A guide to having a baby A practical guide to the impractical, beautiful, wonderful experience of having a baby.

oxford healthy mother, healthy babySM Contents

We’re here for you The Health Mother, Healthy Baby Program. Handy phone numbers, information on prenatal support, plus instructions on enrolling your baby with Oxford.

What you should know about pregnancy 3 Learn all about the big changes coming your way. This section includes: Prenatal Care Your Baby’s Growth Changes in Your Body Nutrition, Exercise and Sleep Preparing for The Big Event

You’re home with your baby. Now what? 23 Calm your new-parent jitters and baby-care. This section includes: Newborn Care It’s Perfectly Normal When to Call the Doctor Taking Care of You

Resources 32 Here’s a list of books, organizations and websites.

About the information in this guide The health-related information contained in this guide is provided by the parenting experts at KidsHealth.® If you would like more information about pregnancy and your health, log onto our website at www.oxfordhealth.com. The Oxford Healthy Mother, Healthy Baby® program

Right about now, you probably have more than a few questions. Fortunately, the Oxford Healthy Mother, Healthy Baby Program has more than a few answers. When you or your doctor told Oxford that you were pregnant, we automatically enrolled you in our program, which is designed to complement the care you are receiving from your health care provider. We continually strive to find ways to help our Oxford members stay healthy. That’s why we created this guide – to help you learn more about caring for yourself and your baby, during and after pregnancy. We wish you the best of health during this special time in your life, and we look forward to providing you with access to our quality network of health care providers.

This information should only be used as an educational tool and is not intended to replace the advice of a doctor or other healthcare professional.

1 We’re here for you

Oxford Support and Guidance from a Notification of Your Baby’s Birth Registered Nurse Within 48 hours of the birth, it is important to let us know that We are proud to offer the guidance of nurses during this special you have delivered your baby. Call Oxford Customer Service time of your life. at the telephone number on your Oxford member ID card or at 1-800-444-6222, Monday through Friday, 8:00 am to Home Nurse Visits 6:00 pm, or notify us online by visiting our member website at After your baby is born, your coverage provides a minimum of www.oxfordhealth.com. 48 hours of hospital care after a vaginal birth or 96 hours of Please note that this notification does not automatically enroll hospital care after a cesarean delivery. For some women, going your child as an Oxford member. Customer Service is also home sooner may be the right thing to do, so we offer home available to answer questions regarding benefits, claims and Keep This Phone nurse care to Oxford members as an option only if they go policies. Number Handy home early. A visiting nurse will provide in-home medical care, Call Customer Service including a full assessment of your health and that of your baby. Enrolling Your Newborn at 1-800-444-6222, Please check your Certificate of Coverage for information about To enroll your baby as a new member under your Oxford Monday through Friday, from your specific benefits. health plan, you should contact your benefits administrator and 8:00 am to 6:00 pm, complete an Addition/Termination/Change Form. Your benefits to notify us within 48 hours Oxford On-Call® of the birth of your baby or ask administrator must sign the completed form and return it to us questions about benefits, claims Whether you are on vacation or have a question at 2:00 in the within 31 days of your baby’s birth. Forms that are submitted or policy information. morning about your child’s health, we understand that you may to us without your benefits administrator’s signature cannot be need immediate health care guidance. In situations like these, processed. you can turn to Oxford On-Call 24 hours a day, 7 days a week. When you dial 1-800-201-4911, you will receive personalized attention from a registered nurse who will follow up with your provider as needed.

2

Guide to this Section 3

Prenatal Care Advice on choosing a health care provider, what to expect at prenatal visits, diagnostic tests, commonhealth What you should know concerns during pregnancy, and when to call the doctor. about pregnancy 8 Your Baby’s Growth How your baby develops, Prenatal Care week by week. 10 You and your health care provider – a good relationship is everything. Changes in Your Body Choosing a health care provider – whether that provider is an obstetrician/gynecologist, family practitioner or certified nurse-midwife – What physical changes you can is one of the most important decisions you’ll make during your pregnancy. Take the time to choose wisely. When interviewing potential expect, plus information on providers from the Oxford network, look for someone whose philosophy on childbirth matches your own and whose personality puts weight gain as well as things you at ease. Here are some points to consider when choosing the provider who will administer your prenatal care: that might surprise you about being pregnant. • Does the provider take time to answer your questions and listen to your concerns, both physical and emotional? 15 • What hospital is he or she affiliated with and what level of services is offered there? Nutrition, Exercise and Sleep • Where does your provider stand on issues like pain management during labor, the birthing environment, cesarean sections, Tips on eating right, staying fit, spouse participation, and inductions? and getting a good night’s sleep.

• Is this a solo or group practice? What are the qualifications of any doctors other than your provider who might care for you 19

during your pregnancy?  Preparing for the Big Event • Who should you call in an emergency when your provider is not available? Advice on childbirth courses, choosing a doctor for your child, • What is the office atmosphere like? Does the staff seem helpful and responsive? creating a safe home environment, • Does your provider handle high-risk pregnancies? This is especially important to know if you have a pre-existing health condition and how to know when you’re or a history of pregnancy complications. in labor. You’re going to be spending a lot of time with your health care provider over the next nine months. Make sure you find someone you’re comfortable with. What to Expect at Prenatal Visits

The First Visit Your first examination should take place during the first six to Expectant parents may also choose to have one or more of eight weeks of your pregnancy or when your menstrual period the following diagnostic tests depending on your specific is two to four weeks late. Seeing your health care provider circumstance and doctor’s recommendation: during this time will help him or her determine an expected delivery date (EDD). Your EDD is 40 weeks from the first day Ultrasound of your last menstrual period (LMP). It’s important to remember You’ll likely have at least one ultrasound examination to make that your due date is only an estimate – most babies are born sure the pregnancy is progressing normally and to verify the between 38 and 42 weeks, and only 5% of women actually expected delivery date. The technician coats your abdomen deliver on their due date. with a gel and then runs a wand-like instrument over it to At your first visit, your provider will take a detailed medical produce images of the fetus on a computer screen. Ultrasound history of both parents and perform a full physical examination, scanning is used to determine whether the fetus is growing at a which may include a Pap test for cervical cancer. You’ll probably normal rate, to record fetal heartbeat or breathing movements, When will I start be asked to provide a urine sample and a blood sample, to see whether you might be carrying more than one fetus, to to show? which will be used for a series of tests. An HIV test is also measure the amount of amniotic fluid, and to identify a variety of When you start showing recommended. abnormalities that might affect the remainder of the pregnancy differs from woman to woman. or delivery. Usually it’s performed at 18 to 20 weeks, but it can Everyone’s body is different, Routine Visits and Diagnostic Testing also be done sooner or later and sometimes more than once. so don’t be alarmed if you If you’re healthy and have no complicating risk factors, you can think you are showing to HIV Test early or to late! expect to see your health care provider once a month until the 28th week of pregnancy, then twice a month until the 36th It is important for women who are pregnant to have their blood week, and then once a week until delivery. tested for HIV, the virus that causes AIDS. If you test positive for HIV, there is a chance that your baby may have the virus At each examination, your weight and blood pressure will too. Certain medications taken during pregnancy can reduce be recorded, and the size and shape of your uterus will be the chance of the virus being passed on to your baby. Current measured to determine if the fetus is growing and developing recommendations are for HIV testing to be offered to all well. Then comes the most exciting part – listening to your pregnant women. baby’s heartbeat! During some visits, your urine will be tested for sugar and protein. Sugar in the urine may indicate gestational diabetes, and protein may indicate preeclampsia (a serious condition characterized by a sudden rise in blood pressure and excessive weight gain). Later in the pregnancy, you may also have a pelvic exam.

4 Screening for genetic disorders and birth age, abnormal AFP, other abnormal screening test results, or defects family history. The test has a small risk for inducing pre-term labor and miscarriage, but the majority are performed without Pregnant women are not offered many tests that can help incident. determine the risk of the fetus having Down syndrome or certain other chromosomal disorders or birth defects. These Diabetes Screen tests, done in the first and/or second trimester, include blood This test, usually performed at 24-28 weeks, checks for tests and sometimes an ultrasound study. If the screening tests gestational diabetes, a short-term form of diabetes that develops indicate a possible problem, additional tests (such as CVS or in some women during pregnancy. After you’ve consumed a amniocentesis, described below may be recommended to more sugary drink, blood is drawn, and the glucose level is measured. specifically determine if there is a problem with the fetus. For some women, such as those who have had gestational diabetes with a previous pregnancy, the test may be done Alpha-fetoprotein Test (AFP) before 24 weeks. Between 16 and 18 weeks, the level of alpha-fetoprotein, a The First Visit protein produced by the fetus, can be measured in the mother’s Group B streptococcus Your first examination blood. Abnormal levels of any of this substance could indicate A bacterium that lives harmlessly in 10% to 35% of women, should take place during the a problem with the development of the nervous system of the group B streptococcus can infect a newborn during delivery first 6 to 8 weeks of your fetus (such as spina bifida) or other problems that might warrant and cause a variety of serious infections. To test for it, at 35 to pregnancy or when your further testing. 37 weeks of pregnancy, samples are taken from the vagina and menstrual period is 2 to 4 rectum of the mother and cultured in a lab. Women who test weeks late. Chorionic Villus Sampling (CVS) positive will be treated with antibiotics during labor. This procedure is used during the first trimester to test for certain developmental or chromosomal abnormalities in the fetus, such as Down syndrome or spina bifida. It involves taking a sample of the tissue that attaches the amniotic sac (the sac around the fetus) to the wall of the uterus. This test is usually performed only if screening tests done earlier in the pregnancy have shown a higher risk for problems in the fetus.

Amniocentesis In this test, a needle is used to remove a sample of the amniotic fluid in the womb and is generally performed between 16 and 20 weeks. Testing the fluid can identify certain developmental or chromosomal abnormalities in the fetus, such as Down syndrome or spina bifida. Typically, amniocentesis is recommended only if there is reason to believe that the risk for such conditions is higher than usual, perhaps due to maternal 5 Common Health Concerns When to Call the Doctor Although most women carry their babies to term with no problem, It can be hard to know what’s normal and what’s not, especially some develop complications that require close monitoring by if this is your first pregnancy. Always err on the side of caution their doctor. Conditions that can be associated with pregnancy and let your provider know if you have a concern. include: Here’s a list of symptoms that would warrant a Gestational Diabetes call to the doctor: About 2% to 3% of women develop this condition during • temperature of 101 degrees Fahrenheit pregnancy. The placenta, which provides the fetus with (38.3 degrees Celsius) or higher nutrients and oxygen, also produces hormones that have an • swelling of the hands, face or feet insulin-blocking effect in the mother. The condition usually develops after the first trimester. Often, gestational diabetes • vaginal bleeding can be controlled with a diet, but sometimes medication • fluid leaking from the vagina is needed. • decreased fetal movement in the last trimester The Importance Preeclampsia (also called toxemia of pregnancy) • sharp stomach pains of Folic Acid A potentially serious condition that develops after the sixth • headache that’s unusually severe or associated with visual Folic acid is found mostly in month, it causes high blood pressure, sudden, excessive weight disturbances leafy green vegetables like kale gain, swelling of the hands and face, severe headaches, and and spinach, orange juice and • urinary discomfort protein in the urine. enriched grains, but most women • sores or blisters on the genitals get it from aprenatal vitamins. Rh-negative Mother/Rh-positive Fetus • any car accident Women who get 0.4 to 0.8 milligrams daily prior to and Rh factor is a substance found in the red blood cells of most • any signs of pre-term labor, including: contractions – more during early pregnancy reduce people. If you don’t have it but your baby does, the incompatibility than four in an hour; cramping; abdominal pain; low backache; the risk that their babies will be can cause serious health problems in the baby. Medications pelvic pressure that feels like the baby is pushing down; an born with a serious neural tube given at 28 weeks and just after birth can help prevent increase or change in vaginal discharge (bloody discharge, for defect (incomplete development these complications. These conditions are serious, but example) of the brain and spinal cord) manageable, so it’s important to know about them and discuss by up to 70%. them with your health care provider.

6 Give your baby the best possible start

During pregnancy, your health and that of your baby go hand in hand. Now’s the time to turn over a new leaf when it comes to unhealthy habits – especially smoking. Women who smoke while pregnant have a greater risk of miscarriage and stillbirth, not to mention cancer and heart disease. Their babies are at greater risk for low birth weight and sudden infant death syndrome. Let the health of your baby be your motivation to stop smoking once and for all. If you need help, talk to your doctor.

Your Baby’s Growth Pregnancy lasts 40 weeks and is divided into trimesters. The first trimester is from conception to the end of week 13, the second trimester is from week 14 to the end of week 26, and the third trimester is from week 27 to the end of the pregnancy.

7 Your baby’s growth

Here are some of the highlights:

Week 8 Marveling over a baby’s tiny fingers and toes is one of the early joys of parenthood. Those fingers and toes are just beginning to form this week, and the arms can even flex at the elbows and wrists. Blood begins to flow through a rudimentary circulatory system.

Week 12 Your baby’s face has a profile now, complete with a tiny chin and nose. The brain continues to develop, and tiny fingernails and toenails form. Though you haven’t had to change a wet diaper yet, you will soon enough. Your baby’s first urine is made and eliminated into the amniotic sac this week.

Week 16 Your baby now weighs about 2.8 ounces and measures about 4.6 inches in length. This week brings the first voluntary muscle movements. Your baby can hold his or her head erect, and the development of facial muscles allows for a variety of expressions such as squinting and frowning.

Week 20 You’re halfway there! Now weighing about 9 ounces and measuring 5.5 to 6.3 inches from crown to rump, your baby’s continued growth will put pressure on your lungs, stomach, bladder, and kidneys. Under the vernix (a protective, waxy coating), your baby’s skin is thickening and developing layers.

Week 24 In preparation for the outside world, your baby’s lungs will now begin to produce surfactant. (Surfactant is a substance that keeps the air sacs in our lungs from collapsing and sticking together when we exhale.) In addition, your baby may be able to tell when he or she is upside down or right side up while floating in the amniotic fluid because the inner ear (which controls balance) is now completely developed.

8 Week 28 Your baby now weighs about 2 pounds, 7 ounces and measures about 10 inches. At your next appointment, your health care provider may inform you whether your baby is head first or feet or bottom first (called breech position) in the womb. Babies who are in the breech position may need to be delivered by cesarean section. Your baby still has two months to switch, though – and many often do – so don’t worry if your baby is in the breech position right now.

Week 32 The final touches are being placed on your baby masterpiece. Fingernails and toenails have grown, and eyelashes, eyebrows, and the hair on your baby’s head are evident. At about 4 pounds and 11.4 inches from crown to rump, your baby would have a very good chance of survival outside the womb if you delivered now.

Week 36 The wrinkly, tiny fetus you may have seen on earlier ultrasounds has evolved into an almost plump baby. Fat is deposited on the cheeks this week, and powerful sucking muscles also contribute to your baby’s full face. Your baby now weighs approximately 6 pounds. Maternal calcium intake has helped to create the baby’s firm skull, but it’s still soft enough to squeeze through the birth canal.

Week 40 After many weeks of anticipation, your baby is here! Or maybe not. Many first-time mothers find themselves waiting up to two weeks after their due date for their baby to arrive. A baby born at 40 weeks weighs, on average, 7 pounds, 8 ounces and measures 19 to 20 inches. Don’t expect your baby to look picture-perfect right off the bat – newborns often have heads temporarily misshapen from passing through the birth canal and may be covered with vernix and blood. Right after birth, someone will suction mucus out of your baby’s mouth and nose, and you’ll hear that long-awaited first cry. Your baby may then be placed on your stomach, and the umbilical cord will be cut, often by the baby’s dad if he chooses to do the honors!

9 Changes in your body

Your baby’s not the only one changing and growing!

Week 8 Pregnancy symptoms such as a missed period, nausea, extreme fatigue, or tight clothes due to the swelling of your uterus have probably prompted you to wonder whether you’re pregnant.

Week 12 Has anyone told you that you have that “pregnant glow”? It’s not just the joy you may feel; there’s also a physiological reason. Your body is bringing more blood to the blood vessels, and the pregnancy hormone hCG is increasing oil gland secretion, resulting in a flushed, plumper, smoother skin appearance. Sometimes, though, the increased oil gland secretion can cause temporary acne.

Week 16 Congratulations – you’re in the second trimester! Your risk of miscarriage is greatly reduced now, so you can breathe a little easier. You may notice that your breasts have changed considerably since your pregnancy began. More blood is flowing to the breasts, which increases their size (many women increase one to two cup sizes) and causes veins to become visible.

Week 20 Your constant concern for your baby’s health may give way to reassurance as you feel your baby’s first movements, usually between the 18th and 20th week. Known as “quickening,” these first movements may feel like butterflies in your stomach or a growling stomach. Later in your pregnancy, you’ll feel kicks, punches, and possibly hiccups.

Week 24 Pregnancy can cause some unpleasant side effects when it comes to digestion. Not only does the hormone progesterone slow the emptying of the stomach to allow for increased absorption of nutrients, but your expanding uterus is putting increased pressure on your intestines. If indigestion and heartburn are making your meals a nightmare, try eating smaller, more frequent meals, and avoiding spicy and fatty foods.

10 Week 28 Iron is important for making extra red blood cells and providing the baby with adequate iron stores after birth. You should be eating at least 30 milligrams of iron each day during the second and third trimesters. Iron deficiency is common during pregnancy, so your health care provider may prescribe a supplement if your iron levels are found to be low.

Week 32 The milk glands in your breasts may start to make colostrum around this time. Colostrum is the thick, yellowish milk that will provide your baby with calories and nutrients for the first few days before your milk comes in, if you plan to breastfeed. If you notice your breasts leaking colostrum, you can buy disposable or washable breast pads.

Week 36 Starting this week, you may begin to see your health care provider every week. Your provider may give you an internal exam to determine if cervical effacement (thinning of the cervix) or dilation (opening of the cervix) has begun. You may experience engagement (also known as lightening), which is when the baby drops into the mother’s pelvis in preparation for labor. Your appetite may return because the baby is no longer putting as much pressure on your stomach and intestines.

Week 40 This week you may experience the moment you’ve been anticipating – your introduction to your baby! But first you’ll have to go through labor and delivery.

There are three stages of labor The first stage of labor works to thin and stretch your cervix by contracting your uterus at regular intervals. The second stage of labor is when you push your baby into the vaginal canal and out of your body. The third and final stage of labor is when you deliver the placenta.

If you do not go into labor within a week of your due date, your health care provider may recommend you receive a nonstress test, which monitors fetal heart rate and movement to determine if the baby is receiving enough oxygen.

Sometimes Mother Nature may need a little coaxing. If your labor is not progressing, or if your health or your baby’s health requires it, your health care provider may induce labor by artificially rupturing the membranes or by administering the hormone oxytocin or other medications. If your pregnancy is high risk or if there are any other potential complications, you may require a cesarean section delivery.

You’ll find that no matter how your baby enters the world, it will be a life-changing event. Savor the moment you meet your child in person!

11 A Word about Weight Gain Weight gain is a much-discussed topic among pregnant women. How do those pounds add up? How do you know if you’re gaining the right amount? Average baby’s weight 7.5 lbs. It’s generally recommended that a woman of average weight gain about 25 to 30 pounds during pregnancy – about two or Breast enlargement 2.0 lbs. three pounds each month. Gaining much more than that can Your body’s extra stored protein, put you at higher risk for prolonged labor, which increases the fat and other nutrients 7.0 lbs. likelihood of fetal distress. Gaining much less can mean your baby’s nutrition is being compromised. Pregnancy is not the The placenta 1.5 lbs. time to cut calories or go on a diet. Enlargement of your uterus 2.0 lbs. Of course, patterns of weight gain vary. If you start out heavier, it’s normal to gain less during pregnancy – about 15 to 25 Amniotic fluid surrounding your baby 2.0 lbs. pounds. If you were underweight before becoming pregnant, you might gain more – 28 to 40 pounds. And if you’re carrying Your extra blood 4.0 lbs. Morning Sickness Tips twins or triplets, 35 to 45 pounds would be considered typical. Your other extra body fluid 4.0 lbs. If you are frequently nauseated, But remember, guidelines on weight are just that – guidelines. eat small amounts of bland More important than how much weight you gain is what makes foods throghout the day. Take up those extra pounds, how you’re feeling and how your baby is your prenatal vitamin before growing. If you focus more on having a healthy pregnancy than going to bed and after a snack, on what the scale says, both you and your baby will benefit. not on an empty stomach. Eat a small snack when you Morning Sickness get up to go to the bathroom Nothing can put a damper on the happy haze of early early in the morning. Keep some crackers by your bedside. Avoid pregnancy quite like morning sickness – nausea and vomiting rich, spicy or fried foods. Suck that, despite its name, can occur at any hour or all day long. on hard candy. If you’re one of the 50% of women who experience it, here’s the good news: morning sickness is unlikely to harm the fetus, and it usually goes away by the end of the third month.

12 10 Things that May Surprise You about Being Pregnant

1. The Nesting Instinct 3. Mood Swings Many pregnant women experience a powerful urge to If you’re happy one minute and crying the next, you have prepare their homes for their babies by cleaning, decorating your pregnancy hormones to thank. Mood swings tend and organizing. Take comfort in knowing you’re not the first to worsen in the first and third trimesters, but if they last mom-to-be who felt compelled to wash the walls or clean longer than two weeks or are accompanied by changes in out the closets in her ninth month of pregnancy! Just be sleep and eating habits, talk to your doctor. It could be a careful not to overdo it. sign of depression, which affects about 10% of pregnant women. 2. Inability to Concentrate In the first trimester, fatigue and morning sickness can 4. Bra Size make you feel mentally fuzzy. But even well-rested pregnant An increase in breast size is one of the first signs of women may experience an inability to concentrate. A pregnancy. Breasts usually become swollen and enlarged preoccupation with the baby is partially the cause, as are in the first trimester because of increased levels of the hormonal changes. Combat forgetfulness by making lists of hormones estrogen and progesterone. That growth in the important dates and appointments. first trimester isn’t necessarily the end, either. Your breasts can continue to grow throughout your pregnancy! 5. Skin 8. Joint Mobility Your “pregnant glow” is a welcome side effect of pregnancy, During pregnancy, your body produces a hormone known but some skin changes are less desirable. Acne is common as relaxin, which is believed to help prepare the pubic area during pregnancy because of increased oil production. for the birth. The relaxin loosens the ligaments in your body, Some women develop brownish or yellowish patches called making you less stable and more prone to injury. When chloasma, or the “mask of pregnancy,” on their faces. And exercising or lifting objects, go slowly and avoid sudden, some will notice a dark line on the midline of the lower jerky movements. abdomen, known as the linea nigra, as well as darkening of the skin of the nipples and external genitalia. These are 9. Varicose Veins the result of pregnancy hormones, which cause the body Varicose veins occur when blood pools in veins enlarged by to produce more pigment. pregnancy. Varicose veins often disappear after pregnancy, Skin stretching can make pregnancy an itchy time for a but you can lessen them by avoiding standing or sitting for woman, and it can also cause stretch marks. Although long periods of time and elevating your feet when you sit. stretch marks may lighten after pregnancy, there’s no product that can remove them entirely. 10. Hemorrhoids and Constipation Hemorrhoids – varicose veins in the rectum – can be 6. Hair and Nails extremely painful, and they may bleed, itch or sting during Now that you’re pregnant, you may finally have the thick, a bowel movement. Coupled with constipation, another luxurious hair you may have always wanted. Hormones common pregnancy woe, hemorrhoids can make going to cause your hair and your nails to grow faster and become the bathroom unpleasant. stronger. But don’t get too used to it; these changes are The best way to combat constipation and hemorrhoids is to temporary, and most women lose a significant amount of hair prevent them. Eating a fiber-rich diet, drinking plenty of fluids in the postpartum period or after they stop breastfeeding. and getting regular exercise can help you stay more regular. 7. Shoe Size Even though you can’t fit into any of your pre-pregnancy clothes, you still have your shoes, right? Maybe not. Extra fluid can cause swelling in your feet and may cause you to go up one or two shoe sizes, and your feet may remain a size larger after you give birth! Nutrition, exercise and sleep Eating Smart

Eating for two doesn’t mean doubling what you eat! To eat well during pregnancy, you must do more than simply increase how much you eat. You must also consider what you eat. Although you need about 300 extra calories a day (the equivalent of one apple, one banana and one cup of lowfat milk), those calories should come from nutritious foods so they can contribute to your baby’s growth and development. Your goal should be a well-balanced diet that includes plenty of fruits, vegetables and whole-grain breads.

Your growing baby’s calcium demands are high. To prevent a loss of calcium from your own bones, you’ll have to significantly increase your calcium intake. Good sources of calcium include milk, cheese, yogurt, and spinach. Other important nutrients are proteins (lean meat, fish, poultry, egg whites, beans, peanut butter, tofu), iron (lean red meats, spinach, iron-fortified cereals) and folic acid (green leafy vegetables, beans, peas, fortified cereals). Use the Food Guide Pyramid (www.kidshealth.org/kid/stay_healthy/food/pyramid.html) to determine how many servings of each kind of food to eat every day.

15 Foods to Avoid During Pregnancy Drinking plenty of water is another must. Food borne illnesses, such as listeriosis and toxoplasmosis, can A woman’s blood volume increases dramatically during be life threatening to a fetus. Avoid the following foods, which pregnancy, and drinking enough water each day can help may carry dangerous bacteria: prevent common problems such as constipation. Monitoring • soft cheeses such as feta, goat, Brie, your urine color is a good way to tell if you’re getting enough. Camembert, and blue cheese If your urine is dark-colored and foul-smelling, it’s time to drink • unpasteurized milk and juices up. If your urine is pale yellow and odorless, you’re probably well hydrated. • raw or undercooked meats, including hot dogs and deli meats Have you had any cravings yet? • raw eggs or foods containing raw eggs, Researchers have tried to determine whether a hunger for a including mousse, tiramisu, and cookie dough particular type of food indicates that a woman’s body lacks • raw shellfish the nutrients that food contains. Although this probably isn’t • pâté Do I Need More the case, it’s still unclear why women get urges for everything Calcium? from peanut butter to spicy salsa. As long as the food you crave • do not eat shark, swordfish, king mackerel, or tilefish during contributes to (or at least doesn’t interfere with) a healthy diet, your pregnancy because they can contain high levels of To prevent a loss of calcium mercury. Instead, you can eat up to 12 ounces per week of from your bones, you’ll have to following your cravings is fine. fish and shellfish that are lower in mercury, such as shrimp, significantly increase your calcium intake. Good sources It’s not always easy to eat right. canned light (not white) tuna, salmon, pollock, and catfish. of calcium include: milk, Your health care provider will likely prescribe a prenatal vitamin cheese, yogurt, and spinach. as added assurance that you and your baby are getting certain Drinks to Avoid During Pregnancy nutrients you both need. Because the iron in prenatal vitamins As for alcohol, no amount is considered safe during pregnancy. and other factors may cause constipation, it’s a good idea to And although many doctors feel that one or two 6- to 8-ounce increase your fiber intake. Try to eat about 20 to 30 grams of cups per day of coffee, tea, or soda with caffeine won’t harm fiber a day. your baby, it’s probably wise to avoid that, too, if you can. High caffeine consumption may be linked to an increased risk of miscarriage.

14 Staying Fit Although you may not feel like running a marathon – especially Once you’re ready to get going: in the first three months of pregnancy – most women benefit • Start slowly, building up to 30 minutes of activity at a time. greatly from exercising throughout their pregnancies. • Whether you’re a pro or a novice, go slowly for the first five Strong muscles and a fit heart can greatly ease labor and minutes to warm up and use the last five minutes to cool delivery – not to mention help you regain your pre-pregnancy down. shape after birth. Exercise can also increase your sense of being in control and boost your energy level at a time when you • Take frequent breaks and don’t overdo it. If you can’t talk wonder whether this strange body can possibly be yours. while exercising, you’re pushing yourself too hard. Keep your heart rate below 160 beats per minute. What’s considered safe? It depends on when you start and whether your pregnancy is complicated. If you exercised • Drink plenty of water to avoid dehydration. regularly before becoming pregnant, most doctors say you can • Opt for a walk in an air-conditioned mall on hot, humid days to continue your program with modifications as needed. If you avoid overheating. weren’t fit before you became pregnant, don’t give up. Begin • Skip your exercises if you’re ill. slowly, gradually increasing your activity. Whatever your fitness How Much Should level, talk to your doctor before exercising during pregnancy. • Above all, use common sense. If you get short of breath or I Eat? feel uncomfortable, slow down or stop. The type of exercise you do should be guided by what you The average woman needs like. Many women enjoy walking, swimming, water aerobics, about 300 extra calories a day, yoga, biking, or dancing. Try for a combination of cardiovascular which is the equivalent of (aerobic), strength and flexibility exercises. Kegel Exercises 1 apple, 1 banana and 1 cup of lowfat milk. Be aware that your growing belly is changing your center Kegel exercises help strengthen the pelvic floor muscles for of gravity, making you more prone to falls. Also, pregnancy delivery and reduce incontinence (leakage of urine) caused by hormones are making your ligaments more lax, increasing the weight of the baby on your bladder. Kegels are easy, and your risk of joint injuries. Avoid activities that include bouncing, you can do them any time you have a few seconds. To find the leaping, or sudden changes of direction or that put you at risk correct muscles, pretend you’re trying to stop urinating. Squeeze for abdominal injury. Your doctor may also recommend that you those muscles for a few seconds, then relax. You’re using the avoid weight training and exercises done on your back after the correct muscles if you feel a pull. first trimester because they reduce blood flow to the fetus.

17 Sleep During Pregnancy You know you’re in for sleepless nights after the baby is born, Experiment with pillows to discover a comfortable sleeping but who would have guessed that catching some ZZZs during position and try the following tips. Remember that over- pregnancy would be so difficult? the-counter sleep aids, including herbal remedies, are not Actually, you may sleep more than usual during the first trimester recommended for pregnant women. of your pregnancy. It’s normal to feel tired as your body works • Cut caffeinated drinks like soda, coffee and tea from your to protect and nurture the developing baby. It’s usually later in diet. pregnancy that most women have trouble getting enough deep, • Avoid eating a full meal within a few hours of bedtime. Try uninterrupted sleep. eating more at breakfast and lunch and then having a smaller The first and most pressing reason is the increasing size dinner. of the fetus, which can make it hard to find a comfortable • Get into a routine of going to bed and waking up at the same sleeping position. Other issues can include constant trips to the time each day. bathroom, leg cramps, heartburn, and anxiety over the baby’s health or becoming a parent. Some pregnant women are even • Avoid rigorous exercise right before you go to bed. Instead, do Lie on Your Left Side kept up by vivid dreams and nightmares. something relaxing, like soak in a warm bath for 15 minutes. (You should not take hot baths or use a sauna.) Some doctors specifically recommend that pregnant • If a leg cramp awakens you, it may help to press your feet women sleep on the left side. hard against the wall or to stand on the leg. Also, make sure Because your liver is on the right you’re getting enough calcium because this mineral can help side of your abdomen, lying on reduce leg cramps. your left side helps keep the • If fear and anxiety are keeping you awake, consider enrolling uterus off that large organ. Ask what your doctor recommends. in a childbirth or parenting class. The more you know, the less In most cases, lying on either you’ll have to fear. side should help take some Finally, if possible, take short naps during the day to make up pressure off your back. for lost sleep. It won’t be long before your baby will be setting the sleep rules in your house, so you may as well get used to sleeping in spurts.

18 Preparing for the big event Childbirth Classes The more information and support you have throughout your pregnancy, the healthier you’re likely to be – and the same goes for your baby. Facts and support can come from a variety of places, and a birthing class is one of them. Birthing classes address all kinds of birth experiences, from vaginal to cesarean, from labor with pain medication to without. They can help prepare you for many aspects of childbirth – for the changes that pregnancy brings, for labor and delivery, and for parenting once your baby is born – in an atmosphere of support with other expectant couples.

The two most common childbirth methods are the Lamaze technique and the Bradley method. Lamaze focuses on relaxation techniques, controlled breathing patterns and the support of a coach to help manage the pain of labor. Lamaze courses don’t advocate for or against the use of drugs and routine medical interventions during labor and delivery, but rather educate mothers about their options. The Bradley method places an emphasis on a natural approach to birth and on the active participation of the birth coach. A major goal of this method is good prenatal nutrition and the avoidance of medications unless absolutely necessary. Check with your health care provider for information on childbirth classes in your area.

19 Choosing a Doctor for Your Child You can use our online search tool at www.oxfordhealth. Learn how the practice works by asking: com to find information on participating network doctors, • What are the office hours? Flexibility of the doctor’s schedule specialists, hospitals, facilities and more. You can also order may be a concern, especially if you work outside the home; a roster of participating physicians and providers online, or you may prefer a doctor who offers weekend and evening ® through Oxford Express , our automated telephone system, at hours. 1-800-444-6222. • Is this a solo or group practice? If it’s a solo practice and your When it comes to medical care for your child, there are three doctor is not available on weekends or evenings, what are his types of qualified providers: pediatricians (doctors who specialize or her coverage arrangements? If it’s a group practice, what in health care for children from birth through adolescence), are the qualifications of the other doctors in the office? family physicians (doctors qualified to care for patients of all ages) and pediatric nurse practitioners (nurses with advanced • Does a pediatric nurse practitioner (PNP) work in the office? training in medical care for children). How does he or she fit into the practice arrangement? Considering that this doctor will be the first to treat your baby, • Which hospital is your doctor affiliated with? Will your doctor Courses That May you’ll want to be sure that you feel comfortable with the doctor’s come to the hospital to examine the baby once he or she is Interest You personality, office staff, location, and environment. A prenatal born? Who will care for your baby if he or she needs to be hospitalized? Like you, your family will also appointment is an excellent opportunity for parents to ask benefit from knowing what to questions and meet the office staff. • How does the office handle phone inquiries during and after expect when you go into labor. The interview is also a great time to observe office procedures. hours? Are special times set aside for parents to call in with questions or is there an open advice line (usually staffed by Some classes have one session Scrutinize the reception area. How many children are waiting? Is a “phone nurse”) during working hours? How are after-hours just for fathers, or one for soon- there a place where sick children can be separated from those to-be big brothers and sisters. in for a well visit? Is the staff polite and considerate? calls handled? Is e-mail communication with the office an option? Some even offer a special Next, get a feel for the doctor’s personality. Is he or she patient session for new grandparents, and willing to explain things carefully? Do you get the impression • Will your child’s doctor handle emergencies, or will your child which is a great way to get them that he or she would be supportive if you requested a second be referred to an emergency room or urgent care center? Are involved and to make sure opinion? Is the doctor a good listener who seems responsive to these facilities equipped to handle pediatric emergencies? they’re up on the latest in baby your concerns? Are you comfortable asking questions, or do you • What are the doctor’s practices regarding referrals to care techniques and safety. feel intimidated? specialists? Many classes also address what to expect after the baby is born, You also should be sure that your parenting style matches • Are lab tests done in the office? Most offices can perform including breast feeding, baby your doctor’s on important issues. How does the doctor feel basic tests, such as complete blood counts, urine testing, care and dealing with the about circumcision? Breastfeeding? Alternative or integrative and rapid strep tests rather than send samples out to a emotional changes of new medicines or techniques? Immunizations? Philosophical issues laboratory. parenthood. may not seem important before you give birth, but if you consider that this doctor may see your child for years to come, agreement on larger issues becomes more significant.

20 Creating a Safe Environment From the moment of birth, you’ll be overwhelmed with a desire Visitors to protect your baby. Keep these helpful hints in mind in It’s a good idea to limit your newborn’s guest list early on. Babies preparing for your newborn to come home: can become overstimulated and cranky if there are too many people around, plus their immature immune systems make them The Nursery more susceptible to illness. Ask anyone who’s sick to wait until Your baby will spend a lot of time in a crib. Make sure it’s up they’re feeling well and are no longer contagious before they to today’s safety standards, with no protruding screws and with visit. You should also ask visitors to wash their hands before sides that latch securely. The mattress should be firm and fit holding your baby. snugly against the sides. Soft toys and pillows should be kept out of the crib because these items can suffocate a baby. Keep Pets the cords of drapes and window shades well away from little Bring home a blanket with your baby’s scent on it – even before hands. Before your child can stand, move the crib to its lowest leaving the hospital. This will help to familiarize your pet with the position. new baby. But remember, even if your pet seems fine around If there’s one rule about babies, it’s to expect the unexpected. your baby, the two should never be left alone together. Using Your Safety Babies reach, grasp, roll, and eventually crawl. It’s incredibly Seat Correctly easy for them to fall off changing tables, sofas, and beds. Keep The National Highway Traffic your baby safe by never leaving him or her alone on a high Safety Administration (NHTSA) surface, even for a second. has set up child seat inspection stations across the country. If The Car you need help installing your Using a child safety seat (car seat) is the best protection you safety seat or would like us to can give your child when traveling by car, and all 50 states check whether you’ve installed require one for bringing your baby home from the hospital. Child your seat properly, visit safety seats can reduce the risk of a potentially fatal injury by www.nhtsa.dot.gov. 69% for babies younger than one year old. Yet as much as 80% of all safety seats are used incorrectly.

21 How Will I Know When It’s Time? Meeting Your Baby No two labors are alike, but here are some general signs that Bluish, waterlogged and covered with a white, cheesy coating could indicate your baby’s on the way: … isn’t your baby adorable? • Contractions that are growing more intense, becoming more No doubt you’ll think your baby is beautiful the first moment you regular, lasting longer, or getting closer together. Be sure to lay eyes on him or her. But the truth is, it’s a rough trip down time them from the start of one to the start of the next. the birth canal. Newborns are tiny, wet creatures when they first • Your water breaks. Whether you experience a gush or a emerge. Their heads are pointy, their faces puffy and their eyes trickle, note the color, odor, and amount of the fluid, and the are often swollen shut. time it occurred, then call your health care provider. They also may look scrunched up because the cramped quarters • Lower back pain that feels like premenstrual cramping. of the womb kept their arms and legs bent at the elbows and knees. Hands and feet may be bluish, and nails appear paper- • The appearance of bloody show (a brownish or blood-tinged thin and very long. Skin may be wrinkled, mottled and covered mucous discharge) or the hardened mucous plug (the plug with a white, cheesy coating called vernix, which protected the that seals the cervix and protects the fetus from infection). skin from constant exposure to amniotic fluid. Some babies The Well­-Stocked Unsure about when to go to the hospital? Call your doctor to actually look furry because of lanugo, a fine hair that develops Labor Bag see what he or she recommends. all over the body in the womb. Photo or object to use as Not to worry. Within a few days, the head will take on a rounded a focal point appearance. Facial swelling will go down. The limbs will Books, music, cards straighten out, and that folded ear, flattened nose or crooked jaw caused by passage through the birth canal will move back Pillows, Stopwatch, Camera into place. Vernix will be washed off during the first bath, and Food for support person, or lanugo will disappear after a week or two. And your baby will still change for vending machines be the most beautiful thing you’ve ever seen. Lip balm and toiletries

Robe, nightgown, slippers, socks

Nursing bra, breast pads and sanitary napkins

A phone to spread the news

Going-home clothes for mom and baby

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Guide to this Section 24

Newborn Care Advice on how to feed your baby, You’re home with your baby. how much sleep a newborn needs, the basics of baby care, and soothing a crying baby. Now what? 28 It’s Perfectly Normal From cradle cap to spit-up, here’s a recap of the strange yet perfectly typical things you’ll notice about your newborn.

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When to Call the Doctor Signs and symptoms in an infant that would warrant a call to the doctor.

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Taking Care of You What you can expect to feel physically and emotionally after you give birth, plus important information on postpartum depression. Newborn Care Breastfeeding Bottle-feeding Breast milk is the best food for babies. It’s nutritionally perfect, As with breastfeeding, let your baby set the pace for how often plus it contains antibodies that help protect a baby from illness. he or she wants to eat. Its composition even changes over time to meet your baby’s In the beginning, most bottle-fed infants take about two to nutritional needs as he or she grows. All that, and it doesn’t three ounces of infant formula every two or three hours. At two cost a cent! months, they require about four to five ounces of formula at It’s generally recommended that you nurse your baby whenever each feeding. By three months, they’ll probably take another one he or she seems hungry (demand feeding) rather than on a set or two ounces per feeding. At four months, about 30 ounces of schedule. Your baby may cue you to his or her hunger by crying, formula takes care of a baby’s nutritional requirements for the putting fingers in the mouth or making sucking noises. day. Be sure to always follow the instructions on the label when A newborn baby may need to be fed as often as every two preparing your baby’s formula. hours or perhaps more frequently for a while. Give your baby the Feeding your baby, whether by breast or bottle, provides a Feeding Your Baby chance to nurse about 10 to 15 minutes at each breast. Watch great opportunity for snuggling and bonding. Always hold your for signs that your baby is full (such as slow sucking or turning baby during feeding times; don’t leave him or her unattended Have you decided whether to away), and stop the feeding session once these signs appear. to drink from a propped bottle. This can lead to choking, and breast feed or bottle-feed your the formula that remains in your baby’s mouth can lead to tooth child? Your child’s doctor or a If you’re breastfeeding, you may wonder how you’ll know if your decay later on. lactation consultant can provide baby is eating enough. If he or she seems satisfied, produces excellent guidance. about six wet diapers and several mustard-yellowish stools a As your baby gains weight, he or she should begin to eat more Whichever method you choose, day, sleeps well and is gaining weight regularly, he or she is at each feeding and go longer between feedings. Still, there feeding your newborn should be probably fine. Your breasts should also feel soft after nursing. may be times when your baby seems hungrier than usual. an unhurried, enjoyable Some signs your baby is not getting enough and could be Continue to nurse or feed on demand during this time. Even experience for both of you. becoming dehydrated include too few wet diapers, a sunken after your baby starts on some solid foods by about four to six soft spot on the head and a dry mouth. months, formula or breastmilk will remain the majority of your By two to three months of age, breastfed babies will probably baby’s diet through the first year of life. want to nurse six to eight times a day, sometimes more if they’re Talk to your child’s doctor if you have concerns about your going through a growth spurt. Nursing mothers need not worry; child’s growth or if you need to awaken your newborn frequently breastfeeding stimulates milk production, and your supply of to eat or continually urge your baby to drink from the bottle or breast milk will automatically adjust to your baby’s demand for breast. it. Just remember to stay well nourished yourself. Nursing moms require about 500 extra calories a day, plus extra calcium and lots of water.

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Sleep and Your Baby “Does your baby sleep through the night?” is one of the You can help adjust your baby’s body clock toward sleeping questions new parents face the most. And the bleary-eyed at night by avoiding stimulation during nighttime feedings and moms and dads almost always answer: “No.” diaper changes. Keep the lights low, and resist the urge to play or Newborn babies don’t know the difference between day and talk with your baby. This will reinforce the message that nighttime night yet, and their tiny stomachs don’t hold enough formula to is for sleeping. You can begin to establish some sort of bedtime keep them satisfied for very long. They need food about every routine (bathing, reading, singing) that should help get your baby three or four hours, no matter what time of day or night it is. to settle down when he or she is a bit older. Even though your newborn may be too young to get the signals yet, setting up the A newborn may sleep as much as 16 hours a day, often in bedtime drill now can keep you on the right track later. stretches of three to four hours at a time. At first, these short stretches may be frustrating for you as they interfere with your Check with your doctor if you think your baby is sleeping too own sleep patterns. Have patience. By three months, about 90% much, is difficult to rouse or shows little interest in eating. of babies sleep through the night (between six and eight hours), Circumcision and Umbilical Cord Care Back to Sleep but if your infant doesn’t, it’s not a cause for worry. Like adults, babies must develop their own sleep patterns and cycles. Immediately after circumcision, the tip of the penis is usually The American Academy of covered with gauze coated with petroleum jelly to keep the Pediatrics (AAP) recommends For the first weeks of life, most parents place their child’s crib that you always place your infant wound from sticking to the diaper. Gently wipe the tip clean or bassinet in their own bedroom. A separate room just seems on his or her back to sleep, not with warm water after a diaper change. Redness or irritation of too far away, especially if you’re breastfeeding. Most doctors on his or her side or stomach, to the penis should heal within a few days, but if the redness or recommend against bringing your infant to sleep in the bed with reduce the risk of Sudden Infant swelling increases or if pus-filled blisters form, infection may be you for safety reasons. The risk of suffocation is greatest if you Death Syndrome (SIDS). present and you should call your baby’s doctor immediately. are overweight or have been drinking alcohol because you are Try alternating the position of less alert and could roll over onto your baby. Umbilical cord care in newborns is also important. Try to keep your baby’s head from night to the area clean and dry until the cord stump dries up and falls night to help prevent a flat spot Always keep safety in mind. Keep blankets and stuffed animals off, usually in 10 days to three weeks. If it becomes dirty, gently (plagiocephaly) from developing out of the crib or bassinet, as well as any objects with cords, wash with soap and water. The infant’s navel area shouldn’t be on one side of the head. ties, or sharp corners. Make sure the crib you are using is up to submerged in water until this happens. Call your baby’s doctor if today’s safety standards. the navel area becomes reddened or if a foul odor or discharge develops.

25 Diapering Whether you choose cloth or disposable, make sure all diapering When your baby is ready for tub baths, the first baths should supplies (a diaper; fasteners, if needed; warm water and cotton be gentle and brief. Use warm – not hot! – water (test the squares, or a diaper wipe; diaper ointment; and a changing pad) temperature with your elbow or wrist). When rinsing your baby’s are within reach before you start. Babies should never be left hair, cup your hand across the forehead so suds don’t get in unattended on a changing table, even for a second. the eyes. After the bath, wrap your baby in a towel immediately, When removing a boy’s diaper, remember to do so carefully making sure the top and back of his or her head is covered. because exposure to air may make him urinate. When wiping Hooded baby towels are great for keeping a freshly washed a girl, wipe her bottom from front to back to help avoid urinary baby warm. NEVER leave your baby alone during a bath. tract infections. Always wash your hands well after changing a Burping diaper. Babies tend to swallow air during feeding and can become Diaper rashes are common in babies. To prevent and heal diaper fussy or spit up if they are not burped frequently. Try burping rash, change diapers frequently, use a diaper ointment with zinc your baby every two to three ounces if you bottle-feed, and each oxide, and let your baby go undiapered for part of the day (lay time you switch breasts if you breastfeed. Gently pat your baby’s him or her down on a few cloths or towels). If the rash doesn’t Bathing Tip back as you hold him or her against your chest or as he or she clear up in two or three days, call your child’s doctor. A bath two or three times a week sits up or lies face down on your lap (remember to support the in the first year is sufficient. Bathing head). Burp again when feeding time is over. You might want to More frequent bathing may dry place a cloth under your baby’s chin or on your shoulder to make out baby’s skin. Give your baby a sponge bath (don’t submerge the baby in cleanup easy if he or she spits up. water) until the umbilical cord falls off and, if you have a boy who’s been circumcised, the penis is completely healed. Trimming Nails Make sure you have everything you need before you begin: a Trimming your baby’s nails for the first time can be unnerving, wash cloth, mild soap and shampoo, a soft brush, a towel, a but keeping nails short can help keep babies from injuring clean diaper, and clothes. themselves. Find a position that allows you easy access to your Pick a warm room and a flat surface, such as a changing baby’s hands. This may mean waiting until your baby is asleep or table. Undress your baby down to the shirt and diaper. Gently even performing the task with a partner: one person holding the wipe your baby’s eyes and face with water only and pat dry. baby and the other trimming the nails. Use baby nail scissors, Next, using baby shampoo, gently wash your baby’s head and which have rounded tips for safety. rinse. When washing your baby’s body, pay special attention to creases under the arms, behind the ears, around the neck, and the genital area.

26 Taking a Temperature Your Crying Baby If you need to take your baby’s temperature, your best bet is to Babies cry a lot, even when nothing’s wrong. Sometimes your use a digital thermometer, which can be used to take rectal (in baby’s cries are sending a message, such as he or she: has the bottom) or axillary (in the armpit) readings. Taking a rectal an empty belly, a wet bottom or cold feet, or is tired, bored, temperature gives the most accurate reading; axillary is the overstimulated, or in need of cuddling. Many moms will tell you next best choice. Once your child is older than three months, that learning to differentiate between your baby’s many cries is a tympanic (ear) thermometer may also be used, although they one of the early joys of parenthood. are expensive and not as accurate. Still, your baby’s first extended crying period at home will To take a rectal temperature, place your baby face down across probably be upsetting to you. Young babies typically cry for one your lap, supporting his or her head, or lay your baby down on to five hours within a 24-hour period, and you can’t always calm a firm flat surface. While holding one hand against your baby’s them. Fortunately, crying usually decreases gradually after lower back to keep him or her still, use the other hand to insert six weeks. the lubricated thermometer through the anal opening, about Don’t be too upset when you aren’t able to console your one- half to one inch into the rectum (stop if you feel any newborn immediately. He or she may just need a good cry. resistance). Read and record the number on the screen, noting Swaddle your baby, sing a lullaby, walk the floor – just let your What’s Considered the time of day that the reading was taken. baby know you’re there. You can’t spoil a newborn by being a Fever? To take an axillary temperature, remove your child’s shirt and too responsive. undershirt and place the thermometer in your child’s armpit. Fold A rectal temperature of Though it may seem impossible now, in a few months it will be 100.4 degrees Fahrenheit your child’s arm across his or her chest to hold the thermometer difficult to recall even the worst of your baby’s crying jags. Plus, (38 degrees Celsius) or higher in place until the reading is complete. usually during your newborn’s first month, you get a glimpse of in an infant younger than three the first smile and perhaps hear the first laugh or giggle. What months of age should be Swaddling Your Baby welcome additions to your baby’s communication repertoire! brought to the attention of the Swaddling is a technique that keeps your baby’s armsclose to child’s doctor immediately. his or her body and his or her legs securely bound. Not only Even a slight fever can be a sign does this keep your baby warm, but the surrounding pressure of a potentially serious infection seems to give most newborns a sense of security and comfort. in very young infants.

Here’s what to do: Spread out the receiving blanket, with one corner folded over slightly. Lay the baby face up on the blanket with his or her head at the folded corner. Wrap the left corner over the baby’s body and tuck it beneath. Bring the bottom corner up over your baby’s feet. Wrap the right corner around your infant, leaving only the neck and head exposed.

27 Is It Colic? Your baby cries every afternoon for hours at a time, and the Spitting up is not the same as vomiting all or most of a feeding crying has worn you down to the point where you feel like If your baby seems to be spitting up too much, try keeping him joining in. What could be upsetting your baby? or her in an upright position (but not slouched forward) for 10 to 15 minutes after a feeding. If that doesn’t help, call your child’s When a healthy baby cries like this, chances are that it’s colic. doctor. In some cases, there may be an allergy or digestive Colic is not a physical disorder or disease. Doctors define colic problem, or it may be gastroesophageal reflux disease (GERD). as three or more hours a day of continued crying. The crying is For babies with GERD, breast milk or formula regularly backs up not due to illness, hunger, a wet diaper, or other visible causes, into the esophagus and sometimes back up and out of the mouth. and the child cannot be calmed down. The good news is that colic usually goes away by three months of age. Because stomach acid is part of what’s refluxed, the esophagus There is no single treatment that always gives relief to can become irritated, making eating painful. Some signs of infants with colic, but there are some things you can do to GERD are vomiting and irritability after meals, an inability to try to soothe your baby: sleep soundly, and frequent “wet burps” or “wet hiccups.” • Walk with your baby or sit in a rocking chair, trying various Skin Rashes Did You Know? positions. Several harmless skin rashes and conditions may be present Pacifiers got their modern form • Because a colicky baby swallows a lot of air during crying at birth or appear during the first few weeks. Tiny, flat yellow or around 1900, patened as a spells and can become gassy, try burping your baby more white spots on the nose and chin, called milia, are caused by the “baby comforter”. often. You could also place your baby across your lap on his collection of secretions in skin glands and will disappear within or her belly for a backrub. the first few weeks. • Put your baby in a swing or bouncy seat or take him or her for Miliaria – small, raised red bumps that often have a white or a ride in the car. The motion may have a soothing effect. yellow head – is sometimes called infant acne because of its • Try running the vacuum cleaner, the washing machine, or a appearance. Although miliaria often occurs on the face and may loud fan. Colicky infants often respond to white noise. be present on large areas of the body, it too will go away within the first several weeks with normal skin care. Caring for a colicky baby can be extremely frustrating, so be sure to take care of yourself, too. If you need a break from your Newborn jaundice – a yellowish discoloration of the skin baby’s crying, call a friend or relative and ask for help. And if – is a common condition that occurs in half of all babies. It you’re feeling overwhelmed or angry, put your baby safely down normally doesn’t appear until the second or third day of life and in a crib and walk away into another room where you can relax disappears within one to two weeks. Jaundice in healthy babies and regain your composure. Remember: NEVER SHAKE A is caused by an inability of the newborn’s immature liver to clear BABY, as this can severely injure an infant. bilirubin (a waste product produced by the normal breakdown of red blood cells) from the body effectively. A mild or moderate level of jaundice will go away on its own by five to seven days of It’s Perfectly Normal age. If jaundice is more pronounced, phototherapy – exposure of the baby to ultraviolet light that helps rid the body of the Spitting Up bilirubin – may be prescribed. It’s normal for babies to spit up small amounts of formula or breast milk following a feeding, especially when being burped or bounced in play. This happens because babies’ digestive tracts are immature. 28 Cradle Cap Soft Spots Seborrheic dermatitis, or cradle cap, often appears in the first Because of the separation of your newborn’s skull bones, few weeks of life as greasy white or yellowish scales on the you’ll be able to feel (go ahead, you won’t harm anything) two scalp and sometimes on the eyebrows and behind the ears. fontanels, or soft spots, on the top of the head. Don’t be alarmed Cradle cap is mostly a cosmetic problem. The scales can if you see the fontanels bulge out when your baby cries or be quite thick and can make the hair hard to comb. Routine strains. The fontanels will eventually disappear as the skull shampooing and massaging of an infant’s scalp with a soft bones close together. brush twice a week to remove any crusts usually prevents the condition from becoming a problem. It almost always goes away Bowel Movements, Gas and Constipation on its own in a few months. Babies’ bowel movements change often in terms of color, Reflexes consistency, and frequency. Breastfed babies tend to have seedy, mustard-yellow stools, and they tend to have them more Infants are born with a number of instinctual responses to often. Formula-fed babies tend to have stools that are yellowish- stimuli, such as light or touch, known as primitive reflexes. tan. The number of stools can vary from six to eight per day to Primitive reflexes gradually disappear as the baby matures. one every other day. As long as your baby is eating well and Primitive reflexes include: the sucking reflex, which triggers an seems otherwise healthy, these variations are all normal. Sleeping Through infant to forcibly suck on any object put in the mouth; the grasp The Night reflex, which causes an infant to tightly close the fingers when Newborns also tend to swallow a lot of air while eating and pressure is applied to the inside of the infant’s hand by a finger crying – and what they don’t get out by burping will travel down By 3 months old, 90% of or other object; and the Moro reflex, or startle response, which the gastrointestinal system until it reaches the other end. Gas babies will sleep through night causes an infant to suddenly throw the arms out to the sides may also be caused by sensitivity to certain formulas or to a (between 6 and 8 hours). and then quickly bring them back toward the middle of the body food consumed by a breastfeeding mother. Gas can be very All fluffy bedding, sheepskins, whenever the infant has been startled by a loud noise, bright uncomfortable for some babies. If your baby seems especially quilts, stuffed animals, and light, strong smell, sudden movement, or other stimulus. fussy and gassy, especially after meals, call your baby’s doctor. pillows should be removed from the crib for your baby’s safety. Breathing Patterns Some babies grunt and turn red in the face when having a bowel movement because the process is not yet coordinated. It’s normal for young infants to breathe irregularly. They This is not the same thing as constipation. Constipation refers commonly will have periods during which they stop breathing to small, hard balls of stool that are difficult to pass. Formula- for about five to 10 seconds and then start up again on their fed babies tend to experience constipation more often than own. When he or she is awake, an infant’s breathing rate may breastfed babies do. vary widely, sometimes exceeding 60 breaths per minute for short periods of time, particularly when the baby is excited or following a bout of crying.

Strange Noises Although he or she won’t be talking until later, your newborn will produce a symphony of noises – grunts, moans, high pitched squeaks – in addition to the obligatory crying. Sneezing and hiccups occur very frequently and don’t indicate infection, allergies, or digestive problems in newborns. 29 When to Call the Doctor Your baby’s health care provider expects questions from new parents on just about every topic. They’d rather have you call than worry about something needlessly. You should also call if you see any of these signs: • rectal temperature of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher in a baby younger than three months • symptoms of dehydration (crying without tears, sunken eyes, a depression in the soft spot on baby’s head, no wet diapers in six to eight hours) • a soft spot that bulges when your baby’s quiet and upright • a lethargic or difficult-to-rouse baby • rapid or labored breathing (immediately call 911 if your baby begins turning bluish around the lips or mouth) You’re the Expert • bloody vomit or stool Remember that you’re an • more than eight diarrhea stools in eight hours (breastfed newborns often have looser stools than expert when it comes to what’s formula-fed babies; check with your child’s doctor for guidance) normal for your child. If you see • any change in the baby’s color, especially paleness or bluish color of the lips and tongue something unexpected or different that concerns you, • baby suddenly becomes “floppy” with loss of muscle tone or becomes stiff call your doctor. • one or both eyes are pink, bloodshot, have a sticky white discharge, or eyelashes that stick together • tenderness, spreading redness, or foul odor around the umbilical cord area • white patches in the mouth • nose blocked by mucus so baby can’t breathe while feeding • forceful vomiting or an inability to keep fluids down • vomiting that lasts for six hours or more or is accompanied by fever and/or diarrhea • baby stops feeding normally • crying for an abnormally long time If your concern is urgent, take your child to a hospital emergency room. With young infants, minor conditions can quickly become serious.

30 Taking Care of You Depending upon your labor and delivery experience, you • Keep your sense of humor, and remember that it can take may feel physically drained and sore. Your hormones may be some time to adjust to parenthood. You’ll be less stressed if struggling to catch up, too. Your baby’s not on any kind of you just try to go with the flow. schedule yet, and your partner may be feeling a little left out. Baby Blues and Postpartum Depression All new parents feel overwhelmed sometimes and question their parenting skills from time to time. In addition to asking You’re the proud mother of a beautiful baby. So how can it be your health care provider for advice, many parents also find it that you’re feeling so unhappy? helpful or reassuring to get information or tips from a trusted Feeling depressed after giving birth is more common than child health or parenting website, such as those listed at the you might think. There are three forms of depression that can end of this booklet. A key to your post-baby sanity is your ability occur after delivery, all of which result from hormonal changes, to recruit help. While in the hospital, use the expertise around exhaustion, unexpected birth experiences, and a sense of lack you – nurses and lactation consultants, for example. At home, of control over your altered life. relatives and friends are great resources. • “Baby blues” – About 80% of new moms experience Find someone to talk to about your feelings. Just knowing that irritability, sadness, crying, or anxiety in the postpartum period. Treat Yourself you’re not alone can help. Here are some other tips for keeping The baby blues typically peak three to five days after delivery Postpartum depression is it all in perspective: and usually resolve within about 10 days after childbirth. treatable, and you don’t have • Set aside time to be with your partner to talk about the changes • Postpartum depression (PPD) – More serious than the baby to face it alone. There’s lots of in your lives. Be open about your feelings and worries. blues, this condition affects 10% to 20% of new moms. It help out there. With support from friends and family and • Let friends and family members help you with child care, may cause sadness, weepiness, a lack of interest in almost proper medical attention, you household chores and errands. all activities, anxiety, insomnia, and guilt that lasts longer than can put postpartum two weeks. Your baby may be several months old before PPD • Find time to do something for yourself, even if it’s only 15 depression behind you. strikes, and it’s more common in women with a family history minutes a day. Try reading, doing something creative, taking a bath, or meditating – anything that you enjoy and find relaxing. of depression. • To fight fatigue and depression, you need your rest. You may • Postpartum psychosis – Postpartum psychosis is a severe and not be able to get eight consecutive hours of sleep, but try to rare (0.1% to 0.2% of women) condition that makes it difficult sleep whenever your baby naps. to think clearly or function, and often causes women to have thoughts about harming themselves or their babies. If you • Exercise, even if it’s just walking around the block a few times. experience any such feelings, call your doctor immediately. The activity and change of scenery can improve your frame of mind and health. It can be difficult to admit you’re having persistent negative feelings or thoughts about motherhood. But if you think you • Eat well, and stay away from caffeine and alcohol. have PPD, or any form of depression, it’s important to discuss • Keep a journal. Write down your feelings and emotions as a your feelings with your doctor. PPD can have long-term effects way of releasing and dealing with them. on a child’s health and emotional well-being, especially if the • Even if you can only accomplish one goal per day, it’s a step condition goes undiagnosed or lasts a long time. in the right direction. There may be days when you can’t get anything done – and that’s normal for many parents. 31 Websites Books

BabyCenter The Complete Book of Breastfeeding Articles, message boards, and chats on a broad range of By Marvin S. Eiger, MD and Sally Wendkos Olds. pregnancy and infancy topics, plus an online store. Published by Workman Publishing. www.babycenter.com. Guide to Your Child’s Nutrition iVillage Pregnancy & Parenting By the American Academy of Pediatrics. A forum for parents to chat with one another about children Published by Villard Books. and ask experts their questions. Also contains information about various aspects of adoption, checklists, newsletters, and The KidsHealth Guide for Parents: state-by-state resources. www.parenting.ivillage.com Pregnancy to Age 5 By Steven A. Dowshen, MD; Neil Izenberg, MD; and Elizabeth Bass. KidsHealth Published by Contemporary Books.. Provides doctor-approved health information about children— from before birth through adolescence. www.kidshealth.org The Pregnancy Book By William Sears, MD, and Martha Sears, RN. Published by Little Brown & Co.

Pregnancy for Dummies By Joanne Stone, MD; Keith Eddleman, MD; and Mary Murray. Published by IDG Books Worldwide.

What to Expect When You’re Expecting By Heidi Murkoff, Arlene Eisenberg, and Sandee Hathaway, BSN. Published by Workman Publishing.

32 Organizations

American Academy of Family Physicians Lamaze International Provides information on family physicians and healthcare and Promotes the Lamaze method of childbirth and includes a includes a directory of family physicians on the web. locator of educators by area. www.lamaze.org. www.familydoctor.org 1-800-368-4404

The Bradley Method® of Natural Childbirth La Leche League International Describes the Bradley method of childbirth and helps Offers support, encouragement and education to expectant parents find an instructor in their area. breastfeeding mothers. www.llli.org. 1-800-525-3243 www.bradleybirth.com. 1-800-4-A-BIRTH March of Dimes American Academy of Pediatrics Information on preventing birth defects, infant mortality and This professional organization of pediatricians offers news low birth weight. www.marchofdimes.org. 1-888-663-4637 articles and tips on children’s health from birth to adolescence. www.aap.org Department of Health and Human Services Centers for Disease Control and Prevention— American Congress of Obstetricians and Vaccines & Immunizations Gynecologists Up-to-date information on childhood immunizations. This organization of women’s healthcare specialists provides www.cdc.gov/vaccines. Hotline: 1-800-232-4636 information on pregnancy, labor, delivery, postpartum care, and breast health. www.acog.org Safe Kids USA® Information on car seats, crib safety and other child-safety American College of Nurse–Midwives topics. www.safekids.com Describes the philosophy of nurse-midwifery care and provides an online locator tool. www.acnm.org. 1-240-485-1800

Wishing you the best of health We are committed to helping you become informed and educated at this exciting time in your life. We hope this guide has answered some of your questions, and helps you take an informed and active approach to your overall health. If you would like more information, log on to our website at www.oxfordhealth.com. Oxford HMO products are underwritten by Oxford Health Plans (NY), Inc., Oxford Health Plans (NJ), Inc. and Oxford Health Plans (CT), Inc. Oxford insurance products are underwritten by Oxford Health Insurance, Inc. MS-10-450 © 2010 Oxford Health Plans, LLC. 7312 R4