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MATERNITY SERVICES by xiuliliaofz

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									Beautiful
   B E G I N N I N G S




                    MATE R N IT Y S E RVICE S
For   BABY




             For   MOM
                    From                       BAPTIST
                                          DEAR NEw MOThER,

     Thank you for choosing to have your baby with us. We know how
       important this moment is, and we want to help make it special.

        We are dedicated to providing high-quality maternity services,
             and strive to make sure every new beginning is beautiful.

           The book you have in your hands is a comprehensive guide
              of what to expect throughout your pregnancy, labor and
                    delivery, and in the first months of your baby’s life.

Our compassionate, highly trained maternity staff is here for you every
  step of the way—whether you need prenatal care or a breastfeeding
          consultant. In addition, we offer a wealth of information and
     educational resources online at www.baptistonline.org/maternity.

         Again, thank you for allowing us to share in your very special
   moment. We hope your experience with us is a beautiful beginning.
       TA B L E O F C O N T E N T S
          1. Your Pregnancy                                   1
              – Your Baby’s Development                       2
              – Changes During Pregnancy                      3
              – Staying Healthy During Pregnancy              6
              – Prenatal Visits and Tests                     10


          2. Labor and Birth                                  13
              – Prepared Childbirth                           14
              – Preparing for Baby’s Birth                    16
              – Relaxation                                    17
              – Massage                                       21
              – Breathing Techniques                          22
              – Pushing                                       26
              – Anatomy                                       30
              – Labor Process                                 31
              – Rupture of Membranes                          34
              – Fetal Monitoring                              35
              – Stages of Labor                               36
              – Analgesia and Anesthesia                      38
              – Caesarean Delivery                            42
              – Other Variations of Labor                     45
              – The Newborn at Delivery                       49


          3. New Mom Care                                     51
              – Mother-Baby Visiting and Bonding              52
              – Pain Management                               53
              – New Mom Care Education                        54
              – Postpartum Adjustment                         58


          4. Feeding Your Baby                                61
              – Breastfeeding Your Baby                       62
              – Bottle Feeding Your Baby                      70


          5. New Baby Care                                    73
              – Your Baby from Head to Toe                    74
              – Taking Care of Baby                           75
              – Newborn Screening                             80
              – Car Seat Safety                               81


          6. Glossary                                         83




Cover image and select inside images provided by Allison Rodgers Photography.
                  www.allisonrodgers.com | 662-890-9393
Your Pregnancy
    YO U R B A B Y ’ S D E V E L O P M E N T
    Your pregnancy will last approximately 40 weeks. That time is divided into three different parts or
    “trimesters.” Below is a chart with a description of how your baby’s body grows:

    First Trimester                                         Third Trimester
    0-14 weeks                                              27-40 weeks
      • Organs, muscles and skeleton start to form.            • Time of rapid growth.
      • Placenta, amniotic sac and umbilical cord form.        • Baby’s brain grows rapidly.
      • Ears, hands, fingers and nails are present.            • Baby begins to store iron and
      • The baby develops sucking ability.                       the skeleton gets stronger.
      • The baby can smile, frown and turn its head.           • Lanugo and vernix gradually disappear.
      • The baby’s eyelids are fused together.                 • Baby responds to light.
      • The heartbeat can be heard with ultrasound.            • Skin is still wrinkled but fat begins
      • Baby is about 3 inches long and                          to smooth it out by end of ninth month.
        weighs about 1 ounce.                                  • Eyes can open and close.
                                                               • Baby is about 18-20 inches long and weighs
    Second Trimester
                                                                 approximately 7-8 pounds.
    15-26 weeks
      • Noticeable movements.
      • Baby sucks its thumb.
      • Eyes may open.
      • Baby’s sex can be determined.
      • Digestion is occurring.
      • Bones are calcifying and getting stronger.
      • Strong heartbeat that can be heard
        with a stethoscope.
      • Responds to loud music and noise.
      • Baby is covered with “fine” body hair
        lanugo, and vernix, creamy baby’s
        covering to protect skin.
      • Baby is thin, and the skin is wrinkled.
      • Baby is about 11-14 inches long and
        weighs about 1.5 pounds.




2
ChANGES DURING PREGNANCY
Pregnancy is a normal, healthy state. A healthy woman should find pregnancy reasonably enjoyable.
Throughout pregnancy, your body goes through extensive readjustments. With major changes taking
place in your body, it is common for you to experience one or more of the following discomforts.

PhYSICAL ChANGES
Common discomforts of pregnancy:


  Discomfort          Cause                                        Relief

  Backache            Poor posture, hormones cause joints to       Increase calcium, pelvic rock (tones
                      relax, standing for too long                 muscles and improves posture), don’t
                                                                   stand for long periods of time, practice
                                                                   posture, and sleep on a firm mattress

  Bleeding gums       Blood volume, hormonal changes,              See your dentist, massage gums, floss
                      inadequate diet                              your teeth, use soft toothbrush, try
                                                                   increasing vitamin C foods

  Burping             Being pregnant                               Have a baby!

  Constipation        Relaxing effect of hormones on muscles       Eat lots of fresh and dried fruits (except
                      of intestines, not enough physical           bananas), drink lots of fluids, try high
                      activity                                     fiber foods, get daily exercise, don’t take
                                                                   laxatives or strain while moving bowels

  Dizziness           Vasomotor changes, weight of heavy           Try not to stand from sitting or lying
                      uterus on vena cava causes low blood         position too quickly, if dizzy, sit
                      pressure                                     immediately and lower head, avoid lying
                                                                   flat on back for long periods of time,
                                                                   check with physician about anemia

  Fatigue             Stress of pregnancy, hormonal changes        Take naps, have your physician
                                                                   check for anemia

  Gas                 Decreased movement of intestines             Avoid gas producing foods,
                                                                   do pelvic rocks

  Groin pain or       Poor posture, standing too long,             Pelvic rock, light massage, pull up leg on
  ache                pressure of baby, cramping of round          same side or lie down on affected side
                      ligament that holds uterus in place          with leg drawn up for relief

  Headaches           Tension, hormonal changes                    Relax; don’t go too long without eating.
                                                                   If headache persists or is very severe,
                                                                   call your physician

  Heartburn           Stomach displaced upward as uterus           Identify the offending food and avoid
                      grows; hormones relax opening of             gassy foods and fats. Engage in
                      stomach and allow excess acid to             moderate physical activity. Eat apples,
                      escape up into esophagus                     yogurt, papaya or toast. Try smaller
                                                                   meals and eat slowly.
                                                                                                                 3
    Discomfort        Cause                                         Relief

    Hemorrhoids       Impaired circulation or constipation          Do pelvic rocks. Elevate feet while
                                                                    sitting on toilet for bowel movements.
                                                                    Take sitz baths. Do Kegel exercises.
                                                                    Avoid straining while having a BM. Use
                                                                    medicated hemorrhoidal pads on area
                                                                    or witch hazel on a gauze pad

    Leg cramps        Slowed circulation, lack of calcium,          Try pelvic rock to improve circulation.
                      sudden stretching or pointing toes            Squat or tailor sit (sit Indian style or
                                                                    cross-legged). Sleep with legs elevated.
                                                                    Avoid pointing toes or stretching too
                                                                    hard. Check to see if salt intake is
                                                                    adequate. Eat foods high in calcium

    Moodiness         Hormonal changes, extra blood and fluid       Be kind to yourself; it is normal
                                                                    and will pass

    Morning           Lowered blood sugar                           Eat small amounts of fruit or protein
    sickness          hormonal changes                              often. Eat a protein snack before going
                                                                    to bed. Eat dry crackers or ginger snaps
                                                                    in morning before getting up

    Nosebleeds/       Increased vascular system                     Don’t use nasal sprays. Try vaporizer
    stuffy nose                                                     or humidifier and saline drops. Apply
                                                                    external pressure over nostrils for
                                                                    nosebleeds

    Shortness of      In latter stages of pregnancy, baby           Sleep propped up. Take it easy. When
    breath            is high in abdomen and diaphragm is           baby drops low in pelvis (38th-40th
                      compressed against lungs.                     weeks) you will feel better.

    Sleep problems    Discomfort due to size in late pregnancy      Be sure to get enough exercise. Cut out
                                                                    coffee, soft drinks, etc. Sleep with more
                                                                    pillows supporting back and knees.
                                                                    Practice relaxation

    Sore breasts      Increase in breast size                       Wear a good-fitting bra and apply
                                                                    heat if needed

    Swollen hands,    Some swelling is normal because               Mild exercise. Try lying down on side
    feet and ankles   of increase in blood volume,                  with feet elevated. Be sure you are
                      fluid retention                               getting the right amount of salt.
                                                                    Drink lots of liquids

    Vaginitis         Acidic change of vaginal secretions to        Notify your physician. Eat yogurt or
                      protect against bacteria                      cottage cheese to help prevent yeast
                                                                    infection. Tailor sit. Wear cotton panties.

    Varicose veins    Impaired circulation due to pressure in       Keep off feet as much as possible.
                      pelvis obstructing the returning blood        Tailor sit. Pelvic rock
                      flow and relaxing of the walls of the veins

4
wARNING SIGNALS
Some “discomforts” may have serious implications. If you experience any of the following, notify your
physician immediately.

   • Severe abdominal pain
   • Vaginal bleeding or clots
   • Severe persistent nausea or vomiting
   • Illness and elevated temperature
   • No movement or decreased fetal movement
   • Dizziness
   • Severe persistent headache
   • Sudden puffiness or swelling of the face, hands or feet
   • Spontaneous rupture of membranes before 37 weeks of gestation
   • Blurred vision or seeing flashes of light



EMOTIONAL ChANGES
From the moment of conception, a metamorphosis begins that will transform a woman and a man into a
mother and father. Pregnancy in the woman is easily recognized and therefore her associated needs are
usually met. As soon as the expectant father realizes or acknowledges his partner is pregnant, he is also
“pregnant” with accompanying needs and concerns. Both expectant parents may experience physical and
emotional changes. Most of the changes you are experiencing are expected and accepted. However, changes
in the “pregnant father” are often more subtle but just as real. The man may share some of your physical
symptoms (ex. nausea/vomiting, cravings and weight gain.)

The first trimester is a time of discovery, ambivalence and anticipation. Once the pregnancy is confirmed,
you and your partner may experience negative as well as positive emotions. It is normal to feel frightened,
worried, anxious or apprehensive. The expectant father may suddenly feel an increased sense of responsibility
and become very protective of his partner and the baby.

The second trimester brings with it acceptance as the couple settles into a more tranquil phase of the
pregnancy. At this time you both may begin to explore your feelings about the meaning of parenthood.
This is often the most enjoyable time since you are less troubled with morning sickness and other common
discomforts associated with early pregnancy.

The third trimester is a time of preparation, excitement, apprehension and anxiety. You may tingle with the
thought of seeing and holding your newborn baby, yet at the same time, tremble at the thought of going
through labor and delivery. You may feel ready to have your baby, but wonder if you can cope with
the birth experience.

The expectant father may experience feelings of rejection or hostility if all attention is being given to you. He
may even be jealous or resentful of the unborn child for making him an “outsider.”

Throughout pregnancy, various feelings are quite common and perfectly normal. It is important to share your
thoughts and feelings with each other and to be sensitive to the other person’s needs. This fascinating phase
of life may be used to strengthen and deepen your relationship with each other.




                                                                                                                    5
    S TAY I N G h E A LT h Y D U R I N G P R E G N A N C Y
    It is very important to take care of yourself while you are pregnant. The health of your baby is very dependent
    on your health, so you should do all that you can to stay healthy. Make and keep appointments with your
    doctor. Follow your doctor’s recommendations on healthy eating, exercise, rest and activity.




    EATING hEALThY
    You are eating for two but you don’t need two times the amount of food. You will need about 300 extra
    calories a day, which should be a total of about 2,100-2,400 calories daily. Your extra calories should be foods
    that are high in protein, calcium and iron. Your diet will furnish all the nutrients your baby will need
    if you follow some simple guidelines.

    Your food choices should be made based on the Food Guide Pyramid. Try to eat the recommended amount
    of foods in each group, limiting sugars, fats and oils.




    Additional food and nutrition information can be found on the following website: www.mypyramid.gov




6
helpful hints

  • Limit sugars – Healthy snacks are fruits, popcorn, hard-boiled eggs, cheese and crackers.
  • If you have morning sickness, you may tolerate smaller, more frequent meals better than large meals.
  • Limit empty calories such as candy, sweets, soft drinks and chips.
  • Limit fast foods; they are high in fat and salt and low in fiber.
  • Salt should be used in moderation unless your doctor tells you otherwise.
  • Limit caffeine products and artificial sweeteners. Ask your doctor what he or she recommends.
  • Increase fiber intake to help avoid constipation. Eat raw fruits and veggies,
    whole grain breads and cereals.
  • Drink lots of water. Aim for eight – 8 oz. glasses a day.
  • Avoid raw meats and sushi.



ThREE IMPORTANT NUTRIENTS

Calcium
  • Aim for four servings a day – needed for strong bones, teeth, muscles, heart and nerves for the baby.
  • If your intake isn’t enough, the baby will draw calcium from your bones, which is bad for you.
  • May help prevent high blood pressure in pregnancy

Foods to try: skim or low-fat milk, Cheddar or American cheese,
corn tortillas, cooked dried beans, almonds and dried fruit

Iron
  • Aim for 30 mg daily.
  • You need more during pregnancy than at any other time in your life.
  • Important to help develop baby’s blood supply and mom’s expanding blood supply
  • Supplements are usually given because it is hard to get it all from your diet.

Foods to try: lean beef; pumpkin; potatoes in their skin; spinach; other dark green
leafy vegetables; collard; kale and turnip greens.

Protein
  • Aim for four servings daily.
  • Most important nutrient in building the cells of a new baby
  • Not getting enough protein can cause a baby to be smaller in size than it should be.

Foods to try: skim or low-fat milk, low-fat yogurt, Swiss or Cheddar cheese, tuna, chicken
or turkey without the skin (white meat), fish, shrimp, whole grain products or other hard cheeses




                                                                                                            7
    wEIGhT GAIN DURING PREGNANCY
    The March of Dimes recommends a weight gain of at least 35 pounds in pregnancy for a healthy baby. Your
    doctor may give you other guidelines depending on your pre-pregnancy weight. Not all the weight you gain is
    “baby” weight – see the chart below.




     weight Distribution During Pregnancy
     Baby                                   7–8 pounds

     Placenta                               1–2 pounds

     Uterus                                 2 pounds

     Amniotic fluid                         1.5–2 pounds

     Breast tissue                          1 pound

     Blood volume                           2.5–3 pounds

     Fat (body stores)                      5 pounds or more

     Tissue, fluid                          4–7 pounds

     TOTAL WEIGHT                           25–35 pounds




    You should never try to diet during pregnancy. If you think you are gaining weight too quickly, check your
    daily calorie intake, and select foods lower in calories and check with your doctor about increasing your
    activity level by exercising. Once your baby is born you will lose approximately 12-14 pounds. The other weight
    will take a little while to come off. If you eat sensibly and try to do regular, consistent exercise, you should lose
    the rest of the weight gradually in 3-6 months.




8
ExERCISE AND PREGNANCY
If you do not have a medical condition that prohibits it and if approved by your doctor, it is beneficial for you
to do some type of consistent exercise while pregnant. Many physical changes are taking place in your body,
so you will need to follow certain guidelines so exercising is safe for you and your baby. If you exercise on a
regular basis you may experience the following benefits:

   • Exercise improves blood circulation, which can help you better deal with common concerns such as
    varicose veins, swollen legs and feet, and leg cramps.

   • Exercise will help make your pelvis, spinal and abdominal muscles stronger, which can help alleviate
    common complaints and make your body stronger for labor.

   • Exercise can help prepare you for the work of labor and delivery, make you more flexible and
    gives you more strength for delivering your baby.

   • Moms who exercise on a regular basis are usually not as tired or fatigued as those who don’t.




Exercise Tips

   • Never exercise right after a meal, and wear loose, comfortable clothing and a pair of good,
    supportive shoes.

   • Start slowly and build up to more activity- Don’t overdo it in the beginning.

   • Daily sessions are easier than longer more sporadic sessions. If you ever feel out of breath, dizzy
    or faint, stop and rest.

   • If you are doing aerobic exercises, make sure to do low-impact movements, avoid jerky movements
    and check your heart rate periodically. Your heart rate should be in the 140 – 160 range, never higher.

   • Slow, easy stretches will increase your flexibility and help tone your muscles so they are stronger.

   • After your fourth month of pregnancy, avoid any exercises that have you lying flat on your back such
    as leg lifts or double leg raises.

   • Drink plenty of fluids before, during and after exercise.




                                                                                                                    9
     PELVIC FLOOR
     The muscles that make up the pelvic floor are arranged very similarly to a hammock. They are suspended
     between the front and back of the bony pelvis. Ideally, this muscle floor should be firm and supportive,
     forming a straight line between the pubic bone and the front of the tailbone. During pregnancy these
     muscles are very stressed with the enlarging size of the uterus and can start to sag. The weight of the uterus
     will only increase, and the muscles will continue to sag. One way to help decrease this is to do what are
     called Kegel exercises. There are three openings in this sheet of muscle: the urethra, the vagina and the anus.
     All these are anchored in one perineal body between the vagina and rectum so the pelvic floor works as a
     coordinated unit.




     KEGEL ExERCISES
     Purpose: To improve the tone in the pelvic floor, which will help support the growing uterus during the
     pregnancy and also promote postpartum healing and comfort by improving circulation to this area.

     Tighten the muscles around the urethra, vagina and rectum. A good way to identify these muscles is to
     imagine the muscles that you would use to stop the flow of urine. Pull up and inward gradually to the count
     of five, hold as firmly as you can for a count of five then gradually release to the count of five. Begin by doing
     five, and as you get more comfortable with it, increase the number you do each day to 50 or more. You can
     also work up to “holding” the muscle contraction for 10 seconds or more.

     The Kegel exercise can be one of the most important exercises you do. Do them during your pregnancy and
     continue after you have your baby. You can start this exercise right after delivery. It is recommended you
     continue doing Kegels the rest of your life to help keep these muscles strong and prevent future problems.
     This exercise can be done at any time or any place.




     P R E N ATA L V I S I T S A N D T E S T S
     It is very important to make and keep regular appointments with your doctor throughout your pregnancy.
     This will help you and your baby stay healthy and prevent problems by catching them early. Your doctor will
     usually see you once a month until you are around 28-30 weeks. At that time, the doctor will generally want to
     see you every other week. Once you get to your ninth month, you should see your doctor every week up until
     the time you deliver. If any kind of problems occur or if there is a change in your medical condition, the doctor
     may want to see you more frequently.

     During these visits your doctor will ask you about any problems you might be having so he or she can assess
     the health of you and your baby. Use these visits to ask questions or discuss any concerns so you understand
     what to do to keep yourself as healthy as possible.

     There will be certain kind of diagnostic tests at different points in your pregnancy. This will be based on
     your medical history or particular situation. Many of these tests are done in normal pregnancies, as well as
     for moms who are having problems. You should always talk with your doctor about the purpose of testing,
     advantages and any risks involved.



10
Routine Tests in Pregnancy

   • Blood type and antibody screen (a blood test)
   • A complete blood count (a blood test)
   • Rubella check (blood test to determine a past infection with German measles)
   • Hepatitis B virus (blood test)
   • RPR screening (blood test for Syphilis)
   • HIV testing (blood test done in the first trimester and repeated in the third trimester)
   • Glucose (blood test after drinking a sugary liquid, can be a one or three-hour test)
   • Pap smear (test of cells from cervix to check for diseases)
   • Urinalysis (urine sample to check for infection or signs of protein in the urine due to high blood pressure)
   • Group B Strep – vaginal swap




DIAGNOSTIC TESTING
Alpha-Fetoprotein (AFP)
The AFP test is a blood test usually done early in pregnancy to help identify the small number of women
whose babies may have a neural tube defect (spina bifida) or Downs syndrome. In open neural tube defects,
high concentrations of the alpha-fetoprotein leaks through the exposed meninges (lining of the spinal cord
and brain) into the amniotic fluid. False positive results may occur with this test. If you have a positive test
result you will need additional testing that can include ultrasound and/or amniocentesis to identify if your
baby truly has a neural tube defect or Downs syndrome.

Amniocentesis
This test is an analysis of the amniotic fluid that surrounds and protects the baby during pregnancy. Early in
pregnancy it can be done for diagnosing if there is a genetic defect in older moms. During the last few weeks
of pregnancy it may be done to determine if the baby’s lungs are mature (usually occurs in moms at risk for
delivering early due to a medical condition.)

An ultrasound will be done to identify the position of the baby and the placenta. Once the position is
determined a needle is inserted through the abdomen and uterus into the amniotic sac and a small amount
of fluid is withdrawn. The fluid will be tested, and the results will be available within hours or a few weeks
depending on the specific test ordered.

One hour Glucose Tolerance Test
This is done after the 20th week of pregnancy. It is a screening test for a condition called gestational diabetes
and is usually done in the doctor’s office. You will have to quickly ingest a specific amount of a very sugary
fluid. Then you will wait one hour, and then a blood sample will be drawn.

Your doctor will be notified of the result. If your glucose level is greater than 140, it is usually considered to be
positive and further testing will be done.

Three hour Glucose Tolerance Test
If you have elevated glucose and a positive test result from the one hour test, a three-hour test will be
scheduled. The three-hour test is done after you have had adequate food intake for three days prior to the
test. You will be instructed not to eat or drink anything after midnight the night before the test. First a fasting
(no food or drink) level blood sample is drawn. You will then ingest a specific amount of sugary fluid and then
a blood sample will be drawn one, two and three hours after drinking the fluid. Your doctor will receive the
results and share them with you.
                                                                                                                        11
     Non-Stress Test (NST)
     A NST is used to measure the response of the baby’s heart rate to the baby’s activity. A fetal monitor, which
     will show a graph of the baby’s heart rate and any uterine activity, will be applied to your abdomen. After an
     adequate time of monitoring, the baby’s heart rate is assessed by looking at periods of rest and activity and
     stimulation. This test can be done in a doctor’s office or the hospital. A non-reactive test means the baby’s
     heart rate does not increase in response to activity or an auditory stimulus. If you have a non-reactive result,
     your doctor will decide what further testing might be needed.

     Biophysical Profile (BPP) Doppler Studies
     A biophysical profile test is done by using ultrasound to assess the baby’s well being. This test is done over
     a 30 minute time frame looking at different things that relate to the baby’s well being. Five different things
     are assessed: baby’s breathing movements, baby’s movements, baby’s tone and amount of amniotic fluid and
     how reactive the baby is.

     Each thing looked at is given a score of “2” or “0” depending on whether or not it is normal. The maximum
     score 15, 10, and a score less than 8 will need to be evaluated further.

     Many different things can affect this score, and your doctor will take all these things into consideration. This is
     usually done as a back-up test if the non-stress test is non-reactive.

     Doppler velocimetry is another type of testing done to evaluate a baby’s status or well being. The purpose of
     this test is to assess blood flow through the umbilical artery or uterine arteries. It can also be used to assess
     blood flow in the middle cerebral artery as well as the baby’s aorta.

     Doppler flow studies are another type of test used to assess the baby’s well being and are usually done in
     conjunction with the non-stress and biophysical profile testing.

     Ultrasound
     This test can be done in the doctor’s office or hospital and usually takes 30-60 minutes depending on
     the baby’s position and activity. You will be asked to come for this test with a full bladder, which helps the
     technician view the baby better. Gel will be applied to the abdomen to help increase conductivity. Then an
     ultrasound transducer will be passed over the abdomen. This transducer receives sound waves and translates
     them onto a small television screen that can be viewed by the mother and the technician performing the test.
     Age and size of the baby, location of the placenta, a multiple pregnancy and abnormalities can be revealed
     through ultrasound testing.

     Fetal Fibronectin (fFN)
     If an expectant mother has symptoms of premature labor or is at risk for preterm birth, her doctor may
     perform a Fetal Fibronectin test. This test is done by using a cotton swab to collect samples of cervical-
     vaginal secretions. If a certain protein is present during weeks 24-34 it may indicate a risk for premature
     delivery. If this is discovered, the doctor can take preventive steps to delay labor. If the protein is not present,
     medical interventions may not be necessary.

     Group B Streptococcus
     Group B Strep (GBS) infection is a common non-sexually transmitted bacteria. It is usually not serious in
     adults but can cause illness in newborns. Toward the end of your pregnancy (35-37 weeks) your doctor will
     swab your vagina and rectum, and test to see if you have GBS. If you do carry GBS or your doctor thinks you
     are at risk for GBS infection you will be treated with IV antibiotics during labor and delivery. Between 10- 30
     percent of all pregnant women will be positive for GBS.



12
Labor and Birth
     P R E PA R E D C h I L D B I R T h
     The terms “natural childbirth and “prepared childbirth” are often used to refer to the same thing but they
     really are two very different things. Natural childbirth occurs when a mom has not had any preparation at all
     including education, motivation or support. Prepared childbirth happens when a mom has educated herself
     by reading and taking classes and has support from others.

     A mom who is unprepared will experience something called the “fear-tension-pain cycle.” Without any
     knowledge she doesn’t understand labor, and her response is to fear labor and the unknown. The fear causes
     her to tighten or tense up which in turn increases the amount of pain she feels. It is a cycle that will repeat
     itself continuously for moms who are unprepared to deal with labor.

     It is normal for you to be anxious concerning birth and the hospital experience. Knowing what to expect will
     help you feel less fear. If you are less fearful it will decrease tension and discomfort. If you read, learn and
     practice you will likely have an easier time in labor because you will know what to expect and you will know
     how to respond to labor.

     Prepared childbirth is a type of mind-body conditioning and is based on Pavlov’s theory of conditioned
     response. Basically, you can condition and/or train yourself to respond in a certain way to different aspects of
     labor. The tools you will learn will help to reduce the pain you will feel.

     Prepared childbirth is not without pain. Contractions are uncomfortable. Every labor is different and everyone
     perceives pain in a different way. When using certain tools and techniques you can certainly expect to feel
     less pain than a mom who is not prepared. Prepared childbirth does not mean that you won’t use medication.
     It may be one of the tools you choose to use or you may find that you don’t need medication.

     Prepared childbirth is a very rewarding experience for both mom and labor partner. You will both be active
     participants in the birth experience. Support from a labor partner is invaluable.

     To accomplish this goal, it is necessary to keep these things in mind:

     Positive attitude – When prepared, you should feel committed and confident in your ability to achieve this
     goal for a fulfilling experience.

     Knowledge of the birth process – If you understand what is happening and know what to expect it will make
     you less anxious. You will be able to communicate with your partner and the medical staff so they can better
     assist you.

     Training – In classes you and your labor partner will learn relaxation and breathing techniques you can
     use in labor. You have to practice what you learn. If you don’t practice these techniques, you won’t
     have a conditioned response.

     Support – The role of the labor partner is very important. His or her assistance and encouragement will help
     you to stay as relaxed as possible. A labor partner can be a husband, mother, friend or nurse.

     Motivation – Without motivation, you will be less likely to do what you need to do. You won’t prepare yourself,
     and any support you receive may not be effective. Ideally you should have a true desire to have a prepared
     childbirth experience.

     Certainly, there are many advantages to having a prepared childbirth. However, it is not always possible
     for everyone to achieve a birth with limited or no medication. No one fails for not having a prepared birth.
     Because of a medical situation, you may have to have a Caesarean section. Or you may choose to have a more
     medicated birth or choose an alternative anesthetic. The ultimate goal is a healthy mom and baby.

14
ThE ART OF SUPPORT
The labor partner has a very special role. By practicing together, you form a unique bond. Providing
reassurance and emotional support is the key role of the labor partner. Having someone who is familiar,
caring and loving will be invaluable to you. Your labor partner should know your needs much better than
anyone else and should provide the support needed during labor.

Labor Partner Suggestions for Communication

  • Be specific with instructions. Instead of a general statement such as relax, tell her how to relax.

  • Give simple, easy-to-follow instructions. Demonstrate what you want her to do.

  • Silence can be golden, especially in the latter stages of labor. Talking may annoy her.
    Keep her environment calm and quiet.

  • Ask her if she needs anything and serve as a liason with the medical staff.
    Ask for explanations of procedures and relay them to her.

  • Comfort measures are key. She may not always realize she is uncomfortable. Offer pillows and blankets
    and remind her to empty her bladder. Offer lip balm to help soothe chapping. Provide a cold washcloth
    for her head or fan her with a small hand fan.

  • Your most important role is to stay calm so she will stay calm.
    She will be looking to you for reassurance.

  • Knowing what to do and wondering if you are doing it right can be frightening for you.
    Follow your instincts. You have practiced together. You know what she likes and dislikes.
    Ask for assistance from staff if you need it.

  • Be confident, not anxious and tense.

Special Note for the Labor Partner
Your primary role is to assist your partner but do not neglect yourself. Below are some helpful tips:

  • Practice relaxation every day so you can be relaxed, too.

  • Eat. Take breaks when you can and have snacks when you can’t.

  • Move around in the room. Stretch. Do head and neck rolls. Don’t glue yourself to a chair.

  • Ask for help if you need it. The nurses are there to help you.

  • Believe in yourself. Sometimes, you will know exactly what to do and other times you won’t.
    If you’re in doubt, ask your partner.

  • Remember there will be times when she will be very frustrated and extremely sensitive.
    Don’t take it personally.


                                                                                                            15
     P R E PA R I N G F O R B A B Y ’ S B I R T h
     Things to do before arriving at the hospital:

        • Complete hospital paperwork by preregistering at www.baptistonline.org/facilities/preregister.asp.
        • Determine the best route to the hospital. Think about different routes for rush hours.
        • Select a pediatrician for your baby. Our website has helpful tips on how to select a pediatrician.
        • Pack your bag for the hospital and have it ready.
        • Get a car seat for your baby. If you need help with installation, call to check about community resources.




      Recommended Items for Labor & Delivery Bag
      Item                                           Purpose

      Cards, books, magazines                        Something to help pass the time


      Music                                          Music helps promote relaxation


      Lip gloss or balm, mouthwash                   Helps keep lips moist


      Toothbrush and toothpaste                      To freshen your mouth


      Unscented powder or lotion                     To soothe skin during massage


      Socks                                          Your feet may get cold during labor


      Hand held fan                                  If you get hot


      Barrette or rubber band                        Helpful for long hair


      Tennis balls in a sock, paint roller or        Used for counter pressure to relieve back discomfort
      massage aids
      Personalized focal point                       Something special to look at while concentrating
                                                     during contractions
      Camera, charger, batteries                     You are allowed to videotape. Consult doctor and
                                                     hospital for guidelines.
      Eyeglasses, contact case                       You may need to remove contacts
      and contact solution
      Cell phone, charger, list of loved ones’       To make calls after delivery
      phone numbers




16
For your postpartum stay – pack in a separate suitcase

   • Nightgowns or pajamas, robe and slippers or extra socks
   • Personal toiletries, including hair care products
   • At least 2-3 nursing or support bras
   • Baby book or journal
   • Going home clothes (they should be comfortable maternity clothes
    as it takes a while to get back to your regular size)
   • Clothing and blanket for your baby to go home in – appropriate to weather

You may also want to bring change for vending machines, personal pillows (you will be given hospital pillows
to use, but you may want your own pillow) and additional snacks for labor partner and mom after delivery.




R E L A x AT I O N
Relaxation is the art of releasing muscle tension. It is a very important tool in labor, especially for moms who
are trying to have a prepared childbirth. If you are able to relax, you will be able to deal with your contractions
more effectively.

Relaxation is helpful in labor because:

   • It helps to reduce pain and break the fear-tension-pain cycle. Fear is diminished through knowledge.
    Tension is diminished through relaxation. If you can relax, you will not feel as much pain. Relaxation
    won’t take away all the pain, but it will help.

   • It can increase the time you are in labor if you are constantly fighting labor by tightening and tensing up
    muscles. The more you are able to relax, the more effectively your uterus can work to dilate your cervix.

   • It helps you conserve energy. Achieving relaxation early in labor allows you to save energy
    for advanced labor.

   • It will help facilitate communication among you, your partner and the medical staff. If you are tight and
    tense, you won’t be able to communicate your needs as effectively.




                                                                                                                      17
     POSITIONS FOR RELA xATION

     Side-Lying
     The side-lying position is usually best for labor. When you are on your side your circulation is better for the
     baby, and usually you will be more comfortable. Your head should be supported with pillows. The top leg
     should be relaxed in front of the bottom leg and should be supported with a pillow. This will place the weight
     of the baby on the bed so your back muscles and ligaments are not used to support the uterus. A pillow may
     be placed under your abdomen for additional support. The bottom arm is placed in a comfortable, relaxed
     position in front of or behind the body. The top arm is supported with a pillow.

     Sitting
     When you are practicing relaxation you can be in a large comfortable chair against the wall to provide
     support with your head and shoulders resting against your labor partner’s torso. If your baby’s head is in a
     posterior position, sitting may be more comfortable for you. The head of the bed can be raised for support.
     Pillows can be placed to support the head, shoulders and knees, and lower back.




     Tips for Relaxation

        • Be sure your bladder is empty
        • Adjust room temperature to a comfortable setting
        • Wear loose, comfortable clothing
        • Choose a quiet environment
        • Get in a comfortable position
        • Use a lot of pillows
        • Flex all your joints
        • Play soft music if desired




     PASSIVE RELA x ATION
     In this type of relaxation you move through your body, concentrating on specific muscle groups and relaxing
     thse areas as you go through your relaxation session.

     Narrative Example…

     Take a deep breath…and let it out…take another deep breath…and let it out… as you exhale…concentrate on
     relaxing every muscle in your body… and releasing any tension that may be present…your breathing should be
     slow and rhythmic...concentrate on total body relaxation.

     Think about the muscles in your feet…concentrate on relaxing the muscles in the toes…heel…the top of the
     foot and the ankles…let any tension go…and allow your feet to become limp and heavy…as they become
     more relaxed…you feel a warm tingling sensation…moving up your feet and your ankles..to your calves…
     feel the relaxation moving into the calves…releasing all tension…you can feel each muscle become longer…
     smoother…and heavier…feel the warm tingling sensation move up into the thighs...let those muscles go…feel..
     them becoming heavier and more limp…your legs are now totally relaxed…they feel very warm and heavy…




18
feel the relaxation moving into the pelvic area…let the muscles relax in your hips…perineum...abdomen…and
lower back…feel the warm, relaxing sensation…as those muscles become free of all tension…concentrate on
breathing slowly and rhythmically…releasing these muscles even more…with each exhalation…let yourself
go...the lower half of your body is very heavy..each muscle totally relaxed…feel the relaxation moving up
the back …to the shoulders…over the shoulders…to the chest…then down the upper arms…feel the warm
tingling sensation as it engulfs these muscles and releases all tension…feel the warm sensation move down
to the forearms…hands…and out through the fingertips…your body is becoming even more relaxed as you
concentrate on allowing these muscles to become longer..smoother…and heavier...you are breathing IN
relaxation…breathing OUT tension...let yourself go...think about the muscles in your neck…feel the warm
sensation moving into the neck…and relaxing those muscles…now up to the jaw…let the muscles around the
mouth become very relaxed and loose…let your mouth open to a comfortable place…and concentrate on
relaxing the muscles in your face…forehead...and scalp…you are breathing IN relaxation and breathing OUT
tension…let yourself go…each time you exhale you feel a warm flow of air going down through your body...
you feel totally and completely relaxed.




ENhANCING RELA x ATION
As you practice relaxation you will begin to notice what enhances or deepens your relaxed state. It can be
very simple things such as music, having your eyes open or closed or having your partner verbally relax you.
Other things that might help are the use of a focal point, visual imagery, body awareness and observation/
touch, and massage.




FOCAL POINT
The focal point is a small, stationary object that you can look at and concentrate on during practice and
labor. You need to direct your attention away from your contractions as much as you can and using a focal
point can help you do this. Some examples of a focal point are: picture of another child, small toy or stuffed
animal or small trinket that can be placed at the bedside. If you don’t bring a focal point you can always use
something in the room such as the thermostat, a door hinge or the clock on the wall. If you practice with a
specific item at home, bring it with you to the hospital.




                                                                                                                 19
     VISUAL IMAGERY TEChNIqUE
     Visual imagery is the formation of a mental vision of persons, places or things – “forming a picture in your
     mind.” During labor this can be a very useful technique that will help you relax more effectively. If you can do
     this, it keeps your thoughts off labor and the discomfort you are feeling. Some people find this very easy to
     do and for other people it is harder to do. Visual imagery does require a lot of concentration so it may or may
     not work for you, but it can be a very useful tool. It is very important to practice if you want this technique to
     work for you.

     An example would be as follows…

     You now feel very calm and relaxed…each muscle feels warm and heavy…Close your eyes…picture yourself in
     a meadow…a very special meadow without any insects or anything to make you feel uncomfortable…you are
     lying on a bed of soft, green grass…It feels like a plush carpet beneath you…it is a beautiful, sunny day…bright,
     blue sky…white fluffy clouds…bright, bright sunshine.

     You can feel the warmth of the sun as its rays shine down on your body…now you are even more relaxed…you
     can feel a warm, soft breeze…you can smell the fragrance of flowers nearby…and hear them rustling in the
     breeze…the birds are singing in the distance.

     With each deep breath...you feel yourself sinking deeper and deeper into the soft bed of grass...you can feel
     the blades of grass coming up between your toes...let yourself go...you can see the blue sky and the white
     clouds....you can feel the warm sunshine...the soft grass and warm breeze...you can smell the flowers as
     they bend toward you in the breeze...you can hear the birds singing...it is a beautiful day...you are very
     relaxed...let yourself go...you feel very calm and very peaceful...take a few moments to experience
     total body relaxation.




20
M A S SAG E
Relaxation is the foundation of prepared childbirth. Massage is a very useful tool to help you achieve a deeper
state of relaxation. There are a lot of benefits to massage. It will increase your sensory awareness, help
improve circulation and relieve stiffness and discomfort. Learning to relax takes a lot of practice and so does
learning to give and receive massage. The massage techniques listed below can be used during pregnancy
and labor. However, there may be times in labor that some women don’t want to be touched.

Just like relaxation, if you set a relaxing mood, it can help you get more out of massage. When practicing
massage, pick a time you won’t be interrupted. The room temperature should be comfortable, and you might
want to include soft music and dim lighting. Position yourself so you are comfortable – either in a side lying
position with pillows if you need them or sitting in a chair with your back facing the person doing the massage
with a pillow placed across the chair back.

Tips for the person giving the massage

   • Be relaxed and stay in a comfortable position. If you are tense, your partner will sense it, and the massage
    won’t be enjoyable.

   • Remove all jewelry to avoid scratching her skin.

   • Oils, lotions or powder can be helpful. Always rub your hands together when using oil or lotion to warm
    them before touching her skin.

   • Always be gentle when placing and removing your hands and move smoothly from one stroke
    to the next.

   • Check with your partner to make sure the pressure you are using is comfortable for her.

   • If there are areas that are tight or tense, spend extra time there working out the tightness.

   • Never apply direct pressure on the spine and be careful not to pinch or scratch with your fingernails.


Common Massage Strokes

Effleurage
Effleurage is a long, gliding massage stroke; use the entire palm of your hand with your hand flat. Effleurage
is good for increasing blood circulation and helps prepare the muscles for deeper massage. It is a good stroke
for the beginning and end of the massage.

Petrissage
Petrissage is often referred to as kneading. So imagine kneading bread dough. This movement will
move muscles over bones by using pressing, squeezing and kneading movements. It is a harder, deeper
massage stroke.

Nerve Stroke
This massage stroke is also known as light effleurage. It is a very light, gliding motion given with
the fingertips. The purpose of this stroke is to relax all the nerve endings that have been stimulated
during the massage.

There are many different opportunities to practice massage. You can use it as a quick pick me up after a
tough day and do shorter or longer practice sessions depending on the amount of time you have. The key
is practicing it often. The end of a massage session is a great time to practice total relaxation techniques
because your muscles are already relaxed.

                                                                                                                    21
     B R E AT h I N G T E C h N I q U E S
     Pain often causes us to hold our breath. Breathing techniques can help you focus on how you are breathing.
     Concentrating on relaxation, your focal point and breathing technique will help distract your attention away
     from the contractions.

     The point at which you would add or change breathing techniques is different for every person. Each mom
     should tailor her breathing techniques depending on her individual needs. Generally the time to begin the
     breathing techniques is when relaxation is no longer effective.

     hyperventilation
     Hyperventilation can happen if you are doing the breathing techniques incorrectly. If you breathe too fast
     and too deep you may hyperventilate. Signs of hyperventilation are:

        • Nausea
        • Dizziness or lightheadedness
        • Tingling in the hands or feet

     You can reverse hyperventilation by cupping your hands over your nose and mouth. When you do this,
     it allows excessive carbon dioxide that has been exhaled to be inhaled again, which quickly reserves the
     imbalance. It is important to relax while doing the breathing techniques and keep your deep breathing
     techniques slow and faster breathing techniques shallow.




     BREAThING TEChNIqUES
     The three breathing techniques are:

        • Slow Paced Breathing
        • Modified Paced Breathing
        • Patterned Paced Breathing

     Before beginning any breathing pattern you will need to take what is called a cleansing breath. This is a big
     deep breath in through the nose and out through the mouth. It helps by signaling you to relax and lets your
     partner know you are starting a breathing pattern. You should also take a cleansing breath at the end of a
     contraction to relieve any built up tension and let your partner know you are finished with that contraction.




     SLOw PACED BREAThING
     Slow paced breathing is the first breathing pattern introduced. It is usually easy to learn and will help you deal
     with your contractions when relaxation alone is not enough. In order to save your energy for the latter stages
     of labor you should utilize this pattern as long as you can. Some women find they can use it throughout most
     of their labor.

     Slow paced breathing is based on a 10-second cycle. It is a continuous breathing pattern so there is never
     a point when the breath is held. After taking a cleansing breath, you should inhale very slowly to the count
     of five, then you will slowly exhale to the count of five. You will continue this pattern throughout your
     contraction, then take a cleansing breath when the contraction is over.

22
                                                  An example…
                                                Cleansing Breath
                                         Inhale – 2-3-4-5; Exhale 2-3-4-5
                                         Inhale – 2-3-4-5; Exhale 2-3-4-5
                                         Inhale - 2-3-4-5; Exhale 2-3-4-5
                                         Inhale – 2-3-4-5; Exhale 2-3-4-5
                                                Cleansing Breath




MODIFIED PACED BREAThING
Modified paced breathing, or “panting,” is done like it sounds. This pattern is harder to learn but can be
very helpful in the later stages of labor. It is more complicated to do and more concentration is required.

Modified paced breathing is a series of short, shallow breaths throughout the contraction. The breathing
should come from the upper chest without taking deep breaths or using any abdominal muscles. Begin
the contraction with a cleansing breath followed by a slow pattern of shallow breaths. As the contraction
becomes more intense, the breathing becomes more rapid. As the contraction subsides, the breathing should
become slower again. Follow the contraction with a cleansing breath. It is important to try to keep your air
exchange equal to avoid hyperventilation. This pattern is all mouth breathing so your mouth will become very
dry. Spoonfuls of ice chips between contractions can help.

This pattern may be performed by saying HA on the exhale. It is important to practice a steady, slow pace to
develop a rhythm and maintain an equal air exchange. The pace can be increased or decreased as needed to
deal with the intensity of the contraction.

Some women can keep the pattern at a steady pace throughout the contraction. It is important to learn and
practice all the variations of the different patterns so you can use whatever is working best for you.

                                                 An example….
                                                Cleansing Breath
                                 HA…HA…HA…HA…HA…HA…HA…HA…HA..HA
                                      HA…HA…HA…HA…HA…HA…HA…HA
                                        HA..HA..HA..HA..HA..HA..HA..HA
                                          HA.HA.HA.HA.HA.HA.HA.HA
                                      HA…HA…HA…HA…HA…HA…HA…HA
                                    HA…HA…HA…HA…HA…HA…HA…HA…HA
                                 HA…HA…HA…HA…HA…HA…HA…HA…HA…HA
                                                Cleansing Breath

It can be very helpful for your partner to learn and practice theses patterns with you. There may be times
in labor when he or she will need to breathe with you to help you maintain control.

Remember there is no specific time when you should change breathing patterns. You can change your
breathing patterns when what you are doing is no longer working for you. You may decide this, or your
partner through observation, may suggest it.



                                                                                                               23
     Another variation of this pattern is called “HE-HA-HOO.” It is performed like the modified paced breathing
     with the addition of alternating HEE-HA-HOO sounds on the exhale.

                                                      An example…
                                                     Cleansing Breath
                                   HEE…HA….HOO….HEE….HA…HOO….HEE…HA…HOO
                                    HEE…HA…HOO….HEE…HA….HOO…HE…HA…HOO
                                                HE..HA..HOO…HEE…HA…HOO
                                                  HE.HA.HOO.HE.HA.HOO
                                                HE…HA…HOO…HE…HA…HOO
                                                HE…HA…HOO..HE..HA…HOO
                                    HE….HA….HOO….HE….HA…HOO….HE…HA…HOO
                                    HE….HA….HOO….HE….HA….HOO….HE….HA….HOO
                                                     Cleansing Breath




     PATTERNED PACED BREAThING
     As labor progresses, the baby will move further down the birth canal, which creates more pressure as the
     baby descends over the rectum. At first, you will probably feel heaviness in the pelvic area, but as you get
     near complete dilation this pressure can become an urge to bear down and push.




     Pant-Blow

     A breathing pattern often used in the transition phase of labor is the “pant-blow” pattern. It is done much like
     modified paced breathing, but after a designated number of pants the air is blown out, similar to blowing out
     a candle. The ratio of pants to blows is a decision a mom can make after practicing various ratios. The most
     common ones used are: 4:1, 3:1, and 2:1.

                                                     An example… 3:1
                                                     Cleansing Breath
                                                HA………….HA……….HA……..HOO
                                                HA……….HA……….HA……..HOO
                                                  HA……..HA……HA….HOO
                                                    HA….HA..HA…HOO
                                                 HA……HA….HA…HA...HOO
                                                HA………HA……..HA……HA….HOO
                                                HA…………HA…………HA……….HOO
                                                     Cleansing Breath




24
Diamond Pattern

A more complex variation of the pant-blow pattern is known as diamond breathing. It is more difficult to
master because it requires a great deal of concentration.

It is done like a regular pant-blow pattern. Rather than changing ratios gradually through labor the ratio is
continually changed in sequence during each contraction. Because it requires so much concentration, it
keeps your attention away from the contraction. The diamond pattern can be done by gradually increasing
or decreasing the number of pants to each blow.

                                                 An example...
                                                Cleansing Breath
                                                   HA……HOO
                                                HA……HA…..HOO
                                             HA…..HA…..HA…..HOO
                                         HA……HA……HA…..HA…..HOO
                                        HA….HA….HA….HA….HA….HOO
                                           HA….HA….HA….HA….HOO
                                              HA….HA….HA….HOO
                                                HA….HA….HOO
                                                   HA…..HOO
                                                Cleansing Breath




Random Pattern

Another variation of the pant-blow pattern is the “random-ratio” pattern. In this breathing pattern the
partner communicates the ratio to mom immediately before it is performed. The ratio is always changing
and never follows a predictable pattern. The partner can communicate the ratio verbally, or through hand
signals or both.

                                                 An example…
                                                Cleansing Breath
                                         Labor partner communicates:
                                          4:1 HA….HA…HA…HA…HOO
                                               2:1 HA….HA….HOO
                                         41: HA….HA…HA….HAA…HOO
                                            3:1 HA….HA….HA…HOO
                                               2:1 HA….HA….HOO
                                         4:1 HA….HA….HA….HA….HOO
                                                  1:1 HA….HOO
                                             3:1 HA….HA…HA…HOO
                                               2:1 HA….HA….HOO
                                                 1:1 HA….HOOO
                                        4:1 HA….HA….HA….HA….HOOO
                                                Cleansing Breath




                                                                                                                25
     BLOwING
     As the baby descends in the birth canal to the area over the rectum an unmedicated mom usually will
     experience an urge to bear down or push at the peak of the contraction. If this urge to push happens before
     you are completely dilated you need to resist the urge to prevent swelling or tearing of the cervix.

     The technique you will use is called blowing. It is similar to the blowing you would do with pant-blow, but it is
     much more forceful. The blowing will cause the diaphragm to be continually lifted off the uterus, which makes
     it impossible to push.

     As the contraction begins you should utilize your desired breathing pattern. You will use the blowing
     technique as the contraction builds near the peak, and you feel the urge to push. As the urge passes, you
     will go back to the breathing pattern you were using.

                                                       An Example…
                                   3:1 ratio with urge to push prior to complete dilation
                                                     Cleansing Breath
                                                    HA…HA…HA…HOO
                                                    HA..HA..HA..HOO
                                                     HA.HA.HA.HOO
                                                     HOO.HOO.HOO
                                                     HOO.HOO.HOO
                                                     HOO.HOO.HOO
                                                     HA.HA.HA.HOO
                                                    HA..HA..HA..HOO
                                                    HA…HA…HA..HOO
                                                     Cleansing Breath




     PUShING
     With a vaginal delivery you will use some type of voluntary pushing whether you have a medicated or
     unmedicated birth. The amount of pushing it will take depends on a number of different things, including
     the number of children you have had previously, the position and station of the baby, the type of anesthesia
     you have and how well you are able to push.

     Once you reach 10 centimeters and are completely dilated, you will usually begin pushing. You will
     continue to push with your contractions until the baby is ready to be born. You should only be pushing
     with your contractions.

     It is very important to concentrate while pushing so your efforts will be more coordinated and effective.
     Some people find this fairly easy. For others, it is harder to do. If you understand what you need to do you
     will do a more effective job. At this point in labor assistance, reassurance and support from your partner
     is very beneficial.




26
Basic Guidelines
Use a workable position. When choosing the position to push in,
consider your comfort, the use of gravity and the position of the baby.
Your nurse will also advise you if you need to change positions due to
any changes in the baby’s heart rate pattern.




Semi-Sitting Position
This position is easy to do and has many advantages. You will need to
make sure to keep your pelvis tilted so the baby’s head can pass under
your pubic bone. Your partner and nurse may need to help support your
legs and the head of the bed should be at a 45 degree angle. You can
use extra pillows for support.




Side Lying Position
This position is gravity neutral and is useful if things are progressing rapidly. In the side lying position, it is
sometimes easier to tilt your pelvis because it can relieve some of your rectal pressure and is less tiring. It is
also the position the nurse may recommend if it is better for the baby’s heart rate pattern.




hands and Knees Position
In this position it is easy to do a pelvic tilt; it can also help reduce any back discomfort and can assist in the
rotation of the baby’s head if it is in a posterior position. This position can also help relieve rectal pressure.
You will not be able to use this position if you have epidural anesthesia.




Squatting
This position takes full advantage of gravity and widens the pelvic outlet. So if it is a tight fit this can give the
baby’s head a little more room. This position can be uncomfortable and tiring for long periods of time so you
will definitely need the support of your labor partner. It is important to rest fully between contractions.




Lithotomy
Lithotomy refers to a supine position with the legs in the stirrups. In this position your legs are pulled back and
apart, which will sometimes help widen the pelvic opening. You are working against gravity in this position,
so that is a disadvantage.




                                                                                                                        27
     OVERCOMING RESISTANCE
     Pelvic floor tension is one resistance you will experience while you are pushing. If you tighten and tense your
     thighs, hips and the birth canal it can slow down the descent of the baby. It is important to learn how to relax
     and release the birth canal while pushing your baby down. If you do not have an epidural, it is normal for
     you to feel burning, pressure and stretching sensations. If you do have an epidural, you will still feel pressure
     sensations. Concentrate on relaxing your pelvic floor and using your abdominal muscles to push the baby out.

     Poor pelvic floor alignment is another common resistance. If you arch your back when you are pushing and
     the pubic bone is tilted in front of the baby, it will cause resistance. If the pubic bone is tilted up, the baby will
     have an easier time descending into the birth canal. It is very important to remember to tilt the pelvis and lift
     the pubic bone up and away from the baby’s pathway out.

     Try to have an “aim.” Concentrate on the direction of the baby’s descent. Push toward the vagina as the baby
     descends under the pubic bone and out the birth canal.

     Use your abdominal muscles. Draw up your abdomen in and around the uterus and use those muscles
     to push with.

        • Keep your efforts smooth and coordinated.
        • Relax and rest between contractions.
        • When it is possible, use a position that makes the most use of gravity.
        • Change your pushing position if the baby is not descending.
         Your nurse will let you know if you need to change positions.




     METhODS FOR PUShING
     There are two main types of documented pushing methods. Become familiar with both so when you are in
     labor you can use whatever works best for you.




     Spontaneous Pushing
     If you have not had an epidural, you will usually experience an urge to push once completely dilated. As the
     contraction builds, you will usually have waves or surges with the urge to push. Usually you will have three or
     four waves or surges with each contraction. As the waves or surges begin, you should be focusing on bearing
     down with each one of them. It is very important to rest totally between contractions so you will have enough
     energy to keep pushing.




28
Directed Pushing
This is the most effective pushing method for mothers who recieve epidurals. It can be very tiring and does
produce more cardiovascular changes. Your nurse will be monitoring for any of these changes and advising
you on your pushing efforts.

When a contraction begins, take two cleansing breaths. Then you will inhale, hold your breath and actively
bear down and push with your abdominal muscles against the uterus. Hold your breath and push for five to
ten seconds, exhale, then inhale again very quickly and hold your breath and push for five to ten seconds,
then exhale and do it a third time. When the contraction is over, stop pushing and take two to three cleansing
breaths and relax until the next contraction.

CAUTION: When practicing this technique DO NOT bear down or hold your breath. Just practice the different
                   positions and sequence. Save your actual pushing for labor and delivery.

                                                   An Example…
                                                Contraction Begins
                                       Cleansing Breath, Cleansing Breath
                                     Inhale – hold your breath and push down
                                                1-2-3-4-5-6-7-8-9-10
                                                      Exhale
                                     Inhale – hold your breath and push down
                                                1-2-3-4-5-6-7-8-9-10
                                                      Exhale
                                     Inhale – hold your breath and push down
                                                1-2-3-4-5-6-7-8-9-10
                                                      Exhale
                               Cleansing Breath, Cleansing Breath, Cleansing Breath




                                                                                                                 29
     A N AT O M Y
     It is helpful for you to have an understanding of some basic anatomy so that you can understand the changes
     your body goes through during pregnancy and labor and delivery.

     Vagina – a muscular passageway that leads from the vulva (your external genitalia) to the cervix.

     Cervix – the neck or opening of the uterus. During labor, the cervix softens, thins, and dilates.

     Uterus – a hollow muscular organ that houses the baby during pregnancy. During childbirth the uterine
     muscles contract to thin and dilate the cervix and then help push the baby out through the vagina.

     Pelvis – On each side of the bony pelvis there are two “bony prominences.” These are called “ischial spines”
     and are used as landmarks when determining how far down the baby is in the pelvis (fetal station.)

     Amniotic Membrane – a sac that surrounds the baby inside the uterus. This sac is filled with approximately
     1 liter of amniotic fluid. This fluid protects the baby against excessive force and extreme temperature changes.
     It also protects both mom and baby from infection.

     Umbilical Cord – This rope-like structure connects mom to baby through the placenta. This cord contains two
     arteries and one vein. This is your baby’s lifeline. Your baby’s needs for nutrients, blood circulation and oxygen
     are met through this cord.

     Placenta – or “afterbirth” forms and grows inside the uterus and is attached to the baby by the umbilical
     cord. The placenta moves oxygen and nutrients to your baby. The placenta also takes care of removing
     waste material from the baby to mom for elimination. Most substances can pass through the placenta
     from mom to baby so always check with your doctor before taking medications of any kind, including
     over-the-counter products.

     Round Ligaments – There are two ligaments that support the uterus on both sides. These ligaments run from
     the base of the uterus to the pelvic bones suspending the uterus. As your pregnancy progresses and your
     uterus and baby grow, you may experience aches or pains in the lower side of your abdomen. These can
     be felt as a temporary sharp pain or pain in your groin, especially during sudden movements or when you
     cough or sneeze.

                                                                         length
                                                                      5.5cm to 8cm
                                                                         Fundus
                                           Fallopian tube

                                                                          UTERUS
                                                   Uterovesical
                                                   ligament                          Round ligament (cut)
                            Ovary
                                                                          CORPUS
                        Uterosacral
                        ligament
                                                                                            Broad
                                                        Bladder                             ligament
                                                                          CERVIx
                                                            Internal os

                                                                                          Cardinal
                      Rectum                           External os                        ligament


                             Rectovaginal
                             ligament      Douglas’         Vagina
                                          Cul-de-sac

30
LABOR PROCESS
Labor happens when a series of uterine contractions occur that result in certain cervical changes. The
contractions can be compared to waves. They gradually increase, rise to a peak and then gradually subside.
When you are prepared for labor you will be able to work with each contraction as it occurs. The changes
that happen as the contractions occur are thinning of the cervix (effacement) and opening or widening of
the cervix (dilation). The contractions will also help push baby down into the pelvis and through the vagina
(birth canal) once you are completely dilated. During a contraction the muscles of the uterus will tighten and
there will be a time of relaxation between the contractions.




CONTRACTIONS
Usually contractions begin in the lower back and work slowly around to the front of the abdomen. As labor
progresses they will get more regular, become closer and get more intense. In labor the contractions will
efface and dilate the cervix. It is impossible for you to know if the cervix is dilated unless you have a physical
exam done. Always be aware of any consistent pattern of contractions and notify your doctor or come to the
hospital if that is happening. If you experience signs of labor prior to your due date you could be in premature
labor. If you are in premature labor there are many things that can be done to stop labor so your baby can
continue to grow inside you. The goal is to keep your baby where it can grow best until it is time to be born.
A delivery is considered premature if it occurs anytime before 37 weeks gestation. Premature babies can have
many different medical issues and problems, so the goal is to prevent a premature birth if possible.

It is important to remember all women are different. Labor can differ from one mom to another and even
from one labor to another. Be sure and talk to your doctor about the appropriate time to come to the hospital
and follow his or her guidelines.

Premature Labor Symptoms

   • Contractions that occur between 20 and 37 weeks of pregnancy
   • Pelvic pressure (feels like the baby is pushing down)
   • Low, dull backache
   • Menstrual-like cramps
   • Change or increase in vaginal discharge
   • Contractions (hardness) occurring every 10 minutes or more often with or without pain
   • Intestinal (stomach) cramping with or without diarrhea




DIGESTION AND LABOR
During labor, digestion slows down almost to a halt. All the body’s energies are focused on labor.
It is suggested that you not eat or drink during labor so there won’t be large amounts of food sitting in your
stomach. Nausea and vomiting are common in labor and if you have a stomach full of food, you are more
likely to experience this. Also, though rare, if you have to be put to sleep for an emergency Caesarean
section, you would have a greater risk of aspirating undigested food into your lungs, which can be a
dangerous medical situation.




                                                                                                                     31
     TIMING YOUR CONTRACTIONS
     When timing your contractions you will monitor:

     Frequency – time elapsed from one contraction to the next

     Duration – how long the contraction lasts

     You will also be asked how intense the contraction is. Later in labor, we can measure contraction intensity to
     some degree on the fetal monitor. The nurse will also be measuring this by putting his or her hands on your
     abdomen when you have a contraction.

     As labor progresses, contractions will become more frequent. The contractions will be longer in duration,
     and the intensity of the contractions will increase.




     what Contractions Accomplish:

     Effacement – This is the shortening and thinning of the cervix. The degree of effacement is measured in
     percentages. Before effacement has really started, the cervix will be long and thick or zero percent effaced.
     Throughout your labor the cervix will thin out (efface) to 100%.

     Dilation – This is the opening of the cervix. This opening is measured in centimeters, ranging from
     0 – 10 centimeters dilated. Ten centimeters is approximately the size of the baby’s head and is also
     called complete dilation.

     Station – Refers to how far the baby’s head is down in the pelvis. Station is measured using the ischial spines
     as landmarks. When the baby’s head is even with the ischial spines it is at a “zero station,” minus one station is
     a centimeter above the ischial spines and so on. “Plus stations” refer to the position of baby’s head below the
     ischial spines. Plus one station is one centimeter below the spines and so on. Usually at a plus three station the
     presenting part of baby’s head can be seen, which is called “crowning.”

     Some effacement and dilation can occur before labor especially for women who have had a baby before.
     Everyone begins labor at a different point. One woman may already be dilated and effaced some; others
     won’t do anything at all until labor begins.



             Complete Effacement                       Complete Dilation
                                                                                       Iliac
                                                                                       crest




                                                                                        Ischial                  Ischial
                                                                                        spine                    spine
                                                                                                    Station




32
Labor Signs To Look For

In the last few weeks of pregnancy a number of changes start to happen that suggest that labor is getting
ready to begin.

“Lightening” and “engagement” refer to the uterus and baby dropping down lower into the pelvis. This can
happen anytime in the last month of pregnancy. This is usually more noticeable in your first pregnancy. Once
it happens, you will be able to breathe a little easier, but you will feel more pressure in your pelvis and have to
urinate more frequently. You may also have an increase in vaginal discharge and occasional leg pains. If this is
not your first baby lightening may not occur until labor begins.

Many women experience a burst of energy and a strong desire to clean and get things ready right before
labor begins. To help conserve your energy it is probably better to rest so you have more energy for labor.

The opening of the cervix is sealed off by a mucous plug – another protective barrier between the baby and
the birth canal. The mucous plug will dislodge and start to come out as you begin to efface and dilate. Losing
your plug does not necessarily mean labor is starting right then; it can occur up to three weeks before you
go into labor. Some women will notice a distinct plug of mucous. For other women it will just be a heavier
mucous discharge containing streaks of blood.

“Show” is another type of discharge that refers to the blood-tinged mucous discharge women experience
in labor. This is normal and happens because small blood vessels will break as the cervix starts to stretch.
In early labor it is usually more of a pinkish colored discharge. In more advanced labor, it is heavier and is
referred to as “bloody show.”

Trying to decide if you are in labor is hard even for women who have had a baby before. You won’t always
be in a great deal of discomfort even though you are in early labor.

Other signs of labor can include any or all of the following:

   • Heaviness in the legs
   • Low backache – crampy, pulling sensation behind the pubic bone
   • Loose bowel movements
   • Menstrual-like cramps or stomach cramps

You can try changing your position and activity level and see if it relieves any of these symptoms. Sometimes
walking or decreasing your activity level by lying down and resting on your side will make contractions go
away. Always consult with your doctor if you are experiencing these symptoms and they don’t go away
quickly on their own.




                                                                                                                      33
     RUPTURE OF MEMBRANES
     The bag of waters surrounding the baby is a protective barrier for baby and mom. As long as the bag of
     waters remains intact it is a very effective means of protection.

     Spontaneous rupture of membranes (when your water breaks) occurs in about 25% of all pregnancies. For
     the majority of women, this won’t happen and your water will break while you are in labor, or your doctor will
     break your bag of waters sometime before you actually deliver.

     If you think your water has broken you will need to come to the hospital within an hour so an assessment
     can be done.

     You can have a “high leak,” or trickle of fluid, or a “low break” with a big gush of fluid. If you have a trickle of
     fluid, you might want to put on a sanitary pad and walk around for about 30 minutes and then see if the fluid
     is still leaking. If it is a “true break,” the pad will be wet, and you will continue to leak fluid. If you are unsure,
     you will need to see your doctor or come to the hospital so a nitrazine test can be done. For this test, your
     nurse or doctor will touch a small strip of nitrazine paper to the fluid. If the paper changes color, it is positive
     for amniotic fluid. If a low break with a large gush of fluid occurs there will be much larger amounts of fluid
     and you may need towels to absorb it. The fluid is constantly produced and will continue to leak until
     the baby is born.

     If your water breaks, stay calm and make the following observations:

        • Time the leakage occurred
        • Color of the fluid
        • Odor – note if there is an unusual one
        • If you are comfortable, you may take a shower but a not a tub bath. Then come to the hospital.

     If your water breaks prior to 37 weeks in your pregnancy, you will need to come to the hospital within an
     hour’s time. It is important to do this because you could go into premature labor and deliver a premature
     baby. Remember the goal is to keep the baby in the place it grows best for as long as possible so the baby
     is born healthy.




     ARTIFICIAL RUPTURE OF MEMBRANES
     In labor, your doctor may decide to artificially rupture your membranes (break your water), which can help
     move labor along. Or the doctor may break your water if there is some question about the baby’s heart rate
     tracing and he or she wants to use a different type of monitoring (internal monitoring) to get a better picture
     of the baby’s well being.

     To break your water, the doctor will use a sterile instrument (amnihook) to penetrate the bag of waters,
     allowing the fluid to escape.

     The procedure takes only a few minutes to do. It will be like having a vaginal exam with some additional
     pressure as the doctor uses the hook to rupture the bag of waters. You will feel a warm gush of fluid, and your
     nurse will change the pads underneath you but the fluid will continue to leak out throughout labor. Once this
     is done your contractions will usually become much more intense.




34
F E TA L M O N I T O R I N G
Your doctor will want to monitor your baby’s status and well being while you are in labor. Labor puts a lot of
stress on your baby, and it is important to know how the baby is responding to the stress so your doctor can
make the best decisions for you and your baby during labor. Below are the different types of monitoring:




External Monitoring
This is the least invasive type of monitoring. Two belts will be put around your abdomen. Each belt will have
a small, flat device attached to it. One will monitor your contractions, and one will monitor your baby’s heart
rate. The one monitoring your contractions is a displacement device. As your contractions occur and your
abdomen hardens, the monitor will pick up the differences and display it on the monitor. The one monitoring
the baby is an ultrasound transducer device and picks up your baby’s heart rate by means of ultrasound and
displays it on the monitor.




Internal Monitoring
When your doctor wants to get a more accurate reading or printout of your baby’s heart rate or your
contraction, he or she may use an internal monitor.

To monitor the baby’s heart rate your doctor will apply a small scalp electrode to the baby’s head. The
electrode is attached directly to baby and gives a much more accurate assessment of the baby’s heart rate.
Your water must be broken to do this and you must be dilated at least 1-2 centimeters.

To monitor the quality and effectiveness of your contractions more appropriately, your doctor may decide to
use an intrauterine pressure catheter which is inserted during a vaginal exam and fits into the uterus between
the wall of the uterus and the baby. When you have a contraction this catheter can measure the exact
pressure of the contractions. Your doctor or nurse will use a formula when counting the contractions that will
indicate if the contractions are effective enough to dilate the cervix. Your water must be broken to do this and
you must be dilated 1-2 centimeters. This device is used most frequently for patients who are being induced
or for patients on whom the external device does not give an accurate reading.




                                                                                                                   35
     S TA G E S O F L A B O R
     STAGE ONE
     Onset of regular contractions to complete dilation


     Effacement Phase

       Contractions        Labor Progress                                how Mom Feels

       Irregular           up to 100% effaced; menstrual                 low back ache
       5-10 minutes        like cramps                                   diarrhea and stomach cramps
       apart               0-3 centimeters effaced                       small amount of bloody show

     You should not eat or drink; you should keep busy but stay calm, get comfortable and relax; urinate often;
     use effleurage and slow deep breathing. Ask your partner to time contractions, assist with relaxation and
     breathing, get your suitcase ready and be calm.


     Dilation Phase

       Contractions        Labor Progress                                how Mom Feels

       3-5 minutes         4- 8 centimeters                              increasing pain with contractions
       apart               minus 2 – 0 station                           more back pain
       Last 45-60                                                        stronger in intensity
       seconds                                                           leg cramps
                                                                         increased bloody show

     You should try to maintain relaxation. Start with slow paced breathing, move to modified paced breathing,
     change positions, urinate often and concentrate on a focal point.

     Your labor partner can promote a restful atmosphere, assist with relaxation and breathing, encourage you to
     change positions, give you a massage and remind you to empty your bladder.


     Transition Phase

       Contractions        Labor Progress                                how Mom Feels

       2-3 minutes         8-10 centimeters                              mood swings, nausea, vomiting
       apart               0 to plus 2 station                           hot/cold flashes
       Last 60-90                                                        very strong intensity
       seconds                                                           leg pain
                                                                         rectal pressure
                                                                         shakes

     Try to maintain relaxation especially between contractions. Use patterned-paced breathing, change positions
     when needed and focus on the progress made. Your labor partner should give specific instructions.
     Use eye-to-eye contact, offer encouragement, breathe with you, offer ice chips and warm or cool cloths,
     fan you, and remind you that the end is near.




36
STAGE TwO
Pushing – Delivery

  Contractions         Labor Progress                               how Mom Feels

  2-5 minutes          BIRTH!                                       nauseous, may vomit,
  apart                very strong                                  vaginal and rectal pressure tingling,
  45-90 seconds                                                     burning and stretching in the birth canal
                                                                    urge to push

Try to find a comfortable workable position for pushing, maintain the pelvic tilt, rest between contractions,
and use abdominal muscles to push. Your partner should offer encouragement and support, remind you to tilt
your pelvis, encourage you when not pushing, and remind you that the end is near.




STAGE ThREE
Delivery of the Placenta or Afterbirth

  Contractions         Labor Progress                               how Mom Feels

  Irregular            delivery of placenta                         sense of relief, fatigued, might
  Lasting about        usually within 5- 10 minutes                 experience, a burst of energy
  60 seconds           after birth of baby                          excitement/joy
  Mild – moderate

You can use breathing patterns if needed to deal with contractions. The doctor may instruct you on pushing
to help deliver placenta. Your labor partner can hold the baby, offer encouragement and praise, and assist
you with breathing if you need help.




STAGE FOUR
First two hours after birth

  Contractions                                            how Mom Feels

  Mild- moderate contractions                             fatigued but relieved, might have the shakes
  “after birth” pains or cramps                           bonding/desire to see and hold baby,
                                                          a need to talk, thirsty

You should be encouraged to rest and relax while bonding with your new baby. We recommend
breastfeeding within the first hour. Make sure to ask for assistance with breastfeeding or getting out of bed.
Your partner should share in bonding, comforting you as needed, making phone calls, telling you what a
wonderful job you’ve done, and taking lots of pictures.




                                                                                                                 37
     ANALG E S IA AN D AN E STh E S IA
     You will have several types of pain medication available to you during labor and delivery. It is important that
     you understand your choices and discuss them with your doctor so you can make an informed decision when
     the time comes. Even if you decide to have an unmedicated birth, there may be circumstances that occur in
     labor that will prevent that, or you may change your mind. Regardless of their initial choice, it is important
     that all moms are well aware of other choices and what those choices involve.

     Every woman’s perception of pain is different. One woman may describe her labor as easy with little or no
     discomfort; another woman may describe her labor as being a very painful experience.

     Factors that contribute to pain in labor:
        • Decreased oxygen supply to the uterus
        • Stretching of the cervix
        • Pressure by the baby on the nerves that are lying near the cervix and vagina
        • Tension on the supporting ligaments of the uterus and surrounding structures during contractions
        • Descent of the baby
        • Pressure on the urethra, bladder and rectum
        • Dissenion of the pelvic floor muscles

     Fear and anxiety may cause a release of excessive stress hormones that can result in a longer labor.
     The degree of any pain you have will also be influenced by the size of the baby, the shape of your pelvis,
     the use of pitocin, fatigue and the length of your labor.

     Your birth experience can also be influenced by your past experiences, beliefs and expectations about birth.
     Just knowing the basis of pain and why it occurs can help you to cope with the discomfort you will feel. Also
     by realizing that this pain is normal and that it will end can help you better cope with contractions.

     The choice of whether to use medication is exactly that — a choice. It is important that both you and your
     labor partner learn about your various options. To avoid any misunderstanding, you should know how each
     option works, when it is given in labor and any side effects associated with it.

     Your partner needs to be involved in the decision you make so that he or she can better support you.
     Ultimately, it is your decision. You and your partner need to have a plan based on your desires and needs.
     Practice and prepare yourself with that goal in mind. Be open to change if it becomes necessary. You cannot
     always predict what will happen in labor or what it will be like. You can only do your best, and no one should
     expect more of you than that. There are a variety of analgesics and methods of anesthesia available to you
     during labor and delivery.




38
LIMITED ANALGESICS
An analgesic agent, whether given in an injection or through an IV, is one whose primary function is to
relieve pain. If you are using prepared childbirth techniques, the use of an analgesic agent may enhance
your relaxation and breathing techniques so that they are more effective. Also, if you want to have an
epidural and your doctor wants you to wait until labor is more established, this is a good option for you to
get some pain relief.

The most commonly used drug is Stadol®. Your doctor will write an order for the nurse to give it to you at
certain intervals as you request it. Stadol® can help you maintain relaxation and raise your tolerance for pain.
Possible side effects can include nausea, vomiting, dizziness and/or euphoria. If you do experience these
side effects it can make it harder for you to concentrate on your breathing and relaxation techniques.

Your nurse will try to avoid giving you this drug closer to delivery so that any side effects to your baby
can be avoided.




ANESThESIA
An anesthetic agent is used to eliminate total or partial sensation in an area of the body. It may be
partial, as in a local or regional block like an epidural, or it may be total, as with general anesthesia that will
put you to sleep.

Regional Anesthetics
This is an anesthetic agent that is injected into a certain area. The medication bathes the nerves that serve a
large area of the body and in turn blocks the pain impulse from going to the brain. Because these medications
do not affect the brain, mom remains awake and alert for the childbirth experience.

Local Infiltration
This is a direct injection of an anesthetic agent into the area where you are feeling discomfort. This is often
used for moms who do not have an epidural but require some pain medication if they have tears or an
episiotomy that has to be repaired after delivery. This type of injection is done by the doctor at the time of
delivery to provide the pain relief needed for any repair work.

Epidural Block
This is the injection of a local anesthetic agent into the epidural space in the back through a small tube or
catheter. This will provide a great deal of pain relief because the medication bathes the nerve fibers along
the spine. It can be a continuous infusion throughout labor or injections as needed to provide pain relief
for as long as needed. An epidural will provide pain relief from the contractions and will also provide
adequate pain relief for repair of an episiotomy or any tears. Epidural anesthesia can also be used for
Caesarean deliveries.




                                                                                                                      39
     EPIDURAL PROCEDURE
     You will first be assessed and asked questions regarding your medical history by an anesthesiologist or
     nurse anesthetist. He or she will want to know information about any allergies you might have, any physical
     problems, diseases or daily medications you take. He or she will also ask about and need to know if you have
     ever had a previous problem with any type of anesthesia.

     During the procedure you will be in a sitting position on the side of your bed. You will have your back to the
     nurse anesthetist and he or she will ask you to round or arch your back like a scared cat. This position helps
     to widen the spaces between your vertebrae and makes it easier to place the epidural catheter. After you are
     in this position he or she will clean your back with an antiseptic solution to decrease the risk of infection. This
     solution will feel cold. Next, you will be given an anesthetic agent in the area where the anesthetist will be
     working. This will numb that area so that you won’t feel what is being done and this may cause a brief burning
     or stinging sensation that will quickly go away. Next, the epidural needle is carefully placed in the epidural
     space in your back. The anesthetist will find this space by using a “loss of resistance” technique. A small
     amount of air is injected into the needle and when the needle reaches the epidural space there will be a loss
     of resistance indicating the right space to insert the catheter. You will not feel pain while this is being done
     but you will experience pressure in your back. Next, the epidural catheter will be threaded through the needle
     into that space, the needle will be removed and only the small soft tube will remain in your back. The catheter
     will be securely taped onto your back. You will be positioned on your back and the end of the catheter will
     be taped to your shoulder. The medication is injected through the catheter and travels to the epidural space,
     bathing those nerve endings that supply the lower half of your body. After an initial test dose, an epidural
     pump may be connected to the catheter so you can receive continuous small doses of the medication. The
     epidural pump helps maintain a more constant level of comfort. However, there may still be times when you
     will need to be given a larger intermittent dose to help you deal with your pain level. The epidural catheter
     will be removed immediately after delivery. It does not hurt to remove the catheter; it just slips out. However,
     the tape can pull on your skin and cause some brief discomfort (like pulling off a large bandage.) You will get
     gradual relief from your pain. Usually within 20 minutes, you will feel the full effect of the relief.




     SPINAL ANESThESIA
     If you are having a scheduled Caesarean section, the anesthetist may elect to use spinal anesthesia. The
     procedure is very similar to an epidural. With spinal anesthesia, the catheter is removed and you will have pain
     relief and numbness that will be adequate for the time it takes to perform a Caesarean section.




     GENERAL ANESThETICS
     A general anesthetic is given to patients having surgery and produces a loss of sensation and consciousness.
     In the event of an emergency situation when it is not possible or there is not enough time to administer
     a spinal or epidural, general anesthesia may be used. Medication will be given by inhalation of gases,
     intravenously or as a combination of both.

     Regional anesthetics are considered the best option for childbirth. They have fewer side effects, are safer for
     mom and baby, and allow mom to be awake and alert throughout labor and delivery.




40
COMPARISONS OF DIFFERENT T YPES OF PAIN RELIEF


 Local Infiltration

 Placement        perineum – delivery of anesthesia given by physician

 Area affected    perineum

 Administered     2nd or 3rd stage of labor prior to delivery

 Takes effect     within 5 minutes

 Effects last     1-2 hours

 Side effects     rare – possible allergic reaction to medication used




 Epidural

 Placement        between the lumbar vertebrae in back

 Area affected    from the waist down

 Administered     when ordered by doctor

 Takes affect     5–20 minutes

 Effects last     continuous relief provided by epidural pump

 Side effects     inability to empty bladder; may cause a drop in blood pressure, nausea and vomiting;
                  post spinal headache; can slow labor; can decrease urge to push, venous uptake of
                  the medication into the blood system, which causes metallic taste in the mouth and
                  ringing in the ears; in rare cases, seizures, inadvert spinal, which may cause a headache




 Spinal

 Placement        between 3rd and 4th vertebrae

 Area affected    from breast level down

 Administered     prior to Caesarean section

 Takes effect     5 minutes

 Effects last     1-3 hours

 Side effects     possibility of post spinal headache, possible drop in blood pressure,
                  inability to empty the bladder

                                                                                                              41
     CAESARE AN DELIVERY
     Every mom has a picture of how she thinks her labor will be. However, there are some possible variations that
     might not be a part of that picture. It is important to be aware of these variations so if they do happen, you
     will know what to expect.

     Many women don’t know they will need a Caesarean section until they are actually in labor. Because most
     women don’t focus on this type of delivery, it can be very scary for them. If you have a good understanding
     of the procedure and what will happen, it won’t be as frightening for you.

     Your support person will still be able to be with you, and you will be awake and alert. The focus is on
     having a healthy mom and baby. You have not failed because you aren’t having a regular vaginal delivery.
     Most Caesareans are performed with either epidural or spinal anesthesia so you will be awake and alert
     during the surgery and will be able to hold and see your baby. General anesthesia may be used
     in an emergency situation.




     REASONS FOR CAESAREAN SECTION DELIVERY

     Emergency Situations

     Non-reassuring heart rate pattern
     The baby will be monitored throughout labor. If the monitor shows a “non-reassuring pattern,” a Caesarean
     may need to be performed. If the baby is not getting adequate amounts of oxygen during contractions, there
     will be changes in heart rate pattern. Different measures will be tried to correct these situations. If the pattern
     persists, the doctor may recommend an immediate Caesarean delivery.

     Prolapsed Cord
     This occurs when the umbilical cord slips through the cervix before the baby’s head is “presenting.” The
     cord can be compressed, which cuts off circulation to the baby. A nurse or doctor will perform a continuous
     vaginal exam, lifting the baby off the cord until the baby is immediately delivered by Caesarean section.

     Abruptio Placenta
     This is premature separation of the placenta from the uterine wall. (This shouldn’t occur until after delivery
     of the baby.) Because the placenta supplies the baby with oxygen and nutrients through the umbilical cord
     if this detachment occurs prematurely, it will compromise the baby’s oxygen supply. Heavy bleeding can be
     present or the bleeding may be concealed inside your uterus. Severe abdominal pain may also be present. If
     this occurs, it usually requires an immediate delivery by Caesarean section.

     Placenta Previa
     Placenta previa occurs when the placenta partially or completely covers the opening of the cervix. A
     symptom can be episodes of painless bleeding. Your doctor will assess your situation and determine if a
     Caesarean delivery should be planned depending on the severity of the previa. When placenta previa is not
     diagnosed until labor begins and heavy bleeding occurs, it can be more of an emergency situation and may
     require an immediate delivery by Caesarean section.




42
Non-Emergency Situations

Diabetes/Renal Disease /Pregnancy-Induced hypertension
Moms who have a medical or obstetrical condition may need to have a Caesarean section. Your doctor will
determine the safest thing to do.

Genital herpes
This viral infection can be transmitted to the baby if active lesions are present during a vaginal delivery.
This can be a very serious complication for a newborn. Rather than risk transmitting a virus, most doctors
will schedule a Caesarean delivery.

Cephalopelvic Disproportion (CPD)
CPD means that the baby’s head (cephalo) cannot fit through mom’s pelvis. This can be caused by the
shape or size of the pelvis, or the baby’s head may be just too large or it can be flexed in a way where
it won’t fit through the pelvis. CPD can’t be determined without you going into labor. This can occur
with any pregnancy.

Breech Presentation
In a breech position, the baby’s foot, feet or bottom may be where
the head should be – down in the pelvis. A baby’s head is his or her
largest part and it can conform to the contours of mom’s pelvis in most
situations. In a breech presentation the head does not get the chance
to mold or fit because it is not the presenting part. For this reason
a first-time mom whose baby is breech will usually need to have a
Caesarean section.

Transverse Lie (shoulder presentation)
In this position the baby is lying “cross-ways” in the uterus with the
head on one side, and the shoulder is the presenting part. Vaginal
delivery is not possible in this position.

Failure to Progress
After an adequate amount of time in labor if the cervix doesn’t fully
dilate, it will be necessary to do a Caesarean section to deliver the baby.

When a decision is made to perform a Caesarean delivery, it is
important to remember that many factors are taken into
consideration. Each situation is evaluated on an individual basis.




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     T YPES OF CAESAREAN INCISIONS
     If you have a Caesarean section, there are different incisions that will be done. The first incision goes through
     the top layer of skin and the tissues right underneath it. The second incision is made through the uterine wall.

     Skin Incisions
     Transverse (straight across) skin incision – the most common type of skin incision. This incision will be low on
     your abdomen, just above your pubic bone.
     Vertical (up and down) skin incision – This incision is used less frequently and involves making a skin incision
     in the middle of the abdomen between your navel and pubic bone.

     Uterine Incisions
     A lower segment transverse incision is used in the majority of Caesarean deliveries. The incision is made
     in the lower segment of the uterus.
     Lower segment vertical incision – This is a vertical uterine incision made in the lower uterine segment.
     Classical vertical incision – This is very rarely used; however there are some medical indications that may
     make it necessary. This is an incision that is made vertically but higher in the uterus.




     CAESAREAN POST OPERATIVE CARE
     For moms who undergo a Caesarean delivery, it is very important to do what is necessary to provide
     adequate pain relief and prevent any post operative complications.

     During and after a Caesarean section you will wear what are called ALP (alternating leg pressure) boots
     on your lower legs. ALP boots help increase circulation in the legs to help prevent blood clots, which can
     be a very serious complication. You will also be encouraged to turn frequently in your bed, cough and take
     deep breaths. This will help decrease the possibility of developing pneumonia. It is important to follow any
     instructions your nurse and doctor give regarding getting out of bed and increasing your activity so you can
     lessen the chance of post operative complications.




     PAIN MANAGEMENT AFTER A CAESAREAN
     Your doctor and anesthesiologist will decide which type of pain management they feel will best meet your
     needs. You may have any of the following: a pain pump attached to your epidural catheter which can be left in
     for a few days; or an injection of pain medication that will last a few days if you have spinal anesthesia or an IV
     pain pump. You will gradually go to oral medication within a couple of days to manage your pain as it lessens.




     VAGINAL BIRTh AFTER CAESAREAN
     For patients who have had a previous Caesarean section, it may be possible to attempt a vaginal birth
     during the next pregnancy. This is called VBAC – vaginal birth after Caesarean. Your doctor will take into
     account circumstances from your previous delivery to decide if this is possible. There are some complications
     associated with this so it is very important to discuss the advantages and possible complications with your
     doctor if you want to consider this option.


44
O T h E R VA R I AT I O N S O F L A B O R
External Version
In some cases a baby’s position can be changed by a method called “external version.” In this procedure your
doctor will give you medication to relax the uterus (prevent contractions) and will attempt to manually turn
the baby’s head into the “head-down” position. An ultrasound will be done to determine the baby’s position,
the location of the placenta and the amount of amniotic fluid.

Forceps
Forceps are metal instruments that resemble large spoons. They can be used in a vaginal delivery to help with
the delivery of the baby’s head. The use of forceps can shorten the second stage of labor in cases where mom
is dealing with exhaustion and not pushing effectively. Forceps may also be used if the baby is showing signs
of distress, needs to be delivered immediately and is low enough in the pelvis.

The blades of the forceps fit inside the vagina alongside the baby’s head. The doctor will use the forceps to
gently guide the baby’s head under the pubic bone to a crowning position so you can push out the baby’s
head. There may be a slight bruising on the baby’s cheeks that will go away within 24-48 hours.

Vacuum Extraction
This method of delivery involves using the attachment of a vacuum cup to the baby’s head. The vacuum
extractor is used for the same reasons forceps might be used. Traction is applied as mom pushes and this
helps the baby’s head descend down into the pelvis. The vacuum cup will be released and removed after
delivery of the baby’s head. There may be some swelling on top of the baby’s head; this will disappear
in a few hours.

Induction of Labor
Induction of labor is the initiation of contractions before labor begins on its own. Inductions may be done
for a variety of medical reasons. Usually mom is in a medical situation where it is more important to try
to deliver the baby now, rather than waiting for labor to begin on its own. Some of the main reasons for
induction include:

  • Pregnancy-induced hypertension
  • Diabetes
  • Post dates (mom goes beyond her due date without going into labor)
  • Prolonged rupture of membranes without spontaneous labor

Factors your doctor will consider:
  • Position of the baby in the pelvis
  • Maturity of the baby (unless there is a medical reason, it is better if the baby is 39 weeks or beyond)
  • Consistency and assessment of the cervix
  • Adequacy of the pelvis




                                                                                                                45
     Pitocin
     The most common way to induce labor is with a medication called Pitocin. Pitocin is a synthetic hormone
     very much like the hormone your body produces called Oxytocin. Pitocin will cause the uterus to contract
     and is diluted and administered through an IV pump according to your doctor’s orders. You and your baby
     will be monitored to assess the effect of the Pitocin on your contractions and on the baby. With inductions
     and the use of Pitocin, your contractions may be closer together and stronger than what you would normally
     experience especially during early labor.

     Pitocin can also be used to augment or make your contractions stronger and more effective in labor if your
     doctor decides your should need that help.

     Posterior Position
     In about 10% of all labors the baby will be in a posterior position, or face up, as he or she comes down
     through the birth canal. It is easier for the baby to fit if he or she is in an anterior position with the head
     facing mom’s back.

     If your baby is in a posterior position it can be a harder fit for the baby and can also slow labor progress.
     The baby may or may not rotate on its own. Sometimes the baby can be delivered in this position; other
     times it might be necessary for the doctor to use forceps to rotate the baby’s head to an anterior position
     or a Caesarean delivery may be necessary. If your baby is in this position you will experience a great deal of
     discomfort in your back. This is called back labor and is caused by the baby’s head pressing up against your
     tailbone. If you use one of the following positions it may be helpful in relieving some of your discomfort:

        • Side-lying position
        • Tailor’s position – leaning forward on a pillow
        • Squatting
        • Kneeling
        • Semi-reclining

     Along with position changes, the use of massage or counter pressure on your lower back may be helpful.
     Have your partner place the heel of one hand against your tailbone and place the other hand on top and then
     use either steady pressure or circular motions on that area.

     Premature Labor
     The exact cause of labor is unknown although there are many theories about what causes a woman to go into
     labor. Any baby delivered before 37 weeks in the pregnancy is considered premature. Premature labors occur
     in about 10 to 15 percent of all pregnancies. It is important to be able to recognize signs of labor so you can
     notify your doctor if any of those signs occur before 37 weeks. If a premature labor is confirmed, there are
     treatments that can possibly be used to stop labor so the baby can grow inside mom a little longer, which will
     result in a stronger, healthier baby.

     If you experience any of these signs or symptoms before 37 weeks, notify your doctor. Contractions occur
     throughout your pregnancy, but if they become regular and consistent, notify your physician.

        • Rhythmic or persistent lower abdominal cramping similar to menstrual cramps
        • Persistent pelvic pressure or heaviness (feels like the baby has dropped)
        • Low backache that feels different from what you normally experience
        • Intestinal cramps or gas pains




46
A baby that is born too early may not be ready to live on its own in the outside world. It is always best for
the baby to stay inside mom to grow as long as possible. Because of this your doctor will probably want
to attempt to stop labor that begins before 37 weeks. There are different medications your doctor can
give you to do this. If you have received any of these medications, you and your baby will be monitored
very closely. You may also receive medications to help strengthen your baby’s lungs just in case premature
delivery does occur.

If a preterm delivery cannot be prevented or it has to be done for a medical reason, emphasis will be placed
on caring for the premature baby. A neonatologist (newborn specialist) or neonatal nurse may be in the
delivery room to take care of the special needs an early baby may have. Depending on those needs and how
the baby does at delivery, the baby may need to be cared for in the neonatal intensive care unit (NICU). This
nursery has specially trained nursing staff, along with all the equipment, special beds and supplies needed to
support and care for premature infants.




MULTIPLE GESTATION PREGNANCIES
A multiple gestation pregnancy is the formation of more than one baby in utero. If you have a multiple
pregnancy, you will be monitored more closely and are at a higher risk for complications during your
pregnancy. It is common for a mom with multiple gestations to deliver her babies earlier, and it is also
common for a Caesarean section to be performed due to the positioning of the babies.

During labor it is important to monitor the babies so an assessment can be made of how they are handling
labor prior to delivery. It is common to ask a neonatologist to be present at delivery to care for and assess the
babies. If necessary, the babies may spend time in the neonatal intensive care unit if they need extra care or
support. Often in twin deliveries if the babies are a good size and don’t have problems, they can be cared for
in the regular nursery. Triplets or quadruplets are almost always cared for in the NICU, as they are generally
born prematurely, are small in size and may have respiratory issues.




GESTATIONAL DIABETES
Gestational diabetes is a condition specific to pregnancy. With this condition, signs and symptoms of diabetes
are discovered after a woman has become pregnant. After delivery, these symptoms will go away, and you
will no longer have diabetes. Treatment can be as simple as diet changes, or some women will have to have
regular injections of insulin to control this while they are pregnant. The type of treatment will be based
on what your actual blood sugar levels are. Often, all that is needed is a change in diet. Your doctor will
monitor you carefully and do different tests throughout your pregnancy to make sure you don’t have any
complications related to this. The tests most often used to monitor gestational diabetes are non-stress testing
and ultrasound.

With good control of your blood sugar and monitoring, you may be able to carry your baby to term. If any
complications occur, your doctor will decide if it is in your best interest to deliver early.




                                                                                                                    47
     PREGNANCY-INDUCED hYPERTENSION
     An increase in blood pressure during your pregnancy is called pregnancy-induced hypertension (PIH). This
     complication occurs in about 5-10 percent of all pregnancies. The exact cause is unknown. If the condition
     occurs late in your pregnancy, it will usually go away on its own in a few days after delivery. It is likely to occur
     if you fit any of the following conditions:

        • You had your first child when you were younger than 18 or older than 35.
        • Your pregnancy is a multiple pregnancy.
        • You have chronic hypertension, heart disease or diabetes.


     The symptoms, which generally appear after 20-24 weeks of pregnancy, can range
     from mild to severe and can include the following:
        • Puffiness of hands and face
        • Sudden increase in weight
        • Blurred vision or visual problems
        • A severe continuous headache
        • Upper abdominal pain
        • Presence of protein in your urine (Your doctor will check for this during your prenatal visits.)

     If you notice any of the above symptoms, it is very important to notify your doctor immediately so
     preventive measures can be taken. The type of treatment your doctor chooses for you will depend
     on how severe your symptoms are. Treatment may include restriction of activity, bed rest, medication
     and/or hospitalization.

     Because PIH is a condition that happens only in pregnancy, the only cure for it is delivery of the baby.
     However, even after delivery you may need treatment for a few days. If the condition is severe enough, your
     doctor may make a decision to deliver your baby early. If you deliver early, your baby will require special care.




     Rh INCOMPATIBILIT Y
     During your pregnancy, your doctor will perform a test to determine if you carry an antigen called the RH
     factor. About 85% of all moms carry this antigen. If you do not have this antigen, then you are RH negative.

     Being RH positive or negative doesn’t affect your baby’s general health. A potential problem can occur if a
     woman who is RH negative conceives an RH positive baby. If mom and baby’s blood mix together, mom can
     form antibodies against the baby’s antigen. This generally does not cause a problem in first pregnancies but
     if left untreated may cause problems in a future pregnancy.

     To prevent the production of these antibodies that could affect future pregnancies, an injection of a
     substance called RH immunoglobulin (RhoGram) is given to mom after the birth of each RH positive child.
     She will also get an injection of RhoGram at some point in her pregnancy. Use of this preparation will almost
     completely eliminate any problems with incompatibility in future pregnancies.




48
T h E N E w B O R N AT D E L I V E R Y
Many new parents express some concern over their baby’s appearance at delivery. Knowing what to
expect can help decrease any anxiety or concerns you might have. Your baby has been on a long hard
journey to get here, and it is normal for them to look a little “weathered.” Listed below are normal
characteristics of a newborn.

Baby’s Skin
Babies are born wet from amniotic fluid and are often streaked with mom’s blood as well. When your baby is
born his or her skin will have some degree of vernix, which is a creamy white substance that covers their skin.
Some babies have a lot of vernix; others don’t have very much. The vernix protects your baby’s skin from the
long exposure to the amniotic fluid. Excess vernix can be wiped off and small amounts are usually just rubbed
into the baby’s skin.

Within seconds of being delivered your baby will start to breathe. As the baby breathes, changes will start to
happen in his or her body and you will notice color changes in the skin. The baby’s skin will be bluish in color
at first but become pinker in color as the baby cries and more oxygen circulates throughout the body. The
baby’s hands and feet may stay a dusky color for a while because they are farther from the heart and are the
last areas to get pink.

As you look closer at your baby you may notice some milia on the nose, cheeks or chin. These small, white
spots are caused by unopened sweat glands; they will gradually disappear on their own.

Some babies will have mottled looking skin; their skin may appear blotchy with areas of redness and
paleness for several weeks after birth. Peeling skin is normal at the wrists, hands, ankles and feet.
No treatment is required.

You will also sometimes notice what are called “stork bites,” which are small areas of superficial blood vessels
that most often are on a baby’s eyelids, nose, forehead or the back of the neck. These will also gradually
disappear over several months and are not permanent birth marks.

Baby’s Body
A baby’s abdomen is large and sticks out, the hips are small, the shoulders are usually narrow and slope a bit,
and the arms and legs will be short and flexed. The average weight of a newborn is around 7 to 7 and a half
pounds and the average length is 20 inches.

Baby’s head
Compared to the rest of your baby’s body, his or her head will seem quite large. Pressure that was on the
head during the birth process may temporarily seem to make it larger, or the baby may have some bruising or
swelling that will go away. Babies are born with two soft spots, or fontanels. These are areas where the skull
bones have not completely fused together yet. There is one soft spot on the top of the baby’s head and one
toward the back of the head. Both will eventually close on their own.

Baby’s hair
Most babies have some hair when they are born. The amount can vary. Some will have a lot of hair; others will
have barely any. You will also notice that your baby has hair on his or her back, shoulders, forehead, ears and
face. This hair is called lanugo and disappears gradually over the first few weeks of life.




                                                                                                                   49
     Baby’s Eyes
     The bright lights in the delivery room will probably cause your baby to keep his or her eyes closed very
     tightly. If you will shade the baby’s eyes and dim the lights, the baby will start to open its eyes while you are
     bonding. It takes a little while to get used to the bright environment. Darker-skinned babies usually have
     brown or dark eyes and babies with fairer skin usually have a blue-gray eye color. The permanent eye color is
     usually apparent by the time baby is a year old.

     Baby’s Genitals
     Both baby boys and girls can be affected by mom’s hormones. Their genitals and breasts will appear swollen.
     Sometimes baby girls will have a milky-white vaginal discharge due to these hormones and baby boys will
     have swollen testicles. These characteristics are normal and will disappear on their own without treatment.




     BONDING
     Bonding is a unique relationship that forms between you and your baby. You have waited a long time for
     your baby to get here, and this can be a very special time as you get to know your little one. Take this time to
     touch, stroke, talk and cuddle with your baby. Right after birth most babies are very alert. Your new baby will
     be observing the new environment and taking it all in and will focus on your voice and stare at your face.

     Hold your baby close to you; newborns enjoy the close contact and it helps them to keep warm. If you plan
     to breastfeed, ask your nurse to assist you. It is important to try to breastfeed within the first hour of birth if
     possible. Your baby may nurse eagerly, show no interest, or just snuggle up to you and lick or suckle a little.
     Any of these are okay. It is just important that the baby tries as early as possible and both of you will learn to
     do it better as you go along.




     YOUR ExTENDED RECOVERY
     There is more information later in this book with specifics about your care after delivery. Keep in mind that in
     the first few days and weeks after delivery your body will once again undergo many physical and emotional
     changes. It will take time for you to recover and adjust. Be kind to yourself, rest and relax when you can, eat
     healthy foods and follow your doctor’s advice about postpartum care. Accept all offers of help. Now is the
     time to get to know your new baby and adjust to your new role. Moms who have support from family and
     friends usually adjust more easily to their new role.



50
New Mom Care
     M OTh E R- BABY VI S ITI N G AN D BO N DI N G
     Your room is the best environment for you and your baby to get to know each other. The baby may need
     to be brought to the nursery for special reasons, such as the hearing screening, circumcision and at the
     pediatrician’s request. Keeping your room quiet and dimly lit protects the baby from excess noise and sound
     as he or she adjusts to the new environment.

     Visitors who have a fever, cough, cold, runny nose, rash, sore throat, diarrhea or contagious disease should
     not be allowed in your room to protect the well being of your baby. This applies to both adults and children
     who might visit.

     Siblings should be encouraged to spend time with their new brother or sister. Adding a new family member
     can be stressful to them. They may feel forgotten, abandoned or unloved. Visiting will help them to feel
     included and important. A responsible adult should accompany children for the entire visit so you are not left
     alone to care for the new baby and other children on your own. It is usually best if short visits are planned, as
     young children become easily bored and distracted. Shorter visits help prevent this and allow new moms to
     get the rest they need. Smoking is never allowed at any time by patients or guests.




     hAND hYGIENE
     Always wash your hands or use hand sanitizer before eating or handling
     the baby and after going to the bathroom or changing the baby’s diaper.
     Washing your hands is the best way to prevent infections. Be sure
     EVERYONE washes or sanitizes their hands before touching the baby.




     whAT TO ExPECT AFTER DELIVERY
     The morning after your delivery can be a very busy time. A variety of
     different team members will be visiting you to get all the things done
     that have to be taken care of before you go home. These members include the mother-baby staff, your
     doctor, the pediatrician, a baby photo representative and a birth certificate representative.




52
PA I N M A N A G E M E N T
Most patients will experience some level of pain or discomfort after giving birth. Our goal is to help you
manage this pain effectively. Your pain can be greatly decreased but may not totally go away. Some patients
experience little or no pain, while other patients have more intense pain. Everyone feels and reacts to pain
differently. Below are some helpful tips on dealing with your pain. You are encouraged to use any that fit your
situation.

Comfort Measures
Relaxation – slow breathing and quiet time (can be done with or without music; music may
help with relaxation.)

Spending time with your baby – Holding, nurturing, and cuddling helps you to relax and takes
your mind off the pain.

Breastfeeding – releases a hormone that helps mother relax

Sleep and rest time is very important to your recovery – Limiting visitors or the length of visits
may help you rest.

Massage – Hand or foot massage helps promote relaxation, light rubbing on the abdomen
will help relieve discomfort from cramping. DO NOT massage the calf or leg.

warm shower – aids in full body relaxation

walking – Moving around will aid in circulation and assist with muscle soreness.

Pain Medication
   • Your physician will order medicine to assist with your pain management.
   • These medications will be safe to use while breastfeeding.
   • Pain medications can only be given at certain intervals and there is usually a maximum
    dosage in a 24-hour period.
   • Following a Caesarean section, pain relief may be a one-time spinal injection, IV medication or
    a continuous epidural pump. You may also need other medication to assist with breakthrough pain.
   • Oral pain medications are not given on a schedule. Request them when you need them. Most can be
    given every four hours.
   • Your nurse will go over information about your medications with you. He and she will let you know what
    medications are available to you and how often you can receive them.

Pain in the Newborn
Babies do experience pain following birth, mostly due to pressure on the head during labor and delivery.
Male infants who undergo circumcision will experience pain and generally get acetaminophen (Tylenol®)
upon getting the procedure. Because babies can’t tell us when they are in pain, we use a “pain scale” based
on what we see (their responses and behaviors) to note their pain status. Babies may experience pain during
the following procedures: heel sticks for lab work, circumcision, tape removal, IV insertion or blood draws
for lab work.

Comfort measures provide the best pain relief for the newborn including breastfeeding, swaddling, touch,
massage, skin-to-skin contact, holding, rocking, cuddling, and reducing lights, loud noises and music.




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     N E w M O M C A R E E D U C AT I O N
     Perineal Care
     Change pads frequently. Do not use tampons until your doctor says it is okay. Fill a plastic squirt bottle with
     warm water (no medication), and rinse the perineum by squirting water over the vagina and the area between
     the vagina and the anus. Your nurse will instruct you. Always rinse from front to back. Rinsing will keep the
     perineal area clean and help make you more comfortable.

     Episiotomy or Laceration Care (Stitches)
     Perineal Care (see above) – Gentle rinsing with warm water will keep the stitches clean
     and help prevent infection.

     hot Tub Baths – Increase the blood supply to the incision area, keep the stitches clean, help prevent
     infection and decrease discomfort. Fill the tub with comfortably warm water and soak for 15-20 minutes
     at least twice a day.

     healing – The stitches will not be removed. They will dissolve. It usually takes approximately 3 weeks for this
     healing to occur.

     Medication – will be ordered by your physician. Use as directed.

     Vaginal Bleeding
     You will have some vaginal bleeding (lochia.) This occurs so the lining of the uterus (womb) may begin to heal
     after delivery. You will have lochia following a vaginal delivery or a Caesarean section. Your flow will last an
     unpredictable number of days and will gradually diminish. It is normal to have some spotting and discharge
     for up to several weeks after delivery. Sometimes this can persist until your six week check up. Your next
     menstrual period will usually occur within five to eight weeks following delivery. It can be longer if you are
     breastfeeding. It is possible to become pregnant before you have your next menstrual cycle. Remember to
     use some form of birth control if you want to avoid another possible pregnancy at this time.

     Douches
     Douching is not recommended. If you have questions, talk to your physician.


     Incision Care
        • Splint abdomen with a pillow for comfort.

        • Wash your hands before and after any contact with your incision site.

        • Bathing – If you had a Caesarean section, you may shower after the epidural catheter is removed.
         It won’t hurt to get your incision wet. Showers are recommended over tub baths. After the shower,
         be sure to pat dry with a clean towel.

        • If you have a fat fold that covers your incision, you will need to lift the fold frequently to allow air to get to
         the incision site. It is important to keep this area dry.

        • Incision dressing – After the initial dressing is removed it is not necessary to cover the incision site unless
         your physician tells you to do so. However, if you have a fat fold place a clean, dry pad or cloth over the
         incision and change it as needed to keep the area clean and dry.

        • An important note to remember – After you go home if you notice any redness, swelling, bleeding or
         drainage from the incision site, notify your physician immediately.



54
hemorrhoids
Hemorrhoids are swollen varicose veins inside or outside of the rectal opening. Pregnancy and delivery
can increase hemorrhoid discomfort. To ease this pain, you may take hot sitz baths, and use ice packs or
medicated creams. Try to avoid straining when having a bowel movement and increase your fluid and fiber
intake to make bowel movements easier to pass; stool softeners can also be helpful.




After Birth Pains
After birth pains are very common and may feel like cramps or mild contractions. They are caused by the
uterus contracting to return to its pre-pregnancy size. After birth pains may not be noticed as much with the
first pregnancy as with subsequent pregnancies. During breastfeeding, a hormone is released that contracts
the uterus and causes you to feel these pains more. Take your pain pills as directed by your physician to
relieve this discomfort. The after birth pains may last one to two weeks.




Activity
Gradually increase your activity as your strength returns and you begin to feel better. Try to avoid getting too
tired. Slow stair climbing and reasonable lifting are okay (nothing heavier than the baby.) Let the way you feel
be your guide. If you are tired or hurting, reduce your activity. You may ride in a car any reasonable distance
and you may drive yourself after two to three weeks. Follow all your physician’s instructions and allow plenty
of time for rest and sleep.




Elimination
Drinking plenty of fluids and walking will help your urinary system return to normal. You may also notice extra
perspiration (sweating) as your body adjusts after delivery. This is normal. Try to remember to empty your
bladder every few hours.

Avoid constipation by eating a diet high in fiber, drinking plenty of fluids and walking. Your doctor may
prescribe a stool softener for you to take while you are in the hospital and at home until your normal bowel
function is restored. If you become constipated, follow your doctor’s instructions on what you can
and cannot do.




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     DIET
     Eating a well-balanced diet will help you recover faster. Foods high in
     protein such as meat, eggs, milk, cheese and dried beans, and foods high
     in vitamin C like citrus fruits and tomatoes will help promote healing.
     Also try to eat plenty of iron rich foods like whole wheat, breads, cereals,
     spinach and raisins to rebuild your blood supply and give you more
     energy. Be sure to drink a combination of at least 64 ounces of water, milk
     or juice each day. Avoid dieting, tobacco, alcohol, or excessive intake of
     fat, salt, caffeine, sugar, artificial sweeteners or junk food.

     If you are breastfeeding, your baby you should have 2,100-2,500 calories
     a day including snacks, plus drink plenty of fluids. Check with your doctor
     about continuing your prenatal vitamins. It is not necessary to avoid certain foods unless you feel they are
     causing you or your baby a problem. These may include spicy foods, onions, garlic, cabbage, beans, peas,
     sweet potatoes and melons. Remember, alcohol and caffeine pass to your baby through breast milk as do
     many medications or supplements, so it is best to avoid these things. Always check with your doctor before
     taking any medication not prescribed to you.

     If you are not breastfeeding, you should have about 1,600 calories a day along with snacks and plenty of
     fluids. This is not the time to start a diet. If you feel you are gaining weight cut back on fats, oils and sweets
     and try to increase your activity when you doctor tells you it is okay to do so.

     A copy of the Food Guide Pyramid and suggestions for healthy eating can be found in the front of the book in
     the pregnancy section on page 6. For more information on the Food Guide Pyramid and healthy eating habits
     and tips go to mypyramid.gov.

     WIC - Women, Infants, and Children is a nutritional grant program serving low-income pregnant, postpartum
     and breastfeeding women and their children. WIC provides nutritious foods, education and referrals to health
     and social services. Eligibility for the program is based on income level and other factors. You can call a local
     health department clinic to see if you qualify.




     ExERCISE
     Kegel exercises may be started right after delivery (explanation of how to do Kegels are in the front of the
     book in the pregnancy section on page 10.) Kegels will help relieve discomfort from your episiotomy or any
     stitches. Follow your doctor’s advice on when you can begin other exercises.




     SExUAL RELATIONS
     Postpone having sex until after your six-week check up. You may notice some vaginal dryness at first, which is
     related to hormonal changes. A lubricating gel is helpful for this. Discuss birth control with your doctor if you
     do not want to get pregnant at this time.




56
BREAST CARE

Non-Nursing Moms
Wear a supportive bra day and night. Engorgement (swelling of the breast) occurs between the 2nd and 7th
day after delivery and lasts approximately 24-48 hours. You should avoid breast stimulation such as warm
water during bathing or showering and squeezing the breast or nipples to check for leakage. If needed, you
can apply ice packs to the breasts for comfort and take pain medication. Watch for any signs of redness or
pain and report these to your doctor.

Breastfeeding Moms
Wear a nursing bra for support. Always wash your hands before handling your breast but try to avoid soap on
the nipples to prevent dryness. Allow your nipples to air dry when you can, which will help prevent soreness.
You may use lanolin cream as directed.

Breast milk or colostrum may be expressed and allowed to dry on the nipples, which can promote healing.
Make sure baby is properly positioned and latched onto the breast to prevent problems or soreness.
The baby should always have the nipple and part of the areola (dark area around the nipple) in his or her
mouth when nursing.

Engorgement may occur when breastfeeding is delayed or interrupted. Milk backs up and the breast
becomes overfull. Engorgement can occur two to seven days after delivery. Some tips that might help
if you become engorged:

   • Wear a supportive bra.

   • Prior to breastfeeding, apply heat and massage the breast. A shower or applying warm washcloths to the
    breast will help with letdown reflex, and the milk will flow more easily.

   • Frequent nursing with proper latch

   • Hand expression if needed to soften the breast so baby can latch on more easily

   • If you are still uncomfortable after a feeding, you can hand express enough milk to make you more
    comfortable or apply ice packs. Discontinue the ice packs 45 minutes to an hour before the next feeding




SMOKING
Smoking is harmful to you and your baby. If you smoke, ask your doctor about help in quitting. Don’t allow
family members or friends to smoke around your baby. Secondhand smoke around babies can lead to more
colds, ear infections, asthma, bronchitis, and also increases the risk of SIDS (sudden infant death syndrome.)
Your baby will grow up healthier if you quit, and quitting will make it more likely that you will be there as your
child grows up.




                                                                                                                     57
     NOTIF Y DOCTOR OF ThE FOLLOwING SYMPTOMS:
       • Temperature of 101 or higher

       • Localized swelling or painful, hot or reddened areas on the breast

       • Bleeding nipples

       • Nipples that are too sore to feed your baby

       • Foul-smelling vaginal discharge

       • Excessive bleeding or a return of bright red vaginal bleeding
         after the drainage has changed to a “rust” color

       • Redness, drainage or odor from an abdominal incision

       • Increase in swelling or pain of episiotomy/stitches

       • Difficulty or burning sensation when urinating

       • Constipation

       • Painful, red, swollen warm area on the calf or leg

       • Symptoms of depression worsen – increase in sleep disturbances, crying, anxiety attacks,
         worried, afraid or sad and can’t understand why, feeling like you might hurt the baby




     P O S T PA R T U M A D j U S T M E N T
     It is very normal to experience a wide range of emotions following your delivery. You will be happy and
     excited it is all over, or at other times you may feel overwhelmed, uncertain or anxious. Caring for your baby
     is hard work no matter how much you looked forward to it. Patient support from family and friends is very
     helpful as you learn to adjust. But there may be times where you are still bewildered and concerned in spite of
     help and support. These emotions maybe classified in three different ways:




     “BABY BLUES”
     “Baby blues” is a very common and normal reaction in the first few days after giving birth. It usually appears
     on the 3rd or 4th day. Fifty to 80 percent of all moms experience the baby blues. Symptoms include crying
     for no reason, impatience, irritability, restlessness and anxiety. These symptoms are usually brief, unpleasant
     and disappear on their own sometimes as quickly as they happen. If the signs of the blues don’t go away on
     their own or get worse within a month, you may have postpartum depression.




58
POSTPARTUM DEPRESSION
Ten to 15 percent of new moms will experience various degrees of postpartum depression. It can occur within
days of delivery or appear gradually, sometimes up to a year later. Symptoms may include:

   • Nervousness
   • Lack of interest in baby
   • Sluggishness, exhaustion, fatigue
   • Guilt, inadequacy, worthlessness
   • Sadness, depression, hopelessness
   • Fear of harming the baby or yourself
   • Appetite and sleep disturbances
   • Exaggerated highs or lows
   • Over concern for the baby
   • Lack of interest in sex
   • Poor concentration, confusion, memory loss

A woman suffering from postpartum depression may experience any one of the symptoms or a combination
of symptoms. They may range from mild to severe. Good days will alternate with bad days. Postpartum
depression can leave a woman feeling very distressed, but it is treatable.




POSTPARTUM PSYChOSIS
Postpartum psychosis is the most severe but fortunately the least common reaction. It occurs about 1 out of
every 1,000 women usually within 3 days of giving birth. Symptoms are very exaggerated and severe and may
include insomnia, hallucinations, agitation and bizarre feelings or behavior. Postpartum psychosis is a serious
emergency and requires immediate medical attention. Any woman who has had a baby within the last year or
so can be affected, regardless of how many times she may have given birth without any problems. It can be
very distressing because generally a woman has never experienced anything like this before.

why?
The cause of postpartum blues, depression and psychosis is unknown. The time right after birth is a time of
big adjustments and demands for new moms, and hormonal changes can also be a factor. It is important to
know these symptoms are not a sign of being weak or inadequate. There is nothing to be ashamed of and it is
not your fault. Effective treatment is available.

Treatment
The type of treatment varies depending on how severe the symptoms are. Treatment is available and may
consist of support, medication and professional help or therapy. Asking for help is an important first step to
getting better and getting the help you need. If you have difficulty adjusting emotionally after giving birth,
get help as soon as possible by sharing your concerns with your doctor.

More information on postpartum disorders can be found on the Web sites below. There are also screening
tests or tools on these Web sites that can help you or family members figure out if you are suffering from a
postpartum disorder. Try www.postpartum.net and www.MedEdppd.org.




                                                                                                                  59
     N OTE S




60
Feeding Your Baby
     B R E A S T F E E D I N G YO U R B A B Y
     When it comes to nutrition, the best first food for babies is breast milk. The American Academy of Pediatrics
     recommends exclusively breastfeeding for the baby’s first six months if possible. Breast milk has exactly the
     right content of all the nutrients your baby will need, is always available and always at the right temperature.
     Breastfeeding has many benefits for both mom and baby.

     Benefits for Baby
        • Breastfed babies generally are healthier and have fewer ear, respiratory and digestive
         problems or infections.

        • Breastfed babies are less likely to have asthma or allergies.

        • Breastfed babies are less likely to be obese later in life.

        • Breastfed babies are less likely to have problems with constipation.

        • Breastfed babies have a lower risk of juvenile diabetes.

        • Breastfed babies have better jaw alignment and are less likely to require orthodontic care later in life.

     Benefits for Mom
        • Breastfeeding lowers the risk of breast, ovarian and uterine cancers.

        • Women who breastfeed have a higher bone density and are less likely to have osteoporosis later in life.

        • Breastfeeding burns up a lot of calories, and moms who breastfeed lose their baby weight more quickly.

        • Infant formula can cost $1,200 a year. Breast milk is more economical.




     TIPS FOR SUCCESS
     Get an early start – Nursing should begin within an hour of delivery, if possible, while the baby is awake and
     the sucking instinct is strong. The colostrum that baby will get contains many antibodies to prevent diseases.

     Nurse on demand – Babies need to nurse frequently, about every two hours and not on a strict schedule.
     This will help stimulate moms’ breasts to produce plenty of milk. Offer the breast frequently, especially if baby
     shows signs of hunger such as increased alertness, mouthing or rooting. Crying is a late sign of hunger.

     Proper positioning – The baby’s mouth should be wide open, with the nipple as far back into their mouth
     as possible. Tips for proper “latching on” can be found later in this chapter. Skin-to-skin between mom and
     baby is best.

     No supplements – Unless there is a medical problem, your baby will not need water or formula supplements.
     They can interfere with nursing, causing a baby to have a decreased appetite. If the baby does not nurse
     frequently, it can interfere with your milk supply.

     Delay artificial nipples – It is best to wait at least 2-3 weeks before introducing a pacifier or bottle so
     the baby doesn’t have nipple confusion. They need to learn to properly suck at the breast before
     getting a bottle or pacifier.

     Air dry – To prevent your nipples from cracking, it is beneficial to air dry them between feedings. If your
     nipples do crack, you can hand express some breast milk or colostrum and rub it over the nipples or use
     creams or lotions recommended by your doctor.



62
watch for infection – Symptoms of breast infection can include fever, painful lumps and redness in the breast.
If you develop these symptoms, call your doctor.

Expect engorgement – A new mom usually produces lots of milk, making her breasts big, hard and painful for
a few days. To relieve this, try the following things: feed the baby frequently until your milk supply adjusts to
baby’s needs, check with your doctor about pain medication, apply warm compresses to the breast and take
warm baths or showers to relieve the pain.

Eat right and get plenty of rest – To help a mom produce plenty of milk, she will need to eat a balanced diet
that includes about 500 extra calories a day and 6-8 glasses of water.




COMMON qUESTIONS:
when should I breastfeed?
When your baby is ready to eat, he or she may its eyes widely, bringing his or her hand to its mouth, suck or
lick its hands, smack its lips or stick out its tongue. Crying is a late sign; don’t let the baby get to the point
of screaming. Your goal should be to breastfeed 8-12 times in a 24 hour period. Follow cues, not a schedule,
when determining when to feed your baby.

what position is best?
The best positions are usually the “football hold,” “the cradle hold” and “the side-lying position.” Your nurse
will assist you, with proper positioning.

how long should I breastfeed?
You should nurse your baby on one breast until he or she is finished on that side. If your baby still appears to
be hungry, nurse him or her on the other side.

how will I know if my baby is getting enough?
A correct “latch” is important, but you also need to be able to recognize signs of milk transfer. These signs
are: audible swallowing; relaxed arms and legs; a satisfied baby after the feeding; a moist mouth; and a
sustained, rhythmic suck/swallow pattern.




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     STEPS FOR SUCCESSFUL BREASTFEEDING

     Before Delivery
       • Choose to breastfeed.
       • Attend a breastfeeding class.
       • Read about breastfeeding.
       • Moms who have at least two people who are supportive of their decision are usually more successful.

     while in the hospital
       • Nurse as soon as possible, preferably in the first hour after birth. Your visitors can wait.
       • Keep your baby in your room.
       • Make sure you and the baby are comfortable.
       • Don’t delay or skip feedings.
       • Nurse according to cues—8-12 times in a 24-hour period.
       • Avoid bottles or pacifiers for at least 3 weeks.
       • Ask visitors to be brief, and don’t let visitors interfere with breastfeeding.

     At home
       • Continue the good breastfeeding practices you started in the hospital.
       • Limit visitors. They can tire you and the baby.
       • Get adequate rest. Sleep when the baby sleeps.
       • Be sure to eat a well-balanced diet and drink plenty of fluids.

     A good, supportive home environment is very important in helping you to be successful with your
     breastfeeding efforts. Including your partner and family in your decision and getting their support will really
     help you stay with it and be successful. If you should have to stop breastfeeding for a medical reason, always
     know that you can get help with learning to pump and store milk for your baby.

     how to prepare for a feeding
       • Have something handy to drink while you are breastfeeding.
       • Include your other children by providing a snack or activity to share during feedings.
       • Turn off your phone or keep it near you.
       • Position yourself comfortably with support for your back, arms and legs as needed.
       • Remove baby’s blanket and clothing to help keep him or her awake.
       • If baby is sleepy, try changing his diaper, sitting him up or holding him upright.
       • Some moms find a nursing pillow with good support to be helpful.
       • Position your baby’s head, tummy and knees facing you.
       • Make sure your baby feels secure and is well supported.




64
BREASTFEEDING POSITIONS
There are several positions that may be used. The most common ones are the football hold, cradle, cross-
cradle and side lying. It is a good idea to try different positions until you find what is comfortable and works
best for you and your baby. Alternate these positions to stimulate all areas of the breast and help distribute
pressure on the nipple. After you are comfortable, place the baby so:

   • Baby’s ear lobe, mouth corner and nipple are in a straight line.
   • Baby’s shoulders are rounded forward and back is curved.
   • Baby’s knees are flexed.
   • The space between the baby’s chin and chest is one to two fingers wide.
   • Baby’s arms are encircling the breast.

Football position
This position can be more comfortable if you have a C-section or if the
baby is having difficulty latching on. It is a good position to start with
because you have a better view and better control of the baby’s position.

   • Sit up straight with your back well supported.
   • Use a nursing pillow or other pillows at your side to keep
    your baby well supported at your breast.
   • Turn your baby slightly toward you.
   • Hold the base of your baby’s head and shoulders in your hand.
   • Be sure to keep your fingers and thumb below your baby’s ears.
   • With your forearm, tuck your baby’s body close to yours.
   • Baby’s nose should be lined up with your nipple.
   • Baby’s head should tip back slightly, looking up at you.
   • Use your free hand to support the breast from which the baby is feeding.

Cradle position
This position is comfortable in most situations, but usually works
better after you and baby are more experienced at breastfeeding.

   • Sit up straight with your back well supported.
   • Use a nursing pillow or other pillows to keep your baby well
    supported at your breast.
   • Place your baby’s head on your forearm near your elbow.
   • Hold your baby’s body in your forearm with baby’s bottom and
    legs tucked in close your tummy underneath the other breast.
   • Both of baby’s arms should be around your breast.
   • Baby’s nose should be lined up in front of your nipple.
   • Baby’s head should tip back slightly looking up at you.
   • Use your free hand to support the breast from which
    the baby is feeding.




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     Cross-cradle position
     This position may be helpful in the beginning when both you and the baby are learning to breastfeed.

        • Sit up straight with back well supported and your lap level.
        • Use your nursing pillow or other pillows to keep your baby well supported at your breast.
        • Hold the base of your baby’s head and shoulder in the hand opposite the breast
         from which the baby is feeding.
        • Be sure to keep your fingers and thumb below your baby’s ears.
        • Hold your baby’s body in your forearm with baby’s bottom and legs tucked in close
         to your tummy underneath the other breast.
        • Both of baby’s arms should be around your breast.
        • Baby’s nose should be lined up in front of your nipple.
        • Baby’s head should tip back slightly, looking up at you.
        • Use your free hand to support the breast from which the baby is feeding.

     Side-lying position
     This position is a good one to learn early because it is more restful
     than any other position.

        • You and your baby both lie on your sides, facing each other.
        • Either place your baby’s head on the inside of your forearm,
         near your elbow or on the mattress.
        • Put enough pillows under your head to help you see your baby.
        • Pull your baby’s bottom and knees close to you.
        • Baby’s nose should be lined up in front of your nipple.
        • Baby’s head should tip back slightly, looking up at you.
        • When latching, pull your baby close to you by putting your hand
         on his or her bottom.
        • Use your free hand to support the breast from which
         the baby is feeding.




     hELPING YOUR BABY LATCh ON
     “Latching on” refers to the way your baby takes the breast into his or her mouth. When your baby is latched
     on well, your nipple and a good portion of your areola are at the back of its mouth. More of your areola should
     be on the tongue side of baby’s mouth. You should be able to see more of your areola above baby’s upper lip
     than below the lower lip.

     With a good latch, breastfeeding should be comfortable and not painful. It is not supposed to hurt to
     breastfeed. Your baby will also be able to get milk more easily when properly latched on to your breast.

     To help the baby, grasp the areola well. Hold your breast with your thumb on top and all of your fingers
     underneath. Be sure to keep your fingers and thumb about 2 inches back from your nipple so baby can
     latch on correctly.

        • Hold your baby’s head at the base, supporting the neck, back and shoulders in your hand. You will need
         to place your hand here so baby’s head can naturally tip back slightly looking up at you.

        • You may support your baby’s bottom cheek with your four fingers.

66
  • Make sure your baby’s nose is in front of your nipple.

  • To encourage a wide-open mouth, brush your baby’s upper lip with your nipple, either from side to side
    or in an up and down motion. You may also stroke from the baby’s nose downward. When the mouth
    opens wide, baby’s head automatically will tip back slightly, and you can aim your nipple at the
    roof of the mouth.

  • You may have to repeat this step once or twice more until your baby opens up wide enough. Be patient
    and continue to brush the upper lip, waiting for baby’s mouth to be open at its widest point.

  • As soon as the mouth opens wide like a yawn, you will need to move baby very quickly onto your breast.
    Most moms are surprised by how quickly they need to move their baby onto the breast in order to
    get a good, comfortable, deep latch.

  • To get the best latch—When your baby’s mouth is open at the widest point, push on the baby’s back
    between the shoulder blades with the base of your hand while you quickly move baby onto the breast
    using your whole arm, not just your hand. Bay’s chin and lower jaw should be pressed into your breast.

  • Your baby should have more of the lower portion of your areola on the tongue and chin side of his or
    her mouth. You should be able to see more areola above the upper lip than below the lower lip. Baby’s
    chin and cheeks should be pressing against your breast during the entire feeding, and baby’s lips should
    be rolled out (flared) around your breast.

  • When beginning to feed, baby will use his or her tongue to pull your breast to the back of the mouth.
    You may notice a few seconds of mild discomfort in the early days of breastfeeding, but that should
    quickly go away and the rest of the feeding should feel comfortable. When breastfeeding is working well
    you will feel tugging on your breast, but it should not hurt! If you feel pain that does not quickly go away
    as the baby starts to feed, stop the feeding. Break the suction by putting your finger in the corner of your
    baby’s mouth between the gums so baby lets go before you pull him or her away from the breast.

  • Breaking the suction before removing the baby from your breast helps to prevent nipple soreness.

  • When your baby is latched on well, unless you have very large breasts, the nose should be away
    from your breast and should not touch your breast.

  • Signs of improper latch include pain, hearing smacking sounds, crimpling of the baby’s cheeks or
    a flattened or uneven shape to the nipple after detaching baby from the breast.

For video clips on how to latch correctly, go to www.drjacknewman.com.

how to know baby is getting milk
  • Watch your baby. What baby does while on the breast and after coming off the breast can
    tell you if he or she is getting enough milk.

  • Even if your breast is in baby’s mouth and the mouth is moving, baby may not be getting milk.

  • Babies have a distinctive sucking pattern when they are getting milk. In the beginning of the
    feeding look for short, quick sucks with short periods of rest. The baby will suck like this to
    stimulate the “let down” reflex.

  • In the middle of the feeding your baby will have bursts of sucking and swallowing with short
    periods of rest. During the first few days while your baby is getting colostrum you may see
    several sucks before he or she swallows.

  • When babies are swallowing, usually they will open their mouths widely and pause briefly as they
    draw in the milk. They will swallow as their mouths begin to close, and their chins move back up.


                                                                                                                   67
         The longer the pause, the more milk they get. They will repeat this several times during a
         burst of sucking and swallowing. You may hear a soft “kuh” sound as your baby swallows.

        • Near the end of the feeding, look for shorter bursts of sucking and swallowing with longer rest
         periods in between.

        • It is normal for babies to lose a little weight after birth. Most babies will be back to birth weight by
         2-3 weeks of age.

     For video clips of what to look for when baby is getting enough milk, you may go to www.drjacknewman.com.

     Breastfeeding Log
     There is a feeding log on page 72 to use in the early days and weeks to help you keep up with your
     baby’s feedings and diaper changes. We recommend you use this tool in the hospital and continue it
     for up to two weeks.

     If you have concerns about your baby not getting enough milk or not having enough wet or dirty diapers in a
     24-hour period, call your pediatrician.

     Breastfeeding is a normal process, but both mom and baby will be learning together the first few weeks.
     Tenderness is common but not pain. If you describe your breastfeeding experiences as painful or if you have
     blisters or bruises on your nipples, something is not right. It is not normal to have blistered, scabbed, cracked
     or bleeding nipples. If you do experience these things, call to get help right away.




     BREAST ENGORGEMENT
     About the third to fifth day after birth your milk supply should become very plentiful. It is normal for your
     breasts to feel fuller, firmer and maybe a little tender. This fuller feeling is due to extra fluid being sent to your
     breasts to help increase your milk supply. It is normal for this to last two to three weeks.

     Engorgement means your breasts feel hard, hot and painful. This is not normal. This usually means your baby
     is not breastfeeding often enough or draining your breasts fully enough at feedings. The secret to preventing
     engorgement is making sure your baby is latching on well and feeding without restrictions after birth.

     If your breasts do become engorged, here are some suggestions:

        • Apply warm, moist compresses. Take a warm bath or shower. In the shower let the water hit
         your back between the shoulder blades, not directly on your breasts.

        • Gentle breast massage followed by hand expression or pumping will help to release some
         milk and soften your breast tissue so the baby can latch on better.

        • Do not skip feedings or pumping.

        • Feed your baby more often and don’t put a time limit on the feedings.

        • Ice packs wrapped in a towel placed on the breasts after a feeding or pumping can help
         to reduce swelling or discomfort.

        • Don’t wear underwire bras or bras that fit too tightly.

        • Check with your doctor about taking an anti-inflammatory medicine that reduces discomfort.

        • Limit visitors, eat and drink well and get lots of rest.

        • Contact a lactation consultant or your doctor if things don’t improve.
68
SUPPLEMENTATION
If you and your physician decide there is a need for supplementation, be aware of the following things:

  • If the baby is not nursing regularly, pumping will be necessary to maintain your milk supply.
  • Some examples of a medical need to supplement might include increased weight loss, decrease
    in wet or dirty diapers and low blood sugar.

Alternative Feeding Devices
Listed below are some alternative feeding devices. Your lactation consultant will explain how to use them if
they are necessary. Challenges can be overcome. Breastfeeding takes practice, patience and time.

Alternative feeding devices include:
  • SNS – supplemental nursing system at the breast
  • SNS – used as a finger feeding
  • Tube feeding
  • Cup feeding
  • Bottle- preferably after other methods have been tried and are unsuccessful




BREAST PUMPS
There are several types of breast pumps. Each has its own advantages. Your lactation consultant can help you
decide what will best fit your needs and can also instruct you on hand expression. Because breast pumps are
a personal care item it is best due to the risk of infection not to use someone else’s pump. When you return to
work you may want to obtain a pump so you can pump milk for your baby. You can discuss your options with
the lactation consultant. Remember the following things:

  • Your baby is always the best pump and will make and remove more milk than a machine.

  • If it will be some time before your baby can breastfeed, try to pump as often as the baby
    would naturally feed (at least 8-12 times in a 24-hour period.)

hand Expression
Massage breast gently to stimulate “let down.”

  • Grasp outer edge of the areola with the thumb and forefinger, or with all fingers
    below the nipple and the thumb as high as possible above the nipple.

  • Press inward toward the chest wall, then squeeze fingers together while pulling forward.

  • Move fingers to a new location around the areola and rotate until all the areas are “milked.”

  • Do not slide fingers on the skin; keep them firmly against the skin.




                                                                                                                  69
     General Pumping Guidelines
     For well or full term babies with latch problems

        • Maximum frequency for pumping is every 2 hours
        • Minimum frequency for pumping is each time baby is fed
        • Sometimes pumping right before a feeding can help with making the nipple “come out” then it is easier
         for the baby to grasp.
        • Pumping right before a feeding can help with “milk letdown.”
        • Remember to save all the colostrum or milk that pump to give to the baby; even drops are important.

     Baby in the Neonatal Intensive Care Unit
        • Initiate pumping as soon as possible, preferably within 6 hours of birth. Don’t wait until the next day.
        • Pump 8-12 times in a 24-hour period.
        • Pump at least 15 minutes on each breast, sometimes more, sometimes less.
        • Label with date, time and any medications you are taking.




     BREAST MILK AND STORAGE
     You will find many different guidelines for milk storage and usage. For well or term babies, freshly expressed
     milk is good at room temperature for 4-10 hours. Refrigerated breast milk is good for 5-7 days and frozen milk
     is good for 6-12 months. Thawed breast milk should not be stored and is good in the refrigerator for 24-hours.
     It should never be refrozen.

     Breast milk can be safely stored in glass, hard plastic containers or bags made specifically for storing breast
     milk. When using plastic containers, make sure they are BPA free. Be sure to leave about an inch of room at
     the top of each container for milk to expand if you are freezing it. When using bags, be sure to squeeze out
     the air before freezing. All containers should be labeled with the date and time collected and mom’s name if
     used in the hospital.



     BOT TLE FE E DI N G YO U R BABY
     If you choose to bottle feed your baby, the baby’s doctor will prescribe the type of formula for you to use.
     Bottles in the hospital are pre-sterilized and ready to use. There is no need to heat them. They can be given
     at room temperature. Use a fresh bottle and nipple for each feeding.

     Tips for Bottle Feeding
        • Hold the baby in a semi-upright position like you would if you were feeding from your breast.
        • Hold the bottle so the nipple and neck of the bottle are always full of liquid.
        • Burp your baby at least once during the feeding and once after the feeding.

     DO NOT REUSE ANY LEFTOVER FORMULA

     Your baby may spit up from time to time and the spit up may contain streaks of mucous. This is normal.
     If your baby continually spits up large amounts or if the spitting is forceful, notify your pediatrician.




70
FORMULA PREPARATION
Formula is available in 3 different forms:
   • Ready to feed (most expensive.) This is pre-measured, pre-mixed, pre-sterilized and ready to feed.

   • Concentrated liquid. This has to mixed 1 part concentrated liquid to 1 part water or as directed
    on the package.

   • Powder (least expensive.) This has to be mixed with water as directed on the package. You will need
    to shake the bottle until the powder is completely dissolved.

It is very important to follow the directions on the formula package when preparing the formula. If you don’t
follow the instructions, it could seriously affect the baby’s nutritional status and overall health.

   • Bottled formula should be refrigerated and used within 24 hours.

   • Have a punch can opener and mixing container you only use for formula.

   • To warm refrigerated bottles of formula, place the bottle in a bowl of warm water for a few minutes.
    Never microwave a bottle or place it in boiling water. “Hot pockets” can scald the baby.

   • The amount to use in the bottle is determined by the frequency of feedings and the size of your baby.
    Follow your pediatrician’s advice.

   • When pacifiers are used too often, they can cause baby not to feed as well. Pacifiers can also harbor
    germs. Boil them frequently, check for signs of wear and replace as necessary. (Always allow them
    to cool off after boiling before giving to baby.)

   • Tug on your bottle nipples to detect weak places or stickiness. Replace worn nipples immediately.

   • Once a bottle has been warmed, it needs to be fed to the baby within an hour.

   • Throw away leftover milk. It should never be saved for the next feeding.

Use a copy of the feeding journal/logs on the next few pages to record feeding and diaper changes. Begin
using these while in the hospital and continue after you go home for as long as you feel him necessary. These
can also be shared with your pediatrician.




                                                                                                                71
     FE E DI N G LOG
     Birth Date:____ /____ /____ Time:_______            AM        PM


      First 24 hours                                                                                          Goal
      12 1   2   3     4   5   6   7   8   9   10   11    12   1    2   3   4   5   6   7   8   9   10   11   8 to 12
     Wet diaper                        W       W         W         W        W                                   1
      Black tarry soiled diaper        S       S          S         S       S                                   1


      Second 24 hours                                                                                         Goal
      12 1   2   3     4   5   6   7   8   9   10   11    12   1    2   3   4   5   6   7   8   9   10   11   8 to 12
     Wet diaper                        W       W         W         W        W                                   2
     Brown tarry soiled diaper         S       S          S         S       S                                   2

     Third 24 hours                                                                                           Goal
     12 1    2   3     4   5   6   7   8   9   10   11    12   1    2   3   4   5   6   7   8   9   10   11   8 to 12
     Wet diaper                        W       W         W         W        W                                   3
     Green soiled diaper               S       S          S         S       S                                   3

     Fourth 24 hours                                                                                          Goal
     12 1    2   3     4   5   6   7   8   9   10   11   12    1    2   3   4   5   6   7   8   9   10   11   8 to 12
     Wet diaper                        W       W         W         W        W       W       W                   4
     Yellow soiled diaper              S       S          S         S       S       S       S                   3

     Fifth 24 hours                                                                                           Goal
     12 1    2   3     4   5   6   7   8   9   10   11   12    1    2   3   4   5   6   7   8   9   10   11   8 to 12
     Wet diaper                        W       W         W         W        W       W       W                   5
     Yellow soiled diaper              S       S          S         S       S       S       S                   3

     Sixth 24 hours                                                                                           Goal
     12 1    2   3     4   5   6   7   8   9   10   11   12    1    2   3   4   5   6   7   8   9   10   11   8 to 12
     Wet diaper                        W       W         W         W        W       W       W                  5+
     Yellow soiled diaper              S       S          S         S       S       S       S                  3+

     Seventh 24 hours                                                                                         Goal
     12 1    2   3     4   5   6   7   8   9   10   11   12    1    2   3   4   5   6   7   8   9   10   11   8 to 12
     Wet diaper                        W       W         W         W        W       W       W       W          5+
     Yellow soiled diaper              S       S          S         S       S       S       S       S          3+


     It is OK for your baby to nurse more than 12 times each day, and to have more wet or soiled diapers. You
     CAN’T nurse too often, but you CAN nurse too little. Please call your physician or pediatrician if you have
     fewer than the numbers on the log.




72
New Baby Care
     YO U R BABY FRO M h E AD TO TO E
     head
     A baby’s head can change shape during the birth process to allow it to fit through mom’s pelvis. This is called
     molding and is very normal. You do not need to do anything to change the shape of your baby’s head. It will
     return to its normal shape on its own in just a short time. Babies have soft spots called fontanels that allow
     for the brain and skull to grow. The largest soft spot can be felt on top of the baby’s head and may stay open
     until the baby is almost two years old. Your baby may have a lot of hair or hardly any hair at all; both are
     normal. Their scalps may be oily, especially the first few weeks after birth.

     Eyes
     Babies have dark slate blue or brownish eyes at birth. They are frequently red and swollen. To clean their
     eye area, use plain water and wipe from the inner side near the nose to the outer corner. If any redness or
     drainage occurs, let your baby’s doctor know.

     Babies love to look at faces—especially yours! They can focus very well about 18 inches from their face. They
     will often open their eyes more widely and look around in dimmer light. They love the contrast between the
     colors of black and white. Simple shapes that are black and white are great for their eyes to focus on and food
     for their growing brains.

     Nose
     Babies have a keen sense of smell. Sweet smells are their favorite. All moms have a sweet smell to their milk
     that babies can easily find. Since their mouths are so busy eating a lot of the time they mainly breathe through
     their noses. They will sneeze a lot; this is normal and their way of clearing their nose.

     Mouth
     Babies have a very strong need to suck on something either to eat or for comfort. A baby also has a very
     strong gag reflex. They do not cough or clear their throat like adults. A bulb syringe can be used to clear
     the baby’s nose or mouth of any mucous. The bulb should be squeezed and then placed in the side of their
     mouth to clear mucous from their mouth or squeezed and inserted just a slight bit into their nose to clear any
     mucous from their nose. Release the suction to collect the mucous then empty it into a tissue. Many babies
     will have a sucking callous or blister on their top lip; this will disappear on it is own.

     Ears
     Babies love the sound of your voice! To clean their ears, just use a washcloth; never put a cotton swab in their
     ear and only clean what you can see.

     Skin
     It is normal for a new baby to have very dry or peeling skin, especially on their hands and feet. This will usually
     clear on its own or you can ask your baby’s doctor about lotions you can use. A bumpy red rash may appear
     the first week. It is called newborn rash. This is normal and will go away on its own.

     Genitals
     Both boys and girls often have swollen genital areas at birth, which is normal. Baby girls may have a mucous
     discharge that is white or pinkish in color. It will disappear. Always wipe the diaper area from front to back.
     Use a different area of the washcloth or a new wipe each time you wipe downward. This will help prevent
     infection. Baby boys do not require any special care of the foreskin of the penis. Care of circumcision is
     discussed on pages 75-76.

74
TAK I N G C AR E O F BABY
CORD CARE
Use a cotton tip applicator, alcohol wipe or cotton ball to apply clear 70% rubbing alcohol to the umbilical
cord three times a day. Pay close attention to the bottom of the cord and make sure you swab this area as
well. There is no feeling in the cord so you will not hurt your baby. Fasten the diaper so the cord is not covered
and remains open to air. It will dry up and drop off in two to four weeks. Some babies may continue to have a
moist area at this site. Continue to clean the area three times a day with alcohol. A scab will form and when it
drops off the cord is healed. Usually the cord is completely healed in about four weeks.




CIRCUMCISION CARE
Circumcision is the surgical removal of the foreskin of the penis. This procedure is performed with permission
of the parents when the baby is about 24 hours old. Usually it is done in the hospital but can be done later in
the physician’s office.

what to Expect
There will be a small amount of bleeding during the first 12-24 hours. If you notice anything more than small
amounts, let your nurse or pediatrician know. There will be some swelling of the penis after the procedure,
which should go away during the first week. By the second day, a yellowish-white discharge may cover the
end of the penis. This discharge is normal and part of the healing process; do not try to wipe or wash it off.
It will clear up in 2-3 days. The circumcision usually heals in 7-10 days.

home Care of Circumcised Infant
   • If baby is circumcised the day of discharge, apply petroleum jelly and a gauze pad to the penis.

   • Do not wash the circumcision area for 24 hours unless soiled with stool. Avoid using soap during
    this time and be gentle when cleaning.

   • After the circumcision is 24 hours old, wash daily with mild soap and water and dry gently.
    It will no longer be necessary to use petroleum jelly or gauze.

   • Diaper baby as you would normally.

Observe For
   • Increased swelling. Swelling should not increase after the first day.

   • Discharge with a foul odor – notify your physician.

   • If bleeding is bright red and will not stop after applying pressure for a minute, notify your physician.

   • Baby’s voiding stream of urine should be high and arching. If baby doesn’t urinate for 24 hours
    after the procedure, call your pediatrician.




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     Plasti-Bell Circumcision
     Plastic rim usually drops off 5-8 days after circumcision.

        • No special dressing is needed.

        • Baby can be bathed and diapered as if he had not been circumcised.

        • Notify doctor if you notice unusual swelling, if the plastic rim has not fallen
         off within 8 days or if the ring slips.

     No Circumcision
        • Follow pediatrician’s orders for care of the penis.

        • The foreskin of a newborn will not be retractable (able to be
         pulled back). This protects him as long as he wears a diaper.
         The only cleaning required is to gently push the foreskin back at
         bath time to see if there is anything at the tip to clean. After
         cleaning, pull the foreskin forward. Your baby will probably be
         3-4 years old before the foreskin is fully retractable.




     BAThING
     Your baby will need to have sponge baths until the cord has fallen off and the circumcision has healed.
     Your pediatrician may have special instructions for you on bathing your baby, but here are some general
     things to know:

        • Room temperature for baby should be around 70-72 degrees or what is comfortable for you.

        • Get everything ready before you undress the baby. Lay some towels down for baby to lie
         on, and have a place that is comfortable for you to bathe the baby.

        • Have some warm water in a basin or bowl. Make sure the water is not too hot.

        • Use a mild soap. Babies have oily scalps so shampoo or soap on their head is okay to use.

        • Undress the baby and cover with a towel. Start with the face and clean the eyes,
         ears and face with a washcloth and plain water.

        • Pat them dry, then move to the neck. Clean in their folds and dry well.

        • You can put some soap on your hands and massage their arms, body, and legs and
         then rinse with water.

        • Gently roll them over and clean the back.

        • Clean the diaper area with a washcloth just like you would when changing a diaper.

        • Wrap your baby in a towel and hold the baby so you can wash the head. Tuck the baby
         close your body and rinse their head from front to back with your hands or use a small
         cup to pour water over their head to rinse. Cover them with a towel.

        • Dress your baby according to the season and according to what you are wearing.




76
NAIL CARE
Wait until the baby is at least two weeks old before cutting nails. The skin under the nail is very close and
easy to accidentally cut. Use baby scissors or gently use an emery board and only cut or file nails that have
separated or have sharp edges. Cutting your baby’s nails while he or she is asleep makes the job easier.
To prevent them from scratching themselves you can cover their hands with mittens, socks or their sleeves.



SLEEP
Sleep patterns are different for every baby. Usually, babies sleep a
large number of hours during the day and wake up at night to eat.
To try to help with sleep, make sure the baby is awakened for feeding
during the day. If the baby is asleep for more than four hours at a time
during daylight hours, try to wake up the baby and feed him or her.
Some ways to do to this are undressing the baby, changing the diaper
and bathing him or her. At night try to feed the baby before you go to
bed or put the baby right back in bed after a nighttime feeding. Try to
play with the baby only during the day.

Notify your pediatrician if your baby has any of the following signs:
   • Rectal temperature of 101 degrees or higher
   • Unusually lethargic or not as active as usual
   • Vomits (not just spits up)
   • Diarrhea or constipation
   • Unusual rash
   • Prolonged crying for more than two hours and can’t be consoled
   • Refuses to eat or has difficulty breathing
   • Redness, swelling, bleeding, drainage or odor from the umbilical cord or circumcision site




SLEEPING POSITION OF ThE BABY
The safest position for your baby is on its back in the infant crib unless your pediatrician tells you
otherwise. During awake times it is good for your baby to have some “tummy time” to practice raising
his or her head and shoulders.

You can lower the risk of SIDS (sudden infant death syndrome) by following these simple steps to create a
safe sleeping environment for your baby:

   • ALWAYS place your baby on its back to sleep for EVERY sleep time at naps and at night.

   • Use sleep clothing such as a one piece sleeper instead of a blanket.

   • Place your baby on a firm sleeping surface such as a safety approved crib mattress with a fitted sheet.
    Never place your baby to sleep on pillows, blankets, quilts, or sheepskins, and never use pillow-like crib
    bumpers in your baby’s sleep area. Keep all objects away from the baby’s face.

   • Do not allow smoking around your baby. If you smoke, it is important to try to quit, and don’t let others
    smoke around your baby.


                                                                                                                 77
        • Keep your baby’s sleep area close but separate from where you and others sleep. Your baby should not
         sleep in a bed, on a couch or armchair, nor should the baby sleep with adults or other children.

        • If you bring your baby into your bed to nurse or feed, put the baby back in its sleep area when finished.

        • Think about using a clean, dry pacifier when placing baby down to sleep, but don’t force the baby
         to take it. (If you are breastfeeding, wait until breastfeeding is well established before offering a pacifier.)

        • Don’t let baby overheat during sleep. Dress the baby in light sleep clothing and keep the room at a
         comfortable temperature.

        • Avoid products that claim to reduce the risk of SIDS because most have not been tested and proven
         to be effective or safe.

        • To reduce the chance of flat spots on your baby’s head, try to offer lots of tummy time when he or
         she is awake.

        • Some studies show that having a fan in the room to circulate air may also be helpful but be sure it is
         not blowing directly on the baby.

        • Whether you are in the hospital or at home, if you are holding your baby and become drowsy,
         place the baby in its crib. This will protect the baby from being accidentally dropped should
         you fall asleep.



     CRYING AND COMFORTING
     Crying is normal in a new baby. If crying is prolonged or lasts longer than 2 hours and the baby can’t be
     consoled, seek medical advice. Crying is one way a baby communicates that he or she is hungry, sleepy,
     lonesome, bored, sick, uncomfortable, wet, dirty, gassy, hot or cold.

     Some comforting techniques to try:

        • Swaddling
        • Walking
        • Rocking
        • Talking softly
        • Extra sucking
        • Body contact
        • Gentle motion
        • Massage
        • Music

     Some babies are fussier than others. When you are tired or frustrated,
     remember to ask for help. If you are alone, it is okay to put a crying
     baby in his or her crib and take a break. Never take your frustration out
     on your baby and NEVER SHAKE A BABY!




78
DIAPER ChANGES
Check your baby’s diaper regularly and change it when it is wet or dirty. Using plain warm water and a soft
washcloth is the best way to clean the diaper area, but baby wipes are okay, too.

Diaper Rash – If your baby has a diaper rash, the two best things you can do are allow more air exposure to
the diaper area and change baby’s diapers frequently. Your pediatrician can also recommend an ointment if
these measures don’t help.




TAKING BABY’S TEMPERATURE
You should have a thermometer on hand to use when the baby is sick or has a fever. An inexpensive digital
thermometer is best. Be sure to use the disposable plastic cover when taking a rectal temperature.

Rectal Temperature – Lubricate thermometer tip with petroleum jelly or personal lubricant and insert no
more than one inch into the rectum. Hold the thermometer steady until the reading is finished. Normal rectal
temperature is 99.6 degrees.

Axiliary Temperature – No lubrication is needed. Place at armpit with clothing out of the way and hold the
arm down firmly so no air can get to the area. Hold the thermometer steady until the reading is finished.
Normal axiliary temperature is 97.6 degrees.




jAUNDICE
Jaundice is a common and usually harmless condition in newborn infants. The word jaundice means yellow
and describes the yellowish appearance of the whites of the eyes and skin. Jaundice can occur because the
baby’s liver is not yet mature and one function of the liver is to cleanse the body of a yellowish substance
called bilirubin. If the bilirubin doesn’t builds up in the bloodstream, it can cause the baby’s skin and whites of
their eyes to turn yellow.

Jaundice can occur from 24 hours to three weeks after birth. In some cases jaundice can be caused by
breastfeeding. Your pediatrician may ask you to temporarily stop breastfeeding or supplement with formula
after nursing. Lactation specialists can assist you with pumping your milk so you can maintain your milk
supply for later.

If you notice any of the following symptoms, notify your pediatrician immediately

   • Jaundice, or darkening of jaundice already present
   • Increased sleepiness
   • High-pitched cry
   • Poor sucking
   • Vomiting
   • Dark urine or light-colored stools
   • Weakness, floppiness, arching of the body like a bow or fever higher than 100 degrees

Whether or not jaundice requires treatment depends on the bilirubin levels.




                                                                                                                      79
     TIPS FOR BABY CARE
        • Room temperature for babies should be between 68 and 72 degrees in the summer and winter.

        • The amount of covering that makes you comfortable is right for your baby — no heavy blankets
         and lighter layers are best.

        • Always use an approved infant car seat for every car ride, including the ride home.

        • If you use a play yard or play pen, always make sure the sides are up. Keep the area free of
         pillows, stuffed animals or heavy, thick bedding while baby is sleeping.

        • Do not allow anyone with a cold or infection to come in contact with your baby.

        • Anyone touching the baby should practice good hand washing.

        • Baby skin care products are not necessary. Check with your pediatrician for
         specific skin care instructions.




     NEwBORN SCREENINGS
     METABOLIC SCREENING
     All states require that every newborn be tested before being discharged from the hospital. This testing is
     done to see if the baby has any rare, but treatable body chemistry disorders. Babies with these disorders can
     appear completely normal at birth. However, if they aren’t diagnosed and treated they can become very sick,
     mentally challenged or even die. If a disorder is found, early treatment can lessen or prevent these problems.
     These tests are done when the baby is 24 hours old and are sent out of town for analysis. The results will be
     sent to your pediatrician, and you will be notified if further testing is necessary.




     INFANT hEARING SCREENS
     A hearing screening is performed on all babies before they are discharged from the hospital. The test is
     harmless to your baby and generally takes about 15-30 minutes depending on your baby and if he or she is
     quiet or crying and fussy. The screenings are performed by a technician in the nursery. You will be told if your
     baby passed or is being referred for additional testing.




80
C A R S E AT S A F E T Y
Each year hundreds of children are killed in motor vehicle crashes because they are not riding in a correctly
installed child safety seat. Your child should be in an approved child safety seat every time he or she rides in
the car, even for short distances. Exact laws are different from state to state but some basics are:

   • Children up to age 1 AND 20 pounds or less must ride in a
    rear-facing infant safety seat (Some rear facing seats go up
    to 35 pounds. Follow your specific seat’s weight
    recommendations for the safest ride for your child.)

   • Children ages 1-3 AND weighing more than 20 pounds
    must be in a forward-facing seat in the rear seat of the
    car if a rear seat is available.

   • Children 4-8 years old who are less than five feet must be
    in a belt-positioning booster seat in the rear seat of the car.
    This provision applies until children are age 9 OR 4’ 9” tall
    whichever comes first.

   • Children ages 9-12 and taller than five feet must be restrained
    by a seatbelt. These children must remain in the rear seat.

Other things to remember

   • The rear facing seat should be reclined at a 45 degree angle so the baby can breathe properly.

   • The harness should fit snugly with no slack coming from the slots at or below the shoulders.

   • The seat should be in the rear (back) seat, preferably in the center position.

   • Rolled blankets can be used to position baby’s head if needed. Do not purchase or
    buy additional equipment to use in your seat. Use only the equipment that comes with the seat.

   • No bulky clothing or blankets; put baby in the seat then cover with blankets. The straps need
    to be next to the baby.

   • Harness clips should be at the level of the baby’s armpits if it is a chest clip.

   • Put carry handle down or behind the seat while baby is riding in the car.

   • Seat should face the rear of the car. Fasten with a seat belt or LATCH belt if your vehicle has one.
    The seat should be tight; there should be no more than one inch of movement from front to back
    or side to side where the belt passes through.




                                                                                                                   81
N OTE S
Glossary
     Abruptio placenta – Premature separation of the placenta from the uterine wall prior to delivery of the baby

     AFP – Blood test to screen for neural tube defect or Down’s syndrome

     Amniocentesis – Withdrawal of amniotic fluid through the abdominal and uterine walls for the purpose of
     evaluating the fetus for health status, maturity or genetic studies

     Amniotic fluid – Fluid surrounding the baby in the uterus. It helps support the baby, permits free movement of
     the baby, prevents heat loss and acts as a shock absorber.

     Amniotomy – Artificial rupture of the bag of waters (amniotic membranes.) This is a sterile procedure done by
     the physician using an amnihook.

     Apgar score – Score or rating given to the newborn at one and five minutes after birth that measures color,
     cry, muscle tone, respirations, and reflexes. The baby is given 0 to 2 points in each category.

     Biophysical Profie – A prenatal test to evaluate fetal well being. This test assesses various parameters
     including: 1.) fetal breathing movements 2.) fetal movements 3.) fetal tone 4.) quantitative amniotic fluid
     volume 5.) fetal heart rate reactivity during a non-stress test.

     Bonding – Period immediately following delivery when parents and baby begin to become acquainted. A time
     when parents can touch and caress their new baby.

     Breast engorgement – Congestion and swelling of the breasts as milk comes in

     Breech presentation – Baby presenting itself in the birth canal with either buttocks or feet first

     Caesarean section – Delivery of the baby by incisions through the abdominal wall and uterus

     Centimeters – Unit of measurement used to describe cervical dilation

     Cephalo-Pelvac-Disproportion (CPD) – Condition when the baby’s head cannot fit through the mother’s
     pelvis due to the structure of the pelvis or size and position of the baby’s head

     Cervix – Neck of the uterus that opens into the vagina. The cervix effaces and dilates to allow passage
     of the fetus.

     Circumcision – Surgical removal of the foreskin of the penis

     Cleansing breath – A deep, audible breath taken in through the nose and blown out through the mouth at the
     beginning and end of each contraction

     Colostrum – Forerunner of breast milk. Creamy, yellowish fluid secreted from the breasts, beginning during
     pregnancy and continuing for 2 to 3 days following delivery. Provides protein and antibodies for some
     immune properties

     Contraction – Tightening of the uterine muscle. Labor contractions cause dilation of the cervix, descent and
     expulsion of the fetus.

     Crowning – Appearance of the baby’s presenting part at the vaginal opening

     Dilation – Opening of the cervix during labor; measured in centimeters




84
Doppler Studies – A technique used for fetal evaluation. Its purpose is to assess blood flow in the umbilical
artery or uterine arteries.

Effacement – Thinning of the cervix. May occur prior to or during labor. Measured in percentages with 100
percent being completely effaced

Effleurage – The long, gliding introductory Swedish massage stroke

Engagement – Descent of the fetal head or presenting part of the fetus into the pelvis to the level of the
ischial spines

Epidural – Regional type of anesthesia used for labor and delivery. Anesthetic agents are injected, as needed,
into the lumbar epidural space.

Episiotomy – Surgical incision of the perineum to enlarge the vaginal opening

FhT or FhR – Fetal heart tones or rate; first heard at about 12 to 14 weeks gestation. The normal rate is 120 to
160 beats a minute.

Foley catheter – Tube inserted into the bladder connected to a drainage bag for continual collection of urine

Fontanels (soft spot) – Areas of the newborn’s skull that have not yet fused together

Forceps – Spoon-like obstetrical instruments used by the physician to aid in the delivery of the baby’s head

Gestation – Period of intrauterine development from conception to birth; measured in weeks. Forty weeks is
full or term gestation.

Glucose Tolerance Test – Blood sugar test to screen patients for diabetes. During pregnancy, this is usually
done to screen for gestational diabetes.

hyperventilation – Oxygen/carbon dioxide imbalance as a result of breathing too rapidly and too deeply.
Symptoms are nausea, dizziness and tingling.

Imagery – Imagination; mental pictures of persons, places or situations

Kegel exercise – Contraction and relaxation of the perineal muscles. Aids in strengthening the pelvic floor

Lanugo – Fine, downy hair covering the body of the fetus

Ligament – A band or sheet of strong fibrous connective tissue. Connects structures for support or to aid or
limit motion

Lightening – Descent of the uterus and the baby into the pelvis

Lochia – Vaginal discharge of blood, mucus and tissue from the uterus during the six-week
period following delivery

Membranes – Bag of waters surrounding the fetus, filled with fluid

Milia – Small, white spots, usually on the baby’s face, which will disappear within a few weeks

Mucous plug – Plug of heavy mucous that blocks the cervix during pregnancy and prohibits bacteria from
entering the uterus


                                                                                                                   85
     Non-stress test – A test to measure the response of the baby’s fetal heart rate to fetal activity

     Oxytocin (Pitocin) – A hormone used prior to delivery for antepartal testing and to induce or augment labor.
     Used following delivery of the placenta to promote contraction of the uterus and to help control bleeding

     Perineum – Area between the vagina and rectum

     Peritoneum – Inner lining of abdominal cavity

     Petrissage – The Swedish massage stroke moving muscle over bone. It is also known as kneading and is
     responsible for increasing muscle tone.

     Placenta – Flat, circular organ in the pregnant uterus that serves as the exchange station between mother and
     fetus for oxygenation, nourishment, and elimination of waste. Also referred to as the afterbirth

     Placenta previa – Implantation of the placenta in the lower uterine segment. May completely or partially cover
     the cervical opening

     Post partum – The six weeks following delivery

     Precipitate delivery – A labor and delivery that takes less than three hours to complete

     Presentation – The part of the fetus closest to the cervical opening

     Primigravida – Woman pregnant for the first time

     Primipara – Woman giving birth to her first child

     Relaxation – A lessening or release of tension from the body

     RhoGam – Immune globulin given to RH negative mothers to prevent sensitization that may occur when the
     infant is RH positive

     Scalp electrode – A device attached directly to the baby’s scalp for internal monitoring. It receives the
     electrical impulses of the heart and provides direct information.

     Show – Blood-tinged mucous caused by capillary breakage as the cervix effaces and dilates. It may occur
     before or during labor. Also referred to as “pink show” or “bloody show.”

     Station – Position of the baby’s presenting part in relation to the ischial spines or the mother’s pelvis

     Stork Bites – The lay term for areas of collected superficial capillaries often located on the neck, eyelids, or
     nose of the newborn. Those disappear by one year of age.

     Transition – The phase of labor in which the cervix dilates from 8 to 10 centimeters. Many different signs and
     symptoms are characteristic of this phase.

     Ultrasound – Diagnostic technique using sound waves to reveal information regarding size, development,
     position of the fetus, and location of the placenta

     Umbilical cord – Cord connecting the fetus to the placenta. Contains three blood vessels that provide oxygen
     and nutrients to the fetus. Also referred to as the baby’s lifeline.




86
Urge to push – Sensation of tremendous pressure in the rectum due to descent of the baby
through the birth canal

Uterus – Pear-shaped, muscular organ that encloses the fetus, placenta and amniotic fluid. Also referred to as
the womb

Vacuum Extraction – Delivery method involving the attachment of a vacuum cup to aid in the delivery of the
fetal head

Vena-cava syndrome – Condition caused by compression of major blood vessels by the pregnant uterus when
a woman is lying on her back. Symptoms often include a drop in blood pressure, dizziness, light-headedness,
and/or nausea.

Vernix caseosa – A lotion-like, creamy white substance that protects the baby’s skin from the long exposure
to the amniotic fluid

Vertex – Top or crown of the baby’s head; most common presentation

Visualization – Ability to use visual images through suggestion to change a mental and/or physiological state




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