Healthy Mom&Baby: Issue 29 by Healthy Mom&Baby

ISSUE 29 / 2021 | $3.95 | health4mom.org

PREGNANCY | BIRTH | PARENTING

WHY YOU NEED PRE- AND PROBIOTICS TATTOOS AND BODY ART Can they aﬀect your pregnancy?

GREEN CLEANING

For a Healthy Home

✦

Save To Your Mobile

Health4mom.org POWERED BY THE NURSES OF

HMB01 Cover.indd 1

ACT ON THESE BABY WARNING SIGNS 18/01/2021 10:14

Swaddle Designs.indd 1

21/09/2020 15:20

Issue 29 / 2021

Contents ◆ healthy moms

◆ healthy pregnancy

11 Prebiotics & Probiotics

30 Pain Relief in Labor

All about “good” bacteria in your intestinal tract, and plant ﬁbers that boost digestion.

13 Healthy Relationships

32 Choose a Place to Give Birth

When our most intimate relationship is a healthy one, it makes our lives better.

You will likely give birth where your provider practices.

14 Cancer in New Moms

34 Postpartum Recovery

One cancer survivor’s helpful guidance to other moms-to-be.

You may be sore or uncomfortable from your birth experience, so now what?

16 Tattoos During Pregnancy

36 Labor Positions to Avoid Cesarean

Can tattoos cause complications during pregnancy, birth and breastfeeding?

Boost the odds of avoiding caesarean delivery using active labor strategies.

19 Care After Pregnancy Loss

38 Periodic Fetal Heart Monitoring

In our culture, talking about pregnancy loss can be taboo.

IMAGES: SHUTTERSTOCK; PROSTOCK-STUDIO

Giving birth can be a painful experience, but birthing people have choices to cope.

Electronic fetal monitoring helps your care provider understand how baby is doing.

21 Baby Friendly and Mom Friendly, Too!

41 Group B Strep and Your Pregnancy

How Baby-Friendly™ hospitals give moms the skills necessary to breastfeed.

GBS can complicate baby’s health at birth.

23 Be Your Own Breast Advocate

43 Nausea & Vomiting

No matter your whether you’re pregnant or not it’s important to know your breasts.

Half of all pregnant women experience nausea and vomiting in pregnancy (NVP).

27 Clean Like Your Life Depends on It!

44 Pregnancy is the Perfect Time to Discuss Birth Control

Green cleaners can keep us safer and work spaces cleaner.

Think about birth control while you’re pregnant and manage family planning.

Use Prebiotics & Probiotics to Promote Your Health

Pain Relief in Labor

◆ healthy babies 48 Prevent Diaper Rash Your newborn’s skin is soft and sensitive, and from birth on it needs special care.

53 Shaken Baby Syndrome Baby can die or be permanently disabled when their head is shocked from violent shaking.

55 Why Baby Needs Vitamin K For babies, vitamin K is essential for blood clotting.

57 Your Newborn’s First Bath There are three great reasons for delaying baby’s ﬁrst bath in favor of warmth and breastfeeding.

58 Safe Travel During COVID Follow advice from experts to make every car trip safe and healthy for baby.

60 Music Therapy in the NICU Early research is showing it can be helpful to build baby’s brain pathways.

63 Act On These Warning Signs When do you need to get urgent care for baby? From blood in vomit or stools to unusual temperature or trouble breathing, these are the warning signs to look out for.

66 Skin Care for the Whole Family; Baby Too Harsh winds and hot baths can rapidly dehydrate our skin. Fight back by cleansing, nourishing and protecting your skin and your baby’s.

Nausea & Vomiting in Pregnancy

Prevent Diaper Rash

Music Therapy in the NICU

ISSUE 29 / 2021 Healthy Mom&Baby

HMB02 Contents.indd 3

19/01/2021 14:27

CHILLS INSTANTLY in ICE WATER for FAST PAIN RELIEF! Lightweight, No Floppy Parts or Rough Edges Easy for Tiny Hands to Maneuver Dishwasher Safe â&#x20AC;&#x201C; FREE of Mold & Bacteria Pediatrician Used & Recommended NO Plastic, Liquid, Latex or Rubber 100% Food-Grade Ingredients

TOOFEZE.com

Free Shipping with coupon code: HMB

PAGE 4.indd 1

18/01/2021 14:11

Join us on Facebook facebook.com/HealthyMomAndBaby

HEALTHY MOM&BABY EDITORIAL ADVISORY BOARD DANIELLE BEASLEY, PhD, RNC-OB University of South Florida Tampa, FL ROBERTA DURHAM, RN, PhD California State University East Bay Hayward, CA

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

BY REBECCA CYPHER, MSN, PNNP

Nurses Are at Your Side

JOANNE GOLDBORT, PhD, RN Michigan State University East Lansing, MI HELEN M. HURST, DNP, RNC-OB, APRN-CNM University of Louisiana School of Nursing Lafayette, LA ELIZABETH JORDAN, DNSc, RNC FAAN University of South Florida College of Nursing Tampa, FL SHARON C. HITCHCOCK, DNP, RN-C University of Arizona Tucson, Arizona JENNIFER LEMOINE, DNP, APRN, NNP-BC University of Louisiana at Lafayette Lafayette, LA PARIS MALOOF-BURY, MSN, CNM, RNC-OB, IBCLC Sutter Health Sacramento, CA RACHEL NAPOLI, DNP, CNS, RNC-OB, IBCLC Sonoma State University Rohnert Park, CA RITA NUTT, DNP, RN Salisbury University Salisbury, MD SUSAN A. ANGELICOLA, MSN, APN Summit Medical Group Cedar Knolls, NJ MICHELE K. SAVIN, DNP, APRN, NNP-BC Thomas Jeﬀerson University Philadelphia, PA JAMIE M. VINCENT, MSN, RNC-OB, C-EFM John Muir Medical Center Walnut Creek, CA

IMAGES: SHUTTERSTOCK

HEATHER WATSON, PhD, MSN, BSRN Johns Hopkins University Baltimore, MD LASHEA WATTIE HAYNES M.ED, MSN, AGCNS-BC, APRN, RNC-OB/EFM Wellstar Health System Atlanta, GA KIMBERLY WILSCHEK, RN, CCE Medical Revenue Solutions Chicago, IL CHARLOTTE WOOL, PhD, RN, CCNS York College of Pennsylvania York, PA

The World Health Organization declared 2020 to be the International Year of the Nurse and Midwife. Nurses across the globe play essential roles to keep people healthy, prevent disease, and involve entire communities to improve their health and wellbeing. In the United States, nurses are the largest group of maternity care professionals that help women during pregnancy, labor, birth and care for their newborns after birth. Some women receive care from midwives and nurse practitioners, but all women have nurses that will provide the highest levels of care as well as oﬀer ongoing support and encouragement. During your pregnancy, nurses will be with you every step of the way, from the start of prenatal care through labor, birth, and postpartum. Nurses will be at your side, helping to care for your baby and will continue to guide you through your baby’s ﬁrst pediatric visits. Health care doesn’t happen without nurses.

A Holistic Approach

Nurses bring a holistic approach to your care. We know that your physical and mental health is inﬂuenced by the food you eat, your physical activity and the social support you get from family and friends. The work you do, your personal responsibilities and the community you live in all play a role in the wellbeing of you and your baby. Getting to know you as an individual lets us understand what’s

important to you during pregnancy, labor and postpartum, so that we can give you personalized attention and advice. We’ll do the same for your baby as they deserve the same level of individualized care.

Supporting Your Decisions

Nurses are committed to giving you the information you need and want to guide you through the many decisions ahead that you will be making in the future. Whether you’re contemplating genetic screening tests, quitting smoking or where your baby should sleep we want you to conﬁdently make decisions based on the latest guidelines and research so you can decide what’s right for you and your baby. Nurses, nurse practitioners and midwives plan and write the articles in Healthy Mom&Baby. We include the evidence for recommendations and the alternatives to consider. We work with pregnant individuals and their personal support team every day, so whether we’re talking to you in person or through the pages of Healthy Mom&Baby, our goal is to give you the information you can use to make choices or as part of the shared decision-making process that you use with your healthcare provider. Find us anytime at Health4mom.org. Nurses are here to support you and your baby so you can make the most of pregnancy, birth and your little one’s ﬁrst year.

REBECCA CYPHER, MSN, PNNP is the AWHONN 2020 President.

ISSUE 29 / 2021 Healthy Mom&Baby

HMB03 President's Letter.indd 5

18/01/2021 10:28

ADVERTISEMENT FEATURE

Pregnancy Pain Relief For All Shapes & Sizes Low Back Pain. Pelvic Girdle Pain. Varicose Veins. Starting around 17 weeks or earlier during pregnancy, discomfort and pain associated with pelvic instability, vulval varicosities, lower back pain, sciatica, pelvic joint inflammation and varicose veins can significantly impact on a womanâ&#x20AC;&#x2122;s ability to enjoy her pregnancy and motherhood. Invented by women for women, these patented SRC Health Medical Grade 1 compression garments were designed in consultation with Melbourne

obstetrician, Dr. Grant Saffer and are endorsed by the Australian Physiotherapy Association. SRC Pregnancy Shorts and Leggings can help ease the strains of pregnancy, provide support and aid mobility so that expectant mothers can work and exercise pain free throughout pregnancy. With an adjustable waistband (Under The Bump) and soft stretch panel (Over The Bump) the garment can be worn from 12 weeks until late term.

Fast Track Your Postpartum Recovery Abdominal Muscle Separation. C-Section. Perineal Trauma. Designed for wear in the first 3 months, SRC Recovery Shorts and Leggings aid mobility and provide stability to the back, abdomen, pelvic region and upper legs. The patented gusset panel design is vital for perineal support and post birth healing; especially helping to reduce episiotomy wound pain. This anatomical panel helps with caesarean wound areas by stimulating blood flow, which aids in tissue healing.

SRC Recovery Shorts and Leggings provide gentle compression to abdominal muscles by stimulating them to be continuously active, encouraging them to come back together to heal any muscle separation. This will compliment any post pregnancy recovery exercise program designed by a health care professional. Many women continue to wear their Recovery Shorts and Leggings for exercise or for aesthetic reasons under fitted clothing.

Order online at srchealth.com to receive 20% OFF (use code SRC20USA) Also available from Amazon at amazon.com/src (no discount applies) Valid from October 1, 2020 to March 15, 2021. Only valid for American customers and delivery to USA. Not valid with any other offer.

ÂŠSRC Health Pty Ltd 2020 221RECO 17-09-2020

SRC Health.indd 1

19/01/2021 12:31

AWHONN AWHONN 2020 President

Rebecca Cypher, MSN, PNNP

Honoring You, Our Readers

Interim Chief Executive Oﬃ cer

By Catherine Ruhl, DNP, CNM

Kathleen A. Hale, MS, RN, NE-BC Vice President, Strategic Partnerships, Communications & Meetings

Billie Robinson, MBA, CAE Editor-in-Chief & Senior Director, Strategic Partnerships & Publications

Carolyn Davis Cockey, MLS, LCCE Director of Patient Education

Catherine Ruhl, DNP, CNM Assistant Managing Editor

You inspire us at Healthy Mom&Baby! Hey mama, we are in awe of your strength, your energy, and your endurance. You are the reason our nurse authors love to share their expertise in these pages. As the COVID-19 pandemic continues, please give yourself credit—so much credit—for all you’ve been through and will go through. Whether you’re newlypregnant or holding a newborn, you’re likely coping with anxiety about your pregnancy and health, and your baby’s and family’s health, too.

Soﬁa Navard MAITLAND WARNE Group CEO & Publisher

Kevin Harrington Editorial

You’re making your way through a health care system that’s in ﬂ ux responding to the waves of pandemic. Maybe you’re also teaching older children online, or working from home, or facing the stress of working on the frontline. Please make your mental health a top priority, and all the more so during pregnancy and when newly parenting. Let’s face it—COVID has skyrocketed stress and anxiety around the globe.

Chris Jenkins Design

Friyan Mehta Production Director

Joanna Harrington Production

Adam Linard-Stevens Cover image

© Liudmila Fadzeyeva | Dreamstime.com Healthy Mom&Baby is published by Maitland Warne in partnership with AWHONN. © AWHONN, 2021. All rights reserved. All material in Healthy Mom&Baby is wholly copyright. Reproduction without the written permission of the publisher 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.

PUBLISHER

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

Your strengths have gotten you through the pandemic thus far. You’d be amazed if you listed all that you’ve done and adapted to since COVID started. Step back and honor yourself—this builds your conﬁ dence for the weeks and months ahead. Set small, realistic goals for each day and take real satisfaction in meeting your goals. Lean on those who truly give you a listening ear. Reach out to a friend or family member and you may ﬁ nd they need support, too, and have been afraid to ask. Lastly, don’t hesitate to tell your pregnancy care provider if you’re feeling overwhelmed. They know that your emotional and physical health are closely connected. They can work to support you with the emotional health care you need to carry your child toward a calmer, brighter place. Wishing you peace,

Catherine

Catherine Ruhl, DNP, CNM

Editor, Healthy Mom&Baby

EDITOR IAL INQUIR IES

AWHONN Catherine Ruhl, DNP, CNM cruhl@awhonn.org 1716 Anderson Pl, SE | Albuquerque, NM 87108 Tel: (202) 255-1172 | www.AWHONN.org

ISSUE 29 / 2021 Healthy Mom&Baby

HMB04 Editor's Letter.indd 7

18/01/2021 10:51

Personalized Gifts Celebrating Baby with Personalized & Footprint Keepsakes like No Hand Other Celebrate your baby with Jewelry and Keepsakes engraved with their unique hand or footprint.

Celebrate your baby’s birth and the lifetime of love ahead with Jewelry and Keepsakes engraved with their hand or footprint, and experience unmatched connection to your new bundle of joy.

FREE CHAIN* with Purchase of a Sterling Silver Pendant

PERSONALIZE YOURS

Today!

*Limited time only. Some restrictions apply.

Personalize Your Keepsakes at

LegacyTouch.com/NewParents

Learn More at LegacyTouch.com/NewParents

Give Your Baby a Great Start You want only the best for your baby. So why buy synthetic vitamins, when you could take natural, plant-based multivitamins made with real, organic whole foods?

Prenatal

Postnatal

with Folate, Iron, Plant Calcium, & DHA to support mom’s health & wellbeing, as well as nourish the baby’s brain, heart, and bones.*

with Milk Boosting Blend of herbs including Fenugreek, Blessed Thistle, and Fennel to naturally stimulate milk production.

Multivitamin

Non-GMO No Gluten, No Soy Gentle on Stomach No Preservatives 100% Vegan

Multivitamin

naturelo.com/newmom

* These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease.

PAGE 8.indd 1

18/01/2021 14:18

healthy

Join us on Facebook

moms

facebook.com/HealthyMomAndBaby

Does Asthma Pack on Extra Pregnancy Pounds? If you have asthma and are trying to conceive, know that asthma may put you at risk for putting on as much as 7 extra pounds during pregnancy as compared to women without asthma, researchers from the National Institutes of Health say in a study published in The American Journal of Epidemiology. You’re also more likely to retain the extra weight for more than three months following baby’s birth. How much weight women with asthma may gain was directly related to how severe their asthma is. Women taking 2 daily asthma medications gained almost 6 pounds more than women who only took asthma medications periodically. Women with asthma triggered by exercise gained almost 5 pounds more than women without asthma. Researchers want to make women aware of the observed risk, which may be because women with asthma may exercise less, have their sleep disrupted more often, and experience greater inflammation overall. Researchers suggest women with asthma maintain a healthy body weight going into pregnancy, and maintain a healthy diet and activity routine to minimize the observed risks.

Working Helps Maintain Brain Health

images: shutterstocK; dreamstime

Breastfeeding Support via Social Media

Women who work tend to have better memory later in life, say experts at the Cleveland Clinic. While we think of education as boosting our brains, Jessica Caldwell, PhD, Director of the Women’s Alzheimer’s Movement Prevention Center at Cleveland Clinic Lou Ruvo Center for Brain Health, said working throughout life is good medicine for our brain. Caldwell’s group followed more than 6,000 women ages 16-55 for 12 years, testing their memory every 2 years. Results showed that after the age of 60, memory decline was 50 percent greater among women who didn’t work a job. This is particularly important news considering women are at greater risk for Alzheimer’s and make up two-thirds of all current cases.

Pick up your phone and ditch the mom guilt; moms who gain breastfeeding support through social media connections are more likely to breastfeed for 6 months or more according to a study published in Nursing for Women’s Health. Especially during a pandemic, the authors observed that social media breastfeeding support groups helped new moms breastfeed exclusively to 6 months postpartum—no masks required!

ISSUE 29 / 2021 Healthy Mom&Baby

HMB05 Healthy Moms section.indd 9

18/01/2021 10:50

It’s all about Immunity for Mom, Baby and Family... One of the most important things you can do to deal with all the influenzas and viruses that threaten us on a daily basis, is strengthen your immune system. During a time of uncertainty, numerous supplements promise virus protection and immune boosting properties. None can make specific claims against the Coronavirus, nor does Prebiotin claim to cure, prevent or treat this virus or other diseases. Look for solutions with scientific support. Prebiotin Prebiotic Fiber is a simple, all-natural, gluten-free solution to address this critical need to strengthen and maintain a healthy immune system. No hype, science based, highest quality prebiotic from Oligofructose-enriched Inulin (OEI). Beneficial to every one of every age, especially our elderly population and those struggling with compromised immunity, as well as for yourself before, during and after your pregnancy. As prebiotic pioneer, Dr. Frank Jackson first learned over 20 years ago, “A prebiotic is a food fiber that is present in plants. The very best of these make the good bacteria in the gut grow prodigiously and make good things happen in the gut and body. There is now significant experimental evidence in the medical literature these good bacteria strengthen the immune system by stimulating the immune cells to be resistant to infection.” To learn more about gut immunity, watch Prebiotin founder, Dr. Frank Jackson, gastroenterologist, discuss how your immune system works.

Read a special message from Prebiotin CEO, Ron Walborn, Jr., regarding COVID-19. www.prebiotin.com/ceo-message Click Prebiotin Structure/Function Claim: Support Health and Immunity for more information and research about how Prebiotin supports health and immunity. www.prebiotin.com/immunity-support Check out Prebiotin’s latest blog, Coronavirus and the Importance of a Strong Immune System, with more detailed information and updated statistics. www.prebiotin.com/coronavirus Important Information from the CDC, www.cdc.gov/coronavirus/ 2019-ncov/index.html

Health Benefits and Cost Savings with Prebiotin® Prebiotic Fiber – prebiotin.com/covid-19 Made of oligofructose-enriched inulin (OEI) derived from 100% chicory root, a rich source of prebiotic fiber, Prebiotin helps feed beneficial bacteria that crowd out undesirable bacteria. A wide range of benefits result, including: Improved digestion Enhanced immunity Decreased risk of heart disease, diabetes, and cancer Increased calcium absorption for stronger bones Improved brain function

SaVE 25% PluS FREE SHIPPIng Use Code Mom25 at prebiotin.net

Scan For More Information

We always recommend consulting with your pediatrician or health professional when making dietary changes. Feel free to contact us at 855-good-gut for more information and visit us at www.prebiotin.com/kids. This product is not intended to diagnose, treat, cure or prevent any disease.

Jackson GI Medical.indd 1

Frequent use of sanitizers and disinfectants will also contribute to less microbiome diversity going forward, which then can weaken our immune system, creating dysbiosis and resulting in increased inflammation and chronic diseases. During this challenging time, when fiber-filled fresh fruits and vegetables may be hard to obtain, shelf-stable Prebiotin will enable you and your family to nurture the beneficial bacteria in your gut microbiome. Prebiotin is the fertilizer for your “inner garden” that is home to 80% of your immune system and can help you to “feel better, do more.”

03/11/2020 17:48

healthy moms

Use Prebiotics & Probiotics to Promote Your Health By tamera Nutter, RN, MSN

robiotics are the “good” bacteria that live in your intestinal tract and help with digestion, among other basic bodily functions. While probiotics can benefit everyone, they do have specific benefits for women’s health. Prebiotics are plant fibers that help boost your digestion, including the nutritional benefits of probiotics. Prebiotics “feed” the probiotics, and can be found in bananas, honey and whole grains.

Prevent Vaginal Infections

Urinary Tract Infections (UTIs) infections in your urinary tract can happen when certain bacteria overtake the normal, healthy Lactobacillus bacteria in the tract. again, several studies have shown that regularly taking a Lactobacillus probiotic supplement can help reduce utis— especially if you have ongoing utis.

Irritable Bowel Syndrome Like urinary tract infections, women are more prone to certain bowel issues such as irritable bowel syndrome (iBS). Experts don’t quite understand what causes iBS, some studies have shown that probiotics can help relieve the symptoms of this disorder. there are also some promising findings related

to probiotics that may help with the symptoms of ulcerative colitis.

Picking Probiotics Probiotics are in certain foods, particularly yogurt and other fermented yogurt-related products, such as kefir, sauerkraut, miso, and tempeh. these foods are great for a healthy diet, but most experts suggest adding a probiotic supplement to get the full benefit of their probiotics. Probiotic supplements contain different bacterial strains, and different concentrations of specific bacterium. talk to your health care provider about which bacterial strains and supplements may work best of for you—you may need to try a few different supplements to find the ones that work best for your health. Tamera NuTTer, RN, MSN, is an expert adviser to Healthy Mom&Baby.

iMageS: SHutteRStocK

Vaginal yeast infections are an overgrowth of candida albicans. usually, these yeast are kept “in check” by the bacteria Lactobacillus. Research shows vaginal yeast infections can be largely prevented by taking a daily probiotic supplement with Lactobacillus. Still, should the tell-tale itching and burning of a yeast infection emerge, experts recommend seeing your healthcare provider, who can treat your infection with medication. Similar to vaginal yeast infections, bacterial vaginosis is another form of bacterial overgrowth.

Your healthcare provider will likely recommend taking probiotics containing the bacteria Lactobacillus in concert with an antibiotic to treat bacterial vaginosis.

ISSUE 29 / 2021 Healthy Mom&Baby

HMB06 Pre and probiotics.indd 11

18/01/2021 10:52

Sizes: 3XS - 3XL

Certifications:

Helps prevent stretch marks

Nourishes hydrates and aids skin texture

Get a discou10% nt! Use co upon

Seaweed

Sizes: S - 2XL

62 Newport Ave, Rumford R.I. 02916 Toll Free 844-869-6962

code MOM1 0a of the t the end purcha se

100% Natural Ingredients & Nutrition for Mom & Baby's Future CONCEPTION Fertility Prenatal

Over 12,000+ Reviews

GLOW Prenatal Folate & DHA

MOMMA Prenatal Probiotic Protection

NOURISH Postnatal Lactation Support

So happy to know that GLOW has high bioavailability & ensures the maximum nutrition reaches your baby." veriďŹ ed Eu Natural customer.

These statements have not been evaluated by the Food and Drug Administration and are not intended to diagnose, treat, cure or prevent any disease.

eunatural.com/mom

PAGE 12.indd 1

18/01/2021 14:20

healthy moms

Create and Maintain Healthy Relationships By Rita Nutt, DNP, RN

Open communication

Remember who you are

Partners in healthy relationships can talk about anything. Couples with healthy communication talk every day. There’s no fear of ridicule, anger or judgment. That doesn’t mean that they always need to agree. The key to good communication is that both partners feel heard, understood and valued.

Remain true to who you are as individuals. Keep your own hobbies, friends and interests, and encourage your partner to do the same. Time away from each other recharges your batteries and enriches your relationship.

ood relationships are essential for healthy lives. Each relationship is unique and comes with diﬀerent rules, roles and challenges. When our most intimate relationship is a healthy one, it makes our lives happier and more fulﬁlled. And we all want that, right?

How relationships change over time

IMAGES: SHUTTERSTOCK

As time passes, healthy relationships evolve, a more lasting connection develops, and a deeper level of intimacy grows. The secret to relationships that survive the changes and tests of time have common characteristics you can work to maintain each day:

Conﬂict Resolution

Trust develops over time, yet if lost, it’s hard to regain. Don’t keep secrets; lying is not part of a healthy relationship. A faithful partner is essential, and when you trust your partner, you always feel safe with them – physically and emotionally.

In healthy relationships, disagreements are handled with mutual respect, honesty, open communication, and a willingness to compromise. One common pitfall in arguing is listening to respond rather than to understand. Be willing to consider a compromise or diﬀerent viewpoint. Strive for communication, not competition.

Fun and games

Equal Partners

Playtime is so vital to a good relationship. Adult playtime can be as simple as snuggling with a bottle of wine and talking, or taking a hike together in nature. Enjoy being with one another, and being silly and carefree.

The healthiest intimate relationships happen when couples view themselves as equals. Some say relationships should be 50/50, but in actuality, the best relationships are really 100/100 – each person gives 100% to the relationship. Sometimes life, work or family demands will shift that balance and one person may carry a heavier load—but if the imbalance lasts too long, anger and resentment can occur. Protect against that. Healthy partners also practice equal decision-making. There isn’t a “boss” who controls the ﬁnances or makes all of the decisions. Each partner feels free to voice their opinion, and each opinion is equally valued.

Trust

We all want relationships that grow stronger over time and that can endure any challenges. Nurture your relationship and lavish it with attention each and every day! RITA NUTT, DNP, RN is an expert adviser to Healthy Mom&Baby.

ISSUE 29 / 2021 Healthy Mom&Baby

HMB07 Healthy relationships.indd 13

18/01/2021 10:58

healthy moms

Cancer in New Moms By Brea Onokpise, MPH, CHES

n January 2014, I started registering for local 5k races after being a member of a national women’s running group for two years. I also purchased a gym membership, and routinely worked out 2-3 times per week. These were my first two steps in planning for a healthy pregnancy. I had been married for almost three years, we were both in our early 30s, and I had decided that it was time. I felt great when participating in the races and working out. I made changes to my diet, drank more water, and really felt a sense of being in control of my health. Then, in May, I felt a smooth lump developing inside the back of my left leg. I believed it was a change in definition in my hamstring muscle since I was using the weightlifting equipment at the gym. The next month, I shared this news about the lump with my primary care provider (PCP) during my annual physical.

Small Signs My PCP ordered an MRI. She assured me that everything was normal according to the report. The lump however didn’t go away. It didn’t hurt, burn, itch, feel inflamed, or impede my running or workouts. By late August, we learned that I was pregnant! This led to the discouraging experience of a 2-week miscarriage. It was heartbreaking news. However, at year’s end, hope returned as I was pregnant a second time. We waited anxiously until the sonogram confirmed the baby’s heartbeat. We then shared the good

news only with our closest family members.

Large Signs By mid-summer, I began to feel some swelling in the lump in my left leg. Still, I saw no need for alarm. My urine samples, blood tests, and assessments of the baby were clear. As my due date approached, my husband and I became increasingly concerned as I was unable to set my left foot on the floor when I sat down. It was not until I was in labor with baby, that my husband realized the lump had grown far larger in such a short period of time. We simply hadn’t noticed. One key advice piece of with w share Report to Biopsy that I no mom s w e n d nt an to Treatment deny, expec ta , e minimiz t o n to is ternal After my daughter’s e any in r set asid o al or birth, my aunt, an with a rare softal physic or ex tern that g n li e fe l obstetric triage nurse, tissue tumor. The a n emotio erience. p x e encouraged me to return multiple reports u o y to my PCP’s office and seek revealed how much care about the lump, including the lump had grown having a biopsy. I must say that I since 2014 when I first have never seen facial expressions like recognized it. the ones we saw from the health care The orthopedic oncologist was providers that day. They scheduled the member of a healthcare team me for radiology tests the next week that developed my care plan. I met and made an appointment with an the radiation oncologist and his staff orthopedic oncologist in Baltimore, MD, at a DC hospital two days after my about an hour away. diagnosis. We set up a treatment plan My most vivid memory is of meeting that would begin immediately, that the oncologist, and sharing my story included five weeks of daily radiation with her. She said that for my age and (excluding weekends). A couple of health status, this was not normal. weeks into the radiation treatment, he The joy of having an almost 4-week old notified me that surgery would follow. I baby was dim that day. Now, things recall feeling many conflicting emotions began moving fast. I was diagnosed and being overwhelmed with planning

health4mom.org

HMB08 Cancer New Moms.indd 14

18/01/2021 15:59

healthy moms

Cancer in New Moms: Lessons Learned X Don’t be afraid to reach out for help X As your budget allows, ask friends or hire help in caring for your children so that you can pay attention to your health X Seek out cancer support resources for young women; they do exist X Advocate for yourself: Take notes, make a list of your questions, and be sure to get answers about the treatment and costs

and coordinating the care of my baby as my husband continued working. My hope increased when the radiation oncologist told me this type of cancer would not affect my baby, was not hereditary, would not prevent me from having more children, and that the goal of my care was ‘curable treatment.’

iMAges: DreAMstiMe

Physical Therapy to 5-Year Anniversary My maternity leave morphed into longterm disability. Our family, friends, and co-workers were extraordinary supporters and phenomenal in caring for my daughter. i was able to return to work after six months. i went from not being able to lift my left leg backwards, to sitting criss cross applesauce (as toddlers say). the orthopedic oncologist strongly recommended that we wait two years before

attempting to have a second child. she explained that this two-year timeframe is when cancer recurrence is highest after the initial diagnosis. so, we waited patiently. My fear of being unable to have more children decreased with each test that came back negative for cancer cells. Finally, we welcomed a second baby girl in October 2018. there were no health issues during my second pregnancy. Over time, my incision healed. there is scarring on my left leg that is sensitive to touch, and the muscle occasionally cramps up, but the lump has not returned. My family and i were beyond thankful when we added a third daughter in August 2020. My five-year cancer-free anniversary is January 2021. Brea OnOkpise, MpH, CHes, is a senior project manager at AWHONN, which publishes Healthy Mom&Baby magazine, in Washington, DC.

X Respond to health care provider and facility surveys; your words have power. Give honest feedback when the service is amazing or when you experience disrespectful care X Pay it forward. Your survivor experience can position you to offer some helpful guidance to others who may receive a cancer diagnosis; share your story only when asked to do so X Remember your health: A diagnosis of one type of cancer doesn’t prevent another. Breast cancer is the second leading cause of cancer death in U.S. women; continue with monthly self-breast exams

ISSUE 29 / 2021 Healthy Mom&Baby

HMB08 Cancer New Moms.indd 15

18/01/2021 15:59

healthy moms

Tattoos During Pregnancy, Childbirth, and Lactation Here’s what you need to know before you go get new ink or a piercing By Carol Rademeyer, CNM, MS, Cindy L. Farley, PhD, CNM, FACNM, and Cheri Van Hoover, CNM, MS, FACNM

etting a tattoo or piercing is typically a choice with special meaning. However, experts advise that adding body art or piercings can create complications during pregnancy, birth, and breastfeeding. Discuss what your tattoos or body jewelry means to you with your pregnancy care provider, so that it can be considered in the full context of your pregnancy care, especially birth and breastfeeding. If you don’t yet have a tattoo or a piercing, experts agree that pregnancy isn’t a time to add permanent body art, which can lead to skin and hypersensitivity reactions that may require treatment. Their advice aligns with the professional standards set by the Alliance for Professional tattooists, which advise against new tattoos during pregnancy. When performed by well-trained and experienced technicians under hygienic conditions, piercing and tattooing carry relatively few serious health risks. Amateur piercing and tattooing put you at far greater risk for infectious disease and traumatic injury, such as infection, bleeding, allergic reaction to inks or metals, and body trauma or scarring. Tongue piercings also increase oral health risks, such as infection or bleeding. During pregnancy, your abdomen and breasts expand as your skin stretches to accommodate baby and all of the extra blood and fluids that are a normal part of a healthy pregnancy. These changes can actually change the appearance of existing tattoos,

Maintain your piercings Healthcare providers know how to remove body jewelry in urgent situations. Piercing tracts can close quickly so swapping your metal for plastic jewelry can help maintain the piercing during pregnancy and birth.

which may not return to normal postpregnancy. Extra caution is advised regarding new tattoos on your lower back because the use of a large, hollowbore needle can move tattoo ink or contaminants into your epidural space, and there is a less common risk of developing arachnoiditis. This painful disorder happens when the arachnoid, which is one of the membranes surrounding and protecting your spinal cord, gets inflamed. Symptoms include a burning sensation and painful stinging. Although considered uncommon, this inflammatory issue can lead to future neurological problems.

Tattoos and breastfeeding Little is known about whether getting new tattoos while nursing is safe. The biggest risk is exposing your breast milk and baby to contaminants from liquid tattoo ink, which could lead to infection or hypersensitivity. Breastfeeding experts at La Leche League International recommend that new tattoos be delayed until your baby is at least 8 months old and is no longer

fully dependent on breast milk for their main nutrition. For the same reasons, they also suggest laser tattoo removal be avoided entirely as it can cause fragmented pigment particles to free circulate within your body.

Piercing during pregnancy and breastfeeding Infection and complications with birthing are the main concerns with existing and new piercings during pregnancy, especially if those infections require medications that could also affect your developing baby. Jewelry can also complicate childbirth. It may seem common sense, but body jewelry should be removed for birth and especially for breastfeeding because of choking risks for baby during nursing. Most healthcare providers agree that it’s best to avoid adding body jewelry through new piercings during pregnancy because piercing tracts can get infected by either bacteria or viruses—this is especially true for the outer rim of your ears, which if they become infected during pregnancy, may require IV antibiotics to heal. And just as your expanding abdomen and skin can change tattoos, the same is true for implanted jewelry and naval piercings. Some moms have required surgical removal for body jewelry at the end of pregnancy when this happens.

Body piercing and childbirth Ideally, all body jewelry should be removed before labor. The rigors of labor increase the risk of snagging or

health4mom.org

HMB09 Tattoo.indd 16

18/01/2021 11:02

healthy moms Typical Time to Heal Site

WeekS

Labia

2–16

Clitoris

2–10

Tongue

3–8

Earlobe

4–8

Navel

4–52

Lip

6–8

Eyebrow

6–8

Clitoral hood

6–16

Nostril

6–16

Nipple

6–36

Ear cartilage

6–36

a s m a ny wo m e n as 1 in 5 rgic nce alle experie e th to s reac tion o ink o tt ta metals in jewelr y. or b o d y

Note: This represents the time until the wound is no longer at greatest risk of infection. Complete healing typically takes one full year.

tearing. During cesarean procedures, metal implanted jewelry can become hot and present a burn risk. Mouth jewelry increases your risks of breathing problems and possible choking. It can also block your airway if you need general anesthesia. Abdominal jewelry within or just under your skin may limit surgical access, and postpartum swelling of the vulva can cause jewelry to become embedded in your tissues.

imAges: sHUTTersTocK

Body piercing and nursing There’s not a lot of research on the effects of nipple piercing on breastfeeding, and most healthcare providers advise removing body jewelry prior to nursing. Some observations have been made about slowing milk let-down because of nerve damage, increased nipple sensitivity, and blocked milk flow due to scarring of the milk ducts. Leaking milk or colostrum can happen when piercing tracts lead to a poor latch or baby gagging at the breast. Nipple jewelry poses a serious breathing risk for baby with observations of barbell jewelry breaking apart during nursing. The presence of jewelry can also affect baby’s developing mouth and palate.

Carol rademeyer, CNM, MS, is a clinical midwife at Full Circle Women’s Care in Jacksonville, FL. Cindy l. Farley, PhD, CNM, FACNM, is an associate professor in the Nurse-Midwifery/ WHNP and WHNP Programs at Georgetown University in Washington. Cheri Van hooVer, CNM, MS, FACNM, is adjunct faculty in the Midwifery Program at Jefferson (Philadelphia University and Thomas Jefferson University) in Port Hadlock, WA. This article was adapted from a journal article published in Nursing for Women’s Health.

ISSUE 29 / 2021 Healthy Mom&Baby

HMB09 Tattoo.indd 17

18/01/2021 16:04

www.facebook.com/HealthyMomAndBaby

HMB Facebook 2020 - Full.indd 1

27/05/2020 17:08

healthy moms

Taking Care of Yourself

after Pregnancy Loss By Delaney Barsamian, RN, PHN, MSN and Roberta Durham RN, PhD

regnancy loss is common, especially in the first trimester. Still, the loss of a pregnancy, no matter how early or late, can be an overwhelming experience. You may feel alone, yet as many as one in four women have experienced pregnancy loss. in our culture, talking about pregnancy loss is uncomfortable, taboo. and it’s this lack of sharing that leaves women feeling alone. So, let’s talk about it.

iMagES: SHUttERStOCK

Experiencing Pregnancy Loss With pregnancy loss, it’s normal and common to feel grief, sadness, shame, nervousness, fear, guilt, anxiety, and depression. You may envy pregnant moms. these feelings are normal. these feelings may come in waves and periods of feeling better in between, only to cycle back into feelings of grief and loss. if these cycles get worse, talk with your healthcare provider about possible postpartum depression. You may continue to bleed after

pregnancy loss for up to a month, including cramping feelings for up to 10 days. Your breasts may be tender, and if the loss was later in pregnancy, your milk may be developing. Wear a supportive bra and use breast pads or cold compresses in areas of tenderness.

Resuming Menstruation generally, your menstrual period will resume within 4 to 6 weeks. Changes in hormone levels can cause mood swings and fatigue. to keep your energy up, drink lots of water and make sure you eat, even if your appetite has decreased. try to stay active but also allow time for rest. Keep a bedtime routine like a calming meditation.

Honor Your Loss acknowledge and honor the loss of your pregnancy. allow yourself privacy, lean on friends and family, and give yourself time and space to mourn. if you have other children, maintain open and honest communication with them. Don’t be afraid to ask for help. Your pregnancy

care provider may recommend local support groups. Consider speaking to a therapist or counselor. Maintain any spiritual practices that are important to you, such as a baptism or a blessing. Hold a memorial or burial to honor traditions and provide closure. Find comfort in activities that create memories. Consider naming your baby. Keep a memory box of items important to your pregnancy and baby, such as a blanket, ultrasound images or sympathy cards received. in late pregnancy loss, nurses can help you create your baby’s footprints, cut locks of hair, and take photographs. Hold your baby, spending as much time as you need. Many women find holding their baby provides comfort and closure. Lean in to what feels right for you to find the ones that work best for your health. Delaney Barsamian, RN, PHN, MSN, is a nurse at Kaiser Permanente Oakland Medical Center. roBerta Durham RN, PhD, is professor emeritus at California State University, East Bay.

ISSUE 29 / 2021 Healthy Mom&Baby

HMB10 Perinatal loss.indd 19

18/01/2021 11:04

Natural & Organic Heirloom Bedding

www.holylamborganics.com sales@holylamborganics.com 888-359-1362

PAGE 20.indd 1

18/01/2021 14:22

healthy moms

Baby Friendly— and Mom Friendly, Too! Paris Maloof-Bury, CNM, RNC-OB, IBCLC

o, you’re planning to breastfeed. You’ve read books and blogs, and maybe you’ve taken a breastfeeding class. You know that breastfeeding is “natural,” but you’ve also heard it can be hard. sometimes, babies don’t latch, or they might latch like a snapping turtle. You’ve chosen a Baby-Friendly™-designated birth place because they’re recognized for their breastfeeding support. Nurses at Baby-Friendly™ hospitals specifically

focus on giving moms the information, confidence, and skills necessary to successfully start and continue breastfeeding their babies. they delay weighing and bathing, making bonding, breastfeeding, and baby’s wellness the top priority. Paris Maloof-Bury, CNM, RNC-OB, IBCLC, is a certified nurse midwife and lactation consultant, and associate editor of Healthy Mom&Baby.

What if my baby isn’t getting enough milk? You’ll know your baby is getting enough by how many wet and soiled diapers they produce each day. Your nurses will also help you watch for jaundice (yellowish color in baby’s skin) and whether baby loses any weight (yes, weight loss is normal in the first few days). If baby isn’t getting enough milk, they’ll help you supplement with your expressed milk, pasteurized donor milk, or formula. If your baby needs extra milk from these sources, your nurses will help you pump your breastmilk to maintain your milk supply.

What if my baby has trouble latching on? a good latch often results from holding baby in a way that helps them latch; supporting your baby while they come to your breast and using a nipple shield can help baby latch. Your nurse may ask you to try a shield if baby is struggling to nurse. time, patience, and support are essential! take a break and try it again. You and baby will get the hang of it!

IMages: sHutteRstOCK

3 4

What about pacifiers? Consider delaying pacifiers until you and baby have formed a great nursing routine—that will likely take a few weeks versus a few days. If baby seems fussy, try nursing before giving a pacifier—they’re likely hungry. each time your baby nurses, your body receives a signal to make more milk. When baby latches onto a pacifier instead of your breast, you’re missing out on the hormonal opportunity to increase your milk supply.

When will I sleep? sleep when baby sleeps, which will be both during the night and day, so daytime napping is necessary. Prolactin (the hormone that makes your milk) peaks during the night, which is when many newborns are wide awake. ask your nurse to help you learn side-lying nursing, a breastfeeding position that allows you to breastfeed while resting on your side.

ISSUE 29 / 2021 Healthy Mom&Baby

HMB11 Baby and mom friendly.indd 21

18/01/2021 11:06

What can I do about my Scar? The leader in scar management ™ has been providing treatment to health care professionals and mothers for over 25 years with remarkable results! ReJuveness self-care products help prevent and treat problem scars from surgery incisions, keloid, and stretch marks. Note: C-section wounds have a longer healing time. Confidence in ReJuveness can promote early conversations between clinician and patient, leading to successful scar management. Early intervention is key to successful results, so talk to your doctor, says Tom Fallon, representative to the FDA in classifying silicone for problem scars.

✩ ReJuveness recognizes favorable bio-active healing properties of certain silicones and their design over others. ✩ Attain results with a combination of a rapid regrowth of the top layer of skin, and a balanced remodeling of collagen in the lower levels. ✩ Strategic taping over the silicone sheet is essential. This combination acts as stent lessoning skin tension, keeping incision edges together and promoting an even collagen production. ✩ For a more positive outcome, give the process a boost with our Hyper-Heal cream in combination with our silicone sheeting, which is cost-effective and reusable. Daily use of the non-adhesive silicone sheeting should be started no less than two weeks after surgery. ✩ Derma needling is emerging as an added tool in scar management as well as revision of older scars with unfortunate repercussions. ✩ Just one sheet of ReJuveness can last up to a year. ✩ Scar advisors are available throughout treatment to answer any questions or concerns.

www.rejuveness.com

*this statement has not been evaluated by the Food and Drug Administration. this product is not intended to diagnose, treat, cure or prevent any disease.

PAGE 22.indd 1

18/01/2021 14:24

healthy moms

Breast Health

Be Your Own Breast Advocate By susan angelicola, msN, aPN

images: shutterstocK

ow well do you really know your breasts? i mean really know them? and what about how they may change when you’re pregnant? are you sure you know when or if you should examine them, or have breast imaging such as a mammogram? No matter your age or whether you’re pregnant or nursing, it’s very important to know your breasts, especially what’s normal for you regarding their look and feel. Knowing what’s normal is the best way to pick up on changes that may need professional care. What is most important is knowing your normal. Be familiar with how your breasts look and feel; this is key

to detecting breast disease. We all have our own lumps and bumps, and variations in our breasts. maybe one breast is larger than the other, maybe there is a mole on one breast. Feel the glands under the areola (the darker skin around the nipple), and feel the breast tissue near your ribs under your breasts. menstruation can cause breast tissue to swell and become tender. some women who use birth control pills also notice their breasts feel heavier or more sensitive. these changes are related to shifting hormones. If you find anything that’s not typical for you, please discuss what you discover with your healthcare provider.

Finding a lump or bump Breast health is a “if you see something; say something” situation. should you find a lump or bump that wasn’t there before, or a lump or mass that feels like a pea or stone, or a painful or tender area that doesn’t go away within a few weeks or after your menstrual period, or if you see brown/black/ milky or bloody nipple discharge, or changes in the skin of the breast that looks dimpled, say something to your healthcare provider. there is never a reason to think you are overreacting or that your concern doesn’t justify a clinical breast exam. these concerns are extremely important and should always be taken seriously.

ISSUE 29 / 2021 Healthy Mom&Baby

HMB12 Breast 101.indd 23

18/01/2021 11:09

healthy moms Your breasts during pregnancy

Mammograms during pregnancy or nursing is it possible to get a mammogram when you’re pregnant or breastfeeding? Maybe. A screening mammogram, done for routine breast cancer screening for women over 40 or younger women at high risk, should be postponed until after your baby is born. However, if a breast lump is discovered or there is a concern about

breast disease or cancer, a diagnostic mammogram should be performed in pregnancy or during lactation. this is not a screening, but a specialized mammogram that focuses on the area of concern. According to the American college of radiology, when you are breastfeeding, you can have a screening mammogram. Some radiologists prefer to wait until 3 months after weaning, so ask your health care provider what is recommended in your area. Breastfeeding increases breast density, so it’s recommended that you pump or breastfeed to empty your breasts within 2 hours of your scheduled mammogram. Breast self-awareness is one of the most important ways to take care of your body. our breasts change so much from adolescence, to adulthood, through pregnancy and lactation, and through menopause. Your breasts are unique, just like you, and getting to know them is key in preventing and detecting breast cancer or other breast diseases. Your healthcare provider is always available to you to share expertise, provide reassurance, and assist in evaluating anything abnormal. Just don’t be afraid to ask. remember – you are your own breast advocate!

Are Breast SelfExams or Clinical Exams Needed? examining your own breasts is called a breast self-exam; having your health care provider do the exam is a clinical breast exam. the clinical breast exam used to be universally recommended for all adult women. Now, for women without risk factors for breast cancer, the American cancer Society doesn’t strongly recommend either exam! research hasn’t shown that these exams will help find breast cancer early. When breast cancer is detected due to a lump, it’s typically because the woman herself has found it during usual activities, such as bathing or showering. if you’re more comfortable having your healthcare provider do a clinical exam, that’s okay. Just know that self and clinical examples aren’t proven in science to detect cancer—be sure to get regular mammograms recommended for your age and cancer risks.

SuSan angelicola, MSN, APN, is an expert adviser to Healthy Mom&Baby.

iMAgeS: SHutterStocK

During pregnancy, your breasts will be active when preparing for lactation and can change quite a bit! Many women feel tenderness in their breasts, and because your blood volume increases and hormones surge, your breasts may grow in size. You may see the veins on your breasts grow larger, more blue and noticeable. Your nipples and areola may also look darker. As your breasts grow, they may feel dry or itchy. You may even leak colostrum—your earliest breast milk—during pregnancy. this is normal, but don’t worry if you don’t, that doesn’t mean you won’t be able to successfully breastfeed your baby. of course, when you’re breastfeeding your baby, your breasts will change again. They may be firm or larger/ heavier, they may feel lumpy or sore and, especially at first, your nipples may hurt or even crack. You may feel a clogged milk duct—a firm tender swelling from the size of a pea to a plum. You’ll get to know how your breasts feel before you nurse your baby—when your breasts are full—and right after when they’re emptied and softer. unfortunately, breast cancer can occur at any time. in fact, it happens in 1 in 3,000 pregnancies and represents up to 3% of all breast cancers! So if you ever feel a lump that is persistent, painful or that increases in size, has unusual or blood nipple discharge, or a dimpling or puckering of the breast skin, let your health care provider know right away. You may not have cancer, but it is very important to be on the safe side

health4mom.org

HMB12 Breast 101.indd 24

18/01/2021 11:09

The go-anywhere breastmilk storage thermos for moms on the go Things change with a new baby, but you don’t need to stay at home all the time. Ceres Chill helps new moms achieve their breastfeeding goals even when they have places to go and things to do. Ceres Chill is a bottle that attaches to any pump & collects and stores your milk. No plastic bottles, bags, power cords, chargers, or bulky ice packs. Dishwasher safe

Cost saving & reusable

Keeps milk cold for 20+ hours

Compact & discreet

Planet friendly

Available on Amazon Prime and at cereschill.com

BabyBuddha is on a mission to give new moms more freedom to move! Introducing The BabyBuddha Breast Pump. The world’s smallest and most portable, rechargeable single and double breast pump on the market. An impressively quiet mechanism allows you to pump discreetly and quietly without drawing unnecessary attention to yourself. This conveniently small pump can be hung around your neck using the included lanyard which allows you to free your hands and pay more attention to your baby. The 100% BPA-free BabyBuddha pump is a closed system ensuring the prevention of milk overflow and contamination. Operating The BabyBuddha couldn’t be easier! Don’t burden yourself with complex controls or tie yourself down with cords. Simply use the trackball to navigate through the various modes, and land on the perfect one with a simple swivel of your thumb. We’ve taken a multipronged approach to make every pumping session as comfortable as possible. The BabyBuddha pump has an extra-soft cushion to prevent nipple soreness, multiple expression and stimulation modes to suit your preference, and an anti-backflow design to eliminate the need to uncomfortably lean forward as other pumps require. Additionally, our unique suction pattern in stimulation mode mimics a baby’s suction pattern to increase milk production. Our team of Lactation Consultants will deliver top-notch customer service as you are assisted with your breastfeeding journey. Come join our community where you can ask questions and share your pumping experience with other BabyBuddha users. Now tell us…

10% discount with code: HEALTH4MOM10

What will you do with your freedom?

PAGE 25.indd 1

18/01/2021 14:25

@healthymomandbaby PAGE 26.indd 1

18/01/2021 14:27

healthy moms

Clean Like Your Life Depends on It! Green cleaners can keep us safer as we strive to keep our homes and work spaces cleaner for ourselves and others By Carolyn Davis Cockey, MLS, LCCE

aybe you’ve heard the phrase, cleanliness is next to godliness. There’s a proven connection between how clean your home may be and your risks for allergies, asthma and illness viruses or bacteria. Having a clean home—or work space if you’re on the frontlines as an essential employee—is an important tool to help prevent infection from coronavirus.

Green Cleansers for Every Use h 1 cup of hot water h 1 cup of vinegar—look for cleaning vinegar which is slightly stronger h Add lemon rind or rosemary sprigs for fragrance as desired

Green Cleansers to the Rescue

imAges: sHutterstOcK

According to the CDC, green cleaning is an “effective way” to clean while also saving money. In New York City, the Department of Health is working with building owners to implement green cleaning after learning how using less toxic cleansers actually creates healthier conditions for residents with asthma, allergies or emphysema. The Department of Health observed reduced bouts of asthma and other respiratory ailments among janitors, who typically experience more work-related asthma than others as an occupational hazard. You won’t get that pungent “boiled in bleach clean” smell from green cleansers, but the science is proving eco-friendly cleaners are just as effective, if not more so. When shopping for eco-friendly cleaning products, look for certifications on the label including “Safer Choice” from the EPA, “Green Seal” and “EcoLogo” as the most common certifications on safer products now for sale. Or make your own!

all-purpose disinfectant

Let the lemon and rosemary diffuse for a week, then spray and wipe to clean and disinfect. Avoid natural stone counters like granite or quartz, which may “etch” when acids like lemon or vinegar are applied. Safely clean countertops and stainless steel with a mix of warm water (1 quart) and 4 tablespoons of baking soda.

Heavy degreaser

Add 1/2 cup of ammonia to enough warm water to fill a 1 gallon container; shake to make sudsy and apply with a sponge to your range, stove top, oven and oven racks. Add a little extra ammonia for heavy grease and grime.

Glass cleaner

Mix equal parts isopropyl (rubbing) alcohol at 70% concentration, white, cider or cleaning vinegar and water— depending on what you need, start with a 1/2 cup of each or 1 cup of each ingredient. Add 1-2 drops of orange essential oil to add a nice fragrance to the room. Swish together in a reusable spray bottle for clear, clean, shiny glass.

Carolyn Davis CoCkey, MLS, LCCE, is a Lamaze-certified childbirth educator and the senior director of publications and partnerships at AWHONN.

ISSUE 29 / 2021 Healthy Mom&Baby

HMB29 Green Cleaning.indd 27

18/01/2021 11:10

Natori Maternity offers comfortable support, feminine beauty, and effortless function. Designed to help fit your fluctuating shape, 4-row stretch hook and eyes and easy, open/ close clasps, offer ease and comfort on the go. BLISS PERFECTION WIRELESS Made of signature 4-way stretch fabric and a plush lace trim that adds a luxurious look and feel to this wireless nursing bra. An inner stabilizer frame and wide plush elastic at bottom band supports without using wires.

FEATHERS Features Natori’s Signature lace trim and plunging neckline. The inner sling is made of “Bliss” Pima cotton fabric for extra softness against the skin. Lace wraps around the body for beautiful, all day comfort and support. Both Bliss Perfection & Feathers Maternity were designed based on Natori’s two, top-selling styles, allowing women to take their favorite bras with them into motherhood. #NATORI #MYNATORI #THEPERFECTBRAISNATORI

Self-Care Solutions for The Mom-To-Be “Is it hot in here?” “May I have extra whipped cream on that?“ “How am I supposed to massage my feet if I can’t even see them?” We know the questions you’re asking because we’ve been there. While we can’t fix all the stressors that arise during pregnancy, we have your self-massage needs covered with a step-by-step, simple solution to soothe your aching feet, legs, back, neck and shoulders that you can do anywhere, any time. This specially designed pre and postnatal self-massage online video program helps with: • Leg Cramps • Low Back/Sciatic Nerve Pain • Ankle/Wrist Swelling • Long Lasting Stress Relief …and much more.

PAGE 28.indd 1

Learn to properly and safely use self-massage Therapy Balls during this time of change and stress to target areas of discomfort, stiffness or limited mobility. Specialized selfmassage techniques, movements and therapy ball placements will assist your body’s physical transition into motherhood, as well as the stressors that come with lifting, carrying and feeding your baby. The Roll Model Mama program creator, Jill Miller, is a mom of two herself. Having been on the forefront of fascia research, fitness, and self-massage for over 15 years, she’s taught hundreds of thousands of people worldwide how to better care for their body and mind. Take care of your body and soul, so you can nurture others.

with Jill Miller

Prenatal Self-Massage for the Expecting Mother & Beyond Prenatal Self-Massage for the Expecting Mother & Beyond

Save 15% with code NEWMOM15

www.RollModelMama.com

18/01/2021 14:29

Join us on Facebook

facebook.com/HealthyMomAndBaby

healthy

pregnancy

Keep Yourself & Baby Safe During COVID Experts at the Centers for Disease Control & Prevention are urging pregnant moms to take every precaution advised to reduce your risks of contracting COVID. “Based on what we know at this time, pregnant people are at an increased risk for severe illness from COVID-19 compared to non-pregnant people. Additionally, pregnant people with COVID-19 might be at increased risk for other adverse outcomes, such as preterm birth,” they advised. Because you can’t eliminate the risk entirely, they advised this simple way to ensure you minimize your exposure to the virus: “The more people you interact with, and the more closely you interact with them, and the longer that interaction, the higher your risk of getting and spreading COVID-19.”

You can have peace of mind that you’re doing everything possible if you and the people you live with do the following:  Limit the number of people you each interact with and keep those interactions as short as possible  Mask up when outside your home, wash up frequently (your hands) and keep your distance (6 feet+) in all interactions  Avoid people who aren’t wearing masks and crowds of people, and events where these precautions can’t be met  Keep all of your prenatal visits and other health appointments, including follow-up care after baby’s birth; ask if telehealth is an option for any of these appointments  Ask your healthcare providers what precautions they’re using for safety, such as can you wait in your car for your appointment? Go straight from your car into an exam room when your care provider is ready to see you? Pay your bill and schedule your next appointment online or over the phone?  Keep an extra 30-day supply of any prescriptions and other medications you need; your healthcare provider may need to contact your insurer for coverage approval

Are Rare Baby Names Surging for 2021? Move over Liam, Olivia, Noah and Emma, coronavirus is pushing sequestered parents toward novel and lyrical new and rare baby names like Pax, Baxter, Indira, and Georgiana, say the record keepers at the Social Security Administration, who have tallied baby names on new cards for newborns since 1879! These rare names are moving up in the ranks; are you ready for Rhys or mad for Millicent? Ava may become Avia or another derivative. What we know for sure is that just like 2020, none of these new baby names will be boring!

IMAGES: SHUTTERSTOCK

 Get a ﬂu shot; yes, they’re safe in all trimesters of pregnancy; ask everyone else in your household to get a ﬂu shot too  Get the whooping cough (Tdap) vaccine during pregnancy to protect both you and baby; whooping cough has similar symptoms to COVID-19  Call your pregnancy provider immediately if you think you have COVID, or if you’re experiencing sadness, feelings that overwhelm you or what you would consider depression during or after pregnancy

ISSUE 29 / 2021 Healthy Mom&Baby

HMB13 Healthy Pregnancy Opener.indd 29

18/01/2021 11:18

healthy pregnancy

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

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

Therapeutic Rest In an ideal world, childbirth would be quick and efficient. But most women experience labor first as contractions coming in starts and stops without a rhythm or pattern that can go on for 2-3 days before active labor kicks in. This process is known as “prodromal” labor, or the earliest labor, and during this phase you should rest as much as possible. As your pregnancy care providers, we hear you when you say it’s quite difficult to sleep with all of those contractions! That’s where therapeutic rest comes in as medication to help you sleep through some of those early contractions so that you have the energy to cope in the busiest and most challenging part of labor for some women—active labor. You may find that a sleep aid is enough to help you ignore the contractions and rest. Two common options are hydroxyzine (an antihistamine) and zolpidem (a

sedative). Both of these are given in pill form. Still, sometimes the pain of contractions in prodromal labor is too strong to sleep through. In these cases a long-acting opioid, like morphine (given as an injection by your nurse) can relieve the pain and provide a bit of sedation. An opioid for therapeutic rest can also be used well in advance of baby’s impending birth so that baby isn’t sedated when they’re born.

Your bo dY Your bir , th

it ’s impo rtant to remembe r that the re is no single rig ht way to give bir th You will k . n ow w h a t is right you in th for e momen t. Follow your inst incts and trust yourself as you giv e bir th. h a p py p u shing!

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

to affect labor progress, breastfeeding, or increase the risk of postpartum depression. Another option is a short-acting opioid, like fentanyl or butorphanol, which can be given to you by your nurse through an IV or as an injection. All opioids easily cross the placenta, so your care providers will advise avoiding this option if you’re likely to birth your baby within the next hour or two. Opioids can make your baby sleepy, and if given too close to the time of birth, they increase the risk for slow and ineffective breathing, or respiratory depression in baby. Your baby may need more time and help latching to nurse, so plan for lots of skin-to-skin contact, and ask for breastfeeding support if you use a short-acting opioid.

health4mom.org

HMB14 Pain Relief Labor.indd 30

18/01/2021 16:19

healthy pregnancy

images: Prostock-studio

“I just want the pain to stop!” If your goal is to feel as little pain as possible during childbirth, an epidural is the way to go. Some women will experience total pain relief with epidural anesthesia, still many will feel some tightening or pressure with contractions, and most of us will feel a lot of pelvic pressure as baby is born. This is a good thing; it means you’ll have enough sensation to work with your body when it’s time to push. An anesthesiologist or nurseanesthetist will place the epidural, so you may have to wait until they’re available to receive some relief. They will use a needle to insert a thin, soft tube in your lower back through

which you’ll receive pain medication throughout labor. Because this is anesthesia, you won’t be able to walk or get out of bed until it’s worn off. Most women will also need a Foley catheter (a tube that drains urine from the bladder) until they can regain the sensation to empty their bladder on their own. Science is conflicted about whether baby’s starting breastfeeding is affected by the anesthesia, so as always, snuggle your baby with lots of skin-to-skin contact and encouragement toward breastfeeding early on. And while the research does not show an increased risk for cesarean birth, epidurals can affect labor progress in some women, so it’s not uncommon to need Pitocin (a synthetic

form of the natural oxytocin that your brain makes to start and sustain labor) to keep labor progressing with an epidural. Similarly, women who receive epidural anesthesia are slightly more likely to need assistance with birthing baby, either with forceps or a vacuum, and are at higher risk for developing a fever during labor. The good news is that very little of the medication goes to the baby, so there’s no concern that the baby will be sedated when born. This means that it’s considered safe to get an epidural, even if birth is imminent. Paris Maloof-Bury, CNM, RNC-OB, IBCLC, is a certified nurse midwife and associate editor of Healthy Mom&Baby.

ISSUE 29 / 2021 Healthy Mom&Baby

HMB14 Pain Relief Labor.indd 31

18/01/2021 11:24

healthy pregnancy

Choosing a Place to Give Birth Paris Maloof-Bury, CNM, RNC-OB, IBCLC

One of the most significant factors in determining how you give birth is where you give birth

Hospital births Hospital birthing facilities vary widely. Some offer care provided by midwives as well as physicians. Most offer pain medications, epidural anesthesia and cesarean birth.

Birth centers Birth centers can be on a hospital campus, or in a home-like facility where midwifery care is provided to healthy women not at risk for pregnancy or birth complications. Narcotics and epidurals arenâ&#x20AC;&#x2122;t available for pain management. People people who choose birth centers often do so for a more natural childbirth. Birth centers are often located close to hospitals should urgent

care be needed. Home birth occurs in your own home perhaps with a midwife or other support people including doulas.

ask about rates of procedures. Assess your risks with your provider about where they will support you during labor and birth: h What is the cesarean rate? The ideal rate for cesarean should be between 10-15%. The cesarean average in the U.S. is about 32%. h If youâ&#x20AC;&#x2122;re choosing an out-of-hospital birth, ask about their rate of transfer to hospital? A sk for the most common reasons women are transferred to the hospital, and how transfers are accomplished.

ask about birth practices. h Ask about movement in labor and birth. Research shows that when women are free to move during labor, they have shorter labors and lower rates of cesarean birth. In hospitals that require continuous fetal monitoring, you may be required to

labor and birth in bed. h Can you eat and drink during labor? Some hospitals limit all laboring women to clear liquids or only ice chips. While this may be appropriate in high-risk pregnancies, for other labouring women, this can be physically and emotionally stressful. You need energy for the work of labor. h What coping options are available? Most hospitals offer epidural and IV narcotics; they may also have showers or birthing tubs, sterile water papules and nitrous oxide. Can you bring a yoga ball, aromatherapy, TENS units, or dim the lighting?

ask about policies. h What is the policy on visitors and doulas? Labor support to help you feel safe in a labor matters. Can your partner be there? Family members? Especially during pandemic, ask if you can bring your own doula for support. Paris Maloof-Bury, CNM, RNC-OB, IBCLC, is a certified nurse midwife and lactation consultant, and associate editor of Healthy Mom&Baby.

images: shutterstocK

here you give birth has a greater influence on your risk of having caesarean birth than your age, weight, or overall health. It can influence breastfeeding success. You often inadvertently choose your birthing place when you choose your pregnancy care provider, as you will likely birth where your provider practices.

health4mom.org

HMB15 Birthplace choices.indd 32

18/01/2021 11:27

PAGE 33.indd 1

18/01/2021 15:19

healthy moms

Strategies for a Comfortable Postpartum Recovery 5 W You may be sore or uncomfortable from your birth experience, whether you had a vaginal birth or a cesarean. So now what? hen you’re in the hospital or birth center, there will be many options to soothe and comfort soreness. However, you may want to have the following items ready for use at home. By Heather Watson, PhD, MSN, BSRN

Breast pads. If you’re breastfeeding you may experience some leaking between feedings. Having disposable pads handy to insert into your bra helps you avoid inconvenient trips to the store.

Ice packs. Grab extras from the hospital if you can, but if not, use soft gel ice packs to reduce swelling.

Witch hazel medicated pads. These will help with tender and inﬂamed tissues and help cleanse any stiches or minor tears.

Heating pad. Soreness is common after labor or surgery, but baths are usually not an option for several weeks. Helpful alternatives are electric or microwaveable heating pads— just be careful not to apply directly to the skin or an incision.

Feminine hygiene pads of various sizes. Postpartum bleeding can last several weeks but typically reduces over time, so having a variety pack is helpful. Remember, you don’t want to insert anything vaginally, so tampons are oﬀ limits.

Savoy cabbage. When your milk comes in, usually between days 2 and 6 after birth, your breasts may become engorged and feel sore and swollen. The best relief is for your baby to nurse often and empty your breasts. Cabbage leaves are an old, and inexpensive remedy to soothe breast engorgement. Use green varieties so as not to stain clothes. Apply a washed leaf to each breast and you may ﬁnd some relief. If nothing else, you can take a funny picture for the baby book!

HEATHER WATSON, PHD, MSN, BSRN is a nurse scientist at Johns Hopkins Health System and expert advisor to Healthy Mom&Baby.

IMAGES: SHUTTERSTOCK

Sitz bath. Sometimes these go home with you from the hospital, but if not, they’re available at local drug stores, and help to cleanse and provide soothing warmth to the perineum.

Maternity belt. Perhaps you wore one toward the end of your pregnancy for support, but if not, ﬁnd them at drugstores or ask at the hospital. The belt provides extra support, especially if you had a cesarean, while you strengthen your abdominal muscles and return to your pre-pregnancy shape.

health4mom.org

HMB16 Postpartum Recovery.indd 34

18/01/2021 11:30

Comfort, Health, Functionality

Using the bathroom after delivery can be challenging and uncomfortable for many new moms, so we designed the Cascade 3000 bidet seat to help. Its aerated, warm water wash stream is soft enough not to cause discomfort but powerful enough to get you thoroughly clean, leaving you refreshed and ready to go. Best of all, we’ve made the Cascade 3000 intuitive and easy to use so you can enjoy all the beneﬁts of bidet cleansing without the learning curve. With its amazing features and sleek look, the Cascade 3000 will keep you feeling fresh throughout pregnancy, postpartum and beyond!

Cascade 3000 ◆ Replaces your existing toilet seat

◆ Soothes and relaxes sore areas while providing gentle, efﬁcient front and rear cleansing ◆ Warm air dryer reduces the need for abrasive, irritating toilet paper ◆ LED nightlight makes it easy to navigate the bathroom in low light ◆ Nozzles self-rinse before and after each use, and silver nano-technology keeps the interior components sterile, so you can rest easy knowing that you’re getting an exceptionally hygienic cleanse ◆ Versatile unit provides a supremely comfortable, convenient and sanitary cleansing experience regardless of life stage or gender

Contact

support@yourdignitysolutions.com Phone: 734-358-2348 COUPON CODE HMB35 can be used on dignitysolutions.com for 35% off your order of a Cascade

The Postpartum Ice Panty PIPs® Panty (Perineal Ice Panty) is an attractive patented boy short underwear designed to ease the swelling, pain and discomfort that many women experience after vaginal birth. THE APPLICATION OF ICE TO THE PERINEUM IN THE

FIRST 24 TO 48 HOURS AFTER DELIVERY IS VERY HELPFUL TO THE HEALING PROCESS. THERE HAS NEVER BEEN A TRULY EFFECTIVE, COMFORTABLE AND DIGNIFIED WAY TO PROVIDE COOLING TO THE PERINEUM FOR WOMEN IN THE FIRST FEW DAYS AFTER BIRTH.

PIPs Panty addresses this problem.

It has a unique design - the crotch has a sewn in pouch with a center opening that holds a re-sealable PIPs ice bag. The ice bag itself also has a center opening that lines up with

the pouch opening. The opening in both the pouch and the PIPs ice bag allows blood from the vagina to ﬂow thru these center channels to the sanitary napkin beneath the pouch. The pouch remains directly against the perineum or vaginal area, providing cooling relief where it is needed unobstructed by the sanitary napkin. The water repellent pouch can be wiped down with a damp washcloth or paper towel when soiled. Your PIPs ice bag can be ﬁlled with ice found on most Maternity Units. There is no need for freezers which are not typically supplied in birthing suites. Best of all, mamas can be up and moving around while wearing PIPs! PIPs Panty and ice bag are washable and reusable.

Coming soon, gel packs for use where freezers are available.

pipscomfortcare.com PAGE 35.indd 1

18/01/2021 14:34

healthy pregnancy

Best Labor Positions to Promote Vaginal Birth By Danielle Beasley, PhD, RN, RNC-OB

s you prepare for the arrival of your little one, you may be wondering how you can increase your chances of having a vaginal birth versus cesarean, which is major abdominal surgery. Otherwise known as normal labor and birth, vaginal birth has fewer risks and typically an easier recovery as compared to cesarean. Currently, the CDC reports that

31.7% of all births are by cesarean, which means your odds of a normal birth are twice that of cesarean. You can help boost those odds using active labor strategies and positions. Frequent position changes during labor to help you be more comfortable and help baby get into the best position, say obstetricians and certified nurse-midwives. Your position in labor can help your cervix

dilate and thin out so that your baby moves down more easily into your pelvis. Your nurses will recommend different positions to try as they monitor your babyâ&#x20AC;&#x2122;s heart rate during contractions. Try to avoid lying in bed, flat on your backâ&#x20AC;&#x201D;this puts pressure on blood vessels, decreases blood flow to your baby, and if you lie on your back and stay

health4mom.org

HMB17 Birth Positions.indd 36

18/01/2021 11:31

healthy pregnancy in this position you can actually slow down your labor, reducing baby’s opportunities to move into the best position for birth. Having pain medication such as narcotics or an epidural may also decrease your ability to change positions during labor. If you choose to receive a narcotic or an epidural for pain, try to move as much as you can beforehand. This could involve independent movement, or with the aid of a birthing or peanut ball. Birthing balls can be unstable—ask your nurse or a family member close by to support you as you get on and off and rock on the ball. Peanut balls are helpful when you’re laboring in bed, and are more typically used if you’re using a narcotic or epidural, or if you prefer the peanut ball to a stability ball. Ultimately, you need to choose labor positions that are the most comfortable and safe for you.

Labor positions may help increase the likelihood of having a vaginal birth:

Hands and Knees Standing or Walking Standing or walking works with gravity, allowing your pelvis to open and your baby to move down into the birth canal. Walking can be done any time during labor. While you’re walking, leaning against a wall, or your partner, for support during contractions may be helpful.

Going on hands and knees (all fours) in a birthing bed is another way to cope more comfortably especially if you’re experiencing back labor. With this position, gravity pushes baby’s head downward against the cervix, which may help speed up dilation. While on hands and knees you can raise the head of the bed so you can lean forward to stabilize yourself. Have your support person or nurse nearby for extra stability, comfort and support. Nurses can help if this is a difficult position to get into with narcotics or an epidural onboard.

When Cesarean Birth is Necessary

images: shutterstocK

Sometimes a cesarean surgery is needed, especially if labor isn’t progressing. Stalled labor might occur if your cervix isn’t opening enough despite strong contractions through several hours of labor. Labor can also slow down or stall if baby isn’t in the best position for a vaginal birth.

Danielle Beasley, PhD, RN, RNC-OB, is an assistant professor at the University of South Florida College of Nursing.

Squatting or Sitting Like standing, squatting also opens the pelvis to give your baby more room to move down. Ask your support person to help you get into a comfortable squatting position. Some hospitals also have a squatting or birthing bar. A squatting bar connects to your labor bed. Leaning on the bar can also help your legs from becoming tired. Some women like to remain squatting during birth. This may be more difficult to do with an epidural in place. Sitting on a birthing ball can help with pain during and between contractions, and sitting on a birthing ball also helps keep your pelvis open for baby. Sit, rock side to side, or back and forth, or bounce gently for counter pressure for your perineum.

Side-Lying This position is very helpful when there is a need to rotate a posterior baby (back of the baby’s head is towards your back) to a better position for birth. Lying on your side is more comfortable if you’re tired and don’t want to remain upright. If you have an epidural and must remain in bed, side-lying is preferred over lying flat on your back. When side-lying, use a peanut ball between your legs to open your pelvis. Hook your legs around the narrower part, or aligned with both knees and ankles resting on the ball. If your hips become uncomfortable, readjust the ball.

ISSUE 29 / 2021 Healthy Mom&Baby

HMB17 Birth Positions.indd 37

18/01/2021 11:31

healthy pregnancy

Learn About Periodic Fetal Heart Monitoring Options By LaShea Wattie Haynes, MEd, MSN, AGCNS-BC, APRN, RNC, C-EFM

Monitoring Baby’s Heart Rate Some pregnancy care providers monitor baby’s heart rate through a “toco transducer.” This gives a visual picture of baby’s heart rate and movement during a short timeframe (15-30 minutes).

These monitors can also be applied when needed so that your movement during labor can still include birthing balls, rocking chairs, walking, and squatting. Labor is a process of movement, this periodic assessment for baby can be a great option to allow labor to naturally progress, reducing the risks of baby not being in the right position for birth or your need for cesarean birth.

Handheld Doppler Monitoring The second option is called intermittent auscultation using a handheld doppler device, similar to how a device was used to listen to baby’s heart rate during prenatal care. Although both external and internal fetal monitoring is used more often in hospitals and universitybased healthcare systems, ask your pregnancy care provider if periodic, intermittent auscultation could be an option in your labor. Also, be sure to discuss whether you or your baby

have any risk factors that would create the need for continuous monitoring of baby’s heart rate, how your labor is progressing, and how well you and baby are tolerating labor, especially during and after contractions.

Mobile Monitoring Some birthing facilities, including hospitals, also have fetal monitoring capabilities that allow pregnancy care providers to monitor your baby while you’re up walking and moving around in specific areas of the facility. Ask your pregnancy care provider, or ask during childbirth education, if this will be an option where you plan to birth. Labor is ultimately a process of movement, so monitoring that will allow for more freedom to move around, can help your labor progress more quickly, and may even decrease the need for cesarean birth.

LaShea Wattie hayneS, M.Ed, MSN, AGCNSBC, APRN, RNC, C-EFM, is editor of Healthy Mom&Baby.

images: shutterstocK

lectronic fetal monitoring helps your pregnancy care provider and nurses understand how baby is doing during labor. Understanding the types of fetal monitoring you may experience will help you ask questions during visits with your pregnancy care provider, in childbirth classes, and tours of the facility where you will birth your baby. Obstetricians and midwives may have their own monitoring preferences, so ask ahead of time what options will be made available to you and how continuous or periodic (“intermittent”) electronic fetal monitoring may support or affect your labor and baby’s birth.

health4mom.org

HMB18 FHM.indd 38

18/01/2021 11:32

These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any diseases

PAGE 39.indd 1

18/01/2021 14:36

Baby

The Problem Applying diaper cream to a baby can be very messy, especially to babies on the move. With most diaper cream this is a very sticky, oily & messy task that requires two hands. Diaper cream creates a moisture resistant barrier to protect a baby’s sensitive skin, which is why it doesn’t wash off with water.

The Solution Swabbies allows for quick and sanitary diaper changes without all the mess. Each sponge applicator is preﬁlled with Swabbies Supreme Diaper Cream for a single-handed, mess-free application. This new, one-of-a-kind design was created by a mom for busy bums on-the-go. Swabbies is pediatrician-tested and approved.

Easy as 123

Gentle enough for the most delicate skin

Splish splash give little one’s a bath with clean, natural ingredients that are gentle for baby’s skin and the planet. Tear-free and dermatologically approved, these true-natural baby shampoo and washes are made with aloe vera and chamomile for a calm and soothing bath. Follow-up bath time with a truenatural baby balm to soothe and protect baby’s skin. Made with aloe vera, shea butter and chickweed to moisturize as it heals and protects, this gentle yet effective balm can be used for everything from diaper rash to skin irritations, and eczema.

Receive 10% off your Nature’s Aid order with code HEALTHYSKIN10 www.naturesaid.com

Pinch neck of Squeeze tube Swab on aplicator tube until cream cream liberally under sponge is at top of as often as to break seal sponge necessary

Available at

More than just a diaper cream

www.swabbiescream.com

PAGE 40.indd 1

18/01/2021 14:38

healthy pregnancy

Group B Strep & Your Pregnancy Catherine Ruhl, DNP, CNM & Rachel Napoli DNP, CNS, PHN, RNC, IBCLC

roup B strep, or “GBS,” is a common bacterium that typically doesn’t cause any symptoms in healthy people. About 1 in 4 pregnant women have GBS bacterium. GBS can complicate baby’s health at birth.

What’s the risk of GBS in pregnancy?

IMAGES: SHUTTERSTOCK

The main risk is that if you have GBS, you could pass it to your baby during labor and birth. Newborns can’t ﬁ ght infections like adults. GBS can cause pneumonia or infections in the blood. About 1 in 6 babies who get a GBS infection will have a serious illness, and some of these babies will die.

How will I know if I have GBS if it doesn’t cause symptoms? GBS can show up in a routine urine

screen during prenatal care. Experts recommend that all pregnant women receive screening for GBS between weeks 36-37 in pregnancy. Ask your healthcare provider about this simple test. It requires your provider swab the outer parts of your vagina and rectum to test for GBS.

What if I have GBS? If your test results are positive for GBS, your provider will recommend an antibiotic given by IV during labor, typically penicillin if you’re not allergic to it. One dose is needed at least 4 hours before you birth to keep your baby from getting GBS. A full-term newborn has a 1 in 200 chance of getting sick from GBS in the ﬁ rst days of life if mom has GBS in her vagina and didn’t receive antibiotics in labor. That drops to a 1 in 4,000 chance if antibiotics were given during labor.

If I’ve just tested positive for GBS, why shouldn’t I get treated now? If your swab comes back positive, you don’t need treatment with antibiotics until you are in labor. If you have a urine culture that is positive for GBS your provider may prescribe antibiotics during pregnancy. You will need antibiotics in labor to protect your baby.

What if I go into premature labor and I haven’t had a GBS test yet? Because premature babies have even less of an ability than a full-term baby to ﬁght infections, health guidelines advise that women in premature labor (less than 37 weeks of pregnancy) be treated for GBS with antibiotics. CATHERINE RUHL, DNP, CNM & Rachel Napoli DNP, CNS, PHN, RNC, IBCLC are advisers to Healthy Mom&Baby.

ISSUE 29 / 2021 Healthy Mom&Baby

HMB19 GBS.indd 41

18/01/2021 11:33

Birth Announcement

The 80s called. They want your old nausea bands back.

BUSY NEW

MOMMY?

KIDBOX will take care of your baby’s wardrobe needs!

Pink Lemonade

We’re a personalized style clothing box. All you do is take our style quiz and an expert stylist creates your baby’s perfect box.

20% Oﬀ with code

JUST GO TO:

www.KIDBOX.com

HEALTHYMOM

Blueberry

blisslets.com PAGE 42.indd 1

18/01/2021 14:40

healthy pregnancy

Nausea & Vomiting in Pregnancy What to do when it’s more than just morning sickness By Susan Angelicola, MSN, APN

alf of all pregnant women experience nausea and vomiting in pregnancy (NVP). Morning sickness typically starts around week 4, and peaks around week 8 of pregnancy. One in 10 women experience the symptoms throughout pregnancy. For most moms, NVP goes away by week 13.

Managing NVP First, let your pregnancy care provider know if you have NVP. Begin with natural ways to manage NVP. Are there particular foods or smells that trigger it or make it worse? You may need to skip some favorite foods for awhile! Small, frequent meals are best. Bland, dry foods, and high protein snacks may be easier to stomach. Get help from your pregnancy care provider if nothing is providing relief, and especially if it’s getting worse.

Medications for NVP

Hyperemesis Gravidarum (HG) If you have NVP to the point where you can’t eat or drink, you may have Hyperemesis Gravidarum, or HG. HG includes severe nausea and vomiting several times a day, dehydration, and dangerous weight loss. It happens in about 3% of pregnancies and is the most common reason for

hospitalization in pregnancy. If you think you may have HG, contact your pregnancy care provider right away. You’ll probably need to receive intravenous (IV) ﬂuids either in the hospital or at home, and antivomiting medications. In severe cases, you may need liquid nutrition and vitamins through a special IV line. Note that Diclegis for NVP is not meant to treat HG.

What about NVP and My Baby? Most women worry that not eating enough, vomiting, or even having HG may hurt their unborn baby. With mild to moderate NVP, there doesn’t seem to be any dangerous eﬀects on the baby. Even with HG, as long it’s treated early, most babies have no problems. But, some studies show that if a woman has HG, her baby may be born earlier or may be smaller. If you think you have NVP or even HG, don’t suﬀer and assume it’s “just something you must go through.” It’s very common, so don’t let NVP keep you from enjoying your pregnancy! SUSAN ANGELICOLA, MSN, APN, is an expert adviser to Healthy Mom&Baby.

IMAGES: SHUTTERSTOCK

Did you know that there are prescription medications as

safe as a prenatal vitamin that very eﬀectively help NVP? It’s a combination of Vitamin B6 (Pyridoxine) and Doxylamine (the ingredient in the sleep aid Unisom). These two medications can be taken separately over the counter. They also work very well as one Rx combined tablet called Diclegis or Bonjesta, that have been studied in pregnant women with no increase in birth defects or problems in pregnancy. Take these every day as prescribed.

ISSUE 29 / 2021 Healthy Mom&Baby

HMB20 Morning Sickness.indd 43

18/01/2021 11:34

healthy pregnancy

Pregnancy is the Perfect Time

to Discuss Birth Control By Susan Angelicola, MSN APN

ou may be wondering why you should think about birth control while you’re pregnant. There are so many other things to learn about related to birth, breastfeeding, and baby care! Of course that’s all very important, but so is your future family planning. How many children would be in your ideal family? How long should you wait after you have your baby to get pregnant again? Can you get pregnant during breastfeeding, or in the first few months after baby’s birth? How soon after birth can you use birth control? These are questions for discussion with your pregnancy care provider in your third trimester. There may be

birth control options available to you immediately after baby’s birth, so if you wait until your postpartum visit to have this discussion, you may miss that opportunity. Whether you’ve had an easy or challenging pregnancy, at some point soon you will have to make the decision as to whether you will have another child, and if so – when? It’s important to know the risks of having another pregnancy too soon. The standard recommendation is to wait 18 months from birth to your next conception. This is considered to be the safest length of time to ensure a healthy mom and baby.

Of course, every woman is different, and your health care provider may recommend or suggest another timeline based on your fertility, economic issues, availability of a partner, or illness. Having a short interpregnancy interval may increase your risk for anemia, preterm birth, low birth weight, and preeclampsia. If you’ve had a cesarean birth, having another pregnancy too soon may also increase your risk of rupturing your uterus. Therefore, making plans to use birth control you’re comfortable with is important when it comes to planning your family and safely spacing pregnancies.

health4mom.org

HMB21 Birth control discussion during pregnancy.indd 44

18/01/2021 11:36

healthy pregnancy What about getting birth control before leaving the hospital or birthing center after I have my baby?

images: shutterstocK

Can I get pregnant when I am breastfeeding or right after I have my baby? This is a common question, and the simple answer is yes! If you’re exclusively breastfeeding, you may not be ovulating, so conception could be more challenging. However, it’s recommended to not rely solely on breastfeeding to prevent pregnancy as ovulation may occur as early as 4-6 weeks postpartum. Once you have been given the all-clear from your health provider to resume sexual activity, you should consider yourself fertile. This is a great reason to talk with your healthcare provider about birth control during your pregnancy, so you’ll know what method you’d like to use, breastfeeding or not.

What birth control is safe after giving birth? Most methods of birth control are

ntrol Bir th co t contain pills tha n ’t be n should estroge onth m the first used in u ’re o y if tum postpar nd not eding , a breastfe ht after g ri a ny o n e y b d e s u to the ir th due giving b k d ris of increase ts. blood clo

safe for use right after birth. Non-hormonal birth control including barrier methods such as condoms, a diaphragm, or the copper IUD (ParaGard) are safe, and won’t interfere with lactation. Progesterone-only methods including birth control pills that only contain progesterone, progesterone IUDs (Mirena, Skyla, Kyleena and Liletta), the implant (Nexplanon), and birth control injection (Depo Provera), are all safe postpartum and most providers agree that using progesterone will not affect breastfeeding. Ask what time frame for starting birth control is safe for you. Some methods, such as natural family planning or predicting fertile times and avoiding intercourse during those times, may be challenging if you are not ovulating or menstruating regularly while breastfeeding .

Yes, this is possible—and one less thing for you to worry about! However, some insurers may not cover this benefit right after birth. Check with your health plan, as well as your state’s rules. Often, contraception needs to be pre-authorized by your insurance company in advance, so that the device is ready for you at your birthing location. Receiving the Depo Provera injection right after birth may be easier to obtain than a long-acting reversible contraception (LARC) such as an IUD or the implant. In recent years, immediate postpartum insertion of LARC has gained in popularity and availability. This means that after your placenta is delivered, an IUD can be manually inserted into your uterus by your provider. This works if you have a vaginal birth or a cesarean. Or, the implant can be inserted into your arm in the first few hours after birth. When it comes to an IUD inserted right away, there is some concern that it may fall out more easily, versus having it inserted at 6 weeks postpartum. This could be due to your uterus being larger right after your delivery, increased bleeding/lochia that is normal, as well as postpartum uterine cramps. But, talk with your provider, because it may be easier to have a long acting method already in place right after your birth. If this is an option for you, planning and approval are necessary, so this is another reason to consider and discuss all options while you are still pregnant. Don’t hesitate to ask questions, especially about birth control, even while you’re still pregnant. Remember – you have the power and responsibility to plan your family, and your health care provider can help. SuSan angelicola, MSN, APN, is an expert adviser to Healthy Mom&Baby.

ISSUE 29 / 2021 Healthy Mom&Baby

HMB21 Birth control discussion during pregnancy.indd 45

18/01/2021 11:37

Your Pregnancy, Your Expert Nurse Adviser Health4Mom.org is a resource from mother/baby nurses for your healthiest pregnancy and birth. ✔ Science-based advice on conceiving, pregnancy, birth, and breastfeeding ✔ Quick Q&A videos with evidence-based answers for your questions ✔ News, updates and recalls

Health4Mom.org PAGE 46.indd 1

18/01/2021 15:20

healthy

Join us on Facebook

babies

facebook.com/HealthyMomAndBaby

Early Birth Puts Babies at Risk for Future Hospitalizations New research published in the British Medical Journal (BMJ) shows babies born before their due date tend to need more in-hospital care—even babies born at near term, or 38 and 39 weeks, according to The BMJ Today. Preterm birth can have long-term effects on a child’s health. Those risks decline as baby’s age. But researchers analyzing the medical records of more than 1 million children in the UK’s National Health System observed that the earlier the gestational age at birth, the more likely that child would be hospitalized later. Gestational age at birth was analyzed in weeks, from less than 28, up to 42 weeks. This extra risk remained up to age 10, even for children born at 38 and 39 weeks’ gestation, representing many potentially vulnerable children, say the researchers. Infections were the main cause of excess hospital admissions at all ages, but particularly during infancy. Breathing and digestive issues also accounted for a large number of hospital admissions in a child’s first two years.

Baby’s First Breath

images: shutterstocK; dreamstime

Newborn Hearing Screening May also Detect Autism Baby’s newborn hearing screen may provide a potential early autism indicator, say experts at the University of Miami and Harvard Medical School. Writing in Autism Research, researchers observed that babies whose inner ears and brain are slower to respond to sounds during the test are more likely to be diagnosed with autism later in life. The tests measure how a baby’s inner ear and brain responds to sound by recording the auditory nerve activity via electrodes on baby’s scalp. The tests are so mild infants may even sleep through them. Researchers aren’t ready to advise clinicians use newborn screening for further autism screening, but “we know autism spectrum disorder is connected to how children process sound, so even if the child’s hearing is normal, it can still be processed differently,” they wrote. “With better understanding of how ABR testing can be used to identify at-risk babies, we can flag children who might be at risk for autism.”

Researchers at the University of Virginia School of Medicine have unlocked an amazing observation within baby’s anticipated and celebrated first breath. Breathing in the womb isn’t required, and only happens intermittently: h Baby’s first gasp at birth is a brain activation to support air breathing h Baby transitions from randomly breathing to lifesustaining through the specific activation of a gene that starts regular breathing for the rest of baby’s life h This gene makes a peptide neurotransmitter chain of amino acids that relays information between neurons just as baby emerges. When this same chain is interrupted in studies involving mice, sudden death can occur Researchers believe this new information may help experts better understand how Sudden Infant Death Syndrome (SIDS) may occur in infants, leading to the possibility of future treatments or therapies.

ISSUE 29 / 2021 Healthy Mom&Baby

HMB22 Healthy Babies section.indd 47

18/01/2021 11:40

healthy babies

Prevent Diaper Rash By Charlotte Wool, PhD, RN

our baby needs their diaper regularly checked and changed— don’t miss this opportunity to make a special connection with your little one as you lovingly work to protect their skin and prevent diaper rash! Your newborn’s skin is soft and sensitive, and from birth on it needs special care and attention, particularly during diapering. Our skin is one of our body’s largest organs and it’s remarkable in that in addition to protecting all of our insides it can also regenerate itself—how cool is that! Among the many things it does, your baby’s skin:  Oﬀers protection against environmental stressors, irritants and infection  Prevents excess water loss  Regulates baby’s body temperature  Responds to sensations including touch and pain.

Diapering That Promotes Health and Wellness Maybe diapering feels like a routine task. At each change, you do your best

to quickly clean and change your baby, and prevent or manage diaper rash. You will change thousands of diapers before you can depend on your little one to use a potty for their needs. So, you may not have given much thought as to how a simple diaper change can protect and enhance baby’s skin as well as prevent diaper rash. The diapers and products you choose to use can have an eﬀect on baby’s skin and overall health. Diaper rash is physically uncomfortable—and can be stressful— for even the tiniest of babies. Rash can escalate to infection if not caught early and treated. Keeping baby’s skin clean and dry is the ﬁrst important step in protecting baby’s skin from diaper rash. Because urine and stool can degrade baby’s skin, most experts recommend opting for the modern diaper technologies found in disposable and hybrid diapers that are made with breathable outer wrappers and super absorbent materials—some even have wetness meters to eliminate the guesswork as to whether baby needs changing! Experts also favor cleansing wipes made to match the pH of your

Diapering Step-by-Step Each diaper change brings the opportunity to enhance baby’s development through your presence, touch, and care.  Gather your materials and prepare a ﬁrm, safe diaper surface for baby  Use a changing pad or waterproof liner under baby  Begin with a loving hug or gentle pat  Gently undress baby, removing the soiled diaper, and carefully wiping away any excess stool as needed with the diaper from front to back  Cleanse baby’s full diaper area with a pH-appropriate wipe or cloth with warm water, including all skin folds  For girls, wipe from front to back and use a diﬀerent, clean part of the wipe with each motion  Allow the diaper area to fully dry—pat dry if need be but never rub baby’s skin in this area  Apply barrier cream if you note signs of redness or rash anywhere in baby’s diaper area  As you put on the clean diaper, check the material around the legs, making sure there are no gaps and baby’s skin isn’t pinched  Maintain eye contact with baby and follow their cues regarding their stress, comfort and contentment

 Pull baby up into your arms for another sweet hug after each diaper change; this simple act promotes emotional connection and a surge of good feelings in both you and your baby

IMAGES: SHUTTERSTOCK

 Touch and talk or sing to your baby

health4mom.org

HMB22a Diaper Rash - 3pg.indd 48

18/01/2021 11:44

healthy babies baby’s skin over warm water washing alone because of their gentleness to skin. The nurses of the Association of Women’s Health, Obstetric & Neonatal Nurses (AWHONN) recommend changing baby’s diaper at least every 1-3 hours during the day and with each feeding at night—or at least once during the night. Diapers that don’t contain super absorbent materials should be changed more frequently. Also, carefully and gently cleansing baby’s diaper area with a skin-friendly wipe is a best practice noted by AWHONN in its newborn skin care guidelines. Choosing diapers with superabsorbent gel will keep moisture oﬀ your newborn’s delicate skin, and reduce your baby’s chances of

developing the type of diaper rash (contact dermatitis) caused by urine or stool lingering on baby’s skin. Fragrances may contribute to diaper rash, so if your baby has sensitive skin avoid wipes with perfumes or fragrances. Find some time each day for baby to go diaper-free. Finally, fi t is everything when it comes to protection and avoiding leaks. Your baby’s diaper should be snug but not so tight it pinches their skin. A poor-fi tting diaper can case irritation and rash by excess chafing. Loose fi tting diapers can also lead to a leaky mess—something all parents would like to avoid. As you fasten baby’s diaper, check for and fi x gaps at baby’s waist and legs and any diaper material folded in to create a leakproof fi t.

Diapering that Nurtures Your Baby Your baby benefits from every diaper change when you practice these 5 habits shown in research to benefit baby’s growth and development:  Create a calm and clean diapering environment through good hygiene and supplies at the ready  Change and check baby regularly, such as every 1–3 hours during the day and at every feeding  Comfort baby by moving slowly through the diaper change to minimize any stress or discomfort  Champion sleep by practicing skin-to-skin care at bedtime and using diapers with wetness indicators to avoid disturbing baby’s snoozing  Cherish confidence and closeness that come from learning your baby’s cues and responding to baby’s needs, such as for a clean, dry diaper Source: Adapted from Huggies® Every Change Matters: A Guide to Developmental Diapering Care

ISSUE 29 / 2021 Healthy Mom&Baby

HMB22a Diaper Rash - 3pg.indd 49

18/01/2021 11:44

healthy babies

Your baby may experience diaper rash in the first year or two of life. Diaper rash is common and typically begins with redness and warmth, followed by raised bumps and sometimes skin breakdown. It can be caused by leaving a wet or soiled diaper on for too long, which irritates your baby’s skin. Other causes include chafing or rubbing, sensitive skin, irritation from a new product, or infection. At times, new foods in your baby’s diet can change the makeup of their stool and cause diaper rash. experts recommend barrier creams containing zinc for treating and preventing diaper rash. if your baby has a rash, or is prone to rash: h gently cleanse your baby’s diaper area, removing all stool or urine at each change h thoroughly dry the diaper area by patting it dry, never rubbing h Apply a thick layer of diaper cream or ointment to the affected area h Finish diapering as normal, making sure the diaper fits well With subsequent diaper changes, it’s not necessary to completely remove all of the barrier cream or ointment. the key is to remove all the stool and urine. When your little one has a rash, attempting to remove all the barrier cream at each change may cause irritation and disrupt the healing process.

Pointers for Preemies Babies born prematurely, before 37 weeks, have thinner skin with fewer layers. Preemie skin just isn’t as strong as a baby’s skin born at term. Being gentle is essential: Preemies are more prone to skin tears and more susceptible to irritants and infections. Depending on how early your baby was born, it may take 2-9 weeks for skin their skin mature. Babies have what experts call an “acid mantle” to their skin. the acid mantle is a slightly acidic, very fine layer on the surface of human skin that protects against bacteria, viruses and other contaminants. Premature babies don’t have a well-formed acid mantle are more susceptible to irritants and

infection during the weeks it takes to develop—which means they need extra-special attention during diaper time. In the early weeks, it’s especially important to avoid soaps, fragrances and other perfumed products that may irritate baby’s skin. Avoid long exposure to stool or urine with frequent diaper changes to keep your baby’s skin as healthy as possible. if your baby’s diaper area does get irritated, try short intervals of diaperfree time so skin is exposed to air; this will also reduce friction and skin wetness. Simply lay an absorbent pad under her and enjoy watching her coo, play and smile. Make sure the room is at a comfortable temperature so your baby doesn’t get too cold. Depending how early your baby was born, ask the nurses if you should use special care in lifting baby’s legs for diapering. they may advise that you lift baby as little as possible—just enough to slide a new diaper underneath. Your nurse may also advise that you keep baby’s hips aligned and use diapers that are flexible and thin between the legs. Charlotte Wool, PhD, RN, is Associate Professor of Nursing at York College of Pennsylvania and an expert adviser to Healthy Mom&Baby.

iMAges: DReAMstiMe

The Dreaded Diaper Rash

health4mom.org

HMB22a Diaper Rash - 3pg.indd 50

18/01/2021 11:44

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 sheâ&#x20AC;&#x2122;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 babyâ&#x20AC;&#x201D;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

AWHONN-Don'tRushMe1.indd 1

23/05/2014 16:08

1 ML

Boiron.indd 1

29/09/2020 15:06

healthy babies

Preventing Shaken Baby Syndrome Learn to care for an inconsolable baby and avoid abusive head trauma By Catherine Ruhl, DNP, CNM

olding an inconsolable baby is stressful, and it’s during these times you may be tempted to move from rocking and cradling to shaking when baby doesn’t respond to your efforts to soothe them. Shaken Baby Syndrome happens when a baby’s head is shocked from being shaken so violently that baby can die or be permanently disabled. This can happen in as little as 5 seconds of shaking.

Recognize Shaken Baby Syndrome

Caring for an Inconsolable Baby

iMages: shutterstoCK

When baby won’t stop wailing, remember these two things, says the CDC: h Having an inconsolable baby doesn’t make you a bad parent h It’s normal for babies to cry excessively, particularly between ages 2 weeks to 4 months Create a care a plan for your inconsolable infant before you’re at your wits end: First, assess and meet baby’s needs: h Are they tired? Hungry? Need a diaper change? h are they showing any signs of illness? Fever? Runny nose? Tugging at their ears? h are their clothes comfortable—not too warm, entangled? h Does anything help soothe them, like walking, cradling, or gently moving? Second, give yourself a break: h Ask your partner or a trusted caregiver to take turns being with baby during the crying

h Calm your nerves by putting baby in a safe place, such as on their back in thier crib or bassinet. Supervise baby from another room within ear shot or via a baby monitor h Check on baby every 5-10 minutes until the crying subsides h Remind yourself that baby’s crying is normal; this period will pass

Abusive Head Trauma shaken Baby syndrome—also called abusive head trauma—happens because a baby’s head is large and heavy but its neck muscles are weak. Shaking moves baby’s brain within its skull, causing bruising, swelling and bleeding, says the National Institutes of Health. This violent motion damages baby’s brain, eyes, spinal cord, and neck—even fracturing bones. Hitting baby’s head against a pillow or mattress can be enough to cause injury or death.

You may know “never shake your baby”; but it’s also important to watch for signs that a relative or caregiver may have shaken your baby. Alert your baby’s healthcare provider if you notice your baby has any of the following: X Acts lethargic or listless X Head or forehead appears larger than usual or soft-spot on head is bulging X Eating very little or nothing at all X Struggling to breathe X Vomiting X Has pale, bluish skin X Experiencing convulsions or spasms X Has rigid or poor posture or can’t lift their head X Pupils of unequal size; can’t follow an object with their eyes X Has bruising or blemishes around the head, neck or trunk Catherine ruhl, DNP, CNM is editor of Healthy Mom&Baby and a certified nursemidwife in Albuquerque, NM.

ISSUE 29 / 2021 Healthy Mom&Baby

HMB23 Shaken Baby.indd 53

18/01/2021 13:39

Keep them close

cudl 4-in-1 The International Hip Dysplasia Institute acknowledges this baby carrier as a hip healthy product.

Parenting can be intimidating—wearing a carrier shouldn’t be. CUDL™ 4-in-1 makes it easy to keep baby close and secure, all while keeping your hands free. Say hello to four magnetic buckles that make securing on-the-go quick and simple. And just like that you are ready in a snap. It’s comfortable and customizable with breathable mesh fabric and padded shoulder and waist straps. CUDL 4-in-1 offers your growing child ergonomic positioning to keep spine and hip development healthy. Keep baby facing in and snuggled up starting with an integrated infant booster for newborns, which then easily unzips as your child grows. CUDL 4-in-1 is designed so you can adjust and put it on alone, no helpers needed. When baby wants to sightsee their world, have them face out or switch to back carry mode for growing toddlers. Find out more at www.nunababy.com

Nuna Baby Essentials.indd 1

11/11/2020 14:29

healthy babies

Why Baby Needs a Vitamin K Injection Soon after Birth By Michele Savin, DNP, APRN, NNP-BC

ot long after baby is born your nurse will give your baby a shot of Vitamin K, and she’ll likely ask you to nurse baby while this happens for baby’s comfort. This injection isn’t a vaccine. Vitamin K is a naturally occurring substance we get from the food we eat and it’s made in our intestines by bacteria. For babies, vitamin K is essential for blood clotting because most babies don’t have enough in their system at birth to prevent potentially lifethreatening internal bleeding.

Vitamin K Deficiency Bleeding

late: usually happens during weeks 3-8, but can occur up to 6 months and is almost always in exclusively breastfed babies. After 6 months many babies get vitamin K from starting more solid foods. Late bleeding is usually in the brain and or baby’s gut, and is often life-threatening. These routine injections before baby leaves the hospital have reduced the number to only one infant a year experiencing severe bleeding. Pediatricians have recommended Vitamin K injections at birth since the 1960s. Are you considering declining vitamin K injection for your baby at birth?

e xper ts estimate that without v itamin K shots at bir th, ab 2 6 6 b ab out ies in th e U S eac ye a r wo h uld expe rience the mos t devasta ting form of internal bleedin g.

Research shows that waiting to give baby vitamin K can put your baby at greater risk for bleeding, especially bleeding in the brain. Almost all babies with late VKDB are breastfed and breastmilk doesn’t contain enough vitamin K to boost baby’s levels even if your own vitamin K levels are normal. Michele Savin, DNP, APRN, NNP-BC, is an expert nurse adviser to Healthy Mom&Baby.

Not having enough vitamin K in baby’s first days can lead to something called vitamin K deficiency bleeding (VKDB), which though rare, can be lifethreatening. This type of bleeding can happen to any baby of any age, with or without risk factors, if they don’t get a vitamin K shot at birth. VKDB happens suddenly and bleeding usually occurs in baby’s brain or intestines. The three types of VKDB are:

images: dreamstime

early: in the first 24 hours after birth. This can happen if you’ve taken medications that interfere with vitamin K, such as anti-clotting medicines or certain seizure medicines. Common sites where baby may have bleeding are in its brain, skin, or belly. classic: occurs on days 2-7 when vitamin K levels are lowest. Bleeding can be at baby’s circumcision site in boys, or in the belly, nose, brain, or skin, including the umbilical cord.

ISSUE 29 / 2021 Healthy Mom&Baby

HMB24 Vitamin K.indd 55

18/01/2021 11:51

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

AWHONN-Don'tRushMe2.indd 1

23/05/2014 16:08

healthy babies

3 Reasons to Delay Your Newborn’s First Bath Heather Watson, PhD, RN

irth is messy, and in a culture that values cleanliness and personal hygiene. What if we gave you 3 great reasons for delaying baby’s bath, and instead suggested you should pull that fresh baby straight onto your chest for warmth and breastfeeding—would you do it?

Vernix—Nature’s Best Barrier Cream

iMAges: sHutteRstoCK,

that sticky thick creamy-like substance is Vernix, which is sometimes called “nature’s cold cream.” it has protected your baby’s skin from breaking down while living in fluid all these months. It’s still skin protective, helping baby stay warm after birth.

Baby Needs Mom’s Warmth to Stabilize

Baby needs the warmth of your body— or their other parent’s body—to help them stay warm. they’ve been living in a constant state of 98 degrees, and just

emerged into a room that 75 degrees or cooler. Now is not the time to put water on baby’s skin while they’re surrounded by cold air—that would be like a polar plunge! once a baby is skin-to-skin with you, they absorb your heat. Drape a blanket over baby’s back to hold in the warmth. Baby risks low blood sugar—hypoglycemia—if they can’t hold their body temperature steady. Hypoglycemia happens far less when baby’s first bath comes long after birth, bonding and breastfeeding. Babies use sugar for energy; they can exhaust their blood sugar if they have to burn more to stay warm. Low blood sugar means baby doesn’t have enough energy to start the work of out-of-womb life, including nursing, eliminating and growing! there’s a misconception that when babies are born they’re normally sleepy. the reality is that birth is shocking to baby, who has left a dark warm watery home, to be compressed through the birth canal, and thrust

into a bright, cold room. Most babies emerge cold and hungry! A stressed baby may well become lethargic and drift off to sleep if they don’t begin feeding. this could make for a sleepy baby who awakens hungry and crying because they didn’t immediately begin feeding post-birth.

Beginning Breastfeeding & Parenting

Delaying baby’s first bath provides time to begin nursing immediately after birth. Research shows that breastfeeding gets off to the best start when baby can immediately bond, snuggle and begin nursing post-birth— which means delaying baby’s first bath. even if you’re planning to bottle feed your baby formula, there are many benefits to baby including stabilizing their body and bonding skin-to-skin during the first hour after birth. heather watson, DNP, APRN, NNP-BC, is an expert nurse adviser to Healthy Mom&Baby.

ISSUE 29 / 2021 Healthy Mom&Baby

HMB25 Delayed Bathing.indd 57

18/01/2021 11:52

healthy babies

Safe & Healthy Travel for Baby During COVID By Carolyn Davis Cockey, MLS, LCCE

f you’re like most moms during this pandemic, you have both disinfecting wipes and antibacterial hand sanitizer at the ready. But wait before you plunge into car seat sanitizing, say experts at the American Academy of Pediatrics. Sure these products may be safe for use on the auto’s door handles, windows, and the harder surfaces, but these chemical cleansers and sanitizers could damage the belts and straps of your car seat system, potentially allowing them to fail in a crash. What’s a conscientious parent to do? Follow the advice from experts at the AAP to make every car trip a safe and healthy trip for your growing baby.

Just as you’ve limited the people you allow into your home during pandemic, the same holds true for your car. Sadly, most car seats, boosters, and the straps and belts of car seats can’t be disinfected. Instead, cleanse them regularly with a mild, infant-safe soap and water. Check the manufacturer’s instructions for your infant carriers and car seats regarding how to safely clean the cloth cover, the seat base, and its many straps and buckles. They may list particular products to use and those to avoid.

Disinfecting your car after a COVID-19 exposure Should an older sibling have a COVID-19 exposure at school, for example, do the following to ensure your little one remains safe in the car around their siblings:

h Clean and disinfect all hard surfaces where the person who has been exposed to the virus rode, including seats, all door and back of seat handles, buttons for windows, locks, radio controls, heat and air conditioning knobs, cup holders, cargo boxes, and use surface-specific cleaning or disinfecting products in a 6-foot radius from where they sat for each of your auto’s surfaces. h Remove all boosters, car seats, carriers, strollers, and other devices for baby, and put them out of reach in tightly sealed plastic bags for 3 days or more. Wear gloves and eye protection while cleaning and disinfecting the vehicle while you also remove all of the contents of the car. h During this 3-day period, use another

car seat for your little one to be as safe as possible h Don’t allow anyone to sit in the seat where the person who was exposed to COVID-19 rode in the vehicle until you’ve disinfected the car and three days have passed h Weather permitting, parking in a sunny location to heat up the car’s interior, and then air the car out by leaving the windows down h When you remove the car seats and other carriers from the plastic bags, clean them with a mild soap and water before putting them back into the car. Carolyn Davis CoCkey, MLS, LCCE, is a Lamaze-certified childbirth educator and the senior director of publications and partnerships at AWHONN.

iMAgES: SHuttErStOCK

Your car is an extension of your home

health4mom.org

HMB26 Child passenger safety.indd 58

18/01/2021 11:53

Because Because Car Car Seat Seat Safety Safety Begins Begins During During Pregnancy Pregnancy

Tummy TummyShield Shield for forpeace peace of ofmind! mind!

Car Car crashes crashes are are the the #1#1 risk risk ofof injury injury toto anan unborn unborn baby. baby. US US Library Library of Medicine of Medicine

Increased Increased Safety Safety Crash Crash Tested Tested to to Seat Seat Belt Belt Standards Standards Made Made With With Crash-Worthy Crash-Worthy Materials Materials More More Comfortable Comfortable ForFor Mom-To-Be Mom-To-Be Easy Easy to to Use Use Recommended Recommended byby Doctors, Doctors, Midwives, Midwives, Paramedics Paramedics and and CarCar Seat Seat Technicians Technicians Best Best time time to to start start using? using? When When you you start start shopping shopping forfor maternity maternity clothes clothes

TummyShield.com TummyShield.com UseUse promo promo code code HMB292020 HMB292020 for $20 for $20 oďŹ&#x20AC; until oďŹ&#x20AC; until 3.31.21 3.31.21

Safe Ride 4 Kids.indd 1

Available Available fromfrom

SAFE SAFE RIDE RIDE KIDS KIDS

19/01/2021 12:34

healthy babies

Music Therapy in the NICU By Heather Watson, Ph.D., RN

ife for your baby is very diﬀerent inside your warm, calm womb; life outside is everything but calm and comforting, especially if your baby needs to spend time in the neonatal intensive care unit, aka, the NICU. The NICU has a lot of stimuli—bright lights, loud noises, many voices. Creating calm in the midst of sounds and lights is where music can make a diﬀerence, especially when that music is recommended based on your baby’s needs by a professional music therapist. Your favorite band may be Maroon Five, but they may not be the best choice to build the pathways baby’s brain needs. Music therapy in the NICU is new, but early research is showing it can be helpful.

Possible beneﬁts of music in the NICU

Positive & Neutral Effects Researchers have observed lower heart rates and better sleep habits in babies listening to lullabies. Music with specific rhythms also seems to help baby organize their suck and breathing. Music even lowers stress in moms when they see their baby managing pain or stress as a result. And these benefits are further enhanced when baby and mom are in low-light conditions, and baby is skin-to-skin with a parent. Knowing this connection with their baby helps boost a parent’s confidence in holding baby while listening to specific music best for baby. Clearly, more research is needed, but the evidence to date is showing it’s worth trying, and worth continued study.

Using Music to Calm Your Preemie Baby  Ask your nurses if they use music therapy with premature babies in the NICU, and if so, can your baby receive music therapy? Also ask how you can be involved in receiving that therapy for baby.  Watch your baby to learn when they’re more quiet, restless, hungry, or content.  Notice baby’s environment: Is it quiet, noisy, bustling? How does the activity around baby aﬀect them?  Ask your nurses how you can practice music therapy once you take baby home.

HEATHER WATSON, RN, MSN, is an expert adviser to Healthy Mom&Baby.

IMAGES: SHUTTERSTOCK

Several studies have shown that music delivered at a speciﬁed volume, time, and type can encourage brain development in premature babies. Still, the jury is out on whether music helps a developing baby’s heart rate,

respiratory rate, and energy use. The outcomes of the research to date has shown either a positive eﬀect, or no beneﬁt; none of the studies have shown any harms, such as stress or pain from music therapy.

health4mom.org

HMB27 Music in the NICU.indd 60

18/01/2021 11:56

SOUND MACHINE

NIGHT LIGHT

Both night light and sound machine, Rest is designed using scientifically proven light colors that promote healthy circadian rhythms and melatonin production with white noise to aid sleep. Rest is fully customizable, programmable, and controlled from your smartphone. As your child moves from bassinet to big kid bed, Rest grows with your needs - first providing soft light for middle of the night diaper changes and nursing sessions, then alerting your toddler when it is ok to get out of bed in the morning.

TIME-TO-RISE

Everybody sleeps better with Hatch!

★ MULTI-FUNCTIONAL: Rest combines nightlight, sound machine, and time-to-rise alert in one easy-to-use device that you can control from your phone! Customize color, brightness, sound, and volume level. Set programs to turn off and on automatically based on your family’s sleep schedule. ★ EASY TO USE: Rest can be programmed to turn on automatically, can be adjusted remotely via phone, or can be tapped on manually as needed. Control remotely via easy-to-use Hatch Sleep app. No need to disrupt a sleeping baby! ★ GROWS WITH YOUR CHILD: Rest grows with your child’s needs - providing soft light and white noise for midnight newborn feeding sessions, the comfort of a nightlight for a preschooler, plus a time-to-rise setting for your older child! Includes toddler lock feature and stays cool throughout the night for safety. ★ ENCOURAGES BETTER SLEEP: Create the ideal sleep environment for your child. Choose from preset sound and color combinations recommended by sleep experts!

Learn more at www.hatch.co

Save time sterilizing & drying baby products • Automatically sterilizes & dries bottles and pump parts • Kills 99.9% of germs with natural steam

PAGE 61.indd 1

18/01/2021 15:24

HMB Twitter 2020 - Full.indd 1

27/05/2020 17:10

healthy babies

Act On These

Baby Warning Signs By michelle savin, DNP, aPrN, NNP-Bc

When to Get offiCe Care

When to Get Urgent Care for Baby

images: shutterstocK

call baby’s healthcare provider or emergency medical service (911) right away if your baby has or is experiencing: h Blood in their vomit or stool h trouble breathing, breathes really fast, or skin has a blue tint h Yellow skin or yellowing in their eyes h seizure h stopped breathing, or starts and stops breathing that’s not normal breathing h eaten a toxin, such as detergent, soap, bleach, bug killer, or similar product that causes vomiting, diarrhea or trouble breathing h hard to wake up or is unusually tired and lethargic h temperature above 100.4° F or below 97.8° F (101°F or greater between 3 and 6 months, or 103°F after 6 months of age) h an injury and may also have bleeding that won’t stop. h stops crying or has a highpitched cry h arches backward h A stiff, limp or floppy body h strange eye movements

Call your baby’s health care provider during regular office hours if your baby has or is: h eating less than usual or shows other changes in appetite h regularly crying, irritable or unable to be comforted h having frequent diarrhea, especially soft or watery for 6 or more diaper changes h Not having any stool diapers for several days h Vomiting frequently or more than 2 to 3 times a day h Suffering with a cold that doesn’t improve or gets worse after a few days h experiencing rash h making fewer than 6 wet diapers in 24 hours h Fluid draining from their ears h tenderness/redness, bleeding or pus coming from penis or umbilical cord area h more pale than usual h Less active than usual

Could it be rotovirus? this common disease causes severe watery diarrhea, vomiting, fever, and/or abdominal pain. if your baby is diagnosed with rotovirus, follow the provider’s instructions about what your child should eat and drink. call your baby’s healthcare provider right away if baby has: h Watery diarrhea h Nausea and vomiting h Develops any fever of more than 100.4° F in the first 3 months of life, 101° F or greater between 3 and 6 months, or 103° F after 6 months of age

What if You Suspect an ear infection? if you see your baby pulling on their ears, trouble laying down on one side or staying asleep, trouble eating or if they’re unusually fussy, have fever, or falling down, clumsy or having problems with balance, call your baby’s healthcare provider to have baby checked for an ear infection. other signs of infection include baby struggling to hear soft sounds or fluid draining from their ears.

ISSUE 29 / 2021 Healthy Mom&Baby

HMB28 Baby warning signs.indd 63

18/01/2021 11:59

healthy babies Dehydration Needs Immediate Care ive N e ve r g baby, a to in aspir er with g a n tee child or hecking ithout c w r er. e v fe a re provid t ealth ca , bu re ra with a h a se c an c au order A spirin ning dis te a re h me in life -t ro d e ye s y n se s ln called R al il es with vir nd a u children fl , s g cold includin p ox . chicken

call baby’s healthcare provider immediately or take your baby to the emergency room if they have any signs of dehydration, including: h No wet diapers for several hours h dry mouth h Lack of tears when crying h increased thirst h sunken soft spot on top of the head or sunken eyes h irritability or lethargy

Create an Emergency Care Plan When Jaundice Needs Urgent Care call your baby’s health care provider right away if your baby: h Looks very yellow, orange or greenish-yellow h is hard to wake up or won’t sleep at all h has trouble breastfeeding or sucking from a bottle h is very fussy h has too few wet or dirty diapers

make a written care plan in case of an emergency with your baby. Keep copies of the plan in your home and baby bag. give a copy to anyone who cares for your baby. the plan should include: h Baby’s name h Baby’s birth date h Any medical conditions that affect baby h medications baby is currently taking, including any emergency drugs h allergies your baby may have (medications, foods, etc.) h Baby’s preferred or restricted foods h Your name and contact information h Name of your child’s primary healthcare provider and specialists, along with their phone numbers h health insurance information (company name, policy and group numbers) h Preferred hospital for treatment h Phone number of your local poison control center h additional information that would help an emergency healthcare worker provide needed care for your baby

call your child’s health care provider if you think your baby has thrush. Your baby may need antifungal medication. thrush appears as white patches on baby’s mouth or tongue. it looks like milk but doesn’t wipe away. Your baby will likely be fussy, may refuse to eat, have trouble swallowing or redness in their mouth and cracks at the corners of their lips. diaper rash infection can also occur when baby has thrush. You’ll see a bright red diaper rash with raised edges or bumps that look like pimples in baby’s diaper area. their skin may be raw and tender to the touch; this type of infection won’t improve with regular diaper cream. this type of diaper rash is usually caused by yeast-like fungus called candida albicans and it should be treated with antifungal cream as well as an oral antifungal medication.

images: shutterstocK; shutterstocK dreamstime

ThrUsh

health4mom.org

HMB28 Baby warning signs.indd 64

18/01/2021 13:42

HIGHEST RATED BABY MONITOR ON AMAZON Snuza HeroSE will monitor your infant’s breathing and abdominal motion while they sleep and will alarm if it stops. It’s lightweight, easy to use and fits in the palm of your hand.

Monitors your baby’s breathing movement while they sleep

If no breathing is detected after 15 seconds it gently vibrates to rouse your baby

If breathing is still not detected after a further 5 seconds, an alarm will sound

BUY NOW ON AMAZON Visit www.snuza.com for more information.

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

PAGE 65.indd 1

18/01/2021 15:28

healthy babies Nourish Moisturizers sooth and lubricate. Some even have extra “active ingredients” that make your skin appear tanned or help fight wrinkles. These products should never be used on babies, as they could irritate or harm baby’s skin. For tots, pick products that help create a barrier to retain natural moisture, such as healing ointments, which are thicker but more difficult to spread. Warm them by putting a dollop in your palms and rubbing your hands together. Baby will love the warmth and the massage.

Protect By Alicia Zalka, MD

Skin Care for the Whole Family; Baby Too H Cleanse Your whole family can benefit from non-soap cleansers. Soaps include detergents that strip the oils from our skin. Degreasing is great for washing dishes but not so great for your soft skin. Choose non-soap washes that are fragrance and dye free. Keep your shower and bath water tepid. If you’re going to soak for more than 10 minutes, add bath oils to help retain moisture.

Dr. AliciA ZAlkA, MD, is a Yale-affiliated dermatologist in private practice in Connecticut. She’s also the founder of surface-deep.com.

Skin Myths BUSTED!

Myth

BusteD!

Moisturizer prevents stretch marks

Stretch marks can’t be prevented. Stretch marks are scar-like skin changes that happen during hormone-surged life stages, such as the teen years or pregnancy. There’s no medically proven way to prevent stretch marks. Luck and good genetics is all you can hope for.

soapy baby = healthy baby skin

Too much bathing and fragranced soaps can irritate baby’s skin. Nothing is yummier than your baby’s sweet smelling skin post-bath. Problem is, too much soaking can dry baby’s sensitive skin—particularly in cold climates. While most babies do fine with lightly scented baby washes, a little goes a long way. If you notice your child’s skin gets red, dry, flaky or itchy, opt for natural alternatives for cleansing.

images: dreamstime

arsh winds can rapidly dehydrate our skin, leaving us with chapped lips, dry hands, and red cheeks. Those long, hot baths we sooth ourselves with also strip our skin of its natural oils. Fight back by cleansing, nourishing, and protecting your skin.

Whether it’s sunny outside or not, don’t be fooled by cloudy skies—you need sunscreen year-round. All moms need a daily SPF of 30+, especially at high altitudes, and during sports. Babies ages 6 months or younger should only be wrapped in clothing for sun protection. Hats and light blankets work too. Once baby is old enough for sunscreen (age 6 months+), start with one for infants and choose one with the least number of ingredients.

health4mom.org

HMB28a Baby family skincare.indd 66

18/01/2021 16:08

HEALTHY MOMS. STRONG BABIES.

FIND SUPPORT AND RESOURCES DURING THE COVID-19 PANDEMIC As the country adjusts to new public health guidelines, moms and moms-to-be want to best prepare for childbirth and infant care while optimizing the health and well-being of themselves and their children, including newborns. Whether pregnant, a new mom or looking to get pregnant, March of Dimes is here as a reliable resource and support system during the COVID-19 pandemic so women and their families can: • • • •

Access and share COVID-19 resources and tools online Take action virtually to step up for moms and babies Give voice to honest stories of pregnancy, parenting and loss Support the urgent need for COVID-19 research, advocacy, education, resources and support

LEARN MORE AT MARCHOFDIMES.ORG/COVID19

March of Dimes.indd 1

13/05/2020 16:52

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.

Inspired by your own perfect care, our perfect diaper is here. PLANT-BASED MATERIALS*

FREE OF PARABENS

OUR SOFTEST EVER

Huggies.indd 1

27/05/2020 11:00