Healthy Mom&Baby: Issue 14 by Healthy Mom&Baby

ISSUE 14 / Summer 2014 | $3.95 | health4mom.org

PREGNANCY | BIRTH | PARENTING

AMANDA’S STORY

Realities of Smoking in Pregnancy

SUPERNANNY’S

Must-Do Toddler Rules

NORMAL BIRTH AFTER CESAREAN

Breastfeeding & Depression NURSING HELPS PREVENT PPD HMB1.cover.bf.indd 1

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34 Amanda’s Story Smoking changed her life and her daughter’s too

Issue 14 / Summer 2014

37 Breastfeeding & Postpartum Depression

( contents )

Three myths busted to prove the protective effects of breastfeeding for moms and babies

44 Sweat Funk Sara Haley highlights a great cardio dance workout

healthy moms

healthy pregnancy

10 Mama Tia!

24 Considering Normal Birth

healthy babies

“Instant Mom” Tia Mowry talks healthy eating

After Cesarean

for conception and pregnancy success

Get the facts to inform your decisions

Super Nanny has 5 rules for transforming everyday

13 Put Out The Fire

26 Are You Eating Enough Fish?

The best time to quit smoking is before

Women and children need to catch up on the

you’re pregnant

nutrition in fish

17 Diagnosis Infertility How to increase fertility

Oral Health

The Symptoms?

of your baby?

Would you know the signs and symptoms of this

53 Cradle Cap

Can pregnancy be a window into your future

29 Sensational Snacks Learn how to eat healthy snacks while eating for 1

21 7 Strategies To Get Going

31 Veggies For A Healthy Pregnancy

How to deal with tough moments in life

be should be eating

When The Going Gets Tough

52 Bottles, Pacifiers & Your Baby’s

27 Preeclampsia: Do You Know life-threatening disorder?

health?

hassles into harmonious households

Do bottles and pacifiers effect the oral health

18 How Pregnancy Predicts Your Future Health

48 The Toddler Rules

The most important veggies that mommies-to-

Amanda’s Story

Simple steps to clear this bodily buildup of oils and skins

54 Your Child in the Emergency Room Tips on taking your child to the ER

57 Caregivers & Safe Infant Sleep Do the people in your life know the safest way for your baby to sleep?

61 Understanding Newborn Screening Learn more about the screening your newborn will go through

66 Intruder In The House Dealing with jealousy when your new baby comes home

There’s help right now for quitting

The most important veggies that mommies-to-be should be eating page 29

FEATURE

ISSUE 14 / Summer 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 ROBERTA DURHAM, RN, PhD California State University Eastbay Hayward, CA JOANNA GOLDBORT, MSN, PhD, RN Union Hospital Health Group Terre Haute, IN HELEN HURST, DNP, RNC, APRN-CNM University of Louisiana School of Nursing Lafayette, LA ELIZABETH JORDAN, DNSc, RNC University of South Florida College of Nursing Tampa, FL CAROLYN “CARRIE” LEE, PhD, CNE, RN University of Toledo College of Nursing Toledo, OH JENNIFER LEMOINE, DNP, APRN, NNP-BC University of Louisiana at Lafayette Lafayette, LA CYNTHIA LORING, MS, RNC, CLC Brigham & Women’s Hospital Boston, MA RITA NUTT, DNP, RN Salisbury University Salisbury, MD SUSAN PECK, MSN, APN Robert Wood Johnson Medical School New Brunswick, NJ MICHELE SAVIN, MSN, NNP-BC Christiana Care Health Services Wilmington, DE PAT SCHEANS, MSN, NNP Legacy Health System Portland, OR SHARON JEAN SCOTT, BSN, RN Mary Washington Hospital Fredericksburg, VA

AWHONN’s mission is to improve and promote the health of women and babies. Healthy Mom&Baby is powered by the nurses of AWHONN.

Benefits for You & Your Baby When You Quit Smoking It’s hard to miss the messages about how dangerous smoking is for you and your baby—during and after pregnancy. Smoking harms almost every organ in your body—your baby’s too—and has lasting health risks and effects. But have you ever considered what you’re missing out on by not quitting smoking, especially if you’re trying to conceive or if you’re pregnant? About 1 in 10 women smoke during pregnancy despite the risks of birth defects, baby being born too small or born early, Sudden Infant Death syndrome (SIDS)—or worst of all— stillbirth, says the CDC. You can quit smoking in pregnancy—55% of women who smoke typically do stop once they’re pregnant, even though more than half will relapse after baby’s birth.

Consider grabbing these health boosts and benefits by not smoking: Boost fertility—smoking is associated with infertility and increases your risk of never becoming pregnant Reduce your risks of heart disease, stroke, lung cancer and lung disease Live long enough to raise your child and know your grandchildren too Enjoy more energy and breathe easier Smell better—especially your body, clothes and home Reduce the chances you’ll miscarry or that baby will be born early (premature) or be stillborn Boost baby’s oxygen even after just one day without smoking Increase baby’s overall growth, lung and brain development Boost the chance that you will bring baby home with you from the hospital after birth Feel good about what you’re doing for yourself and your baby, and talk to your healthcare provider about quitting smoking. There’s help and support at (800) QUIT NOW. You do not have to do this alone.

KIMBERLY WILSCHEK, RN, CCE Medical Revenue Solutions Chicago, IL CHARLOTTE WOOL, PhD, RN, CCNS York College of Pennsylvania York, PA TAMERA YOUNG, RN, MSN Central Ohio Technical College Zanesville, OH

IMAGE © 123RF

CONSUMER ADVISORS MARIA OPLT Lafayette, LA

Catherine Ivory, PhD, RNC-OB, is the AWHONN 2014 President.

ISSUE 14 / Summer 2014 Healthy Mom&Baby

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Editor & Director of Publications:

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Carolyn Davis Cockey, MLS

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Director of Women’s Health:

in babies. These tests can all be done from the

Catherine Ruhl, CNM, MS Editorial Coordinator & Writer

Summer Hunt

comfort of your arms, even while nursing (except the hearing screen). You’ll be asked to agree to screening when

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

you register or arrive at the hospital. Results will be available by baby’s 2-week checkup with the pediatrician or midwife. Be sure to ask for those results if they aren’t shared with you during that visit. A positive result doesn’t necessarily mean baby has a health problem—rather, it means further testing

or screening is needed to rule out a health concern.

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.

articles on newborn screening in this issue that are

To increase awareness of the importance of newborn screening, we’re introducing a series of part of a Newborn Screening Zone at our website, Health4Mom.org. Look for articles on newborn screening in each of the next four issues, and find even more resources online. Until next time,

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

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

ISSUE 14 / Summer 2014 Healthy Mom&Baby

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healthy

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Moms

BY SUMMER HUNT

Pelvic Exam Debates Stirrup Confusion Should you or shouldn’t you? A recent guideline from the American College of Physicians cautions “asymptomatic, non-pregnant adult women” against getting annual pelvic exams, especially if they have no elevated risk of cancer or other disease. However, the American College of Obstetricians and Gynecologists (ACOG) sees value in the diagnostic procedure, saying it “allows gynecologists to explain a patient’s anatomy, reassure her of normalcy, and answer her specific questions.”

IMAGES © 123RF

Ultimately, ACOG suggests that “the decision about whether to perform a pelvic examination be a shared decision between health care provider and patient, based on her own individual needs, requests, and preferences.” Women should continue to schedule annual well-woman visits and consult with a healthcare provider whom they trust about whether or not a pelvic exam is necessary—and don’t be embarrassed to bring up sensitive issues and concerns, like sexually transmitted infections, unusual vaginal discharge, or pain with intercourse, the docs say.

TREATING INFERTILITY

WHAT’S APP, DOC?

If you’re struggling with infertility, ask your healthcare provider about the drug letrozole. A study funded by the National Institutes of Health (NIH) found the drug to be more effective at increasing pregnancy rates than current treatments for women with polycystic ovary syndrome (PCOS).

Your smartphone might actually do your body good: A recent study found that one in six Americans relies on apps to stay healthy. Two-thirds of those people said they felt successful, and more than half reported weight loss. 40% of users said that they preferred healthy living apps instead of seeking help from a doctor—with 60% citing a desire to avoid judgment.

41%

Calorie counting

Women treated with letrozole were more likely to ovulate and also more likely to have a live birth. “A letrozole-based treatment potentially could provide a less invasive, less expensive therapy, with a much lower risk of multiple pregnancy,” says study author Richard S. Legro, MD.

38%

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ISSUE 14 / Summer 2014 Healthy Mom&Baby

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healthy moms

t This Instan s it d re c M om for g n ti a e y health n a d conception pregnancy success

Mama Tia! By Summer Hunt

“I never knew how much patience I had until I had a child” Above: The flu vaccine comes as a shot or as a nasal mist. Here Tia receives the vaccine through nasal mist.

Tia Mowry has a robust resume, from TV shows and movies to an all-natural product line for moms and a memoir about motherhood. Amidst it all, this motivated mommy manages to maintain a healthy household for herself, husband Cory Hardict, and 3-year-old son, Cree. “Health is a huge part of my life, and it became really important to me prior to having my son,’ Tia says. “I’d already had 2 surgeries for endometriosis, and I definitely wanted to have a child. My doctor told me if I wanted a baby and didn’t want to have another surgery, I was going to have to

make some changes.” Tia focused on changing her eating habits and taking better care of herself with a diet of nutritious eats. “I got pregnant almost immediately, and one of the first people I called was that doctor,” she laughs. Fresh Eats After seeing what an impact good-for-you foods made, Tia put those basic eating principles into practice for her family. “Everything we eat is fresh, organic… nothing processed or artificial,” she says. Tia also makes it a point to get moving

health4mom.org

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healthy moms

“After I became a mom, I realized how necessary it was to get vaccinated” watching your belly grow and feeling that first kick… and then all of a sudden, you have this beautiful baby coming into the world.” Shot for Health As proactive as Tia is about protecting her family, she knows the best defense is a good offense—which is why the flu shot is a major part of her annual routine. “I always got it as a child, but it sort of fell to the wayside as I got older,” Tia admits. “But after I became a mom and read more about the effects and consequences the flu can impose on your family, I realized how necessary it was to get vaccinated. A lot of people think it’s just a bad cold, but it’s so much worse— especially for children.” She’s also adamant about regular hand washing and keeps hand sanitizer around for on-the-go germ fighting.

at least 3 times a week. “I have a yoga DVD that I love,” she says. “I also enjoy cycling and dance cardio.” Cree follows his mama’s good example. “He has a habit of walking around the block every day, like clockwork, at 5pm,” she adds proudly. “Going to the park to run and play is a favorite activity, too.” Tia percolates passion for her motherhood role on TV from life with Cree: “One of the things I love most about being a mom is just seeing my child blossom and grow into this cute little human being! You get to experience life from the beginning, from conception to

Beyond Baby Blues In addition to maintaining a nutritious diet, getting regular exercise, and staving off germs, Tia emphasizes how essential it is to really take care of you—not just physically but mentally as well. Experiencing the baby blues after giving birth really threw Tia for a loop. “Becoming a mom is a huge adjustment,” she says. “Know that there are going to be more highs than lows. Children teach you so much; they show you what your strengths and weaknesses are. I never knew how much patience I had until I had a child. And while you want to be the best mom you can possibly be, you are still human. You’re going to make mistakes; remember to forgive yourself.”

Summer Hunt is editorial coordinator at AWHONN and writer for Healthy Mom&Baby.

Tia’s Tips

for a Healthy, Happy Life

1.� Fill up on fresh foods “1 of my New Year’s resolutions was to have a garden, and it’s been fun to build and work on with my son.” 2.� Love what you do “You won’t find me in the gym pumping iron! By finding things I actually like doing, I’ve been able to keep it up.” 3.� Make yourself a priority “Keep sight of your own goals and aspirations, and don’t be afraid or feel guilty to take time for you.”

ISSUE 14 / Summer 2014 Healthy Mom&Baby

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healthy pregnancy

Put Out the Fire The best time to quit smoking is before you’re pregnant.

Simply put, the best and easiest time to quit smoking is before you get pregnant. This is because the medications we recommend to help you quit are easier to use without fear of side effects before pregnancy. By Drs MICHAEL ROIZEN & MEHMET OZ

2 war n in gs

1 Do not take Chantix (varenicline) while pregnant.

nicoti O verall, produ ne replace ment c ts ar to be e conside contin safer than red uing to as c sm conta igarette sm oke ins oth o er che ke k n ow micals n to to you be toxic r unb or n child

Chantix is listed as a category C drug for all trimesters during pregnancy. Category C means that either adverse effects of Chantix have been found in animal studies or that no animal studies have been performed. It may be that there are few or no adequate clinical trials performed in women who are pregnant.

2 Buproprion concerns:

After you’re pregnant, most of the medications designed to help you quit smoking are still safer than continuing to smoke, but then you’re trading risks and benefits around the question: Which is worse for me and my baby—smoking or the medications to help me quit smoking? No butts about it, research shows it’s still a lot safer for you and your baby to use the medications to help you quit in pregnancy.

images: 123RF

Protect Your Baby

If you fear you’ve already done something damaging to your baby, rest assured that human beings are a resilient lot; otherwise we’d have died out millennia ago. Let’s face it: Since 50% of pregnancies are unplanned, plenty of women inadvertently expose their babies to toxins like alcohol and tobacco. The key is simply stop, make a U-turn, and reverse damaging behavior as soon as possible. Even the damage caused by smoking can be offset if you quit in the early part of your pregnancy. Put Out the Fire

Whether from us or from your pregnancy care

provider, you’re going to get this information at some point, so now’s as good a time as any. Please don’t sentence your child to 40 weeks inside a smoky bar. Tobacco turns on genes that are later linked to the development and growth of cancers, as well as inflammation in arteries, which leads to heart attacks, strokes, wrinkles, and impotence. Smoking causes inflammation in uterine arteries, limiting blood flow and making it harder for oxygen and those muchneeded nutrients to travel from mom to baby. One of the reasons we care so much about a mother’s health during pregnancy is that your health affects how the placenta works, including how much surface area will be available to exchange nutrients between you and baby. For example, smoking or having high blood pressure that’s not properly managed can cause your placenta to calcify, limiting the area available for oxygen and nutrients to flow between mom and baby. That’s the bad news. Here’s the good news: When you stop smoking: XX Baby gets more oxygen every day, even on day 1

Bupropion has been assigned to pregnancy category C by the FDA. High-dose animal studies have failed to show toxic effects. In one study that looked at the birth records of more than 7,000 infants whose mothers used bupropion in the first trimester showed now increased risks for malformations in baby, especially cardiovascular malformation. One case report has suggested that bupropion accumulates in human breast milk in concentrations greater than in a mother’s bloodstream. Since the effects of the drug in a nursing infant are unknown, the drug’s manufacturer suggests stopping the drug or stopping breastfeeding. This is a good decision to make in consultation with your healthcare provider.

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healthy pregnancy

You don’t have to quit alone—there’s help, including our breathe-free, addiction-busting program. Here’s how to use it: XX Get everyone else to quit and be a buddy to quitters: Having a spouse who doesn’t smoke or who quits smoking is an advantage. Make your home smoke-free; get rid of all cigarettes in the house and car to increase your chances of quitting. Use your spouse or partner or even a friend as a buddy. Report on your progress and get additional help as needed. XX Get help: If you’re not pregnant but want to be, quit with the program starting at #1. If you’re pregnant, and are smoking less than 7 cigarettes a day, we favor 1 attempt at quitting cold turkey, trying #1. Everyone else—including pregnant women who smoke more than 7 cigarettes a day— start with #1.

2 1 Start walking 30 minutes every day, no excuses, every day. Start this on day one, a week before quitting. Call a support person.

Fill prescription. Ask your healthcare provider for prescriptions for 100 milligram Wellbutrin tablets and nicotine patches dosed according to the amount you smoke, as indicated below: for 1⁄2 pack a day, take 7–10 milligrams (we advise one quit attempt cold turkey if you normally smoke a maximum of seven of fewer cigarettes a day)

for 1⁄2– 1 pack a day, take 14 milligrams

for 1-2 packs a day, take 21 or 22 milligrams

for more than 2 packs a day, ask your doctor

12 Carry 1 bupropion tablet with you at all times to take if you feel a craving.

11 Decrease to 1 bupropion in the evening after one month, and eliminate the other 1 at 2 months.

our quit smoking plan

Decrease patch size by one-third every month.

9 Begin resistance exercises for pregnancy if not already started on day 40 (or earlier). Do not increase your physical activities by more than 10 % a week.

4 On day 9, take 1 bupropion each morning.

5 Apply your nicotine transdermal patch system on day 10 (this is your stopsmoking day). Place one patch on your arm, chest, or thigh (replace daily).

6 8 Phone or e-mail your support person daily to discuss your progress.

7 Continue walking 30-45 minutes each day and call your support person. Feel free to drink as much water as you wish.

XX Have a smoking cessation plan—this is our plan, but please discuss this with your doc before you or anyone you know starts this plan. On our plan we favor using nicotine patches and the drug bupropion. The patch is safer than smoking and gives a more consistent level of nicotine with no hydrocarbons. Bupropion helps you quit without cravings and has been used safely, even at much higher doses, as withdrawal from cigarettes without bupropion and nicotine causes side effects on your unborn child. Although nicotine is a natural neurotransmitter you have in your nervous system, at the higher doses in cigarettes and in patches, it’s a toxin. Let’s be specific—using nicotine replacement products during pregnancy or breastfeeding is considered relatively safe; it’s not entirely risk-free. You already expose your unborn or nursing child to nicotine if you smoke in pregnancy or while breastfeeding. Breastfeeding is recommended even if you smoke or use nicotine replacement products.

3 On day 8: 2 days before you plan to stop smoking, take one 150mg bupropion for up to 250 pounds pre-pregnancy. Please note: Avoid bupropion should you have a history of, or develop signs of, preeclampsia or any other pregnancy condition that may predispose you to seizures. Bupropion should also be avoided if you have severe pregnancyinduced nausea and vomiting.

Babies of smokers are more prone to illnesses, but breastfeeding helps prevent these infections. Breastfeeding also reduces the risk of other illnesses and death for baby. There is no evidence that using nicotine replacement products in pregnancy or breastfeeding results in higher blood levels of nicotine than smoking. The argument for using nicotine replacement in pregnancy, despite potential risks, is that if it increases the chances of pregnant women quitting smoking, then withholding it would be harmful. Compared with a placebo, use of a nicotine replacement product to try to quit smoking during pregnancy improves the birth weight of the babies and may improve birth outcomes by decreasing the risks of low-birth-weight and preterm birth. Overall, nicotine replacement products are considered to be safer than continuing to smoke as cigarette smoke contains other chemicals known to be toxic to your unborn child.

On subsequent days, take bupropion each morning and each evening. Most pregnant women wean off bupropion between days 60 and 90.

Research shows it’s still a lot safer for you and your baby to use the medications to help you quit in pregnancy

images: 123RF

XX Baby is more likely to go to term, making him or her more likely to be healthy XX Baby is more likely to graduate high school without having a disability or needing medications for asthma As you can guess, quitting increases the amount of nutrients your baby receives, promoting his or her growth and development and helping baby avoid issues that can have a major impact on baby’s health later in life.

health4mom.org

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The answer is no, especially when 5 million of them are fertile but still cannot conceive. Meanwhile 65% of these women continue to undergo infertility treatments for two years or more. KNOWHEN® is not only a fertility detecting and tracking solution; it is awareness - a movement, an education and a lifestyle improvement that brings women closer to their bodies like never before. KNOWHEN® is committed to tame the infertility epidemic which is often caused by lack of education, knowledge and usage of the correct device. KNOWHEN ® from Hilin Life Products is a patented revolutionary, non-invasive, natural, easy to use, ISO certified, and FDA cleared ovulation awareness device.

KNOWHEN® is accompanied by an educational CD “Ask the Experts” containing “The Questions and Answers Women Need to Know About Their Body’s Cycle™”. The audio CD explains ovulation, why it is important for women to understand their individual cycle, and how the KNOWHEN® mini-ovulation microscope works.

KNOWHEN® offers a free personal ovulation tracking mobile app with the purchase of a device. The mobile app tracks the daily results easily and accurately. KNOWHEN® is an end to end fertility monitoring device now available not only to help women better understand, track and predict their ovulation cycles, but also to empower and guide them in their decision to achieve their fertility goals. KNOWHEN® differentiates itself in price, usage and effectiveness from alternatives available in the industry for family planning and fertility detection. Unlike other devices requiring repeated purchases and which may not be effective when used with certain medications, the KNOWHEN® Saliva Fertility Monitor is a reusable one time purchase, effective with or without the use of other medications. KNOWHEN® is manufactured in the U.S. and is currently available at www.knowhen.com. Visit the site for more information on how you can take control of your own fertility…and hear some helpful tips from “Eva.”

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healthy moms Act on These Symptoms and Problems Some symptoms and health problems are associated with infertility. Forget the suggested timeframes for determining infertility and instead talk to your healthcare provider if any of the following apply to you or your partner:  Painful, irregular

or no menstrual periods

Boost Her Fertility Eat a healthy, balanced diet rich in vegetables, fruits and omega-3 fatty acids, like the Mediterranean diet to better balance your body’s hormones

Get regular rest —at least seven to eight hours of good sleep nightly

 Trouble

determining ovulation with typical tracking methods (such as basal body temperature or ovulation detection kits)

 Being underweight,

overweight or obese—12% of all infertility is attributed to a woman being under or overweight/ obese

 Had more than one

miscarriage

 Regularly exercise

heavily

 Drink heavily,

smoke or use illegal drugs

 Have ever had

radiation or chemotherapy

Maintain a healthy weight and BMI of 18.5-24.9 (not under or overweight/obese)

Infertility is diagnosed when conception hasn’t occurred after six months (women ages 35+) or one year (women less than 35) of unprotected intercourse. It’s also diagnosed when a woman has had more than one miscarriage. Did you know infertility is a reproductive disease that affects women and men equally?

1/3 of infertility is related to female factors

1/3 of infertility is related to both partners

Exercise in moderation

 Diagnosed with

endometriosis, pelvic inflammatory disease or a sexually transmitted infection

Manage stress through regular relaxation, yoga, meditation, deep breathing or similar activities

Diagnosis Infertility

Kick any bad habits— avoid smoking, drinking or illegal drug use

Learn about your cycle—track ovulation and cycle lengths so that you learn if you’re ovulating and menstruating regularly

Smoking Zaps y Fer tilit

1/3 of infertility is related to male factors

ur to smoke, yo d cont inue baby is at conceive an g early, and Should you din , en r fo eig k bir th-w ht is at ris llbirt h, lowpregnanc y er m bir th, sti d organ development risk for pret an grow th d for dy ing diminished and lungs, an her risks. ot or her brain including his fir st year of life, among in the Smoking reduces fertility in women and men

13% of female infertility is caused by smoking

Smoking or regular exposure to second-hand smoke alone can cause up to a year’s delay in conceiving

Experts recommend seeking expert assistance conceiving if conception hasn’t occurred within these timeframes, or if you’ve had more than one miscarriage. As much as 90% of infertility problems can be resolved through medication or surgery; fewer than 3% of couples trying to conceive will need advanced reproductive technologies like in vitro fertilization (IVF).

# of couples who have trouble conceiving or sustaining a pregnancy

123RF

1in 8

Miscarriage is more likely if you smoke before or during pregnancy

1/3 1/3 1/3

Sources: American Society for Reproductive Medicine; Centers for Disease Control & Prevention; Office of Women’s Health; RESOLVE, the National Infertility Association ISSUE 14 / Summer 2014 Healthy Mom&Baby

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02/10/2014 17:15

healthy moms

How

pregnancy

Predicts Your Future Health Roberta F. Durham RN, PhD

Can pregnancy be a window into your future health? ‘Yes,’ say experts at the Society for Maternal-Fetal Medicine (SMFM), who are asking for healthcare providers to more closely screen women with pregnancy complications for potential heart problems.

Pregnancy as a stressor

“Pregnancy is essentially a cardiovascular stress test,” explains Graeme Smith, MD, PhD, FRCSC, professor of obstetrics and gynecology and biomedical and molecular Sciences at Kingston General Hospital, Queen’s University and co-author of the report. Smith called the following pregnancy complications “perhaps the earliest clinically identifiable markers for future heart disease and death from heart disease”: � Preeclampsia � Gestational diabetes � High blood sugar in pregnancy � Placental abruption 18

� Preterm � Infant

birth with restricted uterine growth

Even whether you gain too much weight in pregnancy is a marker for risk as it increases your risks for obesity up to 10 years later, especially if you don’t lose the pregnancy weight gained within 6 months, he said.

Pregnancy is a “cardiovascular stress test,” experts say

Reducing Heart Disease Risks

But there are steps you can take to manage your risks. Breastfeeding cuts the obesity risk four-fold, the experts found. Plus moms and babies gain the other health benefits of breastfeeding: reduced risks for obesity, high blood pressure, high cholesterol, heart disease and diabetes. Experts also recommend that if you develop gestational diabetes in pregnancy, you will need to continue to monitor your blood sugar regularly so that you don’t subsequently develop type 2 diabetes. Problems like heart disease often take decades to develop and are rare among women in their 20s and 30s. Yet how your body copes with the cardiovascular stresses of pregnancy can be a clue as to what risks you may face as you age, giving you an opportunity to work to reduce those risks before they can ever become real health problems.

Roberta F. Durham

RN, PhD, is a professor at California State University, East Bay, and an expert advisor to Healthy Mom&Baby.

iStock

Whether you develop complications in pregnancy, such as high blood pressure or gestational diabetes, could be the first sign that you may have undiagnosed risks for cardiovascular disease—or are prone to develop it as you age. For example, experts at SMFM observed that women who experience preeclampsia (a condition signaled by high blood pressure and other signs that can develop from week 20 on in pregnancy) have up to four times the risk of high blood pressure later in life. They’re also twice as likely to have heart disease or experience stroke.

health4mom.org

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02/10/2014 17:14

Amanda smoked while she was pregnant. Her baby was born 2 months early and weighed only 3 pounds. She was put in an

Some of the reasons to quit smoking are very small.

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Amanda, age 30, Wisconsin

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healthy moms

7 Strategies By Shawn Anderson

to Get Going When the Going Gets Tough It’s inevitable that at one time or another, life will punch you hard in the gut. No one is immune to tragedy or failure. Whether you’re currently reeling in response to a huge blow, or wondering how you may handle that situation when it comes along—here are 7 strategies that seem to help people who have walked through their toughest moment and made it to the other side with increased passion and purpose.

iSTOCK , 123RF

What sets these people who ‘go the extra mile’ apart from those who give up and simply go through the motions instead of rising with renewed purpose to go on? ‘Extra mile’ people share similar traits; you, too, can adopt these 7 strategies to get going when the going gets tough: Shawn Anderson is a motivational coach and author; his books include Extra Mile

America: Stories of Inspiration, Possibility and Purpose. His organization, Extra Mile America, encourages cities to declare November 1 as ‘Extra Mile Day’ to create positive changes in ourselves, our families and our communities.

Don’t quit on life: Tragedy may have struck, huge mistakes may have been made, but the world continues. People who have walked successfully over life’s hot-coal moments always keep going. They don’t quit living.

Find support: Forge relationships with positive, move-forward type people. Survivors trigger positive energy to flow back into their lives.

Remain optimistic: Support yourself with your own words and actions. Don’t let negative self-talk rule your thinking, and do not surrender to negative, self-defeating emotions.

3 4

6 Seek to add value to the world: People who have weathered a life storm recognize the opportunity to re-evaluate their own contribution to the world. They use their event not as a forever defeat, but rather as an igniting spark to do something meaningful.

Live day-by-day: It’s easy to get overwhelmed by ‘What am I going to do now?’ But go the extra-mile by focusing on the present. Don’t let thoughts of how you’re going to deal with tomorrow defeat you.

Get involved again: Avoid isolation. Transcend life’s tragedies by not choosing isolation when life knocks you down. It’s easy to want to hide in a cave after something bad happens, but the longer we stay in the cave, the more challenging it is to ever leave it.

Trust your faith and look for a higher purpose in your loss: Believe that there is a stronger power at work in the world. Faith in a higher power and yourself works miracles in overcoming bad events.

ISSUE 14 / Summer 2014 Healthy Mom&Baby

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02/10/2014 17:12

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healthy

Join us on Facebook facebook.com/HealthyMomAndBaby BY SUMMER HUNT

Pregnancy

No Safe _ Amount Period THE BUZZ ON BOOZE Binge drinking can increase risk of infertility, miscarriage, stillbirth, premature delivery—and unplanned pregnancy.

Experts know that there is no safe level of alcohol in pregnancy, as it can lead to many developmental issues and fetal death.

PRECONCEP TION

DURING PREGNANCY

Studies show that alcohol consumption can limit baby’s growth and weight gain, even more so than malnutrition.

BREASTFEEDING

You migh that 1 litt t think le sip wo n’t hur t, bu t agree th exper ts at there are no safe le v times to els or safe dri durng pre nk alcohol what ab gnanc y. But out befo after bab re and y?

If you might be pregnant, are not using reliable contraception, and are sexually active, or are trying to get pregnant, don’t drink.

Struggling? Talk to your healthcare provider. She won’t judge you; she’ll help you find strength to make the best possible choices for you and your baby.

Your baby eats what you eat—and drink. For an average 5’4’’ woman, it takes 2 to 3 hours to clear even 1 ounce of alcohol from her system.

BEST PREGNANCY WEIGHT GAIN

IMAGES © 123RF; ISTOCKPHOTO

Move to Reduce Lifetime Diabetes Risks Gaining just the right amount of weight in pregnancy will help your baby keep obesity at bay, say researchers at Kaiser Permanente. Using electronic medical records to explore all aspects of weight gain, researchers found that babies whose moms gained the recommended amount in pregnancy were least likely to be obese later in life. Gain too much weight in pregnancy and your baby is 80% more likely to be overweight or obese in life. Gain too little and the risk for weighing too much is still a whopping 63%, the study showed.

Moderate exercise—as little as 30 minutes of walking per day, 5 days a week—greatly reduces your risks of developing diabetes later in life if you’ve had, or have, gestational diabetes in pregnancy. Gestational diabetes develops in the presence of high blood sugar in pregnancy—and it increases your later-life risks of type 2 diabetes from 35% to 60%, say federal health experts. Eating a healthy diet rich in whole grains, fresh fruits and vegetables, legumes, poultry, seafood and nuts also helps you avoid later-life diabetes.

ISSUE 14 / Summer 2014 Healthy Mom&Baby

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02/10/2014 17:11

healthy moms

Considering Normal Birth after Cesarean Get the facts to inform your decisions By Roberta F. Durham, RN, PhD

Maybe your first baby was born by cesarean and you’ve been told “once a cesarean, always a cesarean.” Or you’ve read about the recent push by obstetricians in the U.S. to have women avoid or delay a “first cesarean” as once you have one, you’re more likely to continue to need to birth this way with future pregnancies. But your question lingers—“even if I’ve had a cesarean, can I still try to birth vaginally, what’s commonly called normal birth?” The Vaginal Birth af ter cesarean debates

You’re not the only one with questions. The benefits and harms of choosing cesarean birth without a

medical reason, repeat cesarean birth, and vaginal birth after cesarean (VBAC) are under vigorous debate by experts and women alike. One third—33%—of all births in this country are via cesarean. Federal experts advise that this is far more cesarean births than is needed, especially in light of taking on the short-term and long-term risks of cesarean as compared to normal birth when cesarean isn’t medically needed. In fact, the goals of Healthy People 2020 are national cesarean rates of: � 24% among women with low-risk pregnancies who have never had a cesarean birth � 82% among women who have had a cesarean birth before. Currently more than 90% of women who have birthed via cesarean continue to do so

Cesarean Around the World United Kingdom Northern Ireland Australia United State As much as more than 50% in some private hospitals in Chile, Argentina, Brazil, and Paraguay

Despite recommendations from the American College of Obstetricians & Gynecologists (ACOG) about the safety of trying a vaginal birth after cesarean, fewer women are doing so. 20 years ago,

images: 123rf

50%

32.9%

23.3%

23%

21.3%

Curren show 50t data pregna % of ages 40 nt women a nd birth viaolder cesarea n.

health4mom.org

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healthy moms 30% of women who had had a cesarean later birthed a baby vaginally. Today, fewer than 10% do. Experts agree that it’s healthy best to birth normally, and for most women this is possible, even women who have had a cesarean. Getting the right information, that is based on research, to help you make decisions about normal birth after cesarean is important. Exploring the Evidence for Normal Birth after Cesarean

Evidence suggests that the benefits of vaginal birth after cesarean (VBAC) outweigh risks when a previous cesarean was done as a lower uterine

transverse incision, and in women who otherwise have no problems that would prevent them from birthing normally. Benefits of VBAC include: � shorter recovery time � less blood loss � fewer infections � fewer problems with blood clots � lower rates of injury, illness or death than with cesarean

Vaginal birth after a cesarean (VBAC) is a technical term used to describe labor and vaginal birth in a woman who has had a prior cesarean. Sometimes, healthcare experts will also call this a trial of labor after cesarean or TOLAC.

If you want a larger family, VBAC may help you avoid some of the future consequences related to multiple cesarean births including: � hysterectomy � bowel or bladder injury � transfusion � infection � problems with the placenta in future pregnancies In 2010, the doctors of ACOG recommended that most women with one previous cesarean birth with a low transverse incision can consider vaginal birth after cesarean birth, and that their pregnancy care providers should discuss their unique pregnancy circumstances and offer this option to them when possible. That’s not to say there aren’t risks to VBAC; there is the small but important risk of uterine rupture, and that risk increases with the number of previous cesarean births a woman has had.

Contemplating Vaginal Birth after Cesarean Consider VBAC if you’ve had 1 or 2 cesarean births via low transverse incision and have no other uterine scars and no other risks factors related to birthing vaginally

Avoid VBAC if you’ve had a vertical or T-shaped uterine incision or other uterine surgery, previous uterine rupture, known problems or abnormalities that would prevent vaginal birth

Consider the Risks of VBAC � Uterine rupture and

its complications (1%), although waiting for labor to start on its own reduces the risk of uterine rupture

images: 123rf, thinkstock

� Failed VBAC or

TOLAC can have more complications than a chosen repeat cesarean

� Uterine rupture or partial

tearing (dehiscence) increases risks for problems, including death, for the baby

Additional risks are similar to those when choosing to birth via cesarean without a medical reason: hemorrhage infection surgical injuries blood clots hysterectomy injury, illness or death

Making Your Decisions � Discuss your

concerns and personal pregnancy status, including risks, with your pregnancy care provider

� Ask whether your

provider would recommend an induction if needed for your health, or baby’s health, so that you could have a trial of labor af ter cesarean (TOL AC)

� Learn whether your

chosen birthing facility has the required medical teams, including surger y and anesthesia, available to per form a cesarean if needed— of ten this is one of the factors that limits a woman’s abilit y to consider VBAC

Roberta F. Durham

RN, PhD, is a professor at California State University, East Bay, and an expert advisor to Healthy Mom&Baby.

ISSUE 14 / Summer 2014 Healthy Mom&Baby

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healthy pregnancy

Are You Eating Enough Fish? By AWHONN Editorial Staff

Women and children need to catch up on the nutrition in fish, federal experts say

Women and children aren’t eating enough fish or shellfish—especially pregnant and breastfeeding women, federal experts say. So the FDA, along with the Environmental Protection Agency, is advising that women get at least 8 to 12 ounces of the flaky protein and crustaceans each week.

and child development, FDA officials cautioned that women who avoid eating fish and take omega-3 supplements instead may be missing out on the full benefits. They also miss out on other nutrients in fish that support overall health. Getting Enough Fish & Shellfish Previously, pregnant and breastfeeding women were told to limit their fish but the latest recommendations now focus on getting enough fish and shellfish into their diets, as well as their developing infants’ and children’s diets. The updated draft advice recommends pregnant women eat at least 8 ounces and up to 12 ounces (2 to 3 servings) per week of a variety of fish that are lower in mercury to support fetal growth and development. White (albacore) tuna is still limited to 6 ounces a week because this type of tuna can be higher in mercury. When eating local fish caught from streams, rivers and lakes, follow fish advisories from local authorities. If advice isn’t available, limit your total intake of such fish to 6 ounces a week and 1 to 3 ounces for children.

Avo id Th es e ty pe s

These 4 fish offenders— typically high in mercury—are still out: 88 tilefish (especially from the Gulf of Mexico) 88 shark 88 swordfish 88 king mackerel

image: 123rf

The two agencies say research shows a good number of pregnant and breastfeeding women eat little to no fish at all due to concerns related to mercury consumption. But removing fish from their diets is robbing them and their children of important developmental nutrition. “For years many women have limited or avoided eating fish during pregnancy or feeding fish to their young children,” said Stephen Ostroff, MD, the FDA’s acting chief scientist. “But emerging science now tells us that limiting or avoiding fish during pregnancy and early childhood can mean missing out on important nutrients that can have a positive impact on growth and development as well as on general health.” Fish is a source of high-quality protein; rich in vitamins, minerals, and omega-3 fatty acids; and low in saturated fat. Plus, there’s evidence that consuming fish can reduce your risk of cardiac death, Ostroff said. Great choices lower in mercury include some of the most commonly eaten fish, such as shrimp, pollock, salmon, canned light tuna, tilapia, catfish and cod. Because fish pack in nutrients needed for fetal

health4mom.org

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02/10/2014 17:05

healthy pregnancy

Preeclampsia:

Do You Know the Symptoms? For expectant and new moms, it’s the unexpected that can quickly change the course of normal pregnancies— especially preeclampsia. Would you know the signs and symptoms of this life-threatening disorder? By Debbie Helton

“The more a pregnant woman knows about preeclampsia, the more likely she is to recognize and report symptoms to her doctor or midwife,” says Eleni Tsigas, executive director of the Preeclampsia Foundation. “That improves time for diagnosis and medical evaluation, which saves lives—for both mothers and babies.”

istock

Know the Symptoms of Preeclampsia

Recognizing and sharing any of the symptoms with your healthcare provider is key to identifying and managing preeclampsia. Contact your pregnancy care provider immediately if you have any of the following symptoms Swelling in your hands or face, especially around your eyes (swelling of your feet is more common in late pregnancy and probably not a sign of preeclampsia) Gaining 5 or more pounds in a week Headache that won’t go away, even after taking medication for pain relief Vision changes, like seeing spots or flashing lights, or partial to total loss of eyesight Nausea or throwing up, especially suddenly, after mid-pregnancy (not the morning sickness of early pregnancy) Upper right belly pain, sometimes mistaken for indigestion or the flu Difficulty breathing, including gasping or panting

These symptoms don’t necessarily indicate preeclampsia but they are cause for concern and require immediate medical evaluation.

Cont a c t you r h e a lt h care p r o v id e r if you f e e l li k e a n y t h in g seem s w rong

Preeclampsia without Symptoms

It’s also important to know that some women with preeclampsia have NO symptoms or they ‘just don’t feel right.’ If you have a sense that something’s wrong, even without symptoms, trust yourself and contact your healthcare provider immediately. Preeclampsia can only be diagnosed by monitoring blood pressure and protein in the urine, which is routinely done at prenatal appointments. Keeping all appointments is vital throughout pregnancy and immediately after birth.

Debbie Helton is a communications specialist with the Preeclampsia Foundation, which is online at Preeclampsia.org.

ISSUE 14 / Summer 2014 Healthy Mom&Baby

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02/10/2014 17:04

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Health4mom.org is the only site for moms-to-be and is created by the healthcare providers you trust most: Nurses. From proper nutrition to best birthing options. Health4Mom.org promotes the optimal health and wellness for you and your baby. Visit Health4mom.org often to get news and articles covering the health topics that you care about.

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healthy pregnancy

Sensational BY MADELINE HURST

Snacks (

)

WE’VE GOT HEALTHY BITES SANS SWELLING OR GUILT!

: K TIP QUIC uit s fr ic acid lan Avoid s if you p as itru like c ing ac tive use on be d s ca n ca foo t h e se ea r t bu r n . h

Tired of the same old snacks? We’ve got tasty options that won’t leave you feeling like you’re mistreating your body or your baby. Processed, prepackaged, fattening foods and snacks that are high in sodium will cause your body to retain fluid and can increase swelling (and mommiesto-be are already prone to swelling!). Try these healthy handfuls—and snack without swelling or guilt. GO GREEN DRESS IT UP A light dip or dressing paired with celery or carrots is a classic quick snack that’s easy to prepare. Add your own favorite veggies if those two don’t tickle your fancy.

QUENCH YOUR THIRST Hydrating fruits like watermelon, cantaloupe, honeydew melon, or blueberries help keep thirst at bay while adding a little sweetness to your life. If a bowl of fruit is too boring, switch it up as kabobs or a salad.

Hummus and pita chips are light and perfectly replace greasy, unhealthy potato chips that usually surround the dip bowl. Had enough of hummus? Puree avocado with a dollop of yogurt or sour cream. Add lime juice and some bell peppers, or another sliced veggie of your choice. Top it off with salt and black pepper to eat with your pita chips.

SMOOTH SNACKING When frozen fruitcicles fail to satisfy, a smoothie is a great go-to snack. Blend your favorite frozen fruit with soy milk or yogurt to add thickness. Sneak in spinach or kale for a bit of fiber.

IMAGES: 123RF

JUICE IT

MADELINE HURST

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

Fruit juices are too sugary to be healthy, but adding a splash of a no-sugaradded fruit juice to sparkling water flavors the fizz while letting you indulge. Freeze your favorite healthy juices in an ice tray to pop into your water or savor as a frozen treat.

CHOW CAPRESE-STYLE Begin with cherry tomatoes and fresh basil leaves. Cut thin slices of pasteurized mozzarella and layer along a skewer. Drizzle with olive oil, salt and pepper or red wine vinaigrette. Too tired to prep kabobs? Toss your ingredients into a salad.

ISSUE 14 / Summer 2014 Healthy Mom&Baby

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22/08/2014 12:48

healthy pregnancy

Veggies for a Healthy Pregnancy By Tammy Lak atos Shames, RD, and Elysse “Lyssie” Lak atos, RD

The most important veggies that mommies-to-be should be eating

Pregnant moms always want to know what to eat to ensure they’re getting the best nutrients for their developing baby, so here it is! You are your baby’s home for the next nine months, so you need nutrients that not only create a healthy environment for the baby to live in, but that also aid baby’s growth and development. You need look no further than the produce aisle. Consuming veggies like asparagus, soybeans, sweet potato, spinach and lettuce helps you meet your needs for folic acid (folate) and other B vitamins, calcium, iron, vitamin A, fiber and antioxidants like vitamin C and vitamin E. Did you know getting enough folic acid helps your placenta grow properly and it also protects against common birth defects? Other B vitamins are critical for the healthy development of baby’s skin, eyes and nerves. Iron helps your baby and your placenta grow, and helps deliver oxygen to baby. Calcium helps your baby have strong teeth and bones; build a healthy heart, nerves and muscles; and to develop a normal heart beat and blood-clotting abilities. If you don’t get enough, you draw on your own calcium stores in your bones, putting them at risk for osteoporosis. Vitamin A is also needed for strong bones and teeth. Antioxidants like vitamins C and E protect you and your baby against free radical damage and help to keep you both healthy. Fiber is your friend when it comes to combating constipation. Need help getting extra veggies in? Try our Sweet Potato Veggie Burgers or Roasted Red Pepper, Spinach, and Feta Portobello Burgers and feel great about what you’re feeding yourself and your baby!

If you think yo can’t sink your u teet into veggies, th h is Portobello bu rger will prove you wro (Recipe next pa ng! ge)

Tammy Lakatos Shames and Elysse “Lyssie” Lakatos, The Nutrition Twins®, are twin sisters and

nationally recognized registered dietitians, trainers and authors of The Nutrition Twins’ Veggie Cure.

ISSUE 14 / Summer 2014 Healthy Mom&Baby

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02/10/2014 17:01

healthy pregnancy

Roasted Red Pepper, Spinach, and Feta Portobello Burger Serves four

This burger is to die for! It’s bursting with flavor. If there is a burger ‘heaven’, you’ll feel as if your taste buds are there… oh and so is your happy waistline, since this burger is just 53 delicious calories! Ingredients:

1 red bell pepper 2 cups spinach 4 portobello caps Olive oil in a spray can or bottle 4 tablespoons low-fat or fat-free feta cheese 2 tablespoons balsamic vinegar Salt and pepper to taste Directions:

� Preheat grill to a medium-high � Wash pepper, spinach, and Portobello caps � Cut pepper into 4 even pieces � Spray Portobello cap and pepper slices with olive oil (about 3 burst sprays per item) for a light dusting of oil � Place on grill with the open side of the mushrooms facing down. Grill for 15-20 minutes, flipping the peppers and mushrooms halfway through. When you flip the mushroom, top with spinach � Once grilled, place one grilled pepper piece on top of each mushroom. Sprinkle with feta cheese and drizzle with balsamic. Salt and pepper to taste � If you don’t have a grill, this recipe works just by broiling the veggies! Broil on high and the cooking times will be the same images: the veggie cure

Per serving (with fat-free feta cheese and no salt to taste): Calories 53; total fat 2g; saturated fat 0g; cholesterol 0mg; sodium 25 mg; carbohydrate 8g; fiber 2g; sugars 4 g; protein 3g. Percent Daily Value: Vitamin A 47 perent; Vitamin C 70%; Calcium 3%; Iron 6%

Sweet Potato Veggie Burgers Yields 8 burgers

Delicious and easy! This juicy burger is so scrumptious and simple to cook that you will wonder why you haven’t discovered this before. All of the tantalizing spices add just the right pizzazz to this veggie burger. Ingredients:

1 (15.5-ounce) can candied sweet potatoes, or 1 and 3⁄4 cups cooked yams 2 (15 ounce) cans low-sodium cannellini beans, rinsed 2 tablespoons tahini 1 teaspoon lemon pepper or cayenne pepper (optional) 1⁄4 cup whole wheat flour 1 cup panko breadcrumbs Canola oil spray

Directions:

� Place drained sweet potatoes and beans in a large bowl and mash with a fork until mixed. � Add tahini, pepper, flour and mix again; the mixture will be moist and sticky. Then add the panko crumbs, and with your hands mix them in until you can form patties about the size of your palms. Add more panko if the mixture is too sticky � Spray a pan or skillet over medium heat with canola oil, and cook patties for two minutes on each side until lightly browned Per burger: calories 205, total fat 3g,

saturated fat 0g, cholesterol 0mg, sodium 25mg, carbohydrates 36g, dietary fiber 6.5g, sugars 5g, protein 9g. Percent Daily Value: vitamin A 6 percent, vitamin C 2%, calcium 9%, iron 19%

health4mom.org

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

Download a free copy of

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

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

Advocacy D E P ARTM E NT

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healthy pregnancy

Amanda’s Story Smoking Changed Her Life and Her Daughter’s Too

Editor’s Note: Amanda is featured in the CDC’s ‘Tips From Former Smokers’ campaign, which features real people living with the effects of smoking-related diseases or exposure to second-hand smoke at www.cdc.gov/tips. By Carolyn Davis Cockey, MLS

re ut mo Find o uit ting at tq abou .gov/tips CDC

Amanda began smoking in the 5th grade. Everyone in her family smoked. And while she knew the dangers of smoking, she didn’t believe it would ever affect her or the children that she dreamed she would have. “I wanted to fit in, and I had really easy access to cigarettes as my entire family smoked. I never thought I would become addicted or have any problems that come from smoking.” Her addiction continued even when she learned she was pregnant. “I had this whole plan made for my life. Becoming pregnant before I was married and finished with college definitely wasn’t part of the grand plan,” she says. “I never thought I’d smoke while I was pregnant. I had always told myself that I would quit before pregnancy, or I’d quit as soon as I found out I was pregnant.” But the struggle ensued when that day became a reality. “When I found out I was pregnant, I was

under a lot of stress. Cigarettes were my ‘go to’ for stress relief. I tried to quit smoking so many times while I was pregnant. There were days when I would throw my cigarettes out and tell myself I was done; promise myself I was never going to smoke again.” But “later, something stressful would happen and I’d go buy more cigarettes, or I’d get one from someone I knew. I wasn’t able to stop.” Deep in denial

Amanda knew smoking was damaging her body, and likely her baby’s body. Still she thought, “it won’t happen to me.” “I knew that babies were born with poor health because of smoking. I also knew a lot of people who smoked while they were pregnant, who all had healthy babies—not premature babies.” To her credit, Amanda worked with a public health nurse in a smoking cessation class to try to quit smoking. But when her healthcare providers asked if she still smoked, she hesitated to share how much she was smoking. “They would always ask in a way that made me feel like I was being judged, like, ‘you’re not smoking now, right?’ Sometimes I would be honest and they would tell me that I really should quit, but more often I felt like I couldn’t really be honest about how much I was smoking.” Amanda wishes her care providers would have been less judgmental: “Something like, ‘quitting smoking can be difficult, and being pregnant doesn’t mean it will be easier to quit. Help is available; is that something you’re interested in?’ Something like that may have worked, but most of the time I didn’t feel comfortable answering honestly about my smoking.”

images: cdc .gov

“There are a lot of programs and resources out there to help you quit”

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healthy pregnancy for 20 minutes to do kangaroo [skin-to-skin] care. Otherwise, I could only put my hand in her incubator while she was having a diaper change or feeding.” Having her daughter in the NICU changed Amanda’s life. “I had to drop out of college. I was in the hospital with her the whole time because the only chance I had to touch her was when she needed a diaper change or a feeding.” Being with her daughter in the NICU was stressful. “I was very scared. I was unsure. I was angry with myself about the whole situation. I was really scared for her. The NICU was full and there were babies coding throughout the day. Babies died while I was there. For the most part, my baby did really well in the NICU, but just being in that situation brought a lot of fear.” Becoming an advocate

“You can have a healthier baby if you stop smoking before you get pregnant, but quitting any time during pregnancy can help your baby get a better start on life”

images: 123rf.com

Facing premature birth

Then came the day when Amanda faced the reality that her daughter was going to be born early. “My water had broken prematurely. Even on my way to that hospital I didn’t think she was going to be born early. I thought I would be on bed rest, and that my baby would be fine, even if she had to be in the NICU. When they told me that her oxygen levels were low and that I was going to have an emergency c-section, I couldn’t believe it. Even up to that point I did not think she was going to be born early.” Amanda was 31 weeks pregnant when she heard her daughter cry for the first time. “She had such a tiny little cry, like a kitten. I had been working as a nanny with a lot of babies. Her cry was just so soft; it wasn’t that loud scream you typically hear from infants. Her cry was small, and so was she. She weighed just three pounds and one ounce.” The realities of birthing premature sank in fast. “I didn’t get to see her for a couple of hours. They kept telling me to relax, and that I needed rest. I had only been able to hear her little cry and catch a glimpse of her before they took her away. I had just gone through surgery, but I really, really wanted to see my baby.” “When they finally let me see her, I wasn’t able to hold her. During the coming days and weeks I was only able to hold her once, maybe twice a day

Living with the consequences of smoking during pregnancy has lead Amanda to speak out to other women. “I would definitely recommend that they stop smoking. You think it’s not going to happen to you, but it very well could. There are so many resources to help women quit.” Her main message: “You can have a healthier baby if you stop smoking before you get pregnant, but quitting any time during pregnancy can help your baby get a better start in life. Smoking doesn’t take stress away. You may feel like it does, but whatever is stressing you out will still be there after that cigarette.” “What’s really stressful is having a child in the NICU.”

Th er e’ s He lp Ri gh t Now fo r Q u it ti n g

1-800-QUIT-NOW 2.

Women can quit, Amanda says. “There are a lot of programs and resources out there to help you quit.” For Amanda, the time to quit came to her during a church service. “I knew it was time to stop. I quit with a lot of prayer and support from my family.” She relied on the skills she learned in working with her public health nurse, including stress reduction techniques. She also motivated herself with her desire to break her family’s legacy of smoking. “I just knew it was time quit. I didn’t want my kids to smoke. I didn’t want them to see me smoke. I want to be around for them.” “If you can’t quit for yourself, quit for your baby. Look wherever you can for support and know that you can quit. You really can.” Amanda still has stressful days, but now she relies on exercise to work through her frustrations.

Call

1-855-DÉJELO-YA 3.

Read

This Quit Guide 4.

Managing stress

Call

Text

QUIT to 47848 and receive motivational texts

ISSUE 14 / Summer 2014 Healthy Mom&Baby

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two bags in one

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Every luxurious Lily Jade bag includes the removable & washable â&#x20AC;&#x153;Baby Bagâ&#x20AC;? organizer.

Stay organized on the go or pass the organizer off to dad! Designed and constructed to serve during baby years and beyond. Unmatched features and quality for this price range. Use code BABY123 for an extra free changing pad.

NuAngel_Lily Jade.indd 1

06/10/2014 17:04

healthy pregnancy

Breastfeeding & Postpartum Depression BY TONIA OLSON, MN, BSN, RN, IBCLC, AND ANGELA BOWEN, PHD, MED, BSN, RN

(

)

3 MY THS BUSTED TO PROVE THE PROTECTIVE EFFECTS OF BREASTFEEDING FOR MOMS & BABIES

Can breastfeeding actually decrease your risk for postpartum depression (PPD)? Can women with PPD safely take antidepressants while nursing? Between 8%-19% of mothers experience depression in the first year after birth. Can you sort myth from fact regarding breastfeeding and PPD? Even well-meaning healthcare providers can struggle with these questions if they donâ&#x20AC;&#x2122;t know the current research. BREASTFEEDING IS PROTECTIVE

Research shows breastmilk is the optimal food for infants, and that breastfeeding can be protective against PPD. While not all moms will choose to breastfeed their babies, there are health benefits to be gained from breastmilk and drawbacks to supplementing with or feeding formula.

ISSUE 14 / Summer 2014 Healthy Mom&Baby

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v The first and only breast pump with patented compression and vacuum motion proven to establish milk supply in mothers of premature and very low-birth-weight infants*

v Highest-grade closed system safety components v Unique comfort with Sof-TouchÂŽ silicone breast cups v Lightweight portability - only 1-1/2 pounds v Unparalleled customer service!

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or call us at 877 - limerick or 877-546-3742 to see how you may be able to get a free PJ's Bliss through your health insurance provider.

*Wight N, Turfler K, Grassley J, Spencer B, Evaluation of Milk Production with a Multi-user, Electric Double Pump with a Soft Flange in Mothers of VLBW NICU Infants: A Pilot Study - Breastfeeding Medicine Journal Abstracts from The Academy of Medicine 16th Annual International Meeting Miami, Florida Nov 4 -6, 2011.

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nongmoproject.org

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healthy pregnancy

MYTH #1:

BREASTFEEDING CAUSES POSTPARTUM DEPRESSION “I don’t understand, she latched well right after the birth, but she hasn’t latched since. I’m worried that I can’t breastfeed. My girlfriend tried to breastfeed and she said it was a really awful experience. She never had enough milk, her baby lost a lot of weight, and her nipples got really sore and were bleeding! She stopped breastfeeding altogether because the whole experience made her feel depressed.” — Cassie THE EVIDENCE Not all women at risk for or currently experiencing depression will find breastfeeding too stressful to maintain, or that it makes their mood worse. While research suggests that struggling with breastfeeding can increase the risk of depression in some women, establishing good breastfeeding actually protects from depression. , In fact, moms with PPD and who stopped breastfeeding early actually described experiencing more depression and anxiety when asked by researchers about their moods. Experts believe that the feel-good hormone, oxytocin, which drives the letdown reflex essential to beginning each breastfeeding session, helps moms feel more relaxed and content. Oxytocin also increases attraction between you and your baby, promoting facial recognition and boosting your caregiving and mothering confidence. Breastfeeding helps you maintain vitamin A-related compounds at levels that are protective against mood disorders, including depression as any excess amounts of these compounds are passed to baby, who receives and uses these nutrients. Choosing not to breastfeed stops lactation, and in some cases, a mom may have a rush of depressive feelings similar to what a she might experience after the loss of a child, research shows. In this way, researchers believe breastfeeding

helps bolster and protect your moods. In fact, many moms with PPD describe breastfeeding as giving them a significant—if not the only—sense of connection to their babies while dealing with their depression. If you’re struggling with early breastfeeding recognize that both you and your baby are going through a lot of changes right now. You’re just getting to know each other and everyone’s breastfeeding experience is unique. Breastfeeding can be uncomfortable in the first weeks when your nipples are stretching and your milk is still coming in. If you are stressed, try some of these ideas to practice a comfortable latch:  Undress your baby and cuddle her against your naked chest

“Many moms with PPD describe breastfeeding as giving them a significant— if not the only—sense of connection to their babies”

 Recline and get as comfortable as possible, maximizing skin-to-skin contact  Allow baby to hear your heartbeat, feel your warmth, and smell your milk  Offer her your breasts when she’s relaxed and alert—don’t wait for her hunger cries as she may be too upset and hungry to latch easily  Try nursing baby within the support of a local breastfeeding group to gain knowledge and help from lactation consultants and other nursing moms

ISSUE 14 / Summer 2014 Healthy Mom&Baby

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healthy pregnancy

MYTH #2:

IT’S NOT SAFE TO TAKE MEDICATIONS FOR DEPRESSION WHILE BREASTFEEDING “I don’t know whether I should breastfeed while taking drugs for depression and anxiety. I don’t want the drugs to hurt my baby; I think I will just stop taking my antidepressants.” — Rosario THE EVIDENCE Newer antidepressants transfer in small amounts only into breastmilk and don’t negatively af fect your baby. In fact, research shows:  Moms with anxiety may safely take antianxiety drugs, like benzodiazepines, while breastfeeding with only a slight increase of sleepiness in some babies  Moms with bipolar disorder can take mood stabilizing drugs such as valproate, phenobarbital, phenytoin and carbamazepine  Experts caution about the use of antipsychotic medications clozapine and olanzapine in women who are very depressed with psychotic symptoms. Still, they suggest that if a mother has safely taken the drug effectively before lactation, she should continue to use that same medication while breastfeeding Using any medication while breastfeeding is an individual decision. Make this decision with your healthcare provider based on the risks and benefits of taking or stopping a drug during breastfeeding, including those health risks to moms and babies when mom chooses not to nurse or feed baby breastmilk.

TRY M OTH ERC EN TE R ED G B R EA ST FE EDIN If you’re struggling with having baby latch for breastfeeding, try what some lactation consultants are calling “laid-back nursing” or “biological nurturing” rather than upright, traditional breastfeeding positions. With laidback nursing, you lean back, reclined, and every part of baby’s body goes skin-to-skin with you in what’s called an “oxytocin-friendly” position. This type of breastfeeding comes out of the fact that babies are born with the natural skills and abilities to breastfeed, and are able to stretch and move and attach to the breast on their own.

“Moms with anxiety may safely take anti-anxiety drugs”

health4mom.org

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Few things are better than a sleeping newborn. Getting your breastpump free is one of them.

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Untitled-1 1

08/07/2014 10:17

healthy pregnancy

MYTH #3:

BREASTFEEDING WOMEN ARE SLEEP DEPRIVED, MAKING THEM AT GREATER RISK FOR DEPRESSION “I want to breastfeed, but we’re thinking of feeding formula at night so that we all get more sleep. I’ve heard that sleep deprivation is a risk for postpartum depression and I worry that my milk just won’t be enough for her”— LaToya THE EVIDENCE digest, which can lead to fussiness and even less sleep for everyone! Just remember that especially in those first few weeks and months, it’s normal for newborns to have fragmented sleep, to need to be fed often at night and to want to be close to you. Babies are brilliant! They nurse often at night because they instinctively know that your prolactin level is highest then. Most infants need to eat at night and they get up to 20 percent of their nutrition during this time. Studies have shown that breastfeeding mothers, even if they wake up often, actually fall back to sleep quicker than if they were formula feeding. Remember, this sleep deficit won’t last forever and eventually you and baby will get into a rhythm with breastfeeding, and one day you both will regularly sleep through the night. Meantime, gain support from your partner or a relative who can help you in the first weeks get comfortable with night-time breastfeeding. They can change baby’s diaper, bring baby to you, burp baby and settle her down after feeding so that you don’t feel so alone and so that you can

DR AW BAC K S OF G FOR M U LA FE EDIN Experts agree that breast milk is unequaled as the best food for babies. Research shows that feeding infants formula only (no human milk) increases an their risks of: Sudden Infant Death Syndrome (SIDS) Ear infection (otitis media) Asthma Type 1 and type 2 diabetes Atopic dermatitis Lower respiratory tract infections

TONIA OLSON, MN, BSN, RN, IBCLC, is a maternal-child nurse and lactation consultant with the Saskatoon Health Region in Saskatoon, Saskatchewan, Canada. ANGELA BOWEN, PhD, MEd, BSN, RN, is associate professor and researcher at the University of Saskatchewan, Saskatoon, Saskatchewan, Canada.

IMAGES: 123RF

There’s an assumption that moms who feed their babies formula get more sleep or free time than moms who breastfeed—but researchers are f inding that this is not the case. While lack of sleep definitely affects anyone’s mood—especially new moms— feeding formula doesn’t improve sleep or mood, particularly because of how it affects the hormone, prolactin, which helps you make milk and sleep. Prolactin is the primary hormone responsible for milk supply and it also promotes deep sleep in adults, research shows. Because of this, studies report that exclusive breastfeeding actually improves mother’s sleep. One group of researchers found that parents of breastfed infants slept an average of 40-45 minutes longer each night than parents of babies who were fed formula. That same finding held true compared to moms who mixed breastfeeding with formula feeding as these “combo moms” as they’re commonly called reported fewer hours of sleep, less energy and higher rates of depression. While it’s true that formula stays in a baby’s tummy longer, this is because it’s more difficult for babies to

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healthy pregnancy

Sweat Funk By Sar a Haley

Dance works almost every muscle in your body for a great cardio workout

regnant or not, cardio dance is one of my all-time favorite ways to get fit and stay fit. With the right moves, you have the opportunity to work almost every muscle in the body and the nonstop movement is one of the most fun ways to get your cardio in. Clearly, including dance cardio in my pregnancy workout was a no-brainer. My Sweat Funk is a 30-minute dance routine that will leave you sweaty and smiling.

Get f it and y for you o ur b with this c aby work ardio out!

Stomp It Out

Begin with your feet together. Alternate stepping forward into a lunge (like you are stomping a bug). Your legs should be far enough apart so that your back heel lifts up. Bend your knees and get your lower body down but keep your chest lifted. Then slide the front leg back in. . The farther out you step and the lower you get, the more youâ&#x20AC;&#x2122;ll work the legs and butt. If you want to get your upper body involved a little more, you can pretend to look at your watch on one arm while you row back towards your hip with the other, which will also work your back and shoulders.

Adam Brown Photogr aphy

Channel your inner dancer, by playing with the tempo of your stomps. Some can be quick and others can be slow. Alternate at least 8 times

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healthy pregnancy

Step Away

Begin with your feet together. If it makes you feel more comfortable, put your hands on your baby. Step one foot out to the side at a time, while you allow your opposite knee to invert, Michael Jackson-style. During pregnancy we get so tight in our chest and shoulders due to our growing bellies, so open up the opposite arm (as you Step Away), and allow your chest to get a little stretch. Once you bring your foot back in and your hands back to baby, bend your knees, squeeze your inner thighs together, and then do a little heel lift to check your balance. Repeat on the other side. Alternate at least eight times.

Swing It

Take your feet wide and just rock your hips right to left. Remember, you want those hips to be open and ready for childbirth, so use them! Allow your arms to swing side to side, like you’re doing the twist. Don’t take yourself seriously on this one. Just work those hips! Alternate at least 8 times. Now it’s time to put on your favorite tune and dance it out with Stomp It Out, Step Away, and Swing It. Feel free to mix them up with some of your own unique moves or just combine these three to make up your own little dance.

Sara Haley is a Reebok Global Master Trainer and a prenatal and postnatal exercise specialist. Sweat Funk is part of Sara’s Expecting More®, a six-workout prenatal workout program that includes a calendar to guide pregnant women through all three trimesters. Get more moves at SaraHaley.com.

ISSUE 14 / Summer 2014 Healthy Mom&Baby

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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

Babies

Join us on Facebook facebook.com/HealthyMomAndBaby BY SUMMER HUNT

BABY BOOKWORM Looking for pin-spiration? Find these favs and more on our “Read to Me” Pinterest board: Best for babies:

The Very Hungry Caterpillar by Eric Carle The Rainbow Fish by Marcus Pfister Brown Bear, Brown Bear, What Do You See? By Bill Martin, Jr. Tops for Toddlers:

Chicka Chicka Boom Boom by Bill Martin Jr. and John Archambault There Was an Old Lady Who Swallowed a Fly by Simms Tabak Llama, Llama Red Pajama by Anna Dewdney

TALK WORDY TO ME

It’s never too early to begin reading to your baby, says the American Academy of Pediatrics. In fact,

parents should read aloud to infants and children—in addition to building a nurturing relationship, children who are read to during infancy and preschool years develop better language skills and are more interested in reading. Even preterm infants in the NICU have better language skills when exposed to adult talk, said AAP experts. Pick appropriate materials. Picture books are great for infants while younger children enjoy short books with rhymes they can repeat or questions they can answer. ‘Books are a useful tool,’ says Pamela High, MD, MS, FAAP, lead author of the policy statement. ‘But we also want parents to understand that reading to their children is so powerful because children think their parents are the most important people in their world.’

(GIVE THE SLING A SHOT!)

Baby-wearing is a great way to bond with your little one—but where do you begin? Newly released standards for slings can help experts and parents alike gain a safe, snuggly fit. Wrap baby so that you can see his face above the sling at all times; routinely check his breathing

Never let baby’s chin rest on or be forced upon his chest, which can hinder his breathing

Squat rather than lean when bending down

Practice wearing baby at home before heading out

Wear baby high on your chest to monitor him

ISSUE 14 / Summer 2014 Healthy Mom&Baby

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healthy pregnancy

anny N r e Sup rules

has 5 sforming

an s for tr ay hassle d s y ever rmoniou a h into seholds hou

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healthy pregnancy

The Toddler Rules So much for reticence. Unlike the British, we Americans don’t hesitate to rush to Jo Frost—aka Supernanny—with our questions and pleas for domestic peace. For 25 years, Jo has been rescuing us from our inefficient childrearing ways with an SOS of her own. By Carolyn Davis Cockey, MLS

Redefining discipline is “about parents teaching “It’s been a beautiful journey here in America children to understand the boundaries and guidelines with respect to having much love and support put in place, and teaching children the consequences from families in person and online—my Twitter of crossing those,” says the Supernanny without even overflows,” Jo is quick to say. Yet, here in the states, a moment’s hesitation. “Every parent who is doing a we want what we want when we want it—and we fantastic job is a parent who understands want family harmony, like now. So are the importance of having to discipline you surprised that Jo says the secret 5 Ru le s o f D isci pl in ed when you provide a consequence that to her success has more to do with Pa re n ti n g backs up a house rule or for a situation parents stepping back, listening that was told to the child could not and then acting in a calm and happen. They crossed a boundary.” chosen way? “To do my job, I’ve got to be a The Toddler Rules very good listener. I listen to those “But Jo,” we protest, “it’s so much families and what they need.” So Adequate sleep harder than when our parents were listen up, gentle reader, because the raising us!” first thing we need to hear is that “Parenting is always evolving,” the controversial “D” word is part she counters. “We have more dads Consistent meals of of the solution we seek. at home and more moms in the the right types and workforce than we did 25 years ago. On Discipline amounts of healthy foods We have technology that didn’t exist “In America, when somebody says, when we were being brought up. ‘I’m a disciplinarian,’ it’s frowned Regardless, good parenting is still upon. We go to this extreme image about feeling confident and trusting of our parents standing over us Social outings for your instincts to bridge the gap with a paddle being unrealistic. A physical activity, stimulation and between you and your child.” parent who is learning to instill interaction The idea that modern parents positive, role model behavior has are just getting it all wrong is to discipline so that a child learns just a myth, says Jo. “I look at the the importance of acceptable and challenges of sleeping, eating, social unacceptable behavior,” says Jo. Early learning play and sibling rivalry and you can’t “When you’re doing a time out, to boost child development put one up higher than the others. you’re going to be teaching what’s They’re all connected, so parents right and what’s wrong. I really need to recognize that if certain want to dispel the problem with things aren’t put into play, they bleed not being able to say, “Actually, I Good behavior into the other areas.” am a very loving parent and there driven by a clear Hence, Jo Frost’s Toddler Rules, are definitely times when I have understanding of what’s expected her newest book, which gives us not discipline my children, and at the with appropriate only the rules but the SOS tools to same time there are times when I corrections when perfect our parenting—specifically can sit back and let them get on needed around sleep, nutrition, social skills, with it.”

1 2 3 4

SO S Pa re n ti n g

Jo promises that the more parents practice this technique the easier and more effective parenting becomes as you gain a moment to find your calm, look at the bigger picture and then take action: XXStep back from the situation to get perspective XXObserve what is actually happening. Who is saying and doing what? XXStep in and make a decision to respond appropriately with redirection or corrections as needed, such as a time out

ISSUE 14 / Summer 2014 Healthy Mom&Baby

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healthy pregnancy

A Giant Parenting Puzzle “It’s a puzzle. When you also see me working with families on television there’s a madness to the mess of everything. So I look at the whole picture with the methods that I’ve broken down in the book: I want to know when a child goes to bed what’s really happening then What they’re eating Do they have a routine for their days and social activities? How does this all come together at the end of the day? “If I have a parent who says to me, ‘Oh, my child just doesn’t listen to me period,’ then I know then they aren’t even going to sit at the table because if they don’t listen during the day why are they going to listen and sit at the table to have something to eat? Often it’s a behavioral problem or standard that’s been set for the day.” “When you can get that straight, you completely shape the appropriate behavior and you don’t end up with those temper tantrums at the table, at sleep time or during social play because you’ve dealt with each fundamental already,” she says so easily, as if saying it simply makes it happen. “But toddlers are moving targets, changing developmentally—we’re not dealing with static individuals!,” we plead. Unflappable, Jo insists, “Here we recognize that we are a part of their development. Through my work, I want parents to become more conscientious of how they’re parenting, and to help them rethink to be mindful of how they’re raising their children.” And one of the reasons this is really important is because “You’ll take the bits you love and you’ll forward them into your own relationships and parenthood. And you’ll leave some bits behind because times have changed and you believe in different things, and you begin to see you’re raising children for the longer term, not the short term.” Well spoken, Supernanny, well spoken.

Carolyn Davis Cockey, MLS, is editor of Healthy Mom&Baby and director of publications for AWHONN.

Supernanny On . . . Sleep

food

“Making sure your children have enough sleep is as important as providing food and water, and keeping them physically safe. Everyone has a body clock but we ignore our body clock and stretch our days longer and longer. We’re stretching our children’s body clocks as well—and that affects their behavior, brain development and their ability to learn. Even their physical health and weight!”

“I’m surprised how America is seduced in consumerism regarding children’s food. As a nanny, I’ve never said, ‘May I see the kid’s menu?’ because I don’t want the over-processed, fried and commercialized—what they call food—as nutrition. I ask for the menu, because if they’ve got it right, I can find a mini-portion of what they’re offering me. I can order a breast of chicken, some brown rice with bell peppers, and some broccoli, and I’ll halve that whole meal for 2 toddlers.”

Learning “I’m passionate about parents being disciplined about their child’s early learning because it’s so critical to their later life success. 85% of your child’s brain development happens by age 5; most of that in the first 3 years! Of course, kids learn best when they’ve had the proper nutrition and sleep.”

Behavior Interaction “When you go out of the house with your kids, they get to see the world and explore, which brings on questions about life. They get to see how other people behave and learn how to interact with others. They get to run and jump and play and get some fresh air as well as a change of scenery. These experiences build up your child’s memories so that you can enjoy life with your child outside of your house doing ordinary things, like going to a park, going shopping or out for a meal together as a family.”

“The more in sync you are with your children, the more you’ll know what they need. When you’ve got a routine in place with a good sleeping pattern, your children will be alert and ready to be stimulated with games and play—what I call eduplay. If you don’t create this canvas for them that allows them to mentally, physically and emotionally bond with you as their first teacher, then they become bored and seek idle fun. ‘I’ll see what that does . . . what happens if I kick or push that over . . .’ And they get themselves into what we see as mischief that all started from them not being stimulated enough.”

learning and good behavior. “Thousands of parents worldwide are struggling to get their children to eat different foods, to maintain healthy sleep, and when I get a family who is frazzled, they’re truly at the end of their tether. What they’re lacking is how these elements work together to either prevent or create problems.”

health4mom.org

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healthy moms

Bot tles, Pacifiers &

Your Baby’s Oral Health By Dr. Bill Dorfman

It’s a well-documented fact that babies have a natural tendency to suck. It helps to soothe and comfort them, which is why so many parents allow their small children to suck on baby bottles and pacifiers. However, if not properly monitored, these items can easily create problems for your baby’s oral health. To protect your baby’s teeth and gums, we’re busting 3 myths about bottles, pacifiers and their safe use.

Myth #2

Pacifiers are harmless

It’s okay to spit-clean a pacifier

In most instances, and only after breastfeeding is established, pacifiers are fine for infants and toddlers. It’s all a matter of choosing the right product and limiting its use. Choose an orthodontic pacifier with rounded tops and flat bottoms that are designed to allow upper and lower teeth to better align. Pediatricians are divided as to when the best time is to wean a child from a pacifier. Some say around 12 months, when speech begins to develop. Others suggest they can be used into the toddler years, or up to age four. However, the longer your little one continues to suck, the more likely they are to develop problems with their teeth, specifically a misaligned bite or cavities. Be sure to talk to your pediatrician and your pediatric dentist regarding what’s best for your growing child.

Children drop their pacifiers on the ground all the time only to have a parent spit-clean it and shove it back in their little one’s mouth. But cleaning your baby’s pacifier with your mouth can transfer tooth decay causing bacteria through your saliva. Think twice before spit cleaning your little one’s binky. Myth #3

Putting a baby to sleep with a bottle of milk or formula is fine Many parents think putting babies to sleep at night with a bottle of breast milk or formula may help calm them—but the American Academy of

Pediatrics warns against this for several reasons. First, an infant should never be left alone with a bottle. Secondly, both breast milk and formula contain some amount of sugar, which means your child’s teeth will be bathing in it all night long, creating tooth decay. The natural forming bacteria in your child’s mouth changes the sugar into acids that break down the enamel on their teeth. This can cause a devastating situation called ‘milk bottle carries’ where most or all of the teeth in a child’s mouth rot beyond repair. Instead, the AAP recommends that if your child needs to suck to soothe while going to sleep, use a pacifier instead of a bottle, as pacifier use is recommended for reducing risks of Sudden Infant Death Syndrome once baby is nursing regularly.

Dr. Bill Dorfman is a frequent guest on The Doctors, as well as author of The Smile Guide & the Billion Dollar Smile.

Images: 123rf

Myth #1

health4mom.org

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healthy babies

Cradle Cap By AWHONN Editorial Staff

Simple steps to clear this bodily buildup of oils and skin

Not long after baby’s birth, you’re likely to see thick, crusty and yellowish scales in patches on baby’s head. These stubborn little scales are commonly called cradle cap (seborrheic dermatitis). What you’re seeing across baby’s scalp (and maybe even parts of his face) is a buildup of body oils and old skin. Most often, cradle cap appears on a baby’s head, but it can also spread to other parts of baby’s body, such as his ears, eyelids, nose or groin—although this isn’t as common. Fact is cradle cap can pop up anywhere baby has oil-producing sebaceous glands, such as under his arms. But don’t worry; even if it appears to be slightly reddish around the patches, it doesn’t hurt or itch, and it usually clears up within the first few weeks or months of life. Just be gentle as you work to loosen the scales over time so that you don’t irritate baby’s sensitive skin.

For stubbor n cradle cap, apply an infant-safe lotion or oil directly to the scales for at leas t an hou r prior to washing to help gen tly loosen the scales

If cradle cap per sists , talk to you r baby’s healthcare provider to discuss other opt ions such as a medicat ed shampoo or lotion designed to eliminat e cradle cap

Clearing Cradle Cap

While you may be tempted to flake it off with your fingers, experts recommend you eliminate cradle cap over time with these steps:

1 2 image: 123rf

Wash baby ’s daily w ith a scalp mild baby sham poo

Download the latest in newborn skincare advice from our nurses in the Newborn Skincare Zone at Health4Mom.org.

Gen tly loosen the scales with a sof t baby brush or infant comb whi le the shampoo is on baby’s head. Avoid put ting pressure on the sof t spot— known as the fon tanel—on his head

ISSUE 14 / Summer 2014 Healthy Mom&Baby

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Your Child in the Emergency Room

healthy babies

By Summer Hunt

One of the most frequent patients in the ER isn’t even able to complete the admission forms —let alone tall enough to reach the counter. Children aged 6 or younger account for 1 in 4 ER visits every year, says the CDC.

Boys vs. Girls

Boys (55.5%) are more likely than girls (44.5%) to visit the ER

one in four ER visits are by kids aged six and younger—here’s what to know when you

Does my child need emergency treatment?

Not every scary situation requires a visit to the ER—but get emergency care for: � changes in vision, difficulty speaking � uncontrolled bleeding � severe or persistent pain, vomiting or diarrhea � severe headache or vomiting, especially following a head injury � unusual abdominal pain � inability to stand up or unsteady walking � skin or lips that look blue, purple or gray � fever accompanied by behavior changes, especially with severe, sudden headache, stiff neck or back, or rashes 54

� any

sudden changes such as loss of consciousness, confusion, delirium, loss of responsiveness or alertness, excessive sleepiness, irritability, seizure or extreme withdrawal

When to Call 911

In some cases, you can drive your child to the ER, but dial 911 to get an ambulance if: XX condition is life-threatening, such as difficulty breathing or shortness of breath XX paramedics or emergency equipment is needed XX moving the child could cause further injury XX child’s condition could worsen, especially if delayed by traffic What should I bring? XX list

of your child’s allergies and medications records and contact info for physicians who have treated your child XX any potentially poisonous substances (in the original container) that may have been ingested XX an overnight bag, including a change of clothes, pjs, and a favorite blanket or stuffed animal XX immunization

Te ll m e w he re it hu rt s. ..

Top 5 reasons* for visiting the ER (ages 18 and younger) XXcold symptoms (26.8%) XXinjury (21.0%) XXnausea or vomiting (5.2%) XXskin symptoms (4.5%) XXabdominal pain (4.3%) (Note: This doesn’t include “all other” which accounts for 22.2% of visits) iSTOCK

If you find yourself facing an emergency, remain calm: Children pick up on your anxiety and panic, experts say. Talk softly and soothingly, and if your child is old enough, gently explain what’s going on. Ask your pediatrician if you should call the office if you’re ever on the way to the ER; some prefer to meet their patients there or alert a hospital-based pediatrician of your impending arrival.

health4mom.org

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healthy babies

ple e pe o Do th our life in y t he know ay for w t safes r baby you ep? to sle

Caregivers

& Your Baby’s Safe Sleep BY SHARON HITCHCOCK MSN, RNC

IMAGES: 123RF

Here’s a story worth repeating: William was six weeks old when Grandma first offered to give us a date night’ away from baby. Dinner and a movie. Since she would spend the night, there was no reason for us to rush. She gently offered again at eight weeks and this time my husband insisted. We had to leave our little newborn sometime, he explained, and I was approaching the end of my 12-week maternity leave. Grandma was a wonderful woman and had raised a wonderful son. We couldn’t have asked for a better babysitter. We were both first-time parents and had vowed not to be over-protective when it came to raising our son. My husband and I went to all the prenatal classes our hospital offered, and though we were a little nervous, we felt well prepared. I tried to not be tense but there seemed to be a lot to worry about! LEAVING OUR BABY WITH A CAREGIVER The movie had just begun and my mind wandered to our house. It was 8pm. Was William taking his bottle of breast milk? Was he getting tired and insisting on being held? Would Grandma rock him

to sleep in our comfy recliner? My next thoughts startled me and took me back to our prenatal class on infant safety and Sudden Infant Death Syndrome (SIDS) prevention. In our class, we had thoroughly reviewed the ABCs of safe infant sleep:  A for baby sleeping alone  B for baby sleeping only on his back  C for baby sleeping in a safe crib Our instructor had implored us to make sure all of our caregivers knew the ABCs of safe sleep as many, especially grandparents, didn’t. I suddenly envisioned William asleep on his stomach, or in the recliner snuggled against a sleeping Grandma! I elbowed my husband and whispered too loudly, ‘Does Grandma know the ABCs of safe sleep?’ My husband jumped out of his seat, pulling out his cell phone. I was right behind him. He tried to sound calm as he talked to his mom. All was fine and Grandma graciously agreed to follow the ABC rules. For now, though, they were still busy playing. We were told to go enjoy our movie.

Caregivers & Unaccustomed Sleeping Unaccustomed sleeping is when a baby who normally sleeps on his back is placed on his stomach or side to sleep. Studies show these infants have a seven to eight times greater risk of SIDS! These deaths usually happen when baby is with a caregiver, such as a daycare provider, friend, grandparent or other relative who doesn’t know the safe sleep rules. Never assume your caregivers know: Clearly explain how your baby is to sleep and post the safe sleep “rules” next to your baby’s crib.

SHARON HITCHCOCK MSN, is the maternal-

newborn educator for Carondelet Holy Cross Hospital and adjunct facility for the University of Arizona College of Nursing in Tucson, AZ.

ISSUE 14 / Fall 2014 Healthy Mom&Baby

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healthy babies

Use the ABCs of safe sleep every time baby goes to nap or sleep:

Breastfeed!

A for baby sleeps alone

Give your baby only breast milk for

B for baby sleeps on back only

the first six months of life.

C for baby sleeps in a safe crib

Share your room—not your bed—with baby

Offer your baby a pacifier

Place your baby’s bed near your bed (at arm’s length is ideal). This is called room sharing.

every time you place him down for a nap or to sleep once

breastfeeding is going well, usually around one month.

3 4

Never sleep with your baby Co-sleeping includes in a bed, couch, chair, recliner, waterbed or your bed, to

Avoid monitors marketed to reduce SIDS risks

name a few. Did you know that infant deaths from co-sleeping are increasing?

Research shows the ABCs of safe sleep are the best way to help prevent SIDS.

Put baby to nap or sleep in a safe crib

Immunize your baby Ensure your baby receives all of his

Bassinets and play yards are also good choices and the same rules apply. Never purchase a used bed of any type for your baby.

Safe Sleep Checklist

Follow these recommendations from the American Academy of Pediatrics and other leading experts to make sure baby always goes to sleep in the safest way—whether it’s you or another care provider putting him or her down for rest.

Avoid soft, loose or fluffy bedding

in your baby’s sleep space, including bumper pads and toys, stuffed animals or other objects. Use a blanket sleeper or swaddle instead of loose blankets.

6 7

recommended well-baby checks.

that meets current safety standards, with only a tightly fitted mattress and tightly fitted sheet.

Don’t smoke when you’re pregnant or after your baby is born

Never allow someone to smoke around baby or in your home.

Don’t drink alcohol or use illegal drugs

During your pregnancy or af ter your baby is born.

Avoid wedges or positioners

Give your baby lots of tummy-time when he is awake

to prop your baby up or keep him on his back.

and being watched to prevent flat

Give every baby its own bed

spots on his head.

Twins or other multiples should

Educate everyone who cares for your baby

Keep the room cool so that baby doesn’t overheat during sleep Use light sleep clothing and keep room temperature comfortable for an adult.

about these safe sleep rules; this includes grandparents, relatives, babysitters, siblings and friends.

IMAGES: 123RF, THINKSTOCK

not be put to sleep together.

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healthy babies Screening actually helps you give your baby a great start. Many of the conditions experts are looking for can’t be detected just by looking at your baby. This makes newborn screening even more important. More than 95% of babies get newborn screening. Most health insurance plans cover it, but you can’t be denied screening for your baby if you don’t have insurance or can’t afford to it. Newborn Screening Tests

Ap re osi t a l w s u l t i s i ve ay s no p r o a h ea t l ble m th

Understanding

Newborn Screening By Helen M Hurst DNP, RNC-OB, APRN-CNM

Don’t panic when your nurse begins your baby’s newborn screening not long after birth. It’s not that she suspects that something’s wrong—newborn screening is required in all 50 states to help detect health problems or potential issues for your baby early on.

The particular newborn tests that get performed are specific to the state where you live, but all states screen for at least 26 different conditions—some as many as 51. The most common ones you may have heard of are the newborn hearing screen, and the sickle cell and PKU (phenylketonuria) screens. Other conditions include: metabolic problems, primary congenital hypothyroidism, hemoglobin disorders, critical congenital heart disease and cystic fibrosis, to name a few. Undergoing Newborn Screening

In the first 48 hours of baby’s life—and before you leave the hospital—your baby should be screened via blood test, speakers on his or her ears and a sensor on his or her skin. If you’ve birthed your baby at home, schedule an appointment with your midwife or pediatrician to have the screening done before baby is more than 48 hours old. Some states require rescreening at two weeks—ask your healthcare provider about your state. What Do the Results Mean?

A positive result does not necessarily mean that your baby has the condition or a problem. Your baby may need retesting or further testing, or you may need to see a specialist for follow up. Helen M Hurst DNP, RNC-OB, APRN-CNM, is a midwife

and expert advisor to Healthy Mom&Baby. This article was developed under an educational grant from BabysFirstTest.org.

images: Thinkstock

The 3 Newborn Screening Tests

1 Heel stick

Your baby’s heel is quickly pricked and a few drops of blood captured on a card that goes to a lab. Your baby may cry but will soon soothe with cuddling or nursing. Results should be available in two weeks.

2 Hearing test

Your nurse will place speakers on your baby’s ears and watch for his or her reactions to sounds. There’s no pain and it’s completed quickly.

3 Sensor test

To check for a heart problem called critical congenital heart disease your nurse will use a small pulse oximeter sensor on your baby’s finger or toe to measure the oxygen in baby’s blood. You’ll have those results right away.

ISSUE 14 / Summer 2014 Healthy Mom&Baby

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healthy babies By Helen M Hurst DNP, RNC-OB, APRN-CNM

Testing Your

Can you hear me now?

Baby’s Hearing

Having your baby’s hearing tested before you leave the hospital is the part of newborn screening you likely already know about.

yo u r Ba by M ay Have He ar in g Lo ss if sH e:

Good hearing is so important. From the moment she’s born, your baby is learning and her brain is developing—much of which through hearing. Children who have untreated hearing difficulties can have problems with learning, language and speech development. Hearing loss also makes it harder to develop social skills, such as playing with others. Catching and correcting hearing problems early allows your child to develop at the same rates as other kids. My Baby Flunked the Hearing Test

Newborn hearing screen is only an initial test. You’ll need further testing to learn if your baby has hearing loss. If your baby doesn’t pass the first screening she’ll be referred to a hearing specialist (audiologist) for a full hearing test. This test should be completed before she is 3 months old, and just like the first screening it’s not painful. An audiologist will ask you lots of questions about your family’s health and any history of hearing loss. After the hearing test, the audiologist 62

will give a report to your healthcare provider and you may be referred to a genetics counselor, an ear, nose and throat doctor (otolaryngologist) or even an eye doctor (ophthalmologist) for follow-up. What If My Baby Has Hearing Loss?

startle, especially at loud noises XXDoesn’t turn toward sounds, especially at 6 months+ in age XXDoesn’t speak simple words like ‘dada’ or ‘mama’ by age one XXDoesn’t turn toward you when you say his name but turns to you when he sees you XXSeems to hear some sounds but not others

Babies with hearing difficulties should receive help by six months. Interventions can range from learning sign language to wearing a hearing aid or having surgery. Babies are really smart; signing as you speak is a great way to communicate. Your baby’s brothers and sisters can learn to sign and there may be infant and toddler signing classes in your area. Even if your baby doesn’t have a hearing loss, learning to sign is a lot of fun and gives your baby another way to communicate. Depending on the degree and type of hearing loss, your baby may need a hearing aid Helen M Hurst DNP, RNC-OB, APRN-CNM, is a or even surgery. midwife and expert advisor Even if your baby passes the first newborn to Healthy Mom&Baby. hearing screen it is important to be aware of signs This article was developed under an educational grant that your baby may have hearing loss. from BabysFirstTest.org.

images: Lucidwater s | Dre amstime.com

XXDoesn’t

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Intruder in the House!

(

)

DEALING WITH JEALOUSY WHEN YOUR NEW BABY COMES HOME

Finally, you and your new baby are on your way home. Your older child is expecting you and everyone is excited. Fast-forward 2 weeks and now things have changed. BY ALICIA BERBERICH, BA, CIC

TAMING SIBLING RIVALRY

Look at this from your older child’s perspective: Before baby, she had all of your attention. You were waiting for the new baby together; you were making plans together. You were a team. Now you’re spending your time holding and feeding the baby, and to her, you’re so busy that she feels left out. Even if you are doing things to include your older child, from their perspective they are now an outsider in this new relationship. Follow these tips to pull them back in and let them see how important they are to you: Th ink about positioning: When your older child comes to visit you at the hospital, are you waiting for her or holding the baby? If you are holding the baby, your hands are full and you can’t hug her. This sends a negative visual message to your child. The same goes for when you arrive home. Plan to have your hands free so you can welcome her with open arms! 66

Cut jealousy off before it begins: Be mindful of jealousy and deal with it proactively. Include your older child in activities with and around baby. Give her simple jobs, like getting a diaper or choosing an outfit. Make choices simple: ‘Should Ariel wear the yellow or the pink shirt?’ Follow what your older child advises; children pick up more than we give them credit for.

“Help your older child become one of baby’s first teachers and first friends.”

Acknowledge their feelings: When they say, “Mommy, I wish the baby would go away now!” Respond positively, “Yes, the new baby is a lot of work! She’s part of our family and she needs us to take care of her. We both have a big job to do; I really need your help now!” Make special time with your older child: Do things you love together: Go to the park, read books, bake cookies—whatever you have always loved to do together. Tell her how important she is for the baby. She is one of baby’s first teachers and first friends. Show her how by example she can help teach baby to smile and to laugh.

ALICIA BERBERICH BA, CIC, is the creator of the Unleash Your Child’s True Potential workshops.

IMAGES: 123RF

Your older child is crying all the time, cranky and hostile toward the baby. She was so excited while waiting for baby, why the change? Welcome to sibling rivalry—even at a very young age.

health4mom.org

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02/10/2014 16:23

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HealthAndYou.net Mozambique.indd 1

06/10/2014 18:11

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!

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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23/05/2014 16:08