Healthy Mom&Baby: Issue 33 by Magazine

ISSUE 33 / 2022 | $3.95 | health4mom.org

PREGNANCY | BIRTH | PARENTING

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Issue 33 / 2022

Contents ◆ healthy moms

◆ healthy pregnancy

◆ healthy babies

11 Respectful Maternity Care

27 Environmental Toxins: Their Eﬀects on Your Health, and that of Your Developing Baby

44 Hepatitis B Vaccine at Birth: What’s the Rush?

Pick the pregnancy provider that suits you best.

15 Pregnancy & Birth at Age 35 and Older Starting a family in your 30s is now far more common than it used to be.

28 Pregnancy Myths—BUSTED! Everyone has advice for you; here’s how to determine what’s true, or not.

16 Birth Control Options

Educate yourself on the wide variety of birth control options and select what you think is best for you.

31 Healthy Summer Treats and Tips for Expectant and New Moms

19 How to Get Help for Postpartum Anxiety and Depression

From smoothies to salads, here are ways to indulge those pregnancy cravings.

34 Managing Anemia and LowIron in Pregnancy

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Don’t worry mama, you are never alone in your postpartum journey.

Your healthcare provider may ask you to take an iron supplement.

21 Lines, Pigment and Stretch Marks

Embracing and pampering your changing body throughout pregnancy is essential care for all moms.

23 How Weight Loss Surgery Can Aﬀect Your Fertility & Chances of Conceiving

From cosmetics to cleaning products, help protect your baby’s health.

36 Placenta Wisdom, Rituals and Traditions—Know Your Placenta’s Worth!

48 Tips for Traveling with Tots Keep your little one happy while traveling with these helpful tips.

49 Baby Proof Your Child’s World Through Age 2

This checklist will help you create a safe and secure environment for your baby.

51 Diapering That Nurtures Your Baby

Develop a blossoming relationship with your baby during diapering.

38 How to Cope with Morning Sickness

56 Pediatricians Update Safe Infant Sleep Guidelines

40 Pain Relief in Labor

58 Read to Your Baby

Everything seems to be swelling; learn what’s normal and what’s not.

There are a range of options you can take to improve your experience in labor.

Lines, Pigment and Stretch Marks

How Weight Loss Surgery Can Aﬀect Your Fertility & Chances of Conceiving

Stay sun safe and skin-protected with these tips when exploring the great outdoors.

37 Swelling in Pregnancy

We’ve got suggestions when it comes to coping with this common discomfort.

47 Essentials for a Safe Summer

54 Get Ready for Breastfeeding & Pumping Breastmilk at Work

Explore the rituals and reasons this organ is vital to your baby’s health.

Considering weight loss surgery to boost your fertility? Here’s what you need to know, and how long you need to wait to conceive.

The facts about Hepatitis B and why your baby needs the vaccine following birth.

Know the law and your rights when pumping breast milk at your workplace.

Maximize the safety of your baby each time they sleep. Boost baby’s brain with these bookish tips before and after birth.

Hepatitis B Vaccine at Birth: What’s the Rush?

Pregnancy Myths— BUSTED!

How to Cope with Morning Sickness

58 Read to Your Baby

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◆ HEALTHY MOM&BABY

EDITORIAL ADVISORY BOARD LASHEA HAYNES MED, MSN, APRN, AGCNS-BC, RNC,C-EFM Editor Perinatal Potpourri, LLC Nurse Mentoring & Consulting Atlanta, Georgia PARIS MALOOF-BURY, MSN, CNM, RNCOB, IBCLC Associate Editor Sutter Women’s Health Davis, California

AWHONN’s mission is to improve and promote the health of women and babies. Healthy Mom&Baby is powered by the nurses of AWHONN.

Will You Go the Full 40 Weeks of Pregnancy? By Sandra Cesario, PhD, MS, RNC, FAAN

JAMIE VINCENT, MSN, APRN-CNS, RNCOB, C-EFM, C-ONQS John Muir Health Walnut Creek, California JOANNE GOLDBORT, PHD, RN Michigan State University College of NursingEast Lansing, Michigan ALIAH THOMAS, RNC-OB Wellstar Health System Atlanta, Georgia ESSENCE WILLIAMS, MSN, BSN, RNCMNN, CCB, LCCE Southern New Jersey Perinatal Cooperative (SNJPC) Crum Lynne, Pennsylvania KIMBER STOVESAND, RN Nomad Health Charlotte, North Carolina LAKISA BALLARD, MSN, RN, C-EFM, RNC-OB Holy Cross Hospital Silver Spring, MD SHAWANA S. MOORE, DNP, MSN, CRNP, WHNP-BC Thomas Jeﬀerson University, College of Nursing Philadelphia, PA RACHEL NAPOLI, DNP, PHN, CNS, RNCOB, IBCLC Sonoma State University Petaluma, CA JESSICA MCNEIL, DNP, APRN, CNM, RNCOB, C-EFM Parkland Health & Hospital System Baylor University, School of Nursing Dallas, TX HEATHER WATSON, PHD, MSN, RN Johns Hopkins Health System Baltimore, MD

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DANIELLE BEASLEY, PHD, RN, RNC-OB, CNE University of South Florida Tampa, FL CHARLOTTE WOOL, PHD, RN, FAAN York College of Pennsylvania York, PA SHARON HITCHCOCK, DNP, RNC-MNN University of Arizona College of Nursing Tucson, Arizona

Are you considering scheduling your baby’s birth? Do you have friends who have asked for inductions to help with busy family schedules? Perhaps you’ve also heard that inductions can lead to increased complications and even cesarean birth. The fact is, when all is going well, waiting for labor to start by itself has deﬁnite advantages for you and your baby. Your baby has their own pregnancy timetable. Experts know that when labor starts on its own it’s because baby signals your body that they’re ready to be born.

Prep for Labor It may feel like not much is happening during those last weeks before labor, but your body and your baby are both busy preparing for birth. The opening of your uterus (cervix) is softening and thinning and baby’s head is moving toward the birth canal. Your uterine muscle ﬁbers are just waiting to respond to the hormone oxytocin, which your body will naturally release to start labor contractions. Experts know that when labor starts

on its own, it tends to naturally progress smoothly and result in a normal birth. On the other hand, labor that starts via an induction can take longer and be more painful as the medication intensiﬁes contractions. You’re also at greater risk for needing cesarean surgery if your labor is induced.

Baby is Busy, Too During this time, baby is also hard at work, growing and maturing and storing a unique fat that will help them keep warm in the first weeks of life. During weeks 36 to 41 (your estimated due date is when you finish 40 weeks), you transfer large amounts of infectionfighting antibodies to baby across the placenta. This immuno-boost helps baby fight off colds, flu and diarrhea at birth and beyond. The nurses who will care for you during your baby’s labor and birth encourage you to consider waiting for labor to start on its own when all is healthy with your pregnancy. Nurses have 40 reasons why you should wait for labor to start on its own at GoTheFull40.com.

SANDRA CESARIO, PHD MS, RNC, FAAN, is a professor and PhD program director in the College of Nursing at Texas Woman’s University in Houston, TX, and the AWHONN 2022 President.

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Nobody likes to be rushed, especially babies. Your baby needs at least a full 40 weeks of pregnancy to grow and develop. Inducing labor even a week or two early is associated with a host of risks, including prematurity, cesarean surgery, hemorrhage and infection. While it may seem convenient for you or your health care provider, labor should only be induced for medical reasons. Your baby will let you know when she’s ready to come out, so give her all the time she needs: at least the full 40 weeks.

Download a free copy of

40 Reasons to Go the Full 40 at www.gothefull40.com.

The nurses of AWHONN remind you not to rush your baby—give her at least a full 40 weeks!

AWHONN PROMO T I NG T H E H E A LT H OF WOMEN A ND NE W BOR NS

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◆ Improving Maternal Outcomes:

We are in this Together!

By LaShea Haynes MEd, MSN, APRN, AGCNS-BC, RNC, C-EFM

AWHONN AWHONN 2022 President

Sandra Cesario, PhD, MS, RNC, FAAN Chief Executive Oﬃcer

Jonathan Webb, MPH, MBA Senior Vice President, Strategic Partnerships, Communications & Meetings

Billie Robinson, MBA, CAE Senior Director, Strategic Partnerships & Publications

Carolyn Davis Cockey, MLS, LCCE Editor in Chief

LaShea Haynes MEd, MSN, APRN, AGCNS-BC, RNC,C-EFM Associate Editor

Paris Maloof-Bury, MSN, CNM, RNC-OB, IBCLC Assistant Managing Editor

Soﬁa Navard MAITLAND WARNE Group CEO & Publisher

Kevin Harrington Sub Editor

Emmanuel Berhanu Design

Joanna Harrington Production

Delicia Tasinda Cover image

Healthy Mom&Baby is published by Maitland Warne in partnership with AWHONN. © AWHONN, 2022. All rights reserved. All material in Healthy Mom&Baby is wholly copyright. Reproduction without the written permission of AWHONN is strictly forbidden. Neither this magazine nor its contents constitute an explicit or implied endorsement by AWHONN or by Maitland Warne of the products or services mentioned in advertising or editorial content. The editorial content in this publication does not necessarily represent policies or recommendations by AWHONN. This publication is not intended to be exhaustive. While every eﬀort has been made to ensure accuracy, neither AWHONN nor Maitland Warne shall have any liability for any errors or omissions. Readers who may have questions should consult their healthcare provider.

I hope you are all having the sunniest summer ever! After our time in this world was plagued by COVID and sheltering in place, I hope you are now getting some much-needed sunshine and vitamin D. This edition of Healthy Mom&Baby is full of tips, information and timely suggestions for you and your growing family. If you have friends and family who are pregnant, share this issue with them too! We have so much important information about how to combat morning sickness, anemia in pregnancy, tackling stretch marks right away and even dispelling pregnancy myths. So once again, we will not disappoint you and this edition will keep you engaged from cover to cover. Remember for the longer version of our articles, or for more content on your favorite pregnancy, birth, parenting, and breastfeeding topics, go to our mobile-friendly website, www.health4mom.org. Did you know that you can access the full website from your mobile just by saving it to your screen? It’s device-responsive so you will have all our articles at your ﬁngertips no matter where you are. And please follow us on Facebook and Instagram as well for news, updates, and live discussions on your favorite topics. I want to extend my thanks for supporting our magazine and send a special hello from our amazing nurse experts on our editorial advisory board. They have really outdone themselves with these articles that are sure to keep you engaged and supported in your journey of pregnancy, motherhood and the ﬁrst few years of parenthood. Take comfort in knowing our articles are evidence-based and written by the educated, professional and passionate nurses of AWHONN. Stay safe and enjoy the rest of your summer! Yours Truly,

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PUBLISHER

MAITLAND WARNE 29 East Madison Street, Suite 809, Chicago, IL 60602, USA Tel: (312) 572 7729 www.maitlandwarne.com

LaShea

LaShea Haynes, MEd, MSN, APRN, AGCNS-BC, RNC, C-EFM

Editor in Chief, Healthy Mom&Baby

EDITORIAL INQUIRIES

AWHONN Soﬁa Navard snavard@awhonn.org www.AWHONN.org

ISSUE 33 / 2022

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Moms & Dads Share Same Fears

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Best COVID-19 Vaccine Timing During Pregnancy Not sure if you should be vaccinated against COVID-19 in pregnancy? Research from the CDC and several studies shows the protective effects of vaccination for both mom and baby. And because pregnant persons and newborns can face increased risks of developing more severe cases of COVID-19 following infection by the virus, researchers are encouraging women trying to conceive or who are pregnant to get vaccinated. Comparing maternal antibody responses in both mom and her newborn, researchers from Massachusetts General Hospital and Brigham and Women’s Hospital published advice that can help moms along with their healthcare providers make the best vaccine choices, with an emphasis on vaccinating early in pregnancy and including a booster as needed in the third trimester. “Our goal was to compare maternal antibody responses and transplacental transfer of antibody to the neonate with vaccination across all three trimesters of pregnancy, and across different vaccine platforms (Moderna, Pfizer, and Johnson & Johnson),” said co–senior author Andrea Edlow, MD, MSc, a maternal-fetal medicine specialist. As suspected, mRNA vaccine-induced antibodies had higher levels and function against SARS-CoV-2 variants such as Alpha, Beta, Delta, and Gamma. Vaccineinduced antibodies also neutralized the Omicron variant. Vaccination in the first and third trimesters led to the strongest maternal immune responses for mom, and the transfer of SARS-CoV-2 antibodies was greatest with the first and second trimester vaccines. The data supports the initial vaccine series early in pregnancy if mom is not yet vaccinated, with possible boosting later in pregnancy to optimize protective antibody titers for both mother and neonate,” says co-senior author Galit Alter, PhD, a professor of Medicine at Harvard Medical School. The study was published in the journal, Nature Communications.

If you’re a first-time mom, your partner is just as likely concerned as you are about your ability to have a healthy birth, a good recovery and to begin effectively parenting. These fears are quite common among all parents, especially with a first pregnancy, according to research in the journal, Nursing Reports. Top ranking parenting fears include: h Whether mom or their partner would be a good parent h How to care for a new baby h If mom could successfully nurse her newborn Financial issues rounded out common new parenting fears, including whether there would be enough money to raise a newborn, resume careers and have adequate and safe housing, as well as family health, personal wellbeing, relationship/support with their partner and the demands of infant care. The good news, perhaps, is that the intensity of the concerns related to returning to work and overall family health is from the third month to the sixth month after giving birth.

ISSUE 33 / 2022

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Respectful Maternity Care:

Strategies for Choosing Your Pregnancy Provider for Best Care & Outcomes

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By Swiyyah Muhammad, MSN, CNM, and Mandesa Smith, DNP, CNM

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icking your healthcare provider is much more than just choosing a midwife or an obstetrician— when, where and how you want to birth your baby are important factors.

Philosophy & Model of Care When selecting a provider, question the provider’s or practice’s philosophy of care to see if it is how you want to receive care. Is it a large practice where clients wait significant time to be seen, to then spend only 10 minutes with their provider? Is it a smaller boutique practice where clients can take up to an hour for their initial visit and have at least 30 minutes at return visits with a provider? Question what additional services the practice has to support you through pregnancy, labor, birth and recovery. Do they provide birthing, postpartum, newborn, and lactation education? Do they offer group prenatal care visits, like the Centering Pregnancy program, to boost education during pregnancy and access to pregnant peers? Do they offer maternal mental health services, or do they refer to other practices?

Run the Numbers Statistics are important; ask about the following: h Induction rates and timing of inductions. For example, does your provider schedule post-term inductions at 40, 41, or 42 weeks? h What is the provider’s cesarean birth rate? The national primary cesarean section rate is around 31%, with a goal to decrease it to 23.6%. The lower their rate the more likely your baby will have a vaginal birth h What are the breastfeeding rates of the facility where you will birth? “Baby friendly” designated hospitals have trained breastfeeding support staff

Maternal Healthcare Crisis The U.S. may be one of the most developed countries in the world,

but it has one of the highest rates of maternal death among American women within 12 months of birthing. Black and Indigenous women die during the postpartum year at rates up to 4 times more than birthing moms of other races or ethnicities. Ask your provider: h What practice changes have you made to reduce the maternal healthcare crisis? h What specific actions does your practice take to improve the outcomes for Black and Indigenous birthing persons? h Will they welcome a doula at your labor and birth for additional advocacy and support? SWIYYAH MUHAMMAD, MSN, CNM, AND MANDESA SMITH, DNP, CNM are Certified Nurse Midwives and co-owners of M&S Maternity Solutions, LLC, a healthcare consulting agency that provides healthcare organizations with resources to decrease the maternal mortality rate and improve obstetric outcomes.

Consider the type of practice your ideal provider is affiliated with. Is it a solo-practice, physician-led practice, midwifery-led practice, or a collaborative practice? OB/GYNs are surgeons who take a medical approach to your care. Midwives are primary care providers who support pregnancy as a normal state of health and give care based on an individual’s needs. If the practice has multiple providers, are patients assigned to each provider, or do you see all the providers? How are urgent problems handled? Who will attend your birth? Do they have a shared call rotation? If so, you may have built a relationship with a provider throughout pregnancy only to have an unfamiliar provider attend the birth.

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Type of Practice

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How Can I Promote Healthy Milk Supply? Do you find yourself increasingly frustrated as your little one fusses and cries during feedings? How about that unfulfilled sensation when pumping ... with minimal results? Here’s a comforting thought: Moms are created to naturally feed their offspring and keep them satisfied. Some tips for stress alleviation as you navigate one of the most gratifying journeys of Motherhood: Keep calm. Happy Mom, contented Baby. Mom’s anxiety can make baby fidgety and that can inhibit letdown — especially when pumping. Reduce distraction. Environment essential for successful nursing experience. If at all possible, aim for a designated nursing/pumping area, with everything you’ll need near at hand. Suggested items to keep at your nursing chair: Phone charger, water, nursing pillow, lanolin, spare burp cloths... Tip for pumping: Help stimulate letdown by watching a slide show of your little one and keeping baby’s scent nearby (burp cloth or such). Mom’s diet plays huge role in milk supply. Certain herbs (mint, sage) weaken supply. Other foods are known to boost supply (avocado, brown rice). With all that, who’s not looking for a quick snack to boost energy and supply… Mommy’s Cookie Jar cookies don’t merely taste great but contain the finest quality of key ingredients known to augment Mom’s milk supply. These include brewer’s yeast, flaxseed and oats. The New Mom Starter Kit comes with a variety of flavors, such as white chip cranberry and mocha chip, conveniently sealed in packs of two to grab and go.

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Pregnancy & Birth at Age 35 and Older By Lakisa Ballard, RN, MSN, C-EFM, RNC-OB

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f you’re in your late thirties and desire children, know that you’re not alone. Many women are waiting to have children until later in life these days. The recommendation to have children before age 35 is not only heard from our healthcare providers, but sometimes from friends and family as well. This is an ongoing topic, and much of it has to do with your overall health and ability to conceive. Discussing your plans with a pregnancy care provider such as a midwife, OB-GYN or fertility specialist is always a best ﬁrst step when desiring to become pregnant. Having a clear understanding of your overall health and goals will help to jumpstart your journey. Be honest and give accurate information and be open to the diﬀerent screenings and tests that give you and your provider the best baseline assessment of your overall health. Many experts would consider pregnancy at age 35 or older as “advanced maternal age,” and as such, you’re considered at higher risk for developing certain complications or conditions that could impact you or your growing baby. Your provider will

describe and address these challenges and give you and your partner the information and education you need to go forward with conﬁdence and understanding about their recommendations for your journey.

Pregnancy At 35 & Older: Preconception Counseling Everyone’s journey is diﬀerent and your health status before pregnancy is a determining factor of a successful pregnancy. We recommend preconception counseling for the healthiest possible start in pregnancy. This may include collaborating with a healthcare team to help manage any preexisting conditions, such as elevated blood sugar or elevated blood pressure. One important health factor, especially for women in their mid-30s and older, is weight at the time of conception. A high BMI can increase the risk for complications such as high blood pressure and diabetes, which are linked to potential premature birth and a potential complicated delivery. Make sure that you and your partner are clear about your goals for your growing family. Bring your partner with you to your appointment. This will allow for clear communication

between the two of you and your provider. This also gives your provider a chance to address any fertility issues related to sperm count. If conception is a challenge, your partner may also need a medical evaluation. All these diagnostic tools help to create a clear picture of next steps in your conception journey. Remember, many women older than thirty-ﬁ ve are having children. Accurate information and a clear understanding of your goals will help guide you. Stay positive while learning about the tools you need to be successful. Consider joining a support group for motivation and resources. You’re counted in, not out! Know your health status and take care of yourself holistically before you begin your conception journey. A healthier lifestyle is a good kickoﬀ to fertility health. Cheers to your growing family! LAKISA BALLARD, RN, MSN, C-EFM, RNC-OB is a Clinical Practice Specialist who specializes in perinatal nursing. She has worked in many high-risk facilities around the country, and has a passion for educating our future nurses in obstetrics. She is a researcher, highly adaptable in every changing situation, and an advocate for innovation that helps to improve patient outcomes. Lakisa’s diverse clinical background contributes to her holistic approach to patient care and versatile teaching methods.

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Birth Control Options By Jessica McNeil, DNP, APRN, CNM, RNC-OB, C-EFM

control methods can be used to treat a variety of other health conditions. It can be easier to understand birth control methods when we categorize them by how long they last, what (if any) hormones they contain, and how they’re used.

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hoosing a birth control method can seem overwhelming. From pills to IUDs, there are several different types to choose from to meet your lifestyle, health, and personal needs. While we most often think of birth control only in the context of preventing pregnancy, many birth

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healthy moms Hormonal Long-Acting Birth Control Methods Hormonal long-term birth control methods are often referred to as long-acting, reversible contraception (LARC). All the hormonal LARCs contain the hormone progesterone only, making them a safe option for those who are unable to use birth control methods that contain estrogen. One particular benefit of these types of birth control methods are that they are very effective and convenient for those that have a busy lifestyle or have difficulty remembering to take a pill. Intrauterine devices (IUDs) are inserted through the cervix and into the uterus. The Mirena IUD can be left in up to 7 years, the Liletta can be left in for up to 6 years, and the Skyla IUD can be left in for up to 3 years. The Nexplanon is implanted in your arm and can be left in for up to 3 years. Some of the benefits of the hormonal IUDs and the Nexplanon are that they are greater than 99% effective, and you can achieve a pregnancy immediately after removing them, allowing greater control over when you conceive. Depo-Provera (often referred to as the “depo shot”) is a long-acting birth control method in which the user gets an injection every 13 weeks. It’s 96-99% effective, depending on whether you get your injection on time! Unlike IUDs and Nexplanon, it’s not quickly reversible, so you need to wait for the shot to wear off before trying to conceive. Side effects typically include spotting or “breakthrough bleeding” between periods. With time, many women find that they have significantly lighter and shorter periods after a few months of use, and some women experience no period at all. In addition, the Mirena can be an effective treatment option for women who suffer from heavy bleeding.

Non-Hormonal LongActing Birth Control Methods For those who prefer a highly effective birth-control method that contains no hormones, the copper IUD is available. The copper IUD is over 99% effective, can be left in for up to 10 years, and like the other IUDs and the Nexplanon—a pregnancy can be achieved the day it’s removed. Side effects include heavier periods and cramping.

Rings, Patches, and Pills Rings, patches, and pills are shortacting birth control methods that are used monthly, weekly, or daily. They contain both the hormones estrogen and progesterone and are considered combined hormonal contraceptives. Depending on their use, these methods are 91-98% effective. There are two types of rings: NuvaRing and Anovera. The NuvaRing requires a fresh ring each month; with the Anovera, a single ring is used for an entire year. To use, simply insert the small, soft ring into your vagina once a month, leave it in place for three weeks, and remove it for one week to allow your body to have a period. When using the patch, the user places a new patch on a recommended area of skin each week for three weeks, then no patch for the fourth week, allowing their body to have a period. This method is less effective in people who are considered obese (with a BMI of 30 or higher). It may not be a good choice if you are a swimmer or spend a lot of time in water. Combined hormonal birth control pills (also referred to as combined oral contraceptives) come in several different forms and require you to take a pill daily. While most birth control pills include both estrogen and progesterone, there is a progesterone only pill that is available for individuals that are unable to use a pill with

estrogen. It’s important that this pill is taken at the same time every day.

Non-Hormonal Short Term Birth Control Methods Less effective than other methods; condoms, female condoms, diaphragms, sponges, cervical caps, and spermicides are all short-term birth control methods that are available. There is also a new nonhormonal vaginal gel called Phexxi that can be inserted into the vagina prior to intercourse. This gel lowers the pH of the vagina making it difficult for the sperm to move. Phexxi is only 86% effective.

Natural Family Planning For those who have regular periods, natural family planning—when followed closely, can be an effective form of birth control. With natural family planning you track your periods, body temperature, and/or monitor your cervical mucus to determine the days when you are most fertile. If you are trying to avoid a pregnancy, then you would refrain from sex during times when your cervical mucus is slippery, stretchy, and transparent or egg white in appearance. There are many apps that can assist in tracking your periods and peak fertility time, and the app and program Natural Cycles (https://www.naturalcycles.com/ plan-pregnancy) has even been FDA approved as a fertility method. It’s important to note that only condoms can prevent sexually transmitted infections (STI’s), so it’s important to use condoms along with other methods if you want protection from STIs. At the end of the day, the best birth control method is the one that you feel is best for you. Before selecting a birth control method, have an open conversation with your healthcare provider to discuss your needs to choose a method that is safest for you.

JESSICA MCNEIL, DNP, APRN, CNM, RNC-OB, C-EFM is a certified nurse midwife at Parkland Hospital in Dallas, TX, and an adjunct professor at Baylor University. Her professional experience has focused on maternal and infant health.

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How to Get Help for Postpartum Anxiety and Depression By Danielle Beasley, PhD, RN, RNC-OB, CNE

he experience of becoming a mother varies for every woman. Some women feel elated while others may not. As many as 80% of new mothers suﬀer with the baby blues, also known as postpartum blues. The baby blues are caused by changing hormones, leaving moms with mild anxiety, crying, and restlessness that go away within the ﬁrst two weeks after giving birth — once your hormones get back to normal levels. If you notice that you’re feeling blue, and that these feelings are getting worse and are lasting longer than a couple of weeks, you may be experiencing a postpartum mood disorder. The reassuring news is that you’re not alone. Two common postpartum mood disorders are postpartum anxiety and postpartum depression.

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Postpartum Anxiety Some new moms have feelings of intense anxiety that lasts longer than a couple of weeks — feeling excessively anxious, overly worried, and having trouble sleeping. Postpartum anxiety, if left unresolved, often turns into postpartum depression. Treatment for panic disorders, such as postpartum anxiety, can require a combination of medication and psychotherapy, such as cognitive behavioral therapy (CBT). CBT is a

type of psychotherapy that focuses on increasing cognitive and social skills, evaluating, and modifying dysfunctional thought patterns, encouraging self-reinforcement, and developing positive coping statements and problem-solving skills.

Postpartum Depression The most common postpartum mood disorder is postpartum depression. Postpartum depression is more severe than baby blues and postpartum anxiety. Postpartum depression persists beyond a couple weeks post pregnancy and, without treatment, can last for months, even years. According to the National Institute for Mental Health, 1 in 7 women experience postpartum depression. As common as it is, most women don’t seek help due to feelings of shame. Please note that postpartum depression rarely goes away on its own, so it’s important to seek the help of a healthcare professional. See your pregnancy care provider or regular healthcare provider if you experience any of the symptoms of postpartum depression:  Crying more often than usual  Feelings of anger  Withdrawing from loved ones  Feeling numb or disconnected from your baby  Worrying that you will hurt the baby  Feeling guilty about not being a

good mom or doubting your ability to care for the baby

Postpartum Anxiety and Depression Resources The good news is that help is available. The most effective treatments for postpartum depression are therapy and medication. Don’t hesitate to reach out to your provider and let them know you need help! In addition, support groups specifically tailored to postpartum anxiety and depression can also be very helpful and effective. Postpartum Support International is an excellent online resource that offers online support groups, a warm line, and tools to help in finding a counselor in your area; call their hotline at 1-800-944-4773. Another great option, Postpartum Depression Resources, has a hotline, screening tools, and quizzes. They also have a section geared towards moms, dads, families, survivors, and advocates: Postpartum Depression Links. Please remember that you are not alone. The first step is to give yourself a voice and be your own advocate. Then you can find the resources that will best support your needs. DANIELLE BEASLEY, PHD, RN, RNC-OB, CNE is an Assistant Professor at the University of South Florida, College of Nursing. She specializes in Maternal-Child Nursing, with an emphasis on labor and delivery. Her research interests include maternal depression, preeclampsia, and postpartum hemorrhage.

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Lines, Pigment and Stretch Marks By Catherine “Catie” Chung, PhD, RN, CNE

ike the rest of your body, your skin during pregnancy changes a lot. The causes of these changes are increased blood circulation, and blood vessel and hormonal changes. Although this sounds like a lot of drama for your skin, there is one major plus: The pregnancy glow. Never fear—most of these changes you can manage, and the good news is that not everyone gets every single skin change!

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That Pregnant Glow Increased circulation gives you that beautiful pregnancy glow, but it also creates more sweat and oil on your skin’s surface. So in addition to your glow, you might have a few more zits! Maintain a normal morning and night skin care regime; these problems will go away after you birth your baby. Oh, mama, those raging hormones. In addition to affecting all the other parts of your body, they zap your skin, too. Hyperpigmentation, or increased darkening of the skin, can happen on your face, your belly, and

even the areolas around your nipples. Brownish patches on your face are called melasma or chloasma. Sunlight exposure tends to worsen these patches, so always wear sunscreen. A brown line that suddenly emerges down the middle of your belly is the linea nigra; don’t worry, that’s normal too. The only place you may keep the extra pigment is the areolas around your nipples; all the other colors will fade after delivery. Don’t waste any time or money on bleaching or fading creams; they won’t work!

Seeing Red All the increased circulation becomes obvious when little red “webs” of veins called vascular spider nevi show up. Usually these happen on your legs, but they can be on your arms, chest, or face. The palms of your hands or soles of your feet might look red as well. While the redness on palms and soles will go away after delivery the spider veins don’t always leave. If they really bother you, there are injectable treatments that can be done through a

dermatologist or cosmetic surgeon to make them go away after baby is born. And stretch marks—you either get them or you don’t. Stretch marks are a result of the way the collagen in your skin, well, stretches! There are no creams, lotions, oils or vitamins that have been proven effective in preventing or treating stretch marks; but lotion can help with the itching that comes along in the process. Stretch marks will fade after your baby is born but they don’t disappear. The only proven method of reducing stretch marks is laser therapy. Really though, what a badge of honor to show your baby how much they stretched your belly as they get older!

Did You Know? About 90% of women experience hyperpigmentation during pregnancy, according to the American Academy of Dermatology. This means a darkening of the skin. CATHERINE “CATIE” CHUNG, PHD, RN, CNE, is a former nurse expert adviser to Healthy Mom&Baby in practice in Las Vegas, NV.

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How Weight Loss Surgery Can Aﬀect Your Fertility & Chances of Conceiving By Katie Conrad, BSN, RN

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onsidering weight loss surgery before conceiving a child? Because being overweight or obese is so prevalent among American women, lots of women have this question. Being overweight or obese reduces your fertility as it aﬀects your body’s metabolism and menstrual cycles, particularly if you have been diagnosed with polycystic ovarian syndrome (PCOS). This condition causes infertility by increasing insulin resistance in your body, which impairs your ability to mature an egg for fertilization (ovulation). If you’re overweight and have irregular periods, ask your healthcare provider if you’re at risk for PCOS. Losing weight, through diet or surgery, can help restore normal menstrual cycles and reduce PCOS.

Weight Loss Surgery Eﬀects Weight loss surgery aﬀects how your body absorbs nutrients, your fertility and your risks for pregnancy and birth

complications. Experts agree that getting pregnant at a normal weight is healthy best. Since no two women or pregnancies are alike, talk with your healthcare provider about whether you would beneﬁt from weight loss surgery and recovery time before trying to conceive. Two common weight loss surgeries are Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding. With bypass surgery, food bypasses major sections of your stomach and intestines so you feel full sooner, eat less, and absorb fewer calories. Gastric banding involves a band placed around the upper portion of your stomach thereby creating a faster sense of fullness and reduced capacity for eating.

“When is it Safe to Get Pregnant After Surgery?” Most experts recommend that you avoid conceiving for at least 1 year after weight loss surgery so that your body and weight can stabilize. During any sudden, rapid weight loss, your body may struggle with absorbing nutrients.

Most women continue to lose weight for up to a year after surgery, including bariatric, gastric bypass surgery or gastric banding surgery. Waiting at least a year post-surgery decreases some of the risks that can emerge in pregnancy immediately following weight loss surgery, such as a birthing baby too small for its age or even fetal death.

Prepare for Pregnancy If you’ve had weight loss surgery, ask your healthcare provider if you need additional vitamins or supplements. Weight loss surgeries, particularly gastric bypass, stops food from traveling through the area where much of the nutrition you eat gets absorbed— you get fewer calories but also fewer nutrients. You may have deﬁciencies in vitamins and minerals essential for a healthy pregnancy, particularly vitamins A, K and B12, as well as iron, calcium and folic acid. KATIE CONRAD, BSN, RN, is a clinical nurse at Miami Valley Hospital in Dayton, OH.

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Finish Strong A whopping 80% of a full-term baby’s iron needs are accumulated during the mother’s third trimester of pregnancy, making adequate iron intake of most importance. If you’re concerned you or your baby may be suffering from iron deficiency, talk with your health care provider before taking any iron supplement.

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Preterm Birth Risk Increases with Phthalates Exposure

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Avoid phthalates in pregnancy to reduce preterm birth risks, say experts at the National Institutes of Health who are cautioning pregnant women to avoid the chemicals that could put their pregnancy at risk. This is no small request— phthalates are common chemicals used in personal care products like cosmetics, detergents, and food packaging. They’re chemicals that make plastic soft and ﬂexible. After analyzing data from more than 6,000 pregnant women in the U.S., researchers corelated a link between higher concentrations of several phthalate metabolites in their urine to an increased risk of birthing their babies prematurely—or at least 3 or more weeks before a mom’s due date. “Having a preterm birth can be dangerous for both baby and mom, so it’s important to identify risk factors that could prevent it,” said Kelly Ferguson, Ph.D., an epidemiologist at the National Institute of Environmental Health Sciences (NIEHS), part of NIH, and the senior author on the study published in the journal JAMA Pediatrics. Higher concentrations of most phthalate metabolites examined were associated with slightly higher odds of preterm birth. Exposure to four of the 11 phthalates found in the pregnant women was associated with a 14-16% greater probability of having a preterm birth. The most consistent ﬁndings were for exposure to a phthalate that is used commonly in personal care products like nail polish and cosmetics. To avoid these chemicals, experts recommend:  Selecting phthalate-free personal care products  Eating fresh, home-cooked meals and avoid processed foods that comes in plastic containers or plastic wraps  Selecting fragrance-free personal care products  Purchasing products labeled as “phthalate-free” for personal and family care

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Olive Oil Boosts Antioxidants in Breastmilk Go ahead and have that salad with a dash of oil and vinegar—olive oil that is. New research out of the University of Barcelona’s Institute for Research on Nutrition and Food Safety shows that olive oil crosses mom’s placenta and boosts bioactive compounds beneficial for baby during pregnancy, and that boost continues in mother’s own milk postpartum. Experts agree that breast milk is the best nutrition for babies as it has essential nutrients and bioactive ingredients including hormones, antibodies, microorganism, and stem cells, to name a few. The benefits of these compounds include reduced infection rates for both moms and babies, and they lower risks of suffering from metabolic diseases later in life. Extra virgin olive oil is the main fat in a Mediterranean diet. This study is the first to show that these beneficial compounds are available to both mom and baby, according to the research published in the journal, Food Chemistry. The authors encouraged olive oil consumption—unless otherwise cautioned—during pregnancy and breastfeeding as it can boost the quality of mom’s own breast milk, and consequently, boost baby’s health both during pregnancy and when nursing.

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healthy pregnancy

Environmental Toxins:

Their Eﬀects on Your Health, and that of Your Developing Baby

By Shawana S. Moore, DNP, MSN, CRNP, WHNP-BC

nvironmental exposures may directly impact your health before, during, and after pregnancy. It’s essential to understand how the environment aﬀects the health of you and your developing baby. While some environmental factors are out of your control, there are some that you do have control over. Let’s review the environmental factors that can impact your health and your developing child, along with some tips to empower you to keep you and your family healthy.

What are Environmental Factors? Environmental factors such as soil, food sources, gases, light, air, water, living things, buildings, parks, temperature, and vegetation all directly impact your health and wellbeing. Some environmental factors, such as pollution, poor water quality, additives in food and household products, and climate change, can cause harm.

Toxic Environmental Exposures Environmental toxins can be harmful to you and your developing baby. They can be found in air and water, personal care products, food packaging, and household products. Lead, pesticides, and phthalates are some of the environmental toxins you can limit or reduce your exposure to.

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Lead Lead is an elemental heavy metal found naturally in the environment and manufactured products. Lead particles can be inhaled (e.g., lead aviation fuel, paint used before 1978, and burning lead-based materials) or ingested

(e.g., dust, water, and imported food). Exposure to lead can impact the brain and central nervous system of you and your developing baby. Lead poisoning is preventable through avoidance of contact with it.  Purchase lead-free products  If your home was built before 1978, have a professional remove the paint, or cover it with fresh paint, wallpaper, or tile  Use wet cloth or mop to clean ﬂoors to keep lead dust out of the air  Filter faucet water to remove any potential lead

Pesticides Pesticides are substances used to kill, repel, or control pests. Pesticide exposure during pregnancy may increase the risk for cancer, autism, and lower IQ in your developing baby.  Avoid using pesticides: • Bug sprays and bombs • Chemical flea collars, flea baths, and flea dips  Use baits and traps  Repair cracks and holes in walls  Clean up crumbs and spills

Phthalates Phthalates are chemicals used in plastics and fragrances. They can be found in personal care products (e.g., soaps, shampoos, hair spray), cleaning products, and foods processed with or packaged in plastic. Phthalates may cause harm for you and your baby, as they can impact the reproductive system, hormones, liver, kidneys, lungs, brain, and central nervous system.

 Avoid fast food and processed foods  Make meals at home with fresh ingredients  Avoid products with fragrance or “parfum.” Choose fragrance-free instead  Minimize your family’s exposure to plastic and vinyl. Choose toys made from wood, cloth, and other natural materials whenever possible

Talk to Your Healthcare Provider It’s essential to discuss potential environmental factors that may impact the health of you and your developing baby. It’s never too early to start this discussion. Your wellness exam, prepregnancy, prenatal, and postpartum visits are optimal times to discuss environmental factors. Together, you can develop a plan to support the health and wellbeing of you and your child. SHAWANA S. MOORE, DNP, MSN, CRNP, WHNPBC is a women’s health nurse practitioner. She serves as an Assistant Professor and the Director of the Women’s Health Gender-Related Nurse Practitioner Program at Jeﬀerson College of Nursing. She is passionate about equitable, respectful, and inclusive maternal-child care.

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Pregnancy Myths— BUSTED! By Aliah Thomas, RNC-OB

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ou’re six months pregnant and that heartburn is getting worse and worse. You think to yourself, “gosh, my little one must have a head full of hair!” Believe it or not, heartburn and the thickness of an infant’s hair are among many common pregnancy myths that have been passed on over many generations. Many of these myths are often debated by healthcare professionals and passed off as old wives’ tales, but a few have been researched. Let’s explore some of the common myths in pregnancy and determine if they’re fact or fiction!

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Heartburn & Thick Hair Heartburn occurs when acids from the stomach backflow into the esophagus or “food pipe.” These acids irritate the lining of the esophagus causing that burning feeling in your chest. During pregnancy, the hormone progesterone causes the valve between the stomach and esophagus to relax, further increasing the chances of the backflow of acids and the development of heartburn. So where does the full head of hair come in? Well, research shows that those same hormones can also cause an increase in the number of hair follicles on your infant’s head during the last 5-6 weeks of pregnancy. Therefore, it is plausible that there is a relationship between heartburn and the amount of fetal hair, but more research is needed. The more likely explanation of the amount of hair on your baby’s head is family genetics. Either way, heartburn is unpleasant, so be sure to eat smaller meals throughout the day, increase your water intake, and try to wait an hour after eating before lying down. These tips will help minimize your chances of developing heartburn. Consult your provider before reaching for an over-the-counter medication, as some aren’t recommended during pregnancy.

Belly Shape & Baby’s Gender “If you’re carrying low, then you’re having a boy!” The shape of your belly and your baby’s gender is also a very common pregnancy myth. The origin of this myth is unknown, but it has been determined that there is no factual evidence to confirm it. During pregnancy, your abdominal muscles stretch to allow for your growing baby and uterus. The abdominal muscles continue to stretch with each following pregnancy. So, one woman’s belly may hang lower

because it’s her third pregnancy or because she previously carried twins, and another woman’s belly may be higher because it’s her first pregnancy or because she simply has stronger abdominal muscles. No matter how your belly looks, the most important thing is to ensure proper back support. Use an abdominal support garment while walking and a body pillow for sleep to help with lower back pain, and leave the gender determinations to your ultrasound technologist.

Acne and Baby’s Gender Ah, the pregnancy glow. Many pregnant moms look forward to this physiological change as it results in brighter, more moisturized skin and an overall “radiant” appearance. However, for some moms, this glow can lead to something else entirely unwanted: acne! Some say that if a woman has a lot of acne during pregnancy, then she’s having a girl, as “girls will steal all of your looks.” As much as you may want this to be fact, it’s fiction. Those same lovely hormones, specifically progesterone, increase in your first trimester of pregnancy. Starting at around six weeks gestation, you may experience an increase of oil production on your face. While this oil helps give you your glow, it can also cause your pores to clog, leading to acne. You have a higher chance of developing acne if you experience outbreaks during your menstrual cycle, if you’re just normally prone to outbreaks, or because of your genetics. So no, your sweet little girl (or boy) isn’t stealing your looks, you’re just experiencing one of the many normal symptoms of pregnancy. Keep your acne at bay by practicing good skin care. Techniques such as changing your pillowcases frequently, keeping your hands off your face,

using a gentle, oil-free and alcoholfree cleanser, and utilizing a handsfree device for your cellphone can decrease the buildup of bacteria on your face.

Baby’s Heart Rate and Gender Another pregnancy myth about baby’s gender is related to their heart rate. As the myth goes, “If the heart rate is fast, you’re having a girl; if it’s slow, you’re having a boy.” Not quite, but let’s talk about babies’ heart rates. While in the womb, your baby’s heart rate is regulated by two different systems and fluctuates during pregnancy. This fluctuation results in a higher heart rate early in pregnancy – between 28 and 32 weeks, and a lower heart rate from 32 weeks onward, no matter the gender. However, multiple studies have researched this popular myth, which may have led to its origin. One particular study found that female fetal heart rates were higher by an average of one to two beats, but also noted this difference was an insignificant finding to the study. Another study lamented that infant males’ cardiac and nervous systems mature more slowly than females, which may explain the difference in heart rates. In the end, there isn’t enough research to solidify this myth as factual. As new parents-to-be, you’re excited about pregnancy and attribute many of these passed-down myths to how your body is reacting and developing. While these guessing games are fun to play, just remember that the one thing that matters most is a healthy mom and baby! ALIAH THOMAS, RNC-OB, is a perinatal nurse who has worked in women’s health for her entire career. She also serves as a Facilitator in the Nurse Residency Program for new graduates at her hospital and is passionate about patient education and advocacy.

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Healthy Summer Treats and Tips for Expectant and New Moms by Danielle Beasley, PhD, RN, RNC-OB, CNE

When You Live in a Food Desert The Centers for Disease Control and Prevention defines “food deserts” as neighborhoods that lack access to reasonably priced fruits, vegetables, whole grains, low-fat milk, and other foods essential to a healthy diet. Start by searching for local organizations that have specific projects to combat food deserts and distribute healthy food to those communities. Healthy, affordable food is available in more places than you think, even if it is just at the dollar or convenience

store in your neighborhood. With planning you can create a tasty meal that is inexpensive including staples like eggs, whole grain bread and pasta, brown rice, canned vegetables, fruit, and yogurt. Create a grocery list of healthy options and stick to it. Don’t shop when you’re hungry if you can avoid it. Plan meals in advance. You can also cook in bulk to save time during the busy week. Planning can also help you to avoid choosing an unhealthy quick convenient option. Read labels, watch your portions, and avoid processed

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ummer is finally here! Ensure you’re fueling your body with the healthy nutrients that it needs. Good nutrition is important for everyone, and it is especially important for expectant and new moms. You may be pregnant or recovering from pregnancy and are working hard to keep yourself and your family healthy and happy. If you live in an area where you don’t have access to fresh and nutritious foods, we’ve got tips to help you get creative and find ways to keep yourself healthy.

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Indulge in Refreshing Summer Treats Getting in your fruits and veggies doesn’t have to be boring. Get creative and make it fun! Try a healthy and nutritious smoothie that’s easy to make at home. Smoothies are a terrific way to get the nutrition your body needs. Ideally, you will make them at home since many storebought smoothies contain a lot of sugar with fewer nutrients. Get adventurous with green smoothies or popsicles that include spinach, avocado, and tropical fruits. Keep frozen fruit in your freezer to throw into a smoothie, or simply let frozen fruit semi-thaw for a cold, refreshing treat to eat. Drink plenty of water to beat the summer heat and stay hydrated. The Office on Women’s Health recommends that pregnant women drink about 10 cups (2.4 liters) of

fluids daily. Women who are nursing a baby need to consume about 13 cups (3.1 liters) of fluids a day. It seems like a lot, but it’s not impossible. You can do it! Pace yourself and try to find a water bottle to keep yourself on track. Adding fruit to your water can help to boost its flavor while adding nutrition; plus, fruit looks so pretty and tastes so good floating in a glass of water.

Eat Healthily; Stay Consistent Each time you reach for a snack or sit down for a meal, choose a healthy option. Don’t fall for fad diets, like the short-term calorie “summer slim down” diets. Rather, focus on healthy choices with each meal or snack, and avoid junk food. This is a year-round habit that leads to good health overall. You need to get plenty of calories, and most of those calories should come from whole foods. If you don’t know how many calories you

should be consuming each day, ask your healthcare or pregnancy care provider. Stock up on healthy foods. If your cabinets, refrigerator, and freezer hold healthy foods, you’re much more likely to maintain healthy eating for life. Focus on nutrient rich foods: h Whole grains h Lean meats and plant-based proteins h Fresh fruits and vegetables (the darker the color, the more nutrients it has) h Calcium-rich foods including dark green veggies, small bone-in fish, tofu, or low-fat dairy h Nuts and beans and other legumes Bon Appetit, and healthy eating and snacking! DANIELLE BEASLEY, PHD, RN, RNC-OB, CNE is an Assistant Professor at the University of South Florida, College of Nursing. She specializes in Maternal-Child Nursing, with an emphasis on labor and delivery. Her research interests include maternal depression, preeclampsia, and postpartum hemorrhage.

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foods with more than five easily identifiable ingredients.

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Managing Anemia and Low-Iron in Pregnancy By LaShea Haynes, MEd, MSN, APRN, AGCNS-BC, RNC, C-EFM

What Causes Anemia? The most common cause of anemia in pregnancy is dietary deficiencies. When your body doesn’t have the nutrients, it needs to make healthy red blood cells, it won’t have enough hemoglobin (the substance inside red blood cells that helps them carry oxygen). This can affect your baby’s growth and make childbirth more dangerous for you. Other less common causes of anemia include heavy bleeding, and the body’s own destruction of its red blood cells.

What are Symptoms of Anemia? Symptoms can vary from person to person but in general you may experience extreme fatigue, cold

hands and feet, weakness, pale skin, headaches, dizziness, chest pain, rapid heartbeat, shortness of breath, brittle nails, and or PICA (craving to eat things that aren’t food, such as ice, starch, or dirt).

How do you Manage Anemia or Low Iron? Some anemia can be prevented or cured with a healthy diet. If that’s the case for you, here are some ideas of great foods you can pack into your diet: h Iron: Found in meat, beans, lentils, and dark-green leafy vegetables h Folate (folic acid): Found in fruits, dark-green leafy vegetables, green peas, kidney beans, cheese, eggs, fish, almonds, and peanuts. It can also be found in vitamin enriched grain products such as bread, cereal, pasta, and rice h Vitamin B12: Found in meat, dairy products, eggs, and fortified cereals h Vitamin C: Found in citrus fruits, peppers, broccoli, tomatoes, melons, and strawberries. Foods with vitamin C help your body to absorb iron If you find that you may need a little boost in addition to an iron-rich diet, you and your provider can discuss to options best for you! Some of the

options you may want to discuss are: 1. Iron pills: Including capsules and extended-release tablets. Your provider will specify how much to take each day 2. Liquid iron: If your provider has prescribed iron pills and you find that constipation or nausea is a problem, discuss the possibility of taking iron in liquid form with overthe-counter products such as Liquid Geritol or Floradix 3. Iron infusion: Intravenous iron may replenish iron stores more quickly and efficiently than oral iron therapy 4. Erythropoietin therapy: Erythropoietin is a red blood cell protecting hormone produced by the kidney. This therapy can increase your red blood cell mass without any ill effects for mom or baby Pregnancy is an exciting journey, and you may encounter a few surprises along the way. The good news with anemia is that you have options, and there are steps you can actively take each day to improve your and your baby’s health. LASHEA HAYNES, MED, MSN, APRN, AGCNSBC, RNC, C-EFM is the Editor of Healthy Mom&Baby magazine. Her nursing career spans 25 years, and she is founder and owner of her own nursing mentoring and education company.

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ery shortly after starting to receive prenatal care you will more than likely have blood drawn to determine your blood count. You may find out you have anemia, a medical condition in which, simply put, you don’t have enough healthy red blood cells. During pregnancy, your blood volume increases by up to 50% to support your growing baby, and you’re more vulnerable to anemia if your diet doesn’t have enough iron, folate, or Vitamin B-12.

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Placenta Wisdom, Rituals and Traditions—Know Your Placenta’s Worth! By Essence Williams, MSN, BSN, RNC-MNN, CCB, LCCE

epending on a person’s customs and beliefs, a placenta may hold significant symbolic and spiritual meaning. In some cases, the placenta is considered precious, sacred, and powerful—worth even more than gold! The placenta supplies oxygen and blood flow to your baby, cleansing it of unwanted toxins and boosting baby’s metabolism. The placenta nourishes and protects baby, and contains hormones required for pregnancy and breastfeeding. It’s common practice for many hospitals and healthcare facilities is to dispose of the placenta as medical waste, however, many parents, doulas, nurses, and midwives honor the placenta and acknowledge its worth. Studies show that the placenta plays a tremendous role in certain ancient traditions, rituals, and holistic and alternative medicine. One of the most common customs is placenta burial rituals.

Placentas Around the World Let’s take a trip around the world via the placenta! In Bali, the placenta is known as “Ari-Ari,” and is considered a physical body of the child’s guardian angel whose spirit stays with the child for life.

The Balinese wrap the placenta in cloth, place it in a coconut and bury it. In some cultures, burying the placenta connects the baby to land and heritage. Among the Navajo and many Hawaiians, the placenta is placed in the ground to connect the child to his or her homeland and ancestors. Native Icelanders call the placenta,“fylgia,” which literally means “guardian angel.” In Hmong culture, the word for placenta means “jacket.” The placenta is believed to be a spiritual jacket worn by the baby as they enter the world. Families in various Caribbean countries bury their baby’s placenta under a fruit tree to help ensure that the child will never go hungry and will always come home. Among the African Igbo, the placenta is called “Our Mother” and connects the child to the spirits in the ground when it is buried. The Kikuyu in Kenya believe that both the placenta and the umbilical cord are a bond and a sacred attachment between mother and child. It is deposited in an uncultivated field and covered with grass and grains as a symbol of fertility. The Mayans also honor the sacred bond between the mother and her baby by burying the placenta under a special tree. This ritual is said to give protective powers over the child. In both Japanese and Chinese culture, the placenta burial is believed to bestow blessings or protection for the child’s future.

In cultures with postpartum rituals, location of placenta burial matters. In Cambodia, the placenta is the “globe of the origin of the soul,” and must be buried in a special location designed to protect the baby from bad spirits. In Malaysia, the placenta is considered a “baby’s other sibling.” In Mexico, the placenta is viewed as it’s “el compañero” or companion. Placentas in Korea are given names depending upon their birth month, before undergoing ritual burial. In Turkey, parents who want their child to be noble and honest may bury the placenta in the courtyard of a mosque. ESSENCE WILLIAMS, MSN, BSN, RNC-MNN, CCB, LCCE, is a maternal child health nurse who manages the clinical nursing component of a high-risk perinatal program affiliated with the Southern NJ Perinatal Cooperative. She also works in collaboration with Cooper University Hospital, Osborn Family Health Center and CAMCare in Camden City, NJ.

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Postpartum Protection

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Swelling in Pregnancy Y

ou’re not imagining it—your ankles are swelling. And maybe your hands are too. More than 70 percent of pregnant women experience this (edema) in pregnancy. So, how do you know what’s normal—and what’s not? Your body goes through many changes as it adapts to your growing baby. Your body increases the amount of blood flowing through your veins, as well as other fluids—by as much as 50 percent! As your uterus expands, it puts increased pressure on the veins in your lower extremities, making it

harder for your heart to pump blood back from your legs, leading to a shift in fluids and swelling in your legs and

feet. You’ll notice that swelling typically occurs late in the day or if you’ve been standing for a long period of time. Fluid can also accumulate around the nerves in your wrist, mimicking something called carpel tunnel syndrome, which may cause pain, numbness, burning or tingling of the hands or wrists. These symptoms aren’t comfortable, and can be annoying, but typically they’re little more than common

By Helen Hurst, DNP, RNC, APRN-CNM

pregnancy discomforts that can be remedied with rest. As always, if you become concerned about any symptoms you have, call your doctor or nurse-midwife and they will be happy to answer your questions.

Help Prevent Swelling in Pregnancy h Elevate feet 2-3 times a day for 30 minutes (at your desk raise your feet on a small stool or chair) h If you have the opportunity, lay down with your feet elevated, or lay on your side 2-3 times a day for 30 minutes or so h Avoid tight fitting stockings or items with elastic at the knee (knee highs) h Avoid sitting with your legs crossed h Wear special maternity hose or stockings meant to reduce swelling h Wear comfortable shoes and be active h Sleep on your side (this keeps the pressure of the uterus off the large vein in your back) h Drink plenty of water (restricting your water intake will not help with swelling)

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When Swelling is Dangerous Call your healthcare provider right away if you experience any of the following in pregnancy: h If your hands or face start to swell h Sudden, large amounts of swelling h If only one leg swells h If you’re gaining more than 2 pounds per week h Swelling accompanied by: • Unusual vision: spots before your eyes, blind spots • Headaches not relieved by acetaminophen • Bad heartburn HELEN HURST, DNP, RNC, APRN-CNM, is a nurse expert adviser to Healthy Mom&Baby.

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How to Cope with Morning Sickness By Susan Angelicola MSN, APN

What Causes Morning Sickness? It’s not exactly known, but the hormones hCG (the pregnancy

hormone that makes pregnancy tests positive) and estrogen are said to trigger it. Stress doesn’t help, either. If your mother, sister, or grandmother had morning sickness, you might, too.

How Long Does it Last? Nausea and vomiting can begin as early as 4 weeks of pregnancy; it usually peaks around 8 weeks. For most women, it subsides after the end of the 1st trimester (about 14 weeks). But for 10% of unlucky moms-to-be, it can last the whole pregnancy. Let your nurse or doctor know when you’re experiencing the symptoms; it may well begin before you have your first appointment.

How Can I Cope with Morning Sickness? Avoid tastes or smells that may trigger your reaction. Try eating small, frequent meals and bland, dry foods and high-protein snacks. Ginger (in all forms) may help nausea. Your healthcare provider may prescribe a medicine called Diclegis®. This is a Pregnancy Category A drug, which means it’s been studied in pregnant women with no increase in birth defects or pregnancy problems.

Could it be Hyperemesis Gravidarum? If nothing relieves your symptoms and you aren’t even able to eat or drink, you may have hyperemesis gravidarum. Signs include severe nausea and vomiting several times a day, dehydration, and dangerous weight loss. This extreme form of morning sickness happens in up to 3% of pregnancies, but it’s the most common reason for hospitalization in early pregnancy. Women with twins or triplets or who have had hyperemesis gravidarum before and first-time mothers are more likely to have HG. Just like nausea and vomiting, hyperemesis gravidarum usually goes away after the 1st trimester but may continue for a very small number of pregnant women. If you think you may have this extreme form, let your nurse know right away. You may need IV fluids and anti-vomiting medications.

SUSAN ANGELICOLA MSN, APN, is an advanced nurse practitioner and an expert advisor to Healthy Mom&Baby.

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o you consider morning sickness as a pregnancy “rite of passage?” Here’s how to enjoy pregnancy when you’re not feeling well. It’s no secret that nausea and vomiting in pregnancy is very common—and it can be a morningnoon-and-night sickness that lasts the whole pregnancy! Most pregnant women (50%–80%) experience nausea, and half-experience vomiting. Maybe you take this as a good sign as some studies associate morning sickness with a healthy pregnancy—but that’s not always a comforting thought in the heat of the heaving. Typically, nausea and vomiting in pregnancy isn’t dangerous for your baby. Even with the most extreme form of nausea and vomiting, as long as it’s treated early, most babies have no problems. However, some studies show that if a pregnant woman has hyperemesis gravidarum, her baby could be born earlier or may be smaller overall.

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Pain Relief in Labor By Paris Maloof-Bury, MSN, CNM, RNC-OB, IBCLC

iving birth is a powerful, joyful, and yes, painful experience. Happily, birthing people have lots of choices to help cope with pain relief during labor, particularly pain medications. Pain during labor is normal, and the goal of pain medication during labor is to help you cope, not completely remove the pain of labor. Sometimes you just need to “labor down” and get some rest—others, you just need to “take the edge off” so that the pain isn’t quite so intense.

Therapeutic Rest In an ideal world, childbirth would be quick and efficient. But most women experience labor first as contractions coming in starts and stops without a rhythm or pattern that can go on for 2-3 days before active labor kicks in.

This process is known as “prodromal” labor, or the earliest labor, and during this phase you should rest as much as possible. As your pregnancy care providers, we hear you when you say it’s quite difficult to sleep with all those contractions! That’s where therapeutic rest comes in as medication helps you sleep through some of those early contractions so that you have the energy to cope in the busiest and most challenging part of labor for some women—active labor. You may find that a sleep aid is enough to help you ignore the contractions and rest. Two common options are hydroxyzine (an antihistamine) and zolpidem (a sedative). Both are given in pill form. Still, sometimes the pain of contractions in prodromal labor is too

strong to sleep through. In these cases, a long-acting opioid, like morphine (given as an injection by your nurse) can relieve the pain and provide a bit of sedation. An opioid for therapeutic rest can also be used well in advance of baby’s impending birth so that baby isn’t sedated when they’re born. It’s important to remember that there is no single right way to give birth. You will know what is right for you in the moment. your instincts and trust Follow yourself as you give birth. Happy pushing!

Pain Relief During Labor: “something to take the edge off” If you want to be upright and active in birth, you may still want something to “take the edge off” so that labor pain isn’t quite as intense while avoiding an epidural. Other times, you may be planning to use epidural for labor pain but aren’t quite ready for that yet. In either case, you have options. An up-and-coming favorite is nitrous oxide, or laughing gas, which doesn’t require an IV to use. You inhale the medication through a face mask, which you hold in place yourself, and as soon as you take the mask off and stop breathing it in, it stops working. Nitrous oxide is relatively new in the U.S., so it may not be available in your birthing facility. It has been in use for many decades in the United Kingdom and other parts of Europe, so you can be rest assured there have been plenty of studies on its safety. Research shows that very little (if any) of the medication crosses the placenta, so this is one of the least risky options for the baby in providing pain relief

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during labor. In addition, nitrous oxide does not seem to affect labor progress, breastfeeding, or increase the risk of postpartum depression. Another option for pain relief during labor is a short-acting opioid, like fentanyl or butorphanol, which can be given to you by your nurse through an IV or as an injection. All opioids easily cross the placenta, so your care providers will advise avoiding this option if you’re likely to birth your baby within the next hour or two. Opioids can make your baby sleepy, and if given too close to the time of birth, they increase the risk for slow and ineffective breathing, or respiratory depression in baby. Your baby may need more time and help latching to nurse, so plan for lots of skin-to-skin contact and ask for breastfeeding support if you use a short-acting opioid.

Pain Relief During Labor: “I just want the pain to stop!” If your goal is to feel as little pain as possible during childbirth, and you

want the maximum pain relief during labor, an epidural is the way to go. Some women will experience total pain relief during labor with epidural anesthesia, still many will feel some tightening or pressure with contractions, and most of us will feel a lot of pelvic pressure as baby is born. This is a good thing; it means you’ll have enough sensation to work with your body when it’s time to push. An anesthesiologist or nurse anesthetist will place the epidural, so you may have to wait until they’re available to receive some pain relief. They will use a needle to insert a thin, soft tube in your lower back through which you’ll receive pain medication during labor. Because this is anesthesia, you won’t be able to walk or get out of bed until it’s worn off. Most women will also need a Foley catheter (a tube that drains urine from the bladder) until they can regain the sensation to empty their bladder on their own. Science is conflicted about whether baby’s starting breastfeeding is affected by the anesthesia, so as

always, snuggle your baby with lots of skin-to-skin contact and encouragement toward breastfeeding early on. And while the research does not show an increased risk for cesarean birth, epidurals can affect labor progress in some women, so it’s not uncommon to need Pitocin (a synthetic form of the natural oxytocin that your brain makes to start and sustain labor) to keep labor progressing with an epidural. Similarly, women who receive epidural anesthesia are slightly more likely to need assistance with birthing baby, either with forceps or a vacuum, and are at higher risk for developing a fever during labor. The good news is that very little of the medication used for pain relief during labor goes to the baby, so there’s no concern that the baby will be sedated when born. This means that it’s considered safe to get an epidural, even if birth is imminent.

PARIS MALOOF-BURY, MSN, CNM, RNC-OB, IBCLC is a certified nurse-midwife and lactation consultant at Sutter Health in Davis, CA.

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Newborns Benefit From 6 Months of Exclusive Breastfeeding

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babies

Help Your Baby Get Better Sleep

IMAGES: DREAMSTIME; ISTOCK / GETTY IMAGES

These tips, which teach self-soothing that’s backed by science, can help your baby and growing children sleep healthier and longer: h Establish a bedtime—including a bedtime routine h Swaddle babies who aren’t yet rolling over at night to distinguish between bedtime and naptime sleep h Keep baths and reading time lowlight, and low-key; avoid exciting your child h Offer a pacifier, soothing gentle touches and soft, shushing sounds h Holding, rocking and feeding should only happen if baby is hungry

It’s healthy for baby to only consume breast milk for the first 6 months of life, according to new guidelines from the American Academy of Pediatrics (AAP), published in July 2022. Starting additional foods around baby’s 6-month birthday ensures a best start, and pediatricians now support continued nursing for two years or more, as may be desired by both mom and baby. The new AAP guidance is an update from 2012, which recommended continued breastfeeding for up to one year or more. The new recommendation is based on data that shows baby’s continued consumption of breastmilk in their second year of life provides essential nutrients and immunologic boosts important for growing toddlers. Consuming breastmilk for up to two years or more results in fewer health disorders for babies, including ear infections, diarrhea, respiratory illnesses, SIDS, inflammatory bowel disease, childhood leukemia, diabetes, obesity and asthma, to name a few. Pediatricians also looked at the effects of nursing on mom’s own health, with data confirming positive effects of nursing for more than 12 months in terms of decreasing risks of maternal type 2 diabetes, hypertension, and breast and ovarian cancer. The pediatricians stressed breastfeeding is far more than just nutrition—it’s also the significant relationship between parent and child. More than 80% of women in the U.S. initiate breastfeeding, but only 1 in 4 are still exclusively breastfeeding their baby by six months. One out of 5 moms also supplement breastfed babies with infant formula within 48 hours of giving birth, the AAP noted.

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Hepatitis B Vaccine at Birth: What’s the Rush? By Sharon Hitchcock DNP, RNC-MNN and Angelica Hibbs, FNP-C

“S

o my baby will need two shots right after birth?” I was surprised and a bit skeptical. I was at the end of my pregnancy and was assured all had gone well so far. The vitamin K shot, to prevent bleeding in the first days of life, made more sense— so I let them give it. The hepatitis B vaccine simply did not. Couldn’t it wait? Did my baby really need it? My labor and birth went well, my prenatal hepatitis B testing was negative, and my baby was born healthy. My nurse brought the topic up again. She was kind and gentle, but obviously hoped I’d change my mind. She offered me a chance to ask all my questions and explained why it’s important to give this first vaccine in the hospital. Here’s what she shared, and why I agreed.

What is Hepatitis B and How Contagious is it? Hepatitis B is a highly contagious viral infection that aﬀects the liver, transmitted through blood and other body ﬂuids. In its most intense stage, it may make the person feel ill, but most infected people don’t get sick or even know they have it, but they are contagious. While most people fully recover, some go on to develop a chronic form of the disease. People with chronic hepatitis B carry the virus in their bodies and can spread it to others without knowing it. This creates a great risk for those around them, especially infants. There’s no cure for hepatitis B and the disease can eventually lead to liver scarring (cirrhosis), liver cancer, liver failure, and even death. There are over 250 million people world-wide

with chronic hepatitis B infections, and over 600,000 people who die from the disease each year.

Hepatitis B in the Newborn Why is there such urgency to vaccinate our newborns so quickly? Part of the answer is this: Pregnant women can have chronic hepatitis B but not know it and pass it to their newborn during birth; or infected family members or caregivers can unknowingly or unintentionally expose the infant once home. In the United States alone, more than 25,000 babies are born each year to mothers with hepatitis B. Here are some other important reasons for this sense of urgency:  Hepatitis B is especially dangerous to infants. According to the Centers for Disease Control and Prevention, 40% of infants born to infected mothers will become infected and 90% will stay infected for life if preventative measures, including the vaccine, aren’t taken  Of these chronically infected infants, 25% will eventually die prematurely from liver disease or liver cancer later in life  Some good news: 90% of infections in exposed infants can be prevented with the hepatitis B vaccine, but timing is important Hepatitis B infection is highly contagious for infants, impossible to cure, but easy to prevent if treatment, including the vaccine, is provided in time. Giving the hepatitis B vaccine to every newborn after birth acts as a safety net for infants who may be unknowingly exposed either during the

birthing process or through contact with infected people at home, such as caregivers, friends, babysitters, or family members. This vaccine is endorsed by the American Academy of Pediatrics, the U.S. Centers for Disease Control and Prevention, and the World Health Organization. Since the vaccine’s introduction, there’s been a 90% decrease in acute hepatitis infections in the United States. The goal is to eliminate these infections completely and we’re getting close!

Hepatitis B Vaccine Safety One ﬁnal lingering concern for me was whether a newborn’s body can handle the vaccine at this age. And, of course, whether the vaccine was safe. Here are a few facts the nurse explained that helped boost my conﬁdence in my decision:  All vaccines are extensively studied before they’re approved for use  The hepatitis B vaccine has almost 40 years of data and has been shown to be very safe. It’s been given to more than 120 million Americans, including newborns and infants  There’s no evidence of long-term health problems such as autism, auto-immune diseases, or asthma with this vaccine or others  The hepatitis B vaccine contains only non-infectious material that the immune system responds to while making the protective antibodies against the actual virus  A newborn’s immune system is well-equipped at the time of birth to handle the small challenge this vaccine provides. The amount of material given to the infant is much

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healthy babies less of a challenge than normal bacterial and viral challenges they face every day from the foods they eat and organisms they are exposed to from their environment  Their body’s normal immunebuilding response can cause parents some concern. The most common discomforts noted are soreness at the vaccination site and a low-grade fever  Severe reactions do occasionally occur but are very rare – about one in every 1.1 million doses given SHARON C. HITCHCOCK, DNP, RNC-MNN teaches nursing at the University of Arizona in Tucson, Arizona. She is passionate about reducing infant mortality and promoting infant safety. She serves on multiple state and national level teams dedicated to educating parents and reducing infant safety-related deaths.

 Infants can become infected during birthing process if mom is acutely or chronically infected, or by coming into contact with the virus from others who may not know they are infected  The virus is transmitted through blood and other body fluids (such as saliva) and can live on objects, even when dry, for at least 7 days  The virus is acquired by direct contact with mucus membranes, such as in the mouth or eyes, or through breaks in the skin. It only takes a small amount of fluid or dry material to cause infection  Infants can become infected from contaminated household items and surfaces such as toys, toothbrushes, or the floor  Babies frequently put their hands and toys in their mouths, where the virus can then be absorbed through the mucus membranes  The virus is not spread through casual contact or from shared air, including touching or hugging a person, or being in the same room with an infected person

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ANGELICA HIBBS, FNP-C is a certiﬁed Family Nurse Practitioner in Tucson, Arizona, specializing in newborns and their families. Angelica is passionate about promoting healthy families and communities through evidencebased education and care.

Top Facts About Hepatitis B and Infants

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Essentials for a Safe Summer

Happy times and good sunshine…Hello Summer!

IMAGES: DREAMSTIME

oesn’t warm weather make you want to go outside and enjoy a sunny day? But with a newborn, it’s important to keep sun safety uppermost of mind. Babies are more sensitive to sunburns because their skin is thinner and more delicate than adult skin. This means that baby’s skin can become irritated and burn more easily in the sun. In addition to the risk of sunburn, the National Weather Service reports that a heat index at or above 90 degrees Fahrenheit poses a significant health risk that can lead to dehydration, heat exhaustion, and heat stroke— especially for babies. Take care and use these tips to keep your baby safe in the heat of the summer: Stay Hydrated: On hot days it’s fine to nurse your baby as much as they want or give them extra pumped milk or formula in a bottle to keep them hydrated. But it’s important to never supplement with water during the first six months. Giving

your young infant water could lead to water intoxication, slow growth and development, electrolyte imbalance, and even seizures. Dress Safe, Stay Stylish: Protect your baby by dressing them in one layer of light-colored, lightweight clothing made from absorbent material to maximize the evaporation of sweat. Include an oh-so-cute hat with a three-inch brim to shield their face and ears. As an additional safety measure and stylish add-on, protect your infant’s eyes with a pair of sunglasses with UV protection that blocks 70-80 percent of light. Cool Off: Plan for a cool retreat into the air conditioning after spending time outdoors on hot days. Don’t have AC at home? Plan for a trip to your closest library, shopping center, or baby cafe. While outdoors, scope out some shade, or come prepared with a tent or beach umbrella. Prevent Sunburn: Keep little ones younger than six months old out of direct sunlight, especially between the

By Aliah Thomas, RNC, OB hours of 10 a.m. and 2 p.m. when the sun’s rays are strongest. Once they hit that six-month mark, use a broadspectrum sunscreen (UVA and UVB) with SPF15 or SPF30. Remember to apply the sunscreen on areas of your infant’s body not covered by clothes, such as the face, hands, and feet. Signs of Dehydration: To keep your sweet one as safe as possible, be aware of the warning signs of dehydration, and call your pediatrician for prompt treatment if your baby develops any of the following: h Decreased urination (Fewer than 6 wet diapers a day) h Fever (temperature at or above 100.4 Fahrenheit or 38 Celsius) h Extreme tiredness (drowsy, unusually sleepy) h Decreased bowel movements h Vomiting ALIAH THOMAS, RNC, OB is a perinatal nurse who has worked in women’s health her entire career. She also serves as a facilitator in a nurse residency program for new graduates at her hospital and is passionate in-patient education and advocacy.

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Tips for Traveling with Tots By Rita Nutt DNP, RN

Make a Traveling with Tots Checklist Preparation is key and nothing makes you feel more organized than a list to check yourself against, and tasks to be crossed off as accomplishments toward your vacation dreams. List the big things first: destination; sights to see; accommodations; flights, train tickets or driving routes/times. Then work on more detailed lists: baby gear you’ll bring or rent at your destination, and what you can order and have waiting for you, such as extra diapers, wipes, sunscreen, and pool toys. Prioritize your packing list: It’s your “to do” list while traveling and returning

home. It will keep you from feeling overwhelmed and calm those lastminute fears that you’ve left something essential at home.

Getting There and Back Don’t over-plan. Choose 1 or 2 activities per day. Your baby may get overwhelmed from all the stimulation and toddlers and preschoolers want to touch and explore everything, so each outing will take longer than you think. Include downtime for naps and free playtime. Bring along comfort objects. A security blanket, stuﬀed animal, or doll for your child, but whatever you do-don’t leave it behind! Your child will feel safer and more comfortable snuggled up with something from home. Pack light when possible. Ship extra clothes, diapers, and wipes to your attention at your destination. Be ﬂexible. A vacation is supposed to be about rest and relaxation, too! Accept that there may be meltdowns and temper tantrums—but there will also be lots of laughter and joy, too.

Flying the Friendly Skies  Children younger than 2 typically fly free in your lap; ask what documentation you need, such as a birth certificate  Most airlines will ship a car seat or stroller free  Consider a red-eye flight to travel during your child’s normal sleeping hours  Nurse your baby, or give them a bottle or pacifier, to help equalize ear pressure during takeoff and landing  The 3.4-oz. liquid rule doesn’t apply to breastmilk, formula, juice, ice packs or gel teething rings; keep these separate from your other liquids

Have a Stress-Free Road Trip  Consider driving through the night to avoid sleep disruptions when traveling with tots  Plan stops for nursing, diaper changes, and relaxing outside the car RITA NUTT DNP, RN is an assistant professor of nursing at Salisbury University in Salisbury, MD.

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ooking to travel with your little ones? Be prepared when you plan ahead—then relax and enjoy the journey when traveling with tots! When you’re traveling with young children, you might think taking a trip sounds like the opposite of fun. With these tips, you’ll be prepared for the twists and turns that are family adventures! Here are our tips for traveling with tots.

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healthy babies

Baby Proof Your Child’s World Through Age 2

hildren explore their world by touching, experimenting, and watching others. They can’t predict the outcomes of their actions, and they can’t think ahead—that’s what you get to do! Use this baby proofing checklist and these proven tips to protect them from the 8 most common dangers in their first 2 years of life. 1. Sleep Injuries and SIDS risk Baby needs a safe sleep space in a crib or bassinet designed just for babies with only a tight fitted sheet and baby—nothing else. The experts at the American Academy of Pediatrics say it’s safest for baby to sleep in your room— just not in your bed.

3. Cars and Car Seat Injuries Baby should always be restrained in a car seat every time they’re in the car, whether it’s your car, your caregiver’s car, or a taxi. It’s safest for baby to ride rear facing until age 2. Get baby’s car seat installation checked at a fire or police station.

6. Poisoning Remember how everything goes in baby’s mouth—that increases their risks for poisoning. Put baby locks on all cabinets, especially base cabinets. Keep dangerous cleaning supplies, dish detergent, vitamins and medications locked well above your child’s reach.

4. Choking Baby wants to put everything in their mouth! Keep small objects out of their reach. Measure items with an empty toilet paper roll—if the item fits inside, it’s a choking hazard, including foods. Avoid round shapes and cut foods into small, angular pieces for baby to pick up and enjoy.

7. Falls Use baby gates around stairs and put locks and guards on all windows. Furniture, like shelves, bookcases, TV stands, should be bolted to the wall.

5. Burns Your kitchen is a danger zone! Install cabinet and appliance latches, and guards in front of kitchen knobs. Never cook with baby in your arms— hot oils or liquids can splash and cause serious burns. Other burn hazards include barbeque grills, fire pits and fireplaces.

8. Drowning Any amount of sitting water poses a risk. A mere 2 inches—like the depth of your dog’s water bowl—is enough water for a child to drown. Drain bathtubs and sinks and use safety alarms and childproof fences around swimming pools. NEVER leave your child unattended in a bathtub or pool—even for a single minute. RITA NUTT, DNP, RN, is an assistant professor of nursing at Salisbury University in Salisbury, MD. A longer version of this article is available at Health4Mom.org.

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2. Prevent Falls Prevent falls by never leaving your baby alone on an elevated surface, such as a couch, bed, or changing table. If you have other children, teach them that they’re not to pick up, lift or carry baby without your help. Little hands can easily drop baby, resulting in injury.

Rita Nutt, DNP, RN

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healthy babies

Diapering

That Nurtures Your Baby By Charlotte Wool, PhD, RN

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hat if you learned that the everyday act of diapering could promote and support your baby’s health and development? That the routine actions of moving, touching and caring for your baby and their skin during a diaper change could create trust, connection and a surge of positive emotions that support baby’s overall health and wellness? That idea alone would turn a rote task into a mini masterpiece! Diapering can be enjoyed and beneficial for baby—not just endured— say the experts of the Huggies® Nurse Advisory Council. Their program, “Every Change Matters: A Guide to Developmental Diapering Care,” explores the research regarding how the very simple act of diapering provides healthful and developmental opportunities for bonding, attachment,

closeness, stress reduction and comfort between you and your infant. Before you ever change your baby’s first diaper, you’ll likely spend months preparing to do so. Maybe you’ll put a changing table in baby’s nursery, or act on the advice of an experienced mom and set up “diapering stations” with supplies all around your home. You’re aiming for ease and convenience— right? You’ll likely change 10,000 diapers before baby transitions to a potty. Isn’t it nice to know you have the opportunity to also help baby grow stronger and healthier during these times? During baby’s first days, you’ll change up to 12 diapers a day—that’s up to 12 opportunities to hug your baby close to you, connect, bond and form fun rituals together that turn the ordinary task of diapering into something extraordinary.

Mindful Moments During Diaper Time Parenting can be stressful and overwhelming—especially when you’re not getting all of the sleep you need. You may feel tempted to rush through daily care tasks to get on to other activities with baby. In your hurry, you might miss out on these little moments to bond with your baby! Diapering is the perfect time to practice mindfulness in your care habits. Mindfulness means being completely engaged in the present moment. It’s taking your life off autopilot; paying attention to each and every second with your baby; and becoming aware of baby’s moods, movements, expressions and most importantly, baby’s cues. Like any good habit, it takes practice. Create a sensory symphony at

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healthy babies go into changing baby. Your focused attention and touch are what baby needs to flourish and thrive—so don’t forget to give your baby another hug when diapering time is over! Being mindful during diaper time instills a sense of calm into your life as you remind yourself that parenthood is a gift. You create a calm environment when you approach everyday routines in a relaxed manner. In our harried and hurried world, take the time to be good to yourself and your baby by approaching diapering in a mindful, caring way.

A Healthy, Safe Diapering Space Practice this intentional closeness in a clean and safe diapering space. Change baby where you can easily see and reach them and have all of your diapering supplies at hand. Keep in mind babies can move and squirm, even at very young ages. They can push off a surface with their feet, too, so always keep your hand gently on your baby during diapering. Secure dangerous items, such as cords and

window blinds, away from the diapering area, and keep cleansing supplies well out of baby’s reach. Safe diapering spaces include: h Changing table or a safe, firm, flat surface h Changing blanket or spread to provide a barrier between baby and the diapering surface h Hand sanitizer for you to use before and after diapering h Super-absorbent diapers h Skin-friendly baby wipes h Protective barrier ointment h A change of clothes, if needed h A trash basket or diaper bin with a lid to mask odors Changing 10,000 diapers may feel like an impossible task at first, but when every diaper change is approached with the physical and emotional desire to connect and bond with baby, it becomes another way you’re supporting baby’s best health and development. CHARLOTTE WOOL, PHD, RN, is a nurse educator and an expert adviser to Healthy Mom&Baby. Development of this article was supported with funding from Huggies®.

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each diaper change with your soft voice, gentle touch, slow and careful movements, and with a sing-song voice sweetly talk or sing to baby. Keeping one hand on baby during diapering is a safety measure but also becomes a reassuring touch, especially if baby should startle or move suddenly. Smile at baby, create calm and happiness by gazing into baby’s eyes— spend a few moments making that emotional connection. Babies love to look at and interact with others, and research tells us that they quickly recognize and enjoy seeing family members, especially their parents. Regularly hug, touch, and love your baby—every diaper change can begin and end with a hug! Research proves the power of touch is linked to positive feelings and uplifting emotions for both you and your baby. When you’re relaxed and engaged, baby feels connected—your bond— through your touch and attention. Your calm demeanor during diapering reassures and calms baby, helping them feel comfortable with the movements, cleansing, diapering, and dressing that

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healthy babies

Get Ready for Breastfeeding & Pumping Breastmilk at Work By Joanne Goldbort, PhD, MSN, RN

(available at no cost to you through most insurance—check to see when you can receive a pump in your state); milk storage containers, and a cooler or a refrigerator to store your pumped milk 4. Practice pumping: Use the pump a few times before going back to work. You’ll be more confident and your partner or a friend or family member can introduce your milk in a bottle to your baby 5. Introduce your baby to a bottle: Help baby begin eating pumped milk from a bottle a couple weeks before returning to work. Some babies have no problem going from breast to bottle, while others will put up quite a fuss, and may even refuse altogether. It’s a learning process 6. Gather all equipment the evening before: Who wants to multitask early in the morning? Ensure your pump, storage bags and bottles of

expressed milk are ready to go each morning, especially if you’re taking baby to their care provider on your way to work

Success with Pumping & Feeding Mom’s Milk With just a few additional tips, you will find yourself treasuring this time spent preparing to feed baby your mom’s own milk while you’re at work: h Consume lots of water while you’re pumping h Look at photos of your baby; play their recorded giggles, whatever helps you relax h Keep a clean hand towel or paper towels available for drips or spills h Keep your pumping space clean and wash your pump and supplies after each use JOANNE GOLDBORT, PHD, MSN, RN, is an assistant professor in the College of Nursing at Michigan State University and an expert nurse adviser to Healthy Mom&Baby.

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eturning to work while nursing is a huge milestone in your parenting journey. Get ready before the big day comes with these action steps designed to help you meet your breastfeeding goals. 1. Know your rights: No matter where you work, know your rights as a nursing parent, and what workplace accommodation laws apply to help you maintain your milk supply and feed your baby. Businesses with more than 50 employees must provide time to express milk for baby up to age 1 and provide a pumping space that’s not a bathroom 2. Make a plan with your employer: Before you go on maternity leave, ensure you’ve got a plan in place with your employer that details when and where you will be able to privately express your milk 3. Get your supplies before you give birth: You’ll need a breast pump

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healthy babies

Pediatricians Update Safe Infant Sleep Guidelines

campaigns were introduced. But the decline in deaths has now remained stalled for more than 20 years. The updated recommendations, published in the journal Pediatrics, include:  Parents should sleep in the same room as baby, but not in the same bed  Babies should sleep on their back on a firm, flat, non-inclined surface free of soft goods, such as blankets and toys. These items are suffocation hazards  Baby’s sleep surface should be a crib or bassinet designed for infant sleep, with only a tight fi tted sheet— no blankets or toys  Babies should never sleep in inclined surfaces including car seats, strollers, infant carriers, and infant seats and slings, especially infants younger than 4 months  Swaddling doesn’t reduce SIDS risk. If baby is swaddled, they should always be placed to sleep on their back. Weighted swaddles or weighted objects within swaddles are unsafe  Swaddling should be stopped



 

when a baby starts trying to roll over, usually at 3 or 4 months or earlier, as a swaddle can be a suﬀocation hazard Avoid devices marketed to reduce the SIDS risk or other sleep-related deaths. There is no evidence for such claims, and they may lull parents into a false sense of security Breastfeed when possible, and any breastmilk feeding is better than none Breastfeeding and paciﬁ er use reduce SIDS risks Parents should avoid using drugs and alcohol, and avoid exposing babies to drugs and alcohol

The AAP expanded their advice regarding wearable sleep monitors stating that there is no evidence that using them will prevent SIDS. Families who use these monitors should still follow the safe sleep guidelines. CAROLYN DAVIS COCKEY, MLS, LCCE, is the founding editor of Healthy Mom&Baby, Senior Director of Partnerships & Publications at AWHONN, and a Lamaze-Certiﬁ ed Childbirth Educator at the Mommy Baby Class in Sarasota, FL.

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he American Academy of Pediatrics has updated its safesleep guidelines for infants for the first time in more than fi ve years, emphasizing that babies should sleep on their backs on flat, level surfaces designed for infant sleep, such as a crib or bassinet, to reduce their risk of Sudden Unexpected Infant Death Syndrome (SIDS). There are approximately 3,500 sleeprelated infant deaths in the U.S. each year—and many of those deaths are preventable. “When you place your baby for sleep, they should be on their back in a crib, portable crib or bassinet that meets Consumer Product Safety Commission standards, and there should be nothing but the baby in the crib,” said pediatrician Rachel Moon, MD, the lead author of the new guidelines, which come from the AAP’s Task Force on Sudden Infant Death Syndrome and the AAP’s Committee on Fetus and Newborn. The U.S. made great progress in preventing infant deaths during the 1990s, when the first “back to sleep”

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Let us know your thoughts and comments on the Healthy Mom&Baby magazine and website. What do you like? What do you dislike? What subjects would you like to read more about? Email your feedback to: health4mom@ awhonn.org

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healthy babies

Read to Your Baby By Carolyn Davis Cockey, MLS, LCCE

Reading Adventures So much is going on when you’re

reading to your little one! Your baby picks up on your emotions as you make expressive sounds reflecting joy, laughter, surprise, or suspense. The sounds you make are cues that support baby’s social and emotional development long before they ever express their first words. As you read, encourage your baby to look at where you’re pointing and to touch any tactile features common in baby books. Introduce baby to soft, pliable books. Babies are drawn to contrast—begin with textured and pop-up books in simple shapes and black and white colors. As baby grows, read repetitive and rhyming books. As baby begins to toddle, they may well hand you a favorite book after a good chew on its corners. Don’t hesitate to ad lib on the stories—remember baby’s not following along with the words. Babies love rhyming—feel free to exaggerate

the sounds—baby is learning language from the tone and inflection in your voice—have fun with it!

Build Baby’s Library Ask friends and family members for recommendations regarding books their babies liked. You can also ask your local librarian for recommendations on raising a reader. Most libraries host a weekly story time, which your baby will likely enjoy. Get ready for the squeaks and squeals as the librarian vies for the attention of all the littles ones. As baby’s first birthday rolls around, put books on a list of desired gifts. Baby books come in all shapes, sizes, and materials including cloth-like paper, cardboard, and with padding. They will be chewed on, sat on, rolled upon, and drooled over at the very least—all of which is part of the adventure in reading to baby.

CAROLYN DAVIS COCKEY, MLS, LCCE, is the founding editor of Healthy Mom&Baby, Senior Director of Partnerships & Publications at AWHONN.

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t’s never too early to start reading to your baby. Whether baby is still in your belly, 10 days, or 10 weeks old, reading aloud to baby is one of the most beneficial bonding activities you can do together. Reading to baby introduces them to new words, emotions, and ideas. And there’s no right or wrong way to do it! Did you know that many expectant parents begin to read to their babies while they’re still in mom’s womb? Don’t be surprised when baby recognizes your voice, and your partner’s voice too, when you’ve been reading to baby throughout pregnancy. Between 6 and 7 months of pregnancy, most babies can hear your voice and the voices of others. Maximize this time to read stories and make funny sounds.

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