The Expectant and New Family Workbook

Birth and Family Education

188177 3/08

The Expectant and New Family Workbook

Birth and Family Education

Copyright © 2006 Fairview Health Services. All rights reserved. Published by Fairview Press, 2450 Riverside Avenue, Minneapolis, MN 55454.

The information in this book should not replace the advice of your care provider. Always follow your care provider’s instructions. Before having any test or treatment, talk to your care provider to be sure you fully understand the risks and benefits involved.

Please tell us if you need a language interpreter.

If you are deaf or hard of hearing, please let us know. We provide many free services including sign language interpreters, oral interpreters, TTYs, telephone amplifiers, note takers and written materials.

Acknowledgments and permissions: “Birth Preferences” worksheet (page 18) and “Baby Care Preferences” worksheet (page 31) by Carla Reinke, adapted with permission. “Comfort Measures in Labor” checklist (page 10) and pain medications scale (page 13) by Penny Simkin, adapted with permission.

SMARTworks 188177 – REV 03/08. Contents

Introduction iv

Learning about Decision Making 1

Learning about Pregnancy 2

Learning about Labor and Birth 3

Learning about Comfort in Labor 5

Learning about Medical Care during Labor and Birth 14

Learning about Feeding Your Baby 20

Learning about Your Newborn 28

Learning about Postpartum and Early Parenting 32 Appendices 37 Glossary 41 Resources 42

iii Welcome! This workbook will help you prepare In case of bad weather for labor, birth and early parenthood. You will receive most of the information you need in class. Please call one hour before class to ask if it’s The workbook will be your guide. been cancelled. On Monday through Friday, call 612-672-7272. On weekends, call the hospital To get the most out of this class, please feel free where you are taking your class: to share with us any concerns, questions or information you have. • Fairview Ridges Hospital: 952-892-2000

• Fairview Southdale Hospital: 952-924-5000 General Information • University of Minnesota Medical Center, Fairview: 612-672-6000 Telephone numbers If class is cancelled, we will try to reschedule. Educator’s name and telephone number: Please call 612-672-7272 three working days later ______to ask about a new date and time. ______Infant car seats Fairview On Call (to register for tours and classes): 612-672-7272 Minnesota State law requires that all infants be in a federally approved car seat when in a car. Birth and Family Education Program Office: 612-672-4118 For information on car seats, call the National Highway Traffic Safety Administration Auto The Birthplace at: Safety Hotline at 1-800-424-9393. Or contact Buckle Up Kids at www.buckleupkids.state.mn.us. • Fairview Ridges Hospital: 952-892-2480

• Fairview Southdale Hospital: 952-924-5000

• University of Minnesota Medical Center, Fairview: 612-273-4040

iv The Expectant and New Family Workbook Learning about Decision Making You will make the decisions you feel you need to make. You will make informed choices. You need clear, accurate informawtion.

This class will add to what you already know " about labor, birth and parenting. It will help you For you to try decide what you want during labor and birth As you learn about each option, use these and how you want to parent your baby. Many questions to make an informed choice. families also make choices about housing, work and financial changes at this time. • What is this (procedure, suggestion, problem)? We will give you the facts in clear, simple terms. This allows you to make the best choices for you • How will it affect me? and your family. • How will it affect my baby?

• How will it affect my care, labor or ______?

• What are my other options?

The Expectant and New Family Workbook 1 Learning about Pregnancy Pregnancy involves the mind, body and spirit. Pregnancy is different for each woman. For both men and women, the role of the parent begins in pregnancy.

Physical Changes: " What’s Happening to Your Body For you to try To check how well you understand what In class, you will learn how your body changes you’ve learned in class, try to describe these as the baby grows. We will define the parts of body parts in your own words. Assume that the body and the changes that take place during you are trying to explain them to someone pregnancy. We discuss: else. If you have any questions, you may ask them in class. • Breasts

• Lungs and diaphragm Emotional Changes: Becoming a Parent • Blood volume Pregnancy is also a time of emotional change. • Stomach and intestines You will start to explore what becoming a parent means to you personally and as a family. You will • Ligaments also begin to examine relationships within the family—and with your unborn baby. • Bladder and urethra Dr. T. Berry Brazelton describes this as the first • Uterus, cervix and vagina of many “touchpoints” between parents and their baby. These touchpoints center around times • Rectum and anus of change. They often lead parents to reflect on their past experiences and knowledge. • Perineum

• Placenta, umbilical cord, membranes and " amniotic fluid For you to try Begin to explore the changes that preg- You will use this knowledge later as you explore nancy, labor and parenthood will bring. the labor process. List the joys and challenges in this preg- nancy so far. It can be helpful for family members to do this separately and then come together to discuss their responses.

2 The Expectant and New Family Workbook Learning about Labor and Birth Families prepare for labor with their own expectations and personal histories. Every woman preparing for labor is able and strong.

The Labor Process Signs of Labor

The steps below provide a framework for The normal signs of labor are listed below. These exploring the labor process. We will help you signs will tell you how your body is preparing for find a way to identify with this process, which labor. They will also help you recognize the signs will help you prepare for labor. of premature labor.

1. The uterus contracts. Possible signs of labor:

2. The baby is pushed against the cervix. • A vague, nagging backache that’s different from the normal backache in pregnancy 3. The cervix thins (effaces 0 to 100%) and opens (dilates 0 to 10 cm). • Soft bowel movements, sometimes with flu- like symptoms 4. The pelvic bones move apart a tiny bit. • Cramps (like menstrual cramps) that happen 5. The baby is pushed down into the vagina. sometimes or all the time

6. The pelvic floor muscles stretch and the • A burst of energy, sometimes called the vagina opens. “nesting” instinct

7. The baby is pushed out. Preliminary signs of labor:

8. The placenta is delivered. • You discharge blood-tinged mucus from your vagina (called “bloody show”).

" • Your bag of waters (amniotic fluid sac) leaks For you to try without contractions. As you learn more about the labor process, ask yourself how it changes from begin- • You have contractions, but they do ning to middle to end. Try to keep these not progress. changes in mind. This will help you to better identify the signs of labor as well as your options for comfort.

The Expectant and New Family Workbook 3 Positive signs of labor: Even if you have only a nagging feeling that “something is wrong,” your doctor or midwife • Your contractions get longer, stronger and will want to hear from you right away. closer together.

• Your bag of waters breaks.

Call your doctor or midwife if you have any of " these signs before 37 weeks of pregnancy. For you to try Other warning signs: Birth stories are powerful tools to help you prepare for the labor experience. They can • Unusual health problems help you understand what a contraction is really like, or how you might feel if you – swollen hands, face, feet or ankles must move from a vaginal birth to a cesar- – severe headache ean birth. – vomiting (throwing up) or nausea (feeling sick to your stomach) that won’t go away Seek out stories from family and friends as well as birth videos and written stories. – blurred vision or spots before your eyes We will provide written stories and birth • A change in vaginal discharge videos in class. – spotting or bleeding from the vagina – increase in discharge before week 37 – the bag of waters leaks or breaks – discharge that smells bad, itches or is a different color or thickness

• Abdominal or back pain that is sharp or that won’t go away

• A change in the pattern or amount of the baby’s movements

• Urinary tract problems – pain or burning when urinating (using the toilet) – fever or chills – a sudden decrease in urine amounts or urinating often in small amounts

4 The Expectant and New Family Workbook Learning about Comfort in Labor Labor support is essential. You will decide what works best for you. The wordcomfort means different things to different people.

As you learn more about the labor process, you Other possible sources of pain: will begin thinking about what you need for Full bladder comfort in labor. We will show you a wide range of comfort measures. You will choose which ones Tension in the body to add to the self-comfort skills you already use every day. Fatigue Hunger, thirst, nausea Physical Sources of Pain Effects of a medical procedure or medicine

First stage: The comfort level for dads and labor partners, may also be affected by hunger, thirst and fatigue Cervical stretching during labor. Lack of oxygen to the uterus Pressure on the bones and joints of the pelvis Psychological Sources of Pain

Pain in areas that share spine and pelvic nerves Feeling alone or abandoned Second stage: Feeling trapped Pressure on the bones and joints of the pelvis Fear (of labor, pain, staff, support people)

Pressure on and stretching of tissues as the Past experiences with pain, hospitals or labor baby passes through the pelvis, vagina and vaginal opening Feeling a loss of control or no control Tearing of tissues Frustration with the labor’s progress Feeling shame; feeling that the task ahead has Third stage: little or no value Contractions Dads and partners may have these feelings as Stretching of cervix and vagina as the well. They may also feel helpless, incompetent, placenta is delivered guilty or overwhelmed. Pressure of the placenta on tears or cuts

The Expectant and New Family Workbook 5 Comfort Strategies and Options " For you to try The list below will help you decide which comfort You may use the tools listed here to explore measures to use during labor. In class we will your options for comfort during labor: discuss how comfort measures can also help labor to progress. Breathing Toward Birth (page 7) Progressive Muscle Relaxation (page 9) • Breathing techniques Comfort Measures checklist (page 10) (Note: A woman in labor needs to breathe for herself, her uterus and her baby. You may You might also want to think about the choose how to breathe and which breathing benefits and drawbacks of using medicines techniques you use.) during labor (page 11).

• Relaxation techniques (to aid the breathing process and help the uterus work better)

• Labor support (your spouse or partner, the father of the baby, a doula, a friend, a relative)

• Movement, changing positions, a birth ball

• Water (a bath, a shower, cool or warm towels, hot or cold packs)

• Touch or massage

• Music, soothing sounds

• Rhythm and ritual during contractions

• Food, fluids

• An empty bladder

• Medicines

6 The Expectant and New Family Workbook Breathing Toward Birth: Eight Ways to Prepare

Remember, breathing is very personal. Do what feels right for you, and you will be able to breathe effectively in labor.

Relaxation Breathing Your most relaxing breath may lie between these two levels, perhaps near your belly button. Move This is breathing deeply and slowly. It can be your hands to where your breath seems the most used in several ways. relaxing. Breathe at that level for a minute or so. If you want, your partner can place his or her • Take a relaxing breath when you feel a hands at that same level on your back. contraction begin. This can help you focus on the coping methods you will use during Spend time breathing at each of these levels. that contraction. Then, finish the following sentence: The depth of breathing that feels the most relaxing to me is: • Keep breathing during the contraction. ______. You can stay relaxed as you focus on your breathing. Deep, Slow-Paced Breathing • End each contraction with a relaxing breath. This can be a signal for your body to relax This is another kind of deep, slow breathing. and rest until the next contraction. Begin by taking a breath in and letting it out (often called a cleansing breath). Then, keep • Continue this breathing between breathing slowly and deeply, in through your contractions. It will help you stay relaxed nose and out through your mouth. You should until the next contraction begins. be breathing at about half your normal rate, or The goal is to breathe in a way that feels most taking six to 10 breaths per minute. relaxing to you. Begin with your hands above To maintain your rhythm, it may help to count: your baby, resting on the top of your stomach. in-2-3-4 and out-2-3-4. Try using this method Breathe in and out so that your hands fill with throughout your labor. End each contraction your breath. You should feel your hands move with a cleansing breath. as you breathe slowly and deeply. If you want, your partner can put his or her hands at about the level of your waist. You can think about Distraction Breathing breathing into your partner’s hands. You can use Relaxation Breathing as your main Next, move your hands beneath your baby. If comfort tool during and between contractions. you want, your partner’s hands can rest low on Or, during contractions, you can focus on the your back. Focus on bringing your breath down rhythm of your breath by counting or chanting. to your hands. This way the contractions may not seem as strong.

The Expectant and New Family Workbook 7 Focus on keeping your breath light and even. If Patterned Breathing you want, you can place your hands lightly on your chest above your breasts. You will feel a This method helps to calm you during labor. slight movement with each breath. You may want When a contraction begins, take a cleansing to count or repeat words like in-out to keep your breath. Begin breathing in a rhythmic pattern breathing even. You can also add a soft sound like using soft blows. You may choose any pattern haa each time you exhale. Some women prefer to (for example, inhale–exhale–blow, or inhale– use hee or hoo as they exhale. Do whatever feels exhale–inhale–exhale–blow). Do not change your best and helps you keep your rhythm. breathing rate or the amount of air exchanged. End the contraction with a cleansing breath. If you want to focus even more on your breathing, you can add a pattern of sounds as you exhale. This can be a repeated cycle of haa- Breathing to Prevent Pushing haa-haa-hee or any pattern that works for you. There may be times in your labor when you will be told not to push. Keeping your breathing Shallow Breathing / very light prevents you from holding your breath Modified-Paced Breathing and bearing down. It does not take away the urge to push. Like Distraction Breathing, this method involves breathing higher and lighter than normal. As To keep your breathing very light, focus on taking your contraction begins, take a cleansing breath. in a small breath that goes just to the back of Then, take a shallow breath: in, then out. You your throat. Then, gently exhale. You can make will breathe up to twice your normal rate, taking a fff sound with each exhale. Or you can imagine about 30 to 40 breaths per minute. Counting blowing out birthday candles. Focus on blowing in-2, out-2 will help with your rhythm. out only one candle with each little puff of air.

A faster rate of breathing will make you more Other Ways of Breathing for Comfort alert, which may be useful during labor. Keeping the inhale and exhale equal will help prevent • You can use any breathing method that has hyperventilation. End the contraction with a worked for you in the past, such as yoga, cleansing breath. singing or the rhythm you use during exercise.

Combination Breathing • When you exhale, you can make a sound that brings you comfort, such as mmm. The sound When a contraction begins, take a cleansing ahh can help you stay centered and focused. breath. Start with slow, deep breathing. As the • You can direct your breath to any area of contraction reaches its peak, increase the rate your body that feels tight or painful. This is of breathing. Return to slow, deep breathing sometimes called “breathing into the pain.” as the contraction grows less intense. End the contraction with a cleansing breath.

8 The Expectant and New Family Workbook Progressive Muscle Relaxation

This exercise helps you recognize and reduce the muscle tension that may develop during labor. The goal is to try to get rid of any extra muscle tension in the body during and after a contraction. This helps the uterus work better.

Begin by tensing a group of muscles and holding Before doing this exercise that tension for five seconds. Then, release the tension in that muscle group and relax the • Think about what will help you relax, such muscles as much as possible. The muscle tension as dim lights, music, an empty bladder or will be replaced by muscle relaxation. Spend a loose clothing. few minutes with this relaxation before moving on to the next muscle group. • When possible, practice this exercise with your partner. This will help your partner You will start the exercise with the feet and move recognize your signs of tension and relaxation. upward, ending with the head and scalp. Try tensing and relaxing the muscles in this order: • Try to get into a comfortable position. Avoid lying flat on your back. 1. Feet (right, then left) For the partner 2. Legs (right, then left) You can help the woman recognize where 3. Hips and buttocks she holds the tension in her body. Watch her 4. Lower back breathing. Is it steady and even, or fast and irregular? Check her hands. Are the fingers 5. Abdomen relaxed, or are they clenched into a fist? With a gentle touch, check other muscle groups in her 6. Chest body. Do the muscles feel soft or hard? Ask her how she would like you to signal to her that it is 7. Shoulders time to relax those muscles.

8. Hands (right, then left) The goal during labor is to relax as much as possible. Before labor begins, think about other 9. Arms (right, then left) relaxation methods that will be helpful to you. 10. Neck

11. Jaw

12. Face

13. Scalp and head

The Expectant and New Family Workbook 9 Comfort Measures for Labor 

Relaxation Massage Attention-focusing

� Relaxation exercise � Shiatsu � Visual focal point, music, touch � Roving body check � Acupressure � Visualization � Touch relaxation � Hand

� Foot Body positions and movement Breathing � Firm pressure � Standing, leaning � Specific technique � Walking � Your own technique Backache measures � Hands and knees (kneeling, � Counterpressure Pushing (bearing down) leaning forward) � Two-handed hip pressure � Sitting up � Breathing to avoid pushing � Hands and knees � Lying down � Spontaneous � Walking � Sidelying � Directed � Cold or hot packs � Squatting Help from birth partner � Rolling pressure (with or without support)

� Suggestions or � Shower to back � Birth ball verbal reminders � Bath Mental activity � Encouragement � Birth ball � Counting during � Compliments contractions � Patience and confidence Water � Chants, mantras, in the woman and her labor � Bath songs, prayers � Ongoing support � Shower � Guided imagery � Eye contact � Hot packs � Rituals, rhythms � Expressions of love � Cold packs and support

10 The Expectant and New Family Workbook Medicines and Labor

Medicine can ease the pain of labor. Whether or not to use this medicine is your choice. As you learn about different labor medicines, go back to the questions on page 1. These will help you make decisions.

Everyone has different feelings about using medicine during labor. We will give you the facts about these medicines in class. Your feelings, along with the facts, will help you decide what role medicines may play in your own labor.

Systemic Medicines Narcotic analgesic (such as Nubain)

The word systemic refers to the whole body. • What it does: Reduces pain awareness and Systemic medicines are absorbed into the aids relaxation. This medicine is avoided bloodstream. They go wherever the blood travels when a woman is close to transition. If in the body. They will cross the placenta and may needed, the drug Narcan can reduce the affect the baby. These medicines are given by pill, effects of Nubain. injection (shot), IV and inhalation (through a breathing mask). Examples include: • Benefits: Doesn’t take the pain away, but takes the edge off. You may be better able Tranquilizer (such as Vistaril) to rest between contractions. Often given in active labor by a shot or IV. • What it does: Reduces tension, anxiety and apprehension. • Possible drawbacks: – To mother: May cause you to feel drowsy Benefits: • Can help you to rest and feel or dizzy. May decrease breathing rate and more relaxed. May also help with nausea blood pressure. May slow labor. (feeling sick to your stomach) and vomiting (throwing up). – To baby: May decrease breathing, alter heart rate and affect muscle tone and • Possible drawbacks: muscle reflexes. – To mother: Can cause you to feel dizzy and confused. May cause dry mouth and Regional Analgesia changes in blood pressure or heart rate. The word analgesia means “absence of a normal – To baby: May affect heart rate, breathing, sense of pain.” Regional refers to the area of the muscle tone and suck reflex if given body helped by the medicine. These medicines too close to birth. For this reason, this are injected into the spine. They provide pain medicine is used during early labor. relief from the waist down.

The Expectant and New Family Workbook 11 Epidural medicine (such as bupivacaine, Intrathecal medicine (such as fentanyl, lidocaine, ropivacaine or other “-caine” drugs) morphine or sufentanil)

• What it does: Numbs parts of the body. It is • What it does: Provides pain relief to parts given through a catheter (small tube) placed of the body. It is given though a needle in in the epidural space (between the vertebrae in the intrathecal space of the spinal cord the lower back). This medicine is often given (between the vertebrae in the lower back, with or followed by a narcotic or narcotic-like through the dura). medicine (like fentanyl or morphine). • Benefits: • Benefits: – Pain relief from the waist down. – Provides pain relief or numbness from – You are able to move and be more active. the waist down. You may feel pressure – Won’t make you drowsy or dizzy. You will during labor. feel the urge to push. – Will not make you feel drowsy or dizzy. Since the catheter is left in place, you • Possible drawbacks: Mother may have receive continuous medicine. The dose can itching, nausea, vomiting, problems urinating be increased as needed. or spinal headaches (rare). Both mother and – Has fewer effects on a newborn than some baby will be watched more closely. other medicines. Dura Possible drawbacks: • (covering that protects – To mother: May cause a drop in the spinal cord) blood pressure (IV fluids are given to Vertebra help prevent this). Requires increased monitoring of blood pressure, heart rate, Intrathecal space temperature and baby, which will restrict (where a needle may inject the mother’s movement. May affect the medicine into the spinal fluid) “urge to push.” May slow labor. Chance of fever. May cause problems urinating. Epidural space – To baby: If mother’s blood pressure (where a small catheter drops, this may cause distress to the baby. may be placed, just outside of the spinal cord) Medicine may affect newborn’s behavior and reflexes. If mother has a fever, baby will be more closely watched. Injections in the Lower Back Epidural medicine goes into the space outside the spinal cord. Intrathecal medicine goes inside the spinal cord, into the spinal fluid.

12 The Expectant and New Family Workbook Regional Anesthesia General Anesthesia

The word anesthesia means “partial or complete This is given by IV or inhalation (breathing loss of feeling.” You may be awake or asleep. mask). It will put you to sleep for surgery. It is Regional anesthesia numbs a specific part of your used for cesarean birth in an emergency. The body. It is often used for cesarean birth. medicine affects the whole body.

Spinal medicine (such as bupivacaine, lidocaine, ropivacaine or other “-caine” drugs) " • What it does: Numbs the body from the For you to try breastline down. It is given though a needle As you learn about the medicines used deep in the spine’s intrathecal space (between in labor, you will start to decide how you the vertebrae in the lower back, through the feel about using these medicines. The scale dura). A narcotic or narcotic-like medicine below may help you explore these feelings. (like fentanyl or morphine) may also be given for pain relief after cesarean birth. Pregnant women, dads, partners and other labor support people should review the • Benefits: Excellent numbing, and you are scale on their own. Then, they can all come able to stay awake. together to discuss how the scale helped them explore the use of medicines in labor. • Possible drawbacks: Mother may have a decrease in blood pressure, as well as nausea and vomiting. Spinal headache are rare.

 How might medicine fit into your labor plan? Use the scale below.

______-10 -5 0 +5 +10

-10 = I do not want to feel any pain in labor. -5 = I want medicine when the labor becomes active. 0 = I don’t know at this point. I will wait to see how my labor feels. +5 = I want to avoid using pain medicine, but I want the option to use medicine if the labor is hard for me. +10 = I do not want any medicine, even for a cesarean birth.

The Expectant and New Family Workbook 13 Learning about Medical Care during Labor and Birth You are entitled to help make decisions about your care during pregnancy, labor and birth. You have a special relationship with your care provider. You have your own history with the health care system.

The medical side of pregnancy, labor and birth is • IV (a small tube in the vein that helps put made up of a wide range of tests and procedures. fluids and medicines into the body) These are often described in ways that are hard to understand. While you may find the medical • Vacuum extraction / forceps (methods to information confusing, you may also take help pull the baby through the birth canal) comfort in knowing it’s there if you need it. • Cesarean birth (surgery to remove the baby from the mother’s abdomen) Medical Procedures That May Be Used during Labor In some cases, you may be able to choose whether or not certain procedures are used. Or Listed below are the common medical you can let your doctor or midwife choose for procedures used in labor. You will learn about you. There are times when the doctor or midwife each procedure in class. will have to use some procedures to make labor as safe as possible. • Electronic fetal monitoring, internal and external (a machine that measures the baby’s heart rate and mother’s contractions " during labor) For you to try List one benefit, one drawback and one • Labor induction (medicine used to start the alternative to each procedure. This may labor process) help clarify the facts of the procedures as • Labor augmentation (medicine used to speed well as your feelings about them. the labor process) Next, use the chart on pages 16 and 17 to • Amniotomy (when the doctor or keep track of what you are learning about midwife breaks the bag of waters to speed the labor process. Add your thoughts and the labor process) ideas about your own labor.

• Episiotomy (a small cut made from the vagina to anus, used to widen the vagina for delivery)

14 The Expectant and New Family Workbook Suggestions for the Hospital 

For the mother, father or partner � Two or three nursing bras

� Birth preferences for comfort strategies � An outfit for the mother’s trip home (something that fit in month � Lip balm 5 of pregnancy)

� Personal focal point to distract mother or � This workbook (to help with feeding help her concentrate your new baby right after birth)

� Camera, film, video camera or tape recorder For the baby � Comfort items (tennis ball, back massager) � Going-home outfit � Unscented lotion for massage � Blankets � Hard candies or suckers � Baby clothes that are right for the season � Change for vending machines, snacks, etc. � Car seat that you know how to use � Slippers or non-skid socks (Minnesota law requires a car seat)

� One or two favorite cassette tapes or CDs, The hospital will supply T-shirts, blankets along with a tape or CD player and diapers for in-hospital use.

� Something for the mother to wear in labor (if she prefers) For your other children

� Activities to distract the mother in early � Special gift or toy from the baby to the labor (book, games, magazines) other children

� Insurance information for mother and baby � Birthday cake or cupcakes for a mini- birthday party after meeting the baby � Telephone numbers of family and friends � Favorite snacks to have while visiting � Toiletries (toothbrush, toothpaste, shampoo) Mom and baby

� Nightgown or robe for after the baby is � Time with Mom and Dad without the baby born (or use the hospital robe and gown)

The Expectant and New Family Workbook 15 Labor and Birth 

FIRST STAGE: Dilation (0 to 10 cm) and effacement (0 to 100 percent) of cervix

Emotional / physical changes Comfort needs and wants Dad’s / partner’s role and needs

Early labor:

Active labor:

Transition:

16 The Expectant and New Family Workbook SECOND STAGE: Delivery of the baby

Emotional / physical changes Comfort needs and wants Dad’s / partner’s role and needs

THIRD STAGE: Delivery of the placenta

Emotional / physical changes Comfort needs and wants Dad’s / partner’s role and needs

FOURTH STAGE: Recovery (first several hours)

Emotional / physical changes Comfort needs and wants Dad’s / partner’s role and needs

The Expectant and New Family Workbook 17 Birth Preferences 

Our doctor or midwife is ______and our due date is______

We (I) would like the medical care staff to know the following things about us (me):

We (I) have these important fears and concerns:

We (I) have these preferences for the first stage of labor:

Comfort strategies Medical care

We (I) have these preferences for the second stage of labor:

Comfort strategies Pushing efforts Medical care

18 The Expectant and New Family Workbook Other things about the birth experience are also important to us (me):

We (I) have these wishes in case of an unexpected event:

Complicated or prolonged labor Cesarean birth or problems with the baby

After the baby is born, these things are important to us (me):

• Special wishes about feeding: � Breast milk � Formula

• Concerns, rituals, needs, visitors:

• Comfort strategies:

• Education needs:

The Expectant and New Family Workbook 19 Learning about Feeding Your Baby How to feed your baby is a parenting decision. Feeding a baby involves the whole family. Every baby is unique.

You will feed your baby breast milk, formula Breastfeeding and Pumping from a bottle, or both. Feeding methods vary, but the process of feeding a baby is the same. There may be a time when you need to pump your breast milk and feed your baby by a bottle. Besides learning how to breastfeed or bottle-feed, Before using a breast pump, ask yourself the you need to learn how your baby communicates following questions. his or her needs. • How soon after my baby is born can I start using a breast pump? Breastfeeding Your Baby • When should I first give a bottle of breast Breast milk is the best food for your baby during milk to my baby? the first year. Breastfeeding provides health and financial benefits to the mother, baby and family. • Will my reason for pumping affect the type Though the mother may need to learn how to of pump I use? breastfeed, her body is already prepared to feed her baby. • Who should give my baby a bottle?

Four things to remember about breastfeeding • Does it matter what kind of nipple is on your baby: the bottle?

• The baby must be in the right position and • How often and at what times of the day must latch onto the breast. should I pump?

• You will need to understand milk supply • How will I know how much milk my and demand. baby needs?

• It is important to learn your baby’s behaviors and feeding cues.

• Help is available.

20 The Expectant and New Family Workbook Selecting a Breast Pump How long should suction pressure last?

There are many breast pumps on the market The breastfeeding baby gives about one suck per today, with a wide range of prices and features. second. Breast pumps that create suction for more The best pumps are the ones that most closely than one second at a time may cause nipple pain. mimic the sucking action of the baby. Fairview Health Services does not endorse any Keep in mind the following when deciding brand of breast pump. For product information, which breast pump is best for you. contact the following makers of breast pumps:

Medela: 800-835-5968, www.medela.com How much suction should a pump create? Hollister: 800-323-4060, www.hollister.com Look for a pump with suction similar to that of Bailey: 800-413-3216 a nursing baby: 200 to 250 mm Hg.* Pressure below 150 mm Hg will not work well to remove Different breast pumps fit different situations. milk from your breast. Pressure above 260 mm Think about how you intend to use the pump Hg may cause breast or nipple pain. You will also before making a choice. See the table below for want a pump that has a range of power settings more information. so that you can adjust suction for comfort.

Situation What to look for

Mother and baby are separated, the A high-quality electric double pump. These can often be baby is in the NICU, or the baby rented. Hospitals sometimes provide rental service. cannot or will not breastfeed.

A high-quality electric pump. A double pump is helpful. Mother is pumping several times Look for one that offers power source options (such as a each day at work. car lighter adapter). You may need to buy the pump, but sometimes you can rent one.

A high-quality electric pump with rechargeable batteries Mother is pumping at work, but she and a car lighter adapter. Pedal pumps are another option. has no access to electricity. Avoid manual pumps if you pump often.

A manual, pedal or mini-electric pump. Any of these will Mother pumps occasionally. work. These pumps must be bought, not rented.

*mm Hg = millimeters of mercury pressure, a standard unit of measure

The Expectant and New Family Workbook 21 Fairview Health Services Breastfeeding Services Resource List

General questions and supplies Fairview Lactation Services

The Fairview Baby Connection Line – Fairview Ridges Breastfeeding Connection 612-672-4789 – 952-892-2552 For questions or concerns about general Phone consultation and outpatient clinic at breastfeeding as well as newborn and family care. Fairview Ridges Hospital in Burnsville, 8 a.m. We will return your call within 24 hours, except to 4 p.m., Monday through Friday. on Sundays or holidays. University of Minnesota Medical Center, Fairview Retail Pharmacies – Fairview – 612-273-2220 www.fairview.org/pharmacy Outpatient clinic located on the Riverside Our pharmacies carry a range of breastfeeding campus. Certified lactation consultant and supplies and pumps. Please call ahead to find out pediatric nurse practitioner, 8 a.m. to 4:30 p.m., what supplies and pumps are available. Monday, Tuesday and Wednesday; 8 a.m. to 4:30 • Fairview Apple Valley: 952-997-4155 p.m. every other Thursday and Friday • Fairview Centennial Lakes: 952-985-8160 • Fairview Columbia Heights: 763-782-8149 Other lactation support • Fairview Eagan: 651-406-8980 Fairview does not endorse the following products • Fairview Eden Prairie: 952-826-6680 or services. This list is for information only. • Fairview Edina: 952-924-1400 • Fairview Elk River: 763-241-5890 Breastfeeding Resource Center – 651-241-6250 • Fairview Hiawatha: 612-728-7180 Phone consultation and outpatient clinic at • Fairview Highland Park: 651-696-5020 United Hospital and Children’s-St. Paul, 8 a.m. to 4:30 p.m., Monday through Saturday. • Fairview Lino Lakes: 651-717-3401 • Fairview Maple Grove: 763-898-1800 Outpatient Lactation Clinic – 651-232-3147 • Fairview Minneapolis-University Village: Phone consultation and outpatient clinic at 612-672-1430 HealthEast Care System. Open 8 a.m. to 3 p.m., • Fairview Northeast: 612-789-7277 Monday through Friday. Lactation experts will • Fairview Outpatient Clinic: 612-626-2828 answer phone calls from 9 a.m. to 2 p.m. After • Fairview Oxboro: 952-885-6166 business hours, calls are answered by HealthEast Care Connection Triage nurses. • Fairview Ridgeview: 952-892-2640 • Fairview Smiley’s Clinic: 612-672-4020 The Breastfeeding Center at Methodist Hospital • Fairview Riverside: 612-672-7500 – 952-993-5124 • Fairview Southdale: 952-924-1499 Phone calls are returned from 8 a.m. to 4 p.m., Monday through Friday.

22 The Expectant and New Family Workbook Other area hospitals providing some outpatient Medela – 800-835-5968, www.medela.com lactation support Provides information on breastfeeding specialists • St. Francis Shakopee (952-403-2064) in your area. These specialists do charge a fee. • Unity Hospital (763-236-3427) To speak with a Medela lactation consultant by • North Memorial (763-520-5830) email, go to the Medela website.

LaLeche League – 612-922-4996, Hollister – www.hollister.com www.lalecheleague.org Information for buying and renting Offers support for breastfeeding women. Call to breastfeeding equipment. find a group in your area. WIC (Women, Infants and Children) Program National Women’s Health Information Center – – 800-WIC-4030 (800-942-4030) 800-994-9662, www.4woman.gov Offers a breastfeeding information line in English and Spanish, 8 a.m. to 5 p.m., Monday through Friday.

The Expectant and New Family Workbook 23 Pumping and Going Back to Work 

If I am going back to work, when should I start pumping and storing milk for my baby?

How many feedings will my baby need while I am at work?

How many hours am I at work? ______

How long does it take to drive to and from work? + ______

How long does it take to drive to child care? + ______

How many hours until I return to my baby? = ______

What do I need to take to work for pumping?

Where will I pump?

When will I pump at work?

How will I store the milk until I go home?

What should I include in the instruction list for my child care provider?

24 The Expectant and New Family Workbook Bottle-feeding Your Baby " For you to try You may bottle-feed your baby formula, breast Bring this workbook to the hospital. The milk or both. If you use formula, it is important following chart will tell you how well you to use a commercially prepared formula. understand your baby’s feeding cues. You will look to the baby’s behaviors and feeding cues to know when and how much your baby needs to eat.

Four things to remember about bottle-feeding your baby:

• Always hold you baby while bottle-feeding.

• It is important to learn your baby’s behaviors and feeding cues.

• A range of nipples and bottles are available. Find one that works for your baby.

• Always follow the directions on the formula package.

The Expectant and New Family Workbook 25 Feeding Your Baby 

Birth through the first several hours What you see and do

Your baby may be in an alert state (bright, open eyes; baby is quiet and does not move very much). Your baby may or may not show interest in sucking at the breast or bottle.

First 24 hours after birth What you see and do

Your baby may sleep more and may often go into a deep sleep (eyes closed with no eye movement; steady, deep breathing; very little body movement). The baby is not bothered by noise. In a deep sleep, the baby is not available for eating.

Your baby may make movements and noises while sleeping. This means the baby is moving into a light sleep (breathing seems faster; chest rises and falls with each breath; eyes move behind closed eyelids). You may notice sucking or mouth movements. In a light sleep, your baby is closer to being awake and is more available for feeding.

Your baby may show no pattern in moving between deep and light sleep.

26 The Expectant and New Family Workbook 24 hours to two or three days after birth What you see and do

Your baby may wake up more often. He or she may put a hand to the mouth to suck, turn toward the breast or bottle when it’s offered and make sucking or mouth movements. The baby might move from deep sleep to light sleep more often and spend more time in an alert state.

Two or three days to one week after birth What you see and do

Your baby may move from deep sleep to light sleep every 30 to 45 minutes. The baby will go back into a deep sleep if not disturbed, unless he or she wants to wake up. Your baby habituates to (is not disturbed by) household noise.

The baby may wake up more often for feedings. There may be no pattern in how long or how often your baby feeds.

You may notice more wet and soiled diapers.

Your baby may have fussy periods, moving the body and crying briefly (active alert state). When fussy, your baby is more sensitive to being hungry, tired or handled.

Around one week of age, your baby may have a growth spurt. He or she might begin to feed more often.

The Expectant and New Family Workbook 27 Learning about Your Newborn Caring for a newborn is a partnership between baby and parent. Getting ready for labor prepares you to care for your baby. You will know your baby best.

As a new parent you will spend time learning how • Your baby will use cues to tell you what he to change a diaper and give your baby a bath. You or she needs or wants. Watch your baby’s will also spend time learning who your baby is as behavior. Bringing a hand to the mouth to a person. Each task that you do for your baby will suck is a cue. It might mean your baby is teach you more about your baby, giving you the hungry or needs to suck for comfort. confidence to handle the next baby care need. This is the attachment process at work. • As your baby’s needs change, his or her behavior will change. Four things to know about newborns: • The relationship you have with your baby • Before your baby can interact with you, he or begins before birth. It will continue to grow she needs to do these three things, in order: as you come together for feedings, care-taking – Maintain body temperature and breathing tasks and play. – Make certain body movements (such as bringing a hand to the mouth) – Move from sleeping to waking " For you to try Use the checklists on the following pages. These will guide you as you get ready to care for your baby.

28 The Expectant and New Family Workbook What You May Need 

Before baby For driving: � Car seat (required by state law) For sleeping:

� Place for the baby to sleep (crib, co-sleeper) Optional equipment:

� Linens for the baby’s bed (at least two sets) � Diaper bag

� Blankets (for warmth and swaddling) � Baby thermometer

� Waterproof pads for bed and changing area � Baby sling or front pack � Stroller For diaper changes:

� Cloth diapers, disposable diapers or a � Baby swing diaper service (if using cloth or a diaper � Baby nail clippers service, have disposables on hand)

� Small cloth or baby wipes for cleaning the After baby baby during diaper changes (avoid baby wipes that have a high alcohol content) � Phone number for your baby’s doctor or clinic For bathing: � Information on breastfeeding and the first � Baby towels, washcloths (several of each) few months at home

� Mild soap and baby shampoo � Phone numbers for postpartum support groups Clothing: � List of friends and family to help you with � Undershirts or “onesies” (five or more) errands, meals, siblings and household tasks

� Gowns or suits with feet (five or more) � A “nest” to go to when feeding your baby, with snacks, water, juice and other items � Booties or socks

� Hats (knit or cotton hat for newborn, sun or winter hat)

� Sweater or jacket

The Expectant and New Family Workbook 29 What You Can Learn 

Before baby � Learn how to:

� Learn what to expect from your baby in the • change a diaper first few days after birth. For example, you may see: • use the car seat

• an alert state right after birth, • swaddle your baby followed by much sleep for the next • put your baby down to sleep. 18 to 24 hours

• an increase in awake time after 24 hours After baby

• a difference between deep and � Learn what your baby’s behavioral cues are light sleep telling you.

• more feedings and diapers changes. � Learn when to take your baby to the doctor for the first check-up and future visits. � Learn what your baby’s behavioral cues may mean. For example:

• Bringing a hand to the mouth may mean hunger or a need to suck for comfort.

• Turning the head away from you or closing the eyes may mean your baby feels overwhelmed.

• Open, bright eyes means your baby is ready to spend time with you.

30 The Expectant and New Family Workbook Baby Care Preferences 

Our baby’s doctor or clinic is ______

We (I) have the following concerns and fears for this baby:

We (I) prefer the following method for feeding this baby:

� Breast milk � Formula

We (I) have these preferences for the baby’s exams or procedures:

We (I) have these preferences if an unexpected event should occur:

We (I) would like to learn more about the following (baby care, feeding, etc.):

The Expectant and New Family Workbook 31 Learning about Postpartum and Early Parenting There is no timeline to the postpartum process. It takes time for your body to recover after giving birth. Your family will experience many changes in the postpartum period.

The word postpartum means “after the birth.” As you journey through this time of change, As you and your baby enter the postpartum you may prefer to think of the process as a series period, the entire family begins a time of of stages. As you complete each stage, you will change. You will learn about some of these move toward a new concept of “normal.” changes before your baby arrives and during the early weeks of parenting.

You and your family will face a number of tasks " in the weeks and months after birth. There is no For you to try timeline to follow, and you can do these tasks in As you learn about the changes that come any order. You will: after birth, read the coping strategies on the following pages. Think about which strat- • Help your body recover. egies you will use when the time comes. What challenges will you face? How will • Adjust to the emotional changes that come you overcome them? with having a baby.

• Discover and get to know your baby.

• Become a new family.

32 The Expectant and New Family Workbook Coping with Change after Your Baby Is Born 

Changes Strategies Your plan

You are no longer an Learn what to expect during the expectant parent—you are a healing process (normal healing new parent. vs. warning signs). Use showers and baths to soothe your body You will need to focus on and mind. physical recovery and healing your body. Limit visitors. Let other duties and people wait.

Rest when you are able. You may not be able to sleep when your baby is sleeping, but you can get off your feet and rest your body and mind.

Changes Strategies Your plan

Pregnancy, labor and birth Expect moments of reflection are past experiences. (you might revisit all that you remember of the experience). You will start to think Know that your birth experience differently about your body. will become part of how you view yourself. You will begin making sense of your pregnancy, labor and Tell your birth story to others or birth experience. write it down.

Talk to your doctor or midwife to help recall what happened and why certain decisions were made. (continued)

The Expectant and New Family Workbook 33 Changes Strategies Your plan

The baby of your pregnancy Comments such as “she has my is now a real baby. dad’s nose” are normal. Look to your family history to help You will put aside dreams understand your baby. and expectations of your fantasy baby and discover Before birth, describe your baby your real baby. in writing. Is he quiet? Is she active? After birth, use this to Caring for your newborn compare what you expected of will help you get to know your baby and what your baby is your baby. You will start to like now. see how your baby fits in with your family. Spend time watching and learning from your baby. This will help you decide when and how to meet your baby’s needs.

Changes Strategies Your plan

You have become a caretaker. Learn the skills you will need to You will begin to accept and care for your newborn. learn more about this role. The more you interact with your You will become more baby, the more your parenting confident in your skills will improve. This will parenting skills. increase your confidence.

Get to know other parents. Sign up for a class or support group for new parents.

34 The Expectant and New Family Workbook Changes Strategies Your plan

You have a new family now. Know that, for a while, the new You will define new family routine will be no routine. roles. You will develop new routines. You will clarify Remember that becoming a boundaries. parent is a big change. It is normal to feel turmoil at this time.

Limit visitors. This not only helps your body to heal, but also allows new family roles to emerge. Take time to be alone with your partner and baby.

The Expectant and New Family Workbook 35 Postpartum Terms You May Hear Postpartum depression: Depression that occurs any time in the first year after childbirth. Signs Involution: The process in which the uterus begins may include: to return to its non-pregnant size. This starts happening right after birth. • feeling sad all the time; constant tears

Afterpains: Contractions after birth. These • constant anxiety about being a parent; feeling contractions help the involution process, keep the unable to care for your baby uterus firm and reduce bleeding from where the placenta was attached. • problems taking care of yourself

Lochia: Blood, tissue and mucus from the uterus • loss of appetite, drastic weight loss that is discharged through the vagina after birth. • feeling unable to sleep at all or wanting to Healing of the perineum: The tissues inside your sleep all the time vagina may be tender and swollen for several days • guilt about your lack of interest in the baby after birth. If you had an episiotomy or tearing that required stitches, this area may also be tender • anger or frustration toward the baby and swollen. Ice packs are often used in the first few hours after birth, followed by warm tub or sitz • an overall feeling of not being able to cope. baths.

Baby blues: More than eight out of 10 new mothers have the “baby blues.” Signs include feeling weepy, frustrated, anxious and disappointed. These feelings last a few days to a few weeks.

36 The Expectant and New Family Workbook Appendix A: Twins, Triplets and More

" Challenges Strategies Resources

Before babies are born: • Physical changes • Emotional changes • Getting ready for labor and birth • Preparing for life after the babies are born

Labor and birth: • Signs of labor • Labor progress • Comfort in labor • Medical care in labor

(continued)

The Expectant and New Family Workbook 37 " Challenges Strategies Resources

In the hospital after babies are born: • Care of the mother, babies and family • Physical changes and recovery • Emotions • Feeding options

Life at home: • Helping the body to recover • Emotions • Newborn care • Lifestyle changes

38 The Expectant and New Family Workbook Appendix B: Preparing Children for a New Baby

Getting Ready for the Baby Preparing for the Celebration

• Help your child get to know the baby before • Have your child help make birth the birth. Children can feel the baby kick, announcements. listen to the heartbeat at clinic visits and talk to the baby. • Plan a party for the baby at the hospital or when the baby comes home. • Talk to your child about what new babies look like and what they can do. Read books • Make or buy a welcome gift together for the about babies, visit a family with a new baby, baby. Have a gift for the baby to give to the talk about what your child was like as a baby. older child, too.

• Practice handling a baby using a doll, stuffed • Plan the role your child will play when animal or a 5-pound bag of sugar or beans visitors come. Your child might introduce the wrapped in a blanket. baby, show a picture he or she made of the baby or tell something about the baby. • Plan what your child can do with the baby. Children can bring diapers and baby • Make or buy something that shows your older clothes to the parents, sing or talk to the child’s new role (such as a button, T-shirt or baby, soothe the baby and help with diaper sticker that says, “I am a big brother/sister.” changes or baths. • Let your child pass out treats to friends in • Talk about the benefits of being a big celebration of the birth. brother or sister (perhaps greater responsibility, a larger room or stickers Using the Birth for Sex Education in reward for helpful behavior). • Talk about how babies are made and born.

• Talk about your child’s birth and show any pictures you have.

• Use correct terms when describing body parts and functions.

The Expectant and New Family Workbook 39 Dealing with Regression and Sibling Rivalry

• Expect some regressive behavior. For example, an older child might begin thumb- sucking again. Ignore such behavior as much as possible.

• Reward good behavior.

• Urge your child to talk about feelings instead of acting out.

• Have your child care for a doll or stuffed animal while you care for the baby.

• Provide loving behavior (hugging or holding) often, so the child doesn’t have to act out to get your attention.

• Plan a special time to do activities your older child likes to do.

40 The Expectant and New Family Workbook Glossary

Amniotic fluid: The fluid that surrounds the Mucous plug: This is between the two openings baby in the uterus. This protects the baby, keeps of the cervix. It protects the baby and uterus it at an even temperature and allows it to move. from outside germs.

Amniotic sac: The sac that surrounds the baby Perineum: The area between the vagina and and holds the amniotic fluid. Also called the rectum. It includes the pelvic floor muscles. membranes or bag of waters. Placenta: An organ that attaches to the wall of Braxton-Hicks contractions: Off-and-on the uterus and nourishes the baby. Often called contractions during pregnancy that help keep the the afterbirth. uterus in shape. They are not usually painful, but they can be uncomfortable. Umbilical cord: Connects the baby to the placenta. Cervix: The lower part of the uterus that opens (dilates) and thins (effaces) during labor, Uterus: The hollow, pear-shaped muscular organ allowing the baby to pass into the vagina. where your baby grows during pregnancy. Also called the womb. Diaphragm: The “breathing” muscle that separates your chest and abdomen. Vagina: The passage your baby will pass through after leaving the uterus. Also called the Dilation: The gradual opening of the cervix birth canal. during labor, measured in centimeters (0 to 10 cm).

Effacement:The gradual thinning of the cervix during labor, measured in percentages (0 to 100 percent).

Fundus: The top of the uterus.

Meconium: The green-black substance in the bowels of your baby before birth. It will be your baby’s first bowel movement after birth.

The Expectant and New Family Workbook 41 Resources

Pregnancy and Birth Simkin, Penny. Pregnancy, Childbirth, and the Newborn: A Complete Guide for Expectant Parents. Enkin, M., et al. A Guide to Effective Care in Deephaven, MN: Meadowbrook Press, 2001. Pregnancy and Childbirth. Third edition. New York: Oxford University Press, 2000. Web resources Fairview Health Services. The Expectant Family: Childbirth Connection: From Pregnancy through Childbirth. Minneapolis: www.childbirthconnection.org Fairview Press, 2004. Doulas of North America: www.dona.org Jones, C. Visualizations for an Easier Childbirth. Deephaven, MN: Meadowbrook, 1988. March of Dimes: www.marchofdimes.org

Kitzinger, Sheila. The Complete Book of Pregnancy National Library of Medicine / National Institute and Childbirth. Revised. New York: Knopf, 2003. of Health: www.medlineplus.gov Klaus, Marshall; Phyllis Klaus; and John Kennell. The Doula Book: How a Trained Labor Postpartum and Newborns Companion Can Help You Have a Shorter, Easier, and Healthier Birth. Cambridge, MA: Perseus Brazelton, T.B. Touchpoints: Your Child’s Publishing, 2002. Emotional and Behavioral Development. Reading, MA: Addison-Wesley Publishing, 1992. Luke, Barbara, and Tamera Eberlein. When You’re Expecting Twins, Triplets, or Quad: Proven Fairview Health Services. The New Family: Guidelines for a Healthy Multiple Pregnancy. Your Child’s First Year. Minneapolis: Fairview Revised Edition. New York: HarperCollins Press, 2004. Publishers, 2004. Huggins, Kathleen. The Nursing Mother’s Manginello, Frank, and Theresa DiGernomino. Companion. Fifth Revised Edition. Boston: Your Premature Baby: Everything You Need to Harvard Common Press, 2005. Know about Childbirth, Treatment and Parenting. New York: John Wiley and Sons, 1998. Humphrey, Sheila. The Nursing Mother’s Herbal. Minneapolis: Fairview Press, 2003. Noble, Elizabeth. Having Twins: A Parent’s Guide to Pregnancy, Twins and Early Childhood. New Kitzinger, Sheila. The Year after Childbirth.New York: Houghton Mifflin Company, 1991. York: Charles Scribner’s, 1994.

Klaus, Marshall, and Phyllis Klaus. Your Amazing Newborn. New York: Perseus Books, 1999.

42 The Expectant and New Family Workbook Misri, S. Shouldn’t I Be Happy?: Emotional Unexpected Outcomes Problems of Pregnant and Postpartum Women. New York: The Free Press, 2002. Covington, Sharon N. Silent Birth: When Your Baby Dies. Minneapolis: Fairview Press, 2003. Placksin, S. Mothering the New Mother: Women’s Feelings and Needs after Childbirth: A Support Freda, Margaret Comerford, and Carrie F. and Resource Guide. New York: Newmarket Semelsberger. Miscarriage after Infertility: A Press, 2000. Woman’s Guide to Coping. Minneapolis: Fairview Press, 2003. Ramey, Craig T., and Sharon L. Ramey. Right from Birth: Building Your Child’s Foundation for Life. New York: Goddard Press, 1999. Web resources A Heartbreaking Choice (support following a Web resources tragic prenatal diagnosis): www.aheartbreakingchoice.com The American Academy of Pediatrics: www.aap.org The Hygeia Foundation, Inc., and Institute for Perinatal Loss and Bereavement (pregnancy and KidsHealth: www.kidshealth.org infant loss resources): www.hygeia.org

March of Dimes: www.marchofdimes.org The International Council on Infertility Information Dissemination (INCIID) (infertility MedEd Post-Partum Depression: resources and support): www.inciid.org www.mededppd.org National Share Office (pregnancy and infant loss Zero to Three (newborn and child development resources): www.nationalshareoffice.com resources): www.zerotothree.org Pregnancy Loss and Infant Death Alliance: www.plida.org Fathering Sidelines National Support Network (high-risk The New Father: A Dad’s Guide to Brott, Armin. pregnancy support): www.sidelines.org the First Year. Abbeville Press, 2004.

Fairview Health Services. The Dad Book: A Guide to Pregnancy, Labor, Birth and Parenting. Minneapolis: Fairview Press, 1998. Also available in Spanish.

Goldman, Marcus Jacob. The Joy of Fatherhood: The First Twelve Months.Roseville, CA: Prima Publishing, 2000.

The Expectant and New Family Workbook 43