Healthy Mom&Baby: Issue 32 by Magazine

ISSUE 32 / 2022 | $3.95 | health4mom.org

PREGNANCY | BIRTH | PARENTING

HOW PEANUT BALLS HELP SHORTEN LABOR

YOU & YOUR HEALTHCARE PROVIDER: SHARED DECISION-MAKING Working together on care decisions provides best possible outcomes

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FERTILITY AT AGE 35+

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BENEFITS OF HUMAN MILK FOR YOUR SWEET BABY 08/03/2022 11:03

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Issue 32 / 2022

Contents ◆ healthy moms

◆ healthy pregnancy

◆ healthy babies

11 Respectful Care: Shared Decision-Making in Labor and Birth

26 Healthy Pregnancy Diet

36 Human Milk is so Amazing; Here’s Why!

These are must-have foods for a healthy pregnancy diet.

Create a positive relationship with your pregnancy care provider.

28 Prevent Lower Extremity Nerve Injury During Childbirth

14 Exploring Birth Control Options

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Know which birth control method is best for your contraceptive needs.

16 Pregnancy & Birth At Age 35 and Older Starting or expanding your family after age 35 is possible for many women.

29 The Wonderful Beneﬁts of Peanut Balls During Labor Peanut balls provide great support during labor—and they can even help your labor progress.

18 Lines, Pigment and Stretch Marks

30 Slow & Steady for Postpartum Weight Loss

Mama, it is important to embrace your body during and after pregnancy.

20 Breastfeeding & Medication Safety

Check these databases to learn if the medicines you’re taking are safe for your growing baby.

22 Optimize Your Breastfeeding Diet

How your legs are positioned in labor and birth can aﬀect your nerves—learn about lower extremity nerve injury during birth.

Learn foods and beverages that are best for your breastfeeding baby.

Get rid of those extra pounds with some simple and easy exercises you can do outdoors or in the comfort of your home.

32 Key Supplements for a Healthy Pregnancy Know which supplements can help boost your body during pregnancy.

Learn the beneﬁ ts of human milk for babies; here are 36 reasons why it’s best.

39 Coming Soon! New Rules for Infant Sleep Products Safe sleep experts are strengthening the rules and restrictions for safe infant sleep.

41 Tantrums: The Reason We Call it the Terrible Two’s Stay calm and be patient when dealing with your toddler’s tantrums.

42 Your Baby, Reﬂux, and Gastroesophageal Reﬂux Disease How much spit-up is too much? Here’s when to get help for your baby’s tummy.

44 What’s with All the Crying? Crying is a normal stage within infant development.

46 Six Strategies for Choosing Newborn Skin Care Products Pick safe products every time!

49 Traveling With Your Baby Top tips for cars, planes, and trains.

Exploring Birth Control Options

Healthy Pregnancy Diet

Your Baby, Reﬂux, and Gastroesophageal Reﬂux Disease Pregnancy & Birth At Age 35 and Older

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Slow & Steady for Postpartum Weight Loss

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After you’ve had a baby, the last thing you want to worry about is postpartum bleeding, discharge and whether you have enough pads. We’ve got you! Our super-absorbent, sustainable, super comfy Period. underwear is perfect for those first all-over-the-place weeks after giving birth. They absorb all flows - from heavy to light - and can last anywhere between five hours and all day before you need to change. Which means, you can focus on your baby without worrying about leaks. After you’ve used them, just pop them in the wash (we know the laundry will be going a lot in those first few weeks), dry and use again. You never have to go to the store or worry about running out of pads, with Period. underwear everything you need for your postpartum bleeding, will be already there in your drawers. period.co

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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.

Respectful Care During Labor & Birth 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

CHARLOTTE WOOL, PHD, RN, FAAN York College of Pennsylvania York, PA

Ask anyone to deﬁne respect and you may get answers that describe admiration, support, aﬃliation—all very positive connotations. Ask about disrespect and you’re likely to hear, “I don’t always recognize when I’m being disrespected but I sure can feel it.” The World Health Organization describes respectful maternity care as a fundamental human right. When you envision birthing your baby, are you in an environment where your pregnancy care provider is expert, collaborative and kind, and the nurses are professional, empowering and caring? The reality for many pregnant people, however, is far more dire. Research is eliciting that all too often birthing people are ignored and shut out of decisions. Disrespectful care ranges from subtle disregard to humiliation or violence. It includes physical or verbal abuse. It’s receiving care without your consent. It can be a provider denying care if they

SHARON HITCHCOCK, DNP, RNC-MNN University of Arizona College of Nursing Tucson, Arizona

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.

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

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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 DANIELLE BEASLEY, PHD, RN, RNC-OB, CNE University of South Florida Tampa, FL

disagree with you. Respectful care means pregnant and laboring persons are free from harm and bad treatment. That every birthing person has the inherent right to make decisions for themselves and their baby, including who they would like to be present for support. Respectful care means all pregnant and laboring persons are treated with dignity, respect, privacy, conﬁdentiality, and equality. AWHONN, the nurses who care for laboring persons in hospitals throughout the U.S., has published a guideline upholding respectful maternity care. In this issue, nurse Kimber Stovesand unpacks the idea of “shared decision-making” with your provider. Never let another human make you feel “less than.” You and your baby matter, mama; you both deserve dignity and respect. Learn more about respectful care at Health4Mom.org.

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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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◆ Your

Body, Your Birth

It’s Your Family’s Moment

AWHONN AWHONN 2022 President

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

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.

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PUBLISHER

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

Welcome to Healthy Mom&Baby. You’re expanding your family and as a nurse and editor of this magazine, I want to welcome you the best advice from nurses for your pregnancy, labor, and birth. In this issue, I know you will feel the passion, knowledge, and love from the expert nurses and healthcare providers who write the articles. We’ve got advice and guidance on topics such as breastfeeding. Your breastmilk is the very best nutrition for your baby—experts call it “liquid gold!” Let’s brag about what you’re capable of producing for your new baby for a moment. Human milk is so unique; it contains the right composition of nutrients, immunity protection, and over 200 bioactive factors to nourish and protect your baby. We’ve also got advice on managing medications safely while nursing, and making most of your diet and nutrition for the healthiest milk composition for baby. For your safety and protection, we’ve got advice on how you can protect the nerves in your hips, knees, and legs during birth (to prevent lower extremity nerve injury). Have you heard about peanut balls? Learn why nurses may help you use these exercise-like balls while in labor, and how they can help shorten labor. Finally, we continue to provide advice about the respectful maternity care you deserve so you can identify what great care sounds, looks, and feels like. It’s your body, your birth, and your big moment. It should be ﬁlled only with great memories. You should feel respected, well cared for, and important to everyone who has the privilege of taking care of you! Stay empowered! Yours Truly,

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 32 / 2022

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Slow ! down Relax.

Don’t rush me!

While it may seem convenient for you or your health care provider, labor should only be induced for medical reasons. G me ive tim e

Your baby will let you know when he’s ready to come out, so give him at least a full 40 weeks.

f 40 or !

Download a free copy of

40 Reasons to Go the Full 40

What’s the hurry?

at www.gothefull40.com.

The nurses of AWHONN remind you not to rush your baby—give him 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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Could it Be Pandemic PTSD?

Increased family care, social isolation, uncertainty, illness, grief, job loss . . . the effects of the SARS-COV-19 pandemic are wide reaching. If you’re at your tipping point, you’re not alone. Women’s health researchers at Yale University are asking if everyone—especially women—may now be experiencing what could be considered post-traumatic stress disorder. “As clinicians, when we ask about symptoms of PTSD, it’s always in reference to a specific traumatic event, with a significant level of shock,” says Dr. Mathilde Husky, a professor at the University of Bordeaux and a lead author of a study on classifying the pandemic’s effect on mental health in conjunction with colleagues at Yale. “In the context of a pandemic that is nearing two years in length, if I ask someone if they are experiencing flashbacks, the question becomes: flashbacks of what? Are they avoiding cues in their environment or situations that would expose them to things that would remind them of the event? Some people report a singular traumatic event in the context of the pandemic, but many do not,” she said. While you may not have full-on PTSD, tips for coping with extreme stressors are relevant as we continue to experience the effects of coronavirus: h Practice relaxing—try deep breathing, stretching, yoga, and mindfulness in your day

h Get outside—no matter the season, take a walk outdoors to reconnect with the natural environment, which boosts mental health h Talk to someone you trust—sometimes just expressing your frustrations can be a huge relief, especially when you find those same stressors are shared by others h Practice positivity—and seek out positive people h Avoid alcohol and drugs, which may actually make you feel worse

Meditate to Make Fewer Mistakes Here’s something that’s healthy for you and that improves your overall mental performance: Just one session of active meditation—being aware of your feelings, thoughts and bodily sensations as you focus—boosts your brain activity that helps you recognize and respond to errors more quickly. Researchers working with 200 individuals engaged in a 20-minute guided meditation while researchers monitored their brain wave activity. What researchers observed was “what just 20 minutes of meditation can do to enhance the brain’s ability to detect and pay attention to mistakes,” said Jason Moser of Michigan State University. “It makes us feel more confident in what mindfulness meditation might really be capable of for performance and daily functioning right there in the moment.”

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EASE YOUR PAIN WITH THE

COOLING COMFORT OF

Get back to life’s important moments. Before, during and after childbirth your body experiences a lot of changes. Don’t let hemorrhoidal flare-ups or perineal discomfort take over during this special time. Medicated cooling pads soothe the burning and itching caused by hemorrhoids, vaginal discomfort and rectal irritation. Gentle witch hazel formula and soft pads are effective at cleansing and treating sensitive areas.

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Respectful Care: Shared Decision-Making in Labor and Birth By Kimber Stovesand, RN, BSN

What is Shared DecisionMaking?

Find a Supportive Pregnancy Care Provider

Shared decision-making allows you, the birthing person, to make healthcare decisions supported by your pregnancy care provider’s expertise and along with your values, desires, and innate knowledge of your own body. While there are some conditions or challenges that can arise during pregnancy, in general, pregnancy is considered a healthy state of being. How does that perspective shape your care during these 40 weeks? As a labor and delivery nurse, use these tips to partner with your pregnancy care provider for the best care and outcomes.

A supportive healthcare provider can make a world of difference in how your pregnancy experience unfolds. Important aspects to question as you consider your choices: 1. Are they qualified to handle your level of care? Obstetricians, certified nurse-midwives, and certified professional midwives can manage low-risk to high-risk care in varying ways. Which one is right for your individual needs? 2. Do they listen to you? One of the most common complaints of pregnant and birthing people is the feeling of not being heard.

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ew milestones are more important than the birth of your children. It’s a time that can be exciting, joyful, and sometimes anxietyinducing. Giving birth might be your first interaction with the healthcare system. There are many decisions to make, from who to trust with your care (midwife or obstetrician), and where to deliver (home, birth center, or hospital), to how you envision giving birth. Each of these important decisions can greatly influence the kind of experience you have. Creating a relationship of shared decision-making with your pregnancy care provider can help reduce stress throughout pregnancy, and during labor and birth.

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Educate Yourself to Empower Yourself You are absolutely your own best advocate. How can you increase your confidence and ability to voice what aspects of pregnancy are important for you? By educating yourself! Education gives you the knowledge

to understand what is and is not normal in pregnancy and birth, and which questions to ask. There are so many resources out there to further your understanding of pregnancy and birth! These can greatly increase your confidence and help you to ask the right questions, advocate for yourself in times of uncertainty, and seek additional clarification when needed.

Create a Birth Plan that Specifies Your Desires Armed with the knowledge gained from a thorough childbirth education course, make a plan! Birth plans are excellent ways to facilitate clear and concise communication with your labor and birth team. They are especially helpful during a time you may not be equipped to explain it all! Formulate your birth plan ahead of time and discuss it with your provider during pregnancy -- before labor begins. Talk with your provider about the things that are important to you and why. Ask your provider to share any limitations of the plan based on your own health situation, their skills or your preferred birth place.

Hire a Doula Doulas are amazing labor support professionals who are knowledgeable about birth and skilled at advocating for pregnant and birthing people. They can be powerful stand-ins during challenging times to ensure that the issues that are important to you are clearly communicated when you might not be able to advocate strongly for yourself. These are just a few examples of how you can help facilitate shared decisionmaking with the full team supporting your labor and birth. It’s important for you to both understand what’s going on in your labor, and be an equal partner in the decisions related to your birthing body and baby. Such a culture of respect will empower you to be your most capable, confident, and strong self. Start your parenting journey on a supported and shared path. KIMBER STOVESAND, RN, BSN, is a travelling nurse who specializes in perinatal nursing. She is honored to be able to use her passion for women’s health to be a staunch advocate for womens’ birthing rights and quality care for women all over the United States.

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Find a provider who you feel listens to your concerns, addresses them in a respectful manner, and validates what is important to you as a person. 3. Do they work with you in a way that meets your needs for pregnancy care? This goes beyond simple health checks and leans more into patient and provider preferences and needs. For example, if you’ve ever been a victim of abuse from a women’s healthcare provider, you would benefit from a provider trained in delivering traumainformed care. Is your baby breech (head up/butt down position)? Will this provider help you birth vaginally and help you avoid a cesarean surgery unless absolutely necessary? Is the provider trained, experienced and supportive of breech deliveries?

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Expert-Tested + Mom-Approved Helpful guides and essential products for every stage of your journey – from planning for baby through your first weeks as a new mom.

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How Can I Promote Healthy Milk Supply? Do you find yourself increasingly frustrated as your little prince 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 will result in a fidgety baby and 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, to best avoid feelings of inadequacy. 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 princess 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.

Order your Starter Kit and see more Mommy’s Cookie Jar products by visiting us online at www.mommyscookiejar.com and following us on Instagram @MommysCookieJar.

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Exploring Birth Control Options By Shawana Moore, DNP, MSN, CRNP, WHNP-BC

here are many birth control methods available to you for your contraceptive needs. Deciding which methods work best for you is an important step you can take when selecting your birth control options. There is no one size fits all, and methods range from daily use, to up to 10-year use (excluding sterilization). Let’s explore common available birth control options in the U.S., and how effective each method is.

Contraceptive Implant (99%+ effective) The contraceptive implant, Nexplanon, is a small rod placed under your skin by a trained health care provider. It protects against pregnancy for up to 3 years and contains a progestin type of hormone. The contraceptive implant is a safe and an effective method to use during breastfeeding.

Intrauterine Device (99%+ effective) There are several hormonal and non-hormonal intrauterine device (IUD) options available. Hormonal and non-hormonal IUDs are placed in your uterus by a trained health care provider. The hormonal IUDs protect against pregnancy from 3-6 years and contain a progestin hormone. The non-hormonal IUD can be used for up to 10 years to prevent pregnancy.

Intrauterine devices are safe and effective methods to use during breastfeeding.

Lactational Amenorrhea Method (98% effective) The lactational amenorrhea method (breastfeeding as a form of birth control) can be used safely to prevent pregnancy up to 6 months postpartum. The following three criteria must be met to use this method: h Not having a period after the birth of your baby; once your period resumes you should consider yourself fertile again and capable of getting pregnant h Fully or mostly breastfeeding (no interval greater than 4-6 hours between nursing your baby) h Less than six months since delivery of your baby You’ll need to find another way to prevent pregnancy if any of these three criteria are no longer true. Let’s look at the most common choices:

Contraceptives (91%-99% effective) Birth control pills can be taken daily to prevent pregnancy. There are combination pills that contain two hormones (estrogen and progestin), and progestin-only pills that contain only progestin. Combination pills should not be used during

breastfeeding. However, progestinonly pills (mini-pills) are safe and effective during breastfeeding. Both require a prescription from your healthcare provider.

Contraceptive Ring (91%-99% effective) The contraceptive ring is placed in the vagina by you for three weeks, removed for one week, then reinserted. There are two contraceptive ring options available in the U.S.: NuvaRing and Annovera. Annovera can be used monthly for 12 months while the NuvaRing is refilled at the pharmacy each month. Both contraceptive rings contain both estrogen and progestin hormones. Contraceptive rings shouldn’t be used during breastfeeding, and they require a prescription from your healthcare provider.

Contraceptive Patch (91%-99% effective) The contraceptive patch is worn on the skin and replaced once a week, with one week off every month. There are two contraceptive patches available in the US: Xulane and Twirla. Both contain the same estrogen hormone but a different type of progestin hormone. The contraceptive patch should not be used during breastfeeding and it requires a prescription from your healthcare provider.

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healthy moms Contraceptive Injection (94%-99% effective) The contraceptive injection, DepoProvera, is given to you by a health care provider every 12-14 weeks. It contains a progestin type of hormone. The contraceptive injection is a safe and effective method to use during breastfeeding, and it requires a prescription from your healthcare provider.

Vaginal Gel Contraception (86%-93% effective)

Barrier Methods Barrier methods prevent sperm from getting to the egg. Some standard barrier methods include the following options with their effectiveness noted: h Male condoms (85%-98%) h Female (internal) condoms (79%95%) h Birth control diaphragm (88%-94%) and cervical cap (71%-86%) h Birth control sponge (76%-88%) h Spermicide (72%-82%) All barrier methods are safe and effective to use during breastfeeding. Additionally, male and female condoms protect against sexually transmitted infections. All the above can be

purchased over the counter with the exception of the diaphragm and cervical cap. Deciding the best contraception method may include relationship factors, how often you have sex, partner preference, side effects, effectiveness in preventing pregnancy, cost, and prevention of sexually transmitted infections. It is essential for you to discuss your options collaboratively with a health care provider. SHAWANA S. MOORE 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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A hormone-free vaginal gel, Phexxi, prevents pregnancy by keeping the vaginal pH within the acidic range, which helps lower sperm mobility. It is a single applicator used for each vaginal-penile sexual encounter. Vaginal gel contraception is a safe and effective method to use during

breastfeeding, and requires a prescription from your healthcare provider.

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Pregnancy & Birth At Age 35 and Older Conception has become increasingly more common over the age of 35 in the U.S. By Essence Williams, MSN, BSN, RNC-MNN, CCB, LCCE

re you in your mid-to-late 30’s, or early 40’s, and trying to conceive? If so, you’re not alone. Conception has become increasingly more common among women ages 35 or older. More women are pursuing higher education, careers, economic freedom and delaying childbearing. For many obstetric medical practices, women ages 30-plus make up most of their patients. This is largely due to the new and improved advancements

in artificial reproductive technology (ART). Getting pregnant is a tremendous, life-changing event that can be full of joy and excitement, but for some women considering pregnancy after their 35th birthday can be frustrating and full of challenges.

Pursuing Pregnancy Infertility is defined as not conceiving after actively trying for more than one year, and for women older than

35, it’s the inability to conceive within a period of 6 months or longer when actively trying to get pregnant. Two obstacles you may face when trying to conceive a baby after age 35 are less frequent ovulation, and reduced egg reserve. As you age, you may even have cycles where your body doesn’t even release an egg. Without an egg, conception can’t happen. In addition, as you age, the quality of your eggs may diminish, and

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healthy moms the number of viable, healthy eggs will decrease (known as decreased egg reserve). If your partner is also in their mid-30s or older, the quality of their sperm may also be compromised. If this sounds daunting just remember that though it may be harder to conceive if you’re age 35 or older, it’s not impossible. Living a healthy lifestyle can boost your egg health, so please choose a healthy diet, regular exercise, adequate sleep, and manage stress to help improve your chances of conceiving and birthing a baby.

Meet with a Pregnancy Specialist

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Dr. Michael J. Glassner, MD, fertility physician, and founder and medical director of Main Line Fertility in Bryn Mawr, PA, advises “For women over age 35, scheduling an appointment with a reproductive

healthcare provider is the first step to be considered after 6 months of unsuccessful efforts to conceive.” The second step is being aware of your own “fertility window.” When you want to have a baby, you can improve your chance of getting pregnant if you know about ovulation and your fertile window. There are about 6 days during your menstrual cycle when you can get pregnant, which includes 24 hours after ovulation (when you release an egg from your ovary), and the 5 days beforehand. This is known as your fertility window. Plan to have sex every 1 to 2 days during your fertile window, or on the 1-2 days leading up to and on the day of ovulation. Learning and tracking your fertile window is an essential tool to conceiving--it’s important to keep track of this time frame. Ovulation predictor kits are an easy and affordable way to know if you’re

ovulating, and on which typical days of your monthly cycle. They track the presence of luteinizing hormone (LH), which surges 10-12 hours before ovulation.

Couples Fertility Check up The third step for women over 35 trying to conceive is to get a fertility checkup. According to Dr. Glassner, a fertility checkup consists of: h Fertility hormone panel on day 13 or 15 of your cycle h Semen analysis (if there is a partner involved) to rule out male-related fertility factors h Progesterone level, which is performed 6 days after ovulation h Cycle day 2 or day 3 ultrasound and bloodwork to check your egg reserve h Ultrasound to observe the thickness of the innermost lining of your uterus and to look at the growth of the egg follicles in your ovaries h Fallopian tube evaluation to make sure your fallopian tubes are open and not blocked h Sims-Huhner Test, which counts the number of sperm and how long sperm survives within your cervical mucus—your egg can only be fertilized within 24 hours after being released from your ovaries You are your own best advocate— it’s your body and your fertility— and every woman has her own experience in this regard. Choose a fertility practice that individualizes your care and experience. Do your research, meet with your pregnancy care provider to discuss your own individual and unique reproductive health. 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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Lines, Pigment and Stretch Marks By Catie Chung PhD, RN, CNE

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 or lotions or 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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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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What can I do about Scars? Is your scar significant? Problem scars are the result of an impasse in healing. Successful scar management assist in overcoming these pauses in healing.

surgery removes scar tissue and lessen the tension across the scar. Also effective is professional skin resurfacing through chemical, laser or micro needling.

Problem or “angry” scars can be swollen, contracting, itchy, painful, causing discomfort and psychological distress. For over 25 years ReJuveness has help the medical community and over 200,000 patients resolve and prevent problem scars.

ReJuveness offers a much less expensive at home micro-needling alternative. All scar revision professional or self-applied can yield improved results when used in conjunction with ReJuveness products.

Less severe scarring and stretch marks can raise cosmological concerns. Uneven skin texture and coloring is normal but undesirable. The solution to these otherwise healthy mature scars is to restimulate the healing process. Expensive Scar Revision

Little scientific evidence exists why standard scar treatments work. It has been found using multiple treatments at once improves results. Scar management principles are: 1. Start scar management early 2. Reduce tension across the scar 3. Promote rapid skin resurfacing 4. Silicone sheeting is the nexus of scar management 5. Certain silicones are more effective for scar management Get a personal scar evaluation by contacting a ReJuveness Scar Advisor. Email your scar description and questions to scar.advisor@rejuveness.com or call 518-623-Heal (4325) Heal Scars!

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Breastfeeding & Medication Safety Do you need to “pump and dump” baby’s breastmilk while taking that medication? By Paris Maloof-Bury, MSN, CNM, RNC-OB, IBCLC

“I

’m sorry you’re sick, mommy,” said no baby ever. So what happens when a nursing parent needs an antibiotic, some cough syrup, or something to fend oﬀ that fever? And what about medications that need to be taken daily, like antidepressants or allergy meds? If there’s one thing parents are good at, it’s putting their kiddos ﬁrst. The good news is that in most cases, you don’t have to choose between what’s best for your own health and nursing your baby. You just need the right information and some good support.

absorbed at a far lower concentration. The only exception to this rule is when the medication might impact your milk supply, which brings us to the next question...

Will Medications Aﬀect My Milk Supply? Some medications, such as antihistamines (Benadryl, Zyrtec, etc.) and decongestants (Sudafed, Claritin D, etc.) can reduce your milk supply. Birth control with estrogen, and fertility medications like Clomid can also decrease your milk supply.

Did You Take the Medication in Pregnancy?

What Medications are Usually Fine?

A good rule of thumb is that if you took the medication in question while you were pregnant, you can probably continue taking it when nursing. During pregnancy, medications you take go directly into baby’s bloodstream via the placenta. Post-birth, during nursing, baby gets any medications you’re taking in your milk. This means baby digests those medications, so they’re typically

According to the American Academy of Pediatrics, most medications and immunizations are safe during lactation. Not only are most vaccines considered safe (including COVID-19) but getting vaccinated allows you to pass antibodies to your baby while nursing. Most medications used to treat postpartum depression and anxiety, asthma, high blood pressure, diabetes,

thyroid dysfunction, and infection (including most antibiotics) are usually fine for nursing parents. General and local anesthesia are also safe. Progestinonly birth control methods are OK as long as they’re started after the first four weeks postpartum. Pain and fever reducers like acetaminophen (Tylenol) and ibuprofen (Advil or Motrin) are safe, as are cough medicines like guaifenesin (Robitussin) and dextromethorphan (Robitussin DM). If you’re not sure, look it up online at MommyMeds for Mothers, LactMed, or Infant Risk Center, or run it by your baby’s pediatric provider first.

Should I Pump and Dump to Be Safe? If you’re not sure if it’s safe to continue nursing while taking that medication, it might seem like a simple answer to switch to bottle feeding (either formula or previously stored milk), and pump so your milk doesn’t dry up. But before you pull out that pump, consider the risks, beneﬁts, and alternatives of that decision.

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healthy moms This decision may affect your baby’s latch and your nursing relationship. In addition, some people find that their bodies don’t respond as easily to the pump as they do to their baby, and this breastfeeding interruption can reduce milk production.

Formula Feeding Some switch to formula “just to be safe” when they don’t know where to find the answers they need about a specific medication. Formula fed babies are more prone to infections in the first year of life because baby isn’t getting the protective antibodies in mom’s breastmilk. Those infections include ear, respiratory, and gastrointestinal infections in babies who are supplemented with formula during their first six months.

Is this Medication Risky? The risk of a particular medication will vary including how easily the medication passes from your bloodstream into your breastmilk, how well it’s absorbed in baby’s digestive tract, and baby’s age (and how mature their liver is).

What Medications Are Too Risky During Nursing?

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Certain life-saving therapies, such as chemotherapy and radiation therapy are absolutely prohibited in breastfeeding/chestfeeding. While human milk is excellent for babies’ health, it’s even more important for mom to be alive! Certain illicit and recreational drugs are also considered unsafe, if you’re in a supervised methadone treatment program you’ll be encouraged to continue nursing. Smallpox and yellow fever are the only two vaccines not considered safe during nursing. PARIS MALOOF-BURY is an associate editor of Healthy Mom&Baby and a certified nursemidwife and lactation consultant in Northern California who loves helping parents grow their families with love, support, safety, and empowerment.

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healthy moms

Optimize Your Breastfeeding Diet By Rachel Napoli, DNP, PHN, CNS, RNC-OB, IBCLC

ost people know that during pregnancy there are some foods and beverages better avoided, but have you considered the importance of your diet while nursing your little one? Knowing what to eat during breastfeeding/chestfeeding is just as important because what you eat influences the nutrition in your breast/ chest milk. Nursing your baby brings benefi ts for both of you, especially decreasing health risks you may face, mom, including diseases such as type 2 diabetes and breast or ovarian cancer, for example. For baby, it means reduced risks for ear infections and sudden infant death syndrome (SIDS). It’s extremely rare for babies to be allergic to breastmilk (fewer than 1% may have a reaction). But you may have concerns (just like in pregnancy) that something harmful could be passed to baby through your milk. Knowing how your diet affects your milk will help you make healthy decisions about what to eat and drink.

What Should I Eat While Breastfeeding? As with pregnancy, it’s important to have a wellbalanced diet. The good news is you can eat all the foods you had to avoid during pregnancy, such as soft cheeses, deli meats, and rare beef. Eating a healthy, well-balanced diet helps to provide your baby with all the essential fats and micronutrients (such as iron, potassium, magnesium, and zinc) they need. You can also continue taking a multivitamin. Nursing requires a lot of energy, which helps you shed the weight gained during pregnancy. If you are losing more weight than you’d like, or having diﬃculty with your milk supply, you may need to increase your calories during breastfeeding/ chestfeeding.

What Should I Drink While Breastfeeding? It’s important to drink plenty of water while nursing. Caffeine is fine in moderation (up to 3-5 servings daily or 300-750mg daily). Infants younger than six months old may be more sensitive to caffeine, so watch your baby for irritability and difficulty staying asleep.

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healthy moms Once your milk supply is abundant, you can reintroduce alcohol. Just plan to wait about 2 hours after each drink before nursing again, and you don’t have to pump and dump. One alcoholic drink is defined as 12 oz. of 5% beer; 8 oz. of 7% malt liquor; 5 oz. of 12% wine; or 1.5 oz. of 40% (80 proof) liquor.

Can My Baby React to What I Eat? It’s rare for your baby to react to the foods you eat. According to the Academy of Breastfeeding Medicine, this only happens in about 0.5-1% of

Can I Prevent Allergies by Nursing? There’s limited evidence that introducing or avoiding certain

foods during lactation can prevent allergies in your baby. However, according to the American Academy of Pediatrics, eczema can be reduced by breastfeeding for at least 3-4 months. Eczema is a risk factor for developing food allergies. If you or a family member has severe allergies, it’s good to speak to your healthcare provider about these allergies and the possible need to limit your intake of the most common allergens (milk or milk products, fish, eggs, and nuts). RACHEL NAPOLI, DNP, PHN, CNS, RNC-OB, IBCLC, is an Assistant Professor of Nursing at Sonoma State University (SSU). She also serves as Assistant Director of the Pre-Licensure BSN Program. She is the lead course instructor for the Care of the Childbearing Family course. She has a passion for expanding baby friendly initiatives and breastfeeding.

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exclusively breastfed babies. The most common cause is cow’s milk proteins (like cow’s milk, cheese, butter, or ice cream). Other causes could include

eggs, corn, soy, nuts, or wheat products, but reactions are so rare that it’s seldom necessary to avoid these foods. If you notice that your baby may be reacting to something you are consuming (abdominal discomfort, skin rash such as hives or eczema, diarrhea, and sometimes with blood in stool), contact your baby’s healthcare provider so they can evaluate your baby and help you decide if you should try to eliminate some foods from your diet to see if this improves their symptoms.

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Baby Girl or Boy?

It May Depend on Your Male Partner’s Siblings Hey mama, the sex of your potential off spring doesn’t fall far from the family tree. Researchers looking at hundreds of years of more than a thousand family trees in North America and Europe say the composition of your male partner’s family of origin holds clues to the sex of your future babies. What they discovered is this—men seem to inherit a tendency to have more sons or daughters from their parents. So, a male partner with lots of brothers is more likely to have sons, and a man with a lot of sisters is more likely to father daughters. Interestingly, the same trend is not true for women and their siblings. Newcastle University researchers suspect that an as-yet-undiscovered gene may affect whether your male partner’s sperm has more X or more Y chromosomes, which affects the sex of the children. On a larger scale, the number of men with more X sperm compared to the number of men with more Y sperm affects the sex ratio of children born each year.

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Probiotics to the Rescue for Morning Sickness The same superheroes that help us fight yeast infections can likely help improve the nausea, vomiting and constipation throughout pregnancy— especially early pregnancy, say researchers writing in the journal, Nutrients. Five out of six pregnant women struggle with morning sickness to the point that it affects their quality of life. The culprit? Pregnancy hormones estrogen and progesterone bring a lot of physical changes and alter your microbiome, which affects your gut and why you don’t feel so great when you go to the bathroom. In the study, pregnant persons took a widely available nonprescription probiotic mostly containing lactobacillus with 10 billion live cultures at the time it was manufactured. Incidents of nausea were reduced by 15% but the biggest payoff was in moms who were vomiting as the probiotics cut the number of episodes by a full one-third. They also reduced constipation “significantly.”

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Healthy Pregnancy Diet Congrats, you’re pregnant! Time to start “eating for two,” right? By Aliah Thomas, RNC-OB

Eat for a Healthy Baby So instead, eat for a healthy baby! According to experts at the National Institute for Health, a healthy pregnancy diet reduces your chances of developing gestational diabetes (high blood sugar), pregnancy-related high blood pressure, and preterm birth. Also, not eating healthfully can lead to too little weight gain for your baby, increasing your baby’s chances of developing diabetes or heart disease in adulthood. Eating too much can set baby up for childhood obesity and diabetes.

Eat for Baby’s Health Now & In the Future Your growing baby receives nutrients via the placenta from what you take in. Baby is the last stop at the end of a long food chain; the nutrition from the food you eat determines baby’s growth. Proper nutrition during pregnancy decreases the risk of birthing a toosmall or too-large baby. Struggling to curb bad habits? Research demonstrates that by the second trimester, it’s often too late to change unhealthy dietary behaviors, as most of the potential adverse outcomes have already been set in motion.

Essential Pregnancy Nutrition There’s no one-size-fits-all diet. Aim for foods high in protein, iron, folate, and calcium. More than 20% of pregnant women suffer from iron-deficiency anemia, which can lead to premature birth and growth restriction for baby, and postpartum hemorrhage for you, mom. A diet low in folate, especially before pregnancy, can lead to serious birth defects in the brain or spinal cord that develop early in pregnancy. Foods like asparagus and dark leafy greens are both

rich in iron and folate. You can get your calcium ﬁx from dairy, nuts, seeds, beans, and those dark leafy greens like spinach and kale. For vegetarians and vegans, ensure you’re getting protein, calcium, iron, and vitamin B12, either from food or from supplements, as these nutrients are often lacking in meatless diets. Reduce animal fat and sugar to lower your chance of developing diabetes in pregnancy. A quick meal of baked ﬁsh, sauteed spinach, and brown rice provides the protein, iron, and B vitamins needed by growing baby. Healthy snacks include fruit or veggie smoothies, or cheese, nuts, and grapes.

Getting Enough Iron Iron helps your body make blood to move oxygen into your cells for energy. During pregnancy, your body needs more iron for your growing baby. Low iron levels are linked to prematurity and low birth weight. The CDC recommends that all pregnant women begin taking an oral, low-dose iron supplement (30 mg/day) at their ﬁrst prenatal appointment, and be screened for iron deﬁciency anemia (IDA). Ask your healthcare provider to check your iron levels and screen for anemia. During pregnancy, boost your iron by eating leafy green vegetables, strawberries and kiwi, quinoa, legumes, seeds, and iron-rich meats such as beef, turkey, and chicken. 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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t may seem tempting but eating twice the food is not only unhealthy, but it can lead to obesity in pregnancy that may remain after you birth your baby. Too much weight gain can also cause pregnancy complications.

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Iron I like because it likes me. Why is Iron Important? Iron is an essential mineral which plays a key role in the making of healthy red blood cells. Without healthy red blood cells, your body doesn’t get enough oxygen. When you don’t get sufficient oxygen throughout your body, you’re going to be exhausted, which can affect everything from your brain function to your immune system’s ability to fight off infections. Iron deficiency in infants* may adversely affect the long-term neuro development and behavior, some of these effects may be irreversible.

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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healthy pregnancy

Prevent Lower Extremity Nerve Injury During Childbirth By Jamie Vincent, MSN, APRN-CNS, RNC-OB, C-EFM

irth isn’t comfortable, and it’s not always safe for nerves in your lower body serving your hips, legs, knees and feet (lower extremities). Hormones released during pregnancy relax muscles and loosen ligaments and joints, especially in your pelvic area. Changing positions during labor helps with birth, holding some positions can increase your risk for injuring your lower extremity nerves.

Protect Your Lower Extremity Nerves A combination of pressure and stretching on the lower extremity nerves over time increases your risk for nerve injury. Prevent injury with these tips:

Compression + Stretch + Time = Injury h Protect your hips and knees: Avoid squatting or pulling your knees outward toward your chest (overflexing) for long periods of time. Keep your legs in a natural, relaxed position between pushes h Avoid bracing your legs against hard surfaces like the bed, side rails or stirrups. Your nurses will happily support your legs, especially if you are using epidural h Change positions every 10-15 minutes during pushing. With an epidural, you may not feel the warning sensations of nerve pressure or stretch

h Regularly change the positions of your hands when pulling behind your thighs or knees

Get Help for Nerve Pain Sometimes lower extremity nerve injury is misdiagnosed or missed because symptoms are often mild. If you develop any these symptoms after an epidural has worn off, quickly alert your maternity care providers. Not all areas may be affected equally—you may have pain in your left hip but not your right. Get care for any of the following: h Numbness, weakness, or loss of function in your lower extremities that affects normal walking or movement h Tingling, tightness, or pain in your lower extremities that doesn’t improve h Increased or extreme sensitivity to touch h Difficulty lifting the front part of your foot (foot drop)

JAMIE VINCENT, MSN, APRN-CNS, RNC-OB, C-EFM, is a Clinical Nurse Specialist in Northern California focused on quality improvement within hospital systems ensuring that high risk obstetric patients receive the highest quality, patient-centered, coordinated care possible. She also serves as a mentor and consultant to multiple committees and agencies, both at the state and national levels, to improve safety and outcomes for families everywhere.

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Use safe positions and change position often during labor and birth to prevent lower extremity nerve injury. You know your body best; tell your care team if something doesn’t feel right.

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The Wonderful Beneﬁts of Peanut Balls During Labor By Lakisa Ballard, RN, MSN, C-EFM, RNC-OB

IMAGES: © PREMIERBIRTHTOOLS.COM; PREMIER BIRTH TOOLS LLC, SHUTTERSTOCK

ho would have ever imagined a large exercise-like ball shaped like a peanut would become an essential tool in helping your labor progress? If you are preparing for labor with an exercise ball at home, you won’t be surprised if and when your nurse brings a peanut ball to support position changes during labor—even while remaining in bed. Peanut balls are latex-free inflatable devices shaped like a peanut—broader on each end, and narrower in the middle. Like exercise balls, only shaped differently, they come in four different sizes, from 40 cm to 70 cm. Nurses love peanut balls because they help laboring women change positions while in a labor bed. Early research suggests that they may help keep labor progressing.

Changing positions in labor encourages baby to descend into the birth canal, and reduces your risk for cesarean birth. Some birthing persons who use these balls say they helped them have a better overall birth experience.

Keep That Pelvis Active Using an epidural during labor? No problem—the peanut ball will support position changes so as not to slow your labor. Ask your nurses to help you with the support of a peanut ball in changing positions throughout labor, depending on how far along your cervix is dilated. Some positions include leaning forward, side lying and the tuck. Peanut balls also help you push more eﬀectively on your side, which helps to reduce your risks of injury to the nerves, supporting your hips and knees

(lower extremities). Such injuries are possible when you lay on your back for hours without a position change.

Using a Peanut Ball Peanut Balls are typically used two ways primarily to help you change your positions in labor. For example, you may sit in bed in a semi-reclined position with one leg over the ball and the other leg out to your side. The peanut ball also supports side-lying position with your upper leg over the ball, which helps open your pelvis.

LAKISA BALLARD, C-EFM, RNC-OB, is a Labor and Delivery Clinical Nurse Educator at Holy Cross Hospital in Maryland. 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 has contributed to her holistic approach to patient care and versatile teaching methods.

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Slow & Steady for Postpartum Weight Loss By Heather Watson, PhD, RN

Start with Movement First, it’s okay to exercise during postpartum recovery, but what you can do will be aﬀected by whether you had a cesarean birth, your prepregnancy routines and whether you worked out in pregnancy. If you weren’t a marathon runner before having your baby, don’t start now. If you did run marathons, retrain

slowly. If you never had much of a routine before, now’s a great time to start one.

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Exercise & Breastfeeding

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If you’re breastfeeding, extreme exercise can reduce your milk production; proceed cautiously. Exercise boosts positive moods and energy. If your partner gained some sympathy weight, they may also want to get back into healthy activity. Support each other! Start slow and steady to both regain strength and return to your desired weight. If you’re tired, creating unrealistic goals will feel even more impossible. Be realistic, and give yourself credit for things you may not have previously deemed “exercise.”  Listen to your body; if it becomes too much, stop  Exercise when you have energy  Exercise with your baby--walk with a stroller, carry the baby up and down stairs or share tummy time with yoga  Increase time slowly; start with a

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10-minute walk, then add time as it feels comfortable Dancing while holding your baby is fun and exercise! Set realistic goals—slow progress is still progress Get a buddy for accountability Involve your family; families who play together, stay together! Talk to your care provider if you’re unsure about your limitations

Building healthy exercise habits after baby’s birth will help you establish a good routine. Feeling good about yourself will positively aﬀect baby, too. You can both love yourself and want to improve yourself at the same time. Love on your postpartum body—it nourished, grew and protected a whole other human! HEATHER WATSON, PHD, RN, is a Nurse Scientist at the Johns Hopkins Health System. Her clinical background includes working as a mother/baby, labor & delivery, and women’s surgical nurse, and as a childbirth educator. Heather has conducted research in maternal sleep, fetal development, and motivation toward healthy behaviors in pregnant women.

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ongratulations! You’re home after a successful birth, snuggling with your newborn, and feeling…well, maybe, feeling everything from happy to sad, from tired to energetic. Many of us feel discouraged after birth because our bodies have changed, or we have some extra weight. And we’re often so dedicated to caring for our babies that we forget to take care of ourselves. You can do both! Be kind to yourself. Don’t rush. “Nine months on, nine months oﬀ ” is a realistic mantra to live by if you’re interested in achieving your prepregnancy health status.

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Key Supplements For A Healthy Pregnancy By Sharon Scott, RN, MSN

Vitamins Vitamin A, D, E, and K are stored in the liver, and you should know that too much vitamin A can cause problems for your baby’s bones, urinary tract, and the central nervous system. It’s important to take a prenatal vitamin instead of a general multi-vitamin, which may contain too much vitamin A. If you’re a nursing mom, your baby is receiving these vitamins through your breastmilk, however, your baby may not be getting enough vitamin D. Many care providers are now recommending that both mom and baby take vitamin D supplements.

DHA Omega-3 and omega-6 fatty acids are important in fetal growth and development, and many experts are now recommending pregnant women take pure quality fish oil capsules in pregnancy, particularly to avoid any mercury in acquiring essential fatty acids from fish sources. DHA, which is in the omega fatty acids, is known for brain and retinal development, and it has been linked to decreases in premature deliveries. Coldwater fish, such a salmon and mackerel, are good sources of omega-3, as are walnuts and flax seed. Experts recommend pregnant women limit their intake of fish with high levels of mercury to no more than 1-2 fish meals per week.

Iron Prenatal vitamins contain iron, which increases blood production and prevents anemia. Extra iron should be used only under your healthcare provider’s recommendation. Your care provider will order blood work to check your iron levels. If your care provider has recommended an iron supplement, take it between meals or at bedtime

with orange juice (or another source of vitamin C) if you experience nausea, heartburn, constipation, or diarrhea with it. Don’t take iron with calcium, milk, tea, or coﬀee, because those substances can decrease its absorption.

Folic Acid Folic acid is important because it can reduce the risk of your baby having a neural tube birth defect, while it may also protect against cleft lip and cleft palate. You should begin to take folic acid—400 micrograms daily—prior to pregnancy because NTDs usually occur in the earliest days of development, before you may even know you’re pregnant.

Boost your nutrition For a healthy pregnancy, you need about an extra 300 calories a day, and adding a supplement ensures that whatever you’re eating—or not, depending on your level of nausea— you get the nutrition you need each day.

SHARON SCOTT, RN, MSN, is a nurse educator in Virginia and a former advisor to Healthy Mom&Baby.

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regnancy can take a toll on a woman’s body, and experts agree that women considering pregnancy, or who are pregnant or nursing, should take prenatal vitamins and other supplements to ensure the best nutrition possible. A deﬁciency in certain substances, such as folic acid, can put your developing baby at risk for neural tube birth defects, while low iron is associated with fatigue and anemia. Here’s a look at the leading supplements recommended during pregnancy.

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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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Can Babies Show Empathy? Heads up parents, your babies are watching you to determine if you’re a friend or foe. New research published in the British Journal of Psychology, shows that babies younger than one can practice empathy and pick out someone who is being bullied at the tender age of 6 months. “Even during the first year of life, babies are able to identify figures who “deserve” empathy and which ones do not, and if it appears that there is no justification for the other one’s distress, no preference is shown,” said Dr. Florina Uzefovsky, head of the Ben-Gurion University Bio-Empathy Lab, and senior lecturer at the Zlotowski Center for Neuroscience. In their experiments, Uzefovsky and colleagues observed that fi ve-to-nine-month-old infants clearly hold a pro-victim preference. Researchers showed the babies videos depicting a square figure with eyes climb a hill, meet a circular friendly figure, then happily go down the hill together, all the while displaying clear positive or neutral feelings. However, in the second video, the same round figure hits and bullies the square figure until it goes back down the hill, showing distress by crying and doubling over. Given the opportunity to select those figures as physical toys, the babies clearly preferred the square who demonstrated distress, thus practicing empathy.

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Go Goo-Goo Ga-Ga Babble away—when people use baby talk with, well, babies, it helps these wee ones learn language. Researchers at the University of Florida say that how we instinctively speak to babies—in high spiking pitches, naturally slowing our words and with exaggerated pronunciation that this not only delights and interests babies—it helps them understand what we’re saying. “It seems to stimulate motor production of speech, not just the perception of speech,” said Matthew Masapollo, PhD, an assistant professor in UF’s Department of Speech, Language, and Hearing. “It’s not just goo-goo ga-ga.” Baby talk is simple but it’s actually doing quite a lot, Masapollo and his colleagues shared. So, while some parents may refrain from such sing-song speech, especially in public, they can now feel emboldened to sing, squeak, squawk and ooh and ahh to their hearts content with their little one knowing they’re laying down the tracks of future language and speech.

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Human Milk is so Amazing; Here’s Why! By LaShea Haynes, MEd, MSN, APRN, AGCNS-BC, RNC, C-EFM and Rachel Napoli, DNP, PHN, CNS, RNC-OB, IBCLC

Do you know about the incredible benefits of human milk for you and for your baby? Here’s 36 ways your baby benefits from human milk!

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uman milk is made especially by your body, mom, for your precious baby. Let’s review just how wonderful this liquid gold truly is for mom, baby, and the community.

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Benefits of Feeding Human Milk (breastmilk) to Your Baby 1. Fewer in ear infections: Baby consuming any human milk reduces their infection risk by 23%; breastfeed baby exclusively for 6 months and reduce their risk by 77% 2. Reduced Sudden Infant Death Syndrome (SIDS) risk: Nursing your baby for at least a month or more reduces SIDS risks by 50% 3. Boosted bonding with baby 4. Reduced risk of asthma if you feed breastmilk to baby for more than 4 months; asthma risks are reduced by 40% in infants with a family history of asthma 5. Lower incidence of obesity 6. Fewer allergies 7. Lower risk of heart, celiac, and childhood inflammatory bowel diseases, and even atopic dermatitis 8. Lower risk of childhood leukemia 9. Increased cognition: Higher intelligence scores are observed among children who were fed human milk as infants for more than 3 months 10. Human-milk-fed preterm infants have fewer hospital admissions in their first 3 years 11. Exclusively feeding human milk for more than 6 months reduces upper respiratory infections by 63% 12. Feeding your baby human milk for more than 4 months reduces their risk of RSV bronchiolitis by 74% 13. Exclusive human milk for 3 months+ reduces type 1 diabetes risks by 30% 14. Any amount of human milk feeding for baby reduces their risk of Type 2 diabetes by 40%

15. Human milk helps prevent obesity: h Feeding your baby human milk reduces the risk of obesity by 24% h Any amount of human milk in infancy compared with none reduces adolescence and adult obesity by 15-30% h Exclusive human milk feeding for 3 months protects against preschool obesity 16. Serious colds, ear, and throat infections are reduced by 63% in infants who are exclusively breastfed for 6 months 17. The risk of developing celiac disease in infants who were fed human milk is reduced by 52% 18. Human milk feeding lowers rates of sepsis, reduces hospital readmissions after birth, lowers incidences of necrotizing enterocolitis (NEC), and boosts brainstem development

Benefits of Nursing for Mom 19. Reduced risks of reproductive, breast, and ovarian cancers when nursing for a year or more. Each year of breastfeeding continues to decrease breast cancer risks by 4% 20. Breastfeeding your baby lowers your blood sugar by extracting the glucose to make lactose in your baby’s milk—how cool is that! 21. Drop that baby weight as you burn a large number of calories each day making milk! 22. Feel relaxed as your body secretes oxytocin—the feel-good hormone—what also helps you get a flat tummy again 23. Nursing more than one baby reduces your risks of osteoporosis and hip fracture by 50% 24. Breastfeeding for a longer period of time reduces your risks of rheumatoid arthritis 25. Nursing baby at birth decreases postpartum bleeding and helps

shrink your uterus back to its normal size 26. Breastfeeding reduces incidences of postpartum depression 27. Breastfeeding is easy—it’s always ready, and at the right temperature for your baby every time! 28. Creates a love connection with your baby, rewarding you with that oxytocin surge 29. Strengthen a lifetime bond between you and your baby 30. Decreased postpartum bleeding and more rapid uterine involution 31. Decreased incidence of postpartum depression 32. More rewarding for you and your baby

Community Benefits 33. Save $13 billion if 90% of new mothers nursed their babies exclusively for 6 months—those savings come from fewer hospital admissions or stays related to sepsis, NEC or readmissions 34. Protect later life health with reduced risks of myocardial infarction, hypertension, and breast cancer, saving and estimated $860 million as a result of improved health 35. Breastfeeding is inexpensive: no bottles or other equipment is required, reducing the environmental trash burden 36. Workplace productivity is boosted by fewer parental absences from work

LASHEA HAYNES MED, MSN, APRN, AGCNSBC, RNC, C-EFM, is the Editor of our Healthy Mom&Baby magazine. Her nursing career spans 25 years, and she is founder and owner of her own nurse mentoring and education company. RACHEL NAPOLI, DNP, PHN, CNS, RNC-OB, IBCLC, is an Assistant Professor of Nursing at Sonoma State University (SSU). She also serves as Assistant Director of the Pre-Licensure BSN Program. She is the lead course instructor for the Care of the Childbearing Family course. She has a passion for expanding baby friendly initiatives and breastfeeding.

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THE SMALL WONDER FOR YOUR LITTLE ONE The small size will make it an indispensable part of your go bag and it will play for more than a day on a single USB charge. LectroFan’s non-looping sound technology does not use recordings, the sounds are generated as you listen to them, so they are guaranteed to never loop. Non-looping sounds are essential for restful sleep, don’t be fooled by cheap imitations. Children are particularly sensitive to sound loops. Adaptive Sound Technologies, Inc. was founded in 2008 and is the leading supplier of advanced sound machines and adaptive audio products. The company’s mission, “Adapting audio to improve lives,” has been the driving force behind its innovation and product development.

www.soundofsleep.com/alpha-3 HELPS YOUR BABY OR TODDLER GET BETTER REST LectroFan Alpha plays soothing sounds that help mask distracting noise.

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GUARANTEED NONLOOPING SOUNDS 7 unique relaxing sounds for baby and parents. Includes 1 heart-beat, 2 fan sounds, pink noise, brown noise, and 2 ocean wave sounds.

NEVER NEEDS BATTERIES Built-in battery recharges with the included USB cable, or use any standard USB C cable. Each charge lasts up to 40 hours at normal volume.

TRAVEL FRIENDLY Portable sleep sounds with a clip for easy transport between nursery, stroller, and car seat. The built-in stand folds up for travel.

WITH CONFIDENCE Lectrofan Alpha is designed in the USA and backed by a great customer care team also in the USA.

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Coming Soon! New Rules for Infant Sleep Products Sharon Hitchcock, DNP, RNC-MNN

“W

ell, if it’s not safe, how can stores sell them?” My daughter, a mother of two, had a good point. Most of us walk into the baby section of a store and assume if it’s on the self, it must be safe. While this is a reasonable expectation, it’s not always true. Sometimes, what appears to be safe turns out not to be, and it often takes a long time before we realize the dangers of a product. There are a lot of risky products created to supposedly make your baby sleep safer or more comfortable. The reality is many of those products can lead to accidental suﬀocation and sudden infant death syndrome (SIDS). While experts acknowledge that not all

SIDS deaths can be avoided, research shows that most SIDS and suﬀocation deaths can be prevented.

New Infant Product Rules Coming The U.S. Consumer Product Safety Commission (CPSC), the government agency responsible for ensuring products sold to the public are safe, has approved a new federal rule intended to ensure certain infant sleep products are indeed safe. These new safety standards will take eﬀect in mid-2022. When the rule goes into eﬀect, all sleep products will have to meet these new standards, which will apply to cribs, bassinets, cradles, playards (pack’n plays), and similar products.

Products such as in-bed co-sleepers, travel bassinets and crib bumpers are likely not to meet the new safe sleep standards

The American Academy of Pediatrics has already warned against these types of products, advising that baby’s safe sleep environment only include a crib with a mattress, a tight-ﬁtted sheet, and baby appropriately dressed for sleep on their back. Sleep products that are currently on the market that likely won’t meet the new safety standards include:  inclined sleep products (any item where the head is inclined greater than 10 degrees)  in-bed co-sleepers including baby “nests,” “pods,” and “docks”  travel and compact bassinets It’s best to steer clear of these products starting now.

Avoid These Infant Products  Baby loungers or gliders  Sleep positioners, wedges, or other devices meant to keep baby from moving  Nursing pillows (in sleep area)  Hammocks  Bumper pads (these may soon be taken oﬀ the market completely)

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 Baby mattresses that are not speciﬁc for infants (mattresses need to be ﬁrm)  Baby nests, pods, docks  Inclined sleeper products  Monitors and other products that promise to protect baby from SIDS

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Safe Sleep Recommendations from the American Academy of Pediatrics especially on a couch or recliner h Back-only position – never position baby on their stomach or side. Do not use wedges or other devices to keep them on their back h Keep the crib empty of everything except the baby – use sleep sacks

altering drugs (legal or not), including sleep aids h Breastfeed as much as possible – this helps prevent SIDS h Offer a pacifier (after breastfeeding is going well) – this helps prevent SIDS too

Car Seats, Swings and Strollers

or sleeper pajamas instead of

h Immunize and take infant to all

blankets. No stuffed animals,

well-baby checks – yep, this is

The new standards do not apply to non-sleep products such as car seats and swings that aren’t marketed for sleep, but none-the-less do get slept in. Parents are reminded here to move your infant to a safe sleep location as soon as they can and not routinely use these products for sleep. The new federal rule also does not address other infant sleep recommendations such as the dangers of bed-sharing, bumper pads, overheating, or fluffy items in the crib. Until the new rule is published, learn the current safety recommendations are for infant sleep, and take a careful – even critical – look before buying products. Be cautious when buying other products as well, as some intended for play (such as baby loungers and swings) so often end up with a sleeping baby inside! Check for recalls on products you regularly use with your baby and sign up for alerts at the CPSC.gov. Finally, when in doubt, just don’t purchase it! While we can safely assume no company ever sets out to purposely harm a baby, sometimes what seems to be perfectly safe at the start, ends up not being so.

bumper pads, or toys. Bare is best!

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.

h Avoid alcohol and any mind-

h Have baby sleep in the same room with you in bassinet or crib for at least 6 months h Keep the room cool to prevent baby from overheating h Do not smoke around the baby

protective as well! h Don’t forget tummy time – babies need time on their stomachs when they are awake and supervised h Make sure everyone who cares for your baby knows these safe sleep rules!

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h Avoid sleeping with your baby,

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Tantrums: The Reason We Call it the Terrible Two’s By LaShea Haynes MEd, MSN, APRN, AGCNS-BC, RNC, C-EFM

he “Terrible Twos” can be a challenging phase for parents. You may even fear taking your child into public places. Will they throw a fit? Kick or wail? Throw their body down to the floor in the middle of the supermarket? All toddlers struggle with their emotions. Parents are left with so many unanswered questions. Is this normal? Is there something I’m doing wrong? When will this behavior end?

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Toddlers Becoming More Independent Let’s take a minute to remember that just a few short months ago, our children were limited in their ability to communicate with us. We catered to their every need. Many of us even tried to foresee what our baby would need even before they requested it. As parents, we did whatever was needed to make our baby feel better. This

was expected and appropriate at that time because our babies were totally dependent on us. But what about now? As our babies grow into toddlers, a few things start to change. We start to expect our children to comply with our requests, instead of the other way around. Some toddlers may have a harder time than others making this adjustment. Your toddler may put you to the test with one tantrum after the next. Just have patience. Eventually, you and your child will adjust to your role as their parent, advisor, instructor, and caretaker.

Managing Tantrums During this phase, use these tips to keep your cool: h Be understanding! Don’t over-react if they do; they’re just beginning to learn how manage their emotions. h Stay calm. When your child is having a tantrum, losing your temper will

not help. Try to ignore the tantrum as much as you possibly can. h Hold your ground. If you give in to whatever your child wants, they will likely continue to repeat the behavior if it results in a positive reward for them. Let your “yes” mean yes, and your “no” mean no. h Finally, be patient. Do not expect your toddler’s fits of anger to resolve overnight, especially if you have tolerated this behavior in the past. Act properly and consistently and the tantrums will likely diminish. Our love for our children has no limits, and love is long-suffering, so remember this behavior will eventually stop altogether. Just be consistent! LASHEA HAYNES MED, MSN, APRN, AGCNSBC, RNC, C-EFM is the Editor of Healthy Mom&Baby. Her nursing career spans 25 years, and she is the founder and owner of her own nurse mentoring and education company.

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Your Baby, Reﬂux, and Gastroesophageal Reﬂux Disease By Britt Pados, PhD, RN, NNP-BC

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o you have a baby who spits up all the time? Your baby may have gastroesophageal reflux (GER), typically called “reflux,” which is very common in most newborns. A smaller number of babies have gastroesophageal reflux disease (GERD), where reflux causes uncomfortable symptoms, such as pain and difficulty feeding.

Gastroesophageal Reflux (GER) GER, or “reflux,” is when the contents of your baby’s stomach move up into their esophagus (the tube between their throat and stomach), whether they vomit or spit up. The muscle that separates the lower end of the esophagus from the stomach (the lower esophageal sphincter) takes several months to mature, until then it can easily open, allowing milk or formula to “reflux” up from the stomach into the esophagus. Because little babies spend so much time lying down, and because babies consume primarily human milk or formula during their first six months, it’s easy for gravity to let that liquid diet flow from the stomach into the esophagus. For most families, this is more of a laundry issue. These healthy infants typically outgrow symptoms between six months and their first birthday.

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Gastroesophageal Reflux Disease (GERD) Gastroesophageal Reflux Disease (GERD) differs in that the stomach acid damages the esophagus and larynx, increasing baby’s risk of aspiration (inhaling fluid), breathing problems, and insufficient growth. Babies with GERD may often be irritable, cry excessively, arch their back and refuse to eat. The following comfort measures are most recommended to help your baby cope with GERD: Stress Reduction: Simple soothing is an excellent way to reduce stress and reflux symptoms. Skin-to-skin contact is one of the best ways to do this. Babies

need to be held several hours each day to feel calm. Wearing your baby in an infant carrier or sling is an easy way to meet this need. Gentle massage and comfort sucking (on your empty breast, your pinky finger, their own thumb or a pacifier) also reduces stress. Comforting Positions: Give baby plenty of tummy time or hold baby in an upright position to soothe symptoms. Babies should always lay flat on their backs for sleep; so only use these comfort positions when baby is awake and supervised. Slow the Flow: For nursing babies, try slowing the feeding by using side-lying or laid-back breastfeeding positions. If you’re bottle-feeding human milk or formula, use a slower flow nipple. Frequent Feeding: Feed your baby more often to reduce acid levels in baby’s tummy. Feed every two hours. If you’re bottle feeding, ask your baby’s healthcare provider how many ounces baby needs in a 24-hour period, and then offer smaller more frequent feedings. Burp: Frequent burping is essential for baby’s comfort; burp baby partway through the feeding as well as at the end. Eliminate Tobacco Exposure: Babies exposed to smoke have significantly worse reflux and respiratory symptoms. Reducing or eliminating exposure to tobacco can help reduce the frequency of reflux episodes and improve baby’s overall health. Build Better Bacteria: Your milk contains both good bacteria and a special type of carbohydrate called human milk oligosaccharide, which feeds beneficial bacteria and protects against bad bacteria. Nursing boosts this transfer of healthy probiotics. Talk with your baby’s healthcare provider about giving additional probiotics containing Lactobacillus reuteri. If you’re

formula feeding, consider a probioticsupplemented infant formula. Wait Six Months for Solids: Both the World Health Organization and the American Academy of Pediatrics recommend exclusive breastmilk feeding for baby’s first six months. Wait to start solids at six months; this allows baby’s intestines time to mature and establish a healthy microbiome with the beneficial bacteria they need to digest other foods. Eliminate Allergies: Cow’s milk protein allergy (CMPA) is the most common allergy in young infants, and 10% to 15% of babies with CMPA also struggle with soy. Most infant formulas are either cow’s milk or soy-based, so if your provider suspects CMPA, they may recommend switching to an extensively hydrolyzed formula to help improve their reflux symptoms. These special formulas are still made from cow’s milk, but they’re extensively processed, and the protein is broken down enough that most infants with CMPA can tolerate it. The best way to reduce your baby’s risk of food and environmental allergies is to feed them with your human milk. According to the Academy of Breastfeeding Medicine, only 0.5-1% of babies will react to an allergen in their mother’s milk; but when it does happen, the removal of cow’s milk and soy from your diet may help improve baby’s symptoms.

Medications Skip medications that reduce acid in baby’s stomach; long term use of these medicines can have negative health consequences for babies, including disrupting healthy bacteria in your infant’s gut and increasing infection risk. BRITT PADOS, PHD, RN, NNP-BC, CLC, FAHA, FNAP, is an assistant professor at the Connell School of Nursing. She is a certified neonatal nurse practitioner, lactation counselor, and trauma-informed professional. Her research focuses on feeding difficulty in infants and young children with medical complexity, particularly those born preterm and with congenital heart disease.

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What’s with All the Crying? Coping with a Fussy Infant When Nothing Seems to Work By Sharon C. Hitchcock, DNP, RNC-MNN

ewsflash: Some babies cry a lot! Infants cry more than 2 hours a day, on average, and some cry as many as 5-6 hours a day during their first few months of life. Often, this extreme crying is an inconsolable, high-pitched wail, and for no apparent reason, meaning baby isn’t sick or hurt. Healthcare professionals traditionally call this excessive kind of crying “colic” or (more currently), “PURPLE crying.” Crying can be intensely frustrating and difficult for parents to hear but it’s a normal stage of infant development,

and thankfully, it doesn’t last forever. Infant crying typically begins to increase at age 2 weeks, and it peaks at age 6-8 weeks, and then decreases to about 1 hour a day by 3-5 months.

What is PURPLE Crying? During periods of PURPLE crying, baby’s cry is longer and typically more intense. Babies may arch their back, flex their legs, or appear to be in pain. The crying episodes occur in a distinct pattern, usually in the afternoon or evening hours. If your baby is crying a lot, check

with their healthcare provider to rule out any illness or injury. A diagnosis of colic should help you relax knowing that your baby may be difficult to soothe right now but is otherwise healthy. Experts don’t know why some babies cry so much, but researchers agree it’s likely due to several contributing factors and not any one thing. It could be baby’s personality, sensitivity to their environment, an immature gastric system including sensitivity to gas, or an immature central nervous system.

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healthy babies Soothing a Crying Baby Many parents exclaim, “this crying makes me feel like a terrible parent!” And you’re right if you feel like inconsolable crying is aﬀecting you and your family. Excessive infant crying is stressful. Research shows that mothers often experience more postpartum depression, stop breastfeeding sooner, and that family relationships can become very strained when their baby

cries excessively. This is when it’s super important to understand, mama, that some babies cry for no reason, and you might not be able to ﬁx it. During these times, it’s important to take care of yourself. If you ﬁnd your own emotions beginning to spiral out of control, hand baby to someone else and take a break. It’s okay to put baby in a safe place for a few minutes and step away until you’ve calmed down. It’s safe to let your baby cry. Rest assured; baby will grow out of this stage. But it’s never safe to shake your baby. Babies can die from being shaken, and it doesn’t take much to cause permanent injury. So, step away from baby, take some deep breaths, turn on some nice music, and maybe call a relative or friend for support.

Soothing a Fussy Baby

What is PURPLE Crying?

Peak of crying – Typically peaks at 2 months old; decreases by 3-5 months

U R P L E

First, make sure baby isn’t sick, hungry, wet, hot, cold, teething, overstimulated, or injured. If no obvious cause is found, try any or all the following:  Wrap baby snuggly in a blanket or swaddle sack  Try burping or oﬀering baby a paciﬁer  Gently bounce or rock baby  Provide soothing sounds such as shushing, singing, or calming music

 Hold baby in a side-lying or forwardfacing position with gentle pressure across their tummy. Front-carriers or slings might help and will free-up your hands  Gently massage baby’s abdomen or bend legs up towards the tummy  Create white noise such as from a vacuum, fan, or clothes dryer  Take baby outside for a ride in the stroller or for a car ride If nothing else works, or if you’re feeling overwhelmed or angry, place baby on their back in a safe crib and leave the room. If you have a baby monitor, keep it with you. Check in on baby every 5-10 minutes, but don’t pick up baby until you’ve calmed down. While you listen to baby through the monitor, do something to relax – listen to music, watch TV, or get some exercise. Talk to a family member or friend. Ask them to come over and be with you, or give you a break. Remember, no baby has ever died of crying. Many, however, have died from being shaken. Excessive crying is normal for some babies and won’t last forever! SHARON C. HITCHCOCK, DNP, RNC-MNN teaches nursing at the University of Arizona in Tucson, Arizona.

Unexpected – Crying comes and goes for no obvious reason

Resists soothing – Keeps crying no matter what you try

Pain-like face – Baby may look and act like they’re in pain

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Long lasting – May cry 5 or more hours per day Evenings – Typically cry more in the afternoon and evening hours

Period: Remember this is a stage of normal infant development that doesn’t last!

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Six Strategies for Choosing

Newborn Skin Care Products By Kimberly Wilschek RN, CCE

here is nothing quite as yummy as the feel and smell of your newborn’s skin. Selecting the right newborn skin care products can help ensure that your baby’s skin remains beautiful, soft and healthy. You’re not alone if you’re a bit perplexed by the oodles of lotions and potions available for your newborn.

The good news is that there are many safe, eﬀective products on the market. Know that your baby’s skin is up to 30% thinner than adult skin, so only use products designed for infant skin. Baby’s skin will also continue to thicken and develop during their ﬁrst year. This makes it more sensitive to irritants, topical products, and sunshine. It also

dries out quicker. The FDA and the Environmental Working Group’s Skin-Deep database, which includes more than 2,000 baby products, are good resources regarding product safety. Armed with product safety information, you just need these 6 simple, evidence-based tips to nurture and protect baby’s skin:

What to Look for in a Baby Wash or Shampoo  Tear-free  No fragrance or dyes  pH neutral or mildly acidic (pH 5-5.7)  Fewest preservatives

Sunscreen Shopping List  Broad spectrum coverage (UVA & UVB)  SPF 15+  Mineral, zinc oxide or titanium-dioxide based  Cream or lotion (avoid sprays)  No oxybenzone or vitamin A

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1. Begin with the basics Baby body wash/soap, baby shampoo and diaper rash cream. Use topical products, like lotions and creams, only when needed. Most full-term, healthy babies won’t need any lotions or creams on their skin during the fi rst few weeks of life. It’s normal to let the creamy white coating (vernix) baby was born with simply wear off. You may also see fl aky skin as your newborn sheds their initial layer of skin cells. If you have any concerns, talk with baby’s healthcare provider before you start using creams and lotions. Irritation from products in your baby’s skin early on may increase their risks of allergies or eczema. 2. Introduce one new product at a time Check for sensitive skin by doing a skin patch test for each new item: Apply a small amount of the product on the inside of baby’s forearm and leave it on for about 24 hours before washing it off. Signs of sensitivity include redness, scaling, bumps, blotches, diffi culty breathing, or vomiting. If you see any of these signs on your newborn, stop using the product and contact your baby’s healthcare provider, particularly if the reaction is severe.

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3. Keep babies 6 months old and younger out of direct sunlight Cover baby with clothing, hats, sunglasses, and shades when they’re outdoors. At 6 months, start using a mineral-based, broad-spectrum sunscreen with SPF 15 that’s made speciﬁ cally for babies. 4. Limit baths early on From those ﬁ rst weeks, your newborn only needs short (5-10 minutes) and infrequent baths (2-3 times a week). This helps limit their exposure to potentially irritating products and in fact, experts don’t recommend daily bathing as it can alter the pH of baby’s

skin and predispose it to dryness. Keep their diaper area clean and sponge bathe where needed. From 6 months on, or when your baby starts crawling, you can bath them more often and for longer periods of time. Use only mild baby washes designed for newborn skin; avoid cleansers with antibacterial cleansers— they’re not necessary and contain harsh chemicals. 5. Keep the diaper area clean Despite the debates, commercial wipes are fi ne for cleansing baby’s diaper area. Choose wipes that are alcohol-free and without added fragrance. If baby seems sensitive to wipes, try a diff erent brand, or just use warm water plus a little baby wash, if need be. For diaper rash, use a diaper rash cream with zinc oxide. If regular zinc oxide creams don’t seem to be helping, talk with baby’s healthcare provider about switching to a product with a higher percentage of zinc oxide. 40% zinc oxide concentrations are the strongest allowed by the FDA without a prescription. Apply diaper creams thickly—like you’re frosting a cake—to dry skin. 6. Be a label reader Just like food labels, the labels on skin care items will tell you exactly what is in the product. Descriptors such as “natural’ or ‘environmentally friendly’ are ambiguous and not regulated by the FDA. One quick way to spot a more natural product is to look at the number and type of ingredients on the back label. Are there just a few ingredients or more than you can quickly count? Are they long chemical names, or things that you recognize? Additionally, remember that naturally occurring ingredients have been known to cause a skin reaction in some children and adults. Always test the product fi rst before applying a liberal amount.

Avoid these ingredients in Newborn Skin Care Products AWHONN disseminates evidencebased guidelines on ingredients in baby products that are safe for baby’s skin. Fewer ingredients are typically safer for baby, as long as all products are safe and made for baby’s skin. Consider choosing products without the following ingredients:  Parabens & Phthalates: Hormone disrupters; found in shampoos, cleanser, lotions  Formaldehyde: Carcinogenic; used as a preservative in some lotions, cleansers, soaps  Triclosan & Triclocarban: Endocrine disrupter; used as a bacteriostatic agent in antibacterial soaps  DMDM hydantoin, bronopol, BHA, & boric acid: Carcinogenic; used as a preservative in some diaper wipes and diaper creams  Baby powder with talc: Airborne particles can damage baby’s lungs if inhaled  Oxybenzone: Hormone disrupter; found in some sunscreens  Vitamin A: Causes skin sensitivity, especially to sun-exposed skin; found in some sunscreens  Alcohol: Causes skin dryness and sensitivity; found in some diaper wipes and cleansers  Fragrance: Causes skin sensitivity; some may act as a hormone disrupter; found in many baby products including wipes, soaps, lotions  Mineral oil: Clogs the pores; may impede natural skin function; choose organic oils: olive, grapeseed, or saﬄ ower oils

KIM WILSCHEK, RN, CCE is a Director of Nursing Services at Surgical Care Aﬃliates. She is a Strategic healthcare leader with extensive and varied expertise in operations, clinical education quality and risk management, program development, team building, and new service line startups.

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ADVERTISING PROMOTION

PRODUCT GUIDE Check out these parent-approved favorites!

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My pharmacist recommended Ferretts Iron over 7 years ago, I had been taking several diﬀerent brands of iron supplements for low iron/ anemia and the other brands were giving me an upset stomach and/ or had not increased my iron levels on my lab work. I started taking the Ferretts and it has changed my life. No more upset stomach and my lab work remains consistent. My levels are in the healthy range and I no longer feel that extreme fatigue. Just a fantastic product. I will never use anything else.

www.betteriron.com

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healthy babies

Traveling With Your Baby By Sofia Navard

your destination, create packing lists, and pad your itinerary with extra time throughout your journey. Check local travel and weather warnings at noaa.gov, and for international restrictions at http://travel.state.gov, where you can also apply for passports and visas. h Wear a mask, watch your distance from others (stay 6-feet apart or more), wash your hands often with warm soap and water for at least 20 seconds, and avoid touching your face or your baby’s face h Wash your hands after blowing your nose, coughing, sneezing, and always before touching your face, eating, and preparing to nurse your baby h Carry and use hand sanitizer that contains at least 60% alcohol; when

h h

using hand sanitizer, it’s important that you rub your hands together until they feel dry Cough or sneeze into a disposable tissue or into the crook of your elbow Avoid eating inside buildings; instead, pick up food at drive-throughs, curbside at restaurants, or buy in grocery stores and eat in your car, a park or another outdoor location Pack disinfectant wipes where you can access them at all times, especially if you’re going to be turning baby’s car seat or stroller over to others at airports and bus or train stations Pack enough medication for the full length of your trip; especially if you or baby uses prescription medications

IMAGES: DREAMSTIME

ravel with your baby during pandemic is stressful! But reasons arise why you may need to make a trip with your little one. According to Experts at the Centers for Disease Control & Prevention (CDC), travel increases your chances of getting and spreading COVID-19. Health experts don’t yet know if one type of travel is safer than another, e.g., a car or plane trip. Airports, bus, gas, and train stations, as well as rest stops, can all be places where you can be exposed to coronavirus in the air and on surfaces. It’s hard to keep your distance, for example, in an airplane or on a crowded train. If you have to travel with your baby during pandemic, this is no time to be disorganized: Research

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healthy babies

When it comes to flying, it’s best to wait until baby is 3-4 months old before traveling with your baby to avoid challenges to their vulnerable immune system. Check to see if your carrier has any age restrictions regarding infants. You can carry frozen or fresh breastmilk through airport security, although it will be scanned for safety. Also bring unopened snacks and empty water bottles you can fill once through security, as there may be no snacks on board. Check with TSA.gov for any updates to the rules before flying.

Car Seat Required If you’ve purchased an airline seat for baby, they must ride in a governmentapproved car seat approved for air travel. Yes, you can fly with your baby on your lap but the Federal Aviation Administration (FAA) strongly urges parents to secure their child in a government approved child safety restraint system (CRS) for the duration of their flight. Your car seat must bear the sticker that says: “This restraint is certified for use in motor vehicles and aircraft,” or it won’t be permitted on-board the airplane and will have to be checked at the gate. Air stewards know to ask and will check for this sticker on your infant’s seat. Most airlines will gate check your stroller and have it waiting for you as you exit the plane post-flight. Keep disinfecting wipes at the ready to clean the surfaces of these items before using them with your baby. If baby’s riding on your lap, a sling or backpack carrier may help you carry them through the airport, but you’ll have to put it away during takeoff and landing. Help baby clear their ears on take-off and landing by getting them to swallow frequently, either with a pacifier, bottle, or by breastfeeding.

Lodging If you’re staying at a hotel or home rental, ask about the facility’s COVID-19

prevention practices before you go: Are enhanced cleaning and sanitation measures being implemented? How often are common areas disinfected? Are guests still able to access common areas with proper social distancing (dining, swimming pools, etc.)? Stay in places that allow you to avoid contact with employees with features like: h Online and in-app reservation and check-in h Mobile room key h Contactless services, including room service h Online or in-app payment and check out Ask if employees are required to wearing face coverings at work. If you have to interact with employees, ask if the facility features plexiglass barriers at check-in counters, and physical distancing signs in the lobby –these features ensure the hotel or lodging is taking your health and safety seriously.

h Antibacterial wipes h Disposable gloves for disinfecting hotel rooms (including door handles, lights, levers, remote controls, window covering controls, and bathrooms) h Moisturizer and baby-friendly sunscreen h Medications you or baby is taking h Your driver’s license and/or passport, baby too, if traveling international h A recent photo of your baby h Emergency contact sheet: include relatives, friends, your pediatrician, and your destination information h Duct tape for baby proofing hotels or houses where you may be staying, e.g. for electrical outlets h Small first aid kit with infant acetaminophen (get dosing chart from your pediatrician) h New toys your baby hasn’t played with yet h Favorite snacks or pacifiers

Packing list

For more information on traveling with your baby, read Traveling with Tots and Tips for traveling with Tots plus Enjoying The Fall Season Enjoy traveling with your baby and Bon voyage!

You’re packing for two (or more!) Aside from the obvious clothes and accessories, when traveling with your baby don’t forget these essentials: h Extra diapers, wipes, and a change of clothes in the diaper bag (especially needed if your checked bag gets lost or delayed!)

SOFIA NAVARD is the Assistant Managing Editor of Healthy Mom&Baby Magazine.

IMAGES: DREAMSTIME

Fly

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F O R A L L YO U R

adventures ahead Out around town or exploring faraway places, we know you need high-performance baby gear that’s in it for the long haul. Our style is timeless, while the features we build into our products are expertly engineered to make travel with baby easier—giving you the convenience you need to discover the world in style.

Fan favorites that our Nuna family’s been raving about.

“

It’s practical for all our travels. Compact and easily foldable, safe, and comfy for baby, and even easy on the eyes.

I have recommended this seat to all my mommy friends. I have already purchased one for my sister’s newborn.

Having a little one is a hand full, but with my Nuna CUDL I can be hands free!! This baby carrier is perfect for a multitasking mami.

All I can say is that it feels like pushing a smooth little Rolls-Royce. It’s compact and easy to fold with one hand.

It doesn’t take up a lot of space but is still roomy enough for my baby and it’s so easy to set up and pack away.

Nicole K.

Amy B.

@victoriamonet

Jerome P.

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FOR

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Follow the journey @nuna_usa

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T H I S WA S N ' T I N A N Y O F T H O S E 25 BABY BOOKS YOU READ... A N D T H A T ' S P E R F E C T.

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