BlueCareSM TennCareSelect

For Mothers-To-Be Helping take care of you and your baby

Table of contents: Resources for You . 1 First Trimester: Weeks 1-13 ...... 2 Your First Doctor Visit. 3 Your First Tests. 4 Warning Signs During . 5 How Big is Your Baby?. 6 Your Health Affects Your Pregnancy . 8 Things to Avoid. 9 Sexual Intimacy During Pregnancy. 10 Having a Baby Costs Money. 11 Just for Dads. 12 Second Trimester: Weeks 14-26 ...... 13. . . . Visiting Your Doctor. 14 Some Tests Your Doctor Might Do. 15 Your Health, Changes in You. 16 How Big is Your Baby?. 18 Things to Avoid. 20 Third Trimester: Weeks 27-40 ...... 21 . . . . Visiting Your Doctor. 22 Your Health, Changes in You. 23 How Big is Your Baby?. 25 Understanding Labor . 27 Tests Your Doctor Might Do at Your Last Visits . 27 Preparing for Birth . 28 Dad Tips. 29 Postpartum: Week 40 and beyond ...... 30 . . . . Your New Mom Checkup. 31 Baby Blues. 32 Your Health. 33 Guide for Breastfeeding Moms. 34 Helpful Breastfeeding Tips. 35 Baby’s First Checkup. 36 Newborn Testing. 37 TENNderCare Well-Child Visits. 38 Protect Your Child from Secondhand Smoke. 39 Safe Sleeping. 40 First Year Milestones. 41 Dad Tips. 42 How to Plan Before You Get Pregnant Again. 43 Dangers of Becoming Pregnant While Using Drugs ...... 45 . . . CaringStart Offers You Support Pregnancy can be a thrilling and wonderful part of a woman’s life. But it can also be a little scary. Every woman has questions about what to do and what not to do, to make sure she has a healthy pregnancy and a healthy baby. Most women do not have problems during pregnancy. But sometimes complications can still develop no matter what you do. Over the next nine months, you will be going through many different and exciting changes. You may also run into some challenges. At BlueCare Tennessee, we want to offer you support during your pregnancy. Our CaringStart maternity program can help. It is voluntary and does not take the place of your doctor’s care. We work with your doctor to make sure you get the quality care you need. At the same time, we give you valuable resources to help you make healthy choices during your pregnancy and after the birth of your baby. As part of the program, you may receive: • Personal support from our maternity nurses • Important educational information about before, during and after pregnancy • Coordination of care and services • An individualized plan of care developed by your CareSmart nurse with input from you and your doctor • A ride to your doctor’s office or clinic. Do You Have Questions? Our team of nurses is available to answer any questions you may have. You can contact them daily, Monday to Friday, from 8 a.m. to 6 p.m. (ET). Just call the toll-free number at 1-888-416-3025. We look forward to working with you and helping you and your baby be as healthy as possible! Resources for • Health Information Library. children birth through the You Listen to taped messages on 5 years and their primary BlueCare Tennessee covers more than 1,200 health topics. caregivers. Visit http://health. your health care for you during The toll-free number is 1-800- state.tn.us/MCH/HUGS.shtml pregnancy and for your newborn. 999-1658. The messages are for more information. Other special benefits available to available 24 hours a day, 7 days • The Tennessee Breastfeeding you are: a week. Just press the 1 key and Hotline . The toll-free number then follow the steps. is 1-855-4BF-MOMS (1-855- • The Women, Infants and 423-6667). Speak to a Certified • 24/7 Nurseline. Speak to a Children (WIC) program. This Lactation Counselor or Registered Nurse (RN) anytime is a special supplementary Consultant 24 hours a day, 7 - 24 hours a day, 7 days a week food program for women, days a week, who can provide by calling 1-800-262-2873 to infants and children up to age up-to-date information and get answers to your health 5. For more information, call support and address common questions. your local health department. questions and concerns about • Text4baby. You can get free Or you may call the toll-free breastfeeding. healthy pregnancy and healthy phone number 1-800-DIAL- baby messages by text every WIC (1-800-342-5942). week. Just text the word • HUGS . The Help Us Grow “BABY” (or “BEBE” for Spanish) Successfully (HUGS) program to the number “511411” to get provides home-based started. Or register online at intervention services to text4baby.org. pregnant/postpartum women,

1 Getting Started

First Trimester: Weeks 1-13 Congratulations! Your Journey to Motherhood is Underway You’re pregnant! CaringStart created this booklet especially for mothers-to-be just like you. This book will give you valuable information about what to expect and look for during the first trimester of pregnancy. By staying informed about pregnancy, you can learn what you need to do to keep both you and your precious baby healthy. Enjoy your new adventure!

2 Your First Doctor Visit is the health care person will also deliver your baby. you get when you are pregnant. Choosing the right health care It includes care given by your provider is only the first step to doctor and the care you give prenatal care. yourself. The first prenatal care appointment with a doctor The next step is building a good should be made as soon as you relationship with your health care think you are pregnant. provider. A good relationship between you and your provider Prenatal care is a priority. Seeing is an important part of good a doctor often can improve your health care. You must be able chances of having a healthier to communicate well with each baby. Regular office visits can other so that your needs are met. also help keep you from having Remember that patients who your baby too early. Plus, you have good relationships with can cut the chances of having their providers tend to be more other serious problems during satisfied with their care. They pregnancy. are also more apt to have better results. You can choose either a doctor Source: http://www.womenshealth.gov/ or to take care of you publications/our-publications/fact-sheet/ during your pregnancy. This prenatal-care.cfm#b

3 In addition, the doctor will give Your First a female sex organ exam to feel the size and shape of the . Tests Other lab tests may also be done. Your first prenatal visit is a The results of these tests help the milestone. At the doctor’s office, doctor plan the most appropriate you’ll go through a series of tests care for you. and checks. This includes having your weight and blood pressure Besides the physical exam, checked. Your doctor might also your doctor will ask you many check the outside of your belly questions about your medical to find out the size and history and any family health of your baby. He or she might problems. Your answers could have you take a urine test too. help determine if your baby is at risk for genetic diseases. During During this first prenatal visit, the visit, you should also get you will also take a full physical a chance to hear your baby’s exam. You might need a Pap test heartbeat for the first time! to screen for cervical cancer as Your doctor will use a special well, depending on how long it’s instrument to listen for it. been since your last screening. Source: http://www.mayoclinic.com/ health/prenatal-care/PR00008

4 Warning Signs During Pregnancy: When to Call Your Doctor Or Go to the ER

It’s tricky to know which to monitor your baby’s fetal symptoms during pregnancy movement. Call your doctor if deserve immediate medical there is a dramatic change in attention and which can wait your baby’s usual movement. until your next prenatal visit. While you’re waiting, try doing Always share your concerns with the opposite of whatever your doctor during visits. But you were just doing. If you keep in mind some symptoms were bustling around, lie or sit should not be ignored no matter down, elevate your feet and how early or how late you are enjoy a cup of ice water. If you in your pregnancy. Be sure to were lying down, get up and contact your doctor immediately move about. if you experience any of the • Contractions Early in the following: Third Trimester. Contractions could be a sign of preterm • Bleeding. Heavy bleeding labor. But it’s possible to with cramping could also be confuse true labor and false a sign of miscarriage in first labor. False labor contractions or early second trimester. are called Braxton-Hicks Bleeding with abdominal pain contractions. They’re in the third trimester may be unpredictable, non-rhythmic placental abruption. This is and do not get more intense. when the separates But regular contractions are If you need emergency from the uterine lining. Any about 10 minutes apart or less health care, go to the bleeding during pregnancy and do get more intense. If should be reported to your you’re in your third trimester nearest ER or call 911. doctor. But what if you’re not and think you’re having • Severe Nausea and Vomiting. contractions, call your doctor sure whether or not It’s very common to have right away. Your doctor may your condition is an some nausea when you’re be able to stop labor if it is pregnant. If it gets to be emergency? You can too early for the baby to be severe, that may be more born. call Nurseline anytime serious. Not getting the proper at 1-800-262-2873. A nutrients can harm your baby. Source: http://www.webmd.com/baby/ • Baby’s Activity Level Drops. guide/7-pregnancy-warning-signs registered nurse will help This applies to the second and you decide what kind of third trimester. Your doctor care you need. This is a may have already told you how free service to BlueCare and TennCareSelect members.

5 How Big Is Your Baby? Doctors measure pregnancy in weeks and months: 40 weeks, or 9 months total. The months of pregnancy are broken down into three parts called trimesters. The first trimester starts with your last menstrual period. Conception happens about two weeks after your period. The first trimester is an important time during the baby’s growth. That is why doctors tell you to prepare your body before you get pregnant. This means no alcohol or smoking. Eating well and exercising are also important.

3½-week 7½-week fetus At 3½ weeks, the fetus will have formed. By At 7½ weeks, the eyes move forward on the the end of the first month, your baby is a tiny face. The eyelids also begin to form. The roof tadpole-like embryo. Its size is smaller than a of the mouth separating the mouth from grain of rice. In the next two weeks, the neural the nasal cavity is almost complete. Also, the tube, heart, digestive tract, sensory organs, and tongue begins to form. The gastrointestinal arm and leg buds will begin to form. The neural tract separates from the genitourinary tract. All tube becomes the brain and spinal cord. vital organs have begun to form. By this time, your baby has grown to be about a half-inch. It’s now about the size of a raspberry.

6 8½-week fetus 10-week fetus 12-week fetus At 8½ weeks, the embryo now A fetus at 10 weeks of growth is Toward the end of the first looks like a human. Facial features about 2 inches long. This is about trimester, a fetus at 12 weeks can keep forming. The private parts the size of a lime. He or she has make a fist and suck its thumb. begin to form. But the rectal fully-formed eyelids and a well- It’s about 3 inches long and membrane is intact. Circulation formed face and ears. Around this through the umbilical cord is well weighs about an ounce. The time, the eyelids close and will baby has fingernails and toenails. developed. Long bones begin to not reopen until about week 28. form and start to take the place More organs are forming. The Tooth buds begin to show for the liver makes bile. Sex organs are of cartilage. By the end of the baby teeth too. second month, the embryo is developed. But it’s still hard to about 1¼-inches long from the tell the sex of the fetus. During head to rear end. One-third of it this stage, your doctor can let is the head. The embryo weighs you listen to the baby’s heartbeat about one-third ounces. This is with a special instrument. about the size of a kidney bean. Source: http://www.webmd.com/baby/ It now has a beating heart. It ss/slideshow-fetal-development also has arms and legs with the beginning of fingers and toes.

7 Your Health Affects Your Pregnancy

During the first three months of in pregnancy. This vitamin is pregnancy, or the first trimester, available in most multivitamins your body is going through many and some foods. Folic acid can changes. As your body changes, also be taken alone as a dietary you might need to make certain supplement. Talk to your doctor lifestyle changes to your normal, about your folic acid needs. everyday routine. Here are some of the most common changes Take prenatal vitamins . At your you might have to make during first prenatal appointment, pregnancy. your doctor will give you a prescription for prenatal vitamins. Eat healthy . You just need to eat Taking these, plus eating a healthy smart and make sure that most diet, ensures your baby gets the of your choices are healthy ones. vitamins and minerals needed That’s because the foods you eat for growth. Talk to your doctor can affect the growth of your about the best way to take your baby. Eat three regular meals a vitamins. day or six small meals. Avoid too much sugar and fat in your diet. Keep fit . Exercise can be a great way to stay in shape during is especially true during the first Choose foods that give you folic and third trimesters. Ten to 11 acid, protein, vitamins, minerals, pregnancy. It boosts your energy level, helps manage stress and hours a night is not unusual for and iron. These all provide pregnant women. To squeeze in nourishment for your growing gets you ready for the strain of labor. Working out can even keep enough hours of sleep, you may baby. Make sure you’re eating need to go to bed earlier than dairy products, leafy vegetables symptoms, like varicose veins and backache, to a minimum. Women usual. This is mainly the case if and dried beans. Good sources you find yourself waking up a few of iron include red meat, dried who work out while pregnant seem to recover faster after times during the night. So, go to beans, eggs, and leafy green bed when you feel tired. Don’t vegetables. Drink plenty of fluids their baby is born. One of the best exercises during pregnancy push yourself to stay awake until too (6-8 glasses a day). Keep in your usual bedtime. Also, rest mind that real 100 percent fruit is walking. Twenty minutes of walking a day can lift your spirits when you can during the day. juice or water is better for you Good times to rest are during than coffee or soda. Your doctor and strengthen your body. Swimming, low-impact aerobics, your lunch hour or before dinner. can advise you on what to eat If you work, take many breaks and drink during your pregnancy. and yoga are also good exercises. Talk to your doctor before to pace yourself and renew your Take folic acid . Folic acid is beginning any exercise program energy. a vitamin that is needed in while you’re pregnant. Sources: http://www.womenshealth.gov/ pregnancy. It helps prevent birth pregnancy/you-are-pregnant/staying- Get plenty of rest . Feeling tired healthy-safe.html;http://www.mayoclinic. defects of the brain and spinal com/health/pregnancy-and-exercise/ cord when taken very early is normal during pregnancy. This PR00096;

8 Things to Avoid In addition to taking on a healthy birthweight baby. But there’s no the fetus has little power to drive lifestyle, you should stay away solid proof caffeine causes these away the heat that the waves from things that could harm you problems. Until more is known, create. and your baby. Making healthy you should limit the amount changes throughout pregnancy of caffeine you drink during Keep out of tanning booths . can protect you and your baby pregnancy. Meanwhile, check with Tanning beds pose the same right from the start. your doctor about the appropriate dangers as the sun. They give out amount for you. UV or ultraviolet, rays. UV rays Quit smoking . When you smoke, cause skin cancer. Plus, there is a your baby is exposed to harmful Stop drinking alcohol . Drinking risk that lying in a tanning booth chemicals. Smoking during any kind of alcohol puts your baby can raise your body temperature pregnancy nearly doubles the risk at risk for miscarriage and serious to a level that may be harmful of having a low birthweight baby. physical and mental problems. If to your baby. This is mostly true It may also increase the risk of you need help to stop drinking, during your first trimester. There’s delivering before your due date. ask your doctor. also the concern that lying on your Plus, smoking may boost your back too long might limit blood chances of having a baby with Keep out of saunas and hot tubs to your heart and baby. Another birth defects. One such problem and avoid hot baths . Saunas, hot downside to tanning booths includes SIDS. SIDS stands for tubs and taking hot baths raise is that pregnant women with Sudden Infant Death Syndrome. the body temperature. This is not sensitive skin may be more prone SIDS is the unexplained, sudden a good idea. They can raise your to getting dark skin splotches. death of an apparently healthy body temperature to a level that infant up to 1 year of age. See page may be harmful to your baby. In Stay away from unsafe chemicals . 38 for help with quitting. turn, this could increase the risk of Products and some cleaning having a baby with birth defects. solutions may be harmful to your Avoid Secondhand smoke . Once your water breaks, you baby. Such products include Breathing in someone else’s should not take a bath of any kind. pesticides, paint and stains. Some smoke is harmful to you and your studies have found that working baby. Secondhand smoke during Don’t cover up with electric with solvents may increase a pregnancy can cause a baby to be blankets . Electric blankets can woman’s risk of miscarriage or born at low birthweight. Babies raise the body temperature to a having a baby with birth defects. who are around secondhand level that may be harmful to your If you work with solvents or other smoke are at greater risk for baby too. They could heighten risky chemicals, talk with your asthma, bronchitis, pneumonia, the risk of fetal damage and doctor about what safety steps to ear infections and respiratory miscarriage from the electricity take. symptoms. They also may used to heat the electric blankets. experience slow lung growth. Don’t change a cat’s litter box . Don’t stand next to or directly Soiled cat litter boxes can spread Limit caffeine intake . Some in front of the microwave while an infection. The reason is that studies show that drinking a lot of it’s in use . It’s believed that the bacteria in cat feces can cause caffeine may increase the risk of growing fetus is, for the most harm to your unborn baby. So, miscarriage. Some also show that part, at risk to the effects of avoid changing a litter box if you it may cause you to have a low- microwaves. The reason is that have a cat.

9 Sexual Intimacy During Pregnancy

You may be wondering if having STDs pose special risks for sex will hurt your developing pregnant women and their baby. For most every pregnant babies. A pregnant woman with woman, the answer is no. Sex an STD can infect her baby is considered safe at all stages before, during, or after the baby’s of pregnancy, as long as your birth. She may also have early pregnancy is normal. Your labor or early rupture of the belly and the in membranes surrounding the baby the womb protect your baby. in the uterus. Unless your doctor tells you of a problem, you and your partner Pregnant women should ask their can keep having sex throughout doctors about getting tested for your pregnancy. STDs, since some doctors do not routinely perform these tests. STDs During an early prenatal visit, The Centers for Disease Control your doctor will probably offer and Prevention (CDC) estimates screening for some of these that about 20 million new STDs infections, including HIV and occur each year, almost half syphilis. HIV stands for Human of them among young people Immunodeficiency Virus. This ages 15 to 24. STD stands for a is the virus that causes AIDS. sexually-transmitted disease. AIDS is short for Acquired STDs are infections you can get Immunodeficiency Syndrome. by having sex with someone who AIDS is a serious, and often fatal, has one of these infections: disease of the immune system. There is no cure for HIV or AIDS. • Chlamydia • Trichomoniasis Some STDs can be cured with • Gonorrhea drugs, while others cannot. But • Genital herpes steps usually can be taken to • Syphilis protect your baby if you have an • Genital warts STD. • Bacterial vaginosis Source: http://www.cdc.gov/std/ pregnancy/stdfact-pregnancy.htm

10 Having a Baby Costs Money Ka-ching! There’s no getting • Make saving a habit. around it. Having a baby is • Look at or buy long-term expensive. BlueCare Tennessee disability and life insurance covers your health care for you coverage. during pregnancy and for your • Check out special benefits for newborn. But if you plan other which you may qualify. Such areas of your finances ahead of benefits include: time, these new costs will be The Women, Infants and easier to manage. Children (WIC) program. This is a special supplementary food What you can do: program for women, infants • Take a look at your budget. and children up to age 5. How will having a baby affect For more information, call your income and expenses? your local health department. • If you work, check the leave Or you may call the toll-free policy at your job. How much phone number 1-800-DIAL- maternity leave do you get? WIC (1-800-342-5942).

11 Just for Dads It’s true that you’re not having the baby. It’s also true that you’re not the one whose belly is growing. But there’s a lot for Dad to do during this exciting and sometimes confusing time.

What Dad can do? • Be involved. Go with your partner to her doctor visits before and during pregnancy. • Watch, listen, browse and read. Watch DVDs, browse the internet or read books about pregnancy, and being a parent • Help plan for the baby. Talk to your partner about what you both want for the baby. Go shopping for baby things. Look together at your finances. • Help your partner stay healthy. • Keep having sex if you and your partner wish to do so. • Support your partner. If she chooses to breastfeed, support her decision.

12 Moving Along Second Trimester: It’s normal to feel as if you’re Weeks 14-26 on an emotional roller coaster. You have your hormones to Adjusting to the Precious thank. You may also be feeling Life Inside You scatterbrained. Even the most Has it sunk in yet that you’re organized women report that pregnant? Many women say that pregnancy somehow makes them it isn’t until they trade in their forgetful, clumsy, and unable to jeans for maternity clothes that focus. Try to cut the stress in your the reality of pregnancy sets in. life. And take your “mental lapses” For others, it doesn’t sink in until in stride. They’re only temporary. they start noticing their swelling bellies. For many, this awareness is both joyful and scary.

13 Visiting Your Doctor During the second trimester, you certain health problems, he or she should keep seeing your doctor will probably want to check you for prenatal care. more often. Most pregnant women have Use your prenatal visits to get monthly office visits with their your questions answered. Write doctor until the end of this down your questions before each trimester. visit so that you will not forget to ask about certain concerns or If you are over 35 years old, your problems you have. With a little doctor will likely want to see you work and good communication, more often. Or if your pregnancy you can have a great working is high risk because you have relationship with your doctor.

14 Some Tests Your Doctor Might Do You will be offered screening for alphafetoprotein. AFP is the . For certain tests to look for birth defects, protein made by the fetus. But reasons, your doctor may talk to disorders and other problems. this test has been expanded you about amniocentesis. This Some of the tests your doctor to also detect two is done when birth defects might suggest in the second hormones – estriol and HCG. or other disorders are suspected. trimester are: HCG is short for human chorionic Late in the pregnancy, this test gonadotropin. As a result, it’s can also tell if a baby’s lungs are Ultrasound . If you haven’t now sometimes called a triple strong enough for him or her to already had one, your doctor screen test. The test is used, by breathe normally. may order an ultrasound. This is and large, to find out the risks for a test that uses sound waves to Down syndrome and other birth Fetal fibronectin (fFN) . fFN is a show a picture of a baby in the defects. If the test results are protein made during pregnancy. It womb. Your doctor will look at positive, your doctor may order works as biological glue, attaching the makeup of your baby. This more testing. the fetal sac to the uterine lining. test can detect most major birth The presence of fFN during weeks defects. It can find out the baby’s Quad screen test . This is what the 24 through 34 shows that the glue sex. It can also find out the size triple screen test is called when may be wasting away ahead of and position of the fetus. it is used to also measure the schedule. This alerts doctors to a level of a fourth substance called chance of preterm delivery. If you Pap Smear . This test checks for inhibin-A. The greater number of have signs of preterm labor, your cervical cancer. It is usually done markers increases the accuracy of doctor might suggest this test. at your first prenatal visit. the screening. The greater number Source: http://www.womenshealth.gov/ Triple screen test . This test also allows it to better spot the pregnancy/you-are-pregnant/prenatal- care-tests.cfm is used to check the mother’s risks for Down syndrome and blood only for AFP. AFP stands other birth defects.

15 Your Health, Changes in You The second trimester of pregnancy Health problems from douching . often brings a renewed sense of Medical conditions linked to wellbeing. The worst of the nausea douching include PID, or pelvic has usually passed. And your baby inflammatory disease, STDs, or isn’t big enough to crowd the sexually transmitted diseases, and organs in your belly and make vaginal infections. All of these lead you uncomfortable. Yet dramatic to big problems during pregnancy. physical and emotional changes are Problems may include infection in on the horizon. the baby, problems with labor, and early delivery. Here’s what to expect . Hemorrhoids . Pressure from the Trouble sleeping . The closer you growing baby presses on rectal get to your delivery date, the more veins. This can cause hemorrhoids. trouble you may have sleeping. You may also be constipated. This Anxiety, frequent urination, can make hemorrhoids worse. heartburn, leg cramps, and general discomfort can mean a short night’s Backache . As pregnancy progresses, sleep for a pregnant woman. But your back must support not only your baby’s health and your own you, but also your growing baby. depend on you getting enough The natural curve of your spine rest. Try a warm bath, soothing is increased. This puts increased music, or a relaxing book to put pressure on your back. you in the mood to snooze. Many Stretching tummy muscles . Usually doctors advise pregnant women to early in pregnancy, the uterus may sleep on their sides, not their backs pull to one side a bit. This can cause or stomachs. That way, the blood a slight pain in the lower right side. flow to the placenta is not limited. This pain is a nagging pain that you If you find this uncomfortable, notice when you move quickly. It try placing a pillow between your is not a serious pain. As pregnancy knees to ease the pressure of your moves forward, other ligaments of weight while lying on your side. your hips may begin to stretch and Chadwick’s sign . This is a dark- be uncomfortable. If you notice blue or purple discoloration of the strong pain in your belly, call your vagina and cervix during pregnancy doctor. caused by increased blood flow. It Itching tummy . As your pregnancy can be seen as early as 6-8 weeks progresses, changes in hormones after the day you actually got and the stretching of skin around pregnant. The symptom is often your mid section can make your used as an early sign of pregnancy. skin itch.

16 Varicose veins . As the amount feel more up to the challenge of blood in your body increases, of getting your home ready for the valves in your blood vessels your baby. As your pregnancy that push blood start to go soft. progresses, changes in your body’s This causes the blood to pool and shape and function may affect form painful bulges. Even though your emotions. Some women varicose veins are most often feel beautiful. Others feel ugly. found in the legs, they can also This is mainly true as their bellies appear in the vaginal area. grow. If you’re struggling with your body image, share your concerns Nasal problems . As pregnancy with your partner. Express love expands your circulation, more and affection in ways that help blood flows through your body’s you feel most comfortable. While mucous membranes. This can anticipation mounts, worries cause the lining of your nose and about labor, delivery or looming airway to swell. It can also restrict motherhood may consume your airflow and lead to snoring, thoughts. Remember that you congestion and nosebleeds. Plus, can’t plan or control everything increased blood circulation can about your pregnancy. Instead, soften your gums. This may result focus on making healthy lifestyle in minor bleeding when you choices that will give your baby brush or floss your teeth. the best start. Emotional changes . During Source: http://www.womenshealth.gov/ the second trimester, you may pregnancy/you-are-pregnant/body- changes-discomforts.html feel less moody. You may also

17 How Big Is Your Baby? As your pregnancy progresses, your baby will begin to seem more real. You may hear the heartbeat at your prenatal visits. And your growing tummy may force your favorite jeans to the back of the closet. While you’re adjusting to the changes in your body, your baby is quickly growing. Two months ago, your baby was simply a bunch of cells. Now, he or she has working 16-week fetus organs, nerves and muscles. You Your baby now weighs about 3.9 ounces and measures about 4.7 should also start feeling the baby inches in length. He or she is about the size of an avocado. Your baby move between weeks 18 and 20. can hold his or her head erect. And the growth of facial muscles lets These first movements are known him or her squint and frown. Your baby may also have frequent bouts as quickening. They may feel like of hiccups. He or she may also be able to make sucking motions with butterflies in your stomach or a his or her mouth. For girls, millions of eggs are forming in the ovaries. growling tummy. You may also be surprised to learn that your baby can now hear. As the nerve endings from your baby’s brain “hook up” to the ears, he or she may hear your heart beating, your belly rumbling or blood moving through the umbilical cord. Your little one may even be startled by loud noises. You may be amazed by how much your baby changes from week to week.

18 24-week fetus 26-week fetus Your baby is still getting oxygen through the Your baby is growing fast. He or she weighs a placenta. But once birth takes place, his or her lungs little less than 2 pounds and measures about 14 will start taking in oxygen on their own. Your baby inches from crown to rump. Your baby still looks now has eyelashes. Because the inner ear is now fully wrinkly. But he or she will keep gaining weight formed, your baby may be able to tell when he or little by little over the next 14 weeks until birth. she is upside down or right side up while floating Your baby now has eyelids that can open and and moving in the amniotic fluid. That is because the close. The brain controls some body functions. inner ear controls balance in the body. If your baby is a boy, his testicles will start their descent into the scrotum. This takes about 2 to 3 days. Source: http://www.webmd.com/baby/ss/slideshow-fetal- development

19 If you need dental CT scans . CT scans use many care while you are Things to X-rays to take 3-D pictures of any pregnant, make sure the part of the body. The guidelines dentist knows you are Avoid for using a CT scan for pregnant expecting so X-rays will Now that you’re pregnant, taking women are the same as those for not be taken. care of yourself has never been X-rays: avoid them as much as more important. You’ll probably you can. Contrast dyes injected get advice from everyone – into the vein to get certain types ranging from your doctor to even of X-ray images should also not complete strangers – about what be used during pregnancy. you should and shouldn’t be doing. But staying healthy during MRIs . An MRI is an imaging pregnancy depends on you. So, technique that creates pictures of it’s important to arm yourself the soft tissues of the body. The with information about the many MRI scanner uses a strong magnet ways to keep you and your baby to collect the naturally occurring as healthy as possible. Here are magnetic fields within the body. some things to avoid in addition This may be harmful to the baby to those listed on page 7. or the woman’s pregnancy. So, MRIs are generally avoided as well. X-rays . X-rays emit ionizing Source: http://www.womenshealth.gov/ radiation. Exposure can cause pregnancy/you-are-pregnant/staying- birth defects, miscarriage and healthy-safe.cfm even a risk of cancer for the unborn baby.

20 You’re Almost There Third Trimester: Weeks 27-40 size and position may make it hard for you to get comfortable. You’re in the Home Stretch! You may also be tired of being The countdown is on! The third pregnant and eager to get it over trimester is the most important with. By the end of the ninth period for both mother and child. month, the baby is probably head Weeks of waiting and wondering down and ready for the delivery. will finally come to an end within During this time, you will also a short period of time. You may have emotional changes as the be looking forward to the birth idea of a new life becomes real. If of your baby with pleasure, you’ve been gearing up for your excitement and concern. It might due date, you may be upset to be hard for you to believe that in see it come and go so calmly. a few short months you will be Try to stay positive as you look holding a new baby in your arms. forward to the end of pregnancy. You will have physical changes Soon you’ll hold your new bundle as the baby develops and grows of joy in your arms! in the womb. During this time, your tummy is very large and firm. Usually the third trimester is the The fetus grows very fast during best time to get ready for the the last three months. Its weight birth of your baby. Enjoy the final multiplies about three to four days of being pregnant. This is it! times. You can clearly see your The next chapter in your life is baby moving when you glance about to begin. down at your tummy. Your baby’s

21 Visiting Your Doctor During the last trimester, women of your baby. As the due date about labor and the birth of your usually see their doctors more draws near, your doctor may baby. You and your doctor will often. From 30 to 38 weeks of give you an exam to find out if talk about what kind of delivery pregnancy, he or she may suggest effacement or dilation has begun. you will have. Some women need one office visit every two weeks. Effacement is the thinning of the to have a C-section. This is when After 38 weeks, women normally cervix. Dilation is the opening the doctor makes a cut in the see their doctor every week until of the cervix. You may also have belly and womb to take out the after the birth. During the visits, engagement. This is known as baby. your doctor will keep checking lightening too. Engagement is your weight gain, blood pressure when the baby drops into the If you plan on a vaginal birth, and urine. He or she will also mother’s pelvis to get ready for you should talk to your doctor check for swelling, varicose veins, delivery. about the pros and cons of pain and any signs of complications. relief. Some women opt for pain Plus, your doctor will check the During your visits, ask questions medicines. Others want to give size, position and heartbeat and share concerns you have birth naturally, without drugs.

22 Your Health, Changes in You Your body continues to count the placenta, amniotic fluid puts pressure on the veins that change as you progress in your and larger breasts. The added return blood from your feet and pregnancy. Many women find it weight is made up of the womb, legs. Your body also withholds harder to take deep breaths. They extra fat and increased blood too. fluid and your blood vessels also notice that they have to go Make sure to visit your doctor widen. This may leave your face to the bathroom more often. This throughout your pregnancy so and eyelids puffy. If you notice is because the baby is getting he or she can keep track of your any sudden swelling, call your bigger. The baby is also putting weight gain. doctor right away. Or if you have more pressure on your organs. a lot of swelling or have gained Don’t worry, your baby is fine and Where does the added a lot of weight quickly, call your these symptoms should go away weight go? doctor as soon as possible. This once you give birth. could be a sign of a complication. • Baby – 6 to 8 pounds • Placenta – 1½ pounds Nutrition • Amniotic fluid – 2 pounds As your metabolism speeds up • Uterus growth – 2 pounds later in pregnancy, you may need • Breast growth – 2 pounds extra calories each day. If you • Your blood and body fluids – don’t take in enough calories, you 8 pounds could slow down the growth of • Your body’s protein and fat – your baby. Most women need 7 pounds 300 calories a day more during at least the last six months of The Placenta pregnancy than they do pre- pregnancy. Keep in mind that As a pregnant woman, you not all calories are equal. Your probably don’t think too much baby needs healthy foods that about your placenta. Yet this are packed with nutrients — not amazing organ is your baby’s “empty calories” such as those lifeline while in the womb. found in soft drinks, candies, and The placenta provides all the desserts. Also continue to drink necessary nutrients and oxygen at least 6 to 8 glasses of water for your baby to grow properly. each day. After the baby is born, the placenta’s job is done. It is usually Distribution of Pregnancy delivered a few minutes after the baby. Weight By your due date, you’ll probably Swelling During Pregnancy weigh 25 to 35 pounds more than Swollen feet and ankles may you did before pregnancy. Your become an issue at this stage of baby accounts for some of the pregnancy. Your growing womb weight gain. But you also need to

23 Preeclampsia meet your baby face-to-face. result, your breathing should be Sudden weight gain, swelling in At the same time, you may be easier. But you’ll probably have to your hands or face, and increased feeling more afraid of becoming go to the bathroom more often. blood pressure may be signs of a mother. You may be worried That is because the baby is lower preeclampsia. Preeclampsia is a about your baby’s health, as and now pressing on your bladder. condition of high blood pressure well as labor and delivery too. in late pregnancy. Headaches or Changes in your hormones may Rupture of Amniotic changes in vision can also be signs make you feel grumpy. Plus, you Membranes may be a bit more clumsy and of this complication. Preeclampsia The holds in the forgetful. All of these feelings could have harmful effects on fluid around your baby. It could are normal and usually related to both the mother and fetus. Be break on its own close to your changes in your hormones. sure to tell your doctor if you delivery date. This is a sign of have any of these signs. labor. Some women feel a large Lightening gush of water. Others feel a Emotional As your body gets ready for birth, steady trickle. For many women, the baby will start to move into the water doesn’t break until Changes its birth position. This is called they’re well into labor. Others lightening or engagement. You need to have their water broken By now, you may be tired of might notice the baby “dropping,” by their doctors during labor. If being pregnant. It is normal to or moving down lower in your you think your water has broken, feel like you just want this to be belly. This can lessen the pressure call your doctor right away. over. You may also be eager to on your lungs and rib cage. As a

24 How Big Is Your Baby? Your womb continues to be a busy place. Your baby is still growing and changing each week as your due date draws near. By this point, your baby may be in a head-down position. If your baby is positioned rump-first or feet-first, there is a potential for problems. Your doctor may choose to do a C-section if your baby is not head down. 29-32 week fetus Most last 37 to 42 weeks. A baby born at this time is The fetus reaches a length of about 15-17 inches. The baby weighs considered full term. Following is a about 4 lbs., 6 oz. The baby’s amount of body fat is increasing fast. look at what’s going on with your baby as your due date draws near. Also, rhythmic breathing movements take place. The lungs are not fully mature. However, the bones are fully developed. But they are still soft and pliable.

25 36-week fetus 37-40 week fetus The fetus reaches a length of about 16-19 inches. It The baby is considered full-term at 37 weeks. He weighs about 5 lbs., 12 oz. to 6 lbs., 12 oz. The soft or she may be 19 to 21 inches long. The soft hair is hair that covers the body begins to go away. The gone except for on the upper arms and shoulders. fingernails reach the end of the fingertips. A baby The fingernails extend beyond the fingertips. And born at 36 weeks has a high chance of survival, but small breast buds are present on both sexes. Also, may need special health care. the hair on the head is now coarse and thicker. Source: http://www.webmd.com/baby/ss/slideshow-fetal- development

26 Understanding Labor The beginning of labor feels Back Labor Biophysical Profile different for every woman. Back labor refers to pain that is felt This is a simple, painless test to You’ll know you’re in labor when in the back during labor. Often, check the health of your baby. you feel frequent and regular back labor takes place when the This test is used to find out the contractions. The average labor baby is in an odd position as it baby’s movements. It can also tell lasts 12-14 hours for a first baby. enters the birth canal. But that if your baby is getting enough But, the length of labor varies for isn’t always the case. During labor oxygen in the womb. The test each woman. Talk to your doctor and delivery, some women simply is typically done if you’ve gone about the signs of labor. feel more tension in their backs beyond your due date. Or it is than others do. sometimes used in your third Preterm Labor trimester if you have a high-risk Preterm labor is labor that Fetal Monitoring During Labor pregnancy. happens before you are 37 weeks Labor is stressful for mom and pregnant. About 12 percent of baby. During labor, your doctor Non-Stress Test (NST) births in the U.S. are preterm. will monitor your baby’s heart If you do not go into labor within A baby born at this time is rate. A monitor will be placed on a week of your due date, your considered term. Preterm labor your stomach or on the baby’s doctor may do a NST. This test can happen to any woman. There scalp. Your doctor will determine checks the pattern of your baby’s is no known cause for preterm the monitor placement. Fetal heartbeat. It also shows how your labor. Talk to your doctor about monitoring during labor is baby responds to stimuli. This the signs of preterm labor. important because it shows how test will let your doctor know if However, there are some factors well your baby is coping with the your baby is doing well. that increase a woman’s risk stress of labor. of having preterm labor, such Group-B Streptococcus as smoking, birth defects, and carrying more than one baby. Tests Your (GBS) Infection Somewhere between weeks 35 The No. 1 health risk for babies Doctor Might and 37, your doctor will screen you born in the U.S. is prematurity. Do at Your for GBS. This is a type of bacteria Tennessee has one of the highest that typically lives harmlessly in premature birth rates in the Last Visits the body. A culture taken from country. Babies born too early just inside the vagina and rectal or too small are at higher risk During the last part of your area is tested for the bacteria. GBS for initial and long-term health pregnancy, your doctor will keep poses no risk to you. But women problems. As a result, premature checking your blood pressure who harbor it may pass it to their babies have to stay in the hospital and weight. He or she will also babies during labor and delivery. If until they grow big enough and keep track of the activity and GBS is found, antibiotics will likely healthy enough to go home. movements of your baby. Here’s be given to you once you go into the lowdown on other tests your labor. doctor might do during your last visits.

Sources: http://www.marchofdimes.com/pregnancy/labor_indepth.html; http://www.womenshealth.gov/pregnancy/childbirth-beyond/labor-birth.html

27 Preparing For Birth Prenatal / Childbirth Classes homework. Make your decision Breastfeeding is not possible Now is the time to start preparing carefully. At the time of delivery, for all women. Some physical for delivery. Many women find you will be asked to name your conditions make it impossible. childbirth classes very helpful. pediatrician. Or you might not have the time or the willpower to dedicate These classes teach you about Breastfeeding or Bottle to breastfeeding. If you choose what to expect during labor Experts believe that breast milk not to breastfeed, your doctor and different ways to give birth. as the best form of nutrition can help you choose a formula Women often bring their partners possible for babies. Breast milk that is best for your baby. Talk to the classes. This is mainly true has disease-fighting antibodies to your doctor if you need more if this person will be with them that can help protect babies information before making your during the birth of the baby. from several types of illnesses. choice. And moth­ers who breastfeed Selecting a Pediatrician have a lower risk of some health Infant Restraint Seats Learn as much as you can about problems, including breast When it comes time to take your the practices and procedures cancer and type 2 diabetes. But baby home from the hospital, you’ll of each doctor. It’s important the decision about whether to need a car seat. Putting your baby that you feel comfortable with feed your child breast milk or in a safe and properly-installed car your baby’s doctor. So, do your infant formula is a personal one. seat can protect your baby.

28 Dad For your For Tips wife/partner: yourself: Your baby will soon join you and • Get your home ready. Work • Begin to plan for the birth. your partner on the “outside.” together getting things for • Check the flexibility of your Your partner’s body is making your baby. work schedule for the birth the final changes to get ready for • Try to view at least two birth and after. labor. At the same time, your baby films together. • Ask two new dads about is growing more to get ready for • Let your partner know that the experiences of their birth. A new flood of feelings may be rising within you as you get you want to be there for her babies’ births. ready to welcome your baby into at the birth. • Reach out to the men in your the world. • Tour the labor and delivery childbirth class. See if you can department of the hospital have a dads-to-be night out. Joining your partner in a childbirth where your baby will be born. • Find an exercise or work-out class is a way to get yourself ready program that you feel you for the birth. More important, could keep up with after the when you take a class with her baby is born. you can begin to get ready as a couple to share the birth experience. Be patient with your partner. Remember to keep the channels of communication open. If you feel overwhelmed between work and getting ready for the baby, talk about it with your partner. This is a good time to reach out for support.

29 Welcome Home! Postpartum: get this ID number, call the Family Week 40 and beyond Assistance Service Center at the toll-free phone number 1-866-311- After Pregnancy 4287. (In Nashville, call 743-2000). Your bundle of joy has finally If you have Medicaid from the arrived! Unfortunately, this special Department of Human Services little person did not come with (DHS), call your local DHS office. an instruction manual. In this Your new mom checkups and section, you will find helpful your baby’s well-child checkups articles on topics ranging from are FREE. Also, transportation can breastfeeding and baby’s first be provided, if needed. Just call checkup to developmental Customer Service for assistance milestones and childhood with scheduling an appointment illnesses. and getting a ride. BlueCare members call 1-800-468-9698 Remember, after the birth of your and TennCareSelect members call baby, you need to get your baby 1-800-263-5479. a TennCare ID number. To help

30 Your New-Mom Checkup Once you have had your baby, the days or weeks after you give swells. To treat this, there are a you need to call your doctor and birth, it’s called a late or delayed number of things you can do. schedule a follow-up visit. The PPH. It could be a complication if Breastfeed your baby regularly. ideal time for your new mom you have heavy bleeding and fill Wear a supportive nursing bra. checkup is three to six weeks more than one pad per hour. If Many mothers express their milk after the birth of your baby. But you have this problem, call or see using breast pumps. Contact you may need to see your doctor your doctor. a lactation consultant at your earlier, especially if you are having local hospital. This person is problems. Problems include Incision, episiotomy care trained to help mothers who postpartum depression, bleeding An incision may be needed to want to breastfeed their babies. and other trouble with your help deliver your baby. This is Or you can talk to your doctor health. If you had a C-section, called an episiotomy. The cut about more information on you may need to have stitches is closed after the baby and breastfeeding. or staples removed before your placenta have been delivered. If new mom checkup. Your new you have this done, you can go mom visit generally includes a back to doing normal activities routine pelvic exam, a Pap test shortly after birth. The stitches and screening for postpartum are absorbed by the body and depression. do not need to be taken out. After the birth of your baby, your Pain and discomfort can be eased doctor will talk with you about with warm baths and medicine the following things you may ordered by your doctor. have to deal with as your body starts to heal. Sore nipples, breast engorgement, breast pump Postpartum bleeding, Within two to three days after hemorrhage you give birth, you may find that You will have spotting or bleeding your breasts feel swollen and after birth. It will be similar to a tender and lumpy. They may menstrual period off and on for also throb and feel painfully full. up to six weeks. This is normal. Sometimes the swelling extends But some women bleed too all the way to your armpit. You much and need special care. may run a low-grade fever, too. This is called a postpartum Don’t worry. This is only short- hemorrhage (PPH). It happens in term. Within 72 hours after you up to 5 percent of women after give birth, plenty of breast milk delivery. It’s most likely to happen “comes in” or becomes available while the placenta is separating to your baby. As that happens, or soon after. If it happens in more blood flows to your breasts and some of the nearby tissue

31 The “Baby blues,” Postpartum Depression Besides the physical changes, you depression can begin anytime soon as possible. Please contact may feel sad or have the “baby within the first year after our office if: blues.” This is normal after you childbirth. If you have postpartum • You think you need help give birth. Between 70 and 80 right away percent of new mothers feel a depression, your symptoms may little sad or depressed after giving include: • You answer 1, 2, or 3 to birth. Your hormone changes, question #10. worrying about caring for the • Feeling restless or moody baby, and lack of sleep all affect • Feeling sad, hopeless, and Get help right now if you: how you feel. If you have the baby overwhelmed • Are thinking about hurting blues, you may: • Crying a lot yourself or your baby • Have mood swings • Having no energy or • Are having trouble caring for • Feel sad, anxious or motivation yourself or your baby. overwhelmed • Sleeping or eating too little or • Have crying spells too much Call Tennessee’s free mental • Lose your appetite • Having trouble focusing or health crisis hotline for help at • Have trouble sleeping making decisions 1-855-274-7471. • Having memory problems The condition can be treated The baby blues most often go • Feeling worthless and guilty safely and effectively. Your doctor away within a few days or a week. • Not enjoying things that used can help you feel better and get The symptoms are not severe to be fun back to enjoying your new baby. and do not need treatment. Be • Withdrawing from friends and These tips may help you get into a patient with yourself. Be aware of family “recovery routine”: your feelings. And let your family, • Having headaches, aches and • Practice healthy habits. friends, and your doctor know pains, or stomach problems • Exercise at least three times what’s going on. Ask them to be that don’t go away. a week. patient and caring. • Spend time with family Your doctor can figure out if and friends. If you are extremely sad or unable your symptoms are caused by • Make time for yourself depression or something else. to care for yourself or your baby, every day. call your doctor right away. You BlueCare Tennessee also wants to help women who may be • Look for what’s good in might have a serious condition depressed. But we have to know your life. called postpartum depression. who may be feeling depressed. • Reward yourself for reaching Postpartum depression is worse There is an easy and quick survey small goals. than the “baby blues.” It lasts in the back of this booklet that longer, doesn’t go away on its you can take that will give us and Sources: http://www.womenshealth. gov/publications/our-publications/fact- own, and can get worse if left you a good idea. Also, shortly after your delivery, you may receive a sheet/depression-pregnancy.html; http:// untreated. Postpartum depression www.healthychildren.org/English/ages- telephone call or a mailing from stages/prenatal/delivery-beyond/Pages/ can get bad enough to make it our office about the survey. Please Understanding-Motherhood-and-Mood- hard for you to care for your take the time to complete the Baby-Blues-and-Beyond.aspx baby or yourself. Postpartum survey. We want to assist you as

32 Your Health Caring for a new baby is one of is important for your recovery. Exercise the most joyous and challenging It is especially critical for breast- If you worked out regularly times in a woman’s life. At the feeding mothers. Try to drink at before and during your same time, new mothers must least eight glasses of water each pregnancy, talk to your doctor take special care of their bodies day. This will help with making about the best way to ease back after giving birth and while milk and keeping your body well into your exercise program. Take breastfeeding. Read on for tips hydrated. It will also decrease it slow and follow his or her about staying healthy and taking constipation. You’ll also need to advice. You may want to go back care of yourself when you get keep practicing a healthy lifestyle. to your pre-pregnancy shape right home from the hospital. You can do this by avoiding away. But keep in mind that your caffeine, cigarette smoking, body needs time to heal. Working Nutrition alcohol and drugs. Talk about any out after having a baby is helpful, Your desire to eat should come diet issues with your doctor. This both physically and emotionally, back soon, if it hasn’t already. includes questions about prenatal for most new mothers. It helps to That’s because there’s no more vitamins. These vitamins should work off the extra pounds gained baby putting pressure on your be continued after you give during pregnancy while boosting tummy and bowels. Also, those birth, especially if you are breast- your self-esteem. Other paybacks irritating bouts of heartburn feeding. They will give you extra include helping minor aches and should have eased up by now. iron and improve the quality of pains that are a normal part of your breast milk. the period after your baby is Maintaining a well-balanced diet born. Follow your doctor’s orders for yourself after the baby arrives on how much activity you can do for the next few weeks.

33 • Cradle Hold – Your baby’s hip should be aligned. Guide for head is in the crook of your 4. After you and your baby are in elbow or on your forearm. position, support your breast Breastfeeding • Cross Cradle Hold – This with four fingers on one side Moms is good for premature and thumb on other. Keep babies or babies who are your fingers behind the areola If you chose to breastfeed your baby, you probably did because having trouble latching (the darker skin around the of the benefits it can provide you on. Hold your baby along nipple) so that they don’t get and your baby. The experience the opposite arm from in the way of the is special for so many reasons the breast you are using. baby’s mouth. including, Support your baby’s head Brush your baby’s mouth with • The joyful bonding with with the palm of your your nipple to encourage the your baby hand at the base of his or baby’s mouth to open up wide • The nutrition only you can her neck. and then bring baby to your provide • Clutch or Football Hold – breast. Your baby should have • The cost savings This is good for mothers the entire nipple and most of the • The health benefits for you with large breasts or areola in his or her mouth. Your and your baby inverted nipples. Hold your baby’s lips should be flanged (like baby at your side lying on a fish) to ensure that he or she is Keep in mind that breastfeeding his or her back with his or latched on correctly. The baby is a learned skill. The more you her head at the level of should never be latched on to know about breastfeeding and your nipple. Support your the nipple only. If you feel pain, the more you practice, the easier baby’s head with the palm you can break suction by gently it will become. of your hand at the base of inserting a clean finger in the his or her neck. corner of baby’s mouth. Then try Learn how to • Side-Lying Position – This to latch on again lets mothers rest while You will know that your baby has breastfeed feeding their babies. This latched on correctly if: position is also good for 1 . Get comfortable. The best mothers who have had a • You see your baby’s jaw position is slightly reclined and cesarean birth. Both you moving back and forth with support or lying down. If and your baby lie on your • You hear swallowing noises you feed your baby sitting up side with baby facing you. • Baby’s nose and chin are you should: Pull baby close and guide touching your breast, or • Use pillows or blankets on his or her mouth to • You can see your baby’s upper your lap to support your your nipple. and lower lip on your breast. arms and the baby. 3. Hold your baby close to you Allow your baby to nurse as much • Rest your feet on a stool or with his or her whole body book to help you recline. as he or she wants and then offer facing yours. the baby the other breast. 2. Choose the position that works • Baby’s mouth and nose best for you and your baby. should face your nipple. Four common positions are: • Baby’s ears, shoulder and

34 Helpful breastfeeding tips • It is recommend that most choices that are okay to use infants breastfeed for at least while breastfeeding. 12 months, with exclusive • Eat a healthy diet and drink breastfeeding for the first plenty of water. You need an 6 months. This means that extra 500 calories a day while babies are not given any foods breastfeeding. or liquids other than breast • If you smoke, it is best for you milk for the first 6 months. and your baby for you to quit • Most newborns will need to as soon as possible. eat at least every two to three • You should avoid alcohol, hours. Your baby should be especially in large amounts. An fed at least 8 times in a 24 occasional small drink is ok, hour period. but avoid breastfeeding for • Always ask your doctor before two hours after the drink. taking any medicine. There are • It is not safe for you to use many medicines that you can or be dependent upon an take while breastfeeding. illicit drug. Drugs like cocaine • You can still breastfeed if and marijuana, heroin and you are sick. Most common PCP harm your baby. Some illnesses, such as colds, flu, reported side effects in babies or diarrhea, can’t be passed include seizures, vomiting, through breast milk. In fact, if poor feeding, and tremors. you are sick, your breast milk • Call the Tennessee will have antibodies in it. These Breastfeeding Hotline for free antibodies will help protect at 1-855-4BF-MOMS (1-855- your baby from getting the 423-6667). You can speak to a same sickness. Certified Lactation Counselor • Breastfeeding can delay the or Consultant 24 hours a day, 7 return of normal ovulation days a week, who can provide and menstrual cycles. But, like up-to-date information and other forms of , support and address common breastfeeding is not a sure questions and concerns about way to prevent pregnancy. breastfeeding. You should still talk with your Source: http://www.womenshealth.gov/ doctor about birth control publications/our-publications/fact-sheet/ breastfeeding.html

35 Baby’s Care for Your Circumcision care Circumcision involves taking First Little One off the foreskin of the penis. The foreskin shields the head Checkup Your baby is finally here! Read on of the penis. Healing time for to find out about how to take Most babies have their first newborns usually is about 1 week. care of your baby in the precious Put petroleum jelly after diaper checkup within the first few first weeks. weeks after birth. Some parents changes to protect it. Some initial swelling and yellow crust around take their infants to a pediatrician. Cord care This is a doctor who specializes the cut is normal. in care for children. Even when Your baby’s umbilical cord stump things are going well, regular should dry up and fall off by 8 Newborn jaundice checkups during the first year are weeks of age. During the time the Normal healthy newborn babies important for checking the health cord is healing, it should be kept often develop mild jaundice at of your baby. Most well-baby as clean and dry as possible. To a few days of age. This often checkups begin with measuring keep it dry, sponge bathe your happens in premature babies. the baby’s length, weight and baby. You should do this rather Most of the time this goes away head circumference. You’ll need than dip your little one into a tub as the baby’s liver becomes to undress your baby, so keep a of water. Keep the cord clean and more efficient. Sometimes a blanket handy. The measurements dry to cut the risk of infection. baby with jaundice may have a will be plotted on a growth chart. more serious problem and need The doctor will use these to more care. Caring for jaundice make sure your baby’s growth is begins with “phototherapy.” This on target from one visit to the is a treatment with light. If you next. If the checkup is your baby’s see that your baby’s skin or the first outing, leave yourself plenty whites of his or her eyes look of time to stock the diaper bag yellow, call your baby’s doctor. and buckle your baby into the A simple blood test can let you car seat. You may be surprised know if your baby’s jaundice how long it takes to get your new needs more care. family out the door!

36 Newborn Testing Newborn babies must have tests done right after birth. Before your baby leaves the hospital, he or she will have a few tests and treatments to make sure that he or she is healthy. Your baby will be tested for several things. This includes overall health, heart, lungs and breathing, reflexes, and skin color. Your baby’s heel will be pricked to get a few drops of blood. This blood will be used to screen for birth defects and other conditions. Your baby may also have a hearing test. Some conditions cannot be seen in the newborn. But they can cause physical problems, mental retardation and even death. Finding and taking care of these problems early can make the difference between lifelong disabilities and healthy development.

Here are some of the conditions that www.marchofdimes.com/baby/bringinghome_ newborn testing looks for: newbornscreening.html

PKU (phenylketonuria) Car Seat Laws Babies with this disorder cannot process a All 50 states have laws that require babies substance called phenylalanine that is found in to ride in car seats. This seat helps protect almost all food. your baby. Make sure you install the car seat properly every time your baby is riding in a car. Hypothyroidism The ideal time to have your infant car seat is Babies with this disorder lack a certain before you give birth. This will give you and hormone. This slows down growth and brain your partner time to practice putting it into development. your car the right way. Local police stations may offer services to check your car seat free Galactosemia of charge. This is very helpful if you are not Babies with this disorder cannot change a sure you know how to place it properly in sugar found in milk into a sugar that the body your car. uses as an energy source. While traveling, be sure to place your baby Today, every state in the U.S. screens babies in a rear-facing car seat in the back seat of for PKU and hypothyroidism. The March of the car. The seat should be away from all Dimes recommends that all newborns be airbags. It should meet current federal safety tested for at least 26 disorders. standards. To learn more about car seat safety guidelines, visit the website of the American Source: http://kidshealth.org/parent/system/ medical/newborn_screening_tests.html#; http:// Academy of Pediatrics at www.aap.org.

37 TENNderCARE Well-Child Visits: Helping Your Baby Grow up Within the first day of life, your WIC Program Healthy baby will have a head-to-toe The Special Supplemental checkup. The doctor will listen to All kids who are younger than Nutrition Program for Women, the heart and lungs. The doctor 21 and who are TennCare Infants and Children (WIC) will also feel the tummy and members have free EPSDT is a program funded by the check the eyes, nose, mouth, benefits. EPSDT means early and federal government. The U.S. head, arms, and legs. Your periodic screening, diagnosis and Department of Agriculture newborn will likely also have treatment. The EPSDT program in (USDA) runs the program. A the first hepatitis B shot before Tennessee is called TENNderCare. number of health agencies also leaving the hospital. He or she will help run it. The well-care visits can help get two more of these shots by find problems early before they 18 months of age. The hepatitis In Tennessee, the WIC program become serious. According to the B virus can cause serious liver provides the following for American Academy of Pediatrics damage. But, this shot protects hundreds of thousands of (AAP) Periodic Schedule, well- your baby against this virus. women, infants and children child screenings need to occur under age 5 each month through Toddlers, youngsters, older kids at certain times during a child’s health departments in 95 and teenagers need exams too. life. Babies grow so fast that counties. To view the recommended they need a lot of TENNderCare schedule for shots and checkups • Nutrition education exams. During the first year of produced by American Academy • Health care referrals life, they need exams at: of Pediatrics, check your member • Breastfeeding support • 2 to 4 days handbook. • Supplemental nutritious foods • 1 month Your baby’s doctor will tell you • 2 months For more information, call your if any problems are found during • 4 months local health department. Or the checkup. If there are any • 6 months you may call the toll-free phone problems, he or she will either • 9 months number 1-800-DIAL-WIC (1-800- treat them or refer you to a • 12 months 342-5942). To get a list of WIC specialist. This is someone who state agencies, visit the website at is an expert about a particular http:// www2.state.tn.us/health/ health problem. wic/index.htm on the state of Tennessee’s Web site.

38 Protect Your Child from Secondhand Smoke Secondhand smoke comes from If your child has asthma and Callers are assigned a coach who lit cigarettes and cigars. It also breathes secondhand smoke, it will give one-on-one help to comes from smoke breathed could trigger an asthma attack. make a plan to kick tobacco use out by smokers. When children for good and provide tips to stay You can take these actions: breathe secondhand smoke, it is on track. like they are smoking, too. They • Do not allow anyone to smoke Tennessee Tobacco Quitline: breathe it at places like home, day near your child. care and in cars. • Do not smoke or allow others 1-800-QUIT-NOW, or to smoke in your home or car. 1-800-784-8669, Eastern Time. Secondhand smoke can cause Opening a window does not Monday through Friday from serious health problems for your protect your child from smoke. 8 a.m. to 11 p.m., Saturday from child. Because your child’s body is • Do not take your child to 9 a.m. to 6 p.m.Sunday from 11 developing, he or she is especially restaurants or other indoor a.m. to 5 p.m. at risk of the dangerous poisons public places that allow in secondhand smoke.Children smoking. For the deaf and hard of hearing who are around secondhand • Teach children to stay away -1-877-559-3816. Counseling is smoke get sick more often. Their from secondhand smoke. available in both Spanish and lungs grow less than children English.To learn more about who do not breathe secondhand Make the Decision to Quit quitting tobacco use and the smoke. They get more bronchitis, Smoking Tennessee Tobacco QuitLine, pneumonia and ear infections. visit http://health.state.tn.us/ The Tennessee Tobacco QuitLine tobaccoquitline.htm. Wheezing and coughing are more is free to all Tennessee residents common in children who regularly who want to stop smoking or Source: http://www.cdc.gov/tobacco/ basic_information/secondhand_smoke/ breathe secondhand smoke. using spit or chew tobacco. protect_children/pdfs/protect_children_ GenPop_508.pdf

39 Safe Sleeping One of the most important decisions you will make as a new mom is where and how you place your baby to sleep. If you follow these safe sleep rules, you will help protect your baby from Sudden Infant Death Syndrome (SIDS), suffocation and accidents during sleep. • Sleep your baby on the back from birth, not on the tummy or side. • Always use a firm sleep surface. Car seats and other sitting devices are not recommended for routine sleep. • Your baby should sleep in the same room as you for the first 6 to 12 months, but not in the same bed. • Keep the crib within an arm’s reach of your bed. Babies who sleep in the same bed as their parents are at risk of SIDS, suffocation and accidents. This is because you can roll onto your baby during sleep. Or your baby can get tangled in the sheets or blankets. • Keep soft objects or loose bedding out of the crib. This includes pillows, blankets and bumper pads. • Wedges and positioners should not be used. • Breastfeeding is recommended. • Offer a pacifier at nap time and bedtime. • Avoid covering your baby’s head or overheating. • When babies are awake, they occasionally need to be on their tummy, but only if someone is watching. If your baby falls asleep on his/her tummy, place your baby on his or her back.

Note: These recommendations are for healthy babies up to 1 year of age. A very small number of babies with certain medical conditions may need to be placed to sleep on their stomachs. Your baby’s doctor can tell you what is best for your baby. Source: http://www.healthychildren.org/English/ages- stages/baby/sleep/Pages/Preventing-SIDS.aspx

40 First-Year Milestones Whether it’s that first smile, wave, “mama,” or shaky step, there’s nothing more exciting than watching your baby grow. Below is a list of facts about a few big milestones during the first year. It will give you some insight into what’s about to take place or is already taking place in your baby’s life. Just keep in mind that babies are people too. Each grows at his or her own pace.

Teething Most babies get their first tooth between 4 and 7 months of age. If your baby’s an early developer, you may see your child’s first tooth as early as 3 months. This is usually one of the bottom middle teeth. If your child’s a late bloomer, you may have to wait a year or more. The last teeth to appear have usually begun coming into place by age 2. These are usually the second molars found in the very back of the mouth on the top and bottom. By age 3, your child should have a full set of 20 baby teeth.

Crawling Most babies learn to crawl between the ages of 6 and 10 months. But your little one may opt for other ways of getting around. Your baby may choose to scoot around on his or her bottom. Or your baby may pick to slide on his or her stomach. Some babies skip crawling altogether and move straight to pulling up, standing, and walking.

Walking Most babies take their first steps sometime between 9 and 12 months. They are walking well by the time they’re 14 or 15 months old. But don’t worry if your child takes a little longer. Children progress at their own rates. If you have concerns about your baby, talk to your baby’s doctor. Source: http://www.marchofdimes.com/baby/growing_ indepth.htm

41 Dad Tips Most couples worry right after breastfeeding, you can bring they take the baby home. It takes her the baby. You can also help about six weeks for most couples them get comfortable. to feel better about having a baby. Here are things you as the new • Help with other jobs too. dad can do to support your mate: Change diapers, give baths and rock the baby. You can • Hug your partner a lot. Tell her also cuddle the baby, read to she’s doing a great job. the baby and sing the baby • Be patient with the baby and to sleep. Most babies love to with your partner. sleep on their dad’s chest. • Ask friends and family members for help with Keep in mind that doctors usually cleaning up, grocery shopping advise you not to have sex for and meals. This is not the four to six weeks after your time to be shy about asking partner gives birth. Before having for help. Everyone needs help sex again, talk to your partner with a new baby! about your plan for birth control • Try to rest whenever you can. to avoid getting pregnant again • Help out with the baby too soon. during feeding time. If mom is

42 How to Plan Before You Get Pregnant Again Spacing Getting pregnant too soon after giving birth can be risky for both you and your baby. Having a baby makes your body work hard. Your next baby may not get enough nutrition if you get pregnant too soon. Becoming pregnant again within a year of giving birth increases the chance that your new baby will be born too soon. Babies that are born too soon can have health problems. Planning your next pregnancy if you want more children — or preventing a pregnancy if you don’t — is important. Spacing pregnancies at least 18 months to two years apart will give your body time to fully recover. A family also needs time to get better physically, emotionally and financially.

Birth Control In the meantime, using reliable birth control is the best way to prevent pregnancy until you decide if and when to have another baby. Women who have just given birth should wait three weeks before using birth control that contains both estrogen and progestin. This includes the pill, the patch, and vaginal ring. Using these methods in the early weeks after giving birth increases the risk of dangerous blood clots. Wait six weeks to use birth control with both estrogen and progestin if you delivered by c-section or have other risk factors for blood clots. These risk factors include obesity, history of blood clots, smoking, or preeclampsia. Women have many good choices for birth control after giving birth. Keep in mind that breastfeeding alone isn’t a foolproof way to prevent pregnancy. Talk to your doctor about your birth control options. Without birth control, you can easily become pregnant again. Source: http://www.womenshealth.gov/pregnancy/ childbirth-beyond/get-pregnant-again.html

43 A healthy pregnancy begins planning a pregnancy. This can drug can pass from you to before you become pregnant. prevent some birth defects your baby. It’s important to learn what you of the brain and spine. Talk to • Consider your health . If you can do now to make sure any future pregnancies are planned your doctor about your folic have a medical condition, be and healthy. Here are a few things acid needs. Some doctors sure it is under control. Some that you can talk about with prescribe prenatal vitamins conditions can cause issues your doctor before you plan a that contain higher amounts of during pregnancy. Asthma, pregnancy. folic acid. diabetes, high blood pressure, • Be prepared. • Be at a healthy weight . Being depression, epilepsy and is your ability to have children overweight or underweight obesity are examples. when you want to have puts you at increased risk for • Get tested . Be aware of them. Being able to prepare problems during pregnancy vaccines and screenings you financially for your children is like gestational diabetes and might need. This includes a a benefit of family planning. preeclampsia. Pap test and tests for sexually The recommended time frame • Stop smoking and drinking transmitted diseases. between pregnancies is at least alcohol. Alcohol and smoking • Know your history . Be aware 18 months. are not good for you or your of health problems that run in • Eat a healthy diet . What you baby. Doing these while your or your partner’s family. If eat will also feed your baby. pregnant can cause things certain issues run in your family You want to make sure you get like brain damage and mental or if you have had trouble plenty of calcium, folic acid, retardation. with previous pregnancies, protein and iron. Talk with your • Don’t use drugs . Any drug your doctor may recommend doctor about what nutrients used when you are pregnant, genetic counseling. This is a you need and how to get them. even medicines prescribed by place to discuss risk factors • Take folic acid . All women other doctors, can hurt your and possibly test for any need folic acid every day. It is baby. They can cause your genetic conditions that could recommended that you get baby not to grow well before be passed on to your baby. and after birth. Almost every at least 400 mcg if you are Source: http://www.womenshealth.gov/ pregnancy/before-you-get-pregnant/ preconception-health.html

44 Dangers of Becoming Pregnant While Using Drugs Any drug used when you become You can also call Customer pregnant can hurt your baby. Service if you need help They can cause your baby not to finding alcohol and drug abuse grow well before and after birth. treatment. BlueCare members Almost every drug can pass from call 1-800-468-9698 and you to your baby. TennCareSelect members call 1-800-263-5479 . Using certain drugs, like narcotics, Source: National Library of Medicine, while pregnant puts your baby at http://www.ncbi.nlm.nih.gov/ risk for becoming addicted to the pubmedhealth/PMH0004566/ drug as well. Examples of these drugs include: heroin, morphine, cocaine and amphetamines. Once born, your baby is still dependant on the drugs and is no longer getting them. Your baby may start having symptoms of withdrawal from the drugs. A baby suffering from withdrawal is irritable. It is very hard to comfort these babies.

Possible Complications Using drugs and alcohol during pregnancy can cause more than just symptoms of withdrawal. It can lead to health problems in your baby like: • Birth defects, like mental retardation • Learning disabilities • Low birth weight • Premature birth • Small head circumference • Sudden infant death syndrome (SIDS)

How to Get Help If you are using drugs, including alcohol or tobacco, ask your doctor for help with stopping as soon as possible. This will keep yourself and the baby safe.

45 Your Pregnancy Guide

Foods/beverages I need to eat/ Date my baby is due: ______drink more often: Who will take me to the hospital? ______Phone: ______Backup person ______Phone: ______Things to think about: ______• Is there something I do regularly that could harm my unborn baby? • Do I need someone to help me stop a harmful habit? ______• Do I want natural delivery or an epidural? ______• Do I want to know the sex of my baby when I have my ultrasound? • If my baby is a boy, do I want him circumcised? (See page 30) ______• What will I name my baby? ______• Do I want to breast feed or bottle feed? • Who do I want to be my baby’s pediatrician? ______• Who will take care of my baby while I am at work/school? • If you need help answering any of the above questions, talk to Foods/beverages I need to eat/ your doctor, parents, trusted friend or relative. Or call a CaringStart drink less often or not at all: nurse. Just dial 1-888-416-3025. This is a free call. ______Baby names I like: What to take to the hospital: ______• Nightgown ______• Toothbrush, toothpaste, ______deodorant, hair brush, comb, ______shampoo ______• Clothes for you (under ______garments, clothes to wear home ) ______• Nursing bra (if you’ll breast feed ______your baby) ______• Car seat ______• Clothes for baby to wear home ______• Telephone numbers of family and friends ______• Baby book ______• This pregnancy baby booklet • Any medications you are taking

46 Baby’s name:______Baby’s birth date: ______Time of birth: ______Baby’s weight: ______Baby’s length: ______Eye color: ______Hair color: ______My baby was delivered by Dr. ______at______The pediatrician I have selected is Dr.______Office phone:______What I would like to remember about my pregnancy and delivery: ______

(baby’s ultrasound picture) (baby’s first picture)

47 My Doctor Appointments My doctor is: Dr. ______

Office phone:______

Questions I want to ask my doctor . ______

List here all prescription drugs, non-prescription drugs and vitamins you take often. ______Give this information to your doctor. MY NEXT DOCTOR VISIT IS: ______MY NEW MOM CHECKUP IS: ______BABY’S 1ST DOCTOR VISIT IS: ______

48 Dear Member: Pregnancy and child birth bring many changes for a woman. Changes to the body are due to hormones and the growing baby. Other changes are emotional and are caused by hormones and feelings about becoming a parent. This is a time when a woman needs to take care of her health. During the weeks and months after delivery, your body will adjust to not being pregnant. It’s important during this special time to take care of yourself. Make sure you have a postpartum visit with your doctor three to seven weeks after giving birth. At this visit, your doctor can make sure you are recovering well. He or she can also help you plan for the future. The emotional changes after birth are as important as the physical changes. The information sheet that came with this letter will tell you about some of the feelings you could be having. It is normal for women to have the “baby blues” after child birth. But for some women, the blues don’t pass. We want to help women who may be depressed. But, to do so, we have to know who may be feeling depressed. Luckily, there is an easy and quick survey you can take that will give us a good idea. The enclosed 10-item survey* comes with a postage-paid return envelope. Please take the time now to read the information sheet, complete the survey, and return it to BlueCare or TennCareSelect, the company that provides your mental health services. We want to assist you as soon as possible. Please call us if: • You think you need help right away, or • You answer 1, 2 or 3 to Question #10.

BlueCare members call 1-800-468-9698. TennCareSelect members call 1-800-263-5479. We hope you decide to complete the survey. But, whatever you decide, you may call us any time of day if you have questions or need help. Thank you and best wishes, BlueCare Tennessee *The Edinburgh Postpartum Depression scale is a tool used to help find mothers who may suffer from postpartum depression.

49 EDINBURGH DEPRESSION SCALE We would like to know how you are feeling. Please indicate the answer which comes close to how you have felt IN THE PAST 7 DAYS, not just how you feel today.

In the past 7 days: 1 . I have been able to laugh and see the funny side of things. ¨¨(0) As much as I always could ¨¨(1) Not quite so much now ¨¨(2) Definitely not so much now ¨¨(3) Not at all

2. I have looked forward with enjoyment to things. ¨¨(0) As much as I ever did ¨¨1) Rather less than I used to ¨¨(2) Definitely less than I used to ¨¨(3) Hardly at all

3. have blamed myself unnecessarily when things went wrong.* ¨¨(3) Yes, most of the time ¨¨(2) Yes, some of the time ¨¨(1) Not very often ¨¨(0) No, never

4. I have been anxious or worried for no good reason.* ¨¨(3) No, not at all ¨¨(2) Hardly ever ¨¨(1) Yes, sometimes ¨¨(0) Yes, very often

5. I have felt scared or panicky for no very good reason.* ¨¨(3) Yes, quite a lot ¨¨(2) Yes, sometimes ¨¨(1) No, not much ¨¨(0) No, not at all

6. Things have been getting on top of me.* ¨¨(3) Yes, most of the time I haven’t been able to cope at all ¨¨(2) Yes, sometimes I haven’t been coping as well as usual ¨¨(1) No, most of the time I have coped quite well ¨¨(0) No, I have been coping as well as ever

7. 7. I have been so unhappy that I have had difficulty sleeping.* ¨¨(3) Yes, most of the time ¨¨(2) Yes, sometimes ¨¨(1) Not very often ¨¨(0) No, not at all

50 8. I have felt sad or miserable.* ¨¨(3) Yes, most of the time ¨¨(2) Yes, quite often ¨¨(1) Not very often ¨¨(0) No, not at all

9. I have been so unhappy that I have been crying.* ¨¨(3) Yes, most of the time ¨¨(2) Yes, quite often ¨¨(1) Only occasionally ¨¨(0) No, never

10. The thought of harming myself has occurred to me.* ¨¨(3) Yes, quite often ¨¨(2) Sometimes ¨¨(1) Hardly ever ¨¨(0) Never

Score Interpretation: Answers are scored 0, 1, 2, or 3 with increasing symptom severity. Items marked with an asterisk are reverse scored (i.e. 3, 2, 1, and 0). The total score is calculated by adding the scores for each of the 10 items. ¨¨1-10 No further screening required ¨¨11-14 Repeat test in 2 weeks ¨¨15+ Contact PCP, OB or PBH provider

51 If you have any questions, just call this toll-free phone number 1-888-416-3025 ¿Habla español y necesita ayuda con esta carta? Llámenos gratis al BlueCare 1-800-468-9698. Llámenos gratis al TennCareSelect 1-800-263-5479. We do not allow unfair treatment in TennCare . No one is treated in a different way because of race, color, birthplace, religion, language, sex, age, or disability. Do you think you’ve been treated unfairly? Do you have more questions or need more help? If you think you’ve been treated unfairly, call the Tennessee Health Connection for free at 1-855-259-0701. If you have a hearing or speech problem you can call us on a TTY/TDD machine. Our TTY/TDD number is 711 and ask for 888-418-0008. Need help in another language? You can call TennCareSelect for assistance in any language at 1-800-263-5479 or the numbers below. Call BlueCare for language assistance at 1-800-468-9698 or the numbers below. Interpretation and translation services are free to TennCare members. Foreign Language Lines call if you need help and need to speak with someone in one of these languages: (Arabic) 1-800-758-1638 Bosanski (Bosnian) 1-800-758-1638 (Kurdish-Badinani) 1-800-758-1638 (Kurdish- Sorani) 1-800-758-1638 Soomaali (Somali) 1-800-758-1638 Español (Spanish) 1-800-758-1638 Ngươi Việt (Vietnamese) 1-800-758-1638

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BCT-26 (4/14) CaringStart Mothers-To-Be Booklet