Healthy Mom&Baby: Issue 13 by Healthy Mom&Baby

ISSUE 13 / Spring 2014 | $3.95 | health4mom.org

PREGNANCY | BIRTH | PARENTING

CHRIST Y TURLINGTON BURNS Makes Every Mother Count BUMPTASTIC BODIES Jade Beall on Real Women BREASTFEEDING PREP

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Find your fertility page 16

Swelling in Pregnancy

Increased fluid, blood pumps up the volume in your body

Issue 13 / Spring 2014

( CONTENTS )

Preparing for Breastfeeding

Get ready for breastfeeding with these strategies

46 Beginning Breastfeeding: Your Questions Answered First-time mom? Find your breastfeeding

healthy moms

healthy pregnancy

7 Ways to be a Better Patient Proven strategies to build a strong

And Baby Makes Three!

You’ve Got Healthcare

Here’s how to gain it and use it

Keep Your Heart Young

Drs Roizen and Oz spotlight the #1 killer of women: heart disease

Find Your Fertility

Outsmart infertility with these top tech tools

48 Group B Strep in Pregnancy: You Ask, We Answer

Creative ways to let the world know you’re

About 1 in 5 pregnant women have GBS near the

expecting

time of birth

Baby shower favorites for moms and babies on

49 Labor Longer to Avoid Cesarean

the move

Avoid cesarean unless it’s medically necessary

partnership that brings better health

concerns answered

Showering Moms and Babies

CrossFit During Pregnancy

Sara Haley modifies moves for mamas-to-be

The Beautiful {Pregnant} Body Project

healthy babies 53

Seeing My Son Through Childhood Diabetes

Dr. Maitland DeLand shares her story

Photographer Jade Beall wants women to accept their bodies

Assisted Reproductive Technologies

Select the right products for your baby’s skin

Single embryo transfer driving in vitro

These nutritious foods are perfect for you and

fertility treatment trends

your growing baby

Powerhouse Pregnancy

Christy Turlington Burns Makes Every Mother Count From pregnancy survival to fitness, this A-lister’s Every Mother Counts models change for women and babies

6 Strategies for Newborn Skin Care Products

Colds V. Allergies

Could your little one’s sneezes be an allergy instead of a cold?

Newborn Screening

A first step in keeping your baby healthy

ABCs of Safe Infant Sleep

Practicing the ABCs of safe sleep gives peace of mind

Taming Toddler Tantrums

They’re never convenient and you can help your child avoid them

Could it be an allergy instead of a cold? page 58

FEATURE

ISSUE 13 / Spring 2014 Healthy Mom&Baby

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HEALTHY MOM&BABY EXPERT ADVISORY BOARD CANDACE ANN CAMPBELL, DNP, RN, CNL University of San Francisco Concord, CA 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

IMAGES © 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.

Avoid Unnecessary Cesarean:

Go The Full 40™ For Baby

It’s hard to miss the recent news from the two leading medical societies in the U.S. advising healthcare providers that women should labor longer, and be allowed to push longer, when all is going well. This is especially important for first-time moms because having a cesarean birth, unless medically needed, with your first birth greatly increases the chance that your next birth will also be by cesarean. Cesarean birth can be life-saving but cesarean and its risks should be avoided unless it’s medically needed. Their advice seeks to reduce our runaway cesarean rate, which has increased 60% since 1996—without health improvements for moms or babies. It is a fact that 1 in 3 births in this country are by cesarean. In addition to rushing labor or setting a time limit for pushing, cesarean birth may also result from trying to induce labor before a woman’s body is ready. AWHONN nurses applaud the efforts of the American College of Obstetricians and Gynecologists and the Society for Maternal and Fetal Medicine to reduce primary cesareans, but nurses know that pushing longer is not the only way! Waiting for labor to begin on its own is best when all is healthy.

Going Full Term & Waiting For Labor AWHONN’s Go The Full 40™ campaign is chock full of advice from nurses about the importance of valuing a full-term pregnancy, of waiting for labor to start on its own when all is healthy, and the importance of going skin-to-skin with your baby as quickly as possible after birth. Skin-to-skin contact helps baby stabilize its body temperature, breathing, and blood sugars, and begin breastfeeding. This close contact may not be possible with a cesarean birth. Join AWHONN nurses by becoming a birth champion: • LIKE and SHARE our GoTheFull40™ champion’s group (Facebook.com/GoTheFull40) • Post your own birth story • Invite other moms to know the “40 Reasons to Go The Full 40” weeks of pregnancy at www.GoTheFull40.com Catherine Ivory, PhD, RNC-OB, is the AWHONN 2014 President.

ISSUE 13 / Spring 2014 Healthy Mom&Baby

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As a mom of 3, there was never a time in any of my pregnancies when I didn’t pause to marvel at how women’s bodies can grow another human being and birth it out into the world—that’s

AW H O N N

amazing! But we’re also self-conscience of the

AWHONN 2014 President:

many changes gestating a baby brings—weight gain,

Cathy Ivory, PhD, RNC-OB Chief Executive Offi cer:

Lynn Erdman, MN, RN, FAAN Vice President; Research, Education & Publications:

swelling, varicose veins, stretch marks and yes, even flabby skin. Our prenatal fitness expert, Sara Haley, was at

Debra Bingham, DrPH, RN

the same time in her second pregnancy voted one

Editor & Director of Publications:

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accosted at a Santa Monica gym (read it on Healthy Mom&Baby Facebook; posted 4/28/14.) She took those gym rats to task in the New York Daily News: “Some people have no filter all of a sudden when they see a pregnant woman training,” she said, rebuffing remarks about stretch marks. In this

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

issue, she’s showing sister pregnant warriors how to safely continue CrossFit. Sara’s favorite reaction to workouts in pregnancy? “Eye contact with a big thumbs up.” Along with Sara, we’re celebrating the power of pregnant women’s bodies. You’ll be moved by

photographer Jade Beall’s Beautiful Body Project,

Neither this magazine nor its contents constitute an explicit or implied endorsement by AWHONN or by Maitland Warne of the products or services mentioned in advertising or editorial content. The editorial content in this publication does not necessarily represent policies or recommendations by AWHONN. This publication is not intended to be exhaustive. While every effort has been made to ensure accuracy, neither AWHONN nor Maitland Warne shall have any liability for any errors or omissions. Readers who may have questions should consult their healthcare provider.

And supermodel Christy Turlington Burns is

which captures incredible femme fatales who have gestated, birthed and nursed the next generation. making every mother count so that no woman dies needlessly in pregnancy. Don’t miss these amazing mamas’ insights into how powerful you and your wonderful body really are! Love your pregnant body, and don’t let anyone else do otherwise. Until next time,

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

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

ISSUE 13 / Spring 2014 Healthy Mom&Baby

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Join us on Facebook facebook.com/HealthyMomAndBaby

Moms

Get the Spill on Olive Oil BY SUMMER HUNT

Olive oil consumption has tripled during the last 20 years, making it a must-have kitchen commodity in households everywhere. And while you may know that it’s one of the healthiest fats, there’s still a lot of fact and fiction floating around this flavor-packed pantry staple. Celebrity chef Cat Cora offers her expertise to bust some popular myths.

Light describes color, not calories.

You’re not doing yourself any favors opting for light olive oil. “It means it’s been pressed 2 or 3 times,” Cora explains. “Calories are the same whether it’s ‘extra-virgin’ or ‘light.’”

You can fry if you want to.

Olive oil has a higher smoke point so bring on the heat. “People don’t deep-fry with olive oil because it’s expensive,” says Cora. Consider saving the extra-virgin for dips and dressings.

Don’t be afraid to double up.

IMAGES © 123RF; RE X FE ATURES

Cooking destroys some of olive oil’s healthy components but all is not lost: “What we do in the Mediterranean,” says Cora, “is we will cook with a little bit of olive oil, and then we’ll actually add a drizzle of fresh olive oil.” Your little top-off gives you that delicious flavor with all the benefits.

Keep it cool, not cold.

There’s no need to keep olive oil in the fridge unless you live in an extremely hot, humid climate. Instead, store it “in a cool, dark place, just like you would with wine,” she says.

Steer for the clear—oil, not container.

Avoid cloudy olive oils, which are unfiltered and don’t last as long. “You definitely want to buy one that’s nice and clear,” Cora iterates. Opt for oils in dark green glass bottles (not clear or plastic) or tins, as light and heat can affect quality.

DID YOU KNOW?

First time?

Know your virgins: Virgin olive oil: Pressed by mechanical or other physical means that don’t alter the oil.

Extra virgin olive oil: High-quality virgin olive oil with excellent taste and aroma.

Juicy little fruits

Meet your new bread’s friend!

Pure olive oil: Don’t let the name fool you—these are often lower-quality, processed oils with little flavor.

Olives are technically a fruit; olive oil is their “juice.”

Butter packs 7 grams of saturated fat per tablespoon. Olive oil? 1.9 grams for the same amount.

ISSUE 13 / Spring 2014 Healthy Mom&Baby

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7 Better Patient

healthy moms

Ways to be a

BY DR. JOSEPH PINZONE

With more people receiving healthcare under the Affordable Health Care Act, maybe you’re about to visit your provider’s office for the first time—or after a long break away. Use these 7 proven strategies to build a strong partnership that brings better health for you, and for your family. PREPARE You wouldn’t walk into a meeting unprepared—before your visit, make a list of your symptoms, other health issues and questions you want discussed during the visit.

SCHEDULE AN UNRUSHED VISIT If your visit ends after 5-10 minutes, something went wrong. You should spend at least 30 minutes with your healthcare provider and leave with all of your questions answered. Right at the outset, tell your healthcare provider, “It’s important to me that we spend this time well. I’ve done my homework and have a number of things I’d like to discuss with you. An unhurried visit is very important to me.”

BRING A CARE PARTNER A care partner—such as a spouse, family member, friend, etc.,—can be a powerful tool. When you’re engaged as a patient it’s challenging to remember the full discussion. Your care partner can take notes and remind you of tidbits you may have missed.

Don’t le your healt ave provider’ hcare s until all o office f questions your been answ have ered.

TELL YOUR STORY Have you ever gotten lost watching a movie because you couldn’t follow the plot? Tell your story clearly: When did your health concern or issue first appear? What were the first symptoms? What did you try to make it better? Did it work? What has changed since those first symptoms? What bothers you the most about your healthcare issue now—what do you want from receiving expert help?

ASK QUESTIONS Don’t leave your healthcare provider’s office until all of your questions are answered. Great questions include: What’s my diagnosis? What’s your prescribed treatment? What will treatment do for me—the good and the bad, the risks and the benefits? How is this likely to work out for me?

IMAGES © 123RF; ISTOCKPHOTO

EMERGE WITH A PLAN Don’t leave your healthcare provider’s office without an action plan. Write down who’s involved, what needs to get done, in what sequence, and on what timeframe.

FOLLOW UP Be sure your healthcare provider and staff are following through on their end, whether it’s with a phone call or follow-up visit. Refer back to your meeting notes—double-check that you and your healthcare provider are on track!

DR. JOSEPH PINZONE, is CEO and medical director of the Santa Monica-based medical and wellness practice AMAI, and assistant clinical professor of medicine at the David Geffen School of Medicine at UCLA.

ISSUE 13 / Spring 2014 Healthy Mom&Baby

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healthy moms

You’ve got

Healthcare BY ELIZABETH T. JORDAN, DNSC, RNC, FA AN

HERE’S HOW TO GAIN IT & USE IT

With the implementation of the Affordable Care Act in January, the more than 6.5 million women who get pregnant each year—and the 4 million who will carry a baby to birth—now have guaranteed access to healthcare, including maternity care and a full range of services, including family health.

Under the new healthcare law, you can’t be charged more for insurance because you’re a woman, and you can’t be denied coverage for pre-existing conditions, like cancer or pregnancy. The good news for childbearing women is that health plans are required to cover maternity services as part of “essential health benefits,” and insurers can’t charge you higher rates or refuse to cover your childbirth costs if you’re pregnant. That’s particularly great news because without health insurance, a typical pregnancy, labor and birth without any complications can cost between $7,000 and $12,000. Those charges can exceed $20,000 if complications emerge or cesarean is required, experts estimate. In fact, all new health plans must cover services for pregnant women at no additional cost. If you’re considering pregnancy, you should take folic acid supplements to prevent the most common neural tube birth defects, and if you’re pregnant already, you should be able to receive these supplements at no additional cost. Same for smoking cessation and counseling at no additional costs for pregnant women. Routine services provided should include but aren’t limited to: Prenatal visits—which are proven to help provide the healthiest outcomes if you get regular prenatal care Ultrasound, X-rays or lab charges 12

Get C ov Get C ered, are

To gain cove yo u r b r a g e a n d u s e to Hea enefit s, go lth call (80 care.gov or 0) 318-2 596.

Hospital or birthing center labor and birth charges (including use of delivery room, hospital bed and board, physician care, and anesthesia, if needed) Routine newborn circumcision, if desired POSTPARTUM BENEFITS

If you return or go to work, your employer is required to provide time and a place for you to pump breastmilk. The Affordable Care Act will also cover home visits from nurses post-birth. And contraceptives, if you’re taking care to not get pregnant soon after birth—experts recommend that pregnancies be spaced at least 18 months apart to allow your body adequate recovery before you place it under the stressors of pregnancy again.

C AR E HEALTH EN OM FO R W As a woman, you gain numerous benefits under the Affordable Act, including healthcare services such as:  Well-woman visits  Gestational diabetes

screening in pregnancy as high blood sugar can affect your and baby’s health

 FDA-approved

contraception, education and counseling

 Mammograms and

colonoscopies (which have actually been available to many women since September 2010)

 Breastfeeding

BUYING HEALTHCARE

If you didn’t purchase healthcare during the open enrollment period in early 2014, you’ll have to wait for the next open enrollment for the Healthcare Marketplace (www.healthcare.gov). There are waivers for special circumstances so check to see if you qualify to get care now. November 15th kicks off the next and last open enrollment period in 2014, and for 2015, open enrollment starts on February 15th, 2015.

support, supplies, and counseling

 HPV DNA testing

for women 30 or older

 Sexually transmitted

infections counseling

 HIV screening

and counseling

 Domestic and

interpersonal violence screening and counseling

Source: Healthcare.gov

health4mom.org

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healthy moms

HEALT HCA FO R A R E LL Every single plan sold through the Healthcare Marketplace provides 10 essential health benefits: 1

Pediatric care, including dental and vision care for your kids

Preconception, prenatal care through pregnancy and postpartum care

IMAGES © 123RF

Preventive care, including counseling, screenings, and vaccines, as well as chronic disease management

Outpatient care (office or clinic)

Inpatient care (admitted to a hospital)

Emergency room visits

Prescription drugs

Lab tests

Rehabilitation services, including physical and occupational therapy, speech, psychiatric and other rehabilitation therapies

Mental health and substance abuse services, including treatment, counseling and psychotherapy

Source: Healthcare.gov

BREASTFEEDING: GET SUPPORT, PUMP & SUPPLIES For nursing moms, most healthcare plans cover breastfeeding support and supplies.

All plans in the Healthcare Marketplace and most plans cover support from a lactation consultant, a breast pump and basic breastfeeding supplies before or after your baby is born. There are some exceptions for plans that remained unchanged under the new healthcare law. For example, if you have an employer-provided health plan, check with your plan’s benefits administrator or call the number on the back of your insurance card to learn about your specific breastfeeding benefits. For plans providing breastfeeding support, buying or renting a breastfeeding pump is covered. Your plan may have specific policies around the types of pumps recommended or provided but the law specifies that the type of pump needed is between your healthcare provider and you. You’ll likely need your healthcare provider’s recommendation or an authorization, depending on your plan’s policies, to get your pump covered. Many breast pump manufacturers and distributors who sell medical devices are launching apps and websites specifically designed to help you use your benefits toward a pump and nursing supplies. Start by exploring your options at manufacturers’ websites, which are designed to help you match your benefits to the pumps they have available to you under your plan and where to purchase or acquire one.

ELIZABETH T. JORDAN, DNSC, RNC, FAAN, is an associate professor of Nursing at the University of South Florida, College of Nursing, and an expert advisor to Healthy Mom&Baby.

ISSUE 13 / Spring 2014 Healthy Mom&Baby

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healthy moms healthy moms

For You

BY DR . MEHMET OZ AND DR . MICHAEL ROIZEN

Get to the

Keep Your Ideal Waist Heart Before Young Pregnancy BY DRS. MICHAEL ROIZEN & MEHMET OZ

PREVENT THE #1 KILLER OF WOMEN BY TAKING CARE OF YOUR HEART NOW

Pregnancy is not the time to start thinking about a weight-loss program. It’s important to be at an appropriate weight—and we add GREAT FOODS Heart disease is the #1 killer women. Even if you’re just approaching 30 did waist to that—with normal blood pressure andofblood sugars before you know that 88,000 women younger than agegain 64 have heart attacks every Add foods such as salmon and you get pregnant. Once you’re pregnant, it’s also important to not ocean trout, cooked tomatoes, red wine, walnuts and a little year? Thstart e statistics are unnerving. too You’re much weight. So let’s with how to get there to begin with. chocolate. providing your W he body with omega-3 fatty acids pregn n you’re ant , yo from the salmon, ocean trout tojust u nee Women often probably Each year, 1 out of every 3 women who dies has eat feel onlyexhausted—you and walnuts (12 halves a day 10% m d t h also decreases weight in several o do anyway—but thisanistan that seems more heart (cardiovascular) disease to blame (much more r he exhaustion e numb calorie studies) that reduce the levels e r of s youkills: severe. Don’t deny it—that Go “ED via 911.” when you add in related causes including stroke and of triglycerides in your blood o rd ea t t o mainta inarily that are a big cause of arterial in you kidney failure, and even when plaque buildup. r weig Begin with the 6 stepshypertensive we use at EnforcerECoaching.com thatmore help our participants lose,

THE 6-STEP PLAN

ht .

FOREVER YOUNG AT HEART factor in You those related to your You can keep your heart on average, 24 poundsyou in 26 weeks. toodeaths can lose and keep extraaging pounds off by sticking young—and we know of nothing arteries). After all, heart disease is really just a form Now that you know what to do when symptoms more important. care of to our Taking 6-step plan. you comes first so you’ll have of aging of your arteries. Th at’s more deaths than all strike, learn how to keep those symptoms away— You the energy to take caresnooze, of those you lose—weight that is. Getting enough sleep (7- 8 hours) every night quiets your you love. forms of cancer combined! now and hopefully forever.

“I’m hungry” hormone. Fortunately, there’s a ton you can do tohow keepmany your caloriesCut down on sugar: it down. Most people underestimate they’re eating so keepYour waist size might go 2. If you eat it, write heart looking (and acting) young (yes, hearts look down and so will a journal of everything you eat. You know the drill—lots of fruits and veggies, lean protein,your and chances of heart disease. FISH wrinkled, spotted and have fat where it shouldn’t Excess sugar in the blood stream damages the grout none of the 5 food felons: grains that aren’t 100% whole, trans fats, saturated fats, added sugars be when they get old, but you don’t have to have a between the tile-like cells lining your arteries and or syrups. wrinkled, spotted or fatty heart at any time). increases infl ammation all Aim to lose 1 pound a week. If you starve yourself, your metabolism slows over your body. Eating 3. Slow and steady wins. less sugar protects those important areas inside your While have been signifi cant improvements to a crawl and your hungerthere hormones scream “Eat More, Now!” blood vessels. And—bonus!—it slows down the in heart health for men, research shows women 4. Eat less but more often. To keep blood sugar levels steady, eat 5 times a day—3 meals and 2 aging of your skin, and decreases wrinkles. aren’t faring as well. So let’s get that straight right snacks. Heart disease isn’t just about your heart. The aging now: If you feel an elephant on your chest (and there 5. Get (and keep) moving. Walk 10,000 steps a day. That’s how you’ll keep a grip on lower blood Salmon and ocean trout are of your arteries affects your whole cardiovascular isn’t one there), get to an emergency department pressure, the only fish in North Americalower blood sugar, and lower lousy LDL cholesterol. system, which is all the blood vessels running into via 911 immediately! Just remember “ED via 911.” consistently with the active Get a buddy with similar goals and enlist your family—almost none of us can do this alone omega 3s 6. and DHA for your and out of your heart, and all over your body. Your Unexplained pain in your neck, jaw, or inner arms, brain and eyes. 3and portions wild can do it if a family member tries to reward your success with one of the 5 food felons. no ofone salmon a week, or 900 mg of arteries begin to age when plaque builds up along and you have nausea, shortness of breath, or tiredness, DHA in supplements a day, also reduces your blood pressure. their walls, reducing blood flow to and from your all require the same response: “ED via 911.” 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 Presbyterian-Columbia University. health4mom.org

health4mom.org

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healthy moms The most important steps:

NUTS

Learn a stress management technique:

The greatest ager of arteries is unmanaged stress. Find a way that works for you to manage stress, such as meditation, guided imagery, progressive muscle relaxation, yoga and/or having a buddy to regularly talk through problems with. If you manage your reaction to the otherwise stressful events, they will hardly age your arteries.

Know and maintain your blood pressure at or about 115/75:

heart, and every organ in your body, including your brain, sexual organs, and yes, your skin too. As those passageways narrow, ruptures of the plaque and blood clots are more likely to form, blocking blood completely and leading to heart attack or stroke. Other problems include heart failure, in which your heart still pumps but not effectively, creating an arrhythmia or abnormal beating of the heart (too fast, too slow, or irregularly). You can also develop problems with the valves between your heart’s 4 chambers. 90% percent of women have at least 1 of the risk factors for heart disease. But don’t lose heart: You can do something about each and every one of them! Whether you know you’re at high risk or not, or don’t know at all, you can take steps now to protect your heart. 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 Presbyterian-Columbia University.

High blood pressure (aka hypertension) makes your heart work harder and damages your blood vessels.

Nuts may help lower cholesterol, partly by replacing less healthy foods in the diet. They also contain mono- and polyunsaturated fats known to benefit the heart while the omega-3 fats found in walnuts may protect against irregular heart rhythms.

Stop smoking:

This is an easy one: If you smoke, quit. Now. Smoking quadruples your chances of getting heart disease, and the effects are worse for women than men—especially if you take birth control pills. Cigarette smoking damages blood vessels. Start a smoking cessation program and quit for good.

TOMATOES

Get moving:

If you’re a gym addict, you’re doing more than burning crazy calories and toning your legs. You’re also getting a great cardiovascular workout. With every sweat session, you’re helping to lower both the top systolic and bottom diastolic numbers of your blood pressure. But you don’t need to be an addict. Regular moderate physical activity like walking can reduce the risk of heart disease and stroke by 25-40%. Getting your heart rate up for at least 30 minutes every day mitigates a busload of risk factors including obesity, high blood pressure, high blood sugar and diabetes. The best program: Walk 10,000 steps a day (yes, you need a pedometer, and usually a buddy), 30 minutes of weight lifting or resistance exercise a week, and 20 minutes of cardio 3 times a week. Start slowly and build up.

Cooked tomatoes or tomato products or extracts in any form make your blood vessels and heart younger by lowering your blood pressure and risk of plaque formation.

CHOCOLATE

AVOID THE 5 FOOD FELONS: AVOID THESE FOODS AS IF THEY’RE POISON—THEY ARE: About an ounce a day of dark chocolate (70%+ cacao, no milk fat, low sugar) may be as effective as the most common antihypertensive medications.

ALCOHOL

IMAGES © 123RF; ISTOCKPHOTO

Simple sugars and syrups. This includes brown sugar, dextrose, corn sweetener, fructose (as in high-fructose corn syrup), glucose, corn syrup, honey, 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 some for recipes.

4 3 Saturated Fat. This includes most four-legged animal fat, milk fat, butter or lard, and tropical oils, such as palm and coconut.

Trans Fat. 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.)

5 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.

One 12-ouce bottle of beer or 4-ounce glass of wine, or a drink with a single shot each night is a prescription for lasting heart health, as long as you don’t have a risk of addiction in you or your family.

ISSUE 13 / Spring 2014 Healthy Mom&Baby

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find

Your Fertility

BY TAMER A YOUNG, RN, MSN

OUTSMART INFERTILITY WITH THESE TOP TECH TOOLS

Experts estimate that the recession-led baby bust is now over and more babies will be born this year and next year than in previous years. Still, a significant number of couples struggle to get pregnant during their prime childbearing years. Share your baby-making plans with your healthcare provider to first rule out any health issues that may prevent conception, and then ask based on you and your partner’s ages and health what a reasonable time for trying to conceive (aka TTC) is before you check back in for further counseling. OUTSMART INFERTILITY With more smart technologies than ever before, and a focus on preconception health more prominent, you’ve got help in conceiving from more than just your healthcare provider. From new medications to induce or enhance ovulation, surgical options, and artificial reproductive technologies (ART), these new options also have increased success rates. DISCOVER IT Where to begin? If you’ve just started TTC, check out apps for smart phones that will help you determine if and when you’re ovulating. Popular options include Ovulation Calendar, Fertility and

Ovulation Tracker, Fertility Friend, OvuView and Baby Maker Fertility. TRACK IT Tracking your body’s resting temperature—your basal body temperature—will help you sleuth out that spike that signals your fertile period of your cycle. New digital basal body thermometers will measure to 1/100th of a degree. New ovulation detectors also test your urine, include vaginal sensors, and microscopes to analyze your saliva. These include iBasal Digital Thermometer, the OvaCue Fertility Monitor and the Fertile Focus Ovulation Microscope. CLOCK IT Another fertility monitor is the Fertility Watch, which is a wristwatch designed to measure the fluctuations in specific salts in your sweat. This device works on the discovery that chloride levels in sweat increase approximately 5 days prior to ovulation. ADD IT If you’re considering the costlier options of assisted reproductive technologies including in vitro fertilization, IVFpredict.com leads you and your partner through a series of questions and then uses a mathematical equation to predict your chances of achieving pregnancy and birth from an IVF cycle. And it’s a little easier on the pocketbook: this website is free and there’s an iPhone app version too.

 If you think you could be pregnant, you can choose from pregnancy test kits that are effective in detecting the presence of the pregnancy hormone as early as 6 days after conception.

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

IMAGES © 123RF

Are you among the 1 in 10 women who struggle to get pregnant or the 1 in 12 who are infertile?

health4mom.org

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Assisted

Reproductive Technologies UPDATE

SINGLE EMBRYO TR ANSFER DRIVING IN VITRO FERTILIT Y TREATMENT TRENDS BY SUSAN PECK, MSN, APN

IMAGES © 123RF

While assisted reproductive technology (ART) seems modern, would you be surprised to learn that the idea of assisted reproduction and infertility treatment was born in the late 1800s? Maybe you’ve heard about the birth of the world’s first “test tube baby” in 1978 or the first IVF clinic that opened in the UK in 1980? But the first recorded case of artificial insemination by a donor occurred in 1884 in Philadelphia. Flash forward 128+ years and more women than ever are using IVF to achieve pregnancy, say experts from the Society for Assisted Reproductive Technology. ART is responsible for more than 1.5% of babies born each year in the U.S. and more than 5 million babies worldwide.

Recent research suggests that transferring 1 high quality embryo individually likely results in the same number of cumulative pregnancies, and factors that may improve single transfer success rates include creating an optimal uterine environment and better sperm selection as well as embryo quality. Another advance used by some ART centers promoting higher success rates with single transfer is to transfer blastocyst (day 5) embryos as opposed to cleavage stage (day 3) embryos. These “older” embryos may yield a higher success rate.

TRENDS IN ART

PRESERVE YOUR FERTILITY

The most exciting trend is opting for single embryo transfer. Traditionally, more than 1 and often multiple embryos are transferred during an IVF cycle. Multiple births have become almost commonplace and are an accepted risk especially as families try to maximize their chances of having a child while minimizing costs for multiple IVF cycles (which average $12,000+ each plus the cost of medications.) Multiple gestations (twins, triplets) can bring multiple complications, including preterm birth, low birth weight, gestational diabetes, pregnancyinduced hypertension, and a greater risk of cesarean birth, which is major abdominal surgery.

Women who want to preserve their fertility have improved options. Egg freezing (oocyte cryopreservation) has been a central part of ART for women at risk of losing their fertility due to age, an illness such as cancer, or as part of the IVF process. However, ice crystals that form during the slow freezing may potentially make eggs less stable and less likely to survive the thaw. A newer, accepted method, called vitrification, is a rapid or flash freeze that results in a more solid cell and no ice crystals. This translates into better survival rates that may lead to more successful pregnancies.

Success rates are still highest for women younger than 35, so it’s important not to delay seeking assistance if you’re thinking ART may be an option you’ll need to help start or add to your family.

SUSAN PECK MSN, APN,

is an advanced practice nurse and an expert advisor to Healthy Mom&Baby.

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By Carolyn Davis Cockey, MLS

Makes Every Mother Count

Christy Turlington Burns

healthy moms Fr pregna om ncy to f itn sur vival e A-liste ss, this r â&#x20AC;&#x2122;s Eve ry Mothe models r Counts cha wome nge for n an babies d .

By Carolyn Davis Cockey, MLS

health4mom.org

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Women in the U.S. have a greater risk of dying from pregnancy-related complications, including hemorrhage, than women in 46 other countries. You had your own close call experience; how would you describe feeling so at risk in birth in a country that is supposed to have one of the most advanced healthcare systems in the world? It was extremely scary. I was fortunate enough, however, to know that skilled, trusted medical professionals were taking care of me. While it was an incredibly frightening experience, there was never a point where I thought that I wouldn’t survive. I had a strong healthcare team. I had health insurance. I felt cared for and listened to. There are too many other women who don’t get to feel that level of certainty. It was later that I realized just how close a call that was and how many other women simply die for lack of skilled care. Since I’ve always traveled and know women and mothers all over the world, the realization that many of them don’t have access to that level of care was jarring. It motivated me to switch gears in my life in a way that has ultimately created Every Mother Counts (EMC; everymothercounts. org). For you, Every Mother Counts is very personal. If a potentially life-threatening childbirth complication can happen to me, it can happen to anyone. I was fortunate to have high-quality, compassionate healthcare when I needed it most. If I’d been a woman in many of the countries where healthcare is limited or denied, I would not be here today answering these questions. I’d be among the almost 300,000 women who die every year from preventable pregnancy and childbirth-related conditions. By sharing my story, some women understand what has also

“We’re beginning to see a groundswell of interest and concern about the welfare of women and mothers in the world. When I had my childbirth complication 10 years ago, there was very little attention being paid to the problem of maternal mortality and poor maternal health conditions.”

Christy Turlington Burns is the founder of Every Mother Counts, an advocacy and mobilization campaign to end preventable deaths in pregnancy and childbirth around the world.

—Christy Turlington Burns happened to them is a fairly universal experience. It makes them realize they’re not alone but that our shared, common experiences represent a bigger problem. My career enables me to shine a light on this bigger problem that affects so many women in the world. I hope it will help generate significant change.

Of which victories with Every Mother Counts are you most proud? There are many. We’re beginning to see a groundswell of interest and concern about the welfare of women and mothers in the world. When I had my childbirth complication 10 years ago, there was very little attention being paid to the problem of maternal mortality and poor maternal health conditions. Because of our supporters, we’ve been able to fund projects that are making a direct impact on maternal health in some of the most in-need countries in the world like Haiti, Uganda, Malawi, Indonesia and the United States. I’m also very proud that people are beginning to look closely at women’s and maternal health conditions right here at home, and understanding that we need to do more, and do things differently, to take care of our own mothers.

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Got a good story to tell? We want to hear from you!

Whatâ&#x20AC;&#x2122;s happening with you regarding pregnancy, childbirth or parenting? What are the best, worst and funniest parts? How has an amazing nurse made a difference for you or your baby? Upload your experiences and pictures at www.health4mom.org/your_story and in each issue, weâ&#x20AC;&#x2122;ll publish the best story submitted between issues and you may win fantastic prizes for you and your family.

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Christy Turlington Burns visiting the Dhaka Medical College and Hospital in Bangladesh in 2011. The country has one of the world’s highest maternal mortality rates, but a growing number of nonprofits working in Bangladesh— including EMC—are focused on improving women’s health and education.

Currently, 1 in 3 babies born in the U.S. are birthed surgically through cesarean. Federal health experts advise that the incidence of cesarean should be more like 1 in 6-7 births. Cesarean is major abdominal surgery, and can leave a woman at risk for health problems in future pregnancies. Is EMC doing anything to address the prevalence of cesarean in countries where rates are higher than they should be? We’re addressing the c-section crisis in the U.S. in 3 ways: First, we consider the education of women, families and healthcare providers to be the most powerful tool we can use to change our healthcare system. We use our blog and social media platforms to write original content and to share content from other resources about maternal health issues. We’re funding a program in Florida that exemplifies the challenges and solutions many American women face in accessing high-quality healthcare and prenatal education. Third, we regularly engage in conferences and conversations that promote examination of what is and is not working in the American maternal healthcare system. We’re talking with your organization, the Association of Women’s Health, Obstetric & Neonatal Nurses (AWHONN), the American College of Obstetricians & Gynecologists, the American College of Nurse Midwives, and many others. For every death, there are exponentially more lifechanging injuries. How is EMC making a difference in this regard? For every woman who dies due to childbirth complications there are 20+ who suffer lifelong disabilities, such as obstetric fistula. We don’t see many incidences of fistula in the U.S. because even women who lack prenatal and antenatal care can usually access emergency room services to treat complications like that. Instead, women are suffering short- and long-term complications related to our high-intervention, high

“For every woman who dies due to childbirth complications there are 20+ who suffer lifelong disabilities.” —Christy Turlington Burns c-section rate model of care. We’re seeing increasing problems with hemorrhage, placental complications with subsequent pregnancies and infections. The way to change that is to directly address the issues that contribute to poor maternal healthcare including lack of health insurance and overuse of unnecessary interventions and surgeries.

Americans perceive the U.S. healthcare system as a leader. How do we not export the mistakes we make here in labor and birth? The U.S. is currently ranked 47th in safe motherhood, so I would say that we are far from being a “leader” in world health. While 99% of deaths that result from pregnancy and childbirth complications occur in the developing world, 800 women die every year right here in the U.S. That’s 2 or 3 every single day. We are very concerned about exporting our mistakes. We’re seeing evidence in many parts of the world that some hospitals are following in our footsteps in terms of implementing too many unnecessary interventions. At the same time, many of these countries and hospitals are still facing extreme lack of access, staff, supplies and skills. We need to address all of these issues while also keeping our eyes open for the mistakes that are so prevalent here at home. Which leads us to ask about Every Body Counts? Every Body Counts explores how women’s overall health and wellbeing contributes to maternal health. Our goal is to get people thinking about maternal health from a wellness angle, offering our audiences ways they can educate themselves and others

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about nutrition, exercise, mindfulness, spirituality, mental health issues and lifestyle factors. Every Body Counts is a natural theme for us to explore because improved physical and mental health contribute to a healthy pregnancy, and ultimately, healthy babies.

How can women actively partner with their doctors, midwives and nurses to ensure that their desires and health needs are met? What barriers do you see that still need to come down to improve outcomes for moms and babies? It starts with education and ownership of our own health and continues with changing the culture of healthcare women receive in the U.S. and around the world. Many women go into their pregnancies assuming their healthcare providers will make all the decisions. They essentially hand over their health to someone else. When women aren’t actively involved in making their own healthcare decisions though, they have no real say in how they’re medically treated. 24

When women and their partners educate themselves about what’s normal and healthy in pregnancy and about the potential complications they might face and when they know their options, then they have a more equal partnership with their healthcare provider. Ultimately, we need to change the way many people still see healthcare. They see the doctor as in charge and the patient as having to do as they’re told. Instead, we need to understand that as patients, we are hiring our healthcare providers to provide us with the information we need to make our own choices. When we trust our doctors, midwives and nurses, and engage in a give-and-take relationship, that’s where the best healthcare decisions can be made.

What will mother/baby health and wellness look like when you can say, “Our work here is done?” Pregnancy and childbirth will be safe for every mother, and there will be no more preventable deaths. Mothers and their children will thrive and girls will see their future lives as mothers as hopeful, safe and supported.

The Every Mother Counts Team ahead of the ING New York City Half Marathon. Running in support of maternal health around the world, the team set out to not only increase awareness for the cause but to also make the vital connection for people that so many pregnant women live far from health services around the world—and that distance does make a difference.

CAROLYN DAVIS COCKEY, MLS,

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

IMAGES © E VERY MOTHER COUNTS; JOSH ESTE Y; MARK SELIGER

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health4mom.org

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before

Listening to Classical Music in the Nursery

Choosing the Best Preschool

there was...

Taking Music Lessons during pregnancy

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Join us on Facebook facebook.com/HealthyMomAndBaby

Pregnancy

Expect the, Um, Expected? BY SUMMER HUNT

From spilling the beans to tossing your cookies, our friends at WhatToExpect are debunking what’s really happening once those first trimester hormones kick in. Their report, Pregnancy Confidential, reveals: We can’t hide our joy: Half of women blurt the news of their pregnancy earlier than planned because they can’t contain their excitement, are outed by pregnancy symptoms, or have their friends or family guess. We can’t keep it down: 2 out of 3 mommies2be enjoy the rite of passage known as “morning sickness”

à la nausea and vomiting in pregnancy. And for most— 92%—sunrise aside, they are running to the restroom at any and all hours of the day. We won’t say sorry: Many moms2be say digestive disturbances affect their performance at work but most simply chalk it up as “just part of pregnancy.” If you’re like nearly half of all preggo moms who think those queasy feelings provide a strange sense of peace, you’re not alone or off-track: The same hormones that disrupt your day keep that little baby in your burgeoning belly safe.

GO NUTS!

IMAGES © 123RF; ISTOCKPHOTO

Be a Birth

Champion Expecting a little peanut of your own no longer means ditching the PB&Js. As long as you’re not allergic to nuts, “there’s no reason for a woman to avoid peanuts during pregnancy,” says Michael Young, MD, of Boston Children’s Division of Allergy and Immunology, and author of a recent study that debunked old advice about avoiding nuts in pregnancy. Young’s study showed that peanut and tree nut allergy incidence was actually lower among children whose mothers ate nuts during pregnancy.

Healthy Mom&Baby readers are no strangers to our Go The Full 40 message—after all, it’s healthy best to wait for labor to start on its own and let baby pick her own birthday! Help us spread the word about the benefits of normal labor and birth when you join our community of fellow birth champions at www.facebook.com/GoTheFull40. Fun facts and pix will keep you coming back to share even more—we promise!

ISSUE 13 / Spring 2014 Healthy Mom&Baby

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From the moment you saw those two pink lines, your heart was filled with joy and anticipation. But then comes another big decision: How do you share your excitement with the people you love? We’ve pored over Pinterest boards and navigated the ’net to find our favorites. Incorporate these ideas into a photo session or design a fun mailer to send out.

Look in g to te family ll close in a but still more intima te creativ e way? little gif A t a big w can go over in mugs, ay: personaliz T-sh ed will de ir ts, ornamen li grandp ght grandma ts s a s , aun ts, unc , and th e like. les,

ju st letting yo u know...

due 9.12. 14 R & G

ITTY BITTY ACCESSORIES From teeny tiny cowboy boots to pint-size football jerseys, babies are known for their adorably small accoutrements. Break the big news by tying in your own interests, hobbies, or sports.

ALL IN THE FAMILY Outfit older children or pets—Fido is a part of the family, after all!—with big sister or big brother T-shirts to announce your expanding brood.

PUNDERFUL NEWS Cook up a creative scene for your photo announcement, say complete with a bun in the oven; or experiment with other witty wordplay—lots of folks work wonders with the saucy brand PregoTM.

The sky may be the limit, but here are a few ideas it’s likely best to steer clear of:  Pictures of you

puking

 Using the phrase

“knocked up”

 Nude photos of

IMAGES © 123RF; ISTOCKPHOTO

the happy couple

SNEAK ATTACK Set up a camera with a self-timer, then tell your partner that you’re pregnant shortly before the shutter closes for a well-documented, genuine reaction. Or, forego a public announcement in favor of a casual mention over dinner: “Please pass the potatoes... oh and by the way, I’m pregnant.”



SEASONAL GREETINGS Scribe your good news in the sand or share your joy in fireworks. Ever-changing seasons and holidays provide perfect times to help you make that big announcement on a day you’ll always remember.

USE YOUR WORDS Spell it out plainly for friends and family with announcements that feature Scrabble letter tiles or baby blocks: We’re Pregnant!

Find more Pinspiration on our ...and Baby Makes Three (or Four, or More) board: http:// www.pinterest.com/ healthymombaby. We’re expecting to see your creative announcement there next!

ISSUE 13 / Spring 2014 Healthy Mom&Baby

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Showering

Active Moms & Babies

(

These Baby Shower Favorites are Unique and Practical for Moms & Babies on the Move!

)

After being cooped up all winter, spring is the perfect time to either prepare or get on the move with baby. We’ve rounded up some of the most fun and practical new gifts sure to surprise and please mom at her baby shower. These are all meant for active moms, dads and kids on the go. Fun and practical but tough enough to tote about! Pick one or all; they’re sure to please the growing family!

The cl oth open-p’s unique design ocket your c protects catch lothes by messy ing those spit-u ps!

1 gift; 3 uses! This cool Baby K’tan 3-in-1 cloth is a soft cotton and microfiber nursing wrap, blanket, and burp cloth with a sewn-in pocket that travels with you everywhere. In dad-friendly colors too from $12.95 at www.babyktan.com

Frankly it’s about time someone created a bib that works as well for moms (hello, burpy spit up!) as it does for babies and growing toddlers. From $19.99+ in sizes that go from newborn to age 9; this may be the only bib you ever need at www.bibbitec.com

y veryda From e the odd fun to ected unexp ncy... emerges, be mom ed! prepar

Who knew that hours of infant video can take such a toll on a smartphone! Recharge mom’s batteries with portable power that even goes solar and stays small enough to fit in the baby bag. Eton Boost portable chargers from $54.99 at www.etoncorp.com

Soft and seriously fun, these 100% silicone bibs are BPA and phlatefree. Ulubulu Baby Bib rolls up for easy storage and feature a crumbcatching pocket. $9.99 at www.ulubulu.com

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Mark milest every o your l ne as i sunsh ttle ine grows .

Save the door molding and chart baby’s growth through these irresistibly cute and customizable wall charts. Printed on canvas instead of paper, they’re designed to last a lifetime. from $39.95 at www.iseeme.com

These “Love Savers” are a life-saver when baby starts to teeth! These soft, chewy teething toys are easy to hold and are made from 100% food-grade silicone making them freezer, microwave and dishwasher safe. $21 at www.littlegiraffe.com

Uptown for an afternoon of shopping or downtown at the park for play, the Kate bag’s sophistication from Timi & Leslie comes packed with everything you need for baby’s day out: from a changing pad and insulated tote to matching stroller straps and a small clutch for stashing cash and credit cards. From $169 at www.shoptimiandleslie.com

Active moms need a stroller that will move with them, like this new jogger from Eddie Bauer that has all of the high-end features but won’t bust your budget. Add the matching car seat and you’ve got a stroller system.

ombie The Wocs the mimi touch, of feelings th and m r a w . cuddle

From $189 at www.target.com

Baby loves to snuggle and there’s nothing more comfy than the Convertible Woombie, which lets baby go arms in or out, or the Air Swaddle for a no-wrap solution. From $26 at www.woombie.com

Forget boring checklists; your baby’s milestones will flash by you on these colorful cards that capture all of baby’s firsts with a space for you to jot the date and a note. From $20 at usa.alexandalexa.com

s seat e car safety s e Th t big are boosings yet gh rat ll enou ss a sma 3 acro . to fit ackseat b

Don’t give up on safety when you need a car seat that can travel too. The Diono Radian RXT Car Seat + Booster meets the highest standards in a compact footprint that folds down for airport ease (via add-on shoulder straps). Rear-facing from 5 pounds all the way to 140 lbs as a convertible booster. From $339 at www.diono.com

Pack around a perfect place for baby to sit when you’re out and about. The Lamaze Sit and See adjusts from seat to tummy time mat for fun on the go! From $79.99 at www.Amazon.com

health4mom.org

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Preserve your baby’s first and most important steps! Handcrafted heirloom quality bisque bone china

Your handcrafted shoe will be personalized with the baby’s name, date of birth, weight, length and time of birth.

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Birth to 5 years old

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CrossFit

During Pregnancy

By Sar a Haley

Our Pregnancy Fitness Experts Modify Meg Moves for Mamas-to-be

ou’ve seen pregnant women pushing the bounds of exercise safety via CrossFit. Everyone naturally asks—is that safe? The general rule for exercise during pregnancy is, assuming you have your healthcare provider’s approval and you’re not considered highrisk, you can typically continue most fitness activities you did prior to pregnancy—but at a moderate level.

Fitness experts agree— unless you’ve been doing CrossFit prior to pregnancy, do not begin in pregnancy. The biggest challenge is determining what’s moderate for you. If you’ve been doing metabolic and anaerobic training, such as CrossFit, prior to pregnancy, you’ve likely been working out at such an extreme level that your “moderate” is much more intense than most women’s activities, even those who exercised prior to pregnancy. But fitness experts agree— unless you’ve been doing CrossFit prior to pregnancy, do not begin in pregnancy. I’m now pregnant with my second child, and I dabbled in CrossFit prior to this pregnancy. I earned a CrossFit certification with my Reebok Master Trainer certification, but to really do CrossFit in pregnancy right I sought the advice of my colleague Yumi Lee, one of the owners of the Reebok CrossFit Lab in Los Angles. I’m in my second trimester, so Yumi took me through some of her recommended exercises for crossfitters during pregnancy. Please pay particular attention to the modifications and always stop if something just doesn’t feel right or safe. For all weighted exercises, choose a weight that allows you to work hard, but NOT one that makes you go breathless—moderation is mandatory in pregnancy. Throughout, except where noted, work up to 8-12 reps but never beyond moderation or at a capacity that leaves you breathless. 34

Upper Body

Modified Push-ups

(Chest, Back, Triceps): In pregnancy, your baby bump becomes too intrusive for push-ups. Consider CrossFit parallettes instead. You can elevate yourself, protect your bump, and still take your elbows to a 90-degree angle for max range of motion. Remember to pull your navel (or think of your baby) closer to your spine, squeeze your butt, and pull your shoulders back and down. Allow your elbows to head out on the angle.

Hanging Tuck

(Back, Shoulders, Core): Once you’re past 20 weeks, abdominal crunches are out of the question. The Hanging Tuck provides both core and upper body benefits. When your belly impedes your knees from coming straight up, angle them out (opening your hips) to make room for your bump! Keep your scapula engaged (pull your shoulder blades together without arching your back), pull your baby closer to your spine, and remember to inhale and exhale deeply. Take breaks as often as you need to.

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healthy pregnancy

LOWER BODY

CARDIO

Cardio can sometimes be the trickiest part of moderating workouts in pregnancy. Sprinting is out of the question so try these 3 CrossFit options:

Rowing Weighted Back Squat to Medicine Ball

(Butt, Legs): Don’t squat more than 90 degrees in pregnancy as this puts too much pressure on your joints and can over-stretch your already relaxed ligaments. Be safe instead with a weighted ball underneath as a stopping point. Perform this exercise with or without the added weights on your shoulders, keeping your hands on your hips. Keep your chest lifted, shoulders down and away from your ears.

(Butt, Legs, Back): This cardio booster works your whole body. Begin with a flat back, drive with the legs first, then extend the hips, and finally row your arms back. On your way back in, arms lead and legs follow. Begin by rowing for 2 minutes at a time and gradually increase duration; but head’s up—eventually your bump will put an end to this activity in pregnancy.

Farmer’s Carry

(Butt, Legs, Core): Squat down, with your chest up to pick up free weights or kettlebells. Then simply go for a walk with your shoulders down and baby hugged in towards your spine. Start by walking for 2-4 lengths of your gym space at a time and gradually increase your distance over time. Remember to breathe deeply!

IMAGES COURTESY OF SAR A HALE Y

Swings & Sumo Deadlift High-Pull with a Kettlebell

(Butt, Legs, Core, Back, Shoulders): Both of these exercises are great for working the core and lower body. Modify by taking your legs wider, opening your hips for comfort and stability, and making room for baby. As you swing the kettlebell, keep your wrists straight, swing no higher than eye level, and drive from your hips. In your Sumo Deadlift, take your feet even wider (than in the swing), so you can really engage the hamstrings and glutes. Swing out a little before you row to avoid baby. Because you can do this with a kettlebell, it’s a good modification for Sumo Deadlift High Pulls, that are usually executed with a weighted bar. See how many swings or high pulls you can do in 30-45 seconds at a moderate level (not breathless).

KEEPING IT HONEST:

Moderate Intensity

Modified Burpees

(Entire body!): CrossFit Burpees involve your chest hitting the floor so that is obviously out. Modify by using parallettes to elevate yourself and instead of jumping or walking the feet as in a traditional burpee, take your feet wide and angled out, so that your hips open to allow room for baby. You may or may not want to jump up at the end. If you do jump, remember to land softly on the balls of your feet first, before lowering your heels to reduce impact.

Talk out loud: If you can’t talk, it’s too intense for pregnancy Don’t get too hot: Dress in layers Stay hydrated: Carry a water bottle with you always Take breaks often: Listen to your body Keep breathing: Never get breathless

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

ISSUE 13 / Spring 2014 Healthy Mom&Baby

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healthy pregnancy

The Beautiful {Pregnant} Body Project By Summer Hunt

�

Photographer

Jade Beall images © Jade Be all

Wants Women to Accept Their Bodies

ISSUE 13 / Spring 2014 Healthy Mom&Baby

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healthy pregnancy

� From

adolescence into adulthood, photographer Jade Beall struggled with body image and acceptance. She found it difficult just to look in the mirror, she says, “unless it was by candlelight”—which is why it’s most curious that Beall began posting semi-nude images of her postpartum body on her blog in 2012. Turns out, she didn’t have to change the way she looked—it was about how she saw herself. After years of negative thoughts, Beall found herself at a time when she was proud of her body. “I really loved being pregnant,” she says. “For the first time in my life, I showed my midsection. I loved my belly, and I felt powerful.” It was after giving birth to now 2-year-old Sequoia that Beall began to feel those negative thoughts creep back in. “I gained 50 pounds with my pregnancy, and that added to my personal er g r a ph history of oppressive selfPhoto ll (shown a e ia) B Jade ith Sequo f loathing in a culture that praises o w here d to let go of e r decid r s in favo ns mostly Photoshopped images a o her fe r ting milli eir h o of women in media.” She felt supp e n a nd t . s m o d of w nant bo ie disappointed in herself, right preg after a time when she felt so strong—after all, growing a tiny human is no easy feat. Beall decided to let go of her fears in favor of supporting millions of women who must have felt the same pressure she did to look a certain way, even after just having a baby. “95% percent of women will not see [themselves] reflected in mainstream media,” Jade says. “I wanted to join the movement of redefining beautiful for selfempowerment, for women to feel validated and for the reshaping of media.” Shortly after that day in 2012 when Beall laid bare her slightly larger body, soft and beautiful and freshly postpartum, people began to take notice. “Hundreds and hundreds of women thanked me for showing a body that resembled their own,” she says. “[They] wrote to tell me their stories... and asked if I would photograph them, just as they were.” Beall received global coverage, which baffled her. “[It was] a complete shock,” she says. “Apparently a whole lot of people are unaware that there are women in this world who don’t ‘bounce back’ after birthing a child, and who are not Photoshopped from their stretch marks and changed hips and breasts.” As her collection of brave, beautiful mamas began to grow, the Beautiful Body Book Project was born. “[It’s]

a collaboration of my photographs and the stories from the women photographed about finding freedom from feeling too fat, too skinny, too dark-skinned, too pale, too wrinkly, too pimply or whatever other story inhibits us from completely loving ourselves just as we are.” The first volume, The Bodies of Mothers—which was 100% crowdfunded—is due out this spring. Beall has plans to expand to more volumes, covering topics like aging, cancer and other illnesses, women of color, and more. Most of the women Beall has photographed echo her sentiments regarding pregnancy. “It is the post-birth body that they are unsure how to love,” she says. “We rarely see imagery of women depicted in a beautiful light whether she has stretch marks, or wider hips, or a belly that still hangs as if a baby were still inside... our culture has forgotten how to praise a woman for her beauty as an irreplaceably beautiful human who has given life.” It is Beall’s hope that the Beautiful Body Book Project will bring all women together, regardless of shape, size, or color, to feel empowered. “Industries and mainstream media no longer have exclusivity over how to showcase women in our culture... nor are they the main curators of digitally altered imagery of women anymore,” she says. “All of us have a way to share beauty with each other, to help our young girls have truthful and inspiring role models.” More than anything, Beall just wants women to accept their bodies—that means every stretch mark, belly jiggle, and lump or bump in the road. “Please don’t buy those magazines that want to sell you the drama of which celebrity has bounced back and which one hasn’t,” she says. Instead, Beall encourages women to seek out support from those around them, following blogs or other websites that foster a feeling of self-worth. Her blog at ABeautifulBodyProject.com features stories and pictures from women discovering their own beauty and reveling in the journey to get there. If Beall could say one thing to every new mother out there struggling to accept their slightly larger thighs or slightly less perky breasts, it would be this: “Sister, you are beautiful, and you are not alone.”

health4mom.org

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healthy pregnancy

This page: A collection of Jade’s photographs from The Bodies of Mothers—the first volume in the photographer’s Beautiful Body Book Project.

ISSUE 13 / Spring 2014 Healthy Mom&Baby

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healthy pregnancy

Powerhouse Pregnancy BY AWHONN EDITORIAL STAFF

Pregnancy puts powerful demands on your body, and your baby needs good nutrition to develop and grow properly, say the experts at the National Institutes of Health. It’s common knowledge that antioxidants play a role in fighting disease in our body, and researchers are exploring how antioxidants may also be protective in pregnancy. Additionally, getting good fats in your diet can help prevent low birth weight—and perhaps even lower your preterm birth risk. Put the two together and you’ve got a recipe for a powerhouse pregnancy when it comes to nutrition. You can get great nutrition at every meal. Pick a protein, add a veggie and choose a fruit for dessert—you’ll feel great knowing you’re giving your body and baby the best nutrition possible. Here are 9 powerhouse foods perfect for pairing in pregnancy. Which are your favorites? What will you choose? 40

(

RICH IN ESSENTIAL FAT T Y ACIDS AND ANTIOXIDANTS, THESE NUTRITIOUS FOODS ARE PERFECT FOR YOU AND YOUR GROWING BABY

PROTEINS +

VEGETABLES +

)

FRUITS

Salmon is serious pregnancy nutrition rich in omega-3 fatty acids like DHA and ALA.

Dark greens not only make a super salad, they’re rich in iron and folate— essential pregnancy nutrients.

Blueberries have more antioxidants than more than 40 other fruits and veggies.

Sunflower seed butters are a rich way to put healthy fats on your morning toast.

We’re crazy for kale, which is a rich beta-carotene and lutein essential for eye health like its cousin, spinach.

Bananas bring much-needed potassium and are one of the easiest healthy fruits to eat on the go.

Eggs are now often fortified with omega 3s, making them a great polyunsaturated fat pick.

Fiber-rich sweet potatoes are also high in folate; their slow-burning carbs won’t bump up your blood sugars.

Black plums are antioxidant-rich say researchers at Tufts University. Dried (prunes), they double up in total antioxidants and help keep things moving smoothly in pregnancy.

IMAGES © 123RF

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healthy pregnancy

Swelling

in Pregnancy

W he n swelling is dangerous

Increased fluid, blood pumps up the volume in your body By Helen Hurst, DNP, RNC, APRN-CNM

You’re not imagining it—your ankles are swelling. And maybe your hands are too. More than 70% of pregnant women experience some swelling (edema) in pregnancy. So, how do you know what’s normal—and what’s not?

images © 123RF; istockphoto

Your body goes through many changes as it adapts to your growing baby. Your body increases the amount of blood flowing through your veins, as well as other fluids—by as much as 50%! As your uterus expands, it puts increased pressure on the veins in your lower extremities, making it harder for your heart to pump blood back from your legs, leading to a shift in fluids and swelling in your legs and feet. You’ll notice that swelling typically occurs late in the day or if you’ve been standing for a long period

Help Prevent Swelling in Pregnancy Wear special maternity hose or stockings meant to reduce swelling

Wear comfortable shoes and be active

If you have the opportunity, lay down with your feet elevated, or lay on your side 2-3 times a day for 30 minutes or so

of time. Fluid can also accumulate around the nerves in your wrist, mimicking something called carpel tunnel syndrome, which may cause pain, numbness, burning or tingling of the hands or wrists. These symptoms aren’t comfortable, and can be annoying, but typically they’re little more than common pregnancy discomforts that can be remedied with rest. As always, if you become concerned about any symptoms you have, call you doctor or nurse-midwife and they will be happy to answer your questions.

Avoid tight fitting stockings or items with elastic at the knee (knee highs)

Avoid sitting with your legs crossed

Elevate feet 2-3 times a day for 30 minutes (at your desk, raise your feet on a small stool or chair) Sleep on your side (this keeps the pressure of the uterus off the large vein in your back)

Drink plenty of water (restricting your water intake will not help with swelling)

Call your healthcare provider right away if you experience any of the following in pregnancy: XXSwelling of your

hands or face

XXSudden, large

amounts of swelling

XXSwelling in only

one leg

XXIf you’re gaining

more than 2 pounds per week

XXSwelling

accompanied by: Unusual vision: spots before your eyes, blind spots Headaches not relieved by acetaminophen Bad heartburn

Helen Hurst, DNP, RNC, APRN-CNM, is an

expert advisor to Healthy Mom&Baby.

ISSUE 13 / Spring 2014 Healthy Mom&Baby

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healthy pregnancy

Preparing for

Breastfeeding

By Joanne Goldbort, PhD, MSN, RN

It’s smart to prepare for breastfeeding before baby arrives. Breastfeeding is a skill you learn by doing—both you and baby. Get ready for breastfeeding with these strategies, and remember, any amount of breastfeeding benefits baby’s health—and yours too!

Learn about breastfeeding

Pick a probreastfeeding provider

Read books, watch videos and attend local breastfeeding support groups. Look for materials created by healthcare experts, including lactation consultants.

Find a healthcare provider (pediatrician, family practice physician, nurse practitioner or midwife) for your baby who supports breastfeeding. The first few days post-birth are stressful—you’re elated and exhausted. Your milk supply is starting to come in. You and baby will need to work together until breastfeeding is going well. You’ll want a healthcare practitioner who is less inclined to supplement with or advise using formula unless medically needed.

5 Manage potential challenges now Tell family and friends you will need time alone with baby those first few days to make sure breastfeeding starts well. Ask them to support your efforts, keep visits short, and focus their support on things they can do for you while you’re nursing baby.

2 Politely decline formula samples

images © 123RF; istockphoto

Prepare to say “no thank you” to any free formula samples. Should your baby require formula, you and your healthcare provider will discuss which one is most appropriate. Some practices and hospitals will offer a “free” diaper bag with enclosed formula samples—keep the bag, as desired, and give a kind “no thank you” on the formula.

Find a BREASTFEEDING-FRIENDLY birthplace Learn what breastfeeding support is available where you plan to birth. For example does your facility have:

� Lactation experts available? � Breastfeeding supplies, such as nursing bras or breast pumps?

� BabyFriendly™ designation? This designation means the care providers are advocates of and prepared to help you with early breastfeeding.

� Specific practices or policies about pacifiers (best delayed until baby is breastfeeding well) or supplementing with formula (best skipped).

If you have inverted or flat nipples—or aren’t sure if you could have problems breastfeeding—now is the time to get help from your care provider or a lactation expert. Find a lactation consultant who is board certified through the International Lactation Consultant Association (ilca.org).

� A lactation support

group—or links to local groups? Attend before baby is born to connect with other nursing moms and gain confidence and information.

� Breastfeeding classes? Plan to attend.

Joanne Goldbort, PhD, MSN, RN, is an

assistant professor at Michigan State University and an expert advisor to Healthy Mom&Baby.

ISSUE 13 / Spring 2014 Healthy Mom&Baby

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healthy pregnancy

Beginning Breastfeeding: Your Questions Answered

Breastfeeding is wonderfully natural and simple yet is complex enough to fill books on the subject. As you look forward to completing pregnancy and welcoming your new little one, here are answers to the most common questions from first-time moms about starting to breastfeed. Talk to your healthcare provider about your breastfeeding goals to ensure your whole labor and birth team work together to get you and baby off to a wonderful start. By Helen Hurst, DNP, RNC, APRN-CNM

1. Experts agree that it’s best for moms and babies to begin nursing as soon after baby’s birth as possible—well within the first hour—if all is well. You can even breastfeed following cesarean by asking to have baby placed on your chest while your incisions are being closed. If this isn’t possible, you can begin nursing in the recovery room. Your baby’s natural instinct to nurse peaks within 30 minutes of birth, and getting right down to nursing gives him the protective effects of colostrum, which will help protect him against infection, and helps him act on his natural desire to suck and swallow. Nursing also gives you a natural oxytocin boost that will help your uterus begin to shrink and help prevent excess bleeding. If you’ve had medicine or an epidural during labor, this can sometimes make baby’s reflexes a little sluggish. But don’t worry; having your baby on your chest, skin-to-skin, will help awaken those natural urges to feed. You can get off to a great start. 46

How long will it take for my milk to come in?

2. The thicker, yellowish and protein-rich pre-milk called colostrum will flow for the first few days and will give your newborn important immunity against illness and infection. Colostrum helps baby pass meconium—that sticky, black first poop you may have heard of. Colostrum is very rich and your baby only needs a few teaspoons to satisfy his small tummy for the first few days. It is considered the perfect food for infants and it will be present in your milk for up to 2 weeks as it gradually shifts over to what looks like regular milk. Your milk will “come in” between days 3-5, and sometimes it will squirt out so quickly that baby will get a milk shower. If you find your milk initially flows too fast, try to first pump a little off so that baby doesn’t have to gulp to keep up with the flow. Your partner may be anxious to feed baby as well but it is best to wait until breastfeeding is going well before introducing breast milk in a bottle to baby.

How often should I nurse my baby?

er ill nev You w time you e th t our regre rov iding y ilk p m spent ith your all y w baby a s specif ic is that w ned for h ig des s! need

The latest evidence and experts agree that breastfed babies should eat “on demand.” Babies should eat when they’re hungry, nursing until they lose interest in each feeding. In those first few days, that could mean as often as every 2 hours for as many as 8-12 feedings in the first 24 hours! Your baby’s need to eat will gradually transition to every 2-3 hours during the day and every 4-5 hours at night, although some babies keep the 2-3 hour schedule for several months. Nursing takes a lot of energy so eat when baby eats, and rest when baby rests. You’re recovering from pregnancy and birth, too, and breastfeeding is one way your body forces you to relax, nurse and sleep when baby sleeps. Eventually, you will get into a feeding pattern and the time spent nursing will decrease even as the time between feedings increases. As baby grows, these patterns will change, and you may notice that baby increases his nursing right before a growth spurt. Helen Hurst, DNP, RNC, APRN-CNM, is an expert-advisor to Healthy Mom&Baby.

images © 123RF; istockphoto

When can I start nursing my newborn?

health4mom.org

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www.divine-mama.com

Divine Mama Bars are a delicious, delightful way for breastfeeding moms to increase milk supply. Nursing burns 500 calories a day—about what you would burn by running three miles. That’s great for losing the baby weight you may have added during pregnancy but can also lead to cravings for snacks. Divine Mama Bars are all-natural and made with 100% lactogenic (milk-producing) ingredients, with no artificial sweeteners, no processed starches, and no new food technology. Whether you’re interested in making more milk, feeling peace of mind when eating a snack, or simply having a scrumptious treat because you deserve it after changing that diaper three times in ten minutes, Divine Mama Bars are the right answer.

Divine Mama Bars are made of all-natural ingredients that are recommended for increasing milk supply. Lactogenic substances are foods, drinks, and herbs known to encourage milk production and increase supply. Women throughout history have turned to them while nursing and have passed their wisdom along to the next generation of family and friends. This understanding of how certain foods affected supply was so much a part of ancient cultures that mother goddesses (the original Divine Mamas) are often represented in art as holding or eating those plants or herbs. Some examples of lactogenic foods are:

Macnut Chocolate Chip Bar

The nutty, hint of chocolate combination in this bar is both sweet and satisfying, just the right blend of salty nut tastes and the ever-wonderful counterpoint of delicious chocolate, with the slightest fruit note from the pressed dates to give it an especially complex, deep—and yummy!—flavor.

Apricots Oats Cashews, Macadamia Nuts, Almonds Dates Flax Seeds Sesame Seeds

Datey Apricot Cashew Bar

This mouth-watering, filling bar is a chewy, delicious mix of two delightful flavor families: a warm, exotic fruit taste from the apricots and dates, and a nutty, savory essence from the mix of oats, almonds, cashews, flax seeds, and sesame seeds.

These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.

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healthy pregnancy

YOU ASK, WE ANSWER

Group B Strep in Pregnancy BY CATHERINE RUHL, CNM, MS

SO WHAT’S THE RISK OF GBS IN PREGNANCY? The main risk is that if you have GBS you could pass it to your baby during birth. Newborns can’t fight infections like adults. GBS can cause pneumonia or infections in the blood. About 1 in 6 babies who get a GBS infection will have a serious illness, and some of these babies will die.

HOW WILL I KNOW IF I HAVE GBS IF IT DOESN’T CAUSE SYMPTOMS? The national recommendation for all pregnant women is to get a GBS test about 4 weeks before their due date. Ask your healthcare provider when you will have this test. It’s simple— your provider will swab the outer part of your vagina and also just inside your anus.

WHAT HAPPENS IF MY TEST SHOWS I HAVE GBS? Your provider will recommend you

get an antibiotic in an IV during labor, typically a form of penicillin if you’re not allergic to it. One dose is needed at least 4 hours before you give birth to keep your baby from getting GBS. A full-term newborn has a 1 in 200 chance of getting sick from GBS in the first days of life if mom has GBS in her vagina and didn’t receive antibiotics in labor. That drops to a 1 in 4,000 chance if antibiotics were given during labor. IF I’VE JUST TESTED POSITIVE FOR GBS, WHY SHOULDN’T I GET TREATED NOW? GBS is easy to treat when it’s in the vagina but much harder to clear from the intestine with antibiotics. So having treatment before labor means GBS in your intestine could show up in the vagina again when you’re birthing.

WHAT IF I GO INTO PREMATURE LABOR AND I HAVEN’T HAD THE GBS TEST YET? Because premature babies have even less of an ability than a full-term baby to fight infections, the national guideline is that all women in premature labor be treated for GBS with antibiotics.

If you test positive for GBS, your healthcare provider will advise receiving intravenous antibiotics during labor.

CATHERINE RUHL, CNM, MS, is a certified nursemidwife and director of women’s health for AWHONN.

IMAGE © 123RF

WHAT IS GROUP B STREP (GBS)? GBS is a common bacteria. In healthy people it generally doesn’t cause symptoms or illness. About 1 in 5 pregnant women have GBS in their intestine, rectum or vagina near the time of birth.

health4mom.org

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healthy pregnancy

Labor Longer to

40 r avoid easons to u n nec essa r y ce GoTh sarean: eFull4 0.com

Avoid Cesarean (

BY CANDACE CAMPBELL, DNP, RN, CNL

AVOIDING CESAREAN UNLESS IT’S MEDICALLY NECESSARY IS ESPECIALLY IMPORTANT FOR FIRST-TIME MOMS

With 1 in 3 births via cesarean—up 60% since 1996—leading experts are calling on healthcare providers and pregnant women alike strive to avoid unnecessary cesarean, particularly with first births.

IMAGE © ISTOCKPHOTO

“Evidence now shows that labor actually progresses slower than we thought in the past, so many women might just need a little more time to labor and deliver vaginally instead of moving to a cesarean,” said Aaron B. Caughey, MD, a member of the American College of Obstetricians and Gynecologists’ obstetric practice committee, which issued the national call to help reduce primary cesarean births along with the Society for Maternal-Fetal Medicine (SMFM). AVOID FUTURE CESAREAN “Most women who have had a cesarean with their first baby end up having repeat cesarean deliveries for subsequent babies, and this is what we’re trying to avoid. By preventing the first cesarean delivery, we should be able to reduce the nation’s overall cesarean delivery rate,” Caughey said. The two medical organizations agree that the rapid increase in cesarean birth rates shows that cesarean happens far more often than it should, especially since it increases risks for moms and babies, and the increase in cesareans hasn’t led to healthier results for moms and babies.

WAIT FOR LABOR Cesarean birth can be life-saving for a baby or mother in need, but this updated advice underscores that when all is healthy and well, you should:  Avoid choosing to induce labor or birth via cesarean without a medical reason  Wait for labor to start on its own  Labor longer, as needed, before pushing  Be given more time for pushing, as needed

If you’re pregnant now, these recommendations mean your healthcare provider is being asked to support you in laboring longer if all is going well, recognize that 6 cm dilation of your cervix is when active labor actually begins, and that you should be given more time to push during this phase, as needed. If you’ve had a baby before, you should be allowed to push for at least 2 hours more than previously thought; 3 hours more if this is your first birth. For women who receive an epidural—which can slow labor—the advice is to push during this labor stage even longer if needed. It all comes down to balancing risk and benefits, and in some cases, cesarean may be needed, said Vincenzo Berghella, MD, SMFM President, who helped develop the new recommendations. “But for most pregnancies that are low-risk, cesarean delivery may pose greater risk than vaginal delivery, especially risks related to future pregnancies.”

)

? D ID YOU K N OW  Only 5% of babies

are born on their due date

 Most babies will

be born between 40 and 41 weeks if moms wait for labor to start on its own, especially first-time moms

 You’re more

likely to breastfeed and bond faster and for longer skinto-skin through normal labor and birth, as well as reduce your risks for the “baby blues”

 Benefits of

normal birth also include shorter hospital stays, lower infection rates and a faster recovery. You also reduce your baby’s risks for breathing problems through normal birth

CANDACE CAMPBELL , DNP, RN, CNL, is an

expert advisor to Healthy Mom&Baby.

ISSUE 13 / Spring 2014 Healthy Mom&Baby

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Mommy’s eyes... Daddy’s nose... and nobody’s genetic disease.

Whether you are planning for a pregnancy or the birth of your baby, it’s important to know if you are at risk.

JScreen provides an easy, convenient saliva test kit that allows you to ﬁnd out if your future children are at risk for serious genetic disorders and helps you plan for your family’s healthy future. 80% of babies with a serious genetic disease are born to parents with no known family history of that disease. It pays to get tested. Results are provided by licensed genetic counselors via phone or video conferencing. To ﬁnd out more and to request your test kit, please visit JScreen.org.

www.JScreen.org • 404-778-8640

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healthy

Babies

Join us on Facebook facebook.com/HealthyMomAndBaby



The phrase may be “soft as a baby’s bottom,” but your newborn requires a delicate touch to stay that way from head to toe. Keep baby’s sensitive skin safe with advice from nurses on bathing, diapering and sun protection in the brand-new Healthy Mom&Baby Parent Pages: Caring for Your Newborn’s Skin. Get the latest research-based tips including: That creamy coating your baby is born with is protective—no need to rub it off It’s OK to bathe baby with the cord stump in place A baby-safe lotion or oil helps loosen cradle cap Download these tips and more at www.health4mom.org/nurses_office/ patient_tools

health4mom

.org

Bath-Time Ba

sics for Baby

There ’s nothin protects baby g quite as wonde rful temperature from bacteria and germsand amazing as newbo . Use these rn skin. It Association research-bas , and helps her body of hold a norma ed to help keep Women ’s Health, Obste tips from the nurse l experts of your baby ’s tric & Neona the skin health tal Nurses y, beautiful (AWHONN) and soft.

Preparation

Parent Pages

health4mom

.org

Out & Abou t

BATHING

NEWBOR There ’s nothin N amazing as g quite as wonderful and newborn skin. It prote baby from bacteria and germs, and cts her body hold a norm helps Use these al research-ba temperature. the nurse sed tips experts of from the Assoc Women ’s iation Healt Nurses (AWH h, Obstetric & Neon of atal ONN) to baby ’s skin help keep healthy, beaut your important to learn propeiful and soft. It ’s diapering, r bathing how and umbilical cord to take care of baby ’s how to prote stump until it falls off, and ct her skin from the sun. As she grows , your baby ’s don ’t hesitate to talk with nurse, midw about her ife or docto particular such as if skincare needsr baby ’s skin , you ’re unsur has a rash or if e specific produ of what types of babycts to use moisturizin for bathin g. g or

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ntial for Easy Arrange his tub, washc Bathing loth and towels reach before you begin. by keeping Bathe baby or blankets, and produ the door closed in a warm cts all within room, and minutes at elimin first —so that when possible. Keep provider has baths short — ate drafts baby told you otherw doesn ’t get cold. about 5-10 still in place. Unless your ise, it ’s OK health to bathe baby with his cord care stump Always start by washin g your hands.

Only use a

mild, cleanser designe gentle d for babies.

Always use

warm – not hot –wa ter, between 100 –10 4 degrees F. Check the water temper ature with a bath thermometer or it on the inside test of your wrist or elbow.

To shamp oo,

first wet baby ’s hair, apply an infant-sthen afe shampoo gently with your hand. Lightly massage baby ’s scalp with your hand or a soft baby brush, and rinse with moving down water the back and sides of baby ’s head. Do not put pressur e on the soft spot –k nown as the fontane l –in his head.

Tub Bath Tips

your Never leave during baby alone or a sponge bath bath while in the a bath tub, even if is used. seat or sling

Place bathtu b in a safe place and surface. on a strong Swirl water so there are no “hot spots. ” While holding feet first. Allowbaby, lower him into the water baby to rest covers just up to his should so that the water tub provid ers. If your es different baby ’s instructions, instructions follow the with your baby ’s bathtu 4 Your b. baby may fuss or cry try swadd ling baby first at first. For comfort, the water. before placing him in 2

THE SKINNY ON SKINCARE Always suppor

t baby ’s head and during bathing neck .

Begin with

a clean cloth and wash baby ’s face first, body second and diaper area last. Always wipe away from eyes and mouth the into the creases as you go behind his ears, around his neck, into his undera between his rms, fingers and toes, and in his diaper area.

Gently rinse baby ’s

body with your or a soft cloth, hands moving from head to feet, ensuring no soap is left behind .

Move baby

from his bath into a towel or blanket and pat skin dry rather his than rubbing it. Once dry, dress baby to keep him warm.

This resource was supported from Johnson through an & Johnson Consumer educationa l grant Companies , Inc.

Facebook

.com/Hea

Sponge Bath

1 Undress baby and

ndBaby

PROTECTION

Pages

Parent Pages

Sun

Most parent s immediately think of bathin babies need protection g and diaper from the sun ing first when from birth it comes to regardless caring for of their age, their little race or skin one ’s skin. But all color. To protec t baby ’s skin:

Tips

4 Wring out wrap him in a excess or receiving towel water from blanket. washcloth 2 Then, place so water your doesn ’t get wrapped baby into baby ’s eyes a second clean on when washing his blanket, towel, face. or 5 Unwra pad. p each area as you wash, 3 Wet a soft pat dry, and re-wra washcloth p to in a keep baby warm bowl as warm of as possible. water.

lthyMomA

Protecting Baby ’s Skin from

Parent

in the Sunshi

SKIN & SUN

BY SUMMER HUNT 1

Avoid direct sun exposu re during baby ’s first 6 months by coverin baby with g clothing and hats with

brims shadin g the head and neck to prevent sun exposu re and potential sunbur n.

From 6 month s on, preven t sunburn with a small amount of an infantsafe sunscr een with a Sunscreen Protection Factor (SPF) of at least 15.

This resource was supported from Johnson through an & Johnson Consumer educationa l grant Companies , Inc.

Facebook

.com/Hea

lthyMomA

Check the label of the infant sunscreen to ensure it protects against ultravio let rays A and B; also, choose a sunscreen specifically for infant skin and that won ’t sting baby ’s eyes.

Caring fo Newbornr Your ’s Skin

Advice Fro m On Bathin Nurses g, & Sun ProtecDiapering tion

ndBaby

This resource was supporte from Johnson d through an & Johnson Consume educational grant r Companies, Inc.

(ID EARLY AUTISM?) If your baby loses interest in eye contact between ages 2 months to 6 months, talk with your pediatrician about whether autism could be a concern.

RAISING BABY Transitioning your twosome to a family of 3 (or more!) can be a tricky time, says clinical psychologist Dr. Francine Lederer of L.A. Talk Therapy, who offers up these tips for managing change as you become parents:

Support and listen to your partner, keep communication open

Accept inevitable changes in sleep patterns, responsibilities and more

Give each other a break, even if it’s just 5 minutes

Other factors include not responding to his or her name, loss of sounds or facial expressions, or playing with a toy in an unusual repetitive way as these are all traits seen in kids later diagnosed with autism, according to a recent study from the National Institutes of Mental Health (NIMH). ISSUE 13 / Spring 2014 Healthy Mom&Baby

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

Download a free copy of

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

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

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

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my story BY DR. MAITLAND DELAND

Seeing My Son through

Childhood Diabetes When my son was diagnosed with type-one diabetes, the whole family went through an adjustment. Suddenly there was a new dynamic, a new level of caring, and a new level of worry. What parent wouldn’t trade places with their afflicted child, carrying the burden themselves in exchange for a child’s health? As a pediatric specialist and mother, I understand how and why parents strive to do everything they can to help their children. I also appreciate how dealing with a sudden and serious illness can bring on feelings of powerlessness. Many moms and dads dive into research and read everything they come across. There is no right way to handle this kind of news. The moment illness strikes, life splits in two: before and after. And it’s normal to yearn to get back to before. But the power is in the after, which is the present and the future. Life does go on, and eventually your family’s new normal feels just that way . . . normal. FIND SUPPORT

for children living with a disease like diabetes. Knowledge is power, and as girls and boys learn more about their illnesses, they become empowered to live with confidence and without worry. As a doctor and a mother, I know it’s hard to cope with your feelings when your child has an illness. Don’t be afraid to ask for help and to use support systems.

DR. MAITLAND DELAND, MD, is a

radiation oncologist who specializes in the treatment of cancer in women and children. She is also the author of The Great Katie Kate series at DelandBooks. com that helps children face serious illnesses.

Pictured with her son who was diagnosed with type-one diabetes, Dr. Maitland DeLand encourages parents to move beyond their fears and instead seek support and help.

For me, meeting other parents of children with diabetes was so beneficial. I learned helpful tips like the best snacks to pack for vacations and how to better help my son regulate his insulin. Knowing you’re not alone is powerful and integral to coping with illness. Not only did we share tips and resources, we also became a group that could comfort one another, whether with laughter or tears.

IMAGE COURTESY OF M. MAITL AND DEL AND

JUST ONE PART OF ME

My son’s health will always be a top priority but our lives don’t revolve around it. Diabetes became a part of my son’s identity, but it didn’t become his whole identity. My daughter, too, added it to her identity. She’s participated in several diabetes fundraisers, and she participated in a clinical trial that is helping to determine risk factors in family members as well as studying prevention, delay, and reverse progression. (Learn more at diabetestrialnet.org.) GAIN WISDOM

Understanding medical information is crucial

ISSUE 13 / Spring 2014 Healthy Mom&Baby

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When you need, or want, to avoid common chemical irritants found in ordinary skin & hair care products. Free of

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healthy babies

Introduce one new product at a time

Begin with the basics Baby body wash/soap, baby shampoo and diaper rash cream. Use topical products, like lotions and creams, only when needed. Most full-term, healthy babies won’t need any lotions or creams on their skin during the first few weeks of life. Simply let the creamy white coating (vernix) baby was born with wear off, which usually happens within the first couple of days. You may also see flaky skin as your newborn sloughs her initial layer of skin cells. If you have any concerns, talk with baby’s healthcare provider before you start using creams and lotions. Irritation from products on your baby’s skin early in life may increase her risks of allergies or eczema.

Strategies 6 For Newborn By Kimberly Wilschek, RN, CCE

Skin Care Products

There is nothing quite as yummy as the feel and smell of your newborn’s skin. Selecting the right skin care products can help ensure that your baby’s skin remains beautiful, soft and healthy. You’re not alone if you’re a bit perplexed by the oodles of lotions and potions available. The good news is that there are many safe, effective products on the market. Know that your baby’s skin is up to 30% thinner than adult skin so it’s important that you only use products designed for infant skin. Your baby’s thinner skin is also more sensitive to sunlight; products that you put on her skin could cause irritation. It continues to thicken and develop during her first year. Her skin also dries out quicker. The FDA and the Environmental Working Group’s Skin Deep database, which includes more than 2,000 baby products, are good resources regarding product safety. Armed with product safety information, you just need these 6 simple, evidence-based tips to nurture and protect baby’s skin:

Check for sensitivity by doing a skin patch test for each new item: Apply a small amount of the product on the inside of baby’s forearm and leave it on for about 24 hours before washing it off. Signs of sensitivity include redness, scaling, bumps, blotches, difficulty breathing, or vomiting. If you see any of these signs, stop using the product and contact your baby’s healthcare provider, particularly if the reaction is severe.

3 Keep babies 6 months old and younger out of direct sunlight Cover baby with clothing, hats, sunglasses and shades when she’s outdoors. At 6 months, start using a broad spectrum sunscreen with SPF 15 that’s made specifically for babies.

ISSUE 13 / Spring 2014 Healthy Mom&Baby

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healthy babies

From those first weeks, baby only needs a short bath (5-10 minutes) every few days (2-3 times a week). This helps limit her exposure to potentially irritating products. Experts don’t recommend daily bathing unless needed as it can alter the delicate balance of baby’s skin and predispose it to dryness. Keep her diaper area clean and sponge bathe where needed (see tip #5). From 6 months on, or when your baby starts crawling, you can bath her more often and for longer periods of time. Use only mild baby washes designed for newborn skin; avoid antibacterial cleansers— they’re not necessary and can contain harsh chemicals.

W HAT TO BU Y IN A BA BY WAS H O R SH AM PO O



Tear-free



Few if any fragrances or dyes



pH neutral or mildly acidic (pH 5-5.7)



Fewest preservatives

Sunscreen Shopping List  Broad spectrum coverage (UVA & UVB)  SPF 15 

Zinc oxide or titanium-dioxide based



Cream or lotion (avoid sprays) No oxybenzone or vita min A



5 Keep the diaper area clean Despite the debates, most common diaper wipes are fine for cleansing baby’s bottom. Choose wipes that are alcohol-free. If baby seems sensitive to one type of wipes, try a different brand, or just use warm water plus a little baby wash, if need be. For diaper rash, use a diaper rash cream with zinc oxide. If regular zinc oxide creams don’t seem to be helping, talk with baby’s healthcare provider about switching to a product with a higher percentage of zinc oxide. 40% zinc oxide concentrations are the strongest allowed by the FDA without a prescription. Apply diaper creams thickly— like you’re frosting a cake—to dry skin.

6 Be a label reader Just like food labels, the labels on skin care items will tell you exactly what is in the product. Phrases such as ‘natural’ or ‘environmentally friendly’ can be confusing and some of the ingredients may not be regulated by the FDA. One quick way to spot a more natural product is to look at the number and type

of ingredients on the back label. Are there just a few ingredients or more than you can quickly count? Are they long chemical names, or things that you recognize? Additionally, remember that naturally occurring ingredients have been known to cause a skin reaction in some children and adults. Always test the product first before applying a liberal amount.

KIM WILSCHECK, RN, CCE, is an expert advisor to Healthy Mom&Baby

Limit baths early on

health4mom.org

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NON GMO

Project VERIFIED

nongmoproject.org

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healthy babies

Colds Allergies BY AWHONN EDITORIAL STAFF

It’s spring and your little one seems stuff y and fussy; and this is not the first time. You’ve been sneezing as well and are left wondering: could this be an allergy instead of a cold?

COLDS

ALLERGIES

If your child is 3 months old or younger, let your pediatrician know baby isn’t well; colds in very young babies can easily progress to more troublesome infections, such as an ear infection or pneumonia.

If your child is age 3 or older, you could be dealing with a seasonal allergy.

KNOW THE SIGNS: 

Stuffy nose, with typically thick, yellow or greenish fluid draining



Cough or sneeze, especially with mucous



Temperature up to 100.4˚F



Fussiness, irritability



Difficulty sleeping



Decreased feeding

KNOW THE SIGNS: 

Stuffy nose, with clear fluid draining



Cough or sneeze, with clear mucous



Watery, irritated-looking eyes



Difficulty sleeping



Decreased feeding



Symptoms get worse at the end of the day, particularly in the spring or fall

HOW TO HELP:

The drainage coming from your child’s nose can also be telling: Colds generally have thick, colored drainage, while nasal secretions are typically clear and runny with an allergy. As always, it’s best to get your pediatrician’s expert advice. And refrain from giving any over-the-counter medications designed to relieve symptoms related to colds or allergies to infants and young children unless advised by your child’s healthcare provider—regardless of what the packaging says.



Keep baby’s hands clean



Gently clear baby’s nose of any drainage



Keep baby’s nose moist with saline sprays or drops made for infants



Keep the air moist with a cool mist humidifier



A warm bath can also help with stuffiness



Nurse often to keep baby hydrated; give breast milk or water often to infants ages 6 months+ who may not be nursing

HOW TO HELP: 

Depending on your child’s age and how severe their allergies are, your pediatrician may advise using nasal decongestants or antihistamines; corticosteriods are also often used but are available by prescription only



Keep your child indoors in the evening, when allergen levels are highest



Bathe your child often, especially after being outdoors



Wash jackets and hats often to remove pollens and other allergens



Use a clothes dryer instead of drying clothes outside

T E LL YOU R P E D IAT R IC IA N IF YOU R C H IL D.. .

Has symptoms and is 3 months old or younger Has a temperature greater than 100.4˚F Is pulling on her ears Isn’t using as many diapers, or the toilet, as typical Has had a stuffy nose with drainage for more than a week Has been coughing for a week Has gooey eye discharge

IMAGES © 123RF

Allergies typically don’t occur in children ages 3 or younger because it takes repeated seasonal exposure to pollen and other allergens to create an allergic response, says the American Academy of Pediatrics. Cold and allergy symptoms may appear similar so begin with your child’s age: The younger they are, the less likely they have an allergy. The common cold is actually a viral infection in your little one’s upper respiratory tract. Most infants will have up to 7 colds in the first year of life.

health4mom.org

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healthy babies

(NEWBORN)

Screening

BY NATASHA F. BONHOMME

A FIRST STEP IN KEEPING YOUR BABY HEALTHY

Have you heard about newborn screening? It’s one of the most important screening tests for your baby that you probably haven’t heard of—until now.

Every year, nearly 12,000 newborns that appear healthy are found to have a condition only detectable through newborn screening. YOUR BABY’S FIRST TEST Between 24 and 48 hours after birth, your baby’s nurse will do a series of screening tests. These screens include a heel prick where blood is taken from your baby’s heel, a hearing screen, and in some states, a heart screen often referred to as “pulse-ox.” These screenings are designed to pick up a range of different health issues before they lead to long-term complications or even death. When found early, babies with these different conditions can receive early treatment and can lead normal lives. WHAT DO THE RESULTS MEAN? As with any health screening, it’s important to

understand the results. A negative results means everything is fine—the outcomes are in the normal range. The other option is an “out-of-range” or positive result. These results mean your baby’s healthcare provider needs to explore what may be causing this outcome. An out-of-range result doesn’t mean your baby has a condition. There are a number of reasons why a result may be out-of-range on the first screen but later test normal, including whether your baby had eaten enough before the screen. If you get a phone call or letter saying your baby needs to be retested, don’t panic, but act quickly. The screening process picks up any baby who might be at risk for a condition. Follow-up testing is needed to determine if your baby actually has a disease. It’s very important to follow up with your baby’s healthcare provider to be sure your baby is healthy. WHERE DO I GET MY BABY’S NEWBORN SCREENING RESULTS? Whether your baby’s results were in-range or outof-range, your baby’s healthcare provider should tell you the results by your 2-week or 1-month wellbaby visit. Even if your baby’s newborn screening results are normal, please tell your care provider if you have any concerns about your child’s health.

RN NEWBO WHAT S AR E SCREEN TED IN C CONDU ? E T MY STA For more information on what conditions states screen for and questions to ask your healthcare provider, go to:  www.babysfirsttest.org

NATASHA F. BONHOMME

is Project Director at Baby’s First Test. This content was supported with an educational grant from Genetic Alliance/Baby’s First Test.

ISSUE 13 / Spring 2014 Healthy Mom&Baby

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healthy babies

ABCs of Safe Infant Sleep

Put ting sleep o baby to n is the s his back ingle m impor t os t a nt s t in redu rateg y cin SIDS ris g k.

BY SHARON HITCHCOCK, MSN, RNC

Did you know experts worldwide think most Sudden Infant Death Syndrome (SIDS) and other infant sleep-related deaths are preventable? Here in the U.S. we have one of the highest rates, with nearly 3,700 deaths a year—that’s an average of 10 babies a day! More than 20 years of SIDS research shows there are many practical things parents and other caregivers can do to help prevent these deaths. One of the most simple is practicing the ABCs of safe sleep. In my hospital, we tell parents “If you remember nothing else, remember the ABCs:” A for Alone

B for Back

C for Crib

ALONE “Alone” means alone. Babies need their own separate sleep area, ideally in your room but not in your bed or with you. This is called room-sharing; research shows room-sharing reduces the risks of SIDS by 50% while offering many of the same benefits as bed-sharing. BACK “Back” means baby needs to be positioned for sleep

flat on his back, never on his tummy or side. Don’t worry; babies don’t choke more on their backs, not even the “spitty” ones. This single strategy is the most important in reducing SIDS risk. CRIB “Crib” means a safety-approved crib, bassinet or play-yard with a firm mattress covered in a tightfitting sheet and nothing else but baby. No loose or fluff y items, bumpers, or stuffed animals. OTHER STRATEGIES Breastfeeding, pacifiers (after nursing is going well), infant immunizations, and well-baby checks all help protect against SIDS. Never allow your baby to become too hot (baby is sweaty in his clothes), and never smoke, drink alcohol or take illegal drugs around your baby.

PUT ME SAFELY TO SLEEP WITH MY ABCs Thank you for reducing baby’s risk of Sudden Infant Death Syndrome (SIDS) and other sleep accidents: d a htnee tig I only with a se or o CR I B no lo er s ba r e s h e e t ; , b u m p g g f it tin y beddin ys or to f luf f

always I must ON E AL sleep for d just in a be ies ba b

A B IS FOR A

LONE

I only my B sleep o n A place CK; nev er me o side n m or t u y m my

IS FOR BACK

IS FO R CR IB

T R A IN YO UR C A R E G IV E RS

You may faithfully put baby to sleep on his back but do others caring for your infant do the same? Unaccustomed stomach sleeping is when a baby who normally sleeps on his back is placed on his stomach or side to sleep. This bumps up baby’s risk for SIDS by 7-8 times! These deaths usually happen under the care of a child care provider, friend or grandparent who doesn’t know the ABCs of safe sleep. Share our ABCs of Safe Infant Sleep card (left) with all caregivers and put a copy near baby’s bed as an ongoing reminder. Can every case of SIDS be prevented? Probably not, but practicing the ABCs of safe sleep and other protective strategies gives peace of mind that you’ve done everything you can do to reduce your baby’s SIDS risks.

SHARON HITCHCOCK, MSN, RNC, is a maternal-

Learn more about safe infant sleep at Health4Mom.org

newborn educator and adjunct faculty at the University of Arizona College of Nursing.

ISSUE 13 / Spring 2014 Healthy Mom&Baby

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healthy babies

Taming

BY ALICIA BERBERICH, BA, CIC

Toddler Tantrums )

You’ve seen this situation—perhaps even been there: A mom is trying to shop while her toddler is screaming and reaching for something on the shelves, jumping up and down and trying to climb out of the shopping cart. This is a full-on tantrum. What should she do? RESPOND RIGHT

When your child is having a tantrum the only thing you can control is how you respond. You only have control over yourself; manage your response. When your child is having a tantrum, she’s stuck and needs help moving on. The first and best strategy is to avoid tantrums altogether. Learn what triggers tantrums in your child. When my daughter hasn’t eaten in 2 hours she becomes very vulnerable to tantrums. This is challenging because I don’t eat that often. So, I set my phone to alert me every 2 hours to ensure she gets something nutritious on her schedule. Then, there’s the element of surprise: Our shopping mom could make a big expression and statement: “Oh wait! Daddy is coming home tonight from his trip and we want to surprise him OVERTIRED

with a special dessert! What flavor ice cream do you think he would like?” The goal is to give her toddler something new to think and talk about. A second strategy is to use humor. Suddenly disappearing around the cart or playing peek-a-boo will help pull your child out of the moment. Make them stop and wonder what is going on. Be creative! “Did you see that pink elephant? Let’s go investigate!” Routines reduce tantrums. Babies and toddlers do better overall (and adults too for that matter!) if they have routines they can count on. Events they can anticipate are easier to manage; the unknown is stressful. And if you’re stressed, it’s likely your child will be edgy too. When tantrums strike, remember you’re not the first or only mom to suffer through one. Be empathetic with yourself, your child and with others who are dealing with this difficult and challenging part of raising kids.

OVERSTIMULATED

OUT OF HER ROUTINE

STOP A TANTRUM BEFORE IT STARTS BY RECOGNIZING AND ACTING WHEN YOUR CHILD IS: HUNGRY

OVERSCHEDULED

FORCED TO DO SOMETHING AGAINST HER WILL

WHEN TANTRUMS STRIKE NEVER GIVE IN or you’ll teach tantrums as a tool to get what your child wants TRY HUMOR OR SURPRISE; even distraction IF NEED BE, LET THE TANTRUM RUN ITS COURSE; keep your child safe, holding him if necessary MAKE SOOTHING SOUNDS or sing a soft tune MOVE ON WITHOUT REWARD WHEN THE CHILD EVENTUALLY CALMS DOWN or else your child could learn tantrums lead to good things

ALICIA BERBERICH, BA, CIC, is a psychologist

and creator of the Unleash Your Child’s True Potential workshops in San Francisco.

IMAGE © 123RF

(

THEY’RE NEVER CONVENIENT AND YOU CAN HELP YOUR CHILD AVOID THEM

health4mom.org

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Slow ! down Relax.

Don’t rush me!

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

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

f 40 or !

Download a free copy of

40 Reasons to Go the Full 40

What’s the hurry?

at www.gothefull40.com.

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

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