YOURGUIDETO CARINGFOR YOURBABYAND Postpartum care YOURSELFAFTER THEBIRTH

BROUGHTTOYOUBYTHEODSHEALTHCOACHINGPROGRAM Table of contents PART 1: BREASTFEEDINGBASICS

4 When and how to breastfeed 4 Positions 6 Your relationship 6 Colostrum 6 Let-down 7 Your 7 Supply and demand 7 Feeding frequency and techniques 11 Breastfeeding concerns 12 Mom’s diet 12 Pumping and storing 13 Feeding your baby formula PART 2: TAKINGCAREOFMOM

15 My postpartum support network 16 Your body after birth 18 Getting your body back 19 Sexuality 19 Postpartum depression PART 3: TAKINGCAREOFBABY

20 Your baby’s body 21 Caring for your new baby 22 Typical newborn behaviors 23 Warning signs and symptoms 24 25 Keep your baby safe 26 emergencies 29 Resources

2 At home with baby

The months — if not years — of planning for your baby are now over, and the real joys of begin. While I’m sure you are excited, you are most likely overwhelmed and very tired, too.

The postpartum weeks are a time of adjustment. You now have a tiny person to get to know and care for. Your hormones are shifting to a non-pregnant status, and your body is adjusting to the task of breastfeeding. In addition, because of these changes, your emotions may spike and dip more often than normal.

It’s important to take care of yourself, even as you are learning to take care of your new baby. This guide provides advice and recommendations for both. Give yourself time to adjust. Get rest when you can, ask for help when you need it, and enjoy these precious first weeks with your child.

If you have questions or concerns that are not addressed in this workbook, talk with your care providers.

This workbook is meant to be a reference to help you live better. It is not meant to be used in place of consultation with your healthcare provider.

3 PART 1: BREASTFEEDINGBASICS

The benefits of breastfeeding are considerable. Human • Be sure you adjust your size as needed toward the milk is the perfect food for all newborns. Breastfeeding end of your . Some women need a bra that creates a strong bond between and child, and it is one or two cup sizes larger during the last weeks. lowers the mother’s risk for breast and ovarian cancer. • Be careful about wearing underwire . If ill- Breastfeeding supports your baby’s development in a fitting, these bras can place pressure on the ducts and number of ways. Human milk has a mix of nutrients and cause a blockage. antibodies that help babies thrive. Breastfed babies have • Allow your breasts to air dry after the shower and if fewer illnesses and allergies. They also have higher IQs. you are leaking colostrum. In addition, breastfeeding can save you more than • Use breast pads if you are leaking colostrum. Do not $2,500 per year compared with the cost of buying use a feminine pad inside your bra, as these do not formula. allow enough air flow. When and how to breastfeed • Get help purchasing a well-fitting nursing bra.

Successful breastfeeding begins at birth. Your baby will be born awake and ready to learn to suck in the first hour after being born. Many babies naturally gravitate toward Positions the breast and begin to suck on their own. Several positions work better than others for However, pain medication given during labor can breastfeeding — for both you and baby. Switching interfere with this process. If your baby is too sleepy, he between these different positions will prevent the baby or she may need more time. Be patient. from latching onto the same pressure points on your While in the hospital, learn as much as you can about nipples and will help with more complete breast- your baby from your nurse. Ask for help with draining throughout the day. breastfeeding. Have the nurse watch the baby on, so you can go home feeling comfortable and confident YOURPOSITION about how to be successful. When nursing your baby, make yourself comfortable. Sit up straight and relax your shoulders. Use a chair with arms if possible for extra support — or rest them on pillows. Place a pillow behind your back if that makes PREPARINGYOURBREASTSFORNURSING you more comfortable. Make your lap as flat as possible Healthcare professionals have differing opinions about and place a pillow on it to support the baby. You can how women should prepare their breasts and nipples for place additional pillows at your side to help support the nursing. Talk with your care provider and gather as much baby, too. information as you can to determine what is best for you. BABY’SPOSITION Here are a few suggestions to help you prepare for breastfeeding: Place your baby on his or her side facing you, so that you are tummy to tummy. Make sure your baby’s ear, • During pregnancy, expose both breasts to the air shoulder and hip are in a straight line — it will be easier every day for a few minutes. for your baby to suck and swallow if he or she doesn’t • Avoid soap on the and — this can cause have to turn the head. dryness.

• Wear a good supportive bra during pregnancy.

4 CROSS-CRADLE

Hold your baby in the arm opposite from the breast you will use to nurse with. Position yourselves tummy to tummy. Support your baby’s body with your forearm and the back of the head with your thumb and index finger.

The cross-cradle and football positions are best when:

• You have a sore abdomen from a Cesarean section

• You have large breasts

• You are learning to breastfeed

FOOTBALL (under the arm)

Place pillows at your side to prop your baby up under your arm so that the head is at the level of your breast and the nose is right in front of your nipple. Support the back of the head with your thumb and index finger, and support the body with your forearm.

CRADLE

Hold your baby in the arm on the same side as the breast you will use to nurse. Cradle the head on your forearm near your elbow with the nose directly in front of your nipple. Support the back and bottom with your forearm and hand.

SIDE-LYING

Lie on your side with your head and neck propped comfortably on a pillow. Place pillows against your back if that makes you feel more comfortable. Place your baby in front of you, lying on his or her side, so that you are tummy to tummy. Your baby’s face should be level with your breast, with the nose directly in front of your nipple.

5 Your breastfeeding Let-down THETHREEC’SOF relationship Each time you nurse, your body BREASTFEEDING Give yourself time to develop a good releases, or “lets down,” your milk so • Calm. Take a few deep breaths breastfeeding relationship with your it is easier for your baby to feed. Let- before you sit down to breastfeed. baby. New often have high down can take a few minutes, Your baby will be able to sense if expectations for themselves and their especially in the first few days as your you are feeling uptight or nervous, babies. While a lot of feeding and body is adjusting. Once you and your so try to relax. nurturing instincts come naturally, baby develop a breastfeeding rhythm, • Comfortable. Sometimes you will good nursing techniques are learned. let-down is likely to occur in just a need to sit in one position without Be patient with yourself and your few seconds. moving for an extended time. Sit baby as you develop your own Some women do not feel anything as up straight and use pillows to breastfeeding routines. Ask for help their milk is let down. Others may make yourself as comfortable as when you need it. experience the following sensations: possible. As you are learning to breastfeed, turn off the ringer on Colostrum • Tingling in the breasts or nipples the phone and place a “Please do The first milk that your breasts • Warmth in the upper body not disturb” sign on your front produce is called “colostrum.” Some door. It’s important that you have • A full feeling in the breasts women see drops of this fluid on their no distractions. nipples during pregnancy — your Emotional upsets, fatigue and tension • Close. Hold your baby close to breasts are fully capable of producing can slow the let-down response. Take your body while breastfeeding. milk after 16 weeks of pregnancy. a deep breath before sitting down to Good positioning helps baby latch nurse your baby, and try to relax. Your baby will receive colostrum for on and enables success. the few days after birth until you You may experience let-down even begin producing higher volumes of when you are not breastfeeding, such milk. Colostrum is often called as when: LATCHINGON “liquid gold,” because it is so • Your baby cries Getting your baby to latch on beneficial to newborns and has a • You think of your baby correctly is important for successful yellowy clear color. Colostrum provides your baby with: breastfeeding. The baby must open • You smell a baby or baby its mouth wide enough to get a good • High amounts of protein products amount of your areola inside. If the • A laxative effect to help clear the • You see another baby baby latches on to just the nipple, he baby’s digestive tract or she will get a limited amount of • You massage your breasts gently, milk and you are likely to become • Help with loosening mucus in such as when you are getting sore. the digestive tract ready to use a

• Protection against disease by passing on antibodies and passive immunities

• A protective coating for the stomach and intestines to keep away invading organisms

6 Your nipples

Take time to observe your nipples. Flat or inverted nipples can make breastfeeding difficult. When you pinch or stimulate your nipples, they should stand erect and not lie flat or be drawn inward. If you suspect you may have flat or inverted nipples, talk with your care provider or lactation consultant.

Supply and demand

Milk production is regulated by supply and demand. The more milk your baby drinks, the more you will produce. The less your baby drinks, the less that you will produce.

Feeding frequency and techniques

Most babies need eight to 12 feedings in a 24-hour period. Your baby will most likely request a feeding every one to three hours, with one four- to five-hour stretch per day.

Occasionally your baby may want several feedings in a row. It’s important to go ahead and feed your baby whenever he or she requests it. Each of these clustered feedings counts toward the day’s total.

WHENBABYISSLEEPY In the first couple weeks of life, your baby will be very sleepy. He or she may not request feedings frequently enough, so you will need to be more actively involved in determining when to feed.

• Watch for hunger cues such as lip smacking, mouth opening and putting the hands up to the mouth.

• Wake the baby 2 1/2 hours from the beginning of the last feeding.

• Keep your baby interested and awake when it’s time to feed.

• Massage and compress your breast to increase milk flow to the baby. This will be a gentle reminder to keep feeding.

HOWLONGTONURSE When you begin to nurse, listen for successful sucking. It may be difficult to hear your baby’s swallowing at first. It sounds like a soft “ca-ca” or soft expiration. When larger volumes of milk come in, you will definitely hear the difference between sucking and swallowing.

Feed your baby until he or she shows signs of being full:

• Self detachment • Sucking less vigorously • Sleepiness

7 OFFER BOTH BREASTS HOWDOIKNOWMYBABYISEATINGENOUGH?

It’s important to offer both breasts to your baby when Because it’s difficult to gauge how much milk your baby feeding in order to stimulate milk production on both is taking in, you may wonder whether he or she is getting sides. Switching sides midway through a feeding also enough to eat. A few clues can help. helps to keep your baby interested and awake. Your baby should be eating every one to three hours If your baby prefers to take only one breast during each during the day. feeding, be sure to switch between the breasts from one • Make sure your baby sleeps no longer than three feeding to the next. To help keep track of which breast to hours between feedings. offer first, place a safety pin on the bra strap of the side you need to start with next. • Time feedings from the start of one to the start of the next. BURPING • Make sure your baby has only one four-hour stretch It’s important to burp your baby when you are switching of sleep at night during the first week. breasts and when you are completely finished feeding. Burping helps get rid of any air the baby has swallowed. Keep close tabs on your baby’s . Not burping can cause tummy upset and crankiness. • You should see one wet in the first 24 hours To remove your baby from your breast while feeding, of life, two on the second day, three on the third, and gently insert your finger into the corner of your baby’s five to six wet disposable diapers or eight cloth mouth and slide it across your nipple to break the diapers per day once your milk is in greater supply. suction. Do not pull your baby off the breast. This can be • Your baby’s first stools are called “meconium,” and painful and may cause your nipples to become sore and they will be thick, greenish-black and sticky. Your cracked. baby will pass meconium for the first few days.

Position your baby so that his or her belly receives gentle • Your baby’stool will change to a mustard yellow pressure: color, with a runny or seedy texture, once your milk • Over the shoulder is in greater supply. You’ll see three to four dirty diapers per day in the first month, and sometimes • Lying belly down across your lap small amounts after each feeding.

• Sitting in your lap with chin supported If you have concerns about your baby’s eating habits, Pat the baby’s back or stroke softly with an upward talk with your baby’s care provider. Sometimes a trip to motion. Sometimes your baby will not burp — this is the office for a weight check can make you feel better. perfectly fine. It just means that your baby didn’t Weight gain is an important sign that baby is feeding swallow much air while eating. After a few minutes, properly. resume feeding or whatever activities you are doing next. Other positive signs that your baby is eating well include:

• You can hear your baby swallowing WEIGHTGAIN • Your breasts are obviously less full after feeding Your baby will lose some weight during the week after the birth, but should be back to the original by • Your baby is satisfied and falls away from the breast day 10. Once your milk is in greater supply, expect your after feeding baby to gain about 4 to 7 ounces per week. Use the pull out worksheets on the following pages to track your baby’s feeding and digestion. 8 MYBABY’SFEEDINGSCHEDULE When you first begin to breastfeed your baby, keep track of how often and how long you are feeding your baby. This can help you understand your baby’s rhythms and to more easily see if something changes.

DATE TIME HOWLONG

9 MYBABY’SDIGESTION It’s important to make sure your baby’s digestive system is functioning as he or she adjusts to life in the outside world. Use the space below to keep track of your baby’s urination and bowel movements for the first few weeks. This can help you understand your baby’s rhythms and to more easily see if something changes.

DATE TIME WETORDIRTY NOTES Cut along the dotted line to detach

10 Breastfeeding concerns Here are some tips for helping with moisturizing. Wear breast shells in discomfort when your breasts are your bra to further protect the area. It’s important to take care of your engorged: breasts while breastfeeding to help Breastfeeding should feel good — it avoid certain uncomfortable • Pump or manually express your should not hurt. conditions. milk before feeding to soften your breasts and nipples. Your BLOCKEDDUCTS ENGORGEMENT baby will not be able to latch on if Sometimes a milk duct in your breast A few days after the birth, your your nipples are too hard. can become blocked. Blocked ducts breasts may become heavier as blood feel like pea-sized or larger lumps • Wear a comfortable bra, even at flow increases to the area, breast under the skin in the main part of the night — just make sure it isn’t too tissue swells and your milk comes in. breast. These lumps are usually sore tight so as not to suppress milk All women experience this sensation to the touch. production. in their own way. Your breasts may Blocked ducts can be caused by the feel swollen and uncomfortable • Apply warm wash cloths to your following: during this time. You may also feel a breasts or stand under a warm throbbing sensation or discomfort as shower to help with let-down. • Change in frequency of feeding your milk is released. You may feel or skipped feedings • Nurse frequently. just a little bit fuller, with no • Nursing from only one breast discomfort at all. • Apply cold wash cloths to your breasts after nursing to relieve • An over-abundant milk supply After 24 to 48 hours, your breasts swelling and soothe discomfort. should feel better. It’s important not • Heavy breasts that are not well- to let yourself become engorged again SOREORCRACKEDNIPPLES supported after this initial period. Engorgement Your nipples may become sore or • A tight bra or underwire that puts sends signals to your brain to stop cracked if your baby is having trouble pressure over a duct producing milk. If your baby refuses latching on. You can also develop to eat or you have to skip a feeding, • Nursing in the same position these issues if your baby’s position is then pump or manually express your every time you feed not quite right. Try to make some milk. If you just wait to feed your adjustments in your feeding • Previous breast surgery baby later, you will see a significant techniques. decrease in your milk production and Here are some tips for relieving the then you may not have enough as Do not abruptly remove your baby discomfort of blocked ducts: from the breast. It’s important to your baby begins to eat more. • Stand under a warm shower or gently break the suction with a finger Engorgement typically can be apply warm wash cloths to the before taking the baby away. Extreme caused by: area. dry tissue can also cause cracking. • Less frequent feedings Dab some expressed milk onto the • Feed your baby frequently. cracked area and let it dry. • Skipping feedings • Hand express or pump your milk If you still have sore nipples, consult gently after each feeding. • Baby not latching on properly a lactation specialist. For cracked • Massage the lumps toward the • Baby not being alert while nipples, you may be able to use nipple while nursing. feeding or not feeding vigorously lanolin for soothing and • Place the baby in a position with his or her chin facing the

blockage. 11 MASTITIS Pumping and storing If you are not able to unblock a duct, it can become While you are breastfeeding, you may have any number inflamed and possibly infected. This condition is known of reasons to pump and store your milk. as “mastitis,” and must be treated immediately. Treatments usually consist of the same treatments used • For baby sitters to use while you are out when the ducts are first blocked, plus: • Returning to work • Plenty of rest • For helping relieve breast engorgement • Lots of fluids

• Antibiotics — if infection is present

Be sure to let your baby’s care provider know if you begin BABIESBORNEARLY taking antibiotics while you are nursing. Tips on pumping and storing your are for healthy, full-term babies. If your baby was born early, talk Mom’s diet with your provider about breastfeeding.

Nursing need about 500 extra calories per day. If you do not eat enough healthy foods, you will become fatigued. Your body will produce the milk it needs, so Here are some tips for pumping your milk successfully: your baby will always get enough even if you are not eating enough to sustain the two of you. • Learn to use your pump before you actually need to use it. During the first four weeks of your baby’s life, milk production is not dependent on what you eat. During • Massage your breasts and stimulate your nipples to this period, your body relies on the fat produced during release your milk. It may be helpful to think about pregnancy to create milk. or look at a picture of your baby.

While nursing, you are also likely to get very thirsty • Pump in the morning if possible, when your breasts because your body is using the fluids in your system to tend to have the most milk. produce milk. Pay attention to how you feel and drink • Pump every two to three hours for 15 to 30 minutes accordingly. It’s not a bad idea to always get a glass of when you are away from your baby. water to sip while you are nursing. This habit ensures that you are getting at least six to eight glasses per day. • Be patient with yourself as you are learning what works best for you. No foods are universally restricted from your diet, but your baby may be sensitive to certain foods. Your baby Breast milk will look thin and watery, and the color may might have digestive issues, gas or a diaper rash. Try to change from day to day depending on what you eat. keep track of what foods you ate just prior to these kinds of problems. The foods you eat will pass through your milk within four to 24 hours. BREASTPUMPS If you think dairy is causing problems, it could take a The market offers many great breast pumps that can give couple weeks after you stop eating it before your baby is you more flexibility and support you in your desire to no longer bothered. breastfeed your baby. Check with your hospital or lactation consultant about breast pump rentals for shorter periods of time.

12 Here are some tips for storing your milk successfully: BOTTLEFEEDINGYOURBABY • Put your milk in clean milk bags , glass bottles or Some babies develop what is known as “flow preference” flexible, milky-colored plastic, usually called if bottles are introduced too early. It’s best to nurse your “polyethylene” or “polypropylene.” baby at the breast until you have established a good • At first, place only 2 or 3 ounces in each container. breastfeeding relationship. Small amounts are easier to freeze and thaw. As your Supplemental feeding of water or formula is not baby gets older, he or she will eat more and you can necessary, unless advised by your care provider for some put more into each container. specific health reason. • Keep your milk in a cooler with ice, in the refrigerator or in the freezer.

• If you are freezing your milk, leave a little space at Feeding your baby formula the top of each container because it will expand as it freezes. Many formulas on the market today are perfectly safe and nutritious for your baby. These options are great for • Write the date you pump your milk on each women who cannot or choose not to breastfeed their container and always use the oldest milk first. babies. • Stored breast milk looks different than fresh. Shake Breast reduction surgery with nipple relocation can the milk gently before feeding it to your baby. affect milk production. Some of these women can still HOWLONGYOUCANSTOREBREASTMILK breastfeed successfully, and some benefit from using a supplemental device. ROOM TEMP. REFRIGERATOR FREEZER All medications you take will transfer through your (70˚ F) breast milk to your baby. It’s important to let your care FRESH provider know about all medications you are taking — BREAST 5 hours 5 days 3 to 4 months including antibiotics, antidepressants and cancer MILK treatment medications — so that together you can determine if breastfeeding is right for you. THAWED Use up to 24 Use within Do not refreeze (DEFROSTED) hours after one hour thawed breast Work with your baby’s care provider to determine which thawing BREAST after thawing milk formula is best and how much to feed your baby. Your MILK baby will probably want to eat every two to four hours.

When you are ready to feed your baby stored milk, you If you choose not to breastfeed, you my still feel a milk will need to warm it up. surge right after your baby is born. Your breasts may feel heavy and uncomfortable for about 24 to 48 hours. Wear • Put frozen milk in the refrigerator over night to a snug, supportive bra and apply ice packs for 20 minutes thaw. at a time every three to four hours to help with the • To warm, put the bottle of milk or milk storage bag swelling. Do not stimulate your breasts during this time, in a bowl of warm water. as it may increase milk production.

• Do not thaw or warm breast milk in the microwave — this can create hot spots in the milk that will burn your baby’s mouth

13 Here are some tips for successful • Tilt the bottle to check the nipple RETURNINGTOWORK bottle feeding: hole. If formula runs out, the hole Returning to work after you have a is too big. Throw that nipple out. • Make sure you have plenty of baby can be empowering. It allows you The formula should drip from bottles and nipples on hand so to continue developing your career and the tilted bottle with ease. If your that you are not searching for independent life apart from your role baby seems dissatisfied when you clean ones when you need them. as a mother. It does not mean you have feed, the hole may be too small. to stop breastfeeding, however. • Use a bottle brush to get all of the • Never prop the bottle in your little parts of the bottles clean. • Pump your milk during the day baby’s mouth and leave him or Always double check bottles and while you are away. her unattended — this could nipples before using. result in choking. • Breastfeed when you are with your • Wash the top of the formula can baby and gradually wean to • If your baby does not finish a with soapy water and then rinse pumped milk — or formula if bottle of formula, throw the rest well before opening it. necessary — fed from bottles. away. Bacteria from the saliva in • Always check the formula can your baby’s mouth will be • Eventually wean your baby before you open it — you may transferred back into the bottle completely, though continue to have thought you purchased during feeding. These bacteria breastfeed your baby at least once “ready to feed” but it is actually can grow very quickly and be a day for nutrients and comfort. “concentrate.” unhealthy for your baby. • Ask your employer about • Check the expiration date on the breastfeeding policies. container.

• If you cannot prepare a full can’s THECHOICEISYOURS worth of bottles at once, cover How you feed your baby is your choice. the can of formula and store it in Millions of healthy babies have been the refrigerator. Be sure to use raised using both techniques. It’s the rest within 48 hours and important that you feel comfortable throw it out if you cannot use it with your feeding method. Do what is that quickly. best for you — not what others want you to do. • Check the temperature of the formula before feeding your Whichever method you use, take the baby. You will gradually learn time to enjoy feeding your baby. It’s what temperature your baby a great time for you to get to know your prefers. baby and for your baby to get to know you. • Warm the formula by holding the bottle under warm tap water.

• Never microwave formula — it can create hot spots that will burn your baby’s mouth.

14 PART 2: TAKINGCARE OFMOM

The days and weeks after the birth of My postpartum support network your baby can be exhausting and Make a list of people you can turn to for extra support, and post it overwhelming. The job of learning to somewhere that is easy to find. This list might include friends, family, care for your new baby is demanding, neighbors, your educator, your healthcare providers and but you also need to take care of community organizations. yourself. Your body needs time to recover from the birth. Identify how each person on the list can help. For example, your mother might be able to answer basic baby care questions or cook for you, your Work with your partner or support neighbor might be able to run errands for you and your best friend might person as a team. Listen to your body. provide emotional support. Every woman experiences postpartum in her own unique way. Name:

Phone number: E-mail:

How this person can help

Name:

Phone number: E-mail:

How this person can help

Name:

Phone number: E-mail:

How this person can help

15 My healthcare provider Your body after birth

Name: You will experience many physical sensations and changes as your body Phone number: heals from the birth. These changes After-hours number: will be different for every woman, but some are more common than others:

My baby’s healthcare provider VAGINALBLEEDING After you give birth, your uterus Name: gradually shrinks down to its pre- Phone number: pregnancy size. You are likely to experience bleeding for several After-hours number: weeks. During the first one to three days, the bleeding might be like a My childbith educator/health coach heavy period. Over the next five to seven days, it will change to a pink- Maternity Care coach: brown color and begin to decrease in Phone number: amount. You will continue to have vaginal discharge for a few weeks. E-mail: If your bleeding becomes very heavy (soaking one pad in an hour) or you Community organizations pass clots larger than the size of an

Cut along the dotted line to detach egg, let your care provider know. This Name: can happen when you increase your Phone number: activity level.

After-hours number: YOURPERINEUM Small tears toward the back of your vaginal opening are common during Name: delivery. These can cause pain and Phone number: swelling for some women. It is important to keep this area, known as After-hours number: the “perineum,” clean and well cared for to avoid infection.

Name: Ice packs can help reduce swelling during the first day after giving birth. Phone number: Fill a clean squirt bottle with warm After-hours number: water and spray the area outside of your vagina every time you use the bathroom. Continue with this spraying until you no longer have postpartum vaginal bleeding or discharge. 16 Sitz baths can help decrease pain and encourage healing. These portable, warm-water containers fit right on your toilet seat and are a convenient way SYMPTOMSTO to sooth the area. Soaking in 4 to 5 inches of warm water in a clean bathtub WATCHOUTFOR is also great. If you experience any of the following conditions, contact your healthcare Things to avoid while caring for an inflamed perineum: provider: • Bubble baths and other bath products, as they might increase irritation • Lower leg pain, tenderness or • Feminine hygiene sprays warmth

• Douching • Back pain

• Tampons • Frequent urination or difficulty urinating • Sexual intercourse • Burning sensation when urinating Constipation and straining during bowel movements can further irritate the perineum after you have given birth. Here are some tips to avoid • Inability to urinate constipation: • Sudden onset of pain or pain not • Get regular exercise, such as walking relieved with medication

• Eat a balanced diet, including plenty of fiber • Foul smelling vaginal discharge

• Drink lots of water • Redness, increased pain, swelling or foul-smelling drainage from • Take a stool softener if necessary — especially if you have hemorrhoids your Cesarean incision or had them before the birth • Temperature of 100.4 degrees or If you go for three days without a bowel movement, contact your health higher provider. • Continued heavy bleeding AFTERPAINS (soaking one pad or more per During the six weeks following birth, your uterus will shrink back to almost hour) the size it was prior to pregnancy. As it’s shrinking, you may at times • Passing blood clots larger than an experience mild abdominal cramping or muscle discomfort. Talk to your egg, followed by heavy bleeding care provider if you feel that pain medication would be helpful. • If breastfeeding: cracked or SWELLING bleeding nipples It is normal to feel puffy and swollen for a week or two after the birth. As • If breastfeeding: Tenderness and your body gets rid of excess fluid, you may experience more frequent red, warm, swollen areas on the urination or night sweats. breast, especially if combined with YOURSKIN fever or flu-like symptoms Your skin may feel a little different after pregnancy. Your belly will be soft • Depression, anxiety or inability to and stretchy, but it should return to normal with time and exercise. Your cope stretch marks will fade, but they will not totally disappear. The dark line on • Thoughts of harming yourself or your stomach, known as “the linea nigra,” may get even darker after the your baby birth but will fade over the next few months.

17 POST-OPERATIVERECOVERY Coughing and deep breathing are DIETANDNUTRITION FOLLOWINGACESAREANBIRTH important post-op treatments. It is Eating healthy foods will help you Since a Cesarean birth is major uncomfortable to take a deep breath. recover from the birth. A balanced surgery, the recovery period will take Therefore, you tend to take shallow diet is important if you are longer than a vaginal birth. breaths. Hold a pillow over your breastfeeding — all of the vitamins incision and put pressure on the and minerals that you consume are pillow with your hands. Take a big transferred to your baby through breath in, blow out, and then cough your milk. If you were not planning on the or clear your throat. This will help to procedure, you may have feelings of expand your lungs and loosen While breastfeeding, drink plenty of disappointment; so you may have some mucous that may have developed. fluids every day and continue to take emotional healing as well. Remember your prenatal vitamins. Expect to have some vaginal that this is still a birth, and you are not discharge following a C-section. If Eating a balanced diet of whole foods a failure as a mother. you start to have any active or bright is also the best way to return to your red bleeding more than a heavy normal weight. Dieting for weight period, passage of clots, a foul loss is not recommended for at least smelling discharge or a fever, call six weeks after your delivery and not If you had an epidural or spinal, you your healthcare provider at all if you are breastfeeding. will be feeling great right after the immediately. surgery. As soon as you start to get EXERCISE your feeling back in your toes and Returning to your normal exercise legs, ask for pain medication and routine may take some time after “catch” the pain before all the The normal post-op hospital stay is 48 giving birth. Start simple and increase anesthesia wears off. By taking pain to 72 hours. Discharge instructions for the amount of exercise you do each medication you will be able to move going home will be thoroughly week. Talk with your care provider around easier and enjoy your little one. reviewed with you by your nurse and before beginning a more vigorous The sooner you get up and move provider. Once you get home from the program. Give your body time to around, the faster you will heal, and hospital, if any questions arise do not adjust and heal — especially if you the better you will feel. Your nurse hesitate to call your healthcare have had a Cesarean section. will have you sitting up on the side of provider. HAVINGYOURPERIODAGAIN the bed, then out of bed in a chair. Before you know it, you will be If you are not breastfeeding, it’s walking in the halls! possible that you will have a period as Getting your body back early as four to six weeks after your A foley catheter was inserted during birth. If you are breastfeeding, you After the birth of your baby, it’s surgery to keep your bladder empty. might not have a period for several important to return to healthy non- This will be removed the first months. During this time, you may pregnant routines so that your body morning after surgery. IV fluids are ovulate, however, which means you can get back to normal. left in until you are taking and could get pregnant. Talk with your tolerating fluids on your own. care provider about birth control options if you do not want to get pregnant right away.

18 Sexuality Postpartum depression

Most healthcare providers suggest that you wait until Some women feel pretty emotional after they give birth. after your first follow-up visit before having sexual Extreme fatigue and anxieties about your new role can intercourse. Your provider will make sure you are lead to the “baby blues,” making you feel upset and healing well and will discuss birth control options at this moody, but this normally fades after a few days. time. Sometimes these feelings become more severe and last Many women experience a decrease in sexual drive for a longer, turning into postpartum depression. Symptoms few months after the birth of a baby. Fatigue, soreness include: and the adjustment to caring for an infant 24/7 can • Loss of appetite contribute to this change. • Crying spells Vaginal dryness is also common after having a baby. It may be necessary to use a lubricant for up to six months • Feelings of hopelessness or loss of control postpartum. This dryness can last longer if you are • Too much concern or no concern for the baby breastfeeding because of hormonal changes. Also while breastfeeding, your breasts may feel “less sexual.” • Fear of touching the baby

All of these feelings and changes are perfectly normal, so • Little or no concern about your own appearance allow yourself time to adjust. It’s important to • Inability to sleep or sleeping more than usual communicate with your partner about what you are experiencing. Honest communication about your Postpartum depression is most likely caused by a feelings and needs during this time is likely to bring you combination of abrupt hormonal changes, dramatic closer together. Snuggling, touching and massage is a emotional responses to the adjustment of parenting, and great way to relax and express your love for one another lifestyle situations such as the responsibility of caring without intercourse. for older siblings, difficulty with breastfeeding or lack of support from a partner.

If you feel you may be experiencing postpartum depression, contact your healthcare provider. It’s important to know that these symptoms do not mean you are a bad mother and are not signs of weakness. Treatment varies for each individual. Medication, counseling and sometimes hospitalization can help get you back on the road to feeling good and enjoying your new baby.

19 PART 3: TAKINGCAREOFBABY

You’re home with your baby — now what? Your job is to SKIN care for your little one around the clock. Some parents Before birth, a white coating called “vernix” protected are overwhelmed by all there is to learn during this time. your baby’s skin. Once the vernix is washed off, the skin Just remember, your empathy, instincts and common may peel as it’s exposed to air. This is normal. Babies do sense will help you know what he or she needs in a not need powders, lotions or oils to keep their skin variety of situations. smooth. Use only mild soaps and skin-care products All babies are unique individuals, but most have certain made especially for babies. common physical traits, needs and behaviors. MILIA Understanding these normal states — as well as certain warning signs — can calm your anxiety and prepare you Your baby may have little yellow-white spots on the for taking care of your baby. nose, upper lip, cheeks and forehead. These spots are called “milia” and are caused by enlarged oil glands. No Your baby’s body treatment is required, and they will disappear on their own. You are likely to spend countless hours getting to know your baby’s body. New parents typically have tons of JAUNDICE questions, and the slightest change may cause alarm. If your baby experiences a buildup of a substance called Your baby will indeed be changing from day to day, but “bilirubin,” his or her skin and whites of the eyes may many of the physical traits you see will be quite normal. turn yellowish. Bilirubin is a normal substance produced The following is a list of things you might expect: in our blood as old cells break down. It is usually processed by our livers and eliminated. EYES Many babies experience excess bilirubin during the first Your newborn’s eyes may be swollen shut after the birth week of life as their body adjusts to being outside of the because of the pressure during delivery. Usually this womb. Your baby’s care provider may order a special swelling disappears after a few days. blood test to determine if the level of bilirubin is too high. SOFTSPOTS All babies have two soft spots on their head. These areas Blood is collected from your baby’s heel, and if the level are where the skull has not yet fused together. The soft is too high, phototherapy treatment may be required. spot in the back usually closes up after two to six months. This treatment involves laying under a special light that The soft spot in the front usually closes up by 18 months will help your baby’s body process the bilirubin. of age. A tough membrane covers the soft spots and Additional feeding also may be necessary to help your normal care and handling, such as shampooing or baby process the bilirubin more quickly. combing, will not harm your baby.

BREASTSANDNIPPLES Sometimes breasts and nipples in both boys and girls can be enlarged because of mom’s hormones. They may also leak a little milk-like substance, known as “witches milk,” for up to two weeks.

20 Caring for your new baby GENITALS Baby girls sometimes have swollen genitals after birth, Newborns have a few specific needs, most of which can and a small amount of bleeding or creamy white mucous be responded to with common sense. may come from the vagina. These signs are normal and BATHING caused by maternal hormones that passed to her via the placenta. When cleaning her diaper area, it’s important You do not need to bathe your baby every day. Every two to always wipe from front to back and to gently clean in to three days is enough if the face and diaper areas are between the folds of skin. kept clean more regularly. When bathing your baby, be sure to keep the room warm and free of drafts. The water An uncircumcised penis is easy to keep clean. No special should be warm, but not hot to the touch. care is required. Simply wash the outside with water. Do not attempt to push the foreskin back — this may harm UMBILICALAREA the penis and can cause pain and bleeding. The natural Keep the belly button area clean and dry. The umbilical separation of the foreskin from the penis can take cord stub will fall off in a couple weeks. Notify your care several years. By the time your son reaches puberty, he provider if the cord has a bad smell, becomes red or will learn to retract the foreskin and clean under it each bleeds. day. If your son is circumcised, the doctor will give you instructions on the daily care . Healing is usually CLOTHING complete within five to seven days. Dress your baby according to the weather or indoor temperature. It’s a good idea to put your baby in one TEMPERATURE more layer than you are comfortable wearing. At night, If you are concerned that your baby has a fever, place a try to avoid overheating. Dress your baby in light sleep digital thermometer under your baby’s armpit and hold attire, and keep the bedroom temperature comfortable the arm down against the torso. A normal temperature is for a lightly clothed adult. between 97.7 and 98.6 degrees Fahrenheit. If your baby’s temperature is 100.4 or higher, call your care provider. FINGERNAILSANDTOENAILS Keep your baby’s nails short to avoid scratches. The best SLEEPINGANDSITTINGPOSITIONS time to trim them is when the baby is sleeping. Take care Sometimes babies develop a flat area on the back of the not to snip the skin when clipping them. Use an emery head from spending too much time lying on their backs board to file them straight across and round the corners. or resting their heads against seats and chairs. Do not bite or tear your baby’s nails as this can lead to • Give your baby regular “tummy time” while alert. infection. This avoids the flat head issue and helps baby to DIAPERS develop shoulder strength. During the first week, you can expect one wet diaper for • Change your baby’s positions frequently when every 24 hours of life. For example, if your baby is three awake and asleep. days old, he or she should have three wet diapers that • When putting your baby down for sleep, turn the day. By the time your milk comes in, you should see six to head to one side for a week, then change to the other eight wet diapers each day, plus three or four dirty side for the next week. diapers. The first stool will be dark green-black and have a sticky consistency. The color will change to a light brown-yellow or yellow-green after a few days. Most babies need a diaper change after every feeding during the first six weeks of life. 21 Typical newborn Babies go through various cycles of OTHERNORMALBEHAVIORS behaviors sleep and alertness. Understanding You may see your baby doing any of these cycles will help you know when the following, but all of these In addition to what your baby looks best to feed your baby: behaviors are normal and not signs of like, you are likely to be equally illness or problems: fascinated by what your baby is • State 1 — deep sleep. You may doing. Below are some typical be unable to wake your baby for • Quivering chin or lower lip when newborn behaviors — all totally feeding. Your baby will have preparing to cry normal and not worrisome. closed eyes, regular breathing and no spontaneous activity. • Hiccups — just small, harmless REFLEXES spasms of the diaphragm muscle • State 2 — light sleep. You may Babies are born with three instinctive be able to wake your baby to • Sneezing — helps the baby clean reflexes: feed. Your baby will have closed the nose of mucus, dust, link and milk curds • Moro or startle reflex. In eyes with rapid eye movement, response to a loud noise or irregular breathing and a low • Wet burps after feeding — it’s surprising movement, your activity level. normal for a small amount of baby’s arms and legs will extend • State 3 — drowsy. You may need milk to come up with a burp outward and then move back to wake your baby up more to • Straining or red face with bowel closer to the torso. Sometimes feed. Your baby may have open movements the baby will cry after this or closed eyes and a confused movement. expression. • Yawning • Rooting or searching reflex. • State 4 — alert. This is a good • Crossed eyes — can be from When you touch a cheek, your time to feed. Your baby will have immature muscle control and baby will turn his or her face in a bright look, perhaps focused on will improve as muscles get that direction and search for an object, and be expressing stronger whatever touched the cheek. minimal activity. • Brick dust — reddish-orange • Suck reflex. When you touch the • State 5 — eyes open. This is the discharge found in the diaper inside of your baby’s mouth, he best time to feed. Your baby will • Passing gas or she will begin to suck. be reacting to voices and touches, and displaying lots of activity, • Coughing — helps remove SLEEP such as thrusting of arms and secretions from the air passages • Babies need about 15 hours of legs. • Irregular or noisy breathing — sleep a day for the first month or not unusual to occur in a content so. It’s important that babies eat • State 6 — crying. Settle your and comfortable baby who is not frequently, so if your baby sleeps baby down before feeding. in distress for more than three hours at a Crying can be a late sign of time, wake him or her up for hunger. Your baby will be feeding. displaying too much activity and intense crying. It may be difficult to calm your baby.

22 Warning signs • Listlessness Call your baby’s healthcare provider and symptoms • Excessive crying with no known and go to the emergency room if your Much of what you see your baby cause baby experiences the following: experiencing will be perfectly • Unusual or severe rash (other normal. However, it’s a good idea to • Drastic behavior changes than prickly heat) understand what behaviors or • Increased moodiness conditions are more serious. • Frequent bowel movements with excess fluid, mucus or foul odor • Excessive crying without a cause If you notice any of the following symptoms of illness, contact your Your baby may not appear to be ill, • Extreme sleepiness baby’s healthcare provider: but difficulty with feeding or • Floppy arms and legs digestion can lead to serious • Blue lips — dial 9-1-1. This is an problems. Call your baby’s healthcare emergency. provider or your lactation consultant • Fewer than three or four stools • Blue or pale skin if you experience the following per day after your milk comes in difficulties: • Yellow skin or eyes • Watery or black stools • Nursing fewer than eight times • Patches of white in your baby’s per day or nursing without truly • Refusal to eat for more than eight mouth eating (be sure to offer feeding hours • Poor eating or refusal to eat every two to four hours around • Tiring or sweating during feeding the clock) • No stool for 48 hours • Fewer than four wet diapers in a • Fewer than six wet diapers per day after the first few days of life day and fewer than six wet diapers • No urination within eight hours per day after the baby is seven after circumcision days old

• Increased swelling, drainage or bleeding from circumcision

• Temperature less than 97 degrees or higher than 100.4 degrees

• Difficulty breathing

• Congested cough, runny eyes or nose

• Repeated vomiting that is forceful or projects several inches — spitting up and dribbling after burps is normal with babies

23 Immunizations RECOMMENDEDIMMUNIZATIONSCHEDULE (AGES 0–18 MONTHS)

Certain vaccinations for Vaccine Birth 1 2 3 4 5 6 12 15 18 and children are Hepatitis B HepB HepB HepB

recommended by the U.S. Rotavirus RV RV RV Centers for Disease Control Diphtheria, tetanus, DTaP DTaP DTaP DTaP (CDC) and prevention. Many pertussis

of these immunizations help Haemophilus influenzae Hib Hib Hib protect your baby from serious type B disease and illness. They also Pneumococcal virus PCV PCV PCV

help prevent widespread Inactivated poliovirus IPV IPV IPV outbreaks of serious disease. Influenza IInfluenza (yearly) The following table shows the Measles, mumps, rubella MMR CDC’s recommended vaccination schedule for babies Varicella Varicella up to 18 months old. Hepatitis A HepA (2 doses)

Not all babies need all Meningococcal vaccines. Ask your healthcare provider to explain what each Courtesy of the U.S. Department of Health and Human Services Centers for Disease Control and Prevention is for and help you make the best choices for you and your baby. Range of recommended ages

24 Keep your baby safe RIDINGINTHECAR

Of course you want to protect your baby from harm. A It’s great to get out and about with your baby. Be sure to few common household precautions can go a long way in follow the latest car safety recommendations to ensure a making sure that your baby is safe. safe ride. Remember that children are always safer in the back seat. POISON • Rear-facing car seat. Use a rear-facing car seat Lock or “baby proof” all cabinets containing household until your child is one year old and weighs more cleaning products and medications. Keep poisonous than 22 pounds. houseplants away from children’s bedrooms and areas. Toxic plants include: > If your baby weighs more than 22 pounds but is less than one year old, be sure to use a rear-facing • Rhododendrons • English ivy car seat designed for heavier babies.

• Lily of the valley • Jasmine > Ne ver put a rear-facing car seat in front of an air • Holly • Mistletoe bag.

If you believe your child has come into contact with a • Forward-facing car seat. Babies one year old and poisonous product or plant, contact the Poison Control heavier than 22 pounds can graduate to a forward- Center at 800-222-1222. facing toddler seat. > Children should sit in forward-facing toddler AIRWAYOBSTRUCTION seats until they weigh 40 pounds. To avoid airway obstruction, be sure to have a tight- fitting crib mattress and remove all pillows and stuffed > Ch ildren should use a booster seat in the back seat animals from the crib while your child sleeps. until they are 4 feet, 9 inches tall or 8 years old.

• Place your baby on his or her back while sleeping. Always read the child seat instruction manual before installing the seat in your car. The seat should fit your • Remove small toys and objects from play areas. child and vehicle properly.

DROWNING Child seats should not be used if they are worn out or Never leave children alone around water. missing parts or the instructions. Do not use a child seat that has been in an accident. • Don’t store water in buckets or in the bathtub.

• Keep the toilet lids down. GET YOUR CHILD’S CAR SEAT CHECKED FALLS Visit www.childsafetyseat.org or call 800-772-1315 to Take furniture with sharp corners and edges away from find a professional near you who can check your child’s play areas, block off stairs, and watch your child carefully car seat for safety. as he or she is learning to walk.

BURNS Turn down the water heater temperature to below 120 degrees Fahrenheit. Avoid carrying or placing hot food or fluids near your baby.

25 Infant emergencies • Use sleep clothing to keep your retardation, paralysis, seizures, baby warm while sleeping rather learning and speech disabilities, neck Most parents do not want to think than blankets. If you do use a and back damage, or even death. about their baby in an emergency blanket, be sure to tuck it in situation. While true emergencies If your baby is upset and you are at around the mattress and bring it are rare, it’s still a good idea to be the end of your rope — after feeding, up no higher than the baby’s informed. The following information changing the diaper, adjusting chest. should give you the basics on how to clothing, gently rocking, cooing, avoid certain emergency situations • Do not smoke or let others singing — take a few deep breaths, try and what to do if an emergency smoke around your baby. to think clearly and ask for help if you occurs. need it.

If you have questions or concerns, be Here are some tips for how to handle sure to talk with your baby’s care Avoid devices designed to maintain these moments of frustration: provider. your baby’s sleep position or to reduce • Close your eyes and count to 10. the risk of rebreathing. Many of these SUDDEN INFANT DEATH have not been safety tested and have • Put the baby down in his or her SYNDROME not been shown to actually reduce the crib and leave for a few minutes Sudden Infant Death Syndrome risk of SIDS. to pull yourself together. (SIDS) is the unexplained death, • Ask a friend, neighbor or family usually during sleep, of an infant Baby monitors also have not been member to take over for awhile. under one year of age. The cause of shown to reduce the risk of SIDS. SIDS is unknown, but studies have • Give yourself a “timeout.” shown the following precautions help • Do not pick up the baby until you reduce the risk: SHAKEN BABY SYNDROME feel calm. • Put your baby down to sleep on Parenting is no easy task. Sometimes • If you think your baby is ill, call his or her back. exhausted parents can become your healthcare provider right • Use a firm mattress in a safety- frustrated or angry when nothing away. approved crib. seems to comfort a crying baby. In these moments, it might be tempting If you or another caregiver has • Do not place infants to sleep on to act out physically against your shaken your baby — or even if you waterbeds, sofas or other soft baby. But please, do not shake your suspect someone has shaken your surfaces. baby! baby — seek medical help immediately. Go to the emergency • Do not place pillows, sheepskin Shaken Baby Syndrome (SBS) room. or comforters under your baby. results when a baby is shaken Signs of Shaken Baby Syndrome • Remove fluffy bedding and forcefully. Abrupt movement of the include: stuffed toys from the sleep area. baby’s head can cause bleeding and increased pressure on the brain. A • Irregular, difficult or stopped • Keep your baby’s head and face baby’s neck muscles are not strong breathing uncovered during sleep. enough and the brain is too fragile to • Extreme crankiness • Avoid overheating during sleep. tolerate strong motion. SBS is one of the leading forms of • Seizures and vomiting and can cause brain • Tremors or shaking damage, blindness, mental 26 • No reaction to sounds or • If your baby is unresponsive, INFANT CPR lifelessness begin CPR as outlined in the next The thought of having to give your coloumn. • Difficulty staying awake baby CPR is frightening for any • Between giving puffs of air, look . Not knowing what to do in an Do not let fear, shame or into the baby’s mouth to see if emergency is worse. CPR for babies is embarrassment stop you from seeking the object is visible. If you cannot a little different from CPR for adults, help. Getting the proper medical see the object, do not attempt a so it’s not a bad idea to take an infant treatment could save your baby’s life. blind finger sweep. CPR class. Most childbirth education classes include infant CPR, but you CHOKING • Continue with CPR. also can contact your local American Babies tend to put everything into Red Cross or American Heart their mouths. Be mindful of what your Association for information on baby is reaching for. If a small object classes. gets lodged in your baby’s throat and YELL OUT, “HELP! your baby cannot cough it up, stops SOMEONE DIAL 9-1-1!” When considering CPR, focus on the breathing or cannot cry, it’s critical to ABCs: dislodge the object as soon as possible. • A: Airways

Here’s what to do if your baby is awake • B: Breathing (responsive) and choking: • C: Circulation • Place your baby face down along your arm. Support the head by Keep these three things in mind when holding the jaw and make sure the dealing with an emergency situation. head is lower than the body. Here are the basics for infant CPR:

• With the heel of your hand, • If your baby is not moving, try to deliver five quick slaps between gently arouse him or her by the shoulder blades. tapping the feet or rubbing the back. Babies do not like this and • Turn the baby over onto the other usually will react right away. arm, facing up. Never shake your baby.

• While supporting the head and • If there is no response, such as body, use the other hand to crying or stirring, check the deliver five downward chest airway. If you do not detect thrusts using two fingers breathing, try infant CPR positioned a finger’s width below immediately — do not dial 9-1-1 the nipple line. Make sure the first. head is lower than the body.

• If the object is still stuck in your baby’s throat, repeat with five back slaps and five chest thrusts until the object is dislodged or the infant becomes unresponsive.

27 • Place the baby on a hard, flat surface such as a table or the floor — not on a bed or in the crib. Expose the baby’s chest and slightly tilt the head back in a neutral position. Do not tilt as far back as you would with an adult because a baby’s airway is small and can be cut off easily.

• Place two fingers in the center of the chest, one finger’s width below the nipple line. Compress ⅓ to ½ the depth of the chest to get the heart to pump blood for circulation.

• Do 30 compressions after two puffs of air — five times. It should take two minutes to do these five • Check again for normal breathing. cycles.

• If your baby is not breathing, cover the mouth and • Continue CPR until help arrives or baby is revived. nose with your mouth and gently puff two times. Look for the chest to rise with the breaths you are • Yell out, “Help! Someone dial 9-1-1!” If you are giving. If the chest is not rising and falling with each alone, dial 9-1-1 if you get no response after two breath, reposition the head and try again. minutes or five cycles of infant CPR. Continue CPR after the call.

YELL OUT, “HELP! SOMEONE DIAL 9-1-1!” If you are alone and get no response after two minutes or five cycles of infant CPR, dial 9-1-1. Then continue CPR after the call.

• Remember, your baby’s lungs are tiny and your full breath will be too much. Each breath should take just one second.

• After two rescue breaths, immediately begin chest compressions.

28 Resources

American Red Cross National Highway Traffic Safety Prevent Child Abuse America www.redcross.org Administration www.preventchildabuse.org 800-448-3543 www.nhtsa.dot.gov 312-663-3520 or 1-800-244-5373 888-327-4236 The ARC of the United States The Shaken Baby Alliance www.thearc.org National Institute of Child Health www.shakenbaby.com 301-565-3842 and Human Development 877-636-3727 (NICHHD) Depression After Delivery (DAD) SIDS Alliance www.nichd.hih.gov infoaboutdepression.blogspot.com www.sidsalliance.org 800-370-2943 800-944-4773 1-800-221-7437 Parents Without Partners National Institute of Mental Think First Foundation (National www.parentswithoutpartners.org Health Depression in Women Injury Prevention Program) 800-637-7974 www.nimh.nih.gov/health/publicati www.thinkfirst.org ons/women-and-depression- Postpartum Stress Center 847-290-8600 or 800-844-6556 discovering-hope/what-causes- www.postpartumstress.com WellMama depression-in-women.shtml 610-525-7527 www.wellmama.org 866-615-6464 Postpartum Support International 800- 896-0410 The National Coalition on www.postpartum.net Shaken Baby Syndrome 805-967-7636 www.dontshake.com 888-273-0071

29 Notes

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