Mom Baby Guide

Congratulations! Reference this guide for all you need to know, learn and do in the first hours and weeks of life with your new baby.

Mercy Hospital of Buffalo • Mount St. Mary's Hospital • Sisters of Charity Hospital

& Welcome to Catholic Health. We know you have a choice, and we truly appreciate you choosing to have your baby with us here at a Catholic Health hospital. We hope you enjoy your stay! At Sisters, Mercy, and Mount St. Mary’s, we believe strongly in the principles of Family Centered Maternity Care: • is a wellness, not an illness. Labor, delivery, and postpartum care are normal life events. • Our goal is for you and your family to learn everything possible before discharge. We want you leaving the hospital confident and fully educated regarding your needs and your baby’s care. • Family and friends are encouraged to be present whenever the new wishes. • We encourage you to keep your baby in the room with you for your entire stay. • We welcome questions and suggestions from any family member. You are also encouraged to take advantage of our wonderful Spiritual Care Department here in the hospital. If you ever want a visit from a chaplain, someone to meditate or pray with you, or if you would like to receive communion, please let your nurse know. Housekeeping is available on the floor during the day and evening hours. Rooms are cleaned each day, but if you need something to be cleaned sooner, your nurse can call Housekeeping for you at any time. In addition to this guide, you will receive a paperwork packet that includes important forms to be filled out and signed before you leave: • BIRTH CERTIFICATE & PATERNITY FORMS — Hand the New Birth Registration form to your nurse as soon as it is completed. We can help you if needed. • SHAKEN BABY EDUCATION — Please watch the video “A Life in Your Hands” on the Newborn Channel or on your smart phone at thenewbornchannelnow.com (use password 05476). This video can also be found on YouTube. Once you watch this, fill out the form and return it to your baby’s nurse. • EDUCATION — Acknowledgement form about protecting children from disease. • DISCHARGE NOTICE — Read this document carefully. We want you to feel ready to leave the hospital and begin life at home with your new baby. If you have any questions or suggestions, please feel free to speak with your nurses. You can also speak with our Managers or Directors at any time. Thank you for choosing us. Warmly,

Maryann Cogdill Joy Kent, RN Victoria Kucinski, MSN, RNC-NIC, CNS, NE-BC Director, Maternity and Nursing Nurse Manager, Mother Baby Unit Nurse Manager, NICU Mount St. Mary’s Hospital Mercy Hospital of Buffalo Sisters of Charity Hospital (716) 298-2932 (716) 828-2028 (716) 862-2360

Shari McDonald, RN Mary Ann Murphy, RN, MS, IBCLC Janet Nordling, MSN, RN Vice President & Chief Nursing Director, Maternal Child Services Director, Maternal Child Services Officer, Patient Care Services Mercy Hospital of Buffalo Sisters of Charity Hospital Mercy Hospital of Buffalo (716) 828-2895 (716) 862-2027 (716) 828-2941

Heather Telford, RN, MS, BCEN, NEA-BC Traci Linn Tracey, BSN, RN Jessica Visser, RN Vice President & Chief Nursing Officer, Nurse Manager, Mother Baby Unit Vice President & Chief Nursing Officer, Patient Care Services, Mount St. Mary’s Sisters of Charity Hospital Patient Care Services Hospital and Kenmore Mercy Hospital (716) 862-1896 Sisters of Charity Hospital (716) 447-6140 (716) 862-1874 GETTING STARTED CARING FOR BABY Welcome Baby Welcome Home The “Golden Hour” Handle with Care...... 30 Skin to Skin...... 3 Sleep Get to Know Your Newborn, Sleep Patterns, Safe Sleep ...... 32 Room In...... 3 Bonding & Soothing Soothing Sounds, ...... 34 Latching On...... 4 Massage...... 36 Sucking...... 5 Thumb Sucking & Pacifiers...... 37 Burping...... 5 Bath Time Bottles / Pacifiers?...... 5 Bathing, Clothing...... 38-39 Breastmilk 101...... 6 Pumping & Bottle Feeding...... 7 Feeding Breastfeeding Hints...... 8 Something More than Milk...... 40-41 Feeding Log...... 9-12 Bill of Rights...... 13-14 NEWBORN HEALTH The First Week...... 15 Primary Care First Check-Ups...... 42 Diapering your Baby Signs of Illness...... 44 Bowel Habits...... 16 Rash...... 16 Vaccinations...... 46-47 Cord Care...... 17 Crying Period / Prevent Circumcision...... 17 Shaken Baby Syndrome...... 48 Newborn Screening CARE FOR NEW MOMS Pulse Oximetry (CCHD)...... 18 Hearing ...... 19 Postpartum Period Blood Tests...... 19 Mom’s Body After Pregnancy...... 50 NYS Screening Program...... 19-21 Managing Discomfort, Activity..... 52 Hepatitis B Vaccine...... 21 Personal Care...... 54 Muscle Recovery...... 56 GOOD WORK, MOM Breast Health During your stay... Milk Supply, Discomfort...... 58 Recover. Rest. Remember...... 22 Breast Examinations...... 60 Common Medications Mammograms...... 61 Pain Relief, Anti-Constipation, Exercise...... 62 Anti-Nausea...... 24 Nutrition...... 64 Tdap Vaccine...... 26-27 Support Birth Record...... 28 “Baby Blues”, Anxiety, Insurance...... 29 Postpartum Depression...... 66 YOUR NEW FAMILY Safe & Sound Lead, Radon, Car Safety, Mom Baby Guide Smoking, Water Safety, ...... 68-71 Home Together Talk to your healthcare provider! Siblings, TV/Reading, Childcare.... 72 This handbook is not a substitute for the advice of a qualified expert. Dear Family ...... 74

1

& While you are in the hospital — Questions Write down any questions you have for your nurses or doctors about you or the baby for the next time they come into your room. If your question is urgent, please use your call light.

Before you leave — Mom’s Checklist Baby’s Checklist  Baby’s completed Birth Certificate  Circumcision done (if elected) form returned to your nurse  Hearing screen done  Video viewed, and Shaken Baby  CCHD Pulse Oximetry done Syndrome sheet signed and returned  State Newborn Screening  Paperwork Packet completed blood test done  Your OB has written your discharge  Pediatrician has approved and  You have your discharge notice written baby’s discharge  You have any prescriptions needed  You have baby’s discharge papers  Mom is dressed  Baby is dressed  You have a ride home  Car seat is in room  Car is packed, car seat base secured (leave base in car)  Get any from fridge  ______ Have a if needed  ______ ______ ______Security sensor removed*

When your ride has walked down to pull the car around to the front of the hospital, you can call your nurses and tell them you are ready to go down.

*Once in the wheelchair, call the nursery and they will come and take the security sensor off the baby.

2 Getting Started Welcome BABY!

THE “GOLDEN HOUR” GET TO KNOW What you do in the very first hour of YOUR NEWBORN your baby’s life can have a significant Spending as much time as — even lifelong — impact on the bond possible with your newborn you have with your baby. baby will help you learn his or We know this is an exciting time her unique personality, moods for your family. We suggest that and feeding cues. visitors be patient and wait to be When they are hungry, babies introduced to baby until he or she may put their hands near their ROOM IN starts to adjust to the shock of a mouth, make smacking motions brand new world. Baby will recognize with their lips, or simply look After you deliver your baby, you by your voice, heartbeat and awake and alert. Many babies Catholic Health recommends scent, which will reduce the stress of may need to eat every 2 to 3 rooming-in with your newborn. being thrust into a new environment. hours — around Limiting nursery time and the clock. having your newborn close to START SKIN-TO-SKIN you while at the hospital can Immediately after delivery, your Look for enhance bonding. baby may be placed with you, EARLY It will help your child adjust skin-to-skin. This intimate bonding hunger to life on the outside both time eases baby’s transition from cues. physically and emotionally, the womb into the world. It helps • hands while it helps you learn how stabilize baby’s heart rhythm, to mouth, to best care for him or her. body temperature and breathing trying to suck naturally. Skin-to-skin contact with baby and suckling at the breast • licking lips, sticking tongue out release mothering hormones that • turning head to side, cause the uterus to contract, shrink opening mouth (rooting reflex) and stop bleeding. It also makes it easy to begin breastfeeding. Crying is a LATE hunger cue. Research has shown breastfeeding within the first hour of life improves infant survival and prolongs the duration of exclusive breastfeeding. Share the Love Dad should also get involved in early bonding — by placing his hands on baby, talking quietly, letting baby gaze at his face and spending time holding baby after the first feeding is done. Dad can do skin-to-skin too! A good start Breastfeeding is the most natural, convenient way to feed your newborn and it may be the best thing that Breastfeeding you can do for you and your should be breastfed on demand. baby. Not only does it create a lifelong bond between mother and child, but it keeps you and your baby healthy. LATCHING ON Helping your baby achieve a good “Deep ” can be key to successful breastfeeding. The American Academy of recommends Ready, Hold exclusive breastfeeding for about 6 months, followed by • Mom places fingers flat continued breastfeeding as A learned skill under breast, away complementary foods are from areola. As mentioned previously, introduced, with continuation • Thumb on top of breast, breastfeeding IS the of breastfeeding for 1 year or pointing nipple up. longer as mutually desired most natural, convenient by mother and infant. way to feed your baby and it is recommended Nipple-to-Nose by the American Acad- • Lay bottom of areola Good for you, emy of Pediatrics. on baby’s upper lip. good for baby But breastfeeding is This lines up baby’s also a learned skill and Breastfeeding your baby nose with mom’s nipple. doesn’t always come exclusively has many benefits: • Tickle baby’s upper naturally to new . • It’s the only food your lip with bottom areola baby needs. until baby opens mouth wide. • Your early breast milk (called colostrum) contains It may take a Be patient... wait for a wide open target! antibodies that help your little practice, for baby fight infections and both you and your baby, Flared “fish lips” disease. to be successful at • Let the bottom of areola breastfeeding. • It’s easy for baby to digest. go into baby’s mouth first, not nipple. Bottom • Breastfeeding burns calories lip should be flared out. and helps you lose weight gained during pregnancy. • Mouth comes up and over onto the areola. • It creates a strong bond Top lip should flare out. between you and your baby. • It’s always available and Deep Latch at the right temperature. When correctly latched, • Not buying formula baby’s chin should be saves money. tucked into the breast, nose barely touching. 4 Getting Started

Ask your lactation consultant for a copy of “What Every Mother Should Know About Breastfeeding”.

SUCKING Keeping baby awake Breastfeeding You should feel tugging and and interested: takes practice pressure, but no pinching • Hand express colostrum, put Talk to your nurse or lactation or pain. some on your finger, insert consultant if you are having it into baby’s mouth, fat pad • Deep sucks transfer milk, trouble. versus short, fluttery sucks. side up. Tickle the roof of the baby’s palate — stimulating Additional breastfeeding the sucking reflex. resources are available: SWALLOWING • Use expressed colostrum or • Mercy Hospital Listen for the “EH” sound. sugar water via eye dropper Lactation Office • following 8 to 10 sucks in the corner of baby’s mouth (716) 828-2616 with colostrum while baby is at the breast — • Mount St. Mary’s • after every 1 to 2 sucks keeps baby sucking and Lactation Office when mom’s milk comes in swallowing. (716) 298-2478 You can encourage • Ensure a “deep latch.” • Sisters Hospital Lactation deep sucks and swallows Baby needs most of the areola, Office and Baby Café by massaging breasts and not just the nipple. Baby will (716) 862-1939 get more colostrum / breast squeezing near areola to push • milk — keeping baby awake, milk into baby’s mouth. International interested and swallowing; 1-800-LA-LECHE plus no pain for mom! RELEASING THE LATCH (1-800-525-3243) You may need to use these Place finger in corner of llli.org tactics several times during baby’s mouth to break • NYSBreastfeeding.org a feeding. suction to take baby off. • Catholic Charities / WIC Never pull your breast away. Breastfeedingpartners.org BOTTLES / PACIFIERS? • American Academy of Pediatrics — aap.org BURPING To avoid “nipple confusion” • WomensHealth.gov Whether breastfeeding or it is best to limit the use of bottle feeding, burp your baby bottles or pacifiers early on, • NYS Department of Health occasionally during feedings. unless medically necessary. health.ny.gov Hold them gently. These can be introduced Breast-fed babies tend to burp at bedtime after 2 to 3 weeks, An electric breast pump is less than bottle-fed babies. once breastfeeding is well established. available during your stay if baby is not nursing well.

5 BREAST MILK 101 Colostrum Colostrum is the first stage of breast milk. It is a yellowish fluid, rich in protein and antibodies. Gradually, colostrum changes and mature breast milk increases 2 to 5 days after delivery. It is bluish-white in color, resembling skim milk.

Fore-milk Fore-milk, stored between feedings, is 80% water and quenches thirst.

Hind-milk Hind-milk, with higher fat content to put on weight, follows as your baby nurses longer.

More frequent nursing helps milk come in faster.

Once your mature milk supply increases, nurse longer on the first side to ensure baby gets the hind-milk to put on weight.

Don’t worry... about how much milk you are producing. The more you breastfeed, the more milk you will produce. 6 Getting Started

Pumping and bottle feeding can work!

PUMPING / BOTTLE FEEDING Formula feeding All mothers are encouraged If breast milk isn’t an option, to breastfeed, even those talk with your healthcare team with babies in the NICU, about proper formula feeding and if the baby is stable enough. nutritional needs. Pumping and bottle feeding, • It is safest to prepare a fresh however, can give your baby all the bottle each time one is needed natural advantages of your breast and to consume immediately. milk if you need to be separated for a time. It can also give another • Read and follow all the caregiver the opportunity to help instructions on the formula’s out and to bond during feedings. packaging. Measure carefully. Adding more or less formula • Start pumping within • To warm chilled breast milk, or water than instructed could the first 6 hours of birth. place bottle in a bowl of hot make your infant ill. water or hold it under hot • You may only get drops at • Formula should be fed at room running water 2 to 3 minutes. first, but this is colostrum temperature or slightly warmed. and is beneficial. • Always test the bottle Your lactation specialist will give temperature with a few drops WARNING on your wrist before feeding you all the information you need for • Discard any “leftovers.” breastfeeding and pumping. your baby. Do not feed baby what is left in bottles from earlier feedings. • Bottles should NEVER be heated in a microwave. Uneven heating and ‘hot spots’ Did you know? could scald the infants mouth. • Bottle fed babies should not Catholic Health’s maternity hospitals serve as depots be propped with a bottle or where you can donate your breast milk to newborns in need. have a bottle in bed. To become a pre-approved donor, contact the Both situations can cause New York Milk Bank at (212) 956-6455. choking or bottle mouth syndrome (decaying baby teeth). • Call your doctor if feeding problems occur such as vomiting, diarrhea, constipa- tion, or excessive irritability.

7 Did you know? BREASTFEEDING HINTS

The first few days babies breastfeed on average PAINFUL LATCH? 10 to 20 minutes Moms may feel tugging, but per breast. pain is a sign of improper latch. • Pull down on baby’s chin Baby’s Stomach is TINY to flare bottom lip out Day 1 Day 3 Day 7 • Pull top lip out for flared “fish lips” CHECKLIST:

• Chin in to Breast GASSY BABY? 5-15 cc 15-30 cc 30-60 cc • Nipple to Nose How much does baby need to eat? Fussy with gas and green stools • Flared “Fish Lips” is a sign of too much fore-milk. At one week of age, baby eats about • Breast Massage / 1 to 2 ounces of breast milk. • Nurse longer on the first side Compressions for the hind-milk Milk volume increases about one • Listen for ounce per week until baby is Swallowing taking about 4 to 6 ounces SLEEPY BABY? at 6 to 8 weeks old. Babies may need to be woken up FREQUENCY: for feedings every 2 to 3 hours. Newborns LOSE weight • Babies should eat • Use skin-to-skin contact to Your baby may feed up to at least 8 to 12 times wake baby – especially for twelve times a day, but still lose in 24 hours. the first 24 hours – it also 7% to 10% of in the promotes bonding first 3 to 4 days. • The more babies eat during the day / evening, • Undress baby, change Don’t worry. the better they do baby’s diaper Once mom’s milk comes in or at night. • Burp baby, rub your feeding patterns emerge, babies • Some babies eat every hand up baby’s spine gain about one ounce per day. 2 to 3 hours around the What if baby nurses for Babies should regain their clock. Others will feed 10 minutes then falls asleep? birth weight by 2 weeks. at irregular intervals. • Burp the baby then continue • Babies should wet 6 to 8 nursing on the same side. and/or soil 2 to 5 a day. Growth Spurts are REAL BY LAW: ACTOR BABY? You may notice baby • You are allowed to Watch your baby’s “characters” nurses more frequently, breastfeed your baby develop while nursing. increasing your milk anywhere in public. volume periodically: • Boxer at the beginning • You have the right to • then Drunken Sailer express or pump breast weeks2 weeks6 months3 milk when you return to • finally a satisfied Milk Coma 2This 6 may 3 last work. about 24 hours. (See pages 13-14.) 8

Remarks/Questions Remarks/Questions

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Left As As milk your increases Approx Minutes Minutes Approx

12 1 pm 2 pm 3 pm 4 pm 5 pm 6 pm 7 pm 8 pm 9 pm noon Time 10 pm 11 pm

8 to 12 times in 24 8 tohours! 12 times — 4 yellow seedymovements. bowel 4 yellow - HOUR BREASTFEEDING LOG HOUR BREASTFEEDING Remarks/Questions Remarks/Questions

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24 8 wet diapers and 3 diapers wet 8 so will your will baby'sso diapers; by day a 6 minimum 4 orof should 5 you see Breastfeed on Breastfeed demand

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Not a part of the permanent medical record. Make copies as needed and save to show your pediatrician. your show to save and needed as copies Make record. medical permanent the part of Not a

Nursing Left Approx Minutes Minutes Approx

12 1 am 2 am 3 am 4 am 5 am 6 am 7 am 8 am 9 am 9 am Time 10 am 11 am midnight Baby’s weight: ______weight: Baby’s Date: ______Date:

9

Remarks/Questions Remarks/Questions

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Nursing Nursing

Left As As milk your increases Approx Minutes Minutes Approx

12 1 pm 2 pm 3 pm 4 pm 5 pm 6 pm 7 pm 8 pm 9 pm noon Time 10 pm 11 pm

8 to 12 times in 24 8 tohours! 12 times — 4 yellow seedymovements. bowel 4 yellow - HOUR BREASTFEEDING LOG HOUR BREASTFEEDING Remarks/Questions Remarks/Questions

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24 8 wet diapers and 3 diapers wet 8 so will your will baby'sso diapers; by day a 6 minimum 4 orof should 5 you see Breastfeed on Breastfeed demand

Dirty

Diapers Diapers Wet Wet

Right

Not a part of the permanent medical record. Make copies as needed and save to show your pediatrician. your show to save and needed as copies Make record. medical permanent the part of Not a

Nursing Left Approx Minutes Minutes Approx

12 1 am 2 am 3 am 4 am 5 am 6 am 7 am 8 am 9 am 9 am Time 10 am 11 am midnight Baby’s weight: ______weight: Baby’s Date: ______Date:

10

Remarks/Questions Remarks/Questions

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Diapers Diapers - Wet Wet

Right

Nursing Nursing

Left As As milk your increases Approx Minutes Minutes Approx

12 1 pm 2 pm 3 pm 4 pm 5 pm 6 pm 7 pm 8 pm 9 pm noon Time 10 pm 11 pm

8 to 12 times in 24 8 tohours! 12 times — 4 yellow seedymovements. bowel 4 yellow - HOUR BREASTFEEDING LOG HOUR BREASTFEEDING Remarks/Questions Remarks/Questions

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24 8 wet diapers and 3 diapers wet 8 so will your will baby'sso diapers; by day a 6 minimum 4 orof should 5 you see Breastfeed on Breastfeed demand

Dirty

Diapers Diapers Wet Wet

Right

Not a part of the permanent medical record. Make copies as needed and save to show your pediatrician. your show to save and needed as copies Make record. medical permanent the part of Not a

Nursing Left Approx Minutes Minutes Approx

12 1 am 2 am 3 am 4 am 5 am 6 am 7 am 8 am 9 am 9 am Time 10 am 11 am midnight Baby’s weight: ______weight: Baby’s Date: ______Date:

11

Remarks/Questions Remarks/Questions

Dirty

Diapers Diapers - Wet Wet

Right

Nursing Nursing

Left As As milk your increases Approx Minutes Minutes Approx

12 1 pm 2 pm 3 pm 4 pm 5 pm 6 pm 7 pm 8 pm 9 pm noon Time 10 pm 11 pm

8 to 12 times in 24 8 tohours! 12 times — 4 yellow seedymovements. bowel 4 yellow - HOUR BREASTFEEDING LOG HOUR BREASTFEEDING Remarks/Questions Remarks/Questions

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24 8 wet diapers and 3 diapers wet 8 so will your will baby'sso diapers; by day a 6 minimum 4 orof should 5 you see Breastfeed on Breastfeed demand

Dirty

Diapers Diapers Wet Wet

Right

Not a part of the permanent medical record. Make copies as needed and save to show your pediatrician. your show to save and needed as copies Make record. medical permanent the part of Not a

Nursing Left Approx Minutes Minutes Approx

12 1 am 2 am 3 am 4 am 5 am 6 am 7 am 8 am 9 am 9 am Time 10 am 11 am midnight Baby’s weight: ______weight: Baby’s Date: ______Date:

12 Choosing how to feed her new baby is one of the important decisions a mother can make in preparing for her infant’s arrival. Doctors agree that for most women, breastfeeding is the safest and healthiest choice. It is your right to be informed about the benefits of breastfeeding, and to have your health care provider, maternal health care facility, and child day care facility encourage and support breastfeeding. You have the right to make your own choice about breastfeeding. Whether you choose to breastfeed or not, you have the rights listed below, regardless of your race, creed, national origin, sexual orientation, gender identity or expression, or source of payment for your health care. Maternal health care facilities have a responsibility to ensure that you understand these rights. They must provide this information clearly for you, and must Breastfeedingprovide an interpreter, if necessary. Mothers’ These rights Bill may be limited of Rightsonly in cases where your health or the health of your baby requires it. If any of the following things are not medically right for you or your baby, you should be fully informed of the facts and be consulted.

1) Before You Deliver: If you attend prenatal childbirth education classes (those provided by the maternal health care facility and by all hospital clinics and diagnostic and treatment centers providing prenatal services in accordance with Article 28 of the Public Health Law), then you must receive the Breastfeeding Mothers’ Bill of Rights. Each maternal health care facility shall provide the maternity information leaflet, including the Breastfeeding Mothers’ Bill of Rights, to each patient or to the appointed personal representative at the time of prebooking or time of admission to a maternal health care facility. You have the right to receive complete information about the benefits of breastfeeding for yourself and your baby. This will help you make an informed choice on how to feed your baby. You have the right to receive information that is free of commercial interests and includes: • How breastfeeding benefits you and your baby nutritionally, medically and emotionally; • How to prepare yourself for breastfeeding; • How to understand some of the problems you may face and how to solve them.

2) In The Maternal Health Care Facility: • You have the right to have your baby stay with you right after birth, whether you deliver vaginally or by cesarean section. • You have the right to begin breastfeeding within one hour after birth. • You have the right to get help from someone who is trained in breastfeeding. • You have the right to have your baby not receive any bottle feeding or pacifiers. • You have the right to know about and refuse any drugs that may dry up your milk. • You have the right to have your baby in your room with you 24 hours a day. • You have the right to breastfeed your baby at any time day or night. • You have the right to know if your doctor or your baby’s pediatrician is advising against breastfeeding before any feeding decisions are made. • You have the right to have a sign on your baby’s crib clearly stating that your baby is breastfeeding and that no bottle feeding of any type is to be offered.

13 • You have the right to receive full information about how you are doing with breastfeeding, and to get help on how to improve. • You have the right to breastfeed your baby in the neonatal intensive care unit. If nursing is not possible, every attempt will be made to have your baby receive your pumped or expressed milk. • If you – or your baby – are re-hospitalized in a maternal health care facility after the initial delivery stay, the hospital will make every effort to continue to support breastfeeding, and to provide hospital-grade electric pumps and rooming-in facilities. • You have the right to get help from someone specially trained in breastfeeding support, if your baby has special needs. • You have the right to have a family member or friend receive breastfeeding information from a staff member, if you request it.

3) When You Leave The Maternal Health Care Facility: • You have the right to printed breastfeeding information free of commercial material. • You have the right, unless specifically requested by you, and available at the facility, to be discharged from the facility without discharge packs containing , or formula coupons unless ordered by your baby’s health care provider. • You have the right to get information about breastfeeding resources in your community, including information on availability of breastfeeding consultants, support groups, and breast pumps. • You have the right to have the facility give you information to help you choose a medical provider for your baby, and to help you understand the importance of a follow-up appointment. • You have the right to receive information about safely collecting and storing your breast milk. • You have the right to breastfeed your baby in any location, public or private, where you are otherwise authorized to be. Complaints can be directed to the New York State Division of Human Rights. • You have a right to breastfeed your baby at your place of employment or child day care center in an environment that does not discourage breastfeeding or the provision of breast milk. • Under section 206-c of the Labor Law, for up to three years following childbirth, you have the right to take reasonable unpaid break time or to use paid break time or meal time each day, so that you can express breast milk at work. Your employer must make reasonable efforts to provide a room or another location, in close proximity to your work area, where you can express breast milk in private. Your employer may not discriminate against you based on your decision to express breast milk at work. Complaints can be directed to the New York State Department of Labor.

If the maternal health care facility does not honor these rights, you can seek help by contacting the New York State Department of Health, or by contacting the hospital complaint hotline at 1-800-804-5447 or via email at [email protected].

14

These are your rights. The First Week Getting Started

Baby’s Feeding Breast- Milk Baby’s Baby’s Activity Routine feeding Supply Urine Output Stools

First 8 Baby is usually Baby may deep Baby will wake You may hours wide awake in sleep 2-4 hours and be alert for be able to first hour of life. after birth. several hours express Baby should after the initial Try to hold baby a few Baby must have a deep sleep. skin-to-skin drops. have at least black-green stool. within 1/2 hour Put to breast to 1 wet diaper (meconium stool) of birth. bond and nurse. in 24 hours.

Babies may Nurse at both DAY not awaken Feed your baby breasts as long on their every 1-1/2 to 3 as baby is own to feed. hours – as often actively sucking 1 Wake your baby as wanted. and mother is gently for feeding. comfortable.

Baby should Try to nurse on DAY Baby should Baby may have be more There both sides at have at least a second very cooperative/ should be each feeding. 2 wet diapers dark stool. less sleepy. at least Mother’s Expect some every 24 hours. (meconium stool) 2 8-10 feedings milk should nipple tenderness. per day. come in between the 2nd and Try to nurse on the 4th day. DAY both sides at Wet diapers each feeding. should increase to 4-6 every Look for early Some nipple 24 hours. 3 feeding cues: tenderness is to • rooting be expected. Baby’s stools • lip smacking ❧ should be • hands to face Nurse each changing from side, finishing Baby’s urine black-green DAY first side first, should be light to yellow. every 2-3 hours yellow, with for the first few 6-8 wet diapers 4 months. in 24 hours.

Note that baby swallows Remember regularly while Milk DAY which side you Baby should Baby should nursing. should be in. ended on and have 6-8 wet have 3-4 yellow, Baby may start on the Breasts diapers per day seedy stools 5 go longer opposite side for may be firm of colorless per day. intervals the next feeding. or leak. or light yellow between urine. feedings. Baby should Mother’s nipple (up to a 5-hour appear satisfied tenderness DAY interval in a The number after feedings. is improved. 24-hour period) of stools may slowly decrease 6 after 4-6 weeks. +beyond

15 Diapering Your Baby Whether you decide to use cloth diapers or disposable diapers — you will probably need about 10 diapers a day or about 70 a week.

BOWEL HABITS DIAPER RASH Bowel habits change as Diaper rashes are a common baby matures. ailment. In fact, more that half Dark green stools turn to of babies between 4 and 15 yellow within a week. months will get a diaper rash over every 2 month period. Breast-fed stools are Fortunately, although they occur Before diapering a baby, make yellow and watery and frequently, they are usually mild sure you have all supplies within should occur 3 to 5 times and easy to treat. reach. You need: a day in the first month. This is not diarrhea. There To prevent or heal diaper rash, • A clean diaper (and fastener should be no foul odor. try these tips: if cloth diapers are used) Bottle-fed stools are pasty, • Change your baby’s diaper • Diaper ointment if brown and yellow with a frequently and soon after the baby has a rash slight odor. bowel movements. • A container of warm water • After cleaning the area with Frequency of stools may decrease with a clean wash cloth / mild soap and water or a wipe, when baby is 6 to 8 weeks old, cotton balls or baby wipes apply a diaper rash or barrier is growing, and is using most of what is taken in. cream. Creams with zinc Never leave your baby oxide are preferable because unattended on the Babies may groan, grunt and turn they form a barrier against changing table. red as they try to pass gas or moisture. move their bowels. It does • If you use cloth diapers, you After each bowel movement, or if not mean they are constipated. may need to be extra vigilant your baby’s diaper is wet, lay your Constipated stools are formed about changing them as they baby on its back and remove the solid and appear dry. Tell your are less absorbent. Wash dirty diaper. Use the water, cotton baby’s doctor if your baby is them in dye-free and balls and washcloth or the wipes passing constipated stools. fragrance-free detergent. to gently wipe your baby’s genital area clean. • Let the baby go without a diaper for part of the day. • When wiping a GIRL, wipe her from front to back DO NOT use talcum or baby to avoid a urinary tract Remember to wash powders. They can interfere infection. your hands thoroughly with your baby’s breathing. • When removing a BOY’s after each changing. If the diaper rash continues for diaper, do so carefully. more than 3 days, call your child’s Exposure to the air may doctor – it may be caused by a make him urinate. fungal infection that requires a prescription. 16 Getting Started

CORD CARE CIRCUMCISION... Cord care includes keeping is a surgical procedure Uncircumcised care the cord as dry as possible. involving removal of the skin At every diaper change, Apply rubbing alcohol by covering the end of the penis clean penis gently with cotton-tipped applicator or (the foreskin). This tissue is mild baby soap and water. cotton ball 3 to 4 times per day. normal and not necessarily DO NOT push foreskin Keeping the diaper folded unhealthy. back in a newborn. below the cord and sponge Some experts have felt in bathing will help keep the the past that boys with intact cord dry. foreskins are at a higher risk Circumcised care of urinary tract infections, penile skin cancer, skin Vaseline is applied to the infections, and sexually area every diaper change transmitted infections. for at least 1 to 2 days. The penis can be cleaned Current thought, however, with simply water alone. is that there are no risks substantial enough to It is normal for the freshly recommend routine exposed skin to appear reddish circumcision of boys. in color for a few days, and you may even notice a In general, the temporary yellowish discharge. decision to circumcise is essentially a personal one It usually takes the penis based on social, cultural approximately 7 to 10 days and in some cases, to heal. religious beliefs. Expect the cord to fall off in Although circumcision is a about 10 to 14 days. relatively simple procedure Notify your baby’s doctor if: with very little risk, it should be pointed out that without • baby does not urinate pain medicine, circumcision normally within 6 to 8 hours Notify your baby’s doctor if: is painful. There are forms after procedure of analgesia (pain control) • redness spreads around • there is persistent bleeding available and these can the belly button • redness around tip of penis be discussed with your gets worse after 3 to 5 days • there is a bad odor healthcare provider. • there is pus-like drainage

17 Did you know? Some medical disorders can affect a child very early Newborn Screening in life – even within the Valuable information about baby’s health. first few days.

PULSE OXIMETRY Pulse Oximetry Screening for Critical Congenital Heart Disease (CCHD).

What is Critical Congenital What if the pulse Heart Disease? oximetry reading is low? Critical Congenital Heart Disease Some babies will have a low (CCHD) is a medical problem oxygen level reading. Your that occurs when a baby’s heart doctor will determine if further or major blood vessels near the testing is needed to look for Babies with a heart defect or heart are not formed properly. CCHD, such as an ultrasound another disorder may appear The heart may not work well and of the heart (also called echo healthy at first. there may not be enough oxygen cardiogram or heart echo). in the blood. If these babies are sent home A low oxygen reading does not before their problem is found, How is pulse oximetry always mean that the baby has they are at risk for serious screening done? CCHD. Some healthy babies illness or death. can have a low pulse oximetry Pulse oximetry, sometimes reading while their heart and called pulse ox, is a test to lungs are adjusting after birth. Prompt testing and determine the amount of oxygen There could be other conditions in the baby’s blood and pulse diagnosis are important. that can cause your baby to rate. Pulse oximetry is fast, easy, have a low oximetry test result. and does not hurt. A small soft sensor is wrapped around the What you should know — Newborn screening can baby’s hand and foot to measure help find critical heart Most babies who pass the pulse the heart rate and oxygen level conditions in newborns, oximetry screening will not have in the blood. As part of universal CCHD. Warning signs that all identify those few infants newborn screening, every baby who may have one of should watch for are: born in New York State will have bluish color to the lips or skin, several rare disorders, and a pulse oximetry screening after infants who have been grunting sounds with breathing, 24 hours of life to see if there fast breathing, poor feeding, exposed to HIV, the virus are signs of CCHD. Waiting for that causes AIDS. extreme sleepiness, and poor 24 hours allows the baby’s heart weight gain. If you notice any of and lungs to fully adjust to life these signs in your baby, please outside his or her mother. With early contact your baby’s healthcare diagnosis and provider right away. medical treatment, serious illness can often be prevented. 18 Getting Started

HEARING BLOOD TESTS Newborn Hearing In-Hospital NYS Newborn Screening Program Medical Testing Screening Program

Why test an Complete Blood This service to families with infant’s hearing? Count (CBC) newborn babies was started in 1965 by the State Department Hearing loss is one of the A CBC blood test is a screening of Health and can now identify most frequently occurring tool drawn on every newborn more than 40 medical disorders, birth defects. Consequences to determine the baby’s blood including: of late identification of hearing count (concentration of various loss include delayed speech cell types in the blood) and to • Cystic Fibrosis and language development, check for infection or anemia. • Krabbe Disease and associated effects on • Mitochondrial Disease social and emotional growth • Sickle Cell Anemia By warming the baby’s and academic achievement. • Hypothyroidism heel and using a small prick, New York State requires a tiny sample of blood is obtained. (See chart, next page.) hearing screening prior to The heels may be bruised but this Although these disorders are discharge to identify newborns bruising will go away. rare, they are usually serious. with significant hearing loss, Some may be life-threatening. and offer early intervention Hypoglycemia Others may slow down the support. baby’s physical development or Follow up will be arranged (low sugar) Protocol cause mental retardation prior to discharge for abnormal Some babies that are large, or other problems if results. had meconium at birth, a undetected and stressful birth or are born to untreated. moms with gestational diabetes will need to be tested to be sure sugar levels are high enough to support proper development. This involves 4 hourly blood tests followed by 3 tests prior to a feeding (every 3 hours). A reading must indicate a sugar concentration of Ask your baby’s doctor about 50 mg/dL or above to newborn screening or visit the discontinue protocol CDC’s website at: cdc.gov/newbornscreening monitoring.

19 GROUP CONDITION Congenital Adrenal Hyperplasia (CAH) Endocrinology Congenital hypothyroidism (CH) Hb SS disease (Sickle cell anemia) Hematology, Hb SC disease Hemoglobinopathies Hb CC disease Other Hemoglobinopathies Infectious Diseases HIV-1 infection (HIV-1) Homocystinuria (HCY) Hypermethioninemia (HMET) Amino Acid Maple syrup urine disease (MSUD) Disorders Phenylketonuria (PKU) and Hyperphenylalaninemia (HyperPhe) Tyrosinemia (TYR-I, TYR-II, TYR-III) Carnitine-acylcarnitine translocase deficiency (CAT) Carnitine pallmitoyltransferase I (CPT-I) and II (CPT-II) deficiencies Carnitine uptake defect (CUD) 2,4-Dienoyl-CoA reductase deficiency (2,4Di) Long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency (LCHAD) Fatty Acid Medium-chain acyl-CoA dehydrogenase deficiency (MCAD) Oxidation Medium-chain ketoacyl-CoA thiolase deficiency (MCKAT) Disorders Medium/short-chain hydroxyacyl-CoA dehydrogenase deficiency (M/SCHAD) Mitochondrial trifunctional protein deficiency (TFP) Multiple acyl-CoA dehydrogenase deficiency (MADD) also known as Glutaric academia type II (GA-II) Short-chain acyl-CoA dehydrogenase deficiency (SCAD) Very long-chain acyl-CoA dehydrogenase deficiency (VLCAD) Glutaric academia type I (GA-I) 3-Hydroxy-3-methylglutaryl-CoA lyase deficiency (HMG) Isobutytyl-CoA dehydrogenase deficiency (IBCD) Isovaleric academia (IVA)

Inborn Errors of Metabolism Inborn Errors Malonic academia (MA) 2-Methylbutyrl-Coa dehydrogenase deficiency (2-MCBD) Organic Acid 3-Methwlcotonyl-CoA carboxylase deficiency (3-MCC) Disorders 3-Methylglutaconic academia (3-MGA) 2-Mythyl-e-hydroxybutyryl-CoA dehydrogenase deficiency (MHBD) Methylmalonyl-CoA mutase deficiency (MUT), Cobalamin A,B (Cbl A,B) and Cobalamin C,D (Cbl C,D) cofactor deficiencies and other Methylmalonic acidemias (MMA) Mitochondrial acetoacetyl-CoA thiolase deficiency (beta-ketothiolase deficiency (BKT) Multiple carboxylase deficiency (MCD) Propionic academia (PA) Argininemia (ARG)

Screening Urea Cycle Argininosuccinic academia (ASA) Disorders Citrullinemia (CIT) Hyperammonemia/hyperorinithinemia/homocitrullinemia (HHH) Biotinidase deficiency (BIOT) Cystic Fibrosis (CF) Other Genetic Galactosemia (GALT) Conditions Krabbe Disease Disorders Identified by the New York State Newborn Screening Program York State Newborn Screening by the New Identified Disorders Newborn Severe Combined Immunideficiency Disease (SCID) For more information on the NYS Newborn Screening Program visit wadsworth.org/programs/newborn/screening. 20 Who gets the screening results? The blood sample, usually taken on the day your Getting Started baby is discharged from the hospital, is sent for analysis to the laboratories of the State Depart- ment of Health in Albany. Your baby’s doctor Hepatitis B Vaccine or clinic will be informed of the results and will Hepatitis B is a contagious liver disease that contact you immediately if anything is wrong. damages the liver over time and has no cure. As a responsible , you should also ask People with chronic hepatitis B usually do not about the results when you bring your baby to experience any outward symptoms and may not the doctor or clinic for the baby’s first check-up. know that they have the disease. The pink form given to you by the nurse will tell you how to get the test results from your doctor. The American Academy of Pediatrics, the What if my baby has one of these American Academy of Family Physicians, and the disorders? Can it be cured? Centers for Disease Control and Prevention (CDC) None of these disorders can be cured. all recommend that every baby born in the United However, the serious effects can be lessened – States be vaccinated against hepatitis B. and often be prevented completely – if a special diet or other medical treatment is started early. Hospital dose Most of these disorders are very complicated All newborns should receive the first shot of the to treat and medical care should be coordinated hepatitis B vaccine before leaving the hospital. by a specialist in the specific disorder. This reduces the risk of getting the disease from In the case of HIV, less than ten percent of mom or family members who do not know that babies who test positive are actually infected they are affected. and will need treatment. This hospital dose is recommended within the first 12 hours of life, but provides best coverage if administered within the first 6 hours of life. If you question whether your private pediatrician recommends a hospital dose, ask your nurse. Three to four doses of the vaccine are required: • The first dose at birth (within 12 hours) • A second dose at 1 through 3 months • A third dose at 6 through 18 months of age • A fourth dose may be administered if your Dear Parents, pediatrician used combination vaccines. Your child’s specimen(s) will be stored by the Newborn Screening Program for up to 27 years under Is this vaccine safe? secure conditions where access is strictly controlled. Hepatitis B vaccine has been shown to be Should the need arise, the specimen(s) may be very safe when given to infants, children, and used for diagnostic purposes for your child with adults. The most common side effects from appropriate consent. the vaccine are soreness at the injection site A portion of the specimen will also be stripped Vaccination of all information that might identify your child and and mild to moderate fever. Serious side effects may be used in public health research that has been are rare. reviewed and approved by a Board charged with overseeing compliance with all applicable laws and Protect your child’s future ethical guidelines. These same medical groups recommend your You may arrange to have your child’s specimen(s) baby get vaccinated against measles, tetanus, destroyed or prevented from being used in public polio and other serious diseases. Start your child Newborn health research by calling (518) 473-7552. on a vaccination schedule to protect his or her future. (See page 47.) 21 We’re taking care of you, Mom.

Comfort Your nurse will be checking your temperature and asking about your comfort and recovery. Please advise staff if you experience painful urination, dizziness, headaches or blurred vision. Bleeding Vaginal bleeding after delivery is to be expected and will be monitored by your nurses while at the hospital. It will decrease daily, but may continue for up to 2 to 4 weeks after you return home. Swelling Nurses will be checking for any swelling in your legs or feet that may indicate thrombophlebitis – a blood clot. During your stay... Postpartum women are at slightly increased risk. To reduce this risk, increase circulation in your legs by doing foot rotations and RECOVER. getting up and walking soon after birth. If it wasn’t work, they wouldn’t Breast Care call it “labor.” Your hospital lactation consultant can help The day after birth you may ache with proper techniques and hints to make all over from the work you did in breastfeeding comfortable and rewarding. labor. Your arms and legs may be sore from pulling back on your Moods legs while pushing out the baby. Talk to your doctor, nurse or minister about Take this time to recover. any fears or concerns you may have.

Did you know? It takes at least 6 weeks for your body to return to its non-pregnant state. This is called the postpartum period.

22 Good Work, Mom

REST. REMEMBER. Perhaps the most common Use the expertise around you feeling of new mothers after during your stay. childbirth is that of being bone tired. We have feeding specialists or lactation consultants who can Often fatigue is combined with help you get started nursing or such excitement in the first days bottle feeding. that sleep is difficult. The usual aches and pains of the early In addition, nurses are a great postpartum period can make it resource to show you how to even harder to sleep. hold, burp, change, and care for your baby. You don’t need to worry about everyday cooking or cleaning, so rest as much as you can while in the hospital.

Nurses and staff are always available – providing special care for new moms.

23 Common Medications There are variety of medications that may be administered during your OB/GYN stay to make you more comfortable.

ANALGESICS – PAIN RELIEF

Motrin / Ibuprofen For relief of: Mild pain / Fever Lortab / Norco / Hydrocodone Administered: By mouth / rectal & Acetaminophen Side effects: Upset stomach, nausea. For relief of: Moderate to Severe pain Continuous use may cause Administered: By mouth ulcers, bleeding, or holes in Side effects: Dizziness, nausea, vomiting, fatigue, the stomach or intestine constipation, itching, dry throat, Not used if: Bleeding / clotting disorders, mental confusion, sweating G6PD deficiencies, Dependence possible with long term use. pregnancies, known ulcers Not used if: Suboxone / Subutex / Methadone use

Tylenol / Acetaminophen Dilaudid / Hydromorphone For relief of: Mild pain / Fever For relief of: Severe pain Administered: By mouth / rectal / IV Administered: By mouth / injection / IV Side Effects: Upset stomach, nausea. Side effects: Dizziness, nausea, vomiting, fatigue, Overuse of more than 4 grams / day constipation, itching, sweating can cause liver damage! Dependence possible with long term use. Not used if: Liver failure / Hepatitis, Not used if: Suboxone / Subutex / Methadone use Heavy alcohol use Morphine / Morphine Sulfate Roxicet / Oxicodone For relief of: Severe pain For relief of: Moderate to Severe pain Administered: By mouth / injection / IV Administered: By mouth Side effects: Dizziness, nausea, vomiting, fatigue, Side Effects: Dizziness, nausea, vomiting, constipation, itching, dry throat, fatigue, constipation, itching, mental confusion, sweating dry throat, mental confusion, Dependence possible with long term use. sweating Not used if: Suboxone / Subutex / Methadone use Dependence possible with long term use. Not used if: Suboxone / Subutex / Methadone use

Percocet / Oxicodone & Acetaminophen For relief of: Moderate to Severe pain Administered: By mouth Side effects: Dizziness, nausea, vomiting, fatigue, constipation, itching, dry throat, mental confusion, sweating Dependence possible with long term use. Not used if: Suboxone / Subutex / Methadone use Most common medications are known by brand name(s) and their generic equivalent. Tylenol / Acetaminophen (brand name / generic name)

24 Good Work, Mom

ANTI-CONSTIPATION ANTI-NAUSEA – ANTI-VOMITING

Dulcolax / Bisacodyl Reglan / Metoclopramide For relief of: Constipation For relief of: Nausea / Vomiting / GERD Administered: By mouth / rectal Administered: By mouth / IV Side Effects: Abdominal cramps, dizziness, diarrhea, Side effects: Warm flushed feeling, burning / stinging at rectum tiredness, sweating, dizziness, Not used if: Rectal bleeding / GI bleeding / excessive urination, headache, Impaction breast enlargement (excessive milk production), Senekot / Senna irregular menstrual cycles For relief of: Constipation Not used if: If any uncontrolled facial Administered: By mouth movements / ticks / Parkinson’s / Side effects: Stomach cramping, dizziness, diarrhea Pregnancy / GI bleeds, Not used if: Rectal bleeding / GI bleeding / or are on certain medicines on certain medicines Zofran / Ondansetron Colace / Docusate Sodium For relief of: Nausea / Vomiting For relief of: Constipation Administered: By mouth / IV Administered: By mouth Side Effects: Dizziness, headache, Side effects: Stomach cramping, dizziness, diarrhea diarrhea, tiredness Not used if: Do not take with mineral oil Not used if: On certain medicines / certain heart conditions / PKU Miralax / Polyethylene Glycol For relief of: Constipation Administered: By mouth Side effects: Nausea, bloating, cramping, gas, diarrhea Not used if: History of Intestinal Blockage, GI bleeds / Certain Medicines

Mylicon / Simethicone For relief of: Gas / Bloating Administered: By mouth (chewable) Side effects: Passing gas, upset stomach Not used if: No known contra-indicators

25 Did you know?

Newborns are at risk for injury accidents! • Suffocation • Falls • Strangulation Be aware — in the hospital and at home! Tdap vaccine is especially After feeding and cuddling it’s easy to fall important for anyone having asleep with your baby in your arms. close contact with a baby younger than 12 months. Pain medication often makes you tired. Infants are most at risk Parents of newborns are often exhausted. for severe, life-threatening complications from pertussis.

• Your nurse will ask you if you received this vaccine during Follow the your pregnancy. If not, we will be offering it to you. There is ABC’s of Safe Sleep no charge for this vaccine. for your baby. • We also offer it to the father of the baby or whoever will be a Alone: primary caregiver to the baby. Do not sleep with your baby. Your baby • The vaccine is given to you by should sleep alone in a crib. Also, avoid your postpartum nurse, in your overheating the baby with clothes or room. too warm of an environment. If Dad or other primary caregivers want the vaccine, Back: your nurse will give them a Babies should be positioned sleeping consent sheet to sign and will on their backs. When babies are placed administer it right in your room. on their sides or stomachs, they are at an increased risk for Sudden Infant Before vaccines... Death Syndrome (SIDS). as many as 200,000 cases Crib: of diphtheria, 200,000 cases of pertussis, and hundreds of Cribs should be cleared of all objects cases of tetanus, were reported that could harm or suffocate the infant. in the United States each year. Keep bumper pads, stuffed animals, blankets and loose items out of the crib. 26 Good Work, Mom

Tdap Vaccine for Parents & Caregivers

Protect your new family from Tetanus, Diphtheria & Pertussis.

TETANUS (Lockjaw) Causes: How can I learn more? causes painful muscle spasms These 3 diseases are all • Ask your doctor and stiffness, usually all over the caused by bacteria. Diphtheria body. • Contact the Center for and pertussis is spread from Disease Control and Prevention It can lead to tightening of muscles person to person through (CDC) 1-800-232-4636 in the head and neck so you can’t secretions from coughing or open your mouth, swallow, or sneezing. Tetanus enters the • If you are uninsured or sometimes even breathe. body through cuts, scratches, under-insured and need Tetanus kills about 1 out of or wounds. vaccinations, call your county 10 people who are infected. Department of Health: Cocooning protects! Erie Co. (716) 858-2373 Unvaccinated adults and Niagara Co. (716) 278-1900 DIPHTHERIA family members are often the can cause a thick coating to form ones who unknowingly spread Risks: in the back of the throat. It can dangerous diseases to babies. As with any vaccine, there is lead to breathing problems, heart Babies less than 6 months old always a chance of side effects. failure, paralysis, and even death. are too young to have received These are usually mild and go all the doses of vaccine that will away on their own. One common PERTUSSIS protect them from pertussis, flu, side effect is fainting after an (Whooping Cough) and other dangerous diseases. injection. Sitting for 15 minutes causes severe coughing spells, after the injection will help Cocooning is a way to protect avoid this. which can cause difficulty babies from catching diseases breathing, disturbed sleep, and from the people around them — Serious or life threatening vomiting. It can also lead to weight parents, siblings, baby sitters, allergic reactions are also loss, incontinence, rib fracture and friends. Everyone has the possible but are rare. Contact passing out from violent coughing. opportunity to protect babies by your doctor if you have any signs Up to 2 in 100 adolescents and getting vaccinated themselves. of allergic reaction such as: 5 in 100 adults with pertussis are very high fever, behavior changes, hives, swelling of the face or hospitalized due to complications, Adults 19 and over should be which could include pneumonia vaccinated and should get a throat. Call 911 or take the or death. booster dose every 10 years. person to the ER if he or she experiences difficulty breathing, dizziness and weakness. 27 Reference: cdc.gov/vaccines Even newborns come with paperwork.

Completing Your Newborn’s Birth Record In addition to this Mom & Baby Guide, new mothers at Catholic Health hospitals receive a separate New Baby Paperwork Packet. It contains important information and forms to be signed before leaving the hospital. When complete, the paperwork should be submitted to your nursing team. Hospital staff can also help you with any questions you may have.

Birth Certificate Social Security Paternity Form It’s time to name your baby! Take a number If the new mom isn’t married

While in the hospital, moms Through the Birth Certificate An Acknowledgement of complete portions of the New registration process, parents of Paternity is a document that Birth Registration form. newborns have the opportunity is signed by unmarried parents to apply automatically for a In addition to spelling out your to establish the child’s legal Social Security number for new baby’s name, information father. Both parents must their child. collected on this form includes voluntarily sign. the Mother’s name, address, If you elect to participate in the The Birth Record Packet has demographics, employment and Social Security Administration’s important information to help Social Security number. There Enumeration at Birth (EAB) you decide whether to sign and is also a form for the Father’s or program, simply complete the submit this form. Social Security Release portion Second Parent’s information. Your child may have the name on the New Birth Registration Once completed and signed, the of either parent. The child’s form. No third party, fee or hospital will submit the form to name will not affect the child’s additional paperwork is required. the New York State Department legal status. of Health and it will be entered Additional resources are available into the Statewide Perinatal Data on the New York State Division System (SPDS). of Child Support Enforcement Once your child’s official Birth website: childsupport.ny.gov Certificate is issued, it will be mailed to you. Be sure to keep this important document in a safe place. Health & Safety Education Forms New parents are educated at the hospital about child safety issues such as as preventing shaken baby syndrome and protecting children from serious disease with vaccinations. After acknowledgement forms are signed and submitted, the New Baby Paperwork Packet can be used to keep patient copies of forms as well as any other papers related to your hospital stay with your newborn. 28 Good Work, Mom

Adding your Newborn to your Insurance or Medicaid Policy Insurance companies typically require a newborn be added to an insurance plan within 30 days from their date of birth. Failure to add your newborn within this time frame may result in you being responsible for payment of their bill.

Blue Cross, Community Blue, Affordable Care Act — Medisource, Fidelis, Univera, Independent Health, NYS Health Exchange: Amerigroup, Yourcare, Commercial Insurance and • If you applied for insurance Wellcare and Medicaid: Children’s Health Insurance through the NYS Health • If Medicaid was obtained Plan also known as Child Exchange, you must contact through NYS of Health, Health Plus: them at (855) 355-5777 to you must contact them • Call your employer as soon as add your newborn to your at (855) 355-5777 or possible to have your newborn insurance plan. As a reminder, via their website at added to your policy. They will newborn dependents do nystateofhealth.ny.gov to send you all the appropriate NOT automatically go on report your newborn’s birth. paperwork to complete and their mother’s insurance and • If Medicaid was obtained return to them for processing. must be added within the first through Erie County, you 30 days of birth. • If your newborn is not covered must contact them at under the mother’s insurance (716) 858-6244 to report plan, contact us with new your newborn’s birth. insurance information. • If you have an “unborn card” • Your newborn may be eligible for your baby, please contact for Children’s Health Insurance our Financial Clearance Plan (also known as CHIP or department via Catholic Child Health Plus), if mother Health Customer Service at has applied for this coverage (716) 601-3600, and provide prior to newborn’s birth. that ID number to our team. Please note: it is still required that you contact Medicaid to report your newborn’s birth.

If you have any questions about your newborn’s insurance coverage, or need assistance in applying for health insurance for you or your newborn, please call (716) 601-3600. Additional Resources are available online at: chsbuffalo.org/billing

29 Welcome Home! Now What?

Handle with care. If you haven’t spent a lot of time around newborns, their fragility may be intimidating.

Here are a few basics to remember:

• Be careful to support your • Make sure your baby baby’s head and neck. is securely fastened into Cradle the head when the carrier, stroller or carrying your baby and car seat. (See page 66.) support the head when Limit car rides and any other carrying upright or when activity that would be too you lay the baby down. rough or bouncy. A newborn is not ready • NEVER shake your for rough , such as newborn or any child. being bounced on Shaking can cause brain the knee or damage, bleeding in the thrown in brain and even death. the air. If you need to wake your infant don’t shake the baby, instead, tickle their feet or blow gently on their cheek.

30 Get as much rest Get to know Enjoy your new role as possible. each other. as... a parent! As a general rule – only take Whether this is your first baby Even though you may feel care of yourself and your baby or there are older brothers and insecure about caring for an for the first 2 weeks. sisters, you’ll soon find out that infant now, in a few short this newborn is a very special, weeks you’ll develop a routine Don’t push yourself beyond and unique individual. and will be your discomfort or tiredness. newborn like a pro! With time, you will learn • Nap when your to understand your new baby’s Do not worry about spoiling baby naps – REALLY! own unique personality and your baby for the first 6 months • Let others help with moods. of life; some babies are more the household tasks. demanding than others. Do not refuse offers of help. Consider the first weeks at home with your baby a “getting As your baby grows and • Take it easy. Limit to know each other” period. matures, he or she will be unnecessary activities. Try to figure out and meet your more content, less demanding, baby’s needs. and will give you more time • Lift and hold your new baby – to rest. not anything heavier. Remember, since each newborn is special and unique, there may Trust yourself and you will be some flexibility in making gain confidence in making decisions about how to care decisions. for your baby. You know your baby best.

The most important advice your baby would give you is – “LOVE ME!” “HOLD ME!” “TALK TO ME!”

31 Caring for Baby

Sleep CRIB SAFETY TIPS As a new parent you may be • If your crib is new, remove surprised to learn that your newborn — and discard all packaging who seems to need you every minute of the day — materials, including the thin actually sleeps about 16 hours or more! plastic mattress cover. • Place the crib out of reach of electrical cords/sockets SLEEP PATTERNS SAFE SLEEP or other hazards like cords Usually a newborn will sleep from window coverings. • Keep your baby’s for periods of 3 to 4 hours at a • If your crib has them, sleep space free. time. Don’t expect your newborn check guide rods, locks to sleep through the night – Pillows, bumper pads, and latches. Keep crib rails because your baby’s digestive stuffed toys and blankets up at all times when the system is so small, the baby can contribute to SIDS. baby is unattended. needs nourishment every few Use sleep clothing, such as a • As soon as your baby can hours and should be awakened one-piece sleeper, instead of pull herself up, move the if he or she hasn’t been fed for a blanket. Nothing should be mattress to the lowest 5 hours. placed near your baby’s head. position. Allow at least 22 inches between the When will my baby sleep • Don’t let your baby mattress and the top of through the nights? get too warm. the rail. Avoid having your baby About 90% of babies sleep overheat wearing too many through the night (between clothes or covers. Keep the A safe crib should have: 6 and 8 hours) at 3 months of room temperature between • A firm mattress (with a age but if your infant doesn’t, 65 and 70 degrees. fitted sheet) that fits snugly it’s not a cause for worry. Like within the crib sides, so adults, babies must develop • Try using a pacifier. your baby can’t be trapped. their own sleep patterns and A pacifier can be soothing No bumpers. cycles. So if your newborn is when placing your infant to • No lead paint. Some babies gaining weight as your baby’s sleep but don’t force your do chew on their cribs, and doctor recommends and appears baby to take it. healthy, don’t despair if your baby ingesting lead can cause When breastfeeding, wait one hasn’t sleep through the night at brain damage. month or until your baby has 3 months. • No corner posts. These can learned to breastfeed before catch a child’s clothing. trying a pacifier. • Sides that don’t drop down. • Slats that are no more than When your infant wakes up crying, walk around 2 3/8 inches apart. holding him or her close to you. Check to see if your baby is hungry or needs a diaper change. Try a pacifier. Then put baby “back to sleep” – Alone, on baby’s Back, in a Crib. 32 Each year in New York State, babies die from Sudden Infant Death Syndrome (SIDS) and injuries in their sleep area. New York State Center for Sudden Infant Death 1-800-336-7437 New York State Office of Children & Family Services 1-800-345-KIDS ocfs.state.ny.us.

Babies sleep safest...

...ALONE ...on their BACK ...in a CRIB YouA don’t have to sleep in the PracticeB “Tummy Time” when CNever put your baby to sleep same bed to keep your baby your baby is awake and is on an adult bed, sofa, water close at night. Your baby is being watched. However, put bed, sheepskin, or other soft safest sleeping in a crib or your baby “Back to Sleep” on mattress – even for a nap. near your bed. his or her back for naps and If you don’t have a crib, put Sleeping with your baby at night. baby to sleep in a firm, (“co-sleeping”) can be enclosed space such as a dangerous. If an adult or The American Academy of playpen or stroller, with no child rolls over on a baby, Pediatrics (AAP) recommends loose bedding, pillows or the baby can be hurt or even that an infant should be placed toys. suffocated. Sleeping with on their “back to sleep” to reduce your baby is especially unsafe the risk of sudden infant if other children also share death syndrome (SIDS). the same bed. It’s particularly dangerous to sleep with a baby on a couch or armchair. Alternate the position of the Babies should never be head of the baby from night allowed to sleep with to night (first right, then left, anyone who: and so on) so that a flat • is overweight spot doesn’t develop on one side of • has been drinking alcohol the head. • has used marijuana or other drugs • has taken medication that causes drowsiness • is ill or extremely tired.

33 Caring for Baby

Bonding Soothing

You bond with your baby when you soothe him or her. This builds trust and comfort.

Bonding with your baby is probably one of the most SOOTHING SOUNDS SWADDLING pleasurable aspects of infant care. Babies usually love vocal For some babies, sounds, such as talking, Begin to bond by cradling swaddling is soothing, , singing and cooing. your baby in your lap and and may help them Your baby probably will also gently stroking the baby in sleep better and cry less. love listening to music. Try a different patterns. variety of types to find your If you and your partner baby’s preference. Baby rattles Swaddling seems to give most both hold and touch your and musical mobiles are good newborns a sense of security infant frequently, baby will ways to stimulate your infant’s and comfort. soon come to know the hearing. A special sleeping bag makes difference between your If your baby is being fussy, try swaddling easy, but a blanket touches. singing or reading as you sway may also be used. Each of you should also or rock gently in a chair. Choose a lightweight cotton take the opportunity to blanket and wrap baby only from be “skin-to-skin” with your the shoulders down to minimize newborn, holding the baby risk of suffocation. against your own skin when feeding or cradling. • Take care not to over-bundle.

NOTE: Some babies may be unusually sensitive to touch, light, or sound. Such babies may startle and cry easily, sleep less than you might expect, or turn their faces away when you speak or sing to them. Keep noise and light levels low to moderate depending upon your baby.

34 CRYING Crying is how babies make their needs known. Most parents quickly learn to identify whether their baby is crying from: • hunger • restlessness • pain/discomfort • anger • some other reason Many babies have unexplainable fussy periods each day as they adjust to living in the world. There are a number of things you can do to help comfort Troubleshooting your baby. • Check for a wet diaper or other discomfort How to safely swaddle • Try to feed the baby or give a pacifier 1. Spread the blanket on a bed or changing table. Fold down the • Give the baby more physical top corner about six inches. contact / movement (walk, Place baby on the blanket gently rock or pat the baby) with head above the fold. • Take the baby for a stroller or car ride 2. Take the corner near baby’s left • Check the temperature in the room – arm and pull it across the body. it should be between 65-70° F Lift the right arm. Tuck the • Gently place the baby “back” to sleep corner under baby’s back on the right side. If all else fails — 3. Lift the bottom corner and just let the baby cry. bring it up over baby’s body. Your baby may need to let off steam. Tuck it into the first swathe. Often babies fall asleep after a good 4. Lift the last corner and bring cry, so allow up to 20 minutes crying it over baby’s right arm. on their own. Tuck it in under the back of the left side. As long as you can hear the baby crying, the baby is OK. Wrap the blanket firmly around the arms. Wrap loosely around It is NEVER OK the legs so they can move freely. Do not stretch baby’s legs straight to shake a baby! or push them together. The legs should be able to bend easily. Serious injuries can occur when an infant or is severely or violently shaken.

35 Caring for Baby

INFANT MASSAGE One of the most rewarding ways to bond with your baby is through massage.

Babies, especially premature Benefits for Baby: Benefits for Parents: babies and those with medical • Relaxes infant — a loving touch • Helps parents to feel more problems may respond to infant can lessen tension, fussiness confident and competent in massage. and irritability caring for their children Like adults, babies collect tension • Provides a special time of • A special time for parent in their bodies which they often communication that fosters love, and child to spend together release by crying. Massage can compassion, respect and security • Helps parents to unwind release tension and help babies • Aids growth and development: and relax fall asleep. Studies have shown increased • Promotes bonding and weight gain and immune function • Rub some baby oil on attachment, reinforces your hands and slowly • Improves baby’s sleep — your good eye contact and very gently massage infant will learn how to relax • Helps parents to understand your baby’s chest and and release stress, helping to their child’s unique rhythm shoulders, arms, hands, improve sleep hips, legs and feet. • Improves digestion Please consult your healthcare provider or a licensed Infant • Continue massaging • Helps to normalize muscle tone Massage Therapist for more the baby’s back, • Improves circulation information. face and head. • Helps to improve sensory • As you massage your awareness baby, sing a lullaby • Helps to increase oxygen and or say loving words. nutrient flow to cells, improves respiration • Helps to relieve discomfort from teething, pain management, congestion, gas and colic

Be careful – babies are not as strong as adults, so massage your baby very gently.

Information regarding Infant Massage was collected from infantmassage.com. 36 THUMB SUCKING & PACIFIERS The need to suck is present in all babies and is very healthy.

Some babies prefer to suck their Pacifiers also tend to be harmless, fingers or thumb, while others however, if you are breastfeeding rely on a pacifier. Some babies it is not recommended to use will get along with neither. a pacifier until breastfeeding is well established – usually at Thumb sucking starts in some 2 to 3 weeks. They can also be infants even before birth. It tends problematic in that they often to be a harmless behavior with fall out when the child sleeps, no cause for alarm. prompting the child to awaken. Many infants will gradually stop (Advantage thumb suckers.) thumb-sucking at about 6 to 12 DO NOT attempt to tie a pacifier months of age, while others will to the crib or to your child’s body continue to do it from time to or clothes as this may result time until a later age, often at in strangulation. times of insecurity or boredom. Most pediatricians recommend If thumb-sucking is affecting weaning off of the pacifier your child’s teeth, palate or if it between 12 and 15 months of does not end by 1st or 2nd grade, age, as children can bite harder you should discuss it with your and cause the nipple to break off, pediatrician. becoming a choking hazard. Sucking provides • Be sure baby’s pacifier is not worn or damaged a natural in any way. calming effect • Never use a bottle nipple as a pacifier as and is important in this practice is unsafe. the development of your child’s A good pacifier should be a temperament. one-piece model with at least 1-1/2 inches across, with air holes. It should be sized appropriate for your baby.

37 Caring for Baby

Bath Time

BATHING Bathing is a fun way to play with your newborn as well as keep him or her clean. Here are a few reminders for the baby bath: • Water should be warm, Sponge Bath not hot, to your wrist Eyes A sponge bath is preferred • The room should be Clean eyes away from the tear until the cord has fallen off free of drafts ducts located near the nose. and, if circumcised, when An infant may have some • Start at the head and the penis is healed. discharge from the eyes, work to the toes Head “sleepies”, but if the eyes are • Soap should not be glued shut with yellow discharge Wash baby’s head with a wash used on the face or become reddened, call your cloth, and rinse thoroughly. baby’s doctor. Using a soft brush on hair can help prevent . Ears Avoid getting water in your baby’s ears. Use a wash cloth. DO NOT use cotton swabs / Q-tips to clean the ears or nose.

38 Never leave your baby alone in the bath or on a changing table.

CLOTHING Dress the baby as you would dress yourself. A baby that is overdressed can be overheated. A baby that is under dressed can become cold quickly. • Choose clothing that is appropriate for the weather. Mouth & Nose • Avoid tight-fitting clothing. Baby’s teeth and gums need cleansing too – use a soft cloth wet with water to wipe them.

SUCTION — Bulb suctioning may be necessary to remove Cradle Cap mucus, breast milk or formula from the baby’s mouth or nose Cradle cap is seen as yellow on occasion. Squeeze the bulb, crusts commonly found on the then gently hold baby’s face still scalp, eyebrows and behind as you gradually release the the ears. suction in the nose or side of If difficult to wash off, try the mouth. softening crusts with baby oil or lotion for 24 to 48 hours. Removal will then be easier. Prevention includes keeping these areas clean, removing soap film completely, and stimulating the scalp by brushing the hair with a soft brush.

39 Caring for Baby

Feeding ...something more than milk.

When to start How to start Most babies are ready to start When feeding your infant, it is solid food by the time they are 4 often wise to start with a little to 6 months old. Your pediatrician formula or breast milk first. This is the best resource to help you takes the “edge” off the hunger know when your child is ready to and makes feeding time less start solids. frustrating. Feed your , and then finish off with more breast milk or formula. The American Academy of Pediatrics recommends • Always feed your baby in an exclusive breastfeeding upright position. for the first 6 months. • Food should always be given on a spoon and not mixed into the bottle (unless specifically By this age they have typically directed by your doctor). gained enough control over their tongues and mouths to safely eat. Most babies will pursue food Baby cereal quite eagerly, but if not, don’t force it. It is best to start with several half-teaspoonfuls of rice cereal per feeding. The amount can be If your baby turns its head to the increased as your baby dictates. side, simply resume the bottle or After rice cereal, try oatmeal breast, and try again in a week. cereal and barley. All cereals The important thing is that the should be specially intended feedings are pleasurable for both for babies. parent and child.

40 As your child gets older, diet will expand. Try to keep it as balanced as possible.

Trying new things Finger foods WARNING: Later you can try veggies, then When your baby can sit by Be cautious of choking hazards, fruits, and then meats. himself, you can offer finger even in older kids, as children often swallow without chewing. Fresh foods can be given by foods. These should be soft, using a blender, however they easy to swallow and cut into Children under 4 years of age should be well-cooked, soft and small pieces (ex. cooked peas, should NOT eat: little pieces of crackers). free of additives. • spoonfuls of peanut butter • nuts • grapes When introducing new foods, • popcorn • uncooked peas it is important to space at • celery • candies least 3 days between each new food you try. Hot dogs should be cut into small pieces. If any foods cause reactions such as vomiting or a rash, you should discontinue and discuss with your pediatrician.

The American Academy of Pediatrics does not recommend home-prepared beets, turnips, carrots, spinach or collard greens because of high levels of nitrates which may be found in these vegetables.

NOTE: • Give eggs as one of the last foods you try as they can often cause allergies. • Honey should be avoided until your baby is one year old.

41 Newborn Health

Primary Care Get to know your baby and your pediatrician. GERMS Don’t allow people who are sick or who obviously have a cold to be around FIRST CHECK-UPS your baby. Infants have protection Just as you had a healthcare from some bacteria, specialist looking after you but not viruses such as while you were pregnant and The first few office visits to the common cold or flu. the pediatrician are to check for the delivery of your baby, Washing your hands your newborn’s growth and your child will need special frequently is the best weight gain. attention as a newborn and way to keep germs from as he or she grows up. The pediatrician will take an spreading. interest in your baby’s eating Upon delivery, your baby is and sleeping habits, behavior given a health assessment and and developmental milestones. is visited in the nursery by a Pediatrician, someone who Regular well-child appointments specializes in infant and also provide excellent opportunities . to ask any questions you may have now that you’ve brought your baby home from the hospital. If you don’t have a healthcare It is also important to work with provider for your new baby, the pediatrician to start on a or if you would like more vaccination schedule to protect information about pediatric your child and your family. care, contact: (See page 45.) • Catholic Health’s HealthConnection You can choose to continue (716) 447-6205 your relationship with that • your local health clinic or hospital affiliated provider, health department or you may choose your child’s pediatrician from among other • your health insurance plan Catholic Health Pediatric Centers • your local Catholic or other healthcare practices. Charities or WIC office. ccwny.org (WIC is a program for Doctor visits are important. women, infants and children.)

42 Baby’s Healthcare Check-Ups

DATE

Baby’s age ______Weight______Height ______Topics discussed ______Treatments or vaccinations ______

Baby’s age ______Weight______Height ______Topics discussed ______Treatments or vaccinations ______

Baby’s age ______Weight______Height ______Topics discussed ______Treatments or vaccinations ______

Baby’s age ______Weight______Height ______Topics discussed ______Treatments or vaccinations ______

Baby’s age ______Weight______Height ______Topics discussed ______Treatments or vaccinations ______

Baby’s age ______Weight______Height ______Topics discussed ______Treatments or vaccinations ______

Baby’s age ______Weight______Height ______Topics discussed ______Treatments or vaccinations ______

Baby’s age ______Weight______Height ______Topics discussed ______Treatments or vaccinations ______

43 Newborn Health

Many parents doubt whether they will recognize if their new baby is sick.

How will I know COLOR CHANGES? if my baby is sick? Color changes in your infant’s When you have no experi- skin are common. ence with babies, being told that “a sick baby behaves • Pink or red blotchy areas differently than a well baby” with white pimples can be is of little comfort. found anywhere on your baby and are normal. CRYING? This is called “newborn rash.” Babies can cry for a couple • White patches in the mouth of hours each day – whether or on the tongue could be they are healthy OR sick. thrush, a fungus. Crying does not tell you as This should be reported much in the first weeks as it to your doctor. will when your baby is older.

• A redness in the diaper area should resolve with air drying and frequent diaper changes. If it does not improve within 2 to 3 days call the doctor.

• Yellowing of the skin, or jaundice, can be normal or a sign of a more serious problem. Call your baby’s doctor.

44 SIGNS OF ILLNESS IN A NEWBORN Ask yourself these questions:

Is there a change in the baby’s behavior? Is the baby crying more than usual? Has the tone of the cry changed? Is the baby crying at a different time of the day than usual? Is the baby sleeping more or less than usual? Does the baby seem listless?

Has the baby’s appetite or digestion changed? Is the baby eating less than usual? Has the baby vomited more than once? If the baby is vomiting, is the vomit forceful? (This is called projectile vomiting.)

Are there signs of constipation? Call your That is, are the stools hard and more solid than usual? Troubleshooting Are there signs of diarrhea? pediatrician. Are they more frequent than usual? When you call the Is the baby urinating less frequently than usual or not office, be prepared at all? (Keep track of how many diapers you’ve changed.) to describe: Has the color of the urine changed? • The signs of illness about which you are Has there been a change in the baby’s breathing? concerned. Does the baby sound congested? Does the baby have a runny or stuffy nose? • How long the signs Is the baby coughing? have been present. After hours, you will How does the baby look? get an answering Is the baby’s skin pale or flushed? service and a doctor Is there a rash anywhere on the baby’s body? will call you back. Do the baby’s eyes look glassy or dull? Is there any discharge from the eyes? If you have any doubts, take the Does the baby have a fever? baby to the hospital. Any of these changes could indicate illness. If you notice any of them, or other worrisome changes in your baby, call your baby’s doctor.

45 Newborn Health

Vaccinations Children are our future — protect them.

Vaccinations Vaccinate your baby! Why does my baby need activate immunity so many vaccinations? While vaccines won’t prevent During the last three months minor illnesses like colds, they It’s true that little babies get of pregnancy, antibodies keep your child safe from many lots of injections, which can from the mother are passed serious diseases including: cause temporary discomfort. to her unborn baby through the But without these vaccines placenta — this is called passive • measles • polio your baby is not protected immunity — but the amount and • tetanus • rotavirus against measles, mumps, type of antibodies depends on • hepatitis A • chickenpox diphtheria, rubella, and other the mother’s immunity. • hepatitis B • influenza preventable diseases. Like hepatitis B, many of these Immunity in newborn babies • whooping cough diseases can result in severe is only temporary and starts • meningococcal disease to decrease after the first few illness, hospitalizations weeks or months. Therefore, While a few of these diseases and even death. it is important to begin child have virtually disappeared when your baby because of vaccination, reported For more information, call is two months old. cases of people with diseases toll-free 1-800-CDC-INFO (1-800-232-4636) or visit Breast milk alone offers some like measles and whooping cdc.gov/vaccines. protection against some cough have been on the rise. diseases, but not for all of Even if some diseases do childhood, much less a completely disap­pear in the lifetime. Vaccination ensures United States, they are common far better protection — for much in other parts of the world and Make sure all your longer. are just a plane ride away. children get all their Vaccination protects your child If we stop vaccinating against vaccinations on time. against serious diseases by these diseases, many more stimulating the immune system people will become infected. to create antibodies against certain dangerous bacteria or If you can’t afford a clinic visit, contact your local viruses. health department for options available to you. Erie County: (716) 858-2373 Niagara County: (716) 278-1900. 46

years 4-6

years 2-3

23 months 19- 18 months Dtap HepA 15 months Hib PCV MMR HepB Varicella 12 months 6 RV Hib IPV PCV Dtap months 4 RV Hib IPV PCV Dtap months 2 RV Hib IPV PCV Dtap months HepB

1 month HepB Birth

DISEASES RV IPV PCV Hib Vaccine Dtap Vaccine MMR Vaccine HepB Vaccine HepA Vaccine Varicella Vaccine Varicella Recommended Vaccines Vaccines protect against protect Vaccines of symptoms a variety which have ...and possible complications. HEPATITIS B: infection of the liver, no symptoms OR fever, headache, weakness, vomiting, no symptoms OR fever, B: infection of the liver, HEPATITIS jaundice, joint pain... possible chronic liver infection, failure, cancer diarrhea, fever and vomiting... possible severe dehydration ROTAVIRUS: DIPHTHERIA: sore throat, swollen glands... swelling of the heart, heart failure, paralysis, death neck / abdomen, trouble swallowing, muscle spasms... breathing problems, death stiff TETANUS: (whooping cough) severe cough, apnea... pneumonia (lung infection), death PERTUSSIS: TYPE B: may be no symptoms OR... possible meningitis (infection HAEMOPHILUS INFLUENZA epiglottitis, pneumonia, death of tissue around the brain & spinal cord), intellectual disability, DISEASE: Pneumonia (lung infection)... blood infection, meningitis, death PNEUMOCOCCAL nausea, headache... possible paralysis, death POLIO: no symptoms OR sore throat, fever, cough, pink-eye... swelling of the brain, pneumonia, death MEASLES: rash, fever, tiredness, muscle pain... meningitis, brain swelling, deafness MUMPS: swollen glands, fever, swollen lymph nodes... can lead to miscarriage or birth defects RUBELLA: rash, fever, possible infected blisters, bleeding CHICKEN POX: itchy rash, tiredness, headache, fever... disorders, brain swelling, pneumonia (lung infection) stomach pain, loss of appetite, jaundice, vomiting, fatigue, A: no symptoms OR fever, HEPATITIS pancreas & blood dark urine... possible liver failure, joint pain, disorders of kidney,

47 Crying Period

Babies communicate their needs by crying. Parents soon learn what their newborn’s cries mean and will sooth baby with warmth, Prevent comfort or food. SHAKEN BABY Many babies have unexplainable fussy times each day as they SYNDROME adjust to living in the world.

Even a healthy, well-fed infant may cry Shaken baby syndrome is a serious more than 3 hours a day, more than form of . 3 days a week, for more than 3 weeks. These symptoms, often described as colic, It describes the serious injuries that do not indicate abnormality, but a normal developmental period for baby. can occur when an infant or toddler is severely or violently shaken. Fussiness may become predictable, and is often worse in the evenings. Baby may resist soothing — techniques that always “did the trick” in the past will be unsuccessful. Taking care of an infant can be challenging, especially when an end to the crying seems This crying period, more pronounced in nowhere in sight. some infants than in others, can be frustrating and exhausting. When Your Child Cries, • May START around age 2 months Take a Break – Don’t Shake • Often PEAKS at around 2 months • Will END on its own usually Shaken Baby Syndrome usually occurs by 3 or 4 months. when a parent or other caregiver shakes a baby because of anger or frustration often Though difficult and distressing, the crying because the baby would not stop crying. period is relatively short-lived. Parents and Children, especially babies, have very weak caregivers should know that, in a matter of neck muscles and do not yet have full sup- weeks or months, this crying cycle will end. port for their heavy heads. When they are Period. shaken, their fragile brains move back and forth within their skulls. This can cause For more information please visit: serious injuries such as: purplecrying.info • Blindness or eye damage or • Seizures dontshake.org • Brain damage • Delay in normal development If you are concerned about your baby, your pediatrician can do a full exam to rule out • Damage to the spinal cord (paralysis) a medical cause for why your baby cries. • Death It is NEVER OK to shake a baby.

48 Act quickly Be honest. If you feel as though you If your baby is severely or Be sure to tell your pediatrician or could lose control: violently shaken, the most other doctor if you know or suspect important step is to get that your child was shaken. Take a deep breath and medical care right away. Many symptoms of shaken baby 1 count to 10. Immediately take your child to syndrome are very much like the pediatrician or emergency those of infant colic, feeding Take time out and let room. problems and fussiness. 2 your baby cry alone. A doctor who is not aware a child Don’t let embarrassment, Call someone close to you has been shaken may assume guilt or fear get in the way of your 3 for emotional support. the baby is vomiting or having child’s health – or his life. trouble breathing because of an Call your pediatrician If your baby’s brain is damaged illness. 4 (there may be a medical reason your child is crying). or bleeding inside from shaking, Your pediatrician should have it will only get worse without complete information so they Place your baby safely in a treatment. can treat your child properly. 5 crib and sit outside the room Getting immediate medical care for 15 to 20 minutes. may save your child’s life and As long as you can hear the prevent serious health problems. baby crying, the baby is OK.

Call the Child Help It is NEVER OK Hotline anytime: to shake a baby. 800-4-ACHILD 800-422-2253 49 Home Care for New Moms

Postpartum Period

The postpartum period is 6 weeks after birth. It takes at least 6 weeks for your body to return to its non-pregnant state. This information will help you care for yourself after leaving the hospital.

MOM’S BODY AFTER PREGNANCY

Joints: Stretch Marks: Joints that relaxed in pregnancy Any stretch marks you have to allow for the baby’s growth will seem more obvious after and birth will return to their birth than before. Although pre-pregnancy condition within stretch marks never completely several weeks of birth. Many disappear, they fade to silvery women, however, feel that the white lines in the months after rib cage and pelvis remain slightly childbirth. expanded for the rest of their lives.

Fatigue: Hair: Perhaps the most common Many women note changes in feeling of new mothers after their hair after birth, most childbirth is that of being “bone commonly, profuse hair loss. tired.” This seems especially true This is because pregnancy of women who have just had hormones stimulate hair growth. their first babies. Often fatigue is With the drop in these hormones, combined with such excitement the extra hair that grew during in the first days that sleep is pregnancy will fall out. This difficult. The usual aches and begins around three months pains of the early postpartum after birth and usually ends period can make it even harder a couple of months after that. to sleep.

Most women find that daily naps are essential.

50 Follow-Up with Healthcare Sexual Intercourse Weight Loss Make an appointment with your Unless your doctor directs you Soon after delivery, healthcare provider within the differently, you may resume sexual you may lose some of first week of leaving the hospital. relations in 6 weeks. Sex may be the weight you gained Your provider may want to see uncomfortable the first few times. during pregnancy. you 4 to 6 weeks after giving You may have a lower than usual Most mothers return birth, some may want to see sex drive due to hormonal changes to their pre-pregnancy you sooner. after pregnancy, fatigue, demands weight within six months of the baby’s birth. During this check-up, your made by the baby and fear of Breastfeeding also healthcare provider will tell you discomfort. Discuss these issues helps to promote a if your body has healed properly. with your partner. steady weight loss. Your options for birth control Discuss any prolonged painful will be discussed. intercourse with your doctor and/or If you would like to lose additional weight, Most mothers stay home for at ask for a referral for physical therapy, talk with your healthcare least 6 weeks before returning provider at your postpartum to work or school. If you need Can I get pregnant again check-up. They can give to go back sooner, let your right after giving birth? you information about doctor know. Yes. You can become pregnant healthy lifestyle practices as soon as ovulation resumes. Do I NEED to schedule or refer you to a dietitian. Breastfeeding may delay ovulation, a postpartum exam? but it may begin before your monthly Yes. It is important for you to period resumes, so you can get be seen after delivery by your pregnant, even while breastfeeding. healthcare provider to evaluate Talk to your healthcare provider your healing and be cleared for about family planning options. all activities. Catholic Health offers the Creighton If you’ve had a cesarean section, Model Fertility Care System your provider will check the featuring NaProTECHNOLOGYTM incision before you leave the to help you fully enjoy your new A healthy diet and hospital. Your incision should be baby and naturally plan the spacing moderate exercise checked again about one week of your children without barriers are the best ways after delivery. If you‘ve had a or chemicals. to lose weight after staple closure, the staples must Visit WomenCareWNY.org or call your baby is born. be removed within a week of (716) 862-1944 for details. leaving the hospital. For a vaginal birth, you should be seen 6 to 8 weeks after delivery. 51 Home Care for New Moms

MANAGING DISCOMFORT

Cramping Constipation Gas It is normal to have some Try the options below to relieve • Lay on your left side in bed cramping or “afterbirth” pains or prevent constipation which is with a pillow between your for 2 to 3 days after your baby common after giving birth. bent knees. is born. • Gently massage abdomen to • Increase your fiber intake by At delivery your uterus or womb relieve gas pain and stimulate eating whole grains, fruits, and the bowel. has stretched to a size large raw vegetables. enough to hold your baby. After your baby is born, your uterus • Drink six 8-ounce glasses will return to its pre-pregnancy of water or juice a day. size, that of a small pear. You • Progressive exercise. will feel the afterbirth pains as (See page 58.) you uterus contracts and gets Make small counterclockwise smaller. Also, you may feel • Most over-the-counter circles starting at your right cramping while breastfeeding stool softeners or laxatives hip. Massage up toward the because of hormones being are fine to take. rib cage, continue across the released that cause the uterus stomach below the rib cage, If constipation continues to be to contract. Afterbirth pains can and then down toward the a problem, please contact your be uncomfortable. left hip. healthcare provider. • Movement can also assist Take pain medication like with passage of gas. Remain Tylenol or Motrin as prescribed mobile, walking around as (if not allergic). much as you can tolerate with your physician’s permission. See pages 62-63 for additional exercises.

ACTIVITY / REST

Rest as much as possible • NAP as much as possible After about ten days, you may for the next 2 weeks. when baby is sleeping. do light housework. Whenever possible, sit down to do work. As a general rule – just take care • ACCEPT offers of help. of yourself and your baby for the • LIMIT unnecessary activity NOTE: If you notice an increase in first 2 weeks. like frequent stair climbing. the amount of vaginal discharge, Don’t push yourself beyond • LOVE, lift and hold your baby, you may be doing too much. discomfort or tiredness. but don’t lift anything heavier. 52 WARNING SIGNS If you experience any of the problems listed below, please call your doctor:

Bleeding: Passing blood clots or heavy bleeding is not normal. Vaginal bleeding will Backache decrease every day and will • Use good posture to help change from a red color to pink relieve or prevent low back or dark brown and then to clear. pain. This discharge will continue for 2 to 4 weeks. Blood in your • Bend your knees – not your urine is not normal back – when you pick up anything. Chills: A temperature above 101° F is not normal. • Keep your knees higher than your hips when you are Urination: Frequent or painful sitting (use a footstool). urination is not normal. • Prop one foot up on a stool Swelling: Swelling or pain in when you are doing work that your legs or feet is not normal. requires standing for a while Warmth in your calves and (doing dishes). swollen or reddened veins are warning signs that you • Use a surface that is at least should report to your doctor waist high if you are folding immediately as they could laundry or some similar task, indicate thrombophlehitis – so you don’t have to bend a blood clot. Postpartum over. women are at slightly Pain medication like Tylenol or increased risk. To reduce this Motrin can also be taken. risk, increase circulation in your legs by doing foot rotations Discuss prolonged back pain and getting up and walking with your doctor and/or ask for soon after birth. a referral for physical therapy, Headaches: Dizziness, headaches or blurred vision are not normal. Unless otherwise instructed by your doctor — Breast care: Soreness, pain, red spots or red streaks on the You CAN: You should NOT: breasts are not normal. • walk the stairs • do any heavy lifting Moods: Feeling like you cannot • ride in a car • do housework cope with caring for yourself or • shower or take a bath • drive a car for your baby are signs of difficulty in a clean tub 1 to 2 weeks or until adjusting to this new lifestyle. You may swim when bleeding you can comfortably Support is important. ends. react quickly if necessary. (See pages 62 and 63.)

53 Home Care for New Moms

PERSONAL CARE

Handwashing Menstruation Perineal Care / Wash your hands before (Periods) Episiotomy Care and after breast care and Lochia (your period right after Continue to do perineal care perineal care. birth) will decrease and change until your bleeding has stopped. Always wash your hands color over the next several weeks. • Always wipe from front before picking up your baby. The flow will go from bright red, to back. to dark red to pink/brown, to yellow/white as the uterine lining • Avoid sitting on a toilet or Bathing heals. It usually stops within donut for extended periods 2 to 4 weeks. During this time, of time. You may take showers or get plenty of rest in order to • If you have stitches, they tub baths as often as desired. allow yourself time to heal. will dissolve over the next You also may take a warm or few weeks. hot sitz bath 2 to 3 times daily • If you are formula feeding, to relieve the discomfort from you can expect your period to • Bowel movements can be stitches or hemorrhoids. return in 6 to 8 weeks. uncomfortable after delivery. • If you breastfeed 6 times a day Folding toilet paper around or fewer, you may get a period your hand and holding as early as 6 weeks postpartum. stitches while you have a bowel movement may help. • If you breastfeed more than See page 52 for options to 6 times a day, you may not avoid constipation. get a period until you stop breast-feeding. • For comfort use tucks or dermaplast spray, or sit in Remember, you can get pregnant a warm, shallow bath. before your get a period. (See page 51.) • Cold can also be used to decrease perineum discomfort. Place witch hazel on a sanitary napkin and place this in the freezer. Once cold, place on perineum for 15-20 minutes at a time as needed for pain. • Do not douche or use tampons until you see your healthcare provider 4 to 6 weeks after delivery.

54 Incision Care (C-Section) Keep your abdominal incision You can treat incision/scar Call your doctor if: clean and dry to decrease any sensitivity with the following: • drainage does not stop risk of infection. • ICE • you notice any changes You may shower or bathe daily, Use Ice 2-3 time per day (ex. separation of the wound, carefully pat incision dry. for 20 minutes as needed redness, swelling, bloody or to decrease scar sensitivity, It is normal to have a small other discharges, or pain) pain and swelling. Use a towel amount of pink, watery drainage around ice. from the incision. • MOBILIZATION • Spend some time lying flat. Make tiny circles with light This will keep your skin used pressure about 3-4 inches from to being stretched so you the incision site for the first 6 can stand without pain in weeks to mobilize the area. your incision. • SUPPORT • Avoid muscle strain especially Use an abdominal binder while lifting or transferring/ for comfort and support. sitting up. (See page 54.) (See page 56.) • Avoid cutting/pressure on your incision site from items such as tight or low rise underwear and pants. It may be helpful to place a pad or towel between car seatbelt and incision to avoid irritation and pain. • When holding/feeding your baby place pillows on your abdomen, use a “football” hold, and rest your baby gently on pillows to protect your incision.

55 Home Care for New Moms

MUSCLE RECOVERY

While your baby grew the muscles of your abdomen had to stretch and elongate. Your muscles worked hard during delivery, and were stretched and pulled even if you had a c-section. After delivery, your abdominal muscles will be very weak and you will need to do exercises to get back to normal. Take care to avoid strain on any incision or stitches.

Lifting Getting in & out of bed Daily Activities • Always face your work and • Position yourself close to your • Log roll in and out of bed. turn by pivoting your feet baby or object(s) to be lifted Roll to your side and push rather than twisting at the • Bend your knees and tighten your trunk up with your arms. waist. your abdominal and pelvic • When picking up from the floor muscles. floor, get down on all fours • Hold and carry close to your to avoid bending and lifting. body, at midline, or equally • Bend only at the hips and on each side. knees. Avoid bending or • Keep your back straight while twisting at the waist. you are lifting your baby or • When vacuuming keep your groceries out of the car by knees slightly bent and your squatting and bending your buttocks tucked in. knees. Avoid taking giant steps by • Avoid holding your breath stepping back and forth with when lifting and moving. Getting up from a chair the vacuum as you work. Think of drawing your belly button in before moving/ • Scoot forward to the edge • Use a step stool when lifting and exhaling with of the chair. necessary and avoid the movement — • Gently pull in your belly. unnecessary reaching. “Blow as you go.” • Push off the chair using your • While working over the sink leg and arm muscles making or stove place foot on a stool Carrying Baby sure to breathe out, exhale or ledge. Keep your knees while you stand. slightly bent and your back • Scoop your baby up from the bottom rater than lifting • Pull up and hold your pelvic straight. under their arms each time floor muscles. If you stand for prolonged periods of time a stool will • Alternate carrying your baby help relieve a sway back. facing you and away for you. • Switch the hip on which you Frequently performing gentle straddle the baby throughout the day. Kegel exercises throughout the day • Initially you may prefer to will help decrease swelling as well as carry your baby in a front strengthen the pelvic floor muscles. carrier however, once your baby gains head control Do not perform these exercises you should switch to a if they are painful! (See page 62.) back carrier. 56 PHYSICAL THERAPY At your 6 week follow-up appointment with your physician we recommend asking for a referral to Catholic Health outpatient physical therapy to assess the progress of your recovery and provide further instruction. Baby Care Activities While discomforts are not Abdominal Support uncommon, they should not • The ideal work height when An abdominal binder may be be considered normal. Licensed caring for your baby is recommended by your physical physical therapists with specialized between your waist and eye. therapist, however it is not training in obstetrics, gynecology essential for recovery. • Keep frequently used items and pelvic rehabilitation can offer such as diapers and baby relief for postpartum issues. A binder is usually worn for wipes on a counter top rather 6-8 weeks, while up and • Pain in the low back, hip, than close to the floor. moving around, especially rib area, pelvis, tailbone, if you are going to be doing • Bathe your baby on a counter shoulder or neck top surface for as long as any housework, exercise or • Pain with intercourse, you can. shopping. There is no need bowel movements, urination to wear the binder while Once your baby transfers to a or movement resting or lying around bathtub, kneel next to the tub • Leaking urine (even a little bit) with baby. with your baby rather than bending at the waist. • Leaking bowel or gas Exercises should be done as prescribed • Prolapse (anything falling out • Place your diaper bag, with the binder. of your vagina) or heaviness purse and/or infant carrier This is essential in your vagina on a table or counter top. to rib, pelvis, organ This way, you won’t have to • Sensitive scars and core recovery. bend over to get them later. • “Something just doesn’t The binder will not • Take the stroller out of the car feel right” help you if you do before you get your baby out. not do the exercise. Many women also ask about diastasis rectus abdominis or We recommend a binder that DRA which is a condition where provides mild support of the the abdominal muscles are abdominals without “cinching” separated by an abnormal or putting too much pressure distance, which causes the on your abdomen. They can abdominal content to bulge. be found on Amazon and other This is a common occurrence online retailers. during pregnancy and typically You may wish to try the Better resolves on its own. If you are Binder Abdominal Support concerned that you have a by Core Products International. DRA, it isn’t resolving or you would like some help with your • If you had a cesarean birth, postpartum core recovery please remember to check make an appointment with our your incision so that it is dry postpartum rehab specialists. to prevent infection. 57 Home Care for New Moms

Breast Health

MILK SUPPLY Almost as a welcome gift for your baby, your breast milk increases 2 to 5 days after delivery. Fullness of the Breast If you are formula feeding: If you are NURSING: Wear a well fitting supportive Fullness results from the milk, Wear a supportive bra 24 hours bra to help you feel more plus increased blood supply to a day (sports bras are great) comfortable. your breast. until the engorgement / swelling period is over. • Change breast pads Your breasts become firm, (either disposable or cloth) swollen, tender and even • Apply ice packs or cool as frequently as needed to lumpy under your armpits. compresses to breasts for re- keep the nipples dry. This only lasts for a day or two. lief and to help reduce swelling. • Pain medication may also help. • A hot shower or warm compress will help the • Avoid breast or nipple Breastfeed your baby frequently “let down” before a feeding. to relieve the pressure. stimulation. • Ice packs or cool compresses • Avoid hot showers and let the Be sure the baby is positioned will help reduce swelling after water fall on your back, not on well and is latched on to a feeding. your front. more than just the nipple. • Avoid using soap on your • Do not express / squeeze out You may need to hand express nipples as this will dry any milk or engorgement some milk to soften the nipple them out. will worsen. so your baby can latch on correctly. Some women pump breast milk and feed baby a bottle.

Breastfeeding helplines are available at Catholic Health maternity hospitals:

Mercy Hospital of Buffalo (716) 828-2616 Mount St. Mary’s Hospital (716) 298-2478 Sisters of Charity Hospital (716) 862-1939

58 DISCOMFORT

Plugged Milk Duct Breast Infection Sore Nipples If you notice a tender lumpy (mastitis) If your nipples become very area in one breast, but feel well Symptoms include: tender, hand express some and don’t have a fever, milk has colostrum / breast milk, spread • fever over 101° F become clogged in one of the it over the whole areola and ducts, blocking the flow to the • feeling achy or ill allow it to air dry, nipple. • a tender lumpy area in the Persistent sore nipples are not To relieve the clog, take a warm breast that is reddened or has normal and position must be shower, massaging the area, red streaks coming from it corrected. working toward the nipple. Warm moist packs to the area, • Change the position you Or use a warm compress and over-the-counter pain medica- use to nurse (cradle hold, gently hand massage to express tions and bed rest will help you football hold, side-lying) milk from the area. feel better. at each feeding. Be sure your bra fits well, does Continue to nurse your baby from • Be sure your baby is close to not have an underwire, and is both breasts. you and properly latched on. not binding in any one area. • You will need antibiotics. This problem is temporary and Continue to feed your baby Call your doctor right away. will subside as you and your frequently, from the affected baby get used to breastfeeding. breast first, changing your baby’s position to completely drain the For additional relief: breast. Purified forms of lanolin, such as PureLan or Lansinoh brands, • If you begin to feel ill, applied to the nipples after you could be developing feeding will help with healing a breast infection. and don’t need to be washed Engorgement off before breastfeeding. Engorgement can be • If you have very sore nipples uncomfortable but can that are painful throughout be relieved. It results from the feeding, or nipples that are mismanaged breastfeeding or bleeding, call your healthcare not nursing frequently enough. provider or pediatrician’s office. Painful latch or engorgement are good reasons to seek help

from a lactation consultant.59 Home Care for New Moms

BREAST SELF EXAMINATION Every woman should do a monthly Breast Self Examination (BSE).

Breastfeeding Moms – Before a mirror Lying down you may not have a period while Examine carefully, first with arms Place a towel or pillow under breast feeding so pick a day of at your sides, then with arms your right shoulder and your right the month, for example the 1st raised above your head: hand behind your head. or your baby’s birth day and do • Look for changes in the size, Examine your right breast with BSE on that day AFTER a good shape and contour of each your left hand: feeding. breast. • With fingers flat, press gently Formula feeding Moms – • Look for puckering, dimpling, or in small circles. do BSE during the week changes in skin texture. • Start at the outermost top after your period. • Gently squeeze both nipples edge of your breast and and look for discharge. spiraling in toward the nipple. KEEP IN MIND • Examine every part of After childbirth your breasts may the breast. feel different due to swelling of In the Shower the breast tissue and milk ducts. Repeat with left breast. Raise one arm. With fingers flat, touch every Remember... part of each breast: there is breast tissue under • Gently feel for any lump your arm, as well. or thickening. • Standing with your arm on Use your right hand to examine a firm surface, use the same your left breast, your left hand circular motion to examine The American Cancer Society for your right breast. the underarm area. recommends that all women should be familiar with how their breasts normally look and feel and report any changes to a healthcare provider right away.

60 The best strategy for defense against breast cancer is a combination of monthly breast self examination, annual clinical examinations, and mammography.

ANNUAL PHYSICAL MAMMOGRAMS Periodic examinations Mammography remains as best weapon against breast cancer.

A breast self exam is not Media attention toward Mammograms can find breast a substitute for periodic mammography has created lumps when they are extremely examinations by a qualified a heightened awareness, as small – too small in many cases physician. well as some confusion in to be detected in a physical A clinical breast examination Mamwomen’s minds,mo aboutg therap hyexamination. should be part of your annual need for this diagnostic tool. The earlier a lump is found, physical by your healthcare Know this: the more likely a cure – up to provider. 97 percent in cases of early Overwhelming research data He or she can help you Size of Tumors Found bydiagnosis Mammography where cancer has confirms that mammography not spread. understand your health history andremains Breast a woman’s Self-Exam best as well as other factors, risks defense against breast cancer. scale in inches 0 1 2 and benefits as they relate to Compare to Commonly Used Coins breast screening options and 0 1 2 3 4 5 your overall health. scale in centimeters The American Cancer Society Average-sizerecommends: lump Average size lump found by found by yearly routine mammogram when Women age 40 to 44 should mammogram past films can be compared. have the choice to start (0.43 in / 1.1 cm) when past films annual breast cancer screening can be compared. Average size lump found with mammograms. by first mammogram. (0.59 in / 1.5 cm) Women age 45 to 54 should get Average-size lump mammograms every year. found by first Average size lump found by women mammogram. Women age 55 and older should doing regular BSE. have the choice to continue (0.83 in / 2.1 cm) yearly screening or switch to mammograms every 2 years. Average size Average-size lump lump found found by women by accident. doing regular BSE. (1.42 in / 3.6 cm)

Average-size lump found by accident. 61 Home Care for New Moms

Exercise will help you restore your body to its normal state. Walking is a great beginning! Start with brief walks of 5 to 10 minutes. Exercise

The Kegel and abdominal bracing exercises are good toning exercises to do after leaving the hospital. These work to strengthen the pelvic floor muscles — the muscles around the vagina and pelvis — which support the uterus and abdominal organs. You can gradually expand to other toning exercises.

Kegel Exercises (Repeat often throughout the day.) Endurance Kegel: Abdominal Bracing • Tighten your pelvic floor Stabilizing your pelvic floor & back. muscles to close the vaginal / (Repeat often throughout the day. rectal openings (like you are – alternate positions possible.) Piriformis Stretch trying to stop the flow of urine) • Lay on your back with your (Repeat 5 times on each leg.) and raise the area up (like an knees bent and feet on the floor. elevator going to the third floor). • Pull the right knee towards • Gently draw your abdominal the left shoulder. • Hold and count to 5 slowly. muscles below the belly button • Hold this stretch for • Relax. Rest for a slow 10 count. towards your spine, up slightly. 20 seconds. • Do 5 to 10 repetitions. • Hold this position for as long Make sure you do not lift the Stop when you feel the kegel is as you can without discomfort. buttock off the floor or twist weaker than the one before it. Count out loud to ensure you the spine. Quick Flick Kegel: are not holding your breath. Reverse: Pull the left knee • Fully kegel and then fully You should feel the pelvic floor towards right shoulder. let go and relax. muscles lift. The deep abdominals • Do 5 to 10 quick kegels in a row and pelvic floor muscles “function without resting in between. like they are tied together.” If you Stop when you feel the kegel is have difficulty feeling the pelvic weaker than the one before it. floor contraction, exercise it separately. Exercise while lying down, sitting or standing. Practice Do not suck the muscles in under Kegels before and during any the rib cage (upper abdominals). activity that requires exertion, Do not pull the muscles in so hard such as sit to stand, lifting, that your back flattens. running, jumping and laughing — anytime, anywhere. If there is downward pressure on the pelvic floor muscles you Make sure you count out loud are either holding your breath, to prevent holding your breath. or incorrectly exercising. 62 Breathing exercises ...can help you relax. What to do: Stretching • Get in a comfortable position. ...can relieve leg cramps and • Breathe in slowly, counting to 5. backaches, and help tone muscles. • Breathe out slowly, counting to 5. You can learn: • Concentrate on relaxing all of • Bends (to stretch back muscles) your muscles as you breathe out. • Trunk twists (to stretch back Ask your healthcare provider and stomach muscles) about other breathing • Calf stretches exercises. Ask your healthcare provider to show you these before trying them yourself.

Lower Bridging Cat and Camel Trunk Rolls (Repeat 10 times.) (Repeat 10 times.) (Repeat 10 to 20 times.) • Lay on your back with the • Get on your hands and knees. • Lay with your back flat knees bent and your feet • Tighten your lower abdominal and your feet together. flat on the floor. muscles by pulling them • Slowly rotate the knees • Perform your abdominal towards your spine. to the left side and then brace and hold it while • Hold muscles tight as you arch slowly reverse the roll to raising your buttocks your back upwards and bring the right side. from the floor. the head into a tucked position. Stay in the pain free ranges. • Hold for 5 seconds. • Hold for 5 seconds. Do not hold your breath! • Slowly reverse directions and Gas: Bridge and twist hips allow the back to sag while to relieve gas discomfort. holding the abdominal muscles tight and raising your head. Do not resume or begin an exercise routine postpartum • Hold this position 5 seconds. until checking with your • Relax. physician at your 6-week follow up appointment. Mom-Bod Fitness ...offers benefits to new moms! • Learn how to safely recover postpartum • Tone your body while having fun • Interact and bond with your newborn! Sign up for a class at (716) 447-6205 or chsbuffalo.org. 63 Home Care for New Moms Nutrition Keep yourself and your new family strong and healthy. This is not the time to go on a crash diet. Your weight loss should be gradual. Eat right. It’s about Balance, More... and Less. Remember these 3 healthy habits:

BALANCE your calories Choose MORE nutrient- 3Choose LESS of other 1 2 foods and drinks. You’ll gain weight if you take dense foods and drinks. in more calories that you burn These are high in vitamins, Cut back on items high in off with activity. And being minerals, fiber and other healthy calories, saturated and trans fats, overweight puts you at risk nutrients and low in solid fats sodium, cholesterol or added for health problems. and added sodium, sugars and sugars like: Check the ingredients and refined starches. • Sweets, fried foods and pizza calories in foods and drinks. Build a healthy plate – fill half • Red and processed meats Track your daily intake. with fruits and vegetables. • Sweetened drinks (such as Frozen and canned ones count, Make adjustments to stay juice or soda) and alcohol within your caloric needs. but use low-sodium versions. Cook with small amounts Have more low-fat or fat-free milk Below is an estimate of of vegetable oils, instead and whole-grain products. calorie needs following of solid fats. pregnancy. Use the lower Replace some meat and Avoid oversized portions! number if you’re not active – poultry with seafood and other the higher number if you are. proteins. Choose lean cuts of Woman’s Daily meat and poultry when you do Age Calorie Needs have them. 16-30 1,800-2,400 31-50 1,800-2,200 1 cup BREASTFEEDING MOMS Use this reference to You use 500 extra calories per approximate portion sizes: 1 Tbsp. day to produce breast milk for your baby! INCREASE: fluids, protein and calcium. LIMIT: caffeine (coffee, tea or soda) LIMIT: alcohol (after 1 alcoholic drink, wait ½ cup at least 2 hours before breastfeeding) AVOID: tobacco and herbal teas, remedies or supplements. One quart of non-alcoholic fluids is 3 ounces suggested along with a prenatal vitamin 1 ounce every day as long as you breastfeed. 64 Source: US Department of Agriculture

Think variety. Make smart choices from each food group every day. Here’s a sample daily eating pattern, plus examples of how to “count” foods.

Fruits (2 cups) Grains/Carbohydrates Fluids These count as 1 cup: (6 ounces) Drink 8 to 10 cups of water • ½ cup of dried fruit At least half (3 servings) should each day. • 1 cup of raw, cooked or be whole grain/complex sources • A lack of water in the body can juiced fruit (Limit juice.) such as whole wheat breads, cause constipation, dizziness, crackers or pasta, whole grain headaches and cramping. cereals and brown rice. Vegetables (2 ½ cups) Limit coffee, tea, juice, soda These count as 1 ounce: Have plenty of dark-green, red and other drinks that have and orange vegetables, as well as • 1 1-ounce slice of bread or caffeine or excessive amounts beans and peas.* 1 6-inch tortilla of sugar. These count as 1 cup: • 1 cup of ready to eat or ½ cup Avoid energy drinks. • 1 cup of raw, cooked or juiced of cooked cereal vegetables • 1 ounce of uncooked or ½ cup • 2 cups of leafy salad greens of cooked pasta or rice * Count beans, peas and soybean • 1 slice whole wheat bread Proteins (5 ½ ounces) products (like tofu) for either the • Bagel – 1 mini-bagel vegetable group or the proteins Vary your protein sources, • 5 whole wheat crackers group. and aim for 8 to 12 ounces Green peas and green beans of seafood per week. Dairy products (3 cups) These count as 1 ounce: count only as vegetables. Switch to low-fat or fat-free milk, • 1 ounce of seafood** cheese and other dairy products. ** Safe Seafood Consumption or lean meat or poultry These count as 1 cup: Eat up to 2 servings a week of a • 1 large egg • 1 cup of milk, fortified soy variety of fish and shellfish that are • ¼ cup of cooked beverage or yogurt low in mercury. beans or peas* • 1 ½ ounces of natural Recommended options include cheese, like cheddar shrimp, canned light tuna, salmon, • 2 ounces of processed cheese catfish and pollack. Albacore has more mercury than canned tuna, so one serving of albacore tuna may be eaten per week. Pregnant or nursing women should not eat shark, swordfish, tile fish or king mackerel.

65 Home Care for New Moms

Support After giving birth, it is important to recruit help and find ways to reduce stress and worry. Get the support you need.

Understand emotions. Watch for depression. What are the symptoms? Pregnancy and childbirth may In the first two weeks after • Exhaustion feel like an emotional roller delivery, up to 80% of mothers • Irritability coaster! You are elated, scared, experience some sort of happy, and worried. You may “Baby Blues.” Baby Blues is • Rapid weight changes / feel ready for the experience one characterized by an extreme changes in appetite minute and uncertain the next. sense of letdown – crying, • Crying / crying spells These ups and downs are often sadness, worry and fatigue – without cause that lasts approximately caused by hormonal changes • Despair / feeling of 2 weeks. Symptoms usually and are completely natural. worthlessness resolve on their own. Postpartum Talk with your partner. depression is more complicated • Difficulty focusing / inability to concentrate Share your feelings. Discuss and longer lasting. It does not your hopes, worries and fears. resolve itself within a few weeks • Excessive worry / desperation or a month, and if left untreated, Remember, concern for your • Lack of joy in life / it may lead to a more severe baby’s health is normal. feelings of hopelessness If worrying starts to interfere anxiety / panic disorder. • Sleep problems / insomnia with your life, talk to your healthcare provider. What is postpartum • Loss of sexual interest depression? • Guilt, sadness and anger Make time for yourself. Postpartum depression (PPD) • Forgetfulness / First, get plenty of rest. Ask is a psychological disorder indecisiveness family members to help out experienced days, weeks, or with chores or other tasks. Take even months after delivery. • Obsessive / compulsive breaks and naps when you need It refers to a wide range of behavior them. emotional changes a woman • Withdrawal Then, remember to do something may experience after the birth • Not bonding with baby of a baby. Postpartum mood you enjoy every day. Having fun • Suicidal thoughts is important to good mental disorders include depression, health, too. For example: anxiety, panic and obsessive / compulsive disorder. PPD is not • Start a hobby, read completely understood but it is or listen to music recognized that physiological, Reach out to your • Visit a friend biochemical and hormonal healthcare provider if • Go for a walk or factors contribute to the disorder. you are experiencing any exercise if you can. PPD is fairly common, affecting symptoms of depression at least 10 to 20 percent of new or anxiety. mothers.

66 Lighten What kinds of treatment Ask for help. the load. are available? Talk to your OB / GYN or your Taking care of a A professional treatment plan may baby’s pediatrician right away. newborn, yourself include medical and psychiatric • Ask for a list of referrals for and your home can evaluations, psychotherapy and specialists in women’s mood be overwhelming. group therapy. disorders. Medications that help can be • Contact the Postpartum Get help at home. prescribed. New anti-depressants Resource Center of New York. act more specifically toward PPD Relatives and friends can Call toll-free (855) 631-0001 and pose no known threat to be a great resource. or visit postpartumny.org. breastfed babies. They may be more than • Consider attending a support eager to help, and though The sooner you ask group for new mothers or you may disagree on for help, the sooner women with postpartum certain things, don’t you’ll begin to feel better. depression or anxiety. dismiss their experience. Call Catholic Health at Be sure your doctor considers (716) 862-1678 for information. other physical and medical Or, you might consider causes of depression, such • Increase support from those hiring someone to help as thyroid imbalances. around you so you get a break. you for a short time after the birth.

NOTE: PPD should not be confused with postpartum psychosis. Postpartum psychosis is characterized by hallu- cinations, delusions, and thoughts of suicide or of harming the baby. If you experience these severe symptoms, find a capable adult to care for your infant and seek help. (716) 834-3131 crisisservices.org 67 Your New Family

Safe & Sound

LEAD Lead can be found in old paint, There are many steps parents can take dust, soil, and water. Some folk to prevent lead poisoning in children. medicines for upset stomach also have lead. Lead can also • Keep children away from • Avoid having children play in be found in cosmetics imported peeling paint and broken soil, especially around the from the Middle East. plaster. foundations of older building • Wash their hands often. and near roadways. If lead gets into a child’s body, Wash their toys often, • When windows are open in it could cause: especially teething toys. warm weather, wash the sills • A lower IQ • Use cold water – not hot – for and window wells any time • Behavior problems infant formula or cooking. Let you see dust, but at least • Growth problems the cold water run for at least once a month. • Anemia a minute to flush lead picked • Feed children foods high • Kidney damage up from pipes. in iron and calcium, both • Hearing loss • Use lead-free dishes. of which can help prevent Transfer food from open cans lead poisoning. to glass or plastic containers. Foods high in iron: • Some crafts and hobbies have • dried beans supplies like paints, glazes, • lean meats pottery and solder that may • spinach contain lead. • whole grain bread • Don’t bring lead home from • eggs work. People who work at • tuna construction, plumbing, • collard greens painting, auto repair and other Foods high in calcium: jobs can be exposed to lead. • milk Wash work clothes separately. • cheese • yogurt • cottage cheese • pudding • cream soups • lasagna Erie County Department of Health • maccaroni and cheese Childhood Lead Poisoning Prevention Program erie.gov (716) 961-6800

68 Lead poisons people. Lead is especially bad for children.

RADON Get a lead risk assessment Radon is a naturally occurring radioactive gas found in soil and Your pediatrician or healthcare provider should assess children rock. It seeps into homes through 6 months to 5 years of age at each well-child visit for risk of cracks in the foundation, walls, high dose lead exposure. and joints. Radon comes from the Children between 9 months and 3 years natural breakdown of uranium in are especially at risk for the effects of lead. soil, rock, and water, and gets into YES NO Unknown the air you breathe. It can occur Does your child live in, or regularly visit, a in any type of building – homes, house or building constructed before 1978, schools, offices – but you and with peeling or chipping paint, or with recent, your family are likely to get your ongoing, or planned renovation or remodeling? greatest exposure at home, where you spend most of your time. Has your family/child ever lived outside the United We live in an area where many States or recently arrived from a foreign country? homes have high levels of radon. Does your child have a brother or sister, You can’t smell it or see it, but it house mate, or playmate being followed can leak into your home. or treated for lead poisoning? If you breathe air Does your child frequently put things in with radon in it: his/her mouth such as toys, jewelry, or keys? • you may have an increased Does your child eat non-food items (pica)? chance of getting lung cancer later in life Does your child frequently come in contact Since you want to keep your with an adult whose job or hobby involves new baby as safe and healthy exposure to lead? as possible, it is important to find Does your child live near an active lead smelter, out if your home has a high level battery recycling plant, or another industry likely of radon. to release lead; or does your child live near a Test for radon heavily traveled major highway where soil and Radon test kits are available at dust may be contaminated with lead? hardware stores, county health departments, and the New York You may be asked additional questions specific to your State Department of Health. particular community. Call the NYSDOH for more If your family and/or child recently arrived from a foreign county information or to request a kit. or visited developing or underdeveloped countries for substantial (518) 402-7556 periods of time, tell your pediatrician or healthcare provider. health.ny.gov/radiation

69 Your New Family

Safe & Sound

CAR SAFETY Safety seats save lives and they are the law in every state.

Babies, and children Read your manuals: Be aware: all have unique body shapes and features which require • Carefully read the owners A special seats to keep them manual for the seat AND your MAY NOT BE SAFE if: safe while travelling. car to make sure that the seat • it has been in a crash is compatible with your child • it is on a recall list and automobile. • it has missing parts On all trips, no matter • Always make sure straps • it is over 6 years old how short, your child must are securing your child • it has no labels or stickers be securely fastened in an appropriately as pointed • it is not used properly. appropriate car seat.* out in your manual. • If your infants head is flopping forward, consult your manual Learn the right way: Travel Safe: on how to adjust the seat to Catholic Health has monthly • Your baby must ride in an adequately recline. car seat classes. You can learn approved rear-facing car how to install your car seat seat from birth. It’s best correctly and have it checked to be sure it’s put in right! to maintain this until LATCH: weight /height limits of Call (716) 447-6205. the rear facing seat are Since 2002, all new car seats You can also contact reached. have the LATCH (Lower Anchors your local fire or police and Tethers for Children) system. • The use of approved child department’s non-emergency Check your vehicle’s manual to restraints or a booster seat number, or find an inspection learn which locations work with is required in New York State location from the National the LATCH system. until a child’s 8th birthday. Highway Transportation Car seat belts still work well to Safety Administration: • Usually the center of the secure car seats, but be careful back seat is the safest place safercar.gov not to use both LATCH and the for the seat to be installed. 1-866-SEAT-CHECK seat belt together. (1-866-732-8243) • Children under the age of 12 should always ride in Find more safety tips and recall the back seat. information at: seatcheck.org

* Taxis and public transportation buses are exempt from the occupant restraint law. Child safety seats are available with many rental cars.

70 WATER SAFETY SMOKING Drowning is one of the Be aware of the dangers that leading causes of death in secondhand smoke poses children under 5 years of age. for you and your new baby. A few inches of water • Allergies is all it takes for drowning to occur. • Asthma • Ear infections IN THE HOME Infants and toddlers are at • Upper respiratory greatest risk of drowning in a infections bathtub or in large household • Sudden Infant Death buckets. You should always be Syndrome (SIDS) with your baby while in the bathtub. Even a few seconds Stay away from places where away are too many. Infant your baby may be exposed to supporting devices should secondhand smoke. not be a substitute for a parent. Make a “no-smoking” rule for your home so that your new Toilets and large containers of Never put a car seat baby – and your whole family water (e.g. a cooler with melted near an airbag! – can breathe easily. ice) should all be treated as potential household hazards. If the front seat is the It’s not too late to quit! Bathroom doors should always only option, switch off be shut and any containers the airbag for that trip, emptied of fluids. Toilet lids even if it’s just a short ride. should always be closed.

Never use an infant SWIMMING POOLS carrier as a car seat. If you have a tobacco or other Swimming pools are another drug addiction, talk to your Carriers are not approved obvious drowning hazard. healthcare provider right away, for transporting a baby in or contact: The American Academy of a vehicle and cannot be Pediatrics recommends secured properly in a car. • NYS Smoker’s Quit Line: that your youngest child be 1-866-NY-QUITS at least 5 years old prior to purchasing a pool. Never leave a child (1-866-697-8487) alone in a hot car. • Substance Treatment and Pool slides are Your baby could be in Recovery (STAR) facilities: not recommended at any danger within minutes, Buffalo (716) 893-9350 or age because of their even if the windows are Amherst (716) 862-2059 high rate of injury. open. Always take your • PATHWAYS – prescription If a family has a pool, close baby with you. drug / heroin addiction: supervision of all children is a (716) 862-1330 must. Parents are encouraged • Center for Substance to learn CPR. The pool should Abuse Treatment’s be totally fenced in (at least Referral Service: 48 inches tall) and separated 1-800-662-HELP from the rest of the yard. The (1-800-662-4357) fence should be self-closing findtreatment.samhsa.gov and self-latching, and the latch should be too high for a young child to reach. 71 Your New Family

Home Together

OLDER SIBLINGS Depending on the ages of your • Involve Your Child Make sure your child new baby’s siblings, they may Try to get your child knows that although have difficulty adjusting to involved with the baby babies are cute and fun, inevitable changes which will as much as possible. they also cry a lot and occur. This is usually worst with demand much of your time. Having children help shop for children aged 2 to 3 years. clothes and even help with Be honest At this age, kids are still very diaper changes can make with your child. attached to parents and are them feel part of the “team”. unable to easily understand Do not state that all • Major Changes sharing you with somebody else. things will be the same, Try to accomplish major because they won’t. In general you should discuss the changes in your child’s routine baby with your preschooler when prior to the baby arriving. Catholic Health offers special the child begins to notice your classes for small children enlarging “belly” or wonders Trying to tackle potty training expecting siblings. These can about the new nursery furniture. or changing beds or rooms can often be a nice way to introduce Young children cannot easily be overwhelming to a toddler your baby to him or her, and understand the concept of an who is trying to adjust to the to prepare your child for the unborn baby, so discussing new infant. hospital experience which it too soon before there is • Special Things will accompany delivery. something realistic to notice Try to do some of those Call us at (716) 447-6205 will be confusing for them. “special things” you have or visit online: chsbuffalo.org. done with your child in the past. This can be a favorite game, a book, or even little Be confident in an hugs. EMERGENCY The more your child’s If a child was hurt or choking, routine can be retained, the would you know what to do? easier the transition should be. Catholic Health offers monthly classes on infant CPR and pediatric first aid. It’s important that grandparents, older siblings, and other caretakers be able to recognize a To find quality daycare or child care, dangerous situation and react. contact the Child Care Resource Network For more information call at (716) 877-6666 or visit wnychildren.org. (716) 447-6205 or register online: chsbuffalo.org. 72 Sharing words and sounds is critical to language development. Read to your child, walk them around and tell them what everything is, or describe what you are doing while you make dinner or work around the house. Little ones listen & learn.

TELEVISION STORY TIME Although we live in a society where Of course, there are high quality, Spending time talking and television is an important part of nonviolent children’s shows that, reading with your child is our lives, it is not necessarily the if used appropriately, can have a important at every age. It is healthiest thing for children. positive educational effect. fun and relaxing and helps to grow little imaginations and As adults, we rely on TV for communication skills, too! news, weather, and entertainment. The American Academy of Children, however, are going Pediatrics recommends no TV Read to Succeed though a critical developmental under the age of 2 years, and Read to Succeed Buffalo period that requires them to no more than 1 to 2 hours of is a non-profit organization spend time: non-violent educational dedicated to increasing • playing programming per day for early childhood literacy and • reading children who are older. third grade reading scores. • socializing. Through the Dolly Parton Imagination Library program, Television significantly reduces Parents are advised to set limits RTSB provides a free the opportunities with family and on TV time, closely monitor the children’s book each month friends for valuable interactive type of programming that is to children up to 5 years old activities and development being watched, seek out high in select ZIP codes. to occur. quality children’s videos, and discuss often with your children Call (716) 843-8895 or visit American children what they see on TV. rtsb.org for more information. watch about 4 hours of television per day. Most importantly, encourage other activities such as reading, playing and Time spent with video games spending time only worsens this number. with others. Not only does this reduce their opportunity to socialize, but it also makes them more sedentary and at risk of being overweight. Television also exposes kids to great amounts of violence, sex, substance abuse and marketing.

73 Dear Family, Be present... Fathers and other caregivers are extremely important in the lives of their children. You do not need to have wise words of wisdom, be the smartest or the strongest. By just being present in your child’s life — spending time with your child — your child will thrive. The amount of love you will receive from your child will be well worth it. Be ready for change... As partners, discuss how you will balance your responsibilities. You may need to increase your chores at home to assist the new mom. Jobs that were formally hers now may become yours, such as making dinners, dishes, laundry, food shopping, etc. Please remember that the new mom is tired and used to a certain way of having things done. Discuss with her what you can do to help and how she likes those chores done. Do your best, and remember, the lack of sleep may make a new mom cranky. Please be patient, this time will pass. Be supportive... Your new mom may also appreciate some alone time. After being with a baby all day, even a short nap or warm bath alone can be a life saver, especially if you’ve been at work. Offer to watch the little one for a short time to give her a break. Remember, you’re both tired and you need to support each other. Also remember that intercourse is not recommended until after her six week postpartum exam. She may also become pregnant before she has a menstrual period, therefore, unless you want another little one that soon, wait until she discusses contraception with her doctor. Women may have a lower than usual sex drive due to hormonal changes after pregnancy, fatigue, demands made by the baby and fear of discomfort. Letting her rest by helping with the baby or household chores may help increase her mood. Be creative... Many partners experience a “baby blues” period after the baby is born. The new mom is busy with the baby with little time or energy for you. You may feel neglected or left out. Be creative in spending time alone with your spouse. Eat dinner together or go for a walk with the baby in a stroller. Enjoy the experience of a new member of your family.

74 Resources: Breastfeeding Suport Mercy Hospital of Buffalo (716) 828-2616 Mount St. Mary’s Hospital (716) 298-2478 Sisters of Charity Hospital (716) 862-1939 New York Milk Bank (212) 956-6455 (See additional resources on page 5.) Car Seat Safety Catholic Health Car Seat Classes (716) 447-6205 safercar.gov Daycare/Child Care Child Care Resource Network wnychildren.org (716) 877-6666 Insurance Catholic Health Customer Service Center chsbuffalo.org/billing (716) 601-3600 Lead/Radon Erie County DOH (716) 961-6800 Niagara County DOH (716) 278-9212 New York State DOH (518) 407-7556 Newborn Screenings Contact your pediatrician or visit wadsworth.org/programs/newborn/screening or cdc.gov/newbornscreening Nutrition choosemyplate.gov Post-Partum Depression / Psychosis CrisisServices.org (716) 834-3131 CH Support Group (716) 862-1678 Postpartum Resource Center of New York postpartumny.org (855) 631-0001 Safe Sleep American Academy of Pediatrics AAP.org NYS Center for Sudden Infant Death (SIDS) 1-800-336-7437 Shaken Baby Syndrome Child Help Hotline 1-800-4-ACHILD purplecrying.info dontshake.org Smoking NYS Smoker’s Quit Line 1-866-697-8487 (See additional resources on page 67.) Vaccinations Center for Disease Control and Prevention 1-800-232-4636 Erie County DOH (716) 858-2373 Niagara County DOH (716) 278-1900

75 You might find it helpful to keep important information handy. Mom’s Doctor Name ______Phone Number ______Baby’s Doctor / Pediatrician Name ______Phone Number ______Pharmacy Name ______Phone Number ______Health Insurance Plan Plan Name ______Phone Number ______Plan or Group Number ______Poison Control Phone Number ______1(800) 888-7655 Fire Company* Phone Number ______Police* Phone Number ______Other important names and numbers ______McAuley Seton Home Care (716) 685-4870 ______*Service may be faster calling direct than calling 911.

76 Three ways to register:

1. Any time you check in at a Catholic Health facility (ask the front desk staff), Take control or during a home visit from of your health with one of our Catholic Health nurses or therapists.

2. While you’re in the exam room – your clinician can provide instant activation.

MyChart – the advanced new patient portal 3. At MyChart.chsbuffalo.org – simply hit the “Sign Up Now” button under from Catholic Health – makes it easier and “New User” and follow the prompts. more convenient than ever to manage your health. You can schedule appointments, Questions? Call (716) 559-3700 access your medical records and contact a provider – plus so much more – all in one, easy-to-access online portal.

Learn more at MyChart.chsbuffalo.org

D E D I C A T I O N This publication is dedicated to the staff and managers of Catholic Health’s OB centers, maternity departments and home care. Every day you inspire us with your innovative ideas and passion for taking care of moms, babies, and families. T H A N K Y O U

Eddie Bratko Arron Chang Tom Gleason Susan G. Littler, MD President President Senior Vice President Chair of OB/GYN Mercy Hospital of Buffalo Sisters of Charity Hospital Home and Community Based Care Mercy Hospital of Buffalo

Mark Weissman, MD Anthony Pivarunas, DO Charles J. Urlaub Chair of OB/GYN Chair of OB/GYN President Kenmore Mercy Hospital Sisters of Charity Hospital Mount St. Mary’s Hospital Mount St. Mary’s Hospital

77 Maternity Services Mercy Hospital of Buffalo 565 Abbott Road • Buffalo, NY 14220 (716) 828-2895 Mount St. Mary's Hospital 5300 Military Road • Lewiston, NY 14092 (716) 298-2932 Sisters of Charity Hospital 2157 Main Street • Buffalo, NY 14214 (716) 862-2027

Additional services available at: Sisters Hospital, St. Joseph Campus; Kenmore Mercy Hospital; Home & Community Based Care

Our Mission We are called to reveal the healing love of Jesus to all. Our 2025 Vision As your trusted partner, inspired by faith and committed to excellence, we lead the transformation of healthcare and create healthier communities.

Catholic Health Administrative & Regional Training Center 144 Genesee Street, Buffalo, NY 14203

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(716) 447-6205 20984 - REV 12/7/20