This book belongs to:

Transcription

1 Becoming a Family

2 This book belongs to: Dates to remember: Healthcare provider: Phone: Healthcare provider: Phone: Healthcare provider: Phone:

3 Becoming a Family

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5 This book has been written to help you understand what to expect at the hospital, and to give you some basic information about breastfeeding and caring for your newborn. While we feel all of the information in this book is important and will help you take care of yourself and your baby, please be sure to review these sections carefully before your baby is born: Skin-to-skin care...page 2-5 The physical effects of labor and delivery...page 3-1 Rooming-in...page 3-2 Routine care...page 3-3 First 24 hours of breastfeeding...page 4-6 Vaccines...page 5-17 Your labor and delivery experience will be unique to you and your baby but reading these sections will help you understand what to expect during your hospital stay. We are proud to offer two hospitals that give obstetrical and neonatal care and provide family-centered care. You can choose to have your baby at Poudre Valley Hospital located on Lemay Avenue in Fort Collins, or Medical Center of the Rockies, located at I-25 and Highway 34 in Loveland. Please talk to your healthcare provider about which hospital is right for you and your family. BECOMING A FAMILY

6 Welcome to Poudre Valley Hospital and Medical Center of the Rockies We would like to welcome you and your family, and acquaint you with our philosophy of patientand family-centered care. Patient- and family-centered care creates a partnership with families and builds a foundation of: Support for family decision-making and caregiving. Recognition of the vital role that families play in the health and well-being of family members. Respect for patient and family choices. Patient- and family-centered care nurtures those strong bonds between babies and their families that begin before birth. We encourage families to keep their baby with them at all times during their hospital stay. This allows families to learn more about their baby before going home. This is the philosophy of care that our department follows and supports: Family health care needs are unique and change over time. Each family is individual in its needs and background. Families can include members who are not related by blood or marriage. Care is a partnership between families and healthcare providers. Birth is one of life s special events. Birth and parenting can occur with greater ease, comfort, and joy when families have the information they need. Newborn care addresses the specific needs of each child and his/her family. Thank you for choosing Poudre Valley Hospital or Medical Center of the Rockies. We look forward to caring for you and your baby. BECOMING A FAMILY

7 Table of contents Preparing for baby Labor and delivery Caring for new moms and babies Feeding your baby Caring for your baby Something s not right (postpartum mood disorders) Caring for mom Resources Index BECOMING A FAMILY

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9 Preparing for baby

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11 Preparing for baby Congratulations on the upcoming birth of your baby! Although you re probably busy and excited getting ready for your baby, you may find that life will be busy those first few weeks after your baby s arrival. Take time now to put your feet up, relax, and read as much as possible about life with your new baby. PREPARING FOR BABY 1-1

12 Prenatal care While pregnant, it is very important to take good care of yourself. Please see your healthcare provider or midwife as often as they recommend. Follow your healthcare provider s advice on nutrition, rest, exercise and any medications you should or should not be taking. Selecting a hospital We are proud to have two Baby-Friendly hospitals to care for you and your baby during labor, delivery and recovery. In addition to our team of healthcare providers and nurses, and state-of-the-art technology, we offer: Centralized fetal monitoring so your nurse is able to see your baby s heart rate. Anesthesiologists available around the clock to meet any medical pain management needs you may have. A high level neonatal intensive care unit at PVH. Our NICU routinely cares for premature and sick babies and is the highest level NICU between Denver and Billings, Montana. The special care nursery at MCR cares for babies born as early as 34 weeks and those who are sick or need a little extra help after birth. Expert neonatal nurse practitioners who specialize in taking care of your baby s needs and are available around the clock at both hospitals. Our neonatalogists, pediatricians with three additional years of training focused on the care of critically ill newborns, supervise the medical team that provides the daily medical care for babies in the NICU and SCN. The neonatologists based at our hospitals are members of the faculty of the University of Colorado at Denver and Health Sciences Center. They are members of the nationally renowned physicians group that cares for newborns at Colorado Children s Hospital in Denver. Our mission is to bring technology and expertise to Poudre Valley Hospital to provide comprehensive, state-of-the-art care for your baby in northern Colorado. We encourage you to tour both hospitals to see which hospital is the best fit for you and your family. 1-2 PREPARING FOR BABY

13 Financial arrangements We ask that you pay any amount on your account not covered by insurance, such as copayments, deductibles and coinsurance, when you leave the hospital. Payment plans are available. You may also make arrangements prior to delivery. To make financial arrangements, ask about current maternity estimates, discuss payment plans available once you are pre-registered, or review financial assistance options, please contact a financial representative at If you have insurance, we suggest you discuss with your company early in pregnancy what is and what is not covered by your policy. To avoid delays, please remember to notify your insurance plan within 30 days of your baby s birth if you want coverage for your baby. Preparing for childbirth We encourage you to attend childbirth classes to help prepare for labor and delivery. The classes give you information about your birth options and ways to make your labor and delivery more comfortable. You can take classes through our Family Education Program. Some healthcare providers also offer classes. Our classes and tours fill quickly. Please register early in your pregnancy and complete classes one month before your due date. Package deals are available. For a complete listing of classes, visit pvhs.org/classes. For more information, call SUPPORT GROUPS ARE AVAILABLE AFTER THE BIRTH OF YOUR BABY: Breastfeeding Support Groups PVH: MCR: Welcome to Motherhood Group Call for information. For more information on other support groups, look at the resource section of this book. PREPARING FOR BABY 1-3

14 Preparing for childbirth (Continued) HEALTHY KIDS There are many free or low cost programs available for families through the Community Health department. To learn more, go to pvhs.org/community. Preparing your family Having a baby is a time for adjustment - for you, the baby s father, other siblings, friends and other relatives. Start now by making realistic expectations about life after baby. Those first few months can be physically, emotionally and mentally exhausting, but also very rewarding, too. Use these tips to help make those first few months go smoothly: Set limits on visitors so you and baby get needed rest. The first hour after birth is a special time for mom and baby to bond through skin-to-skin care. Encourage visitors to wait to meet your baby until you ve had this special time together. Ask friends to prepare meals. Get help with household chores. Sleep is important to your health and recovery. Take naps when the baby naps. Re-evaluate your priorities, remembering that your baby is only going to be little once and doesn t care if the house is dirty. Simplify tasks. Get out of the house. Keep your sense of humor. Be flexible - babies don t know schedules or clocks. Have someone watch the baby so you can have a little break. Eat healthy meals to help keep up your energy. If your baby cries a lot, don t take it as a sign that you re a bad parent. Some babies are just fussier than others. 1-4 PREPARING FOR BABY

15 Preparing your family (Continued) Ask for help if you feel like you re losing control because of your baby s constant crying. Call family, friends or one of these resources: Your healthcare provider. Connections Women s Center Preparing brothers and sisters If you have other children, now is the time to start preparing them for the new baby. It is common for children to be jealous, feel left out, become quiet, ignore you or demand extra attention. These tips can help: Encourage older children to talk about their feelings. Let them know it is all right to have bad feelings toward the baby, but it is not OK to hurt the baby. Have visitors pay attention to your other children as well as the new baby. Show by actions and words that the other children are still loved the same as before. Have the other children help with baby tasks that are appropriate for their age. Try to maintain routines so the children feel secure. Use the same discipline methods. Spend special time alone with each child when you can. Don t count the minutes you spend with each child; rather meet the needs of the children as they arise. Car seat safety Motor vehicle crashes are a leading cause of hospitalizations and death to children in Larimer County, Colorado and the U.S. Protect your littlest passenger by restraining him in the appropriate car seat or booster seat. Safe Kids Larimer County can answer questions about or provide assistance with installing your seat: For a complete listing of car seat resources in Larimer County, recall information and details about our free car seat fit station services, visit safekidslcc.org. PREPARING FOR BABY 1-5

16 Car seat safety (Continued) REMEMBER the back seat is best for ALL children under age 13! BEST PRACTICE GUIDELINES FOR BUCKLING UP YOUR CHILD: Babies under 2 years old should: Use rear facing car seats. Sit facing the back of the car in her car seat. Always ride in a back seat and never in front of an air bag. Always ride in a car seat made for baby s size and age. Have straps that are snug on baby (no more than a finger s width of space between baby s collar bone/shoulder and the harness strap). Have a car seat that is buckled tightly in the car and doesn t move more than one inch when an adult pulls it. Use a bigger seat rear-facing until she outgrows the harness. Many harnesses go to 35, 40 or 45 pounds. HOW DO I INSTALL MY CAR SEAT INTO THE VEHICLE? Remember these two main points when installing your car seat: 1. Your child must be buckled snugly into the seat. 2. The car seat must be buckled tightly into your vehicle. HOW DO YOU KNOW IF YOUR SEAT IS INSTALLED CORRECTLY? To install your car seat prior to your baby s delivery, contact one of the agencies below to MAKE AN APPOINTMENT. Each agency has certified child passenger safety technicians to help you. These locations do not see drop-in clients so scheduling an appointment is the only way to get your car seat installed. Please keep in mind that the firefighters and EMS personal are on duty and may be called out to respond to a fire or other emergency. Your patience and understanding are greatly appreciated. Berthoud: Berthoud Fire Protection Estes Park: Estes Park Fire Department PREPARING FOR BABY

17 Car seat safety (Continued) Evans: Evans Fire Department Fort Collins: Poudre Fire Authority Nice Car Incorporated Greeley: Greeley Fire Department Johnstown: Johnstown Police Department Loveland: Fire and Rescue Windsor: Windsor Severance Fire Protection District Larimer County: Colorado State Patrol PVHS Emergency Medical Services Weld County: Auto Collision Specialists Colorado State Patrol Platte Valley Fire Protection District PVHS Emergency Medical Services For the most current list of community fit stations, go to safekidslcc.org If your baby is born at PVH, you can schedule an appointment before you leave the hospital to help with car seat installation. This is free, grant-funded education program. MCR does not currently offer this service. Only use a secondhand seat if: 1. You know the full history of the seat and it has never been in a crash. 2. It has not been recalled by the manufacturer (check latest recall list at 3. You have the manufacturer s instruction manual for the seat. 4. The seat has all its parts, including all labels. 5. The seat is less than 6 years old. 6. Your child/infant is within the weight and height requirements specified for that seat. PREPARING FOR BABY 1-7

18 Car seat safety (Continued) USING YOUR CAR SEAT Follow manufacturer s instructions for using and installing the seat. Read your vehicle owner s manual to learn how your safety belts work. You may need to use a locking clip to secure the seat tightly in the vehicle. Baby supplies Now is the time to make sure you have a few basic supplies on hand so you can clothe and take care of your baby properly. And remember, babies grow fast and clothing sizes generally run small, so you might want to avoid buying too many tiny outfits. The most important thing you can provide your baby is lots of love. TWIG Twig, part of Twenty Three Trees, is a great, low-cost resource for high-quality, reliable products and supplies for you and your baby. We carry breast pumps and supplies. The certified lactation counselors at WeeSteps can help with questions about lactation supplies. Located in Westbridge Medical Suites across the bridge from PVH: 1107 S. Lemay Avenue, Suite 160 Fort Collins, Colorado We will deliver to MCR Drug and alcohol use during pregnancy It is a fact that half of all pregnancies are unplanned. This doesn t mean that these babies are not wanted, but because they are unplanned, many babies are exposed to drugs or alcohol unintentionally prior to a woman even knowing she is pregnant. It is estimated that one out of 10 babies may be affected. Substances that may harm a developing infant are called teratogens. These could include: Alcohol. Cocaine. Heroin. Marijuana. Methamphetamine (meth). Prescription painkillers. Tobacco. 1-8 PREPARING FOR BABY

19 Drug and alcohol use during pregnancy (Continued) Alcohol has been identified as the leading preventable cause of birth defects. According to the US Department of Health and Human Services, one million babies a year are exposed to alcohol and drugs during the pregnancy. We also know that most drugs are not used independently. For example, alcohol, tobacco and meth may be used together, or alcohol, marijuana and prescription painkillers together. A combination of substances can make the effects more harmful to the baby. WHAT KINDS OF THINGS MIGHT HAPPEN TO MY BABY? Anything you eat, drink or take affects all body systems. During the first 3 months an infant is developing his or her internal organs, so problems may occur if you have used drugs and alcohol during your pregnancy. Problems may include: Premature tearing away of the placenta. Low birth weight. Premature birth. Small brain. Seizures. Poor coordination in movements. Irritability. Sucking problems. Feeding problems. PREPARING FOR BABY 1-9

20 Drug and alcohol use during pregnancy (Continued) THINGS THAT MAY HAPPEN TO YOU ARE: Hemorrhage. High blood pressure. Stroke. Infection. Dental problems. MY FRIEND USED DRUGS AND HER INFANT IS FINE. We don t know that for sure. The infant s brain grows the most during the last half of the pregnancy and continues until the baby is 2 years old. Many effects to the brain are invisible so we call these soft signs. These include: Sleep problems. Developmental delays. Problems in school. Too much or too little muscle tone. Hypersensitivity to stimulation in the environment. Lower I.Q. Memory problems. Attention Deficit Disorders. Poor coordination. Poor problem solving ability. Impulsiveness. Hearing and speech problems. Poor social skills. Because the brain continues to grow rapidly until the second year, any tobacco or drug use in the home can continue to affect the infant s development. Second-hand smoke from tobacco, marijuana or meth can negatively affect growth, and can cause asthma or other lung problems as well. I AM ALREADY PREGNANT AND WAS USING SUBSTANCES. WHAT CAN I DO NOW? The most important thing to do is get consistent prenatal care. Women who get prenatal care even with drug use have better outcomes for their babies PREPARING FOR BABY

21 Drug and alcohol use during pregnancy (Continued) Stop using substances! If you can t stop, cut down on your use. Any reduction in use will have a positive effect on your baby. Be honest with your healthcare provider or midwife. If you weren t totally honest in the beginning, share with them now about your use. They will be able to more closely monitor your baby and also can help you get help for your addiction through a drug and alcohol counselor. WHAT WILL HAPPEN WHEN I GO INTO LABOR AT THE HOSPITAL? You will have your temperature, heart rate and blood pressure checked, and your baby s vital signs will also be checked by a fetal monitor. You will have an exam to see how far your labor has progressed and a health and social history will also be done. Colorado Vital Statistics gathers a great deal of information from your baby s birth certificate about prenatal care, tobacco, alcohol and substance use. The information is used to monitor the State s progress in improving outcomes for infants. If your health history indicates that your baby may be at risk from substance use, you may be asked to have your urine checked for the presence of drugs. This test is not done to judge you; it is to help us know how best to care for you and your infant. Babies may be tested by collecting their first bowel movements, which is called meconium. Meconium starts developing in their intestine about halfway through the pregnancy. It will contain drugs that have been used at a level high enough to be called abuse. It will not pick up occasional use of alcohol, even though we know that small amounts can also cause effects to the baby. Sometimes parents are not able to control their use of substances and a baby may not be in an environment that is safe. Healthcare professionals, social workers and teachers must report concerns to the Division of Child and Family Services. This is never to judge parents but to help speak for the infant who may need more help. Our goal is to keep parents and children together in a safe and thriving environment. WE KNOW THAT: Your intention is never to harm your baby. Addictions are hard to overcome by yourself. Relapse is often a part of recovery. PREPARING FOR BABY 1-11

22 Drug and alcohol use during pregnancy (Continued) Pregnancy is the most successful time for recovery from substances. Your healthcare provider and midwife care about you and will help you seek treatment. A consistent and stable environment for the baby is crucial. The first three years of a child s life are the best time to start treatments if delays or problems exist. RESOURCES Your healthcare provider Connections Mental health and substance abuse referrals Fort Collins: Loveland: United Way Community resources, including Alcoholics Anonymous, Narcotics Anonymous and other treatment centers. Antepartum care We provide a wide variety of services if you should need to be hospitalized for an extended amount of time prior to the delivery of your baby. The Birthing Center at PVH and the Mother and Family Center at MCR are equipped to provide you with a private room with 24 hour monitoring of your baby as ordered by your healthcare provider. If it is in your and your baby s best interest to remain hospitalized, you can expect: Intermittent fetal monitoring as ordered by your healthcare provider. A private room with refrigerator. Primary nursing (a core group of nurses will be assigned to your care to provide you with continuity). A visit from physical therapy to help with body positioning and exercises that can be done in bed to help alleviate pain and improve relaxation. Counseling referral for support as needed. For long-term stays, a care conference may be set up with you, your family, your healthcare providers and the nursing staff to develop a plan of care for your stay PREPARING FOR BABY

23 Antepartum care (Continued) If you are anticipating a possible preterm birth, you will be visited by a neonatal intensive care unit/special care nursery staff member to explain what to expect in the NICU/SCN. Having your baby Your healthcare provider gives you guidelines on when to arrive at the hospital after your labor begins. Be sure to fill out the admission form online (visit pvhs.org/babies) or mail it to the hospital at least four weeks before your due date so you can be quickly admitted. WHAT TO BRING TO THE HOSPITAL Robe. Slippers. Supportive bra. Toothbrush, toothpaste and shampoo. Loose, comfortable clothing to wear home. Clothes for your baby to wear home. Blanket for your baby. Names for your baby. The name of your baby s healthcare provider. A car seat. Labor tools. WHAT ISN T ALLOWED Alcohol, candles, incense and anything that burns are not allowed in the hospital. Where to go MEDICAL CENTER OF THE ROCKIES Anytime day or night Use the Emergency Department entrance. You may park in Stork Parking spots and come into the ED and go directly to the concierge desk for assistance. The ED is accessed by driving to the northeast corner of the building. PREPARING FOR BABY 1-13

24 Where to go (Continued) POUDRE VALLEY HOSPITAL 8 a.m. to 5 p.m. weekdays Use ER-Surgery entrance on the south side of the hospital. Park in the reserved Stork Parking spots near the Surgery entrance. Any other time Use ER Entrance (south side of building). Park in the reserved Stork Parking spots near ER door. GETTING TO LABOR AND DELIVERY At MCR, you ll take the elevator to the fifth floor and go to the Mother and Family Center. At PVH, you ll take the elevator to the third floor and follow the signs to the Birthing Center. At MCR, you will labor, deliver and recover in a room on one side of the unit, then you ll change rooms to the west side of the unit. You ll stay in your postpartum recovery room until you are ready to go home. At PVH, you will go through labor, delivery and recovery in the Birthing Center. You will move to your postpartum room on the Women s Care Unit a few hours after your baby s birth. You ll stay there until you are ready to go home. Both units have two operating rooms for C-sections PREPARING FOR BABY

25 Friends and family Visitors of your choice are welcome while you are in labor. A waiting room is also available nearby. All children must be accompanied by an adult. Children may attend the birth but please make sure you carefully prepare them for the experience. Room features Each birthing center room features: GetWell Network. (An educational tool available through your in-room TV. It provides useful information about taking care of yourself and your baby.) Free movies. Free internet access. Free wifi. A refrigerator. A kitchen with a microwave and refrigerator is available for your support person. Laboring mothers, however, should check with a nurse before eating or drinking anything. PREPARING FOR BABY 1-15

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27 Labor and delivery

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29 Labor and delivery The birth of your baby is a special time in your life. We are honored to share this experience with you. We would like to help you create a unique birth experience, and encourage you to share your feelings, questions and requests with all of your care providers. Before labor, we encourage you to talk with your healthcare provider about: the benefits of breastfeeding, pain relief choices and choosing a healthcare provider for your baby. The Parents Preview Tour offers an opportunity to see a birthing room and ask questions about what to expect at the hospital. We hope the information in this section is helpful in understanding what to expect at PVH and MCR. LABOR AND DELIVERY 2-1

30 Labor and delivery routines INDUCTION OF LABOR If you are scheduled for an induction procedure, your healthcare provider will give you a handout when your induction is scheduled. We do not schedule inductions or C-sections prior to 39 weeks gestation unless medically necessary. ADMISSION When you are admitted to the hospital, a fetal monitor will be placed on your belly for about 20 minutes to assess the baby s well-being and your contraction pattern. Your nurse will ask you questions which will help us care for you and your baby. Your nurse will draw blood for tests according to your healthcare provider s orders. We will continue to assess your labor and the baby s heart rate according to how your labor is progressing. Many care providers order a buff cap. This is a plastic catheter placed into your vein, and it allows access for IV fluids or medicine if needed. You will be encouraged to drink fluids. UMBILICAL CORD BLOOD BANKING If you re interested in donating your baby s cord blood, visit clinimmune.com/cordbloodbank. You may also wish to instead privately bank your baby s umbilical cord so that it is reserved for your family s own use. There are a number of private banks that will store your baby s cord blood and charge you a fee. You can discuss this option with your healthcare provider. ACTIVITY DURING LABOR We encourage you to walk, change positions, and use the reclining chair in your room during your labor. Occasionally, walking may be limited due to certain medical conditions or procedures. You may wear your own bathrobe and slippers. Some mothers like to change the temperature in the room. Support persons are encouraged to bring light and heavier clothing to wear because they may become hot or cold in the room. COMFORT MEASURES AND PAIN RELIEF IN LABOR We try to keep mothers and their support person(s) well informed of pain relief options, and we encourage flexibility to make changes in the birth plan if circumstances change. 2-2 LABOR AND DELIVERY

31 Labor and delivery routines (Continued) Many comfort measures are available that do not involve medicine. Examples are: coaching in breathing techniques, visualization, aromatherapy (nothing that burns), music, jacuzzi, shower, back pressure, warm packs, fit balls, and TENS units. Your care provider and your nurse will offer information about medicine and pain relief during labor. RECOVERY AFTER DELIVERY You and your baby will recover in the labor and delivery unit for a few hours after birth. We recognize the importance of mother, baby and family being together during those special early moments of life. We make every effort to keep your baby with you. The first hour after birth is a very special time for bonding with your baby. We encourage you to limit visitors during this time and hold your baby skin-to-skin (baby is naked or wearing only a diaper and is placed on your chest). We also encourage all moms to breast-feed and can assist with nursing. If your baby has physical needs that cannot be met safely in your delivery room, it may be necessary for your baby to go to the nursery. Your support person is encouraged to accompany the baby to the Neonatal Intensive Care Unit (NICU) at PVH or the Special Care Nursery (SCN) at MCR to be involved with your baby s care. We make every effort to reunite mother and baby as soon as possible. Following a vaginal birth, the hospital stay is usually one to two days. LABOR AND DELIVERY 2-3

32 Labor and delivery routines (Continued) CESAREAN BIRTH A Cesarean section is a method of delivery and is done to protect your health and/or your baby s health, or when a vaginal birth is not optimal. The operation is done in a special operating room on the labor and delivery unit. If a cesarean birth is necessary, your healthcare provider will talk with you and ask you to sign a consent form. Your support person can be with you in the operating room. Go to pvhs.org/c-section for more information about C-sections. You may bring your own music for use during labor and delivery if you would like to have background music. After the birth, you and your baby will recover in the recovery room for about one hour. During that time your nurse will monitor vital signs and provide pain management. You will be able to hold and breast-feed your baby. You may choose to have visitors in the Recovery Room. The hospital stay is usually three to four days following a Cesarean. Transition newborn care If your baby s health status is normal, routine care for your newborn is done in your birthing room. A nurse from the Neonatal Intensive Care Unit at PVH or the Special Care Nursery at MCR attends the birth of every baby. If your baby s health is normal, routine care for your baby is done in your birthing room. This includes: Weight and length measurements. Skin-to-skin time, especially in the first hour immediately following your baby s birth, are strongly encouraged. Baby s first foot prints. Baby s first bath. Eye antibiotic ointment and vitamin K injection within the first hour of life. Identification bracelets placed on the baby, mother and the person of mother s choice. THESE SHOULD NOT BE REMOVED UNTIL THE BABY IS DISCHARGED FROM THE HOSPITAL. 2-4 LABOR AND DELIVERY

33 Skin-toskin care We encourage skin-to-skin care is for all babies. Skin-to-skin care is a way of holding your baby to allow him or her to be closer to you. Your baby is naked (possibly with a diaper on) and is held between the mother s breasts or next to the father s chest. We understand how valuable this precious first hour after birth is and we know this opportunity is one to be cherished. Because this Golden Hour is so special, we encourage you to limit visitors during this time so your baby has one on one time with you and your support person. This special time will help your baby initiate breastfeeding and helps you and your baby develop a strong bond. Our goal is to allow you at least 60 minutes of this important time between you and your baby immediately after birth. We will do our best to support this model of care as long as mother and baby are physically stable and able to participate in this time together. If you or your baby aren t able to participate immediately in this time together, we will do our very best to give you that opportunity as soon as we can. This is one of the first things you as parents can do for your baby and it is a crucial first step in really getting to know your baby. LABOR AND DELIVERY 2-5

34 Skin-toskin care (Continued) THE BENEFITS OF SKIN-TO-SKIN CARE Skin-to-skin care during the first hour of life and the days after your baby s birth has multiple benefits for you as parents and your baby. The first and most important is that overall skin-to-skin care promotes infant-parent bonding and attachment. BENEFITS FOR YOUR BABY: A more stable heart rate and more regular breathing. Stimulation to breast-feed and all gain the benefits of breast milk. Improved circulation and better use of oxygen throughout the body. Longer periods of alertness and longer periods of sleep. More rapid weight gain. Increased likelihood of going home from the hospital earlier. Being soothed by listening to the sound of the parent s heartbeat. Being calmed by the gentle rocking of a parent s breathing. BENEFITS FOR YOU: Feeling of special closeness with your baby. Mother feels more confident/controlled in her ability to care for her baby. Stimulates production of breast milk. You feel more comfortable taking your baby home. 2-6 LABOR AND DELIVERY

35 Caring for new moms and babies

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37 Caring for new moms and babies The birth of your baby is a time filled with excitement, fatigue, anticipation, discomfort and many changes unique to each individual. It is our goal to support and care for you as you enter this new phase in your life. Labor and delivery can be physically draining. During your hospital stay, you will be tired and feeling the physical affects of labor. We encourage you to limit visitors so you can rest when your baby rests. Babies are awake a lot at night. The ideal time for mom to rest is whenever baby is asleep throughout the day. The following section highlights what to expect during your stay at PVH or MCR after the birth of your baby. Please talk to your nurse about your needs, questions and concerns. CARING FOR NEW MOMS AND BABIES 3-1

38 Room assignment Patient rooms are filled on a first-come basis. All rooms either have a built-in bed or recliner for your support person. Nursing care for mom We are honored to care for you and your baby. We will work with you and teach you how to care for yourself and your baby. Please keep these things in mind during your hospital stay: We want to provide the best care possible during your stay. To help us accomplish this goal, please communicate with your nurse about your needs. Your nurse is routinely assigned to care for multiple patients. Clearly communicating your needs helps your nurse provide the best care possible. Please ask for pain medicine if needed, help with feeding your baby, or any questions you have. We are here to help you get ready to care for yourself and your baby at home. While in the hospital, we encourage you to care for yourself and your baby as much as possible, and use the nurses as resources. This will help build your confidence in caring for your baby. Rooming-in (having the baby in your room at all times), is routine so you and your baby can get to know each other. Many comfort measures are available. They may include but are not limited to: personal sitz baths, pain medicine, ice, Tucks pads, Dermoplast spray and breast shells for sore nipples. Please talk with your nurse about your needs so we can help you be as comfortable as possible. If you have chosen to breast-feed your baby, all of our nurses are trained to help you. Please call your nurse to assist you with feedings. Proper latch and positioning are important for preventing sore nipples. If you and your baby need additional help, we have certified lactation counselors to help you. The benefits of rooming-in Rooming-in, keeping your baby in your room at all times during your hospital stay, benefits both you and your baby in many ways. You and your baby will sleep better. (You should sleep when your baby sleeps, even during the day. Babies are up a lot at night.). Your baby will cry less. 3-2 CARING FOR NEW MOMS AND BABIES

39 The benefits of rooming-in (Continued) Better breastfeeding. Your milk will come in sooner, you ll learn your baby s feeding cues better, your baby will be fed more often and you will likely have a higher rate of exclusive breastfeeding. Your baby will gain weight better. Babies who room-in have decreased jaundice. You ll be better prepared to take care of your baby at home because you get to know your baby right away. Rooming-in promotes bonding with your baby. Routine care Our goal is to create an environment of care that is quiet and restful, with minimal disruptions. However, the following activities are considered essential to provide the best and safest care for you and your baby. Your nurse can help you plan these activities to best meet your needs. If you want to designate rest times, special signs are available to post outside your room. You can expect these hospital visitors during your stay: Healthcare providers for both you and your baby. This includes nurses, nurse aides, physicians, certified nurse midwives and possibly residents and student nurses. Nurses who give a bedside report. At the change of shift, your nurses will discuss the plan of care for you and your baby at your bedside. Your input is valuable. Nurses/nursing assistants who check on you each hour (hourly rounding). Your needs, including personal needs, pain management and overall comfort and safety, will be assessed each hour. Nursing leadership will briefly visit with you and your family. Leadership rounding helps us ensure your needs are being met or make any changes that will enhance your stay. Laboratory technicians will perform routine lab draws early in the morning so healthcare providers have results when they make rounds. Nutrition assistants will deliver your meals. Housekeepers. Birth certificate clerk. CARING FOR NEW MOMS AND BABIES 3-3

40 Routine care (Continued) PVHS volunteers to provide newborn hearing screen. Certified lactation counselors. Larimer County nurse. Volunteers. Visiting the hospital Your baby s father and brothers/sisters may visit anytime. Your other children must have adult supervision other than you. We encourage you to limit visitors during your hospital stay and sleep/rest when your baby sleeps. We also encourage family nap time each afternoon. Babies are usually awake a lot at night and you ll feel better and heal faster if you are well rested. If there is a time when you would rather not have visitors, let your nurse know. Please limit the number of visitors you have at one time. For the health of our moms and babies, anyone who has symptoms of an illness, such as runny nose, cough or fever, should not visit the hospital. We appreciate your help in keeping our moms and babies healthy. Meals HOSPITALITY SERVICES IS PROUD TO OFFER ROOM SERVICE Hospitality Services at Poudre Valley Hospital is proud to offer At Your Service Dining. Your meal will be prepared and delivered directly to your room when you are ready. A menu will be provided for you; simply call our customer services representative at at MCR or at PVH to place your order from. 3-4 CARING FOR NEW MOMS AND BABIES

41 Meals (Continued) COMPLIMENTARY ROOM SERVICE IS OFFERED FOR YOUR CONVENIENCE: Your meal can be delivered any time between 7 a.m. and 7 p.m. at MCR and 7 a.m. and 9 p.m. at PVH. Your meal is made fresh before delivery. Please allow minutes for delivery. Your diet was ordered by your healthcare provider. If you have food allergies or special dietary needs, please inform your nurse. There is a pantry stocked with ice, juices, crackers, and other snacks for our patients. We invite you and the guest of your choice to enjoy a complimentary gourmet meal served in your room. Ask your nurse for the Baby Bistro menu. Baby Bistro lunch orders must be placed by 9:30 a.m. and dinner orders must be placed by 2:30 p.m. Other guest meals are available for $6 per tray and include a dinner salad, entrée, side dish, dessert and drink. You will need to pay for the meal at the time of delivery with cash or check. The cafeteria is located on the lower level. Family members are welcome to purchase food in the cafeteria and bring it to your room. Nursing care for baby If your baby is in the NICU or SCN, the nurses and healthcare providers will talk with you about your baby s daily routine. If you and your baby are on the postpartum recovery unit, you ll have a nurse that is specially trained to care for both you and your baby. We encourage you to ask any questions you have about caring for yourself or your baby. Please keep track of baby s feedings and any diaper changes on the diaper diary given to you by your nurse. Your baby will be examined each shift. The nurse will listen to your baby s heart, lungs and abdomen. She will watch for any signs of illness. Supplies for your baby, such as diapers, wipes and blankets, are stored in the cabinets under your baby s crib. CARING FOR NEW MOMS AND BABIES 3-5

42 Birth certificate information You may choose any name for your baby. Your baby s last name does not have to match the mother s or father s, and hyphenated names may be used (example: Henry Jones-Smith). While you are in the hospital, your baby will be given the same last name as you. This is for security reasons and does not necessarily reflect what the baby s legal last name will be. The time of birth will be recorded in military time on the hospital paperwork (example: 2130= 9:30 p.m.), but not on the official state birth certificate. Last names of all mothers are recorded on the birth certificate using the mother s maiden name. If you use your maiden name as your middle name, leave the middle name space blank on the worksheet. If your baby is born on the weekend, the birth certificate paperwork will be prepared on the following Monday. Before discharge, write baby s full name and your phone number on a special weekend/holiday form and give to your nurse. Information packets will be mailed to you. If you have not named your baby before you go home, the Birth Certificate Clerk will call you. If a name is not selected within eight business days of birth, the birth certificate is filed without first and middle names. They will then need to be added by making a written request to the state. Information about social security numbers is included in the birth certificate packet you will receive from the hospital. The baby must have at least a first name before a social security number can be requested. Information about the father will not be included on the birth certificate if the mother is unmarried at the time of baby s birth, or was not married at the time of conception or anytime during the pregnancy. A Statement of Paternity can be filed with the birth certificate. The father s name can then be added to the birth certificate. There is no fee for filing a Statement of Paternity if it is done at the same time as the birth certificate. Information can be added later, but there will be a fee. Ask the Birth Certificate Clerk if you have any questions about your baby s birth certificate. -- MCR: PVH: CARING FOR NEW MOMS AND BABIES

43 Hearing screen All babies will have their hearing tested. The test is done to check for hearing loss, which can lead to learning delays and problems learning speech and language. The test is easy, painless, reliable, and must be done while the baby is resting or sleeping. This test can be done in your room. Small patches are placed on the baby s cheek, forehead and the back of the neck. Small earphones are placed over baby s ears. The hearing is tested by measuring brain waves in response to clicks made by a machine. If the baby passes the test, you can be assured he or she can hear sounds needed for speech and language development. A letter will be placed in baby s crib to give you the results. A refer means only that the baby needs to be tested again in one month. Please talk to your baby s healthcare provider. Many babies that refer are not asleep at the time of the test, or have some fluid in their ears from delivery that makes it hard to hear the clicks. You will receive information about scheduling that second test. If your baby is discharged before being tested, you will receive a letter with instructions for scheduling the test as an outpatient. It is important to have the test done within the first month of baby s life. Newborn screen When your baby is about 30 hours old, a small blood sample will be taken from baby s heel for the Colorado State Newborn Screen. This test is required for all babies. Your baby will need a second test done at 8-14 days of life. You will be given instructions and information when your baby is discharged. In addition to the Newborn Screen, a lab test will also be done for a total bilirubin to check for jaundice. CARING FOR NEW MOMS AND BABIES 3-7

44 Newborn screen (Continued) The test screens for 30+ medical conditions. Newborn babies who have these disorders look healthy, but babies with some of these disorders will get very sick or die just a few days or weeks after they are born if they are not tested and treated. Other disorders can cause mental retardation. The newborn screening test helps find these disorders early, so babies can get medical treatment before they get sick. Some of the conditions are listed below with the problems that can develop if not treated. These conditions are not common but there are no cures. If these disorders are found early and your baby gets treatment, serious problems can be prevented or reduced. With early and continuous treatment, most babies can grow and develop normally and live healthy lives. CONDITION Phenylketonuria (PKU) Galactosemia Hypothyroidism Sickle Cell Anemia Cystic Fibrosis Biotinidase Deficiency Congenital Adrenal Hyperplasia PROBLEMS IT CAUSES Mental retardation Become very sick, liver and eye damage, mental retardation Do not grow and develop normally, mental retardation Infections, growth, anemia, and pain Growth problems and lung infections Seizures, mental retardation, hair loss, skin rashes and sudden death Death in infancy, do not grow and develop normally, early onset of puberty Infant security We care about your safety and that of your baby. You should become familiar with the following security information: KEEPING YOUR BABY SAFE IN THE HOSPITAL Everyone at the hospital is working to keep your baby as safe as possible. Staff in the maternal and child care area has been trained to spot a potential abductor. There are also strict rules on who can handle your baby, and how your baby is moved for examinations and tests. 3-8 CARING FOR NEW MOMS AND BABIES

45 Infant security (Continued) Security systems have been installed to help stop an abductor, including door locks, cameras, and an electronic infant protection system. The small tag applied to your baby s ankle means that your baby is being monitored at all times. If anyone tries to remove the tag or take your baby through a protected exit, an alarm will sound at the nurse station. Try to keep away from protected exits with your baby. You might set off an alarm by accident. Your nurse can give you more information on the infant security system in this hospital. YOUR ROLE You have an important part to play in your baby s safety, too. During your hospital stay, here are things you should do. KNOW YOUR NURSES At the beginning of each shift, the nurse who will be taking care of you and your baby should come to your room to introduce him/herself to you. It s a good idea to become familiar with the staff in the maternal and child care area. NEVER LEAVE YOUR BABY UNATTENDED While in your room, keep your baby in sight at all times. Whether you re taking a nap or just going to the bathroom, ask a family member to watch the baby for you, or take the baby in the bassinet into the bathroom with you. Keep the bassinet beside your bed, on the side away from the door. At night it is also a good idea to keep at least one light on so the nursing staff can help you keep an eye on your baby. CHECK FOR AN OFFICIAL HOSPITAL ID BADGE Be cautious of any person you do not know who enters your room. Before you let anyone touch your baby, check that person s photo (ID) badge. It must be facing forward so you can see the employee s name, picture, and the hospital s official logo. In addition, staff members who are authorized to move your baby wear special identification. Ask your nurse about this special identification. CARING FOR NEW MOMS AND BABIES 3-9

46 Infant security (Continued) If you re not sure about someone who has come into your room, press your nurse call button for immediate help. MAKE SURE YOUR BABY TRAVELS IN THE BASSINET Any time a nurse takes your baby from your hospital room, your baby must be in the bassinet. Only authorized staff members are allowed to move or care for your child during your hospital stay. If you are walking in the hall with the baby, always use the crib. DO NOT take the baby anywhere else in the hospital. MATCHING YOU AND YOUR BABY For most of your stay in hospital, your baby will remain right beside you in your room. There may be times, however, when your baby has to be away from you. When your baby is brought back to you, your nurse will check in to make sure you and your baby are correctly matched. Here s what to expect: CHECKING ID BANDS Matching identification bracelets are placed on the baby, mother and support person of mother s choice immediately after the birth of the baby. These bracelets need to remain in place until the nurse removes them upon discharge from the hospital. Every time your baby is returned to you after being away, your nurse will check that your ID bands match CARING FOR NEW MOMS AND BABIES

47 Infant security (Continued) AFTER GOING HOME For additional information about keeping your baby safe once you ve left the hospital and infant abduction, visit pvhs.org/baby-security. WeeSteps breastfeeding support program WeeSteps offers a wonderful opportunity to get help with breastfeeding from a certified lactation counselor one-on-one after you go home. You are invited to make an appointment to come to our office with your baby and anyone else you would like to bring. A full examination of your baby, including weight, and a check for any problems, such as jaundice, are part of the visit. The certified lactation counselor will observe a feeding and help with any difficulties. If you need additional assistance with breastfeeding, follow up appointments can be scheduled. After you get home you may have many questions and maybe some concerns about taking care of yourself or your baby. Your WeeSteps appointment is a great chance to ask those questions, and discuss any feeding issues for your baby. WeeSteps can help with a variety of topics including: -- Back to work support. -- Breast pump set up. -- Clogged ducts. -- Feeding support. -- Free weight checks. -- Milk supply questions. -- Opportunity to participate in milk donation. -- Positioning and proper latch. -- Transitioning to solid foods. -- Weaning support. -- Weekly support groups. CARING FOR NEW MOMS AND BABIES 3-11

48 WeeSteps breastfeeding support program (Continued) Going home Plan to make an appointment before you leave the hospital. There is no charge for this service. Some insurance companies offer the benefit of having the nurse come to your home. Check with your insurance plan. WHAT TO EXPECT DURING YOUR DISCHARGE Our goal is to provide an efficient discharge in a timely manner. Please talk to your nurse and let her know what time you plan to go home. Before you go home: The hospital asks that you pay any amount on your account not covered by insurance when you leave the hospital. Bedside checkout is available for paying your account. Please ask your nurse to have a bedside admitting clerk come visit with you. We must have a healthcare provider s order for both you and your baby before you can go home. Paperwork must be signed for both you and your baby. It is helpful to discuss with your nurse the time you plan to go home, so paperwork and teaching can be done before that time CARING FOR NEW MOMS AND BABIES

49 Going home (Continued) THE FOLLOWING SHOULD BE COMPLETED BEFORE DISCHARGE The following paperwork, teaching and activities are essential to provide the best and safest care to you and your baby as you leave the hospital. Review of the information you received during your stay regarding feeding and baby care. A visit from the birth certificate clerk. A visit from a laboratory technician for the newborn screen blood draw. The newborn hearing screen. Other tests as ordered by your baby s healthcare provider. A car seat for your baby is required for discharge. Follow manufacturer s instructions for use. Please be sure to install and check your car seat prior to discharge. PVH has a free education program to help with car seat installation. Our certified child passenger safety technicians offer car seat installation assistance to ensure your baby is traveling safely in the car. Appointments are scheduled in your hospital room prior to discharge. This program is not yet available at MCR. If you do not have a car seat, please tell your nurse as soon as possible. Complete and sign all discharge paperwork with your nurse. You will receive copies for your records A wheelchair and cart for belongings are available if needed to help you to your car. CARING FOR NEW MOMS AND BABIES 3-13

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51 Feeding your baby

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53 Feeding your baby Since feeding is one of the most important aspects of baby care, we want to give you helpful information about feeding your baby before your baby is born. By reading this information now, you ll find it easier to feed your baby those first few days. If you would like additional information, we offer a prenatal class on breastfeeding. You can register online at pvhs.org/classes or call for more information. FEEDING YOUR BABY 4-1

54 Feeding your baby Exclusive breastfeeding (only feeding your baby breast milk, not formula or water) is recommended by the American Academy of Pediatrics, UNICEF and the World Health Organization. Breast milk (or formula) is the only source of food your baby needs for the first six months. Do not give your baby cow s milk (whole, two percent, or skim) until one year of age. It has the wrong balance of nutrients, and can lead to a low red-blood-cell count and allergies. The American Academy of Pediatrics recommends introducing solid foods when your baby is six months old. We recognize that breastfeeding can be difficult in the beginning and we have many resources to help you reach your breastfeeding goals. How you choose to feed your baby is a personal decision. Whatever you decide, be comfortable and happy with your decision. Baby-Friendly Hospital Initiative Being a Baby-Friendly Hospital means that we have received a prestigious award that recognizes hospitals and birthing facilities that offer mothers the information, confidence, and skills to successfully initiate and continue breastfeeding their babies. Poudre Valley Hospital and Medical Center of the Rockies are two of only three hospitals in the state of Colorado to be designated as a Baby-Friendly Hospital at the time of this printing. Both hospitals follow the Ten Steps to Successful Breastfeeding set by the Baby- Friendly Hospital Initiative. These steps have been shown to increase breastfeeding rates by providing support to mothers: 1. Maintain a written breastfeeding policy that is routinely communicated to all health care staff. 2. Train all healthcare staff in skills necessary to implement this policy. 3. Inform all pregnant women about the benefits and management of breastfeeding. 4. Help mothers initiate breastfeeding within one hour of birth. 5. Show mothers how to breast-feed and how to maintain lactation, even if they are separated from their infant(s). 6. Give infants no food or drink other than breast milk, unless medically indicated. 4-2 FEEDING YOUR BABY

55 Baby-Friendly Hospital Initiative (Continued) 7. Practice rooming in. Allow mothers and infants to remain together 24 hours a day. 8. Encourage unrestricted breastfeeding. 9. Give no pacifiers or artificial nipples to breastfeeding infants. 10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic. The Baby-Friendly Hospital Initiative is sponsored by the World Health Organization (WHO) and the United Nations Children s Fund (UNICEF). The Centers of Disease Control and Prevention (CDC) has stated that hospitals can either help or hinder mothers and babies as they begin to breast-feed. The CDC encourages more hospitals to follow the guidelines set forth by Baby-Friendly to ensure mothers can start and continue breastfeeding. We re proud to have two hospitals, PVH and MCR, in northern Colorado that follow these recommendations and help give moms and babies a successful start with breastfeeding. Breastfeeding advantages There are many breastfeeding benefits for you and your baby. Breastfeeding promotes bonding with your baby and helps you and your baby sleep better. Breast-fed babies are sick less often than formula-fed babies. Breastfeeding is also economical. Breast-fed babies are less likely to be overweight when they become teenagers and adults. BREASTFEEDING: Optimizes hand-eye coordination. Enhances brain development. Improves speech development. Facilitates proper jaw, dental development. Makes baby less likely to develop diabetes, juvenile rheumatoid arthritis. Improves the effectiveness of baby s immunizations. BREAST MILK: Gives your baby important disease-fighting antibodies which makes your baby healthier. Helps baby s immune system develop. FEEDING YOUR BABY 4-3

56 Breastfeeding advantages (Continued) Has antibodies to help prevent sickness. Protects against respiratory infections, bacterial meningitis, diarrhea, reflux. Lowers risk of getting ear and urinary tract infections. Is easier to digest and is more soothing to baby s intestines. Is less likely to cause allergies, constipation, or diarrhea. Provides the right amounts of fat, protein, and carbohydrates for your baby. Enhances brain development. Acts as medicine for sick babies, helping them grow and thrive. SOME BREASTFEEDING BENEFITS FOR MOM INCLUDE: A quicker recovery after childbirth. Reduced risk of postpartum bleeding. A higher likelihood of returning to your prepregnancy weight than mothers who formula feed. Increased self-confidence and feelings of closeness and bonding with your baby. A lower likelihood of developing ovarian and premenopausal breast cancers. Reduced osteoporosis and risk for long-term obesity. Increased self-confidence and feelings of closeness and bonding with your baby. Weight gain Babies normally lose up to eight to 10% of their birth weight for the first three to four days after birth. Once your milk comes in, your baby will start to gain weight: In the first three months, babies gain five to seven ounces a week. Breast-fed babies tend to gain a little more slowly than formula-fed babies. Breastfeeding information Breasts are made up of three kinds of tissue: 1. Milk-producing glands or alveoli 2. Fibers for support 3. Fat (determines size of breast) 4-4 FEEDING YOUR BABY

57 Breastfeeding information (Continued) Size does not affect a woman s ability to breastfeed. Milk-making cells, connected together like a bunch of grapes, are connected to main milk ducts. Near the nipple, each duct swells to form a storage place. The tip of the nipple has many openings, one for each duct. When the baby s sucking motion pulls on the nipple, milk is released. About halfway through pregnancy, the breasts start preparing for breastfeeding by producing a yellowish fluid called colostrum. This rich liquid is higher in protein and lower in fat and sugar content than milk. With healthy infants, colostrum is the only nourishment your baby needs until your milk comes in. Your baby gets a small amount of colostrum, but it is loaded with antibodies to help your baby adapt to his/ her new world and stay healthy. The amount of colostrum matches the size of your newborn s stomach, about the size of a teaspoon. After childbirth, your hormone levels change and the breasts start producing milk. Milk usually comes in three to five days after birth, but two to four days is also common. At first, breast milk is a watery yellow color. Over time, it may take on a watery blue or green tint. It does not look like formula or milk from a carton. Sucking stimulates the milk-producing glands to contract, pushing the milk into the ducts. This is called letdown. As letdown occurs, baby gets more milk faster. Successful breastfeeding in the hospital If possible, attempt to breast-feed your baby within one hour of delivery. Practice skin-to-skin care as much as possible while in the hospital. Skin-to-skin means that baby s skin is touching a parent s skin directly, usually at the breast or between the breasts, with or without the diaper. Skin-to-skin can be done with either mom or dad. Keep your baby in your room with you while you are in the hospital. Research shows that you will get more sleep and better sleep when you are not separated from your baby. Avoid pacifier use until breastfeeding is wellestablished, usually around one month of age. If you need additional help after you go home from the hospital, contact WeeSteps: Fort Collins: Loveland: FEEDING YOUR BABY 4-5

58 Feeding cues Watch for these early signs that baby is hungry: Sucking sounds. Sucking mouth movements. Rooting. Hand-to-mouth movements. Rapid eye movements. Soft cooing or sighing sounds. Crying is a late sign of hunger. Tips for successful breastfeeding THE FIRST 24 HOURS OF LIFE Babies feel comforted and connected when they are held skin-to-skin with mom. The best place for baby when mom is awake is skin-toskin as long as both mom and baby desire. Watch for any early feeding cues and attempt to feed baby. We encourage you to place baby skin-to-skin at the breast with all feeding cues, and at least every two to three hours if baby has been sleeping, in a crib, held by family, etc. If you need breastfeeding assistance or are unsure if baby is latched-on properly, call your nurse. We re here to help you. Baby may be sleepy for the first 24 hours, but still needs to be encouraged to feed (by being held skin-to-skin) every two to three hours. Baby should have at least one wet diaper and one stool before baby is 24 hours old. Use our diaper diary to keep track of baby s feedings, wet diapers and stools. 4-6 FEEDING YOUR BABY

59 Tips for successful breastfeeding (Continued) THE NEXT HOURS OF LIFE Continue with baby skin-to-skin as much as possible, especially with feedings. Continue to follow feeding cues and offer baby the breast with any signs of hunger. Sleep/rest when baby sleeps. Most babies start to cluster feed their second night of life, most commonly between 9 p.m. and 3 a.m. Babies will cluster feed at night regardless of how much/how often they ate during the day it s how they are wired. Baby should have two wet diapers and two stools between 24 and 48 hours of life. Continue baby s diaper diary. Babies needs change as they grow. Instructions you receive from staff during your hospital stay will reflect these changes. AFTER 48 HOURS OF LIFE Continue lots of skin-to-skin time, especially with feedings. Babies at this age need to eat at least eight to 12 times every 24 hours. Baby may need to be woken to eat by changing diapers, undressing, gentle massage, holding skin-to-skin if baby is not feeding a minimum of eight times every 24 hours. The more often a baby eats the less engorgement mom experiences, the sooner mom s milk comes in and in greater quantity, and the sooner a baby begins to regain weight and gets more of those great antibodies. By five days old baby should have six to eight wet diapers and four or more stools every 24 hours. Continue baby s diaper diary until baby is feeding well consistently and has regained birth weight (at least one week). FEEDING YOUR BABY 4-7

60 Breast massage Massaging breasts or hand expressing milk before starting to pump helps: -- Letdown reflex and starts milk flow. -- Move milk from back of breast to nipple. -- Express more milk. HOW TO DO BREAST MASSAGE Wash hands and expose breast fully. Using the fingers of both hands, stroke gently but firmly. Alternate hands working around breast. Always massage toward nipple. Breast massage Massage all around your breast from the shoulder down: -- Below the breast up. -- Under the arm in. -- The center of the chest to the nipple. Hand expression of breast milk Milk may be hand expressed or with a mechanical pump. Hand expression doesn t require equipment and involves manually removing milk from your breasts. A good place to learn and practice is in a warm shower. Practice during a feeding after letdown has occurred, or after baby has nursed a little on the second side. Do not try after a feeding when your breasts are less full. Wait until engorgement passes because it is hard to learn on hard, tender, engorged breasts. To watch a helpful video on hand expression of breast milk, go to pvhs.org/hand-expression-of-breast-milk. 4-8 FEEDING YOUR BABY

61 Hand expression of breast milk (Continued) MARMET TECHNIQUE: DRAINING THE MILK RESERVOIRS 1. Position the thumb (above the nipple) and first two fingers (below the nipple) about 1 to 11/2 from the nipple, though not necessarily at the outer edges of the areola. Use this measurement as a guide, since breasts and areolas vary in size from one woman to another. Be sure the hand forms the letter C and the finger pads are at 6 and 12 o clock in line with the nipple. Note the fingers are positioned so that the milk reservoirs lie beneath them. Avoid cupping the breast. 2. Push straight into the chest wall. Avoid spreading the fingers apart. For large breasts, first lift and then push into the chest wall. 3. Roll thumb and fingers forward at the same time. This rolling motion compresses and empties milk reservoirs without injuring sensitive breast tissue. Note the position of thumb and fingernails during the finish roll as shown in the illustration. 4. Repeat rhythmically to completely drain reservoirs. Position, push, roll... Position, push, roll Rotate the thumb and fingers to milk other reservoirs, using both hands on each breast. AVOID THESE MOTIONS Do not squeeze the breast, as this can cause bruising. Avoid pulling the nipple which may result in tissue damage. Sliding hands over the breast may cause painful skin burns. Marmet Technique copyright 1978, revised 1979, 1981 and Used with permission of Chele Marmet and the Lactation Institute, 1616 Ventura Blvd., Suite 223, Encino, California Breastfeeding positions FEEDING Wash hands. Find a comfortable sitting position out of bed Choose a chair with armrests, or use pillows to support elbows and baby. FEEDING YOUR BABY 4-9

62 Breastfeeding positions (Continued) POSTURE FOR BREASTFEEDING If you are not comfortable, it is difficult to relax in order to breast-feed. When feeding your baby, try these tips: sit upright, try not to slouch, let your neck and shoulders relax. try a small towel roll at the waist line to support your low back. use a nursing pillow or pillow to bring the baby up to the breast. Avoid bending down to bring the breast to baby. As the baby grows the nursing pillow may be too largetransition to a bed pillow to keep good positioning. The armrest of the chair may also assist in supporting the baby. try to keep your hand relaxed as you hold your baby or breast. Maintaining a grip on the breast for prolonged periods may contribute to carpal tunnel symptoms. if nursing in sidelying- keep pillows under your head only, not under your shoulder. FOOTBALL HOLD Sit with baby s body along your side and under your arm. The hand on the side where the baby is nursing holds the baby s head and neck. The other hand holds the breast. This position is especially helpful if you ve had a C-section. Football hold CROSS CRADLE HOLD Cross cradle hold is similar to cradle hold except that baby is held in the opposite arm from the side baby will nurse from. The hand is used to support baby s head, and baby s bottom is supported by the elbow. The breast is held by the arm that is on the same side. Cross cradle hold SIDE LYING Side lying Baby and you lie on your sides facing each other. Support baby s head and back with your lower arm, or roll up a blanket behind baby s back. This position may not work well for the first several weeks FEEDING YOUR BABY

63 TUMMY TO TUMMY (CRADLE HOLD) Tummy to tummy This position works best when baby is a few weeks old. Place baby level with your breast. With infant s face directly facing your nipple, support baby s head and back with your forearm and rest the head in the bend of your elbow on the same side the baby is nursing from. This same hand grips the bottom or thigh, while the other hand holds the breast. Attaching Use hand to support breast during feeding. Letdown Start each feeding on the breast that feels most full. Hold the breast with the hand in the U position (thumb on the side of the breast and the fingers behind the dark area of the nipple). Position baby s nose to nipple. When baby s mouth opens wide, pull baby toward you onto the breast beyond the nipple. Lead with baby s chin. Make sure baby takes a deep latch of both nipple and dark area surrounding the nipple into his/her mouth when latching. Sucking stimulates the milk-producing glands to contract, pushing the milk into the ducts. This is called letdown. As letdown occurs, baby gets more milk faster. THE SIGNS OF LETDOWN ARE: Uterine cramping. Tingling in the breasts, a pins and needles feeling. Leaking from the opposite breast. A feeling of well-being or relaxation. A change in your baby s sucking pattern. Pain, stress, fear or embarrassment can block the letdown reflex, causing the baby to get only a small amount of watery milk. You may never feel letdown even though it is happening. Some moms never do. FEEDING YOUR BABY 4-11

64 Letdown (Continued) Break suction safely with your forefinger. TRY THESE TIPS TO ENCOURAGE LETDOWN: Nurse baby in a quiet, private place and in a comfortable position. Relax and take a few deep breaths before feeding. Place warm, moist heat to the breasts minutes before a feeding. Massage the breasts. Hand express milk prior to latching your baby on. Get plenty of rest. Drink fluids while nursing, such as caffeine-free tea, juice or water. Nurse on demand rather than on time schedules. Detaching To detach, gently break the seal by inserting your finger along the side of your breast into your baby s mouth all the way to the gum line. It s more comfortable if you keep your fingernails trimmed. Burping Over-the-shoulder position Try to burp baby after nursing on the first breast and at the end of the feeding. Baby may not burp every time. If baby cried before feeding, try burping before or soon after starting to feed. If baby stops eating or slows down, try burping. It is normal for baby to spit up small amounts of milk with a burp or after a feeding. Baby may occasionally spit up most of a feeding. Call your doctor if baby throws up most of a feeding two or three times in a row, or if vomit is yellow-green or green. Lap/Sitting Position 4-12 FEEDING YOUR BABY

65 Burping (Continued) Lap/lying position BURPING POSITIONS Hold your baby upright against your shoulder or chest. Sit baby on your lap, head leaning forward and supported by your fingers placed in front of the ears. Lay baby across your lap. Pat baby gently on the back until the burp comes. If baby hasn t burped within five minutes, stop and try again at the end of the feeding. If baby still hasn t burped, place in a semireclining position, such as an infant seat, for five to 10 minutes to bring up bubbles. Breastfeeding twins Feeding twins, no matter if you breast-feed or bottle-feed, takes time, commitment and patience. Below you will find some tips and advice on breastfeeding twins. ONE BREAST PER FEEDING BABY Some moms choose to breast-feed one infant per breast. With proper stimulation, one breast can produce enough milk to nourish an baby. If one baby remains in the hospital after the other has gone home, you may want to do one or a combination of the following: Nurse the twin at home on both breasts at a feeding to maintain supply and your comfort. Then double pump your breasts and store this milk for the hospitalized baby. Nurse the twin at home on one breast per feeding, alternating sides. Pump the other side after each nursing to save for the baby in the hospital. FEEDING YOUR BABY 4-13

66 Breastfeeding twins (Continued) ASSIGNING A BREAST OR SWAPPING? Should each twin have its own breast? At first, most moms switch babies back and forth. One twin frequently has a stronger suck and alternating breasts better stimulates milk production in both breasts. As time goes by, each twin eventually may have its own breast, with the supply on each side adjusting to each baby. When in doubt, nurse the hungriest baby on the fullest breast. FEEDING TOGETHER OR SEPARATELY? Nursing two at a time saves time but you may not feel comfortable doing this. It can be difficult getting both babies to start feeding at the same time or getting a baby to latch back on. In the beginning, it helps if you have someone help you with these situations, but as the babies grow and become experienced nursers, it becomes easier. Try both ways and see what works best for you. FEEDING Wash hands. Find a comfortable sitting position. Choose a chair with armrests, or use pillows to support elbows and baby. Positions for feeding together Sit in a chair with arms and have several pillows handy. Try: Both babies in a football hold. Both babies in cradle position with legs slightly down, one set of legs lying next to the other or across the other set. One baby in football hold, the other in cradle position. POSTURE FOR BREASTFEEDING If you are not comfortable, it is difficult to relax in order to nurse. When feeding your babies try these tips: Sit upright, try not to slouch, let your neck and shoulders relax. Try a small towel roll at the waist line to support your low back FEEDING YOUR BABY

67 Positions for feeding together (Continued) Use a nursing pillow or pillow to bring the baby up to the breast. Avoid bending down to bring the breast to baby. As the baby grows the nursing pillow may be too largetransition to a bed pillow to keep good positioning. The armrest of the chair may also assist in supporting the baby. Try to keep your hand relaxed as you hold your baby or breast. Maintaining a grip on the breast for prolonged periods may contribute to carpal tunnel symptoms. If nursing in sidelying- keep pillows under your head only, not under your shoulder. Football hold DEMAND FEEDINGS Most moms of twins follow a modified demand schedule. If one baby is hungry, feed the other baby to make a mutual nursing time. GROWTH SPURTS Cradle position As all babies do, twins go through growth spurts. But both may not have it at the exact same time. Frequently, one will be followed by the other, so the combined time is four to seven days. YOUR CARE Taking care of twins is demanding. Get help from friends and relatives so you can get your rest. One Football, one Cradle Producing enough milk for twins requires extra calories and fluids. Stay hydrated, keeping your urine a pale yellow to clear color. Continue to eat your healthy pregnancy diet. Breastfeeding problems Often women stop breastfeeding after several weeks because they think they re not producing enough milk, or they re having other feeding problems. When you breast-feed, especially at the beginning, it may seem like your baby is always at your breast. Don t despair. It does get easier. Meanwhile, some of the tips below may help you get through those rough periods. Sore nipples Sore nipples can be normal as you begin breastfeeding your new baby. However, having very sore, cracked or bleeding nipples is not normal. Usually this problem is related to the way your baby latches on to the breast. FEEDING YOUR BABY 4-15

68 Sore nipples (Continued) It is important to have your baby get a big mouthful of the nipple and areola. Whether you hold your baby across your chest in a crosscradle hold or at your side in a football hold, turn your baby onto her side and hold her so her mouth is directly in front of the breast near the nipple. BASIC TIPS Feed your baby frequently, at least eight to 12 times in 24 hours. Feed your baby before she cries. Taking some deep breaths and relaxing before baby attaches. Rotate feeding positions to avoid putting stress on the same spot. Use your fingers inserted into baby s mouth past the gums to break the suction before removing baby from the breast. Hand express a small amount of breast milk onto the nipple and letting it air dry. (You can do this in place of using lanolin). Try a product called Hydrogel Pads or Soothies to aid in quicker healing of sore nipples. POSITIONING Position your baby with pillows so she is breast height. This reduces strain on your nipple and prevents soreness. Roll the baby completely on her side so she is belly to belly with you. This also reduces nipple strain and soreness. A cross-cradle hold or football hold works best to achieve a good latch-on with a newborn. Position your baby with her nose to your nipple so she has to reach up slightly to reach the nipple. This is an asymmetric latch. LATCH-ON Compress your areola slightly to make a nipple sandwich for the baby. This will allow the baby to get a deeper latch FEEDING YOUR BABY

69 Sore nipples (Continued) Be sure to stroke her nose with your nipple and pull her quickly to the breast, leading with her chin, when she opens her mouth wide. Wait for her mouth to open wide and her tongue to come forward. Then pull her to the breast so she gets a good mouthful of the areola (the dark brown part of the breast) in her mouth. Remember, the initial latch may be painful because nipples are already sore. The discomfort should improve within the first minute of a feeding. If pain continues, detach baby and start over. LOOK FOR THESE FOUR THINGS: 1. The angle of your baby s lips at the breast is greater than 140 degrees. 2. Most of the areola is in your baby s mouth. One inch from the base of your nipple, more near the baby s lower lip than the top. 3. You feel deep pulling sensation as baby nurses. You should not feel sharp pain or have pain that lasts more than a moment while baby latches-on. 4. Listen for swallowing every three to five sucks after your milk comes in. HEAL YOUR NIPPLES Alternate the way you hold your baby in at each feeding. Try cross-cradle hold one time and football hold the next time. If your breasts are very full and engorged, try to hand express a little milk or use a breast pump for a minute or two before your baby latches-on. This will make it easier for your baby to latch-on. Breast shells may help during the healing process. Breast shells promote the circulation of air around the nipples and keep the pressure of the bra off the nipples. After each feeding, massage a little of your own colostrum or breast milk into the nipple and areola. A combination of expressed colostrum or breast milk and breast shells is one the fastest ways to promote healing. Notify your healthcare provider of any cracks, blisters or bruises on or near the nipple. Please seek help with a Certified Lactation Counselor or your healthcare provider if your problem persists. FEEDING YOUR BABY 4-17

70 Engorgement Engorgement generally occurs when your milk first comes in or if you have missed a feeding. However, not all women experience it. It is usually caused by inadequate or infrequent milk removal, which can then cause inflammation of the breast. Engorgement can also be caused by extra fluid in the breasts. If your feet and ankles are swollen, your breasts may become swollen also. Your breasts may feel overly full and become larger, heavier, harder, tender and warm to touch. Latch-on may become more difficult due to fullness of breast and nipple. You also may have a slight fever for 24 hours. To help engorgement, try: Feeding baby at least every two to three hours or more often. Taking a warm shower and massaging breasts from outer portion inward while in the shower to express milk. Placing warm, moist heat on breasts before nursing. Placing ice packs on your breasts in between nursing for comfort. Leaning over a tub of warm water, placing breasts in the water. Hand express or pump a small amount of milk before feeding to soften breasts and make nipples easier to grasp. Pumping to relieve discomfort only. Pumping more than this will increase milk supply, therefore making engorgement worse. Consulting your caregiver for approval to use Ibuprofen to help inflammation and discomfort. Unrelieved engorgement is a medical emergency because it could result in loss or decrease of milk supply FEEDING YOUR BABY

71 Feeding problems BABY ONLY NURSES ON ONE SIDE Attempt to use different positions. On the less favored side, try the football hold. Start on the favored side until your baby seems calm for the feeding, then try switching to the rejected side. Always offer the second side Begin feeding when baby is slightly sleepy. You will need to pump the rejected side for stimulation each time baby nurses until breastfeeding improved on that side. If baby continues to reject one side or suddenly rejects one side, it is important to call your doctor for a breast exam. BABY IS TOO SLEEPY Babies are sleepy for the first hours. They become more active around day three or four. Premature babies, mom s medicine or a long or hard birth can make your baby sleepy. These wake-up tricks may help: Unwrap your baby. Place your baby skin-to-skin. Change baby s diaper. Burp before feeding. Exercise baby by moving legs and arms. Stroke baby s chin. Tickle soles of baby s feet. Do not stimulate the baby while actively suckling. BABY IS HUNGRY BEFORE MILK COMES IN Place your baby skin-to-skin. Put baby to breast whenever you notice a feeding cue (on demand). Hold and rock your baby. Wrap a frantic baby snugly in a blanket (do not cover baby s face). FEEDING YOUR BABY 4-19

72 Is baby getting enough? Many women stop breastfeeding because they think baby isn t getting enough to eat. Baby is getting enough milk if: Birth weight is regained by two weeks of age. Gaining a minimum of five to seven ounces a week. By the fifth day of life, baby should be: Breastfeeding at least eight times in 24 hours, but expect eight to 12 times or more. Wetting at least six diapers in 24 hours. Urine is pale yellow or clear. Having at least four green or yellow, seedy bowel movements a day. Content after feedings. If you re not sure if your baby is getting enough breast milk, contact your baby s healthcare provider or WeeSteps. Important points BREAST-FED BABIES USUALLY WANT TO NURSE EVERY ONE AND A HALF TO THREE HOURS You have a milk supply even though breasts are no longer engorged and are smaller. After milk comes in, baby may nurse for shorter time periods because more milk is received with less effort. Breast milk is easily digested so baby may nurse eight to 12 times in 24 hours, especially in the first month. It is okay to put baby to breast for comfort and feeding. Constant crying is not necessarily a sign of poor milk supply. Most babies cluster feed. They want to feed frequently for a few hours, then will sleep for a long period of time. MAKE BREASTFEEDING YOUR FIRST PRIORITY. MANY PROBLEMS ARE SOLVED WITH A CHANGE IN DAILY ROUTINE. Get help with housework and/or other children. Tell visitors to come later. Turn your phone off. Rest when baby naps FEEDING YOUR BABY

73 Reasons for low milk supply Baby isn t nursing often enough. Baby is receiving extra bottles and mom is not pumping for stimulation. Baby isn t getting enough of the nipple into the mouth. Mom needs to drink more fluids. Leaking Leaking may occur at the start of a feeding, when you think about your baby, or hear your baby cry. To prevent or stop it, apply firm pressure to the nipple. Leaking usually decreases around the third month. Clogged milk ducts CAUSES Pressure from a tight or underwire bra. Incomplete emptying of a breast and/or going too long between feedings. SYMPTOMS Warm, tender, red area with a tiny lump. No fever. TREATMENT Nurse more often, starting with affected breast, making sure to empty breasts completely. Use different nursing positions to help unclog and drain plugged ducts. Apply warm, moist heat and gently massage breast toward the nipple just before and during feedings. Lean over a basin of warm water and soak breasts while doing breast massage. Remove dry secretions that block the nipple openings. Avoid nipple creams or ointments. In place of creams or ointments, rub a small amount of breast milk on your nipples and allow your nipples to air dry. Get extra rest, eat a good diet and stay hydrated, keeping your urine a pale yellow to clear color. Wear a proper fitting bra. If your bra leaves any marks on your breasts, it doesn t fit properly. FEEDING YOUR BABY 4-21

74 Mastitis Mastitis is an infection of the breast. Wash hands well with soap and water before feeding baby to help prevent infection. Mastitis is likely to occur: During newborn period, especially when breast is not emptied properly, or when you are very tired. When nipples are cracked. Following abrupt weaning. If baby is too ill to nurse, pump milk from breasts. When there are changes in supply and demand. If you are wearing tight clothing. SYMPTOMS Fever and chills. Redness. Spot is tender and warm to touch. General body aches. Flu-like symptoms. TREATMENT Call your doctor because antibiotics are needed to treat the infection. You may also need pain medicine. Go to bed and rest. Apply warm, moist cloths to the breast. Nurse often. Start on the affected side and keep that breast empty. Do not stop nursing! The infection is in the breast tissue, not in the milk. This infection will not hurt your baby. Mom s medicines Medicine you take may be in your breast milk and affect your baby. Ask your baby s doctor before taking any medicine FEEDING YOUR BABY

75 Additional breastfeeding resources BOOKS* Breastfeeding Made Simple: 7 Natural Laws for Nursing Mothers Nancy Mohrbacher, IBCLC and Kathleen Kendall-Tackett, PhD, IBCLC The Breastfeeding Book: Everything You Need to Know About Nursing Your Child from Birth through Weaning Martha and William Sears Dr. Mom s Guide to Breastfeeding Marianne Neifert, M.D. The Essential Guide to Breastfeeding Marianne Neifert, M.D. The Nursing Mother s Companion Kathleen Huggins The Nursing Mother s Guide to Weaning Kathleen Huggins, RN, MS and Linda Ziedrich The Womanly Art of Breastfeeding LaLeche League International Inc. ONLINE RESOURCES* There are many resources available on our website. Visit pvhs.org for more information. aap.org/healthtopics/breastfeeding.cfm cdc.gov/features/breastfeeding lllusa.org nlm.nih.gov/medlineplus/breastfeeding.html usbreastfeeding.org *Note: PVHS does not endorse any of the vendors of breastfeeding related services or products. Introducing solids Solids are usually added to your baby s diet at six months of age because that is when babies natural stores of iron begin to deplete. Some babies diets need to be enriched with iron fortified foods at this time. For detailed information about introducing solid, go to pvhs.org/introducing-solids. FEEDING YOUR BABY 4-2 3

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79 Caring for your baby Remember, there is more than one way to take care of your baby. Use common sense and do what is comfortable for you. Be flexible and have confidence in yourself. And if you re having problems or are confused by conflicting advice, ask your healthcare provider for help. This section covers some things you need to know about baby hygiene, feeding, crying, sick baby care, safety, development and well baby care. CARING FOR YOUR BABY 5-1

80 Newborn appearance Remember, there is more than one way to take care of your baby. Use common sense and do what is comfortable for you. First-time parents often are surprised at their newborn s appearance. The way your baby looks depends partly on how long he was in the womb (gestational age) and on the delivery. The following are common in new babies: Skin that is red, bruised, loose, wrinkled or peeling. Ears that are folded; eyelids that are puffy or matted. Nose that is flattened or crooked. Molded head from being squeezed through the birth canal. Head returns to a normal shape in a short time. Lanugo - fine, thin hair on the back, shoulders, cheeks, forehead or ears that disappears by 4 months. Milia - little white spots on the nose and chin. This is not acne and goes away in a few weeks. Mongolian spot - bluish-black spot on bottoms and lower back that occurs most often with Asian, black and darker-skinned babies. These are harmless. Newborn rash - spots that look like reddened pimples that come and go. Stork bites - blotchy pink areas over eyelids, on the bridge of the nose or the back of the neck. These fade by 1 year but may reappear with crying, anger or blushing. Diapering Wash hands before and after diapering. To prevent rashes, change diapers immediately when wet or soiled. Use a wash cloth and warm water to clean dirty bottom, making sure to get into all of the creases. Commercial wipes are okay if they are alcohol-free. Let bottom air-dry or pat dry with a cloth. For girls, clean genitals from front to back, making sure to get in all of the folds. Some clear or white mucus may be in the center of the folds and does not need to be removed. For boys, be sure to clean all of the folds around the scrotum. For boys with a circumcised penis, follow care directions described in the circumcision section. 5-2 CARING FOR YOUR BABY

81 Diapering (Continued) For boys with an uncircumcised penis, wash only the outside. A white, cheesy substance working its way out of the penis foreskin s tip is normal for uncircumcised boys. Lotions, powders and ointments are not needed. If a diaper rash develops, leave skin open to the air as much as possible. Consult baby s doctor if the rash does not clear up. Stool/urine appearance Call your healthcare provider if your baby doesn t have six to eight wet diapers of pale yellow urine every 24 hours, starting on day five of life. The number and appearance of bowel movements varies with your baby s age and diet. After birth, babies pass a dark, tar-like stool called meconium. It can be very thick and sticky, and may be a large amount at times. On day three or four, stools are dark green but less tar-like and sticky. After mom s milk comes in, breast-fed babies tend to have frequent, mild-smelling, and bright yellow stools that are loose to very soft. They may look like a mixture of cottage cheese and mustard. Formula-fed babies tend to have less frequent, yellow-brown or green, strongersmelling stools that are pasty to softly formed. Texture and color change after solids are started. The number of stools usually decreases after a few weeks, when babies may go a day or two without a bowel movement. Call your doctor if bowel movements become hard, seem painful or are bloody, or if there is no stool for three to four days. CARING FOR YOUR BABY 5-3

82 Umbilical cord care Cleaning umbilical cord The umbilical cord takes two to three weeks to fall off and heal. Keeping cord dry and open to the air speeds healing and decreases the chance of infection. Fold diapers down below cord, or use cut-out type diapers. Wash the base of cord with soap and water once a day until cord falls off. You may bathe your baby as needed. Bathing Bathe baby only every two or three days because Colorado s climate tends to dry the skin. Avoid bathing right after meals or when baby is hungry. Have all items handy before starting bath. Never leave baby alone; babies can drown in as little as two inches of water. Allow plenty of time. Make sure room is warm and free of drafts. Use warm water (94-97 F). Test water with elbow because hands are conditioned to hot water. Don t get upset if baby cries. Some parents prefer to give sponge baths for the first few weeks until they feel more comfortable handling their baby. Most babies do not need baby lotions, ointments, or powders. Use of powder can cause respiratory problems. For dry skin, use a water-based lotion without perfumes or additives. Sponge bath ITEMS NEEDED Basin of water. Clean washcloth and towel. Mild soap and shampoo, or baby bath products. Soft bristle brush. Cotton balls. Clean diaper and clothes. 5-4 CARING FOR YOUR BABY

83 Sponge bath (Continued) Washing eyes Washing head Washing genital area DIRECTIONS Use plain warm water. Wipe each eye from the inside corner out with two separate corners of the washcloth or two cotton balls. Wipe outer ear with washcloth. Do not clean ear canal because the ear is selfcleaning. Never use cotton-tip the swabs on the ear. Wash face with plain water. Wet the scalp by holding head over a bowl of water (hold baby gently tucked along the length of your arm with fingers supporting the head). Apply baby shampoo or soap to the scalp, rubbing with fingertips or soft bristle brush, making sure to wash the soft spot and behind the ears. Rinse, dry and cover head. Remove shirt. Add mild soap to water or cloth. Lift chin, wash and dry the neck. Wash, rinse and dry the chest and arms. Wash hands, making sure to get between fingers. Turn baby on side or tummy and wash, rinse, and dry back. Put on clean shirt. Remove diaper. Wash, rinse, and dry legs and toes. Be sure to wipe girls from front to back, cleaning in folds. For boys, follow care instructions for circumcised or uncircumcised penis. Also, be sure to clean the folds around the scrotum. Put on clean diaper and finish dressing. CARING FOR YOUR BABY 5-5

84 Tub bath Gently but firmly put baby in tub. Gently hold baby s neck while washing back. ITEMS NEEDED Portable tub or bathtub Clean washcloth and towel Mild soap and shampoo, or baby bath products Soft bristle brush Cotton balls Clean diaper and clothes DIRECTIONS Fill tub with two inches of warm water. Never put baby in while water is running. Undress and gently put baby in water, supporting the head and back with your forearm and grasping baby s arm with your hand. Wash from the head down. To wash the back, tilt baby forward over your arm. Wrap in a clean towel, pat dry, diaper and dress. Offer support while taking out of tub. Dressing Dress baby as you would dress yourself, plus one additional layer for newborns. Use hats in the summer for sun protection and in cold weather to prevent heat loss. Use this gauge to check if baby is dressed properly: Touch the baby s back or chest with your hand (make sure your hand isn t cold). Damp or hot - baby too warm Cool - baby needs more clothes Warm - baby is dressed properly Remember that newborn babies often have blue or cold hands and feet. This does not mean baby is too cold. 5-6 CARING FOR YOUR BABY

85 Circumcision If you have a boy, you need to decide whether to have him circumcised. Circumcision is usually done in the hospital when he is about 24 hours old. This procedure is not considered medically necessary and is usually performed for personal or religious reasons. A consent form needs to be signed. Measures will be taken to keep your baby as comfortable as possible during and after circumcision. Ask your doctor if you have questions. Circumcised penis PLASTIBEL METHOD Leaves a small plastic ring around the end of the penis. Ring should fall off between five and eight days of life. Call your doctor if the ring falls off sooner or is still on after eight days. The dark brown or black ring around the plastic rim goes away when the ring falls off. GOMCO CLAMP Penis is wrapped in petroleum jelly gauze. New gauze and petroleum jelly should be reapplied with diaper changes until 24 hours after the procedure. Your nurse will instruct you on how to do this. If the gauze gets stuck, remove by pouring warm water on it. Pull off gently. Apply a little petroleum jelly to the inside of the diaper until site is healed. GENERAL CARE FOR BABY AFTER CIRCUMCISION Baby may be sleepy, irritable, feed poorly or cry when he wets for a day or so. It usually takes five to ten days to heal. The yellow substance on the end of the penis is normal healing tissue and should not be washed off when cleaning the penis. Wash the penis gently with soap and water if stool is on the penis. CALL YOUR DOCTOR If you see any bleeding, pus or increasing redness below the cut edge. For excessive bleeding, put pressure on the site and call your doctor immediately. CARING FOR YOUR BABY 5-7

86 Uncircumcised penis The foreskin of a newborn does not normally retract. The tip of the penis and the foreskin stick together and may not be moveable for weeks, months or years. To clean, wash only the outside. It is unnecessary to retract the foreskin to clean. Cheesy, white substance on the foreskin s tip is normal. Foreskin generally does not retract until he is five to 10 years old. Cradle cap Cradle cap can be seen as oily scales or flakes on scalp, sometimes extending onto the face. Is not a sign of poor hygiene. Regular shampooing with a soft bristled brush helps prevent it. See your baby s healthcare provider if the problem persists. Nose care Babies sneeze a lot to clear the nose and throat of mucus. Dry mucus causes stuffy noses. A cool humidifier in your baby s room is helpful if dry mucus problems continue. To moisten nasal mucus, dissolve 1 4 teaspoon of salt in a cup of boiled water that has been cooled before using; or buy over-the-counter plain saline drops. Use an eyedropper to put one or two drops in one side of baby s nose. Let mucus soften for one minute. Use bulb syringe to suction out mucus. 5-8 CARING FOR YOUR BABY

87 Nose care (Continued) USE OF BULB SYRINGE To use bulb syringe, squeeze bulb. Put bulb in nose, being careful not to release the squeeze. Once bulb is in place, release squeeze so suction occurs. Repeat squeeze and release on tissue to clear mucus from bulb. Repeat as needed in nose. To clean bulb, squeeze and release in hot water. Clean bulb syringe with each use. The bulb syringe also can be used in baby s mouth. Nail care Trim nails while baby sleeps. Use blunt scissors, baby clippers, or an emery board. Nail scissors usually work better than clippers for babies. To avoid cutting skin, press finger pad down and out of way as you trim. Cut straight across. Do not shape the nails. Covering baby s hands with mittens or socks helps prevent scratches. Do not bite or tear off your baby s nails. SIDS Healthy babies should be placed on their backs any time they are put down for sleep. Sudden Infant Death Syndrome (SIDS) is the sudden and unexplained death of an infant under one year of age. It is also known as crib death. There are no known causes for SIDS, but there are some things that can reduce your baby s risk. BACK TO SLEEP Healthy babies should be placed on their backs any time they are put down for sleep. Talk to your baby s healthcare provider about any health problems your baby may have, because a few babies should sleep in other positions. There is no evidence that sleeping on the back causes choking. CARING FOR YOUR BABY 5-9

88 SIDS (Continued) Babies can and should be placed on their tummies during supervised awake time. Once breastfeeding is well established (about one month of age), offer your baby a pacifier each time you put your baby to sleep. Studies show a protective effect of pacifiers on the incidence of SIDS according to the American Academy of Pediatrics. SIDE VS. STOMACH Recent data shows that side position may be just as dangerous as stomach sleeping. BACK IS BEST. BREASTFEEDING Rate of SIDS is lower for breast-fed babies. BEDDING Use a firm mattress. Do not use fluffy blankets or comforters, water beds, sheepskins, no pillows, stuffed toys. Crib bumper pads are not recommended. A separate but proximate sleeping environment is recommended for your baby. -- Crib, bassinet or cradle in the same room as parent. -- Safety of cosleepers not yet established. -- Your baby should not share a bed with other children. -- Your baby should not sleep on a couch or armchair. ROOM TEMPERATURE Keep baby s room at a temperature that is comfortable for you. Rooms that are too hot increase the risk of SIDS. To keep your baby warm, use one thin blanket or blanket sleeper. SMOKE-FREE ENVIRONMENTS Never allow tobacco smoke around your baby. Having a baby is a great reason to quit smoking. It will improve your health and your baby s, too. The risk of SIDS is higher for babies whose mothers smoked during pregnancy CARING FOR YOUR BABY

89 SIDS (Continued) VISIT YOUR HEALTHCARE PROVIDER Early and regular prenatal care is important to reduce the risk of SIDS. Be sure to keep appointments for all routine visits. Take your baby to the doctor if baby seems sick. Get baby all immunizations (shots) on schedule. Sleep Healthy babies should be placed on their backs any time they are put down for sleep. Newborns generally sleep about 16 to 20 hours per day. Sleep patterns vary from baby to baby. American Academy of Pediatrics recommends that babies be placed on their backs to sleep and not on their stomachs (tummies). Newborns rarely sleep through the night (they may sleep five to six hours at a time for one stretch at night). Giving baby solid foods early does not help baby sleep longer and may cause an upset stomach and fussiness. (Exclusive breastfeeding for six months is recommended.) To help baby sleep: -- Keep baby warm, dry and away from drafts and bright lights. -- Dress baby in comfortable and roomy clothing. -- Avoid using pillows. -- Avoid being too quiet. Your baby will learn to tune out the noise initially. -- Babies never exposed to noise will not be able to ignore it when they are older. Crying Crying is your baby s way of communicating hunger, dirty diapers, loneliness, colic, pain, illness or just boredom. Sometimes babies cry for no apparent reason. A crying baby does not mean that you are a bad parent. Babies do not cry to manipulate, punish, or annoy you. Hold or respond to your baby for all fussy crying during the first three to four months. CARING FOR YOUR BABY 5-11

90 Crying (Continued) When your baby is crying, try asking yourself these questions: -- Is baby hungry? -- Does baby need to burp? -- Is baby too warm or cold? -- Does baby need a diaper change? -- Does baby need a position change? -- If baby continues to cry, try the tips below. TIPS FOR SOOTHING A CRYING BABY: First try putting baby skin-to-skin. Swaddle baby (see pictures at left). Walk or dance with baby. Try dancing to different kinds of music and rhythm. Wrap corner of blanket around right arm. Wrap corner of blanket around left arm. Fold bottom of blanket up and around shoulders. Rock baby. Bounce baby gently in your arms or on a bed. Take baby for a ride in the stroller or car. Put baby in a baby swing. Turn up some music, run the vacuum or hair dryer. Offer baby a noisy toy and shake or rattle it. Sing or talk to baby in a quiet sing-song way. Carry baby in a soft-front carrier close to your body. Lay baby tummy down across your lap (perhaps on a warm towel or blanket) and rub baby s back. Wrap you and baby together in a warm blanket. Hold baby close and breathe slowly and calmly. Baby will feel calmness and become quiet. Let someone else take over for a while. If a family member is not around, consider hiring a sitter for a short time. Allow yourself to take a break. Put baby in a safe place, take a few deep breaths, count to 10, then go back to trying to calm your baby. NO MATTER WHAT, NEVER SHAKE YOUR BABY CARING FOR YOUR BABY

91 Shaken Baby Syndrome Shaking your baby, even for a second, can cause serious injury or death. Shaken Baby Syndrome is a serious type of brain injury that happens when a baby or toddler is violently shaken usually in response to crying that will not stop. Babies neck muscles aren t strong and don t provide much support for their heads. When someone forcefully shakes a baby, the baby s brain repeatedly strikes the inside of the skull, injuring the brain. It is important to know that shaking a baby or any other type of violent behavior is a serious form of child abuse with serious consequences for the adult too. Shaking a baby can cause: Severe brain damage. Blindness. Hearing loss. Learning problems. Seizure disorders. Cerebral palsy. Paralysis. Death. HAVE A PLAN IN CASE YOU FEEL OVERWHELMED No one plans to shake a baby, but without a plan in place to help calm a baby, it can happen. If you are feeling frustrated, overwhelmed, or angry: Set the baby down. It is OK to leave a crying baby alone in a safe place (like a crib or infant seat) for a short time. Close the door and go in another room for a quick break. Take care of yourself. Take several deep breaths, calm down (feel yourself relax), and wait a few minutes before you return to the baby. Call a reliable adult to help. A friend or relative can help calm you down, or even take care of the baby while you take a break. CARING FOR YOUR BABY 5-13

92 Shaken Baby Syndrome (Continued). When I need help, I will call: Name: Phone: Name: Phone: Or, call baby s healthcare provider. Name: Phone: Source: calmacryingbaby.org. Colic Colic is a catch-all term for a healthy baby who cries despite all comfort measures that are tried. Newborn babies do not get colic. Usually begins about two to three weeks after birth; it rarely lasts longer than three months. Baby is generally more colicky in the evenings (when you are tired and less able to cope). COMMON CAUSES INCLUDE: A sensitive nervous or digestive system. Reaction to a full day s stimulation. Gas trapped in the lower loops of the bowel. Sensitivity to infant formula or to certain foods in mother s diet if breast-fed. Solid foods introduced too early. REMEDIES Colic hold Carry in the colic hold by positioning baby facing down on your forearm with baby s face near your palm, tummy against your forearm, and legs draped over either side of your elbow. Rub or pat baby s back or try tips for soothing a crying baby on previous page CARING FOR YOUR BABY

93 How do I know if baby is sick? You can usually tell your baby does not feel well by looks or by actions. Call your healthcare provider if your baby has any of the following symptoms: Temperature under the arm is less than 97 F or greater than 100 F. Sick babies can have a temperature above or below normal (98.6 F). Baby s color is pale, flushed (red), jaundiced (yellow), or slightly blue. Baby throws up most of a feeding two or three times in a row, or the vomit is yellowgreen or green. Baby won t eat for three or more feedings in a row. Baby has diarrhea (bowel movements are more frequent and/or watery). Baby wets less than six diapers in 24 hours or urine is tea-colored. Baby has a regular cough. Baby is sleeping more than usual or tires easily when eating. Baby is very cranky and hard to comfort. Baby has a rash or infected umbilical cord or circumcised penis. Hints when talking to your healthcare provider Take your baby s temperature before calling your healthcare provider. Write down baby s symptoms, temperature, age and last weight in the office. Have pencil and paper to write down instructions. Ask your healthcare provider to repeat or explain instructions you don t understand. Be in a different room than the baby when calling the doctor. It is hard to listen when holding a fussy baby. CARING FOR YOUR BABY 5-15

94 Rashes DIAPER RASH Most babies get a diaper rash at some time. To prevent a diaper rash: Change wet or dirty diapers right away. Use a wet washcloth or baby wipe that is alcohol-free to clean diaper area. Avoid using ointments or lotions. Call your healthcare provider if treatments below do not help. TREATMENT Use cloth diapers without plastic pants. Let your baby go bare-bottomed for a while. It is messy, but it works. Avoid using baby powder or cornstarch because baby may breathe the powder. If using cloth diapers, try: -- Increasing rinses in the wash. -- Using a cup of vinegar in the last rinse. -- Using a soap without dyes or perfumes. -- Using chlorine bleach from time to time when washing the diapers. -- Using 1 4 cup baking soda instead of fabric softener. -- Using a diaper service. -- Using disposable diapers. If using disposable diapers, try: -- Changing brands. -- Using cloth diapers. PRICKLY HEAT Rash with tiny red irritated spots. Usually caused by baby being over-dressed and too warm. Thermometer Cooling baby usually helps. DIGITAL THERMOMETER May be used to take your baby s temperature both under the arm (axillary method) and rectally. Ear thermometers are NOT recommended for newborns CARING FOR YOUR BABY

95 Thermometer (Continued) AXILLARY METHOD Use a digital thermometer. Place tip in center of baby s armpit. Hold baby s arm down firmly to seal around the tip until the thermometer beeps. Normal temperature is 97.6 F - 99 F. Try both arms. A difference of 1 is common. RECTAL METHOD Axillary method Only check a rectal temperature if directed by your baby s healthcare provider. Use a digital thermometer. Apply petroleum jelly to the tip. Turn baby on side and grasp both legs in one hand. With the other hand, insert only the tip. Hold thermometer between your fingers with your hand around baby s bottom and legs until the thermometer beeps. Normal temperature is 99 F F. Immunization An immunization is a vaccine (medicine) that protects against certain illnesses. It is either given as a shot or as a liquid taken by mouth. The body responds to the vaccine by making antibodies (special cells that fight off the disease). Vaccines safely provide immunity (protection against the illness). Immunizations are required by law for a child to attend a public school. In certain religious or medical cases, a release is signed to excuse the child from immunizations. Keep a record of your child s immunizations. Follow your healthcare provider s advice for an immunization schedule. Hepatitis B Vaccine (HBV) An infection of the liver caused by the Hepatitis B virus (HBV). It is one of several viruses that can cause hepatitis. Anyone can get HBV. One out of twenty people in the United States has been infected with HBV. When contracted during infancy or early childhood, HBV symptoms may not show until years later. CARING FOR YOUR BABY 5-17

96 Hepatitis B Vaccine (HBV) (Continued) Infection occurs right after contracted and can last from a few weeks to several months. Some people recover, others remain infected for the rest of their lives. These people are known as chronic carriers and can spread this illness. 10,000 people get HBV per year and are hospitalized, and of those 10,000, 250 die. Most deaths are from liver failure. TRANSMISSION HBV passes from one person to another in blood or certain bodily fluids, i.e., sexual relations, sharing toothbrushes, razors, or needles used to inject blood. Babies can get HBV at birth from their mother. HBV VACCINATION FOR BABY Vaccinate your child against this virus to protect into the teenage years and beyond. WHEN TO VACCINATE Three doses of Hepatitis B vaccine are needed to be fully protected against Hepatitis B infection. This vaccine prevents HBV infection in more than 95% of children if all recommended doses are taken. First dose is usually given at birth, second at one to two months of age, third at six to 18 months. Your healthcare provider will tell you when the three shots are needed. VACCINE SIDE EFFECTS No serious reactions are expected and most children have no side effects. Fussiness. Soreness. Swelling or redness where shot given. Symptoms begin within 24 hours after the shot is given, are mild and go away in two to three days. The above information is from the American Academy of Pediatrics and the U.S. Department of Health and Human Services CARING FOR YOUR BABY

97 Safety hazards HOME SAFETY CHECKLIST Follow these 10 tips to protect your child from injury in the home: PREVENT FALLS 1. Use stair/baby gates at the top and bottom of stairs. Wall mounted gates are best as they provide a secure barricade. 2. Install window guards on upper windows. PREVENT POISONINGS 3. Keep cleaners, medications and beauty products in a place where children can t reach them. Use child safety locks as necessary. 4. For Poison Help call Call if you suspect a poisoning, need help or want information about poisons. Call if someone needs to go to the hospital right away. PREVENT FIRES AND BURNS 5. Have working smoke and carbon monoxide alarms and hold family fire drills. If you build a new home, install fire sprinklers. 6. Use tape to set up a kid-free zone three feet in front of the stove. Use back burners and turn pot handles toward the back of your stove. 7. Set your hot water heater at 120 F to prevent burns. CARING FOR YOUR BABY 5-19

98 Safety hazards (Continued) PREVENT CHOKING AND SUFFOCATION 8. Keep coins, latex balloons and hard round foods, such a peanuts and hard candy where children cannot see or touch them. Things that can fit through a toiler paper tube can cause a young child to choke. Beware of coin/button lithium batteries if swallowed, the battery can cause serious harm or even death. 9. Place babies to sleep on their backs, alone in their crib. Don t put pillows, blankets, bumpers, comforters or toys in cribs. These things can sometimes keep a baby from breathing. PREVENT DROWNING 10. When your children are in or near water, watch them very carefully. Stay close enough to reach out to them. This includes bathtubs, toilets, pools and spas - even buckets of water. Information provided by Safe Kids Larimer County. For additional safety information, visit safekidslcc.org or call the Safe Kids office at CARING FOR YOUR BABY

99 Something's not right

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101 Something's not right: Your feelings during and after pregnancy. Postpartum Mood Disorders (PMD) can affect any mother in the first year after the birth of her child. You may have PMD after one child and not the next. Having PMD does NOT make you a bad mother. There are many resources that can help you through this time. SOMETHING S NOT RIGHT 6-1

102 Postpartum depression and anxiety BABY BLUES The baby blues are very common and can begin soon after birth. Fifty to eighty percent of new moms will have feelings of sadness, anger or nervousness. Some women have lots of ups and downs -like a roller coaster. Symptoms of the baby blues can include trouble sleeping, irritability, fatigue, anxiety, restlessness or worry and moodiness including crying easily. The baby blues usually go away in about two weeks. Take good care of yourself. Ask for and accept help from others. The symptoms should get better with time. Let your healthcare provider know if the blues last more than two weeks or if you are feeling worse. DEPRESSION AND ANXIETY Depression and anxiety are much worse than the baby blues and last longer. They can be treated with caring support, medication or by talking with a counselor. About one in seven women will have depression or anxiety during pregnancy, soon after pregnancy or any time in the year after birth. Depression is the most common complication of pregnancy. No one knows for sure what causes depression and anxiety, but there are some factors that increase your risk. These include: Disrupted sleep patterns. A past history of depression. A family history of depression. Anxiety or any other mental health issue. An unplanned or unwanted pregnancy. Lack of support from loved ones. Let your healthcare provider know if you experience any signs of depression or anxiety (see page 6-4) right away. Together, you can decide the best treatment to help you feel better. 6-2 SOMETHING S NOT RIGHT

103 Postpartum depression and anxiety (Continued) SIGNS OF DEPRESSION AND ANXIETY Crying. Feelings of guilt. Counting, cleaning or checking things. Headaches. Feeling anxious or worried. Sadness. Sleeping problems (difficulty going back to sleep after night-time feedings or wanting to sleep all the time). Lack of energy. Feeling irritable or easily angered. Loneliness. Loss of or change in appetite. Feeling restless. Anxiety or panic attacks. Rapid mood swings. Feeling overwhelmed. Odd or unusual thoughts. Frightening thoughts. Thoughts of hurting self or baby. Hopelessness. Loss of interest in things that used to bring pleasure. TAKING GOOD CARE OF YOURSELF HELPS YOU CARE FOR YOUR BABY Depression and anxiety during and after pregnancy (sometimes called Postpartum Depression) can be treated. Let your healthcare provider know if you experience any of the signs mentioned. Together, you can decide the best treatment to help you feel better. The tips in this book may help you cope with your feelings. Your doctor might also suggest medication to help you feel better. Let your healthcare provider know if you are breastfeeding your baby so he or she can suggest medication that is okay for breastfeeding moms. SOMETHING S NOT RIGHT 6-3

104 Postpartum depression and anxiety (Continued) SLEEP Sleep when the baby sleeps. If you can t sleep, rest when the baby is sleeping. Limit your caffeine after noon. If you smoke, stop smoking two to three hours before bedtime. (Never smoke around your baby.) Contact the Colorado QuitLine for smoking cessation support: QUIT.NOW ( ). EAT Eat good foods, like grains, fruits, vegetables, protein and dairy. Eat small amounts at a time, several times a day, if you have a poor appetite. Make sure you drink at least a quart of water a day. TAKE TIME FOR YOURSELF Try to take time every day just for you. Ask for and accept help from others. If you can, let someone else take care of the baby for a while. Take time away from the baby each day. Laugh and see the funny things in life. Exercise, even if it s just walking around the block. POSTPARTUM MOOD DISORDER QUIZ Mark the answer that comes closest to how you felt in the past seven days. If you answer four or more with Yes, please tell your healthcare provider. Immediate help is available by calling the Connections program, , or I am unable to laugh and see the funny side of things. Yes No I cannot look forward with enjoyment to things. Yes No I blame myself unnecessarily when things go wrong. Yes No I am anxious or worried for no good reason. Yes No I feel scared or panicky for no very good reason. Yes No I have disturbing mental pictures or thoughts. Yes No I have been so unhappy that I have had difficulty sleeping. Yes No I feel sad or miserable. Yes No I have been so unhappy that I have been crying. Yes No The thought of harming myself or others has occurred to me. Yes No 6-4 SOMETHING S NOT RIGHT

105 Postpartum depression and anxiety (Continued) GET SUPPORT Talk about your thoughts and feelings with someone who cares about you. It s okay to cry. You may find support online, in a support group, at church or with family and friends. You might keep a journal or diary to help express your feelings. Sometimes medicines are helpful in treating depression and anxiety. Most of these medicines are safe to use while breastfeeding. HOW DOES MY MOOD AFFECT MY BABY? If you are depressed or anxious, you: May have trouble taking care of your baby s basic needs. May have trouble bonding or falling in love with your baby. May not have the energy to talk, sing or play with your baby. Depression or anxiety can interfere with your relationship with your baby and cause problems as your child grows. These conditions can also affect your relationship with your baby s father. Getting professional help quickly will help you and your family. A MESSAGE FOR DAD, FAMILY AND FRIENDS Help mom get time for herself by caring for the baby and other children, and preparing meals. Ask for help from family and friends. Let mom talk about her feelings. Take her seriously and listen to her concerns. Help her set limits. Encourage her to get help or get it for her if she is not getting better. Don t wait! GETTING HELP Get professional help from a healthcare provider who knows about treating depression during and after pregnancy SOMETHING S NOT RIGHT 6-5

106 Postpartum depression and anxiety (Continued) LOCAL RESOURCES Connections Mental Health Resources mentalhealthconnections.org Fort Collins: (8 a.m. to 5 p.m. weekdays) or (24 hours) Loveland: Sponsored by the Health District and the Larimer Center for Mental Health Postpartum Support Group MORE RESOURCES A Mother s Wings / mhacolorado.org Kempe Postpartum Depression Intervention Program / kempe.org/ppd Postpartum Support ppdsupportpage.com Postpartum Support International 927 N. Kellogg Avenue Santa Barbara, CA / postpartum.net BOOKS Behind the Smile by Marie Osmond Beyond the Blues by Shoshana Bennett and Pec Indman Down Came the Rain by Brooke Shields Evaluation and Treatment of Postpartum Mood Disorders by Ann Dunnewold Resources for Partners: The Postpartum Husband by Karen Kleiman The New Father s Panic Book by Gene Williams This Isn t What I Expected by Karen Kleiman and Valerie Raskin

107 Caring for mom

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109 Caring for mom Your healthcare provider will probably want to see you approximately six weeks after delivery. If you have any questions or problems before this time, call your healthcare provider. The information in this section is designed to help you take care of yourself after delivery. CARING FOR MOM 7-1

110 Hygiene Shower instead of taking a bath for the first few weeks after delivery. If possible: Shower instead of taking a bath for the first few weeks after delivery. Check with your healthcare provider to see if it is okay to take baths. Hot-tubs are not recommended. Change sanitary pads every time you go to the bathroom. Do not use tampons, other feminine hygiene products or douche during the first six weeks after delivery. Perineal and episiotomy care Use plain soap and water to clean the perineal area, and rinse with the squirt bottle received in the hospital. Use Tucks and/or topical spray. Take sitz baths (see below). Stitches dissolve by themselves. Hemorrhoids Hemorrhoids are swollen rectal veins that are irritated by constipation. Comfort measures include: -- Placing ice packs on the area. -- Taking sitz baths. At home, fill a clean bathtub with four inches of warm water and soak for minutes. -- Taking stool softeners, suppositories, topical sprays, or ointments ordered by your healthcare provider. Vaginal flow Call your healthcare provider if you have increased pain or swelling, heavy bleeding or prolonged discomfort. Bloody vaginal flow is normal after delivery. For the first 24 hours, flow is dark red, heavier than a normal period and may have small clots. On the second to third day, flow is still red, but begins to decrease in amount. Flow then turns to a pink and/or brown color, no heavier than a regular period. Flow then turns to yellow-white for up to six weeks after delivery. Periods may begin four to eight weeks after the birth. 7-2 CARING FOR MOM

111 Vaginal flow (Continued) If you re breastfeeding, your periods may not start for another two to 18 weeks after breast feeding stops. Call your healthcare provider if vaginal flow: -- Turns to a bright red color and becomes heavier than a normal period. -- Has a foul odor. -- Fills a pad from front to back in one hour. -- Contains many small clots or any large clots. Bowel function Bowel movements often do not occur for two to three days after delivery. To help soften stools, drink plenty of fluids and eat a diet high in fiber such as fruits, vegetables, cereals and whole grain breads. Mild laxatives or stool softeners (such as milk of magnesia) can be used if no bowel movement in three to four days. When on the toilet, position yourself with feet flat. You may try a small step stool under your feet to assist in having a bowel movement. Dehydration also contributes to constipation. Be sure to drink non-caffeinated fluids to assist in preventing constipation. Urinary tract infection The bladder is often irritated during labor and delivery. It is common to be unable to empty bladder completely or urinate at all. Germs grow when urine is left in the bladder, causing bladder or kidney infections. Contact your healthcare provider if you have any of these symptoms: -- Painful urination. -- Frequency and urgency of urination. -- Blood in the urine. -- Fever and chills. -- Headache. -- Pain on one or both sides of the back in the rib area. CARING FOR MOM 7-3

112 Pelvic pain and incontinence Pelvic pain and incontinence should end within six to eight weeks after you have your baby. Incontinence is not a normal part of aging or life after childbirth. Pain can develop in the pelvic floor with sex or other activities postpartum but this can be corrected. Physical therapy can be beneficial for some women to address these problems. If this continues to be an issue, discuss physical therapy with your physician. Call our physical therapy department at with questions or to schedule an appointment. Cesarean delivery care Recovering from a Cesarean section is similar to recovering from other major abdominal surgeries, except that you have a newborn to care for and to love. After a C-section it is very important that you get proper rest so your body has a chance to heal. Take advantage of those extra days in the hospital to get some muchneeded sleep. In addition to the physical discomfort, sometimes one or both parents are disappointed that a C-section was performed. These feelings are normal. It is important to express your feelings. INCISION CARE Hold your incision with your fingers or a pillow for support when rising from bed or chairs or when coughing or sneezing. Take pain medicine as needed as prescribed by your healthcare provider. Wear loose clothes and waist-high cotton underwear with feminine pads to prevent rubbing on the incision site. Keep incision and paper tape (Steristrips) clean by washing and drying with a blowdryer. Call your healthcare provider if you have redness, separation, increased pain or drainage from your incision. Your healthcare provider may want to see you two weeks after delivery to make sure your incision is healing properly. 7-4 CARING FOR MOM

113 Cesarean delivery care (Continued) SCAR MANAGEMENT After a C-section, the scar across your abdomen can become tight, restrictive, and sensitive. Scar management can aid in good healing as well as the scar appearance and mobility. Keeping the incision dry and infection free are the first steps toward managing the scar. When the incision is well healed with no scabs (wait at least six weeks) and is infection free, you may begin scar massage. Lotion or oil can be used but is not necessary. Massage the scar by rubbing up and down on the scar. Stroke along the length of the scar. Roll the scar between your finger and thumb. Pick up or pluck up the scar from the underlying tissue using your finger and thumb. Scar massage can be performed daily for five to 10 minutes. The scar is continuing to change until it is white/light pink (six months to one year). Continued scar massage during this time can be beneficial. If the scar is too sensitive to massage, begin with desensitizing the scar by rubbing it with a soft material. Start out with a cotton ball and work up to a terry cloth towel until the scar can tolerate light pressure. If you continue to have issues with scar pain or tightness, physical therapy may help. Call to discuss your concerns with one of our women s health physical therapists or to schedule an appointment. CARING FOR MOM 7-5

114 Cesarean delivery care (Continued) BOWEL FUNCTION Surgery and anesthesia can slow bowel activity, causing nausea, heartburn, gas or discomfort. Help is provided by: -- Increasing activity, especially walking. -- Avoiding gas-causing foods, carbonated drinks, ice cold fluids and greasy foods. -- Taking anti-gas medicine containing simethicone. -- Drinking warm fluids such as mint tea. -- Lying on right side for 20 minutes after eating. -- Placing a heating pad on low on your abdomen, but avoid incision area. -- When on the toilet position yourself with feet flat. You may try a small step stool under your feet to assist in having a bowel movement. URINARY FUNCTION Your urinary catheter is used for one to two days after surgery. Your urine output is watched after catheter is removed. Empty your bladder often to decrease chances of infection and prevent incision pain from bladder pressure. Pelvic pain and incontinence should end within six to eight weeks after you have your baby; incontinence is not a normal part of aging or life after childbirth. Pain can develop in the pelvic floor with sex or other activities postpartum but this can be corrected. Physical therapy can be beneficial for some women to address these problems. If this continues to be an issue for you, discuss physical therapy with your physician. Call our physical therapy department at with questions or to schedule an appointment. 7-6 CARING FOR MOM

115 Cesarean delivery care (Continued) BREASTFEEDING You can successfully breast-feed. Your milk supply is unaffected by surgery. Avoid painful pressure on your abdomen. Make sure you are comfortable and baby is in a good position before helping baby to latch on. Use pillows on your lap and under your arms for support. Use the football hold or cross cradle hold position. Set and keep priorities. Your rest, recovery, and breastfeeding must come first. AT HOME CARE Nap when your baby sleeps. Get help doing your housework do only the necessary things. Accept offers of help with laundry, cooking or cleaning. Walk and move to avoid stiffness and build strength. Avoid doing activities that hurt. Avoid exercise until approved by your healthcare provider. To help yourself feel better Ask for help with household chores. Limit visitors and phone calls. Get plenty of rest and plan at least one nap a day. Eat a well-balanced diet. Keep daily activities simple and allow time each day for yourself. Get some light exercise every day. Join a support group for new mothers, or take a mother-baby exercise class to provide a chance for adult company and sharing of common interests. Share your feelings with your partner or friend. Do special things for yourself that make you feel feminine. CARING FOR MOM 7-7

116 Body mechanics and back care When a baby comes home, parents are now manual laborers holding and moving the baby and the equipment including car seat, stroller, etc. It is not uncommon for parents to develop back pain due to these new demands. The following tips should help protect your back and keep you more comfortable. WHEN SITTING Sit tall, use a small towel or cushion at the waistline to support your back; avoid slouching. When sitting, keep your feet flat on the floor or use a small step stool. When feeding your baby, use a pillow or nursing pillow to bring the baby to you instead of bending down to meet baby. Avoid crossing your legs at the knees for prolonged periods (crossing your legs at the ankle is OK). WHEN STANDING Avoid carrying your baby with one hip pushed out. Try to carry your baby front and center. Use a baby support or age/weightappropriate sling/carrier to help hold your baby. Keep weight equal on both your legs and practice tightening the abdominals and pelvic floor to support your back. WHEN LIFTING Keep baby or objects close to you when lifting. Slide things close to you before lifting. Avoid twisting or bending when lifting. Bend your knees and hips, keep your back straight or slightly arched. Pivot with your feet instead of twisting. Pull in lower abdominal muscles (like zipping up a tight pair of pants) and keep breathing as you lift. When lifting baby in and out of the crib, lower the rail in order to avoid bending over into the crib. When putting baby in the car seat, stay close and bend your knees. 7-8 CARING FOR MOM

117 Body mechanics and back care (Continued) TWENTY THREE TREES Twenty Three Trees Medical and Wellness Spa offers spa services for mothers-to-be and new mothers including massage and facials. To help you care for yourself, consider a visit to Twenty Three Trees. Call schedule a spa service. Birth control Discuss birth control options with your healthcare provider, taking into consideration your lifestyle, health and how important it is to prevent another pregnancy. Most healthcare providers recommend that you wait until your six-week postpartum checkup before having intercourse. Birth control is necessary to prevent another pregnancy even if you are breastfeeding. THESE BIRTH CONTROL MYTHS DO NOT WORK: Your partner withdraws before ejaculation. You have intercourse close to your period. You have intercourse standing up. You douche after intercourse. CARING FOR MOM 7-9

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119 Resources

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121 Resources Babies, children and youth Clothing and household goods Daycare referrals Education and support Financial aid Health services Housing assistance Infant and toddler car seats Paternity/custody information Services for children with special needs For additional information about the following resources and services, call United Way by dialing or RESOURCES 8-1

122 Car seat safety check Evans: Evans Fire Department Fort Collins: Poudre Fire Authority Nice Car Incorporated Greeley: Greeley Fire Department Johnstown: Johnstown Police Department Loveland: Fire and Rescue Windsor: Windsor Severance Fire Protection District Larimer County: Colorado State Patrol PVHS Emergency Medical Services Weld County: Auto Collision Specialists Colorado State Patrol Platte Valley Fire Protection District PVHS Emergency Medical Services Clothing and household goods LOW-COST OR FREE Birthright (baby clothes) Loveland Christ Center Community Church Outreach Center (clothing, household, furniture, food baskets) Crossroads Ministry of Estes Park Goodwill Industries House of Neighborly Services and Resource Organization Mary s Closet (St. Joseph s Parish) Open Door Mission Salvation Army Fort Collins Greeley Seventh Day Adventist Community Services Fort Collins Loveland Unique Repeats (PVH Thrift Shop) Daycare referrals Association of Family Child Care Homes Child Care Assistance Program Early Childhood Council Family Care Connections RESOURCES

123 Education and support Breastfeeding Counseling (WeeSteps) Breastfeeding Success Bright Beginnings Child Advocacy Resource and Education Colorado Adoption Education Service Angel Eyes (Sudden Infant Death Syndrome) Local Information Education and Life Training Center C.O.R.E. Center Family Center (parenting education) First Call (listing of support groups) Fort Collins Parents of Multiples Fullana Learning Center (Early Head Start) Healthy Beginnings Prenatal Program Loveland HOPING (Helping Other Parents in Normal Grief) La Leche League (support for nursing mothers) Lutheran Family Services (parenting education) Mother s Center of Fort Collins Mothers of PreSchoolers (MOPS) First Baptist Church Faith Evangelical Free Church Timberline Church Parent Education Network...LarimerParentEducation.net Poudre Valley Health System (childbirth education classes, support for breastfeeding and postpartum mothers) Project Self.Sufficiency (for single parents) Fort Collins Loveland Safe Kids Larimer County Office (child safety education, car seat information) Teen Parent Program Fort Collins High School Loveland (alternative school) Wee Steps MCR PVH Women s Center Young Parent Program ext. 306 RESOURCES 8-3

124 Financial and emergency food assistance Catholic Charities Northern Mission (emergency food) Colorado Child Health Plan (insurance) Colorado Resident Discount Program (PVH) House of Neighborly Service (emergency food) Loveland Larimer County Department of Health (WIC, nutritional aid) Larimer County Department of Human Services or Fort Collins Loveland Estes Park (Temporary Assistance for Needy Families, formerly AFDC, Baby Care, Medicaid, Food Stamps) Poudre Valley Hospital Financial Counseling Poudre Valley Prenatal Program (prenatal care) Salvation Army Fort Collins SHARE Colorado (purchase of monthly commodities) Weld County Public Health Weld County WIC Health services Ask a Nurse Line Children s Therapy (Poudre Valley Health System) Connections Mental Health Resource Fort Collins Loveland Early Periodic Screening (diagnosis & treatment) Family Medicine Center Health District of Northern Larimer County Kempe Postpartum Depression Intervention Program Larimer County Department of Health Immunization Prenatal Plus Program - Fort Collins Prenatal Plus Program - Loveland Loveland Community Health Center Nutritional Counseling Services (PVH - Outpatient) 8-4 RESOURCES

125 Health services Continued Planned Parenthood (birth control counseling, abortions, vasectomy) Postpartum Support International Poudre Valley Prenatal Program (prenatal care) PVH Physical Therapy (prenatal and postpartum care for mothers) Salud Family Health Center (medical services for low-income, uninsured, medicaid recipients) Weld County Prenatal Plus Program Weld County Public Health Weld County WIC Women s Center Fort Collins Loveland Housing assistance Birthright (assistance for mother-to-be) Loveland Care Housing Catholic Charities Northern Mission N. Linden, Fort Collins 7 p.m.-8:30 a.m. Crossroads Ministry of Estes Park Crossroads Safehouse (battered women and children) Fort Collins Housing Authority House of Neighborly Service (emergency assistance services) Loveland Housing Authority Neighbor-to-Neighbor (housing counseling /assistance) Open Door Mission Jefferson, Fort Collins 24-hour shelter Salvation Army (rent assistance) Fort Collins Weld County Housing Authority Youth Safe Residential RESOURCES 8-5

126 Paternal/custody information Birth Certificate Office (MCR) Birth Certificate Office (PVH) Department of Human Services Services for children with special needs Barton Childhood Center (early interventions for children with special needs / at risk) Children s Therapy Services (Poudre Valley Health System physical, occupational and speech therapy) Cleft Lip/Palate Clinic (Poudre Valley Health System) Disabled Resource Services Fort Collins Loveland Disability Connection Children s Therapy (early childhood education, support and resources) Foothills Gateway (case management, services, education) Health Care Program for Children with Special Needs (HCP) Hearts in Hand Child Care Center Mile High Downs Syndrome Support Littleton local information Namaqua Center Parents of Asthmatic and Allergic Children Respite Care, Inc (short-term and overnight care) Social Security Administration RESOURCES

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129 Index Listings show the section number and page number. Admission After birth Alcohol and drug use Antepartum care Attaching, breastfeeding Baby Blues Baby safety Baby security Baby-Friendly Hospital Initiative Baby-proofing your home Back care Back to Sleep Bathing Bed rest, antepartum care Birth certificate Body mechanics Bowel movements, baby Bowel movements, mother Breast massage Breastfeeding Breastfeeding help Breastfeeding positions Breastfeeding resources Breastfeeding, twins Brothers and sisters Bulb syringe Burping Car seats , 8-2 Circumcision Classes Clogged milk ducts Clothing resources Colic Cord blood banking Cradle cap Crying Custody information Daycare referrals Delivery, where to go Depression, postpartum Detaching, breastfeeding Diaper rash Diapering Discharge, from hospital Discharge, vaginal Dressing baby Drug and alcohol use Emergency food assistance Engorgement, breastfeeding Episiotomy care, mother Expressing milk by hand Family adjustment Feeding Feeding problems Financial arrangements Financial assistance Going home Healthcare provider, hints Health services Hearing screening Hemorrhoids, mother Hepatitis B Hospital ID badge Hospital, routine care Hospital, routine care for mom Housing assistance ID bands INDEX 9-1

130 Index Immunizations Incontinence Induction of labor Labor room, PVH Labor, where to go Leaking Letdown Low milk supply, breastfeeding Manual expressions, breast milk Massage, breast Mastitis Meals Nail care Newborn appearance Newborn Screen Nose care Nursing, care for baby Nursing, care for mother Pain relief Painful sex Parking Paying your bill Pelvic pain, postpartum Perineal care, mother Physical Therapy , 7-4, 7-5 Poisoning Postpartum depression Postpartum mood disorders Rashes Recovery after delivery Room assignment Room features Room service Rooming-In Safety Screenings, newborn Security, for baby Shaken Baby Syndrome Siblings Sick, when is baby SIDS Skin-to-skin care Sleeping Solids, introducing Sore nipples Special needs, children with Sponge bath Stool/urine appearance Supplies, to bring to hospital Supplies, to have at home Temperature, taking Thermometer Tub bath Twenty Three Trees Twig, mom/baby supplies Twins, breastfeeding Umbilical cord blood banking Umbilical cord care Uncircumcised penis Urinary incontinence Urinary tract infection, mother Vaccinations (immunization) Vaginal flow, mother Visitors WeeSteps Weight gain, baby...4-4, INDEX

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132 2315 East Harmony, Suite 200 Fort Collins, Colorado PVHS Phone: Poudre Valley Health System does not discriminate against any person on the basis of race, color, national origin, disability, age or sexual orientation in admission, treatment or participation in its programs, services and activities or in employment. For further information about this policy, contact Poudre Valley Hospital s patient representative at or Medical Center of the Rockies patient representative at Copyright 2012 Poudre Valley Health System