babywise education
important information about your recovery and the care of your infant
during your stay While You are in the Hospital
Education and Support
Welcome to the Mother/Baby Unit at Providence Health & Services. Our nursing team will be caring for both you and your baby. In our short time together, we want to provide you with the information you need for a quick recovery as well as get you started on the care and feeding of your new infant.
The Newborn Channel is available for 24-hour viewing on the following channels:
Your baby will be kept with you in your room for as much of your stay as possible. This allows you the opportunity to observe and participate in your infant’s care. You and your nurse will work together to plan your baby’s feeding routines and daily schedule.
Visiting Guidelines • Your partner is not considered a visitor and may be with the mother and baby at all times.
• Channel 10 in English (Providence Holy Cross) • Channel 28 in English (Providence Saint Joseph) • Channel 20 in Spanish (Providence Holy Cross) • Channel 17 in Spanish (Providence Saint Joseph) Some of the topics covered include breastfeeding, infant care, parenting and information about your recovery. A schedule of viewing times is available in your room.
What to Bring to the Hospital • Camera (still and/or video)
• Family and friends may visit from 11 a.m. to 8 p.m.
• Robe or nightgown
• Visitors under age 14 must be siblings of the newborn
• Toiletries: shampoo, toothbrush, toothpaste, lotion, soap, deodorant, hairbrush, makeup and any other essentials of beauty and hygiene
We recommend no more than two visitors at a time. • Make sure all visitors wash their hands before cuddling newborns. Those who are ill should refrain from visiting the hospital to protect the health of both the infant and the mother.
Your Baby’s Safety Please be aware that all Mother/Baby Unit staff wear pink color-coded photo identification badges that are prominently displayed. The photo should match the person wearing it. If you have questions or are uncertain about any staff members, press your call button, and someone from the nursing station will assist you. Never leave your baby unattended. If you plan to nap or use the restroom, alert your nurse so assistance can be provided, if necessary. Do not hesitate to question anyone who enters your room or asks about your baby, even those wearing a hospital uniform, lab coat or cover gown. Only staff with proper identification will transport your baby. Alert visitors not to release your baby to anyone. Providence Health & Services does not authorize any phone solicitation. Do not provide your telephone number, address or personal information to solicitors. Alert your nurse if you receive solicitation calls. If you wish to walk in the hallways with your baby, please place the baby in the bassinet and wheel him/her around slowly.
• Playing cards, books and other distractions • Going home outfit for you (remember you still may have a sizable abdomen) • Going home outfit for your new baby (including a receiving blanket and booties) • Infant car seat (required)
mother’s home care Going Home
Breast and Nipple Care
Vaginal Bleeding
Voiding and Bowel Function
Around 8 a.m. on the day of discharge, you’ll begin preparing to leave. Your nurse will give you a final check and review your going-home instructions with you. Many mothers have their family load the car while she dresses the baby. The infant safety rules you learned from your nurse and the Newborn Channel will be helpful to you as you begin your new life with baby.
Breasts should be kept clean by daily washing with warm water. Avoid excessive amounts of soap on your nipples. This could lead to dryness and cracking.
Color
It is normal to have an increased output of urine on the second and third day after delivery. We recommend you drink prune juice once daily and include a sufficient amount of whole grains, raw vegetables and fruit in your diet. Increasing fluids (juices or water) will also help soften the stool and avoid constipation.
IMPORTANT: Be sure to have an infant car seat properly fastened in your car before you leave the hospital.
Engorgement: breast fullness and tenderness usually begin 48 hours after delivery.
Blood may be dark red for the first one to three days, changing to light red from four to seven days, gradually diminishing to the consistency of whitish mucus for approximately one to six weeks. Discharge should gradually become less in amount and lighter in color.
If you are breastfeeding:
Amount
• Feed your baby frequently, using both breasts at each feeding. • Apply warm towels to your breasts just before feeding your infant, or take a warm shower. • Express some fluid from your breasts before nursing your baby. • Be sure the baby takes the whole nipple and areola area (dark area) in the mouth — this is MOST important. • Wear a firm, supportive bra. Expose your nipples to air as much as possible.
If you’re not breastfeeding your baby: • Wear a supportive sports bra until engorgement subsides. • Apply ice packs on each breast three to four times a day. • When showering, try to avoid having shower spray directly on breasts, to prevent stimulating milk production.
Flow may be heavy for the first two days. It is normal to expel several small clots. You may notice that when you stand after lying down for several hours or while breast feeding, there may be a slight gush of blood on your pad. This is to be expected, and is NO cause for alarm. If after three to four days your flow becomes bright red and increases in amount, it usually means you’ve been too active. Rest more! Call your physician if the bleeding continues to be heavy.
Perineal Care Cleanse the perineal area after each voiding and stool from front to back, in a direction away from the vagina, using warm tap water and the plastic peribottle provided to you in the hospital. Apply medication to the suture area if ordered by your physician.
Hygiene Only take showers for the first six weeks after birth. If recommended by your physician, sitz bath for perineal care is accepted (only six to eight inches of warm water in a tub for twenty minutes). Do not take full tub baths until advised by a physician.
Incisional Care for C-Section • You may gently wash over incision when showering. • Pat steristrips dry. DO NOT remove steristrips — they may fall off. This is okay. • Or, if you have staples, gently pat dry. A home health nurse or your doctor will remove them.
Activity • Follow your physician’s directions. You need to rest frequently and should take naps whenever possible. For the first 10 days, we recommend you concern yourself with your own physical needs and the care of your infant. The housework will wait. • Your friends and family who want to help may be asked to fix meals, do the laundry, vacuum and shop. Do not overtire yourself by entertaining those who simply want to pass the time.
Call Your Obstetrician if You Have: • Chills and fever. • Difficulty, pain or frequency of urination. • Heavy, bright red bleeding saturating more than two pads in an hour. • Fainting episodes. • Redness or severe pain in the breast area. • Drainage, excessive redness, swelling or pain at C-Section incision site. • Anxiety or depression — the blues — that lasts more than 2 weeks or is disabling.
infant’s home care Skin Care Because your baby’s skin does not normally need moisturizing, the routine use of lotion, oil, powder or cornstarch is not recommended. Your pediatrician can advise you in this regard. To avoid skin irritation and diaper rash, we suggest these helpful hints: • Frequent diaper changes are the best way to prevent diaper rash. • Clean the diaper area with a damp washcloth or towelette after each voiding and bowel movement. Wipe girls from front to back. • Most diaper rashes can be treated by keeping the irritated area clean and dry. Apply a thin layer of Desitin® or A&D Ointment® and occasionally leave the diaper off to expose skin to air. If the rash worsens or persists, notify your pediatrician. Neonatal acne is a very common facial rash in infants that is often described as pimples. This rash is frequently due to hormonal changes occurring in your baby. Wash the face with a soft cloth and warm water, and avoid applying soap, lotion, or powder. The rash will usually fade away on its own.
Bathing It is helpful to designate a regular time for bathing. The room should be warm and without drafts. • We recommend you wait until the cord falls off before giving your baby a tub bath. A sponge bath is fine in the meantime. It is not necessary to bathe your baby daily.
• Always keep a firm hold on baby after lathering. Soapy bodies are slippery! • NEVER LEAVE YOUR BABY ALONE DURING THE BATH, NOT EVEN FOR A SECOND.
You will need: • Bath towel • Soft washcloth or sponge • Diaper/Velcro diaper wrap • Pad • Infant’s clothes • Receiving blanket • Cotton balls • Mild baby soap and/or baby shampoo • Safety pins (if using a cloth diaper or diaper wrap)
When Bathing Baby • Wash your hands. • Fill a basin with about three inches of warm water, and test it for the correct temperature. • Arrange all necessary items (see list) within reach. • Undress baby and place on the pad. • Wash the face with a soft washcloth and plain water. • Wash eyes gently with a moist cotton ball. Start at the inner corner of the eyes and wipe toward the ears. Use a fresh cotton ball for each eye.
• Baby’s hair can be washed with a mild shampoo. Be sure to rinse off all the soap!
• Wash the outer part of the ear and nose with a moist washcloth or rolled cotton ball. Use clean cotton for each ear. DO NOT USE COTTON SWABS INSIDE BABY’S EARS.
• Avoid using cotton swabs to clean nose and ears. Remember, your baby will not have much contact with dirt until the creeping and walking stages.
• Clean in the skin folds and between fingers and toes. Rinse off the soap with a wet washcloth and dry with a soft towel.
• When your baby is ready for a bath, consider using a plastic tub, bathinette or bath table. • You may prefer to use the sink for convenience. Scrub and rinse it well before use. • Work at a comfortable level to avoid back strain.
Also, please follow these safety tips: • Gather all the things you need BEFORE you start giving the bath (see below). • Temperature of the room should be 75° to 80° F to keep your baby from chilling. • Bath water should be slightly above 100° F to prevent chilling or burning. If you do not have a bath thermometer, test the water with your elbow — it should feel warm, not hot.
• If your baby is a boy, make sure all the folds and wrinkles of the genitals are thoroughly cleansed after bowel movements and with diaper changes. The uncircumcised penis requires no extra cleaning — just wash, rinse and dry it, along with the rest of the baby’s bottom. DO NOT retract (pull back) the skin that is over the head of the penis. In a newborn, the foreskin is almost always attached to the end of the penis. Separation will evolve over time. Forcing back the foreskin may harm the penis, causing pain or bleeding. Most foreskins are retractable by age five. • If your baby is a girl, spread the fold of the genitals apart. Wash gently, front to back, with soapy water. Rinse and dry. • Wrap baby in a towel, leaving the head exposed. • Pick up baby. Support the head in your hand and the back with your forearm. Rest baby’s bottom on your hip. Holding your infant this way gives a sense of security. Wet baby’s hair with water and then make a soapy lather with your hands. Apply a small amount of lather to the head, including the soft spot. Rub gently in a circular motion. Hold baby’s head over the basin and rinse off the soap with water, using your hands or a wet washcloth. When all the soap is gone, pat the head gently with a towel to dry.
After the Bath Dress baby and brush hair. Put your baby in a safe place and THEN clean the basin and put all items away. Clean baby’s nails and trim them as needed. Nails should be kept short to prevent facial scratches (see Nail Care).
Special Scalp Care If your baby’s scalp becomes dry, scaly or dirty looking, apply baby oil after shampooing the hair. Leave the oil on until the next day and then shampoo it off. Brush hair and scalp well enough to remove any old skin. If you follow this procedure several times and the scalp still does not look normal to you, you may want to seek advise from your pediatrician.
Cord Care Your baby’s cord usually will fall off after 10-14 days. Until it does, observe the base of the cord with each diaper change. Fold the diaper down so the cord stump is exposed to air. A slight amount of discharge can be expected until healing is complete. Notify your pediatrician if bright bleeding, redness or a foul-smelling discharge occurs. You might see a few drops of blood a day or two before the cord falls off.
infant’s home care Circumcision Care
Nail Care
Caring for your son’s circumcision is quite simple. Wash your hands. The glans, or head of the penis, will appear red in color for several days. This will fade gradually. Within the first couple of days during healing, you may notice a yellowish, scab-like coating. This is a normal part of healing. Clean the penis with plain water only until healing is complete.
Cut baby’s nails when infant is asleep. Use small scissors, nail clippers or an infant emery board and avoid cutting the nails too short.
Apply Vaseline® to the penis with each diaper change the first three to four days. After this length of time, the circumcision usually is healed.
Voiding The newborn normally wets six or more diapers in a 24-hour period after the milk is established. Notify your pediatrician if your baby does not void after discharge from the hospital.
Diaper Care
Bowel Movements
Cloth diapers are the least expensive choice. You might want to consider using a diaper service for the first few weeks to conserve your energy, or friends may want to provide this service for you. Disposable diapers cost more, but can be a convenience.
Stools will vary in consistency and frequency depending on whether your baby is breast or bottle-fed. After two months, breastfed babies may have stools as often as after every feeding or as seldom as every few days. The stools will appear yellow in color and be very soft to runny in consistency. Bottle-fed babies will have stools as often as every feeding to once or twice a day. The stools usually appear yellowish or greenish in color and are soft to slightly formed in consistency. If the infant appears to be straining excessively or has stools with the consistency of small pellets, your baby is constipated. Call your pediatrician’s office for further advice.
If cloth diapers are used, we recommend: • A supply of four to six dozen. • A pail with a lid for soaking soiled diapers. To avoid bacteria development, add one to two tablespoons of Borax to each pail of water, depending on its size. • Launder diapers as needed.
CALL YOUR PEDIATRICIAN IF YOUR BABY: • Has an elevated temperature. • Vomits (not spitting-up) or refuses several feedings in a row. • Has an unusual rash (see Skin Care). • Is listless. • Has loose, watery, foul-smelling stools more than three times in a row. • Has jerky or convulsive movement.
• Consider using diaper liners.
Sleeping
• Cries constantly for no apparent reason.
• When washing the diapers, use a mild soap and be sure your washing machine has a-three-rinse cycle.
Your baby should be placed on its back with its head to the side. Never leave your baby on its stomach unless you are present. Babies normally sleep two to three hours at a time during the first month of life.
• Has an increasing yellow color to the skin.
Apply diapers in this manner: • Fold for double thickness at the front for a boy and double thickness at the back for a girl. • If using cloth diapers, stick the pin in horizontally, from front to back. Diaper pins can be applied more easily if they are stuck in a bar of soap before using. • Never leave open diaper pins where they can cause accidents. Get in a habit of closing the pins immediately after removing them. • One-piece Velcro® diaper wraps are available.
Clothing Your baby’s clothing needs are modest. For the usual newborn, three to five long-sleeved shirts (overlap-type styles with snaps) are good for starters. Knitted gowns with ties or snaps are even better as they eliminate the need for socks or booties. Always wash clothing and blankets before using on baby. Dress your infant according to the temperature of the day. Don’t overdress; if you do not need a sweater, neither does your baby.
Temperature Taking • Take off enough of your baby’s clothing so that you can easily slip the bulb end of the thermometer into the armpit. Press the arm closely against the side and keep it there for at least three minutes. • Read the degree of temperature. • Normal armpit temperature is 97.5° to 99.5° F. Notify your pediatrician if your baby has a temperature more than 100° F in the first two months of life.
your baby & jaundice Your Baby & Jaundice If you are like most parents, you have done a thorough inspection of your new family member. If you have noticed that your baby’s skin appears a bit yellow, don’t be alarmed. This yellow color is fairly common among newborn babies; it is called jaundice. The following information was developed to help you understand about jaundice and to explain the care your doctor believes is important for the treatment of your baby. Most jaundice in newborn babies is NOT serious. In the majority of cases, it disappears after a few days, usually without any special treatment. Once the jaundice disappears, medical science has discovered NO evidence that it will appear again or have any lasting effects on your baby. If your baby has jaundice, try not to worry — it is fairly common among newborns. The staff is doing everything necessary to care for your baby. When you go home, if your baby’s skin becomes yellow, please notify your baby’s pediatrician, a simple blood test will probably be done.
What does “jaundice” mean? The word jaundice comes from the French word “jaune,” meaning yellow. In medical terminology, jaundice means the skin color appears yellow.
What causes the skin to appear yellow? The yellow appearance of the skin is caused by an excess amount of bilirubin (a yellowish pigment, pronounced billyroo-bin) in the skin. Normally, small amounts are found in everyone’s blood.
Why does my baby have excess bilirubin in the blood? Babies have an excess of red blood cells before birth because red blood cells carry oxygen. When the baby starts to breathe after birth, the excess red blood cells are no longer needed. When they are destroyed or broken down, the cells release a substance which is bilirubin, and as more cells are broken down, the baby’s skin takes on a yellow color. Another name for this natural process of the breakdown of red blood cells is physiological jaundice (the rapid breakdown of red blood cells).
What happens to the bilirubin? In an adult, bilirubin is normally passed easily through the liver where it is processed and eventually excreted from the bowels, urine and skin. But many organs in a new baby are not as fully developed as an adult. Your baby’s liver simply cannot work as hard and as fast as the normal adult’s. It has nothing to do with liver disease; it simply means that your baby’s liver is not as fully developed as yours, and thus there is some delay in eliminating the bilirubin. Bilirubin is
also excreted through the GI tract. This is why it is important to breastfeed your baby frequently and ask to see a lactation consultant if breastfeeding is not going well.
Are there other causes of jaundice? Occasionally, there are other factors which will cause your baby’s red blood cells to break down. Of particular importance are the two conditions called ABO incompatibility and RH incompatibility. If the jaundice in your baby is caused by either one of these conditions, your doctor or nurse will give you additional information. The same process that happens with physiological jaundice also causes jaundice that occurs with ABO and RH incompatibilities; however, the reasons for this red cell breakdown are different.
What happens when my baby has jaundice? Physiological jaundice usually appears around the second or third day of life. When it is noticed, your doctor may request a blood test. Based on the results of the test and the general condition of your baby, your doctor will decide whether treatment should be started. If no treatment is deemed necessary, the jaundice will usually decrease after a week and disappear within two weeks.
Can jaundice hurt my baby?
TREATMENT FOR JAUNDICE
Most infants have mild jaundice that is harmless, but in unusual situations the bilirubin level can get very high or elevated which may cause problems such as kernicterus (bilirubin deposits in the brain) which can lead to brain damage. This is why newborns should be checked carefully for jaundice and treated to prevent a high bilirubin level.
Jaundice is treated at levels that are much lower than those at which problems are likely to occur. Treatment can prevent the harmful effects of jaundice. Putting your baby in the sunlight is not recommended as a safe way of treating jaundice. A common treatment for jaundice is phototherapy — sometimes called a Bili-Light or Bili-Bed.
When should my newborn get checked after leaving the hospital?
What Is a Bili-Light?
If your baby appears jaundiced (yellow) or was discharged from the hospital before 48 hours of life, it is important for your baby to be seen by a nurse or doctor when the baby is between 24 and 72 hours after discharge. This is usually when a baby’s bilirubin level is highest. The timing of this visit may vary depending on your baby’s age when discharged from the hospital and other factors.
Which babies require more attention for jaundice? Some babies have a greater risk for high levels of bilirubin and may need to be seen sooner after discharge from the hospital. Ask your doctor about an early follow-up visit if your baby has any of the following:
The unit is a series of ordinary-type fluorescent lights that are placed over the baby’s crib (Bili-Lights) or under the baby (Bili-Bed).
How does the light work? The light from the fluorescent unit helps the baby get rid of bilirubin that is found just beneath the surface of the skin. This happens through photo decomposition. The light helps break down the bilirubin and allows it to be excreted.
How is the light used? The light unit is placed over the baby’s crib or under the baby. The baby is unclothed to provide maximum skin exposure; the baby’s skin will not darken or burn under this light.
How can I tell if my baby is jaundiced?
• A high bilirubin level before leaving the hospital
How long is the Bili-Light used?
The skin of a baby with jaundice usually appears yellow. The best way to see jaundice is in good light, such as daylight or under fluorescent lights. Jaundice usually appears first in the face and then moves to the chest, abdomen, arms, and legs as the bilirubin level increases. The whites of the eyes may also be yellow. Jaundice may be harder to see in babies with darker skin color.
• Early birth (more than 2 weeks before the due date)
The baby usually is under the light for a few days. Laboratory tests and physical appearance guide the doctor in evaluating the baby’s progress. The light will be discontinued as soon as possible. If your baby requires phototherapy after your hospital discharge, it is possible to continue treatment at home.
• Jaundice in the first 24 hours after birth • Breastfeeding that is not going well • A lot of bruising or bleeding under the scalp related to labor and delivery • A parent or brother or sister who had high bilirubin and received light therapy
Call your baby’s doctor if: • Your baby’s skin turns more yellow • Your baby’s abdomen, arms, or legs are yellow
What care does the baby receive under the light? A mask is placed over the baby’s eyes to prevent exposure to the bright light with the Bili-Lights. The baby’s position is changed frequently to make sure all areas of the baby’s skin are exposed to the light, and to ensure the baby’s comfort.
• The whites of your baby’s eyes are yellow
How do babies react to the light?
• Your baby is jaundiced and is hard to wake, fussy or not eating well
Each baby’s response is individual and unique. Some babies are very fussy because they miss being wrapped tightly in their blankets. Other babies sleep very contently. While under the light, the baby usually has frequent and loose bowel movements and in some circumstances, the bowel movements are greenish in color. This is temporary and should stop when treatment is discontinued. We know that you are concerned about your baby and realize that having your baby underneath the light limits your parent-child contact. Remember, this treatment lasts only a few days. Soon your baby will be ready to go home.
questions about baby Choosing How to Feed Your Baby The choice for feeding your baby may have been made already. The choice of human milk or formula should be based on your doctor’s advice and your knowledge of the benefits of human milk for your baby. Breastfeeding has a positive impact on the health and development of infants and children. Benefits of breastfeeding include enhanced immune response and reduced risk for asthma, diabetes and inflammatory bowel disease. Breastfeeding may also reduce childhood obesity. In addition, breastfeeding also has benefits for the mother. It may improve your health, decrease postpartum bleeding and reduce your risk of ovarian and breast cancer. Exclusive breastfeeding (not using formula supplements [unless medically indicated]) may increase your baby’s health benefits even more. The American Academy of Pediatrics recommends that infants be exclusively breastfed for the first six months of life and be breastfed for 12 months or longer with the addition of appropriate foods. Breastfeeding sometimes takes patience, practice, and a belief in your body’s ability to provide for your baby. Your body will continue to nurture your baby now, just as during the pregnancy. Don’t hesitate to ask your nurses and doctors questions to help make the best decision for you and your baby.
Breastfeeding Your Baby Many women have concerns and questions as they start breastfeeding. The following information will help you and your baby have a successful and pleasant breastfeeding experience. Breastfeeding is a wise choice — it provides your baby a nutritious diet, decreases the chance for allergies and provides a special closeness with your infant.
Frequently Asked Questions About Baby How do I get my baby properly attached to my breast? • Hold baby comfortably in your arm with baby’s head at your elbow and your hand holding the leg — tummy to tummy. • With your other hand, pick up your breast with your thumb on top and fingers underneath. Try to place your fingers away from the areola (dark area) near the nipple because that is where you want the baby’s mouth to go.
• Tickle your infant’s mouth with your nipple to tease the baby into opening the mouth wide. • When baby turns toward your breast with an open mouth, pull infant close to you with your arm so your baby’s nose is close to your breast. Babies breathe well even very close to the breast. The cheeks will be touching the breast and baby’s chin will be into the breast.
How will I know if my baby’s getting enough milk? Newborn babies need to nurse every one to three hours, or at least 12 times in a 24-hour period. Some mothers worry that this means their baby is hungry and not getting enough milk. The major reason, however, for frequent nursing is human milk is digested easily, so your baby is ready to nurse more frequently. Follow these guidelines to assure yourself your baby is getting enough milk: • After your baby has nursed until the interest is gone, see if he seems content or has fallen asleep. • Count the number of wet diapers. Six or more per day is average after the milk is established. • Count dirty diapers. The number will vary with each baby. Some babies have dirty diapers at every diaper change while others have one bowel movement per day. It is not abnormal for some babies to go several days without a bowel movement as they get older. • Take your infant for well baby checkups. In addition to the regular checkups, your baby will be weighed. Three to four ounces per week is a normal weight gain. • The more often your baby nurses, the more milk you will produce. The sucking stimulation plus the milk from the breast are what encourage milk production.
Should I limit the time my baby spends at the breast? Successful nursing mothers have noticed their babies spend a long time at the breast, often up to an hour. Some mothers let the baby nurse on one breast for as long as there is interest and then the second breast for as long as there is interest. The next feeding begins with the breast nursed last so that the breasts appear equal in size. Mothers of sleepy babies may prefer to nurse for 5-10 minutes back and forth until the baby is satisfied. Switch from one breast to the other when the baby becomes sleepy or sucking becomes ineffective.
Should I burp my breast-fed baby? Breast-fed babies swallow less air. Routine burping is not necessary. If your baby is fussy after a feeding or spitting up, you might try burping to see if this helps.
What if my baby is fussy? • A fussy baby is a normal phenomena and can occur daily. • Relax and allow baby to suck. There may be delayed let-down at first, but as milk comes in, let-down will occur more and more quickly. • Baby may require closer contact such as rocking, holding, touching and massaging; or use a snug sack or baby carrier. • Bundle your baby in a flexed position. • Try burping your baby in different positions; these include over shoulder, sitting up, across knees, etc. • Assess your own wellbeing. Overtired? Improper diet? These may affect your reaction to normal fussy periods. Your infant may be reacting to your emotional changes. • Change diapers more often. • Decrease or eliminate cow’s milk in your diet for at least 3 days. If there’s no change, you may resume milk intake. • Limit caffeine in your diet (coffee, tea, soda, chocolate). • Check baby’s temperature, look for rashes, runny nose, diarrhea. If in doubt, call your pediatrician. • Spend time at regular intervals playing, singing, stroking, talking and rocking. Your baby needs your attention. • Fussiness is common during growth spurts: 10–14 days, six weeks, three months and six months. Baby will want to nurse more frequently.
What if baby still seems hungry after being fed? • Return baby to breast and let baby end feeding. It may take 10-60 minutes, due to baby’s age and effectiveness of suck. • Feed often, every one, two or three hours, with a minimum of eight feedings per day at first. Ten to twelve feedings in 24 hours is normal for the first couple of months. • Expect six to eight wet diapers a day with breast-fed babies.
• Watch for baby to fill out physically and gain weight. Three to four ounces per week is an average weight gain.
Are shorter nursing periods normal? As baby’s suck becomes more efficient, he may take less time to get a sufficient quantity of milk.
Why is baby fussy after nursing? Babies often take a few minutes to settle down and fall asleep. Rock the crib and pat the baby on the back.
Why doesn’t baby sleep through the night? Babies rarely sleep more than three to four hours at a time until at least six or eight weeks old. Then they may increase to five or six hours. Nurse baby just before YOU go to sleep.
Is baby getting the milk? Listen for the suck/swallow response. Once let-down occurs, baby should swallow after each suck. If not, try relaxation techniques to promote let-down. Take naps, get help with the house and other children if necessary.
What if my baby suddenly wants to nurse constantly? Your baby may be experiencing a growth spurt (generally at about two, six and 12 weeks and at five to six months). Each growth spurt lasts approximately three to five days before baby returns to a normal feeding pattern. More frequent nursing will increase your milk supply to satisfy your baby’s growing needs.
Will bottle feeding interfere with my milk supply? An occasional bottle of expressed breast milk won’t hurt if you are away from your baby for a few hours, but regular supplementing will decrease your milk production. Avoid too many supplemental feedings. Only nipple stimulation caused by sucking or pumping will produce milk. Get breastfeeding well established before starting supplementation. This usually takes four to six weeks.
questions about mother Frequently Asked Questions About Mother What do I do if my breasts get engorged? Engorgement (full, firm, painful breast) can occur in the first weeks after delivery. Nursing your baby more often will usually relieve this. To help milk flow, place warm wet washcloths on the breast before nursing. If baby has trouble taking the breast properly because your breast is too full and firm, gently massage the areola (dark area) surrounding the nipple after you apply the warm washcloths. Then hand express before latching the baby. This will soften the area and allow your baby to take the breast properly, relieve engorgement and prevent sore nipples.
If my breasts get smaller, is my milk supply decreasing? Soft, smaller breasts after two to three months are normal. Your body will become efficient at producing milk and will produce an adequate amount with regular nursing.
Why can’t I express or pump much milk? Relax and check your technique. Let-down needs to occur before milk appears. Take a shower, hand massage breast, drink a glass of warm milk, hold and play with infant, get a back rub, try soft music and dim lights, read, try relaxation exercises. Of course, your baby remains the best stimulant to let-down.
What if a plugged duct makes my breast sore? • Feed frequently - at least every one to three hours on demand. • Do not skip ANY feedings. • Avoid supplemental bottles. • Avoid frequent use of pacifiers. Let baby nurse instead, as the milk plug needs to sucked out of the breast. • Avoid tight-fitting bras. Over time, pressure over the ducts prevents free flow of milk within the breasts. • If using a non-nursing bra, remove the bra rather than lifting it above the breast while feeding.
• Avoid nipple shields. • Massage sore area of breast toward nipple, then nurse. • Apply warm, moist heat to breast with washcloth or take warm shower and allow water to run over breast prior to nursing. • Rest frequently. • Vary positions when nursing. • If you have a fever, flu-like symptoms or notice a reddened, warm, painful area, you may have a breast infection. Call your doctor and continue to nurse frequently.
How can I prevent nipple soreness? Sore nipples occur when baby improperly latches onto the nipple. With correct nursing, baby works the milk out of your breast with a gentle up and down motion of the jaws on the areola. To prevent sore nipples, pull baby close to the breast for best latch-on.
What else can I do to prevent sore nipples? Prevent engorgement: • Nurse baby as soon after delivery as possible — ideally within the first hour. • Nurse as often as possible — observe and respond to early feeding cues. • Ideally in the early days unrestricted feedings (not exact timing) are ideal.
Careful beginnings help: • Ask the nurse to observe how the baby nurses. • Air dry your nipples after feeding and rub colostrum into the nipples. • Avoid any creams that have to be washed from your breast before feedings.
Breast care is important: • Wash your hands, but not your nipples, before nursing. Your daily shower and clean, dry bras are all that’s necessary to keep your nipples clean. • Avoid excessive use of soap on your nipples — it causes drying and cracking by removing the special oil that breasts produce to keep nipples soft.
What should I do if my nipples become sore? • Follow the preventive steps outlined on the previous page. • Check for proper body positioning — tummy to tummy, buttocks tucked in toward mother. • Observe baby’s mouth — it should be wide open before taking the breast, with mouth past nipple onto areola. • If engorged, hand express a little milk to soften areola so baby can grasp it with his mouth. • Nurse on least sore side first to initiate let-down. • Vary nursing positions — cradle hold, football hold, lying down, etc. • Monitor position of your baby and establish deep latch with flanged lips, extended tongue over the gum ridge and full cheeks. • Keep nipples dry. Air dry after feeding. Avoid plastic or nylon-lined bras or nursing pads. Change wet pads often. • If cracking occurs, call BabyWise at (818) 847-4142 for a lactation referral. • Use only water to cleanse nipples. No soap or drying preparations are necessary. Break suction to release baby’s mouth from breast (insert clean finger inside of mouth or press on breast next to mouth). • Nurse both breasts during feeding. • Wear properly fitted bra that doesn’t add pressure on nipples. • Use breast pumps properly. Use GENTLE pressure, not vigorous pumping. Pump for comfort. • Check inside baby’s mouth for a white coating. Thrush can cause a sudden onset of extreme pain to nipples and will persist until treated. • Do not give up. Just when you feel your worst — that’s when your nipples get better. • Most important: relax. This is a learning process for you AND your baby. It takes time to learn something new.
How do I prevent leaking?
• Increase your fluid intake to eight to 10 glasses per day.
• Use pads inside your bra (without plastic or nylon liner). A handkerchief or diaper squares work well.
• Rinse nipple openings with water to remove any secretions.
• Apply pressure directly to nipple with your hand or arm by crossing your arms over your breasts.
• Apply gentle pressure to nipple with your fingers for a couple of minutes. • Leaking will decrease after two to three months. • Leaking will occur during sexual stimulation or orgasm. • Let-down may occur when you hear any baby cry — not just your baby.
What about my diet while breastfeeding? Your food intake needs to be increased by about 500+ calories per day. Fruits, vegetables, meat or beans (protein), dairy products and whole grains are all important. • Your doctor may suggest that you continue your prenatal vitamins. Eating wisely ensures that a mother can supply all of her infant’s nutritional needs. Research has proven that a well-nourished mother provides milk of consistently good quality. The calories you consume provide energy for both milk content and production. • Friends and relatives may also tell you about foods to avoid while breastfeeding; however, babies are individuals, and what bothers one baby may not bother another. Eat the foods you are used to eating (provided they are good for you). Foods do not have to be eliminated from the diet unless they have an effect on the baby, such as producing loose stools or colic. If you notice that a particular food bothers your nursing baby, eliminate it from your diet, and then try it again in a couple of weeks to see if the same reaction occurs. • The importance of an adequate diet, consisting of three well-balanced meals, cannot be overstressed. The apparent slight weight gain during nursing is easily lost in due time.
Guidelines on breast milk storage & use • Fresh breast milk: use within 4 hours or refrigerate. • Refrigerated breast milk: use within five to seven days. • Frozen breast milk: store in back of freezer up to 3-6 months. Label container with the date collected and use oldest dated milk first. Ice cube trays are handy for collection and initial freezing. • Thawing breast milk: thaw under running water, first cool, then warm until it liquefies. Thawed breast milk will keep up to 24 hours in refrigerator. DO NOT refreeze! DO NOT heat in a microwave oven.
questions about mother Maintaining milk supply after returning to work • Nurse thoroughly just before leaving home. • Pump at least once at work, or hand express. Milk may be stored in the refrigerator or in a cooler. • Nurse well when first arriving home from work. • Nurse at least once during the night. • Nurse around the clock on days off. Hint: Introduce a rubber nipple one or two weeks before returning to work. Feed breast milk rather than formula so baby will recognize the familiar taste even though the nipple is strange. Have someone other than you feed with the bottle while you are out of the room. Babies need to learn how to breastfeed. With minimum effort, you can learn to help your baby nurse correctly, ensure the infant is getting enough milk and prevent complications like engorgement and sore nipples. Remember, if you need assistance, your physician or BabyWise are only a phone call away.
Lactation Education and Support at Providence Health & Services At Providence Holy Cross and Providence Saint Joseph Medical Centers we’re committed to helping you and your baby get off to the best start. Providence encourages and offers support for mothers who choose to breastfeed through the Lactation Education Program. Most women are able to breastfeed, but may need a little extra assistance to successfully establish breastfeeding. Providence Holy Cross and Providence Saint Joseph Medical Centers are proud to offer comprehensive lactation support services including inpatient and outpatient lactation education.
Services include: Inpatient Lactation Services While you are in the hospital, your nurses will provide you with support and education to help you get breastfeeding off to a good start. They will assist you in latching and positioning your baby onto the breast, provide you with helpful breastfeeding information, as well as answer any questions. If special problems or concerns develop, lactation consultants are available by referral.
Lactation Phone Support After you go home, if you are experiencing breastfeeding difficulties, have questions or concerns call 818-847-4142. Often our Lactation Consultants can resolve many of your
concerns over the telephone. Phone calls will be returned Monday through Friday from 8 a.m. to 5 p.m. If you are having urgent breastfeeding concerns after 5 p.m. or on the weekends or major holidays, please call your pediatrician.
Outpatient Lactation Consultation If your concerns cannot be resolved through phone support, we offer individual one-to-one appointments with our Lactation Consultants. Fees vary depending on services rendered. Call 818-847-4142 for more information or to schedule an appointment.
Weekly Breastfeeding Support Group This helps mothers learn more and enables them to share experiences with other mothers. There is a small fee per session. No registration is required. Providence Saint Joseph Medical Center Wednesdays, 10 a.m. to 12 p.m. Babywise Classroom 501 S. Buena Vista Street, Burbank Providence Holy Cross Medical Center Mondays, 1 p.m. to 2:30 p.m. Mother Baby Unit Nursery 15031 Rinaldi Street, Mission Hills Westfield Valencia Town Center Mall Fridays, 10 a.m. to 12 p.m. Community Room 24201 W. Valencia Blvd, Valencia For additional locations please contact our Babywise Department at 818-847-4143.
Breastfeeding Store Our breastfeeding store, located in the Babywise Department, is open Monday through Friday from 8 a.m. to 3:30 p.m. Supplies include Medela® pump rentals and sales, and other breastfeeding supplies. Call 818-847-4143 for more information. For more information about the Lactation Education and Support Center at Providence Heath System, please call 818-847-4142.
Books on Breastfeeding The Nursing Mother’s Companion Kathleen Huggins, R.N., M.S., The Harvard Common Press, Boston Having Twins Elizabeth Noble, Houghton Mifflin Co., Boston Nursing Your Baby Karen Pryor, Pocket Books, New York The Breastfeeding Guide for Working Women Ann Price and Nancy Bamford, Simon and Schuster, New York The Premature Baby Book Helen Harrison with Ann Kositsky, R.N., St. Martin’s Press, New York The Womanly Art of Breastfeeding La Leche League, International, New American Library, New York Your Premature Baby Robin M. Henig with Anne Fletcher, M.D., Ballantine Books, New York
Formula Feeding Formula Feeding Your Baby Here are a few helpful hints for bottle-feeding your baby. They will help make feeding time a pleasant and memorable experience. • When bottle feeding your baby, the formula should be at room temperature. If you want to warm the formula, put the bottle in a pan of hot (but not boiling) water for a few minutes. Test the temperature of the formula by shaking a few drops on your wrist — it should feel lukewarm. We do not recommend heating bottles in a microwave oven. The bottle may remain cool, but the formula may be too hot and the baby could be burned. • Hold your infant in the curve of your arm with the baby’s head resting comfortably. Remember to tilt the bottle when holding it so the nipple and neck of the bottle remain filled. • DO NOT prop up the bottle and leave the baby alone to feed. Feeding time provides togetherness for the very important bonding and attachment process needed by infant and parents. Ask family and friends to help with household chores so you can enjoy the closeness of feeding times. • Burp your baby at least once during and again at the end of each feeding. Some babies swallow a lot of air and may need to be burped every half-ounce. There are several ways to burp your baby: 1) hold baby upright over your shoulder and pat the back gently a few times; 2) lay your infant face down across your lap and gently rub the back; 3) sit baby on your lap, supporting the head and chest, and rub the back gently in an upward motion. • Review formula preparation instructions with your nurse and pediatrician before leaving the hospital. Feel free to ask for help at any time! • Be sure you READ THE LABELS on all formula cans you purchase. THERE IS A DIFFERENCE between the types marked “ready to feed” and those labeled “concentrated liquid.” NEVER feed your baby concentrated formula without first adding water. If you have any questions or concerns, call your pediatrician.
1 Providence Holy Cross Medical Center
15031 Rinaldi St., Mission Hills, CA 91346 (818) 365-8051 2 Providence Saint Joseph Medical Center
501 S. Buena Vista St., Burbank, CA 91505 (818) 843-5111 3 Providence St. Elizabeth Care Center
10425 Magnolia Blvd., North Hollywood, CA 91601 (818) 980-3872 4 Providence Saint Joseph Diagnostic Center
201 S. Buena Vista St., Suite 125, Burbank, CA 91505 (818) 847-4988 4 Providence Saint Joseph Breast Health Center
201 S. Buena Vista St., Suite 200, Burbank, CA 91505 (818) 847-4999 5 Providence Saint Joseph Health Center
3413 W. Pacific Av., Burbank, CA 91505 s Providence Home Care (818) 953-4451 s Providence Saint Joseph Occupational Health Center (818) 953-4408 s Providence Saint Joseph Urgent Care Center (818) 953-4408 6 Valley Radiation Oncology Center
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5529 Reseda Blvd., Tarzana, CA 91356 (818) 774-2860 7 Providence Holy Cross Diagnostic Center
11570 Indian Hills Rd., Mission Hills, CA 91345 (818) 898-4445 7 Providence Holy Cross Surgery Center
11550 Indian Hills Rd., Mission Hills, CA 91345 (818) 256-2100 8 Providence Holy Cross Health Center
26357 McBean Pkwy., Santa Clarita, CA 91355 (661) 288-5900 9 Providence Holy Cross Health Center
19550 Rinaldi Street, Porter Ranch, CA 91326 Opens Fall 2008 Providence Center for 10 Community Health Improvement
6801 Coldwater Canyon, Suite 1A North Hollywood, CA 91605 11
1-888-HEALING www.providence.org/losangeles
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