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ISSUE 27 / 2019 | $3.95 |


CONTAINER BABY SYNDROME Avoid this Complication


PLAN FOR YOUR 4TH TRIMESTER How to Thrive Post-Birth


SEE OUR N E W S ImT.oErg H e a lt h 4 m

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Avo id this ME Com plic atio n


If You Use , Doe s Bab So y


How to Thr ES TE R Pos t-Bi rth ive


Her e’s How to Cop e

◆ healthy moms

◆ healthy pregnancy

11 Vitamin D for Moms and Babies

33 1st Trimester

Vitamin D is essential during pregnancy for both you and baby’s health.

13 Understanding Mastitis You and your newborn are hitting your groove nursing when suddenly you notice a hard, red, hot area in your breast.

From pregnancy tests to morning sickness, here’s how it all begins.

34 2nd Trimester






44 Considering Cord Blood Banking or Donation?



New advancements make cord blood banking more mainstream than ever before.

Welcome to your second trimester—soon you’ll be halfway to term!

◆ healthy babies

37 3rd Trimester

50 Baby is Hungry All the Time

14 New Dads Can Have Postpartum Depression

You’re headed into the third trimester of your pregnancy and may wonder what changes to expect as you get closer to giving birth.

Your top newborn feeding questions answered.

Being a new dad can be tough on even the strongest person.

38 Painkillers in Pregnancy

17 Planning for the 4th Trimester

Opioids painkillers can be addictive for you and your baby.

Dreaming of a beach or exotic get-away before baby gets mobile?

You’re likely familiar with the first, second and third trimesters—but did you know there’s a fourth?

21 Post-Birth Warning Signs Learn these post-birth warning signs.

25 Your Perineum After Vaginal Birth You may be surprised about the physical aspects of recovery from a vaginal birth.

27 Pelvic Floor Recovery Leaking urine is more common than you might think—there are ways to cope with light bladder leakage.

Vitamin D for Moms and Babies

40 Marijuana Do you know how marijuana can affect your pregnancy and your baby?

42 Fetal Alcohol Spectrum Disorders Alcohol is the leading cause of preventable birth defects.

53 Traveling with Your Baby

54 Navigating Vaccine Decisions Vaccines can help protect you and your family from dangerous diseases during your pregnancy as well as through your child’s first years of life and beyond.

57 Keeping Baby Safe from the Start

43 Fetal Heart Rate Monitoring

Immediately after birth, there are a few important things that can keep baby safe and healthy.

Here’s why your care provider regularly checks on your baby’s fetal heart rate and rhythm.

63 Is Your Baby at Risk for Container Syndrome? Keeping baby confined to carriers or equipment can result in delays.

1st Trimester


Traveling with Your Baby


11 Post-Birth Warning Signs



Vaccine Decisions


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HEALTHY MOM&BABY EDITORIAL ADVISORY BOARD DANIELLE BEASLEY, DMSN, RNC-OB University of South Florida Tampa, FL 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 SHARON C. HITCHCOCK, DNP, RN-C University of Arizona Tucson, Arizona JENNIFER LEMOINE, DNP, APRN, NNP-BC University of Louisiana at Lafayette Lafayette, LA PARIS MALOOF-BURY, MSN, CNM, RNC-OB, IBCLC Sutter Health Sacramento, CA RACHEL NAPOLI, DNP, CNS, RNC-OB, IBCLC Sonoma State University Rohnert Park, CA RITA NUTT, DNP, RN Salisbury University Salisbury, MD SUSAN A. ANGELICOLA, MSN, APN Summit Medical Group Cedar Knolls, NJ MICHELE K. SAVIN, DNP, APRN, NNP-BC Thomas Jefferson University Philadelphia, PA PAT SCHEANS, MSN, NNP Legacy Health System Portland, OR JAMIE M. VINCENT, MSN, RNC-OB, C-EFM John Muir Medical Center Walnut Creek, CA


HEATHER WATSON, BSN, MSN Johns Hopkins University Baltimore, MD LASHEA WATTIE RNC, C-EFM, BSN, M-ED Wellstar Health System Atlanta, GA KIMBERLY WILSCHEK, RN, CCE Medical Revenue Solutions Chicago, IL CHARLOTTE WOOL, PhD, RN, CCNS York College of Pennsylvania York, PA

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


Understanding the 4th Trimester The months after you give birth are known as the 4th trimester. You and your baby were a pair throughout the nine months of your pregnancy—being a pair doesn’t stop when the umbilical cord is cut.

4th trimester changes

Some of the powerful hormones that fueled your pregnancy decrease dramatically when your placenta delivers. Other hormone levels rise as your baby begins to nurse for the first time. These hormones produce physical and emotional changes. So be gentle with yourself in the 4th trimester. It took nine months for your baby to grow and develop and your body changed throughout the entire nine months to sustain your baby. Now your body, mind and soul need time to adapt to the reality of your post-birth self.

A new family is born

The social changes of bringing a new family member—your baby—into the home can be profound. Whether you’re a first-time parent or an experienced one, adding a new member to your family brings changes for all, even your pets! Everyone is adapting to new roles, routines and responsibilities. Be ready for lots of ups and a few downs as your new family structure takes shape.

New recommendations about postpartum care

New national recommendations say that post-birth care should be ongoing with your pregnancy care team, rather than a single visit, and scheduled to meet your needs. Traditionally in the U.S. women have only had one visit at six weeks postpartum, unless they had a cesarean or birth complications. New guidelines advise that you be in contact with your pregnancy care providers within three weeks of giving birth. If your care provider doesn’t offer a visit before six weeks postpartum, ask when you can be seen. Ask your care provider if there is a lactation consultant you can call if you have questions about breastfeeding. And review the numbers to call if you have questions or problems outside of office hours.

Be proactive about postpartum support

Before your baby is born, arrange with several of your friends and family members to provide support and care during the post-birth days and weeks. These important people can advocate for you if you experience any physical or emotional complications. They can keep you company as you adjust to the daily routines of a newborn, and help you recover in the best way possible. CHERYL ROTH, PHD, WHNP-BC, RNC-OB, RNFA, is the AWHONN 2019 President

ISSUE 27 / 2019 Healthy Mom&Baby

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he perfect addition to any nursery library with its loving and inspiring message This the first time there’s ever been you, so I wonder what wonderful things you will do. . . .

Your baby’s doctor knows what is best for their health, but only you know what is best for their heart and mind. In the #l New York Times bestselling picture book, Emily Winfield Martin celebrates every individual child and the infinite possibilities ahead of them.

Art © 2015 Emily Winfield Martin

Even more books for dreamers . . .

For more information, visit

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AWHONN AWHONN 2019 President

Cheryl Roth, PhD, WHNP-BC, RNC-OB, RNFA Chief Executive Offi cer

M. Suzanne C. Berry, MBA, CAE Vice President, Strategic Partnerships, Communications & Meetings

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

Carolyn Davis Cockey, MLS, LCCE Director of Patient Education

Catherine Ruhl, DNP, CNM MAITLAND WARNE Group CEO & Publisher

Kevin Harrington EDITORIAL

Managing Editor: Elika Roohi


Art Editor : Jason Craig

ADMINISTRATION Production Director: Jo Harrington Production Coordinator: Severine Eidem Printed in the United States on paper made with 30% post-consumer recycled fiber. Please recycle this magazine!

Healthy Mom&Baby is published by Maitland Warne in partnership with AWHONN. © AWHONN, 2019. All rights reserved. All material in Healthy Mom&Baby is wholly copyright. Reproduction without the written permission of the publisher is strictly forbidden.

Your Pregnancy and Post-Birth Guide As the new editor of Healthy Mom&Baby, I’m happy to welcome you to the latest issue. I’ve been a nurse-midwife for 31 years and am honored to be editor of the only nurse-authored mom and baby magazine, brought to you by the national organization for obstetric nurses, AWHONN—the Association of Women’s Health, Obstetric & Neonatal Nurses. I’m taking over from Carolyn Cockey, the founding editor of Healthy Mom&Baby. Carolyn birthed Health Mom&Baby and skillfully shepherded the magazine for a decade, always committed to bringing women and families expertauthored, actionable information. When you read Healthy Mom&Baby, it’s like getting helpful, evidence-based advice from a group of friends who are all nurses and midwives with years of experience working with women and babies. We want you to have the information you need to feel confident in decisions you make. We want you to understand normal changes in pregnancy, during labor and birth, and post-birth. We also want you to know what physical and emotional changes you might experience that should concern you. Healthy Mom&Baby is designed to be your pregnancy and post-birth guide. Essential information about what to expect in all four trimesters is in every issue. Healthy pregnancy, healthy moms and healthy babies sections are framed around core content; features about trending topics in each section bring you new information. In this issue look for features on marijuana and pregnancy (p. 40), how alcohol affects your baby’s brain (p. 42), the latest on keeping your baby safe so you can both get quality sleep (p. 59) and ideas for a Mother’s Blessing, the 21st century alternative to a baby shower (p. 66). Don’t forget that your nurse-authored pregnancy guide is online at where you’ll find the Healthy Mom&Baby digital edition and new stories from moms dealing with real life issues on our Mom and Baby Blog. From all of us at Healthy Mom&Baby, here’s wishing you comfort, reassurance and strength to move confidently through all the trimesters of your pregnancy and post-birth journey. Be in touch,

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.

Cathy Catherine Ruhl, DNP, CNM

Editor, Healthy Mom&Baby



MAITLAND WARNE 29 East Madison Street, Suite 809, Chicago, IL 60602, USA Tel: (312) 572 7729 EDITOR IAL INQUIR IES

AWHONN Catherine Ruhl, DNP, CNM 1716 Anderson Pl, SE | Albuquerque, NM 87108 Tel: (202) 255-1172 |


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High blood pressure in pregnancy and heart disease later in life


Did you have high blood pressure during pregnancy? You may have had pre-eclampsia, which develops in the second half of pregnancy, most often in the last weeks. Or you may have developed high blood pressure without any other symptoms earlier in pregnancy. Regardless of the type of high blood pressure condition you had, you should know you’re at a higher risk to have high blood pressure in coming decades, as well as heart problems. A recent large study showed women who had hypertensive disorders of pregnancy had a greater incidence of coronary artery disease, heart failure and heart valve problems in middle age. If you had high blood pressure in pregnancy, share this information with your health care providers now and in the future. Use this knowledge to stay motivated to be physically active and maintain a healthy weight.

Breastfeeding Decreases Risk of Diabetes


Informally sharing breast milk A new study found that more than half of moms surveyed didn’t have concerns about using breast milk informally donated. More than three quarters reported they trusted the donors and didn’t feel it necessary to medically screen them. Nikita Sood, from Cohen Children’s Medical Center/Northwell Health in New York City, who led the study said “Informal milk sharing is becoming increasingly popular and widespread. It is therefore crucial that physicians become aware of this practice and the associated risks so that they can educate patients and address this growing concern.” The American Academy of Pediatrics discourages informal human milk sharing due to safety concerns. The American Academy of Breastfeeding Medicine has issued guidelines about medical screening of donors. Appropriate storage, labeling and transport of informally shared breast milk is another area of concern.

You’ve likely heard of the benefi ts of breastfeeding to protect your baby against infections, allergies and other conditions. But did you know that breastfeeding provides moms with powerful protection against disease, too? Researchers combined the results of similar studies to assess benefi ts to over 200,000 women who breastfed for longer than 12 months and found women had a 30% decreased risk for diabetes later in life compared to women breastfeeding for less than 12 months. Breastfeeding uses 500 calories per day and this energy expenditure may re-set a woman’s metabolism, helping her avoid diabetes.

ISSUE 27 / 2019 Healthy Mom&Baby

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Is your baby getting enough vitamin D? Vitamin D is known for supporting normal bone and teeth development as well as muscle strength. Vitamin D helps the body use calcium and phosphorus from our diet to build and maintain strong bones and teeth.*

Did you know? The American Academy of Pediatrics and The National Academy of Medicine recommend that all breastfed, healthy term babies receive a daily vitamin D supplement of 400 IU.

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*These statements have not been evaluated by the FDA. **This product is not intended to diagnose, treat, cure or prevent any disease. TM ©2019 Ddrops Company. All Rights Reserved. Ddrops is a registered trademark of Ddrops Company. U.S. Patent 9066958.

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healthy moms

Vitamin D for Moms and Babies By AWHONN Editorial Staff

Why it’s important; how to get enough For several years now, the American Academy of Pediatrics has recommended moms give their breastfeeding babies vitamin D supplements (infant formula is supplemented) to decrease the chance of rickets, or softening of the bones.

What is vitamin D?

Vitamin D (you may see it as D3 on supplements) is a fat-soluble vitamin and hormone that helps your body absorb calcium. Our bodies make vitamin D from sunshine, and we also take it in from foods or supplements. Recently, vitamin D deficiencies in pregnancy have been linked to increased risks for gestational diabetes, preeclampsia, vaginal infections and even a greater likelihood of needing a cesarean birth in moms. For babies, D deficiencies have been linked to increased likelihood of cavities, an increase in asthma and respiratory infections, softening of the skull in infancy and decreased bone health by age 9.

Vitamin D Sources One serving of each of these includes 100 IU of vitamin D XX Cod liver oil XX Cold water fishes,

including salmon, mackerel and sardines (but limit fish consumption in pregnancy to 2-3 servings per week) XX Fortified orange

juice, milk and yogurts XX Eggs

25-hydroxyvitamin D level. In fact, the AAP recommends that all pregnant women have this test.

Getting enough

The new recommended daily amount of vitamin D during pregnancy is 600 IU/day. Most prenatal vitamins have 400 IU, so you’ll need to get extra elsewhere. But vitamin D can be too much of a good thing—experts have set safe upper daily limits of anywhere from 2,000 IU to 4,000 IU during pregnancy.

Get tested

If you’re pregnant, ask your healthcare provider about having a vitamin D blood test, and whether you may need to add a vitamin D supplement. Check the amount of vitamin D in your prenatal and supplement with foods known as good sources.

Where to find it


It’s hard to determine how much vitamin D we synthesize from the sun. UVB rays are more potent during the summer, and depending on your geographical location, you may experience more or fewer cloudy days throughout the year. UVB doesn’t penetrate darker skin as well as lighter tones, and it doesn’t go through glass. Most experts don’t advise direct sun exposure (without sunblock) because of skin cancer risks. How much vitamin D you receive from food and supplements can be affected by your body fat percentage, and different supplements and prenatal vitamins vary in dose, purity and absorption. The only way to really know your personal vitamin D level is to have a blood test to check it—it’s called your serum

ISSUE 27 / 2019  Healthy Mom&Baby

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healthy moms

Mastitis: Understanding This Painful Nursing Complication By Charlotte Wool, phd, rn

Nursing is going great, you and your newborn are hitting your groove when, WHAM!, you notice a hard, reddish hot area in your breast—you may even feel like you’re coming down with the flu. This familiar incidence among breastfeeding moms is called mastitis, a common breastfeeding complication or infection Charlotte Wool, PhD, RN, is a nurse educator and an expert advisor to Healthy Mom&Baby.

What is mastitis?

Mastitis typically begins as a lumpy, tender area in your breast caused by an inflamed milk duct, and it can develop into an infection—but not all cases result in an infection. It’s most common in the early weeks of nursing. Mastitis can develop from plugged milk ducts or pores, sore or cracked nipples, not alternating and emptying both breasts at each feeding, missed feedings, poor latch, injury to your breasts, or your own illness or stress. Signs of mastitis include a hot, reddened area in one or both breasts, including the areola and nipple. If you have mastitis, you may also have the sudden onset of fever, chills, body aches and headache.

Treating mastitis

Call your nurse or lactation consultant at the first signs of mastitis. If you’ve developed an infection, you’ll be asked to take antibiotics for 10-14 days. Discuss which antibiotic will be safe for you to continue nursing while taking, and what you can do if a yeast infection emerges while taking antibiotics, as it does for some women. You may also be advised to take an antiinflammatory medicine like ibuprofen for relief of pain and discomfort. Try to get extra rest during this time—your body is likely fighting an infection. You can also try applying moist heat or ice to your breasts before nursing to ease the pains of mastitis. Heat can increase inflammation; cold can decrease swelling—see what works best and feels the most comfortable for you.

Continue nursing

Most importantly—if possible—keep breastfeeding! Suddenly stopping breastfeeding and weaning your infant will bring about other problems and put you at risk for complications like engorgement or developing a breast abscess, which is a pus-filled cyst within your breast. Emptying your breasts is the best way to move mastitis toward healing. Start each feeding with your least painful breast and continue with frequent feedings to ensure your breasts don’t become overly full. In very rare cases, some nursing moms will experience frequent bouts of mastitis—this could be a warning sign that you may have an underlying breast concern, such as a tumor or an abscess. Tell your nurse or lactation consultant if mastitis returns after your first episode resolves—you may need further screening to help identify why this complication is developing.

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healthy moms

New Dads Can Have Postpartum Depression S Whether you’re new to fatherhood, or your family has grown by leaps and boun ds, being a new dad can be tough on even the strongest person. This is why it’s important to understand that just as new mothers can suffer from postpartum depression (PPD), so can new fathers ELIZABETH ROCHIN, PHD, RN, NE-BC, is President of the National Perinatal Information Center.


ome 10% of men worldwide suff er from Paternal Postpartum Depression, or PPPD, according to JAMA, the Journal of the American Medical Association, and experts believe that PPPD could aff ect as many as 1 in 4 (25%) dads. While we certainly do not want to take away from the serious issue of postpartum depression in moms, dads deserve our attention, too, in their transition to fatherhood.

Dads can be sad, too

How many times have you heard the phrase, “Man up?” Probably more times than you can count. And that is what makes paternal postpartum depression so diffi cult. Men are supposed to be “tough,” and not be sad or depressed. Sometimes men even feel ashamed to be sad or depressed, and they don’t want to talk about their feelings. Being aware that dads can be sad or “blue” after the birth of a new baby is so important. Awareness is key! Yes, new dads can be sad, too.

Parenting as a team sport Talking about feeling depressed or sad is not something most dads want to discuss with their partner, particularly if mom is feeling blue herself. But it’s also just as important for new moms to know how dad is feeling. Parenting is a team sport! Dads: fi nd other men who you can talk to and be supported by during this incredible change in your life. Remember the Johnson & Johnson commercial, “A Baby Changes Everything?” They’re right! A baby does change everything, but with the right support system, being a new father can be a wonderful experience. Finding

that right support system is important. And support systems take many forms… family, friends, nurses, “dads” meet-up groups, health department staff, work colleagues, whatever your support system may be, take advantage of it!

Take care of yourself

Just as mom is going to need some time to herself, so is dad. And being at work doesn’t count as “me time.” Remember that support system? Now is the time to rely on trusted family and friends to watch baby while you and mom can have time apart, or even better, have some couple time! What reduces your stress? Be thinking about those things that can help you relax and make it easier for you to care for your family. Taking care of yourself is going to be the most important gift you can give your new baby and your partner. Conversely, spending time caring for and nurturing your baby will build your confi dence as a dad, boosting those good feelings to help off set those doubts and insecurities every parent feels with a new child.

Common signs of postpartum depression in all parents include: 

Feeling overwhelmed, exhausted and insecure

Crying spells, sadness, hopelessness

Anger, irritability, frustration

Repetitive fears and worries


By Elizabeth Rochin, PhD, RN, NE-BC

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healthy moms

Just for moms Mom, right after baby’s birth, you’ll be exhausted, and you may feel a little blue emotionally—a new baby can be very exciting and at the same time be hard work. Your partner wants to be able to support you and your needs with your new baby. Just as you need that support, so does your baby’s dad. Just as you listen and watch for subtle clues and changes with your new baby, do the same for your partner, as they no doubt are listening and watching out over you. Is he withdrawing from you and the baby? Suddenly difficult to talk to? Not eating? Even though sleeping might be tough for both of you now, significant changes in sleep are important to notice.

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Is just what the doctor ordered! VagiKool is a reusable cold pack specifically contoured and designed for the most sensitive and delicate area of a woman’s body. A natural delivery can be a traumatic experience to a vagina. Sure we all know someone who broke water, dropped, and delivered in one hour but that’s not the norm. Delivery can take up to 24 hours (or more) and when it’s time it’s time and there is nothing that you can do to stop the process (not that you want too) until you hear you’re tearing or the doctor wants to do an episiotomy (e·pi·si·ot·o·my). Cold is one of the most effective ways to relieve pain but icing your vaginal area may not be the easiest thing to do. After all a bulky ice pack or bag of frozen peas wasn’t made to fit comfortably between a woman’s legs!

Littlebeam is a perfectly-sized, versatile nursing pillow that allows for ideal positioning for breastfeeding babies. Created by Dr.Kathleen McCue, renowned lactation expert, littlebeam is ergonomically designed to help babies and mothers find the most comfortable positions whether in the home or on the go. Littlebeam is perfect for travel,feeding and provides great back support for moms when sitting, pumping or sleeping.

Tired of being covered in spit up during feeding time?!? Handy Burp’ems solves that problem! This one of a kind design covers your hand while providing ease of feeding.

The VagiKool Reusable Feminine Cold Pack soothes in seconds, and it’s the only cold pack specifically designed for the most delicate area of a woman’s body. Its targeted cold relief reduces swelling while promoting natural healing. VagiKool is Non-Toxic and Latex Free and best of all is Made in the USA. VagiKool’s Komfort-fit™ design provides for discrete concealment with its close-to-body near invisible fit and nobody will know you have it on unless you tell them!

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healthy pregnancy

Planning for the Fourth Trimester By Charlotte Wool, PhD, RN

You’re likely familiar with the first, second and third trimesters— but did you know there’s a fourth? And it’s just as important for baby’s development and your health as the first three

Fourth Trimester Recovery 

Post-birth bleeding may last 4 to 6 weeks, gets lighter each day after the first few days.

Swelling in your legs due to IV fluids decreases after early days, legs should not be red or warm.

Healing of the tissues of the vagina or a cesarean incision takes place over the first several weeks, but you should experience a steady decrease in pain and discomfort.

Emotional shifts: tearfulness, irritability, anxiety, feeling overwhelmed. These feelings should peak in the first week and improve by two weeks; if not, call your provider.

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healthy pregnancy


◆ Post-birth Warning Signs

Call 911 if you have: XX Pain in chest XX Obstructed

Breathing XX Seizures XX Thoughts of

hurting yourself or someone else Call your healthcare provider if you have: XX Bleeding soaking

through one pad/ hour or clots size of egg or bigger XX Incision not

healing XX Red or swollen leg XX Temperature of

100.4F or higher XX Headache that

doesn’t get better after taking medicine or headache with vision changes

it’s your sense of humor, your patience, your determination. Maybe it’s your ability to plan ahead in practical ways. One mom shared this about how she got through the fourth trimester.

The Sisterhood

“I had a good friend who had her first baby and was so lonely during the first months. She really felt isolated which led to her feeling down in the dumps. When I became pregnant with my first a year later, I wanted to ensure I would not get lonely. I am an extrovert and love being around people—they give me energy. I decided to call on several of my very good friends to ask them to be my sounding board and support system after the birth of my daughter. They all agreed, of course, and that gave me a chance to catch up with at least one adult each day and talk about my day and how it went. In turn, my friends kept me in the loop about their lives and organized meals for me for three whole weeks, so I did not need to cook. I would say that my willingness to call on The Sisterhood was my superpower.” Charlotte Wool, PhD, RN, is Associate Professor of Nursing at York College of Pennsylvania and an expert adviser to Healthy Mom&Baby

images: Shut ter stocK


ou made it through pregnancy—all three trimesters—and labor and birth. Now you and your baby are in the fourth trimester, a phrase used to describe the first three months after your baby is born. Some experts believe the fourth trimester should include the entire first year after baby is born, and for good reason. The fourth trimester is remarkable in so many ways. It is a time of life-changing transformations for you and your family, some of which come easily and some of which are hard-fought adjustments. The fourth trimester includes physical, emotional, and mental transitions. Don’t underestimate the power of these transitions. Plan for all the support you can arrange from family and friends, in the ways that will work best for you, during this critical period. Learn what the normal physical and emotional changes are and signs of problems requiring your provider’s attention. Trust your instincts and call your provider if you feel something’s just not right with your physical or emotional wellbeing. During pregnancy, as you plan for the fourth trimester, identify your personal superpower(s). A superpower is a strength you have that you can access when you are feeling overwhelmed and in need of a boost during the fourth trimester. Maybe

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healthy moms

◆ Complications

Post-Birth Warning Signs Learn these Post-Birth Warning Signs


Did you know that according to the CDC: XX Although still

rare, an increasing number of women are dying from pregnancy-related problems before, during and after their baby’s birth, and at least half are preventable. XX Severe

By Lisa Kleppel, MPH, PMP arah Duckett had only been home from the hospital for a week with her second baby when she sensed something 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. She remembered the post-birth warning signs her nurse had discussed with her and wondered if she was experiencing one of these signs. It didn’t make sense—hers had been a perfectly uneventful pregnancy and normal birth. Sarah’s mom took her to the emergency room, where the staff checked her blood pressure, ran several lab tests and did a chest x-ray and CT scan. They discovered a small blood clot in her lung. Sarah received treatment, and avoided further

and Deaths Among New Mothers Increasing

complications, all because she trusted her instincts, and knew the warning signs to look for.

Reduce Your Risks for Problems in and after Pregnancy

Many moms return home from the hospital, tired and overwhelmed with the excitement of a new baby. Naturally, you may be more focused on caring for your new baby but pay attention to your own health. Be aware of signs and symptoms that could mean you’re having a complication. The mother/baby nurses of AWHONN have created specific instructions for postpartum moms called “SAVE YOUR LIFE: Get Care for these POST-BIRTH

complications of childbirth, such as losing enough blood to need a blood transfusion, seizures, and life-threatening infections, are 100 times more common than a woman dying from a childbirth related complication. XX While some women

may be at higher risk of developing complications than others, ALL women are at risk of developing postbirth complications. XX If you are surprised

by these facts, you’re not alone.

ISSUE 27 / 2019  Healthy Mom&Baby

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healthy moms 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.

Act on Your Instincts; Get Help! If you think you are experiencing one of the post-birth warning signs, act on your instincts. 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. Whether it’s the 911 operator, emergency room or urgent care providers or your own provider, tell them, for example: “I had a baby (give date) and I have a really bad headache that won’t go away.” 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. The sooner your care providers can identify your symptoms, the sooner they can make a diagnosis and provide the necessary care.

◆ Know the Post-Birth Warning Signs

Do you know the signs of potentially life-threatening complications that could affect you after you give birth? These are specific signs to watch for during the first year after birth.

Call your provider if you have: XXBleeding

that is soaking through one pad/hour, or blood clots the size of an egg or bigger


Call 911 if you have: XXPain

in your chest


breathing or shortness of breath

XXSeizures XXThoughts

of hurting yourself or someone else

that is not healing


or swollen leg that is painful or warm to touch


of 100.4° F or

higher XXHeadache

that doesn’t improve after taking medicine or headache with vision changes

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!” In this case, her knowledge may have saved her life. Lisa Kleppel, MPH, PMP, is a public health researcher and expert advisor to Healthy Mom&Baby.


images: Shut ter stocK , GETT Y

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HMB10 Post Birth Warning Signs.indd 22

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Caring for Your Perineum After Vaginal Birth You may be surprised about the physical aspects of recovery from a vaginal birth


ou just birthed your baby—a baby which took around nine months to grow—so be gentle with yourself and don’t expect your body to feel like it did pre-pregnancy any time soon. One area that needs tender care is your vagina and perineum—areas that stretched a lot to allow your baby to enter the world and may have torn or been cut. If your provider made a small cut, or incision, in your perineum— the area between your vagina and anus—this is called an episiotomy. Episiotomies increase the risk of infection and blood loss; an episiotomy can be more extensive

By Catherine Ruhl, DNP, CNM than a natural tear. Tears, if small, typically heal faster than episiotomies. Recovery may take a few weeks. If you had an episiotomy it may feel tender as you walk or sit. Keep your perineal area as clean and dry as possible; change pads every 2-4 hours. Gently pat yourself dry front to back after urinating to decrease infection risk. Get fresh air to your perineum to speed healing. If lying down to breastfeed or nap, take off your underwear and pad for a while. No two moms recover the same way, and no one knows your body

better than you—so listen to those twinges, pains and sore areas— and be gentle and nurturing with yourself after birthing. Tell your healthcare provider if you experience any of the following in the weeks after a vaginal birth: ◆ Perineal or vaginal pain or swelling that gets worse, not better, in the first week ◆ Not able to control your urine or stool ◆ Pus-like discharge from the tears or episiotomy ◆ Pain when you resume sexual intercourse

◆ A Recovery Care Package Prepare for your body’s recovery by having these supplies ready at home: XX Common pain relievers—

acetaminophen and ibuprofen are safe during breastfeeding

XX Period pads from heavy to light

until your bleeding ends

XX Witch hazel for vaginal pain or

hemorrhoids—soak pads in witch hazel and chill them

XX Stool softener to help your

bowels get moving again postbirth

XX Sitz bath for soothing pain XX Squirt bottle—fill with warm

water to rinse during and after urinating for comfort Catherine Ruhl, DNP, CNM is editor of Healthy Mom&Baby and a certified nurse-midwife in Albuquerque, New Mexico.

ISSUE 27 / 2019  Healthy Mom&Baby

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03/12/2019 11:46

Trusted for postpartum care since 1866 Many women experience swelling, pain and soreness in the vaginal and rectal areas post childbirth. Tears, episiotomies or hemorrhoids can occur during pregnancy or labor causing discomfort in sensitive areas. T.N. Dickinson’s Witch Hazel Hemorrhoidal Pads are gentle enough to comfort, cool and relieve hemorrhoidal and vaginal discomfort. With aloe and glycerin, our extra-soft pads allow for the gentlest treatment and provides a protective barrier where you need it most. Purchase yours at Amazon and Experience postpartum relief you can rely on. Trust T.N. Dickinson’s for all your Witch Hazel needs. Additional products available at CVS and other fine retailers. IRI First Aid Category Multi-Outlet ending 9/8/2019

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healthy moms

Pelvic Floor Recovery M

aybe you’re on a jog or simply sneezing and you feel a small amount of urine dribble out—you can’t stop it. You might be asking yourself, “Should I be leaking urine at such a young age?” Truth is light bladder leakage can happen for women at any age, regardless of previous pregnancies or births, even if you’ve had a cesarean.

What is light bladder leakage?

Light bladder leakage, also called incontinence, is urine loss you can’t control. 1 in 4 women experience it.

By Susan A. Angelicola, MSN, APN

Leaking urine is more common than you might think—there are ways to cope with light bladder leakage

The 2 most common types are stress incontinence and urge incontinence. Stress incontinence is when you leak urine during activities like running, jumping, coughing or sneezing. Urge incontinence is the frequent, sudden need to pee that can cause bladder contractions and leaking. Caffeine, alcohol, drinking too much water and medications like diuretics (water pills) can irritate your bladder, leading to urge incontinence.

ISSUE 27 / 2019  Healthy Mom&Baby

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healthy moms What can I do?

Don’t be embarrassed by light bladder leakage, it’s common and you’re not alone. Talk to your nurse about it, even if they don’t ask. You can build up your pelvic floor to prevent light bladder leakage. Since your whole pelvic floor is supported by muscle, you can strengthen it with pelvic floor exercises to prevent or improve bladder leakage. At first, squeezing these muscles may feel odd, but you’ll get used to it with practice.

Weight loss to reduce leaking

If you’re overweight or obese, just losing 5 to 10 pounds can relieve some abdominal pressure on your bladder. Remember to decrease bladder irritants, such as caffeine or alcohol, and don’t let your bladder get too full—even on busy days.

Make pelvic floor exercises a daily practice

Physical therapy for light bladder leaking


Pelvic Floor Power!

If you’re doing pelvic floor exercises correctly to minimize bladder leakage, no one will know. Make it your secret exercise! XXFind the right muscles. To identify 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. XXPerfect your technique. First, take a cleansing breath in and

out. Then breathe in with a relaxed pelvic floor and when you breathe out tighten your pelvic floor muscles, hold for 5 seconds, and release. 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. XXMaintain your focus. For best results, focus on tightening only

your pelvic floor muscles. Be careful not to flex the muscles in your abdomen, thighs or buttocks. XXAim for at least 3 sets of 10 repetitions a day.

Susan A. Angelicola, MSN, APN, is an advanced nurse practitioner and an expert adviser to Healthy Mom&Baby.

images: Shut ter stocK

So what if you’ve regularly done your pelvic floor exercises, lost some weight, and curbed the caffeine but the bladder leakage isn’t improving? You should definitely talk to your nurse or provider about a referral to a physical therapist (PT) who specializes in the pelvic floor. A pelvic floor PT will review your health history: how many pregnancies you’ve had, how much your babies weighed, what makes the leakage better or worse and if you’re taking any medicines that could irritate your bladder. The PT will evaluate your posture, back and hips and may ask your permission to do an internal exam to better check your tone, but this won’t involve any equipment like a speculum. You’ll probably be given a treatment plan of home exercises and be asked to return for follow up evaluation and care. If these efforts don’t seem to help, you may need a urogynecologist—a gynecologist with a subspecialty in pelvic floor medicine. This type of specialist may offer other treatments including surgery but not all women will need surgery for better bladder control.

HMB12 Pelvic Floor Recovery Postpartum.indd 28

03/12/2019 11:47

Join the DetergentFREE Generation For your baby’s sake


elcome to Grandma’s Pure & Natural! Grandma knows as a parent of five kiddos w/ 14 grandchildren, you want only the BEST for your littles. Their skin is so soft, precious and sensitive. You shouldn’t use just any soap on your baby’s skin without first doing some research. Why didn’t someone tell me most soap on the market contain chemicals, detergents and chemical fragrance that can irritate my baby’s sensitive skin? Also, the detergents, used in laundry detergent, actually don’t rinse out of their clothing and bedding, resulting in skin irritation. You should consider using non-detergent laundry soap for better results. In addition, research shows exposure to parabens, found in many liquid soaps and lotions, are known to disrupt hormone function, an effect linked to increased risk of breast cancer. Try a natural approach to skincare. Try Grandma’s. We have three soaps especially crafted with your baby in mind:

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1. Grandma’s Baby Bar 2. Grandma’s Non-detergent laundry soap 3. Grandma’s Stain stick (Great for getting those poopy stains out of diapers and clothes.)

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Try TUCKS® To Soothe PostPartum Vaginal Discomfort And Hemorrhoidal Pain After vaginal delivery, many experience swelling, pain and soreness in the vaginal and rectal area. This may be caused by a tear, an episiotomy, or from hemorrhoids developed during pregnancy and labor. Constipation can be another side effect of childbirth, both vaginal and C-sections, that causes rectal irritation. Chances are going to the bathroom after delivery will be uncomfortable and proper care will be important. Tucks Medicated Cooling Pads soothe the burning and itching caused by hemorrhoids, as well as vaginal and rectal discomfort associated with pregnancy and childbirth. The mild witch hazel formula and soft pads are effective at gently cleansing sensitive areas, and they can also be used as a moist compress to calm inflamed tissue. Whether you experience pain during pregnancy or after childbirth, don’t let hemorrhoids or perineal tenderness take over. Trust Tucks to provide immediate relief. pg 30.indd 1

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MIDWIFE-ATTENDED BIRTHS ASSOCIATED WITH FEWER CESAREANS Hoping to avoid interventions and a cesarean when you birth? A study of 23,000 low-risk women in 11 hospitals in the Northwestern U.S. showed that women cared for by midwives had fewer interventions in labor, such as epidurals and episiotomies, and fewer cesareans compared to those who had care from obstetricians. Women having midwife care for their first birth had a 30% lower cesarean rate, and women who had previously given birth had a 40% lower rate. Researchers acknowledged their results could have been affected by preferences of the women who chose midwives as their care providers. According to Suzanne Shores, division director of midwifery at the UPMC Magee-Women’s Hospital in Pittsburgh, Pennsylvania, women choosing midwives often “want a low-intervention birth and no epidural.”

Protect yourself and your baby from the flu


Pregnant and breastfeeding women warned against using CBD products The Food and Drug Administration (FDA) warns pregnant women not to use marijuana of any kind, including products containing cannabidiol (CBD). CBD is the second-most prevalent active ingredient of cannabis (marijuana) and is marketed to combat anxiety and chronic pain. Unlike THC, the component of marijuana that causes a “high”, CBD has not been shown to be addictive. However, the lack of research about the safety of CBD for the fetus or newborn causes experts to warn against equating little evidence with safety. The FDA believes many CBD products may be contaminated with harmful chemicals like pesticides, fungus and heavy metals. These contaminants can harm your baby—before or after birth. Products with CBD are not regulated by the FDA and their safety and effectiveness is unknown.

Only a little more than half of women receive the flu vaccine during pregnancy, despite longstanding national recommendations for all pregnant women to receive it. The vaccine has been shown to be both safe and effective for pregnant women and the fetus. The flu can be deadly to both pregnant women and babies due to their increased risk to develop pneumonia. The flu vaccine is not just about keeping you from getting the flu. When you’re pregnant and get the flu vaccine, you form antibodies against the flu which you pass on to your baby. This means your baby has flu protection in the first few months after birth, which is important because the flu vaccine is not recommended for babies until they’re six months. Pregnant women who get vaccinated have a 40% lower risk of being hospitalized with the flu and their babies have a whopping 72% decrease in flu hospitalizations under six months. If you get the flu while pregnant, you have a higher chance of developing severe complications due to pregnancy-related changes in your body. You also have a higher chance of miscarriage, preterm labor and giving birth early.

ISSUE 27 / 2019 Healthy Mom&Baby

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healthy pregnancy

1st Trimester Week 1-12

Early Pregnancy Events From pregnancy tests to morning sickness, here’s how it all begins By Susan A. Angelicola, MSN, APN


elcome to your 1st and sleepiest trimester; during these 12 weeks your baby will grow from an embryo 1/5th the size of the period at the end of this sentence, to a nice juicy plum. Every day, the pregnancy hormone HCG is increasing and it’s what makes your pregnancy test positive. It’s also responsible for feeling tired, tender or sore breasts, frequently needing to pee and for many women— morning sickness. It’s normal to want a nap every day—your body is working hard to grow your baby—it’s exhausting! Before you knew you were pregnant, baby’s neural tube—what becomes her brain and spinal cord—formed and closed. The 800 micrograms of folic acid in most prenatal vitamins protect against neural tube birth defects, so it’s important to take a prenatal vitamin before conception and through pregnancy and breastfeeding. Baby finishes the 1st trimester 10 times bigger than at conception. Your body is changing too: Your breasts are likely bigger and sore, you may have frequent headaches, fatigue and nausea. It’s not unusual to have some spotting or mild

Start or continue—habits that keep your pregnancy as healthy as possible all the way to term: XX Daily prenatal

vitamin, especially if you haven’t been taking one XX Make and keep

all prenatal appointments XX Healthy food with

lots of water XX No, smoking,

drinking or using illegal drugs if you have any of these habits XX Caffeine limited to

no more than 200mg a day—that’s up to 12 ounces of coffee. Foods like chocolate and other beverages have caffeine too

cramping and this doesn’t always mean miscarriage. Call your provider right away, especially if the bleeding is heavy or if you’re cramping. Around week 8, you’ll have your first prenatal visit; after that you’ll likely see your provider: ● Every 4 weeks (until 28 weeks) ● Every 2 weeks (28-36 weeks) ● Weekly (week 36+) You may be offered 1st trimester screening—non-invasive tests done between weeks 11-14 for chromosome disorders like Down Syndrome and genetic testing. Your nurse can talk with you about the risks and benefits of these tests. Bring your questions to every prenatal visit—your care providers expect and welcome them! As you complete week 12, you can relax— all of baby’s organs and bodily systems have formed and the next 28 weeks are all about growing. You’ll be able to hear your baby’s heartbeat and the early symptoms of pregnancy should begin to subside. Susan A. Angelicola, MSN, APN, is an advanced nurse practitioner and expert advisor to Healthy


ISSUE 27 / 2019  Healthy Mom&Baby

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2nd Trimester Week 14-27

Enjoy the Energy Burst of the Second Trimester Welcome to your second trimester—soon you’ll be halfway to term!


uring this trimester, your little one grows from the size of a peach to an eggplant. You’ll have more energy, feel less sick and be hungry! At 13 weeks, your placenta starts producing the hormones that maintain your pregnancy, and it gives baby oxygen and nutrition and removes waste. You begin to ‘show’, happily trading jeans for maternity yoga pants!

What to expect at prenatal visits

1 in 10 women develop diabetes in pregnancy. You’ll drink a sweet liquid and have your blood drawn at 1 hour. If your 1-hour test is high, you’ll do a similar 3-hour test, but only 1 in 3 women who need that test will have gestational diabetes. Around 27 weeks, ask for the Tdap vaccine, which protects against pertussis (whooping cough). Newborns can’t get vaccinated against pertussis until they’re 2-3 months old and pertussis can be deadly for babies. Also, get a flu shot in pregnancy before flu season—this vaccine is safe in any trimester. Your baby’s heart is beating fast in the second trimester—

about 140-150 beats/minute, which is normal. She’s sucking and swallowing amniotic fluid as she prepares for nursing. Don’t be surprised when you feel her hiccups! Her lungs are exhaling amniotic fluid, preparing for those first breaths after birth. Your baby can recognize your voices and will respond to them at birth.

Weight gain in the second trimester

Many women experience their biggest weight gain during the second trimester and that is normal. Your baby’s growth accelerates and the extra amount of blood in your body needed to sustain your baby peaks at the

images: Shut ter stocK

Between weeks 24-28, you’ll be checked for the most common pregnancy complication: gestational diabetes. As many as

By Susan A. Angelicola, MSN, APN


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02/12/2019 15:05

healthy pregnancy

Nutrition know-how XX Hydration is key; drink at least

8, 8-ounce glasses of water a day plus more during exercise XX Minimize heartburn by skipping

spicy or heavy meals, acidic fruits like tomatoes or eating late at night XX Take in an extra 250 calories

a day in the second trimester— up to 350 calories in the 3rd trimester—to maintain steady weight gain XX Pick high-protein snacks like

eggs, nuts, cheese sticks or hummus XX Fill up on fiber in beans, bran

or berries to keep your bowels regular

start of the third trimester. Amniotic fluid, the water around the baby, is also increasing in the second trimester and your breasts continue to prepare to produce milk when baby’s born. The pace of many women’s weight gain slows in the third trimester, which is also normal. Aim to make every calorie you eat a healthy one that is supporting both your body (and mind!) and baby’s. Prioritizing protein, fiber and enough liquids (see box) will help you maintain your energy and avoid complications such as low blood sugar, constipation and energy swings. Susan A. Angelicola, MSN, APN, is an advanced nurse practitioner and expert advisor to Healthy Mom&Baby.

Other changes can include: XX An energy burst—ask your nurse what exercises you can continue or

begin in pregnancy XX Lower back pain as your uterus grows and changes your center of

gravity XX Heartburn can occur when your growing uterus slows down digestion XX Constipation—your intestines slow down during pregnancy and iron

supplements can also contribute XX Soreness or twinges along the sides of your belly as your uterus

stretches and moves higher in your abdomen XX Nasal stuffiness or even snoring from increased hormones and blood

flow; soothe with saline nose drops and a humidifier XX Varicose veins in your legs—even your vagina, from relaxed blood

vessels and slower circulation; elevate your legs or wear support or compression stockings XX Itchy skin or stretch marks; belly butters and balms can ease the

itching XX Baby’s first flutters—around weeks 17-20 you may be surprised by

flutters in your belly—that’s your baby moving! More exciting is your second trimester ultrasound. Will you try to learn whether you’re having a girl or boy?

ISSUE 27 / 2019  Healthy Mom&Baby

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Most pregnant women aren’t aware of their breastfeeding rights Among most expectant mothers, it’s well-known that breastfeeding is best. According to the CDC, there are about 3.6 million births per year in the U.S. and approximately 83% of those moms will try breastfeeding. Unfortunately, more could be done to ensure these moms are set up for nursing success. A survey conducted for Byram Healthcare revealed that 82% of moms-to-be don’t know their breastfeeding rights under the Affordable Care Act (ACA). Out of 1,000 expectant mothers in the U.S., the survey found: 42% didn’t know breast pumps are covered at no cost 64% didn’t know lactation consultant sessions are covered at no cost ■ 61% didn’t know employers must provide breaks for mothers to pump ■ ■

With providers like Byram Healthcare, ordering a breast pump through insurance takes just minutes and pumps should be received in 4-7 business days with most plans. Moms report that breast pumps have afforded them many benefits, including helping with latch and allowing a more flexible feeding schedule. Pumps are also key for moms who plan to continue breastfeeding after returning to work. For additional information on no-cost breast pumps through insurance, call 1-877-773-1972 or visit



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Goodbye Scars.

You won’t be missed. pg 36.indd 1

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healthy pregnancy

3rd trimester Week 28-40

Third Trimester Changes By Joanne Goldbort, PhD, MSN, RN

You’re headed into the third trimester (weeks 28-40) of your pregnancy and wonder what changes to expect as you get closer to giving birth


he third trimester brings moments of anticipation and excitement as you move away from the more restful past 12 weeks and into a period of increased growth and changes as your body gets ready for birth. Let’s look closer at what some of those changes may be.

Goodbye, sleep!

As your baby’s body continues to gain weight, develop and mature, you may find it difficult to sleep at night, especially during the last few weeks of the pregnancy. Perhaps you’re noticing increased heartburn due to added pressure on your diaphragm. Relief for both of these issues will happen when the baby “drops” or settles into the pelvis around the last few weeks of pregnancy. This is known as “lightening.” You may or may not notice when your baby does this subtle movement but friends and family will, so expect statements, such as, “oh, you’re getting closer as your belly looks lower!” Heartburn may also diminish during this time but be replaced by increased pressure on your bladder

and the urge to use the bathroom more frequently. Even sleeping restfully gets more difficult as you get closer to birthing your baby.

Watch for the mucus plug When your baby moves into your pelvis, more pressure is put on your cervix, and you may even lose the mucus plug that sits inside the cervix. You may notice this happens when you wipe after urinating—a thick, clear, gloppy substance may appear on the toilet paper. No need to worry; this is normal, and for some women it’s a sign that birth is getting closer.

trimester ◆ 3rd warning signs Call your healthcare provider if any of the following happens: 

Your water breaks. This may happen as a trickle of clear fluid that at first may seem like you have to urinate but continues even after you go to the bathroom. Or it may be a gush of fluid. Either way it’s important to get this checked out—you very well could be headed quickly into labor!

If you have bright, red bleeding

You have contractions or tightening of your belly that occur regularly—about 5 minutes apart, lasting for a minute or so and continuing for at least an hour

You have a headache or heartburn that won’t go away after taking over-the-counter medications for the problem

Prepare for birth

If you haven’t already done so yet, attend childbirth classes to learn more about labor and birth, and meet other women going through the same experiences as you. You’re nearly finished with pregnancy. In these last weeks, remember to get plenty of rest, drink lots of water, continue to be active and eat a wellbalanced diet. Soon you will meet your baby!

JOANNE GOLDBORT, PHD, MSN, RN, is an assistant professor in the College of Nursing at Michigan State University and an expert nurse adviser to Healthy Mom&Baby.

ISSUE 27 / 2019 Healthy Mom&Baby

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Painkillers in Pregnancy Opioids painkillers can be addictive for you and your baby By Jennifer Lemoine, DNP, APRN, NNP-BC


received a prescription for opioid painkillers for short-term or ongoing pain. If you were abusing opioid painkillers, or a non-prescription opioid like heroin, before you got pregnant, talk to your care provider to learn if you can get treatment for your addiction during pregnancy. The typical treatment is to use other drugs such as methadone or buprenorphine. These drugs help you stop using opioids until you can quit them. Never quit suddenly on your own, especially if you’re pregnant as this could also cause problems for your baby, including death.

Side effects of painkillers for you and baby 

Opioids affect your body in many ways; common side effects with short term use include drowsiness, nausea and vomiting, and constipation. Longer term use of these drugs can cause sleep apnea, when you stop breathing for short periods of time during sleep. Pregnant women with sleep apnea are more at risk to develop pre-eclampsia. Opioid painkillers used long term can also create:

Tolerance, so that you need stronger doses to get the same pain relief

Addiction—where you physically crave and need to take the drugs

Withdrawal symptoms such as anxiety, insomnia, diarrhea and vomiting

Just as you experience withdrawal symptoms when you stop taking painkillers after longer term use, so do babies. In babies, this is called “neonatal abstinence syndrome,” (NAS).



an you take painkillers in pregnancy? Nearly all moms question whether it’s safe to take medication during pregnancy: “Can I continue to take my allergy medication? Should I take medication if I experience nausea and vomiting during the first trimester?” Nine out of 10 moms take some type of prescription or over-thecounter medicine while pregnant. While many are safe for both you and your baby, some can create serious problems or harms. With more women than ever before using opioid painkillers, there are more pregnant women than ever before potentially using these drugs—and they’re not without problems for you or your baby. Opioids are the most commonly abused prescription drugs. Opioid pain relievers (analgesics) include hydrocodone, also known as Vicodin® when it’s mixed with acetaminophen. Another is Percocet®, which is oxycodone combined with acetaminophen. Opioids are also found in some cough syrups, are prescribed for pain and often provided to women after surgery or dental procedures. Maybe you have

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Opioids in pregnancy Experts think opioids for a very shorttime use in pregnancy are probably ok and don’t cause any long-term problems for you or your baby. For example, if you have a tooth removed, and you take an opioid medication for two to three days, you’ll likely be fine. Problems begin to arise if you need to take one of these medications for weeks or months—or take them in increasing doses. Opioids can increase your risks for miscarriage or preterm labor or birth and puts your baby at risk for defects, including heart and spinal problems. Even if your healthcare provider has prescribed these medications, take only the recommended dose for the shortest period of time. If you have been using opioids before pregnancy, and continue to use them in pregnancy, your baby is likely to have NAS at birth, putting him at risk for breathing problems. He may need care in the neonatal intensive care unit (NICU). Baby’s withdrawal symptoms will peak anywhere from 72-96 hours

after birth; the severity of the baby’s withdrawal symptoms are typically related to the strength and amount of the pain killer used, as well as the last time mom took a dose before baby was born.

How do I know what medication is safe in pregnancy? Typically, if you’re pregnancy care provider has prescribed a particular medication for you, it’s considered safe for your pregnancy—but don’t just take our word for it—ask your provider why the medicine is considered safe, and how it may affect your pregnancy, if at all. Always take medications exactly as instructed on the label. If you need to take opioid medications in pregnancy, talk to your care provider to make the best choices and decisions possible for you and your baby. JENNIFER LEMOINE, DNP, APRN, NNP-BC, is a neonatal nurse practitioner, an assistant professor at the University of Louisiana at Lafayette and an expert nurse advisor to Healthy Mom&Baby.

ISSUE 27 / 2019 Healthy Mom&Baby

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Marijuana How It Affects You & Your Baby Do you know how marijuana can affect your pregnancy and your baby? By Cheryl K. Roth, PhD, WHNP-BC, RNC-OB, RNFA

If you use marijuana, baby uses marijuana

The major active compound in all cannabis products is commonly known as THC. This compound quickly crosses your placenta, meaning if you’re using marijuana, your baby is also using marijuana— only baby receives a blood-level concentration of an equivalent or higher dose of THC than you’ve received. Cannabis can be detected in both your baby’s cord and urine or stool after birth, and while in your womb, it continues to circulate


in your baby’s blood for up to a full month. One of the biggest challenges marijuana users face is not knowing how much THC they’re taking in as it varies widely from plant to plant, or even on different parts of the plant. Cannabis sold in the US can be highly potent.

How cannabis affects baby

Research shows cannabis can cross both the placenta and the bloodbrain barrier, although most of this evidence comes from research in animals as it’s nearly impossible to do this type of research in pregnant women. Studies with lab animals show offspring exposed to cannabis in the womb can have disrupted brain development and function. Exposure to marijuana in pregnancy is associated with decreased attention spans and behaviour problems in children. Alarmingly, increasing evidence has shown that both natural and synthetic THC are harmful to a developing embryo as early as 2 weeks after conception—and that THC can affect your baby’s brain long before you skip a period or get those first symptoms that alert you to the fact that you’re pregnant.

Quit marijuana for you & your baby

If you’re using marijuana now and aren’t doing anything to prevent

pregnancy, or are actively trying to conceive a pregnancy, it’s important that you stop using cannabis for your health and your baby’s short and long-term health and development. Know that the drug use healthcare providers are required to report by law vary from state to state, with some states having mandatory reporting of cannabis use.

Breastfeeding & marijuana

THC can accumulate in your breastmilk in high enough concentrations that your baby will pass THC in his or her urine during the first 2 to 3 weeks after birth. Your baby may also show the effects of the marijuana, including being quiet and sleepy, having poor muscle tone and nursing ineffectively at your breast. Experts advise that if you’re going to use marijuana after baby’s birth that you should avoid breastfeeding altogether, which robs both you and baby of the many protective and developmental benefits of lactation. Talk to your nurse about why you use marijuana—is it for a healthor medical-related reason? Ask about other options to manage any problems you’re trying to aid with marijuana. Cheryl K. Roth, PhD, WHNP-BC, RNCOB, RNFA, is a nurse expert and the 2019 AWHONN President.

images: Shut ter stock


arijuana (cannabis) is the most commonly used substance in pregnancy, according to the National Survey on Drug Use and Health from the National Institute on Drug Abuse. Experts estimate that as many as 10% of pregnant women in both the US and in Europe use marijuana at some point or in some form in pregnancy. Healthcare providers are advised to not prescribe medical marijuana in the preconception,pregnancy,postpartum or breastfeeding periods. Medical marijuana is legal in 33 states, and legislation is pending in others. None of these states recommends, or approves, cannabis use during pregnancy. Marijuana is still considered an illegal drug at the federal level, and it’s not regulated by the Food and Drug Administration (FDA).

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Be aware of the possibility of: Cannabinoid Hyperemesis Syndrome XX Using marijuana can put you at risk for a rare complication called

cannabinoid hyperemesis syndrome where you experience intense abdominal pain, unrelenting nausea and intractable vomiting that typical anti-nausea medications won’t help.

Cannabis Withdrawal Syndrome XX After you quit marijuana, cannabis withdrawal syndrome may start within

10 hours and increase in their intensity up through 48 hours. You may feel restless, anxious, and irritable. You may have trouble falling asleep and may have muscle tremors. You may also experience changes in your heart rate, blood pressure, begin sweating and experience diarrhea.

ISSUE 27 / 2019  Healthy Mom&Baby

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Fetal Alcohol Spectrum Disorders By Catherine Ruhl, DNP, CNM

Alcohol is the leading cause of preventable birth defects. While pregnant, there is no safe amount of alcohol, no safe time to drink alcohol and no safe type of alcohol

You’re taking steps to eat healthy foods, get more physical activity and avoid anything that could harm your developing baby. So, you should know that if you drink alcoholic drinks of any kind during pregnancy, in any amount, and at any point in pregnancy, there can be effects on your baby. When mom drinks, baby gets as much alcohol as mom gets, if not more. This is because a developing baby has little or no ability to clear the alcohol. When mom drinks alcohol it can accumulate in the amniotic fluid around baby and this means baby is exposed a second time. Babies exposed to alcohol in the womb can have lifelong effects including damage to developing organs, hyperactivity, learning disabilities, poor reasoning and judgement and difficulties communicating socially.

Effects of alcohol on pregnancy

Women who drink alcohol during pregnancy have higher rates of miscarriage, prematurity and stillbirth. Studies have shown that women drinking five drinks or more per week have several


Alcohol ◆ Fetal Spectrum Disorders (FASDs)

FASDs are lifelong—but they’re also preventable XX Alcohol in pregnancy

has been shown to be more harmful than other recreational drugs, including cocaine, heroin and marijuana XX Alcohol can damage

a developing baby before you even know you’re pregnant XX FASDs are often

missed or not diagnosed promptly, making it an invisible disorder Source: Catherine Ruhl, DNP, CNM, is editor of Healthy Mom&Baby and a certified nurse-midwife in Albuquerque, New Mexico.

times the risk of these adverse pregnancy outcomes compared to women who did not drink at all during pregnancy. Exposure to alcohol in pregnancy is also associated with higher rates of Sudden Infant Death Syndrome.

The impact of alcohol on baby can’t be predicted

You may be thinking—I know plenty of people who drank a little during pregnancy and their children are just fine. The effects of alcohol for a mom and baby pair, during each pregnancy, can’t be predicted. Both mom and baby’s genetics can influence the outcome of mom’s drinking and so can the timing in pregnancy of alcohol exposure, other substances mom may use such as marijuana, mom’s nutrition and even her stress level.

It’s never too late to stop drinking

If you’ve drank alcohol during your pregnancy, discuss this with your healthcare provider. If you’re worried about your drinking don’t hesitate to ask for help. Stopping drinking at any point in pregnancy can make a positive difference to you and your baby.

images: Shut ter stocK

When mom drinks, the developing baby drinks

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Understanding Fetal Heart Rate Monitoring Here’s why your care provider regularly checks on your baby’s fetal heart rate By Cynthia Loring, MS, RNC, CLC


ince the 1800s, midwives and obstetricians have listened to baby ’s heart rate as one way to check on baby ’s wellbeing. Fetoscopes—similar to stethoscopes—were the first technology used to listen in on baby ’s beating heart. Measuring fetal heartbeats can be a reassuring sign that baby is getting adequate oxygen through their placenta and umbilical cord (normal range for babies is 110-160 beats per minute and in this range your baby ’s heart can var y by 5 to 25 bpms). Outside of these ranges, baby may not be getting enough oxygen or may be experiencing other problems.

Checking baby’s heart rate

During prenatal care, providers typically use a wireless ultrasound device called a Doppler to listen to baby. A fetal Non Stress Test records baby ’s heart rate when baby is moving. Late in pregnancy, you may be

asked to have a Contraction Stress Test to measure baby ’s heart rate during contractions; you may need to be in the hospital with medication to start contractions for this test. Once you’re in labor, baby ’s heart rate is typically checked intermittently unless there are medical reasons to monitor it continuously. The Association of Women’s Health, Obstetric & Neonatal Nurses (AWHONN), which publishes Healthy Mom&Baby, supports fetal heart rate monitoring. AWHONN advises that monitoring should happen in ways that are consistent with a pregnant woman’s preferences and desires, and that unless clinical concerns require more increased monitoring, the least invasive ways for checking on baby ’s heart rate should be used to promote normal, vaginal labor and birth. CYNTHIA LORING, MS, RNC, CLC, is a nurse expert adviser to Healthy Mom&Baby.

fetal ◆ Electronic monitoring devices 

Electronic fetal monitoring involves two devices strapped to your belly via stretchy belts, and attached to the fetal monitoring device by cables.

Ultrasound transducer: for tracking baby’s heart rate

Tocodynamometer: for tracking your contractions and uterine activity

If the ultrasound transducer doesn’t pick up baby’s heart rate well enough, your provider may recommend placing an internal monitor, called a scalp electrode, on baby’s scalp. This is done during a vaginal exam.

If your pregnancy care provider needs more information about the intensity and frequency of your contractions, you may also receive an internal device (intrauterine pressure catheter) that sits between your baby and uterine wall, with a cable extending out to a fetal monitor.

When your labor is progressing normally, being upright and moving including rocking on a birthing ball, relaxing between contractions, and staying hydrated all support baby’s heart rate.

ISSUE 27 / 2019 Healthy Mom&Baby

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Considering Cord Blood Banking or Donation? By Jamie Vincent MSN RNC-OB C-EFM

New advancements make cord blood banking more mainstream than ever before 44


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

Download a free copy of

40 Reasons to Go the Full 40 at

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


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ince the first umbilical cord blood transplant in 1988, using stem cells taken from umbilical cord blood to treat diseases such as cancers, immune deficiencies and genetic disorders, has grown considerably. Umbilical cord blood can be used to treat more than 80 blood-borne cancers and other diseases, and to date more than 25,000 patients around the world have received cord blood transplants. Primarily, stem cells can regenerate a person’s blood or immune system. After transplant into a patient, the stem cells move to the person’s bone marrow where they multiply and regenerate cells, creating a new blood and immune system. Still, despite advances in research and therapies, most pregnant women don’t save or donate their baby’s cord blood or placenta. According to the non-profit Save the Cord Foundation, of the 4 million births in the US each year, 97% of women don’t donate or bank their child’s cord blood and it’s discarded as medical waste.

Saving Your Baby’s Cord Blood

At birth, you have an option to save and bank—or donate—your baby’s cord blood, which is the blood left in baby’s umbilical cord and placenta post-birth. Both the blood and

the umbilical cord tissue contain stem cells, and stem cells have the potential to change into various types of specialized cells, like nerve, skin, muscle, and blood cells. Stem cells treatments can be advantageous over bone marrowbased treatments as they can be used within a wider group of people than bone marrow, which generally requires a perfect match between the donor and recipient. As the number of potential therapies using cord blood continue to increase, more health care experts are encouraging parents to save or donate their baby’s cord blood. Donating to a public cord blood bank means your baby’s cord blood is available to anyone in need or for research.

Plan Ahead to Save Your Baby’s Umbilical Cord Blood

Experts writing in the journal, Nature, caution pregnant women to plan if they want to bank or donate their baby’s umbilical cord blood, as this requires completing paperwork and arranging with the hospital where you plan to birth to facilitate the donation at birth. Most public banks accept cord blood bank donations without charge, although the hospital where you’re birthing may charge to collect and manage the donation. Private banks typically charge

Did you know? Nearly 800,000 cord blood units are in public banks, and more than 5 million samples are stored in private banks.

an initial storage fee plus annual maintenance fees and may charge for collection kits and shipping. Many people bank umbilical cord blood for private use in the event their child or a family member develops a disorder treatable with umbilical cord blood transplant. As you make decisions related to your baby’s post-birth cord blood and placenta, consider that the American Academy of Pediatrics estimates that the likelihood of using your baby’s cord blood for a disease baby develops later in life is 1 in 200,000. The journal, Bone Marrow Transplant, reports public banks have released approximately 30 times more umbilical cord blood units for therapy than private banks. Jamie Vincent, MSN, RNC-OB, C-EFM, is a perinatal clinical nurse specialist and a nurse expert adviser to Healthy Mom&Baby.

◆ Consider Cord Blood Banking XX Do you have a family member with a disease

XX Do you want to donate to a public cord

blood bank? You may be helping someone who needs a stem cell transplant. Learn if the hospital where you will give birth participates in a public cord blood bank, or how to donate to a public hospital at


images: Shut ter stocK

treatable with cord blood transplant? Some private cord blood banks offer banking for little or no cost to eligible families

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Gentle enough for the most delicate skin

How often has your heart leapt out of your chest over your little one? Whether they ran out of your sight, or you found them teetering on the edge of danger, chances are you’ve felt that awful feeling once too often. And of course, those electrical cords are the worst! Before


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


This remarkable cable box is nice and roomy with specially designed locks, so it is a tough match for even the most persistent toddler! The cable wrap keeps cords tidy and hidden away from playful kids and pets too. Plus, its key parts are flame resistant for extra protection.

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Bundlebliss® Ultra Thin Nursing Pads 29/11/2019 09:33


armies has been providing soothing warmth and comfort to Moms and their little ones for over 25 years. So what are Warmies? Warmies are microwave safe plush toys that are filled with natural flaxseed and real dried French lavender. Flaxseed has great heat retention characteristics and is wonderful as a filling in plush toys. Warmies uses the softest and finest fabrics, very luxurious and so nice to the touch. But the secret sauce is French Lavender. For centuries lavender has been synonymous with tranquility, relaxation, serenity, soothing and calm. Warmies contain just the right amount of REAL dried French Lavender. Combine all these things in a super cute plush toy that is safe for all ages and you are in for a real treat. Babies, Toddlers, Kids, Teenagers, Adults, EVERYONE loves, and can’t resist, Warmies. Parents everywhere have come to know and trust Warmies as their “go to”. Here’s just a few comments from some happy parents:

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“My daughter received this as a gift when she was born and it became her favorite toy. She HAS to have it for naps and bedtime. Warming it up when she was a newborn worked great for her stomach issues/colic.”

“Someone suggested this to me when I was having issues with my daughterwho was still nursing and co-sleeping and I was trying to get her in her own room... It has a bit of weight and gets nice and warm and it smells so nice... She just hugs it right to sleep... Definitely recommend!”

“We have a fussy baby with acid reflux. This has been a game changer. Heat up and go. Baby instantly soothes and is comfortable. What a game changer. Wish I had this months ago.”

03/12/2019 10:01



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Baby safety tips when traveling You’ve child-proofed your home and know your baby can safely crawl to his heart’s content. But what about when you’re spending nights away from home? Whether at a hotel, vacation house or when visiting family or friends, keep your baby’s safety in mind. Dr. Harvey Karp, a nationally renowned pediatrician, child development specialist and Assistant Professor of Pediatrics at the USC School of Medicine, gives these tips for parents and caregivers.

1 2 3 4 5 6

Crawl around the floor to find loose staples, plastic bits, buttons, coins

7 8

Check sofa cushions for loose change Cover electric outlets with tape or little blank stoppers Make sure your toddler can’t pull over any heavy furniture, drawers, TVs Hide any dangling cords (like curtain pulls) that can get around a child’s neck Put a bit of paper medical tape + a cotton ball over any sharp corners or hard metal/brick edges Make sure the smoke alarms/fire extinguishers work and you have an exit strategy in case of fire Have the number and location of local hospital, doctor and friends nearby

Sleeping safely Many moms know the safest position for their baby’s sleep is on the back. A new study showed 78% of moms reported usually putting their babies in this position to sleep. Back sleeping has been a national recommendation for 25 years after many studies found back sleeping decreased the risk for sudden infant death syndrome (SIDS). In the new study, not as many mothers reported following other key recommendations to keep babies safe during sleep. Sharing a room with baby, but not the bed, was reported by 57%, avoiding soft bedding by 42% and baby sleeping on a separate, approved surface such as a crib or bassinet by 32%. Know your baby’s risks for sleep accidents. Babies born prematurely or of low birth weight are more at risk for SIDS as are babies living in houses where there’s second-hand smoke or if mom smoked during pregnancy. Overheating baby with either too much clothing, blankets or too hot a room temperature also increase SIDS risk.

Milk: The drink of choice for babies New national guidelines drafted by the American Academy of Pediatrics and other key dental and health organizations call for babies up to 6 months of age to have only breast milk or formula. Parents of babies 6 to 12 months can introduce water along with solid foods. The guidelines call for adding plain, pasteurized whole cow’s milk in the second year of life and avoiding fruit juice as much as possible. Experts advise not giving low-calorie sweetened drinks or drinks with caffeine to babies and young children. “From the time children are born through those first few years, beverages are a significant source of calories and nutrients and can have a big impact on health long into the future,” said Richard Besser, president of the Robert Wood Johnson Foundation, which helped fund the effort. “Families deserve clear and consistent guidance on what their young children should drink and what they should avoid.”

ISSUE 27 / 2019 Healthy Mom&Baby

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Why Is Your Baby Hungry All the Time? Your top newborn feeding questions answered

normal for baby Q Istoitseem hungry

all the time?

So, you’re home after a busy birthing experience and your baby wants to nurse “all the time.” This is a typical and normal response from your newborn; in fact, your baby will likely want to nurse 10-12 times in those first days! This may seem too frequent


to family and friends who aren’t familiar with what to expect with a breastfeeding infant. But rest assured, most healthy newborns feed “on demand”, which means your baby will be nursing about every 2 hours with unlimited time at the breast each time.

How will I know if Qmy baby is hungry

or just crying?

Your baby will give you clues to her hunger: She may smack or lick her lips, open and close her mouth, or suck on her tongue, lips, finger or toes. She may also fidget or “root” by turning her head toward your breast—and her food! Crying is a late sign when it comes to hunger. Don’t wait for crying or baby may be too upset to relax and latch on to your breast. If you find yourself in this state with baby, be patient, calm her and offer her your breast until she latches on.

baby just QShould keep feeding and feeding?

Sometimes, often in the evenings when you’re more tired, baby will want to feed more frequently, and for longer periods of time. These are called cluster feedings. The best thing is to find a comfortable place to nurse and let the others take care of the house and you. Keep baby close to you with a wrap so that she can feed frequently. How often and for how long baby feeds is her way of helping you produce milk; it also calms baby and makes her feel secure. She’ll pull off the breast when she’s done nursing. You can always offer her your other breast just in case, but if she’s truly done, start the next feeding with the other breast. JOANNE GOLDBORT, PHD, MSN, RN, is an assistant professor in the College of Nursing at Michigan State University and an expert nurse adviser to Healthy Mom&Baby.



t’s a shock to many new parents that just 48 hours after baby is born, you’re back at home and apart from the safe, secure cocoon of expert nurses at the hospital who stood ready to help and guide. Don’t worry—you’ve got this, and we’ve got the answers to the top 3 questions most parents have when it comes to feeding a newborn. In these first weeks after birth, you’re creating your milk supply, so rest when baby rests, and keep her close by so that you can catch her feeding cues.

By Joanne Goldbort, PhD, MSN, RN

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W your kids WILL

love this Restricing carbs, fat or calories?

No Thank You!

We embrace all food groups!


The My First Workout® kit is a starter homegym for kids age 5-10 with 8 pieces of kid-size equipment & step-by-step programming in both video and poster format of the 13 best exercises for kids. For all skill levels. Early habits become lifestyle habits.

Cradle Cap (officially known as seborrheic dermatitis), is an extremely common skin condition that develops on the scalps of about 70% of newborns, first appearing as a stubborn, fine, flaky dandruff. It can turn patchy, scaly and crusty before you know it. It can also appear on the ears and eyebrows (use a washcloth there). While it’s not a painful or dangerous condition, it might be itchy and is just plain UGLY!

Growing a precious baby within your body and nurturing this life at your breast is a beautiful privilege you’ve been gifted. But with this gift of motherhood comes a lot of giving on your own part too. You will not only be giving a deeper kind of love than you have ever poured out before, but a deeper output of nutrients and energy from your own body’s reserves. Most diet plans kick you off at this time of your life, but Trim Healthy Mama confidently takes you under its safe and nourishing wing. No need for pregnancy and breastfeeding to make you feel like you have to abandon all sense of healthy weight and shape. Guided by our sound yet simple principles, you can gift your baby all the nourishment he or she needs while gifting yourself a smart bounce back.

• Safely restore your waistline • Delight in fats & rejoice in carbs • All food groups are celebrated

And Chocolate?

Of Course!

Necessity is the mother of invention, which was the case with our product, Bean-b-Clean™. Our grandson developed a full-blown case of Cradle Cap at about 3 weeks of age. Hospitals used to use a sponge/brush combination and send one home with parents in their newborn kits. The trouble with those is that the sponge portion can become a breeding ground for bacteria as they’re meant for one-time use. We did some research, tweaked the bristles and came up with a pop-off plastic top to replace the sponge (making it reusable) and the Bean-b-Clean™ was born!

Give calorie counting the shove & embrace a trimmer and healthier



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Bean-b-Clean™ has been rigorously tested to meet CPSIA standards, is safe, soft and babies seem to find it soothing as they’re getting their heads massaged. We recommend using it even before any signs of cradle cap present themselves and before babies have their first fully submerged bath. It’s highly effective but gentle enough to use every day, whether they already have cradle cap or not. Directions for usage are on the back of each package.

find out where to purchase at

29/11/2019 09:36

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29/11/2019 09:37

healthy babies

Traveling with Your Baby Dreaming of a beach or exotic getaway before baby gets mobile? By Summer Hunt, ELS


efore you make big plans, ask your healthcare provider if there are any reasons your baby shouldn’t be traveling by air or otherwise. Then plan. This is no time to be disorganized: Research your destination, create packing lists and pad your itinerary with extra time throughout your journey. Check local travel and weather warnings at noaa. gov, and for international restrictions at, where you can also apply for passports and visas.

images: Shut ter stocK


It’s best to wait until baby is 3-4 months old before flying to avoid challenges to his or her vulnerable immune system and to ensure breastfeeding is well-established. That said, some babies do fly as soon as 2 weeks post birth. Check to see if your carrier has any age restrictions regarding infants. You can carry frozen or fresh breastmilk through airport security, although it will be scanned for safety. Also bring unopened snacks and empty water bottles you can fill once through security as there may be no

◆ Pack for the plane ride Include these items on your packing list XX Extra diapers, wipes and a

change of clothes in the diaper bag XXHand


XXSunscreen XXMedications

you or baby are

taking XXYour

driver’s license and/ or passport, baby’s too, if traveling international


toys your baby hasn’t played with yet (quiet ones for flights)


snacks or pacifiers


contact sheet: include relatives, friends, your pediatrician and your destination information

Summer Hunt, ELS, is an editor and author with a passion for women’s health.

snacks on board. Check with TSA. gov for any updates to the rules before flying.

Go hands-free

Most airlines will gate check your stroller or car seat for free, and it will be waiting for you as you exit the plane post-flight. If you’ve purchased a seat for baby, she must ride in a governmentapproved car seat. Look for the sticker on the seat that says “This restraint is certified for use in motor vehicles and aircraft” printed on it, or it won’t be permitted on-board—your steward will look for this. If baby’s riding on your lap, a sling or backpack carrier may help you carry her through the airport, but you’ll have to put it away during take-off and landing. If not in a car seat in the seat next to you, baby is safest when held on your lap in your arms. Help baby clear her ears on take-off and landing either by getting her to swallow frequently with a pacifier or bottle, or by breastfeeding.

ISSUE 27 / 2019  Healthy Mom&Baby

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28/11/2019 12:02

healthy babies

Navigating Vaccine Decisions for You and Your Family By Candice Robinson, MD, MPH

your baby before birth. These antibodies


provide your newborn some short-term, early protection against whooping cough. Flu (influenza) vaccine any time during pregnancy. Note that pregnant women should get a flu shot, not the nasal spray flu vaccine. Changes in your body during pregnancy make you more likely to get seriously ill from the flu. The flu can also cause serious problems like premature labor and delivery. Get the flu shot if you are pregnant during flu season—it’s the best way to protect yourself and your newborn baby for several months after birth.

Vaccines for Your Baby

Vaccination is one of the best ways you can protect your baby from 14 serious childhood diseases before age 2. The CDC sets the immunization schedule in the United States. It’s a good idea to review this schedule before your baby’s first shot visit so you know what to expect and can write down any questions you want to ask at your baby’s next appointment. Diseases that vaccines prevent can be very serious—even deadly—especially



regnancy and parenthood are Vaccines can full of excitement. They can also help protect be challenging as you navigate you and your some new areas, like babyproofing, breastfeeding, sleep routines, and so family from much more. This may include what to dangerous do about vaccines—there is a lot of diseases information out there, and it can be hard during your to know what to believe. pregnancy Vaccines During Pregnancy as well as When you are pregnant, you share through your everything with your baby. That means that when you get vaccinated, you are child’s first not just protecting yourself—you are years of life giving your baby some early protection and beyond. too. The Centers for Disease Control Here is some and Prevention (CDC) recommends the following for pregnant women: information Whooping cough (also called Tdap) to consider as vaccine during your 27th through 36th you navigate week of pregnancy, preferably during the earlier part of this time period. making When you get the Tdap vaccine during decisions pregnancy, your body creates protective about vaccines antibodies and passes some of them to

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healthy babies

for infants and young children. For example, a high number of measles cases and outbreaks have been reported in the U.S. so far in 2019. Measles is very contagious. Anyone who is not vaccinated is at risk of getting infected, including babies who are too young to receive their measles-mumps-rubella (MMR) vaccine (the first dose is normally given between 12 and 15 months of age and the second dose is given between 4 and 6 years old). It is very important to stay up to date on your baby’s vaccinations. It can take weeks for a vaccine to start working, and some vaccines require multiple doses. If you wait until you think your baby could be exposed to a serious illness—like when they start childcare or during a disease outbreak—there may not be enough time for the vaccine to provide protection.

Finding Credible Information

It’s normal to have questions about vaccines. If you are already a parent,

Questions to ask your nurse: 

Which vaccines do I need during pregnancy?

Is my child up to date on her shots?

What side effects can I expect after my child gets her shots?

What other shots will my child need as she gets older?

Which diseases are these shots preventing?

Which vaccines are important for my partner and other caregivers?

CANDICE ROBINSON, MD, MPH, works for the Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases

talk to your child’s nurse or doctor. If you are pregnant, ask your obstetrician or midwife about vaccines during pregnancy. If possible, find a doctor for your baby early, so you can schedule a prenatal consultation and ask questions about infant vaccines. There is a lot of vaccine information online, but not all of it is credible. Here are some sources that you can trust: ♦ Healthy Children—from the American Academy of Pediatrics ( ♦ CDC’s website ( Vaccine Education Center at the Children’s Hospital of Philadelphia ( vaccine-education-center) Part of becoming a mom is learning how to navigate all kinds of important health decisions for your family. Learn more about vaccines so you can keep yourself and your family on track for a long and healthy life.

ISSUE 27 / 2019 Healthy Mom&Baby

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02/12/2019 15:32

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 !

Download a free copy of

40 Reasons to Go the Full 40

What’s the hurry?


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


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23/05/2014 16:08

healthy babies

Keeping Baby Safe from the Start

By Sharon C. Hitchcock, DNP, RN-C and Melanie Welch, MSN, RN

Immediately after birth, there are a few important things that can keep baby safe and healthy


abies are recommended to be placed on their mom’s chest, skin to skin, when they’re born, if all is well. This practice soothes your baby and helps with breastfeeding and bonding. Holding baby skin-to-skin can be a normal part of how you care for your baby beyond your hospital stay. Most hospitals provide the opportunity for you to “room-in” with your baby until you go home. Your baby will stay with you all the time rather than going to a nursery, which promotes baby being able to feed as needed, benefi tting both of you. If you’re breastfeeding, your milk comes in sooner the more your baby is at the breast. There are a few cautions about placing baby in bed with you, skin to skin. Many women are tired, maybe exhausted, after labor and birth. No one wants to think about falling asleep while breastfeeding

in bed and dropping their baby or rolling against the baby so baby can’t breathe (accidental suff ocation). Newborn babies are not able to move themselves out of a dangerous position. Although rare, falls and accidental suff ocation are real risks. The good news is that almost all accidents are preventable by taking a common-sense approach. Take steps to make sure you don’t fall asleep while breastfeeding, whether you’re in bed or lying on a couch or other soft surface. You could set an alarm on your phone or ask your companions to wake you if you begin to fall asleep. When baby is feeding or sleeping in your arms make sure you can see baby’s face. How your baby’s positioned is important. For many years it’s been known that babies are safest when placed on their backs to sleep, not on their sides or tummies. Research shows that the majority of newborn falls occur at night when mom is holding baby in her arms and falls asleep. Her body relaxes, and baby slips out of her arms to the fl oor.

be afraid ◆ Don’t to ask for help, especially in these situations 

You’ve had a cesarean birth— remember this is major surgery

You’re taking narcotic pain or other sedating medications

You have birth complications such as postpartum hemorrhage or preeclampsia

You don’t have family members who can stay with you at the hospital and when you first go home

You are exhausted or feel overwhelmed by having undergone a powerful, and life changing, event— giving birth

ISSUE 27 / 2019 Healthy Mom&Baby

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healthy babies

Asking for extra help in the hospital:

A grandmother’s story My first grandson was born at 5 in the morning. By the time he finally arrived, my daughter had had very little sleep for the previous 48 hours. Her birth was considered completely normal, but she was also completely exhausted. Breastfeeding was not going well, and the baby was losing weight. My daughter was tense and slept very little the next night, and baby lost more weight. By day three the stress level was extremely high. Thankfully, in this hospital they had a staffed nursery at night, but it was not readily offered, and we had to ask them to take the baby so my daughter could get the rest she needed. Sharon C. Hitchcock, DNP, RN-C is a clinical assistant professor at the University of Arizona College of Nursing and an expert nurse adviser to Healthy Mom&Baby. Melanie Welch, MSN, RN is a clinical instructor at the University of Arizona College of Nursing and childbirth educator at St. Joseph’s hospital in Tucson, Arizona.

images: Shut ter stocK; NICHD

Falls can also occur when another family member is holding baby while sitting on a couch or chair and drifts off to sleep. Make sure baby is never left alone on a bed or couch while at the hospital or at home. If baby is not being held by a fully awake adult, place baby back into the bassinet or crib. While most moms are fully able to care for their newborn, there are times this may not be the case—and you may need extra help! And you’re the best person to know if you need more support. In the hospital, your nurse will assess your need for help but there may be details the nurses won’t know about you, your family situation, and background. Infant safety starts the moment your baby is born and being aware of what can go wrong is a huge first step to prevent accidents.


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02/12/2019 15:40


AEGIS properly positions your newborn for safe skin to skin bonding and will help reduce the risk of accidental infant falls.




pg 59.indd 1

03/12/2019 09:34

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29/11/2019 09:40


PRODUCT GUIDE Check out these parent-approved favorites!

WINIX 5300-2


This Disney/Pixar Toy Story Spin and Explore mat from Lamaze brings fun to tummy time. Designed with developmental experts, the comfy center spinner supports baby as they learn to move around the play mat. Baby builds upper and lower body strength as they spin to find all there is to see. Hidden surprises, crinkly sounds, squeaks, and a chewy star to grab and hold encourage exploration. The cover removes for easy cleaning and the mat is sized right for on-the-go fun.

An air purifier with the correct filter can help contain allergens and dust to keep your baby breathing purer air, as well as diaper odors or other unpleasant smells. The Winix 5300-2 has carbon filters to capture odors and is fitted with a true HEPA filter for all fine particles.


Baby Ddrops® is a purified vitamin D3 supplement for babies, specifically designed for breastfed infants. Apply just one drop where baby feeds, or onto a clean surface like a washed fingertip. There’s no taste, so Ddrops don’t interfere with feeding.


A safe, clinically-proven solution, SRT applies microcurrent, a solution based on the scientific concept of increasing skin’s inter-cellular metabolism to re-awaken the skin’s ability to regenerate and reduce scars. Reducing scar size reduces pain. ISSUE 27 / 2019 Healthy Mom&Baby

HMB27 Baby Gear.indd 61


02/12/2019 15:23


BRAIN SSmulaaon crucial for networking & motor development

EYES Develops baby’s visual system including tracking & coordinaaon between the eyes.

HEAD Prevent the back of baby’s head from developing flat spots BACK Helps develop posture, strength & align back vertebrae and muscles

HANDS Aids in the development of hand/eye coordinaaon & fine motor skills

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ARMS Strengthens arms. Pressing against forearms enables baby to lii its neck

LEGS Encourages baby’s legs to straighten

TUMMY Improves muscle tone & strength. Helps relieve colic

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pg 62.indd 1

02/12/2019 15:57

healthy babies

Is Your Baby At Risk For Container Syndrome? W Keeping baby confined to carriers or equipment can result in delays By Lori Grisez, PT, DPT

hile it’s tempting and convenient to have baby at arm’s length in a variety of swings, bouncy chairs, rockers, strollers or their car seat, keeping baby harnessed into a device can lead to what experts are starting to call “container baby syndrome.” Equipment or carriers can include everything from swings and packs to nursing pillows, highchairs and car seats. Most of these carriers are advertised as safe and effective ways to care for baby. They often boast the ability to ensure the baby’s security while mom is busy, and some even help parents transport baby from one place

to the next. But babies need time to stretch, move, roll and kick around; all under supervision, of course. Because equipment meant to keep baby safely contained can hinder the development of certain motor skills, it’s important to watch for and recognize the signs baby may be developing a problem, especially if baby has: ♦ Delays in achieving expected motor milestones (rolling, sitting, standing) ♦ Flat spots on the head due to lack of movement (plagiocephaly) ♦ Tightness in the neck (torticollis)

ISSUE 27 / 2019  Healthy Mom&Baby

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02/12/2019 15:24

healthy babies Tummy Time

Give baby adequate tummy time to ensure proper muscle development and to avoid development of flat spots on the head from being strapped into swings, seats, chairs or carriers. You may be surprised at how quickly baby’s time in various devices adds up—from time spent in a car seat, in a swing, to lying under a toy arch. Particularly pay attention to how much time baby spends on his back versus active playing, stretching and moving around on the stomach. Not long after the public health campaign “Back to Sleep” launched pediatricians noticed increased incidents of flat spots and neck tightness as more parents were putting their babies on their backs apart from sleep time. Parents were then encouraged to ensure baby was getting enough tummy time. On their tummy, babies are forced to lift their torso with their arms, lift and turn their head and neck, and move their arms and legs. Place baby on a hard, flat surface and use toys to distract baby from the fact that he’s on his tummy to ensure he is working his muscles. Lori Grisez, PT, DPT, is a board-certified pediatric clinical specialist and developmental therapist at Nationwide Children’s Hospital.

Encouraging Motor Development and Safety


XX At Daycare, Ask Questions

and Observe—If your child is in daycare, ask how much tummy time they plan and assist with for babies. It’s also a good idea to ask what activities they have to keep children entertained while on their tummies. When choosing a daycare, always check to see what equipment they have and how many children are in them. Observe if babies are simply rotating in and out of the equipment. If so, look for a facility that is more committed to active tummy time.


XX Monitor Baby’s

Development—Your pediatric care providers will follow baby’s development closely throughout the first year. Use these visits to express concerns you may have about development as they come up. If you’re not seeing your baby achieve typical developmental milestones, like rolling or sitting, ask if there is anything you should be concerned about or doing differently.


XX Promote Safety with

Pack and Plays—An easy way to address safety while encouraging mobility is to use a pack and play or a crib for playtime. You can set up the pack and play close to the kitchen and have baby awake playing on their tummy while remaining close by as you prepare a meal. This way, you can ensure baby is still getting that tummy time but they’re not in a place where an older sibling might step on them or where they might crawl away.

images: Shut ter stocK


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02/12/2019 15:24


The Child Forgotten in Automobile Solution Baby Alert International Inc’s SaferChild® Car Seat Monitors Designed specifically for the parent whose child is not always within their personal care.

g Disturbin Statsds a child is

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“Any person is capable of forgetting a child in a car under circumstances where a parent is going through an (autonomous) routine and the child is in the backseat ...”. Dr. David Diamond, Prof. of Psychology, University of South Florida. There’s little, if anything, more important to a parent than the safety of their child. The question that often presents itself is how does one protect against an inadvertent danger, in a way that delivers real security and peace of mind? Hypothetically speaking, the best prevention against a child being forgotten in a car would require multiple caregivers accompanying the child whenever the child was in an automobile. However, this was not practical until now. Keeping your child safe even when they are not with you. Upon the child being placed within an automobile, the SaferChild® System autonomously apportions the child-in-automobile safety responsibilities amongst the multiple caregivers. Sharing the driver’s experience;Caregivers in realtime see, hear notifications and warning as if they were actually in the car with their child. The SaferChild’s ® Arrival / Departure Notification System keep parents and caregivers in the know of their child’s location.

SaferChild® ... no matter who is driving you’ll know that your child is safe. Baby Alert Int-1 copy.indd 1

27/11/2019 10:51

healthy moms

A Mother’s Blessing The idea of a Mother’s Blessing is based on a sacred Navajo ritual called a Blessing Way By Paris Maloof-Bury, MSN, CNM, RNC-OB, IBCLC

Your Body Is A Universe By Kathleen Mitchell-Askar

Your body is a universe Cells shining like stars When the planet behind your navel Loosens from your womb Let the hum of creation Fill the rivers, your veins. This is the current we share, This is the birth that binds us. Let the mothers of the ages Be the banks to gird your waters Let your breath be the wave That smooths sensations. Pain and glory will join in a push And the rush of life, The first inspired breath, Another shining universe, Your baby boy. Your love will be his gravity. Ground him in peace. images: Shut ter stocK


odern women created the Mother’s Blessing (sometimes called a Birthing Way) and based it on the Blessing Way, with the intention of strengthening, empowering and preparing the new mother for her journey through birth and new motherhood. At my Mother’s Blessing, each guest brought three things: a thought, poem or scripture to share; a bead; and a meal for my family’s freezer. Unlit candles were set up around the room, and the guests sat in chairs arranged in a circle. Each woman introduced herself, shared her words (the thought, poem or scripture) and lit a candle. Finally, each woman strung her bead onto a long thread and we collectively made a birthing necklace that I would wear during my labor, a symbol of the long chain of mothers, and the support these women offered. Each woman took a fresh candle with her when she left, as well as the phone number of another woman. Later, everyone’s sacred words were put into an album for me to keep. When my labor started a friend initiated the phone chain. Within an hour, each woman who had been at my Mother’s Blessing knew I was in labor, lit her candle and offered a prayer (whatever that meant to her) for my safe and gentle birthing and for a healthy baby. As I labored through that beautiful September morning, I felt the cool weight of my birthing necklace around my neck, a calming reminder that I was not alone. I still have that birthing necklace and the album from my Mother’s Blessing. One of my favorite poems in the album was written by my dear friend Katie.

Paris Maloof-Bury, MSN, CNM, RNC-OB, IBCLC, is a certified nurse-midwife and lactation consultant at Sutter Health in Davis, CA.


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02/12/2019 15:25

Discover the power of Prebiotin Prebiotic Fiber before, during and after birth.

Prebiotics benefit you and your baby too… Prebiotics aren’t just for parents. A full-spectrum prebiotic can fertilize the good bacteria you pass on to your baby during the birth process. A healthy gut microbiome creates harmony between your probiotic bacteria (live organisms) and the prebiotic bacteria (soluble fiber) that feed them in your colon. Eating nutritious food such as fruits and vegetables, whole grains, lean protein and plain Greek yogurt may help you avoid digestive stress, strengthen your immune system and increase calcium absorption, for both a healthier mom and baby. Breast milk serves as a prebiotic. It contains human milk oligosaccharides or HMOs that can’t be digested in the small intestine. HMOs are the third most abundant ingredient in breast milk after fat and carbohydrates. The HMOs travel intact to the colon, where they stimulate the growth of healthy bacteria that support a baby’s immune system. Since the gut is where 80% of the immune system exists, a baby with a healthy amount of bifidobacteria can have a great start on good health for life!

Don’t Worry if You Can’t Breastfeed or Had a C-section… If you are not able or choose not to breastfeed, or had a C-section, you can still make sure your child has a good balance of microbiome bacteria. Numerous research studies find that children who receive chicory root based inulin and oligofructose (the ingredients in Prebiotin) as a supplement show improvements in growth of healthy bacteria such as bifidocolonies in the gut. With your doctor’s support, an easy solution may be the addition of oligofructose-enriched inulin (Prebiotin Prebiotic Fiber) to your baby’s formula.

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Jackson GI Medical.indd 1

As your child grows, supplementing a healthy diet with Prebiotin may start them on a path to a balanced gut microbiome (the collection of microorganisms living in the gut). These lifelong benefits may include: An improved immune system Improved bowel regularity and decreased constipation Increased calcium absorption for strong bones Better appetite control and less obesity Help with heart and brain health

Safe for Infants and Children Studies have shown that Prebiotin is both safe and beneficial for infants and children. Our prebiotic fiber contains only two ingredients, inulin and oligofructose, both natural food ingredients derived from chicory root, the most medically researched prebiotic fiber available. That’s why Prebiotin is the choice for many clinical and university research institutions, some funded by the NIH.

We always recommend consulting with your pediatrician or health professional when making dietary changes. Feel free to contact us at 855-good-gut for more information and visit us at This product is not intended to diagnose, treat, cure or prevent any disease. Photography credit Jenna Elliott – One Eleven Photography.

07/06/2019 17:25

All HUGGIES Diapers are


• Clinically proven hypoallergenic • Paraben-free • Fragrance-free • EU allergen-free • Free of natural rubber latex • Free of elemental chlorine bleaching

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Huggies-jh.indd 1

14/12/2018 15:59

Profile for Healthy Mom&Baby

Healthy Mom&Baby Issue 27  

The latest issue of Healthy Mom&Baby investigates the use of opioid painkillers in pregnancy, offers a guide to navigating vaccine decisions...

Healthy Mom&Baby Issue 27  

The latest issue of Healthy Mom&Baby investigates the use of opioid painkillers in pregnancy, offers a guide to navigating vaccine decisions...