Baby and You Getting Ready for Motherhood & Baby

Battle Creek Adjusting to Pregnancy

Changes Pregnancy is a major life change. Your entire life will have new direction and focus after the birth of your baby. For most of us, the joys of pregnancy and parenthood make for many ups and downs. Things affected by pregnancy and birth include: Table of Contents – 1st Trimester • Your body • Your relationship with others • Your work, school, and daily schedules Adjusting to Pregnancy...... 3 • Your nutritional needs • Your moods - up one minute, down the next Nutrition...... 4 Things to Do Preparation for Childbirth...... 5 Things that you can do to help you enjoy being pregnant are: • Read the handouts given to you by your nurse, midwife or doctor • Ask your nurse how you can sign up for classes • Write down your questions and bring them with you to your appointments Notes • Get plenty of sleep • Eat a healthy diet • See your doctor, nurse or midwife regularly Talking to your friends and family is important. Share your feelings and listen to each other. Talk to your nurse, midwife or doctor if you are having a hard time coping with your pregnancy due to the following problems. • Emotional • Physical • Money

When to Call Your Nurse, Midwife or Doctor While most women have a healthy pregnancy, things can occur that need the attention of your medical professional. We want you to tell us if you notice any of the following: • Vaginal bleeding • Changes in your vision • Abdomen tightening or cramping • Swelling of your face or fingers • Backache that comes and goes • Burning or pain on urination • Severe abdominal pain • Fever or chills • Any fluid coming from the vagina (birth canal) • Nausea or vomiting for more than 24 hours • Severe headache that won’t go away • Your baby isn’t moving normally (after 5 months)

For More Information As a part of the Baby & You program, you received a coupon for a free copy of the book What to Expect When You’re Expecting. The Baby & You program often refers to sections of that book. If you have not done so, please return the coupon to Bronson Battle Creek for your free copy. If you have the book, please refer to pages 100- 118 for this topic, Adjusting to Pregnancy. Of course, feel free to read the entire book, but for now, we think that these pages will be most helpful.

2 Baby and You, Getting Ready for Motherhood & Baby – 1st Trimester J14323-14 11/11 Baby and You, Getting Ready for Motherhood & Baby – 1st Trimester 3 Nutrition Exercise Women who exercise regularly during pregnancy: Your growing baby depends on you and the things you eat to build a healthy body and mind. • Have easier labors • Usually have more energy Many women have nausea and vomiting (“morning sickness”) during pregnancy, which makes it hard to eat • Cope better with the minor discomforts of pregnancy healthy. This usually goes away after the third month. You can do things now to help yourself feel better. • Control their weight easier • Keep some healthy snacks like whole-wheat crackers and dried fruit at your bedside. Check with your doctor, but usually you may continue with exercise that you were doing before you were • Eat small frequent meals (6 per day.) pregnant. Later in your pregnancy, your growing baby and the changes in your body make exercise harder. • Don’t drink liquids and eat solids at the same meal when you experience severe nausea. Skating or biking, which require more balance, are generally okay early in pregnancy. However, these activities • Sip liquids between meals throughout the day. will have to stop as your balance changes. Do not exercise to the point of not being able to talk while exercising. It’s time to get moving. If you have not been exercising, go for a walk and do it regularly. Many community Please read pages 104-107 in What to Expect When You’re Expecting. 2 centers have specific exercise programs for expectant moms. If you need the support of group activity, check your local center. Be sure to read pages 189-198 in What to Expect When You’re Expecting. For more Food Groups and Daily Amounts You Should Eat Everyday information about your activities please ask your nurse, midwife or doctor.

Meat or Poultry 2 to 4 servings Hot Tubs Fish Serving size is 3 ounces Hot tubs and hot baths can raise your body temperature. This could be a danger to a developing fetus if your body temperature gets above 102 degrees. Eggs No more than one egg per day Suggested Readings /dairy products 4 servings Exercise Breads/cereals 5 or more servings 1. Moving Through Pregnancy, Elizabeth Bing Citrus fruit (oranges, grapefruit) 2 servings 2. The Pregnancy Exercise Book, Barbara Dale; Johanna Roeber ½ grapefruit = 1 serving Mother Wisdom Yellow or dark green vegetables 1 to 2 servings 1. 25 Things Every New Mother Should Know, Martha Sears; William Sears Other fruits or vegetables 1 to 2 servings 2. The Attachment Parenting Book: A Commonsense Guide to Understanding and Nurturing Your Baby, Martha Sears, William Sears Fat (margarine, salad oil) 8 tablespoons Preparation for Childbirth Liquids (8 ounces = 1 serving) 8 servings 1. The Birth Partner, Penny Simkin 2. Pregnancy, Childbirth and the Newborn, Penny Simkin; Ann Keppler; Janet Whalley Everything that you consume goes to your baby. Therefore, you need to avoid: 3. What to Expect When You’re Expecting, Heidi Murkoff; Sharon Mazel • Smoking, including being close to people who are smoking. Smoking lowers blood flow and oxygen to the 4. Your Pregnancy Week by Week, Glade B. Curtis; Judith Schuler baby and may affect brain development. • Alcohol, which can cause birth defects in babies. • Drugs, which can permanently damage your baby. Do not take any drugs unless ordered by your doctor 1. The Ultimate Breastfeeding Book of Answers, Jack Newman; Teresa Pitman or midwife. 2. Breastfeeding Pure and Simple, Gwen Gotsch, International 3. Breastfeeding: A Parent’s Guide, Amy Spangler 2In the book What to Expect When You’re Expecting, you can find more information about your diet during 4. The Womanly Art of Breastfeeding, La Leche League International pregnancy along with some recipes on page 80-98. 5. Nursing Mother, Working Mother, Gale Pryor For more information about diet, talk to your nurse or midwife about nutrition classes. 6. The Breastfeeding Book: Everything You Need to Know about Your Child from Birth through Weaning, William Sears

4 Baby and You, Getting Ready for Motherhood & Baby – 1st Trimester Baby and You, Getting Ready for Motherhood & Baby – 1st Trimester 5 Child Care and Development 1. Taking Care of Your Child, Robert H. Pantell; James F. Fries; Donald M. Vickery 2. The Irreducible Needs of Children, T. Berry Brazelton; Stanley I. Greenspan 3. The Baby Book: Everything You Need to Know about Your Baby from Birth to Age Two, William Sears; Martha Sears; Robert Sears; James Sears 4. The Mother of All Baby Books: The Ultimate Guide to Your Baby’s First Year, Ann Douglas 5. Your Baby’s First Year Week by Week, Glade B. Curtis; Judith Schuler Perinatal Loss Table of Contents – 2nd Trimester 1. Empty Arms: Coping After Miscarriage, Stillbirth and Infant Death, Sherokee Isle 2. Timothy Duck, Lynn B. Blackburn 3. Forever Silent, Forever Changed: The Loss of a Baby in Miscarriage, Stillbirth, or Early Infancy - A Mother’s Preterm Labor...... 8 Experience, Kellie Davis Post Partum Depression Checklist for Packaging 1. Down Came the Rain: My Journey Through Postpartum Depression, Brook Shields for the Hospital...... 9 2. Women’s Moods, Women’s Minds: What Every Woman Must Know about Hormones, the Brain, and Emotional Health, Deborah Sichel; Jeanne W. Driscoll Feeding Your Baby...... 9 3. Beyond the Blues: Understanding and Treating Prenatal and Postpartum Depression & Anxiety, Shoshana Bennett; Pec Indman Baby Names...... 13

Preparation For Childbirth

Notes None of us would jump into the deep end of a swimming pool without knowing how to swim. In the same manner, no one should approach labor and birth without knowing what to expect and some idea how to respond to it. There are many ways to get ready for childbirth. 2 You might want to start by reading pages 206-213, 236-248, and 260-308 in What to Expect When You’re Expecting.

There is no best way for everyone to get ready for labor and birth. However, we suggest you enroll in childbirth preparation classes. These are taught by nurses who are specially trained to help women get ready for the birth of their babies. Classes will teach you what to expect during labor, birth and time after you deliver. You will learn: • Breathing patterns that help you relax during labor • Exercises that will get you ready for delivery • Different ways to control pain during labor (you will see videos of vaginal and cesarean births) • Roles of the doctor, midwife, nurse, patient and support person • How to tell when you are in labor • When to go to the hospital and what to take with you

The classes will also help your support person. He or she will also learn how to be more comfortable during labor and ways to help you. You and your support person will be able to ask any questions. Be certain to sign up for the childbirth preparation classes as soon as possible. You will go to one class a week for five weeks. You may also sign up for the class on breastfeeding. If you cannot go to classes, you can still help yourself by watching videos and reading about childbirth preparation. For more information about getting ready to have your baby, be sure to talk to your doctor, midwife or nurse. For information on Bronson Battle Creek childbirth education classes call (877) 462-2247.

6 Baby and You, Getting Ready for Motherhood & Baby – 1st Trimester Baby and You, Getting Ready for Motherhood & Baby – 2nd Trimester 7 Pre-term Labor Checklist When Packing for the Hospital

Instruction sheets from your childbirth class Signs of Pre-term Labor A comfortable nightgown or nursing (front button) gown Pre-term labor is labor that begins after 20 weeks and before 37 weeks of pregnancy. Most women go into Bath robe and slippers, and nursing pads, lotion for back massage labor between 37 and 42 weeks of pregnancy. Pre-term labor can be dangerous to both mother and baby. It is Shampoo, soap, deodorant, toothpaste, toothbrush, and necessary cosmetics important to know the signs of pre-term labor. They are: Barrettes, ponytail bands or a headband for hair if necessary • Increase in mucousy vaginal discharge Loose-fitting, comfortable ‘coming home’ clothes for mom • Tightening or cramping in the stomach List of relatives and friends with phone numbers to be called when the baby arrives • Low back pain or pressure – especially if it comes and goes several times an hour and doesn’t improve ‘Coming home’ clothes for the baby and a blanket with rest Snacks • cramps with or without diarrhea Camera and film (be sure to check the batteries before you pack) • Aches, pains, pressure or feeling of fullness in the pelvis, thighs or groin Gifts for siblings • Any fluid coming from the vagina Car-seat for going home • Regular cramps – or cramps that are coming faster and lasting longer Feeding Your Baby Labor contractions usually start in the back and move around to the front. However, women experience labor in different ways. If you are unsure whether you may be experiencing preterm labor, try the following When thinking about a way to feed your baby, you may find the following ideas helpful. There are two ways to 1. Empty your bladder. feed your newborn baby. One is breastfeeding (also called nursing.) The second is bottle-feeding. 2. Try lying on your left side. Today more and more women are choosing to breastfeed. Human milk is the perfect food for babies. 3. Drink 2-3 large glasses of water. Breastfeeding can please the sucking needs of the baby and help him or her develop a sense of trust or security. It allows the mother to get to know the needs of her baby. The entire family will find that breastfeeding the If symptoms do not stop within 1-2 hours, call your nurse, midwife or doctor. baby saves time, money and energy. It is possible to have all of these signs and not be in labor. But, we don’t want to take chances with you and your baby. If your nurse, midwife or doctor thinks you are in labor, you may be sent to the hospital. There are many Benefits of Breastfeeding things that can be tried to stop labor so your pregnancy can continue. •  milk is the best food for your baby. • Breastfed babies have higher IQs. Causes of Pre-term Labor Breastfeeding is said to be the healthiest feeding • Breastfeeding makes a bond through skin-to-skin choice for babies by the American Academy of The possible causes of pre-term labor are: contact between mother and child. Pediatrics, The World Health Organization and • There is less of chance of Sudden Infant Death • Poor eating habits – Women do not eat enough or • Bladder infection in the last three months of UNICEF. enough of the proper foods before and/ or during pregnancy Syndrome (SIDS) in breastfed babies. • A mother’s resistance to disease is passed on to her pregnancy. • Prior pre-term delivery, low birth-weight baby or • Breastfeeding promotes healthy oral development. baby through her milk and helps the baby’s own abortion late in pregnancy • Mothers who breastfeed have less risk of • Smoking – The more you smoke the greater the risk. immune system. • Too much physical activity during pregnancy • Pregnancies less than two years apart premenopausal breast cancer. • More than one baby (for example, twins) •  can help to prevent or delay allergies. • Alcohol or drug use • Mothers who breastfeed have less risk of • Congenital birth defect • Breast milk is used better by the baby and is easier ovarian cancer. • Age – Women under 18 or over 35 are at greater risk • Previous surgery on the cervix to digest. than women between 19 and 34 • Breastfeeding saves money because breast milk is free • Vaginal bleeding or spotting after the 12th week of • Breast milk is a living, changing food that cannot be and there are fewer visits to the doctor. • Being exposed to certain drugs before you were born, pregnancy factory-made. • Breastfeeding lessens bleeding after delivery and such as DES, a drug which may have been given to • Dehydration • These unique properties of breast milk protect against helps to shrink the uterus back to its normal size faster. your mother to prevent miscarriage • Dental or teeth infection upper respiratory, digestive and ear infections; there • Breastfeeding increases your calorie needs and helps • Infection in the uterus is less vomiting and diarrhea. Elements of breast milk you lose weight. If you have any of these risk factors you should tell your nurse, midwife or doctor. either destroy bacteria or retard its growth. • Breastfeeding is safe for the environment. • Breast milk has living cells that fight infection, help 2For more information about pre-term labor, read page 219-221 and 361-362 in What to Expect When You’re digestion and aid with stomach development. • Breast milk can be pumped and saved to feed the Expecting. Also, your nurse, midwife or doctor is ready to answer your questions. baby when mother is not around.

8 Baby and You, Getting Ready for Motherhood & Baby – 2nd Trimester Baby and You, Getting Ready for Motherhood & Baby – 2nd Trimester 9 Breast Changes What Grandparents Can Do Q. What is the grandparents’ role in breastfeeding? Early pregnancy Mid–Late Pregnancy A. Grandparents can support the mother’s decision. Remember that mom will be giving baby the best possible • Breast tenderness • Increase in breast fullness. food. It doesn’t leave grandparents out. Grandparents can at first offer help with: • Increase in breast fullness • May or may not leak . • Veins more noticeable on chest/ • Meals • Cleaning • Caring for older children • Laundry • Grocery shopping Delivery • Colostrum is the first milk ready for the baby at birth. • Put your baby to breast whenever the baby shows Grandparents can also: It is has many proteins, calories and antibodies. Small signs of wanting to suck. Remember, practice helps – Support the new father. Show him how to get to know his baby by rocking, talking and singing to baby, amounts are perfect for the baby’s first feedings. the baby and you to get better at each feeding. bathing and changing baby. • The first 24 hours of feeding may be quite irregular. Many feedings and holding the baby increases the – Allow the mother privacy if she wants. If you are uncomfortable having her breastfeed in your presence, and This depends on the effects of delivery on the baby. hormones that make milk. have a hard time getting used to it, let her know. You may be surprised how discreetly it can be done. Your 3-4 Days after Delivery approval and excitement for her decision makes breastfeeding more positive. • There will be more milk. Your breasts may feel very • If you become full enough that your breasts are – Don’t blame every baby “problem” on breastfeeding. Remember, babies cry for many reasons which may not full for about 48 hours. Nursing often will keep you painful, keep nursing your baby. It may also help to be related to breastfeeding. more comfortable. remove milk from your breasts by: • Breasts will soften again and not be overly full - Pumping - Applying ice packs What Not to Say - Hand expression - Taking pain medicine - Leaking during a shower – Are you sure you have enough milk? – A bottle won’t hurt. Answers to Common Questions – Your milk looks thin. Do you think its rich enough? – Cereal will help him sleep through the night. Q. Do breastfeeding mothers have to show their breasts in public? – Are you feeding that baby again? A. No. Breastfeeding can be done around other people. A mother can turn her back to begin nursing. Use Comments like those can make mothers doubt their ability. In time, this can cause the experience to fail. a blanket or shawl over the chest and shoulder to hide the breast. Many people think that the mother is Q. Are breastfeeding parents more likely to stay at home? cuddling her baby. Q. Can breasts be too small or too large to breastfeed? A. No. During the first months when babies need to be nursed often, usual activities can be done with the baby. Breastfed babies are easy to take along almost anywhere. When baby is hungry, mother can nurse and then A. No. Enough milk is made whether the mother has large or small breasts. The more often the mother nurses, carry on what she’s doing. the more milk is made. Milk comes from the glands in the back of the breast and then is carried to the by the milk ducts. This breast-feeding tissue develops early during pregnancy in every woman. Q. Can breastfeeding continue if the mother returns to work or school? Q. Does breastfeeding cause mothers to lose their figures? A. Yes. More and more women continue to breastfeed and return to work or school. Breastfeeding is a skill A. Breast size increases during pregnancy and while nursing. Breasts return to their normal size after weaning. and becomes easy. It does have to be learned. Common problems usually happen during the early weeks of Breasts may become less firm after pregnancy. However, this is from pregnancy, not breastfeeding. breastfeeding. Most are brief and can be avoided or solved. Frequent feedings are perfect for baby’s digestion Q. Do breastfeeding mothers have to follow a special diet? and help to build a good milk supply. Spending time with your baby will provide him or her with the security he or she needs to grow self-confidence. You will be closer to your baby and him or her to you. Many A. The only diet needed during breastfeeding is a well-balanced one. You do not need to avoid certain foods. If mothers find this a joy. there is a family history of food allergy, you may want to not eat that food. While breastfeeding, you will not to be able to use all types of birth control. Ask your medical professional if you The Father’s Role need more information. Q. What role can the father play in breastfeeding? Preparation A. Fathers can have a special bond with their breastfed baby. Fathers can show love without connecting it to food. They can get involved by changing diapers, bathing and dressing. When mother goes shopping, • The more a woman learns about breastfeeding, the more likely she is to be successful. Know what to expect exercising, or to an appointment, father can feed the baby pumped milk if needed. A father can help during the first few weeks after baby’s birth. breastfeeding by giving support to the mother at times when she is tired or discouraged. A father can also • Ask your doctor’s office to help you sign up for a breastfeeding class at Bronson Battle Creek. This class will help with housework or cooking so the mother gets enough rest and a balanced diet. Anything special the give you helpful tips to start breastfeeding. father can do for the mother helps the ongoing success of breastfeeding. • Call (877) 462-2247 to register for breastfeeding classes or call (269) 245-8586 to talk to a certified consultant (a nurse who has special training in helping mothers to breastfeed).

10 Baby and You, Getting Ready for Motherhood & Baby – 2nd Trimester Baby and You, Getting Ready for Motherhood & Baby – 2nd Trimester 11 Breastfeeding Books Preparation Check with your local library or bookstore. The following books may be helpful to you: • It’s helpful to go to a baby care class. You will learn how to prepare formula and safety tips. 1. Breastfeeding: A Parent’s Guide, Ninth Edition, Amy Spangler • Have bottles and formula ready when you come home from the hospital. Read the directions on the formula 2. The Womanly Art of Breastfeeding, La Leche League International container and check the expiration date. 3. Breastfeeding Pure and Simple, Gwen Gotsch, La Leche League International • Babies usually drink 1-2 ounces every 3-4 hours by the time you go home. At first put only 1 to 2 ounces of 4. The Ultimate Book of Breastfeeding Answers, Jack Newman; Teresa Pitman formula in the bottle so that you don’t waste formula. Any formula left in the bottle after feeding your baby 5. The American Academy of Pediatrics New Mother’s Guide to Breastfeeding, Joan Younger Meek; Winnie Yu must be thrown out. You must not save it for the next feeding. Do not keep open already made formula for more than 48 hours. All open prepared formula must be kept in the refrigerator. Formula Feeding • A discussion of bottle-feeding is included in our Prepared Childbirth class. Call (877) 462-2247 to register. The second way of feeding a baby is formula feeding. Formula Feeding Books Benefits Check your local library or bookstore for What to Expect the First Year, by Heidi Murkoff, Sharon Mazel, Arlene • Anyone can feed the baby with this method. Eisenburg, and Sandee Hathaway. • Some mothers feel they have more freedom with formula feeding. • Some mothers are more comfortable with this method. • Formula provides good nutrition. Baby Names • It’s easy to see how much baby is taking. • There are choices of birth control methods. • Some are more comfortable feeding in public. Picking a name for your baby can take time. Some know what they are going to name their children before they are pregnant. Others wait until after the baby is born. There are many books and online resources to help you Answers to Common Questions chose a name.

Q.Which type of formula should I use for my baby? Suggested Readings A. Attend a baby care class to learn about making formula and different types. Ask your medical professional if 1. The Baby Name Wizard: A Magical Method for Finding the Perfect Name for Your Baby, Laura Wattenberg he/she has a suggestion. 2. Baby Names Made Easy: The Complete Reverse-Dictionary of Baby Names, Amanda Elizabeth Barden Q. Will my baby get tooth decay if I bottle feed? Online Sources A. Do not put your baby to bed with a bottle. Not only will this cause tooth decay, but the baby can choke on his/her milk. 1. www.babynames.com 2. www.babynamesworld.parentsconnect.com Q. Can I prop my baby’s bottle? 3. www.momswhothink.com A. No. It can lead to baby’s choking. And this is a special time to hold and bond with your baby. Always hold your baby during feedings. This is important because the baby needs love and cuddling during feeding for his/ her normal development. Q. How long will I need to feed my baby formula? A. Babies must have either breast milk or formula (or both) until they are at least a year old. Don’t give cow’s milk to your baby until the doctor tells you to. Don’t feed solid foods to your baby until your nurse or doctor tells you. Q. Are there any drawbacks to formula? A. Yes. Formula: • Provides no immunities or protection against • Contributes to pollution of environment (formula infection production, plastics, etc.) • Can be costly • Leads to more illness (ear infections, diarrhea, • Must be made unless using ready-to-feed formula upper respiratory infections) (the most expensive) • Does not provide the same nutrients as • Offers no health benefits for mother breastfeeding. All of the nutrients in human milk • Babies may develop milk allergies and formula is cannot be reproduced in formula. harder to digest.

12 Baby and You, Getting Ready for Motherhood & Baby – 2nd Trimester Baby and You, Getting Ready for Motherhood & Baby – 2nd Trimester 13 After Your Baby Is Born

In The Hospital The time after your baby is born is called ‘postpartum.’ During the first hour after your baby is born, the nurse will check your: Table of Contents – 3rd Trimester • Blood pressure • Fundus (the top of the uterus) • Pulse • Your bleeding (called lochia)

After Your Baby Is Born...... 15 The first time you get out of bed, you may be dizzy and weak. Ask someone to help you get up. Your first time up, you may have a gush of blood. This is not unusual. The nurses will show you how to: Signs of Illness • Check your stomach in Mother Or Baby...... 17 • Care for your stitches (episiotomy) • Feed and bathe your baby Infant Care, Nutrition and Safety...... 19 If you have an episiotomy, take your hospital provided care squirt bottle home. Use it to clean your stitches each time you go to the bathroom. Checklist for Dad...... 20 Sometimes you and your baby cannot go home together. If you have a problem where you have to stay in the Circumcision...... 22 hospital longer, your baby may go home before you. If that happens, your family may need to make plans to care for the baby. Our hospital staff can help you with these plans. We can offer a home care nurse to go to your house to check the baby. If your baby must stay in the hospital, you will still be discharged home. You are welcome to come back to feed and hold your baby at any time. If your baby has special needs upon discharge, we will help you meet them. Notes Things to Expect the First Few Days Bleeding – You should expect: • 2-3 days of bright red to brownish red bleeding • Yellow white discharge up to three weeks • 3-10 days of pink discharge postpartum. It will smell like a period. Tell your doctor if you have a foul smell. Cramps – You will feel cramps, especially while you breastfeed. This is your uterus returning to normal. Postpartum “blues” – These occur in the first few days. Symptoms may include: • Crying for no apparent reason • Restlessness • Impatience • Anxiety • Irritability These will usually go away within a few weeks.

Preventing – Your milk will come in 3-4 days after your baby is born. Your breasts may become hard and painful (engorged). Some things that help are: • Wearing a bra 24 hours a day • Taking pain medication • Applying ice packs If you are breastfeeding, breastfeed your baby frequently from birth. Nurse the baby every two hours during this time. If you are bottle-feeding, do not massage the breasts, apply heat or try to remove the milk. Engorgement lasts about 24-48 hours.

Hemorrhoids – You will experience enlarged veins and swollen tissue around the rectum.

14 Baby and You, Getting Ready for Motherhood & Baby – 3rd Trimester Baby and You, Getting Ready for Motherhood & Baby – 3rd Trimester 15 Other Postpartum Changes Nutrition

You may have the following changes during the first few months of postpartum. Your diet is as important now as it was during your pregnancy. Your body is going through major changes. • Increased sweating It needs good food to help it heal. If you are breastfeeding, your baby is depending on you for all the things • Hair loss important to her or his growth. The best way to deal with this is to continue the good diet that you followed • Mood swings during pregnancy. Review pages 80-98 of What to Expect When You’re Expecting. Another helpful source for • Less interest insexual activity – This may be due to being tired, fear of pain or fear of pregnancy. nutrition advice is the information found in the 1st trimester section of Baby & You (pg 4). • Postpartum depression – This can occur within days after delivery or slowly show up. Most of us begin to think about weight loss as soon as possible after delivery. If you are breastfeeding your baby, You may have the following symptoms up to one year after birth: it is important to remember that the baby consumes about 500 calories per day. Those must be part of your • Nervousness • Panic food intake. Doing the following should have you back in shape soon. • Fatigue • Sadness • Stick to a good basic food pattern. • Hopelessness • Sleep disturbances • Avoid empty calories such as “junk food.” • Confusion • Memory loss • Get some regular exercise (such as walking). • Uncontrollable crying • Anxiety How soon you may begin any exercise program will depend on your condition after delivery. Talk to your doctor, • Over-concern for the baby • Exhaustion nurse or midwife after your baby is born. • Sluggishness • Appetite changes • Depression • Irritability Rest • Poor concentration Your body is going through some major changes. Your baby also demands lots of time. For the first few weeks, If you experience any of these symptoms or are unsure, call your doctor, nurse or midwife. limit your activities to caring for yourself and your baby. Limit visitors as well. Nap when the baby naps. This is very important. Contraception

Your first menstrual period may come about 6-8 weeks after birth, possibly longer if you are breastfeeding. If When to Call Your Doctor, Nurse or Midwife you are not sure what birth control to use, ask your nurse, doctor or midwife before you leave the hospital. Do • Bleeding (more than one pad per hour) not put anything in the vagina such as suppositories, douches, or tampons. Ask your doctor about when you • Foul smelling vaginal discharge can start having intercourse again. • Discharge that increases or becomes brighter red – This may be a sign that you need to lie down and rest with Doctor Visits your feet up. If it doesn’t slow down within 1-2 hours, call your doctor, nurse or midwife. • Pelvic pain (more than occasional cramping the first few days) You need to make a check-up appointment six weeks after you have your baby. If you had a C-section, you need • Burning or pain when you go to the bathroom to be seen at two weeks. Your baby needs an appointment at two weeks, or as your doctor says. Call the office • Flu-like symptoms along with breast pain as soon as possible after discharge from the hospital to make your appointment. • Fever Returning to Work • Severe depression – always sad, no joy in your baby, feeling desperate (see previous page), anxiety 2 For more information about what will happen after your baby is born, read pages 373-411 in What to Expect This is also the time to begin planning for your return to work. It is a good idea to go over your workplace When You’re Expecting. policies about maternity leave. • Are there forms that you have to complete before leaving? Breastfeeding Questions?

• How much leave is allowed? Call our certified at (269) 245-8586. • What forms do you have to complete before returning to work? • Who is going to care for your baby while you are at work? Unless you have a family member or friend who has promised to care for your baby, it may take time to find a good caregiver for your baby. Begin looking now.

16 Baby and You, Getting Ready for Motherhood & Baby – 3rd Trimester Baby and You, Getting Ready for Motherhood & Baby – 3rd Trimester 17 Signs of Illness in Mother or Baby Umbilical cord - It is important to keep the umbilical cord clean and dry. Use alcohol on the base of the cord 3-4 times a day to speed healing. Continue to use alcohol after the cord has fallen off. The area underneath should be completely dried. This usually takes place 3-5 days after birth. Call your doctor if any of the following It is important to talk about some things that can go wrong with either you or your baby in those first few symptoms occur around the cord area. weeks at home. • Area turns red Signs of Illness in Mother • Starts draining • Has a foul odor Bleeding or Discharge – Let’s think first about you, the new mother. One possible problem is bleeding or the Keep the diaper turned down so it doesn’t rub the cord area. Don’t be afraid to move it to clean at the base of vaginal discharge that happens after the baby is born. Remember, this discharge should never return from pink the stump. It won’t hurt the baby. or yellow to red. The amount of bleeding should decrease over time. If your discharge returns to red, it is an early warning sign that you are doing too much. Rest for an hour, drink a glass or two of water, and see what Rashes - New babies tend to get rashes. Their skin is very delicate and easily disturbed by many things. Avoid happens. If you have an unusual change in your discharge or if it has a foul smell or you pass clots bigger than a putting perfumed creams or lotions on the baby. Use mild, unperfumed soap to wash the baby. When doing the 50-cent piece, it is important you notify your doctor or midwife. baby’s laundry, make sure to do the following. Infection of the breast () – Infection of the breast, or mastitis, may occur. The breast is very sore, • Use a mild detergent feels hot to the touch and painfully hard. You also will probably have fever and flu-like symptoms. If you notice • Rinse laundry twice these symptoms, and if your breasts don’t feel better after breastfeeding, call your doctor or midwife. This is a • Always wash new clothes or linens before using them around the baby condition that requires medical treatment. You should continue to breastfeed. Ask your midwife to refer you to a lactation consultant. Call your doctor if the baby has any of the following symptoms: • Gets a rash that does not go away in a day or two Swelling around the rectum (hemorrhoids) – Hemorrhoids are common during the last weeks of pregnancy and the first few weeks after you deliver. Witch hazel pads, “Tucks,” applied to the sore area will help. You also • Skin blisters may try some over-the-counter items like Preparation H. It is important to include lots of fruits and vegetables in • Has a discharge your diet and to drink enough fluids to avoid hard, painful stools. • Fever Please call your doctor or midwife if you notice any of the following: Jaundice (yellow skin or eyeballs) – Before a baby is born it needs more red blood cells than it needs after • Fever over 100.4 degrees • Pelvic pain more than mild cramping birth. The extra red blood cells are broken down by the liver. Even a full term baby has a liver that is not fully • Pain or burning when you pee • Pain or swelling in your legs developed. That liver is now working overtime. If the liver cannot keep up with the removal of extra dead red blood cells, the skin and eyes develop a yellow color called jaundice. For most babies, time takes care of the • Unusual vaginal discharge or bleeding • Severe pain in the area where you have stitches problem. Frequent feeding and making sure the baby is getting enough fluid helps. Watch your baby for this or an incision • Hot, tender breasts yellow skin color between 3-10 days old. If you notice that the yellow color getting worse and baby is not • Depression waking for feedings, call your doctor. Signs of Illness with Baby Vomiting – Many new babies ‘spit up’ a bit after eating. A baby may sometimes vomit all or most of a feeding for no real reason. You should call your doctor if your baby is: Fever - If you think that your baby is sick, begin by checking his/her temperature. Now look for other signs. • Vomiting frequently • Does the baby have a stuffy or runny nose? • Is fussy or not active enough • Does his/her breathing sound heavy? • Has a fever • Is the baby coughing or sneezing? Diarrhea – Diarrhea is frequent and watery stools. Call your doctor if your baby’s diarrhea: These symptoms could signal illness. For mild illness, running a humidifier in the baby’s room may help. Call your • Lasts more than a day doctor’s office if the baby: • Is accompanied by vomiting, fever and behavioral changes • Has a fever If you are breastfeeding, loose and yellowish stools are normal. • Refuses to eat or drink Poor Eating/Lethargy – You may notice your baby sleeping more, is hard to waken or is acting weaker. The • Is having trouble breathing suck may be weaker, and baby may be eating less. You may notice these as the first symptoms of illness. Remember to write down the baby’s temperature and how you took it (mouth, armpit, ear.) The nurse or doctor will want to know what it is.

18 Baby and You, Getting Ready for Motherhood & Baby – 3rd Trimester Baby and You, Getting Ready for Motherhood & Baby – 3rd Trimester 19 Prevention Shopping for Your Baby

Prevention is the best medicine. It is important, especially in the first three months of your baby’s life, to protect Clothes – You will need lots of undershirts, diapers, and receiving blankets. Avoid wool items. Wash all clothes him/her against disease. These simple rules will help: in mild detergent before your baby wears them for the first time. Babies grow very quickly, so buy carefully. 1. Minimize the baby’s contact to crowds. 3. Anyone who handles the baby should wash their Toys – Babies need different sights, sounds and textures. Your baby should have a variety of toys. Be sure that 2. Keep sick adults or children away from the baby. hands. they are correct for the baby’s age. While in the hospital, keep your baby in the room with you. You can learn all about the things that make your In Review baby special. Never leave your baby alone.

In review, call the baby’s doctor for any of the following: • Fever that remains for more than eight hours or • Difficulty in breathing Checklist for Dad continues to go up (In newborns under two weeks • Any lasting illness Last minute items for nursery Lotion for back massages for mom old, call at the first sign of a fever.) • Poor feeding Crib/bassinet has fresh sheets and bumpers Flowers for mom • Skin sores with a discharge • Increased jaundice • Continued vomiting and/or diarrhea Rocking chair for mom; lamp/nightlight; nursery Celebration gifts for family and friends monitor; hamper Arrange for any necessary religious ceremonies 2For further information on this topic, read What to Expect When You’re Expecting. For answers to your Diapers/baby wipes/powder/diaper cream including food, flowers, and the rabbi, priest or questions, talk to your doctor or nurse. Buy groceries minister Make sure bills are paid Consider taking some time off work to help with Infant Care, Nutrition and Safety Change sheets on mom’s and dad’s bed household chores. The new mother needs to care for herself, baby and to rest. Relieving her of household Rent or purchase or buy formula. work will help her get back to normal faster. Preparing Your Home If you need help, call your wife’s ob/gyn or call our education office at (877) 462-2247. Now is the time to begin getting your home ready for your new arrival. Here are some key safety factors to consider: Caring for Your Baby in the First Weeks Your baby’s crib Don’t let anyone other than known members of the nursing and medical staff care for your baby. Ask to bathe • The crib bars must be no more than 2 and 3/8 • Be sure that there is no lead paint on the crib or the baby with the nursing staff looking on. This will help you feel comfortable with your baby’s care. inches apart. anywhere else around the baby. 2 Please review Caring for Your Baby: A New Mother’s Guide, which will be given to you after the baby is born. • The mattress should be firm and fit snugly into • If you cannot afford a crib call 211 for help in the crib. obtaining one (Calhoun County only.) Limit your visitors – This applies in the hospital and in the first few weeks at home. This is the time for you to • Do not use pillows or waterbeds. get to know your new baby. It’s also time for your family to adjust to their new roles. Remember that your new baby needs extra protection against infection in the first few weeks of life. It is important to limit the number of Your baby’s car seat people who handle the baby. Don’t let anyone with a cold or other contagious disease be close to the baby. It is • Read the directions. • Never leave the baby unattended in the car. also very important to have everyone in contact with the baby do careful hand washing before touching the baby. • Know how to use it properly. Practice using it before • When you are discharged from the hospital, the your baby is born. person taking you home must have an appropriate Feeding your baby – Your baby’s stomach is about the size of his/her fist. Your baby will need to eat about • Your baby must be securely fastened into the car seat car seat for the baby. Car seats are available from every 2-4 hours during those first weeks of life. It is important to hold your baby while you are feeding. The for every ride – no matter how short the ride. many different sources. You may choose either to sense of love is very important to your baby’s well being. This will also prevent choking. It is important to note that it is normal and healthy for your baby to want to suck on his finger, fist or pacifier. • Be sure the car seat is correct for your baby’s age and buy or to rent the baby’s first car seat. Ask your nurse about car seat rental, if needed. size; read the directions. Bathing your baby – Until the umbilical cord has healed, you may give your baby a sponge bath as needed, usually every 2–3 days. Cleanse the diaper area with each diaper change. Bathe your baby in a room that is Your home warm. You should have enough space to lay out all things needed for the bath. This should be a happy, playful • New babies put everything they can reach into • Your home should have at least one smoke time for you and your baby. An infant care class is part of prepared childbirth classes. their mouths. Put medicines, cleaning products detector. It should also have one multi-purpose fire and plants up high or in locked cupboards. You extinguisher on each floor. Dressing your baby – Your baby will be comfortable in clothing similar in weight to what you are wearing. Do not use the baby’s hands or feet to check for warmth. Use the back of the neck. A new baby’s hands and feet can buy child safety locks for cupboard doors at • Ask those who must smoke to go outside. any hardware store. usually feel cool. It is important to cover your baby’s head, unless it is really warm outside. Your baby’s head is the largest part of its body, and the baby can chill quickly if the head is not covered. Protect your baby’s skin and • Electrical outlets should be covered with safety plugs. eyes from the sun when outdoors. 20 Baby and You, Getting Ready for Motherhood & Baby – 3rd Trimester Baby and You, Getting Ready for Motherhood & Baby – 3rd Trimester 21 Sleep patterns – Most new babies sleep between 12 and 18 hours a day. A new baby’s sleep is not like that of Circumcision an older child or adult. Your baby may open his/her eyes and even cry for a little bit and go right back to a sound sleep. Positioning your baby right in the crib is important to their sleep and safety. Getting ready for the birth of your baby involves a lot of decisions. For boys, one decision that you need to make 2 Refer to Caring for Your Baby: A New Mother’s Guide, which will be given to you in the hospital. is about circumcision. Circumcision is the cutting away of the foreskin. This is the skin that covers the head of Safe sleep points: the penis. Many parents have strong feelings either for or against circumcision. These feelings may be related to 1. Baby sleeps by him or herself in a crib, portable crib 4. Keep baby’s face uncovered during sleep for easy family custom, religion. Or it’s the desire to have the new baby boy treated as his father, brothers or grandfathers or bassinet. breathing. Use a sleeper instead of a blanket. were treated. Until a few years ago, most baby boys in this country were circumcised. Lately, there has been a lot 2. Always put baby to sleep on his or her back even 5. Don’t allow anyone to smoke anything around baby. of talk about the topic. This handout will help you make a decision about circumcision. when he/she can roll over. 6. Don’t overheat the baby. Dress the baby in as much Reasons Not to Circumcise 3. Have nothing in the sleep area. No pillows, blankets, or as little clothing as you are wearing. • Routine circumcision is not supported by the American Academy of Pediatrics. comforters, stuffed animals or other soft things. 7. Use a firm mattress with tightly fitted sheet. • The procedure seems upsetting and painful for the baby. Looking at Your New Baby • The baby is restrained during the procedure. There are several things that you will notice about your new baby in his or her first week of life. This section is a • Many babies are fussy for a while after circumcision. brief summary of your baby’s looks. • Possible problems of the procedure are uncommon, but include infection, bleeding, injury to the penis or urethra, and scarring. Molding – The bones in your baby’s head change in shape as he/she passes through your birth canal. At first, your baby’s head will show the signs of this “molding” and may also have some bruising. In a few days the head Reasons to Circumcise will return to its usual shape. • The circumcised penis is easier to clean. • There is less irritation or infection. Stork bites – Many new babies have red areas around their: • Boys who are not circumcised and do not do proper cleaning of the penis may develop a problem which • Foreheads requires circumcision later in life when it is far more painful to do. • Eyelids • There are reports which show a lower incidence of cancer of the penis in men who have been circumcised. • Noses This is very rare. • Or on the back of their neck • There are also reports which show that uncircumcised babies have a higher risk of urinary tract infection. Less These are called stork bites. They will be more visible when the baby cries. Stork bites will go away by themselves than one percent of circumcised males develop a urinary tract infection. during the baby’s first year. Preparation Milia – These look like little whiteheads or pimples. They usually appear on the nose or chin. They go away by If you decide to have your son circumcised, you will need to sign a consent form giving permission. Circumcision themselves in the first weeks of life. Do not squeeze or put cream or lotion on them. is done before you take your son home. Your doctor will check on your baby and let you know when he is ready. The circumcision takes about 15-20 minutes to do. The baby is taken to the nursery. Nurses will get him ready Jaundice – While the baby is in your womb, he or she needed a lot more red blood cells than after birth. Shortly for the procedure. The area is cleaned with Betadine an orange colored cleaning solution. This may discolor the after birth, the baby’s body begins to break down those extra red blood cells. This is hard work. Many new skin for a short time. Usually the doctor or midwife who delivered him will perform the circumcision. Sometimes babies get a yellow color to the skin and the whites of the eyes. This is called jaundice. It usually starts 2-3 days your pediatrician will perform the circumcision. After the circumcision, the baby will be watched closely for 2-4 after birth and last about 7-10 days. If you notice that it is getting worse, call your doctor. It can be a sign of hours. Cuddling and feeding should sooth him after the procedure. The baby’s penis will have a piece of gauze other problems. with petroleum jelly (Vaseline®) on it.

Hormones – For a girl baby, your hormones may affect her. These may cause your newborn to have some breast Circumcision Care swelling. They can also have a little bloody mucous coming from the vagina. These will go away and do not For the first 24 hours after circumcision, place a piece of gauze coated with petroleum jelly on top of the baby’s require treatment of any kind. penis. The nurse will show you how to do this. This should be done each time the diaper is changed. It prevents the healing penis from sticking to the diaper. If you should run out of gauze just put the petroleum jelly right on As new parents, you will have lots of questions. It will be helpful to keep some paper handy so that you can the baby’s penis. This should be done at each diaper change until the penis is healed. The penis is usually healed jot down your questions. Bring them with you to your baby’s office visit. At that time, the doctor or nurse can within 2-4 days. Watch for excessive bleeding. answer your questions. Remember that your baby’s first year is a learning process for the whole family. Be patient and take time to enjoy one another. A whitish, yellow covering may be noted for 2 – 3 days. This is normal healing tissue. Do not try to remove it. Cleanse the penis with a damp cloth without soap and pat dry. Keep your infant off his stomach to prevent irritation.

22 Baby and You, Getting Ready for Motherhood & Baby – 3rd Trimester Baby and You, Getting Ready for Motherhood & Baby – 3rd Trimester 23 Reasons to Delay Circumcision Notes Circumcision is not done if the baby’s condition is not stable. If, for example, the baby is very jaundiced or requires oxygen, the circumcision may be postponed. If circumcision is delayed, talk to your baby’s doctor or nurse to arrange to have the procedure done.

Care of the Circumcised Penis 1. Make sure you clean all the folds and wrinkles of the genitals after each diaper change. The uncircumcised penis requires no extra cleaning – just wash, rinse and dry it along with the rest of the baby’s bottom. 2. Wash away any whitish secretion (smegma) appearing on the outside of the penis, but don’t try to wash or clean under the foreskin (the skin over the top of the penis.) 3. DO NOT retract (pull back) the foreskin over the glans (the cone shaped tip) of the penis. Forcing the foreskin back may harm the penis, causing pain, bleeding, scarring and adhesions. 4. Separation of the foreskin from the glans normally may take years. Your pediatrician will talk to you about this. 5. If, after reading this handout, you still have questions, please talk to your nurse, midwife or doctor.

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