Guidebook for new parents

www.ksshp.fi Contents

Foreword 3 Newborn blood sugar screening 17 Pelvic floor muscles 29 First days with your newborn 4 Neonatal jaundice 18 Mood changes 30 First day 4 Newborn metabolic screening 18 Smoking and alcohol 30 Second day 5 Skin-to-skin contact and facilitated Relationship and sexuality Baby care basics 6 tucking during sample collection 18 after 30 Nappy changing 6 tips 19 Frequently asked questions 32 Bathing 6 massage 19 When to contact a medical professional 34 Eyes 6 Hand expression 20 Useful contact information 35 Umbilical stump care 7 shield 20 Helplines 35 Nails 7 Avoid pacifiers and baby bottles 21 Useful websites 35 Getting your newborn to sleep 7 Cup-feeding 21 Fresh air 7 Breast care 22 Physical examination 8 Neonatal ward 25 Hearing screening 9 Breastfeeding problems 27 Compiled by Midwife (IBCLC) and Breastfeeding Coordinator Breastfeeding 10 Storing and freezing breast milk 27 Jenna Muhonen, Midwife (IBCLC) Merja Nevalainen, Good 11 Recovering after childbirth 28 Midwife (IBCLC) Taina Palve, and Physiotherapist Pirkko Åkerman. Breastfeeding techniques 12 Vaginal birth 28 Approved by Chief Physician Jyrki Jalkanen. Is your newborn getting enough milk? 14 C-section 28 Photography by Mikko Laitinen, Ville Keto, Pieta Haatainen, and Taina Ristikivi. Increasing your milk production 16 Child health clinic 29 Layout: Mainostoimisto M1 Supplementary milk 17 Physical exercise 29 Print: Siirtopaino Oy, Jyväskylä Foreword

Congratulations on your new family member! most importantly, give your baby a chance to new family member. New mothers should The first weeks with your baby is an important charm you! keep this in mind and give the other parent a and unforgettable period in your life. We have chance to spend time with the baby. Open and compiled this guidebook full of information Childbirth may leave new parents exhausted. clear communication is vital for the well-being and tips for you so that you could enjoy this It might be a good idea to lower your stand- of the whole family. A healthy, functioning re- special time to the fullest. ards for a while, and focus on taking care of lationship between the parents is good for the yourself and your baby. Learn how to rest with baby, as well. Spending time and doing things Having a baby is a major change in your life your baby, and postpone things that do not together with your partner is a great way to – especially if it’s your firstborn. Your baby is require your immediate attention. Hormones take care of your relationship. The partner has dependent on you, and that may evoke all help new mothers cope with sleep depriva- an important role in making sure the mother kinds of feelings: joy, love and affection may tion, but they can’t replace rest. is doing ok, and in supporting breastfeeding. If take turns with fear and even anxiety. Some the newborn has older siblings, it’s important parents feel immediate affection for their Sometimes the role of the family’s second to take them into consideration so that they child, but some need a little more time for the adult may transform into something you don’t feel left out. Taking part in babycare usu- feeling to grow. Mothers become sensitive haven’t exactly prepared for. The relationship ally helps them adapt to the new situation. to their babies’ messages instinctively, and between a mother and a baby may seem sometimes it may feel like you’ve become like a symbiosis that leaves the other parent a little too sensitive. If low spirits seem to feeling like a third wheel. However, there stick, it’s always a good idea to discuss it with are many things for the other parent to do: a medical professional. Give yourself time, bathing, soothing, and providing skin-to-skin and listen to yourself and your feelings. And contact all help in building a bond with your

3 First days with your newborn

First day well. Your newborn hears and recognises your act according to their reflexes and gravitate heartbeat, and the baby’s temperature, pulse towards the mother’s , preparing them Immediately after childbirth, and blood sugar levels stay normal, as no for feeding by rubbing, licking and pecking at babies tend to be lively and energy is wasted crying. Skin-to-skin contact them. Allowing babies to take their time will 1 ready to be fed after an hour. usually activates the baby to latch onto the help them grasp the breast and latch onto it. In day After the first breastfeeding, breast and suck. This is why we recommend the beginning, ask the staff of your maternity most babies fall asleep for you to enjoy as much skin-to-skin contact as hospital to make sure that breastfeeding has a long nap. It takes time to recover from the possible during the first few days. started well. During the first 24 hours, your birth and settle in to the new surroundings, so baby should be fed at least six times, but your babies need a lot of sleep. Feed your baby whenever you notice signs baby may want to eat even more often. If your of hunger: babies tend to start rooting for baby seems too sleepy to suck enough milk, Skin-to-skin contact feels safe and natural the breast, making sucking motions, licking, try expressing milk by hand and directing the for the baby. Babies can’t get enough of it, so moving their head around to find the breast, drops straight into your baby’s mouth or into a it’s good to spend as much time as possible or finding something to suck, usually their cup for cup feeding. This way your baby gets enjoying skin-to-skin contact. Forget every- fingers. These signals are called feeding cues. important drops of colostrum. thing else, take off your baby’s clothes apart Most babies tend to have their eyes closed from the nappy, and place the baby on your at this stage, as they are still half asleep and During the first 24 hours, there won’t be much bare chest. Raise the backrest of your bed and gradually waking up. Crying is the last sign of to see in your baby’s nappy, but you should make yourself comfortable. Let yourself enjoy hunger, and at that stage it may take some still check it every now and then. One wet and rest with your baby, and you’ll notice more effort to calm the baby to latch onto the nappy and one meconium (sticky baby poo) is how much pleasure your baby takes in this as breast. Skin-to-skin contact allows babies to enough. For the first couple of days after birth,

4 your baby will pass meconium which is black find the most comfortable feeding positions for in colour, and has a sticky, tar-like texture. you. Parents can take turns keeping the baby After a few days, your baby’s stools will have in skin-to-skin contact. After a long feeding a more yellow colour to them. Meconium may session, babies tend to also sleep longer, so be difficult to wipe off your baby’s bottom, and make sure you get some rest as well. From if washing your baby with water won’t seem to the second day onwards, babies should have do it, try using baby oil. at least 8 successful feeding sessions, wet the nappy twice, and pass stool once. Skin-to-skin contact should help keep your baby awake for enough feeding sessions. Don’t hesitate to ask Second day help and guidance from the staff.

At certain stages, newborns go through phases of cluster feeding. The first one usually Skin-to-skin contact 2 takes place around the sec- day ond night after birth. The baby • Take off your baby’s clothes, leave seems to be suckling all the only the nappy on. time, and doesn’t seem to settle for anything. This is your baby’s way of ordering more • Lay your baby on your bare chest, milk – the more stimulation to the breasts, the stomach down. more milk they will produce. The first cluster • Find a comfortable position, either feeding phase will last for 12–48 hours. So half-sitting or laying down, and make don’t worry, it will pass! Keep the baby in sure you can see your baby easily. skin-to-skin contact, as it will both calm the baby and support milk production. Breastfeed • Cover the baby, but leave the head whenever your baby wants to be fed. Try to uncovered.

5 Baby care basics Newborns need feeding, contact, and cleaning. Looking after their needs makes them feel loved.

Nappy changing a week. If your baby’s skin isn’t very dry, you can bathe even more regularly. Make sure to Nappies should be changed whenever it’s nec- dry your baby carefully, also between the skin essary. When you learn your baby’s rhythm folds. You should check your baby’s bends, in and temperament, you’ll find the best times for between the fingers, and behind the ears each nappy changing. If your baby is sleepy, chang- day. Plain water is all you need to wash your ing the nappy will act as a natural wake-up. If baby’s skin. If your baby’s skin seems dry, you your baby is temperamental and feels irritated can use baby lotion after bath. when you change the nappy before feeding, it’s better to do it afterwards. You don’t have to Eyes wash your baby after each wet nappy. If your baby has passed stools, use plain water for the Newborn’s tear ducts are still narrow and they wash. If the baby’s skin is in good shape, there clog easily, which may cause stickiness of is no need to use baby lotion. For dry and ir- the eyes. Eyes should be cleaned daily or, if ritated skin, a lotion might prove helpful. necessary, even more regularly. Use a moist cotton pad, starting from the outer corner of Bathing the baby’s eye and working your way towards the inner corner. Use separate cotton pads for Visit our website ksshp.fi for instructional vid- each eye. If this doesn’t seem to help and the eos on how to give your newborn a bath. At eye remains pink and crusty, it may be a sign home, give your baby a bath a couple of times of an infection. In this case, the eye needs

6 to be checked for bacteria, and if necessary, Nails Fresh air treated with eye drops. Most babies have long nails that may cause Spending time outdoors provides your baby Umbilical stump care scratches. However, you should not cut your with fresh air and sunlight. At the same time, baby’s fingernails during the first two weeks, your baby learns how to tolerate changes in Visit our website ksshp.fi for an instructional as this may cause infections in your baby’s temperature. Spending time outdoors provides video on how to clean the umbilical stump. cuticles. Using mittens or clothes that cover babies with stimulation, and mothers with new The stump should be cleaned once or twice a the fingernails will prevent your baby’s face energy. It is also a fun activity for the whole day. Use a moist cotton swab, and dry the area from getting scratched. Remember to check family to enjoy together. During the summer, carefully. Move the swab along the bottom of in between the fingers each day, as too much babies can spend time outdoors as soon as the fold between the stump and skin. Keep the dampness is not good for the skin. Using baby they’re discharged from the hospital. When the area dry and clean. The stump should come oil may help soften sharp fingernails. temperature is similar both indoors and out- off after a week or so. If you notice a foul smell, doors, there’s no need to wait before you spend use a non-stinging disinfectant. Getting your newborn to sleep time outdoors with your baby. Winterborn babies should spend time outdoors only after a It is recommended that you put your baby to couple of weeks of age, and start gradually to sleep on their back. Room temperature should let them adjust to temperature changes. be average. Avoid places that are too warm in order to reduce the risk of sudden death Make sure your baby is dressed appropriately syndrome. You can put your baby to sleep in when spending time outdoors. If your baby is your own bed as long as neither of the parents sweaty and feels hot to touch, clothing is too smokes or is under the influence of strong heavy. If your baby’s hands and feet seem medication, drugs, or alcohol. The baby should cold after spending time outdoors, the clothing have their own blanket or a sleeping bag. A has been insufficient. The pram and its hood good place for the crib is near the parents’ bed, and throw will help keep your baby warm, but so that the baby can feel the parents are close. newborns should not be taken outside when It also makes breastfeeding during the night it’s -10 ºC or colder. easier.

7 Physical examination

When your baby is around two days old, a pediatrician will check the baby. This examina- tion includes listening for sounds in your baby’s heart and lungs, red reflex screening, checking the femoral pulse, and feeling the baby’s fonta- nel, abdomen and spine. Your baby’s legs will be rotated to check the hips. The pediatrician will also check your baby’s reflexes. During the examination, it’s important that the baby stays as calm as possible. You can express milk from your breasts to be fed to your baby with a sy- ringe. Feeling the presence of parents will help the baby feel safe and calm.

Newborns get two ID tags: one around the wrist and the other around the ankle. Please notify the staff if you notice a tag is missing.

8 Hearing screening

Newborn babies are screened for potential hearing problems using an otoacoustic emis- sions test (OAE). An electrode is placed in your baby’s ear to send a signal and study its transmission. The test is prone to disrup- tions, and some babies may have a temporary blockage from amniotic fluids in their ear. A successful test from one ear is enough. Should the test be unsuccessful in both ears, you will be called in to the hospital after a couple of weeks, and the test will be carried out again.

9 Breastfeeding

Breastfeeding is more than just a way to feed show that breast milk prevents overweight. secretion during night time. A hormone called your baby: it makes your baby feel safe and Breastfeeding is beneficial to the mother’s oxytocin is responsible for the let-down of milk. loved. THL, the Finnish Institute for Health and health as well as the baby’s. Your body will secrete oxytocin when your Welfare, recommends exclusive breastfeeding baby latches onto your breast, but also when during the first 4–6 months, and World Health Your body prepares itself for milk production you stimulate your nipple and breast by hand. Organization recommends it during the first as early as during the second trimester of Anxiety and stress may interfere with oxytocin 6 months. This means that your baby should your . The first breast milk is called secretion. have nothing but breast milk and vitamin D colostrum, and small amounts of it will be supplements for the first six months. After 6 prepared in your breasts already during preg- The first breast milk, colostrum, is rich and months, it is recommended that you continue nancy, even though proper milk production full of nutrients. The amount of colostrum you breastfeeding along with appropriate solid starts only after the placenta is delivered. A produce is not high, but it should still cover foods until the baby is 1–2 years old, or even hormone called prolactin enables milk produc- your baby’s needs during the first days. The longer if that is your wish (THL recommends tion in the breasts, and your baby’s suckling first milk drops your baby suckles will form a breastfeeding up to one year, whereas WHO will stimulate its secretion. This means that the much-needed protective shield for your baby’s recommends two years). Breast milk provides more your baby sucks your breasts, the more alimentary tract, and help fight infections. Your optimal nutrition for your baby, and it supplies milk is produced. During the first days, your baby will make sure there is enough milk and all the nutrients, minerals and vitamins your baby wants to be fed frequently, which ensures will suck more when it’s needed to boost your baby needs. The antidotes in breast milk pro- there’s enough milk later on. Breastfeeding at milk production. These days are called phases tect your baby against infectious diseases and night is also important for milk production, as of cluster feeding. gastrointestinal problems. Additionally, studies your body hits the highest levels of hormone

10 You should feed your baby whenever you spot Good latch early signs of hunger and your baby wants to latch onto the breast. Let your baby suckle When your baby has a good latch, most of as often and as much as they want. This way the is covered by the baby’s mouth: the your baby’s blood sugar levels stay normal, the lower lip should cover lower areola entirely, intake of fluids is guaranteed, and the bowel and most of the upper part should be covered movements begin. by the baby’s upper lip. The baby’s lips should be flanged out, and tongue should remain on It feels natural to keep the baby close to the the lower lip. The baby’s chin should touch the mother, skin to skin. Newborns feel safe when breast, and the nose can touch it as well. The they sense that parents are close and hear fa- motion from your baby’s jaw should be visible miliar voices such as the mother’s heartbeat or near the ears. The baby uses the tongue to the voices of parents and siblings. Being close push the nipple closer to the roof of the mouth to your baby makes them feel precious and to make milk trickle down closer to the phar- Wrong latching technique can put a strain loved. Breastfeeding is the most natural form of ynx. Your baby should suck rhythmically, and on the and make them sore and close contact with your baby. When you get to you should be able to hear sounds of swal- cracked. If the baby doesn’t suck hard know your newborn, you’ll start to notice how lowing. It can be difficult for the mother to see enough or the mother is in pain, the let- your baby communicates their needs. There whether the baby has a good latch. down of milk may become insufficient. can never too much love and contact when it When you first start breastfeeding, con- comes to your baby. sult the staff to make sure your baby has a good latch.

10 11 Breastfeeding techniques

Breastfeeding position should be comfortable for the mother, as breastfeeding takes several hours each day. Most newborns eat at least 8–12 times a day, and each breastfeeding ses- sion can take from ten minutes up to two hours. It’s natural for the feeding rhythm to be irregu- lar. Some babies want to have a series of short feedings before they’re about to go to sleep. This is not a sign of insufficient milk production, as it’s normal behaviour. When the mother lies down during breastfeeding, she gets a chance to rest and have short naps while the baby takes a break from sucking. Side-lying also allows much needed rest for the mother’s back after the strains from pregnancy.

In side-lying position, mother and baby should be side to side, facing each other. Baby’s head should be tilted back gently and your baby is in the right place when the baby’s aligned with the body, and hips should be nose is in line with the mother’s nipple as you bent. Baby’s chin should touch the breast, start breastfeeding. Baby’s back can be sup- and the nose can touch it as well. You know ported from behind.

12 Breastfeeding in a sitting position starts with Biological nurturing position starts with you you making yourself comfortable. You can sitting down and leaning backwards. Make use a pillow, if you want. Keep your shoulders sure your back is supported and you see your relaxed and your back straight, and lie back. baby without your neck getting tense. Lay You can place your baby on a pillow on your your baby in between your breasts in prone lap so that your baby can reach your breast. position. Let your baby act according to the You can hold your baby gently at the skull reflexes and shift towards the breast. Skin- base and upper back to guide the head. Baby’s to-skin contact is best for this, as it enhances Baby crawling towards the breast. head and body should be aligned. When your the baby’s instincts. Gravitation will help your baby is placed under your armpit, it’s good baby crawl towards the breast, root at it, peck, to support the baby with a pillow against the and latch onto it. You can use your arm to mother’s side. support the baby’s head.

12 13 Is your newborn getting you feed your baby, and how brisk the sucks Safe signs of your baby getting enough milk? feels. One breastfeeding session can take enough milk anything between ten minutes and two hours. You should breastfeed your baby at least 8 On the next page, you’ll find a chart you can • Your baby has a successful feeding times a day. Your baby should have a good use to keep track of feeding, urinating, and session at least 8 times a day. latch and suck energetically, and you should passing stools.. be able to hear sounds of swallowing. Well- • Your baby latches onto the breast fed babies pass tar-like meconium at least properly. once a day during the first 2–3 days. From day 4 onwards, stools should become yel- • Your baby passes stools every day, low, and your baby should urinate at least 5 and the stools turn yellow when the times a day. Most newborns lose some weight baby is 3–4 days old. after the birth, but weight loss shouldn’t be • From day 4 onwards, your baby more than 10 percent when your baby’s get- urinates five times a day. ting enough milk. Well-growing babies reach their birth weight again by the time they’re 10 • Your baby’s weight loss doesn’t days old. If you suspect your child is not get- exceed 10 percent, and weight gain ting enough milk, contact your child health starts when the baby is 4–5 days old. clinic so that your baby can be weighed. In the beginning, you should keep track of how often • Your baby is back to the birth weight by day 10.

14 Breastfeeding (min. 6 times) Notes on breastfeeding Day 1 Urination (min. once) Stools (min. once) Colour of stools

Breastfeeding (min. 8 times) Notes on breastfeeding Day 2 Urination (min. twice) Stools (min. once) Colour of stools

Breastfeeding (min. 8 times) Notes on breastfeeding Day 3 Urination (min. 3 times) Stools (min. once) Colour of stools

Breastfeeding (min. 8 times) Notes on breastfeeding Day 4 Urination (min. 5 times) Stools (min. once) Colour of stools

Breastfeeding (min. 8 times) Notes on breastfeeding Day 5 Urination (min. 5 times) Stools (min. once) Colour of stools

Breastfeeding (min. 8 times) Notes on breastfeeding Day 6 Urination (min. 5 times) Stools (min. once) Colour of stools 14 15 Increasing your milk production

There are several reasons why a mother may not produce enough milk to meet the baby’s • Your baby should have 10–12 feeding sessions a day. needs. Milk let-down can be affected by in- • Have lots of skin-to-skin contact with your baby. It’s good for your hormones, too. sufficient stimulation of the breasts, stress, fatigue, or pains. Here are some tips on how to • To increase milk production, enhance breast stimulation by using an electric increase your milk production. You should see . a change after two days of enhanced breast- feeding and skin-to-skin contact (nesting). • At night time, you can have one longer period of sleep (4–5 hours). Breastfeeding Remember to keep your home a place where during the night is especially beneficial to milk production. you can rest, and rest while your baby rests. It • Enhance the stimulation of your breasts by changing the breast you use to breast- takes a few days for the hormonal changes to feed/express milk from after each session. increase your milk production. • An easy way to enhance breast stimulation is to use hands to express milk in be- tween breastfeeding or pumping sessions. Even if you can’t collect any milk from those sessions, it provides valuable stimulation.

• Massaging your breasts gently, taking a warm shower, or a relaxing shoulder mas- sage can all help enhance milk let-down.

The more effort you put into it, the more you will get in return! However, don’t forget to rest and eat well. Enjoy the moments you get to share with your baby.

16 Supplementary milk meet the needs of your baby. Ask the staff to safe signs of breastfeeding. If you suspect help you with expressing breast milk. you’re not meeting the safe signs or that your For most healthy, full-term babies, breast baby doesn’t suck effectively, contact your milk is all they need. The law of supply and The staff will help you determine when child health clinic or maternity ward. demand can be applied to breastfeeding as the amount of supplementary milk can be well: the more you breastfeed, the more milk reduced or discontinued altogether. If your Newborn blood sugar screening you produce. Milk production is a continuous baby gets small amounts of supplementary process, which means that you can and you milk in the hospital, the need for it may Certain factors, such as should breastfeed even after short breaks. come to an end quickly once breastfeeding and pre-, can cause your baby to and expressing have enhanced your milk have low blood sugar levels. In that case, your If your baby is premature, small, or suffers production. If your baby is under one week baby’s blood sugar levels are monitored regu- from low blood sugar, supplementary feeding old, supplementary feeding can be stopped larly through the first days. You can help keep may be needed. The staff will help you de- at once as long as your milk let-down feels your baby’s blood sugar levels normal by termine the need. If your baby needs supple- normal, your baby meets all the safe signs of having as much skin-to-skin contact as possi- mentary milk, it’s important that you stimulate breastfeeding (see page 14), and the amount ble, and allowing your baby to suck regularly. your breasts. If only you can, express milk as of supplementary milk your baby has re- Frequent doses of breast milk is the best way often as you would breastfeed. At first, you ceived has been less than 40 ml per feeding to keep blood sugar levels normal. You can may not collect much milk from these ses- or 320 ml per day. Otherwise the amount also express milk in between breastfeeding sions, but after some time, you might be able of supplementary milk is reduced gradually. sessions either straight into your baby’s mouth to use your own milk as the supplementary While reducing the amount, it’s important to or into a cup or a spoon for feeding. feed. This will also help your milk production enhance breastfeeding. Pay attention to the

17 Neonatal jaundice the few babies that have some of these disor- ders, early screening and diagnosis is vital and Yellowing of the skin, a condition called jaun- can help save their whole life. The screening dice, is caused by underdeveloped liver func- requires a blood sample that’s collected from tions. It usually peaks at the age of 4–5 days. the baby’s heel. If the test results come back It’s a common condition that occurs in every normal, the hospital won’t contact you. other full-term baby, and nearly all premature babies. In most cases, the yellowing starts to Skin-to-skin contact and fade when the baby is a week old. Approxi- facilitated tucking during mately 5% of babies need phototherapy to sample collection lower the bilirubin levels in the baby’s blood. The levels are monitored from blood samples. Skin-to-skin contact with a parent as well To make sample collection easier for babies, as facilitated tucking offer effective pain and the samples are taken while the baby enjoys stress relief for babies during a heel stick. skin-to-skin contact or facilitated tucking with Babies can also suck either on their own fist or a parent. This makes the process more pleas- mother’s breast during sample collection. The ant for babies. Skin-to-skin contact and facilitated tucking staff will assist you with the methods during during sample collection the heel stick. Newborn metabolic screening

We recommend metabolic screening for all newborns. With parents’ permission, the sam- ple is collected when the baby is 2–5 days old. The samples are screened for more than 20 rare metabolic disorders. When discovered early, they can be treated, whereas a late diag- nosis can lead to disability or even death. For

18 Breastfeeding tips

Breast massage 1. Place your hands on both sides of your breast, and move your palms in opposite di- To enhance milk let-down, you can try mas- rections while pressing gently. Start crosswise, saging your breasts gently for about 30 sec- and continue lengthwise. onds before breastfeeding. This will quick-start the let-down, and your baby won’t have to use as much energy to suck. This will put less strain on your nipples, which may be helpful 2. Use your fingertips to stroke your breast especially if your nipples are sore. You can use very lightly. Stroke all the way from your the same massaging technique before you chest towards and over the nipple. express breast milk.

3. To finish the massage, cup your breast with your hand, shake the breast gently, and squeeze out a few drops of milk.

19 Breastfeeding tips

Hand expression the stimulation of breasts, which is why you breastfeeding without it from time to time. The should enhance your milk let-down by mas- best time for trying is when your baby is still Before you start breastfeeding, you can ex- saging your breasts, and expressing a couple a little sleepy, or has already started suck- press a few drops of milk before your baby of times a day. When placing a nipple shield, ing. Nipple shields aren’t effective in relieving latches onto your breast, as this tempts your make sure the tip of your nipple is in as deep breastfeeding pains. It’s important that you baby. If you’re separated from your baby or as possible. Ask the staff for advice on how to look into what’s causing the pains. supplementary feed is needed, you can ex- use the shield. Most babies will learn to suck press larger amounts of milk as well. Start off without a nipple shield, and you should try with breast massage. Then place your index finger and thumb on opposite sides of your breast, approximately 2–3 cm from the tip of your nipple. First, push the fingers towards your chest, and then towards each other. When you can’t get any more milk from one place, move your fingers to another spot.

Nipple shield

You may need a nipple shield if your baby is premature or has latch-on issues, or your nip- ples are flat or inverted. Nipple shield affects

20 Avoid pacifiers and baby bottles Cup-feeding

Supplementary milk should be avoided un- Cup feeding is often the easiest way to give less there is a medical reason to use it. It your baby supplementary milk, if it’s neces- Cup-feeding may result in your baby not suckling on the sary during the first days. Cup-feeding is better breast often enough, which in its part may than using a bottle, as it allows your baby to disrupt milk let-down. If supplementary milk control the amount of milk more easily. Hold is needed because of a medical reason, it is your baby upright, and place the cup on the important that the breasts are stimulated using baby’s lips. At first, it should touch the lips expressing techniques. During the first weeks, gently, so that your baby starts to lick. After breasts need all the stimulation they can get, that, you can place the cup a little deeper, and therefore it is recommended to avoid us- so that the edges reach the corners of your ing pacifiers during the cluster feeding phase. baby’s mouth. Let your baby use tongue for Baby bottles in their part can interfere with suckling, don’t pour large amounts of milk your baby’s sucking technique, and cause into the mouth. You can also use a spoon or a the baby to prefer bottles over breasts. Trust syringe to feed your baby the milk you have yourself and your baby. If you meet all the expressed. You can also try a supplemental safe signs of breastfeeding (see p. 14), cluster nursing system. feeding is not a sign of your baby requiring supplementary milk. Supplemental nursing system

21 Breast care

It’s normal for your breasts to feel a little won’t be able to get a good latch. A constantly latch. Sometimes the reason is a breast pump tender during the first few days. A hormone poor latch may cause your nipples to crack. with a funnel that’s the wrong size for you, or called prolactin causes higher sensitivity in If you can’t fix latching problems alone, don’t the vacuum is too high. It’s important to identify breasts. We recommend you change breast- hesitate to ask your health centre or maternity and treat the reason behind cracked nipples. feeding positions from time to time, as it will hospital for guidance. If breastfeeding starts to both help you empty your breasts, and avoid cause you pain later on, it may be caused by a Cracked nipples should always be treated: nipple strain from just one direction. The first yeast infection. • Hygiene is essential in avoiding any infec- few sucks can sometimes feel uncomfortable. tions. Wash your hands before breastfeed- However, breastfeeding shouldn’t cause you Your milk comes in usually after 2–5 days ing or expressing. Rinse cracked nipples pain. If breastfeeding continues to feel painful after your baby is born. Your breasts may tem- with warm water after breastfeeding. after the first 10 seconds, lift your baby off the porarily feel very tender and full, and the baby • Keep the wound moist. It will help heal the breast and try again. In most cases, the reason may have a hard time getting a good latch on wound faster and prevent it from forming a for pain is a poor latch. To fix it, try breastfeed- swollen breasts. A breast massage or express- scab. If the wound forms a scab, it usually ing while leaning backwards. While you’re ing before breastfeeding might prove helpful. comes off during breastfeeding and causes breastfeeding, make sure that your baby’s head • If necessary, take ibuprofen and paraceta- further damage to the nipple. Use saline can be tilted backwards. To make tilting easier, mol for the pain. Follow the directions on water to wet a wound dressing, and place move your baby towards their feet as it makes the package. it on top of the nipple. Use a nursing pad to opening their mouth easier for them. Use sup- • The symptoms should ease within a few keep your clothes from getting wet. Change port to keep your baby very close to you, and days. the dressing and pad after each time you make sure that baby´s stomach is touching you. breastfeed. Saline water and wound dress- If your baby needs to rotate their head, they Cracked nipples are usually caused by a poor ings are available in pharmacies.

22 • Breastfeeding from a might baby bottles to make sure your baby’s be painful. To enhance milk let-down in a latch isn’t affected. The sucking technique sore breast, start breastfeeding from the required by pacifiers and bottles differ from other breast, massage your breasts, or the way a baby should suck a breast, and use a warm compresses before you start. it might make latching problems worse. If the wound is too painful for breastfeed- ing, a short break from it might be in order. A nipple shield is sometimes recommended However, it is important that you keep to treat and protect a cracked nipple. However, expressing to empty the breast, as this it doesn’t protect or treat cracked nipples. The will prevent engorgement and ensure milk best way to treat the issue is to fix latching production later on. Hand expression is problems. A breast shield can be used if the the most comfortable way to empty a sore mother’s nipples are inverted, or the baby is Always wash your hands before breastfeeding breast. If using a breast pump isn’t painful, premature. or expressing. you can use it as well. • After expressing, you can for example For more information on nipple shields, see Keep the wounds on cracked nipples moist cup-feed your baby. Avoid pacifiers and page 20. using wound dressings.

• If breastfeeding is painful, you can take ibu- • Redness, swelling, or discharge can be profen and paracetamol three times a day. signs of a bacterial infection. Itching, Follow the directions on the package. redness, and flaking skin imply a yeast infection. Both can prevent wounds from • If you have followed these instructions but healing. your nipple wound doesn’t start healing after a few days, contact your child health • Your child health clinic can refer you to a clinic or maternity hospital. breastfeeding clinic, if necessary.

23 Yeast infection may cause pain in your have a blocked duct, it’s important to empty cool down your breasts in between breast- breasts. It causes nipples to crack and itch, your breast properly. Breastfeed as often as feeding or expressing sessions. If your symp- and you might feel radiating pain around possible, you can also express milk by hand toms don’t ease after the first 24 hours and shoulder blades and deep in your chest. Your or using an electric pump. A good way to you feel unwell, contact your doctor in order baby may get red wounds and white spots or ease engorgement is to take a warm shower to rule out . patches inside the mouth and on the tongue, where you massage the breast and express and you might notice diaper rash as well. milk. Massaging the sore area towards the Mastitis is accompanied by similar symptoms Yeast infections are treated with pharmaceu- nipple during breastfeeding or expressing as a blocked duct, but it also causes a high ticals, and your doctor will determine if you makes emptying the breast easier. You can fever and other flu-like symptoms, such as need them. If your symptoms are mild, you also try warming the breast during or before muscle aches and fatigue. If the symptoms can use vichy water to rinse your breast, and/ breastfeeding, for example a warm compres- persist after 12 hours of enhanced breast care, or swipe your baby’s mouth with a cotton sion is good for this purpose. After emptying contact a doctor to assess the need for anti- swab dipped in vichy water, or let your baby the breast, you should cool it down using biotics. Emptying your breasts frequently is suck on a gauze fabric dipped in vichy water. for example a cold cabbage leave or cold important even when you’re taking antibiotics. Lactobacillales may prove helpful, as well. compresses. A blocked duct may cause your You can breastfeed your baby normally during Swallow the capsules, or empty their contents temperature to rise. You can take ibuprofen mastitis and while taking antibiotics. To treat onto your breast. Give your nipples air baths, and paracetamol to treat the pain and tem- the symptoms, take ibuprofen and paraceta- and don’t forget about hand hygiene. You perature, follow the directions on the package. mol. If you continue to have symptoms after should use disposable nursing pads instead of Your symptoms should be relieved within 24 you finish your antibiotics course, contact your reusable ones. Remember to disinfect pacifiers hours as long as you empty your breast as doctor again. by boiling them, or replace them altogether. frequently and as effectively as you can, and Wash your nursing in 60 ºC.

A blocked duct is caused by engorgement in your breasts. The first signs include a hard You can and you should self-observe your breasts while you breastfeed. The best lump in the affected breast, which may also time to do it is after breastfeeding when the breast is softer. This allows you to spot feel hot or look red. If you suspect you might early signs of clogs and other deviations.

24 Neonatal ward

In the neonatal ward, parents take care of their a time), and at least one of the times should duction, and sometimes it just isn’t possible to baby with the help of nursing staff. If the situa- take place during night time. During daytime, meet the target amount of milk. It’s only natural tion in the ward allows it, parents can stay with you can express milk as frequently as you like that worrying about your child affects the milk their baby 24 hours a day. and whenever it fits in your schedule, during let-down and the amount of milk you produce. the night you can take one longer break. If the Sometimes milk production gets a kick-start If your baby stays in the neonatal ward, breast situation allows it, you can express milk in once the baby’s health is stabilized. milk is especially important, as it contains an- the ward with your baby by your side. If your tibodies and other important things your baby baby’s health allows it, you can also have skin- The amount of milk you are able to collect var- needs. You can help your baby by expressing to-skin contact. ies from one expression session to another, and breast milk, as even small amounts of it are pre- that’s why it’s more relevant to keep track of cious. Expressing by hand is the best way to get Before expressing milk, wash your hands care- your daily production rather than focus on how milk during the early days and to collect small fully. At the hospital, use hand sanitizer as much milk you collect at a time. As frequent amounts. Later on, as your milk production well (allow it to dry before you start). Relaxing expressing increases milk production, you will increases, you can start using an electric breast enhances milk let-down, and you may find a start getting more milk after two or three days pump. You can start expressing already in the massage, warm compresses, or looking at your after childbirth. If you aim to feed your baby delivery ward, don’t wait more than six hours baby or a photograph helpful. You can express solely on breast milk, the target amount of after the delivery or after your baby was taken milk from both of your breasts at the same time milk should be at least 750 ml per 24 hours to the ward. Even if your baby can’t suckle, if you have a double-kit for it. This will save you after two weeks. Your baby may not require kangaroo care is important. Skin-to-skin contact time, but also enhance milk production. If you that much milk, but it’s easier to increase the can be arranged even with breathing support, have one kit, you can promote milk production production now rather than later. This will guar- and it is good for both the baby and the parents. by changing the breast a couple of times while antee you’ll produce enough milk to meet the you express. The sooner you start increasing needs later on. It’s a good idea to keep track of You should express milk at least 8 times dur- your milk production, the easier it is. However, expressing. ing a 24-hour period (15 minutes per breast at there are several factors that affect milk pro-

25 Chart for expressing

Date Morning Daytime Evening Night Amount of milk/24h

It’s important that you express milk at least 8 times per 24 h. At least one of the times should take place during night time.

26 What if breastfeeding is difficult?

Breastfeeding isn’t always easy, and many support at the breastfeeding clinic. For peer new mothers find it challenging in the begin- support you can contact the local breasfeed- ning. Our staff is happy to help and guide you ing support group. to make sure you find breastfeeding as com- fortable as possible. In most cases, breast- You should not feel guilty even if you find feeding problems can be solved, even if it breastfeeding difficult or it causes you anxiety. takes a few weeks to do so. Patience is golden There are plenty of other ways to enjoy close when it comes to breastfeeding. contact with your child, have skin-to-skin con- tact, and make sure your baby is eating well. Latching onto the breast is challenging for some newborns. In that case it’s important to Storing and freezing breast milk ensure milk production by expressing milk. Some babies need more time to learn the After expressing, breast milk keeps four hours technique. Sometimes the milk let-down or in room temperature. If you plan to use the production aren’t yet in full swing. Don’t forget milk later, place it in the fridge immediately. In that it’s not just your baby that needs rest: you the fridge it will keep for 48 hours. In a freezer need it as well. (-18ºC), breast milk keeps for 3 months. Before expressing, make sure your hands and equip- If you have any problems with breastfeeding, ment are clean. To warm breast milk, use a contact your child health clinic or maternity warm water bath and not a microwave oven. ward. Sometimes you might need professional

27 Recovering after childbirth

Vaginal birth using the bidet to shower the area helpful. your vaginal discharge has ended. Tampons Your episiotomy cut may feel sore for several are not recommended, as they increase the Skin-to-skin contact helps the new mother days. If needed, take anti-inflammatory pain- chance of infections. relax and tune into the baby’s messages after killers to ease the pain. childbirth. It will also get the milk let-down C-section started, and enhance recovery by caus- Childbirth slows down your digestive system. ing the uterus to contract. Sometimes the To boost your digestion, make sure you drink Recovering from a C-section takes approxi- contractions can be painful. To ease your enough fluids, have a balanced diet, and get mately a month. During this time, you should discomfort, try using a warm compression on some exercise. You can try taking laxatives, if avoid lifting heavy objects, strenuous house- your lower back, or a back massage.You may necessary. work, reaching up too high, and sudden rota- need painkillers, as well. After childbirth, you tional movements. You can nurse, lift and carry will experience vaginal discharge for approxi- Many new mothers suffer from haemorrhoids your baby normally. The best way to get out of mately a month. As time goes by, the colour after childbirth. They are enlarged and swollen bed is to turn onto your side and push yourself will turn lighter, and the texture becomes veins in or around the lower rectum. They can up using hands. Pay attention to your posture: mucus-like. Recovering from an episiotomy be painful especially when you go to the toilet. keep your back straight and shoulders relaxed. takes usually a couple of weeks, and the In most cases, hemorrhoids disappear on their stitches dissolve on their own. Shower the own and soon after childbirth, but creams and You can take a shower after 24 hours from area several times a day, and change your suppositories can help relieve the discomfort. your section, despite the stitches. You can sanitary pad frequently. During the first few shower the area through the surgical tape and days after childbirth, urinating may cause the You can start going to sauna when you feel give it air baths. The stitches are removed in cut and possible tears to sting. You may find up to it. Avoid swimming and bathing until your own health centre or child health clinic,

28 usually after a week. You may experience Pregnancy strains and stretches your mus- support in the pelvic floor. Muscle contraction numbness and bruising around the wound. cles, and physical exercise and muscle train- is vital in preventing involuntary leakage. Keep out of the sauna until 24 hours after ing fort both your whole body and pelvic floor your stitches have been removed. Vaginal will help tone up the muscles and help you You can start pelvic floor exercises straight discharge will take around four weeks to stop, recover faster. Physical exercise is refreshing, after your baby is born. It’s important that and its texture will become mucus-like over it gives you strength, and it lifts your spirits. you first identify the correct muscles, and the time. If you notice any of the following symp- Start off with light forms of exercise, such as difference between tightened and relaxed toms, contact your health centre: the wound walks, as soon as you feel up to it. You should muscles. You should start the exercises lay- won’t stop bleeding, you notice redness or wait until your postnatal medical examination ing on your side or your back. To identify the swelling, the wound feels warm, the wound before strenuous workout. muscles, clench your anus, and at at the feels moist or has a foul smell, you experience same time, clench your vagina and urine tract increasing pain, or your temperature rises. Pelvic floor muscles inwards and upwards as if you were holding urine. Hold the pose for 6 seconds, and relax. During pregnancy, your pelvic floor is under Perform this exercise 12 times at a time, 3 Child health clinic continuous strain, and on top of that, hormonal times a day. If you’re not sure you’re clench- changes decrease muscle contraction. Due to ing the correct muscles, you can perform a Contact your child health clinic as soon as you childbirth and these changes, you may tempo- simple test: while urinating, partially empty get home so that you can schedule the first rarily suffer from incontinence. Exercising your your bladder, and then try to stop or slow the appointment. Your postnatal medical exami- pelvic floor muscles on a regular basis will help flow of urine. If you manage to do that, you’re nation will take place at the child health clinic you prevent bladder and womb prolapse. It will doing it right. But remember, this is just a test, or at a private practice approximately 6–12 also enhance your sexual pleasure. so don’t perform it as a daily exercise! weeks after childbirth. Exercising your pelvic floor muscles helps re- Keep exercising on a daily basis, but leave Physical exercise duce and prevent incontinence. The pressure 1–2 days a week for resting. As you make in the abdominal cavity increases as you for progress, try doing the exercises sitting down, Each new mother recovers from pregnancy example cough or lift objects, and this should standing up, and in the middle of of your and childbirth at her own individual pace. make your muscles contract to retain proper everyday chores, physical activities and, most

29 importantly, while lifting objects, coughing, and is common for new mothers to challenge their outside. If you smoke, do not put your baby to sneezing. Consciously contracting your pelvic motherhood in the beginning, as it takes time sleep next to you in your bed. floor muscles before physical exertion will help and effort to grow into the new role as a par- prevent leakage. Persistent and regular exercise ent. Most parents find it helpful to share their Your baby’s body can’t metabolize alcohol the (2–6 months) will help you with incontinence feelings with their partner and loved ones. Try way yours can, and it is more prone to the issues and enhance your quality of life. to arrange time for yourself, get some rest, injurious effects of alcohol. Babies may feel in- and do things you find enjoyable. secure around a parent who is under the influ- Should the incontinence continue after three ence of alcohol. It is important that the baby is months of exercising, make an appointment Smoking and alcohol looked after by a sober carer. Alcohol passes with your doctor or a physiotherapist special- into breast milk at concentrations similar to ised in pelvic floor dysfunction. Smoking reduces milk production and is bad those found in the mother’s bloodstream, and for your child’s health. Nicotine levels in baby’s it takes the same time to clear from breast Mood changes blood stream get proportionally higher than in milk as it does from the bloodstream. You mother’s. Cigarette smoke irritates the sensi- don’t have to empty your breasts for that. Hormonal changes may leave you vulnerable tive respiratory systems of babies, and expose to mood swings, and you may feel particularly the child to allergies as well as infections in Relationship and sexuality emotional. A few days after your baby is born, respiratory tract and middle ear. Pregnancy and after childbirth your temper can boil up and cool down within breastfeeding provide motivation to quit smok- seconds. One moment you feel happier than ing. Nicotine replacements may prove helpful. Once the baby is born, your relationship and ever, and before you even notice, you’re filled Even reducing the amount of cigarettes is ben- family dynamics will change for good: it’s with fear and anxiety. Sometimes you can’t eficial. If you are unable to quit smoking com- not just you two anymore. Your baby will help crying, but this is perfectly normal and pletely, smoke after you have fed your baby, determine your daily schedule during the first will pass. However, if you or your loved ones and when your baby is about to take a long weeks. Your normal routines can’t be carried feel like your low spirit and negative thoughts nap or go to sleep. This way the nicotine levels out the same way anymore, and that often are overpowering, don’t hesitate to contact have time to decrease before your baby needs comes as a surprise. Your baby may keep your child health clinic. Don’t be afraid of tell- to be fed again. Do not smoke in the same area you up at nights, and you will most likely feel ing how you feel, as there is help available. It where your baby is, the best place to smoke is more tired than you ever have. Therefore, it

30 is important you don’t forget to rest while the of hurting the mother, and mother might feel Breastfeeding your child will change the way baby rests. The first couple of weeks should be insecure about whether her partner still finds you think of breasts: their most important task dedicated for the family and getting to know her attractive. Try to find time for yourself and is to feed your baby. The mother may not con- the new family member: others will have time your relationship. Keep in mind that sexual in- sider her breasts erotic, and caressing them to meet and greet the baby later. tercourse is not the only way to show affection may feel uncomfortable for her. The erotic and give pleasure to your partner: you can try sense of the breasts is usually restored after It is only natural that childbirth affects your for example oral sex or just enjoy being close you no longer breastfeed. It may also be the libido, and it may take some time before you to your partner. Usually this new phase in partner who feels like breasts should be re- feel like having sex again. This is due to the your life means that you have to make some served for the baby. For women, arousal may hormonal changes in the mother’s body. Her adjustments and break your earlier habits. take more time than before, and it can be hard body needs time to recover from pregnancy to take mind off the child. In time, childbirth and childbirth and the natural changes caused After a normal vaginal birth, it takes some may start to feel sexually liberating and boost by them. She may feel exhausted, and lost in time for the perineum to recover from pos- a woman’s self-confidence. her own skin. The baby may keep you up at sible tears or an episiotomy, and you should nights, and it can be hard to find alone time listen to your body. After a C-section, you After your baby is born, it is recommended with your partner. The partner may feel like a should avoid any pressure on the wound. that you use a condom. This is particularly third wheel, or that the baby has taken their While breastfeeding, the mother may suffer important until the vaginal discharge (lochia) place in the relationship. Don’t be afraid to talk from vaginal dryness as well as an irritable ends. Women are more prone to infections about your feelings and thoughts. You may and tender vagina, which is caused by the low after giving birth, and condoms protect the have to make compromises to find common estrogen levels. Lubricants may prove helpful, uterus from infections. Breastfeeding in itself ground. Planning ahead might prove difficult and you may want to try using different posi- is not a reliable contraceptive, so you should in this stage of your life. tions in order to find what feels good for you. not rely on it. You can start using contracep- Pelvic floor muscles are strained during the tive mini-pills six weeks after the delivery. Seeing your partner in their new role might childbirth, and the mother should start exercis- The copper IUD may also be an option while affect your libido, as well. It may take weeks ing them as soon as she feels well enough. you breastfeed. It might be a good idea to talk before sexual intercourse feels satisfactory for This will help you restore pleasure. about contraception with your doctor during the both of you. The partner might be afraid the postnatal medical examination.

31 Frequently asked questions

Why is my baby getting a rash? Is my baby having nal hormones. A small amount of white milky an eye infection? substance may exude from the nipple. This The skin of a newborn is smooth as silk, but does not require medical attention. many newborns develop blotchy red skin reac- The tear ducts of a newborn can get blocked, tion called erythema toxicum, usually after 2–3 which may cause stickiness of the eyes. Is that blood in my baby’s nappy? days after the birth. It is a normal newborn rash Sticky eyes are not always a sign of infection. and will clear after a few days even without Sticky eyes should be washed daily, or if nec- You may notice a red brick-coloured, powder- treatment. If the rash resembles blisters, get in essary, even more regularly. Use a moist cot- like residue in your baby’s nappy. This residue touch with your child health clinic. ton pad, starting from the outer corner of the is called urate crystals. You don’t need to be baby’s eye and working your way towards the alarmed, as this is common during the first Why is my baby’s skin so dry inner corner. If this doesn’t help and the eye few days. As your baby starts to urinate more, and cracked? remains red and crusty, it may be a sign of urate crystals will go away. If your baby is a an infection. Contact your child health clinic, little older, urate crystals may be a sign of the In the womb, your baby’s skin is covered in and they will test the eye for any bacteria and baby not getting enough fluids. Make sure vernix, a wax-like coating. However, vernix prescribe eye drops, if needed. your baby gets enough milk. Some baby girls can ”wear off”, especially if the child is born may experience a small amount of vaginal overdue, which may result in dry and cracked Why are my baby’s nipples bleeding due to maternal hormones.This is skin. There is no need to worry about this, and swollen? perfectly normal, and will not require medical it is not an indication of further skin-related attention. problems. If your baby’s skin is extremely dry, The nipples of a newborn may sometimes get you can try using lotion or baby oil. swollen after birth due to exposure to mater-

32 Why is the umbilical stump absorb into the nappy, especially if the mother bleeding? produces a lot of milk. The colour of the stools may vary from mustard to greenish. Some- As the umbilical cord stump dries out and times loose stools may be accompanied by eventually drops off, you may notice some pressure and some noise, but that is perfectly bleeding. This is perfectly normal. Keep the normal and not a sign of diarrhea. navel clean, and keep an eye on the bleed- ing to see that it stops. Get in touch with your Abdominal separation child health clinic, if necessary. During pregnancy, the abdominal mus- Did my baby catch a cold? cles that run down the middle of your stomach can separate from the midline. Newborns sneeze a lot, as it clears their nasal After childbirth, they should return back and respiratory passages. Therefore sneezing towards each other. During the first 8 is not a sign of a cold. weeks after childbirth, you should avoid any activities that increase the abdominal How do I cure hiccups? cavity pressure too much.

Hiccups are perfectly normal, and usually To distinguish abdominal separation, lie on they don’t even bother your baby. There is no your back with your knees bent. Lift your upper ”cure” for hiccups, and they will pass as fast body, and reach for your toes. If you have ab- as they arrived. dominal separation, you will see either a bump or a trench approximately where your navel is. How can I tell if my baby has You will be checked for abdominal separation diarrhea? during your postpartum check-up, and in case you have it, a health centre physiotherapist will Milk-fed babies can pass loose stools that help you get started with exercises.

33 When to contact a medical professional

Mother Baby

Contact a doctor in case your postpartum Contact your child health clinic or maternity bleeding suddenly gets heavier or turns bright hospital in case you notice or suspect any of red, you notice clots or a foul smell, you ex- the following symptoms: perience pain in your lower abdomen, or run - Yellowing of the skin, if your baby is unu- a fever. If the bleeding starts suddenly and is sually drowsy, doesn’t eat well, or the unusually heavy, call an ambulance. yellowing persists after your baby is one week old. Contact a doctor in case you experience con- - Your baby is not eating well. stant bleeding from your C-section wound. - Your baby becomes unusually drowsy and Swelling, wound feeling hot, redness, foul floppy. smell, fever, growing or continuous pain, or - Heavy vomiting (not normal spit-ups) your wound dressing becoming thoroughly - Continuous, unusual crying damp may all be signs of an infection, and - Watery diarrhea absorbed by the you should seek medical attention. nappy - Fever, over 38 ºC - Baby is struggling for breath or breathing fast - Skin is pale or turning blue

34 Useful contact information Useful websites www.naistalo.fi The Crisis Center Mobile – Information on women’s Jyväskylä. health (in Finnish) Tel: 014 266 7150. My health centre My child health clinic www.kriisikeskusmobile.fi/ Tel: Tel: Kansaneläkelaitos – in-english/ The Social Insurance Institution of Finland The Federation of Mother and www.kela.fi/web/en Child Homes and Online chat with pediatrician. For more information, visit www.ksshp.fi Shelters (in Finnish) THL – National Institute for www.ksetu.fi Health and Welfare Useful phone numbers (information on vaccinating) Keski-Suomen monikko-per- www.thl.fi/en/web/thlfi-en heet ry (Multiple Births Asso- Central Hospital On-Call Service 0100 84 884 ciation in Central Finland) Väestöliitto – www.suomenmonikko-per- Central Hospital, Emergencies 014 269 1811 Family Federation of Finland heet.fi/finnish-multiple-births- www.vaestoliitto.fi/ association/ Maternity ward 014 269 1002 in_english/ Äimä ry (peer support for 014 269 1005 MLL – Mannerheim League for mothers going through post- Child Welfare partum depression) Delivery ward 014 269 1204 www.mll.fi/en/ www.aima.fi/in-english/

Consider donating milk? Milk service 014 269 1935 Breastfeeding support group in Kevyt – Association of Jyväskylä, Premature Babies’ Parents Facebook group www.kevyt.net Helplines Jyväskylän Miessakit ry National breastfeeding support line 09 4241 5300 imetystukiryhmä ry (support for men) www.miessakit.fi/en Mannerheim League’s support line for parents 0600 12277 Imetyksen tuki ry (Breastfeed- ing peer support Sateenkaariperheet ry Teratology Information Service 09 4717 6500 www.imetys.fi/in-english/ (association for rainbow (Information on pharmaceuticals and breastfeeding, families) Monday to Friday 9:00–12:00, normal price) www.sateenkaariperheet.fi

35 05/2020 | 3000 www.ksshp.fi/imetyskysely www.thl.fi/synnytyskokemus Keskussairaalantie 19 | 40620 Jyväskylä | Tel. 014 269 1811 | www.ksshp.fi | Tel. 19 | 40620 Jyväskylä Keskussairaalantie You can answer both surveys anonymously. Your identity won’t be disclosed at any point point be disclosed at any identity won’t Your both surveys anonymously. answer can You of the surveys. You can fill in fill can the surveys using ratherthe in computers use your If you’d hospital. the You use these device, you can mobile QR codes access for easy own to the surveys. You’ll find also online: the surveys (available in English) www.thl.fi/synnytyskokemus www.ksshp.fi/imetyskysely Please fill in the following surveys concerning the experienced surveys concerning Please fill in the following to hear want We guidance. breastfeeding and care quality of as a we get all the feedback experiences and value your about work. our to further improve way Give us feedbackGive us