ISSUE 15 / Winter 2015 | $3.95 | health4mom.org
PREGNANCY | BIRTH | PARENTING
YOUR PREGNANCY BY TRIMESTER How to Choose a
BABY-FRIENDLY BIRTHPLACE ASK OUR NURSES YOUR QUESTIONS
Why Babies Need To Start Their Birth
HEALTHY EATS Munch this, Skip that
40
FIRST DAY WITH BABY
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WEEKS
Great Expectations Abound In This New Pregnancy Movie 31/10/2014 18:02
Nobody likes to be rushed, especially babies. Your baby needs at least a full 40 weeks of pregnancy to grow and develop. Inducing labor even a week or two early is associated with a host of risks, including prematurity, cesarean surgery, hemorrhage and infection. While it may seem convenient for you or your health care provider, labor should only be induced for medical reasons. Your baby will let you know when she’s ready to come out, so give her all the time she needs: at least the full 40 weeks.
Download a free copy of
40 Reasons to Go the Full 40 at www.gothefull40.com.
The nurses of AWHONN remind you not to rush your baby—give her at least a full 40 weeks!
AWHONN PROMO T I NG T H E H E A LT H OF WOMEN A ND NE W BOR NS
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healthy babies
Issue 15 / Winter 2015
49 Baby’s Nursery as a Safe Haven
( CONTENTS )
These eco-friendly choices make your baby’s nursery safe and sound
52 The First Hours After Birth
You and your baby’s first 24 hours together
54 Protect Baby from Pertussis
ns? stio ur Que “Ask O in r atar u o Find rses” av r video Nu sue fo nline. is this swers o an
healthy moms 12 This Healthy Diet Won’t Fail
Use These Strategies for Effective Weight Loss
& Flu
Build a cocoon of protection from these illnesses that can be deadly for infants
55 Feeding Baby: The First Year
From nursing to finger foods, nourish your little one’s first 12 months
healthy pregnancy
14 How to Get a Second
Opinion
56 Sleep Safely, Baby
Reduce your baby’s SIDS risks with these sleep strategies
26 Your Healthiest Pregnancy
Second opinions increase your chances of a better outcome
Trimester By Trimester
59 The Great Diaper Debate
What’s happening in those 40 weeks
15 How To Choose The Right
Which diaper is better for your baby?
32 What to Eat & Avoid In
Prenatal Vitamins
60 Bathing Your Baby
Here’s what you need and how to get it
Pregnancy
16 Find Your Fertility
Munch this; skip that—your choices matter
Follow these essential steps to bathe baby right each and every time
34 Wait For Labor to Start On Its Own
61 Caring For Your Newborn’s Skin
Can pregnancy be a window into your future health?
17 Boost Your Fertility to
It’s so soft and delicate; protect it
Let nature take over for your easiest birth
Conceive A Perfect Pregnancy
62 Cutting Edge Strategies When
35 Why Baby Needs A Full 40
These tips will increase conception chances
Baby Is Teething
Weeks Of Pregnancy
19 How to Overcome Infertility
Don’t miss the benefits of going full term
These tips will help your baby cut her chompers with as little pain as possible
21 Pregnancy & Your Partner
37 Beginning Breastfeeding
66 Mom v. Dad
22 Negotiating Pregnancy &
38 Breastfeeding Apart
Get the facts on your rights
Keep the breastmilk flowing even with a
Fertility can be achieved if you know the facts
Their role in conception, pregnancy & birth
Your Job
Who parents baby better?
Baby will be ready at birth; will you?
From Baby
busy schedule
45 The Best Way to Labor
Gravity is your friend when it comes to birth
40 Weeks ON OUR COVER: Real mom Phoebe Hamilton and her daughter from the new movie, 40 Weeks
40
FEATURE
CHRISTO
PHER , DO
MINIQUE
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AND GA
IA
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NATALI A AND MAURI CIO
QUINTAN A
ISSUE 15 / Winter 2015 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 KIMBERLY WILSCHEK, RN, CCE Medical Revenue Solutions Chicago, IL CHARLOTTE WOOL, PhD, RN, CCNS York College of Pennsylvania York, PA
IMAGE © THINKS TOCK
TAMERA YOUNG, RN, MSN Central Ohio Technical College Zanesville, OH
CONSUMER ADVISORS MARIA OPLT Lafayette, LA
AWHONN’s mission is to improve and promote the health of women and babies. Healthy Mom&Baby is powered by the nurses of AWHONN.
Partner with Your Nurse for the Healthiest Pregnancy Possible Want a healthier pregnancy and birth? Talk with your nurse. In addition to checking your weight, blood pressure and providing healthcare, research shows a great relationship with your nurse boosts your chances for the healthiest pregnancy possible. Your nurse is there to provide you with advice and information and to help you manage any problems that may arise for you or your baby. Your nurse can freely discuss with you any issue that affects you or your baby during this 40-week journey—from the importance of eating healthy food and taking a daily prenatal vitamin to quitting dangerous habits like smoking or drinking alcohol. Need information on breastfeeding? Unsure about the signs of labor? Curious about when to call if “something just doesn’t seem right?” Nurses want to answer your questions and concerns that naturally come up during pregnancy—even if this isn’t your first baby. Experts know this is true from the outcomes of the more than 40-year-old Nurse-Family Partnership program in which nurses have visited women during pregnancy all the way through baby’s 2nd birthday, improving health for those moms and babies as they provide care and information. This is why the nurses of the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) produce Healthy Mom&Baby—so that women just like you can get health advice and information that’s based on science and that’s useful and trustworthy. Begin with the advice from nurses in this issue and find even more online at Health4Mom.org. QUESTIONS FOR YOUR NURSE Questions are a great way for you to learn more from your nurse about pregnancy. Don’t hesitate to ask questions like these at each visit—or even call with these questions between appointments: How is my pregnancy progressing? Has anything changed that you’re worried about? How can I know that my baby is doing well from week to week? Where can I begin to learn about breastfeeding? Do I have any health problems or risk factors that we should talk about? If something about my pregnancy isn’t normal, will you share that with me?
During pregnancy, you’ll receive care from many nurses—beginning with nurses at your pregnancy care provider’s office to the nurses who care for you during and after labor and birth. Bring your questions and concerns; they’ll be happy to share their expertise, advice and experience so that you and your baby have the best pregnancy journey possible. Catherine Ivory, PhD, RNC-OB, is the AWHONN 2014 President.
ISSUE 15 / Winter 2015 Healthy Mom&Baby
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advice in this special issue of Healthy Mom&Baby. We’ve got even more for you online at Health4Mom.org, where you’ll find the nurses who guide Healthy Mom&Baby ready to take your
AW H O N N
questions. They’ve answered a few already for you
for 4 issues!
AWHONN 2014 President:
Cathy Ivory, PhD, RNC-OB
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Debra Bingham, DrPH, RN
through pregnancy, labor, birth and parenting.
Editor & Director of Publications:
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Lynn Erdman, MN, RN, FAAN
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Healthy Mom&Baby is published by Maitland Warne in partnership with AWHONN. © AWHONN, 2014. All rights reserved. All material in Healthy Mom&Baby is wholly copyright. Reproduction without the written permission of the publisher is strictly forbidden. Neither this magazine nor its contents constitute an explicit or implied endorsement by AWHONN or by Maitland Warne of the products or services mentioned in advertising or editorial content. The editorial content in this publication does not necessarily represent policies or recommendations by AWHONN. This publication is not intended to be exhaustive. While every effort has been made to ensure accuracy, neither AWHONN nor Maitland Warne shall have any liability for any errors or omissions. Readers who may have questions should consult their healthcare provider.
on tasks like bathing and diapering We’re also introducing you to an amazing pregnancy journey movie that’s now in theaters and online, 40 Weeks (www.40weeksthemovie. com). In the movie, AWHONN nurses are shown providing patient care and 1 of the 9 families followed is that of a pregnant AWHONN nurse. AWHONN nurses are hosting screenings throughout the US; find one near you at www.gathr. us. At these screenings, our nurses will take your questions and lead a discussion after the movie. Until next time,
PUBLISHER
MAITLAND WARNE 730 North Franklin street, Suite 604, Chicago, IL 60654, USA Tel: (312) 701-0000 Fax: (312) 284-5864 www.maitlandwarne.com EDITOR IAL
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Carolyn Davis Cockey, MLS Editor & AWHONN Director of Publications Health4Mom@AWHONN.org
ISSUE 15 / Winter 2015 Healthy Mom&Baby
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Moms
BY MICHELLE SAVIN, MSN, NNP-BC
Make a Plan that Protects & Boosts Your Fertility
2: RE A SON #1 time e w in lge Indu re a before you’ or more. e om es re th l
go ful reasons to Read all 40 m TheFull40.co Go at m ter
IMAGES © 123RF
Do you have a reproductive life plan— meaning have you and your partner decided if and when you’re going to have children? For example, if you don’t want children, how will you prevent pregnancy? If you’re not ready for children, how can you delay pregnancy? What health risks should you address now so that you can enter pregnancy as healthy as possible? A plan simply states your goals. When you and your partner both get healthy and prepare before pregnancy, research shows your efforts create better outcomes for all.
MEN: PROTECT YOUR FERTILITY
BUILD YOUR PLAN Think about what’s important in your life. How does having a family fit in that picture? Make your plan personal and flexible; you can change it whenever you want. You may even find that creating a reproductive life plan helps you define other goals for what you want in life. Plans can be as simple as: “We want to get pregnant but my diabetes will complicate that. I’ll ask my healthcare provider what I need to do before we try to conceive.” “I’m not ready for children. To prevent pregnancy, either I won’t have sex or I’ll use contraception every time.” “I’d like to have a stable job to support my family, so first I’ll finish my degree. My spouse and I will use contraception until we’re both ready for a baby.” “My baby is 3 months old and I want to space my pregnancies by at least 2 years. I’ll visit my nursemidwife for contraception so I don’t have another baby before I’m ready.”
According to the CDC, the 5 most important things women can do to have the healthiest conception possible are: 1. Take at least 400mcg of folic acid daily for at least 3 months to reduce the risk of birth defects 2. Stop smoking and drinking alcohol 3. Get any medical conditions under control, such as asthma, diabetes, gum disease, obesity or epilepsy 4. Discuss how medications and supplements you’re taking now may affect your pregnancy with your healthcare provider 5. Avoid toxic substances, such as chemicals, or cat and rodent feces
Get annual checkups and manage or treat any health problems Eat healthfully, get regular exercise and 7-8 hours of sleep each night Avoid smoking, alcohol and other dangerous substances Know your family health history
Avoid toxins
MICHELLE SAVIN, MSN, NNP-BC, is a neonatal nurse practitioner in Wilmington, DE.
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ISSUE 15 / Winter 2015 Healthy Mom&Baby
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Advertisement Feature
After the First 40 Weeks The real Wonder Weeks start! Breakthrough science reveals the true reasons of fussiness and weeks of wonders After 40 weeks of being in a safe haven to grow in the womb, a baby is physically ready to be born into this world. Those 40 weeks are when he or she develops from two cells into a complete human being. From that day on, he or she will be preparing him or herself for the 10 major leaps he or she will make in his or her mental development, or better said, the 10 Wonder Weeks. In 20 months, your baby will develop from a newborn into a toddler and his or her brain will double in size. Worldwide experts and authors of the multiple award-winning book The Wonder Weeks, Dr. Frans Plooij and Dr. Hetty van de Rijt, have probably been responsible for most of the breakthrough research on the mental development of babies. Their studies revealed the true reasons why a baby is fussy at set times and why a baby cries more, sleeps less, and clings more to their parents during these troublesome times. Moreover, they discovered that these fussy phases are actually good signs and that gigantic leaps forward in baby’s mental development is on its way. As new-time mom Monika Sketcher says, “The knowledge of the existence of Wonder Weeks helped ensure that we tried to relax about the small things because really big things were going on in our son’s world.”
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SOME OF THE SIGNS OF A LEAP ARE: » Sleeps less, has nightmares, or wakes up often » Cries more and seems to be scared » Clings to mom and dad and does not want to give up physical contact » Hurts him or herself more often (falls, scratches, etc.) » Eats less or wants to be breastfed the whole time
EVERY LEAP COMES IN THREE PHASES: 1. The fussy phase of the 3 C’s. 2. The week of wonders where suddenly, your baby is able to do so many things he or she couldn’t do before. The real Wonder Week! 3. The practice period.
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PHASE ONE: YOU WOULD CRY, BE CRANKY, AND BE CLINGY TOO! Dr. Frans Plooij: “A baby’s perception of the world comes in leaps, and every baby makes 10 leaps during his [or her] first 20 months of life. With every leap your baby makes, he [or she] gains access to whole new abilities to perceive the world. These leaps come unexpectedly and surprise him or her. It’s like he or she suddenly wakes up on a new planet and everything he [or she] knew suddenly is different. He [or she] perceives new things, and that is scary. What would you do if you would wake up one day and everything was different? Yes, you would start to cry, be cranky, and you would cling to the one thing you recognized: your parents.” This is why every baby is Cranky, Clings more, and Cries more during the first phase of each leap. This is the so called 3 C’s. Research has shown that parents that know why their baby is fussy are able to deal with the 3 C’s much better. They don’t question themselves or their baby, and they don’t lose self-confidence or confidence in their baby.
“Once we discovered the concept of The Wonder Weeks, it took the edge off of the anxiety of being a new parent. We could see that what we were experiencing was not only normal but now had tips for how to help our baby through it.” Pamela Webb Eliott
PHASE THREE: PRACTICE, PRACTICE, PRACTICE! This phase is all about mastering more skills as your baby can’t possibly master all skills belonging to the leap at once. Practice makes perfect, and with your help, he or she will continue to practice with his or her body what his or her mind is able to do since the leap. Your baby needs you to show him or her around and to help him or her master the skills. When you know what is going on, you can really make a difference.
“Of all the baby books out there, The Wonder Weeks is the one to get! Let’s face it, once baby comes, we are slapped with the reality that we actually have no idea what we are doing. The Wonder Weeks helped me keep my sanity during the fussy periods and reassured me I wasn’t imagining [my] baby’s behavior suddenly changing. It also taught me to see the world from [my] baby’s perspective and to be more patient once I understood their needs. I particularly liked the quotes from other parents featured throughout the book as my frustration and emotions were reflected in what they were saying and gave me comfort that I was not alone. I recommend the book and app to all my pregnant friends.” Lauren James
PHASE TWO: HE GETS IT! After each Wonder Week, it’s like your baby is born again into a different phase of his life. To be a part of this incredible journey through life together with your baby is the most magical experience a parent can have. Yet even more important is a parent that is part of these leaps by being prepared and offering the proper help. This helps their baby in the right way and the way the baby deserves.
“People tell me I have the happiest baby around. When they ask what my secret is, I tell them The Wonder Weeks! It helps me prepare for her ‘cloudy’ moments way ahead of time. It truly has been a lifesaver!” Ashley Marie Sams-Suggs
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Interested in getting into your pre-baby jeans? Noshing extra calories whiletime nursing a baby? Pregnancy is not the to start thinking about a weight-loss Fighting fat and just want to become and stay thin? program. It’s important to be at an appropriate weight—and we add For whatever reason you want to lose weight, you waist to that—with normal blood pressure and blood sugars before want a diet that won’t fail. We have the answer.
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fat fight. It’s time to nsmarts, you’re and with healthy win with elegance, Most diets promise common sense solutions to prewith g na n t , you ne to eat as ed as a Simon choices that become tight-pants problems: Eat less; weigh less. Keep on automatic than t ly 10% mor h e e num Cowell barb. calo your mouth closed—you’ll THE 6-STEP PLANkeep the pounds off. b e r of ries yo u o rd ea t t o Sweat like a sauna-dwelling sumo and you’ll wind mainta inarily in you up thinner than the a sheet of paper. if diets really LOSElose, THE WEIGHT r weFOREVER Begin with 6 steps we useBut at EnforcerECoaching.com that help our participants ight . worked that way,24we wouldn’t showing has just started to unlock the biological on average, pounds in 26beweeks. You up tooon can lose and keep extra pounds offScience by sticking Google Earth. If itplan. were really that easy, most diets mysteries that explain why we store fat and gain to our 6-step wouldn’t fail. weight. Having theyour medical evidence about food, You snooze, you lose—weight that is. Getting enough sleep (78 hours) every night quiets 1. Maybe “I’m mosthungry” diets hormone. have it wrong. Should appetite and satiety (satisfaction, that’s right!) you simply theit, corn croissants and underestimate how many calories means youeating can tackle your weight problem with you eat writechips, it down. Most people they’re so keep 2. Iftackle cheesecake awith brute It’s you foodknow in the drill—lots of fruits and veggies, the only weapon that journal of force? everything youversus eat. You lean protein, andworks: Knowledge. You can a lifetime ght. But this fithat ght aren’t is always reprogram your body so that you can keep off extra none heavyweight of the 5 foodfifelons: grains 100% whole, trans fats, saturated fats, added sugars fi xed—and not in your favor. weight forever. or syrups. When itSlow comes dieting, trying whip1 fat smarter, notslows harder. On our plan, you can andtosteady wins. Aim to to lose pound a week. If you starve yourself, Work your metabolism 3. with willpower is theand food of holding expect to drop up to 2 inches from your waist (or to a crawl yourequivalent hunger hormones scream “Eat More, Now!” your breath underwater. You often. can doTo it for while, sugar levels steady, eat 5 times aaday—3 dress size) within less but more keepa blood meals and 22 weeks. You’ll continue to see 4. Eat but no matter how psyched you get, at some point results steadily after that. You may be focused on snacks. your 5. body—your you 10,000 to thesteps a day. That’s how you’ll keepthe end on goal, but blood we believe the path you choose to Get (and biology—forces keep) moving. Walk a grip lower surface gasping for air. get there is what really determines whether you’ll pressure, lower blood sugar, and lower lousy LDL cholesterol. So it diets: with At some point, your body it ordo not. Getwith a buddy similar goals and enlist your family—almost none make of us can this alone 6.goes forces you and to gasp (orcan gulp) Nomember matter tries to reward your success with one of the 5 food felons. no one do itforif food. a family Pregnancy is NEVER a time how hard you try not to eat, some hidden force AUTOMATIC WAIST MANAGEMENT to diet or try to lose weight. deep inside is always prying your mouth back open, Think of your waist management plan a little like Instead, eat healthfully, getting the extra calories your baby making it impossible to win. the way you’d driveC.toOZ, work. Maybe the first day MICHAEL F. ROIZEN,for MD,willpower is chief wellness officer and chair of the Wellness Institute at the Cleveland Clinic. MEHMET needs to develop well. and vice chairman of surgery, as well as MD, is the host and executive of the Dr Ozmake TV show. He is also a professor Instead of sparring withproducer your waistline, on a new job in a new city, you took the highway. director of the Cardiovascular Institute and Integrated Medical Center, at New York’s Presbyterian-Columbia University.
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health4mom.org health4mom.org
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healthy moms But then you found out it was more clogged than Rapunzel’s shower drain. So you experimented with a few back roads, shortcuts and bypasses until you found the very best way to get to work. Now you don’t need a map; you do it automatically and don’t spend a single nanosecond worrying about what turn to take. It’s automatic—just the way your approach to eating should be. When you’re starting out on this plan, you’ll experiment with different routes, get stuck in a
few traffic jams, and maybe even get a little lost along the way. But if you stick with it and fi nd the right course, you’ll automate your habits, regulate your body’s hormones, and make healthy eating the easiest trip you’ve ever made. It will take some effort at the start to retrain your habits, palate and muscles, but this program is a lifelong eating, activity and behavior plan that will become as routine as going to the bathroom before bed.
MICHAEL F. ROIZEN, MD is chief wellness officer and chair of the Wellness Institute at the Cleveland Clinic.
MEHMET C. OZ, MD,
hosts the Dr. Oz show; he is also a professor and vice chairman of surgery, and director of the Cardiovascular Institute and Integrated Medical Center, at New York’s PresbyterianColumbia University.
YOUR LAST DIET: THE PLAN GET ACTIVE Get a buddy: Hardly anyone accomplishes anything alone—so the first thing you need is a buddy. She or he can be a committed spouse or an exercise friend who has your back and cheers you on to great healthful food choices and will not sabotage your plan, no matter what. Walk: Your ultimate goal is 10,000 steps every day—NO EXCUSES! Your buddy can help you build up to 10,000 daily steps. Walking improves all of your body’s systems and builds the habit and motivation you need for ongoing success. It’s THE most important thing you can do to affect weight loss. Stretch: Do 3 to 5 minutes of stretching after your walk. While it keeps your muscles limber and flexible, which helps prevent injury, stretching also has a meditative element that helps you refocus and cope with cravings. Be gentle—“no pain, no gain” doesn’t apply here.
EAT FOR LIFE! Dump your fridge: Read the ingredient labels on everything in your kitchen cupboards, refrigerator, breadbox and everywhere else you stash food. TRASH any of the 5 Food Felons listed herein. Go food shopping: The fi rst week, you’ll have a larger-than-normal shopping list because you’ll stock up on essentials as well as ingredients you’ll need for healthy recipes. We want to turn your kitchen into a nutritional honor society so that it’s filled with good-for-your-waist foods that make it easy (and automatic!) to eat right. Map your meal strategy: Eat 3 main meals
plus snacks, so you’re never hungry. No eating within 3 hours of bedtime. Consider dessert an every-other-day treat at most. By incorporating snacks, you avoid hunger emergencies, for which apples, almonds, walnuts and edamame (soybeans) are good choices. Automate 2 meals & 2 snacks each day: To help make eating automatic, pick at least 1 meal a day to alter and have the same few food choices every day for all other meals and snacks— alternate 1 or 2 breakfasts, 1 or 2 sets of snacks, and 1 or 2 lunches. Then, spice up dinnertime with varied and interesting meal choices. AVOID THE 5 FOOD FELONS! 1 & 2 Simple sugars & syrups: Th is includes brown sugar, dextrose, corn sweetener, fructose (as in high-fructose corn syrup), glucose, corn syrup, invert sugar, maltose, lactose, malt syrup, molasses, evaporated cane sugar, raw sugar, and sucrose. Keep a little table sugar, honey and maple syrup handy, because you’ll use them for recipes. 3 Saturated fats: Th is includes most 4-legged animal fat, milk fat, butter or lard, 2-legged animal skin and tropical oils, such as palm and coconut. 4 Trans fats: Th is includes partially hydrogenated fats, vegetable oil blends that are hydrogenated and many margarines and cooking blends. 5 Enriched flours and all flours other than 100% whole grain or 100% whole wheat: Th is includes enriched white flour, semolina, durum wheat and any of the acronyms for flour that is not whole wheat— they should not be in your kitchen.
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How To Get a Second Opinion (
Second opinions increase your chances of a better outcome
)
By AWHONN Editorial Staff
You may feel like you’re checking up on your healthcare provider by getting another opinion but research shows you’ll be doing yourself a big favor—increasing your chances of getting the best possible treatment by as much as 30%! You can even get a second opinion during pregnancy. � When faced with a big medical decision, “always get a second opinion,” say the YOU Docs, Mehmet Oz, MD, and Michael Roizen, MD, authors of You: The Smart Patient. In fact, they devote a whole chapter of their New York Times bestseller on how to do it. A second opinion is when you get another healthcare expert to give you advice about your existing medical records, your condition and how it should be treated. And a second opinion should always include an in-person exam as well as a records review, the YOU Docs stress. A second look is important because even though healthcare providers may get similar education and training, they have their own opinions and thoughts about how to provide care. Some providers are more conservative while others are more progressive, using the newest tests and therapies, say the experts at the National Women’s Health Information Center. Circle Back
The more options you have, the better the healthcare choices you can make, experts say. And in getting additional opinions, it’s always good to circle back for a full discussion with your primary healthcare provider in making your treatment choices. If the advice from your primary and secondary providers are in conflict, repeat these steps for a third opinion. And don’t worry about hurting your healthcare provider’s feelings—most welcome another set of eyes and additional advice, particularly if surgery or a long treatment is involved. 14
5 STEPS TO A SUCCESSFUL SECOND OPINION
#1. Get referrals: Ask your healthcare provider and friends with similar conditions for referrals; you may even find specialists outside of your area through online advocacy groups for your condition. #2. Check your insurance: Learn what is and isn’t covered. #3. Send your records to the second provider: You will need to request this in writing. Ask your primary care provider if they have a form their office uses for records requests. Consider requesting a copy of your records for your own reference; some offices charge for this service. #4. Be an informed patient: Learn as much as you can. Visit a medical library, go to reputable health sources online— typically a government (.gov), teaching (.edu) or non-profit (.org) source will provide expert-based, reliable information. Make a list of your questions and thoughts and bring them when you see a provider. #5. Be seen in person: Don’t rely a records check alone without an exam. You may be asked to have additional tests or procedures.
123rf
Know Your Choices
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healthy pregnancy how to choose
the Right Prenatal Vitamin By Tamer a Young, RN, MSN
During pregnancy, your body needs additional vitamins and minerals for you and your growing baby. A daily prenatal vitamin is your insurance against any deficiencies from conception through pregnancy and breastfeeding. prevent birth defects Start prenatal vitamins before conception to support baby’s earliest development. Your prenatal should have at least 400 micrograms of folic acid to prevent neural tube defects, which occur in the first 28 days of pregnancy—often before you even miss a period. Folic acid is the synthetic form of the B vitamin folate, which is found in leafy greens and other foods. Some prenatals have as much as 800 micrograms of folic acid, which is safe and helps prevent birth defects. If you’ve had a pregnancy affected by a neural tube defect, you may need even more folic acid. dha
Want to nourish a smarter baby? Many prenatal vitamins now include omega-3 fatty acids in the form of DHA (docosahexaenoic acid). This healthy fat promotes baby’s brain and eye development. Coldwater fish such as salmon is a good source of omega-3, as are walnuts and flax seeds. Experts recommend eating 8-12 ounces of seafood (1-2 meals) a week (low-mercury fish only) during pregnancy.
image: 123rf
vitamin d
The recommended daily amount of vitamin D during pregnancy is 600 IU/day. Most prenatals have 400 IU, so you’ll need to get extra elsewhere. But vitamin D can be too much of a good thing—
safe upper daily limits are 2,000 IU to 4,000 IU during pregnancy.
St ar t pre nata bef ore co l vitamins nception support baby ’s ea to rliest developm ent.
customize your vitamin
Does your throat close at the thought of swallowing a capsule? Look for a chewable, liquid or even gummy prenatal vitamins. Vitamin B6 can help ease nausea and morning sickness. Most experts advise 50 milligrams of B6 daily for morning sickness. If you’re prone to iron deficiencies, look for a higher level of iron in your prenatal vitamin, but be aware that iron supplements can cause nausea and constipation. If you’re not anemic, pick a prenatal vitamin without iron. Not all prenatal vitamins are created equal and because not all supplements have been tested for safety in pregnant women, so stick to meeting your basic needs. For example, too much vitamin A can be harmful to your baby so this vitamin is often reduced in prenatals, which is one reason why a regular multivitamin just won’t work during and after pregnancy. Skip herbal supplements altogether— many are considered too risky for your baby; discuss any herbs or other supplements with your health care provider before you take them. Lastly, a prenatal vitamin isn’t an excuse for poor eating—strive to get the nutrition you and your baby need each day through your food.
Choose a prenatal vitamin with at least the following: 99 400 mcg of folic acid 99 400 IU of vitamin D 99 70 mg of vitamin C 99 6 mcg of vitamin B12 99 10 mg of vitamin E 99 3 mg of thiamine 99 2 mg of riboflavin 99 20 mg of niacin 99 15 mg of zinc 99 200 to 300 mg of calcium
tamera L. Young, RN, MSN, is an obstetric clinical instructor in Newark, OH.
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Basal Body Temperature
Your body temperature will rise slightly on the day you ovulate. Take your ‘resting’ temperature each morning at the exact same time before you rise from bed and chart it. Use a digital body basal thermometer since the shift can sometimes be in 10th’s of a degree. You’re most likely to conceive in the 2 to 3 days before and for 24 hours after the temperature shift.
Calendar
If your periods are fairly similar in length and you know your average cycle length, say 29 days for example, you can count back 12-16 days from when you expect your next period and have your targeted timeframe for ovulation.
Ovulation Predictor Kit
Find Your Fertility
Finding when you’re most likely to conceive and become pregnant starts with understanding your menstrual cycle. You’re most likely to get pregnant in the 5 days leading up to and the 24 hours after you ovulate, which typically happens around mid-cycle. Do you know how long your cycles are? The average is 28 days, with the first day of bleeding counted as day 1: Between days 1 and 7 your body prepares to release an egg from your ovaries By day 11, your uterine lining begins to thicken to host a fertilized egg, should that happen Around day 14, your body releases an egg from your ovaries and down the fallopian tubes where it can meet up with sperm if intercourse has occurred in the last few days If a sperm unites with an egg to fertilize it, it can then implant in the uterus, and voila! You’re pregnant. If fertilization doesn’t happen, your hormones change and around day 25 your body begins to shed your uterine lining, which results in it bleeding out around day 28. Discover When You Ovulate Learning when you ovulate is essential to increasing your odds of conceiving. Use one or several of these methods—for many of which you can find an app to help with tracking—through a few cycles to sleuth out your pattern. 16
Cervical Mucus
Your body will actually give you specif ic signs it’s about to ovulate. The mucus from your cervix will change from a creamy consistency to a clear, stretchy consistency like raw egg whites.
Saliva
Like cervical mucus, your saliva may form a pattern that looks like ferns under a handheld scope as you near ovulation. Ferning patterns made of up dots and circles emerge due to estrogen surges prior to ovulation. But some women may never ‘fern’ or do so inconsistently apart from ovulation, say experts at the FDA.
VIOLA POLOMENO, RN, PhD, is faculty at the University of Ottawa in Ontario.
IMAGES © 123RF
BY VIOLA POLOMENO, RN, PHD
These kits scan for an increase in luteinizing hormone (LH) in your urine to predict ovulation, typically 24 to 36 hours in advance. Fertility Monitor These hand-held devices help predict ovulation and signal when it has occurred by analyzing hormones in your urine via test stick, your basal body temperature readings and your cycle lengths.
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healthy babies Dr. Michael Lu, MD, MPH
10 Healthy Practices to Conceive a Perfect Pregnancy
Trying to conceive? Studies show these 10 healthy practices can affect your body’s ability to get pregnant and have a healthy pregnancy. Start these 10 practices while trying to conceive so when you do get pregnant, your body will be ready for baby. 1. Get preconception care Schedule an appointment with your healthcare provider to identify and treat any issues that could affect your pregnancy.
5. Take a prenatal vitamin Daily, take a prenatal vitamin with at least 400800 micrograms of folic acid to prevent the most common birth defects: Spina bifida or anencephaly.
2. Nourish for 2 Eating before and during pregnancy is more about quality, not quantity. Eat more highly nutritious foods and decrease foods high in fats and sugars. The foods you eat today are the building blocks for your baby tomorrow. 3. Eat more brain foods Help your future baby grow a healthy mind with beans, eggs, nuts and seeds, olive oil, Alaskan wild salmon (or any other cold water oily fish), yogurt and kefir, whole grains, spinach, collards, kale, broccoli, prunes, raisins, blueberries, oranges, red bell peppers and tomatoes.
image: 123rf
4. Avoid toxic foods
99 Avoid fish that are high in mercury, including swordfish, shark, king mackerel and tilefish 99 Skip products with unpasteurized milk— they can carry bacteria that causes listeriosis, which in pregnancy can cause miscarriage or stillbirth, premature delivery or infection in babies 99 Avoid hot dogs, deli meats, raw or smoked seafood, raw or undercooked meat—these can also contain the bacteria that causes listeriosis 99 Scrub all of your veggies and fruits—unwashed produce can carry and spread certain disease-causing microscopic organisms 99 Avoid all saturated fats and trans fats, partially hydrogenated oils, added sugars (e.g. high-fructose corn syrup) and refined flour
The foods y eat today a ou re building blo the c for your ba ks by tomorrow.
6. Achieve a healthy weight Being underweight or overweight puts you at risk for a number of pregnancy complications. Achieve a healthy weight before pregnancy. Stabilize for at least 3 to 6 months before trying to conceive at your healthy weight. 7. Learn to relax Deep breathing, progressive relaxation, mindfulness exercise, and transcendental meditation can all help you relax. Positive mental health and a strong network of social support will help you stay resilient through the stresses of pregnancy and parenting. 8. Tune up your immune system Infection and inflammation pose perhaps the biggest threats to a healthy pregnancy. Reduce saturated and trans fats from your diet, and eat more whole grains, fruits and vegetables that are loaded with antioxidants. 9. Detoxify your environment ‘Go green’ with as many common household products as possible to avoid potential reproductive and developmental problems. 10. Make a family man Men contribute about half of baby’s genetic materials. Sperm DNA can get damaged by tobacco, alcohol, drugs, caffeine, diet, medical conditions and environmental toxins. Since men continue to make new sperm, if they take good care of themselves for 3 months, they can replace a lot of the damaged goods with healthy sperm.
Dr. Michael Lu, MD, MPH is an OB/GYN and
associate administrator of maternal and child health at the federal Health Resources and Services Administration (HRSA).
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Helping Couples to Conceive, Naturally… Female Fertility Support Natural supplements to help with cycle regularity, egg quality, and cervical mucus production plus other products to help women conceive naturally.
Male Fertility Enhancement Clinically validated supplements with an array of vitamins, minerals, antioxidants and amino acids to help improve sperm parameters.
Ovulation Prediction A variety of tools to help accurately pinpoint ovulation including basal thermometers, fertility monitors, and more.
Use code “HealthyMB” for 10% off your order www.fairhavenhealth.com Phone: (800)367-2837
These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.
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healthy pregnancy
How to
Overcome Infertility At a time when more women are delaying childbearing for their careers, Alice ‘Ali’ D. Domar, PhD, is helping us see you can’t always ‘have it all’ without paying an emotional or physical toll—especially if you want to start a family. BY CAROLYN DAVIS COCKEY, MLS
IMAGE: MIND/BODY INSTITUTE, THINKSTOCK
As the founder and executive director of the Domar Center for Mind/Body Health and an associate professor at Harvard, Ali is a research leader in women’s health— especially infertility. When Healthy Mom&Baby caught up with her, we asked about her center’s secret to success in achieving conception in women who have otherwise struggled with infertility. When you founded the Domar Center for Mind/Body Health in 1987, you achieved high pregnancy rates with what others call your 6th sense of the emotional needs of women. What’s that about? My parents struggled with both primary and secondary infertility. It took them 7 years to get pregnant with my sister and 5 years with me. I grew up hearing how hard that was on my mom; it seeped into who I wanted to become. When my mom was trying to conceive, she was prescribed the equivalent of valium and got pregnant. I grew up knowing that I wouldn’t have had an older sister if my mom had not relaxed. We help women relax. How do you get women to actually let go? If you’re trying to be perfect, you’ll be anxious all of the time. You’re putting way too much pressure on yourself and diminishing your self-esteem. My goal is to help women be physically and psychologically healthy. Women typically just need permission. Just get more than one person to say “it’s ok” to let the stress and pressure go. The ones who have the most success agree to let go.
What exactly does that look like, especially when we’re struggling to balance a career and start a family? Every morning when you’re jolted awake by a screaming alarm, spend 15-20 seconds thinking of 1 nice thing that you can do for yourself: buy flowers, call a friend, eat a good piece of fruit. Make the first thought a positive thought about you. I was in Los Angeles and woke up early one morning thanks to the time change. I realized, “There’s a farmers’ market down the street with fresh fruit. That’s a nice place I can take myself today.” And I did. How does stress jeopardize our fertility? Wanting to have a child is a basic instinct. Difficulties conceiving change your outlook on everything from your work to how you see your partner and your closest relationships. By the time we see women for treatment, they’re dealing with an array of emotions— these feelings affect their ability to conceive and their outlook on treatment. The stress of infertility is comparable to that of serious illness. Women and couples who are struggling to conceive should seek treatment early—it makes them better prepared for their experiences, and it significantly lowers their stress as compared to those who go it alone.
By the time w ome seek tr eatmen n they ’re t, dea ling w it h an a r r ay o f emoti ons .
Ali Domar helps women achieve conception by relaxing.
ask our nurses AWHONN nurses say when to get help for infertility in this video: health4mom.org/?p=1276
CAROLYN DAVIS COCKEY, MLS is editor of Healthy Mom&Baby.
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healthy babies way with information. X X Take a childbirth class together—you’ll learn breathing, massage and other coping techniques that will help you help your partner through the waves of contractions that intensify as labor progresses. Your hands-on practice during class will help it feel more natural when you’re called to duty in the delivery room. X X Create your birth plan together—you are your partner’s best advocate when she can’t focus or remember exactly how she wanted things to go. X X Bring back-up—a labor support person, known as a doula, can be an incredible asset to you both. These skilled labor coaches know how to communicate effectively with healthcare providers and offer advice and suggestions based on their years of working with birthing couples. Bef o r discu e labor, ss w ill g how you o bir th through toge t her.
Pregnancy &
Your Partner Guys, be prepared for your role in conception, pregnancy & birth. By Carolyn Davis Cockey, MLS
ask our nurses Nurses share how laboring moms are supported in this video: health4mom.org/?p=1278
Go Full Term
images: Thinkstock
Reason #12: Indulge in ‘we’ time before you’re a threesome or more. Read more reasons at GoTheFull40.com.
Carolyn Davis Cockey, MLS is editor
of Healthy Mom&Baby and director of publications at AWHONN.
While there once was a time when dads waited patiently to hear whether they now had a son or daughter, today’s family-focused birthing means dad is front and center for the pregnancy, labor and birth. And the same holds true if you’re not a traditional couple or family—the person you call your partner has an important support role to play in conception, pregnancy and birth. Be Prepared Experts at Lamaze International recommend you join in the adventure with your pregnant pal as follows:
XX Attend all prenatal appointments, as possible, with your partner—her healthcare provider will be preparing you both along the
Expect the unexpected Talk with your partner long before labor and birth about each of your roles during labor and birth. Obviously mom is having the baby, but ask her where she wants you to be—near her head offering words of encouragement and support or waiting for baby to emerge and that first opportunity to hold him.
Decid e how yo u wi ll su pp or t mo m— do yo u wa nt to : Help ‘catch’ baby Cut the cord Hold baby immediately upon birth Accompany mom or baby if they have to be separated for any reason Talking through the different scenarios before birth occurs will help you both be prepared for the amazing miracle of welcoming your baby into your lives.
Your Packing List 99 Changes of clothes 99 Toothbrush/paste 99 Electronics: Everything from iPads and cell phones to video cameras and chargers 99 Snacks: Avoid anything with strong smells or loud sounds 99 Books or magazines 99 Massage devices, for example, a roller or relaxation ball
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Negotiating
Your Pregnancy & Your Job By Elizabeth T. Jordan, DNSC, RNC, FAAN
Pregnancy is an exciting time—but it can be an anxious time, especially if you’re like most women and currently hold a job outside of your home. While it may seem your coworkers will warmly welcome your happy news, the sad truth is that many women are treated unfairly or let go after they share their pregnancy plans, federal experts say. If you work in company or organization with 15 or more employees, you have protections for your job under the Pregnancy Discrimination Act. And under the Family & Medical Leave Act, you can take up to 12 weeks of unpaid leave if you work in a firm with 50 or more employees. More than 80% of moms return to work within 12 weeks of giving birth, according to the Labor Department. Still, most employment experts recommend women take the following actions before announcing a pregnancy or negotiating how any leave may be structured with an employer:
XX Determine how much time you’ll need: Ask for the longest amount of leave possible knowing it will be a bonus for your colleagues if you gradually return to full-time work or even end leave early XX Learn what others have done: This will help you know what’s worked in your organization XX Explore alternatives: Are you willing to work part-time during any part of leave? Be available for meetings or telephone calls? Are there circumstances where you can you work from home? XX Be flexible: Be willing to be a ‘case study’ for alternative leave options; a successful leave is one that works both for you and your family, and your employer Elizabeth T. Jordan, DNSC, RNC, FAAN is an
associate professor at the University of South Florida, College of Nursing
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Postpartum Pump ing Plans Thanks to recent changes in federal laws, you can continue to provide your baby the important benefits of breast milk via pumping once you return to work. If you return or go to work, your employer is required to provide time and a place for you to pump breastmilk.
BB Start planning for pumping before giving birth. Let your employer know that you plan to pump milk for your baby when you return BB Make your case with tips from the federal program Business Case for Breastfeeding, available at WomensHealth.gov BB Ask other working moms what worked for them regarding pumping and storing All plans in the Healthcare Marketplace and most private plans cover support from a lactation consultant, a breast pump and basic breastfeeding supplies before or after your baby is born. There are some exceptions for plans that remained unchanged under the new healthcare law. Check with your plan’s benefits administrator or call the number on the back of your insurance card to learn about your specific breastfeeding benefits.
images: 123rf
XX Know what you’re entitled to: Review your employee manual and other HR documents related to family or medical leave or time off
health4mom.org
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Join us on Facebook facebook.com/HealthyMomAndBaby
Consider Group Prenatal Care
Pregnancy Pregnancy is no time to go it alone— with every twinge and symptom you want to ask ‘is this normal?’ Centering Pregnancy delivers 1-on-1 prenatal care with group education, discussion and support—how cool is that? Centering Pregnancy was developed by nursemidwife Sharon Schindler, and it’s proving to reduce preterm birth risks and boost infant birth weights. Parents found the prenatal model so popular Centering Parent has emerged to support new moms and families up to baby’s 1st birthday. For each of your 14 or so prenatal appointments you meet privately with your pregnancy care provider and then you join a group of 8-12 women with similar due dates to go through pregnancy together. You can raise questions privately with your provider, in the group, or both. Hot topics like nutrition, your baby’s development, pregnancy discomforts, exercise, relaxation, labor, parenting, contraception and infant care naturally arise.
REASON #2 : Savor the jo urney— soon you w ill meet your baby!
Read more reasons to go full term at GoTh eFull40.com
If complications occur with your pregnancy, you meet individually with your provider for additional care and you continue to meet with the group until you go into labor. Your partner can join in too. It’s no surprise many Centering moms gather together on their own after their babies are born for support and baby playtime. Find a Centering Pregnancy group near you at www.centeringhealthcare.org.
WH EN IS MY BA BY MOST LIK ELY TO BE BO RN ?
AVOID A 1ST CESAREAN BY LABORING LONGER Avoid cesarean birth unless medically needed, say experts at the American College of Obstetricians & Gynecologists (ACOG), particularly with first births. With 1 in 3 births via cesarean—up 60% since 1996— experts are trying to reduce overall cesarean rates in the U.S. “Most women who have had a cesarean with their first baby end up having repeat cesarean deliveries for subsequent babies; this is what we’re trying to avoid,” said Aaron Caughey, MD, a member of the ACOG obstetric practice committee. Cesarean can be life-saving for a baby or mother in need, but ACOG’s updated advice underscores that when all is healthy, you should:
40-41 WEEKS Most babies are born to first-time moms 4-8 days past their due date when mom waits for labor to start on its own. The most common gestational birthday in subsequent pregnancies when mom waits for spontaneous labor is 2-3 days after baby’s due date.
Avoid inducing labor or choosing cesarean without medical need Wait for labor to start on its own Labor longer, as needed, before pushing Be given more time for pushing, if needed, during labor
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Your Healthiest Pregnancy Trimester by Trimester By Susan Peck, MSN, rnc
For pregnancy care, your provider may be a midwife, obstetrician or family practice doctor. Then evaluate the facility where she or he will help you birth. Use our checklist to gauge how your potential birth facility may match your goals for labor and birth. This list is doesn’t cover everything but for each ‘yes’ you can give, the greater the chances that you may be supported toward your desired birth. Ask if the facility is committed to:
99 Supporting natural birth with freedom to move around, and equipment, such as birthing beds to support upright labor and birth, birthing balls and showers or tubs for pain relief and labor support, limited use of electronic monitoring unless medically indicated and staff to provide ongoing labor care 99 Induction or cesarean only when medically needed: You’re more likely to have cesarean surgery if the facility has cesarean rates above the national average (now 33%); risks to mom and baby increase when major surgery could have been prevented 99 Rooming in: This keeps your baby with you 24/7, increasing your opportunities for breastfeeding and bonding 99 Breastfeeding as the optimal food and best way for you to feed your baby, including having expert lactation support available 99 Initiating breastfeeding as quickly as possible post-birth: Ideally, within the first minutes of life but no longer than an hour for a normal, vaginal birth; and within 2 hours if you undergo cesarean 99 Skin-to-skin care: This helps baby more
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rapidly stabilize his or her heart rate, temperature, and respiratory rate, improve bonding and increase breastfeeding success 99 Baby-Friendly™—this designation goes to hospitals and birthing centers that give moms the information, confidence and skills needed to successfully start and continue breastfeeding their babies, as well as feeding formula safely for those moms who will do so. Find a Baby Friendly™ facility near you: babyfriendlyusa.org/eng.
Go Full Term Commit to go the full 40 weeks of pregnancy, wait for spontaneous labor and breastfeed your baby. Discover 40 reasons to go full term at GoTheFull40.com.
How much weight should I gain in pregnancy? Pre-pregnancy BMI
BMI
Total Weight Gain Range (lbs)
Underweight
<18.5
28-40
Normal weight
18.5-24.9
25-35
Overweight
25-29.9
15-25
Obese
≥30
11-20
Pregnancy around the World Some pregnant Hispanic women don’t eat ‘hot’ foods such as chilies or strong spices because it’s believed these foods can cause baby to have spots or rashes.
In Germany, pregnant women carry a Mutterpass—mother’s pass—at all times. It tracks their pregnancy information, vitals and tests and they bring their pass to the hospital when labor begins.
In many countries, such as England and Australia, pregnant women get care from midwives. Physicians care for women with high-risk pregnancies, complications or those needing cesarean surgery.
In Panama, moms-to-be won’t share how far along they are; they believe sharing this will put their baby at risk for complications.
Susan Peck, MSN, RNC
is a nurse practitioner in New Brunswick, NJ.
images: 123rf
Experts agree that the best way to have the pregnancy and birth that you envision is to begin with a qualified healthcare provider who shares your beliefs and values about pregnancy, labor and birth. <
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healthy moms Go Full Term
Your Pregnancy Week by Week:
99 Reason #1: End right by starting right—keeping all of your prenatal appointments helps ensure a healthier ending
From week 1 to full term, discover what’s going on with your body and baby week-by-week in Healthy Pregnancy at Health4Mom.org.
1st
Trimester:
From pregnancy tests to morning sickness, here’s how it all begins Welcome to your 1st and sleepiest trimester; during these 12 weeks your baby will grow from an embryo 1/5th the size of the period at the end of this sentence to a nice juicy plum. Every day, the pregnancy hormone HCG is increasing and it’s what makes your pregnancy test positive. It’s also responsible for feeling tired, tender or sore breasts, frequently needing to pee and for many women— morning sickness. It’s normal to want a nap every day—your body is working hard to grow your baby—it’s exhausting! Start—or continue—habits that keep your pregnancy as healthy as possible all the way to term: XX Daily prenatal vitamin, especially if you haven’t been taking one XX Make and keep all prenatal appointments XX Healthy food with lots of water XX Exercise, as it’s safe in pregnancy, ask your nurse if you have questions about what you can do XX No, smoking, drinking or using illegal drugs if you have any of these habits
images: 123rf, thinkstock
XX Caffeine limited to no more than 200mg a day—that’s up to 12 ounces of coffee. Foods like chocolate and other beverages have caffeine too Before you knew you were pregnant, baby’s neural tube—what becomes her brain and spinal cord— formed and closed. The 800 micrograms of folic acid in most prenatal vitamins protect against neural tube birth defects, so it’s important to take a prenatal vitamin before conception and through pregnancy and breastfeeding. Baby finishes the 1st trimester 10 times bigger than at conception. Your body is changing too: Your breasts are likely bigger and sore, you may have frequent headaches, fatigue and
99 Reason #10: Nourish your body— a healthy diet and breastfeeding will help you lose the baby weight
Your 1st Trimester: Weeks 1-12 nausea. It’s not unusual to have some spotting or mild cramping and this doesn’t always mean miscarriage. Call your provider right away, especially if the bleeding is heavy or if you’re cramping. Around week 8, you’ll have your first prenatal visit; after that you’ll likely see your provider:
99 Reason # 20: Maximize those little lungs—babies born just 2 weeks or more early can have twice the number of complications with breathing Read all 40 reasons to go to term at GoTheFull40.com
• Every 4 weeks (until 28 weeks) • Every 2 weeks (28-36 weeks) • Weekly (week 36+) You may be offered 1st trimester screening— non-invasive tests done between weeks 11-14 for chromosome disorders like Down Syndrome and genetic testing. Your nurse can talk with you about the risks and benefits of these tests. Bring your questions to every prenatal visit—your care providers expect and welcome them! As you complete week 12, you can relax—all of baby’s organs and bodily systems have formed and the next 28 weeks are all about growing. You’ll be able to hear your baby’s heartbeat and the early symptoms of pregnancy should begin to subside.
Nu tr iti on Kn ow-H ow No one food combats morning sickness; smaller meals eaten more frequently seem to help Eat 3 servings of protein daily, such as lean meats, low-mercury fish, nuts, beans, milk or eggs, to support your growing baby Eat no more than an extra 100 calories a day—that’s a small apple and 6 ounces of skim milk Bulk up on fruits, veggies and water to combat constipation
Your Pregnancy By Trimester Pregnancy is 40 completed gestational weeks, the count for which starts on the first day of your last menstrual period. Those 40 weeks are divided into 3 trimesters: XX 1st trimester: Weeks 1-12 XX 2nd trimester: Weeks 13-27 XX 3rd trimester: Weeks 28-40
ISSUE 15 / Winter 2015 Healthy Mom&Baby
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healthy moms Nu tr iti on Kn ow-H ow Hydration is key; drink at least 8, 8-ounce glasses of water a day plus more during exercise
2nd
Trimester:
Minimize heartburn by skipping spicy or heavy meals, acidic fruits like tomatoes or eating late at night
Your 2nd Trimester: 7 Weeks 13-2
Take in an extra 250 calories a day—up to 350 calories in the 3rd trimester—to maintain steady weight gain
Enjoy the energy burst that may come as you also feel your baby move for the first time Welcome to middle pregnancy—soon you’ll be halfway to term! During this trimester, your little one grows from the size of a peach to an eggplant. You’ll have more energy, feel less sick and be hungry! At 13 weeks, your placenta starts producing the hormones that maintain your pregnancy, and it gives baby oxygen and nutrition and removes waste. You begin to ‘show’, happily trading jeans for maternity yoga pants! Other changes can include:
XX An energy burst—ask your nurse what exercises you can continue or begin in pregnancy XX Lower back pain as your uterus grows and changes your center of gravity
images: 123rf, thinkstock
XX Soreness or twinges along the sides of your belly as your uterus, stretches and moves higher in your abdomen XX Nasal stuffiness or even snoring from increased hormones and blood flow; soothe with saline nose drops and a humidifier XX Varicose veins in your legs—even your vagina, from relaxed blood vessels and slower circulation; elevate your legs or wear support or compression stockings XX Itchy skin or stretch marks; belly butters and balms can ease the itching
Around weeks 17-20 you may be surprised by flutters in your belly—that’s your baby moving! More exciting is your 2nd trimester ultrasound. Will you try to learn whether you’re having a girl or boy? Between weeks 24-28, you’ll be checked for the most common pregnancy complication: gestational diabetes. As many as 1 in 10 women develop diabetes in pregnancy. You’ll drink a sweet liquid and have your blood drawn at 1 hour. If your 1-hour test is high, you’ll do a similar 3-hour test, but only 1 in 3 women who need that test will have gestational diabetes. Around 27 weeks, ask for the Tdap vaccine, which protects against pertussis (whooping cough). Newborns can’t get vaccinated against pertussis until they’re 2-3 months old and pertussis can be deadly in infants. Also, get a flu shot in pregnancy before flu season—this vaccine is safe in any trimester. Your baby’s heart is beating fast—about 140150 beats/minute, which is normal. She’s sucking and swallowing amniotic fluid as she prepares for nursing. Don’t be surprised when you feel her hiccups! Her lungs are exhaling amniotic fluid, preparing for those first breaths after birth. Your baby can recognize your voices and will respond to them at birth.
Pick highprotein snacks like eggs, nuts, cheese sticks or hummus Fill up on fiber in beans, bran or berries to keep your bowels regular
Go Full Term 99 Reason #15:
Give baby’s development the benef it of time since you may not know exactly when you got pregnant
99 Reason # 22: Respond to requests to speed baby’s birth with the facts that inductions of ten create more painful labors and lead to cesarean 99 Reason # 28: Shamelessly wear stretchy, comf y clothes Read all 40 reasons to go to term at GoTheFull40.com
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healthy moms
3rd
Trimester:
Finish this pregnancy marathon strong by letting baby pick her birthday!
In these last weeks, your baby is growing more each day as she prepares to meet you—which means as she grows you also grow more uncomfortable. Your baby is blossoming from the size of a butternut squash to a large watermelon at birth. Her weight will more than double during this trimester as she puts on more fat to help keep her warm at birth. Her brain, lungs and other organs are rapidly developing—did you know your baby’s brain is only 2/3rds of the size at 35 weeks that it will be at term? If you’re not yet registered at your birthplace and enrolled in childbirth and breastfeeding classes, it’s time to do so. To finish strong: XX Wait for labor to start on its own—avoid interventions in pregnancy unless medically needed XX Alert your provider if you have any of the signs of dangerous high blood pressure in pregnancy: swelling (especially your face and hands), persistent headache, nausea or vomiting, sudden vision changes with light flashes XX Know the signs of preterm labor—Call your provider if you have contractions closer than every 10 minutes, low back pain that won’t ease, menstruallike cramps, fluid leaking from your vagina, increased
Go Full Term
Your 3 r Trimes d t e r: Weeks 28-40
pelvic pressure, discharge or bleeding XX Ask your pregnancy care provider when you should call if you suspect you’re in labor It’s normal to wonder if labor is starting with every twinge and cramp. Your vaginal discharge may increase, and your mucus plug may come out. It may look like a big, sticky piece of mucus or just heavier discharge, and it may be tinged with brown, pink or red streaks. This is all normal; call if you see heavy vaginal bleeding. When you do go to the hospital in labor, your nurse will be with you during your labor and birth as your advocate, expert care provider and biggest supporter. Your nurse will alert your midwife or doctor to any urgent concerns that may arise. Less than 5% of babies are born on their estimated due date—most are born between 40 and 41 weeks when labor starts on its own. Now is the time to remember your commitment to going full term and doing what’s healthy best for you and your baby—birthing normally following spontaneous labor when all is healthy and well.
99 Reason # 3: Let nature take over— there are fewer complications and risks for both you and baby through natural childbirth 99 Reason #16: Let baby pick her birthday—if she decides to emerge af ter 37 weeks there’s no need to stop your spontaneous labor 99 Reason # 26: Finish well—more time in the womb usually means less time in the hospital Read all 40 reasons to go to term at GoTheFull40.com
W hat ha ppen s if I go pa st my du e date ? You’ll have more frequent visits with your pregnancy care provider, probably twice a week, to ensure you and baby are safe and healthy. You might have a: BB Non-stress test with a fetal monitor to check baby’s heart beat and for contractions
BB If either of these tests is abnormal, an induction of labor may be considered.
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images: 123rf
BB Biophysical profile via ultrasound to check baby’s muscle tone, movement, breathing, and amniotic fluid
health4mom.org
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healthy pregnancy
What to Eat In Pregnancy and avoid
(
)
Fish is your friend, but skip the lunch meats and sof t cheeses please! By AWHONN editorial staff
Pregnancy as a time of unrestrained eating is so old skool! What you eat—and how much you eat— affects the health of your pregnancy and baby.
Rea so Eat n ind Healt #14: u lge hf u ll cr a o v i n g cc a s y — s w iona r i l t e h mo Re a d r se ou t t o mor
er g GoT o f ull t eason er s he F ull4 m a t 0.co m
Face it: In pregnancy, you need only an extra 100 to 300 calories each day to grow a healthy baby. That’s as simple as a sliced apple with peanut butter or low-fat yogurt with fresh fruit. Use the latest research and our suggestions for healthy eating by trimester:
1st Trimester
3rd Trimester
Morning Sickness Relief
Emphasize Healthy Eating
Ramping Up for Birth
Morning sickness can be miserable. And a review of the latest research shows that all of the common remedies—from ginger tea to vitamin B6—failed for most to cure nausea and vomiting during the first weeks of pregnancy. Combat any loss in nutrition with daily prenatal vitamins. Start the day by munching on a few saltine crackers before rising, and wait until after breakfast before brushing your teeth.
What’s great nutrition for all Americans also works for you and your baby. New dietary guidelines recommend filling half of your plate with fruits and veggies at every meal or snack. Not only will you get the essential vitamins, nutrients and fiber your body craves in pregnancy, you’ll have more energy.
The latest headlines are exploring a link between eating more fish and reducing early birth risks—including preterm birth. Experts recommend 8-12 ounces a week of low-mercury fish—or about 2 meals—a week. In research, women who ate fish up to 3 times weekly reduced their preterm birth risks. Choose safer fishes high in omega 3 fatty acids, like wild caught salmon.
BB Fruits and vegetables BB Whole grains BB Lean proteins (chicken, beans, eggs, some fish and seafood, lean red meats) BB Lean dairy (low-fat milk, low-fat hard cheeses, yogurt)
Skip These Foods • Limit or avoid caffeine—more than 6-12 ounces a day increases miscarriage risks in some women • Alcohol is entirely off-limits during your entire pregnancy; there is no safe level • Cold cuts, deli meats and soft cheeses as these can contain listeria, a bacteria that can be harmful during pregnancy • High-mercury fish: shark, tilefish, king mackerel, and swordfish • High-fat foods, fried foods, junk foods and sugary foods and drinks
Energy Boosters BB Apple topped with natural almond butter BB Non-fat Greek-style yogurt with banana and real maple syrup BB
Chocolate-peanut butter smoothie: low-fat chocolate milk blended with natural peanut butter plus a few ice cubes
BB
Almond-berry smoothie: vanilla almond milk plus frozen blueberries and blended with natural almond butter
Munchies for the Marathon BB Flakes cereal with golden raisins and low-fat milk BB Mini whole-wheat pita stuffed with hummus and shredded carrots BB
Hard boiled egg with one small cucumber sliced plus cup cherry tomatoes with low-fat Swiss on whole-wheat Melba toasts
BB Corn tortilla warmed with black beans and half an avocado sliced
ask our nurses Nurses share what to eat in pregnancy in this short video: health4mom. org/?p=1255
Images: 123RF
Best Choices
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2 nd Trimester
health4mom.org
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healthy pregnancy
Will You Wait
for Labor to Start on its Own? HERE’S WHY YOU SHOULD SKIP REQUESTING AN INDUCTION AND REAP THE BENEFITS OF SPONTANEOUS LABOR INSTEAD
Are you considering scheduling your baby’s birth? You have friends who have asked for inductions to help with busy family schedules, but you’ve also heard that they can lead to increased complications and even cesarean birth.
ask our nurses You labor may need to be induced for reasons nurses explain in this video: health4mom.org/?p=1286
BY CATHERINE RUHL, CNM, MS
Fact is, when all is going well, waiting for labor to start by itself has definite advantages for you and your baby. Babies develop on their own timetables, learning to roll over, stand, walk and talk when they’re ready. Similarly, your baby has her own pregnancy timetable. Experts believe labor starts on its own in large part because baby signals your body that she’s ready to be born.
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BABY IS BUSY, TOO During this time, baby is also hard at work, growing and maturing and storing a unique fat that will help her keep warm in the fi rst weeks of life. During weeks 36 to 41 (your estimated due date is when you fi nish 40 weeks), you transfer large amounts of infection-fighting antibodies to baby across the placenta. Th is immuno-boost helps baby fight off colds, flu and diarrhea at birth and beyond. Babies have immature immune systems so it makes sense to give them as much womb time as possible before birth. It’s important to not rush labor even by a week or 2 with induction unless there’s a medical reason. Babies who are born after labor starts on its own have fewer breathing problems and are ready for breastfeeding at birth. They also have brains, lungs and other organs more ready for life outside the womb.
GO FULL TERM Consider waiting for labor, if all is healthy with your pregnancy, until your body and your baby are ready. Then you can both enter labor at the top of your game. Nurses have 40 reasons and more why you should wait for labor to start on its own at GoTheFull40.com.
CATHERINE RUHL,CNM, MS is Director of Women’s
Health at AWHONN in Washington, DC.
IMAGES: 123RF
PREPARING FOR LABOR It may feel like not much is happening during those last weeks before labor, but your body and your baby are both busy preparing for birth. The opening of your uterus (cervix) is softening and thinning and baby’s head is dropping. Your uterine muscle fibers are primed to respond to the hormone oxytocin, which your body will naturally release to start labor. High levels of this same hormone promote effective contractions, and help you bond with baby at birth and as you begin breastfeeding. Labors that start on their own also tend to go more quickly and result in a natural birth. The synthetic form of oxytocin, called Pitocin, doesn’t quite yield the same results when used to induce labor. Induced labors tend to take longer and be more painful. They more often result in a cesarean, which is major abdominal surgery with a longer hospital stay and recovery time. After cesarean, you may be separated from your baby at birth, which can make starting breastfeeding more difficult.
health4mom.org
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healthy moms
Why Baby Needs a
Full 40
Weeks of Pregnancy HELEN M. HURST DNP, RNC, APRN-CNM
PROBLEMS WITH BEING BORN EARLY
Did you know that babies who are born even a few weeks early could have immediate and lifelong health issues, including struggles feeding, breathing and staying warm, premature brain or lung development and problems maintaining stable blood sugars? Babies born early also have increased lifetime risks for diabetes, heart disease, high blood pressure and attention deficit hyperactivity disorder if born before the full 40 weeks. GET TO TERM
In those last few weeks, your baby will gain weight more rapidly so she has enough fat to hold a normal body temperature. Her lungs, liver and brain will also continue to rapidly change—at 35 weeks her brain is only 2/3rds of the size it will be at term. You may be told that your baby is “measuring big” but this is no indication of whether her lungs are mature. Baby’s liver is also maturing: Being born early makes her more prone to developing newborn jaundice—a yellowing of the skin that shows her liver can’t rid her body of a substance called bilirubin. If baby has jaundice, she may have
to stay in the hospital under special lights, and in severe cases, her brain could be affected. During those last few weeks, your body gives baby a big boost of antibodies that helps her fight infection once born. And being born too early could hamper breastfeeding because the brain development baby needs to coordinate sucking and swallowing doesn’t happen until the last few weeks of pregnancy. Worst of all, many of these problems could result in you having to leave your baby at the hospital when you are discharged home, which is very distressing for any mom!
ask our nurses Nurses share why it’s healthy best to wait for labor to start on its own in this video: health4mom.org/?p=1284
JUST HOW LONG CAN BABY STAY IN THERE? Most providers will support women and their babies gestating for up to 42 weeks, after which time the uterine environment may begin to deteriorate to the degree that it puts your baby at risk. During weeks 40-42, your provider may ask you to: Perform daily kick counts with baby and call with any changes Take a non-stress test, which uses a fetal monitor to watch baby’s heart rate for 20-40 minutes. This is usually done at the provider’s office Undergo a biophysical profile via
ultrasound to observe baby’s breathing, heart rate, amniotic fluid amount, and body movements
DON’T RUSH ME GO THE FULL 40 It’s healthy best to go full-term in pregnancy, wait for labor to start on its own and birth normally when all is well. Discover 40 Reasons to Go the Full 40 at WWW. GOTHEFULL40.COM.
HELEN M. HURST HURST, DNP, RNC, APRN-CNM is
an assistant professor at the University of Louisiana at Lafayette.
ISSUE 15 / Winter 2015 Healthy Mom&Baby
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IMAGE: 123F
As you get closer and closer to your due date, it probably seems like your baby will never arrive. You’re having a hard time sleeping, your back hurts, your feet are swollen and just when you finally get comfortable, you have to use the bathroom again. But don’t give up with the finish line in sight. Your last few weeks of your pregnancy are very important to your baby.
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healthy babies Hea lth b rea stfe edyin g po sitio n s
Beginning Breastfeeding ( )
IT MAY BE NATUR AL AND BEST FOR YOU AND BABY BUT YOU HAVE TO LEARN TO BREASTFEED
BY TAMER A YOUNG, RN, MSN
Breastfeeding is the healthiest and best way to feed a baby, but for some moms, when the little one arrives, it seems more challenging than expected. Breastfeeding is natural, but both you and your baby must learn how to nurse. Begin by taking a breastfeeding course before baby is born. Talk to lactation consultants at your birthing center or provider’s practice. Learn as much as you can ahead of time and then tackle the top feeding problems with these 3 tips:
IMAGE: 123RF
1. GET INTO POSITION At each feeding, your baby must take in the entire nipple and areola of your breast. Try one of the popular nursing positions that also promote a good latch: cross-over, football hold, or side-lying hold. 2. CHECK YOUR MILK SUPPLY An inadequate milk supply is actually rare and more typically a perception problem. If your baby is latching properly and you’re seeing sucking and swallowing, your baby is getting enough milk. Right after birth, your body produces colostrum. Th is earliest milk is smaller in volume but packed with nutrients and is all your baby needs in the beginning. Most newborns want and need to nurse 8-12 times every 24 hours, and will give you wet diapers
in return. Babies typically take from 10-45 minutes per feeding at the start. Your baby is getting enough milk if she has 1 wet diaper per day of life through the first week, then at least 6-7 wet diapers daily after the first week. So at 1 day of age, she should have at least 1 wet diaper, at 4 days of age, she should have at least 4 wet diapers, etc. Th is is also true if your breasts are fi lling and then softening, or emptying, at each feeding. If you need to supplement your nursing, find a human milk bank through the Human Milk Banking Association of North America at www.hmbana.org. 3. DELAY PACIFIERS, BOTTLES Introducing a bottle or pacifier too early can complicate nursing because babies have to suck differently on natural versus artificial nipples— even the ones designed to mimic your body. Wait 3-4 weeks before introducing a pacifier or bottle of breastmilk to avoid this problem.
Cross-over: Hold your baby in the arm opposite the breast at which she’ll be nursing, with her head in your hand and her body along your forearm, and lift her to your breast. Add a pillow—such as a Boppy—to support her weight under your arm. Football hold: Tuck your baby under your arm adjacent to the breast from which she will be nursing, face toward your breast, with her head in your hand and her body resting on your forearm. This removes contact with your abdomen if you’ve had a cesarean birth and is good for nursing twins. Side-lying hold: You and baby lay on your sides, tummy to tummy, as you lift your breast with one arm while you gently guide baby’s head to latch with your other arm. This works when you’re uncomfortable sitting upright.
ask our nurses Is any amount of breastfeeding good for baby? Nurses answer in this video: health4mom. org/?p=1249
TAMARA L. YOUNG, RN, MS, is an
obstetric clinical instructor in Newark, OH.
ISSUE 15 / Winter 2015 Healthy Mom&Baby
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healthy babies
Breastfeeding Apart from Baby BY HELEN HURST, DNP, RNC, APRN-CNM
IT’S IMPORTANT TO KEEP THE BREASTMILK FLOWING EVEN WITH A BUSY SCHEDULE
ESTABLISH GOOD BREASTFEEDING Experts agree that establishing good breastfeeding habits and milk supply from the beginning is truly the key to successful pumping and bottle feeding later on. For the 1st 4-6 weeks, breastfeed your baby exclusively and on demand. While it’s tempting to start pumping early so dad can give a bottle during the night, nothing empties the breast as well as your baby, and effective nursing is integral to developing an ample supply Buy or rent a good breast pump. Not all pumps work well on all breasts. Get recommendations from your friends or other mothers at postpartum support groups. Ask if you can borrow their pumps and see which ones work best for you. Know your insurance likely will provide a pump for you under the Affordable Care Act Consider how portable you need your pump to be—if you’re out on the road all day, for example, using and cleaning a hand-pump may work well 38
Pla n yo ur pu mpi ng Ask your employer if there’s a breastfeeding room for you to use and if there’s a pump available. If there’s no designated room, ask what private space will be available for you. Don’t be surprised if you’re the first person to ask for this—be an advocate for other moms at your work Turn your car into a pumping room with a portable refrigerator or cooler that plugs into a power outlet Determine how you’ll store your pumped milk until you’re back at home— whether in a cooler you bring or in a refrigerator available to you
Put y o u r boo bs s ch edu le o n a Determine the best times each day for you to pump and stick to that schedule as closely as possible. This is essential to successful pumping and feeding. Your body is remarkably smart and will adjust to the schedule you set for it. Start this 2 weeks before returning to work and stick to it even on your days off Put your pumping schedule into your work and social calendar so that you won’t get scheduled into meetings or events during this time While you’re pumping remember that this is one way you’re staying connected to your baby even when you’re apart—relax and enjoy—it’s only for a year or so and it’s the healthiest thing you can do for yourself and for your baby
ask our nurses Wean your baby when it’s time with these steps from nurses in this video: www.health4mom. org/?p=1242
HELEN M. HURST, DNP, RNC, APRN-CNM, is an assistant professor at the University of Louisiana at Lafayette.
IMAGE: 123RF
As a new mom, whether you’re working or not, you’re going to experience times when you need to be away from your baby—so it makes sense to plan how you’ll keep breastfeeding going when you’re apart. Creating and maintaining a supply of frozen breastmilk is foundational and the first step in ensuring that you can breastfeed your baby for at least a year or more, as recommended by the American Academy of Pediatrics. What moms really want to know is what strategies work for pumping, storing and keeping a good milk supply while juggling a busy schedule. Here’s how moms we know make breastfeeding work for them.
health4mom.org
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08/07/2014 10:17
healthy pregnancy
40 Weeks
From isolation to community; that’s where the filmmakers of this new documentary are taking pregnant women and their families
BY CAROLYN DAVIS COCKEY, MLS
It’s a typical challenge any pregnant mom has— where to get useful pregnancy information you can trust and act on. That’s where New Yorker Dominique Debroux found herself—absolutely miserable with 1st trimester pregnancy symptoms, unable to concentrate long enough to stare at a book or find a pregnancy support group for advice. “I was so morning sick I couldn’t concentrate on the written word; I also didn’t have the community around me because I was 42. Some of my friends had had children a while back, and the rest of my friends weren’t having children,” she shares, recalling the journey now more than 7 years ago. “I kept saying to Christopher, ‘it would fi x everything for me if I had videos to watch—a movie to watch—because at least I’d be going through it with someone even if they are not someone that I know. It’s still a virtual someone.’ I thought if I just had something I could listen to, something I could watch, I wouldn’t feel so alone in my pregnancy,” reflects Dominique. Christopher is Christopher Henze, Dominique’s filmmaker husband, business partner in Big Belli and father of their daughter Gaia. That unmet need gestated as they raised their daughter to the point where, in awe of his wife’s gifts and strengths in pregnancy, and particularly of the gift of Gaia, Christopher birthed an idea that would give back to not only to his beloved but to all women and their partners. GIVING BACK TO WOMEN “Once I watched Dominque go through pregnancy, and reflected on how I was really looking at her do one of the most dangerous things a woman can do, and then getting to hold my daughter in my arms,
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‘It would fix everything for me if I had videos to watch—a movie to watch—because at least I’d be going through it with someone even if they are not someone that I know. It’s still a virtual someone.’ —Dominique Debroux the perspective of what it means to do good changed for me,” remembers Christopher. “I wanted to create a future for my daughter, and for the world, that is as beautiful as she is. My desire is to give something back to women who give so much to us. This is what 40 Weeks is. It’s my hope for women to have healthier and better pregnancies so that they can have healthier and better babies. It’s about improving pregnancy from where we’re at,” says Christopher. “Seeing my daughter gave me HENZE CHRISTOPHER perspective around something that parents always say:
health4mom.org
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healthy pregnancy
P H O EBE
AND JEN
HAMILTO
N ELIZ ABE T
H AND M
A X JOICE
‘Once you’re a parent, you just can’t describe that so someone who isn’t knows what it means to be one.’ I’m trying my best to put that to good use.” This storytelling pair is in synch: “I knew having a child was going to change my life, but I did not realize until it all happened how much it changed my life,” offers Dominique. “I just knew whatever we had been dreaming needed not to be a dream anymore. I wanted to show my child that you can desire something and you can make it happen,” eff uses Dominique of her passion for making movies with Christopher.
ISSUE 15 / Winter 2015 Healthy Mom&Baby
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IMAGES BIG BELLI/40 WEEKS
DIANA TRAN-KIM
THE MAKING OF COMMUNITY 40 Weeks is about turning that dream into community. “At the base, the desire is hormonal. I’m a career woman. I’ve got friends. I traveled a lot for most of my life and that kind of daily need to check in with girlfriends was not necessarily something that I felt before I got pregnant,” insists Dominique. “I got pregnant and things changed overnight. I wanted to be in a kitchen with my grandmother and my great-grandmother and my mother and sisters. All of a sudden, I wanted to go through this with other women who know what this is and who are in this with you.” Pregnancy is never a good time to be alone; it’s all about the sisterhood. “A lot of changes are happening in your body. You want to talk to somebody about it—you know it’s not a big deal but you just need to talk about it,” Dominique declares. “I could talk to Christopher but he couldn’t really fully commiserate. I wanted the commiseration, the empathy, between people going through the same thing.”
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healthy pregnancy Sometimes you don’t know what you need until you see it: “I don’t know what this deep need is but I’ve learned that in England, for example, when you get pregnant your midwife sets you up with a support group of women who are pregnant in just about the same trimester as you. You enter this group and just start meeting. It’s your choice whether to go but lifelong friendships get built through this, and after the baby’s birth there’s playgroups and this or that.” “After birth,” Dominique continues, remembering her own postpartum, “it takes you awhile to be able to not be sleep deprived enough to find those parts of a life. For those first 3 months you can feel so alone—but not if you had started with a group in pregnancy because then you would know each other already. Then, it’s no big deal to just sit with somebody who doesn’t mind that you need a shower; that you have spit up on you—all because you know them already. Women are communal and that is our strength.” A VIRTUAL TRIBE 40 Weeks then is both a movie and a philosophy: “There are a lot of things about our innate communal natures that can help us change the world; we really ought to be living in tribes.” Segue to the couple’s shared hopes: “Through this movie, we’re creating a virtual tribe, and then through the movie’s website, we hope to create actual face-to-face tribes.” “It was astounding to me in making this film to find out how isolated women feel. That alone drives me to give them a very easy way to not feel so isolated. I keep telling my team that the movie is something someone can have on at home. It can be in the background, or they can watch it intently and participate in the story,” adds Christopher. Weekly, Christopher and his team sojourned with and filmed the families who opened their homes and lives to the all-seeing lens. During their absences, handheld camcorders captured video diaries. Knitted together, the journeys are personal, intimate and genuine. There’s naturalness and a sense of presence to the film that draws you in. “My job is to be a listener,” quips the director, “and to the degree I’m able to sit with a woman— and I so desperately want to understand what she’s going through—it encourages them to be more open and to be more present. I love listening and they love talking and it’s that love you feel on the screen.” Now, 2 years into the making, 40 Weeks is ready to reach through the rich diversity of women and families featured in the film into our lives, calling us
42
CHR ISTOPHER , DOMINIQUE AND
VIC TORIA M
GAIA
OODY
NATALIA AN
D MAURICIO
QUINTANA
“It was astounding to me in making this film to find out how isolated women feel.” —Christopher Henze to add our own childbearing experiences and unite with the tribe toward better outcomes for women, babies and families everywhere. “My hope is that women will have a little more solace and a little more confidence in pregnancy. To feel ok; to feel like ‘I’m going to get through this’ and be empowered through the process,” Christopher says, turning to Dominique. Concluding, she returns to the film: “In sharing my hope, I’m going to use the words of nurse Debra Bingham in the movie—that viewers would be inspired to ‘learn to trust the power and wisdom of a woman’s body.’ ”
CAROLYN DAVIS COCKEY, MLS is editor
of Healthy Mom&Baby and director of publications at AWHONN, which has partnered with Big Belli to promote healthy, full-term pregnancies through the movie. Find 40 reasons to go the full 40 weeks of pregnancy at AWHONN’s public health campaign, GoTheFull40.com.
health4mom.org
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Rx Only
Pregnancy is no time to downsize your nutritional support
The right nutrients in the right amounts ■ Calcium citrate—to support both your and your baby’s bones ■ life’sDHA®—the recommended amount of DHA from a natural plant source1 ■ Comfort-enhancing stool softener is in very few prescription products and in no OTC options ■ CitraNatal® Assure is gluten-free and lactose-free
Benefits only available at CitraNatal.com ■ Enroll in the one-of-a-kind Join the Family program for savings, rewards, and invaluable information personalized to your stage of pregnancy
CNA-14121
Ask your health care professional for a sample pack
INDICATIONS: CitraNatal Assure® is a multivitamin/mineral prescription drug indicated for use in improving the nutritional status of women prior to conception, throughout pregnancy, and in the postnatal period for both lactating and nonlactating mothers.
Important Safety Information CONTRAINDICATIONS: This product is contraindicated in patients with a known hypersensitivity to any of the ingredients. WARNING: Accidental overdose of iron-containing products is a leading cause of fatal poisoning in children under 6. KEEP THIS PRODUCT OUT OF THE REACH OF CHILDREN. In case of accidental overdose, call a doctor or poison control center immediately. WARNING: More than 3 grams total intake per day of omega-3 fatty acids from all sources, including both food and supplements (like Docosahexaenoic Acid [DHA] and Eicosapentaenoic Acid [EPA]), have been shown to have potential antithrombotic effects, including an increased bleeding time and INR. Administration of omega-3 fatty acids should be avoided in patients on anticoagulants and in those known to have an inherited or acquired bleeding diathesis. WARNING: Folic acid alone is improper therapy in the treatment of pernicious anemia and other megaloblastic anemias where vitamin B12 is deficient. See full Prescribing Information on reverse for additional information including Precautions and Adverse Reactions. Reference: 1. Simopoulos AP, Leaf A, Salem N Jr. Workshop on the essentiality of and recommended dietary intakes for omega-6 and omega-3 fatty acids. J Am Coll Nutr. 1999;18(5):487-489.
Mission Pharmacal.indd 1
Working together for stronger, healthier babies
Mission Pharmacal is a proud supporter of the March of Dimes.* * March of Dimes does not endorse specific products or brands. March of Dimes is a registered trademark of the March of Dimes Foundation.
24/10/2014 13:35
status of women prior to conception, throughout pregnancy, and in the postnatal period for both lactating and nonlactating mothers. CONTRAINDICATIONS: This product is contraindicated in patients with a known hypersensitivity to any of the ingredients. DESCRIPTION: CitraNatal Harmony® is a prescription prenatal/ postnatal multivitamin/mineral soft gelatin capsule. The prenatal vitamin is a purple, opaque soft gelatin capsule containing a greenish-gray liquid to semi-solid fill. The capsule is printed “0796” in white ink. Each prenatal capsule contains: Calcium (Calcium citrate) ............................................. 104 mg Iron (Ferrous fumarate, carbonyl iron) ......................... 27 mg Vitamin D3 (Cholecalciferol)......................................... 400 IU Vitamin E (dl-alpha tocopheryl acetate) ....................... 30 IU Vitamin B6 (Pyridoxine HCl) ........................................ 25 mg Folic Acid ..................................................................... 1 mg Docusate Sodium ........................................................ 50 mg Docosahexaenoic Acid (DHA 40% from 650 mg Algal Oil) ............................. 260 mg
WARNING: Accidental overdose of iron-containing products is a leading cause of fatal poisoning in children under 6. KEEP THIS PRODUCT OUT OF THE REACH OF CHILDREN. In case of accidental overdose, call a doctor or poison control center immediately. WARNING: Ingestion of more than 3 grams of omega-3 fatty acids per day has been shown to have potential antithrombotic effects, including an increased bleeding time and INR. Administration of omega-3 fatty acids should be avoided in patients on anticoagulants and in those known to have an inherited or acquired bleeding diathesis. WARNING: Folic acid alone is improper therapy in the treatment of pernicious anemia and other megaloblastic anemias where vitamin B12 is deficient.
INDICATIONS: CitraNatal Harmony® is a multivitamin/mineral prescription drug indicated for use in improving the nutritional status of women prior to conception, throughout pregnancy, and in the postnatal period for both lactating and nonlactating mothers.
PRECAUTIONS: Folic acid in doses above 0.1 mg daily may obscure pernicious anemia in that hematologic remission can occur while neurological manifestations progress.
CONTRAINDICATIONS: This product is contraindicated in patients with a known hypersensitivity to any of the ingredients.
ADVERSE REACTIONS: Allergic sensitization has been reported following both oral and parenteral administration of folic acid.
WARNING: Accidental overdose of iron-containing products is a leading cause of fatal poisoning in children under 6. KEEP THIS PRODUCT OUT OF THE REACH OF CHILDREN. In case of accidental overdose, call a doctor or poison control center immediately.
DOSAGE AND ADMINISTRATION: One tablet and one capsule daily or as directed by a physician.
WARNING: Ingestion of more than 3 grams of omega-3 fatty acids per day has been shown to have potential antithrombotic effects, including an increased bleeding time and INR. Administration of omega-3 fatty acids should be avoided in patients on anticoagulants and in those known to have an inherited or acquired bleeding diathesis. WARNING: Folic acid alone is improper therapy in the treatment of pernicious anemia and other megaloblastic anemias where vitamin B12 is deficient.
STORAGE: Store at 20-25°C (68-77°F) NOTICE: Contact with moisture can discolor or erode the tablet. HOW SUPPLIED: Six child-resistant blister packs of 5 tablets and 5 capsules each - NDC 0178-0891-30 To report a serious adverse event or obtain product information, call (210) 696-8400. Please consult your health care provider with any dietary concerns.
CAUTION: Exercise caution to ensure that the prescribed dosage of DHA does not exceed 1 gram (1000 mg) per day. DOSAGE AND ADMINISTRATION: One capsule daily or as directed by a physician. Store at controlled room temperature. NOTICE: Contact with moisture can discolor or erode the capsule. HOW SUPPLIED: Bottles of 30 capsules each - NDC 0178-0796-30. To report a serious adverse event or obtain product information, call (210) 696-8400. Please consult your health care provider with any dietary concerns.
DESCRIPTION: CitraNatal Assure® is a prescription prenatal/ postnatal multivitamin/mineral tablet with Ferr-Ease®, a patented dual-iron delivery comprising both a quick release and slow release iron, and a capsule of an essential fatty acid. The prenatal vitamin is a white, coated, oval multivitamin/mineral tablet. The tablet is debossed “0891” on one side and is blank on the other. The essential fatty acid DHA capsule is caramel colored and contains a light yellow to orange semi-solid mixture. 120 124 35 400 30 3 3.4 20 25 1 150 25 2 50
mg mg mg IU IU mg mg mg mg mg mcg mg mg mg
Each DHA gelatin capsule contains: Docosahexaenoic Acid (DHA, 40% from 750 mg Algal Oil) ............................ 300 mg Eicosapentaenoic Acid (EPA) ..............Not more than 0.750 mg Other ingredients in DHA gelatin capsule: Gelatin, sunflower oil, glycerin, caramel color, sunflower lecithin, rosemary extract, tocopherols, ascorbyl palmitate. INDICATIONS: CitraNatal Assure® is a multivitamin/mineral prescription drug indicated for use in improving the nutritional
Mission Pharmacal.indd 2
120 159 90 400 30 3 3.4 20 20 1 150 25 2 50
mg mg mg IU IU mg mg mg mg mg mcg mg mg mg
Each DHA gelatin capsule contains: Docosahexaenoic Acid (DHA, 40% from 750 mg Algal Oil) ............................ 300 mg Eicosapentaenoic Acid (EPA) .............. Not more than 0.750 mg Other ingredients in DHA gelatin capsule: Gelatin, sunflower oil, glycerin, caramel color, sunflower lecithin, rosemary extract, tocopherols, ascorbyl palmitate. INDICATIONS: CitraNatal® 90 DHA is a multivitamin/mineral prescription drug indicated for use in improving the nutritional status of women prior to conception, throughout pregnancy, and in the postnatal period for both lactating and nonlactating mothers.
Each prenatal tablet contains: Vitamin C (Ascorbic acid) ............................................ 120 mg Calcium (Calcium citrate) ............................................ 120 mg Iron (Carbonyl iron, ferrous gluconate) ........................ 20 mg Vitamin D3 (Cholecalciferol) ........................................ 400 IU Vitamin B6 (Pyridoxine HCl) ........................................ 25 mg Folic Acid ..................................................................... 1 mg Each vitamin B6 tablet contains: Vitamin B6 (Pyridoxine HCl) ........................................
25 mg
CONTRAINDICATIONS: This product is contraindicated in patients with a known hypersensitivity to any of the ingredients. WARNING: Accidental overdose of iron-containing products is a leading cause of fatal poisoning in children under 6. KEEP THIS AND ALL DRUGS OUT OF THE REACH OF CHILDREN. In case of accidental overdose, call a doctor or poison control center immediately. WARNING: Folic acid alone is improper therapy in the treatment of pernicious anemia and other megaloblastic anemias where vitamin B12 is deficient. PRECAUTION: Folic acid in doses above 0.1 mg daily may obscure pernicious anemia, in that hematologic remission can occur while neurological manifestations remain progressive. ADVERSE REACTIONS: Allergic sensitization has been reported following both oral and parenteral administration of folic acid. DOSAGE AND ADMINISTRATION: One tablet every eight hours, beginning with “Tablet 1” , or as directed by a physician. STORAGE: Store at 20-25°C (68-77°F) NOTICE: Contact with moisture can discolor or erode tablets.
WARNING: Accidental overdose of iron-containing products is a leading cause of fatal poisoning in children under 6. KEEP THIS PRODUCT OUT OF THE REACH OF CHILDREN. In case of accidental overdose, call a doctor or poison control center immediately. WARNING: Ingestion of more than 3 grams of omega-3 fatty acids per day has been shown to have potential antithrombotic effects, including an increased bleeding time and INR. Administration of omega-3 fatty acids should be avoided in patients on anticoagulants and in those known to have an inherited or acquired bleeding diathesis. WARNING: Folic acid alone is improper therapy in the treatment of pernicious anemia and other megaloblastic anemias where vitamin B12 is deficient. PRECAUTIONS: Folic acid in doses above 0.1 mg daily may obscure pernicious anemia in that hematologic remission can occur while neurological manifestations progress. ADVERSE REACTIONS: Allergic sensitization has been reported following both oral and parenteral administration of folic acid. DOSAGE AND ADMINISTRATION: One tablet and one capsule daily or as directed by a physician. STORAGE: Store at 20-25°C (68-77°F) NOTICE: Contact with moisture can discolor or erode the tablet. HOW SUPPLIED: Six child-resistant blister packs of 5 tablets and 5 capsules each - NDC 0178-0821-30 To report a serious adverse event or obtain product information, call (210) 696-8400. Please consult your health care provider with any dietary concerns.
CitraNatal Harmony®: Capsules are MADE IN CANADA CitraNatal Harmony® contains life’sDHA® .
life’sDHA® is a trademark of DSM.
Trademark of Mission Pharmacal Company U.S. Patent No. 6,521,247
U.S. Patent No. 7,163,811 U.S. Patent No. 7,824,892 U.S. Patent No. 8,669,090
CitraNatal Assure® and CitraNatal® 90DHA contain life’sDHA®.
DHA capsules manufactured for: MISSION PHARMACAL COMPANY San Antonio, TX USA 78230 1355 Prenatal tablets manufactured by: MISSION PHARMACAL COMPANY San Antonio, TX USA 78230 1355
HOW SUPPLIED: Six child-resistant blister packs of 5 multivitamin/multimineral tablets and 10 vitamin B6 tablets each - NDC 0178-0832-30. To report a serious adverse event or obtain product information, call (210) 696-8400. Please consult your health care provider with any dietary concerns.
CitraNatal Harmony®, CitraNatal Assure®, CitraNatal B-Calm® and CitraNatal® 90DHA contain Ferr-Ease®.
Copyright © 2014 Mission Pharmacal Company. All rights reserved.
life’sDHA® is a trademark of DSM. U.S. Patent No. 7,579,174 U.S. Patent No. 8,129,172 U.S. Patent No. 8,124,384 U.S. Patent No. 8,288,135 U.S. Patent No. 8,669,090
citranatal.com missionpharmacal.com
CNF T2900 Rev 0614
Each prenatal tablet contains: Vitamin C (Ascorbic acid) ............................................ Calcium (Calcium citrate) ............................................. Iron (Carbonyl iron, ferrous gluconate) ........................ Vitamin D3 (Cholecalciferol)......................................... Vitamin E (dl-alpha tocopheryl acetate) ...................... Thiamin (Vitamin B1) ................................................... Riboflavin (Vitamin B2)................................................. Niacinamide (Vitamin B3) ........................................... Vitamin B6 (Pyridoxine HCl) ........................................ Folic Acid ..................................................................... Iodine (Potassium iodide) ............................................ Zinc (Zinc oxide) .......................................................... Copper (Cupric oxide) ................................................. Docusate Sodium ........................................................
DESCRIPTION: CitraNatal B-Calm® is a prescription prenatal multivitamin/mineral tablet with B6, along with two vitamin B6 tablets. The prenatal tablet contains Ferr-Ease®, a patented dualiron delivery comprising both a quick release and slow release iron. The prenatal tablet is white, coated, modified oval, and is debossed with “0832” on one side and is blank on the other. The B6 25 mg tablets are white to off-white, uncoated, round, and are debossed with “B” on one side and “6” on the other.
INDICATIONS: CitraNatal B-Calm® is a multivitamin/mineral prescription drug indicated for use in improving the nutritional status of women prior to conception, throughout pregnancy, and in the postnatal period for both lactating and nonlactating mothers. CitraNatal B-Calm® may be used in conjunction with a physician prescribed regimen to help minimize pregnancy related nausea and vomiting.
®
Each prenatal tablet contains: Vitamin C (Ascorbic acid) ............................................ Calcium (Calcium citrate) ............................................. Iron (Carbonyl iron, ferrous gluconate) ........................ Vitamin D3 (Cholecalciferol)......................................... Vitamin E (dl-alpha tocopheryl acetate) ....................... Thiamin (Vitamin B1) ................................................... Riboflavin (Vitamin B2)................................................. Niacinamide (Vitamin B3) ............................................ Vitamin B6 (Pyridoxine HCl) ........................................ Folic Acid ..................................................................... Iodine (Potassium iodide) ............................................ Zinc (Zinc oxide) .......................................................... Copper (Cupric oxide) ................................................. Docusate Sodium ........................................................
CONTRAINDICATIONS: This product is contraindicated in patients with a known hypersensitivity to any of the ingredients.
PRECAUTIONS: Folic acid in doses above 0.1 mg daily may obscure pernicious anemia in that hematologic remission can occur while neurological manifestations progress. ADVERSE REACTIONS: Allergic sensitization has been reported following both oral and parenteral administration of folic acid.
DESCRIPTION: CitraNatal® 90 DHA is a prescription prenatal/ postnatal multivitamin/mineral tablet with Ferr-Ease®, a patented dual-iron delivery comprising both a quick release and slow release iron, and a capsule of an essential fatty acid. The prenatal vitamin is a scored, white, oval multivitamin/mineral tablet. The tablet is debossed “CN 90” on one side and “0821” on the other. The essential fatty acid DHA capsule is caramel colored and contains a light yellow to orange semi-solid mixture.
CNF T2900 Rev 0614 CNF-14122
24/10/2014 13:35
healthy babies
The Best Way to
Labor & Birth
Find a Labor-Friendly Healthcare Provider
BB Choose a care provider who supports ‘mobile moms’—ask what percentage of their patients stay mobile during labor
Your Baby
BB Know the facts on fetal monitoring—in low-risk mothers, research shows that occasional checks of the baby’s heart rate are just as safe as constant monitoring BB Choose the right support—a doula or labor support person can help you stay moving and help you manage each contraction
GRAVITY IS YOUR FRIEND; laboring upright and in motion will help your baby move down and out.
By Michele L. Deck, RN, MEd, BSN, LCCE, FACCE
image: thinkstock
Close your eyes and imagine you’re in labor. If you picture the scene as it occurs regularly in movies and on TV, you probably see yourself lying in a hospital bed, hooked up to an IV and wearing belts around your belly to continuously monitor your baby’s heartbeat and the contractions. What’s wrong with this picture? A lot, according to research. The Best Way to Labor The best way to keep your baby moving down and out is to keep your own body in motion, say the experts at Lamaze International, an international non-profit organization dedicated to promoting a natural, healthy and safe approach to pregnancy, childbirth and early parenting. Many hospitals and birthing facilities have routine protocols, such as requiring continuous fetal monitoring, that inadvertently limit your movement in labor. If you’re using an epidural, for example, you’ll typically need to remain in bed. Research regarding moving around in labor shows that women who are encouraged to walk, move
around, or change positions during labor may experience: BB Less severe pain BB Less need for pain medications, such as epidurals and narcotics BB Shorter labors BB Less continuous monitoring BB Fewer cesarean surgeries BB Lower likelihood for an episiotomy and use of vacuum extraction or forceps Staying upright during labor means that gravity can aid your body’s natural efforts as it lets your pelvic bones open as much as possible. Don’t be afraid to stand up for what you want in labor and birth. It’s difficult to go against hospital or birth center routines. The easier the birth is for you and your baby, the better the chances of a safe and healthy outcome for both of you.
BB Use a birthing ball when you need a rest—you may need to bring your own, since many hospitals and birthing centers may not support women laboring in upright positions BB Stay upright during pushing—many care providers put you on your bottom during pushing, but these positions shrink the pelvis and make it harder to push the baby out
6 Healthy Birth Practices BB Let labor begin on its own BB Walk, move around and change positions throughout labor
BB Bring a loved one, friend or doula for continuous support
BB Avoid interventions that
aren’t medically necessary
BB Avoid giving birth on your back; follow your body’s urges to push
BB Request to be kept
Michele L. Deck, RN, MEd, BSN, LCCE, FACCE, is
a childbirth educator and a former president of Lamaze International.
together with your baby at all times; it’s best for you, baby and for breastfeeding
ISSUE 15 / Winter 2015 Healthy Mom&Baby
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Babies
Join us on Facebook facebook.com/HealthyMomAndBaby
TAKE THE STING OUT OF SHOT S
HAVE YOUR CHILD’S CAR SEAT INSTALLATION
ISTOCK
DOUBLE-CHECKED FOR SAFETY From birth through elementary school, you’ll depend on a car seat or booster to protect your most precious cargo—in fact, you can’t even take your baby home from the hospital without having her infant car seat installed and ready to go. But did you know that even when parents follow the manufacturer’s instructions, most (85%) car seats aren’t installed properly, according to the National Highway Traffic Safety Administration’s SaferCar.gov. Their goal is the right car seat for your child’s age and size installed properly each time, and their website has checklists and videos to guide your car seat installation. Most police and fire stations have certified car seat installers available to help you learn the best way to install your child’s seat, as well as double-check your work. Use the Inspection Station Locator at SaferCar.gov to find one. Federal experts and the American Academy of Pediatrics recommend your child: Ride rear-facing for as long as possible up to age 2 in an appropriate car seat for the child’s age and size, and installed in a back seat Transition through front-facing car seats and boosters that are age and size appropriate as he grows Keep riding in a back seat through age 12
Help your baby get his immunizations by distracting him when the needle goes in. “Don’t look and it won’t hurt” turns out to be true, including flu shots and vaccinations, says the journal Pain. Whether we tell our baby or toddler the shot won’t hurt does little to mask the pain or their fear, research shows. Instead, looking away is the best way to avoid the pain, researchers say. Some pediatricians will use either a distraction or shot blocking counter pressure device—ask if your little one can benefit from that for his immunizations.
(SAFELY SUNSCREEN BABY) All babies need protection from the sun from birth regardless of their age, race or skin color. To protect baby’s skin: Avoid direct sun exposure during baby’s first 6 months by covering baby with clothing and hats with brims shading the head and neck to prevent sun exposure and potential sunburn Prevent sunburn from 6 months on with infant-safe sunscreen with a Sunscreen Protection Factor (SPF) of at least 15 Check the label of any infant sunscreen to ensure it protects against ultraviolet rays A and B; also, choose a sunscreen specifically for infant skin and that won’t sting baby’s eyes Discover more baby skin care tips in the Newborn Skincare Zone at Health4Mom.org.
ISSUE 15 / Winter 2015 Healthy Mom&Baby
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Nursery Furniture Picks
Baby’s Nursery as a safe haven By Tamer a L. Young, RN, MSN
From furnishings to the walls, floors and other décor, eco-friendly choices will help baby flourish in a healthiest environs possible. Baby will spend more time in her nursery during the first years of life than almost any other room. Create a healthy, safe haven from the flooring up.
image: thnkstock
walls and floors
Paints and floors can off-gas potentially harmful fumes. Start with wooden, eco-friendly floors like bamboo and choose low- to no-VOC (volatile organic compounds) paints, which are available at almost all retailers. Although thick carpets can be plush and soft, going carpet-free is best. Like paint, new carpet and padding can emit toxic fumes. Carpet is difficult to clean thoroughly and can harbor dust, mold and mildew that can be potentially harmful for your baby. Soften wood floors with area and throw rugs that can regularly be washed. Research flooring choices carefully, and look for woods that are renewable, recycled and that have low emissions from VOCs and formaldehyde.
Choosing furniture can also have an impact on both the environment and your baby’s health. Opt for solid wood furniture, as composites can emit fumes from formaldehyde. And while experts recommend baby sleep in a new crib or bassinet—never a used or ‘hand me down’ bed—you can be more flexible when it comes to her non-sleep surfaces, such as changing table, rocker or dresser. This is a great time to consider second-hand furniture or recycle pieces from other rooms in your house. Whether new or used, make sure any baby furniture placed into use is safe by researching its manufacturer and model at the Consumer Product Safety Commission, and sign up for their recall alerts. Only use antique or painted furniture after you’ve tested it as safe with a lead swab or similar test kit that you can find at your local hardware store. Lead is highly toxic and babies should never be exposed to lead paint.
baby bedding Your baby’s bed is one the best and easiest places to go green. When choosing a mattress, pad or fitted sheet, look for non-toxic, natural materials grown organically: cotton, silk, bamboo, wool or hemp, to name a few, so that you can rest well knowing you are helping both baby and the environment. There are non-toxic mattresses now available so this is especially important if baby’s crib will convert into a toddler bed as baby could then spend up to 5 years on her crib mattress.
bare is best Because of Sudden Infant Death Syndrome (SIDS) and other risks, the American Academy of Pediatrics recommends against any soft bedding, blankets, pillows, bumpers (solid or otherwise) and objects like plush toys or positioners be in her crib. It’s practical to skip the ‘room-in-a-bag’ bedding sets when you may only be able to use the fitted sheet from the set in baby’s crib. Creating a ‘green’ nursery may feel overwhelming at first, a few simple considerations can make a world of difference for both the health of your baby and the Earth. tamera l. young, RN, msn is an obstetric clinical instructor in Newark, OH.
ISSUE 15 / Winter 2015 Healthy Mom&Baby
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healthy babies BUY A SAFE CRIB In 2011, the Consumer Product Safety Commission issued new crib standards, making millions of cribs, bassinets and play yards manufactured prior obsolete. Drop-side cribs are definitely out after 32-related infant deaths, and used or ‘hand me down’ cribs are cautioned against as the most common crib deaths and injuries are related to hardware failures from repeated assembly/disassembly, or errors in correctly putting the crib together—especially without the original instructions. To ensure your baby’s nursery and sleep environment is the safest follow the latest guidelines:
5. Look for fine, strong mesh: Mesh-sided bassinets or play pens should have mesh less than 1/4” in size with no tears, holes or loose threads to entangle her. Mesh should be securely attached all around with no gaps or missing, oose or exposed staples or other attachments.
1. Buy a new crib manufactured to the latest safety standards: Quality materials and hardware are more important than price. Compare models in a store and shake them to see if they wobble or give. Make sure there are no cut-outs where clothes or limbs can get caught. Your baby can strangle to death if her body passes through any gaps between loose components or broken slats while her head remains entrapped.
6. Buy the right mattress size: You should be able to squeeze no more than 2 fingers’ width between the mattress and the sides of the crib or bassinet; a tighter fit reduces entrapment risks. The crib’s instructions will give you the exact size mattress specifically designed to fit. Use only the manufacturer-supplied sleeping pad for your bassinet or play yard and do not add any padding or other bedding to these sleep surfaces.
2. Register your crib as soon as you buy it with the manufacturer to receive any recall notices or parts updates
7. Buy the right sheets: Only use sheets designed for your mattress or bassinet/play yard. They must be secure, tucked-under on all sides and should not come lose as baby lays or rolls on them.
3. Avoid used cribs: While experts strongly recommend against re-using a crib, if you must reuse a crib from another sibling or buy a used one, make sure it was manufactured after June 2011, that it has all original crib hardware and parts, and complete instructions. Never buy a crib that’s missing the sticker with its manufacturing date and serial number. You should still register the crib with the manufacturer to receive future recall notices.
8. Prevent entanglements: Never place your baby’s sleep center near a window with blinds, roman shades, curtains or baby monitor cords. Babies can strangle on cords or become entrapped in window treatments. If you want to mount a monitor near your baby, place it on a shelf or piece of furniture away from the crib or sleeping surface and enclose the cord in wire molding (available at hardware stores) so that baby can never pull the cord into her bed.
IMAGE: THNKSTOCK
4. Assemble the crib or bassinet/play yard exactly as instructed. Failure to assemble or use
the crib properly is the #1 cause of infant injuries or deaths in sleep areas. Install each part exactly as directed; if unsure, call the manufacturer’s installation number provided with the instructions.
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Temporal Artery
Thermometer Accurate Temperature with a Gentle Forehead Scan. Preferred by Nurses Preferred by Pediatricians Best Selling Thermometer Accuracy Supported by more than 50 Clinical Studies • Recommended for the entire family • Fast, non-invasive - ideal for busy moms on-the-go • Use on sleeping child even with an ear infection
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03/11/2014 18:03
healthy babies
The First Hours After Birth
by Catie Chung, PhD, RN
You may already know that it’s best to have your baby placed skin-to-skin on your chest immediately after birth, but did you know that this is the best place for baby to remain for her first hours of life? Even if you’ve had a cesarean you go skin-to-skin in the operating room or as soon as you get to a recovery room if all is well. At birth, baby is adapting from a warm, water-filled environment where the placenta did the breathing and feeding for her to a cooler, air-filled environment where she now must manage to survive on her own with your care. Research shows that as you hold your baby skin-to-skin: BB Your body responds hormonally to your baby’s needs by warming or cooling your chest and breasts BB Your body releases hormones that relax you and make you feel happy and loving toward baby BB Baby’s natural instinct to feed compels her to root around your breasts—in fact, babies born alert (typically following a birth without any pain medication) can scoot and crawl to your breast and latch on to begin nursing BB Resting on you, baby will breathe normally, warm herself and stabilize her blood sugars
Th o f y o e m a jo r i toget ur first d t y a qu he r s hou a y ie ld b ot h t t i m e f o b e r you a s yo u nu r s e a n d bon d , re t oge t he r. s t
Hour.’ Your nurses can help you and baby begin breastfeeding if you haven’t started that yet on your own, check baby’s vital signs and look her over from head to toe, all while she rests on you. Your nurses will check her breathing, suction any mucous from her nose as needed and give her antibiotic eye ointment to prevent infection from bacteria she may have encountered during birth. Baby will also get her first shot—vitamin K—to help her blood clot; her own vitamin K won’t be ready until she’s about 1 week old.
Before Baby Goes Home Before baby leaves the hospital, her pediatrician will give her an exam. Your nurses will also screen her for potential problems that can be detected in the first 24-48 hours through blood and hearing tests—what’s called newborn screening. You’ll get the results at baby’s first pediatric care provider appointment. If this seems exhausting—it is! The majority of your first day together should be a quiet time for you both as you bond, nurse and rest together.
Relish the First Hour after Birth
Experts recommend that you and baby be together uninterrupted during this ‘Golden
52
catie chung, phd, rn is in Henderson, NV.
Ask Our Nurses Watch AWHONN nurses explain newborn screening in this short video at health4mom.org/?p=1263.
when baby needs extra care Should baby need medical help at birth, she may go to the neonatal intensive care unit (NICU). If that happens, your nurses will help you start pumping your breastmilk so that baby can get the nutritional support of your colostrum and milk during her first days.
Delay Cord Clamping Your partner may be anxious to cut the umbilical cord but research shows it’s best—especially if baby is preterm—to delay clamping baby’s cord. When delayed a minute or more, baby has higher hemoglobin in the days after birth, and higher iron stores up to 6 months post-birth.
image: thinkstock
You & Your Baby’s First 24 Hours Together
health4mom.org
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healthy babies
The Great Diaper Debate
BY AWHONN EDITORIAL STAFF
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Find step-by-step diapering in our Newborn Skincare Zone at Health4Mom.org
With diapering there are a whole lot of choices when it comes to providing your baby with a wearable, portable potty until he can take care of business for himself. Google “diaper blogs” and you get more than 2 gazillion results; okay, well it’s really like a little more than 2 million results, but still! All of that talk basically boils down to choosing among 3 types of diapers: Disposable Cloth Hybrid/green Or some combination thereof. Every family is different, and that’s good news, because that means with so many choices there’s likely a diaper just for you and your little one’s bum.
GREEN POOP The debate regarding cloth versus disposable isn’t as clean-cut as some would like. According to ConsumerSearch.com, more than 27 billion disposable diapers go into landfi lls in the US each year, making them 1% of all trash there.
But experts warn that how you wash cloth diapers can reduce their ‘greenness’. If you use bleach in a high-temperature wash, dry them in the dryer or have them delivered by a service that does the same then their environmental impact is comparable. If you’re comparing costs, say experts at ConsumerSearch, a diaper service comes in at about the same as buying and laundering your own cloth diapers. When it comes to the disposable categories, most makers offer mega boxes that help with cost savings, and most parents can now find choices among chlorine-free disposable options for about the same price. In the hybrid category, parents get a disposable liner that fits into a washable outer shell.
EXPLORING YOUR OPTIONS Whatever type of diaper you choose, you are going to need a lot of them—a baby goes through somewhere around 5,000 diapers from the time he’s born until he’s fully potty trained. Look for the following features: A foldable waist or notch to keep the diaper away from baby’s umbilical area Elastic or gathers at the waist and legs for the best fit (read leakproof!) Absorbent core that wicks moisture from baby’s skin A soft natural outer shell or cover Easy, adjustable fasteners
CLOTH
DISPOSABLE
HYBRID/GREEN
These were the first and are the most enduring diaper. Typically made from cotton or bamboo, they’re lined with additional absorbent cloth to soak up baby’s spoils.
Invented around 1949, most disposable diapers today have ditched the plastic feeling for a softer outer shell complete with elastic around the waist and legs for the best possible fit.
The best of these combine the convenience of a disposable (some even flushable!) inner liner with a cloth outer wrapper that looks more like clothing than a diaper.
Average $2 per “one size” cloth diaper.
54
e reason s to go fu term at G ll oT heFull4 0.com
$0.25-0.40 cents each.
Average $12 for an outer shell; $0.40 per disposable liner.
IMAGE: 123RF
Paregents Parenest
While it seems like the choice between paper or plastic is starting to wane in your grocer’s checkout lanes, the great diapering debate continues to rage on.
R E A SON #29: Postpon e the even changing tual 5,00 0 diapers baby will + use. Read mor
health4mom.org
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healthy babies
Feeding Baby: The First Year BY HELEN M. HURST, DNP, RNC, APRN-CNM
From nursing to finger foods, here’s how to nourish your little one’s first 12 months. As you settle into a nursing routine, you may be wondering when baby can start to eat other foods. Experts recommend babies be exclusively breastfed during the fi rst 6 months before introducing other foods. The American Academy of Pediatrics recommends breastfeeding for at least baby’s 1st year, and the World Health Organization recommends feeding babies breastmilk for the first 2 years of life. After that, both organizations say moms and babies should continue nursing for as long as they both want to do so.
is still giving your baby valuable nutrition and bonding time. In fact, you may find that your baby who used to nurse every 2-3 hours may taper down to 3-4 times a day. Eventually, you may only nurse during morning and bedtime routines.
WEANING 101
Take your cues from baby when weaning. Allow him to breastfeed for as long as he wants. There will come a point when he naturally spends less time at the breast. When he’s ready to wean, you can feel good that you’ve given him the healthiest start in life by giving him human milk and the natural closeness and bond that develops GO THE DISTANCE During baby’s first year, breastmilk should always through nursing. To begin, gradually replace 1 nursing each day be offered first—then other foods. Since baby only with a bottle or sippy cup of breastmilk. Continue needs a few spoonfuls of these other foods, offer to replace nursing this way, weaning slowly, so them only after nursing, allowing him to get the that you can gradually decrease your milk supply full value of breastmilk as his main meal. As baby gets older, it’s natural for him to not nurse without engorgement. for as much or as often. Don’t worry, nursing
ISTOCK
Age
ASK OUR NURSES AWHONN nurses explain bottle feeding breastmilk in a short video at Health4Mom.org/?p=1239.
4-6 Months
6-9 Months
HELEN M. HURST, DNP, RNC, APRN-CNM is an
assistant professor at the University of Louisiana at Lafayette.
9-12 Months
What she’s eating
Breastmilk
Primarily breastmilk; nurse before other foods are offered
Breastmilk and other foods
What to introduce
At 6 months, as baby shows interest, introduce pureed single-ingredient foods like banana, applesauce, pear, sweet potato, or rice cereal mixed with breastmilk
Pureed mixed ingredient foods, like apple-banana sauce or pureed meats; increase the texture as she seems interested in it
Finely chopped finger foods like graham crackers, soft fruits, pasta, cheese, or fork-mashed foods from your meals
What to watch for
Your baby can become constipated when you start solids. If this happens stop the food and increase nursing. Never add cereal to a bottle of breastmilk or feed cereal from a bottle
Emerging teeth; which allow you to begin to gradually increase the texture in foods. Choking is always a concern, so keep pieces small and odd-shaped, never tubular or round
Baby’s readiness to begin to self-feed; offer her small pieces of cheese, for example, and let her work on those fine motor skills in picking them up
ISSUE 15 / Winter 2015 Healthy Mom&Baby
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healthy babies
BY SHARON HITCHCOCK, MSN, RNC
Sleep Safely, Baby ( ) REDUCE YOUR BABY’S SIDS RISKS WITH THESE SIMPLE SLEEP STR ATEGIES
Experts think most Sudden Infant Death Syndrome (SIDS) and other infant sleep-related deaths are preventable. In the U.S., nearly 10 babies a day die of SIDS. SHARON HITCHCOCK, MSN, RNC is a maternalnewborn educator and adjunct faculty at the University of Arizona.
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ABCs OF SAFE INFANT SLEEP “Alone” means alone. Babies need their own separate sleep area—ideally in your room but not in your bed or with you. Th is is called room sharing. Research shows room-sharing reduces the risks of SIDS by 50% while offering many of the same benefits as bed sharing. “Back” means baby needs to be positioned for sleep flat on his back, never on his tummy or side. Don’t worry; babies don’t choke more on their backs, not even the “spitty” ones. Th is single strategy is the most important in reducing SIDS risk. “Crib” means a safety-approved crib, bassinet or play-yard with a firm mattress covered in a tight- fitting sheet and nothing else but baby. No loose or fluff y items, bumpers or stuffed animals. Breastfeeding, pacifiers (after nursing is going
TRAIN YOUR CAREGIVERS You may always put baby to sleep on his back but do others caring for your infant do the same? Unaccustomed stomach sleeping is when a baby who normally sleeps on his back is placed on his stomach or side to sleep. Th is bumps up baby’s SIDS risk by 7-8 times! These deaths usually happen when someone else is caring for baby, such as a friend or grandparent who doesn’t know the ABCs of safe sleep. Share the ABCs of safe infant sleep with every caregiver and post a copy near baby’s bed as an ongoing reminder. Can every case of SIDS be prevented? Probably not, but practicing safe sleep and other protective strategies give peace of mind that you’ve done everything you can do to reduce your baby’s SIDS risks.
IS FOR BA CK
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B IS FOR BACK Avoid sleep positioners as they
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increase risks
Never sleep with your baby
Never put baby to sleep on his side or stomach
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Skip commercial sleep
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to smoke—around baby
Avoid alcohol or illegal drug use Spend quality tummy time together when baby is awake
56
well), infant immunizations and well-baby checks all help protect against SIDS. Never allow your baby to become too hot and never smoke, drink alcohol or take illegal drugs around your baby.
monitors—research shows the ABCs of safe sleep are most effective
Ensure baby gets all of its shots
C IS FOR CRIB Only use new cribs or bassinets Avoid hand-me-down or used
cribs or bassinets
Tight-fitting mattress and sheet only in crib Keep blankets, toys, bumpers, soft animals, pillows, positioners and all other items out of baby’s bed Share the ABCs of safe sleep with everyone who cares for baby
IMAGE: 123RF
B
LON E
Research shows there are practical things parents and caregivers can do to help prevent these deaths. The most simple is practicing the ABCs of safe sleep: A for Alone; B for Back; C for Crib.
health4mom.org
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healthy babies
Bu il d Y o u r C o co o n The CDC advises the following to protect and build your baby’s immunity, especially in her first 6 months:
Protect Your Baby
Breastfeed your baby: Strive to breastfeed exclusively for 6 months. Breastfed babies have fewer respiratory infections and other illnesses. Wash your hands thoroughly: Everyone should do this each time they touch or care for baby. Wash for at least 20 seconds with warm soap and water, and carry hand sanitizer to use when soap and water aren’t handy.
From Pertussis & the Flu
BY KIM WILSCHEK, RN, CCE
Avoid touching your eyes, nose, and mouth: And baby’s too; most germs are spread this way.
Build a cocoon of protection for your baby from these illnesses that can be deadly for infants. Newborns and young infants are especially vulnerable to infectious diseases, particularly pertussis (whooping cough) and influenza. If your baby were to contract either of these, her life could be threatened and she could end up in the hospital. Pertussis is especially risky for newborns because routine immunization doesn’t start until 2 months of age, and it takes more than 1 vaccination to get full immunity. Also, babies don’t routinely get flu shots until at least 6 months old. So, how do you protect your baby from these potentially deadly infections in the meantime?
ISTOCK
A COCOON OF PROTECTION Public health and medical experts alike are now recommending that parents build a cocoon of protection around their newborns and infants. Th is means everyone who will be around the baby— family, babysitters, friends—needs to be current on all vaccines. Th is surrounds the baby with “herd” immunity. Adults need the seasonal flu vaccine each year. And, the pertussis vaccines that we all received as children don’t last a lifetime. Currently, the CDC recommends pertussis vaccination or a booster for the following:
All women who are trying to conceive, who are pregnant at a gestational age of at least 20 weeks or more, or who are postpartum. The Tdap vaccine is recommended after 20 weeks gestation because it ensures baby gets the greatest benefit from the build-up of antibodies from mom. Th is gives baby the most protection against pertussis at birth and in the earliest months Any adolescent ages 11 to 18 who may have completed childhood vaccinations and will now need 1 lifetime booster Adults of all ages, especially parents, grandparents, caregivers and anyone who will be providing care for a baby, particularly infants ages newborn to 12 months
GET GRANDPARENTS, CAREGIVERS VACCINATED Prepare for baby’s birth by having dad, grandparents and babysitters vaccinated ahead of time. If you’re pregnant, get the Tdap or ask for it after birth; it’s typically available in hospitals and safe during breastfeeding.
Avoid sick people: Remember, not all sick people have a fever. Avoid people who are coughing, sneezing, complaining of new aches or pains, or being treated for an infection. Keep baby out of large crowds. Practice safe coughing: Into your elbows or a tissue to be discarded; never cough into your hands. Get vaccinated: Require all household, family members and others who will have contact with your baby to get both the Tdap and flu vaccines, as well as any other missing adult vaccinations. Require proof of vaccination for babysitters and nannies.
KIM WILSCHEK, RN, CCE, is a perinatal educator at Edward Hospital in Naperville, IN.
ISSUE 15 / Winter 2015 Healthy Mom&Baby
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healthy babies
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Follow these essential steps to bathe baby right each and every time.
Many new parents are shocked to find that the first few bath experiences for baby may be downright frightful! As baby wiggles and hollers, you may be tempted to think, “Didn’t you just spend the last 40 weeks in my tummy in a warm water bath of sorts?” Over time, however, babies typically come to love their baths, and it’s a great bonding time for you and your baby. Follow these simple steps to set the stage for success with baby’s bath each and every time.
READY, SET, BABY BATH TIME
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Before you begin the bath, arrange baby’s tub, washcloth and towels or blankets and products all within reach. Choose a warm room, and eliminate drafts by keeping the door closed when possible. Keep baths short—about 5-10 minutes at first—so that baby doesn’t get cold. Unless your healthcare provider has told you otherwise, it’s OK to bathe baby with his cord stump still in place.
Start by washing your hands Use warm–not hot–water, between 100–104 degrees F. Check the water temperature with a bath thermometer or test it on the inside of your wrist or elbow Support baby’s head and neck during bathing Begin with a clean cloth and wash baby’s face first, body second and diaper area last Always wipe away from the eyes and mouth into the creases as you go behind his ears, around his neck, into his underarms, between his fingers and toes and in his diaper area Only use a mild, gentle cleanser designed for babies To shampoo, fi rst wet baby’s hair, then apply an infant-safe shampoo gently with your hand and then lightly massage baby’s scalp with your hand or a soft baby brush, and rinse with water moving down the back and sides of baby’s head. Do not put pressure on the soft spot–known as the fontanel–in his head Gently rinse baby’s body with your hands or a soft cloth, moving from head to feet, ensuring no soap is left behind Move baby from his bath into a towel or blanket and pat his skin dry rather than rubbing it Once dry, dress baby to keep him warm
IMAGE: 123RF
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health4mom.org
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healthy babies CARING FOR
Your Newborn’s Skin BY AWHONN EDITORIAL STAFF
Baby’s skin is so incredibly smooth and soft—here’s how to care for it and keep it that way.
Your baby’s newborn skin protects baby from bacteria and germs, and helps her body hold a normal temperature. Most babies are born with a white creamy coating on their skin called vernix, which keeps it soft and protected. It’s sticky and may not come off during bathing but there’s no need to rub it off —let it wear off on its own. Experts recommend you bathe your baby no more than 3 times a week—or every other day— and for about 5-10 minutes, especially during the first month of life. Daily bathing, in fact, can alter
ISTOCK
UM BIL ICA L CO RD CA RE Umbilical cord stump care isn’t a big mystery. The cord should fall off by baby’s 3rd week, and unless your baby’s healthcare provider has told you otherwise, it’s okay to immerse baby’s cord in her bath. When caring for the cord: Always wash your hands before touching baby’s cord stump Fold the top of baby’s diaper down and away from the cord Keep the cord area clean and dry Wipe the cord with soft, warm and wet cloth if it gets soiled with baby’s waste Avoid using rubbing alcohol or creams on the cord or covering it with a bandage Talk to your baby’s healthcare provider if your baby’s cord: Appears red Has fluid or drainage around it Smells bad Hasn’t fallen off by baby’s 3rd week of life
the pH of baby’s skin and predispose it to dryness. From 6 months on, or when your baby starts crawling, you can bath her more often and for longer periods of time, as desired. You may be surprised to learn it’s okay to bathe baby with her cord stump still in place. As for what to slather and lather, begin with the basics: Baby body wash/soap, baby shampoo and diaper rash cream. Use topical products, like lotions and creams, only when needed. Most full-term, healthy babies won’t need any lotions or creams on their skin during the first few weeks of life.
ask our nurses Can you use sunscreen on babies? Nurses answer in this video: health4mom. org/?p=1224
WHEN IT’S DIAPER RASH To prevent diaper rash, change your baby’s diaper as soon as it’s been soiled as diaper rash can be caused by urine or stool staying too long on her skin. See baby’s healthcare provider if a red rash in the diaper area appears swollen, has red bumps or raised areas. When rash is present, keep baby’s diaper area clean, allowing the skin to air dry before Bath-Time Basics for Ba applying barrier cream and a clean by diaper. Use Out & Abou t in the Sunsh the following barriers depending on the rash: ine health4m
om.org
Parent Pages
There’s nothing quite as protects baby wonderful and amazing temperature. from bacteria and as newborn germs, and helps her Association Use these research skin. It body -based tips of from the nurse hold a normal to help keep Women’s Health, Obstetri your baby’s experts of skin healthy, c & Neonatal Nurses the beautiful (AWHON and soft. N) Prepa
health4m
om.org
BATHING
ration is Essent
There’s nothing
ial
start by washing your hands.
your Never leave baby alone during or a sponge bath bath while in the bath tub, even if a is used. seat or sling
▷ Only use a
NEWBORN
quite as wonder amazing as ful and baby from newborn skin. It protects bacteria and her body germs, and hold a normal helps Use these research-basedtemperature. the nurse tips experts of Women’s the Associa from Health, tion of Nurses (AWHO Obstetric & NN) to help Neonatal baby’s skin keep your healthy, beautifu important l and soft. to learn proper bathing It’s diapering, how to take and umbilical care of baby’s cord how to protectstump until it falls off, and her skin from As she grows, the sun. your baby’s don’t hesitate to talk with about her nurse, midwife or doctor particular such as if skincare baby’s skin needs, you’re unsure has a rash or if specific productof what types of babys to use moisturizing. for bathing or
Arrange his for Easy Bathin tub, washclot reach before h and towels g by keeping you begin. Bathe baby or blankets, and products the door in a warm all within closed minutes at room, and first—so that when possible. eliminate Keep baths provider has drafts baby doesn’t short—a get cold. still in place. told you otherwise, Unless your bout 5-10 it’s OK to healthcare bathe baby with his cord stump ▷ Always
SKIN & SUN
warm– not hot–wate r, between 100–104 degrees F. Check water temperat the ure with a bath
▷ To shampoo
, first wet baby’s hair, then apply an infant-safe shampoo gently with your hand. Lightly massage baby’s scalp with your hand or a soft baby brush, and rinse with moving down water the back and sides of baby’s head. Do not put pressure on soft spot–kno the the fontanel– wn as in his head.
thermom eter it on the insideor test of your wrist or elbow.
▷ Always support
baby’s head and during bathing. neck
▷ Begin with
a clean cloth and wash baby’s face first, body second and diaper area last. Always wipe away from the eyes and mouth into the creases as you go behind his ears, around his neck, into his underarm s, between his fingers and toes, and diaper area. in his
Tub Bath
Sponge Bath
▷ Gently rinse
baby’s body with your or a soft cloth, hands moving from head to ensuring no feet, soap is left behind.
▷ Move baby
from his bath into a towel or blanket and pat skin dry rather his than rubbing it. Once dry, dress baby to keep him warm.
This resource from Johnson was supported through & Johnson an educational Consumer grant Companies, Inc.
Facebook.co
Tips
1 Place bathtub in a safe surface. place and on a strong Swirl water so there are no “hot spots.” While holding baby, lower feet first. him into the Allow baby water to rest so covers just that the water up tub provides to his shoulders. If your baby’s different instructio ns with your instructions, follow the baby’s bathtub. may try swaddlin fuss or cry at first. For comfort, g baby first the water. before placing him in
2
3
Protecting
4 Your baby
1 Undress
wrapped baby on a second clean blanket, towel, or pad.
3 Wet a soft
washcloth in a warm bowl of water.
m/HealthyMo
mAndBaby
4 Wring out excess
water from washcloth so doesn’t get water into baby’s eyes when washing his face. 5 Unwrap each as you wash, area pat dry, and re-wrap to keep baby as as possible. warm
Baby’s Skin
Parent
from
Most parents Sun immediately babies need think of bathing protection and diaperin from the g first when sun from it comes to birth regardle caring for ss of their their little age, race one’s skin. or skin color. But all To protect baby’s skin:
Tips
baby and wrap him in a or receiving towel blanket.
2 Then, place your
Pages
N
Pages
Skin slightly red? Apply a thick layer of petroleum jelly at each diaper change until the rash is gone Skin very red? Apply a thick layer of white diaper cream that contains zinc oxide at each diaper change. Don’t remove this cream during diaper changes; it’s protective. Rinse the area with warm water, pat or air dry and apply more diaper cream until the rash is gone mild, cleanser designedgentle for babies.
▷ Always use
Parent
PROTECTIO
1
Avoid direct sun exposure during baby’s first 6 months by covering baby with clothing and hats with brims shading the head and neck to prevent sun exposure and potential sunburn.
2
From 6 months on, prevent with a small sunburn amount of an infantsafe sunscree n with a Sunscree Protection n Factor (SPF) of at least 15.
This resource from Johnson was supported through & Johnson an educational Consumer grant Companies, Inc.
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m/HealthyMo
mAndBaby
3
Check the label of the infant sunscreen to ensure it protects against ultraviole t rays A and
B; also, choose a sunscree n specifically for infant skin and that won’t sting baby’s eyes.
Caring for Newborn Your ’s Skin
Advice From On Bathing, Nurses & Sun Prot Diapering ection
This resource from Johnson was supported through & Johnson an educational Consumer grant Companies, Inc.
Find step-by-step diapering in our Newborn Skincare Zone at Health4Mom.org
ISSUE 15 / Winter 2015 Healthy Mom&Baby
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healthy babies
Baby’s Chompers By AWHONN Editorial Staff
these tips will help your baby cut her first teeth with as little pain as possible There’s not a breastfeeding mom out there who hasn’t gazed down at her nursing infant and wondered with a mix of curiosity and fear, “when will my baby get her first tooth?”
Teething ranks right up there among the highest stressors infants face; experts know, because along with the new pearly whites come loads of fussiness as they cut through your little one’s gums. Do you know that your baby was born with her tooth buds already embedded in her gums? here they come Long before you ever see the first edge of a tooth pushing its way into your baby’s mouth, you may notice that she is a lot more fussy than usual, is drooling, wants to nurse or feed more often and may have a low-grade fever (up to 100.9⁰F). Your baby may also want to put everything in her mouth and chew with her gums. Excess saliva may cause a rash around the face and she may refuse to nurse although she seems interested in nursing.
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Easing Teething You can help your baby ease into her teeth with minimal discomfort by practicing good gum care from birth. Ask your dentist for or purchase a finger-sock-like baby toothbrush or use a washcloth and begin massaging his or her gums with cool water on a regular basis. Skip the toothpaste until she is age 3 and can swish and spit it out, say experts at the American Dental Association. It’s time for your baby’s first visit to a pediatric dentist when she has 8 teeth in her mouth, which is typically around age 1. Starting early with good dental care will not only help your baby with her first set of teeth but will also protect permanent teeth from bacteria and decay as they’re forming in the gums, and until they begin to make their first appearances around age 6.
To p Teethers Give your baby something cold to mash her gums against to reduce pain and swelling while teething. Avoid pain medications (infant Tylenol is OK) unless nothing else soothes her.
n at u r a l t e e t h in g s s t r at eg ie BB A cold or frozen clean wash cloth
BB A medical-grade
silicone teether (avoid ones with liquids as they can leak or be bitten through)
BB Soft baby foods, like applesauce or yogurt
BB Frozen fruit safely
contained in a “mashing” bag designed for babies to chew on
BB Teething crackers
image: thinkstock
Contrary to popular beliefs, teething doesn’t give your baby a high fever (101⁰F or more) or diarrhea. When these symptoms are present, it’s time to see your pediatrician. Although babies can even be born with a tooth or 2 already in, they will get their 2 bottom and 2 top front teeth in that order before the molars and side teeth emerge. By their 3rd birthday babies should have 20 teeth in total. As their teeth debut, you may even see small cysts on the gums where the tooth below is breaking through.
health4mom.org
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ISSUE 15 / Winter 2015 Healthy Mom&Baby
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ISSUE 15 / Winter 2015 Healthy Mom&Baby
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healthy babies
That magical brain chemical oxytocin (sometimes called the love hormone) is the glue of parenting and bonding. Moms and dads both have it in their brains, and it increases when they touch their baby. Birth, breastfeeding and affectionate contact also increase oxytocin in moms. Being physical and being active, such as with exploration or adventure play, increases oxytocin in dads. So the effect is similar, but the cause is slightly different: Moms make more of it when they affectionately touch their baby, and dads make more of it when they are physical with their baby. Either way, baby loves and needs you both.
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V. Dad
Mom
By Pat Sheans, MSN, NNP
In the parenting wars, can baby pick a winner when it comes to parenting styles?
their kids’ care, and when they’re parenting, they’re more likely to spend time alone with children, and also spend more time multi-tasking. Mom is also more likely to chauffeur baby to play dates.
In case you haven’t noticed, moms and dads definitely parent differently. But guess what? Each of you has unique, positive qualities that baby needs. Since babies can’t understand words, they learn about the world around them by watching the expressions on their caregiver’s face and by listening to the tone of their voice. Both parents nurture, and both are important to their child’s emotional development.
Do Dads Play More? Dads are more likely to spend their parenting time playing than any other kinds of caring. Dads excel at physical play, handling their baby, tossing the baby in the air and other rough and tumble activities. Dads tend to play longer with baby sons, and are more physical with boys than with girls. Dads try to surprise their babies with new games and activities, leading to more excitement, more laughter, and more tears than when babies play with mom. Moms are more likely to play with their baby using objects and toys, and moms pay more attention to changes in their baby’s face, and whether baby is looking around. Dads react to smiling less often than moms, and dads tend to talk to their baby more, while moms tend to touch baby more.
Do Moms Parent More? Even with more co-parenting and stay-at-home dads, research has consistently found that moms still spend 2 to 3 times as much time with the kiddos as dads do—even when mom works full time. Kids with dad at home benefit because shared parenting increases. Moms tend to spend more time with them on a day-to-day basis than working dads do, stepping in to her primary parent role soon after she gets home from work. Moms also take more overall responsibility for
Pat Sheans, MSN, NNP is a neonatal nurse practitioner in Portland, OR.
image: 123rf
b r illi a n t bon ding
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Nobody likes to be rushed, especially babies. Your baby needs at least a full 40 weeks of pregnancy to grow and develop. Inducing labor even a week or two early is associated with a host of risks, including prematurity, cesarean surgery, hemorrhage and infection. While it may seem convenient for you or your health care provider, labor should only be induced for medical reasons.
Slow ! down
Relax.
Don’t rush me!
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.
.
Download a free copy of
40 Reasons to Go the Full 40 Go
f 40 or !
at www.gothefull40.com. Now in English and Spanish.
What’s the hurry? AWHONN PROMO T I NG T H E H E A LT H OF WOMEN A ND NE W BOR NS
The nurses of AWHONN remind you not to rush your baby—give him at least a full 40 weeks! Silver Member
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