space pregnancies

Finally, women have another long-acting reversible contraceptive (LARC) option. For the first time in 12 years, the FDA has approved a new intrauterine device (IUD), Skyla—and the implant is growing in popularity. What LARCs Do For You

While the pill may be the most commonly used contraception, there are many great reasons to consider a LARC. IUDs are safe, highly effective choices for most women. In fact, the American College of Obstetricians & Gynecologists recommends them as first choice for contraception. Perhaps more importantly, they’re the “forgettable” contraceptive. Unlike daily, weekly, or monthly methods, IUDs are inserted and only require minimal attention. This makes avoiding pregnancy or spacing your pregnancies much easier. Lastly, when used for at least 2½ years, IUDs are a cheaper to use compared to other contraceptives. Choosing an IUD

Currently, 3 IUDs are available for use: 1 The Copper T380, Paragard, has been used in the US since 1989. It is a non-hormonal plastic copper-containing IUD approved for women who have or haven’t had children for up to 10 years. It prevents pregnancy by inhibiting sperm and ovum (egg) migration and is spermicidal. 2 The levonorgestrel IUD, Mirena, has been available since 2000. It’s a synthetic progestin hormone that is FDA-approved only for women who have had a child (although many providers

images © BAYER

IUD Choices IUD

Duration Of Use

Hormonal

Common Side Effects

Copper T380 Paragard

10 years

Longer, heavier periods

Levonorgestrel IUD 52mg Mirena

5 years

Yes, progestin only

Shorter, lighter, often irregular bleeding

Levonorgestrel IUD 13.5mg Skyla

3 years

Yes, progestin only

Shorter, lighter, often irregular bleeding

believe in the safety of the device and will offer it to women who haven’t had children). It’s effective for 5 years and prevents pregnancy like the Copper IUD, but also thickens cervical mucus, thereby inhibiting pregnancy. 3 The newest levonorgestrel containing Skyla slowly releases IUD is Skyla, recently approved for use the progestin hormone levonorgestrel into the in January 2013 for women who have or uterus, meaning only small of the hormone haven’t had a child and is effective for 3 amounts enter the blood. years. It prevents pregnancy in the same way as Mirena, and overall it’s smaller and shorter acting. Women who haven’t been pregnant may have a smaller uterus, which means Skyla may provide a more comfortable insertion. It’s also an excellent choice for women who may not want to wear it for more than a few years.

LARC should be considered a safe choice for all childbearing women. Using LARC, such as one of these IUDs, provides women with the power to easily control if, when, and how often pregnancy is desired. Susan Peck, MSN, AP, is a women’s health nurse practitioner and an

expert advisor to Healthy Mom&Baby in a busy OB/GYN practice in New Jersey.

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Drop 5 Pounds BY CAROLYN DAVIS COCKEY, MLS

(

)

CHEF MELISSA D’AR ABIAN SERVES UP THE SECRETS TO SUCCESS WITH FOOD AND WEIGHT LOSS

If it seems you’re watching Melissa D’Arabian every time you flip through your fav foodie channels, you’re right. From helping us lose 5 pounds to persuading picky eaters to broaden their palates, this super chef is always dishing up practical advice designed to solve our mealtime and parenting problems.

What woman doesn’t want to drop 5 pounds? We all feel like we can or should—what’s the secret to your success? Drop 5 Pounds is quintessential Good Housekeeping—an icon of good quality and standing. It’s really taking that topic—losing weight, which is fraught with emotion and feelings—and turning our actions into examples of loving ourselves and treating ourselves to the quality lives we deserve. It’s understanding that it’s the small changes that we make in our lives—not the big steps we occasionally take—that shape who we are and that really make a difference in the longer term. It’s inspiring people to see the positive, loving side of eating healthfully, not the depravation of “I can’t eat this or that,” which isn’t sustainable. It’s using tools to support real weight loss. What kinds of changes and tools? One of the things that I do is never let myself get too hungry; I’m a smart snacker. Often, we think when we’re losing weight that we shouldn’t snack—but the opposite is true! You’re not doing yourself a favor by showing up for your meals starving. So, I always carry raw almonds with me because I know that a little bit of high-quality fat plus protein will stick with me. Carry a 100-calorie snack with you, and be smart with your 100 calories. You could have 100 calories of candy, but a snack like almonds is good 18

nutrition that’s filling. Another tip: I always try to have raw fruit or veggies with every meal. It’s making the loving choice for me. If I’m going to treat myself to a little bit of something— like when it’s my daughter’s birthday and we’re doing cupcakes—I’m not comfortable saying to my daughter, “I’m sorry I can’t have a cupcake on your birthday.” That’s not how I want to live my life. I’m comfortable with having a cupcake, and that’s the more loving choice. But if I have 7 cupcakes, I have to ask, “How loving is that for myself?” One last tip: When you’re traveling, bring whole fruit. I throw a couple of mandarin oranges in my carry-on so when they’re serving food on the plane I can just say, “No thanks.” I also like to bring my own herbal tea; I feel like it puts me in a better space when I love myself this way.

Your viewers really connect with you; whether it’s $10 Dinners, Drop 5 Pounds or Picky Eaters, you really put yourself, your life and your family right out there for us to meet and interact with. I love the parts of my shows where we bring in expertise but I also add real life experience. I’ve struggled with my weight since I was 15 years old, which was my age when I first ever went on Weight Watchers. I’m not one of those women who can say, “I breastfed and the weight just fell away.” I breastfed 4 kids, and while I may have gotten the first 10 pounds that way, everything else was good oldfashioned hard work.

Eating the right kinds of healthy fats, like those found in salmon, can help you lose weight. Truly a superfood!

In certain instances, it is beneficial to eat raw vegetables. This is because cooking can destroy essential nutrients such as vitamin C.

Become a smart snacker. Almonds not only deliver a host of nutrients, but they will also provide you with energy and keep your appetite fueled until your next meal.

IMAGES © FOODNE T WORK .COM; 123RF; ISTOCKPHOTO

When we caught up with Melissa, she had just wrapped up Drop 5 Pounds with Good Housekeeping on the Cooking Channel and was launching her Picky Eaters Project on the Food Network. As expected, she’s serving up nuggets of wisdom that can transform our lives through small changes and simple strategies.

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healthy moms

Make smart choices when it comes to snacks. Being clever with 100 calories can prove key in dropping those extra pounds!

Berries are the most powerful antioxidant fruit. They contain various vitamins, extremely beneficial minerals and have anti-aging effects.

Which brings me to something most of us don’t want to hear: If you want to lose weight, it’s going to take a bit of doing. You can’t keep doing what you’re doing and expect different results. Put on your big-girl panties, and let’s make some of these healthy recipes; it could be a really positive change. It’s not as hard as you think, and you’re not going to get where you want without your own participation. Let’s show up for our own lives.

You’re big on making promises: How do you make good on your promises to help us look and feel younger with moodboosting foods? I like the idea of looking and feeling younger from the inside out. We can plump up collagen by eating lean meats and help our cell structures by eating antioxidants, like those found in berries. There are definitely things we can do from the inside out that will help our skin look better and give us more energy.

One of my favorite quotes is “fat is your friend.” It dispels the myth that fat is bad for you—eating the right kinds of healthy fats, like those in salmon and nuts, can actually help you lose weight. Not only is it ok to eat these fats, but you’ll also feel more satisfied and have a greater sense of wellbeing overall.

But some say it costs more to eat healthfully—produce seems pricier than processed foods. Well, here’s the good news: There’s huge crossover between saving calories and saving money. And nowhere is that more obvious than the produce aisle. I shop the produce aisle first, filling my cart up with what’s in season—which means I’m not making a fresh peach pie in January. Seasonal produce is usually abundant and on sale—and when you buy healthy food, your budget stays in check as do your calories, and your weight-loss goals are easier to achieve.

When traveling, fruit such as a banana, apple or a mandarin orange can be a great go-to snack!

Carolyn Davis Cockey, MLS, is editor

of Healthy Mom&Baby and director of publications for AWHONN. Follow her Momalogues blog at Health4Mom.org.

ISSUE 12 / Fall 2013 Healthy Mom&Baby

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SHOULD I WAIT FOR LABOR? Only 6 more weeks!

Are you nervous? This is your first! What if she’s not here by her due date?

Pregnancy

Make Way for Baby

BY SUMMER HUNT

Sure, your baby’s siblings know something’s up with your everincreasing bump. Ease the transition for toddlers and teens alike by helping them understand what’s happening and when.

It’s not a deadline—it’s an estimate of when she’d finish 40 weeks.

9 months. 40 weeks. It’s confusing.

No worries. Experts say she’ll trigger labor when she’s ready. There’s a big hormone cascade that preps her for life outside— especially her lungs/brain. Didn’t know that. How long can I wait? She can’t stay in there forever! LOL—since you don’t know exactly when you conceived, it’s best to let baby pick her birthday.

Yea, my nurse sent me to GoTheFull40.com. She said to wait for labor to start on its own. So I’m waiting…

IMAGES © 123RF; ISTOCKPHOTO

Play it safe. Don’t evict her, ha ha. She’ll emerge when she’s ready.

TAKE YOUR TOTS TO YOUR NEXT PRENATAL CHECK TO HEAR BABY’S HEARTBEAT OR SEE HER ON ULTR ASOUND.

DON’T RISK DISASTER BY ASKING IF YOUR CHILD WANTS A BROTHER OR SISTER.

SHARE STORIES AND PICTURES FROM WHEN THEY WERE BAKING IN YOUR BELLY.

TELL YOUR CHILD TO BE A BIG BOY OR GIRL.

EXPLAIN BABY’S DUE DATE SIMPLY, LIKE WHAT THE WEATHER WILL BE LIKE THEN.

MAKE ANY MAJOR CHANGES, LIKE RUSHING POT T Y TR AINING OR GIVING UP A BABY BLANKET.

The 411 on BMI and C-Sections You might be eating for two, but gaining more than 30 pounds during pregnancy may put you at a greater risk for needing an intervention at birth, particularly cesarean surgery. And this is regardless of pre-pregnancy weight, say researchers in Norway. Already overweight or obese? Women with a BMI of 40 or more before conceiving are most likely to need cesarean to birth baby. Remember our mantra: Eat for 1.1, gradually adding from 150 to 300 extra calories a day as the months roll by. Pick your calories carefully and opt for nutrient-dense choices like veggies with hummus or an apple with peanut butter.

ISSUE 12 / Fall 2013 Healthy Mom&Baby

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healthy pregnancy

7 Fast Moves By Sar a Haley

Got 5, 15, 30 or 45 minutes to work out?

ome days you just have 5 minutes. These moves are from my second Daily SweatÂŽ and Sweat UNLIMITED workouts. I can choose 1 or all of them based on how much time I have: 5, 15, 30 or 45 minutes.

Build muscles for calorie burn

As a par finding ti ent, m exercise c e to an be a challeng e!

5 minutes is better than 0 This plank is perfect when you only have 5 minutes because it works so many muscles at once. Start in plank (top of a push-up) and do any of these: XXHold the plank XXAdd challenge: Lower down to your forearms XXRow one arm back to your rib cage at a time,

tightening the back muscles around your bra line

Throughout, pull your navel to your spine and squeeze your butt for added stability. Repeat up to 1 minute; combine with 4 other favorite exercises for a quick 5-minute workout.

Spend 5 minutes each on your upper and lower body, and 5 minutes on your core with elbow-to-knee obliques that whittle your waistline: XXBegin on knees, right leg out to the side, right foot on the floor XXWith hands behind your head, lean your upper body (torso leading) toward

the knee, getting your elbow as close to your knee as possible, keeping your hips to the front

XXAdd challenge: Lift your right foot off the floor as you bring your elbow

toward the knee

Repeat the exercise 10 times on each leg.

Use your body weight

XXStand with feet shoulder-width apart XXReach arms up XXSit back with your weight in your heels, like a traditional squat XXAs you get lower, reach toward 1 ankle with both hands XXKeep your feet, knees and hips to the front as your torso and upper body slightly

rotate and twist toward 1 ankle

XXStand tall again and repeat toward opposite ankle

If your knees buckle as you squat, widen your stance until you gain inner thigh strength.

images courtesy of sar a hale y

Donâ&#x20AC;&#x2122;t load an exercise with weight; do it differently, as with this rotational ankle squat:

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Dance it out

Tabata training

It’s quick, efficient, and only takes 20 seconds at a time! Take a drill (jogging in place) or an exercise (push-ups) and give it everything you’ve got for 20 seconds, then rest for 10. Repeat 8 times. Try doing 2-8 different drills. Trust me; it beats the heck out of running on a treadmill: I love to dance; it’s the perfect cardio for me. If you’re more into sports, try sports-specific cardio drills! Here’s a favorite dance move anyone can do called “Swing It”: XXBegin in a plié squat, hips and toes rotated out

to the corners

XXSwing your arms back and forth behind your

back (a great chest opener, moms!)

XXRotate your hips and feet to the corners XXBend both knees, as you rotate into a lunge toward the left corner your right knee

should get closer to the floor, as you punch the right arm toward the floor

XXAdd challenge: Go lower, hit the floor if you can XXQuickly go back through the center and rotate into a lunge to the right corner XXPush off the floor in between each lunge to get a little air time in the middle

Repeat for 20 seconds, rest for 10 between, for 8 rounds.

XXBend your knees, and as you swing from right

to left, push off the floor into a little jump

XXLand with the balls of the feet on the ground

first, followed by your heels

Pick up boxing

Put on your favorite song; freestyle on the verses and “Swing It” on the chorus!

Remember to stretch!

It’s an amazing cardio and strength-conditioning exercise that works your core like crazy: Give yourself a 5-minute minimum stretch with my big spinal twist: XXSeated, cross your right leg over your left;

right knee up

XXCross your left arm over your right leg XXRotate to the back XXHold for 2 counts, then return to start

XXStand with feet shoulder-width apart XXBend your knees into a mini squat XXWith arms tight, squeeze your elbows close to your body, and block your face a

bit with your hands

XXFrom this position, extend and punch 1 arm out in front of you at a time; your

knuckles should be in a straight line to the front

Repeat for speed for 30-60 seconds.

XXRepeat up to 4-6 times on one side XXRepeat other side

Sara Haley (sarahaley.com) is a mom and certified fitness instructor. These exercises and more are from her Daily Sweat® and Sweat UNLIMITED work-outs, available online or on DVD.

ISSUE 12 / Fall 2013 Healthy Mom&Baby

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healthy pregnancy

Satisfy Pregnancy Cravings EATING FOR 1.1

Sure you need extra calories each day for a healthy pregnancy—but not so many to justify a daily trip to Ben & Jerry’s. Truth be told, our experts Drs. Michael Roizen and Mehmet Oz unpack it this way: You only need a 10% increase in calories during your first

1ST TRIMESTER

+100 CALORIES

trimester, hence 1.1, and it goes up from there. Fuel up and calm your cravings with these healthy, juicy suggestions for taking in the extra needed calories each trimester. All calorie accounts are approximate— measure and calculate your ingredients as you go.

2ND TRIMESTER

+250 CALORIES

3RD TRIMESTER

+300 CALORIES

WHOLE WHEAT ROLL (1), HARD CHEESE (1OZ) AND GR APE TOMATOES

JUICY PEACHES (2) OR PLUMS (3)

PLAIN GREEK YOGURT (6OZ), GR ANOLA (1/2 CUP) AND BLUEBERRIES (3/4 CUP)

2 STRING CHEESE & FROZEN GR APES (1 CUP)

ICY COLD SKIM MILK (8OZ)

TROPICAL SMOOTHIE: LIGHT YOGURT, BANANA AND PINEAPPLE (1/2 CUP EACH); ADD WATER AND ICE TO DESIRED CONSISTENCY

PITA PICNIC: 1/2 PITA, HUMMUS (2 TBSP), CHILLED STEAMED VEGGIES

IMAGES © 123RF

HUMMUS (3 TBSP) WITH WATER-PACKED CELERY

CHOCOLATE (EXTR A DARK, EXTR A GOOD!) DIPPED FROZEN BANANA

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healthy pregnancy

Antidepressants BY TAMER A YOUNG, RN, MSN

in Pregnancy

S serot elec tive on inhibit in reuptak e o don’t rs (SSR Is) in stillbir crease th ris k s.

If you struggle with what you think could be depression, or if you have been diagnosed with depression, talk to your healthcare provider about treatment during pregnancy. Deciding whether to use any medication during pregnancy comes down to balancing the risks with the benefits, including antidepressants. TREATING DEPRESSION IN PREGNANCY You may be worried about the effects of the medication on your unborn baby. Earlier this year, research across more than 1.6 million births in the Journal of the American Medical Association demonstrated that the popular selective serotonin reuptake inhibitors (SSRIs) don’t increase stillbirth risk, as previously suspected. For your health, and for your developing baby’s health, experts at the Mayo Clinic advise treating depression through pregnancy because you may:  Neglect yourself and your pregnancy, including avoiding prenatal care.  Eat poorly, avoiding healthy foods your baby vitally needs.  Soothe feelings with alcohol, cigarettes or drugs, all of which could harm your baby. As a result, your baby could be at increased risk for being born early or having a low birth weight, and you may experience postpartum depression that prevents you from bonding with or nursing your baby. If you’re taking drugs for depression and have just

Some studies suggest that, while rare, these medications can put the developing baby at risk for lung or heart defects. Know what’s safer to use in pregnancy:

learned you’re pregnant, never quit your medications “cold turkey”—this puts you at risk for significant side effects. Talk with your healthcare provider to learn if your medication needs to be changed in any way. OTHER THERAPIES AND HELP If you struggle with depression, boosting your intake of Omega-3 essential fatty acids, like those in coldwater fishes or olive or flaxseed oil; using light therapy; getting regular exercise (most days of the week); and counseling and group support are helpful for some women during this time. Left untreated, depression during pregnancy can harm both you and your baby. Tell your healthcare provider if you struggle with preexisting depression or if you’re experiencing feelings of moodiness, isolation, withdrawal or disinterest, which can be signs of depression emerging during pregnancy. Help is available, and getting care is best for you and your baby. TAMERA YOUNG, RN, MSN, is an expert advisor to

Healthy Mom&Baby.

Generally considered safe

SSRIs (selective serotonin reuptake inhibitors, such as Celexa or Zoloft) Avoid in pregnancy

MAOIs (monoamine oxidase inhibitors, such as Parnate) Generally considered safe

Tricyclic antidepressants (Pamelor) Avoid in pregnancy

Paxil (specific SSRI associated with 1st trimester fetal heart defects) Generally considered safe

Bupropion (Wellbutrin)

IMAGE © 123RF

Pregnancy isn’t always a time of happy anticipation. Women who have depression will continue to struggle during pregnancy, and some women even develop depression during pregnancy. As many as 1 in 5 women may deal with depression in pregnancy, experts estimate.

health4mom.org

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30/10/2013 10:09

healthy pregnancy

Busting the top

myths about

Breastfeeding

(

)

By Amy Spangler , MN, RN, IBCLC

“Breastfeeding is natur al.” Sound familiar? If you assume that breastfeeding is natur al, it doesn’t take a leap of faith to accept that breastfeeding must be easy. Why then do so many mothers describe breastfeeding as hard?

Know that myths masquerading as facts can undermine the success of even the most ardent mom. Learn to separate fact from fiction and you will gain the knowledge and confidence you need to meet your breastfeeding goals. 1. Engorgement is normal It’s easy to confuse breast fullness, which is normal, with breast engorgement, which can hint at a problem that will only worsen if ignored. If feedings are infrequent, delayed or missed, your breasts can overfill and engorgement can occur. Classic signs of engorgement include swollen, hot, painful breasts and a low-grade fever. Engorgement is best prevented by breastfeeding early (as soon as possible after birth) and often. 2. Pain is normal Many new mothers describe breastfeeding as “painful.” Any discomfort that you feel should be at the start of a feeding and last only a few seconds. If the pain persists throughout the feeding, it

Breast m infants ilk gives nutrie all the need fo nts they r develo healthy pment .

can signal a poor latch. Remove your baby from the breast and try again. Breastfeeding “through the pain” will only result in a stillhungry baby and a damaged nipple. 3. Babies cry when they need to be fed Babies cry for many reasons. While it’s true that your baby’s cry can signal hunger, crying is a late sign of hunger. Watch, instead, for early cues such as sucking on fingers or fists, smacking lips, squirming and fussing, and feed your baby before she cries. 4. Latch is more important than position Position and latch go hand-in-hand. It’s hard to achieve a good latch when your baby is poorly positioned. The best breastfeeding

ISSUE 12 / Fall 2013 Healthy Mom&Baby

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healthy pregnancy

positions are the ones that work for you and your baby. Regardless of which positions you choose, make sure your baby is well supported and facing your breast.

The fact is, most mothers are able to breastfeed their babies exclusively, both by nursing and bottlefeeding breastmilk. Although formula supplements are widely used, they’re seldom medically indicated.

5. Many moms just don’t make enough milk ‘Not enough milk’ is every mom’s fear. It’s also a top reason moms say they stop breastfeeding sooner rather than later. While it’s hard to measure what you can’t see, poopy diapers and weight gain will let you know your baby is getting enough to eat.

8. How much milk you pump is how much milk you make How much milk a mother expresses from her breasts is seldom a reflection of how much milk she makes at a feeding. In the beginning, you may only get enough milk to cover the bottom of the collection container. Don’t worry. It can take days or weeks before you see an increase in how much you can pump.

7. A lot of breastfed babies will need formula supplements Despite compelling evidence of the benefits of exclusive breastfeeding, work, school demands, illness, pain and low milk supply are among the many reasons mothers give for feeding formula.

9. You need to wait at least 2 hours after you pump to breastfeed The same rule that applies to breastfeeding applies to pumping: Watch your baby, not the clock, and feed your baby at the first sign of hunger. There is no need to wait for even one minute after pumping before feeding your child. In fact, the more milk you remove from your breasts by breastfeeding or pumping, the more milk you will make. 10. ‘No leaking’ means ‘no milk’ Milk leaking from your breasts is a sure sign that your body is making milk. Now you just need to get the milk out of your breasts and into your baby. Once your baby acquires a feeding routine (about 6–12 weeks of age), leaking usually stops. Don’t panic! You’re not losing your milk. Your breasts have simply learned how much milk to make and when to make it.

Amy Spangler, MN, RN, IBCLC, is an

internationally recognized breastfeeding and child nutrition expert. Find her online at Babygooroo.com.

images © 123RF; ISTOCKPHOTO

6. Inadequate weight gain is common Knowing how much weight babies typically lose and gain during their first weeks of life can help you know if your baby is gaining too little or too much weight: � Newborns lose, on average, 5% of their birth weight during the first 5 days after birth. � Some babies lose as little as 2% or as much as 7%–10%. Weight loss greater than 10% or continued weight loss after day 5 can be cause for concern. � Most babies are back to their birth weight by 10 days of age and gain between 4–8 ounces a week during the remainder of the first 3 months.

The World Health Organization (WHO) recommends that breastfeeding should begin within 1 hour of birth and should be “on demand”—as often as the baby wants (day and night). Avoid bottles and pacifiers until baby is breastfeeding well.

health4mom.org

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31/10/2013 09:55

healthy pregnancy

Avoiding

Early, Elective Deliveries (

This hospital watchdog lets you learn where you could be at increased risk for birthing early By Carolyn Davis Cockey, MLS

)

Your bab needs a fu y weeks of p ll 40 regna to grow a ncy nd develop.

Could where you plan to birth put you and baby at risk for delivering early, even risking prematurity for baby? It could, if you’re planning to birth in a hospital or facility that doesn’t restrict early, elective births—especially before 39 weeks.

Hospitals are reducing early, elective deliveries thanks to the efforts of watchdog groups including The Leapfrog Group, says CEO Leah Binder. By publishing early, elective birth rates, Leapfrog is forcing hospitals to reconsider their policies and practices, and helping pregnant women find mom and baby-friendly places to birth.

Birthing the way nature intended is healthy best for most pregnant women. No doubt if you’re reading Healthy Mom&Baby you’ve likely seen the “Don’t Rush Me . . . Go the Full 40” weeks of pregnancy campaign (GoTheFull40.com) from the Association of Women’s Health, Obstetric & Neonatal Nurses (AWHONN), the nursing association that produces this magazine. At the heart of this effort is advice and encouragement from experts to help you know why it’s healthy best to let your pregnancy go full term, to wait for your labor to naturally start on its own, and to have a normal, vaginal birth when all is well. Allowing your pregnancy to go full term is best for your health. While being done with pregnancy may seem tempting, especially during those last few weeks, inducing labor is associated with increased risks including prematurity, cesarean surgery, hemorrhage and infection. Non-medically related choices—called “elective”— include inducing labor without cause, as well as birthing via cesarean without a medical reason for surgical delivery. When these choices are made without cause before your pregnancy is term, they’re called “elective, early deliveries.” They’re also called “dangerous” for the many immediate and life-long risks documented in research for both you and your baby.

Know Your Hospital’s Numbers

One group that’s trying to drive down these interventions by reporting elective, early birth practices at hospitals is the hospital quality watchdog, The Leapfrog Group. Through a voluntary annual hospital survey, Leapfrog reports elective, early delivery rates at www.LeapfrogGroup.org. When we spoke with Leapfrog Group CEO Leah Binder, she explained why she’s celebrating recent declines in early, elective interventions across the country, and why there’s still more work needed.

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healthy pregnancy

images © 123RF

How do you measure what the hospitals report? We’re looking at all the deliveries that take place between 37 and 39 completed weeks of pregnancy, and of all of those births, we’re measuring the percentage of those births between 37 and 39 weeks that were done electively—for no medical reason. So, when a woman looks up her hospital’s rates on our website and sees an 80% or a 100%, that means that 80% or 100% of those deliveries between 37 and 39 weeks were for no medical reason—they were elective, by choice, for convenience or whatever other reason, such as when the physician is on call. Leapfrog’s goal is to get early, elective deliveries to 5% or less; should it be 0%? There are some cases where there may be a particular non-medical related issue that affects a woman under a particular circumstance that may not be accounted for in the broad ways we classify medical need. Since there are exceptions to medical need for these circumstances, we account for those exceptions by allowing up to 5%.

So, what should happen if a pregnant mom looks at LeapfrogGroup.org and can’t find her hospital in your survey? We would encourage women to approach their local hospital and ask them to please report to Leapfrog. Currently, about ¼ of all birthing hospitals are reporting. Second, call you doctor or midwife and ask about their views on preventing early, elective deliveries. If your provider says, “we schedule them a lot,” then you may want to reconsider your choice of obstetrician or midwife. If they’re strongly opposed to early, elective deliveries, ask if the whole practice feels the same way and practices likewise. Often, we don’t want to challenge [our providers] because they know better than we do, it’s scary for us, or we don’t want to get on the wrong side of our physician. But you are entitled to ask these questions of the person with whom you’re entrusting your life, and the life of your family. Not all doctors and hospitals are the same. You have to be picky. We find big variation in the early, elective delivery rates for one hospital compared to another that might be literally down the street. You have to think of yourself as a consumer of health care; you have to shop. How can an army of pregnant moms make a difference in their community? It’s important for women to reach out to their legislators in their states. Medicaid pays for about half of all childbirths in this country, so your state should be actively engaged in using that leverage to influence the way births take place. States can certainly insist that hospitals make every effort to avoid early, elective deliveries. I need to mention something a little bit cynical: When hospitals reduce their rate of early, elective deliveries, their neonatal intensive care unit admissions go down—some have reported by as much as half after implementing these policies. So, while these policies are great for babies, for moms and for our country as a whole, they’re not so great for the hospital’s bottom line because the NICU is a high-profit center. There is a problem in our whole [healthcare] payment system where we have created this horribly perverse incentive that results in suffering babies, which is truly not excusable. We need the payment system to force hospitals to do what’s right for these babies and these moms. It’s going to take all of us to really push that agenda.

Avoid dangerous DELIVERIES Early, elective deliveries come with considerable risks:

For moms, risks increase for: XXBirth by cesarean,

including the risks of uncontrolled bleeding (hemorrhage)

XXLonger hospital

stays and longer recovery

XXAnemia XXEndometriosis XXUrinary tract

infections

XXSepsis

For babies, risks increase for: XXPrematurity XXLow or lower

birth weight

XXNICU admission XXHealth

complications, now and life-long

XXDeath, especially

in the first year of life

Carolyn Davis Cockey, MLS, is editor of Healthy Mom&Baby and director of publications for AWHONN. Follow her Momalogues blog at Health4Mom.org.

ISSUE 12 / Fall 2013 Healthy Mom&Baby

17_early elective_RB.indd 33

Source: Leapfrog Group

How is Leapfrog Group pressuring hospitals to curb early, elective deliveries, which you and many other experts call “dangerous?” We started publicly reporting, hospital by hospital, 2 years ago on early, elective delivery rates, and that quickly changed the conversation. Groups like AWHONN, the March of Dimes and the American College of Obstetricians and Gynecologists have been trying to reduce the rates of early, elective deliveries for years. But those efforts really didn’t see the kind of traction they deserved until we put the numbers out there. Many hospitals didn’t even realize how high their rates were. Since we started drawing attention to the issue, our data shows 75% of hospitals improved this year, and the national average for these deliveries dropped from 14% to 11.2%—evidence to the commitment many hospitals are making to put babies and mothers first. Our simply shining a light on the practice has had an enormous impact. I’ve talked to hospital executives who until they looked at this data said they had no idea that this was a problem at their facility. For example, I spoke with one director of obstetrics who, after reporting to Leapfrog and looking at the data, completely revamped his hospital’s practices. He created a PowerPoint presentation for the entire staff entitled, “What Were We Thinking?” I give credit to nurses and physicians who have been fighting this for a long time. Now, they have the momentum for change.

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7Steps to Save Your Back

healthy pregnancy

PREGNANCY BACK PAIN

BY DR. MICHAEL PERRY, MD

The 40 weeks of pregnancy are full of joyous moments, but there are often times a mommy-to-be’s comforting thoughts about her new baby can drift to her aching back. Weight gain in the belly area puts stress on your lower back, and the added tension causes vertebrae to bunch up and crowd. If you experience back pain in pregnancy, stick to safe over-the-counter pain relievers like acetaminophen (Tylenol) and avoid ibuprofen (Motrin). Massage, acupuncture and safe exercise programs are also helpful. Follow these 7 strategies to help prevent and manage back pain in pregnancy:

SLEEP ON YOUR SIDE WITH A PILLOW BETWEEN YOUR LEGS Sleeping in this position allows your spine to rest in a natural position. Try sleeping on your left side in pregnancy to enhance blood flow.

TRY PRENATAL MASSAGE

Massage in general is good for anyone who has back pain. Even when you are pregnant, it’s a safe treatment option.

MAINTAIN GOOD POSTURE TO REDUCE STRAIN ON YOUR LOWER BACK While pregnant, you should carry your shoulders back when sitting or walking. Use lumbar support when you are in a chair; good options include a semi-deflated beach ball or rolled up towel. Being pregnant changes your center of gravity and increases back discomfort.

4 IMAGES © 123RF

AVOID LIFTING HEAVY OBJECTS If you do lift, bend with your hips and legs—not your back! Don’t bend over and lift with your spine. As you gain weight, how much you can pick up and carry may be limited. Listen to your body and use caution if you feel you’re straining.

CHOOSE COMFORTABLE SHOES WITH SUPPORT Stay away from high heels or flats. Shoes with good inner arch support are best.

LOG YOUR PAIN TO LEARN WHAT IMPROVES IT AND WHAT MAKES IT WORSE See your healthcare provider post-birth if the pain is still present. You may have a separate injury or condition that needs care.

STRENGTHEN YOUR BACK WITH EXPERT-APPROVED EXERCISES Walking and swimming are two good examples that will help strengthen you overall and help you control pregnancy weight gain. Swimming gives you buoyancy so you’re not carrying the weight on your joints but still offers muscle-toning exercise.

DR. MICHAEL PERRY, MD, is the medical director at the Laser Spine Institute. ISSUE 12 / Fall 2013 Healthy Mom&Baby

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healthy pregnancy

Antidepressants BY TAMER A YOUNG, RN, MSN

in Pregnancy

S serot elec tive on inhibit in reuptak e o don’t rs (SSR Is) in stillbir crease th ris k s.

Some studies suggest that, while rare, these medications can put the developing baby at risk for lung or heart defects. Know what’s safer to use in pregnancy:

Healthy Mom&Baby.

Generally considered safe

SSRIs (selective serotonin reuptake inhibitors, such as Celexa or Zoloft) Avoid in pregnancy

MAOIs (monoamine oxidase inhibitors, such as Parnate) Generally considered safe

Tricyclic antidepressants (Pamelor) Avoid in pregnancy

Paxil (specific SSRI associated with 1st trimester fetal heart defects) Generally considered safe

Bupropion (Wellbutrin)

IMAGE © 123RF

health4mom.org

HMB15_Antidepressants_RB.indd 26

30/10/2013 12:29

healthy pregnancy

Induction Decisions

FI N D A H E A LT H C A R E P ROV ID E R W HO SU P P O RT S Y OU R B IRT H IN G G OA L S

BY CATHERINE RUHL, CNM, MS

(

UNLESS THERE’S A MEDICAL REASON, IT’S BEST TO WAIT FOR L ABOR TO START ON ITS OWN

Are you considering induction? Inducing labor is common—but experts agree that unless it’s for a medical reason, induction is risky and best avoided. In recent years there has been a movement to wait to induce labor without medical reasons until at least the 39th week—which is 1 week before your due date. But most women won’t go into labor on their own until their due date or a week or so after, and there are many advantages for both women and babies of waiting until your body signals everything is ready by naturally starting labor.

)

as preeclampsia or poor fetal growth, in which case it’s riskier for pregnancy to continue than for baby to be born early. If your provider is recommending an induction, ask why. Some reasons, such as the baby is “too big,” may not indicate an urgent need for baby to be born.

INDUCTIONS INCREASE CESAREANS

Ask your provider: What their advice is based on What alternatives you can consider What the risk is right now for you and your baby if you choose to wait for labor to start on its own

Induction increases your risk for cesarean, especially if your body isn’t ready to labor (see “Learn the Bishop’s Score”). Your healthcare provider may recommend inducing labor if you or your baby are experiencing medical problems, such

AVOID ELECTIVE INDUCTIONS Deciding to induce labor without a medical reason is an “elective” induction. Reasons for elective inductions include choosing to induce labor for

Look for a midwife or doctor whose practices align with your desires and goals for pregnancy, labor and birth. Use these questions to learn more about a provider’s practices around spontaneous labor and induction: 1

Do you routinely recommend scheduled inductions when all is healthy?

If so, how close to my due date?

What are the medical reasons you might recommend induction, and why?

What are my alternatives to induction?

What are the risks of inductions?

What are the benefits and risks of waiting for spontaneous labor?

How will we resolve conflict if you advise an induction and I want to wait for labor to start on its own?

ISSUE 12 / Fall 2013 Healthy Mom&Baby

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healthy pregnancy

KS AN R I S ES CESARE QUENC E S N O &C Women who undergo cesarean when an induction doesn’t result in a vaginal birth are at risk for the complications and consequences of cesarean:

These hormones start labor when both you and your baby are completely ready and help you have a labor that usually goes faster, with gentler contractions for your baby, than when labor is induced with synthetic hormones. When considering induction, remember: This is your body, your baby and your future. Making sure you know the reason for this recommendation means you can truly make a decision, and not just agree to what could be a life-changing choice.

either your or your provider’s convenience. Examples might be scheduling induction when your mom is in town or when your provider is on call. Elective inductions bring short-term and lifelong risks for you and your baby. Experts agree that an elective induction should never occur before 39 weeks because your due date is just an estimate. Inducing before 39 weeks could put baby at risk for problems of being born early (premature). But even after 39 weeks, if your body isn’t ready for labor, you still have an increased risk for a cesarean when labor is induced. Women who undergo induction lose the benefits of their body’s natural hormones preparing them and their baby for labor.

 Excessive bleeding

(hemorrhage)

 Infection  Delays starting

breastfeeding after birth

 Longer recovery  Problems with the

placenta in future pregnancies, which increases with each pregnancy if a woman has repeat cesareans

 Life-threatening

hemorrhage during future pregnancies if these placental problems occur

CATHERINE RUHL , CNM, MS, is a certified nurse midwife, and Director of Women’s Health Programs at AWHONN in Washington, DC.

LEARN THE BISHOP’S SCORE One way your healthcare provider can know how ready your body may be to labor is the Bishop’s Score. It’s the sum of 5 factors that show how “ripe” or “ready” your cervix is for labor.

   

0cm = 0 pts 1-2cm = 1 pt 3-4cm = 2 pts > 5cm = 3 pts

Score of:

0–5

Effacement How much is the cervix thinned out on the edges? (0-3 pts)

   

0-30% = 0 pts 31-50% = 1 pt 51-80% = 2 pts > 80% = 3 pts

Not ready; a much higher chance of a failed induction and cesarean

Fetal station How low is baby’s head in the pelvis? (0-3 pts)

   

-3cm = 0 pts -2cm = 1 pt -1cm, 0cm = 2 pts +1cm, +2cm = 3 pts

Score of:

6–8

Position of the cervix How far back is the cervix? (0-2 pts)

  

Posterior = 0 pts Middle = 1 pt Anterior = 2 pts

Borderline ready; increased risk for cesarean

Consistency How soft is the cervix? (0-2 pts)

  

Score of:

Firm = 0 pts Average = 1pt Sof t = 2 pts

9–13

Ready

IMAGES © ISTOCKPHOTO

1 Dilation How open is the cervix? (0-3 pts)

health4mom.org

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Nobody likes to be rushed, especially babies. Your baby needs at least a full 40 weeks of pregnancy to grow and develop. Inducing labor even a week or two early is associated with a host of risks, including prematurity, cesarean surgery, hemorrhage and infection. While it may seem convenient for you or your health care provider, labor should only be induced for medical reasons. Your baby will let you know when sheâ&#x20AC;&#x2122;s ready to come out, so give her all the time she needs: at least the full 40 weeks.

Download a free copy of

40 Reasons to Go the Full 40 at www.gothefull40.com. Now in English and Spanish.

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

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

Advocacy D E P ARTM E NT

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healthy pregnancy

ď &#x; Fashion Designer

Liz Lange Pioneers Pregnancy Style

Oh, So Very

! s u o i c i l a p Bum C KE Y, M LS N DAV IS CO BY C A RO LY

health4mom.org

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healthy pregnancy

Dressing the bump has never been easier, but that wasn’t the case when you first started. How did you become the progenitor of pregnancy style? When I started in 1997, my idea that pregnancy clothing could look, feel and fit just like regular clothing was revolutionary, groundbreaking. Why did pregnancy clothing needed to be so oversized; why did it always include some kind of big belly pouch? I started with a line of very simple, fitted clothing in stretchy fabrics that looked like regular clothing. It took off beyond my wildest expectations. When I started, no one cared what pregnant celebrities were wearing; that’s hard to imagine today when you can’t open a magazine without a bump watch. I started dressing pregnant celebrities and customers one at a time, personally making clothes to order for them. I ultimately landed the very, very big partnership with Target, where I became their exclusive maternity designer.

IMAGES COURTESY OF LIZ L ANGE

What brought the huge shift in society’s attitude toward pregnancy fashion? Celebrities really led the charge by being proud about the way they looked when pregnant. People have veracious appetites for celebrity. As the clothing got better, the press became more interested in it. Women also got to the point where they were not going to take it anymore. 9 months is a very long time—more than 2 seasons of clothing. Some women can’t afford to take 9 months off anything and not look good.

Style-wise, do we dress differently when pregnant? We get insecure dressing the bump. It’s something I’ve always fought against, but there’s this general

misimpression that you might look thinner if you cover your pregnant body by wearing something oversized. I’ve worked hard with customers to show them that it’s actually quite the opposite. If you wear something fitted, people can see that you are pregnant, and they see where you have some new curves. Ultimately, fitted clothes are more slimming, more flattering. In today’s market, you can find every single item you would ever want to wear in maternity, from jeans to office and formal wear.

What are we doing right with pregnancy style? Women are embracing their own personal style and mixing maternity clothing that they like with something that’s already in their closet. From where I am, I see a parade of chic pregnant women; it’s really fantastic.

We know Liz Lange as the founder and president of Liz Lange Maternity. But this talented designer is also a fashion and retail pioneer, wife to Jeffrey Lange, mother of Gus and Alice (pictured above), and a cervical cancer survivor.

You’re the only maternity clothing designer in the Council of Fashion Designers of America. Will we ever have a maternity-focused Project Runway or Fashion Week? Project Runway did a maternity challenge when Nina Garcia was pregnant. So, yes, particularly because celebrities embrace pregnancy. They invite us into their homes to see their nurseries, and to see what they’re dressing themselves in. When you think of the excitement we have had over the two pregnant “Ks”—Kim Kardashian and Kate Middleton—and what they were wearing, there’s no shortage of coverage or interest in sight.

CAROLYN DAVIS COCKEY, MLS, is editor

of Healthy Mom&Baby and director of publications for AWHONN. Follow her Momalogues blog at Health4Mom.org.

ISSUE 12 / Fall 2013 Healthy Mom&Baby

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30/10/2013 11:26

Many New Moms Experience Occasional Constipation After Delivery

aving a new baby is an exciting and life-changing event. You’ve read the books, taken the classes and talked with other new moms. Of all the advice offered to pregnant women and new moms, there’s one piece of information that too often goes unmentioned, and that is you might experience occasional constipation. Many new moms I care for don’t realize that they may suffer from occasional constipation or digestive problems sometime after delivery. A recent survey of new moms revealed that 61% did not anticipate experiencing occasional constipation after childbirth. This survey of 501 new mothers was conducted in November 2012 by Russell Research in collaboration with Colace® Capsules, a stool softener in the Purdue Products L.P., line of laxatives. Constipation and difficulty going to the bathroom are common after childbirth, and moms should not be embarrassed to discuss it with their doctor. As a registered nurse, I see plenty of new moms dealing with post-childbirth constipation.

The key is eating healthy foods, drinking sufficient amounts of water and trying to get a little exercise. Here are some tips I share with new moms post-delivery: • Drink up. Water is vitally important but sometimes overlooked. Adequate hydration helps prevent constipation and is key if breastfeeding.

• Eat nutrient rich foods. A healthy diet can help healing and boost energy that you need to care for yourself and your newborn.

• Add fiber to your diet. Increase fiber in your diet, by eating fresh fruit, vegetables, legumes and whole grains.

Start the day with a high fiber, whole grain cereal and fruit, consume a vegetable or fruit with lunch and dinner and snack on fresh veggies throughout the day.

• Get Some Exercise. Listen to your body, but get moving. Build up activity slowly and talk to your doctor before initiating a rigorous exercise plan.

As a mom, I know how challenging it can be to make time to exercise and to maintain a balanced diet, which are both important in helping to avoid occasional constipation. So when new moms discuss occasional constipation with me, I recommend what my doctor recommended for me, Colace® Capsules. Colace is the #1 stool softener brand recommended by doctors and pharmacists. If pregnant or breastfeeding, you should always ask a healthcare professional before use and only use as directed. Linda Ciampa, RN

Log onto www.ColaceCapsules.com for more information on how to relieve occasional constipation, and to find healthy recipes and exercise tips Please read full product label before use. If pregnant or nursing please consult with your doctor before use.

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healthy pregnancy

Steps to Avoid

Constipation in Pregnancy By AWHONN Editorial Staff

If everything seems to be slowing down in pregnancy, including your bowel movements, you’re not alone. Most pregnant women experience constipation at some point in pregnancy. Several factors work against your keeping regular during this time, including the fact that each day baby is getting bigger, leaving less room for your bowels to work. Other culprits keeping you less than regular include the hormone progesterone, which is dominating your body right now, relaxing your smooth muscle tissue, and slowing down your digestive tract overall. Iron, whether in your prenatal vitamin or if you’ve been asked to take supplements, can also add to constipation. Constipation is rarely serious in pregnancy but call your healthcare provider if you have constipation with mucous or blood, with diarrhea, or sudden abdominal pain.

n is a in tipatio Cons problem on fully comm c y. Thank u an yo p r e g n a r e w ay s o u t there age it with r an can m ming you o ha r y. b a b yo u r

Fill up on fiber

Act on the urge

Now is the time to fill up on fiber-rich foods each day, such as beans, nuts, seeds and fiberenriched breads and cereals. Of course, fruits and veggies are some of your best fiber-rich choices as they have the added bonus of being rich in water too.

2. Listen to your body and go when you first feel that urge. Your bowels are more active after you eat, so try to gently go after each meal. Straining or pushing too hard to pass a bowel movement can inflame hemorrhoids, which are swollen veins in your rectal area. Never delay trying to go when you get the urge as that could actually make things worse.

Liquefy your diet

5. Ask about fiber supplements or stool softeners Be sure to drink at least 6-8 glasses of water each day, and other non-caffeinated beverages. Prune juice can help soften your stool and get things moving. If you don’t like its taste, mix it with another fruit juice or hide it in a smoothie. Try a mug of something warm first thing in the morning, like juice or herbal tea, to help get your system moving.

images © 123RF; ISTOCKPHOTO

Keep moving

Gravity is your friend when it comes to regular bowel movements. Gravity plus activity. Take a brisk walk or prenatal aerobics class regularly to help your bowels continue to push stool through.

Most experts recommend if you’ve tried steps 1-4 and still haven’t had a bowel movement in 3 or more days, talk to your healthcare provider about whether you should use fiber supplements or take a stool softener. But avoid laxatives as they can dehydrate you. Most softeners are considered safe in pregnancy and can help moisten your stool so that it’s easier to pass. If your pregnancy care provider gives the OK on the fiber or stool softener, follow their directions specifically for use.

ISSUE 12 / Fall 2013 Healthy Mom&Baby

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healthy pregnancy

Baby Spacing

By Helen Hurst, DNP, RNC, APRN-CNM

When is the right time for another baby? Although your body is designed to have babies, pregnancy is a major system stressor. Balance your desire to grow your family with your body’s need to recover from each pregnancy and the time spent breastfeeding. Your body needs time to rebuild its nutritional stores, especially iron and folate. And if you’re already dealing with a chronic health issue, like high blood pressure or high blood sugar, spacing your pregnancies is considered essential both for your health and the health of your next pregnancy and baby.

Tak older e a break— k self-su ids are mo can b fficient andre e with t a big help he bab y.

(

Give your body a much-needed break bet ween pregnancies— here’s why

)

Set the Clock Generally, experts agree that 18–24 months seems to be a good buffer—allowing you time to nurse your baby at least 12 months or more, and to prepare for your next pregnancy. Some studies show that moms who become pregnant within a year of a previous birth have a greater chance of complications such as placenta previa (where part, or all, of the placenta covers the cervix) or placental abruption (where part, or all, of the placenta separates from the uterus). Adequate spacing between babies also reduces your future baby’s risks of being born at low birth weight or being small for its gestational age—as well as being born premature. In fact, researchers in the Journal of the American Medical Association found that babies conceived within 6 months of mom giving birth face major health risks and are 61% more likely to be born with low birth weight and 40% more likely to be born early. Those risks drop when mom waits 18+ months to conceive again. Talk to your healthcare provider about birth control before leaving the hospital.

Pl an Yo ur Pr eg na nc ies Conception planning is about why it’s important to know if—and when—you want to become pregnant: Am I ready for pregnancy? Have I recovered fully from a previous pregnancy knowing it can take many months for my body to rebuild its nutrient stores? Is my body physically and nutritionally ready to gestate a baby? Are we ready for pregnancy? What about my partner, are we ready for a pregnancy? How would a pregnancy affect our relationship? Our couple time? Family interactions? Are there toddlers or young siblings to consider—and the differences in their ages to discuss?

Helen Hurst, DNP, RNC, APRN-CNM, is an expertadvisor to Healthy Mom&Baby.

image © 123rf

Can we afford another pregnancy? Are we ready for the costs associated with gestating, birthing and caring for another child? Are we ready for the costs of caring for 2 or more children? How will more children affect our jobs or careers both now and as our family evolves?

health4mom.org

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U can, U plan, U succeed with Uconceive Today in the United States more and more couples are having difficulties getting pregnant. They find themselves faced with the dilemma of “just keep trying’’ or proceeding with a fertility evaluation that may cost several thousands of dollars. Often times, this evaluation finds no significant problems. Money wasted? If a problem is found, assisted reproductive techniques will cost several more thousands of dollars; again with no guarantee of getting pregnant! Uconceive was developed by a board certified fertility specialist with these couples in mind. Simply stated, it is the easiest and most effective way to naturally increase your chances of getting pregnant. Uconceive is a complete conception kit with an integrated program that addresses the multiple aspects of the conception process. Included in the kit is an easy to follow instruction manual that guides you through the process. Ovulation predictors (5 of them!) are included so that the upcoming ovulation of the egg can be detected. A very sensitive basal body temperature thermometer is included along with the Uconceive BBT chart to confirm that ovulation has occurred. Highly specific male and female conception supplements are also provided. The female’s supplements are divided into two separate formulations. The first formula specifically addresses the first half of the ovulation cycle - the follicular phase. A second formula is used during the second half of the cycle - the luteal phase. This formula also contains all the essential elements of a prenatal vitamin, so doubling up on pills is unnecessary. Uconceive is doctor-developed and is based upon medical science and studies conducted from around the world. It has been created to be both safe and effective. If you want to have a baby and you want to get pregnant now, then you want Uconceive.

a couples conception kit

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Slow ! down Don’t rush me!

Relax.

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

f 40 or !

What’s the hurry?

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

Download a free copy of

40 Reasons to Go the Full 40 at www.gothefull40.com. Now in English and Spanish.

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

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

Advocacy D E P ARTM E NT

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healthy

Babies

Join us on Facebook facebook.com/HealthyMomAndBaby

SHAKE THE SALT OUT OF YOUR KIDS’ DIETS BY SUMMER HUNT

Big Offenders: Sandwiches Breads & rolls Poultry Cold cuts & cured meats Pizza

 Prepackaged nibbles are great for moms on the go, but these salty snacks could leave a sour taste. The CDC says more than 70% of popular toddler eats exceed 210mg of sodium per serving— with some as high as 630mg per serving. That’s more than 40% of the daily-recommended 1,500mg of salt for the short set. Use these smart strategies to make healthy eating quick and easy: Shop smart—Select fresh fruits and veggies; opt for no-saltadded frozen varieties. Plan ahead—Keep cut-up celery, carrots, and bell peppers on hand. Start early—A nutritious diet now may prevent high blood pressure later.

BIRTH TRENDS

51% Boys

Boys account for 51% of births in the U.S.—but the overall population is 51% female.

51% Girls

IMAGES © 123RF; SAFE T Y TAT

By 2018, minorities will comprise at least half of everyone aged 18 and younger, creating our most diverse population ever.

More babies are born in September than any other month, followed by August and June.

( BABY’S FIRST TEMPORARY TATTOO) Nearly every state has laws against tattooing minors— especially infants and toddlers—but a temporary

tattoo may just keep your toddler safe while out and

about. Easy-to-apply temporary tattoos from companies like SafetyTat and My Precious Kid feature phone numbers, food allergies, and more. Keep your kiddo armed with necessary information in case of separation or food issues; they scrub off when they’re no longer needed.

ISSUE 12 / Fall 2013 Healthy Mom&Baby

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30/10/2013 12:39

PROTECT YOUR BABY’S EYES. Did You Know That One in 10 American Children Has Undiagnosed Vision Problems?

If undetected, vision problems can lead to permanent visual impairment, developmental delays, and in rare cases, life-threatening health risks. InfantSEE®, an ongoing public health program developed by Optometry Cares® - The AOA Foundation and Vistakon, Johnson & Johnson Vision Care, Inc., was designed to provide professional eye care for infants nationwide at no-cost, regardless of family income or number of eligible children. If your infant is 6 – 12 months old, schedule a comprehensive eye assessment today! To find an optometrist in your area, please visit www.infantsee.org.

American Optometric Association | 243 N. Lindbergh Blvd. | St. Louis, MO 63141 | 888-396-EYES (3937)

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healthy babies

BY AWHONN EDITORIAL STAFF

Do You See What I See?

(

)

VISION ASSESSMENT IS AN ESSENTIAL INFANT HEALTH CHECK

While most parents can reasonably expect that their infant or toddler gets an overall health screen each time they go for a well-child check, there’s one important assessment that no child should miss because it’s free and can save your child from both vision and learning difficulties down the road. A free InfantSEE® eye exam between the ages of 6 and 12 months is available in every state, yet

only 13% of all new parents take advantage of this public health vision program in baby’s fi rst year. 1 in 10 babies will have vision problems by the time they’re preschoolers, and if caught and corrected early, many common eye problems can be fi xed. Find an InfantSEE® care provider for your baby’s free vision assessment during his fi rst year at InfantSEE.org.

YOUR BABY’S DEVELOPING VISION

BY 2 MONTHS

BY 4 MONTHS

IMAGES © 123RF; ISTOCKPHOTO

BY 6 MONTHS Idealor time fy’s bab n v i s io . e xam

Sees objects about 12” away Sees moving objects Reaches for objects

 Help baby develop bilateral and binocular

Eye movement and body coordination skills develop Both eyes should focus equally

 Use a nightlight in baby’s room  Move the crib around the room, and your

vision by moving both sides of your baby’s body at once, such as moving her arms or legs at the same time. You probably already play this way with baby.

baby’s sleeping position in it regularly

 Talk to baby as you walk around her  Alternate feeding her from her right or

left side  Hang a mobile above and outside of her crib  Keep toys within reach (8”-12”) when playing with her

Continued eye-body coordination skills development Eye contact starts to replace physical contact

 Encourage baby to crawl

Uses both eyes to judge distances

 Help baby play with stacking and

BY 8-12 MONTHS

and explore

 Play “patty cake” and “peek-a-

boo” with your baby

take-apart toys  Give baby toys to touch, hold, and manipulate

WATCH FOR S VISION PROBLEM About 1 in 10 preschoolers have vision problems, according to the American Public Health Association, but your preschooler doesn’t know the difference. Watch for these signs that may warrant a needed eye exam:  Squinting  Tilting their head  One or both of the

eyes turning in or out

 Sensitivity to light  Short attention span

for the child’s age

 Sitting close to toys,

holding a book too close, or sitting close to the TV

 Frequently rubbing

their eyes

 Difficulty with

eye-hand-body coordination when playing

 Avoiding any

detailed activities, like stacking blocks, coloring or puzzles

Source: American Optometric Association

ISSUE 12 / Fall 2013 Healthy Mom&Baby

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30/10/2013 12:51

Many New Moms Experience Occasional Constipation After Delivery

• Eat nutrient rich foods. A healthy diet can help healing and boost energy that you need to care for yourself and your newborn.

• Add fiber to your diet. Increase fiber in your diet, by eating fresh fruit, vegetables, legumes and whole grains.

Start the day with a high fiber, whole grain cereal and fruit, consume a vegetable or fruit with lunch and dinner and snack on fresh veggies throughout the day.

• Get Some Exercise. Listen to your body, but get moving. Build up activity slowly and talk to your doctor before initiating a rigorous exercise plan.

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healthy babies

(

COULD YOUR GURGLING, BUBBLING FUSSY EATER HAVE INFANT REFLUX?

)

Burping! Spitting! Oh My! BY MARIA OPLT

It’s a good thing you received all those adorable homemade burp cloths at your baby shower because your bouncing boy seems to do nothing but spit up!

Prevent Reflux in Babies Your baby’s healthcare provider will likely recommend you try these lifestyle changes to help baby battle the burn:

 Avoid spicy foods and “gassy” veggies (cauliflower, broccoli, asparagus, and Brussels sprouts) while you’re nursing. IMAGES © 123RF; ISTOCKPHOTO

 Hold baby more upright

when nursing/bottle feeding breastmilk, and keep baby upright for at least 30 minutes after each meal.

 Avoid breastfeeding while laying down tummy-to-tummy if baby has reflux.  Always burp your baby at

regular intervals, even after a short feeding, and especially during those long nighttime feedings.

It’s no joke, babies seem to output just as much as they intake. They may cover you and poor unsuspecting visitors in ooey, gooey milk vomit for a number of reasons; most of the time, however, it’s harmless and unavoidable. Infant acid reflux happens when your baby’s stomach contents are forced upwards into the esophagus and mouth—similar to symptoms you yourself may feel after a spicy pepperoni-and-onion pizza. It’s more common in younger infants and usually resolves on its own by 18 months, say experts at the Mayo Clinic. WHEN IT’S REFLUX

Your baby may have reflux if he cries or squirms while eating, has lots of vomiting, and chokes or coughs, especially while feeding. Baby may struggle to eat or even refuse because it’s just too uncomfortable—even painful. Some babies may even gag from the discomfort. Sounds a bit terrifying, right? Not to worry! Reflux in babies is quite common, and after checking with your baby’s healthcare provider, there are many things you can do to get your little one through this stage. Baby may be given a prescription or OTC medication if lifestyle modifications don’t ease his upset tummy.

WHEN REFLUX IS MORE SERIOUS Infant reflux can develop into the more serious gastroesophageal reflux disease (GERD), in which the reflux includes stomach acid that can damage the lining of baby’s esophagus. Talk to your baby’s provider if he:  Is age 6 months+

when symptoms begin

 Isn’t gaining weight

regularly

 Projects his

stomach contents out of his mouth

 Vomits green or

yellow fluids, or what looks like brownish coffee grounds

 Refuses to eat  Has blood in

his stool

 Struggles to

breathe during or after eating

MARIA OPLT, is a mom and advisor to Healthy Mom&Baby.

ISSUE 12 / Fall 2013 Healthy Mom&Baby

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30/10/2013 12:52

healthy babies

Ear Infection?

Does my baby have an

By Lynn L’Hote

How would you know if your baby develops an ear infection, what experts call otitis media? 2 out of 3 kiddos will have at least 1 before they’re 2 years old.

Three distinct parts make up your baby’s ear, with the thin eardrum between the outer and middle ear:

� � �

Outer ear canal Middle ear, where infections can develop Inner ear, where baby’s center of balance is

E a r In fe c t io

n Ri s k s

Ea r In fe ct io n

Your baby may be more prone to ear infections if your baby:

Ear infections can be particularly painful. Your baby may be developing or have an ear infection if you see any of these signs:

� � � �

Drainage from her ear Fever of 100.4+ Fussiness or crying during feedings Wakes at night, especially after a cold

�

Has had a recent cold or respiratory infection

�

Is around smokers or secondhand smoke

� � �

Uses a pacifier

� �

Was born premature Is a boy—male infants get more ear infections Attends a group daycare Has a family history of ear infections

After a cold or respiratory infection, middle ear infections can sometimes develop. Since your baby can’t really tell you what hurts, it’s up to you to play detective. Ear infections can be viral or bacterial, and infants are more likely to develop them because of how their ear is structured. Your baby’s Eustachian tube connects her middle ear to the back of her nose, and helps drain fluid. Because it’s small and lies more flat than angled, fluid may not drain well, allowing bacteria to grow. Is it an ear infection? Only her healthcare provider can look into her ears and make an accurate diagnosis. You can help relieve ear pain by applying a warm compress to the affected ear and giving her an infantspecific pain reliever like acetaminophen (Tylenol) or ibuprofen (Advil) for comfort. Ask your provider for the infant dosing chart since these OTC pain relievers are dosed by weight and age. Your care provider may recommend a “watch and wait” approach if symptoms are mild as 80% of cases will get better on their own. But if your baby is 6 months old or younger, antibiotics should be used to prevent a more serious infection. If your baby is younger than age 2, the AAP recommends treating diagnoses of otitis media with antibiotics to prevent a developing infection from worsening. Amoxicillin is usually the first antibiotic of choice unless your baby is allergic to penicillin. Annual flu shots can also help prevent illness that can lead to ear infections and are recommended. Lynn L’Hote , is a nurse in Louisiana.

images © 123RF

Your Baby’s Ear

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healthy babies

Baby’s Essential 6

Shop with safety in mind for baby’s top gear.

By AWHONN Editorial Staff

There’s nothing like a positive pregnancy test to get the credit card warmed up and ready for the registry. After all, baby can’t even leave the hospital without being strapped into his first car seat— likely an infant car seat that’s part of a larger travel system to help you tote and roll him around. Then he needs a place to sleep—a crib or bassinet. Co-sleeping is a nono based on the continued piling up of research that shows the increased

risks to baby when sharing a soft, squishy surface with sleepy parents. Bath time will be easier with a tub made just for his little, wiggly body and of course you’ll need a monitor and safety gates once all of that scooting and rolling becomes crawling and walking. With an ever-increasing number of recalls on baby products, though, how can a skeptical parent buy products with both safety and function in mind? We’ve assembled the best advice from leading experts on what we call “Baby’s Essential 6”—the 6 (but not all!)—products you’re likely to need and use the most in baby’s first few years of life. This certainly isn’t all that you should consider but it’s a good healthy start. B a by c s af e a n s lee p ly prop w i t h a f i t te e r cr i b d , a nd ma t t r e sh ss not h ee t , a n d i ng e l se .

b a by Keep cing a f r ea r gh t h rou . + age 2

2 Ca r S e a t

1 C rib o r B a s s in et

Research shows that a crib is the safest place for your baby to sleep. Have baby sleep in a crib in your room during her first year of life to provide bonding, attachment, nursing and nighttime care. If you’re looking for a drop-side crib, you should know that they’ve been banned since 2011. Buy the safest crib possible with these tips from the Consumer Product Safety Commission (CPSC) and Consumer Reports: �Buy a crib—there are no federal standards on other types of infant sleepers; the CPSC released the first federal standards in September 2013 to make bassinets safer �Buy a basic crib with straight rails and finishes, without fancy woodwork or cutouts, which increase baby’s entrapment risks �Buy new—the CPSC greatly revamped crib standards in 2011 and 2012; used cribs are likely to be dangerous cribs by today’s standards �Buy a crib certified by the Juvenile Products Manufacturers Association (JPMA) �Buy a mattress the exact size specified by the manufacturer for the crib purchased; the mattress should fit tightly into the crib �Buy sheets the same way as the mattress; they should fit tightly and tuck evenly down around all sides. Toss the bumpers, pillows and other decorative items that may come with the sheets. The only safe sleep surface for baby is a proper crib, mattress, fitted sheet and nothing else

The biggest change in recent advice is to keep your baby/toddler in a rear-facing car seat for as long as possible. All infants should ride rear-facing for at least 1 year, and now the AAP is recommending through age 2+. Infant car seats are made to be rear-facing but won’t likely fit your child through his or her second birthday. A convertible car seat typically has a heavier weight limit and your child can continue to ride rear-facing as long as his body and weight are appropriate for the seat. The CDC estimates that keeping babies and toddlers rear-facing would eliminate as many as half of infant and toddler deaths in car crashes. Find the right seat and size for your child at safecar.gov. Buy a car seat that: �Fits your child’s appropriate age, weight, height �Fits your car—test it in your car before buying or save the receipt for a return if testing isn’t an option �Passes inspection. Get your installed seat inspected at a certified car seat inspection station; find one near you at www.nhtsa.gov

ISSUE 12 / Fall 2013 Healthy Mom&Baby

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healthy babies

3 Bath Tu b

With so many baby bathtub choices, it’s important to know what to buy—and not to buy. First the “don’ts”: Skip the inflatable tubs, say the CPSC. They’re associated with a significant number of infant deaths and accidents. Also avoid tubs with continuously running sprayers or hoses; your baby could be injured by a sudden change in water temperature or risk drowning in a stream of water. Do look for the following features, says Consumer Reports: A sturdy tub that won’t slip around in your bath tub A sloped inner support for baby, similar in angle to her car seat Foam liners that keep baby from slipping around in the tub Mesh support (not rods) on any slings or hammocks that help hold newborns in the bath tub Stability and non-slip features in portable or flexible tubs meant to be used in the kitchen or other large sinks Storage pockets with drains to keep baby’s toys, cleansers and wash cloth at fingertip reach so that you never leave a baby unattended in a tub for even a moment

r u se N e ve r e u s e r p s ed t moun ith w gate s s . stair

4 Sa fety gate s

r s a re Carrie ered consid han t saf er s . sling

e one er s a r es t Stroll g ig b o f t h e t s pa r e n t s n e m t ou inves ake, so y t c a n m t r u s t t ha to want using one r e ’r u o y p you ill kee . w t a th saf e b a by

5 Ca rrie r o r Sli n g

Front or parent-facing baby carriers are generally considered safer than slings as they don’t have the same suffocation risks of slings when used improperly. Some carriers come with infant inserts to help baby until she can hold her own head up, generally around 6 months. Most experts recommend: Wait until baby is born and then “borrow” a carrier from other parents before you “buy” to determine the best kind of carrier for you and baby Hinges and straps should be away from baby’s hands and legs to avoid pinching or entrapment Wider straps to help distribute the weight load on your body If you opt for a sling, wait until baby is 4 months old to reduce suffocation risks; and have a friend help you when you’re learning to use it according to the manufacturer’s instructions. Slings require ongoing adjustment. Avoid any carrier or sling where baby’s head rests with his chin upon his chest blocking his airway

Stro lle r

Babies can become entrapped, have fingers pinched or cut, or get injured when strollers topple over. For these reasons, the AAP recommends finding the following in any stroller you buy: Wide wheelbase Easy-to-operate brakes, and without a brake release anywhere near baby’s reach Brakes that lock at least 2 wheels are preferred to brakes on 1 wheel Seat that fits baby yet keeps his hands and feet away from wheels A seat belt and harness A single foot rest spanning both seats in side-by-side twin strollers to prevent a baby’s feet from entrapment between single foot rests

N ev leav er u n a t t e b a by e tub— nded in a n f o r a o t e ve n seco nd .

Safety gates are essential even in the first 6 months of baby’s life, and a must-have once baby starts to move around either rolling, scooting or crawling. Experts say it’s generally safer to “gate” a baby out of a room, such as a bathroom, rather than depend on childproofing devices, which can fail or break. To gate off stairs and other hazards, buy baby gates with these features: Certification by the Juvenile Products Manufacturers Association Wall-mounting hardware, instead of pressure mounting. Never use pressure mounted gates at the tops of stairs Straight slats and frame to prevent entanglement. Rails should be tightly fitted into the frame and close enough together to keep arms and legs out, but wide enough to keep fingers free Fine mesh panels rather than wider mesh, which can actually provide toe and finger holds for little climbers Through-bolted hardware out of baby’s reach

health4mom.org

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30/10/2013 11:39

The Go-To Diaper Rash Ointment for Moms-in-the-Know.

The #1 thermometer preferred by pediatricians, accuracy backed by more than 50 published medical studies, more than any other thermometer.

• Helps treat even the most severe diaper rash, often overnight • Fast-acting premium blend of ingredients

 www.facebook.com/HealthyMomAndBaby

Accurate Temperature with a Gentle Forehead Scan.

Temporal Artery Thermometers:

Don’t miss out

• Goes on like a cream. Protects like an ointment.® • Pediatrician developed. • Gentle on baby’s skin

For locations nearest you DoctorSmiths.com

For more information visit: www.exergen.com/usa

055.indd 1

Made in the U.S.A.

30/10/2013 12:45

healthy babies

Conquer

Colic By Christine Wood, MD

One thing most moms can agree on is how challenging it is to have a baby with colic. A common question I get from distraught parents: “Is it colic… or something else?” While colic is most typically identified as inconsolable crying without an obvious reason, sometimes we can identify a cause for colic-like behavior. coUld it be?

try: Some babies are sensitive or allergic to certain foods. There’s a difference in these two problems even though symptoms can look the same. Food sensitivity or intolerance causes gassiness, fussiness, or a change in stools. Examples would be diarrhea, cramping, and bloating because of lactose intolerance. Babies can also be sensitive to foods you eat while nursing, like broccoli, cabbage, onions, beans, garlic, chocolate, caffeine or spicy foods. Skip or eliminate these foods to see if it makes a difference for baby.

Food allergies in breastfed babies

True food allergies may cause symptoms like chronic congestion, hives, eczema, gassiness, fussiness, wheezing, vomiting or diarrhea. If you suspect a food allergy, discuss it with your baby’s healthcare provider.

Overactive let-down reflex

If you’re making more milk than you may need at each feeding, baby may be chugging and gulping, which can make them gassy, or fussy, or even accidentally pull off your breast early. Try nursing just one side per feeding and position baby so she is more upright.

At the end of the day, milk supply can diminish. Try pumping a few ounces after every feeding, especially in the morning, and save for future use, or for a top-off bottle in the evening once breastfeeding is well established (usually after 3 to 4 weeks of nursing). If your baby seems hungry and fussy all day long, have a weight check to make sure he or she is getting enough milk and gaining appropriately.

Formula sensitivities, allergies

Are you feeding baby formula, which may include cow’s milk, soy or both? Babies can react to these ingredients; discuss your suspicions with your provider before changing formula.

This may occur when baby cries a lot or gets air with bottle-feeding. Try burping baby frequently, each time you switch sides and after each feeding.

Christine Wood, MD, is a practicing pediatrician and author of How to Get Kids to Eat Great & Love It.

Low milk supply

Swallowing excess air

Babies can be fussy with feedings, but if your baby is spitting up—a lot—discuss this with your healthcare provider, especially if baby arches her back or cries while feeding. Consider these situations and suggestions the next time you have a seemingly colicky baby in your arms:

health4mom.org

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Give Us Your Opinion

You Could Win a Graco Travel System 

Healthy Mom&Baby wants to know what you think about the magazine, its website, iPad app and more. Please complete our reader survey on the following pages (59-60) and enter our Reader Survey Sweepstakes for a chance to win a Graco FastAction™ Fold Jogger Click Connect™ Travel System and other prizes. SURVEY IS ALSO AVAILABLE ONLINE AT HT TP://BIT.LY/HMBSURVEY

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SWEEPSTAKES RULES The Healthy Mom&Baby Reader Survey Sweepstakes is open to all residents of the United States. Employees of Healthy Mom&Baby/ AWHONN are not eligible. NO PURCHASE IS NECESSARY. The Healthy Mom&Baby survey sweepstakes runs from 10/15/13 to 12/31/13. To enter, contestants must fill out the survey that follows (or complete the survey online at http://bit.ly/hmbsurvey) including their contact information, and return to: Healthy Mom&Baby Reader Survey; c/o AWHONN, 2000 L St., N.W., Suite #740, Washington, DC 20036 by 12/31/13. Entries post-marked after 12/31/13 will not be eligible for the sweepstakes prizes. Drawing to occur on or about 1/15/14 at Healthy Mom&Baby/ AWHONN’s office. All entries become the property of Healthy Mom&Baby/AWHONN. Multiple entries are not permitted. One winner will be awarded a $319 Graco FastAction™ Fold Jogger Click Connect™ Travel System in Chili Red; other prizes may be awarded at Healthy Mom&Baby/AWHONN’s sole discretion. Winners may be required to provide identification and agree to have their name and likeness in part or whole used in association with the sweepstakes outcomes. Winner will be selected from all entries that include complete contact information and received by the deadline in a random drawing under the supervision of the executive office of AWHONN. Winner will be notified by email or telephone. Odds of winning will be determined by the number of entries received. There is no substitution of prizes; winners may not opt or elect for other prizes. The Healthy Mom&Baby Reader Survey Sweepstakes is void where prohibited by law. The name of the winner will be announced at Healthy Mom&Baby/AWHONN’s sole discretion on its website and/or social media.

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3; 2/31/1 1 y b Enter ers will be winn t random a drawn 1/15/14. on

30/10/2013 16:15

Healthy Mom&Baby Reader Survey 

Complete our survey and become eligible to win a $319 Graco FastAction™ Fold Jogger Click Connect™ Travel System in Chili Red, along with other prizes in our sweepstakes drawing. You must complete the survey and enter the sweepstakes as described in the rules by 12/31/13 to be eligible to win. We value your opinion; we promise not to share your name or personal information without your permission. Prize winners will be contacted by Healthy Mom&Baby for permission to share contact information with the prize donors in order to ship the prizes and publish their name as the prize winner. ’s sole discretion on its website and/or social media. The name of the winner(s) will be announced at Healthy Mom&Baby’s

Enter our dr aw ing to W IN a Gr aco Tr av el Sy stem!

You may complete this survey online at http://bit.ly/hmbsurvey or mail this completed form to Healthy Mom&Baby Reader Survey, c/o AWHONN, 2000 L St., NW, Suite 740, Washington, DC, 20036. All entries must be completed or postmarked by 12/31/2013. (See sweepstakes rules on p. 58). 10. Which of the following best describes you? (Select one)  Pregnant with first child  Pregnant, have child(ren)  One child, not pregnant  None of the above

HEALTHY MOM&BABY MAGAZINE

 Planning to one day get pregnant and birth a child  Actively trying to conceive a child  No children, not pregnant  Two or more children, not pregnant

1. How do you get or read Healthy Mom&Baby? (Select all that apply)  Magazine from my healthcare provider/nurse  iPad app/digital download  Health4Mom.org website  Social media (Facebook, Twitter)

 Magazine subscription  Online flipbook at Health4Mom.org  Friend/family member  Other: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. What is your pregnancy status now? (Select one)  Trying to conceive naturally  Trying to conceive with IVF or assisted technologies 2. How do you prefer to get or read Healthy Mom&Baby? (Please rate each)  Pregnant: 1st trimester  Pregnant: 2nd trimester Most Prefer Somewhat Prefer Least Prefer Don’t Prefer/Use  Pregnant: 3rd trimester  Postpartum/after baby’s birth  Doesn’t apply Print magazine

iPad app/digital download Online flipbook at Health4Mom.org

12. When did you first start reading Healthy Mom&Baby? (Select one)

Health4Mom.org website

Subscription Friend/family member Facebook Twitter Pinterest Google+ Other; please describe:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. How much time will you spend with an issue of Healthy Mom&Baby? (Select one)  1-2 hours  2-3 hours  3+ hours

 Less than 60 minutes

4. For how long do you plan to continue to read Healthy Mom&Baby? (Select one)  During pregnancy through birth (up to 1 year+)  Before pregnancy, and through pregnancy & birth (1+ years)  Through baby’s first birthday (1-2+ years)  Through baby’s second birthday (2-3+ years)  Between, during and after each pregnancy (3+ years)  I will read on and off with each pregnancy (1-3+ years)  I will not read going forward 5. How important is it to you that Healthy Mom&Baby: (Rate all that apply) Very Important

Somewhat Important

Neutral/ Don’t know

Not Important

Is written by nurses Gives practical advice Gives advice you can act on Is published by the leading mother/baby nursing organization Covers women’s health Covers pregnancy health Covers infant/toddler health Other: What is most important to you about Healthy Mom&Baby? .......................................................................................................

 Before conception  While trying to conceive  1st trimester  2nd trimester  3rd trimester  Postpartum/after baby’s birth  Doesn’t apply/I don’t know

13. How many children, if any, do you or would you like to have? (Select one) 1 2 3 4  5+  Doesn’t apply/I don’t know 14. In what ways have you heard of or encountered Healthy Mom&Baby’s “Don’t Rush Me . . . Go the Full 40” public health campaign promoting waiting for labor to start on its own and normal birth, and avoiding non-medically indicated interventions in labor and birth when all is healthy? (Select all that apply)

       

I have not seen Go the Full 40  Ads in Healthy Mom&Baby “40 Reasons to Go the Full 40 Weeks” article  Ads at Health4Mom.org Facebook, Twitter or other social media  GoTheFull40.com website “Wait for Spontaneous Labor Pledge” (www.awhonn.org/full40pledge) My nurse or healthcare provider shared the campaign with me My childbirth educator shared the campaign with me I saw a poster about the campaign  I received a handout about the campaign Other:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

INTERACTIVE MEDIA 15. Have you ever visited Healthy Mom&Baby’s website, Health4Mom.org?  Yes  No; if no, skip to question 19 16. When did you first visit Health4Mom.org? (Select one)  Before conception  While trying to conceive  1st trimester  2nd trimester  3rd trimester  Postpartum/after baby’s birth  Don’t remember/I don’t know 17. Why do you visit Health4Mom.org? (Select all that apply)  Expert health advice  Nutrition advice  Information on conceiving  Pregnancy information  Labor and birth advice  Breastfeeding advice  Infant feeding information  Infant care information  Vaccination advice  Circumcision advice  Parenting information  Green/organic living  New products information  Interactive tools (flipbook, app, video)  Beauty and fashion information

6. What other mother/baby/pregnancy magazines do you read? (Select all that apply)  I don’t read other mother/baby/pregnancy magazines  American Baby  Fit Pregnancy  Pregnancy  Pregnancy & Newborn  The Bump 18. Please rate how Healthy Mom&Baby’s Health4Mom.org compares to other  Other(s): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . mother/baby/pregnancy websites: (Rate each as apply) 7. Please rate how Healthy Mom&Baby compares to other mother/baby/ pregnancy magazines: (Rate all that apply) Best

Better Than

Neutral/I don’t know

Not as Good

American Baby Fit Pregnancy Pregnancy Pregnancy & Newborn The Bump Explain:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. How interested are you in each of the following topics: (Please rate each) Interested

Neutral

Not Interested

Best

Better than

Not as good

Don’t read

BabyCenter.com BabyZone.com CafeMom.com FitPregnancy.com Parents.com Pregnancy.com Pnmag.com TheBump.com Explain:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. Have you downloaded Healthy Mom&Baby’s iPad app?  Yes  No

Expert health advice Nutrition advice Information on conceiving Pregnancy information Labor and birth advice Breastfeeding advice Infant feeding information Infant care information Vaccination advice Circumcision advice Parenting information Beauty and fashion information Green/organic living Interactive tools (flipbook, app, video) New products information Other; please describe:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

HEALTH & FITNESS 20. Has anything you’ve read or seen in Healthy Mom&Baby or Health4Mom.org helped you to make a healthy change or better choice for you or baby? (Select one)  Yes; please describe: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ........................................................................................................  No; why not? Please describe: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ........................................................................................................ What is needed in Healthy Mom&Baby to help with healthier choices/changes? . . . . . . . ......................................................................................................... ......................................................................................................... What is missing from Healthy Mom&Baby to help with healthier choices/changes? . . . ........................................................................................................ .........................................................................................................

9. After reading Healthy Mom&Baby, what do you do with it? (Select all that apply)  Save all or most of my issues  Act on products advertised  Act on health advice or information  Act on discount or promo codes  Share my issues with other expectant moms, or moms with children

Hospital Birthing center Home

21. Where have you or do you prefer to birth? (Rate all that apply) Have birthed

Will birth

Prefer to birth

ISSUE 12 / Fall 2013 Healthy Mom&Baby

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22. Please share whether you use or plan to use prenatal nutrition supplements: (Select one for each) Yes

Prior to conceiving During pregnancy Postpartum/after baby’s birth 23. Before or between pregnancies, or after you’ve completed your family, do you plan to use any of the following birth control methods: (Select all that apply)  Pills  Patch  Vaginal ring  IUD  Diaphragm  Condom  I prefer to not use birth control  Other: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24. After pregnancy, what are your health & fitness concerns: (Please rate each) Greatest Concern

Somewhat Concerned

Least Concern

Not Concerned

Proper recovery for my body Losing the weight gained in pregnancy Becoming more active/fit Eating healthfully Getting adequate sleep Managing my moods/emotions Managing stress Breastfeeding baby Feeding baby Transitioning baby to solid foods Avoiding another pregnancy right away Resuming sexual relations with my partner Balancing family while resuming my job Other:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PERSONAL CARE 25. Do/did you switch brands on any of the following beauty or skincare products during pregnancy? (Select all that apply)  Cleansers  Body/hand lotion  Cosmetics/makeup  Moisturizers  Hair products  Sun care/sunscreen  Other:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ABOUT YOU 33. Are you: (Select one)  Female  Male

26. How important are natural/organic products to you? (Select one)  Somewhat important  Not important

 Very important

INFANT CARE 27. Did you or do you plan to breastfeed your baby? (Select one)  Yes, I did: For <3 months | 3-6 months | 6-9 months | 9-12 months |  Yes, I plan to start breastfeeding post birth  No, I have health complications preventing breastfeeding  No, I plan to feed baby artificial infant nutrition (formula)  Unsure/Undecided

12 months+

Private cord blood bank

Public cord blood bank

Somewhat Likely

Not Likely

Doesn’t apply

34. Into which group does your age fall?  <18  18-24  25-34  35-39  40+

35. How many children ages 18 or younger live with you now? (Select one)  1  2  3  4  5+  None (Check all that apply)

 Newborn to 6 months  6-12 years

29. Did you or do you plan to bank your baby’s cord blood or placenta? (Select one)

 No; please select why:

Very Likely

36. Of the children who live with you now, into which groups do their ages fall?

28. Do you plan to vaccinate your infant? (Select one)  Yes, we do/will vaccinate according to current schedules  Yes, we do/will vaccinate but on a modified schedule  No; please explain: Don’t believe in vaccinations’ protective effects Think vaccinations could cause problems Other: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  Yes; please select how:

Over-the-counter medicines: Pain relief Teething Colic/gas Baby clothing: Onesies, sleepers Sleep sacks Swaddling wraps Baby gear: Crib Bassinet Changing table Mattress/bedding Diaper disposal system Humidifier Baby monitor Car seat/booster seat More than one car/booster seat Car seat/stroller system Stroller Sling/wrap carrier Backpack carrier Front-facing carrier Activity center/mat Bouncy chair/seat Swing Play yard High chair Safety gates/child-proofing items Books/music Toys/electronics Videos/DVDs

Unsure

Too expensive Ongoing maintenance costs Don’t believe cord blood products can be used as therapies Don’t know enough about cord blood banking

 7-11 months  13+ years

 1-2 years

 3-5 years

37. What types of media/devices do you use/prefer for gaining health information? (Select and rate all that apply) Most prefer

         

Somewhat prefer

Don’t prefer

Doesn’t Apply/Don’t know

Print magazines Websites Printed books eBooks Tablet Laptop/Computer SmartPhone/iPhone Text message Apps Other: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

38. What social media sites do you use/prefer? (Select and rate all that apply) 30. Where did/will baby primarily sleep after birth? (Select one) Most prefer Somewhat prefer Don’t prefer Doesn’t Apply/Don’t know  In a crib/bassinet in baby’s room  Other:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  Facebook  Twitter  Google+ 31. Please rate your concerns as a parent from greatest to least regarding the  Pinterest following infant care practices: (Please rate each)  Other: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Greatest Somewhat Least Not  In a crib/bassinet in my room  In my bed (co-sleeping)

Bathing baby properly Caring for baby’s skin Dressing baby appropriately Treating skin issues like diaper rash or cradle cap Sun protection for baby Caring for baby’s gums and teeth Feeding baby Playing with baby Day-to-day infant care

Concern

Concerned

Concern

Concerned

40. What is your employment status? (Select one)  Employed  On maternity leave

 Not employed

41. What is your current annual household income before taxes? (Select one)  Less than $35,000  $35,001-$49,999  $50,000-$74,999  $75,000-$99,999  $100,000-$149,999  $150,000-$199,999  $200,000+

GO SHOPPING 32. How likely you are to buy/register for the following products: (Please rate each) Baby care: Diaper rash creams/ointments Diapers Wipes Cleansers Shampoos Feeding baby: Breast pump/nursing supplies Nursing cover/wrap Breastmilk storage supplies Breastmilk warmer Bottles/sippy cups Bottle sterilizer Infant formula Age-related baby foods Organic baby foods

39. What is the highest level of education you have completed to date? (Select one)  Some high school  High school  Some college  College  Post-grad

Very Likely

Somewhat Likely

Not Likely

42. What is your ethnicity? (Select one)  White/Caucasian  Black/African American  Native American  Prefer not to answer

 Hispanic/Spanish  Asian  Other: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Doesn’t apply

ENTER OUR DRAWING: Complete this section to enter our drawing. All completed surveys that include the following completed information and that are received by 12/31/13 will be entered into our drawing. Winners will be notified on or about 1/15/2014; prizes will be shipped to winners by the donor. (See sweepstakes rules p. 58).

Name:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Address:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . City:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . State:. . . . . . . . . . . . . Zip:. . . . . . . . . . . . . . . . . . . . Email:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Telephone:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

health4mom.org

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Llama Llama is back again in this new title Llama Llama and the Bully Goat. Perfect for tots starting preschool, this fantastic introduction to playing nice, getting along, and being a good friend has all of the hallmark charm of the other Llama titles.

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ISSUE 5 - Summer 2011 Healthy Mom&Baby

31/10/2013 10:00

healthy babies

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Baby loves you both, even though you’re different

Mom

Dad By Pat Sheans, MSN, NNP

In case you haven’t noticed, moms and dads definitely parent differently. But guess what? Each of you has unique, positive qualities that baby needs. Since babies can’t understand words, they learn about the world around them by watching the expressions on their caregiver’s face and by listening to the tone of their voice. Both parents nurture, and both are important to their child’s emotional development. Do moms parent more? Even with more co-parenting and stayat-home dads, research has consistently found that moms still spend 2 to 3 times as much time with the kiddos as dads do— even when mom works full time. Kids with dad at home benefit because shared parenting increases. Moms tend to spend more time with them on a day-today basis than working dads do, stepping in to her primary parent role soon after she gets home from work. Moms also take more overall responsibility for their kids’ care, and when they’re parenting, they’re more likely to spend time alone with children, and also spend more time multi-tasking. Mom is also more likely to chauffeur baby to play dates.

Dads tend to be more phys ical with their baby while moms are more likely to bo nd with af fectionate touch.

Do dads play more? Brilliant bonding Dads are more likely to spend their That magical brain chemical oxytocin parenting time playing than any other (sometimes called the love hormone) is kinds of caring. Dads excel at physical play, the glue of parenting and bonding. Moms handling their baby, tossing the baby in the and dads both have it in their brains, and air, and other rough and tumble activities. it increases when they touch their baby. Dads tend to play longer with baby Birth, breastfeeding, and affectionate sons, and are more physical with boys than contact also increase oxytocin in moms. with girls. Dads try to surprise their babies Being physical and being active, such as with new games and activities, leading to with exploration or adventure play, increase more excitement, more laughter, and more oxytocin in dads. So the effect is similar, tears than when babies play with mom. but the cause is slightly different: Moms Moms are more likely to play with their make more of it when they affectionately baby using objects and toys, and moms pay touch their baby, and dads make more of more attention to changes in their baby’s it when they are physical with their baby. face, and whether baby is looking around. Either way, baby loves you both. Dads react to smiling less often than moms, Pat Sheans, MSN, NNP, is an expert advisor to and dads tend to talk to their baby more, Healthy Mom&Baby with Legacy Health System in while moms tend to touch baby more. Portland, OR.

health4mom.org

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