ISSUE 21 / 2017 | $3.95 | health4mom.org
PREGNANCY | BIRTH | PARENTING
OOPS! DID I JUST LEAK? CONSIDERING
CHOICES IN BIRTH PLACES POST-BIRTH WARNING SIGNS BODACIOUS
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Good start to parenting Your pre-pregnancy checklist
Finding the path to pregnancy is a very personal journey for couples planning to start a family. Whether you are just starting out or receiving care from fertility specialists, this pre-pregnancy checklist can help you have a good start to parenting.
4 ways to plan for success: 1. Ask your physician about carrier screening. One early checklist step is to do carrier screening which is a genetic test to discover whether you are a carrier of a genetic disorder that could be passed on to your child. The American Congress of Obstetricians and Gynecologists (ACOG) and the American College of Medical Genetics and Genomics (ACMG) recommend that physicians should offer carrier screening to all women of childbearing age.
2. Discuss whether Preimplantation Genetic Screening is right as part of your IVF. For couples pursuing In Vitro Fertilization (IVF), there have been advances in genetic testing that may help to improve your chances of a successful pregnancy. Powered by next generation DNA sequencing (NGS), preimplantation genetic screening, or PGS, looks to identify embryos with the correct number of chromosomes to decrease the chance of miscarriage and improve the chances of a successful pregnancy. Good Start Genetics is proud to be the first company to use NGS technology for reproductive health.
3. Be sure to take care of yourself along the way. It’s important to make sure you are getting enough rest, eating a nutritious diet and drinking water. Following your doctor’s advice and leading a healthy lifestyle can also help you get ready for a healthy pregnancy.
4. Get your questions answered. At any time during your pregnancy planning, our Good Start genetic counselors are available to explain more about carrier screening and our GeneVu product or talk with IVF patients about our EmbryVu PGS. Our goal is to help couples have a good start to parenting.
Want to learn more? We’re here to help. 855-765-0845 | email@example.com
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healthy babies 47 Why Is My Baby Crying?
Babies cry for your attention; here’s what it could mean
Issue 21 / 2017
( CONTENTS ) healthy moms
11 How Diabetes Affects You
and Your Baby
If you need insulin in pregnancy, you’re more likely to develop type 2 diabetes
12 The Nursing Care You Deserve in Childbirth
A good relationship with your caregiver is vital to a healthy pregnancy experience
14 Am I at Risk for Maternal Depression?
1 in 6 moms suffer from depression during pregnancy; here’s what you need to know
15 Stillbirth & Its Ripple Effects
Meet a woman working to end suffering for those who experience stillbirth
19 Cold, Flu or Allergies?
Learn the differences and control the symptoms
20 Oh No, My Leaky Bladder!
Light bladder leakage is common; here’s how to cope with it
21 Can I Prevent Osteoporosis?
Prevent osteoporosis with this plan to promote bone health
49 Newborn Jaundice
esn’t Who do y’s b a b e v lo pple sof t, su skin!
What is jaundice and how is it treated?
50 Diapering That Nurtures Your Baby
25 Choosing the Right Prenatal
Additional vitamins and minerals are essential for a healthy pregnancy
27 Trimesters, Zika and Kick
Our nurses answer your questions
28 Why Is My Provider Sending Me to the Hospital Birth Unit?
Diapering can mean so much more than just a clean, dry bottom
53 Promote Baby’s Supple Skin
Nourish and protect baby’s skin with these tips
54 What’s New with Safe Infant Sleep?
Learn about the latest safe sleep recommendations
61 Car Seat Safety First
Use these checklists to help your child travel as safely as possible
63 It’s a Sign!
What to expect if you get sent to your hospital
These basic signs can help you decipher baby’s needs
birth unit during your pregnancy
66 Hello, My Name Is…
31 Choosing a Childbirth Class
The most popular names for boys and girls
Explore the best childbirth classes for you
32 Post-Birth Warning Signs Learning these warning signs could save your life
40 Which Breast Pump Should You Use? Continue to feed your baby breastmilk— even when you can’t always be there
Storing Breastmil k
Diapering That Nurtures Your Baby How you engage with your baby during diapering can promote their development, growth, well-being, family bond and sleep. Learn more in our Parent Booklet.
50 ISSUE 21 / 2017 Healthy Mom&Baby
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HEALTHY MOM&BABY EXPERT ADVISORY BOARD
AWHONN’s mission is to improve and promote the health of women and babies. Healthy Mom&Baby is powered by the nurses of AWHONN.
CANDACE ANN CAMPBELL, DNP, RN, CNL University of San Francisco Concord, CA
BY EMILY DR AKE, PHD, RN, FA AN
Learn These Post-Birth Warning Signs
ROBERTA DURHAM, RN, PhD California State University East Bay Hayward, CA 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 CAROLYN “CARRIE” LEE, PhD, MSN, CNE, RN University of Toledo College of Nursing Toledo, OH JENNIFER LEMOINE, DNP, APRN, NNP-BC University of Louisiana at Lafayette Lafayette, LA CYNTHIA LORING, MS, RNC, CLC Perinatal Consultant Enf ield, NH RITA NUTT, DNP, RN Salisbury University Salisbury, MD SUSAN PECK, MSN, APN Summit Medical Group Cedar Knolls, NJ MICHELE SAVIN, MSN, NNP-BC Christiana Health Services Wilmington, DE PAT SCHEANS, MSN, NNP Legacy Health System Portland, OR SHARON JEAN SCOTT, DNP, MSN, RN Germanna Community College Locust Grove, VA JAMIE M. VINCENT, MSN, RNC-OB, C-EFM John Muir Medical Center Walnut Creek, CA KIMBERLY WILSCHEK, RN, CCE Medical Revenue Solutions Chicago, IL
IMAGE THINKS TOCK
CHARLOTTE WOOL, PhD, RN, CCNS York College of Pennsylvania York, PA
You might be surprised to learn that pregnancy-related deaths are increasing in the US, and that in fact we live in one of only a few countries worldwide where these types of deaths among women have been rising. Pregnancy-related deaths, what experts call “maternal mortality,” are the death of a mother from complications related to pregnancy and childbirth within the first year after birth. Learning to recognize these POST-BIRTH warning signs and knowing what to do may help save your life and ensure you have the healthiest and safest recovery possible from pregnancy. Most women who give birth recover without problems, yet any woman can have complications after the birth of a baby. Before you leave your birthing facility, please ask your nurse about the warning signs that can signal serious complications for which you may need care.
Protect Your Health After Baby’s Birth
By learning these POST-BIRTH warning signs, and asking your partner, family and friends to also know them and be ready to act on them, you can help protect your health as you recover from the birth of your baby. Put the POST-BIRTH handout in this issue (p. 33) where you will see it, learn and recall the warning signs, and know how to act if any of these signs emerge. Many nurses ask moms to post this handout on their refrigerator so that everyone in the house becomes familiar with these signs.
POST-BIRTH stands for: P: O: S: T:
Pain in your chest Obstructed breathing or shortness of breath Seizures Thoughts of hurting yourself or your baby
B: I: R: T: H:
Bleeding, soaking through one pad/hour, or blood clots, the size of an egg or bigger Incision that is not healing Red or swollen leg that is painful or warm to touch Temperature of 100.4°F or higher Headache that does not get better, even after taking medicine, or bad headache with vision changes
When you seek care, tell every healthcare provider that you’re pregnant or that you’ve had a baby within the past year; this is a sign to them that this could be a pregnancy- or postpartum-related complication. Trust your instincts: ALWAYS get medical care if you’re not feeling well or if you have questions or concerns during and after pregnancy. Rest assured that while pregnancy-related deaths are increasing, they’re still very rare. Your nurses are there for you with expert care, guidance, advice and support, and they welcome the opportunity to help you have the healthiest pregnancy, birth and postpartum recovery experience possible.
MARIA OPLT Lafayette, LA
Neonatal Nurses (AWHONN).
TAMERA YOUNG, RN, MSN Central Ohio Technical College Zanesville, OH
EMILY DRAKE, PHD, RN, FAAN, is the 2017 President of the Association of Women’s Health, Obstetric and
ISSUE 21 / 2017 Healthy Mom&Baby
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If you’ve ever lost a wanted pregnancy, you know the physical and emotional pain that follows in the days and weeks after and the anxiety it brings to future attempts to conceive and carry a healthy baby to term
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Promoting of Women &the Health Newborns
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Healthy Mom&Baby is published by Maitland Warne in partnership with AWHONN. © AWHONN, 2017. 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.
and birth. Losing a pregnancy—a baby—isn’t like breaking an arm or leg. Just as your hormones had to escalate to conceive and sustain a pregnancy, now they must also ramp down— which takes some time. This makes every day different, including the swirl of emotions compounded by grief and loss. In this issue, meet stillbirth advocate Debbie Haine, who has walked this path many, many times in building her beautiful family. She’s now fighting for better outcomes for moms who experience pregnancy loss. Her story is on p.15. Going through stillbirth, Debbie’s experiences were also greatly affected by how her doctors, nurses and even aides provided care. This is why the nursing organization that produces this magazine for you has developed “The Nursing Care Women and Babies Deserve” (p. 12). Learn firsthand what true expert and empathetic nursing care looks like in practice—and expect it. Our nurses answer your top questions left at Health4Mom.org on p. 27. And our own “Why Is My Provider Sending Me to the Hospital Birth Unit?” (p. 28) is a primer for what can and may happen if you’re asked by your healthcare provider to go to the hospital for a “quick check.” Cover to cover, we’re ready to support you from that first positive pregnancy test to beginning breastfeeding. Pour a cuppa something, sit back, relax and enjoy! Until next time,
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Carolyn Davis Cockey, MLS, LCCE Editor & AWHONN Director of Publications Health4Mom@AWHONN.org
ISSUE 21 / 2017 Healthy Mom&Baby
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Join us on Facebook facebook.com/HealthyMomAndBaby
Bankroll Takes a Backseat to Work-Life Balance
BY SUMMER HUNT
Do you fantasize about a f lexible work schedule? You’re not alone. Most parents put work f lexibility (84%) and work-life balance (80%) at the top of their lists when considering a job opportunity—compare that to those prioritizing salary (75%) and health insurance (42%), according to a FlexJobs survey of about 1,200 parents with kids aged 18 or younger. The basic 9-to-5 is at risk as more moms and dads seek f lexible work schedules, particularly f lexible scheduling including full or part-time telecommuting, alternative scheduling and freelance work. Wanting to be more involved at their children’s schools and having more balance in their own lives topped the reasons why more parents are seeking f lexible employment.
Shake the Salt from Your Diet
OVARIAN CANCER SCREENING KITS UNRELIABLE
Americans need to shake the salt out of their diets: According to the updated 2015-2020 Dietary Guidelines for Americans, you should limit yourself to less than 2300mg per day. But cutting back goes beyond skipping the salt shaker—sodium sneaks its way into packaged foods including breads, crackers and ready-made sandwiches. Experts at JAMA offer these tips for skipping salt: Ditch the drive-thru; cook more at home Perk up foods with fresh herbs and new-to-you spices Seek reduced-sodium options of your favorites Check labels—better yet, cut down on packaged foods Shop your store’s perimeter, filling up on fruits and veggies
n t e a s p oo A ly r a e n of salt is y il a d e half th limit sodium g) (1200m
IMAGES © 123RF
Don’t be fooled by medical tests marketed for ovarian cancer screening, warns the FDA. There are currently no ovarian cancer screening tests that have been cleared or approved. The federal agency also noted that research and data from clinical trials show existing ovarian cancer screening tests are not accurate or reliable. If you’re concerned about ovarian cancer, talk to your healthcare provider and know: There is no safe and effective ovarian cancer screening test at present Avoid ovarian cancer screening tests when making health or treatment decisions Your healthcare provider is your best ally with upto-date information and effective screening tools ISSUE 21 / 2017 Healthy Mom&Baby
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Learn The Proven Method To Communicate With Your Baby • Let your baby communicate their needs as early as six months • Reduce tantrums and increase bonding • Help your baby speak earlier and have a richer vocabulary • Increase IQ by up to 12 points*
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Visit babysignlanguage.com for a FREE quickstart guide to start signing with your baby * Linda P. Acredolo, and Susan W. Goodwyn, The Longterm Impact of Symbolic Gesturing During Infancy on IQ at Age 8, International Conference on Infant Studies (July 18, 2000: Brighton, UK)
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UNDERSTANDING DIABETES Type 2 diabetes—the most common form of diabetes—occurs when your body can’t properly manage blood sugar. Your body uses the hormone insulin to move sugars (glucose) from your bloodstream into your cells, where it’s used for energy. Insulin acts like a key, unlocking cellular walls to let sugar inside. If your body doesn’t produce enough insulin, or if your cells can’t use insulin efficiently (called insulin resistance), you’ll be left with too much blood sugar circulating in your body. Although many women with type 2 diabetes develop it after they’ve had their children, some develop it before they’re done with childbearing. If you have type 2 diabetes before pregnancy, talk to your healthcare provider before you’re pregnant to be sure your blood sugars are in good control. High blood sugars in the first 2 months of pregnancy put your baby at an increased risk for birth defects. Be sure any medications you may take will be safe during pregnancy. Use a reliable form of contraception until you have good blood sugar control. If yo insuli u need n preg during you’r nanc y, likely e more t ype to develop 2 within diabetes 5 yea rs.
IMAGE © 123RF
How Diabetes Affects You & Your Baby If you’ve wondered about whether you may be at risk for diabetes, pregnancy can be a crystal ball, allowing you to see what may be in your future.
EFFECTS OF GESTATIONAL DIABETES When diabetes develops during pregnancy (usually diagnosed in the last 3 months) it’s called gestational diabetes. If you have gestational diabetes, your body can’t increase insulin production, leaving higher levels of blood sugars than normal in your bloodstream. Some women can keep their blood sugars normal by changing their diets and increasing their physical activity. Others need medications, either pills or insulin injections, to keep blood sugar normal. If you need these during pregnancy, you’re at increased risk to develop type 2 diabetes within 5 years, research demonstrates. Prevent diabetes by avoiding the unhealthy habits that increase insulin resistance in your body, including being overweight or obese, eating an unhealthy diet and avoiding exercise. Work with your nurses to adopt healthy lifestyle habits that will keep you on track to avoid diabetes in pregnancy and throughout your life. EFFECTS OF DIABETES IN PREGNANCY FOR MOM
Too much amniotic fluid (polyhydramnios)
Poor organ development, including neural tube or heart defects
Increased risks of spontaneous abortion or stillbirth and intrauterine death
Kidney infection (pyelonephritis)
Abnormalities such as enlarged liver, pancreas or heart
Problems with labor
Lifelong risks for obesity, high blood pressure and diabetes
Cesarean birth risks
Skeletal and limb abnormalities
Damage to your retinas
Abnormal growth patterns—being too large or small, or growth restricted during development
Increased risks of metabolic syndrome
Birth problems or trauma
CAROLYN DAVIS COCKEY, MLS, LCCE, is editor of Healthy Mom&Baby.
ISSUE 21 / 2017 Healthy Mom&Baby
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women who are involved in decisio nmaking during la bo r are mor e satisfie d with the ir bir th experie n ce s .
The Nursing Care You Deserve in Childbirth By Catherine CatheRine ruhl, Ruhl, CnM, Cnm, MS ms
You’re 8 months pregnant with your second baby and are starting to think about labor. When you recall how your first labor went—a 24-hour marathon—you find yourself hoping you’ll have nurses like the ones who supported you through that marathon. You recall your nurses really listened to you, asking what was important to you and your partner for labor and birth. You felt respected and had confidence that your nurses would help you meet your goal of a satisfying birth experience. You remember that your nurse never left your side while you were pushing, cheering you on and giving you confidence in your first hours as a mom as you began breastfeeding your new little one. Your relationship with Your nurses Did you know that research shows women say their relationship with their nurses and other caregivers during childbirth was more important than their perceptions of labor pain? Research also shows that women who feel they were involved with decisions during childbirth are more satisfied with their experience. The Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN)—the professional organization 12
for labor and delivery and postpartum nurses that publishes this magazine—says hallmarks the of the nursing care women and babies deserve are compassion, courage, humility, wisdom, and integrity. As a childbearing woman, you deserve care from nurses who truly engage with you, expertly guiding you as you navigate childbirth and new motherhood. Finding Compassionate Care providers How will the nurses at your chosen birthplace provide care for you? Make time to take a tour or classes at your chosen birthplace and ask to meet some of the nurses who work there. Reach out to other moms and ask them about their experiences with the nurses at the hospital or birth center where you are planning to have your baby. Ask if they felt respected, safe and listened to. Ask if they trusted their nurses to be knowledgeable guides, giving them confidence in their intuitive abilities as new mothers. The nursing care you receive during labor and birth, and even through the early postpartum days and weeks, makes a lasting impression and can affect how you feel about your labor, birth and early days of motherhood. Wise, courageous and compassionate nurses who are fully present and engaged with you and your baby are providing the nursing care that all women and babies deserve in childbirth and beyond. Catherine ruhl, CnM, MS is director of women’s health at aWhOnn and an expert advisor to Healthy Mom&Baby.
images © 123RF
Your relationship with your nurses—and other care providers—can have lasting effects on how you feel about your labor and the memories of giving birth that you’ll carry with you for a lifetime.
HMB7.Nursing Care REVISION2.indd 12
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.
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 !
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What’s the hurry?
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
AM I AT RISK FOR
Maternal Depression? BY VALERIE M. K ADING, NP, MSN
1 in 6 moms experience some form of depression during pregnancy. Here’s what you need to know now.
MATERNAL DEPRESSION RISK FACTORS Experts say the following factors increase your risks of depression during pregnancy:
Previous depression or anxiety: Depression in a past pregnancy or any time before pregnancy increases risk for experiencing depression during and after pregnancy Stressful circumstances: Big life events, like losing a significant partner or loved one, divorce or losing a job can lead to depression No support: Being on your own without support can lead to sadness, loneliness and depression Struggling financially: Especially if you have a low income Ethnicity: African-American and Hispanic women experience maternal depression more so than women of other ethnicities Being a teen: Pregnancy during the teen years can create family issues, lowering a teen’s self-esteem WHAT IF I HAVE SOME RISK FACTORS? Maternal depression is a complex health challenge. Discuss any of the mentioned risk factors with your pregnancy care provider; get mental health care if you have any risks for depression in pregnancy. Secondly, replace risky behaviors such as using tobacco, alcohol or drugs with healthy habits, like seeking support from others.
Having risk factors doesn’t always mean you’ll experience maternal depression. If you’re concerned about any of the risk factors, ask your nurse for advice and specific actions you can take to reduce your risks. WHAT ARE THE RISKS FOR ME & MY BABY? Untreated, maternal depression can lead to postpartum depression and potential risks to your baby including premature labor and birth, poor bonding between you and baby and delays in baby’s development. REDUCE YOUR RISKS FOR MATERNAL DEPRESSION
Be healthy: Eat healthy meals, avoid alcohol and illegal
drugs, follow your pregnancy care provider’s recommendations for exercise and get at least 7-8 hours of good sleep each night Be resilient: Promote healthy relationships, set appropriate boundaries with others, practice mindfulness, meditate, and try prenatal massage (as recommended by your healthcare provider) Ask for support: Reach out to your partner, family and friends. Set regular dates with people that you’re close with; avoid isolation. If you’ve experienced a recent stressful life event, seek the assistance of a counselor or therapist Manage stress: Be as strong as possible emotionally and physically before pregnancy. Keep stress low Find local support groups at postpartum.net VALERIE M. KADING, NP, MSN, is the associate director of medical
operations at Sierra Tucson, a hospital and behavioral residential treatment center in Tucson, AZ.
IMAGES © 123RF
Depression during pregnancy can affect not only your health but baby’s too, including baby’s birth outcomes. There is no one single cause for depression in pregnancy, also called maternal depression.
Debbie Haine Vij
ayvergiyha and fam
The d ILLBIRTH e baby ath or los bef or s of a e or bir th stillbir . Miscarria during th g b u t a a r e b ot h e a n d t dif fe f et a l loss re n t p reg n s the lo anc y. Mis tages of carria ss of ge is a bab week y s of a b ; stillbir th before 20 aby a is the f te r loss pregn 20 weeks of anc y.
And Its Ripple Effects BY CAROLYN DAVIS COCKEY, MLS, LCCE
“I have birthed two living babies and one dead baby. As a woman and a mother, this is something I never thought I would be able to say,” Debbie Haine Vijayvergiyha wrote in an Every Mother Counts blog post last year. Since that time she’s been telling her story again and again, advocating for awareness, support and accurate autopsy data when it comes to stillbirth.
Like most good connections, I met mom and stillbirth activist Debbie Haine Vijayvergiyha through a friend who spends her days working for healthy outcomes for pregnant women and their babies. Pregnancy and birth have never been easy for this New Jersey-native and her family. Following the birth of her fi rst child, a daughter, Debbie developed both a systemic infection and blood clot that nearly took her life. Then, she suff ered 2 miscarriages. With a fourth pregnancy, Debbie and her husband faced yet another devastating pregnancy reality at a routine 2nd trimester check-up: Her expectant daughter’s heart had
ISSUE 21 / 2017 Healthy Mom&Baby
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healthy moms stopped beating; her umbilical cord had collapsed, cutting off her oxygen. Yet hope prevailed. Nearly a year to the day after she had delivered her beautiful stillborn daughter, Autumn Joy, Debbie birthed a healthy baby boy. Her story includes incredible sorrow but more so courage and action driven by the desire to create much needed conversation regarding stillbirth.
When we arrived at labor and delivery, everyone was expecting me. They immediately put me into a room to get changed. As soon as the door closed, I heard a baby start crying; it was the most surreal moment—someone in a room next to me was bringing new life into the world as I was preparing to do the exact opposite. Within seconds a nurse appeared and ushered me to another room at the other end of the hall—away from the new life and joy that was otherwise happening. lbirth is a men to know stil Once I settled in, a series of healthcare providers Debbie wants wo US the in sis cri h alt he hidden mater na l came and went, talking to me, and medicating me. A social worker stood against the wall near the end of my bed, never coming close, and rattled off a list visit was hospital protocol following the loss of a child. He sat of questions: “Did I want to hold my baby?” “Have down, and without looking at my chart, said to me, “Do you hand and footprints made?” “Save a lock of hair?” In that think maybe all this pain is psychosomatic?” I looked at him moment, the only response that came out was “no.” I didn’t enraged; we exchanged words. He left and never returned. want to believe that any of this was happening. In shock and My experience at the hospital was seriously lacking. No one on morphine, my senses were numb; I was in denial. I shut ever came to talk to me about what I was experiencing, to suggest down; I didn’t know how else to cope. how we should talk with our daughter about the loss of her sister, I delivered Autumn at 4:59 the next morning. Hours or to share bereavement resources. I left the hospital with a pat later, I began to experience significant pain in my abdomen. on the back, a handout on the 12 stages of grief, and a brochure Testing showed I had contracted a uterine infection. for their monthly support group. My experience at the hospital I was lying in bed, visibly uncomfortable, when the wasn’t what I deserved, or what my daughter deserved. It took me hospital’s psychiatrist came to see me. He explained that his 16
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IMAGES © LISA R AYMAN GOLDFARB PHOTOGR APHY
EXPERIENCING STILLBIRTH Can you take us to that moment when you learned Autumn had passed? In that moment, the world stopped moving; everything came crashing down around me. I laid there on the examination table as my doctor looked at me and said, “I’m so sorry, we cannot fi nd a heart beat; your baby is dead.” She repeatedly apologized and then off ered to leave the room so that I could make my calls. Th irty minutes later, my husband found me on the exam table, frozen, unable to move. We went home to wait for a hospital bed to become available. We were at a loss. What would we say to our three-and-a-half year old daughter? How would we tell people? What does one pack for the hospital to birth a dead baby? So many questions and no good answers. The hospital called soon after to let us know a bed was ready. I had never felt so scared in my life.
healthy moms a very long time to come to terms with what had happened during my stay.
IMAGES © LISA R AYMAN GOLDFARB PHOTOGR APHY
MOVING BEYOND MEMORY What about that experience brought you to where you are today as an activist working to raise awareness of the effects of stillbirth as well as create the support needed for families experiencing pregnancy loss? “Everything! I had always considered myself a worldly, educated person. And yet I never knew about stillbirth or that it could happen to me. After losing Autumn, it took me a very long time to come to terms with our new reality. The only way that D e bb ie say I could make any sense of our f irst t s t he im ew learn heartbreaking tragedy was to give a b ou o m e n t s h ou it purpose. I couldn’t sit by and ldn’t stillbir th b e wh i t’s ha let others suff er like we had. I felt en p pe n in compelled to help; not just for t he m g to . me but for Autumn too. The fi rst time women learn about stillbirth shouldn’t be when it happens to them. We must break the silence and taboos around stillbirth. It’s essential that we fi nd ways to educate and empower expectant moms and families through their childbearing years about the importance of prenatal care, the risks and realities of stillbirth, and how to be an advocate for their unborn baby. It’s also important that our healthcare providers understand that they play a vital role in the journey of the grieving family. The way they treat a patient and their family has a significant impact on grieving families’ journeys. PAIN INTO ACTION Stillbirth affects about 1% of all pregnancies. Each year about 24,000 babies are stillborn in the US. That’s about the same number of babies who die in their first year of life. But even more shocking, it’s more than 10 times as many deaths as the number babies who die from sudden infant death syndrome (SIDS). Did you begin to tell your story as a way to create change? Absolutely. I needed to believe that Autumn’s life wasn’t lost in vain. I knew what SIDS was before I ever had children but I had never heard of stillbirth. And we must find a way to improve our data collection; it’s imperative that we find a way to collect concise and consistent data, including perinatal autopsy data. In a perfect world, I would love to see all of this tied into a national stillbirth awareness campaign. Goals are important. Once we do all of that, we can put together the kind
of information that can help us create real change beyond the numbers—it’s clear that the numbers don’t speak loudly enough. And once that is all said and done, then I would like to believe that stillbirth will begin to be recognized as the tragic maternal health crisis that it is. I know; I have big goals. Without our voices our babies’ stories will never be told. If we don’t remove the taboo of stillbirth, no one’s ever going to know the truth behind the tragedy of stillbirth. The suff ering doesn’t end the moment you walk out of a hospital. What goes unnoticed is how surviving stillbirth is a life-altering event. People don’t talk about it or consider the negative impact stillbirth has on our society. The truth is that marriages fail, families fall apart, friendships dissolve, and careers are lost. I speak from experience. We must create a greater sense of urgency around the unmet needs in stillbirth, raise our social conscience on this topic and help generate increased funding for stillbirth research. There is no easy fi x but I have to believe that one day we will be able to improve stillbirth outcomes in this country. I know we can; we just need to fi nd the right people to support our cause because no one should ever know the pain of losing a child to stillbirth. Learn more about Debbie’s work at stopstillbirthasap.org and The2degrees.org; and follow her on Instagram and Facebook at stillbornstillmatters and The 2 Degrees Foundation.
CAROLYN DAVIS COCKEY, MLS, LCCE is editor of Healthy Mom&Baby.
ISSUE 21 / 2017 Healthy Mom&Baby
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healthy moms BY CAROLYN DAVIS COCKEY, MLS, LCCE
Cold, Flu or Allergies: Here’s How to Tell the Difference
As the seasons change, your family faces new airborne and bacterial challenges. The next time you’re achy, stuff y and not sure what’s happening, use this quick guide to sleuth if you’re experiencing a cold, the flu or allergies. You’ve got symptoms, and frankly your head is just too congested to think them through. You’re coughing with a burning feeling at the back of your throat. Could it be a cold? Allergies? Or even the flu? Sometimes it’s hard to distinguish what your body is battling, especially when colds, flu and allergies all affect your respiratory system. Colds and flu tend to hang around for up to 2 weeks, but allergy symptoms will persist for as long as the allergen is present. Seasonal allergies tend to occur for about 6 weeks at a time. Knowing what you’re experiencing helps you choose the right treatments and actions to get through recovery as quickly as possible. And, “If you know what you have,
COLDS WHAT IT IS
Respiratory illness caused by viruses; symptoms can linger for up to 2 weeks Colds can also lead to sinus infection and middle ear infections or asthma
HOW IT AFFECTS YOU
you won’t take medications that you don’t need, that aren’t effective, or that might even make your symptoms worse,” says NIH’s Dr. Teresa Hauguel. Read labels carefully when choosing over-thecounter medications or taking a prescription. Many treatments for colds, flu and allergies contain similar drugs, such as a decongestant and a pain reliever. You could accidentally get a double dose or worse if you don’t pay attention to how much of each drug is in the medicine you take. CAROLYN DAVIS COCKEY, MLS, LCCE, is editor of
FLU Respiratory illness caused by viruses; flu symptoms are like cold symptoms but come on more suddenly and more severely and can last for up to 1-2 weeks Flu can lead to pneumonia, which can be life-threatening
ALLERGIES A condition where your body’s immune system responds to a trigger, like dust, mold or pollen Allergies can also lead to sinus infection and middle ear infections or asthma
High fever (100-102⁰ or more)
Runny or stuffy nose
Body aches, pains
Watery, itchy eyes
Runny or stuffy nose
Typically no body aches or pains
Typically no body aches or pains
Congestion Cough, chest discomfort
IMAGES © 123RF
HOW TO GET BETTER
Prescription anti-virals if caught early
Lots of fluids like water or herbal tea
Over-the-counter medicines for symptoms
Lots of fluids like water or herbal tea
Annual flu vaccine
Avoiding people who act or appear to be sick
Over-the-counter medicines for symptoms
Avoiding people who act or appear to be sick
Avoiding allergens, such as pollen, house dust mites, mold, pet dander, cockroaches Taking an over-the-counter anti-allergy drug is key to reducing flare ups
ISSUE 21 / 2017 Healthy Mom&Baby
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Per fectin pelvic floog exercises r is key
to making bladder leakage a thing of the past .
BY SUSAN PECK, MSN, APN
Oh No, My Leaky Bladder! Leaking urine is common, and there are ways to cope with light bladder leakage. Maybe you’re on a jog or simply sneezing, and you feel a small amount of urine dribble out; you can’t stop it. What is happening? After all, you only had 1 vaginal birth—you might be asking yourself, “Should I be leaking urine at such a young age?” The truth is light bladder leakage can happen at any age. Light bladder leakage (LBL) is urine loss you can’t control. 1 in 4 women experience it. Don’t ever be embarrassed by light bladder leakage; it’s common. Stress incontinence is leaking urine when there’s pressure on your bladder like with coughing, running, jumping or sneezing. Urge incontinence is the frequent, sudden need to pee that often causes bladder contractions and leaking small or moderate
amounts of urine. Caffeine, alcohol, drinking too much water, medications like diuretics (water pills) or neurological conditions can irritate your bladder, leading to urge incontinence. PELVIC FLOOR STRENGTH During a pelvic examination, your healthcare provider may ask you to squeeze your pelvic floor muscles; they want to check how much your muscles resist stretching. Since your whole pelvic floor is supported by muscle, you can strengthen it. Maintaining good pelvic floor muscle tone is critical to preventing or improving bladder leakage. Pelvic f loor exercises are the easiest way to strengthen these muscles. According to the Mayo Clinic, perfecting pelvic f loor exercises is key to making bladder leakage a thing of the past. Create mental reminders to do these exercises daily—do a set at every red traffic light or during a commercial. At fi rst, squeezing these muscles may feel odd, but you’ll get used to it. SUSAN PECK, MSN, APN, is an expert adviser to Healthy Mom&Baby.
If you’re doing pelvic floor exercises correctly no one will know. Make it your secret exercise! • Find the right muscles. To find your pelvic floor muscles, stop peeing midstream. If you succeed, you’ve got the right muscles. Once you’ve identified your pelvic floor muscles, you can do the exercises in any position, although you might find it easiest to do them lying down at first. • Perfect your technique. Tighten your pelvic floor muscles, hold the contraction for 5 seconds, and then relax for 5 seconds. Try it 4 or 5 times in a row. Work up to keeping the muscles contracted for 10 seconds at a time, relaxing for 10 seconds between contractions. • Repeat. Avoid holding your breath. Instead, breathe freely during the exercises. Aim for at least 3 sets of 10 repetitions a day.
IMAGE © 123RF
FLOOR PELVIC ER! POW
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healthy moms Just being a female in menopause makes you more likely to have brittle, thin bones. So does: Being Asian or Caucasian Being very thin or petite Having a family history of osteoporosis Having a mother who had a hip fracture related to thin bones Smoking cigarettes Drinking a lot of alcohol or caffeinated drinks Using certain medications including steroids (for more than 3 months) Taking some medications to treat breast cancer
BY SUSAN PECK, MSN, APN
Can I Prevent Osteoporosis? Here’s a 3-pronged plan to promote bone health and help prevent osteoporosis: calcium, vitamin D and exercise!
CAN OSTEOPOROSIS BE PREVENTED? As a woman, even if you’re age 30 or older and have already reached your peak bone mass, it’s important to get enough calcium in your diet to keep your bones strong. Dairy and dark leafy greens are your best food sources; supplements are effective too. You’ve got 3 great tools to support your bones: calcium, vitamin D and exercise. Calcium is key to saving bones. Experts at the National Institutes of Health recommend 1,000 mg of calcium daily for women ages 19-50; bump up that recommended daily intake to 1,200 mg after you celebrate your 51st birthday. Vitamin D is calcium’s partner, but unfortunately, vitamin D is a bit harder to get from food. While sunshine is a good natural source for vitamin D, even if you live somewhere like sunny Florida, wearing sunscreen or a hat blocks natural vitamin D. Consider taking a D supplement—600 IU each day up to age 70, when your RDA bumps to 800 IU per day. Some studies recommend more, but never exceed 4,000 IU per day. Lastly, add in weight-bearing exercise (pretty much anything other than swimming) to keep your bones healthy and strong. Walking—even without holding weights—is an easy way to keep your skeleton strong.
IMAGE © 123RF
Sometime between the ages of 30 and menopause, your body stops adding bone density to your skeleton. This is why it’s so important to bone up on bone health—and build as much bone as possible from your late teens through early adulthood. WHAT’S OSTEOPOROSIS? Osteoporosis is a medical condition wherein our bones become brittle, thin and fragile. On X-ray pictures, bones affected by osteoporosis look like Swiss cheese, and they’re more likely to break if you fall or have an accident. Having weak, thin bones increases your chances of developing osteoporosis later in life. Osteoporosis is common: More than 54 million people have it, and 1 in 2 women will have a fracture or break a bone related to osteoporosis during her lifetime. SUSAN PECK, MSN, APN is a nurse practitioner in New Brunswick, NJ, and an expert adviser to Healthy Mom&Baby.
ISSUE 21 / 2017 Healthy Mom&Baby
10 Tips for a 1. 2. 3. 4.
5. 6. 7.
Learn about the wonderful ways your body is changing and how your baby is growing. Eat nutrient-rich foods and learn the appropriate range for weight gain. Take prenatal vitamins with folic acid before conception and during pregnancy. Stay active! Continue exercising as you were before pregnancy or according to the recommendations of your health care provider. Get plenty of rest. Talk to your baby and enjoy your growing bond. Manage the stress in your life. Keep communication open with your partner, and build your support system. Consider practicing meditation or taking a prenatal yoga class.
Think about whether you want to give birth at a hospital, at a birthing center, or at home and choose a health care provider who will be able to assist you in your chosen location. 9. Prepare for your baby’s birth. Based on your chosen birth location, consider your preferences and discuss these with your care provider. 10. Enjoy this special time in your life! Your partner, family and friends can help you make the most of this wonderful transition. Online classes cover all stages of pregnancy, labor and early parenting at Lamaze.org/OnlineClasses. Live classes are taught by experienced Lamaze Certified Childbirth Educators, visit Lamaze.org/LocalClass to find a class near you.
Are you expecting, or hoping to be soon? Learn how to plan for a healthy pregnancy and birth with Lamaze classes.
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Join us on Facebook facebook.com/HealthyMomAndBaby
Pregnancy BY SUMMER HUNT
Morning Sickness = Healthy Pregnancy?
SOMETHING TO REALLY SLING ABOUT Midwives in Minnesota are hoping a new birthing sling will shorten labor, decrease a mom’s need for an epidural, and potentially lower her risk of needing a cesarean. Leaning into a soft ribbon of fabric anchored into the ceiling, laboring women are supported in upright positions as labor progresses, rather than laboring flat on their backs. Upright positioning is proven to increase a woman’s movement in labor, make contractions more effective as baby makes an easier journey through the birth canal, and reduce labor pain scores. Birthing slings are new to the U.S. but more common in Europe. Experts say women who can support their own weight in labor and who desire to labor upright and birth normally can try using a birth sling. Women with high-risk pregnancies, such as those with high blood pressure, may not be able to use this tool. Ask your pregnancy care provider if your desired birth site has labor slings.
Next time you’re kneeling over the porcelain, consider this: Researchers say that women who experience morning sickness are less likely to miscarry or go into labor prematurely. Additionally, babies born to moms who experienced nausea in pregnancy may have fewer birth defects and score higher on IQ tests. This doesn’t mean that women who don’t experience nausea and vomiting in pregnancy should be concerned—routine retching doesn’t necessarily guarantee a perfect pregnancy. Lead author of the study Dr. Gideon Koren says momsto-be should take the sickness as a sign their bodies are producing the necessary hormones for better outcomes and some decreased risks during pregnancy.
IMAGES © 123RF; THINKSTOCK
3 Key Questions When Buying a Breast Pump 1
Manual or electric? When and where will you most likely pump? Options include manual and powered pumps, which run on batteries or electricity. Double pumps can extract milk from both breasts at the same time. Rent or buy? Most breast pumps are designed to be used by one person. If you’re
renting, make sure you’re receiving a commercial grade pump designed for multiple users over time. Easy to clean? Can you assemble and break down your pump with your eyes closed? Does it have tubing or flanges with hard-to-clean areas? Look for easy assembly and use, as well as dishwasher-friendly parts.
ISSUE 21 / 2017 Healthy Mom&Baby
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BRAIN, EYE AND NEUROPATHWAY DEVELOPMENT STARTS WITH MOM! Many studies conﬁrm the importance of DHA, and how critical it is in pre- and post-natal care for both Mom and Baby. Supplementing with DHA during pregnancy and after in breast feeding is important for healthy brain, eye and neuropathway development of the baby. ChildLife Prenatal DHA contains 500mg per one soft gel. Dr. Murray C. Clarke, founder of Childlife essentials, who formulates the entire ChildLife line, focuses on purity—with no detectable levels of heavy metals, mercury, aluminum, PCB’s, Dioxins or other contaminants. A clinical report carried out by the American Academy of Pediatrics suggests children with higher levels of DHA could show 4 to 5 IQ points higher by age 4. The American Academy of Pediatrics found 7 of 10 kids deﬁcient in Vitamin D and recommends 400 IUs of Vitamin D3 per day for babies and infants from BIRTH.* Vitamin D3 supports healthy, immune, respiratory and bone development.
www.childlife.net *Based on ﬁndings from a study by Juhi Kumar, MD, MPH, of Monteﬁore Medical Center; Michal Melamed, MD, of Albert Einstein College of Medicine and colleagues.
Ollie the Owl
Important Notice: Childlife Essentials’ products are not meant to diagnose, treat or cure any disease or medical condition. These statements have not been evaluated by the Food and Drug Administration. Please consult your doctor before starting ANY exercise or nutritional supplement program or before using these or any product during pregnancy or if you have a serious medical condition.
Portable Bluetooth Speaker and Soother Our VoiceShare mobile app is an open invitation for loved ones to connect with baby. White noise, a favorite story read by Daddy while he’s on the road or even a personal playlist: all can come from a chew-safe, fuzzy friend.
Learn more at: wavhello.com/soundbub
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healthy pregnancy 1st
Skip he supplemerbal nts— m
any are co too risk y fonsidered Discuss he r baby. other sup rbs or with your plements h provider b ealthcare efore take them you .
BY TAMER A YOUNG, RN, MSN
How to Choose the
Right Prenatal Vitamin During pregnancy, your body needs additional vitamins and minerals for you and your growing baby. A daily prenatal vitamin is your insurance against any deficiencies from conception through pregnancy and breastfeeding. Start prenatal vitamins before conceiving to support baby’s earliest development. Your prenatal should have at least 400mcg of folic acid to prevent neural tube defects, which occur in the first 28 days of pregnancy—often before you even miss a period. VITAMINS, MINERALS & MORE Folic Acid Folic acid is the synthetic form of the B vitamin folate, which is found in leafy greens. Some prenatal vitamins have 800mcg of folic acid, which is safe and helps prevent birth defects. If you’ve had a pregnancy affected by a neural tube defect you may need even more folic acid. DHA Want to nourish a smarter baby? Many prenatal vitamins include DHA (docosahexaenoic acid), an omega-3 fatty acid that promotes baby’s brain and eye development. Salmon, walnuts and flax seeds are good sources of omega-3.
IMAGE © 123RF
Vitamin D You need 600 IU/day of vitamin D during pregnancy. Most prenatals have 400 IU, so you’ll need to supplement. Excessive amounts of vitamin D can be too much of a good thing—don’t exceed 2,000 IU to 4,000 IU a day. Calcium Calcium helps protect against bone loss during pregnancy—super helpful when you’re growing another skeleton! Get 1,000mg per day. If dairy’s not your thing, eat calcium-rich foods like broccoli, kale, white beans and oranges. Vitamin B6 It ain’t easy being queasy. Vitamin B6 can ease nausea and morning sickness; experts advise 50mg of B6 daily.
What You Need from Your Prenatal Vitamin VITAMIN Folic acid Vitamin D Vitamin C Vitamin B12 Vitamin E Thiamine Riboflavin Niacin Zinc Calcium Iron
AMOUNT 400 mcg 400 IU 70 mg 6 mcg 10 mg 3 mg 2 mg 20 mg 15 mg 200 to 300 mg 27 mg
DOES YOUR THROAT CLOSE AT THE THOUGHT OF SWALLOWING A CAPSULE? Look for a chewable, liquid or even gummy prenatal vitamin.
Iron If you’re prone to iron deficiencies, choose a prenatal with a higher level of iron; just know iron can cause nausea and constipation. If you’re not anemic, get at least 27 mg/day. Find it in lean red meats, chicken, fish, dried beans and peas and prune juice. Absorb iron better when you eat these with vitamin C-rich foods including tomatoes and citrus fruits. CHOOSE WISELY Not all prenatal vitamins are created equally, and not all supplements have been tested for safety in pregnant women. Choose your prenatal carefully and stick to meeting your basic needs—think maximum impact with the minimum number of daily supplements. For example, too much vitamin A can be harmful to your baby and is often reduced in prenatals, which is one reason why a regular multivitamin just won’t work during and after pregnancy. And prenatal vitamins won’t make up for poor eating—get the nutrition you and your baby need each day through your food. TAMERA YOUNG, RN, MSN, is an expert advisor to Healthy Mom&Baby.
ISSUE 21 / 2017 Healthy Mom&Baby
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Keep your skin healthy and beautiful while pregnant! As a mommy to be we know how important what you put in and on your body is. LUMIONskin… • Safe + non-toxic. • HOCL + Oxygen promote skin health by mimicking our body’s own immune system. • Helps to ﬁght bacteria, reduce hormonal breakouts + redness. • Keeps you + your skin healthy + glowing. • Free of alcohol, parabens, gluten, fragrance, phthalates, sulfates, + dye. Mist multiple times daily to hydrate and help naturally ﬁght bacteria. We suggest misting your hands too. Use LUMION serum AM + PM after cleansing. Apply directly to skin irritations throughout the day to soothe (blemish, dryness, redness, etc…)
“LUMIONskin takes skincare back to the basics with natural, safe and active ingredients that help optimize skin health. Easy to use and effective – this natural alternative helps skin look its best without risk or irritation.” - Dr. Dendy Engelman, Dermatologist
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ÒB ecause every birth defect has a causeÓ ÒW hy My Child?Ó ItÕ s the question every family asks when they have a child with a birth defect. We help to answer that question and support the family with speciﬁc information about their childÕ s birth defects. We also connect families who have children with similar problems. And provide referrals to support groups and resources their child may need. BDRC also sponsors the National Birth Defect Registry, a research project designed by prominent scientists to collect data for studies of the unknown causes of birthFOR CWF LOGO (W/ TYPE) GUIDELINES defects. No Smaller Than 1.5”
PMS 541 PMS 194 OR PROCESS COLOR
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C M Y K
100 57 0 38
C M Y K
0 100 64 33
ask our nurses Your questions answered by our expert mother/ baby nurses at Health4mom.org/ ask-our-nurses.
Ask Our Nurses:
Pregnancy Trimesters, Zika and the Importance of Kick Counts
IMAGE © 123RF
WHAT’S A TRIMESTER—AND WHY DO I NEED SO MANY VISITS WITH MY HEALTHCARE PROVIDER? A normal, full-term pregnancy is divided into 3 stages or trimesters. The first trimester is from 0-12 weeks of pregnancy. The second trimester is from 13-28 weeks. The third trimester is from 29-40 weeks. Each trimester is unique—your baby’s growth, your body’s changes, how you feel, testing that is offered—are all different among the first, second and third trimesters. Keep all of your prenatal visits. At each visit your midwife or doctor will check your health and the growth and health of your baby, as well as assess for any risk factors that could be an indication that you or your baby may be developing a problem. Research shows that keeping all of your prenatal visits gives you and your baby the greatest opportunity for the best outcomes possible. We know life is really busy, so use this time to enjoy listening to your baby’s heartbeat and gain peace of mind about your baby’s growth and health. —Helen M. Hurst, DNP, RNC-OB, APRN-CNM IS ZIKA STILL A THREAT TO MY PREGNANCY AND BABY? The Zika virus continues to spread through the U.S., particularly in the southernmost states. As of the end of 2016, there were 32 infants born in the U.S. affected by the birth defects Zika causes and 5 pregnancy losses due to Zika.
Zika causes microcephaly, which includes baby being born with a too-small head, calcium deposits in a baby’s brain indicating possible brain damage, excess fluid in the brain, missing or poorly formed brain structures, abnormal eye development, and other problems resulting from damage to the brain that affects nerves, muscles and bones, such as clubfoot or inflexible joints, as well as hearing loss. Avoiding mosquitos and their bite is still the only way to prevent Zika, say experts at the CDC. —Helen M. Hurst, DNP, RNC-OB, APRN-CNM WHAT ARE KICK COUNTS—AND DO I NEED TO DO THEM? How often your baby moves is a window into how she is doing and her overall health. Spend time getting to know your baby and her overall activity level so you’ll know if something changes or seems different. Kick counts help you make sure your baby is active throughout the day. Kick counts should be done every day when your baby is most active. Take a break, put your hands on your growing belly, and count baby’s movements. You should be able to count 10 movements within 2 hours or less. Start kick counts from weeks 24-28 on, and call your healthcare provider right away if you’ve observed your baby for 2 hours or more without at least 10 distinct movements. —Michele Savin, MSN, NNP-BC
ISSUE 21 / 2017 Healthy Mom&Baby
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healthy pregnancy 3rd
WHY IS MY PROVIDER SENDING ME TO THE HOSPITAL BIRTH UNIT BY CATHERINE RUHL, CNM, MS
Are you having a pregnancy emergency? Is birth imminent? There are many reasons your healthcare provider may send you to the hospital birth unit for a quick check.
OBSTETRIC TRIAGE AT THE BIRTH UNIT At larger hospitals you’ll likely go to an area of the birth unit called OB triage. At a smaller or less busy hospital you may go straight into a birth room for care. You’ll fi rst see a nurse, and they’ll want to know why you’ve come; any labor signs like contractions or your water breaking, if you’ve had vaginal bleeding, how your baby is moving and how your pregnancy has been going. Your nurse will review your medical records, if available. They’ll check your blood pressure, pulse and temperature. If you’re in labor they’ll see how you’re coping with the contractions. Nurses working in this area are expected to see you as promptly as they can; their assessments typically take about 10 minutes. PRIORITIES IN PREGNANCY & CARE Based on their fi ndings, your nurse may assign you a priority level from 1-5, which rates how urgently you need care. Assigning a priority level is called triage. A woman at the highest priority (level 1) needs attention right away—for example, if her baby is about to be born. A woman who is assigned a 5 could be at the birth unit for a scheduled procedure. Someone at term and in
active labor needs to be seen promptly, so she’s likely a 3. The triage unit doesn’t work on a fi rst come, fi rst served basis. Someone who has a more urgent need for care will be seen fi rst. Call your midwife or doctor before you go to the hospital; they can advise if going in is needed, or if staying home is a better idea, for example, to wait for contractions to get closer and stronger. If you’re too anxious to stay home, tell them you would feel better to come in and be evaluated. Once you’ve been checked out by your midwife or doctor, the two of you can make a plan about whether you need to be admitted to the hospital, be observed for a period of time or if you can return home. Getting all of your questions answered as you make decisions will help you have peace of mind, especially if the decision is for you to return home. CATHERINE RUHL, CNM, MS, is director of women’s health at AWHONN and an expert advisor to Healthy Mom&Baby.
IMAGES © 123RF
So what can you expect if you get sent to your hospital birth unit during pregnancy, whether you think you may be in labor or if you’re experiencing another problem, like bleeding?
HMB16.3rd TrimesterrREV2.indd 28
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Kopa Birth® is the #1 online childbirth class for couples planning a natural birth in a hospital. You can have a natural childbirth! Kopa Birth® will Prepare you. Register online at www.kopabirth.com
7 ways to prepare for a natural hospital birth
1 - Take a hospital-friendly natural childbirth class 2 - Find a hospital with a low cesarean birth rate 3 - Choose a doctor or midwife that supports natural birth 4 - Talk with your doctor regularly about your birth preferences 5 - Learn and practice a wide variety of labor coping tools 6 - Write a birth plan that will be well received by healthcare staff 7 - Create a supportive birth team, including a partner &/or doula
Preggie Pop Drops The Natural Way to Ease Morning Sickness
Preggie Pop Drops are naturally flavored and specially formulated products made for pregnant women. For generations, women have sought out certain natural therapies to ease morning sickness. As healthcare professionals, we have developed a solution: convenient, delicious, high quality and all natural lollipops, lozenges and chews. Preggie Pop Drops offer relief via a combination of essential oils, aromatherapy and our unique delivery system. In addition, our Preggie Pop Drops alleviate dry mouth, provide quick calories and energy during labor, and are an overall soothing and comforting way to address the needs of pregnant women. Preggie Pop Drops are also drug free and healthcare provider recommended.
These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.
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04/04/2017 06/01/2017 09:06 14:49
healthy pregnancy BY JAMIE M. VINCENT, MSN, RNC-OB, C-EFM
How to Choose a
Childbirth Class The months leading up to the birth of your baby are filled with many questions. You might be wondering, “How do I prepare for birth? What type of birth experience do I want? What role will my partner play?” A childbirth class helps to answer your questions. WHAT ARE CHILDBIRTH CLASSES? Childbirth classes are as varied as the childbearing families who attend them: Some are online, some are an extension of group prenatal care, and many are the more commonly known series of weekly in-person classes led by a childbirth instructor who is trained in a particular technique, such as Lamaze, the Bradley Method or HypnoBirthing—to name a few. Some facilities will even jam all of the sessions into one super Saturday or weekend to help you prepare for birth. In class, you and your partner or support person will learn how labor begins and progresses, practice coping techniques for managing labor pain and learn why it’s important to be upright and to change positions frequently throughout labor. Coping and comfort techniques include massage, relaxation and breathing techniques and positioning for comfort during labor and birth. Most importantly, in a childbirth class, you’ll learn that as a woman your body was designed to birth intuitively and that you can trust your instincts to guide you.
and birth and a healthy mom and baby. The 12-week series teaches natural childbirth and birth as a natural process. The core belief with the Bradley Method is that most women, with proper education and preparation and the help of a loving and supportive coach, can give birth naturally. bradleybirth.com HypnoBirthing® focuses on addressing and reducing the fear associated with the pain of childbirth and creating a calm, trance-like state, which allows the muscles to relax and the woman to experience a calm and gentle birth. us.hypnobirthing.com
FIND A MIDWIFE OR DOULA: American College of NurseMidwives (ACNM) | midwife.org/ find-a-midwife Doulas of North America (DONA) | dona.org/find-adoula
JAMIE VINCENT, MSN, RNC-OB, C-EFM, is an
expert advisor to Healthy Mom&Baby.
IMAGE © 123RF
WHAT METHOD IS BEST FOR ME? Look for a program taught by a certified instructor. Regardless of the class you choose, the most important thing is practicing what you’ve learned regularly with your partner as you prepare for birth. Birthing is intense—it’s a time to rely on what you already know and are comfortable with, which is why practice is so important. Lamaze’s® Six Healthy Birth Practices are the foundation of its classes—promoting labor and birth practices based in research, including letting labor start on its own; standing, walking around and moving in labor; bringing a friend or loved one for support; avoiding non-medically needed interventions including birthing on your back; following your body’s own urges to push; and beginning breastfeeding at birth. Lamaze also encourages the support of doulas for you and your partner. lamaze.org The Bradley Method® revolves around “husbandcoached natural childbirth,” or coach-supported labor
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Sarah and her newborn enjoy an early snuggle after an uneventful birth
Learn These Post-Birth Warning Signs IT COULD SAVE YOUR LIFE
She remembered a handout her nurse had discussed with her— post-birth warning signs—could this really be happening to her? She never thought those warning symptoms her nurse discussed would apply to her. After all, hers had been a perfectly uneventful pregnancy and normal birth. She asked her mom to get the postpartum warning signs sheet from her stack of hospital discharge papers. At fi rst, her mom thought that she was just overly tired and perhaps a bit anxious since she was caring for 2 children, but then they read the handout together. As Sarah describes it, they read “shortness of breath, 911” and said “we’re going in.” Sarah’s mom took her to the ER. She received a blood pressure check, several lab tests and then a chest X-ray and CT scan, which revealed a small blood clot in her lung. She recalls having mixed emotions, and through tears she said, “I feared not knowing if I 32
was ever going to hold my baby again.” She struggled to believe that without risk factors, this was still happening to her and potentially threatening her life. While Sarah was hospitalized for treatment, she made a point to thank her nurses, grateful they had told her that shortness of breath and difficulty breathing could be a warning sign of a serious post-birth complication. In this case, postpartum discharge education and trusting her instincts saved Sarah further complications, possible injury, or even her life. DEATHS INCREASING AMONG NEW MOTHERS Did you know that according to the CDC: An increasing number of women are dying from pregnancyrelated problems before, during and after their babies’ birth. More than half of all mothers’ deaths in the US happen after baby is born and goes home from the hospital. At least half of all pregnancy-related deaths among mothers are preventable! While some women may be at higher risk of developing complications than others, ALL women are potentially at risk of developing post-birth complications. If you are surprised by these facts, you’re not alone. WHY MATERNAL DEATHS ARE INCREASING Many moms return home from the hospital tired and overwhelmed with the excitement of a new baby. Naturally, you’re more focused
Images Cour tesy of Sarah Ducket t; AWHONN
Sarah Duckett had only been home from the hospital for a week with her second baby when she sensed something just wasn’t quite right. She didn’t feel like herself; something was off. Her heart was beating rapidly just from walking across a room. It was hard to get a breath in without coughing.
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Get Care for These POST-BIRTH Warning Signs
Most women who give birth recover without problems. But any woman can Learning to recognize these POST-BIRTH warning signs and knowing what to do can save your life.
POSTBIRTH WARNING SIGNS
Pain in chest
Obstructed breathing or shortness of breath
if you have:
Thoughts of hurting yourself or your baby
Bleeding, soaking through one pad/hour, or blood clots, the size of an egg or bigger
Incision that is not healing
Red or swollen leg that is painful or warm to touch
Temperature of 100.4°F or higher
Headache that does not get better, even after taking medicine, or bad headache with vision changes
Call your healthcare provider if you have: (If you can’t reach your healthcare provider, call 911 or go to an emergency room)
Trust . stincts your in medical
YS g e t ALWA you are not if re r a c well o feeling tions or s e u q have rns. co n c e
Tell 911 or your healthcare provider:
“I had a baby on ________________ and (Date)
I am having ____________________.” (Specific warning signs)
These post-birth warning signs can become life-threatening if you don’t receive medical care right away because: • Pain in chest, obstructed breathing or shortness of breath (trouble catching your breath) may mean you have a blood clot in your lung or a heart problem • Seizures may mean you have a condition called eclampsia •
mean you have postpartum depression
• Bleeding (heavy), soaking more than one pad in an hour or passing an egg-sized clot or bigger may mean you have an obstetric hemorrhage
• Incision that is not healing, increased redness or any pus from episiotomy or C-section site may mean you have an infection • Redness, swelling, warmth, or pain in the calf area of your leg may mean you have a blood clot • Temperature of 100.4°F or higher, bad smelling vaginal blood or discharge may mean you have an infection • Headache (very painful), vision changes, or pain in the upper right area of your belly may mean you have high blood pressure or post birth preeclampsia
My Healthcare Provider/Clinic: ______________________________________ Phone Number: ________________________ Hospital Closest To Me: __________________________________________________________________________________ 16002 ©2016 Associat ion of Women’s Hea lt h, Obstet ric, a nd Neonata l Nurses. A l l rig hts reser ved. Requests for permission to use or reproduce should be directed to firstname.lastname@example.org.
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healthy pregnancy on caring for your new baby. But it’s important to pay attention to your own health and be diligent in looking for signs and symptoms that could mean you’re having a postbirth complication—especially if this is your first baby. You may not know what’s normal or not, what to do or who to call. For example, some bleeding after birth is normal and expected and should decrease over time, but do you know how much bleeding is too much bleeding— to the point it potentially puts your life in jeopardy? The mother/baby nurses of AWHONN have created specific instructions for postpartum moms called “SAVE YOUR LIFE: Get Care for These POST-BIRTH Warning Signs.” Learn these post-birth warning signs because knowing how to recognize and respond to these specific signs and symptoms may help save your life. REDUCE YOUR RISKS FOR PROBLEMS IN AND AFTER PREGNANCY Do you know the signs of potentially life-threatening complications that could affect you after you give birth? Specific signs you should watch for during the fi rst year after birth include:
Pain in your chest Obstructed breathing or shortness of breath Seizures Thoughts of hurting yourself or your baby Bleeding that is soaking through one pad/hour, or blood clots the size of an egg or bigger Incision that is not healing Red or swollen leg that is painful or warm to touch Temperature of 100.4° F or higher Headache that does not improve, even after taking medicine, or bad headache with vision changes
If you think you are experiencing one of the post-birth warning signs, it’s important to get help and let the person responding to your needs know that you’ve just had a baby within the past year. For example, if you call 911, tell the operator: “I just had a baby a week ago, and I have a really bad headache that won’t go away.” Or “I had a baby on [give the date], and I am having some chest pain and trouble catching my breath.” Do this with any encounter you have when seeking help, whether it’s with 911, an emergency room or urgent care provider or your own healthcare provider. The sooner your nurse, midwife or doctor can identify your symptoms, the sooner they can make a diagnosis and provide the necessary care. Just as your nurse will share these instructions with you, please share this same information with your family and friends; you may not be able to act on your own, for example, if you’ve have had a stroke or seizure. Share this information with other pregnant moms you may know. Together, we can help ensure that no mom suffers injury or death because they didn’t recognize the signs of a post-birth problem. Sarah is a living testament to the old saying, “Knowledge is a powerful thing!”
LISA KLEPPEL, MPH, PMP, is the project manager for
AWHONN’s Postpartum Discharge Education Project, a project aimed at reducing maternal injury and death through education. She is also a mom, a doula and an educator in Washington, DC.
ACT ON YOUR INSTINCTS: GET HELP! You receive a lot of instructions when you leave the hospital with your new baby. Trust your instincts. If you feel something is wrong or you just don’t feel quite right, always call and get evaluated by your healthcare provider. If your symptoms worsen or you do not hear back from your healthcare provider, call 911 or go to the nearest emergency room. Learning the most common post-birth warning signs can save your life or the life of someone you love. Sarah’s pregnancy was uneventful—she never thought her own health would be at risk after birth
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#1 Choice Nursing Pillow by Lactation Consultants and millions of moms for 20 years
My Brest Friend is the only nursing pillow designed to perfectly position baby for latch-on while supporting mom’s body where she needs it most. Mom is comfortable and at ease, while breastfeeding. Baby is nursing, healthy and happy.
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One-handed velcro* adjustment. Silent release clip lets you remove the pillow without waking baby *Velcro adjustment feature available on Deluxe and Twin pillows only.
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revololution Join the rev olution
Join the baby box revolution with Pip & GrowÕ s Smitten Sleep System
Smitten was perfect for us. I was able to safely put Maddy to sleep in the living room, our room, or anywhere we happened to be, and she was always safe and comfortable. Way more convenient than a pack and play or crib, and I really loved that it had such a small footprint compared to other options out there. It is really beautiful too!
Ñ Kelly, mom to Maddy
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BABY’S BABY’S FIRST FIRST FRIEND FRIEND
very newborn deserves a very newborn deserves a safe and happy start. Enter safe and happy start. Enter the WubbaNub! The trusted the WubbaNub! The trusted nursery essential combines the nursery essential combines the soothing properties of a pacifier soothing properties of a pacifier with the warmth of a lovey. The with the warmth of a lovey. The adorable, intelligent invention adorable, intelligent invention was designed to lend peace was designed to lend peace of mind to parents thanks to a of mind to parents thanks to a secure, plush animal attachment secure, plush animal attachment and BPA-free, medical-grade and BPA-free, medical-grade silicone pacifier. A cinch to silicone pacifier. A cinch to clean and find, ‘Wubs’ ultimately clean and find, ‘Wubs’ ultimately become a child’s first friend. become a child’s first friend.
Beginning its 18th year of Beginning its 18th year of business, WubbaNub continues business, WubbaNub continues to wow parents, pediatricians to wow parents, pediatricians and hospitals everywhere. and hospitals everywhere. Super-popular classic animal Super-popular classic animal friends include Red Dog and friends include Red Dog and Green Frog, while new limitedGreen Frog, while new limitededition styles, Birthday Bichon edition styles, Birthday Bichon and Monster are now available. and Monster are now available. Beloved Panda and Moose Beloved Panda and Moose will also become “regulars.” will also become “regulars.” You simply can’t go wrong; the You simply can’t go wrong; the cuteness factor for all picks is off cuteness factor for all picks is off the charts. the charts.
Visit www.wubbanub.com to choose from Visit www.wubbanub.com to choose from a variety of animal friends that promise to a variety of animal friends that promise to aid in a sweet beginning with lots of smiles! aid in a sweet beginning with lots of smiles! 203-799-7633 | www.wubbanub.com
Pip and Grow - Wubba.indd 1
We support the American Academy of Pediatrics and the Consumer Product Safety Commission’s recommendation for practicing safe sleep habits. We recommend using the WubbaNub for observed napping and awake sucking. Please visit www.wubbanub.com/safety for more information.
for Moms & Babies
with the d da ngling bottles, Ditch the cords an mp pu pump your brea st innovative Willow nner wi ” of e a bra. A “best fits discreetly insid , ow Sh cs ni tro er Elec at the 2017 Consum red? brea stmilk untethe mp pu u yo ll wi where .com mp pu $430 at Willow Coming soon from
From innovative breast pumps to car seats that keep your tyke rear-facing up to 50 pounds, we’ve got the roundup of some of the most fun and parent-beloved new mom and baby products.
Dress for Success
On trend split-sleeve nursing dress is fashion first but tota lly functional before and after baby is born. Only you know it’s also easy access for nursing baby. $56 at MilkNursingWear.com
Double-take Breastfeeding Scarf
Is it an infinity scarf? Breastfeeding cover? Soft jersey wrap? Makeshift baby blanket? Yes to all of the great ways mom can use the Itzy Ritzy Nursing Happens Infinity Breastfeeding Scarf. $25 at Itzyritzy.com
Women Helping Women
She may be a mom but she’s still a woman who likes to glam it up— especially when it helps other women. This beautiful choker, as well as other necklaces and earrings, from BraveChick.com benefit charities focused on ending domestic violence and sexual assault. From $25 at BraveChick.com
Rock Star Shoes
Baby’s feet meet a natura l treat that promotes hea lth y foot development in these butter y sof t shoes. From $30 at Sof tstarshoes.com ISSUE 21 / 2017 Healthy Mom&Baby
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Go Wild, Baby
Cool New Ride
Delight and entertai n your little one with the clever and adorable creatures of Animal Ark, by Newbery Medal-wi nning author Kwame Alexander with photos from Nationa l Geographic photographer Joel Sa rtore. $15.99 at popular book sellers includi ng Amazon .com
Baby will stay comfy and cool no matter the weather with this fun stroller liner that cools in three ways with a top layer to wick away moisture, a bottom mesh layer to allow air to flow, and quilted channels to move warm air away. From $20 at SkipHop.com
A beloved parent favorite, the Da sh Diaper Bag is stylish enough for mom and practical for dads, too. $52 at SkipHop.com
Foolproof swaddling is gua ranteed with the Easy Swaddle that features adjustable snaps and an open weave muslin to reduce risk s of overheating. $25 from Adenandanais.com
Baby Joggers are perennial favorites with both moms and dads, and the City Tour convenience stroller doesn’t disappoint—“folds small for big adventures,” as they say. $199 at BabyJogger.com and online retailers.
Snuggle with the Snoggle
Dash Out in St yle
For 9 months, all mom really wants to do is get comfortable, which makes a pregnancy pillow a must. Leachco’s Snoggle is a parent favorite from $50 at Amazon.com
Baby, Stretch Your Legs & Your Car Seat
Now all kids can ride rear-facing with ease through age 2! The Graco Extend2Fit™ 3-in-1 car seat provides another 5” of leg room and holds kiddos rear facing up to 50 pounds, ensuring you can meet the AAP’s safe travel recommendations. $279 at most online retailers including Amazon.com
HMB19.new products.Rev2.indd 38
Importers of the finest organic European baby foods produced with the highest organic certifications in the world.
Organic Baby Foods
Free from GMO’s, MSG, synthetic fertilizers, pesticides, added sugars, food dyes, and unnecessary chemicals. A collection of primarily gluten & soy free products suitable from birth through 3 years of age. Products range from bottles, clothing, gifts, biscuits, teas, purees, cereals, and porridges with a variety of flavors and textures. All of our products are highly digestible with minimal ingredients used.
10% off your first order! code: healthybaby Valid until July 31st 2017
Where Learning Begins at Birth SmartNoggin Toys has created a line of toys like no other in the industry. Every toy is research-based and designed by early childhood experts to develop critical early milestones through play, beginning at birth. NogginStik® was designed to help parents, caregivers and early intervention therapists begin encouraging early milestones in infants. The NogginStik head lights up red, blue and green to stimulate a baby’s eyes and to encourage visual tracking. The base of the NogginStik makes a soft rattle sound to please the ears. It even has an easy-to-hold handle for mastering grasping. The toy’s fun textures delight baby’s sense of touch. Ages Birth+ NogginRings™ offers infants the chance to practice developing skills through play. The ﬂexible rings encourage batting, reaching, grasping and transferring from one hand to the other. Give it a shake and the rattling sound encourages baby to turn in the direction of the noise. Ages Birth+ The NogginSeek™ is designed for babies ages 3 + months. It promotes gross and ﬁne motor skills, cognitive and language learning. The toy features a clear sphere that baby can see and observe along with a textured handle that is sized for easy grasping. A striped tube slides in and out of the handle for visual interest and to encourage wrist rotation. Beads hide in the striped tube when the rattle is held upright piquing baby’s curiosity and encouraging awareness of object permanence. When baby shakes the toy, the movement of the wrist offers a lesson in physics, and ultimately, STEM learning. A Parent Guide to Baby’s Milestones is included in every SmartNoggin product. Everyone knows the ﬁrst three years of a baby’s life are a period of incredible growth and development. But those precious early months are also critical to achieving baby’s milestones. This guide will assure and alert parents (and grandparents) to monthly achievements from newborn to blowing out the candle on the ﬁrst birthday cake!
www.SmartNogginToys.com Udderly - SmartNoggin.indd 1
How to Choose
By Tamer a L. young, rn, mSn
the Right Breast Pump for You
a BreaST pump aLLowS you To conTinue feeding your BaBy BreaSTmiLk even when you can’T aLwayS Be There.
Congratulations on your decision to breastfeed your baby! You have made a thoughtful, healthy choice that research shows is best for you both. Now that you have decided to breastfeed, you’re also likely thinking of those times when you won’t be able to nurse your baby, like after you’ve returned to work, if you have to spend more than 2-3 hours away from baby, or if you develop a health condition that requires you to stop nursing for any period of time. Having a pump to express your breastmilk will keep both you and baby happy and ensures baby is fed. There are several types of breast pumps available, and the best type for you will depend on how often you need to pump milk for your baby and how easy it is to use and clean.
Manual versus powered puMps If you only need to pump breastmilk occasionally, a manual pump can be a good option. They’re portable and very affordable. These pumps work on only one breast at a time and do require “hand power.” We hear moms say they toss one of these in their purses or diaper bags “just in case.” Prices for these start at around $15 and go up. If you need more frequent pumping but are still home most of the time, then a mid-range battery-powered or electric pump could be your best bet. These pumps are usually very lightweight and portable and have the advantage of no-hand pumping! Pumping can be time consuming, so pay attention to how long it takes to express the desired ounces of milk you want to express.
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IMAGES © 123RF; ISTOCKPHOTO
These pumps may or may not have adjustable suction or cycle length like their more expensive counterparts. Durability is also a concern if you’re using these pumps more frequently. They may not hold up to the use designed for hospital-grade breast pumps. Prices for these pumps are typically $60 to $150. If you’re returning to work full-time or need to frequently pump and store milk for your baby, high-end electric pumps are best. After hospital-grade pumps, these are the most expensive pumps available; however, they’re also the most durable and customizable. You can fi nd pumps that will express milk from one or both breasts at the same time. They usually provide the fastest way to express your milk through variable cycle lengths and often the suction is also adjustable, which provides maximum comfort. Most models have battery backup available, as well as car adapters. They typically have attractive carrying cases for portability, breastmilk cooling and storage. Some of the latest devices on the market even have accompanying apps to help you track your pumping sessions! Prices for these pumps start at about $300. If you’re not ready to buy, hospitalgrade electric pumps are available for rent and are great for full-time pumping needs. Check with your hospital’s lactation consultant for more details. When renting pumps, you’ll receive your own accessory kit ensuring no other mom has used the pump parts that will come in contact with your breastmilk.
KEEP IT CLEAN! Experts at the FDA recommend taking these steps to keep your pump parts—and your milk!—clean and free from contamination: Use cool water to rinse pieces that come in contact with your milk as soon as possible af ter use Wash each piece separately with dish soap and warm water Rinse thoroughly with hot water Allow all parts to air dry If you notice tubing looking moldy or cloudy, replace it immediately Regularly sterilize your pump parts as directed by the manufacturer’s instructions
ER FE AT U RE FI N D
Which of these common features are important to you? Check all that applies and then compare your feature list to pumps you’re considering buying or renting: Double electric
pumps that pump both breasts at once
in addition to a wall plug
Simulates the way
a baby nurses at your breast
Easy to assemble,
disassemble, and clean
DOES YOUR INSURANCE PROVIDE A PUMP FOR YOU? Currently, the Affordable Care Act requires most health insurance plans to cover the cost of a breast pump for pregnant moms. Plans must also provide breastfeeding support, counseling and equipment while you’re breastfeeding. Th is applies to Health Insurance Marketplace plans and all other private health insurance plans, except for grandfathered plans. Contact your provider to see what specific equipment and breast pumps are covered under your plan. For more info, go to bit.ly/ACA_healthcare. Ask if you can acquire your pump during pregnancy—many plans will not make you wait until your baby is born to get a breast pump.
Freezer tote to
keep your breastmilk cool if you can’t use or access a fridge right away
Pump storage and
BUYER (OR RENTER) BEWARE Don’t purchase or use a previously owned personal-use breast pump—this includes both manual and electric pumps. Most breast pumps aren’t designed to be used by more than one mother; used pumps can harbor bacteria or viruses. Avoid sharing your breast pump with another mom— even with someone you know. Hospitalgrade pumps are manufactured differently and are designed to be used by more than one mother over the pump’s useful life. TAMER A L. YOUNG, RN, MSN is an expert advisor to Healthy Mom&Baby.
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Storing Breastmilk No more crying over spoiled (breast)milk! Use these tips to effectively store that precious liquid gold. Breastfeeding is the best, most nutritious way to feed your new baby. For those times when you have to be away from your little one, you’ll want to pump and store breastmilk. When stored properly, you can even freeze a breastmilk stash for months to come. Always wash your hands before pumping or handling breastmilk. Pump into clean bottles or storage bags designed for expressed breastmilk and that seal tightly. Always leave a little room at the top of the container because frozen liquids expand. This will help you avoid a big mess later. Clean your pump and storage equipment immediately after use with warm, soapy water and air dry. FOR THE FRIDGE Refrigerate breastmilk as soon as possible. Fresh breastmilk may be left at room temperature for 6-8 hours or stored in the back of your refrigerator for up to 5 days (120 hours). Date the containers, and if you’re sending breastmilk with your child to daycare, add their name. If you’re pumping at work or traveling and don’t have access to a fridge, bring a cooler bag with frozen ice packs to keep your milk cool for up to 24 hours. FOR THE FREEZER Store breastmilk in 1- to 4-ounce increments so you can get as much or as little milk as you need each time. Once frozen breastmilk is thawed, use it within 24 hours or discard. Never refreeze breastmilk. Freeze breastmilk as soon as possible, and store it in the coldest part of the freezer—never the door. Use frozen
breastmilk within 2 weeks if your freezer is inside of a refrigerator. Your breastmilk is good for up to 3 months in a separate freezer, such as a refrigerator/freezer where each compartment is separate either side-by-side or with the freezer draw below. You can safely store breastmilk for up to 12 months in a deep freezer. Label/date your bottles or storage containers and bags with the date you pumped the milk. Use the oldest milk first as you make your way through your stash. It’s also a best practice to never add fresh milk to already frozen milk; always pump and store fresh milk into a new container. FEEDING YOUR BABY To feed your baby pumped breastmilk, bring it to room temperature on the kitchen counter or in a breastmilk warmer. Never use a microwave to thaw or warm breastmilk; hot spots can form in microwaved foods and liquids and you risk burning your baby if that happens. For refrigerated milk, let the milk come down to room temperature before feeding your baby. For frozen breastmilk, thaw in the fridge as time allows. You can use a breastmilk warming device or try this simple method: Stand a bottle of pumped milk in a pan of warm, not boiling, water. Keep the water level above the milk but below the lid of the bottle to avoid contamination. Th is will also ensure heating throughout. Always swirl the milk as it’s heating to ensure even heat distribution. Don’t worry if the milk fat separates out; swirl the milk to remix it. Check the temperature of the milk on the top of your hand to ensure it’s safe for your baby. Discard any milk left in the bottle after feeding. SUMMER HUNT is the editorial coordinator at AWHONN and a writer for Healthy Mom&Baby.
IMAGES © 123RF
BY SUMMER HUNT
Fee breas d baby f r e t po s s i b m i l k w h e s h va l u a l e — i t c o n e v e r n b facto le antimi tains cr rs nutri , enzymes obial e be aff nts that m and e cted ay f ree z b y d ee p ing.
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The Pumping Professional: Success in Steps Brought to you by
If you are planning to pump at work, you are not alone. Every year millions of moms pump when they return to work.
PICKING YOUR PUMP
Prior to choosing a pump, be sure to check out all your options to ﬁnd the one that works best for you. Separately adjustable speed and suction allow you to better customize the settings your needs. A closed system pump prevents milk from entering the tubing or motor, and means fewer parts to clean.
About two weeks before you return to work, if you haven’t already, open your pump and sanitize the parts. Take time to get familiar with your pump and the diﬀerent pieces. Assemble and disassemble the pump a few times to get the hang of it. You’ll also want to download the Lansinoh Baby App to track your pumping sessions.
Once your pump is assembled, practice pumping. Try out some diﬀerent combinations of the suction and speed cycles to see what works best for you. This will help you ﬁgure out your pumping routine and help you identify any accessories you might need like Lansinoh® Simple Wishes™ Hands-Free Pumping Bra.
A couple weeks before returning to work, try to build up a freezer stash so that you aren’t pumping exactly how much baby needs for the following day. Trains get delayed and traﬃc happens. A little extra in the freezer gives you a lot of peace of mind.
As a breastfeeding mom headed back to work, one of the biggest transitions can be the switch from feeding at the breast throughout the day to pumping breastmilk at work. Lansinoh has a full line of products to help ease the transition including the Lansinoh® Smartpump™. Here are a few tricks to help get you in the swing of things.
PACK YOUR BAG
Your pump bag should hold your essentials plus a few *oopsie* items. Don’t forget your pump pieces or clean bottles for each pumping session. You’ll also need your cooler bag and ice pack to get that precious milk home. Toss in an extra shirt in for unexpected leaks and a few nursing pads just in case.
SET THE MOOD
At work, your body may need a little trickery to get in the pumping mood. A picture of your baby and a warm compress, like the Lansinoh® TheraPearl® 3-in-1 Breast Therapy Packs, wrapped around the pump ﬂanges will get help get those let-down hormones ﬂowing.
Pumping on your baby’s schedule will help keep your milk supply where it needs to be. Set a timer in the Lansinoh Baby App and do what you can to ensure you’ll be able to take about 20 minutes per session to pump throughout the day.
The Lansinoh Baby App connects directly to your pump and automatically tracks your pumping sessions along with your baby’s activities.
Ask your insurance provider about getting your Lansinoh® Smartpump
Lansinoh Laboratories Inc.indd 1
For the twenty minutes you spend pumping, think about your baby as a reminder that you are doing the absolute best for your baby.
SwaddleDesigns is the brand that so many parents trust
Stylish • Quality • Essentials
New parents around the world have wrapped their babies in soft cozy fabrics for thousands of years. This time honored tradition helps babies as they transition from the womb to the world. Our premium muslin swaddles are super soft and feature our helpful pictorial how to swaddle label with safe sleep reminders sewn to the edge of the blanket.
SwaddleDesigns founder is a registered nurse. Our newborn essentials are designed with baby’s best interest in mind and your style at heart. Our swaddles are more than a blanket - use as a burp cloth, play mat, privacy throw, and over the stroller. Recommended by nurses, doctors, and newborn care educators, SwaddleDesigns products are baby registry must-haves and favorite baby gifts.
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BY SUMMER HUNT
Safel y put ba by to sle ep w ith t heir A LO N A BC s: E , on t heir B AC K , in a CRIB or ba ssine t.
Room Sharing with Baby
Hey parents: Meet your new roomie—your baby. That’s right, pediatricians are advising you share your room—not your bed—with your baby for at least 6 months, ideally for 1 year. Baby gets their own sleep surface, though, and should always be placed on their back for sleep on a f irm surface such as a crib or bassinet, advises experts at the American Academy of Pediatrics (A AP) in recently updated sleep guidelines. And while those fuzzy toys and f luf f y bumpers may look adorable, they
IMAGES © 123RF; THINKSTOCK; COURTESY OF HALO
SKIP HOMEOPATHIC TEETHING TABLETS
Wailing babies sucking their fingers like nobody’s business are sure signs of teething discomfort, but skip the homeopathic teething tablets and gels as these are risky at best, the FDA has warned. In fact, the FDA has asked parents to stop using these products, which are sold by Walgreens, CVS, Hyland’s and others. The FDA warns some babies have experienced seizures, difficulty breathing, lethargy, excessive sleepiness, muscle weakness, skin flushing, constipation, difficulty urinating and agitation after receiving these products. Seek emergency care if you’ve given your child teething tablets or gel and observe any of these signs in your baby.
have no place in baby’s crib as they can pose suf focation risks, the kids’ docs warn. We know you’re struggling to keep your eyes open during those late-night feedings, so guidelines advise you to opt for nursing baby in your bed instead of a couch. A AP still recommends against bed-sharing, but your bed is safer for baby than a sofa should you fall asleep with baby in your arms. Get all of the new recommendations on p54.
MEASURE MEDICINE MORE PRECISELY WITH A SYRINGE Give your baby the most accurate dose by using an oral syringe, rather than a measuring cup, says the National Institutes of Health, which measured that as many as 84% of parents give the wrong dose when pouring medicine into a measuring cup, especially when dosing instructions aren’t clear. Next time you pick up any type of medication for your little one, toss the plastic cup that comes with the product and ask your pharmacist for a well-marked oral syringe.
ISSUE 21 / 2017 Healthy Mom&Baby
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BY CELESTE R. PHILLIPS, RN, MSN, EDD
Why Is My Baby Crying?
IMAGES © 123RF; ISTOCKPHOTO
She appears to be dreaming. Her eyelids may flutter, facial expressions may change, and she may make sucking sounds. She may move and her breathing is not as regular as in deep sleep. Again, watch but don’t disturb or soothe baby unless it seems to help calm her.
Babies cry. Nature has designed your baby’s cry to be disturbing, to get your attention. Your baby is trying to communicate. Babies cry for lots of reasons. They might be hungry or thirsty. Perhaps they’re uncomfortable, or having gas or other pain. Sometimes babies are lonely or just want to be held and loved. Other times a change in routine, a new experience or feeling tired is enough for a baby to start crying. When infants cry, it’s our challenge to figure out why and soothe them.
WHEN BABIES CRY Babies typically cry during different stages of sleep and wakefulness. If you can recognize the stage your baby is in, you can use this information to follow her cues and better soothe and communicate with her.
PURPLE CRYING Sometimes young babies tend to cry without reason—and just because you can’t soothe them, it doesn’t mean you’re doing a bad job. Their crying is perfectly normal. All babies go through a period of increased inconsolable crying between ages 2 weeks and 2 months and continue for a couple of months; it’s called the Period of Purple Crying. Experts consider it a normal stage of development for every baby. Don’t be surprised if what typically calms or comforts baby doesn’t work. Ask your partner or relative for extra help if you need to take 5-10 minute breaks from baby’s crying during these episodes.
Baby is sleepy, and she may be waking up or falling asleep. Watch for yawning, unfocused eyes, and droopy eyelids. Help her awaken or drift off to sleep to soothe her tears.
Active alert Her eyes are open, as in the quiet alert state, but she has bursts of movement involving her whole body. Her breathing is irregular and she may be fussy. This state often occurs before a feeding; this may be your cue she’s starting to get hungry. Time to encourage interaction and distract her from her crying!
Your baby is very still except for an occasional startle or twitch. Breathing is smooth and regular. This is no time to disturb her.
Baby is awake, alert and relaxed; her eyes are open and bright. Her breathing is regular. She will look into your eyes, respond to your voice and may even mimic your expressions. This is a great time to encourage interaction and distract her from her crying!
CELESTE R. PHILLIPS, RN, MSN, EDD, is president of Phillips and Fenwick Inc., and a passionate expert and advocate on mother-baby nursing and care. ISSUE 21 / 2017 Healthy Mom&Baby
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Nobody likes to be rushed, especially babies. Your baby needs at least a full 40 weeks of pregnancy to grow and develop. Inducing labor even a week or two early is associated with a host of risks, including prematurity, cesarean surgery, hemorrhage and infection. While it may seem convenient for you or your health care provider, labor should only be induced for medical reasons. Your baby will let you know when 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
BY CANDACE CAMPBELL, DNP, RN, CNL
Is your newborn’s skin yellowish? Do you see yellowing in your baby’s eyes? Newborn jaundice occurs in just more than half of all babies born at term and in most (80%) preterm babies. It typically appears around day 2 or 3 post-birth, peaks at day 5, and clears by the end of baby’s first week. HOW JAUNDICE BEGINS Imagine you’re a baby, f loating happily in the safety of your mother’s womb. Since your lungs aren’t active during this zero gravity experience, oxygen circulates through your body via a special form of hemoglobin that attaches to your red blood cells (RBCs), which carry it out to your body through your blood superhighway. At birth, your lungs inf late and you take your first breath. Since breathing is a much more efficient way to deliver oxygen, your brain sends a message to your liver (your recycling plant) to start breaking down extra RBCs. As your RBCs start to break down, they produce a substance called bilirubin. Jaundice happens when bilirubin builds up faster than your liver can pass it through your intestines to exit your body. A newborn’s liver can get overwhelmed by the work (think traffic jam). Excess bilirubin shows up as a yellowish color in your skin or eyes.
WHAT IF IT GETS WORSE? Jaundice is typically harmless. At low levels, jaundice may mean your baby has an infection or a thyroid problem, say experts at the Mayo Clinic. This is why experts at the American Academy of Pediatrics advise all newborns be screened for jaundice during their first few days of life. However, if the back-up of bilirubin in the blood reaches dangerously high levels, it can cross baby’s blood-brain barrier and cause severe, permanent mental delays. Other rare but serious side effects include cerebral palsy or deafness. Your care provider will measure the bilirubin circulating in your newborn’s body with either a blood test or bilirubin meter. If your provider asks you to come back within a few days to have your baby’s levels checked, be sure to keep that appointment! HOW IS JAUNDICE TREATED? Low-level jaundice usually clears on its own within baby’s first week of life. If your baby’s blood levels of bilirubin are in the high-risk range, the most common treatment is phototherapy under a light specifically designed to break down bilirubin. This may take a few days to accomplish. Jaundice is more common in breastfed babies; experts recommend that you continue to nurse your little one to help him stay hydrated.
IMAGES © 123RF
Boys a more p re r to jaun one dice than gi rls.
R IS K FAC T O FO R JAU N R S D IC E
Premature birth Bruising/birth
is most common in Asian babies) Previous sibling with jaundice requiring phototherapy Babies born to moms with diabetes or gestational diabetes Blood incompatibilities between mom & baby
OTHER CAUSES OF JAUNDICE Internal
bleeding, hemorrhage Viral, bacterial or blood infection Liver malfunction Enzyme deficiency Red blood cell abnormality
CANDACE CAMPBELL, DNP, RN, CNL, is an expert advisor to Healthy Mom&Baby.
ISSUE 21 / 2017 Healthy Mom&Baby
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THAT NURTURES YOUR BABY BY CHARLOT TE WOOL, PHD, RN
Diapering can be a time of healthful bonding between you and baby—and for baby’s development, it can mean so much more than just a clean, dry bottom.
ON -TH E-G O DIA PER ING
Keep that calm and clean mindset as you diaper on-the-go. First, choose a safe surface and wipe with cleansing wipes. Lay baby on a protective changing pad. While diapering, keep one hand on baby at all times to prevent falls. Keep a wellstocked diaper bag:
Hand sanitizer Changing blanket or spread Fresh diapers Disposable wipes Change of clothes for baby Disposable bags to seal soiled diapers before discarding Small, soft toy for baby to touch or hold
Before you ever change your baby’s first diaper, isn’t it nice to know you can also help baby grow stronger and healthier during these times? Initially, you’ll change up to 12 diapers a day—that’s up to 12 opportunities to hug your baby close to you, connect, bond and form fun rituals together that turn the ordinary diapering into something extraordinary. MINDFUL MOMENTS DURING DIAPER TIME Diapering is the perfect time for mindfulness in your care. Mindfulness means being completely engaged in the present moment. It’s taking your life off autopilot; paying attention to each and every second with your baby; and becoming aware of baby’s moods, movements, expressions and most importantly, baby’s cues.
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 experience with 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 diaper changes to minimize any stress or discomfort Champion sleep through 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 Source: Adapted from Huggies® Every Change Matters: A Guide to Developmental Diapering Care
IMAGES © 123RF
What if you learned that the everyday act of diapering could promote and support your baby’s health and development? That the routine actions of moving, touching and caring for your baby and their skin during a diaper change could create trust, connection and a surge of positive emotions that support baby’s overall health and wellness? Diapering can be enjoyed and beneficial for baby—not just endured—say the experts of the Huggies® Nurse Advisory Council. Their new program, Every Change Matters: A Guide to Developmental Diapering Care, explores the research regarding how the very simple act of diapering provides healthful and developmental opportunities for bonding, attachment, closeness, stress reduction and comfort between you and your infant.
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PREEMIE POINTERS Create a sensory symphony with your soft voice, gentle touch, slow and careful movements, and with a sing-song voice sweetly talk or sing to baby. Keeping one hand on baby during diapering is a safety measure but also becomes a reassuring touch, especially if baby should startle or move suddenly. Smile at baby. Create calm and happiness by gazing into baby’s eyes—spend a few moments making that emotional connection. Babies love to look at and interact with others, and research tells us that they quickly recognize and enjoy seeing family members, especially their parents. Regularly hug, touch and love your baby—every diaper change can begin and end with a hug! Research proves the power of touch is linked to positive feelings and uplifting emotions for both you and your baby. When you’re relaxed and engaged, baby feels connected through your touch and attention. Your calm demeanor reassures and calms baby through the movements, cleansing and dressing of diapering. Your focused attention and touch are what baby needs to f lourish and thrive! Changing so many diapers may feel like an impossible task at first, but when every diaper change is approached with the physical and emotional desire to connect and bond with baby, it becomes another way you’re supporting baby’s best health and development.
CHARLOTTE WOOL, PHD, RN, is a nurse educator and an expert adviser to Healthy Mom&Baby. Development of this article was supported with funding from Huggies®.
Premature babies (born before 37 weeks of pregnancy) need extra attention and care. When it comes to diapering for a premature baby, a calm environment is especially important. Create a comforting diapering space for your preemie baby by: Keeping loud noises to a minimum Controlling the lighting to avoid a bright light Maintaining a constant, comfortable temperature in all changing areas Limiting unpleasant odors
NEWBORN SKIN CARE ONLINE
Get more newborn skin care advice from nurses, particularly on diapering and preventing diaper rash, online at bit.ly/newbornskin
ISSUE 21 / 2017 Healthy Mom&Baby
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Did you know that some of the products you put on your skin can end up in your blood stream within seconds? Yikes! That means ingredients in your kiddo’s lotion, washes, balms,etc. can wind up in their little bodies. Double yikes! It makes you wonder what kind of ingredients are getting into your child’s system, doesn’t it? Why go organic? For starters, some moms want to avoid harsh chemicals, synthetic ingredients, perfumes, dyes, mineral oil, parabens, hormone disruptors, etc. Discover e•raorganics, an organic skincare line that will not only leave your baby’s skin soft and clean but also healthier and stronger. e•raorganics uses food grade, organic ingredients to strengthen and nourish your baby’s skin during these crucial formative months. e•raorganics is one of the few fully USDA Certified Organic skincare brands for moms and babies on the market. These products are designed to give everything your baby’s skin needs and nothing it doesn’t. Nothing but the best for you and your baby.
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healthy babies Caring for your baby’s skin is easy when you know the basics. Most babies enjoy having their skin gently rubbed and massaged. But they don’t come with owner’s manuals recommending how often they should be bathed, slathered and pampered.
Keep Baby’s Skin Supple
Ch e c N ew k O u t O ur bo Ca re r n Sk in Zon e: b new it .ly/ bor n sk in
All Year Long By AWHONN EditOriAl StAff
There’s nothing quite as wonderful and amazing as newborn skin. It protects baby from bacteria and germs, and helps their body hold a normal temperature. As you strive to keep your baby’s skin healthy, beautiful and soft, it’s important to use products made specifically for newborn or infant skin.
Are lotions sAfe for bAby’s skin? Lotions made for babies can help moisturize your baby’s skin. Always choose lotions made for infant skin, say the nurses of the Association of Women’s Health, Obstetric & Neonatal Nurses in their latest Newborn Skin Care Evidence-Based Guideline. When you apply lotion, use this time to massage and interact with your baby. Most babies crave this ritual and closeness with their mom or dad. If baby’s skin feels rough or dry to you, use a small amount of infant-specific moisturizer. If the dryness in baby’s skin doesn’t clear up, ask baby’s healthcare provider if rash or another skin condition could be an issue. To prevent irritation, use lotions that are fragrance-free, as some fragrances may irritate or cause a rash. It’s important to avoid using products that aren’t made specifically for baby’s skin as they may contain ingredients that could irritate baby’s sensitive outer layer. ChAnge in bAby’s skin Through the first year of baby’s life, you may be shocked or surprised to find that your baby’s skin may be irritated by soaps or detergents used to wash their clothing or bedding. Opt for infant-friendly detergents and cleansers and double-rinse baby’s laundry for their first year of life. You may even choose to wash baby’s things apart from the rest of the family’s clothes. As your baby grows, don’t hesitate to ask your nurses about baby’s particular skincare needs, such as if baby has a rash or if you’re unsure of what types of baby-specific products to use for cleansing, moisturizing or sun protection.
ProteCt bAby’s skin from the sun
images © 123RF
Most parents immediately think of bathing and diapering first when it comes to caring for their little one’s skin. But all babies need protection from the sun from birth regardless of their age, race or skin color. to protect baby’s skin:
Avoid direct sun exposure during baby’s first 6 months by covering baby with clothing and hats with brims shading the head and neck to prevent sun exposure and potential sunburn
Prevent sunburn from 6 months on by using a small amount of an infant-safe sunscreen with a Sunscreen Protection factor (SPf) of at least 15
Choose infant safe sunscreens: Check the label to ensure it protects against ultraviolet rays A and B; also, choose a sunscreen specifically for infant skin and that won’t sting baby’s eyes
ISSUE 21 / 2017 Healthy Mom&Baby
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What’s New With Safe Infant Sleep? By Sharon hitchcock, MSn, rnc
As a nurse, I am all about prevention. The latest safe sleep recommendations are based on what experts have learned are known risk factors for sleeprelated infant deaths. As a mom, I also get the need for sleep. During my second pregnancy, I worked full time, chased around a two-year-old, and developed insomnia! Prior to going into labor, I was exhausted. I went home with my newborn even more exhausted, and I stayed that way for a long time. I understand the desperate need for sleep that parents feel. Safe Sleep effectS on familieS For families, some of these recommendations can create gut-wrenching dilemmas as not all of the guidelines are easy to follow, and babies don’t always cooperate. Nevertheless, one fact keeps me passionate about promoting safe sleep: Every year in the US, 3,500 infants die suddenly and unexpectedly while sleeping. Many of these deaths are due to sudden infant death syndrome (SIDS), accidental suffocation, entrapment, and strangulation. This is almost 10 babies a day. While some SIDS cases can’t be prevented, most sleep-related deaths occur in unsafe sleep environments—and these deaths are preventable. As a parent, there’s so much you can do to help your baby sleep safely. Most of the time, the parents I counsel simply don’t know all of the recommendations or understand the reasons for them. new Safe Sleep GuidelineS In October 2016, the American Academy of Pediatrics (AAP) published updated safe sleep recommendations and guidelines that acknowledge the realities and
dilemmas parents face. We’ve got the full list of recommendations in this article, and here’s an overview of the changes since perhaps your last childbirth education or parenting class: Back to Sleep: This is still the most important safe sleep “rule.” Studies have proven babies don’t choke more on their backs because their feeding tube (esophagus) is positioned below/behind the airway tube (trachea). Thus, when a baby on their back regurgitates fluid, it will pool next to the esophagus, not the trachea. The opposite is true when babies are on their tummies. And side-positioning isn’t recommended because infants may roll over too soon when put to sleep in this position. They may not be strong enough yet to move themselves out of danger, such as from blankets. SwaddlinG: This is considered safe and can help calm baby as they fall asleep on their back. It can also be dangerous if not done correctly. Safe swaddling includes these actions: • Baby must be on their back only—not their side or tummy • Swaddle should be snug (but not tight) around the chest and hips Once baby is trying to roll over, stop all swaddling— this can happen as early as age 2 months. You can purchase swaddle sacks; they’re a good alternative to swaddling with a thin blanket (as done in many hospitals). BreaStfeedinG: Nursing your baby is shown to reduce infant death risks—experts can’t emphasize and recommend breastfeeding strongly enough. Breastfeeding can reduce the risk of SIDS by as much as 50%! Exclusive breastfeeding is best, but some is better than none. Skin-to-Skin: Going skin-to-skin with your little one is safe and highly encouraged as it promotes breastfeeding. Just make sure to return baby to their own sleep space when you first begin to get sleepy. It’s not safe if you fall asleep with your baby skin-to-skin.
PUT YOUR BABY TO SLEEP SAFELY EVERY TIME: AAP’S SAFE SLEEP RECOMMENDATIONS 1. Get regular prenatal care during pregnancy—this gives baby the best possible start
8. Don’t smoke during or after pregnancy and baby’s birth
2. Baby on their back to sleep for all sleep, starting at birth. Side and stomach positions are unsafe
9. Avoid alcohol and illicit drugs during pregnancy and after baby is born
3. Baby sleeps on a firm sleep surface, such as a firm infant mattress in a safety-approved crib, play yard, or bassinet
10. Baby sleeps in a cool room: Avoid overheating baby and covering baby’s head during sleep
IMAGE: Shut terstock , Think stock
4. Breastfeeding is protective; exclusive nursing is best, but any amount is better than none 5. Room-share without sharing a sleep surface: Couches and armchairs are more dangerous than an adult bed. No bed-sharing situations have been found safe 6. No blankets, pillows, and other loose items in baby’s sleep area 7. Pacifiers are protective
11. Ensure baby gets all scheduled immunizations according to current recommendations 12. Skip monitors or devices marketed to reduce the risk of SIDS 13. Avoid commercial products, such as wedges or positioners, which are inconsistent with the safe sleep recommendations. These are not proven safe and have created hazards for baby 14. Provide “tummy time” when the baby is awake and supervised
ISSUE 21 / 2017 Healthy Mom&Baby
Snuza’s Newest Wearable Monitor Connects Parents to Baby While They Sleep us.snuza.com
The revolutionary new Snuza Pico wearable baby monitor attaches directly to your baby’s diaper and alarms if no abdominal movement is detected. If there is no abdominal movement detected after 15 seconds, the device will vibrate in an effort to rouse your baby awake. After 20 seconds of no abdominal movement, the Pico will alarm. The Snuza Pico is the first wearable baby movement monitor in the Snuza line that allows parents to directly connect to a smartphone or tablet via a Bluetooth App. The App, which is Apple and Android compatible, also monitors your baby’s skin temperature, sleeping position (side, face-down, face up) and is a fall detector.
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HIGHLY DANGEROUS BED-SHARING SITUATIONS 1. Baby is 4 months old or younger 2. Baby was born premature or with low birth weight 3. You or your partner smokes 4. You smoked during pregnancy 5. You or your partner take drugs 6. You or your partner take medications that cause drowsiness 7. If you or your partner have drank any alcohol
IMAGE: Shut terstock , Think stock
8. If your partner is not a parent 9. The sleep surface is soft, such as an old mattress, waterbed or a pillow-top mattress 10. The sleep surface is a couch, sofa, or armchair 11. There is soft bedding, like pillows or blankets, in the bed
ISSUE 21 / 2017 Healthy Mom&Baby
healthy babies Room-shaRing: Parents—you’ve got a new roommate. This is actually a recommendation that continues from previous advice—that baby should sleep in their own safe infant bed in your room, such as a safe crib, bassinet or play yard. Many parents tell me the play yard is more useful than a bassinet as it can accommodate a sleeping child up to age 1 and is portable, making room-sharing easier. Room-sharing offers the same benefits as bedsharing, is safer than baby sleeping alone in their own room or nursery, safer than bed-sharing (or sharing the same sleep surface, such as on a bed, couch or armchair), and room-sharing decreases the risks of all sleep-related deaths by 50%! The Consumer Product Safety Commission (CPSC) has recently published safety standards for some of the new bedside sleepers that attach to the adult bed, though the AAP does not advise about their use. in-bed sleepeRs: These products, which are designed to give baby their own space in your bed, are still questionable. They haven’t been thoroughly studied, and the CPSC hasn’t created safety standards for their use. In time, we may learn more about whether in-bed sleepers are a safe option. bed-shaRing: This is still a controversial topic that I find many parents would rather not discuss. What makes this topic confusing is the mix of research results. There is strong evidence that bed-sharing is not safe, and so the AAP recommends against it. There is also research that shows bed-sharing is good for bonding and comforting and makes nighttime feeding easier. Most healthcare providers agree, however, that the risks of bed-sharing outweigh the benefits. While some parents will choose to sleep with their babies because of the benefits, research has shown that many will bed-share unintentionally by accidentally falling asleep with baby in bed. It’s so hard not to fall asleep with your baby when feeding at night. The experts at the AAP recognize this and offer the following advice anytime you’re feeding your baby at night and you might fall asleep: Feeding baby in your bed is much safer than on a couch or armchair, both of which are highly dangerous. To reduce the risks of bed-sharing, then, make sure your bed is as safe as possible for baby: • Keep blankets, comforters and pillows away from baby in case you fall asleep • Put baby back in their own safe crib or bassinet as soon as you get drowsy; if you doze off, put baby in their own bed as soon as you wake up • Consider setting an alarm when you begin to nurse baby at night Studies show that the longer you are asleep with your baby in your bed, the more dangerous it is. See the AAP’s 58
list here of highly dangerous bed-sharing situations that should be avoided at all times: • Sleeping with an infant younger than 4 months of age • Sleeping with a baby born preterm or with low birth weight • Sleeping with a parent who smokes or is impaired by alcohol or drugs—even prescription or over-the-counter medications • Sleeping together on a soft surface such as a couch, sofa or arm chair, or with loose bedding pacifieR: Research supporting using pacifiers to reduce SIDS death is only growing stronger. Studies show that using pacifiers can decrease an infant’s SIDS risk by 50-90%! How pacifiers protect babies from SIDS isn’t fully known, but to gain the benefits, offer a pacifier as soon as possible after birth or after breastfeeding is going well, which is usually within the first 3-4 weeks of baby’s life. During sleep, once a pacifier drops from baby’s mouth, there’s no reason to put it back in place. soft oR loose bedding: Infants rolling into or getting covered by soft or loose bedding continues to be a common cause of death, especially in infants older than 3 months, when they are beginning to roll over. Make sure to continue to keep the crib empty of bumper pads and all soft, loose, or fluffy items until the infant is 12 months old. infant seats oR ReclineRs: Finally, while no one is fond of disturbing a sleeping baby, infant gear including car seats, strollers, swings, bouncy chairs and slings aren’t recommended for routine sleep, especially for babies ages 4 months or younger. The pediatricians at AAP advise that if your baby falls asleep in one of these devices, move them to an infant crib or bassinet as soon as safe and practical. shaRe these Recommendations to pRotect baby As a nurse, mom and new grandma, I want to do everything in my power to teach parents about safe infant sleep—and keep that conversation going, even when it’s controversial. Do your friends and family know the recommendations and steps they can take to reduce a baby’s risk for sleep-related infant death? While some parents would rather not discuss the topic, the more we talk and help each other problem-solve unsafe sleep situations, the more deaths we can prevent. Thankfully, the goal of the AAP has remained unwavering, and that is to ultimately eliminate sleeprelated deaths entirely.
Sharon hitchcock, MSn, rnc, is faculty for the University of Arizona College of Nursing in Tucson, AZ.
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Car Seat Safety First By Carolyn Davis CoCkey, Mls, lCCe
3 out of 4 babies and toddlers ride in car seats that aren’t properly installed—a statistic that both frustrates and scares many parents. Use these tips and checklists to help your child travel as safely as possible every time you roll down the road. Safe RIDe CheCklIST Our friends at SafeKids.org recommend these top 5 checks to ensure your child’s seat is safe and ready to protect your little one. The National Highway Traffic Safety Administration also lists car seat inspection stations. 1 Right Seat: Is the seat appropriate for your child’s age, weight and height? Babies and toddlers grow fast; regular checks ensure your child is in the right seat for their size. 2 Right Direction: Experts recommend your baby ride rear-facing for as long as possible, which is typically around age 2. Once your child is ready for a forward-facing seat, use a top tether lashed to the back of the seat base in addition to the a nchors o r s eat b elt t hat f irmly h old t he s eat in place. 3 Inch Test: After installing the seat, give it a good shake at the base—it shouldn’t move more than an inch, if any at all. 4 Pinch Test: With your tyke secured by a 5-point harness, and the chest strap aligned with their armpits, pinch the strap at your child’s shoulder—you should not be able to pinch any excess webbing. 5 Right Place: The backseat is where all VIPs— very important persons—ride. This is where all of your children belong until at least age 13. CaRolyn DavIS CoCkey, MlS, lCCe, is editor of
Car Seat Do’S anD Don’tS
Buy new—a car seat that has been involved in a crash is no longer useful. Buy used only when you know the previous owner personally and can be certain the car seat has never been af fected by an accident or problem
Check the expiration date on the car seat label.
Materials break down over time, and every car seat has a set useful life, which is typically no more than 6 years, says the Mayo Clinic
Sign up for recalls with the seat’s manufacturer, even on a brand new car seat
Provide only soft toys during the ride; secure hard toys and any loose objects in the vehicle so that they can’t injure your little one in the event of a sudden stop or impact
Buckle baby while bundled in their coat or a blanket; add soft items for warmth or comfort only after baby is safely buckled in without additional layers between them and their car seat straps
Use the car seat as a sleeping surface or crib replacement as depending on your own child’s development, sitting upright in a car seat might compress a newborn’s chest and reduce air flow Install the seat without reading the manufacturer’s instructions as well as the instructions regarding car seats in your vehicle’s owner’s manual; when in doubt, have your seat checked for free by a car seat technician Progress your child to forward-facing, booster or using the car’s seat belt only too soon; use the correct seat for your child’s height and weight until they’re big enough to use an adult seat belt, which is generally between ages 8-12, and at least 4’9” tall
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Before bedtime stories, preschool, and music lessons...
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It’s a Sign! By Awhonn EditoriAl StAff
with your hands fisted in front of you, extend your pointer fingers so that they are pointing at each other. Bring them together until your fingers touch, repeat.
Place your whole hand, fingers splayed, over your face—covering your eyes. Pull your fingers together in a pinch as you drag your hand down your face, ending with your fingertips on your chin, eyes closed.
I lovE you
hold your hand in front of you, fingers open and thumb extended; fold down the two fingers between your index and pinky fingers.
with one hand, bring your pinched fingers to your mouth and tap your lips.
with both hands, tap your pinched fingers together in front of you.
images © 123RF; shut teR stock
It will take time before you and your baby can have a conversation—but that doesn’t mean you can’t communicate with baby signs! When you first hold your baby in your arms, he feels how much you love him just by how you hug him close and shower him with kisses. You try your best to decipher his cries: Is he hungry? Does he need a diaper change? In the stages between itty-bitty baby and when your child can verbally ask for what he needs, you can make use of baby sign language. If your baby follows your moves with her eyes or tries to mimic your actions, she’s probably ready to learn to sign. To teach your baby, do the sign with your hands as you say the word and do the action. Use the same sign with the same word and action every time. Even though your baby might not yet be able to sign back to you, it’s a good idea to start early. Here are some of the most popular signs to practice with your baby:
hold both hands in front of you, palms facing toward you, then palms facing out, repeat.
hold your open palm in front of your face, with your thumb pointing toward your chin. Bring your hand in toward your face, tapping your thumb to your chin.
hold your open palm in front of your face, with your thumb pointing toward your forehead. Bring your hand in toward your face, tapping your thumb to your forehead.
touch your thumb to your chin with your pointer finger raised and other fingers closed. Swoop your hand down to rest on the top of your other hand in front of you, repeat.
touch your thumb to your forehead with your pointer finger raised and other fingers closed. Swoop your hand down to rest on the top of your other hand in front of you, repeat.
ISSUE 21 / 2017 Healthy Mom&Baby
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Baby Gear ADvERTISING PROMOTION
out Checkarentthese proved app ites! favor
Babylonia Everlywell F lexia Carrier Keep baby close! The new Flexia Carrier from Babylonia is the only baby carrier you need from birth to 3. Each carrier comes with 3 different sized panels that act as baby’s seat, zipping in for a secure fit! Flexia is organic and ensures that baby is supported knee to knee, promoting hip health. Available at www.FlexiaCarrier.com
Pip and Grow Baby Plus
Everlywell’s at-home Breastmilk DHA Test was designed to empower breastfeeding mothers by providing them with a way to know more about their breastmilk. DHA is a vital Omega-3 fatty acid that plays a crucial role in the first 2 years of a child’s development, including visual acuity, cognitive development and more.
Join the baby box revolution! Designed by a leading safe-sleep expert, the Smitten Sleep System is chic, lightweight and easy to move from place to place ensuring safe sleep is always close at hand. Experience what European families have been celebrating for decades. Smitten is proudly made in the USA.
BabyPlus is a developmentally appropriate set of sounds that introduce patterns to your baby in the only language he/she understands—the maternal heartbeat. As a baby compares the simple rhythmic sounds of BabyPlus from those of the mother, learning and enrichment begin. To learn about the remarkable benefits, go to
Get ready to blast off with the Lamaze Stacking Starseeker. This spaceship separates into 4 segments that baby can use to foster motor skills by stacking up, taking apart and putting back together. The plush figure and starteether encourage put-in and takeout play, while the crinkles and bright patterns stimulate the senses.
The Snuggle Pod by Chibebe was originally designed to relieve symptoms of GERD reflux, allowing you to mold the beans to any position including flat on an incline or upright. The Snuggle Pod molds to your baby’s head instead of the other way around. It even alleviates symptoms of LM. Select your Snuggle Pod today at
Created by a mom, WubbaNub is the original pacifier-andplush combination. All WubbaNubs are latex-, BPA-, and Phthalate-free and made with a medicalgrade silicone pacifier. The patented design permanently attaches the pacifier to the plush toy making it easy to grasp, nearly impossible to lose, and instantly comforting. WubbaNubs are baby’s first friend.
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West 4th Wraps are soft and mould to your body to give you support and comfort during pregnancy, and to carry your baby until they are a toddler and beyond. Our wraps are used for comfort measures during pregnancy, for temporary support of mom’s belly, to apply counter pressure in a hip squeeze, and for partner for assisted squats. Carrying your baby in a West 4th Wrap or RingSling allows for skin to skin contact, that develops an amazing bond between baby and mom and other members of the family.
Use coupon code “HealthyMom” to receive 10% off your purchase
Protect your baby from the effects of GERD reflux, flat head syndrome and LM (laryngomalacia) The Snuggle Pod by Chibebe is the original baby bean bag! The amazing design of the Snuggle Pod has been proven, through in home use, to help your baby get needed relief from Gerd Reflux and LM during their awake times. It also molds to your baby’s head preventing flat head syndrome. It is easy to clean by simply removing the inner bag liner and washing the rest. You can even add accessories such as the Pod Warmer and Pod Rocker when they need that extra warmth and movement. Your baby will get the comfort and relief they deserve while you get the amazing styles, ease of use, and security of knowing your baby is safe. Get yours today at www.chibebe.com.
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… s I e y Nam MM BY S U
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S IR IS H FAVO RI TE YS FO R BO
M ES TOP 5 BA BY N A YS O FOR G IR LS & B
Declan Charlotte Atticus Ava Oliver
Declan Aidan Liam Finn Killian Ronan
POPULAR FLOWERY NAMES Rose Violet Iris
FROM TOP NEW NAMES GS PL ACES AND THIN
Arrow & Zeppelin (twins) Aspen Dream Major Tiger Hero Justice
Ace Maverick Story Boomer Winner Luna Heiress Eros
Poppy Lily Daisy
IMAGES © 123RF
Would a baby named Rose be as sweet by any other name? How will you choose your baby’s name? Will you go with a family name, venture out with a trendy moniker, or stick to a timeless classic? Are any of the names on our lists of what’s trending or making a comeback on your list of favorites?
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The power of hugs.
What hugs mean to baby. Over 600 medical studies on the effects of human touch prove what moms have always known: Hugs are important. In fact, more and more hospitals state that they are vital to the healthy development of a child. And the beneﬁts of human touch for babies often extend throughout childhood.
The beneﬁts of hugging. Every hug sets off cascades of hormones that beneﬁt health and help regulate body temperature. Oxytocin, the hormone released by touch, is even nicknamed the “bonding hormone.” A hug can stabilize heart rate, increase oxygen levels, strengthen the immune system, and reduce crying and stress.
How will you greet your babies? After the ﬁrst hug, let the second thing that touches baby’s skin feel just as good. Huggies® Little Snugglers Diapers and Huggies Natural Care® Wipes provide our best care to help keep their skin clean and healthy. And as perfect as the day they were born. www.huggieshealthcare.com ® Registered Trademark and * Trademark of Kimberly-Clark Worldwide, Inc. © KCWW. © Disney. Based on the “Winnie the Pooh” works by A.A. Milne and E.H. Shepard.