Parent ’s Guide
Pa rent ’s Guide
Taking Care of
Baby & Me
Welcome! Women’s Hospital is truly unique. The program and facility are specifically designed to meet the comprehensive healthcare needs of women throughout central North Carolina. Women’s Hospital represents our commitment to improving healthcare for women and infants. We are dedicated to providing the best care available in a manner that exceeds your expectations. We want your stay to be a positive family experience. The information in this Parent’s Guide is designed to give you a practical resource that you can use during and after your hospital stay. We are here to assist you in any way we can. If you have any questions, please do not hesitate to let us know. Thank you for choosing Women’s Hospital, part of the Cone Health Network for Exceptional Care. Sincerely,
Cynthia B. Farrand President Women’s Hospital
Welcome
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Table of Contents BABY SAFETY Hospital Safety..............................................3 Visitation Guidelines.....................................4 Dangers of Smoking & Secondhand Smoke.................................5 Safe Sleeping................................................6 Period of Purple Crying.................................7
CARING FOR MOM IN THE HOSPITAL Physical Changes After Delivery....................8 Breast Care...................................................9 Vaccines (Tdap, MMR and Pneumonia)........9
CARING FOR MOM - AT HOME
Congratulations on the Birth of your New Baby!
At Women’s Hospital we practice family-centered maternity care, which means we keep mothers and babies together. Both are cared for in the mother’s room by the same nurse. This allows you to practice skin-to-skin with your baby, which helps your breast milk supply and helps your baby to learn to breast feed.
When to Call Your Doctor..........................10 Emotional Adjustment................................10 Taking Care of Yourself...............................11 Sexual Adjustment......................................12 Post-Delivery Exercises.................................13
Your baby should be placed in skin-to-skin contact with you immediately after birth and several times during your hospital stay. Research has shown that your baby will immediately begin to react to you. Your baby can hear and feel your heartbeat and become familiar with the feel of your skin.
SKIN-TO-SKIN........................................14
Even if your baby isn’t actively feeding from the breast, keeping the baby skin-to-skin helps decrease your baby’s crying, improves your baby’s breathing, heart beat and temperature, and is an important part of your bonding at birth and beyond. Holding your baby close will help you learn to recognize cues that your baby is ready to eat.
CARING FOR BABY IN THE HOSPITAL Medications for Baby..................................16 Vaccines for Baby........................................16 Tests for Baby..............................................16 Jaundice......................................................17
CARING FOR BABY - AT HOME When to Call Your Baby’s Doctor................18 Taking Your Baby’s Temperature.................19 Feeding Your Baby......................................20 Warning Signs for Feeding Issues...............21 Breastfeeding Positions...............................22 Breastfeeding Tips.......................................23 Baby’s Weight Gain.....................................24 Breast Milk Storage Guidelines...................25 Defrosting Breast Milk................................25
CLASSES & SUPPORT........................26 INDEX.........................................................28
We encourage breastfeeding because breast milk is designed to be the perfect nutrition for new babies. We do not give supplements of formula to your baby without first discussing it with you and your baby’s doctor. Even one formula feeding can lead to: • Risk of protein allergy. • Risk of diarrhea due to changes in normal bowel flora or bacteria in the bowel that helps digest food and protect your baby from illness. • An interruption in your breast milk supply. Family-centered maternity care does not mean you are expected to care for your baby alone. Your mother/baby nurse will assist you with your baby’s needs. Our family-centered maternity care provides your new family the opportunity to have “hands-on” learning from your nurse and doctor in the comfort of your own room. As a result, your family leaves the hospital more confident and comfortable with how to care for your new infant. We are here to help you, so please call with any questions.
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• Congratulations!
Baby Safety Information
for Parents
Your baby’s safety is a high priority at Cone Health. You can take an active part in protecting your baby by following these important steps: • Do not remove the identification bracelets issued to you, your support person or your baby. • Always make sure that your bracelet numbers match your baby’s numbers each time the baby is given to you. • Do not remove or give your identification bracelet to anyone. Everyone issued a bracelet should leave it on until the baby is discharged. (If for some reason a bracelet is removed, contact your nurse immediately.) • If a bracelet falls off or is damaged, notify a nurse immediately. • The infant security system includes a tag, which will be placed on the baby shortly after birth. The tag must stay on the infant until discharge.
Check for proper identification before giving your baby to anyone. The hospital personnel who have permission to transport your baby must wear an identification nametag that reads in pink “Baby Safe Carrier” as part of their pictured hospital identification badge. Feel free to ask to see the picture on the badge to make sure the person and the picture match. Do not give your infant to anyone who does not have “Baby Safe Carrier” written on his or her picture identification badge.
Familiarize yourself with the hospital personnel who work in the maternity/newborn area. • Only hospital personnel with the identification described above have any reason to take your baby anywhere. • Other hospital staff members who may come into your room include housekeeping, dietary and lab personnel. Volunteers may come to deliver flowers or mail. • Volunteers may transport your baby to the acute care/procedure nursery. Anyone who takes your baby will have a nametag that says “Baby Safe Carrier.”
Baby Safety
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In Case of an Emergency, dial 911 In case of emergency, please take your baby to the
Children’s Emergency Department at The Moses H. Cone Memorial Hospital. Women’s Hospital and Wesley Long Hospital do not have facilities for pediatric emergencies.Please take your sick or injured child to the Children’s Emergency Department at The Moses H. Cone Memorial Hospital. The department offers the latest technology and service and has fun, colorful murals so your child will be cared for in a comforting, kid-focused space. More room and more staff mean even faster treatment for all our young patients. Doctors and nurses who are board certified in pediatric care are available 24 hours a day, seven days a week to provide the care your child needs.
Never leave your baby unsupervised. • Place your baby on his or her back in the crib to sleep. • Do not go to sleep with the baby in your hospital bed. This will protect your baby from falling or accidental harm. • Always transport your baby in his or her crib. Do not carry your baby in the hallway. Report anyone carrying an infant around the hospital to any hospital employee. • Wheeled cribs need to be pushed or pulled lengthwise, not sideways.
Share visitation guidelines with family and friends. • Infants must remain in the mother/baby area of the hospital. Do not take babies to the gift shop, vending area, etc. • For added safety, the number of visitors in a room at one time is limited based on the patient’s location. For example, in the mother/baby unit, limit the number of visitors to five. • The patient’s healthcare team determines visiting hours in the Neonatal Intensive Care Unit. When permitted, visitors are limited to three per family. • For the safety of everyone, brothers and sisters of the baby must remain with parents or another responsible adult. Children may not be left unattended in waiting rooms or lobby areas. • All visitors should wash their hands before handling infants. All visitors should use alcohol hand gel when entering and exiting the hospital. • Guests with a fever, runny nose, cough, sore throat, diarrhea or other signs of illness should not visit for the protection of mom and baby. • If a child has been exposed to a communicable disease such as chicken pox, measles, rubella, etc., inform your nurse so that the newborn’s doctor can be consulted before the child visits with the baby. • Visitors must wear their hospital-issued photo ID badge at all times during their visit. Visitors must “scan out” at the visitor’s desk when leaving. • Guests should keep visits brief so patients can rest comfortably and recuperate. • Latex balloons are not allowed in Cone Health hospitals. Some people are allergic.
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Feel free to question anyone who comes into your room. • If you feel unsure of anyone who comes in to check your baby or to ask about your baby, call the nurses’ station. • Always check for the “Baby Safe Carrier” identification nametag, and remember, it is your right to question anyone who comes in your room.
Be safe when you and your baby go home. Don’t use outdoor decorations such as balloons or wooden storks to announce your baby’s arrival. Law enforcement officials have determined such displays can serve as conversation starters or door openers for criminals.
The Dangers of Smoking and Secondhand Smoke Secondhand smoke is a mixture of smoke given off by the burning end of a cigarette, pipe or cigar, and the smoke exhaled from the lungs of a smoker. Secondhand smoke is also known as passive smoke, and exposure to this smoke is called involuntary smoking. Secondhand smoke is a very serious health risk for your infant. Secondhand smoke affects an infant’s small, developing lungs. It increases colds, coughs, wheezing, pneumonia, bronchitis, ear infections and asthma. Secondhand smoke also increases the risk of a baby dying from Sudden Infant Death Syndrome (SIDS). For the health of your baby, do not smoke or allow others to smoke around your baby or inside your home. If you are a smoker, making the decision to quit is a choice that only you can make. However, this decision is not only for you, but also for your family and children. Your doctor or healthcare provider can give you resources to help. Cone Health offers a free eight-session program of smoking cessation classes to any smoker over the age of 18. Call (336) 832-0894 or visit www.conehealth.com/stopsmoking for more information. Other help is available by calling 1-800-QUIT-NOW or 1-800-784-8669. Steps to consider in this journey include: • Making the actual decision to quit. • Setting a quit date. • Choosing a quitting plan. • Dealing with withdrawal. • Staying positive, but vigilant.
Why get the Hepatitis Vaccine while in the Hospital? We recommend that well newborns receive the first dose of Hepatitis B Vaccine in the hospital. This is important because if the mother was exposed to Hepatitis B during the end of the pregnancy, the risk of giving the virus to the baby could be greatly decreased by receiving the vaccine. After your infant is vaccinated, we will give you a copy of your baby’s immunization record to take home. (See additional information on vaccines elsewhere in this book.)
Baby Safety
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ABCs of Safe Sleep
A B C
ALONE On their BACKS In their CRIBS
Safe Sleeping Sudden Infant Death Syndrome (SIDS) is the sudden death of a child under one year of age. Many times SIDS is unexplained even after thorough investigation. One of the best ways to reduce the risk of SIDS is to place infants on their backs when putting them down to sleep at nighttime or naptime. The American Academy of Pediatrics recommends the following to help reduce the risk of Sudden Infant Death Syndrome (SIDS): • Place infants to sleep on their backs. • Use a crib that has been tested and approved for safety. • Do not place babies to sleep on adult beds, soft mattresses, sofas, cushions or waterbeds. • Always use a firm sleep surface. Car seats are not recommended for routine sleep. • Keep bed free of fluffy bedding, soft toys and pillows. • Don’t sleep in the bed with your baby. • Provide a smoke-free environment. • Ensure that your baby doesn’t get too warm when sleeping. Avoid covering the infant’s head. • Ensure that babies receive their immunizations on schedule. • Breastfeeding is recommended. The safest place for babies to sleep is in the parents’ bedroom in a crib. Be sure to share these important recommendations with babysitters, grandparents and other caregivers.
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Period of Purple Crying... crying is normal
For new parents, the first few months are filled with many challenges as they adjust to their new roles. Often, the most stressful time is when the baby cries. Frustration can build when they try everything yet nothing seems to comfort the child. Moms and dads begin to wonder if these difficult periods of crying mean their child has colic, or they have poor parenting skills. The most important thing to remember is crying is normal. It is your baby’s way to communicate. Research now shows there is more to the crying spells. We now refer to this period as “The Period of Purple Crying.” Each of the letters in the word PURPLE stands for one of the properties.
P
Peak of Crying • Usually occurs at 2 months and then decreases at 3-5 months.
U R P
Unexpected • Crying can come and go without knowing why.
Resists Soothing • Crying may not stop despite comfort.
Pain-like Face • They look like they are in pain when they are not.
L E
Long Lasting • Crying can be as long as five or more hours a day.
Evening • Periods of crying often occur in the late afternoon or evening.
You may view a video on “The Period of Purple Crying.” Ask your nurse to help you view it on the education channel. This video helps describe the characteristics of crying in healthy infants. It also gives you alternatives to use when you feel you need a break from a crying baby, such as handing off the baby to another caregiver or going to another room while leaving the baby in his/her crib with the rails up for periods no longer than 15 minutes.
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Caring for Mom In the Hospital
Physical Changes After Delivery of a Baby After delivery, your body will go through many changes. Giving birth is stressful and physically demanding, and you may feel very tired. Please ask for assistance when getting out of bed for the first time because you may be weak or faint. Resting frequently and drinking fluids will help you regain your strength. Your nurse will monitor your progress.
Vaginal Birth If you need an episiotomy, keeping that area clean is necessary for your stitches to heal and to prevent infection. Your nurse will instruct you on the care of your episiotomy. Episiotomy care should be done until all soreness is gone. Sitz baths, ice packs and anesthetic sprays can make your episiotomy feel more comfortable. The stitches will be absorbed by your body and do not have to be removed.
Cesarean Birth Because of your incision, you may need medication for pain control. Please don’t hesitate to ask your nurse for medication as needed. Keep the incision clean and dry. If you are permitted to take a shower, pat dry the incision after showering. Your incision may be covered by a transparent dressing that will stay on until after you go home. Your nurse will give you instructions about removing the dressing. Your nurse will get you out of bed during the first day. Walking in the hallway is encouraged to prevent complications, stimulate your bowels and relieve soreness from the incision. Do not lift objects heavier than your baby or do vigorous exercise until instructed by your physician. Climb steps slowly and only when necessary.
Bladder and Bowel Care It is not unusual to urinate frequently as your body gets rid of extra fluids. A bowel movement may take several days because of the physical stress of birth. Drinking fluids (eight glasses of liquids a day), eating fresh fruits, vegetables and whole grain breads, and walking will assist you in the return to normal bowel habits. Occasionally a mild laxative is required.
Hemorrhoids Hemorrhoids often occur with pregnancy and delivery. It takes time for hemorrhoids to shrink. Soaking in a sitz bath two or three times a day will help you feel more comfortable and promote healing. Please ask your nurse for a sitz bath if needed. In addition, ask your doctor or nurse for medications that may be available. Avoid becoming constipated because this can make the hemorrhoids worse.
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Bleeding
Breast Care for the Bottlefeeding Mother
You will have vaginal bleeding as the uterus heals. It will be bright to dark red and heavy at first. The bleeding may increase if you become active after lying down for a period of time or during breastfeeding. Notify your nurse if you are concerned or if you pass blood clots. Vaginal bleeding or discharge will become lighter in color and decrease in amount over the next several weeks. Your normal menstrual period may resume in a month or may be delayed if you are breastfeeding. Although breastfeeding may delay the return of your menstrual cycle, it does not prevent pregnancy.
You may wear a well-fitted bra day and night. If your breasts feel full or tender, you may apply ice packs for comfort. Avoid hot showers, hot baths and attempting to express fluid from your breasts because this stimulates milk production.
Cramping You may feel cramps in your abdomen as your uterus begins to shrink back to its pre-pregnancy size. This discomfort may be more intense during breastfeeding and/or if you have had a baby before. Applying a heating pad, emptying your bladder frequently and taking pain medication should relieve most of the discomfort. Please let your nurse know if these methods do not work. The cramping will diminish during the first week after delivery.
Caring for Yourself Breast Care for the Breastfeeding Mother You may wear a well-fitted bra (day and night) for comfort while you are breastfeeding. Keep your breasts and nipples clean and dry. Do not use any soaps or alcohol-based preparations directly on your nipples because they remove natural protective oils. If your nipples become tender, you may need to reposition your baby at feedings. Please ask your nurse for assistance with positioning the baby. “Air drying” your nipples by leaving the bra flaps down after each feeding will promote healing. Massaging colostrum on sore nipples also promotes healing. Early and frequent feedings will help prevent engorgement. If you become engorged, ice packs applied to the breasts before feeding may help to reduce swelling and discomfort. Using a hand or electric breast pump is helpful if your breasts are very full and uncomfortable. (Please see section on breastfeeding beginning on page 20.) If you have questions after you go home or need to see the Breastfeeding Consultant after discharge, please call (336) 832-6860 for help.
Medications Your doctor will give you prescriptions for medications you need to take at home. Check with your doctor about continuing your vitamins and iron.
Vaccines for Mother Tdap The Tdap Vaccine protects the baby’s caregivers from carrying a serious illness called pertussis. The Tdap Vaccine is recommended for all pregnant women to receive during the third trimester of pregnancy. By getting vaccinated during pregnancy, antibodies are transferred to the newborn, giving them some protection in the infant’s early life. DTaP or Tdap (depending on the family member’s age) is recommended for all family members and caregivers of the infant at least two weeks before coming in contact with the baby. Women, including those who are breastfeeding, should receive a dose of Tdap in the immediate postpartum period if they have not been previously vaccinated or the status of the vaccine is unknown.
Measles Mumps Rubella (MMR) If contracted during pregnancy, the rubella virus can cause serious birth defects. The rubella vaccine cannot be given during pregnancy. During your prenatal care you were most likely tested for a rubella status. If you were negative or had a low titer you are a candidate to receive a vaccination of MMR in the hospital. It is important not to become pregnant for three months after the vaccine, so it is advised that you receive this vaccine in the hospital.
Pneumonia Vaccine The pneumonia vaccine is important for mothers who have certain risk factors. Your nurse will screen for those risk factors. Some common ones are asthma, smoking and diabetes.
Caring for Mom
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Caring for Mom - At Home When to Call Your Doctor It is important that you have a doctor’s examination four to six weeks after delivery. Notify your obstetrician or clinic if you experience any of these symptoms before your appointment: • Increased bleeding – bleeding more than your normal period or frequently passing clots. • Unusual abdominal pain or tenderness, other than uterine cramping. • Burning, painful or frequent urination. • Painful, reddened or hot areas on your breasts. • Chills, accompanied by fever greater than 100 degrees. • Foul-smelling vaginal discharge. • Severe headaches, fainting. • Fever.
Accepting the idea that the first months after birth are a period of adjustment and finding ways in which both parents can care for the relationship and the infant can help families through this period of change. Setting a few weeks aside in which you slow down the pace of your life can be hard – but it is easier than falling into the trap of trying to be Supermom or Superdad. Finding ways to just take care of yourselves and your baby and sharing feelings, fears and needs openly with one another also can ease the wear and tear during this time of adjustment. In the first weeks after birth, infants are working hard to develop control over their nervous system and adjusting to the new environment. Parents are working hard to meet their baby’s needs and getting used to the shifts in relationships – between one another and with grandparents, friends and relatives. Allow yourself time to adjust to these new roles. Take time to get to know your baby and take care of yourself. The majority of the overwhelming feelings of the early weeks of parenting are normal and need not cause worry. There are, however, some things that may be warning signs.
Emotional Adjustment After Baby is Born Most parents expect a period of physical adjustment after birth, but are surprised by the emotional experience of early parenting. Becoming a parent brings greater change than almost any other experience. New mothers and new fathers often experience feelings of being overwhelmed. Those feelings result from the responsibilities of being a parent and also from responding to the baby’s needs 24 hours a day. Many parents comment that they did not anticipate the strong emotions they experienced. Women may experience “the baby blues” in the first days and weeks after birth. Common symptoms of the blues are mood swings and crying spells. Some women note a change in appetite. Some want to sleep more than before; others find restful sleep difficult. These symptoms can come and go during the first weeks and months of parenting. Initially, they can be related to hormone changes, but they are also the result of getting used to a new role. In that sense, men can experience the blues as well. Men often speak of feeling left out of the newly forming relationship with the baby or are frustrated by limited time with both their infant and partner.
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Postpartum depression occurs in about 10 percent of all new mothers. Postpartum depression may result if the “blues” linger and do not subside, or it may occur anytime within the first year after birth. Symptoms vary between women and can include: • Feelings of sadness, doubt, guilt, irritability, hopelessness or uncontrollable crying that seem to increase each week and interfere with your ability to care for yourself or your baby. You may have trouble handling your usual responsibilities. • Not being able to sleep at night when you are tired, even if your baby is sound asleep. • Lack of interest in things that were once pleasurable. • Overconcern or worry about the baby. • Fear of harming the baby or yourself. With skilled professional help, postpartum depression is treatable and temporary. If untreated, symptoms can worsen or last longer than they need to. Reaching out for help is an important step. If you are concerned, don’t hesitate to get in touch with your physician. For more information and access to our Feelings After Birth Support Group, call Women’s Hospital at (336) 832-6682. This group is lead by a registered nurse and enables mothers to support other mothers.
Occasional feelings of anger and resentment toward the demands of the baby are normal and occur with most parents. But sometimes those feelings are so overwhelming that parents fear they may hurt their baby. If you should have this feeling or find you are having trouble responding to your baby’s needs, seek help immediately. If you experience these feelings, you need to take a break. It is helpful to call on a friend or relative who can care for your baby for a short time. Another way to cope is simply put the baby in a safe place, like a crib, and leave the room for a few minutes. Do not shake your baby. This can cause damage to your baby’s brain and even death. If you should have these stressful feelings, contact your healthcare provider. In North Carolina, there is a Safe Surrender law. This law states that a baby who is seven days old or younger may be surrendered to “any responsible adult” without legal consequences. A “responsible adult” may be an on-duty healthcare provider, law enforcement officer, social services worker or emergency medical services worker. Call 911 for assistance, if needed. We encourage all parents to look for and join in area parent education programs. There are programs available in the greater Greensboro area through Women’s Hospital and several United Way agencies, such as Family Service of the Piedmont and the Family Life Council.
Taking Care of Yourself Some things you can do to help adjust to your new life are: Rest – Get help with household responsibilities or let them go temporarily. Try to get extra rest during the day. Taking a nap while your baby rests can be very helpful. Leisure Time – Arrange for time away from your child/children for relaxation. This could include shopping, reading, time alone or a “date with Dad.”
Nutrition Pregnancy and the postpartum period offer a wonderful time in your life to promote healthy eating habits. During pregnancy, your food intake is essential to promote a healthy pregnancy. After delivery, your nutritional intake remains just as important. You need to consume a balanced, healthy diet in order to keep up your energy level and regain your strength. If you are breastfeeding, you should eat a balanced diet with 500 additional calories a day. If you are considering a diet plan, please discuss it with your doctor. Drink plenty of fluids. It is important to get enough fluids when you are breastfeeding. Drink about eight to 12 cups of water, juice or milk each day. Don’t force yourself to drink, but drink when you feel thirsty. Limit your caffeine intake, including sodas, to two or less a day. Caffeine may cause you to lose fluids, and it can make your baby fussy and restless. The daily food guide detailed on this page may be helpful to make sure you get enough to eat every day. Remember that variety and balance are very important. Make sure you eat a variety of foods every day, and try to balance your food choices between all of the food groups. Your diet should include: lean meats, eggs, milk products, vegetables, fruits, whole grain breads (such as wheat bread) and whole grain cereals (such as Total or Raisin Bran).
Food Group
Serving Size
Minimum Number of Servings per Day: Pregnant Lactating Non-Pregnant
Meats
3 ounces
2
2
2
Milk & Dairy Products
1 cup
4
4 - 5
4
Breads, Grains & Cereals
1 slice or ½ cup
5 - 6
6 - 8
4-5
Fruits & Vegetables
½ cup
2+
2+
2+
Fats
1 teaspoon
3
3
3
Fluids
1 cup
8 - 12
10 - 12
8 - 12
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Sexual Adjustment After Childbirth Sexual intercourse should not be resumed until bleeding stops. This indicates that the uterus has healed. Many mothers need more time than this to feel fully ready for intercourse – especially if an episiotomy or a cesarean section was necessary. Discuss this with your physician. Waiting until both partners feel ready and being especially gentle nurtures a loving relationship. Intercourse may be uncomfortable after childbirth. It can be normal for the vaginal opening or vaginal walls to be tender for six to nine months after childbirth. These things may help: • Sometimes the cause of pain is a snug episiotomy repair. While sitting in a tub of warm water, use your fingers to gently massage and stretch the vaginal opening. • There can be limited genital/vaginal secretions as the result of hormone changes. This means the woman’s genitals and vaginal walls remain dry during intercourse. This can limit pleasure for both partners and may be painful for the woman. Use a water-based lubricant such as K-Y Jelly, available in any drugstore, on both partners’ genitals. • Use positions for intercourse that avoid pressure on the site of an episiotomy repair. Examples of positions that may provide more comfort during penetration are the woman on top or lying on her side. The same may be true for women who have had a cesarean. • Taking a warm, relaxing bath before lovemaking and using loving, gentle foreplay creates a non-demanding atmosphere and helps both partners feel more ready for intercourse. Thinking of sex as giving and receiving pleasure also helps take the focus off intercourse as the only way for partners to give pleasure to one another. This is “lovemaking” and is something most new parents resume before they resume intercourse. • Birth Control or Family Planning - It is important to know that you can get pregnant in the first weeks after childbirth. If you want to prevent pregnancy, protect yourself. Before discharge from the hospital, talk with your physician about acceptable methods of birth control. If both partners learn about family planning choices, you will have more success in choosing a method that will work best for both of you.
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Post-Delivery Exercises Restoring good muscle tone is important to your recovery. Your abdomen may be soft and large after delivery, and you may want to begin an exercise program. The state of your health and whether you had a vaginal or cesarean birth will determine when and what type of exercise program you can start. Before discharge, talk with your physician about an appropriate exercise plan for you. Keep in mind that you must build up your exercise program gradually, according to your physical condition and tolerance.
Walking Walking is a safe and effective way to begin your exercise program, both for vaginal deliveries and cesarean births. Start out with short walks and gradually increase distance as your strength returns.
Headlifts Lie on your back with knees bent. Take a deep breath, then raise your head, exhaling as you do. Lower head slowly and inhale. Raise your head a little more each day, gradually working up to lifting your shoulder slightly. (Wait three to four weeks to do full curl-ups.) Do this 10 times per session, three times a day.
Kegel Exercises You can begin this exercise immediately after delivery. This exercise can be practiced anywhere. You may not feel yourself doing them at first. To do Kegels: Pull in abdominal muscles, squeeze buttocks together and firmly tense the muscles around your vagina and anus. Hold for five to 10 seconds; then slowly release the muscles and relax. (The exercise can also be explained as stopping the flow of urine midstream, but do not practice this way. This could lead to urinary tract infections.)
Pelvic Tilt Lie on your back, with your knees bent and your feet about 12 inches apart, soles flat on the floor. Inhale as you press the small of your back against the floor. Then exhale and relax. Repeat three or four times to start; increase gradually to 12 and then 24 repetitions.
Leg Slides Lie on your back with both legs flat on the floor. Slide your right foot, sole flat on the floor, back toward your buttocks. Keep the small of your back against the floor. Slide your leg back down. Repeat with left foot. Start with three to four per side and increase gradually to 12. After three to four weeks, move to a modified leg lift (lifting one leg at a time slightly off the floor and lowering it very slowly).
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Skin-to-Skin Our family-centered model of care focuses on the needs of the mother, infant and family. Research indicates babies who are held skin-to-skin and heart-to-heart adjust to their new environment much quicker. Whisking your baby away from you immediately after delivery is not our practice. Skin-to-skin closeness helps your newborn adjust his/her body temperature and blood sugar, and it gets breastfeeding off to a good start. Your baby will smell you, hear you, feel you, and be calmed and loved by you. Studies have shown that an infant who stays in the room with his or her mother will cry less, stay warmer and calmer, and startle less frequently. For first-time mothers, your hospital stay is a chance to practice hands-on baby care with a group of medical experts close by for assistance when needed. No matter how many books you read before delivery, you learn from direct care of your little one. With each diaper change or feeding, you become more confident as a parent. Nurses are part of the support team. The goal is for you and your family to leave the hospital more confident and comfortable with the care of your newborn. Keep cuddling your baby skin-to-skin after you leave the hospital. Your baby will stay warm and comfortable on your chest, and the benefits of bonding, soothing and breastfeeding likely continue well after birth. Skin-to-skin can help keep your baby interested in nursing if he’s sleepy. Dads can snuggle, too. Fathers and mothers who hold babies skin-to-skin help keep them calm and cozy. Skin-to-skin positioning is also used for comfort with painful procedures. This includes injections and heel sticks. It is preferred that the baby be skin-to-skin for 10 to 15 minutes before and 10 to 15 minutes after the stick. Skin-to-skin with breastfeeding also works well for pain control.
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Skin-to-Skin
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Caring for Baby In the Hospital Medications for the Baby During his or her hospital stay, your baby will receive the following medications: • Vitamin K: An injection of Vitamin K is given to prevent excessive bleeding. • Antibiotic eye medication: State law requires antibiotic eye medication to protect your baby from eye infections. Occasionally, the medicine causes redness, swelling and/or drainage. These symptoms usually disappear within a few days. Some parents worry that eye ointments may interfere with their baby’s ability to see. Research shows, however, that during the early weeks of life, an infant can see light and shapes and can detect movement, but distance vision remains quite blurry. • If skin-to-skin positioning is not available for a painful procedure, the baby can be given sucrose for pain control.
Vaccines for the Baby The first dose of the Hepatitis B Vaccine should be given to well newborns while in the hospital. This helps prevent transmission of the virus to the baby from mom. As of July 1994, all children are required by North Carolina law to have completed the Hepatitis B Vaccine Series before entering kindergarten. Hepatitis B is an infection of the liver caused by the Hepatitis B virus. The virus is found in body fluids, including blood, urine, vaginal secretions, saliva, semen and sweat. It is strong enough to survive for seven days in dried blood. This means that Hepatitis B is easier to “catch” than most people realize. You will be given a copy of the Center for Disease Control’s vaccine information sheets that you and your baby have been recommended to receive. Please talk with your pediatrician if you have questions about this information. Please note: Your doctor’s immunization schedule may vary due to individual circumstances.
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• Caring for Baby
Your Baby Will Have These Tests Blood Sugar This test may be done to determine the baby’s blood sugar level. The blood sample is collected from a needle prick on the baby’s heel.
Newborn Screens Most newborns are born healthy and normal, however, there are some health problems that may not be detected on a routine exam by your baby’s physician. This is why blood tests are used to screen newborns for these problems. A filter paper blood spot sample is required by state law to be submitted to the NC State Laboratory of Public Health for each infant born in NC. The sample is tested for conditions that may cause mental retardation or death, if untreated. To prevent the effects of disease, the sample is drawn at Women’s Hospital after 24 hours of age. Conditions tested include metabolic diseases such as Phenylketonuria (PKU) and 34 other known disorders. • Amino acid, organic acid and fatty acid conditions: These tests also include detection of a condition called PKU. • Galactosemia: This test determines a high level of galactose in the blood caused by the congenital absence of an enzyme that changes galactose into glucose. • Thyroid: This test determines if the thyroid is working properly. • Sickle Cell: This test determines the presence of sickle cells that may cause severe, chronic anemia (insufficient healthy red blood cells). • Congenital Adrenal Hyperplasia: This test screens for an inherited disorder that affects the production of the hormone 17-hydroxy-progesterone. • Cystic Fibrosis: This test screens for an inherited disorder that involves respiratory complications and impaired growth. • Biotinidase: This test screens for a condition that affects the body’s ability to recycle the vitamin biotin.
Universal Hearing Screening This test is performed to check for the possibility of undetected hearing loss. The hearing test lets us know if your baby will need special help with speech and language development. Please talk with your baby’s doctor about the test results.
Congenital Heart Screening After your baby is 24 hours old, your nurse will perform a congenital heart screening. Your nurse will place an oxygen sensor on the baby’s right hand and then on either foot for a reading. This tool measures the percentage of oxygen in your baby’s blood. It is not painful. Pulse oxygen screening does not detect all cases of congenital heart disease.
Jaundice New red blood cells are continually being created while old red blood cells are being broken down and removed from the body. Bilirubin is a by-product that occurs when old red blood cells are destroyed. The liver normally helps break down bilirubin so it can be excreted in the baby’s bowel movement. The liver of a newborn baby may not be fully mature, which prevents the baby’s body from getting rid of the bilirubin. This buildup of bilirubin in the baby’s blood stream results in the yellow color of the skin that is known as jaundice. This yellowing is usually seen first in the face and then in the chest, abdomen, arms and legs. This type of jaundice is seen in approximately 50 percent of all term babies and an even greater number of premature babies. Jaundice also may occur when the baby’s blood type and the mother’s blood type are different. In this situation, the mother’s body may produce an antibody that breaks down the baby’s red blood cells. This causes an increased level of bilirubin in the newborn’s blood. Jaundice levels usually peak by the third day of life and then gradually decrease. A test is performed to determine if there is an elevated bilirubin level. Frequent feedings may help prevent jaundice by increasing the number of bowel movements. The American Academy of Pediatrics recommends that breastfed babies be fed at least eight to 12 times a day during the first days of life. If the bilirubin level continues to rise, your pediatrician may order “phototherapy” for the baby. This special kind of fluorescent light helps the baby breakdown the bilirubin so it can be passed out of the body. Bilirubin levels will be obtained one or more times daily until the levels decrease and stabilize. Although this condition is common, high levels of bilirubin can damage the baby’s nervous system. Notify your pediatrician immediately if your baby’s skin becomes more yellow or if you notice a yellowing in the whites of the baby’s eyes. The American Academy of Pediatrics recommends that you schedule an appointment with your baby’s pediatrician when the baby is 3 to 5 days old to monitor for jaundice.
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Caring for Baby - At Home Diaper Changes
When to Call Your Baby’s Doctor • Refusing to eat. Refusing two feedings in a row is not normal for a healthy baby. • Foul-smelling discharge from umbilical cord or circumcision. This may represent an infection. • Drastic change in the baby’s behavior. Constant crying or fussiness in a normally calm baby may be an early sign of illness. A baby who is much sleepier than usual also may be sick. • Fever. Call your pediatrician for a temperature greater than 100.4 degrees rectally. (See Taking Your Baby’s Temperature.) • Vomiting. Vomiting is forceful “throwing-up.” • Diarrhea. Diarrhea is frequent, watery stools that may be any color. • Frequent cough with or without nasal drainage. This may represent respiratory illness. • Unusual rash. This may represent an infection. In case of emergency, take your baby to the Children’s Emergency Department at The Moses H. Cone Memorial Hospital. Women’s Hospital and Wesley Long Hospital do not have facilities for pediatric emergencies.
Burping Burp your baby frequently after every ½ to 1 ounce if bottlefeeding or when switching sides if breastfeeding. You may hold your baby in a sitting position or place him on your shoulder and pat him on the back to encourage burping. As your baby gets older, he will need to be burped less often.
Bowel/Bladder Habits Refer to the table on page 24 for normal bowel and bladder habits. Breastfeeding babies usually have yellow, soft or semi-liquid bowel movements that may look like seeds. They may have a bowel movement after each breastfeeding. Bottlefeeding babies usually have pale yellow to light brown bowel movements that are firmer in consistency with a stronger odor. They may vary in frequency from once every other day to four to seven times a day. Constipated stools look like hard pellets. Your baby may “strain” with bowel movements, but this does not mean he or she is constipated. Call your pediatrician if there is blood or mucus in the bowel movement, if the baby has diarrhea (more than the normal number of stools) or if the stool becomes hard.
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• Caring for Baby
Your baby’s diaper should be changed when wet or soiled unless the baby is sleeping. Gather supplies before beginning the diaper change. Never leave your baby alone when changing his diaper. Do not use diaper wipes if your son has a circumcision that has not healed or on your baby if he/she has a diaper rash. If you have a diaper-changing table or change your baby on a bed, always stand close to prevent a fall. Clean your baby’s genital region after The use of every bowel movement and pat dry. powder is not For females, separate the labia and recommended wash gently from front to back. If because of the your baby gets diaper rash easily, let risk of harming him or her air-dry without a diaper. You can apply petroleum jelly to dry the baby’s lungs. skin if your child has a diaper rash. If the rash does not clear up after a few days, you should contact your pediatrician. Cornstarch promotes growth of yeast and is not recommended.
Umbilical Cord Care Be sure to keep your newborn’s umbilical cord dry and clean. Use a clean cloth and water only. Gently lift the cord to clean around where the cord attaches to the skin. Be sure to dry the area gently afterward. In order to promote drying, fold the diaper below the cord. Never use lotions, powders, petroleum jelly or creams on or around the cord area. The cord usually falls off in one to three weeks, and, at that time, there may be a small amount of bleeding; this is normal. Call your pediatrician if there is yellow discharge, foul smell or redness present around the umbilical area.
Circumcision Care If your baby boy has been circumcised, gently clean the penis with plain water until the circumcision is healed. Healing usually takes from seven to 10 days. During this time, it is normal for a sticky film to develop in the healing area. Petroleum jelly on the circumcision area will prevent the penis from sticking to the diaper and make your baby more comfortable. Your pediatrician will show you how to gently pull back the foreskin after the circumcision is healed. After the circumcision has healed, you may wash your baby’s genitals with mild soap and water. Bleeding, foul odor or pus at the circumcision site should be reported to your pediatrician immediately.
Dressing Your Baby The amount of clothing needed depends on the weather. Your baby will probably be comfortable in the same number of layers you are wearing. The hands and feet may feel cool most of the time. For babies less than five to six pounds, you may need to add another layer of clothing to maintain a normal temperature. Do not overdress your baby.
Bathing
Facts You Should Know About Taking Temperature A digital thermometer is recommended. It should be cleaned according to the manufacturer’s directions.
Make sure the room is 70 degrees and free of drafts so that your baby is not chilled while bathing. Assemble all items needed and place them within easy reach before the bath. Until the umbilical cord falls off, your baby should have sponge baths only to keep the cord dry. After the cord falls off, you may bathe your baby in a sink, basin or tub. Use a towel beneath your baby to keep him or her from slipping.
Oral temperature
A mild soap is recommended for bathing the body. Wash your baby’s face with clean water and a washcloth. Begin with the inner corner of one eye, wiping to the outside corner. Repeat with a clean area of the washcloth on the other eye. Then finish washing the rest of the face. Don’t forget the neck area. Shampoo the hair two or three times a week, using a special brush with soft bristles to massage the scalp. This will help prevent a buildup of dead skin and oil that causes a scalp condition called “cradle cap” (a yellowish scalp crust). Do not put oil on the scalp unless your pediatrician tells you to do so. Don’t be afraid to wash over the fontanel or “soft spot” on your baby’s head.
Underarm temperature
Never leave the baby alone in water — not even for a second!
Nail Care Your baby’s nails are soft and can be gently filed. This is more easily done with the baby asleep. Nail clippers and scissors are not recommended until the baby gets older. Ask your baby’s doctor when to begin using scissors or clippers.
Taking Your Baby’s Temperature Digital thermometers are recommended because of the risk of exposure to mercury if a thermometer breaks. When taking the baby’s temperature, leave the thermometer in place for the length of time recommended by the manufacturer while holding the infant still. (See additional information at right.)
Bulb Syringe The bulb syringe is used to keep the nose and mouth clear of mucus. Always compress the bulb with your hand before you place the bulb syringe tip in your baby’s nose or cheek. While you are in the hospital, keep the bulb syringe in the corner of the crib so it is available in case of choking.
This method is not used with babies.
Ear temperature Digital ear thermometers are not recommended for babies younger than 6 months old. Normal range is 97.7 to 99.5 degrees Fahrenheit. This method is preferable for an uncooperative child of any age or for one younger than 4. • Be sure armpit is dry and clothing is not between the arm and chest. • Place tip of thermometer high in the child’s armpit. • Hold the arm snugly against the body for the length of time recommended by the manufacturer.
Rectal temperature Normal range is 98 to 100.4 degrees Fahrenheit. • Lubricate thermometer bulb with petroleum jelly. • Place infant on his stomach and spread buttocks so anus is easily seen. • Slowly and gently insert the tip of thermometer into anus slightly less than one inch. The tip will no longer be seen. • Hold thermometer carefully in place for the length of time recommended by the manufacturer.
When you get home, wash the bulb syringe inside and out with soapy water, rinse afterward and sterilize it in boiling water for 10 minutes. Repeat the cleaning and sterilizing process every day you use the bulb syringe. It is recommended that you keep a bulb syringe in your baby’s crib and in your diaper bag at all times.
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• 19
Feeding Your Baby Breast milk provides complete nourishment for babies up to 6 months of age. The American Academy of Pediatrics recommends that an infant continue to breastfeed exclusively up to six months without supplemental water, formula or other foods. It is also recommended that the infant breastfeed up to one year of life or longer. Extensive research documents the advantages for the infants, mothers, families and our society when infants breastfeed.
Benefits for the baby: • Fewer cases of diarrhea, respiratory tract infections, urinary tract infections and ear infections. • Reduced chance of Sudden Infant Death Syndrome (SIDS). • Decreased risk of allergies and asthma. • Decreased incidence of insulin-dependent diabetes. • Decreased incidence of obesity.
Benefits for the mother: • • • • •
Enhanced relationship with baby – “bonding.” Faster return to pre-pregnancy weight. Less risk of pre-menopausal breast cancer. Decreased risk of uterine cancer. Fewer hip fractures caused by osteoporosis.
Benefits for the family: • More convenient – no need to warm milk or worry how much the baby is drinking. • Less cost (fewer sick visits to the pediatrician and no formula costs).
Benefits to the community: • Decreased healthcare costs. • Decreased employee absence and associated loss of family income. • More environmentally friendly.
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• Caring for Baby
Getting Started Breastfeeding gives you the assurance of giving your baby the very best. Relax and enjoy these special times with your new baby. Learning to nurse takes time, practice and patience. So, don’t get discouraged. YOU CAN DO IT! You should start nursing your baby as soon as possible after delivery and hold your baby skin-to-skin at least every 1½ to 3 hours thereafter. These frequent feedings will establish your milk supply. Ask your nurses to help you if you are having trouble getting started or at any time during your hospital stay. Don’t hesitate to call the Lactation Consultation Services at Women’s Hospital after you go home. If you have any questions or problems, call (336) 832-6860. Newborns sleep a lot during the first 24 to 36 hours. Look for feeding cues (see examples below). If there are no cues in three hours, place your baby skin-to-skin. This will help you get to know your baby’s needs and respond to feeding cues. Nurse frequently, 10 to 20 minutes or more on each breast. Your baby should nurse about eight to 12 times in 24 hours. Count the time from beginning of one feeding to the beginning of the next. There may be times that your baby wants to “cluster feed” with small breaks between each feeding. Afterward, your baby will usually have a longer sleep stretch. This is normal and usually occurs right before your milk production begins to come in and during a growth spurt. Newborn feeding cues let you know that it is time to feed your baby: • Sucking movements of the mouth and tongue. • Soft sounds. • Hand-to-mouth movements (avoid wrapping your baby’s arms in blankets). • Rapid eye movements under the eyelids. • Body movements. • Crying is a late hunger cue. Don’t wait for your baby to cry before you feed your baby.
All mothers need to know how to hand express their milk. Gently massage the breast, placing your thumb and index finger about one to two inches behind the nipple making a “C” or “U” shape around your breast. Gently push back toward the chest wall, compressing the breast without causing discomfort. Then, release the breast tissue and repeat several times, switching breasts until milk begins to flow. Ask your nurse to help you with hand expression. Make sure you collect the milk in a clean container.
Why hand expression is important. • Easy way to express colostrum. • Increases your confidence because you are able to see early breast milk. • Softens your breast to assist your baby with latching. • Taste may entice your baby to latch. • Provides additional calories. • Increases your milk supply. • Cost-free way to remove milk. Avoid supplementing with formula or using a bottle or pacifier, unless it is medically necessary, for at least three to four weeks. This will ensure that you and your baby are getting off to a good start. Supplementing with formula or using artificial nipples (bottlefeeding) can lead to nipple confusion as well as decreased milk supply.
Back to Sleep
Several studies show the use of pacifiers may reduce the risk of SIDS. For breastfed infants, don’t give your baby a pacifier until one month of age to ensure that breastfeeding is firmly established.*
Tummy Time
Most babies lose weight in the first few days. Be sure to check to see what your baby’s weight is just before leaving the hospital. As your milk volume increases, your baby will begin to gain again. When gaining appropriately, your baby will be back to birth weight by 2 weeks of age and will gain four to eight ounces each week. * American Academy of Pediatrics (AAP)
WARNING SIGNS
Call your baby’s doctor or a Lactation Consultant if: • Your baby refuses to feed more than two consecutive feedings. • Your baby has fewer than six wet diapers each day (from the fourth day on). • Your baby has fewer than two to three yellow liquid stools each day (by the fourth day and through four weeks). • Your baby has not had a wet or a stool diaper in 24 hours. • Your milk is “in,” but you don’t hear gulping or swallowing when the baby breastfeeds. • Your nipples are painful throughout the feeding. • Your breasts have painful areas or lumps. • Your baby is routinely breastfeeding fewer than eight times in 24 hours (from 3 to 4 days of age). • Your baby seems to be breastfeeding all the time and never seems to be content after feedings. • You don’t feel as though your milk has “come in” by the fifth day. • Your baby hasn’t regained birth weight by 10 days to two weeks or is gaining less than ½ to 1 ounce per day.
Place your baby on his back to go to sleep.
Your child may be placed on his or her stomach while awake for “tummy time.” You can begin tummy time when your child is 2 to 3 weeks old by placing him on his stomach across your lap or chest to help him get used to this position. Your child can have tummy time several times a day. An adult should always stay with and watch the child during tummy time. This position helps your child’s neck and shoulder muscles become stronger. Your child should always be placed on his or her back to sleep. Allowing tummy time during the day helps to prevent flattening of the back of the head. You also can help avoid this flattening by alternating the position of your child’s head when going to sleep. For instance, with your child lying on his back, you may turn his head toward the right tonight and toward the left tomorrow night. Limiting the amount of time your child spends in swings, car seats or bouncy seats also helps prevent flattening of the back of the head.
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• 21
Breastfeeding Positions Under the Arm or Football This is the easiest position when learning to breastfeed. Use a pillow to support your baby at breast-level. Hold your baby’s back and shoulders in the palm of your hand. Place your baby’s bottom at the back of the chair. Tuck your baby under your arm, lining up your baby’s lips with your nipple. Hold your breast until your baby nurses easily.
Side Lying Lie on your side with a pillow at your back and lay your baby so you are facing each other. To start, prop yourself up on your elbow and support your breast with the opposite hand. Pull your baby close to you, lining up your baby’s mouth with your nipple. Once your baby is nursing well, lie down.
Cradling Cradle your baby in the arm closest to the breast, with your baby’s head in the crook of your arm. Have your baby’s body facing you, tummy-to-tummy. Use your opposite hand to support the breast. This is for an older baby.
Across the Lap Lay your baby on pillows across your lap. Turn your baby facing you, tummy-to-tummy. Reach across your lap to support your baby’s back and shoulders with the palm of your hand. Support your breast from underneath to guide it into your baby’s mouth.
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• Caring for Baby
Breastfeeding Tips • Use lots of pillows or folded blankets to make you and your baby comfortable and help with latch-on. • Before your baby latches on, gently massage your breasts to make the milk release more easily and soften your breasts. Express a few drops of milk before nursing to let your baby taste the milk. • Gently support the breast with a C-hold (four fingers underneath the breast and thumb on top). This will help your baby get and keep enough of the dark area around the nipple in his mouth and ensure a deep latch. • Hold your breast throughout the feeding so it does not slide out of your baby’s mouth. • To latch on, touch your baby’s lips with your nipple until your baby’s mouth opens wide and the tongue is down. Pull your baby quickly onto the breast. • If nursing hurts after the first minute or so, break the suction with your finger between your baby’s gums and take the baby off. Reposition if needed and start again. Make sure your baby’s mouth is wide open (like a yawn) and the tongue is down before pulling your baby close. • You should feel a tug on your nipple as your baby nurses, not a pinch or pain throughout the feeding. Most of the time sore nipples occur when the baby is not latched on well. Be sure to take enough time to get your baby latched on correctly. Call a Lactation Consultant for help if nursing still feels painful. • Allow your baby to complete the feeding on one side, softening the breast. Wake your baby, if needed, and offer the other breast if your baby is interested. • Breastfeeding is usually a comfortable, pleasant time for both you and your baby. However, some new mothers experience tender nipples for the first few days of nursing. This usually goes away within a week or so. • To prevent nipple soreness, start with correct positioning and latch-on. (Refer to diagrams below for tips on positioning and latch-on procedures.)
Incorrect Latch On
Correct Latch On
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Other measures to prevent nipple soreness:
This fluid is in addition to the accumulation of milk. Before breastfeeding, moist heat and massage may be helpful. After breastfeeding, ice packs may help reduce swelling. If needed, you may pump for relief before and after feeding. The best practice is to breastfeed frequently with a good latch to relieve discomfort and assist in establishing a sufficient milk supply.
• Breastfeed your baby whenever you observe feeding cues. If your baby does not nurse frequently, he/she may become frantic. This increases the possibility of over-vigorous nursing and may cause nipple soreness. • Always release suction before you remove your baby from the breast. Do this by placing a clean finger in the side of your baby’s mouth or between the gums. • After a feeding, express a little colostrum or breast milk onto the nipple and areola. Massage it into the nipple so it will absorb into the area. Then air-dry the nipples. • Do not use soap or alcohol on your breasts. Water is all that is needed to clean your breasts when you shower or bathe.
Engorgement becomes more severe if your breasts become tight, shiny, very hard and painful to touch. You may develop a low-grade fever, and it may be difficult for your baby to nurse effectively. If this occurs, follow the instructions below. • Apply cold compresses, ice packs or packages of frozen vegetables (such as peas) for 20 minutes to the breast, to reduce swelling and pain. Do this before and after you breastfeed. (Moist heat just before feeding may help some mothers with milk letdown.) • If needed, express or pump for a few minutes to soften the areola before feeding. Wear breast shells or do reverse pressure softening. This technique will push the fluid away from the nipple and make it easier for your baby to latch on. • If your baby will not latch onto the breast, pump for 15 to 20 minutes and give the pumped breastmilk to the baby using another feeding method. • If unable to express milk or latch your baby on, call Lactation Consultation Services at (336) 832-6860. • Take mild analgesics for pain. Products containing aspirin are not recommended for nursing mothers. • If you develop a high fever, body aches, chills, red streak(s) on the breast, call your healthcare provider.
If your breasts become sore: • Check positioning carefully. • Check your baby’s latch. • Pump breasts for three to five minutes before feeding to initiate milk flow. • Alternate nursing positions. • Use pain relievers as prescribed by your doctor. Products containing aspirin are not recommended for nursing mothers. • Use lanolin to soothe the soreness if you are not allergic to wool. • Use breast shells to increase circulation of air and healing. • Contact a Lactation Consultant for assistance. During your first few days at home, your breasts will begin to feel fuller and firmer. This is considered normal engorgement that is caused by increased flow of blood and fluid in the breast, which leads to the swelling of surrounding tissue.
Feeding Issues
How to tell if your breastfed baby is getting enough to eat:
If, at any time after you leave the hospital, you feel that your baby is not feeding properly, having fewer than six wet diapers in a 24-hour period, you should contact your baby’s pediatrician.
First 6 Weeks
Day 1
1-2
1
Your baby should also gain weight.
Day 2
2-3
2
Your baby needs to be seen by a healthcare provider for a weight check two to three days after discharge. It is your responsibility to contact the doctor to schedule office visits. If you are having problems with breastfeeding, check with Women’s Hospital Lactation Consultation Services at (336) 832-6860.
Day 3
3-4
At least 3
Day 4
4-5
At least 3
Day 5
4-5
At least 3
Days 6 to 45
6 or more
At least 3
After 6 weeks
6 or more
May decrease
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• Caring for Baby
Wet Diapers Dirty Diapers Per Day Per Day
Breast Milk Storage Guidelines Room Refrigerator Home -20° C Temperature Freezer Freezer
Freshly Expressed 6-8 hours 5 days 3-6 months Breast Milk
Thawed Breast Milk Do not Up to (Previously frozen and store 24 hours thawed in the refrigerator)
Do not refreeze thawed milk
Up to 12 months
Do not refreeze thawed milk
Defrosting Tips To thaw frozen breast milk: • Use oldest milk first. • Place sealed container in a bowl of warm water for 20 minutes or place under warm running water. Don’t use hot water because this can destroy some of the protective properties of the milk. • Place milk in the refrigerator the night before you will use it. Refrigerator defrosting takes eight to 12 hours.
Additional Safety Tips • Thawed refrigerated milk is safe for 24 hours, if kept refrigerated. Do not refreeze. • Sometimes babies do not completely finish bottles of breast milk. Any bottles not finished within 1 hour should be discarded. • The cream in breast milk may rise to the top of the container. The separation of the cream is not a problem. Gently shake the container to mix the layers together. • CAUTION: Never microwave breast milk. Microwaving can cause severe burns to the baby’s mouth from hot spots that develop in the milk during microwaving. Microwaving also can change the composition of breast milk.
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Classes to Take
After Your Baby’s Birth
To offer parents more information on parenting topics and caring for their baby, we have expanded our childbirth education courses to include a variety of classes. Most classes are held at The Education Center at Women’s Hospital, 801 Green Valley Road, Greensboro. Visit conehealth.com/classes to register.
Baby and Me These classes are designed to give new parents the support needed to get off to a great start. Moms discuss their new roles as parents, infant care, feeding, calming a fussy baby and other parenting topics. Moms will learn ways to help their babies reach their highest potential. Topics include growth and development, infant massage, special activities to enjoy with your baby, sleep issues, adding solid food to your baby’s menu, fire safety, traveling with your baby, and quick, easy meals for your family. This group is for parents with infants from 3 weeks to crawling. A nurse specially trained in pregnancy and parenting issues leads the sessions. Babies are welcome. There is a small fee to attend.
Infant and Child CPR This class teaches participants rescue techniques for infants and children in the event of choking, breathing problems and/or cardiac arrest. Register online.
Feelings After Birth Support Group This support group gives new mothers an opportunity to experience support and encouragement from other mothers, learn about postpartum anxiety, and develop skills to better cope with new responsibilities. You may attend anytime after your baby’s birth. Meets every Tuesday at 10 a.m.
Breastfeeding Support Group Led by a Lactation Consultant, this group meets at 11 a.m. every Tuesday. Have questions about breastfeeding? Come for support and sharing. Please call (336) 832-6682 for more information on any of these courses.
Fit For Two Pre- and postnatal fitness instructors help you tone up and exercise safely, both before and after birth. Check online to view the various classes offered (yoga, pilates) and times. These classes are intended to: • Reduce stress. • Restore muscle tone. • Reduce discomfort. • Enhance circulation. These classes are also an opportunity to share with other moms. Infants are welcome. For additional information call (336) 832-6682.
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• Classes & Support
N
O
T
E
S
Notes
• 27
Index 17-hydroxy-progesterone ...................... 16
Dressing Your Baby................................. 19
Newborn Screens.................................... 16
Antibiotic Eye Medication....................... 16
Emergency, In case of............................... 4
Nipple Soreness................................23, 24
Baby and Me Class................................. 26
Emotional Adjustment After Birth.......... 10
Nutrition for Mother............................... 11
Baby Blues.............................................. 10
Episiotomy Care........................................ 8
Pacifier Use............................................. 21
Baby Safe Carrier.................................. 3, 5
Exercises, Post-delivery............................ 13
Pelvic Tilt, Exercises After Childbirth........ 13
Bathing Your Baby.................................. 19
Expressing Milk by Hand......................... 20
Period of Purple Crying............................. 7
Bilirubin................................................... 17
Family Planning After Childbirth............. 12
Pertussis.................................................... 9
Biotinidase Test....................................... 16
Feeding Cues.......................................... 20
Phototherapy.......................................... 17
Birth Control After Childbirth................. 12
Feelings After Birth
PKU (Phenylketonuria)............................ 16
Bladder Care for Mother After Birth......... 8
Support Group..........................10, 26
Pneumonia Vaccine.................................. 9
Bladder Habits of Baby........................... 18
Fit for Two Class...................................... 26
Post-Delivery Exercises............................. 13
Bleeding, Post-delivery.............................. 9
Fontanel.................................................. 19
Postpartum Depression........................... 10
Blood Sugar Test for Baby....................... 16
Freshly Expressed Breast Milk, Storage.... 25
Pulse Oxygen Sensor .............................. 17
Bottlefeeding, Breast Care........................ 9
Galactose ............................................... 16
Rubella...................................................... 9
Bowel Care for Mother After Birth........... 8
Galactosemia.......................................... 16
Safe Sleeping...................................... 6, 21
Bowel Habits of Baby.............................. 18
Glucose................................................... 16
Safe Surrender Law................................. 11
Breast Milk Storage Guidelines............... 25
Hand Expressed Milk............................... 21
Secondhand Smoke, Dangers of.............. 5
Breastfeeding Benefits............................ 20
Headlifts, Exercises After Childbirth........ 13
Sexual Adjustment After Childbirth........ 12
Breastfeeding Positions........................... 22
Hearing Screening................................... 17
Sickle Cell................................................ 16
Breastfeeding Support Group................. 26
Hemorrhoid Care...................................... 8
Sitz Bath.................................................... 8
Breastfeeding Tips................................... 23
Hepatitis B Vaccine for Baby................... 16
Skin-to-Skin.................................14-15, 20
Breastfeeding, Breast Care........................ 9
Hepatitis B............................................... 16
Smoking Cessation Program..................... 5
Bulb Syringe............................................ 19
Hepatitis Vaccine....................................... 5
Smoking, Dangers of................................ 5
Burping Your Baby.................................. 18
ID Bracelets............................................... 3
Soft Spot................................................. 19
Caffeine.................................................. 11
Incision Care after Cesarean Birth............. 8
Sucrose for Baby..................................... 16
Cesarean Birth.......................................... 8
Infant and Child CPR Class..................... 26
Sudden Infant Death
Circumcision Care................................... 18
Infant Security System............................... 3
Classes to Take After Childbirth.............. 26
Jaundice.................................................. 17
Tdap for Mother....................................... 9
Cluster Feeding....................................... 20
Kegel Exercises After Childbirth.............. 13
Temperature, Taking Your Baby’s............ 19
Colostrum.....................................9, 21, 24
Lactation Consultant,
Thawed Breast Milk, Storage.................. 25
Congenital Adrenal Hyperplasia............. 16
When to Call.......................21, 23, 24
Thyroid.................................................... 16
Congenital Heart Screening.................... 17
Latch On................................................. 23
Tummy Time........................................... 21
Cradle Cap.............................................. 19
Leg Slides, Exercises After Childbirth....... 13
Umbilical Cord Care................................ 18
Cramping, Post-delivery ........................... 9
Measles..................................................... 9
Vaccines for Baby.................................... 16
Crying....................................................... 7
Medications for Baby.............................. 16
Vaccines for Mother.................................. 9
Cystic Fibrosis Test................................... 16
Medications for Mom After Birth............. 9
Vaginal Birth............................................. 8
Defrosting Tips for
Menstrual Period, Return of...................... 9
Vaginal Bleeding, Post-delivery ................ 9
Expressed Breast Milk...................... 25
MMR Vaccine............................................ 9
Visitation Guidelines................................. 4
Diaper Changes...................................... 18
Mucus .................................................... 19
Vitamin K................................................ 16
Diaper Changes,
Mumps..................................................... 9
Walking, Exercises After Childbirth......... 13
Nail Care for Baby................................... 19
Weight Gain for Baby.......................21, 24
28
How Many to Expect....................... 24
Syndrome (SIDS)......................5, 6, 21
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