Mother and Infant Care Manual by wpr1947

VIEWS: 43 PAGES: 123

									Mother
and Infant
Care Manual
                                    Introduction

   Congratulations on the anticipated arrival of your new baby. We are sure you
will have many questions about your pregnancy, your care at the Sault Area Hospital
                          and the care of your new baby.

     We wish to make your stay with us as informative and pleasant as possible.
    This booklet will give you most of the information you need to care for yourself
                                 and your new baby.

      Keep this booklet handy and bring it with you to the hospital when you
                           come to deliver your baby.

        The Maternity Unit is located on the 3rd floor of the Sault Area Hospital –
                                       General site.

    The nurses of the Sault Area Hospital Maternity Unit compiled this booklet.
  Adaptations of some content were made from information booklets from various
  hospitals throughout Ontario, the Algoma Health Unit and the Postpartum Parent
              Support Program manual by Health and Welfare Canada.




MotherInfantCare2
Revised 05/2002;03/04;06/04
                                           Table of Contents

Overview of Our Model of Care

         Clinics              .......................................................................... 1
         Prenatal Tours       .......................................................................... 1
         Follow-up Program .......................................................................... 1
         Registration         .......................................................................... 2
         Admission to Hospital........................................................................ 2
                 What to Bring with you to hospital .......................................... 3

When Do I Go To Hospital . . .

         Signs of True Labour......................................................................... 4
                Contractions .......................................................................... 4
         Am I in Labour
                True Labour .......................................................................... 4
                False Labour .......................................................................... 4
         Changes in Your Cervix .................................................................... 5
         Did My Water Break .......................................................................... 6
                Warning Signs ........................................................................ 6

Understanding Cesarean Birth
      What is a C-Section .......................................................................... 7
      Vaginal Birth after C-Section – Can You ........................................... 7
      What are the reasons for Cesarean Birth?........................................ 8
            The Risks      .......................................................................... 9

Admission to the Labour Unit....................................................................... 10
        Birthing Room      .......................................................................... 10
        Medical Residents and Nursing Students ......................................... 10
        10 Ways to be a Good Coach ........................................................... 11
Visiting in Labour         .......................................................................... 12
Pain Management in Labour........................................................................ 12
After Delivery             .......................................................................... 12
Combined Care and 24 Hour Rooming In.................................................... 13
Length of Stay             .......................................................................... 13
Telephone and Television/Educational Channel 24..................................... 13
Smoking Policy             .......................................................................... 14
Latex Policy               .......................................................................... 14
Security                   .......................................................................... 14
Baby’s O.H.I.P. Coverage and Ontario Health Card .................................... 14
        Welcome to the Maternity Unit .......................................................... 15
Visiting Guidelines for Combined Care/300B............................................... 16
Neonatal Nursery           .......................................................................... 17
Visiting in the Neonatal Nursery................................................................... 17

Taking Care of Yourself

After Your Baby is Born      .......................................................................... 19
Vaginal Bleeding             .......................................................................... 19
Peri-Care                    .......................................................................... 20
Episiotomy or Perineal Tear......................................................................... 20
        Call your doctor if .......................................................................... 20
Abnormal Cramping            .......................................................................... 21
Hemorrhoids                  .......................................................................... 21
Hormones and Emotions .......................................................................... 21
        Postpartum Depression Fact Sheet .................................................. 23
Exercise Guidelines          .......................................................................... 24
Cesarean Section Delivery .......................................................................... 26
Nutrition                    .......................................................................... 28
        For Breast Feeding Moms................................................................. 28
               Canada Food Guide (Insert)
Sexual Relationship after Delivery ............................................................... 29
        If you are breast feeding ................................................................... 30
        Birth Control        .......................................................................... 30

Feeding Your Baby

Breast Feeding              .......................................................................... 31
Breast and Nipple Care      .......................................................................... 31
Mom’s Comfort               .......................................................................... 31
Position of Baby            .......................................................................... 32
Getting Started             .......................................................................... 32
Signs of a Good Latch       .......................................................................... 33
Signs of a Poor Latch       .......................................................................... 33
How Long Should Baby Nurse..................................................................... 34
       Cues for Feeding . . . ........................................................................ 34
Removing Baby from Breast ........................................................................ 34
Weight Gain and Growth Spurts .................................................................. 35
Growth Spurts               .......................................................................... 35
Labour and Delivery         .......................................................................... 36
Colostrum                   .......................................................................... 36
       How Do I know my baby is getting enough ....................................... 36
Positions for Breast feeding ......................................................................... 38
       Tips for Breast Feeding..................................................................... 42
       Things to Remember......................................................................... 42
       What to Do with a Sleepy Baby......................................................... 43
Bowel Movements for Breast Fed Babies .................................................... 44
Breast Fed Babies and Wet Diapers............................................................ 45
Bowel Movements (Stools) for Bottle Fed Baby........................................... 46
Wet Diapers for the Bottle Fed Baby............................................................ 46
       Notify your baby’s Doctor is . . . ........................................................ 47
Breast Feeding Problems
      Engorgement         .......................................................................... 48
      Treatment of engorgement is . . . ...................................................... 48
      Cabbage Leaf Treatment for Engorgement....................................... 48
      Nipple Soreness     .......................................................................... 50
             To Treat Sore Nipples ........................................................... 51
      Blocked Ducts       .......................................................................... 52
      Mastitis            .......................................................................... 53
How to Collect and Store Breast Milk
      Reasons to express . . . .................................................................... 54
      Expressing Breast Milk...................................................................... 54
      Expressing by Hand .......................................................................... 55
      Expressing by Pump ......................................................................... 56
             Breast Feeding Support.......................................................... 57
      Storing and Freezing Breast Milk ...................................................... 58
      How to Use Frozen Milk .................................................................... 58

Formula Feeding             .......................................................................... 59
       Suggested Amounts of Formula........................................................ 59
How Much Baby Wants to Eat ..................................................................... 60
Spitting Up                 .......................................................................... 60
Vomiting                    .......................................................................... 60
Comfort                     .......................................................................... 60
       Guidelines for Formula Feeding ........................................................ 61
       Never Leave your Baby with a Bottle Unattended............................. 62
Formula Preparation         .......................................................................... 63
       Cleanliness is the Key . . .................................................................. 65
Burping                     .......................................................................... 67
Spitting Up                 .......................................................................... 67
Hiccups                     .......................................................................... 68
Sneezing                    .......................................................................... 68
Sometimes Babies Cry        .......................................................................... 68

Other Aspects of Your Baby’s Care

Bathing Your Baby          .......................................................................... 69
When to Bathe              .......................................................................... 69
Preparation                .......................................................................... 70
      Guidelines for Bathing Your Baby ..................................................... 71
Diapering                  .......................................................................... 73
      Diaper Rash          .......................................................................... 73
             To prevent diaper rash ........................................................... 73
Heat Rash                  .......................................................................... 73
Eczema                     .......................................................................... 74
      Suggestions for preventing rashes.................................................... 74
SIDS – Sudden Infant Death Syndrome
      Reduce the Risks .......................................................................... 75
      Can my baby sleep with me? ............................................................ 75
       Smoke and Drug Free Environment.................................................. 76
       Dressing Baby for Sleep ................................................................... 76
       Breastfeeding       .......................................................................... 76
       Shaken Baby Syndrome ................................................................... 76
Crib Information           .......................................................................... 78

How and When Should I Take My Baby’s Temperature .............................. 79
     Suggestions if your think your baby has a temperature .................... 79
          Notify your doctor if . . ............................................................ 80

Circumcision               .......................................................................... 81
      Care of the Circumcised Penis
      The Pastibell Method ........................................................................ 81
             Call your doctor if . . ............................................................... 82

Jaundice
      What is Jaundice .......................................................................... 83
      Causes of Jaundice .......................................................................... 83
      How Can I help?    .......................................................................... 83
            When to Call your Doctor ....................................................... 84
      Treatment of Jaundice ...................................................................... 84
      Newborn Screening .......................................................................... 84
      Thrush             .......................................................................... 85
            When to be Concerned for Mom ........................................... 87
            When to be Concerned for Baby ........................................... 88

Discharge Instructions – Going Home..................................................... 89

Infant Car Seats                     .......................................................................... 90
Strollers                            .......................................................................... 91

Questions                    .......................................................................... 92
Information About Your Baby....................................................................... 93
Prenatal Classes             .......................................................................... 94
LaLeche League Canada – Mother to Mother Support for Breastfeeding.... 95
Women’s Health Centre Programs .............................................................. 96
Just for you                 .......................................................................... 97
A New Mother’s Emotions – The “Baby Blues” ............................................ 98
Young New Mom’s Support Group – Nobody’s Perfect Parenting Class ..... 100
Nurse Practitioner Clinic Information............................................................ 101
Algoma Health Unit – Parent Child Services................................................ 102
“Let’s Grow” in Algoma       .......................................................................... 104
Other Relevant Services .......................................................................... 105
Children’s Health – Early Development
       Immunization Information and Schedule ........................................... 106
Services for New Parents .......................................................................... 110
Overview of Our Model of Care
At the Sault Area Hospital we regard childbirth as a natural and normal life event.
We believe in family centred care. Our goal is to have you return to your family and
familiar home surroundings as soon as possible after the birth of your baby.

Clinics
We have introduced some changes to how we deliver care.

Our Prenatal Clinic will provide contact with you, before your hospital stay. You
must attend the Prenatal Clinic to receive detailed information about our services.
An admission assessment will be done as well as questions regarding education and
support requirements will be answered. We can then plan together how best to
meet your needs.

Prenatal Tours
Prenatal tours are offered the 1st Tuesday of each month at 1:00 p.m. and the 3rd
Monday of each month at 7 p.m.. Please register by calling 759-3434, extension
5470, and leave your name, phone number and which session you plan to attend.
Length of tours is thirty to forty minutes, simply meet on the 3rd Floor, A-Wing
General site.

Follow-Up Program
As part of our follow-up:
• A five-minute questionnaire will be completed by you and your nurse at the time of
  discharge. The information received will help us plan or adjust services to better
  meet the needs of the families using our service.
• A nurse from the Prenatal Clinic will call you at home at approximately six (6)
  weeks to discuss your progress with breastfeeding. Information obtained will be
  utilized to improve services to you, other families, educate staff and gather
  statistics.
After discharge, you may have concerns or questions about yourself or your baby.
The Parent Child Information Centre at 126 Queen Street is available on a drop in
basis Monday thru Friday, between 1:00 p.m. and 3:30 p.m. A Public Health Nurse
will meet with you and your baby about your concerns and answer any questions
you may have.
At other times you can get assistance by calling the :
Algoma Health Unit at . . . Parent-Child Information Line
                             9 a.m. to 4 p.m.   541-7101
                             Monday to Friday
                             1-888-537-5741
Sault Area Hospital at . . .
              Mother Infant Help Line       4 p.m. to 9 a.m. 759-3690
                                           24 hours on the weekend and holidays


                                         -1-
Registration

Registration takes place in the Admitting Department, which is located in the front
lobby of the hospital. Please register prior to attending the Prenatal Clinic. Bring
your Hospital Identification Card with you for all your future hospital visits.

The Prenatal Clinic is located at the General site on 300B at the end of the hall.


Admission to Hospital

1. You must always stop at Admitting before coming to the Labour Unit

2. You need to bring . . .
     • Your Hospital Identification Card
     • Ontario Health Card

3. If you have your Yellow Antenatal Forms from your Doctor’s office, please bring
   them with you.

4. After 9 p.m., all the back doors to the hospital are locked. The front main door is
   open for use after this time.

5. Be prepared for paid parking upon exit from the hospital lot. Change machines
   are located throughout the hospital for your convenience.

     Patients and visitors are requested to keep cellular phones at home,
             as they can interfere with some hospital equipment.




                                          -2-
 What to Bring with you to the hospital . . .

For mom . . . .

 Mother Infant Care Manual
 Sanitary Napkins
 Depends – (hospital only supplies 1 for heavier flow – Shopper’s
  Home Health has a package of 4 available for sale)
 Nursing Pads
 Any medications mom is taking
 Pen/Pencil

       Kleenex                                  Chapstick
       Toothpaste & toothbrush                  Favourite Pillow
       Mouthwash                                Lotion
       Powder                                   Deodorant
       Shampoo                                  Hairbrush
       Snack/juice                 Housecoat (lightweight)
       Nightgowns
       Extra Underwear (panties, bras, nursing bras)
       Portable Sitz (if you have one)
       Money (coins for vending machines, parking lot, pay phone, etc.)


For baby . . .

 Newborn Diapers
 Soother (if you are planning to use)

       Car Seat
       Clothes to go home in (including hat and blanket)

       Optional: soap, baby shampoo

                     Bring in suitcase for Labour




                                 -3-
When Do I Go To Hospital


Signs of True Labour

Contractions:        This is the most common sign of labour starting. When you
                     have a contraction, you feel your abdomen become quite hard.

                     You may or may not feel pain with these early contractions. As
                     time goes on, your contractions will likely get close together and
                     become stronger.

                     Contractions on their own are not a sure sign you are in labour.
                     Many women have contractions during their pregnancies,
                     especially near the end. These are called Braxton Hicks
                     Contractions -- they are occasionally uncomfortable and are
                     not regular. They are “not the real thing”.


Am I in Labour . . . .

             True Labour                                     False Labour

• contractions occur at regular                 • contractions irregular (i.e. q 2-4-3,
  intervals, (i.e. q 5 minutes for 1-2            never consistent)
  hours)                                        • pain or discomfort remains same
• discomfort or pain gradually                  • discomfort located in abdomen
  increases, lasting 15-30 seconds              • walking doesn’t increase pain and
  then 30-45 seconds and up to 1                  often gives relief
  minute                                        • there is no blood show
• pain originates in lower back and             • water is intact
  radiates to lower front                       • cervix on exam is usually not
• walking causes more discomfort                  effaced and closed
• cervix thins (effaces) and opens              • contractions stop with rest
• blood mucous show is usually
  present with cervix thinning
• rest does not stop contractions
• you may have diarrhea before
  labour starts




                                          -4-
Changes in Your Cervix (Neck of the Womb/Uterus)

Your cervix has to open for you to deliver your baby. If you have contractions and
your cervix is changing, then you are in labour.

You won’t be able to see your cervix changing. When you get to the hospital, a
nurse or doctor will check your cervix. They will want to know if your cervix is
Effaced (thinned) and how much it is dilated (open).




                                          The cervix is the neck of the uterus. It is
                                          2cm long and has thick walls.
                                          As you near your due date your cervix
                                          starts to soften..




                                          When your labour begins and your cervix
                                          begins to shorten and thin out, tiny blood
                                          vessels in the cervix (break) mix with
                                          vaginal mucous and you get bloody show.




                                          It takes some time for your cervix to
                                          become thin and dilate. It depends on
                                          many factors. First babies usually take
                                          longer to be born than subsequent babies.




                                         -5-
                                                 Eventually your cervix will be effaced
                                                 (thinned out).

                                                 You normally thin with your 1st baby
                                                 first and then dilate to 10cm. With 2nd
                                                 and subsequent babies your cervix
                                                 may thin and dilate at the same time.



Did My Water Break?

You baby is enclosed in a bag of waters. This bag is called the amniotic sac and
contains clear fluid. At some time during your labour, this sac will break. Many
people call this “breaking of the waters” or “rupturing of your membranes” (the
fluid should be clear). Report any colour to your nurse!.

Your membranes can rupture before you go into labour, during labour or near the
end.

Some people have a big gush or others just a trickle. Usually there is no control
over leaking when water breaks.

It is a sweet unmistakable odour unlike urine, which is ammonia like.

Come to hospital when your water breaks.

Midwifery Clients follow the direction of your midwife.



                   Warning Signs

                   There are some signs you should be aware of to
                   Go to Hospital . . . .

                   •   bright red bleeding from your vagina (like a period)
                   •   continuous abdominal pain with no relief
                   •   rupture of your membranes
                   •   lack of movement of baby for a long period of time




                                           -6-
Understanding Cesarean Birth

What is a C-Section


Cesarean Section (C-section) is the surgical delivery of a baby through an incision (a
cut) in the abdomen and the uterus. It can be a lifesaving operation when you or
your baby experience certain problems before or during labour. Most mothers would
prefer a vaginal birth but all would agree that having a healthy baby is more
important than the method of delivery.

Being prepared for a cesarean birth includes knowing when it is indicated, what can
be done to reduce your chances of having one, what is involved in this surgical
procedure, and being able to accept the disappointment that some women feel
about not being able to deliver vaginally.


Vaginal Birth After C-Section -- Can You?

Repeat c-sections used to be the rule -- “once a c-section, always a c-section”. That
was because years ago doctors feared a rupture along the previous incision, which
was usually a high, up-and-down cut in the uterus. Today, most women can try to
give birth through the vagina after having a previous c-section and have a successful
vaginal delivery if no other risk factors are present. The horizontal incision, which is
made low across the uterus, has made such ruptures rare. The risk of uterine
rupture is 1/1000. Discuss the risk and benefits with your provider. You may be a
candidate for vaginal birth after cesarean (VBAC) if . . .
       • a low, horizontal uterine incision was used previously;
       • you experienced no complications during or after your c-section, which
          could affect this pregnancy and birth;
       • you will deliver your baby in a hospital or birth centre where an emergency
          c-section can be performed, if needed.




                                          -7-
What are the reasons for a Cesarean Birth?

A cesarean section delivery is major surgery and should only be done when the
health of the mother or baby is at risk. It should not be an option for the
convenience of the doctor or the parents, or for any other non-medical reason.

Cesareans are done for the following reasons . . .

• cord prolapse (when the umbilical cord falls into the vagina)
• bleeding from the placenta
• abnormal pelvic structure, for example as a result of a serious injury
• malpresentation of the baby
• serious maternal health problems (i.e.. infection, diabetes, heart disease, high
  blood pressure, etc.) when labour would not be safe for either mother or baby
• dystocia (difficult childbirth), which includes labour that fails to progress,
  prolonged labour, and CPD (cephalopelvic disproportion) when the baby is too
  large to pass safely through the mother’s pelvis
• breech presentation (buttocks or feet first)
• “fetal distress” the baby may show signs of “distress” such as slowing of heart rate
  or poor oxygen in the blood before vaginal delivery can be completed quickly

Cesarean sections are done in the Labour and Delivery Suite.

Your care provider will discuss your need for a C-section with you if he/she feels this
is a necessary method of delivery. They will answer your questions, so you will be
able to make an informed decision.

A spinal or epidural anesthetic is the preferred method of anesthesia during a C-
section, however there may be times when a general anesthetic is used.

Your partner may be with you during your surgery if you are have a spinal/epidural
anesthetic. You will awake during the operation but should not feel pain.

Your baby may visit you in the Recovery Room, so that you are able to breast feed,
as early as possible, and so you and your family can get to know your baby.

Your will be closely observed for a few hours after delivery.




                                          -8-
The Risks

Cesarean birth carries greater risk for both the mother and the baby. Some of the
increased risks for the mother include:

• infection -- women develop post-operative infection of the uterus and nearby
  pelvic organs less than 10% of the time
• increased bleeding -- twice as much blood loss as a vaginal birth
• blood clots in the legs, pelvic organs and sometimes the lungs
• death -- although maternal death is very rare, it is four times more likely with a
  cesarean birth than in a vaginal birth

Major Risks for baby include:

• Rapid breathing of the newborn due to excess fluid in the lungs not squeezed out
  when passing through the birth canal. This usually is resolved within 24 hours.

A cesarean birth also is more painful, more expensive and takes longer to recover
from than a vaginal birth. You can expect two to four days in the hospital and four to
six weeks before full recovery.


If you require a Caesarean Section, you will be taken to the Operative Delivery Room
in the Labour Unit and then to the Recovery Room. A spinal or epidural anaesthetic
is used most of the time for a Cesarean Section. You will be awake during the
operation but will feel no pain. When necessary a General Anesthetic will be given and
you will go to sleep.

Your baby may visit you in the Recovery Room, so you and your family can enjoy
him/her. You will be closely observed for a few hours after delivery and your nurse will
check your blood pressure, pulse, incision and vaginal flow.

C-sections are done in the Labour and Delivery suite.




                                           -9-
Admission to the Labour Unit

If you are not sure you are in labour, you may call the Sault Area Hospital and ask
for the Labour Unit. One of our nurses will take your call, discuss your progress with
you and advise you if it is time to come to the hospital. You will be admitted when you
are in active labour, as it is better for you to stay home in familiar surroundings in the
early stages of labour. When you come to the hospital, you will be assessed in a
labour room and when labour progresses you will be moved to a birthing room. If not
in active labour, the nurse will discuss various options with you.

Upon admission, the nurse will check your blood pressure and temperature and apply
the fetal monitor for approximately 20 minutes to listen to the baby's heart. The nurse
will time and feel your contractions and probably perform a vaginal examination to
assess the progress of your labour. A staff member from the laboratory will take a
blood sample for testing.

We do Not routinely give you an enema, shave the pubic area or start an intravenous
infusion unless it is necessary.

During your labour, we will check your blood pressure, temperature and baby's heart
rate on a regular basis. We will encourage you to be up walking, relax in one of the
rocking chairs, take a warm shower and try various positions to increase comfort.
Clear, high caloric drinks will also be encouraged during your labour. We have juices,
gingerale, popsicles and ice water in our kitchen.

Birthing Room

At present we have three birthing areas’ available and unfortunately this does not
accommodate all our patients while in labour. The birthing room provides an area for
admission, labour, delivery and recovery in the same room. Women who are having
twins, will labour in the birthing room, if available, and will deliver in the Operating
Room. A short time after delivery you and your baby will be transferred to
300B/Combined Care, where you will stay for the remainder of your hospitalization.

Medical Residents and Nursing Students

Medical residents from various universities in Ontario spend time with our physicians to
learn about Obstetrics. Nursing students from Lake Superior State University and
Sault College also spend time observing in the various departments of the hospital.
We welcome both groups and would hope you would do the same. If you do not wish
to have either of these with you please let your nurse or physician know.




                                            -10-
                   10 Ways to be a Good Coach
                                 Speak in a calm and gentle voice even
Be Encouraging                   though your partner may be experiencing
                                 painful contractions.


Be Brief                         Keep conversations to a minimum.


Be Gentle                        Touch gently and lightly -- soothe her.


Be Responsible                   Learn techniques along with her-- its
                                 your job.


Be Conscientious                 Take all this seriously; it is not a joke.
                                 When labour starts, you’ll be glad you
                                 did.


Be Supportive                    Stand behind her; if she needs pain
                                 relief, don’t make her feel guilty.


Be Calm                          Don’t panic, stay cool. The staff knows
                                 what to do; she needs you to be steady
                                 and in control.


Be There                         Try not to leave her; your presence and
                                 encouragement are needed.


Be Open                          Share this experience together. The
                                 birth of a baby is wonderful.


Be Proud                         She couldn’t go through labour as well
                                 without you. Coaches are essential in
                                 prepared childbirth.




                               -11-
Visiting in Labour

Your partner/coach is welcome as a support person during labour and will be
encouraged to remain in your room at all times or in the waiting room down the hall
near the elevators.
Visitors are discouraged during labour unless they are in a supportive role. In order to
provide privacy, a quiet atmosphere, keep the patients, staff and other visitors safe
from exposure to infectious diseases, we limit visiting to two (2) at a time including
the partner and request that your DO NOT VISIT IF YOU ARE NOT WELL.
Visitors who do not comply with the visiting regulations will be asked to leave.
    Due to patients right to privacy, we ask that you keep family and friends
      informed of your progress, as information about your condition can not
                       be given over the phone by nursing staff.

Pain Management in Labour
At some point during the admission your nurse will discuss with you, options for pain
management during your labour. Some women have decided on a specific approach
ahead of time while others wait until they are in labour and then decide their needs.
Either way you may change your mind during the process. The nursing and medical
staff will work with you to manage your labour in the way which is best for you and your
baby and will be happy to answer any questions that you may have.

Some approaches to pain management include walking, warm showers, back rubs,
breathing and relaxation techniques and/or pain medications.

A common pain medication Demerol is given by injection. Nitrous Oxide an inhaled
gas will be beneficial when you are close to full dilation or while waiting for other
methods of pain relief. An epidural is also available at the Sault Area Hospital and is
given by an anaesthetist. Your physician will order these if you request it and your
nurse will explain any details to you.

After Delivery
After your delivery, if your baby is well he will stay in your room. This will give you the
opportunity to put your baby to breast or just enjoy some quiet time with your baby as a
new family.
If you have a Caesaren Section your baby will be cared for in Neonatal Nursery for the
first 12-24 hours post delivery. Your baby will be taken to you for feedings and will
remain in your room when you are able to assist with its care. If you wish,
arrangements can be made to have your baby room in with you after surgery. Please
discuss with your nurse.
Although your time with us in hospital will be short your care will be planned
according to you and your baby’s needs.


                                            -12-
Combined Care and 24 Hour Rooming In
In keeping with the philosophy of family centred care, the hospital has adopted the
practice of combined care. Combined Care means that the nurse cares for both you
and your baby in your room. Having the baby in the room with you 24 hours a day
provides you and your family with more time to get to know your baby, and for your
nurse to teach and assist you with baby care. You will do most of the care for your
baby, although the nurses will always be available to assist you. Hopefully this
experience will make you more comfortable afterwards with the baby at home. Please
ask questions and request assistance whenever necessary. We are here to help you
as much as possible.

Length of Stay
Mothers who give birth vaginally can expect, in most cases to return home
approximately 48 hours after the baby is born. If your baby is born by caesarean
section you can expect to be discharged approximately 3-4 days following the birth.
Some mothers leave earlier at their request. Either way you will find you have much to
learn in a short time.

Occasionally babies must remain in hospital longer than the mother must. It is very
difficult to leave without your baby, especially if you are trying to establish
breastfeeding. We have a Mothers’ Room available for discharged moms. It is
available on a first come first serve basis. If you live out of town, you will be given
priority. The Neonatal staff arranges this. We will assist you in any way we can to
make this go smoothly.

Telephone and Television
• Using telephone at bedside
• Call Telehealth at extension 5462
• If you wish to have one or both services for a daily fee
Leave a message including . . .     Your name
                                    Room number
                                    Bed number
                                    Hospital you are in
                                    Service requested -- telephone, T.V. or both
Payment is due at hook-up by Visa, MasterCard, Personal cheque or cash.

You may make local calls, collect calls or calling card long distance calls by dialling “9”
to get an outside line.
Please ask your nurse for information.




                                            -13-
Smoking Policy

The Sault Area Hospital is a smoke free facility. Make arrangements with your family
to watch the baby if you leave your room for any reason. Please do not leave your
baby unattended.


Latex Policy

Sault Area Hospitals will no longer accept latex balloons for Health and Safety
Reasons.


Security

We are very concerned about the safety of your baby. Every baby, mother and
partner/coach will have an identification bracelet with matching numbers on it and
information about date and time of birth. All infants are footprinted after birth or prior to
leaving the delivery room or birthing room. Nursing staff will regularly check bracelets
for matching identification and may question unfamiliar people handling the baby.

  Check with your nurse before releasing your baby to unfamiliar personnel!!

            DO NOT LEAVE YOUR BABY UNATTENDED AT ANY TIME.

The nursing staff or your family will observe your baby when you require a shower.

At time of discharge you will be asked to verify the matching bracelet numbers of you
and your baby and sign that you have done so. This is done before you leave.


Baby's O.H.I.P. Coverage and Ontario Health Card

While in the hospital you will be asked to sign an O.H.I.P. Coverage form. You will be
given a temporary health card to ensure baby's coverage. A permanent health card
will be mailed to you in approximately 6 weeks.

You will also receive your Registration and Child Tax Credit papers. They will be at
your beside on admission to 300B. Please be sure to take these home, fill in and
return to the proper address.




                                           -14-
Welcome to the Maternity Unit

Partner/Coach or Family Member Participation

Family centered nursing on the Maternity Unit is encouraged. The maternity nurses
are happy to assist you in becoming more involved with the care of your partner and
baby during their stay with us.

Facilities are available for a partner or family member to sleep overnight if you wish
to assist with care of your partner or infant at night. We provide cots for this
purpose -- however, space and availability are concerns. To prevent any problems,
the following guidelines have been drawn up:

1. As there are a limited number of cots, or sleep chairs, they are obtained on a first
   come first serve basis and only one cot per family is available.
2. A partner or one family member is allowed to stay overnight if the mother is in a
   private room or in a semi-private room.
3. One support person only is allowed to stay per patient.
4. Please remember to wear appropriate clothing when staying overnight. Jogging
   suits or regular clothing is preferred. Undershorts or pajamas alone are not
   acceptable.
5. You may use the toilet and sink facilities in the room you sleep in if you are in a
   private room. Otherwise, partners or family members must use the facilities in
   the father’s waiting room by Labour. Showers are to be taken at home. Please
   bring your own toiletries.
6. At 7 a.m. when the staff arrives to continue care for your partner or family
   member, we ask that you fold the cot or sleep chair and put it away. Cots
   will not be used from 7:00 a.m. - 9:00 p.m. The hospital day starts early and
   the laboratory staff, nurses and physicians begin rounds at this time.
7. If at any time you have questions, please be sure to ask the nurse caring for your
   partner or family member, or stop at the nursing station and one of the staff will
   assist you. The Nurse Manager -- Roberta Barbeau at extension 5302 will be
   available to assist with concerns that are not addressed.
The Combined Care Staff




                                        -15-
Visiting Guidelines for Combined Care/300B

When planning for visitors, please keep in mind that your time spent in hospital after
the birth of your baby will be short. You should consider this time a learning
opportunity, when the nursing staff will be available to provide you with important
information about your care after birth and care for your baby.

We suggest you limit visitors and the time they spend with you and perhaps plan for
people to visit you at home once you are feeling up to it.

Above all, please remember to consider the other mothers and babies on the unit.
People and noise in the hallways are disruptive both to new mothers and their babies.

Although your family and friends are welcome to visit . . . .

TWO (2) VISITORS AT A TIME WILL BE ALLOWED INCLUDING THE PARTNER
CHILDREN ARE NOT ALLOWED TO VISIT.

The Nursing Staff and Security have been encouraged to enforce these visiting
policies.

We encourage your partner, and/or family support member to be an active participant
in you and your baby's care.

            * Mother, family member and any visitor must HAND WASH
                              before handling baby!

To protect your baby, anyone exposed to the following should be CAUTIONED NOT
TO VISIT:

Within the last four weeks has the sibling/visitor been exposed to . . .

              Chickenpox                           German Measles (Rubella)
              Measles                              Whooping Cough
              Mumps                                Other Contagious Illness

(Exposure to Chickenpox is only significant if sibling has NEVER had Chickenpox)
(Exposure to Measles, Mumps, Rubella is only significant if child has not received
MMR immunization)

To protect your baby and other babies on our unit, anyone with the following symptoms
should be CAUTIONED NOT TO VISIT.

Within the last two days has the sibling/visitor had . . .

              Fever                 Rash                        Runny Nose
              Cough                 Diarrhea                    Vomiting
              Sore Throat           Cold Sores (Herpes)
                                            -16-
Neonatal Nursery

When babies experience difficulty after birth, require more observation or if they need
to grow and gain weight, they are admitted to the Neonatal Nursery. The neonatal
staff realizes it can be a frightening experience for you and the entire family when your
baby is admitted to the neonatal nursery. We are here to assist you and your infant
during your stay with us. We encourage you to ask questions and to participate in your
baby's care as much as possible. However, there may be a time when you may not be
able to hold or feed your baby until his condition allows but you may still visit in the
nursery. If you are unable to be with your baby we will attempt to keep you informed of
your baby's condition.

There may be a time when your baby requires tests or treatments that can not be done
at the Sault Area Hospital and as a result may need to be transferred to another
hospital. The doctors and nurses will prepare your baby and any necessary equipment
to make the trip.

When babies are first admitted to the Neonatal Nursery, they are frequently placed on
open beds with overhead warmers, which help keep them warm. If the baby needs
help to breathe, this kind of bed allows the nursery staff to easily provide necessary
care. When appropriate, babies are placed in an isolette, then moved into a crib.


Visiting in the Neonatal Nursery

       Parents

       You are encouraged to visit often and call whenever possible.

       Regular visiting hours are:
                                     7:30 a.m.          -       6:30 p.m.
                                     7:30 p.m.          -       11:00 p.m.

       You may be asked to leave during certain procedures, emergencies, nursing
       reports or physician rounds.

       A hallway phone outside the neonatal nursery is used to request entrance to the
       unit.


       Siblings

       Your children that are 3 years of age or older are allowed to visit once a week
       for a short time if they are well and have not been exposed to recent infections.
       Ask nursing staff for further information.




                                            -17-
Grandparents

Grandparents are allowed into the Neonatal Unit for a brief visit when
accompanied by a parent.




                                            Only 2 visitors per infant are
                                            allowed to visit at one time.

                                            Extended family and friends
                                            may see your new baby through
                                            the viewing windows.

                                            Help us maintain a healthy, safe
                                            environment by ensuring that you
                                            WASH YOUR HANDS when
                                            entering and leaving the nursery.

                                            Mothers, bring in your identification
                                            bracelet that matches baby’s when
                                            you come to visit.

                                            Please ask any questions or
                                            let us know how we may meet
                                            your needs.




                                   -18-
Taking Care of Yourself
After the birth of your baby, it is very important that you take care of yourself. This is a
time to gather the support of your partner, family and friends to help you get the rest
you need to care for yourself and your baby. If you have had a cesarean birth, we
have included an additional section to help you understand your care.

After Your Baby is Born
After you have had your baby you will be in the birthing room or recovery room for one
to two hours. When you are moved to 300B, the postpartum unit, your nurse will often
check your blood pressure, temperature, uterus and vaginal flow. If you have an
episiotomy, a tear that has been sutured or hemorrhoids, your nurse will offer
suggestions to help reduce the swelling. As soon as you feel able and the effects of
the epidural have worn off, you will be helped to the bathroom.
        Please do not get out of bed for the first time on your own, as you
                       may feel somewhat dizzy or weak.
A Nursing Assessment (temperature, respirations, weight measurements, etc.) and
their first bath will be done by a postpartum nurse prior to your baby being settled in
your room with you. The nurse will assist you with the care for both you and your baby.
She will continue to monitor your infant frequently.

                  Please feel free to ask for assistance at any time!

Vaginal Bleeding
After the birth of your baby you will have vaginal bleeding which may continue for 2 to 6
weeks. At first, the bleeding, called lochia will be dark red like a heavy period. The
colour and amount will change in a few hours to a moderate dark red, to a pinkish
colour after a few days, then to a scant brownish discharge. If you are breastfeeding, it
is normal to experience an increase in flow of brighter red blood following a feeding.
This will decrease over time. If your flow (lochia) changes from a scant discharge back
to a bright red flow after you are at home, it may be from too much activity, and more
frequent rest periods may be needed. Once you are at home, if you have bright red
bleeding that continues after resting, or if you soak through one perineal pad in one
hour or less, or if you pass clots (after the first 24-48 hours) call your physician or
report to Emergency. If you are unsure about the amount of bleeding, you may call the
Child Information Line at 541-7101(1-888-537-5741) or Mother Infant Helpline at 759-
3690.

In hospital, please let your nurse know if . . .
      i.      your bleeding increases
      ii.     you pass any clots (show these to your nurse)
      iii.    your lochia has a bad odour
      iv.     you feel feverish


                                             -19-
Peri-Care

We will provide you with a plastic squirt bottle to use whenever you go to the bathroom.
Using plain warm water, direct the stream of water so that it sprays from the front-to-
back. This is soothing for your bottom, as well as cleansing. Using the toilet paper, pat
dry from front to back. Change the pad every time you use the toilet. Do not use
tampons until after you see your doctor at your postpartum check up. Continue with
peri-care, until your bleeding stops.

               Be sure to wash your hands before leaving the bathroom

Often it is difficult to empty your bladder completely because of swelling, bruising and
discomfort. Pain medication is available every three to four hours if necessary. If you
are breastfeeding, the medication is safe for your baby.

Using ice packs helps to relieve swelling and bruising for the first 24 hours. After that,
heat can be soothing and keeping the area clean will promote healing. This can be
done in various ways:
   i. a portable sitz bath (available on our unit at a charge of $5.00, ask your nurse
        for details)
   ii. a spray from the shower head
   iii. a warm bath . . . at home in a clean tub (avoid oils or Epson salts in the water)


Episiotomy or Perineal Tear

The stitches that were used to repair the episiotomy (cut) or tear will dissolve on their
own, usually within 2 weeks. Occasionally you may notice a piece of suture on your
sanitary napkin or on toilet tissue. If you are having episiotomy discomfort, be sure to
take the pain medication that your doctor has prescribed. The above sources of heat
will help to make your perineal area feel better faster. (See kegels under exercise
guidelines).

Call your doctor if . .

   i.     you have discharge with a foul odour
   ii.    the perineal area becomes hot, swollen and reddened
   iii.   the episiotomy or tear site is becoming more painful instead of feeling better
    iv.   you have a fever over 38°C or 100.4°F




                                              -20-
Abnormal Cramping

After pains are normal after delivery, but the discomfort will begin to lessen after a few
days. If you have had other pregnancies or if you are breast feeding you may notice
the cramps more. If this is the case, discuss pain relief options with your nurse.

Self Medication Kit

A self-medication kit is available if ordered by your physician. These medications
are for your use only. They are to be kept in your bedside table.

 “Please keep in a closed drawer when not in use and do not let children near
                              the medication.”

These medications are safe to take while breastfeeding. Your nurse will explain how
to use the kit on admission to your room.

Hemorrhoids

Hemorrhoids are swollen veins around the rectum. Try the sitz bath, ice packs, or
"Tucks". To relieve burning or itching you can use a cream or suppository that your
doctor has ordered, which is better absorbed following a warm sitz bath. Your nurse
will gladly help you decide what works best for you.

Avoid sitting or standing for long periods. Keep bowel movements soft by eating a high
fibre diet and drinking lots of fluids (6-8 glasses per day). Your nurse will offer you a
laxative or suppository ordered by your doctor if you need it. Hemorrhoids usually
disappear a few weeks after the birth, if you just developed them in this pregnancy.

Hormones and Emotions

Mood swings, worry, unexplained crying, irritability and feeling overwhelmed are
commonly experienced in the postpartum period, but these feelings usually pass
quickly. They can occur due to the hormonal changes taking place in your body, and
the lack of sleep. This usually happens between the second and tenth day after birth.

Try to get as much rest as possible.

Discuss how you feel with your partner, friend or nurse.

Go ahead and cry! Let those feelings out.

Gain confidence in yourself as a mom, by learning as much as possible about caring
for your baby while in the hospital, and then allow time to get to know his/her needs.




                                            -21-
Be realistic. Don't try to do too much. You and your baby come first. Housework and
entertaining can wait.

Arrange for time to go out on your own.

If you don't feel better about life by two weeks after delivery, call your doctor,
Parent Information Line at 541-7101 (1-888-537-5741) or the Mother and Infant
Helpline at 759-3690 for advice.




                                          -22-
Postpartum Depression

Fact Sheet

Do I have postpartum depression?

The birth of a baby is expected to be a time of joy and happiness, but for at least one in
ten women it can lead to anxiety, loneliness and depression, called postpartum
depression.

A woman who is going through postpartum depression may experience the following:
           • crying for no apparent reason
              • feeling very sad
              • feeling angry or irritable
              • difficulty sleeping
              • feeling overwhelmed and unable to cope
              • anxiety and/or panic attacks
              • feelings of helplessness or inadequacy
              • thoughts of hurting yourself or your baby
              • other confusing feelings

What should I do if I think I have postpartum depression?

• remember you are not alone, help is available
• see your doctor to discuss your symptoms and possible treatment options such as
  anti-depressants
• consider contacting a counselor, mental health agency or public health unit for
  professional support group
• learn about postpartum depression
• most importantly TAKE GOOD CARE OF YOURSELF


For more information contact the Algoma Health Unit at 541-7101 (1-888-537-
5741) or the Canadian Mental Health Association at 759-0458.




                                             -23-
Exercise Guidelines

It is natural to want to get back in shape after your baby is born. Allow yourself time to
recover, and then begin exercise gradually. Kegel exercises can begin as soon as
possible.

You may find that a little exercise can be refreshing and can be a great stress reliever.
Walking is a great way to keep fit.

Avoid long tiring sessions. Exercise slowly and smoothly, and avoid holding your
breath.

Vigorous exercises such as jogging and skipping can wait until after your postpartum
check-up.

 If you feel pain, stop exercising. Begin again only after the pain has stopped.

For your exercise session to be most effective, practice on a firm surface and do each
exercise 10 times each, about 2 to 3 times daily.

1. Pelvic Floor Contraction Exercise (Kegel)

  As explained previously, Kegel exercise aids in healing of episiotomy and
  hemorrhoids and helps to restore bladder tone and strengthens pelvic-floor muscles.
  Also it helps to prevent prolapse or slipping of the uterus in later life and may add
  sexual enjoyment during intercourse.

  **   Lying on your back with your legs crossed at the ankles - squeeze knees,
       thighs and buttocks together as if preventing yourself from urinating. Hold and
       count to five. Relax. Repeat. Gradually, this exercise can be done without
       ankles crossed and can be done anytime, sitting or standing.

2. Pelvic Tilt Exercise

  Relieves backache and improves posture
   ** Knees bent with feet flat on the floor, place hand in hollow of back, tighten your
      abdominal muscles and press the hollow part of the lower back against your
      hand.
      Hold and count to three, and relax. Repeat five times, and when you are able,
      increase this number.

   This exercise can be done sitting in a chair with your back against the back of the
   chair. It can also be done standing with your back against the wall, heel five to six
   inches from the wall.




                                            -24-
  For good posture, repeat pelvic tilt in standing position. Hold the pelvic tilt and
  walk around. Try to maintain this good body alignment and check it daily in front of
  a mirror.
  When lifting objects from the floor, plant your feet distributing the weight equally on
  both legs. Bend your knees, keep your back straight and bring the load close to
  your body.

3. Abdominal Exercises

  Strengthens abdominal muscles giving support to your back and helps to regain
  your figure.

  Stage 1

  Lying on your back with knees bent and feet flat on the floor - stretch arms out
  towards your knees, push the small of your back into the floor and lift head and
  shoulders only. Keep chin tucked in. Hold and count to three at first, then
  gradually increase to longer holds. Stay at this stage for at least six weeks, giving
  your body time to heal.

  Stage 2

  Continue the above exercise, but now begin to get closer to a full sit-up.

  Stage 3

  (Cross-over). As in Stage 1 with arms outstretched toward your knees, push small
  of back into the floor and reach diagonally across to the outside of the opposite
  knee.
  Hold and count to three, and slowly return to starting position. Repeat five times to
  one side, then to the other. Increase as you are able.




                                          -25-
Cesarean Section Delivery

Your Cesarean birth may have been planned or decided during your labour due to
complications that may have put you or your baby at risk.

Regardless of the reason for your C-section, the first 24 hours after surgery you may be
sleepy and uncomfortable.

Your baby will be remaining in the Neonatal Nursery for the first 12-24 hours after surgery.
Your baby will be taken to you for feedings and visits. We encourage your partner and
family support member to be an active participant in your baby’s care.

With special arrangements, a well baby may room in if you have a 24-hour support person
staying with you.

You may experience many emotions such as disappointment, anger, guilt and relief
because you were unable to deliver vaginally. These feelings are normal. It is important
for you to share these feelings with your nurse, partner or support person and other
mothers who have had a Cesarean birth.

During the first 12 to 24 hours after your surgery, you will have an intravenous. You will
have this until you are able to drink enough fluids. Your diet will begin with liquids, Jell-O
and custards, then will gradually increase to normal eating. Your diet will increase when
you are tolerating foods and when you start passing gas rectally.

You will have a catheter in place to keep your bladder empty for the first 12 to 24 hours.
Once this is removed, you will be helped to the bathroom.

In most cases, a small dressing will cover your incision. Usually, on your second
postoperative day, you may shower and your dressing will be changed and gauze
dressing will be applied. This gauze dressing will be replaced on a daily basis, after your
shower.

Your incision may have no visible stitches but a knot at one end of it. As each doctor has
their own preference, your incision could have staples, or one long continuous stitch. If
you have a knot, it will be clipped before you leave the hospital. If you have staples or a
long continuous stitch, removal may be before discharge or at a later date. Your doctor
will let you know before you go home.

You may have steri-strips (small paper-like Band-Aids across your incision). As you
shower/bathe they may loosen and curl. Remove them after the first week if remaining strips
have not fallen off.

To help control your pain after surgery, you may receive pain medication by needle every 3-4
hours for the first 24 to 48 hours. The Anesthetist may administer Epimorph (pain medication)
into the epidural or spinal space at the time of your anesthetic. This will control your pain for
up to 12-24 hours. After your surgery, Indocid suppositories (assist with pain control) are

                                            -26-
often administered for additional pain control. After 24 to 48 hours your pain can usually
be relieved by the use of pain pills. Be sure to take them, as you need them.

After your surgery, it is important that you do deep breathing and coughing exercises to
help clear mucous from your lungs. Placing a pillow across your incision will help
decrease any discomfort caused by coughing.

Change positions frequently (at least every hour) while in bed. This helps to prevent
stiffness and helps the “gas” to start moving.

Move your feet, ankles and legs often. This will help to maintain circulation.
You will be helped out of bed soon after your surgery. On the first day, you will walk
around your room and to the bathroom. The sooner you start
moving, the sooner you will feel better.

Some tips to help gas discomfort . . .
• Avoid ice water and carbonated drinks (leave the pop opened for awhile to let it go
  flat).
• Walk as soon and as much as you are able without becoming over tired.
• Drink warm fluids (ask your nurse to make a peppermint tea).
• Avoid the use of straws as it increases gas discomfort.
• Lie on your left side when you are in bed.
• A laxative or suppository may be necessary to get the gas moving.

Once you are at home, you may want to consider increasing the fibre and roughage in
your diet. If you tend to be constipated you can take Metamucil and drink plenty of
water. The Algoma Health Unit Nutrition Department has information on fibre
containing foods call 759-5437.

To care for your incision . .

• Shower daily, this will keep the incision clean.
• Normal healing - the incision appears clean, with the edges of the incision close
  together. It is normal for the skin around the incision to feel numb. The scar will
  fade as it heals.

Tip:           To stop your underwear from rubbing against the incision, stick a mini-
               pad to the inside of your panties along the elastic.

       Call Doctor if . . .

       •   Increased redness, tenderness or swelling along the incision line.
       •   Bleeding or other discharge from the incision.
       •   Separation of the incision.
       •   Fever (over 38°C or 100.4°F)




                                            -27-
Nutrition

Healthy eating is important at all stages of life. A healthy diet will help you to be well
nourished during and after pregnancy and while breastfeeding. Enjoy a variety of
foods from the four food groups of Canada’s Food Guide to Healthy Eating every
day.

After delivery it is important to get enough fluids and to choose foods that provide fibre,
extra calcium and iron.

Constipation is a common problem after having a baby. Here are some suggestions to
help:

•   choose whole grain breads and cereals
     100% whole wheat bread
     bran cereal, oatmeal
     bran muffins
     whole wheat pastas or brown rice
•   eat more vegetables and fruit throughout the day
•   include legumes such as dried peas and beans
•   drink at least 8 glasses of fluid a day (water, milk, juice)
•   walk around as much as you can after delivery

To ensure you are getting enough calcium choose milk, yogurt or cheese and enriched
cereals, dried fruits, meats and dark green vegetables are your best choices for iron.


For Breast Feeding Moms

•   Choose healthy meals and snacks thoughout the day
    following Canada’s Food Guide to Healthy Eating.
•   Eat according to your appetite. You may find you are hungrier
    as producing breastmilk is an energy intensive process. You
    will need to eat around an extra 450-500 calories each day.
    That’s the equivalent of a sandwich, glass of milk and an
    apple.
•   Drink plenty of fluids like water, milk and juice.
•   If you think you are eating a food that is causing problems for
         your baby, call a Public Health Nurse at the Parent Child
         Information Line at 541-7101.
•   Do not try to lose weight by eating less while breastfeeding as it can reduce your
    ability to make enough milk.
•   Limit caffeine-containing foods such as coffee, tea, chocolate or soft drinks.
    Caffeine passes into breastmilk and can keep your baby awake.




                                              -28-
Sexual Relationship after Delivery

The decision to resume intercourse is a personal one and the right time for you will be
when both of you are comfortable.

Many couples are not prepared for the impact having a baby has on their sexual
relations, interests and responses. Many adjustments must be made by both of you. It
helps if you speak frankly to each other about how parenting is affecting your sexual
response to each other, your feelings and your needs.

Once stitches are healed, bleeding has stopped (usually 2-6 weeks) and you are
comfortable, intercourse can be resumed. If unsure you can consult with your
healthcare provider.

After 2 to 3 months, sexual responses gradually return to what they were before
pregnancy.

The many physical and hormonal changes that occur after having a baby that may
affect your sexual relationship include:
        • shorter and weaker orgasm (due to weaker vaginal muscles)
        • less lubrication in the vagina
        • longer arousal time
        • fear of another pregnancy
        • fatigue for both mom and dad
        • baby's crying
        • discomfort during intercourse
        • fear of hurting the incision after Cesarean birth

The following suggestions may help you deal with these temporary changes . . .

    • daily repetitions of kegel and pelvic exercises to help restore pelvic and vaginal
      muscle tone.
    • use of K-Y jelly or spermicide cream helps decrease the discomfort from
      dryness in the vagina - Vaseline is not recommended
    • increased fondling, cuddling and kissing may help with getting each other
      interested in lovemaking
    • use of various positions will lessen the pressure on the tender areas in the
      vaginal area, the abdomen and the breasts
    • try placing a pillow under your hips to decrease pressure during intercourse
    • if you had a C-Section delivery you might try a side lying position where the
      woman can control penile penetration and avoid pressure on her incision
    • to avoid pressure or discomfort, you may want to position yourself on top so that
      you can control the entrance of the penis




                                          -29-
If you are breastfeeding . . .

You may find that your breasts are tender and full and that you will have a milk let-
down during orgasm. Nursing your baby before love making will help to prevent this
and also decreases the chance of being interrupted by a crying baby.

Although mothers who totally breast feed may not menstruate, they can still become
pregnant.

           Breastfeeding is not an effective method of birth control.


Birth Control

You may become pregnant, even if you are not menstruating.

Should you decide to have intercourse before you see your doctor, be sure to use an
effective contraceptive method.

Discuss which method of birth control you will use with your partner. Once you have
chosen a specific method, consistency and proper use is extremely important.

For further contraception counselling, discuss with your doctor at your next check-up.
For more information, call the Parent-Child Information Line at the Algoma Health Unit
at 541-7101.

Most women who breast-feed will experience milk leaking from their breasts during
orgasm.

It is not unusual for some women to require a longer period of time before they are
ready to resume intercourse. Share your feelings with your partner.


Remember there are many satisfying ways to express your
sexuality and sensuality. Tenderness, cuddling, and kissing can be
part of your sexual activity until you are both ready.




                                          -30-
Feeding Your Baby

Breastfeeding

Breastfeeding can be challenging during the initial month of learning. It is two
“amateurs” getting together learning a new skill. With much patience and help from
breastfeeding resources it will be a beautiful experience.

Breastfeeding has many benefits for you and your baby. Infants who are breast-fed
are less likely to develop allergies, and have less chance of bowel and respiratory
infections.

Breastfeeding is free, readily available and enhances the relationship between mother
and baby. We support breastfeeding at the Sault Area Hospitals and have made a
decision to help make this hospital and community as breastfeeding friendly as
possible.

Before you have your baby it is important to learn about breastfeeding. Reading
information about breastfeeding, attending prenatal classes and La Leche meetings in
the community will help you to do this. If you are unable to put baby to breast soon
after delivery or at any point throughout your hospital stay, see pumping section of this
book. The nurses who work on the maternity unit are committed to helping you
succeed at feeding your baby.


Breast and Nipple Care

• no need to wash your nipples - a bath or shower once a day is enough
• avoid use of soap on nipples as it dries the skin
• after each feeding, express a few drops of breast milk, massage onto nipple and let
  air dry
• some women may want to use nursing pads - change them as necessary -moist
  pads will result in sore nipples and cause germs to grow
• never use plastic backed or nylon lined breast pads - they do not allow air circulation
  - cotton re-usable or disposable breast pads are recommended
• wear a bra that provides good support - should have wide non-elastic straps, and
  should be large enough for the cup to cover the whole breast




                                           -31-
Mom's Comfort

Your comfort will help you to relax and feed your baby successfully. If you have had an
episiotomy or hemorroids you may need something to relieve the discomfort and a
pillow to position yourself.

•   Use pillows to support your arm and back and on your lap to support the baby.
•   If seated in chair use a footstool for comfort.
•   Baby should be level with the breast so mom is not leaning forward.
•   Relax your shoulders.


Position of Baby

• In whatever position you choose to feed - baby's ear, shoulder and hips should be in
  a straight line.

• Bring baby to level of mother's breast. Position infant's body so that the baby's head
  is tilted slightly back.

• The baby's body may be supported with pillows, to allow the mother to bring the
  baby to her breast without straining her neck, shoulders and arm. Baby faces
  mother's body so they are tummy to tummy, chest to chest and nose to nipple.

• The infant’s nose should be directly facing the nipple.


Getting Started

• Support breast with fingers underneath and thumb resting lightly on top (not
  pressing down) throughout the feed. This is called the "C Hold".

• Keep fingers well back of the areola (brown area around the nipple).

• Tickle baby's lower lip with the nipple, when baby OPENS MOUTH WIDE, WAIT
  FOR A WIDE OPEN MOUTH, centre your nipple and quickly pull the baby toward
  you (move the baby close to you - do not move forward to the baby).

• If baby fusses, stop, soothe and start again.

• Once latched the top lip will be close to the nipple, the chin will be well in against the
  breast with more of the brown area covered by the lower jaw.




                                            -32-
Signs of a Good Latch

• If the baby is correctly latched on, the mother should experience no pain while the
  baby is nursing.

• Muscles of the face working so that the ears wiggle.


• Hear infant swallowing.


• There is a rhythm of suck/swallow throughout feeding.


• The baby’s mouth will remain wide open, with the lower lip curled out and his

  chin pressed into the breast.

• The baby’s lower lip will appear to be covering at least 1 inch or most of the areola.

• 4-5 wet, disposable diapers a day ONCE YOUR MILK HAS COME IN (by day 4-5)


• 6-8 cloth diapers




Signs of a Poor Latch

• Small, rounded mouth.

• Sucked in cheeks.



• Slipping off the breast.


• Tongue flicking nipple.


• Many jaw movements to each swallow.

• Sore or cracked nipples
                                                          Correct position on the breast



                                           -33-
How Long Should Baby Nurse

It is important to feed longer on the first side to make sure baby gets both the foremilk
and hind milk. Foremilk is high in water and sugar and hind milk is high in fat. Both are
required for a good feeding and important for the infant's growth and satisfaction. Most
babies will stop feeding and release the nipple when ready. The infant should be
burped and may be offered the other breast if feeding cues (listed below) remain.
Sometimes, the baby will nurse for only a short time on the second breast. Offer this
breast first the next time.

Mothers need to realize that all infants are unique in their feeding schedules and
should breastfeed according to the needs of her own baby rather than following any
prescribed length of time for nursing. Babies may breastfeed as often as 8 -12 times in
a 24 hour period.

** During the first few days of life, if a baby does not waken spontaneously to nurse,
   the mother should waken him every 2-3 hours. If waking baby, do so during the
   light stage of sleep when the eyes are moving rapidly under the lids and the baby is
   moving their lips.

Babies nurse best on “cue” before they reach the crying state and as often as they are
interested.

Rooming in will help you recognize these signs (cues) that baby is getting ready to
feed.

Cues for feeding . . .

•   baby moves from deep sleep into light sleep
•   stretching, stirring, hand to mouth movements
•   baby is fully awake and starts to suck and root
•   rapid eye movement

One sign of good breastfeeding is 10-20 minutes in total of a deep slow sucking pattern
(open-pause-close) at each feeding. Refer to “What to do with a Sleepy Baby” in this
manual.

It is important to remember that the initial pattern of feeding established in hospital may
not last. As infants become older and better at nursing, the length of feeding time
becomes much shorter.


Removing Baby from Breast

Slide finger into the corner of the baby's mouth and exert gentle pressure on the lower
gum to release suction. Remove the breast ONLY when suction is completely
released.

                                            -34-
Weight Gain and Growth Spurts

It is normal for all babies to lose as much as 7 to 10% of their birth weight in 3-4 days.

Weight gain is determined from the lowest weight, which occurs on the third or fourth
day of life.

• Birth weight regained by 2-3 weeks
• Weight gain is usually _ oz to 1 oz per day or 4-8 ounces per week in the first 3
  months
• Birth weight is doubled by 5 to 6 months


Growth Spurts

All babies have sudden growth spurts during their early months.

When your baby suddenly wants to feed more often, it is usually because he is having
a growth spurt.

Many babies go through several growth spurts.

Your milk supply will normally increase to meet your baby’s increasing needs as he
nurses more often. After a few days of increased feedings your baby will return to a
more regular schedule.

These growth spurts are usually seen at 10 days, 3 weeks, 6 weeks, 3 months and 6
months. However, growth spurts can occur as often as every 2 weeks.

You will notice at this time that you will lose initial fullness in your breasts, which may
lead you to believe you are losing your milk supply -- but this is not the case.




                                             -35-
Labour and Delivery

Your baby should be offered the breast 20-30 minutes after the birth. At birth babies
are alert for the first couple of hours, then may go to sleep for 4-5 hours before
awakening again. Although the baby may not be interested in breastfeeding during
a sleepy period in the first 24-hours, “It is very important” to attempt breastfeeding
every 2-3 hours to stimulate mom’s hormones to make milk. Skin to skin contact,
when initiating breastfeeding stimulates the release of hormones in the mom. This first
feeding at breast has been proven to increase breastfeeding success. If the baby does
not feed well this first time, do not be discouraged, sometimes it takes a little longer for
some babies to catch on. This is a learning experience for both of you, be patient with
yourself.


Colostrum

Colostrum is the yellow creamy milk present in the breast during pregnancy and the
first few days after birth. It is easier for baby to digest and richer in antibodies than
mature breast milk. Colostrum protects the baby from infection.

In the first few days after birth, the baby's dark, tarry stools (bowel movements) are
called meconium. This is the stool that the baby has been storing since before birth.
Colostrum is a natural laxative and is important in helping the infant pass this first stool.
The baby's stools will change in color and consistency after mother's milk comes in.


How Do I know My Baby Is Getting Enough

As the baby nurses at the breast, he opens his mouth wide and there is a noticeable
pause before he closes his mouth. Each pause is a swallow of milk. You may also
hear swallowing.

Remember the law of supply and demand:

The more your baby nurses, the more milk you will produce.

• During a newborn's first two or three days (while he is receiving colostrum), he will
  wet only one or two diapers a day.

• When your mature milk has "come in" in the later part of the first week (4-5 days) it
  will be a blue white colour and thinner than colostrum -- your baby should have 4-5
  disposable wet diapers or 6-8 cloth diapers in 24 hours and at least 2-3 bowel
  movements per day -- if this is happening baby is getting enough milk.

• Bright eyed, alert baby.

• Moist mouth.

                                             -36-
• Reasonably content between feedings.

• When the baby is finished breastfeeding, baby will
  let go of the nipple on his own. If you
  are ending a feeding yourself and are having to
  break the latch, perhaps your baby is not yet
  finished.

• Breastfed babies usually prefer a two to three hour-
  span between feedings, with a longer stretch
  perhaps once a day.

• Supplements of water are not necessary and may
  make your baby feel too full or sleepy to nurse well.

• Sucking a bottle or pacifier in the first few weeks of life can cause nipple confusion.
  Sucking a bottle is very different than breastfeeding.

• After several weeks of breastfeeding, the breasts feel less full. This is normal and
  does not mean your milk has gone. The milk is still there and your nursing baby will
  keep up your milk supply. Have confidence.




                                            -37-
Positions for Breast feeding

Make sure you are in a comfortable position for feeding. Four of the positions you can
use for breastfeeding are . . .

   i.     Cradle Hold
   ii.    Modified Cradle Hold
   iii.   Football Hold
   iv.    Side Lying

Try to use each of the different positions while you are in hospital, and ask the nurse to
help you the first time you try each position. In most cases the modified cradle hold or
football hold are the best for latching the newborn.



Modified Cradle Hold

Sit in an armchair with your feet slightly
elevated on the lower rung of your bed
rail. Put a pillow on your lap to support
your baby. Hold your baby's neck and
upper back firmly with the hand
opposite to the feeding breast. Keep
the arm holding your baby's body close
to you. Use your other hand (same
side as the breast to support your
breast by cupping your breast with your
fingers and your thumb behind the
brown area (C-Hold). This position is
recommended for the first few weeks of                       Modified Cradle
feeding because it gives the mother                           Hold Position
better control of the infants head when
the infant is put to the breast.
                      or
Sit in bed with the head of your bed
raised, and the pillows to support your
shoulder and back.




                                                                    Cradle Hold

                                             -38-
Cradle Hold
                                                                               Sitting Position
                                                                                          with
Sit in an armchair with your feet slightly elevated on the                         Cradle Hold
lower rung of your bed rail. Put a pillow on your lap and
under the arm-supporting baby. Hold your baby securely,
with his head resting in the crook of your arm. His back is
supported by your forearm and your hand cups the baby's
buttocks or thigh. Or sit in bed with the head of your bed
raised and pillows to support your shoulders and back.

The baby should be positioned on his side with his stomach pulled in close to his
mother, "tummy to tummy". He should not have to turn his head to take the breast.
His ear shoulder and hip should be in a straight line. Tuck baby's lower arm
around mom's your waist or under your breast.

This position provides less control of the infant's head when first learning to latch. After
the first few weeks of breastfeeding and the baby is well established with a good latch
this position is comfortable for moms and their babies.




                                            -39-
Football Hold

Sit in an armchair. Place an additional
pillow on the chair arms or on the bed
beside you to rest your arm on. Or sit in
bed with the head of the bed raised and
pillows to support your shoulders and
back.

The baby faces the mother while his
body is tucked under her arm along her
side. The baby's bottom rests on the
pillow near the mother's elbow and
against the back of the chair, sofa or
against the wall, if she is sitting up in
bed. The baby's upper back rests
along his mother’s forearm while she
supports his neck with her hand. Use
your other hand to support your breast
by placing your fingers under the breast
and your thumb on top of your breast
behind the areola (brown area around               Football Hold Position
nipple).

This position is preferred for mother's
who have had a Caesarean Section
because it allows her to feed without
putting pressure on her incision.

Larger breasted women may also be
more comfortable with this position. It
gives mother control of the infant's head
when the infant is learning to latch onto
breast in the first few weeks.
It also allows the mother to see more
clearly how her baby is latched.




                                            -40-
Side Lying

In this position the mother is completely
on her side and not twisted. Pillow
support is needed behind her back
under her head and between her
knees. The baby is on his side facing
his mother with his back resting against
his mother's forearm and his body and
legs pulled in close to his mother.
(Tummy to tummy). To keep the baby
on his side facing his mother a rolled
blanked may need to be propped
behind his back. The baby's mouth
should be at the level of the mother's
nipple and head should be slightly tilted
upwards once infant latches. (chest to
chest, nose to breast).

The side-lying position allows the
mother and baby to rest while they
nurse. This position may be preferred if
a mother has a sore bottom. This                   Side Lying
position is more challenging in the                 Position
learning stage.




                                            -41-
Tips for Breastfeeding

Essentials to Getting Started                    Things to Remember . . .

• Comfortable position for mom                   • With proper latching on and
                                                   positioning, breastfeeding is NOT
• Tummy to tummy, chest to chest,                  uncomfortable
  nose to nipple (breast)
                                                 • Let nipples air-dry after feeds
• Express a drop of milk from nipple
                                                 • A drop of milk gently rubbed into
• Place baby's mouth directly opposite             nipple after feed and allowed to dry
  nipple                                           prevents sore nipples

• Support the breast with hand, thumb            • Change nursing positions to assure
  on top, fingers underneath and well              proper emptying (baby's chin points
  behind areola                                    to the area of breast being best
                                                   emptied)
• Tickle baby's lips with your nipple -
  wait for wide open mouth                       • Best way to build milk supply is to
                                                   nurse the baby every 1_ to 3 hours;
• Pull baby quickly toward you to get              (8-12 feedings in 24 hours) *nurse
  nipple and areola on top of baby's               more to make more milk
  tongue
                                                 • Avoid bottle feeding or using
                                                   pacifiers for at least the first 4-6
                                                   weeks to avoid nipple confusion




“Tummy to tummy, chest to chest and
nose to nipple”.




                                          -42-
What To Do With a Sleepy Baby

Try not to let your baby fall asleep as baby is nursing. Babies
who sleep while nursing tend to nurse for long periods and
can cause nipple soreness. If your baby is sleepy or takes
long pauses try . . .

• dim lights . . . baby will shut eyes in bright light
• undress your baby down to diaper
• stroking under his chin
• stroke behind the ear
• lift upper arm up and down
• massage soles of feet
• with your finger, do circle on the baby’s forehead
• compress the breast intermittently to stimulate bursts of sucking
• blow on baby
• wash baby’s face with cool cloth
• burp more frequently
• change diaper at midpoint of feeding
• talk to baby as you sit baby in your lap facing you and
  help baby to do sit ups
• holding your baby securely and rocking baby gently
  and slowly side to side

• keep the room at a comfortable temperature (increased heat
  decreases sucking)




                              -43-
Bowel Movements for Breast Fed Babies

Counting the number of bowel movements and size of the bowel movements is one of
the best ways of knowing that the baby is getting enough milk.
It is normal during a bowel movement for your baby to grunt and his face to become
red from the exertion of pushing.
The first bowel movements your baby will have are large, sticky black stools called
meconium.
The first bowel movement normally occurs within the first 8-24 hours of life.
Gradually this will change to the "Transitional" stool which may be greenish black,
greenish brown, brownish yellow, greenish yellow and it may also contain mucous.
This will normally be seen 3-5 days after birth.
Follow this guide to know if your baby is having the right number, colour and size of
bowel movement in the first week of your baby's life while breastfeeding.
Days 1-3        dark green almost black sticky stool
Days 4-5        getting lighter in colour and gradually changing to greenish then
                golden yellow
Day 6-7         usually by the 7th day the bowel movements have taken on the
                appearance of the normal breast stool - pasty to watery mustard
                coloured and usually with little odour - 2-4 substantial (dollar coin)
                yellow bowel movements or more per day is expected.

During the first 4-6 weeks, at least 2-5 bowel movements in 24 hours are normal.
Some breast fed babies who receive no supplements and are older than 4-6 weeks of
age may suddenly change their stool pattern to 1 bowel movement every 3 days or
even less. If the baby is otherwise well, this is normal. Breastfed babies rarely
become constipated. There is no reason to think that your baby is constipated unless
stools are dry and hard and your baby has difficulty passing them.
When formula is introduced and feeding amounts and routines change the breastfed
baby's bowel movements may also change.
The number of bowel movements may decrease during growth spurts. Breast fed
babies may go for 5-7 days without a bowel movement after 4-6 months.




                                            -44-
Breast Fed Babies and Wet Diapers

Follow this guide to know if your baby is
having the right number of wet diapers
during the first week of life while breastfeeding.

Days 1-3              may have only 2-3 wet diapers every 24 hours with pale yellow
                      urine but increasing each day

Days 4-5              should have 4-5 wet diapers in 24 hours with pale yellow urine

Day 6 or more         should have 4-5 disposable or 6-8 cloth wet diapers every 24
                      hours with pale yellow urine

During the first 2-3 days of life some babies pass red or pink urine. This color is due to
uric acid crystals. This is normal and they should soon disappear. When this occurs a
nurse should check the baby's latch. Only if the baby is properly latched on the breast
can he get his mother's milk.

If your baby is voiding less than he should, or the urine is concentrated and dark in
colour, baby may be dehydrated (not enough fluids).

If you have any concerns call . . .

Parent-Child Information Line at the Algoma Health Unit at 541-7101 (1-888-537-5741)

                                             or

                         The Mother Infant Helpline at 759-3690

                                             or

                                      Your Physician




                                             -45-
Bowel Movements (Stools) for Bottle Fed Baby

Counting the number of bowel movements and size of the bowel movements is one of
the best ways of knowing that the baby is getting enough milk.

It is normal during a bowel movement for your baby to grunt and his face to become
red from the exertion of pushing.

The first bowel movements your baby will have are large, sticky black stools called
meconium.

The first bowel movement normally occurs within 8-24 hours after birth.

Gradually this will change to the "Transitional" stool which may be greenish black,
greenish brown, brownish yellow, greenish yellow and it may also contain mucous.
These are normally seen by 3-5 days following birth.

The type and number of your baby's stools will depend on the type of feeding:

• The bottle-fed baby may have several movements a day at first. Gradually this will
  change to one or two bowel movements a day.

• After the first week the stool will become paler yellow, brownish yellows, more
  formed and drier -- will have some odour.

• The number of bowel movements will decrease in the first 2 weeks from 5-6 to 1-2
  per day.


Wet Diapers for the Bottle Fed Baby

Bottle-fed babies should have 4-5 disposable or 6-8 cloth wet diapers every 24 hours
with pale yellow urine. If baby is passing less urine or urine is concentrated and dark
yellow in color, baby may be dehydrated and should be seen by a physician.




                                           -46-
Notify your baby’s Doctor if . . .

1. Your baby’s stool is watery, has a strong odour or has blood
   in it.
2. Your baby is vomiting forcefully.
3. Your formula-fed or your breast-fed baby younger than 1
   month of age has few or no bowel movements for over 3
   days on more than one occasion.
4. Your baby still has very dark green bowel movements after
   five days of age.


Diarrhea can cause babies to become ill within a very short
time from dehydration.

If your baby’s stool is hard, your baby will feel uncomfortable
and have difficulty passing it. This probably means that the
baby needs more fluids. Make sure baby is taking appropriate
amount of fluid as per page 55.

If you are bottle-feeding, offer cooled, boiled water between
feedings - or - you may try mixing 2 ounces of cooled, boiled
water and one teaspoon of brown sugar and offer to baby
between feedings if constipated. If you are breastfeeding, feed
your baby more often.

Note:
        Laxatives, enemas and suppositories should not be used
        unless recommended by your baby’s doctor.




                              -47-
Breast Feeding Problems

Engorgement

On the second to fifth day after delivery, your breasts may become full as
breast milk forms. This is normal fullness.

If breasts feel hard, tender and warm to touch this is called
Engorgement. Engorgement is not normal and can be prevented by
frequent feedings, which results in softening of the breasts

Treatment of engorgement is . . .

• frequent feedings of the baby (every 1_-3 hours or 8-12 times a day)
• finish one side first (offer second breast if baby shows interest)
• warm cloths or a warm shower on the breasts, helps the flow of milk
  before feeding
• breast massage and hand expression of milk before breast feeding to
  make it easier for baby to attach to the breast
• cold compresses after feeding will relieve tenderness and swelling
• firm supporting bra – that does not bind - be sure to have a proper fit –
  a tight bra could cause blocked ducts -- wear it 24 hours
• ask your nurse about cabbage leaves
• a mild pain relief medication taken about _ hour before feedings
• avoid artificial nipples including pacifiers during this engorgement
  period


Cabbage Leaf Treatment for Engorgement

Purpose:      A cool alternative to hot engorged breasts.

Action:

1. Provide relief in the form of heat absorption away from
   the engorged breasts
   seems to have anti-inflammatory, anti-edema and
   anti-infectious properties.




                                            -48-
Method:

1. Wash chilled cabbage leaves in cold water, pat them dry, remove base of hard core
   vein. Wrap leaves around breast and areola inside your bra.

2. Cover with a cool towel, leave on for 30-45 minutes or until wilted, whichever comes
   first.

3. Discontinue using once engorgement is relieved as overuse can decrease the milk
   supply (usually within 8 hours)

4. If areola still needs to be softened for baby to latch use hand expression, or a breast
   pump prior to feeding. Gentle massage to the breasts will help facilitate milk flow.

5. Frequent breastfeeding is encouraged every 1_ - 3 hours.

6. To suppress lactation in the case of a late-trimester miscarriage, or after the death
   of a baby, abrupt weaning or if bottle-feeding and engorgement develops, cabbage
   leaf compresses can also be used. Use cold compresses and avoid heat on the
   breasts.


Advantages:          There are no chemicals that affect the baby, no known side-
                     effects and its cost are minimal.


For Bottle Feeding Mom

To suppress lactation use cabbage leaves as above. Leave on until warm or wilted.
Repeat treatment throughout day as required.

May use ice or anything cold if cabbage not available for shorter periods of time.
i.e. Frozen wet washcloths, diapers, and vegetables in baggies




                                           -49-
Nipple Soreness

Many new mothers experience nipple tenderness at the beginning of the
feeding. This tenderness should improve daily.

If the baby is latched on and sucking correctly, nipple tenderness
may be felt only at the start of feeds, you should not experience
pain during feeding.

Nipple Soreness is usually related to:

       •   improper positioning and POOR Latch
       •   engorgement
       •   not breaking the suction when removing baby from nipple
       •   baby who has an ineffective sucking pattern
       •   thrush

To Prevent or Minimize Sore Nipples, we suggest you . . .
  • recheck your infant's position and latch - ask a nurse to observe
    feeding
  • do not let baby nibble on the nipple - wait for a wide open mouth
  • keep your fingers well back of the areola (brown area around
    nipple)
  • frequently change the feeding position of the baby
  • put baby FIRST, to the breast which is the least sore as your baby's
    suck will be most vigorous when really hungry
  • nipple pain is not preventable by nipple preparation prenatally




                                         -50-
                                 To Treat Sore Nipples

Breastfeeding is a natural, comfortable choice for mothers. Mothers may experience
some tenderness at first, but breastfeeding should not be painful.

If you have sore nipples . . .

1. Check positioning and latch
   ♦ Mom sits straight up, feet on footstool so knees are above hip height
   ♦ Mom and baby positioned tummy to tummy and baby supported on a pillow at
     nipple height
   ♦ Mom use C-hold, tickles baby’s lower lip with nipple supported on a pillow and
     baby’s mouth opens wide to take the breast. Bring baby to breast with a
     quick motion
   ♦ Baby feeds with flanged lips, sucks strongly and rhythmically and does not
     hurt mother

2. Breastfeed frequently, 10-12 times in 12 hours.

3. Feeding on ”cue”, before infant begins to cry – some infants cues are:
   - rapid eye movements under closed lids
   - waking
   - stretching and stirring
   - hand-to-mouth activity
   - sucking, licking, rooting

•   Allow infant to breastfeed on the least sore side first
•   Encourage active sucking while at breast using breast compression
•   Try different breastfeeding positions, i.e. cradle hold, football hold, side-lying
•   Apply a small amount of pure anhydrous lanolin, i.e. Lancinoh/Purelan to promote
    healing or apply expressed breast milk at end of feeding and allow to air dry

If nipples remain sore, drop in to the Parent-Child Information Clinic

For more information . . .

Algoma Health Unit
Parent Child Information Line . . . 541-7101 or 1-888-537-5741
Monday to Friday
9:00 a.m. to 12:00 p.m. and 1:00 p.m. to 4:00 p.m.

Parent Child Information Centre
126 Queen Street East, Suite 101
Sault Ste. Marie, On
Monday to Friday
1:00 p.m. until 3:30 p.m.



                                         -51-
Blocked Ducts

     May feel like a Small Lump and could be painful. It could be
     caused from tight fitting bra pressing on a duct or from not feeding
     the baby often enough, or an abundant milk supply.

What to Do?

• Reassess positioning and latch
• Watch for effective suck/swallowing                Plugged
  for a least 10-15 minutes in total                 Duct
  each feeding.
• Use warm, moist cloths on affected
  area prior to each feeding.
• Gently massage lump towards nipple
  while showering or breastfeeding.
• Breastfeed frequently, every 1_ to 3
  hours starting on the affected side
  first.
• Hand expression or use of an electric
  breast pump may be necessary for
  the other breast to prevent
  engorgement.
• Try different feeding positions for the
  baby.
• Rest
• Drink to satisfy thirst.
• Check bra fit. Avoid prolonged
  pressure on breasts
• Look for signs of mastitis (see
  following page)
• Call Algoma Health Unit for help at
  541-7101




                                        -52-
Mastitis

Mastitis is a breast infection, which may cause flu-like symptoms. You may experience
redness, mild swelling and lumpy areas of the breast, fever or chills. Factors that add
to the risk of getting mastitis include; stress, fatigue, cracked nipples, plugged duct,
tight bra, engorgement and a sudden decrease in the number of feedings. Treatment
includes:
• Breastfeed frequently to empty to the breast
• Apply moist heat to reddened area
• Increase your fluid intake
• Bedrest. Set your priorities: no housework or visitors, off to bed to feed and rest.
   Have your partner bring you meals in bed. This will help your body fight the
   infection
• See your physician and take antibiotics until completed. Mother should continue
   breastfeeding while on most antibiotics
• With your physician’s permission, acetaminophen for pain and a non-steroidal anti-
   inflammatory drug such as ibuprofen may be helpful


Should mom continue to feed if she has . . . .
          • a cold
          • flu
          • or mild infection

• It is best for the baby to keep breastfeeding when his mother has a cold, flu or a
  mild infection.

• Continuing to breastfeed also has advantages for the mother.

• The mother with a fever may need to drink extra fluids.

• The mother can decrease the baby’s chances of catching her illness by frequently
  washing her hands well.

• When the mother is exposed to an illness, such as a cold or the flu, her body very
  quickly begins producing specific antibodies that protect her breastfeeding baby.
  By the time, the mother begins to feel sick, her baby has already been exposed to
  her illness. Continuing to breastfeed will help the baby fend off the mother’s
  illness. And if he does get sick, the breastfeeding baby usually has a milder case
  because of antibodies he/she receives from his mother’s milk.

• Many mothers find it easy to conserve their strength by tucking the baby into bed
  with them and breastfeeding lying down when the baby gets hungry. For the sick
  mother who has to care for her baby alone, breastfeeding makes this easy. She
  does not have to go out and buy formula or get up and prepare bottle. If the
  mother has household help, encourage her to breastfeed the baby in bed and
  then ask her helper to change and entertain the baby while she rests.



                                      -53-
How to Collect and Store Breast Milk


You want to be able to nourish your baby with breast milk, but there may be occasions
when you will be unable to be there at feeding time. To overcome this problem, you
can express and store your own breast milk for use at a later date.

Reasons to Express Milk . . .

1. If your baby is premature or ill, baby may be unable to breastfeed for a period of
   time.

2. Your breasts are engorged and the area around the areola needs to be softened for
   the baby to latch.

3. Your breasts are so engorged that they must be emptied for a comfort measure.

4. Your nipples are sore and cracked and expression is desired instead of
   breastfeeding.

5. Your baby is feeding poorly. Expression will help to stimulate milk production and
   empty a full breast.


Expressing Breast Milk

• Breast milk can be expressed by hand or by using a manual or electric pump - both
  techniques require patience and practice. Hospital Grade Rental Electric Pump is
  most effective type of pump to increase or maintain milk supply if pumping for an
  extended period of time.

• If you are pumping to save an occasional bottle, express right after the baby has
  nursed. For this purpose a hand pump may be adequate.

• If you are pumping to maintain your milk supply, because your baby is unable to
  breastfeed - pump every 3 hours during the day and every 4-5 hours during the
  night for a least 10-15 minutes on each breast.

• Above all, make sure you are in a comfortable chair. Perhaps a picture of your baby
  in front of you, a glass of juice or milk beside you, and some quiet soothing music
  might help.




                                       -54-
Expressing by Hand
• Wash your hands thoroughly with soap and water.

• Express milk into a sterilized wide-mouthed collection container.

• Alternating milk expression with breast massage, stroking and
  shaking will help to stimulate the milk-ejection (or let-down) reflex.

1. Position your thumb and first two fingers about 1 to 1 _ inches           Position
   away from the nipple. If your breasts are large, lift first, and then
   push into the chest wall.



2. Push thumb and first two fingers straight back into your chest wall. Push
   Avoid spreading your fingers part. If your breasts are large, lift first
   and then push into the chest wall.



3. Roll your thumb and fingers forward as if making thumb and              Roll
   fingerprints at the same time. -- This rolling motion of the thumb
   and fingers presses and empties the milk sacs without hurting
   sensitive breast tissue.


4. Repeat rhythmically to drain the milk sacs. Position, Push, Roll;
   Position, Push, Roll . . .                                              Repeat



5. Rotate the thumb and finger position around the breast to milk the
   other milk sacs. You may want to use both hands on each breast
   to reach more milk ducts.




                                             -55-
Expressing By Pump

There are a variety of pumps available, hand and electric. Whatever one you choose,
remember it must be kept clean. Follow the manufacturer's directions, for proper
assembly and cleaning. If purchasing a pump, purchase one made by a breast pump
company.
Cylinder Pumps:                manually operated, popular, inexpensive and easy to
                               use.
Battery-Operated Pumps:        convenient and portable, batteries have to be replaced
                               frequently, less efficient than electric pump.
Electric Pumps:                can be rented (see Community Resources), especially
                               helpful if pumping for a long period of time, gentle and
                               efficient, similar to sucking pattern of baby; some rentals
                               have double pumping accessories to pump both breasts
                               at once. Smaller electric pumps can be purchased at
                               pharmacies and medical supply stores.

Bicycle Horn Trumpet-          Do not use this type! It is difficult to sterilize
Shaped Breast Pump:            and may damage your nipples.

Procedure for Pumping (Manual or Electric)
1. Wash your hands.

2. Prepare the equipment according to the directions, and make sure all parts
   are cleaned as directed.

3. Use warm compresses, if necessary.

4. Lubricate areola (brown area around nipple) with water before positioning the
   pump to create a better seal

5. Center nipple and areola in funnel or shield to begin pumping, making sure a
   seal is formed between the shield and breast tissue.

6. Alternate the breast expressed first each time.

7. Turn pump on to a minimum suction setting, if an electric pump is being used. The
   suction level may be increased to a comfortable level as milk begins to flow.
   Suction should be maintained at a comfortable level. Should your nipples be sore,
   leave the setting at "Minimum" (if controls indicate Minimum/Normal)



                                           -56-
8. If single pumping, express for 5 minutes on first breast, then 5 minutes on the
   second breast -- Massage, Stroke and Shake. Express 3 minutes on first
   breast, then 3 minutes on second breast . . .Massage, Stroke and Shake.
   Express 2 minutes on first breast, then 2 minutes on second breast. Pump
   for a total of 10 minutes on each side. As your milk increases, you may want
   to increase this to 10 to 15 minutes on each side or until the milk flow
   diminishes. The collecting container should be changed if it becomes _ full to
   prevent milk from backing up into the pump.

9. When finished pumping, reduce suction to "Minimum", and turn pump off. If
   using a manual pump, release the suction by pressing on the breast tissue
   closest to the funnel.

10.Store expressed breast milk in a sterile plastic container, (a volu feeder or
  glass container with a tight lid or specially designed breastmilk freezer
  bags) and label with baby's name, the date and the time of expression.
  Disposable bottle liner bags should be avoided because they are made
  from a thinner plastic that may break when frozen and are not airtight.



Breastfeeding Support

Algoma Health Unit (Information, Support, where to rent pumps)

Parent-Child Information Line (Monday-Friday, 9 am – Noon & 1-4) ..................... 541-7101
                                                     Toll Free ............... 1-888-537-5741

Parent-Child Drop-in Centre (1:00 – 3:30 pm, Weekdays) .................................126 Queen St E
      Website: www.ahu.on.ca ........................................................... Suite 101

Mother-Infant Helpline (Sault Area Hospital, 4:00 pm – 9:00 am). ...............759-3690

LaLeche League (24 hour Breastfeeding Support, ......................................................759-0733
Meetings last Tuesday every month) ................................................................ 2562809

Breast Pumps available at

Prescription Centre ............................................................................... 253-3206




                                                          -57-
Storing and Freezing Breast Milk

• Store collected milk in sterile, single use plastic container (use volu feeders
  with sterile caps).

• Label each container with infant’s name, date and time of collection.

• Use separate container for each collection of breast milk.

• Smaller amounts of cold breast milk can be added to frozen breast milk

• Use breast milk or refrigerate/freeze as soon as possible after expression.

• Use thawed refrigerated breast milk within 24 hours. Throw away unused
  portion.

Fresh breast milk . . .
         • can be stored in refrigerator for 3 days
         • refrigerate or freeze soon after collection
         • should be kept cool during transport

Frozen breast milk should be kept . . .
         • in freezer within a refrigerator for 2 weeks
         • in separate door freezer of refrigerator for 2-3 months
         • in a deep freeze for 6 months


How to Use Frozen Milk

• Always use the oldest container of frozen milk first, providing it has not
  passed the expiry date.
• Thaw milk under cold running water until it starts to liquefy, then place in
  warm water until thawing is complete (this should take no longer than 15
  minutes).
• Place container in refrigerator for 4 hours.
• Never thaw milk at room temperature, in the microwave or on stove top
• Refrigerate the milk until you are ready to use it.
• Before using, gently mix warmed milk to blend cream that has risen to the top
• Use thawed milk within 24 hours; if milk is not all used, throw it out.
• Do not re-freeze thawed milk!



                                            -58-
Formula Feeding
               All formulas for newborns provide the nutrients necessary for
               your baby's growth and development. Your baby should stay
               on formula until they are 9-12 months old. There are several
               kinds available commercially, i.e. powdered, concentrated and
               ready-to-serve, with or without iron. Your physician can help
               you decide which is best for you and your baby. The use of
               soy-based or lactose-free formulas should be discussed with
               your doctor before using them. The Canadian Pediatric
Society recommends that the formula you choose to feed your baby be iron-
fortified.

Cows milk or evaporated canned milk, should not be given to babies less than 9-12
months of age because . . .
1. Cow's milk has too much protein - far more than baby needs as well as being hard
   on your baby's kidneys.
2. The kinds of protein and fat in cow's milk are more difficult for babies to digest or
   absorb than the protein and fat in breast milk and formula.
3. Cow's milk has much more sodium than is recommended for young babies.
4. Cow's milk lacks vitamin C and E, copper and iron.

Suggested Amounts of Formula
Young babies need to eat often. As your baby gets older, it will feed less often
but take more each feeding. The following chart gives you examples of what
quantities of formula you might offer to your baby. Remember these are
suggested amounts. Always be flexible and adjust quantities according to your
baby’s hunger signals.

           Age            Number of Feedings/24 hours        Amounts of Formula/feeding
      Birth to 1 week     6-10 feedings                       2-3 ounces (60-90 mL)

      1 -2 weeks          6-8 feedings                        2-3 ounces (60-90 mL)

      3 wks - 2 mths      5-7 feedings                        4-5 ounces (120-150 mL)

      2-3 months          5-6 feedings                        5-6 ounces (150-180 mL)

      3-4 months          4-5 feedings                        6-8 ounces (180-250 mL)

      5-7 months          4-5 feedings                        7-8 ounces (210-250 mL)

      8-12 months         3 – 4 feedings                      7-8 ounces (210-250 mL)




                                            -59-
* Young infants being exclusively formula fed generally require approximately
2_ ounces of formula per pound of body weight in a 24 hour period in order to
meet their energy requirements.

It is important to hold your baby for feedings. It should take 20 to 30 minutes to
feed your baby and the formula should flow evenly and gently. Don’t force your
baby to finish the bottle if they are no longer hungry.

How Much Baby Wants To Eat

Most babies have growth spurts at 2 to 3 weeks, 6 weeks, 3 months and at 6
months when they will seem extra hungry for a few days. Try giving your baby
extra formula feedings. Do not rush to start feeding your baby solid foods. At
about six months of age, your baby should be developmentally ready to start
solid foods. This means they can hold up their head, sit with support, show you
when they are full, swallow solids easily (no tongue thrust) and show an interest
in eating. For more information call the Parent-Child Information Line for advice
at 541-7101.

Spitting Up

Most babies will at times, regurgitate, or "spit up" a small amount of milk after
feeding. To help reduce this, burp your baby often during a feeding and handle
your baby gently.

Vomiting

Vomiting is more complete emptying of the stomach or spitting up of large
amounts of milk (especially when it occurs some time after feeding your baby).
If your baby vomits often or forcefully, notify your baby's doctor.

Comfort

Fussiness after taking all the formula may mean that your baby is wet or dirty
and needs changing, that he needs to suck more, wants to lie in a different
position, wants to be cuddled or needs burping.




                                           -60-
Guidelines for Formula Feeding . . .
Wash your hands!
a) The equipment you use must be both clean and sterile.

b) Prior to feeding change your baby's diaper if necessary. He will learn to associate
   feeding with comfort.

c) Just before feeding remove the bottle of formula from the refrigerator. Warm it to
   room temperature. Place the bottle under warm running water or in a saucepan of
   warm water. Test the formula on your inner arm or wrist before offering it to your
   baby. The formula should not feel hot or cold. Microwave ovens should not be used
   to sterilize bottles or to warm the refrigerated bottled formula. Do not leave the
   baby's formula out of the refrigerator for longer than 1 hour.

d) The nipple hole should be large enough to permit the formula to run out a drop at a
   time.

e) Make sure that the formula is filling the nipple so that the baby will not be swallowing
   air.

f) Remove the bottle by touching the corner of the baby's mouth to break the suction,
   then gently take out the nipple.

g) As very young babies often fall asleep while feeding, burp your baby in mid bottle,
   and/or change baby’s diaper. See "What to Do with a Sleepy Baby" (page 43).

h) If your baby is sleepy, try feeding baby small amounts more frequently.

i) Hold your baby so that the head is slightly higher than the body. Hold your baby
   close to you so that there is eye to eye contact if your baby's eyes are open (this
   may not happen very much in the first couple of weeks). Change from one side to
   the other to encourage baby to use both eyes. -- Holding your baby for feedings
   provides a strong emotional tie (bond) with your baby!

j)   Discard any formula that is left in a bottle after a feeding. Formula can grow
     bacteria and your baby can become ill if they drink milk that has been left at room
     temperature for more than one hour. If your baby empties the bottle and seems to
     want more, pour some formula from a bottle you have prepared.

k)   Rinse the bottle and nipple directly after feeding. This will save you time when
     washing one day's supply of bottles. Continue to sterilize bottles and utensils, and
     use cooled boiled water for preparing formula, until your baby is 3-4 months old.


                                            -61-
Never Leave Your Baby with a Bottle Unattended for
Feeding
1. When your baby is young, he can choke on the formula. The milk will get into his air
   passages and lungs.

2. Even when baby can hold the bottle, do not leave your baby in crib with milk or juice.
   This can cause tooth decay from these fluids always being in their mouth.

3. It is unfair to your baby. He needs the closeness, comfort and security of being held
   when fed.

4. Ear infections are more common in babies who are fed with the bottle propped.




                                           -62-
Formula Preparation
There are various types of formula:

Powdered:                      Follow the directions on the can for the correct amount
                               of powder and water (boiled and cooled). Different
                               brands of powdered formula have different instructions,
                               so be sure to read carefully. Pour into sterilized bottles.
                               Most economical type of formula.

Concentrated Liquid            Read directions carefully. Shake the can well. Open
                               and combine equal amounts of formula and cooled,
                               boiled water in a sterilized measuring cup. For example,
                               for 4 ounces of prepared formula, use 2 ounces of water
                               and 2 ounces of liquid formula. Pour into sterilized
                               bottles.

Ready-to-Feed                  Shake the can well. Open and pour the required
                               amount into each sterilized bottle. Do not dilute by
                               adding water. This is more expensive but convenient
                               for travelling or if unsure of water quality.

For Added Safety . . .

1. Read the directions on the formula products carefully.

2. Always check the expiry dates on the formula products.

3. In rural areas, check with the public health nurse or regional health office about the
   safety of the well water.


Equipment You Will Need

       large pot, or sterilizer
       bottle brush
       nipple brush
       tongs
       measuring cup (Pyrex)
       funnel
       can opener
       glass jar with holes punched in lid
       can of formula (check expiry date)


                                             -63-
If using re-usable bottles . . .
8 to 10 bottles
8 to 10 caps
8 - 10 screw-on caps
12 to 16 nipples

or if using disposable bottles . . .
8 to 10 bottle holders
rings and caps
1 roll of disposable bottle-liners

These amounts are recommended, but you could manage with less




                                       -64-
Cleanliness is the Key

It is important to keep milk fresh and as free from
bacteria (germs) as possible!

1. Wash your hands before preparing formula and feeding baby.

2. Boil water (to be used for mixing formula) in a separate pot for 5 minutes and cool
   (use stainless steel or ceramic pot . . . not aluminium and not in kettle). The
   directions for the amount of boiled water you need will be on the can. Remember
   to cool the boiled water because adding boiling water to the formula will
   destroy vitamins.
   If using well water to prepare your baby’s formula it is recommended to have it
   tested by your nearest health unit twice a year. This is indicated because it may
   contain unsafe levels of bacteria, certain chemicals or heavy metals.

3. Wash the equipment thoroughly with hot, soapy water and a bottle brush and then
   rinse under hot running water.

4. Hold bottles to the light to be certain that all milk rings are removed. Rinsing
   immediately after a feeding will prevent this problem.

5. Squirt hot water through nipples to clear away any clogged milk and ensure that the
   hole is clear.

6. Place the equipment to be sterilized in a large pot or sterilizer. Place a cloth in the
   bottom of the pot to prevent bottles from chipping.

7. Put nipples into a jar and cover with the top that has the punched holes.

8. Put the equipment in the pot, laying the bottles on their sides. Stand jar of nipples
   upright. Fill pot with water, but not to the top of the jar. Steam will sterilize the
   nipples without destroying the rubber. Boil rapidly for 5 minutes and allow to cool. If
   using a measuring cup, can opener, tongs and funnel be sure to sterilize in another
   pot for 5 minutes, as well.

9. Once cooled, remove the bottles and the jar of nipples with tongs.

10.Wipe the top of the formula can with a clean cloth, then rinse with boiling water.

11.Make the formula. Do not dilute the formula more than is recommended. It is
  important to follow directions so that your baby receives adequate nutrition.

                                            -65-
12.Refrigerate the prepared formula until it is needed.

13.If you are using a disposable nursing system, the holder must be washed and
  rinsed well. Place a sterile liner in the holder making sure that you do not touch the
  inside of the liner. The caps and nipples and any other equipment (i.e. measuring
  cup, can opener, tongs) must be sterilized before each use by placing in large pot
  and boiling water for 5 minutes.

14.Each batch of formula should be used within 24 hours of preparation.

  An open can of formula (concentrate or ready to feed) should be covered,
  refrigerated and used within 48 hours.

  An open can of powdered formula should be covered and stored in a cool, dark
  place and used within one month.

15.If your baby needs a little more formula, remove a bottle from the refrigerator and
  pour some of it into one already in use.

16.Do not leave the baby's formula out of the refrigerator for longer than one hour.

17.Bottles may be sterilized in the dishwasher, if it has a sterilizer cycle. However,
  nipples should be sterilized as described above.

18.Continue to sterilize bottles and utensils until your baby is three or four months old.




                                            -66-
Burping

Try burping your baby after each breast if breastfeeding or after every ounce if bottle-
feeding. Breastfed babies do not always burp after the first breast.

To burp your baby, put a cloth over your shoulder, then put your baby up so that baby's
chin rests on your shoulder. Pat his back or rub it from his waist upwards. Often just
changing the baby's position will cause baby to burp. You can also burp your baby by
sitting baby on your lap holding head in one hand, your thumb and index finger on the
cheeks in front of baby's ears and the chin resting between them. You will often see
your nurse burp your baby in this manner. Ask your nurse to show you these
positions. If your baby does not burp within a few minutes, baby might not need to --
try again later.




   Shoulder Position for Burping                  Sitting Position for Burping


Spitting Up

Your baby may be spitting up a small amount of milk when burping after feedings. This
is normal. Try not to handle your baby too much after feeding. Frequent burping and
smaller feedings may help. If your baby is always spitting up or you are concerned
about the amount of feeding your baby is spitting up, contact your doctor.




                                           -67-
Hiccups

During the first month of life hiccuping is common and not harmful. They often occur
following a feeding. You have probably noticed that hiccups last for only a few
moments. Pat your baby gently on the back or give him a little more milk. To prevent
spitting up (regurgitation) of milk while your baby is hiccupping, hold his head up.


Sneezing

Your baby sneezes, some days quite frequently, to clear mucus and dust from his
nostrils. In the first few months of life this helps your baby in the breathing process. It
does not mean that he has a cold.


Sometimes Babies Cry
Crying is your baby's way of telling you that baby is hungry, has an upset tummy, is
hot, cold or ill, has a dirty diaper or sometimes, bored or over-stimulated. You will not
spoil your baby by responding to these signals for care. Check first, to see if there is
any physical reason for crying. Changing baby's diaper or burping again after a
feeding may be all that is needed.
If your infant is hard to settle after a feeding and is making sucking movements, baby
may still be hungry. You may have to feed baby more often during growth spurts.
Try wrapping baby in a warm blanket. This helps a young baby feel secure.
Around 3 to 6 weeks of age, most babies go through these "fussy periods". This may
not mean baby has colic. Try giving baby a warm bath, a ride in the car, gently
rocking, an automatic swing ride or close contact in an infant carrier.

If your baby will not calm down, it is normal to feel frustrated. You too, may feel like
crying or you may feel angry. If this happens, ask someone to take over while you take
a break. For more information about crying or colic, call the Parent-Child Information
Line at 541-7101.




                                            -68-
Other Aspects of Your Baby's Care

Every baby is unique. Some rarely cry - some frequently. Some love to suck or nurse,
others have to be taught. Some are awake for long periods, others have to be
awakened for feedings. No one can love and care for your baby as well as you! Use
your nurse as a source of information, but use your baby as your own personal guide.
Make the most of your rooming-in experience to get to know your own baby's unique
wants and needs.


Bathing Your Baby

Bathing your newborn baby should be a relaxed and enjoyable time for both you and
your baby. Initially, some parents find bathing difficult. In no time, however, you will be
handling your baby easily. At first, your baby might not enjoy bathing, but most babies
learn to enjoy bath time. It is an excellent time for play and exercise. Your nurse is
available to answer your questions and help you bathe your baby if desired.

A few safety precautions . . .

        • Never leave baby alone in the bath or on a table.

        • Do not add warm or hot water to the bath while the baby is in it.

        • When supporting your newborn baby, ALWAYS support the head and neck.


When to Bathe

Bathing your baby can be done whenever convenient for you and the rest of the family
if they wish to be involved. Bathe your baby before a feeding so that baby does not
spit up from the activity of the bath. Some families will bathe their infants daily or less
often. This is your choice.

The baby may be placed in the tub before the cord falls off. If this is your choice be
sure cord area is dry. A "sponge" bath may also be given. Choose a time that is best
for you and your baby.




                                           -69-
Preparation

1. Gather everything you will need before beginning and place everything close at
   hand.
   basin (bath)
   baby shampoo
   non-perfumed soap
   towels -(one for wrapping, one for drying and one as a mat for your work surface)
   shirt, diaper, blanket
   Vaseline, Q-Tips

  Baby powder is not recommended. If inhaled by your baby, it can be dangerous!

2. Remove sharp rings, watch, and bracelets.

3. Wash your hands.

4. Fill the basin or tub with warm water. The water should be comfortable to touch with
   your wrist or elbow. Never add warm or hot water while your baby is in the basin or
   tub.

5. Bathe baby in warm room with the window closed.




                                          -70-
Guidelines for Bathing Your Baby

1. Go from top to bottom, clean to dirty.
2. To ensure that your baby doesn’t get cold, leave the diaper on and wrap in a
   receiving blanket while doing steps 1-5 below. Then unwrap and completely
   undress baby to complete step 6.
3. Relax and enjoy this time!

Steps

1. Eyes - Moisten the wash cloth with clear water, wiping from the inner corner to
   outer. Use a separate corner of the washcloth to do second eye -- this prevents
   spreading anything from one eye to the other.

2. Face - Use clear water - No soap.

3. Nose - Wipe only particles that are outside the nose. Do not use cotton tipped
   swabs as you might hurt the nose, or push particles further into the nose.

4. Ears - Cleanse the outer ear with the face cloth. Wash behind the ear and
   thoroughly dry.
   Never use a cotton-tipped applicator. Wax may be pushed further into the ear
   canal. This can cause damage to the canal wall. The wax in the ear will "work out"
   naturally.

5. Hair - Wash hair once or twice a week to keep the scalp clean. Wrap your baby in
   a towel. Hold your baby under the arm (football hold). Your baby's head should be
   over the basin or tub and baby's face turned upward. Use mild soap or baby
   shampoo. Rinse well and dry. Brush the hair gently everyday. This will help
   prevent cradle cap, a greasy yellow scale that sometimes forms on your baby's
   scalp.

6. Body - Wash your baby's body with soap. Use either your hands or washcloth.
   Begin at the neck and work down arms, chest and legs. Pay special attention to the
   creases. Turn your baby over, supporting the head and wash the back. Rinse and
   dry your baby well. Cover your baby after you have bathed each section.

Genitalia

  Female       Wash gently from front to back. Cleanse anal (rectal) area by wiping
               front to back. This prevents spreading bacteria into the urinary system
               and vagina.




                                          -71-
Male      Cleanse and dry penis and scrotum. Clean and dry anal area. If your
          baby is uncircumcised Do Not push back the foreskin of the penis to clean.
          The foreskin will naturally retract back itself as your boy gets older (3 or 4
          years of age). At that point he can be taught to cleanse himself.

Cord

Normal Healing -    Usually the stump of the umbilical cord dries cleanly. After
                    approximately 10-14 days the cord separates. The navel
                    may be a bit red and raw and a little spot of blood may be
                    seen when the cord falls off. This area will soon heal.

Cleansing the Cord -       Clean the cord base and the cord itself with cotton tipped
                           swabs soaked with warm tap water. This procedure is
                           painless. Clean the cord at each diaper change until
                           healed. Try to keep the cord as dry as possible while
                           bathing baby. It is recommended that you fold down the
                           top of the diaper to expose the cord. If at any time the area
                           becomes reddened, has an odour and/or discharge, notify
                           the doctor. If you have any questions, or need further help
                           cleaning the cord, your nurse will be happy to assist you.

Cutting Nails -     At birth, babies nails tend to be soft. Do not cut the baby's nails
                    for the first 2 weeks of life. If they are long, nighties with cuffs
                    that cover the hands will prevent your baby from scratching his
                    face. Little mittens or socks worn will also help to keep your
                    baby's nails from marking his face. A small emery board may be
                    used to file sharp edges.




                                           -72-
Diapering

With every diaper change, wash your baby's
bottom with baby wipes or warm water. If he
has had a bowel movement clean with soap
and warm water. After drying the bottom, apply
a thin layer of Vaseline to protect the baby's skin. It has been recommended that baby
powder not be used.

If you are using disposable diapers, place your
baby on an open diaper with the tapes at the back under your baby. Bring the front of
the diaper up between baby's leg and fold down the top edge so that the diaper is
below the level of the cord. This helps to keep the cord dry. Open tapes and press
firmly into place over the folded edge.

If Vaseline is on the diapers where the tapes are placed, the tape will not stick. Wash
your hands after every diaper change.

Diaper Rash

Some babies develop an allergic reaction to certain kinds of soap, food and disposable
diapers. Their skin can become irritated from urine and stool in the diaper.

To prevent diaper rash . . .

   i.     change diapers frequently
   ii.    clean diaper area thoroughly and dry well
   iii.   apply Vaseline at each diaper change if desired
   iv.    expose baby's bottom to air daily

If the rash persists, you may use medicated diaper cream. Expose bottom for several
hours a day, after removing all traces of bowel movement. To keep your baby warm,
dress him in a shirt and cover with a sheet.

If using disposable diapers try changing brands if skin reactions are noted.

Heat Rash

The system that controls your baby's body temperature is immature. This causes baby
to become overheated easily in the summer months. Try not to overdress your baby.
Your baby should be dressed in the same amount of clothing as an adult.
Overdressing causes a pink rash in the shoulder and neck area. Keep baby's skin
clean and dry.




                                             -73-
Your baby's skin is very sensitive. Baby is prone to sunburn and heat rash. To
protect your baby's eyes and head, put a hat on baby. Infants under 6 months
should be protected from the sun by being placed in the shade out of the direct
sun, as well as being dressed in protective clothing and sun hats. Over 6
months of age, while continuing to protect your baby from the sun, a child’s
sunscreen with an SPF of 15 or more can be used according to directions.

When it is extremely cold, do not keep baby outside for long periods. To prevent heat
loss, never take your baby outside without a hat. Keep the baby's hands and feet well
covered to prevent frost bite and protect his face from the wind.


Eczema

Eczema is a rough, red and itchy rash. It usually occurs around the ears, face, in
creases and at times on the legs and arms. Consult your baby's doctor if this rash
persists.


Suggestions for preventing rashes . . .

     1. Wash your baby's diapers in a very hot water and rinse thoroughly.

     2. Launder all your baby's clothing before using.

     3. Do not use bleach or fabric softeners (may contain chemicals that could irritate
        skin).

     4. Rinse baby's clothing well.

     5. If changing brands of soap, make one change at a time. This will help identify
        the cause of any adverse reaction.

     6. If using disposable diapers try changing brands.




                                          -74-
SIDS – Sudden Infant Death Syndrome – Reduce the Risk

                       Sudden Infant Death Syndrome (SIDS), also knows as Crib
                       Death, refers to the sudden and unexpected death of an
                       apparently healthy infant under one year of age. Each week,
                       three babies die of SIDS in Canada. Such deaths usually occur
                       while the child is sleeping and remain unexplained even after a
                       full investigation. Nobody knows how to prevent SIDS, but the
                       latest research shows that there are things you can do to make
                       your baby safer.

Sleeping Position

SIDS is less common in babies who sleep on their back.

Put your baby to sleep on his or her back on a firm flat surface. You do not need
anything special to do this. Babies who sleep on their back are not more likely choke.
Some babies have a medical problem that means they must sleep on their tummy.
Ask your doctor which position is best for your child.

When the baby is awake and being watched, some “tummy time” is necessary fro the
baby’s development. This will also avoid temporary flat spots, which sometimes
develop on the back of their head from lying on their back.

Older babies may be able to turn on their own from their back to their tummy. It is not
necessary to force babies to sleep on their back when they are able to turn from their
back to their tummy on their own.

Avoid soft mattresses, fluffy pillows, comforters, stuffed toys and bumper pads in the
baby’s crib as these could prevent proper air circulation around your baby’s face.
Plastics, such as the manufacturer’s mattress wrapping, may also prevent air
circulation, and should be removed to reduce the risk of SIDS and also suffocation.

Can my baby sleep with me?

Yes, as long as it is done safely:
• Place your baby on his back to sleep
• Sleep on a firm, flat surface
• Ensure that the sleep surface is safe and that the infant will not become
     entrapped between the mattress and headboard or wall
• Don’t sleep with your baby if you or your partner smoke
• Don’t sleep with your baby if you or your partner have taken alcohol or medication
   that would make you sleepy




                                           -75-
•   Don’t sleep with your baby in a waterbed or leave your baby alone in a waterbed
•   Don’t use pillows, thick coverings, sheepskin or loose bedding near your baby

Bedsharing is a common practice for many families. However, the risk of SIDS will not
necessarily be reduced if your baby sleeps in the same bed as a parent, brother or
sister. In fact, the risk of SIDS increases if the baby sleeps with a person who smokes.
Your baby is also at risk if the person has been drinking alcohol or taking drugs that
may make them less able to respond to the baby.


A Smoke and Drug-Free Environment
Create a smoke and drug-free environment for your baby before and after birth.
Avoid using drugs such as alcohol, marijuana, crack, cocaine and heroin if you are
pregnant, planning to become pregnant or breastfeeding. No one should smoke
near your baby, not only for the baby’s health, but also to reduce the risk of SIDS.


Dressing Baby for Sleep
Keep your baby warm – not hot!
Babies need to be warm, but they should not become too hot. If the room
temperature is right for you, it’s right for the baby too. To check if your baby is too
hot, place your hand on the back of his/her neck. Your baby should not be sweating.
Use lightweight blankets, which you can add or take away according to the room
temperature.


Breastfeeding
Breastfeeding is good for your baby.
Breastfeeding is the best way to feed your baby. It has many benefits and may give
some protection against SIDS


Shaken Baby Syndrome
Remember that babies are fragile and easily injured if handled roughly. It is very
important that you never shake your baby for any reason. Shaking can damage a
baby’s brain, can cause permanent disabilities or even cause death. If you feel in
danger of losing your temper and harming your baby, leave your baby in a safe place
such as a crib and call another adult for immediate help.




                                           -76-
 It is important that parents who have lost a child due to SIDS
  should not blame themselves. Until the cause or causes of
 SIDS are found, research can only show us how to reduce the
                              risks.

Copyright: Her Majesty the Queen in Right of Canada, represented
by the Minister of Public Works and Government Services Canada,
1999

For more information on Sudden Death Syndrome (SIDS)
call 1-800-ENDS-SIDS (363-7437)
or visit www.hc-c.gc.ca/hppb/childhood-youth




                                -77-
Crib Safety
Cribs made before September 1986 are dangerous.
They do not meet current standards. It is illegal
to sell, import or advertise these cribs.

Cribs that were made before September 1986 or
without a label are not safe for use.

Safety Tips
The Crib:
• Look for a label on the crib that shows when the crib was made.
• Check the crib often to make sure the frame is solid. Tighten loose screws regularly.
• Check the crib to make sure the sides lock into place.
The Mattress:
• Make sure the mattress is tight against all four sides of the crib.
• Replace the mattress if it is not firm or if it is worn-out.
• Move the mattress down to its lowest level as soon as the baby can sit up.

Baby Safety:
• Lock the sides into place after putting the baby in the crib.
• Never tie the baby in the crib and do not let the baby wear a necklace or a soother on
  a cord around the neck.
• Place the crib away from windows, curtains, blind cords, lamps, electrical plugs and
  extension cords.
• Bumper pads should never be used.
• Babies should always be supervised with toys and bottles.
For more information, contact the Product Safety Bureau Health Canada, at:
Hamilton, ON         (905) 572-2845              Toronto, ON         (416) 973-4705
Ottawa, ON           (613) 952-1014

In Addition:
•   Mobiles should be removed from crib as soon as the baby is able to reach and grab
    them.
•   As soon as the baby is able to sit up, remove crib exercisers or any top that are strung
    across the crib.
•   Remove any large toys or crib bumper pads that could serve as steps to climb out.
    Stop using the crib when your baby can climb out.
•   For greater safety, do not place a baby under 2 years of age on an adult bed. Avoid
    the risk of suffocation . . . never place a baby on an adult waterbed.




                                         -78-
How and When Should I Take My Baby's Temperature

Health and Welfare Canada recommends taking your baby's temperature under the
armpit (axillary) rather than by mouth or rectal.

Ear (tympanic) thermometers might be used in children older than 2 years if you wish,
but there is evidence that they are not always accurate in younger children, so their
use with infants is not recommended.

Note:       Thermometers are now available with digital display for home use.

    1. Shake mercury thermometer before using until reading is 35°C or lower.

    2. Place the bulb end or tip under your baby's arm in armpit (axilla).

    3. Hold his arm securely against his body for 5 minutes.

    4. To read the mercury thermometer, hold it by the end opposite the bulb and at eye
       level. Read at the point where the mercury stops.

Take your baby's temperature at any time you think he is sick. Write down the
temperature and the time you take it.

Normal Axillary Temperature - 36.5°C - 37.5°C or 97.7°-99°F

An Axillary Temperature above 40°C (102°F) CAN BE SERIOUS

It is normal for babies to have fussy periods. The time of day differs from baby to baby.
If your baby feels unusually warm, has flushed cheeks and is irritable, he may have a
slight fever.


Suggestions if you think your baby has a temperature . . .

i. Take your baby's temperature.
ii. Give your baby extra fluids.
iii. Dress your baby in light clothing. Do not bundle your baby with heavy blankets.
     Often this is not serious, and this may be all that is necessary to settle the baby
     and bring his temperature down to normal.

.




                                             -79-
Notify your doctor if . . .
a) axillary temperature 38°C (100.4°F) or higher
b) temperature persistently lower than normal 36.5°C by
   axilla
c) diarrhea
  • for breast fed babies more than 10-12 bowel
    movements in 24 hours
  • for bottle fed babies more than 6 watery bowel
    movements in 24 hours
d) Vomiting
e) Persistent Rash
f) Sleepy or extremely fussy for a long time
g) Baby looks ill (eyes do not look interested, colour is
   pale)
h) High-pitched cry along with the other symptoms

              If your baby has a seizure,
        take your child to a doctor immediately.




                     -80-
Circumcision

Newborn circumcision is a procedure that is no longer paid for by O.H.I.P. and the
newborn's family is now responsible for this cost. The hospital and physician fee must
be paid prior to the procedure taking place. Please inform your nurse of your decision
as soon as possible so arrangements can be made.
Circumcision is the surgical removal of the foreskin covering the tip of the penis. As
with any surgical procedure there are risks such as bleeding, infection, and surgical
trauma. The procedure is usually done without anesthesia, although some physicians
offer a local anesthetic.
Many parents are concerned that if dad, or brother has been circumcised, this baby will
be seen as different. However, there are other natural physical differences such as
hair color, build and size. The decision about circumcision is up to you and your
partner. After your baby is born, discuss your decision with your baby's doctor.
At birth, the foreskin is tightly attached to the head of the penis and normally cannot be
retracted or pushed back until around 5 years of age or even several years later.
Pushing the foreskin back before it is ready and thus breaking the adhesions, may
cause infection and could cause tightening of the foreskin around the head of the
penis. The penis should be washed daily, without pushing back the foreskin.

Choosing to circumcise . . .
Circumcisions are no longer done while you are in hospital. Please let your nurse know
your choice as soon as possible, so that arrangements can be made for this procedure
to be done as an outpatient on a later date.


Care of the Circumcised Penis

The Plastibell Method of Circumcision
There is a plastic ring on the foreskin. Diaper as usual, checking frequently for
bleeding and observe for his first void. A small amount of bleeding may occur after the
circumcision. Do not use Vaseline when the Plastibell Method is used. Vaseline may
cause the string to slip off. The plastic ring will come off as the site heals in 5-8 days.
The ring should not be pulled off. During healing a light sticky yellow drainage will
form. This is part of the normal healing process and should not be cleaned off or
removed.

To clean:

•   The baby can be bathed and diapered, as if he had not been circumcised.
•   Frequent diaper changes will help to prevent irritation and infection.




                                            -81-
Call your doctor if . . .

a)   your baby has not voided by 24 hours after circumcision
b)   the plastic ring has not fallen off in eight (8) days
c)   the ring has slipped onto the shaft of the penis
d)   any abnormal drainage/bleeding
e)   unusual swelling
f)   redness
g)   foul odour

       PlastiBall Ring      Ligature


                                                         PlastiBell
                                                         Circumcision Device




                                           -82-
Jaundice

What is jaundice?

Jaundice is not a disease, it is a symptom. Jaundice is common in newborns
(occurring 2-4 days after birth). It is caused by large amounts of bilirubin in the blood,
resulting in yellowish tinges to the baby's skin and in the whites of the eyes. Bilirubin is
the normal product of the breakdown of red blood cells. The liver usually handles it but
because their livers are immature many babies become jaundiced in the first few days
of life. Bilirubin is passed out in the baby's bowel movements and may give the stool a
greenish or black colouring.

Causes of Jaundice

Some situations that cause jaundice to last longer or increase are:

1. Premature babies:       because the liver is less mature, it takes longer to excrete
                           Bilirubin.

2. Infection:              liver may not work as well.

3. Bruising:               during the birth process, bruising can result in more than
                           usual amounts of bilirubin.

4. Mother's and baby's blood types are different: antibodies produced by the mother's
   bloodstream may enter the baby's bloodstream and attack the baby's red blood
   cells.

How Can I Help?

Colostrum and breast milk have a laxative effect on your baby to help him get rid of
bilirubin in his stools. If you notice that your baby is becoming jaundice, feed your
baby frequently (at least every 2 or 3 hours). If your baby is sleepy, which is a sign of
a jaundiced baby, try to keep him/her awake while feeding by undressing baby and
place baby on the bed away from you for awhile, washing baby's face with a warm
washcloth, and stroking under the chin once baby is latched.

In the hospital newborn babies are closely monitored for jaundice. Blood tests may be
arranged to be certain that the level of bilirubin in your baby's blood does not rise




                                            -83-
high enough to cause damage to the brain. A bilirubin test may be done before your
baby is discharged. Your nurse will tell you the results. Your doctor may want another
blood test done as an outpatient. Your nurse will explain this before you take your
baby home. With early discharge, jaundice may increase once you are at home.

When to Call Your Doctor or Bring Your Baby to the Emergency Department

1. Your baby looks like he is becoming more jaundiced (you notice his skin colouring
   and the white part of his eyes are becoming more yellow)
2. Your baby is not feeding well because he is too sleepy to do so.
3. He is not having 5 disposable wet diapers per 24 hours by the third to fifth day when
   your milk comes in (see Guidelines for Normal Bowel Movements and Wet Diapers).

Treatment of Jaundice

Keep in mind that jaundice is a normal process that peaks usually 4 days after birth.
After your doctor sees your baby, he may order a bilirubin test. Should the level be
high, he may decide to begin Phototherapy. The baby is placed under special lights
to clear the bilirubin from the body because the light changes bilirubin into a harmless
chemical. Your baby will be in an isolette, with eye shields covering baby's eye. The
phototherapy light fits over the isolette. Frequent feedings and phototherapy will bring
the bilirubin levels down within a few days.

Newborn Screening:          PKU and CH

All newborns have the possibility of being born with 2 disorders that can lead to mental
retardation and other abnormalities. These disorders if detected early can be corrected
either by treatment or special diet.

For this reason all newborns have a blood test done to detect disorders such as thyroid
disease (CH) and phenylketonuria (PKU).

The PKU test checks to see if the baby's body chemistry is out of balance. If this
imbalance exists it can lead to brain damage and mental retardation. The other part of
the test CH checks to make sure the baby's thyroid is working properly.

All newborn infants are tested for PKU and CH at 24 hours of age.

The Ministry of Health advises that those infants discharged from hospital before 24
hours of age need to be tested before discharge and again before the baby is 5 days
old.




                                           -84-
This test is very important if the problems do exist. Early diagnosis and treatment will
help babies reach normal growth and development.

The results of the tests are sent to your baby's doctor. He or she will contact you if the
test results show a positive reading.

Thrush

Thrush is a fungus that can cause symptoms for the mother and the baby.

Candida albicans the one-celled organism that causes both thrush and vaginal
yeast infections, is a fungus that thrives in moist dark environments such as on the
nipple, in the milk ducts, in the mother’s vagina and in the baby’s diaper area.

In the mother, possible symptoms of thrush include:

• intense nipple or breast pain that occurs from birth, lasts throughout the nursing,
  and is not improved with better latch-on and positioning;
• sudden onset of nipple and/or breast pain after the newborn period;
• nipples that are itchy or burning and appear pink or red, shiny, flaky, and/or have
  a rash with tiny blisters;
• cracked nipples;
• shooting pains in the breast during or after feedings;
• nipple and/or breast pain with correct use of an automatic electric breast pump;
• vaginal yeast (monilial) infections.

In the baby, possible symptoms of thrush include:

• diaper rash;
• creamy white patches inside baby’s mouth, cheeks or tongue;
• a whitish sheen to the saliva or the inside of the lips;
• baby repeatedly pulling off the breast, making a clicking sound while nursing, or
  refusing the breast (because his mouth is sore);
• gasiness and fussiness;
• rarely, thrush is a contributing factor in slow weight gain.

The baby may also be without visible symptoms.

If thrush is diagnosed, both mother and baby will need to be treated
simultaneously with medication prescribed by their health care providers.




                                            -85-
Standard treatment varies in different parts of the world. Nystatin nipple cream for
the mother and oral nystatin suspension for the baby’s mouth are commonly
prescribed. Oral nystatin is sometimes prescribed for the mother if there is a
recurrence. Some strains of Candida albicans have become nystatin-resistant, and
in this case, other medications may be needed. In Australia, some medical
practitioners recommend a combination of oral nystatin for the mother and topical
micozole or clotrimazole gel for both mother and baby.

Because thrush can be harboured in many places including milk, encourage the
mother to wash her hands frequently so that thrush does not recur.

If thrush is suspected, suggest the mother contact her doctor for diagnosis and
treatment.




                                         -86-
When to be Concerned . . .




  For Mom -- Call your doctor if . . .

  •   bright red flow reappears after day 3 and soaks one
      pad in one hour, or you start to pass clots larger than a
      loonie coin

  •   you have a fever over 38°C or 100.4°F

  •   your vaginal flow smells bad

  •   you have pain when you pass your water (urinate)

  •   you urinate frequently or in small amounts

  •   you have trouble breathing

  •   your incision from your Caesarean Section is more painful
      or draining

  •   the area around your episiotomy (cut/tear) is becoming more
      painful and the stitches are coming apart




                               -87-
For Baby, Call baby's doctor if . . .
•   your baby has no bowel movements for over 24 hours
    this applies ONLY to the first week of life

•   does not have 6-8 wet diapers in 24 hours - if bottle
    feeding

•   breastfeeding and by day 4 does not have 4-5 wet
    diapers or no bowel movements in 24 hours

•   breastfeeding and by day 6-7 does not have 6-8
    wet diapers or no bowel movements in 24 hours

•   does not feed at least 6 times in 24 hours (breast or
    bottle feedings)

•   baby's skin turns yellow or whites of the eyes are yellow

•   your baby has a fever --
    Axillary (armpit) temperature - 38°C (100.4°F)
    Normal Axillary temperature - 36.5°C - 37.5°C (97.7°-99°F)

•   your baby has diarrhea (loose watery bowel movements)
    Breastfed babies more than 10-12 bowel
    movements in 24 hours
    Bottle-fed babies more than 6 watery bowel movements
     in 24 hours

•   the area around the cord is very red, smells bad or is
    draining

•   your baby has been circumcised and there is a
    greenish or bad smelling drainage from his penis,
    or he has not urinated (passed water)




                         -88-
Discharge Instructions -- Going Home

Before leaving the hospital with your baby you will need to sign a form indicated that
you and your baby's bracelets have matching I.D. numbers. If your baby needs to stay
in hospital after you are discharged, please keep your I.D. bracelet with you at all times
as it is our only means of identifying you with your baby.

•   Be sure that you receive your hospital card and baby's temporary health card
    number before you go home.

•   Take home your Registration and Child Tax Benefit envelopes to mail

•   If your baby’s cord clamp is still on, ask your nurse to remove the clamp before you
    go home.

•   A representative from Growing Family will take your baby's pictures if you wish
    before being discharged. An order form will be provided so you can select what
    package you wish.

•   Before you leave the hospital, you or your partner will be asked to go to the
    cashier’s office in the main lobby to settle your account.

•   Healthy Baby Healthy Children Program consent will be obtained by your nurse to
    enrol your baby in the program

•   An Algoma Health Unit nurse will call and follow you and your baby within 48 hours
    of discharge (see information page – New Moms)

•   Further instructions for you and your baby will be given to you at the time of
    discharge.

•   When you are ready to leave please have an approved rear facing car seat for
    your baby in your room. Car seats cannot be placed in front seats of cars
    equipped with air bags. Your nurse will check that your baby is in the car seat
    properly and that the harness is snug. The responsibility of making the car seat
    safe in the car is the parents.

The staff of the maternity unit wishes you well as you leave our care. Whether this is
 your first or fourth baby, the next 6-8 weeks will be filled with many emotions and
  new experiences as you adapt to parenthood. Remember this is all part of the
   process of becoming parents. Be patient and understanding with yourselves.
  Believe in yourselves and trust your instincts as parents. Ask for help when you
         need it. Above all remember to enjoy yourself with your new baby.




                                            -89-
Infant Car Seats
Babies need to be restrained securely when they travel because their muscles, bones
and ligaments are undeveloped. The infant seat is specially designed to keep the baby
safely in place even if the vehicle stops suddenly or is hit by another vehicle. The
infant seat goes backwards (facing the rear) to increase the baby’s level of
protection in the case of a collision.

Make sure the baby is properly secured in the infant seat:
1.   Harness straps should come from slightly below the infant shoulders or at the
     infant shoulders. The shoulder straps should never be above the infant
     shoulders when rear facing.

2.   The harness straps should not be more than one finger away from the infants shoulder, not his
     outfit.

3.   The strap should come between the legs of the infant.

4.   The chest clip should be at chest line; nipple line or armpit and the harness strap should come from
     behind and over the front of the clip so the tab is showing.

5.   Never put anything under or behind the infant as it could shift when driving and change the position
     of the infant in the car seat. (If there is a cushion that comes with the car seat it is all right to use.

6.   The car seat should be placed rear facing in the vehicle and be levelled at a 45-degree angle. There
     should be no more than _ inch movement from side to side where the seat belt attaches to the car
     seat and no more than one inch movement from the back of the vehicle seat.

7.   When the car seat is in the car, the carrying handle must be down.

8.   When purchasing a brand new car seat please complete and send in the registration form to the
     manufacturer. Most car seats expire after 6-8 years, but it is best to check with the manufacturer for
     the expiration date.

9.   If the car seat is a previously used seat, it should be checked to make sure there has not been a
     recall. You can do this by contacting the Parent Child Information Line at 541-7101/1-888-537-5741
     or Transport Canada at 1-800-333-0371.

10. Purchase your car seat in Canada – safety standards are different. It is the responsibility of parents
    to know how the car seat works and how to secure properly into the car. This information should
    come with the car seat is purchased new.


If you have any questions or would like to book an appointment for a car seat
inspection, please call the Parent Child Information Line at 541-7101/1-888-537-5741.
.
                              Parent child Health Services
                              Algoma Health Unit
                              126 Queen Street East
                              Sault Ste. Marie, ON P6A 1Y5
                              Telephone (705) 541-7101/1-888-537-5741




                                                   -90-
Strollers

Taking your baby for a walk is enjoyable for both of you. The stroller you use must
suit your needs, as well as being safe and comfortable for baby.

• A stroller must have a wide base to prevent tipping.

• The safety strap should be attached to the frame not just to the fabric.

• The brakes should lock into the wheel, not rub against it.

• If you kick the frame of the stroller when taking a step, then find another that gives
  more space.

• An attachable shopping cart should not touch the back wheels.

• The upholstery should be well padded for comfort and the seat should be able to
  recline in a comfortable position for your baby.

• Never leave a child unattended in a stroller.

• You should stop using the stroller when your child reaches 35 lb. (16 kg.), since at
  this point the child is usually too heavy and active for a stroller.




                                      -91-
Questions

For My Nurse . . .

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________


For My Doctor . . .


____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

__________________________________________________________________




                              -92-
Information about Your Baby


Name:     ___________________________________________________________

Birthdate: _________/___________/__________

Birth Weight: _____________________________

Length: __________________________________

Head Circumference: _______________________

Discharged Weight: _________________________

Blood Group: ______________________________

Corrected Age: _____________________________

Taking your infant home is an exciting time for any new parent. It may also be
somewhat overwhelming. This booklet is designed to give parents information to
help in adjusting to life with an infant.

Infant’s Feeding Schedule

Breast:       Mother knows best -- every 2-4 hours

Formula: __________          Amount: ___________           Last Feed: _________

It is best to waken your baby to feed every 3-4 hours. You will know your baby is
getting enough to eat if there are 4-5, disposable wet diapers (6-8 wet cloth diaper),
is fairly content (it is normal to have a fussy period of 1-2 hours a day).

Remember never prop a bottle. Take this opportunity to cuddle your infant, relax
and get to know your baby better.

The recommendation for settling an infant to sleep is that a normal healthy infant is
placed on their back for sleep and they are cared for in a smoke-free environment.




                                      -93-
PRENATAL CLASSES


CHOOSE
the sessions that
interest you
and attend
as many as
you like.


A new series starts
each month!



                      SESSION ONE
                    A Healthy 9 Months
                 SESSION TWO:
             Your Baby's Birth - Part 1      PHOTO COURTESY KEVANNA STUDIO




                 SESSION THREE
              Your Baby's Birth - Part 2
                      SESSION FOUR
                    Breastfeeding Basics
                      SESSION FIVE
                    After the Birth Day

                                                                        Register Early:
                                           Call the Parent Child Information Line at:
                                                                              541-7101
                                           If you can't make it to a session, ask about
                                                        our information packages and
                                                                     one on one visits!
                                                         All classes at 126 Queen St.
                                                    Downtown Sault Ste. Marie, ON




                                   -94-
Teen Prenatal Classes
 in Sault Ste. Marie




 Free of charge
 Supper snack provided
 Classes are held once a week
  for five weeks

       SESSION ONE
     A Healthy 9 Months

      SESSION TWO:
  Your Baby's Birth - Part 1

     SESSION THREE
  Your Baby's Birth - Part 2
      SESSION FOUR
    Breastfeeding Basics

       SESSION FIVE
     After the Birth Day


                                          Register Early
              Call the Parent Child Information Line at:
                                                 541-7101
              If you can't make it to a session, ask about
                           our information packages and
                                        one on one visits!
               La Leche League Canada
              empowering women to breastfeed their babies

     Mother-to-Mother Support for Breastfeeding




There are La Leche League leaders in Sault Ste. Marie who are
available anytime to answer all of your breastfeeding questions
or concerns.

Your leaders are:          Sandra       256-2809
                           Dorothy      759-0733

Le Leche League is a non-profit, international organization
whose purpose is to help mothers breastfeed through
encouragement and support, education and information. In
Sault Ste. Marie, on the 3rd Monday of every month we have
meetings that are open to anyone who is pregnant, nursing or
thinking of breastfeeding. Spouses, partners, young children
and babies are welcome to attend. At meetings we discuss
various topics including: advantages of breastfeeding to mom
and baby, bringing baby home, avoiding or coping with
difficulties, nutrition and weaning.


        Please call your leaders anytime if you have
                any questions or concerns.




                                -95-

                              -95-
           Women’s Health Centre Programs
Please register early as space is limited.
Fees are non-refundable and must be paid at least one week in advance
to reserve your space.
We reserve the right to cancel sessions with insufficient registrations (fees
will then be refunded).
Please advise us when you register if you are unable to manage one flight
of stairs.

Prepared Childbirth Classes

A series of six classes are offered to prepare expectant parents for the
birth experience. Classes are held Thursday s from 7 p.m. to 9 p.m. at
the Y.M.C.A. (teen room). Body building exercises, relaxation and
breathing techniques is taught to assist the pregnant woman during
labour and delivery. The classes are most effective if taken in the last
two months of your pregnancy and are taught by a registered nurse.
Bring a pillow to each class. You will also need a coach (your partner, a
friend or relative) to help you with the exercise and techniques. We use
the mats at the Y.M.C.A.
Cost is $35/couple for enrollees of the Group Health Centre and
$40.00/couple for non-enrollees.
Please call the Women’s Health Centre at 759-5552 to register for this
class or if you need further information.

Breastfeeding Class

This is a single session program held monthly at the Women’s Health
Centre from 3:30 p.m. to 5:30 p.m., always on a Monday. The class is
intended as an introduction to breastfeeding. Prenatal preparation of the
breasts, proper “latching” and other breastfeeding techniques will be
discussed. A video will be shown prior to the class at the Women’s
Health Centre.
Please bring a doll or teddy bear to class.
There is no fee for this class, please call the Women’s Health Centre at
759-5552 to register or for more information.



                                 -96-
Just for you . . .
If you’re . . .

• having your first baby

• between the ages of 14 and 24

• between 12 and 24 weeks pregnant

• want to learn more about how to be a good parent

• wanting emotional support during pregnancy

                     Call 759-9100
     to learn more about the Baby Bathtub Program
              Algoma Crisis Pregnancy Centre

Workbooks:                        Group Sessions
• Where I Am Now                  • Bathing Your Newborn
• Getting to Know Myself          • Breastfeeeding
• Making a Good Decision          • Comforting Your Child
• Am I Ready to Parent
• Parenting Expectations
• Budgeting


                           -97-
                             A New Mother’s Emotions
                                        The “Baby Blues”
                              Shouldn’t last longer than two weeks.

                      You are not alone.               There is help.         There is hope.

Many new moms feel sad right after the baby is born.
If the blues last longer than two weeks and are not helped by rest, mom
may be experiencing a postpartum mood disorder.

Facts                                                    Symptoms
                                                         List to give to your doctor:
Baby Blues                                               p Crying
• Affects 50-80% of new moms                             p Feeling sad
• Occurs within the first 3 to 5 days after birth        p Feeling irritable
• It usually goes away within 1 to 2 weeks               p Feeling frustrated
                                                         p Feeling tired
                                                         p Difficulty concentrating
                                                         p Difficulty sleeping

Postpartum Depression                                    p   More intense and longer-lasting symptoms than the
• Affects 10 to 15% of new moms                              “blues”
• May start suddenly or slowly                           p   Feeling overwhelmed or anxious
• It can occur within 3 weeks of delivery and up         p   Changes in appetite
    until 1 year after the birth of your baby            p   Having no feelings about your baby
                                                         p   Fearing that you might hurt yourself or your baby
                                                         p   Feeling “out of control”
                                                         p   Feeling numb inside

Postpartum anxiety                                       p   Panic attacks
Onset is the same as Postpartum Depression and may       p   Difficulty sleeping
start in pregnancy                                       p   Irritability
                                                         p   Feeling distracted

Postpartum Obsessive-Compulsive Disorder                 p   Having repeated scary thoughts about baby
Onset is the same as Postpartum Depression                   (“seeing” baby drown, “seeing” baby fall down stairs

Postpartum Psychosis                                     p   Hallucinations (hearing or seeing things)
Occurs in 1 to 2 in 1000 births                          p   Paranoia
                                                         p   Difficulty sleeping
Least common mood disorder but most serious              p   Strange behaviour


                                                -98-
What Can You Do?

•   Get Help! Talk to someone about how you are feeling. Delaying treatment can delay recover.
•   Take Care of Yourself. Sleep when baby sleeps, eat right and get some exercise.
•   Accept Your Feelings. It is normal to feel bad sometimes. You are adjusting to your baby.
•   Try to Take Breaks. Take time to be by yourself. Take a bath, read a magazine, go for a walk.
•   Ask for Support. It is okay to have help taking care of baby and yourself. Choose someone you
    can talk to, who is patient and caring.
•   Get Counselling. There are many professionals who can help you talk through your feelings.
•   Consider Medication. Antidepressants are not addictive. Talk to your doctor about what is right
    for you. You can continue to breastfeed while taking certain medications.
•   Be Patient. It takes time for recovery. Remember there is hope.
•   Delay Major Decisions. Wait until you are feeling better so you can concentrate and think
    through problems.


Get Help!!
“There is comfort in not being alone.”

When symptoms last more than two weeks or you feel you may harm yourself or your
baby, call for help:
∗   Family or friends
∗   Family doctor
∗   Algoma Health Unit                   Parent-Child Information Line
                                         541—7101 or 1-888-537-5741
                                         Monday to Friday 9-4
                                         (ask for postpartum depression support group)
∗   Sault Area Hospital 24-hour Crisis Services                 759-3398 or 1-800-721-0077
∗   Canadian Mental Health Association                          759-0458
∗   Parent Help Line (24-Hour)                                  1-888-603-9100
∗   Telehealth (24-Hour)                                        1-806-797-0000
∗   Parent support groups
∗   Early Years Centres
∗   Our Sister’s Place (Monday – Friday, 9-5)                   1-866-363-MOOD


Helpful Websites

∗   Pacific Postpartum Support Society                  www.postpartum.org
∗   Postpartum Support International                    www.postpartum.net
∗   Depression after Delivery Inc                       www.depressionafterdelivery.com
                                                            Financial Assistance by Health Canada




                                                        -99-
                  Young New Mom’s

                      Support Group
 Welcome to a group for new, young mothers. Come to share in the joys
 and the frustrations of being a new parent. You will have the opportunity
to meet other moms just like yourself. Activities and discussions are open
                            to your suggestions.


  Nobody’s Perfect Parenting Class
This program is built around five booklets, which are offered to the parents
  at a minimal cost. Participants will be encouraged to work together to
                   discover positive ways of parenting.

We offer . . .
                           Child Care
                       Parenting Education
               Encouragement and Support of Peers
                Refreshments for Mom and Children

Location:
                      First Baptist Church
       465 Albert Street East (corner of March and Albert)


For more information call . . .
               Algoma Crisis Pregnancy Centre – 759-9100




                                 -100-
The Algoma Health Unit, Parent Child Services Centre now has a . . .



                     Nurse Practitioner Clinic

    What is a Nurse Practitioner (NP)? An NP is a Registered Nurse with
    additional training to perform physical examinations, diagnose a disease or
    illness, prescribe certain medications and order certain lab or x-ray tests. The
    NP will work with local Obstetricians to provide prenatal care, and with local
    Family Doctors and Pediatricians to help with you with health problems that are
    more serious. If the health problems are more serious, the NP will either
    consult with a physician over the telephone, refer you to a specialist or direct
    you to the Walk-In Clinic or Emergency Department.

    What services will be provided at this new clinic? Postpartum care for mom,
    birth control, pap smears, screening for possible health problems, well baby
    care, immunizations, monitoring of growth and developments of children,
    treatment of common problems.

    Who can come to the clinic? Expectant mothers and caregivers with children
    under 6 years of age, who live in Sault Ste. Marie and surrounding area and
    who have no family physician.

    Hours of Operation:             Monday, Wednesday and Friday
                                    9:00 a.m. to 4:00 p.m.
                                    Closed between 12:00-1:00 for lunch

    How to get an appointment: Call the Parent Child Information Line to book
                               your appointment with the Nurse Practitioner
                               541-7101

    Where is the clinic located?    126 Queen Street East, just past the City Bus
                                    Terminal




                                       -101-

                                       -101-
                                           Algoma Health Unit

                                      Parent Child Services
                                        at 126 Queen Street East
                                               541-7101
                                                                         Prenatal
                                                                           Programs
       Preschool                      Healthy Babies                          •    Information packages
Dental Services                         Healthy Children                      •    Evening prenatal sessions
 •       Check ups                     •   Moms get a telephone call          •    Teen prenatal classes
 •       Teeth cleaning                    from a Public Health Nurse         •    Individualized education
 •       Fluoride Treatment                within 48 hours after birth             sessions
 •       Dental Health Education       •    Supportive home visiting          •    Canada Prenatal Nutrition
                                            by a Public Health Nurse               Program – free milk and
         These services are                 is offered to all families             health food for pregnant
         offered, free of charge by    •    Family Support Workers                 and nursing women who do
         a Registered Dental                provide extra in home                  not heave enough money to
         Hygienist.                         support and                            eat well
                                            encouragement to some
                                            families during difficult
 Infant Development                         times
  Program
     For families with children who                                      Preschool
     are developmentally delayed or     Parenting                          Speech & Language
     at risk.                                                                           Services
     • Services are offered in            Programs                        •       Assessments
          home and in office                                              •       Therapy for speech and
     • Developmental                       We offer these classes on a            language disorders/delays
          assessments and                  rotating basis.                •       Workshops for parents and
          programming                      • You & Your Baby                      caregivers
     • Weekly drop-in clinic –             • Teen You & Your Baby                          These services are
          call for appointment             • Right from the Start                       provided by a team of
                                           • Nobody’s Perfect                          Speech and Language
     These services are provided by        • Mother Goose Program                               Pathologists.
     a team of Parent Infant               • Anger Stress Tool Kit
     Advisors..                            • Kids have Stress Too!
                                           • Setting the Stage
                                           • You Make the Difference
 Postpartum Depression                     Call to find out which
   Support Group                           program meets your needs.
     •    Taking care of yourself
          helps you to take care of
          your baby
     •    Join other moms for
          weekly support and
          encouragement
     •    Childcare is provided


                                                 -102-
                     Algoma Health Unit

               Parent Child Services
                  at 126 Queen Street East
                          541-7101

            “Supporting you before and after your
                 baby comes home as your
                     baby grows . . . .”
                  Drop by the Parent Child
                    Information Centre
                      For a visit with a
                     Public Health Nurse
           We offer . . . . .
           • Prenatal and Parenting Resources
           • Support and Advice
           • Breastfeeding support
           • Baby Weight Checks
           • Referrals to other services

                            If you
                   have any parenting
                          questions
                        and concerns:
                    Call the Parent Child
                     Information Line
                            541-7101
               and talk to a Public Health Nurse
              Monday to Friday 9 a.m. to 4 p.m.
(After hours, you can leave a message and a Public Health Nurse
          will return your call the next business day.)




                          -103-
                                     “Let’s Grow” in Algoma
Parenting Resource

Parents of newborns in Sault Ste. Marie and Algoma District will be welcoming
another new arrival. Let’s Grow, a series of free newsletters that focus on important
information about the health growth and development of children and families, will be
mailed to all new parents if they agree to a phone call from a Public Health Nurse
after the discharge from the hospital.

Issues of Let’s Grow will be sent to parents at intervals corresponding to the
development age of their child until their child reaches age six. In addition to general
information, inserts will be included on topics such as:

•    Immunization
•    Parenting workshops
•    Parent stress management
•    Toilet training and bedwetting

Sample Let’s Grow packages are available at all hospitals, family resource centres
and libraries in Sault Ste. Marie and Algoma District.

Where Did I Come From?

Let’s Grow was originally developed in Owen Sound, Ontario community health
agencies of Bruce and Grey Counties. This newsletter has received positive reviews
from many sources and it is now being widely adopted throughout Ontario. Let’s
Grow comes to Algoma parents through the partnership of the Healthy Babies
Healthy Children Coalition-Algoma, a network of Healthy Children Coalition-Algoma,
visit www.hbhc-algoma.ca.

How Do I Subscribe?                      (if you don’t agree to a phone call from a public health
                                         nurse after hospital discharge)

If you have a small child and wish to begin receiving Let’s Grow please call the
Algoma Health Unit Parent-Child Information Line at (705) 541-71701 or e-mail
letsgrow@ahu.on.ca. Subscription forms are also available at all social services
offices, hospitals and Healthy Babies Healthy Children Coalition agencies. Parents
may choose to cancel their subscription at any time by call the above number.
This article was originally published in Healthy Babies Healthy Children website.




                                                         -104-
Other Relevant Services:
Genetic Counselling Services
Helps individuals and families understand genetic factors in diseases, disabilities and
birth defects.
When individuals are informed about testing, treatment and available choices, they are
able to make decisions that are best for them.
Requests for information, counselling and testing, (including prenatal screening,
diagnosis) are welcome from interested individuals, families and health care
professionals. Call 759-5287.


Infant Hearing Program

The first months and years of a baby’s life are very important for developing language.
Undetected hearing loss is one of the causes of delayed language development.

All newborn babies in Ontario can have their hearing screened prior to discharge from
the hospital with parent’s consent. The mothers are told the screening results right
away. Occasionally the screening cannot be done before discharge or the baby needs
a second screening. If either of those happen, the mother will be contacted for the
baby to be seen at a Community Clinic. The Community Clinics in the Algoma District
are in Sault Ste. Marie, Blind River and Elliot Lake and are scheduled at least monthly.




                                       -105-
Children’s Health – Early Child Development
                               Information for Parents
                          Immunization: Your Best Protection

What is immunization?

Immunization means vaccination or needles. When children are immunized, they
receive a shot that will protect them from serious childhood diseases.


Why immunization is important?

When children are immunized their bodies make antibodies that fight infections. If they
are not protected and come in contact with one of the infections, they may get very sick
or even die. In addition, documentation of up-to-date immunization or a valid
exemption is required for each child attending school in Ontario. Parents/guardians
are required, by law, to provide this information to their local public health unit and to
update the information as necessary. You may decide because of medical, religious or
philosophical reasons not to immunize your child. In this case, if the disease appears
in your child’s school or day-care; your child may have to stay out of school, day-care
until the disease is gone.

When to get immunized?

For immunization to work best, children should have all their shots at the times
checked on the chart below. For children attending school in Ontario, documentation is
required, by law, for diphtheria, tetanus, polio, measles, mumps and rubella vaccines.
There are also immunization requirements for children attending licensed day-care
centres.

  Age of                                                               Haemophilu
               Diphtheria     Pertussis      Tetanus        Polio                         Measles      Mumps        Rubella
Vaccination                                                               sB
   2 months                                                                
   4 months                                                                
   6 months                                                                
 * 12 months                                                                                                             
  18 months                                                                
   6-6 years                                                
 14-16 years                                                 #
           *   Measles, Mumps and Rubella (MMR) – Must be given after the first birthday.
           #   Check with your doctor or local public health unit to find out if this dose of polio vaccine is required.




                                                    -106-
Thinking of getting pregnant?

Be sure you are protected against rubella before pregnancy to protect your future baby
from serious problems during its development.

Disease that can be prevented with immunization.

These vaccines are paid for by the government:

•   Diphtheria is a very serious bacterial infection. It can cause breathing problems,
    heart failure, paralysis (loss of control over muscles in the body) and death.
•   Pertusis (Whooping Cough) causes severe coughing spells for weeks or months.
    It can also cause pneumonia (lung infection), middle ear infection, convulsions
    (seizures), and inflammation of the brain and death. The risk of complications is
    greatest in children younger than one year of age.
•   Tetanus (Lockjaw) causes painful muscle spasms, breathing failure and death. It
    is cause by bacteria and spores in the soil than can infect wounds.
•   Polio can cause paralysis (loss of control over muscles in the body), inflammation
    of the brain and death. People get polio from drinking water or eating food with the
    poliovirus in it. It is no longer common in Canada because of high immunization
    rates, but cases do occur elsewhere in the world and may be acquired when
    travelling.
•   Haemophilus B (Hib) is a bacteria that can infect any part of the body. It can
    cause middle ear infections, breathing problems, damage to joints, pneumonia
    (lung infection), and inflammation of the brain leading to brain damage and death.
•   Measles causes fever, headache and painful swelling of the glands in the mouth
    and neck, earache and can cause inflammation of the brain. It can also cause
    temporary or permanent deafness and swelling of the ovaries in women and testes
    in men, possibly leading to sterility.
•   Rubella (German Measles) causes fever, rash, swelling of the neck glands and
    swelling and pain in the joints. It can cause bruising and bleeding. If a pregnant
    women gets rubella, it is very dangerous for the unborn baby.

Vaccines against the following disease are recommended but not required by
law for day-care and school age children:

•   Hepatitis B is a virus that can cause serious liver problems that can be fatal such
    as liver failure and liver cancer. The vaccine is free to grade 7 students in Ontario.
•   Influenza is a viral infection that causes cough, high fever, chills, headache and
    muscle pain. It can cause pneumonia, middle ear infections, and infection of the
    breathing tubes, heart failure and death. The danger of this infection varies from
    year to year depending on the strain and can be mild to life threatening. Anyone six
    months of age and older can get the vaccine each year free of charge.




                                       -107-
Other disease for which vaccines are available:

Vaccines are also available against chickenpox (Varicella) and certain types of
bacterial infections (Pneumococcal and Meningococcal disease) that can cause
serious illness such as meningitis. These vaccines are not currently available free of
charge in Ontario for routine immunization. Talk to your doctor or local health unit for
more information on these vaccines and the diseases they prevent.

Where to get immunized?

Call your doctor to make an appointment. If you don’t have a doctor, call your local
public health unit to find out where you can receive immunization.

Are there any side effects?

For most people, there are no side effects from immunization. However, some people
may experience mild pain, swelling and redness where the shot has been given. Talk
to your doctor about how these reactions can be prevented or minimized. Serious
side effects are rare. For more information ask your doctor or call your local health
unit.

You should always discuss the benefits and risks of any vaccine with your doctor.

Keep an immunization record. It is important!

Get a yellow immunization card from your doctor to keep a record of the shots. This
will prevent having to give unnecessary extra shots. Written immuniztion records are
needed when:
• Starting day nursery or kindergarten;
• Transferring to a school in another area;
• Going to camp;
• Starting university, college or job;
• Going for emergency health care;
• Travelling to other countries.

It is the parent/guardian’s responsibility to provide immunzation records for all school
children to the local health unit. Please call the Algoma Health Unit Immuniztion
Records with dates of all immunization that your child receives (541-7145 or 541-
7159). Doctors do not forward immunizations to the health unit.

Don’t forget to update the health unit when/if your child gets another needs.

Don’t forget:

Adults need an influenza shot each year and a tetanus and diphtheria shot every 10
years throughout life to be protected against diseases.



                                       -108-
Where can I get information?

Talk to your doctor or public health nurse if you have questions about vaccines or your
child’s health.

For more information about immunization:

•   http://www.cnn.com Vaccination, 1977, by Ronald Gold MC and the Canadian
    Paediatric Society
•   The Canadian Immunization Awareness Program www.immunize.cpha.ca
•   The Canadian Paediatric Society www.cps.ca
•   Health Canada, Immunization Division www.hc-sc.ca/pphb-dgspsp/dird-
    dimr/index.html
•   Algoma Health Unit Vaccine Preventable Diseases Program www.ahu.on.ca or
    telephone (541-7376)




                                      -109-
                                                Sault Ste. Marie
                               Services for New Parents
                                  Before, During and After Pregnancy

Congratulations! Now that you are entering the exciting world of parenthood, you
may be interested in finding information and support services in your community. In
addition to local contacts, we have also included phone numbers and websites that
may be helpful. Best wishes!

Adoption Services
Children’s Aid Society ........................................................................949-0162
Community and Social Services (Private Adoption)...........................(416) 327-4730

Alcohol & Substance Abuse Support
Community Alcohol & Drug Assessment Program.............................759-1844
Motherrisk Alcohol & Substance Use Helpline...................................1-877-327-4636

Breastfeeding Support

Algoma Health Unit (Information, Support, where to rent pumps)

Parent-Child Information Line (Monday-Friday, 9 am – Noon & 1-4) ..................... 541-7101
                                                     Toll Free ............... 1-888-537-5741

Parent-Child Drop-in Centre (1:00 – 3:30 pm, Weekdays) .................................126 Queen St E
      Website: www.ahu.on.ca

Mother-Infant Helpline (Sault Area Hospital, 4:00 pm – 9:00 am). ...............759-3690
LaLeche League (24 hour Breastfeeding Support, ......................................................759-0733
Meetings last Tuesday every month)

Baby Equipment Safety

Parent-Child Info Line (Info, Appts. for Car Seat Inspections) .......................... 541-7101
Transport Canada.................................................................................... 1-800-333-0371
       Website: www.tc.gc.ca
Health Canada Product Safety (Cribs, Playpens, etc) ................................. 1-416-973-4705
       Website: www.hc-sc.gc.ca/hecs/sesc
Safe Kids Canada .................................................................................... 1-888-723-3847
       Website: www.safekidscanada.ca




                                                    -110-
Children with Special Needs
Algoma Health Unit
      Communication Development Services...................................... 942-3103
      Genetic Counselling Services...................................................... 759-5287
      Infant Development Program....................................................... 942-3103
         Website: www.ahu.on.ca
      Children’s Rehabilitation Centre Algoma .................................... 759-1131

Clothing Assistance
Parent-Child Info Centre Community Closet (1-3:30pm) .......................... 126 Queen St E
Indian Friendship Centre Clothing Depot ............................................... 256-5634
The Pregnancy Centre Care Closet ....................................................... 759-9100
Salvation Army (Social Services)............................................................ 759-4143

Crisis & Counselling Services
Algoma Family Services .......................................................................... 945-5050
Child & Family Centre (Sault Area Hospital) .......................................... 759-3433
Perinatal Bereavement Services of Ontario ........................................... 1-888-301-7276
Sault Area Hospital 24-Hour Crisis Services.......................................... 759-3398
                                                                           Toll Free ....... 1-800-721-0077
Sexual Assault Care Centre .................................................................... 759-5143
Women in Crisis (Algoma) Inc................................................................. 759-1230

Financial Assistance
Child Tax Benefits.................................................................................... 1-800-387-1193
Pregnancy-Parental Leave Benefits ....................................................... 1-800-531-5551
Ontario Works .......................................................................................... 759-5266
LEAP Program (Learning, Earning & Parenting) ................................... 759-5266
Credit Counselling Service ...................................................................... 254-1424

Food Assistance
Soup Kitchen Community Centre ........................................................... 942-2694
Good Food Box Program ........................................................................ 942-2694
Salvation Army Social Services .............................................................. 759-4143
Canadian Red Cross Community Kitchens............................................ 759-4547
Canada Prenatal Nutrition Program........................................................ 541-7101
                                                                        Toll Free ....... 1-800-537-5741
Community Assistance Trust (Baby equipment, Emergency Help) ................. 541-7327

Medical Services
Algoma West Academy of Medicine (Finding a Doctor) ............................. 265-5842
Group Health Centre................................................................................ 759-1234
      Obstetrics & Gyncecology............................................................ 759-5613
      Women’s Health Centre............................................................... 759-5552




                                                    -111-
Midwives of Algoma................................................................................. 253-4158
Sault Area Hospital .................................................................................. 759-3434
       Emergency Department............................................................... 759-3664
       Prenatal Clinical............................................................................ 759-3629
       Prenatal Hospital Tours (Extension 5470) .................................. 759-3434
Health Cards/Health Insurance (formerly OHIP) ................................... 759-8598
Telehealth Ontario (24 hour Medical Info Line)...................................... 1-866-797-0000
Motherrisk (exposures/medications/drugs during pregnancy or breastfeeding).........1-416-813-6780
       Website: www.motherrisk.org

Parenting Information & Support
Algoma Health Unit
Parent-Child Info Line (advice, referral, home visiting, support groups) .......... 541-7101
                                                                                 Toll Free ....... 1-888-537-5741
Healthy Babies Healthy Children Program............................................. 541-7101
       Website: hbhc-algoma.ca
Indian Friendship Centre ......................................................................... 256-5634
Metis Family Resources .......................................................................... 256-6146
Ontario Metis Aboriginal Association ...................................................... 946-5900
Ontario Early Years Centre (Station Mall) .............................................. 942-6008
Ontario Early Years Satellites
       Dacey Road (extension 246) ....................................................... 945-8898
       Prince Township ........................................................................... 779-3267
       Le Carrousel des Amis................................................................. 942-5343
       Waabinong.................................................................................... 253-3129
               Website: ontarioearlyyears.ca
Parent Help Line ...................................................................................... 1-888-603-9100
Wanuskewin Centre................................................................................. 254-9424

Prenatal Information Support
Algoma Health Unit (Preconception/Pregnancy Info) ...................................... 942-3103
                  Website: www.ahu.on.ca
          Pregnancy Testing/Sexual Health Services................................ 759-5289
          Canada Prenatal Nutrition Program (Milk coupons, info) ................ 541-7101
          Prenatal Classes (Adult/Teen/Individual).................................... 541-7101
                                                                            Toll Free ....... 1-888-537-5741
          Genetic Counselling Services...................................................... 759-5287
Group Health Centre Lamaze Classes/Breastfeeding Class ................ 759-5552
Indian Friendship Centre ......................................................................... 256-5634
Infertility Awareness Association of Canada .......................................... 1-800-436-8477
Ontario Early Years Centre (Station Mall) .............................................. 942-6008
          Pregnancy Websites: www.womenshealthmatters.ca
                                  www.folicacid.ca
                                  www.motherrisk.org
                                  www.modimes.org/pnhec
Pregnancy Centre (Baby Bathtub Program, Pregnancy Testing, Support) .......... 759-9100



                                                    -112-
Sault Ste. Marie Public Library (Main Branch) ....................................... 7595236
Wanuskewin Centre................................................................................. 254-9424

Postpartum Adjustments/Coping with Stress
Postpartum Depression (Info/Support Group Referral) .................................. 541-7101
      Website: www.postpartum.org
Canadian Mental Health Association...................................................... 759-0458
      Website: www.ontario.cmha.ca
Algoma Family Service............................................................................ 945-5050
                                                                           Toll Free ....... 1-800-461-2237

Smoking Cessation
Algoma Health Unit (Advice, Resources) ..................................................... 759-5287
Smoker’s Helpline (Canadian Cancer Society)...................................... 1-877-513-5333
     Website: www.pregnets.org




                                                   -113
                   Acknowledgments

   The nurses at the Sault Area Hospital Combined Care Unit
compiled this booklet. Adaptations of some content were made
  from information booklets from various hospitals throughout
  Ontario, the Algoma Health Unit and the Postpartum Parent
    Support Program manual by Health and Welfare Canada.

    We would like to thank our colleagues for their support.

								
To top