Healthy Mom&Baby Issue 17 Final

ISSUE 17 / Summer 2015 | $3.95 | health4mom.org

PREGNANCY | BIRTH | parenting

Girlfriends’ Guide to PREGNANCY JOIN OUR

DIAPER DRIVE!

B

is for ONDING

CAN PREGNANCY

BE A STROKE RISK? Dads Describe Their

Partner’s Pregnancy Powered by the Nurses of

5

NUMBERS TO KEEP NORMAL FOR HEALTH

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healthy babies 51 Wipe Out Diaper Need Among 1 in 3 Families

Issue 17 / Summer 2015

(

CONTENTS

Make a difference for babies in your community by donating to the Wipe Out Diaper Need Drive

)

53 Prematurity and Your Baby ’s Vision

Get the facts on how prematurity affects your baby ’s vision

healthy moms

healthy pregnancy

54 Hit Those Milestones

10 5 Numbers for Optimal Health

23 Healthy Alternatives to

59 B is For Bonding

13 Could You Have a Stroke?

25 Your Healthiest Pregnancy

Here ’s what baby can do up to age 8 months!

Pregnancy Cravings

These foods can meet those intense food cravings

Know your essential 5 numbers for great health Understand how pregnancy can be a stroke risk factor for some women

Trimester by Trimester

Early pregnancy signs; 2nd trimester overview, and laboring before cesarean

14 Exploring Endometrial

Cancer

33 Top 5 Breastfeeding Positions

The facts about this gynecologic cancer

Find breastfeeding success with our all-time favorite positions

15 Nurture Yourself Postpartum

Take care of your post-baby body

37 What ’s Baby-Friendly

16 Manage How Stress Affects

This nurse shares why you need a designated BabyFriendly® birthplace

Transform stress to tranquility to boost your fertility

41 Manage Sinusitus in Pregnancy

®

Birthing?

Your Fertility

Find out why Momma ’s touch is essential for your little one ’s development

61 Recognizing PANDAS/PANS

Could these out-of-the-blue behaviors actually be a sign of a serious complication?

62 Shower an Adopted Baby

We give tips on how to celebrate your new addition

65 Diapering: Change is Good

Disposable and hybrid diapers top cloth when it comes to diaper recommendations for baby ’s bum Hit Those Milestones! p.46

5 tips to get you comfortable and breathing easy again

18 Girlfriends ’ Guide to Discussing Pregnancy

42 Anxiety in Pregnancy

Find the right way to discuss the hard pregnancy and parenting topics with your friendsss

Are your emotions, fears or concerns causing you stress or worry in your pregnancy?

44 Daddy Dearest

Take it from the dads of the 40 Weeks documentary, babies change everything!

Daddy Dearest Papa ’s got a point of view on his partner ’s pregnancy in this closer look at some of the dads from the 40 Weeks documentary.

Director/d ad Christoph e Henze wit r h his daughter, Gaia

44

FEATURE

ISSUE 17 / Summer 2015 Healthy Mom&Baby

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HEALTHY MOM&BABY EXPERT ADVISORY BOARD CANDACE ANN CAMPBELL, DNP, RN, CNL University of San Francisco Concord, CA ROBERTA DURHAM, RN, PhD California State University Eastbay Hayward, CA JOANNA GOLDBORT, MSN, PhD, RN Union Hospital Health Group Terre Haute, IN HELEN HURST, DNP, RNC, APRN-CNM University of Louisiana School of Nursing Lafayette, LA ELIZABETH JORDAN, DNSc, RNC University of South Florida College of Nursing Tampa, FL CAROLYN “CARRIE ” LEE, PhD, CNE, RN University of Toledo College of Nursing Toledo, OH JENNIFER LEMOINE, DNP, APRN, NNP-BC University of Louisiana at Lafayette Lafayette, LA CYNTHIA LORING, MS, RNC, CLC Brigham & Women ’s Hospital Boston, MA RITA NUTT, DNP, RN Salisbury University Salisbury, MD SUSAN PECK, MSN, APN Robert Wood Johnson Medical School New Brunswick, NJ MICHELE SAVIN, MSN, NNP-BC Christiana Care Health Services Wilmington, DE PAT SCHEANS, MSN, NNP Legacy Health System Portland, OR SHARON JEAN SCOTT, BSN, RN Mary Washington Hospital Fredericksburg, VA JAMIE M. VINCENT, RNC-OB, C-EFM, MSN, CNS John Muir Medical Center Walnut Creek, CA KIMBERLY WILSCHEK, RN, CCE Medical Revenue Solutions Chicago, IL

IMAGE © THINKS TOCK

CHARLOTTE WOOL, PhD, RN, CCNS York College of Pennsylvania York, PA TAMERA YOUNG, RN, MSN Central Ohio Technical College Zanesville, OH

CONSUMER ADVISORS MARIA OPLT Lafayette, LA

AWHONN ’s mission is to improve and promote the health of women and babies.

Healthy Mom&Baby is powered by the nurses of AWHONN.

BY K AREN T. HARRIS, MSN, RN, WHNP-BC

Caring for Your Baby ’s Skin There’s nothing quite as soft and supple as newborn skin. From the time your baby is born, your nurse will be by your side, teaching you and your partner, and your family too, how to care for your little one’s cuddliest feature.

Every year, 98% of all births throughout the U.S. occur in hospitals where AWHONN mother/baby nurses are the clinical leaders who help moms and new families get off to the best start. This includes showing you how to: B Go skin-to-skin right after birth to begin breastfeeding and bonding B Keep baby warm with your own warmth or by layering clothes and swaddles for him or her B Give baby his or her first bath B Change your baby’s diaper without getting soiled yourself, especially if your little one happens to be a boy!

B Know what’s normal and not for your baby’s skin, including rashes and dryness B Protect that supple, fragile new skin from the sun NEWBORN SKINCARE ZONE ONLINE But your nurse won’t stop there: At Healthy Mom&Baby online, nurses have created a Newborn Skincare Zone to keep the learning going once you’re at home again following birth. From baby acne to thrush, prickly heat to cradle cap, it’s amazing how much time you will spend caring for your baby’s skin, and we’ve got the latest in research to guide you.

Chances are you’ll visit your baby’s healthcare provider if diaper rash develops; 1 out of every 5 pediatric visits is for problems with diaper rash! In the Newborn Skincare Zone you’ll find diapering and skincare tips to help you prevent rash before it ever happens, or treat it early if you suspect it’s developing. It’s also important to know when that rash you’re seeing on baby’s bottom is actually something else, like an infection.

Just like Healthy Mom&Baby you can trust and act on the information in the Newborn Skincare Zone at Health4Mom.org because it’s written by nurses for you and your family to provide the best healthy advice for your new baby.

KAREN T. HARRIS, MSN, RN, WHNP-BC, is the AWHONN 2015 President.

ISSUE 17 / Summer 2015 Healthy Mom&Baby

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City: State/Zip: Check One: Credit Card Card Type: Name on card: Credit Card No: Exp. Date: Signature:

Check Money Order Call us at 312-572-7729 or mail payment to: Maitland Warne, 730 N. Franklin St. Suite 604, Chicago, IL 60654, USA. Make checks payable to Maitland Warne.

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go to childcare, which in turn hinders their parents from going to work. Without steady income, it ’s hard to buy diapers.

See the vicious cycle? You can help change

Chief Executive Offi cer:

donate diapers or dollars for diapers online at

Lynn Erdman, MN, RN, FAAN Vice President; Nursing, Research, Education & Practice:

launching Wipe Out Diaper Need! and you can Health4Mom.org that benefit diaper banks and families right in your local community. You can

Debra Bingham, DrPH, RN, FAAN

even start a diaper drive locally and we ’ll count

Vice President; Marketing, Communication & Publications

your efforts in the national campaign.

Working with the National Diaper Bank Network, nurses, moms2be, parents and families,

Carolyn Davis Cockey, MLS

we ’re raising awareness of this ongoing problem

Director of Women’s Health:

while linking families-in-need with local diaper

Catherine Ruhl, CNM, MS Editorial Coordinator & Writer

Address:

these babies can ’t

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Editor & Director of Publications:

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Please recycle this magazine!

Healthy Mom&Baby is published by Maitland Warne in partnership with AWHONN. © AWHONN, 2015. All rights reserved. All material in Healthy Mom&Baby is wholly copyright.

Reproduction without the written permission of the publisher is strictly forbidden.

Neither this magazine nor its contents constitute an explicit or implied endorsement by AWHONN or by Maitland Warne of the products or services mentioned in advertising or editorial content.

The editorial content in this publication does not necessarily represent policies or recommendations

by AWHONN. This publication is not intended to be exhaustive. While every effort has been made to ensure accuracy, neither AWHONN nor Maitland Warne shall have any liability for any errors or omissions. Readers who may have questions should consult their healthcare provider.

banks. How can you get involved? Visit the Newborn Skincare Zone at Health4Mom.org and get going!

Read more about diaper need on p. 60.

It ’s easy to talk about diaper need but have you ever got all hot and bothered when talking to your girlfriends about pregnancy? Everyone has an opinion about your baby, your body! We ’ve got the Girlfriends ’ Guide to Discussing Pregnancy on p. 20 to help keep things cool and calm when your bump ’s the center of conversation.

If you ’re looking for a new nursing position, we ’ve got the top 5 with step-by-step instructions on p. 31. And meet the dads of the 40 Weeks documentary on p. 42 to learn just what guys think about all of the changes their partners go through from pregnancy, to labor and birth, to parenting.

Until next time,

PUBLISHER

MAITLAND WARNE 730 North Franklin street, Suite 604, Chicago, IL 60654, USA Tel: (312) 701-0000 Fax: (312) 284-5864 www.maitlandwarne.com EDITOR IAL

AWHONN Carolyn Davis Cockey, MLS carolyndc@awhonn.org 1208 Western Pine Circle Sarasota, FL 34240 Tel: (877) 377-5326 www.AWHONN.org

Carolyn Davis Cockey, MLS Editor & AWHONN Director of Publications Health4Mom@AWHONN.org

health4mom.org

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Moms

Get Your Fill of Folic Acid

BY SUMMER HUNT

Preventing serious birth defects could lie in your next bowl of bran flakes. Eating foods fortified with folic acid —especially before you become pregnant — can reduce the risk of neural tube defects (NTDs), which affect the brain and spinal cord, research shows. New data from the CDC found a 35% decline in NTDs since 1998, when foods like bread, pasta and enriched cereals began being fortified with folic acid. About 3,000 pregnancies in the U.S. still are affected by NTDs annually.

The Institute of Medicine recommends all women get 400mcg of folic acid daily from either fortified foods or a supplement. Add a diet rich in folate, the natural form of folic acid —think lentils, leaf y greens and black beans —for a one-two punch of this powerful B vitamin.

Cervical Treatment Won’t Affect Fertility Surgically diagnosing and treating precancerous cervical lesions won ’t affect your ability to get pregnant, concluded Kaiser Permanente researchers in a 12-year study that looked at more than 100,000 women. Each year, 3 million women get an abnormal pap result. Trying to get pregnant? Go ahead and follow up on that Pap:

Of the medical cases examined, 14% of women who had cervical treatment got pregnant,

VITAMIN D FOR DEPRESSION?

IMAGES © 123RF, USDA

compared to 9% of women who did not have a procedure

and 11% who had a biopsy or colposcopy.

Low levels of vitamin D may be connected to depression in otherwise healthy young women. The findings come from a new study in which nearly half of women had insufficient levels of vitamin D, and a third of the women reported significant depression and its symptoms.

You need vitamin D for bone and muscle development and function, yet most North Americans are low on this vital vitamin.

YOU NEED 600 IU/15 MCG OF VITAMIN D DAILY —ABOUT THE SAME AMOUNT IN 5 GLASSES OF LOW-FAT MILK.

ISSUE 17 / Summer 2015 Healthy Mom&Baby

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5

BY DRS. MICHAEL ROIZEN & MEHMET OZ

Numbers for

Optimal Health

Ready for a fresh start?

We’ve got 5 essential numbers that set you up for flourishing health, longevity, and more energy than the Energizer Bunny®. You’ll be ready to birth a baby, enjoy your children—even grandchildren—if you get and keep these 5 numbers within normal range.

We’re talking about 5 measures: Your LDL cholesterol, hemoglobin A1C (blood sugar), waist size, cotinine (tobacco toxins), and blood pressure. Together, these measures make or break your risk for developing chronic disease or sustaining a major adverse health event.

Keep—or bring and keep—these 5 measures into “normal range” and you reduce your risk of disease or disability by 80 to 90%. (Now would be a time to jubilantly shake the nearest rattle!)

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5 HEALTHY MEASURES Here ’s normal for women (nonpregnant) and men:

1.

LDL CHOLESTEROL UNDER 100 MG/DL

2.

HEMOGLOBIN A1C BETWEEN 4-5.6% OF PLASMA GLUCOSE, AND ALWAYS KEEP YOUR BLOOD SUGAR UNDER 110MG/DL

3.

WAIST SIZE UNDER 32.5 INCHES FOR WOMEN; UNDER 35 INCHES FOR MEN

4.

COTININE

(TOBACCO TOXIN)

0NG/ML

5.

BLOOD PRESSURE UNDER 115/75

health4mom.org

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healthy moms

YOUR NUMBERS DURING PREGNANCY Now when baby’s on board, expect fluctuations in these numbers (some of them, at least). It goes without saying that you need to steer clear of tobacco (and hence have 0 cotinine) before, during, and after pregnancy (and always and forever).

Don’t be alarmed though if you find that over the course of your pregnancy, your LDL elevates progressively—in the 1st trimester “normal” can range from 60 to 153mg/dL, and by the 3rd trimester that can bump up to 101 to 224mg/dL. Your Hg A1c, however, should not rise too much, except perhaps slightly in the third trimester (6% or higher, pregnant or not, is considered diabetes), and you can expect your blood pressure to drop slightly in the 1st and 2nd trimesters as progesterone relaxes your vessel walls, and then rise in the 3rd. If you already have blood pressure numbers above these, it is very important to manage that with your healthcare provider, and stay on any blood pressure medications you may have been on pre-pregnancy.

We will not lie to you: You should expect a change in waist size as baby grows, all the way through term. However, do not be lured by the idea that eating for 2 actually requires anything near eating twice as much food—for optimal nutrition for baby, and for healthy weight gain for you, you should aim to eat for about 1.1!

That means you should take in, on average over the course of your pregnancy, about 10% more calories a day than you normally do, and these calories should ideally come mostly from low-fat, healthy proteins.

In the 1st trimester, increase your calories by an extra 100 calories a day (a tall glass of skim milk); in the 2nd trimester to about 250 calories a day (about 10 walnuts plus an apple), building to an

extra 300 calories a day in the 3rd trimester.

Start a daily prenatal vitamin with DHA omega-3 at least 3 months prior to conceiving. Just learned you’re expecting? Pop a prenatal now and continue daily until at least 6 months after birth and breastfeeding. Prenatals with DHA taken 3 months prior to and during pregnancy decrease congenital defects by 80%, childhood cancers to age 6 by 65%, and autism by 40%.

LIFELONG HEALTH Lay the foundation for lifelong health in pregnancy, both for you and your child—and his or her children and grandchildren. That’s what’s so amazing about how the choices you make in your own health can have long-term effects on the health of your children. Once you see those effects in person, you’ll really see why it’s so important to start this process with this end goal in mind. But there is even more good news!

If the 5 numbers aren’t normal for you now, forgive yourself and change course: You do get a 2nd chance. You can reverse health problems associated with inactivity, overeating, addictions, depression, much of your genetics, and most anything else. You can live life with high energy and happiness no matter the nature of your health concern. No matter how long you’ve had it. No matter what kind of shape you’re in right now. No matter what you’ve tried in the past.

You can have a Do-Over. You deserve a DoOver. So reach for those 5 normals. You will feel much better, and taking time to get to normal is really showing love for those you care most about. You’ll be there to care for them rather than them having to care for you.

Prenatals with DHA taken 3 months prior to and during pregnancy decrease autism by 40%.

MICHAEL F. ROIZEN, MD, is a professor of

internal medicine and anesthesiology, Chief Wellness Officer, and Chair of the Wellness Institute at the Cleveland Clinic. Read more about the 5 normals in his new book, This Is YOUR Do-Over.

MEHMET C. OZ, MD,

is a professor and vice chairman of surgery, as well as director of the Cardiovascular Institute and Integrated Medical Center, at New York ’s PresbyterianColumbia University. His Doctor Oz show has won 5 consecutive Emmys.

ISSUE 17 / Summer 2015 Healthy Mom&Baby

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O-Cal Prenatal vitamins for a healthy Mom and Baby Proper nutrition is the foundation for a healthy life and oftentimes we don’t eat correctly, which is why taking the correct prenatal vitamin daily is important. The Center for Disease Control urges women to take Folic Acid daily starting at least one month before getting pregnant.

Folic Acid is very important in preventing major birth defects of the baby’s brain and spine (anencephaly ERH WTMRE FMǝ HE 8EOMRK +SPMG &GMH prior to conception may also reduce the risk of Autism by 40%. Iron and Folic Acid are two major nutrients that are crucial during pregnancy

for neurodevelopment of the baby.

Studies show that mothers who take iron and Folic Acid during pregnancy have smarter babies.

80% of a newborn baby’s iron stores are accumulated in the 3rd trimester of pregnancy, thus it is very important that Mom not be iron HIǝ GMIRX &JXIV HIPMZIV] ]SY RIIH an adequate diet rich in essential nutrients such as calcium and Folic Acid to support nursing and replace depleted nutrient stores. ,IX SǺ XS E KVIEX WXEVX [MXL XLI 4 (EP JEQMP] SJ 5VIREXEP ERH 2YPXM ZMXEQMRW Ƴ XLI 'IWX 6YEPMX] ERH XLI 'IWX :EPYI

Available at www.Pharmics.com or by calling 800-456-4138

Don’t miss out

Follow us

B www.facebook.com/HealthyMomAndBaby

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healthy moms

Stroke?

COULD YOU HAVE A

ask our nurses Nurses explain why check your blood pressure and urine at each prenatal visit: http://www. bit.ly/1EdVezq

JENNIFER B. LEMOINE, DNP, APRN, NNP-BC

New guidelines address the risks women face related to hormones, pregnancy and birth

Stroke probably isn’t something you worry about most days, but did you know 1 in 5 women will have a stroke at some point in their lives? Your risk for stroke is influenced by whether you’ve ever been pregnant, take birth control pills, have migraine headaches that include auras, among other factors. Approximately 3 out of 10,000 pregnant women will have a stroke during pregnancy, compared to 2 out of 10,000 non-pregnant women.

For the first time, guidelines have been developed by the American Heart Association to address the unique stroke risk factors in women because of hormones, pregnancy and childbirth.

MANAGE YOUR RISKS PRE-PREGNANCY 1. BIRTH CONTROL PILLS: Doubles stroke risk, particularly with existing high blood pressure x Get screened for high blood pressure before taking birth control pills x Don ’t smoke, quit smoking x Know that smoking while taking birth control pills increases stroke risk

2. MIGRAINE HEADACHES: Women with migraine headaches with auras, and who smoke, are more likely to have a stroke

NEW STROKE GUIDELINES FOR WOMEN

x Quit smoking

The biggest risks for stroke—whether you smoke, are obese or have high cholesterol—are common to both women and men.

However, high blood pressure and migraine headaches with visual changes (auras) are stroke risk factors more common in women. The hormonal changes that occur throughout a woman’s life, including those before, during and after pregnancy, can increase the risk even more!

Preeclampsia and eclampsia are blood pressure disorders during pregnancy that cause major complications, including stroke during or after delivery, premature birth, and risk for stroke long after childbearing. Preeclampsia is observed through high blood pressure and high protein levels in your urine, and when seizure also occurs, this is called eclampsia.

Here’s how to recognize and manage your risks for stroke:

3. HIGH BLOOD PRESSURE: Increases risks pre-pregnancy for preeclampsia

x Discuss with your healthcare provider using low-dose aspirin, starting in the second trimester (week 13+)

x Also discuss if you should take calcium supplements to reduce preeclampsia risk

PREGNANCY 1. HIGH BLOOD PRESSURE: Highest incidence of stroke is in the 3rd trimester or during the postpartum period

x High blood pressure in pregnancy should be evaluated and treated with medication, as needed

2. PREECLAMPSIA: High blood pressure that develops in pregnancy

x Blood pressure readings of 150-15mmHg/100-109mmHg may need treatment via medication; your healthcare provider can discuss the risks for you and your baby x Blood pressure readings of 160/110mmHg or higher should always be treated

POST-PREGNANCY 1. HISTORY OF PREECLAMPSIA: Doubles your risk of stroke; quadruples high blood pressure risks later in life

x Know your increased stroke and high blood pressure risk factors x Get screened for high blood pressure 6 months-1 year after birth x Get screened for other stroke risk factors: obesity, smoking and high cholesterol

ISSUE 12 / Fall 2013 Healthy Mom&Baby

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EXPLORING

BY SUSAN PECK, MSN, APN

The word cancer always strikes fear in our hearts and minds, but when it affects the uterus (womb), a woman’s life- giving organ, it’s even scarier. There are 2 types of uterine cancer: endometrial carcinomas (cancer that starts in the lining of the uterus) and uterine sarcomas (cancer that starts in the muscle layer of the uterus). Almost all uterine cancers are endometrial cancers.

Endometrial cancer is the most common gynecologic cancer, more common than cervical, ovarian, or vulvar cancer. A woman’s average lifetime risk of being diagnosed with endometrial cancer is 1/37. According to the American Cancer Society, about 54,000 cases will be diagnosed this year. Of that number, about 10,000 women will die from uterine cancers. These cancers most commonly occur in women ages 45 and older.

Warning Signs Abnormal vaginal bleeding, such as a change in menstrual periods, bleeding in between periods or bleeding after menopause, is the most common warning sign for endometrial cancer. About 90% of women who have endometrial cancer have abnormal vaginal bleeding. This symptom may not always 14

mean cancer, but it’s always important to see your nurse or doctor to get checked Endometrial cancer can only be diagnosed from a tissue sample taken from the uterus. This sample can be collected from tests such as an endometrial biopsy, performed in your health care provider’s office or a dilation and curettage (d&c), usually performed in a surgical suite.

The good news is that if endometrial cancer is caught early and has not spread, 5-year survival rates are high: 90% or more.

Manage Your Risks To lower your risk for this cancer, maintain a normal healthy weight, exercise, stop smoking and report any abnormal bleeding to your healthcare provider right away.

Did you know that using birth control pills lowers your risk of endometrial cancer? The pill controls estrogen levels, which protects the endometrium. Birth control pills can reduce the risk of endometrial cancer by 50%; the risk is minimized most in women who use the pill for a long time. And the protection continues for up to 20 years after stopping the pill.

Several of these risk factors are related to extra estrogen, a hormone produced in the ovaries. If there is a shift in the normal balance of estrogen and other hormones, this may increase your risk of endometrial cancer. Risk factors for endometrial cancer include: B Obesity B Irregular periods B Never having a baby B Getting your period at an early age B Going through menopause at a late age B Use of Tamoxifen to treat or prevent breast cancer B Cigarette smoking B Family history of endometrial or colorectal cancer

SUSAN PECK, MSN, APN, is a nurse

practitioner in New Brunswick, NJ, and an expert advisor to Healthy Mom&Baby.

IMAGES © 123RF

Endometrial Cancer

Know Your Risks: Endometrial Cancer

health4mom.org

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healthy moms

Nurture Yourself

BY AWHONN EDITORIAL STAFF

IMAGES © 123RF, THINKSTOCK

Postpartum

If you feel like you’ve just completed a triathlon post-birth, you’re not alone.

Pregnancy and birth are often compared to a marathon. You won’t get your prepregnancy body back overnight but these proven tips that will help you ease into feeling like yourself again.

Google “first postpartum poop” and you’ll find you’re not the only one anxious about that first movement after birth.

If you didn’t eat much before going into labor, it could be a while before you feel the need to go. Experts at the Ohio State Medical Center advise:

MANAGE SLEEPLESS NIGHTS

B B

It’s going to be 8 weeks or more before you wake up one morning and realize your baby has slept through the night.

You never get used to being awakened in the night for nursing. Ease into motherhood by following these steps: X Rest when you can: Your friends and family want to see the baby so let them; nap while they adore her X Sleep when baby sleeps: Skip the housework or let someone else do that for you X Give yourself permission to simply eat, sleep and care for yourself and your baby during this time X Use pillows as positioners to help you get into the most comfortable nursing and sleeping positions X Sustain mild activity: It’s amazing how a short walk outdoors can rejuvenate your spirits

YOUR FIRST MOVEMENT

B B

A high-f iber, healthy diet Hydration: You need lots of water to help your body make breastmilk as well A stool softener Alert your healthcare provider if you haven ’t had a bowel movement in 7 days

NOT FEELING NORMAL AGAIN? After childbirth you may feel sad, weepy, and overwhelmed for a few days, and that ’s typical, say experts at the National Women ’s Health Information Center. But if those feelings don ’t diminish within the first 2 weeks despite the sleepless nights, call your healthcare provider.

Postpartum depression can happen any time within the first year after birth. Call 911 or a family member right away if you have any thoughts of harming yourself or your baby. You might have postpartum depression if you ’re:

B B B B

Restless, sad, depressed or crying a lot Tired, struggling to focus, forgetful or having trouble making decisions Disinterested in others, particularly your baby, or daily life, including eating and caring for yourself Without pleasure from regular activities, including holding and feeding your new baby

Nurses have lots of advice to help you get into the swing of caring for an infant while you ’re struggling to care for yourself. Never hesitate to call your healthcare provider ’s office if things just aren ’t quite right for you or your baby.

ISSUE 17 / Summer 2015 Healthy Mom&Baby

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healthy moms

MANAGE HOW STRESS

Affects Your Fertility

BY EVA SELHUB, MD

When you feel stressed, your brain senses that you’re under attack, releasing stress hormones like cortisol and adrenalin (among others) to turn off those bodily systems that aren’t in demand at that moment, including your digestive and reproductive systems.

Problem is your brain doesn’t distinguish between real or imagined threats, physical, psychological or emotional. The economic recession or your struggles to conceive are no different than a lion to your brain. The more you worry, the more you put your body in ongoing—even chronic—stress.

Chronic or ongoing stress can hinder your efforts to conceive and cause infertility. On the fl ip side, managing stress improves fertility.

Think about it this way: Your body’s stress response system shuts down fertility when you feel unsafe, unsupported and in danger. So your goal is to feel the opposite: safe, supported, loved and nurtured. Here’s how:

M FOR S E E K CO

T

Connect with those you love who can love you back.

Support heals all kinds of physical and psychological problems. Join a support group; spend time with friends. Reach out.

Meditate and allow yourself to get lost for a short while within a universe that is much larger than your own world. Spend time outdoors communing with nature, or think on images you find soothing, like a sand-swept beach or secluded mountain lake.

FE ELING S H O N O R YOU R Choose to surround and fill yourself with love. Every time you feel bad, sad, frustrated, stressed, fearful or angry, stop and simply let yourself feel whatever you ’re feeling. Feel it and then release it by doing the following several times in rhythm:

X X X X X X X X

Close your eyes Imagine the face of someone dear Imagine that person smiling at you Imagine the person ’s eyes are looking deep into your eyes Your eyes are now locked You begin to breathe in sync You both inhale deeply and then when you cannot breathe in any more, exhale completely, in synch Repeat these words to yourself: “I am safe. I am loved. I am accepted as I am. ”

Be kind and gentle toward yourself. This is the hardest of all, especially when your body isn ’t giving you what you so want. Throw off the blame and shame so common in our lives; don ’t beat yourself up for not being good enough.

Simply stop. Start to love yourself. Cherish your body as the temple a life would want to enter.

16

DR. EVA SELHUB is a clinical instructor of medicine at the Harvard Medical School and a senior staff physician at the Benson Institute at Massachusetts General Hospital.

IMAGES: 123RF

LOV E YOU R SE LF

health4mom.org

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FEEDBACK

Send us your feedback and comments! health4mom@awhonn.org

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healthy moms

BY K AITLYN DIXON

Girlfriends ’ Guide

)

Are you a well-read and informed parent who believes you’re making the healthiest choices for your baby? Do you ever hear friends describe different parenting choices and think, “She’s doing it all wrong!” You want to help, but don’t know what to say?

Here’s our advice, girlfriend to girlfriend!

BE A FRIEND FIRS

T

Remember that doing things differently doesn ’t mean parents don ’t love their baby, or that what they ’re doing is all wrong. We each make what we believe are the best choices for our family. With those assumptions out of the way, don ’t be afraid to talk about your experiences and share information without judgment.

18

ASK TO UNDER

STAND

We make health decisions based on our own knowledge, expectations, fears, benefits, and options. Our views are shaped by our experiences, our family and friends, the information we get from our healthcare providers, media, and other influences. So if your friend talks about a parenting choice that you believe is unhealthy, ask her why she thinks that choice is best—you might be surprised.

Consider these stories and how the experiences of the individuals and families shape these women’s seemingly less-thanbest choices: B The stomach sleeper: Aly’s baby doesn’t sleep well.

When complaining to her mom about her lack of sleep, her mom tells her to put the baby to sleep on his stomach. Her mom says she put her babies on their stomachs for sleep, so did all her friends, and she never knew of a baby who died of SIDS. Sleep-deprived, Aly is willing to try this, and is happy when her son seems to sleep better. At their next well-baby visit, Aly mentions the sleep change to her pediatrician, who talks to her about SIDS and safe sleep. Aly feels that because her son doesn’t have other risk factors for SIDS like prematurity or secondhand smoke, the benefits of him sleeping on his stomach outweigh the risks.

B The formula feeder: Mia has never seen anyone breastfeed. Her friends feed formula to their babies, and her older sister told her that breastfeeding was really painful, and that she never had enough milk.

At Mia’s prenatal appointment, her pregnancy care provider tells her that breastfeeding is the best way to feed her baby, and she is surprised. She says she is planning to formula feed. The pamphlets her care provider gives her seem to contradict everything she’s heard from friends and family. She expects that if she tries to breastfeed, her experience would be painful and she won’t have enough milk, just like her sister, so she doesn’t plan to try.

IMAGES © 123RF

(

TO DISCUSSING HEALTH & PARENTING

health4mom.org

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healthy moms RESPOND HONESTLY

KAITLYN DIXON

is a public health educator who writes for Healthy Mom&Baby.

If your experiences and information are different than your friend’s, share them, offering advice and encouragement while still being understanding. For example, you could say to Aly, “It’s so hard when the baby doesn’t sleep well!

I found that swaddling my baby helped her sleep much better on her back.” Or to Mia, “It can seem strange and difficult to feed our babies from our breasts, especially if you haven’t seen anyone do it, but it can be really wonderful. I love nursing my baby and I’ve found it to be easy and with plenty of milk! There are lactation consultants to help if you have trouble.”

If you’re really concerned that your friend is making an unhealthy choice, be honest! For example, if you have a friend who wants to schedule an early induction so the baby will be born when her mom can be in town, you could say, “Based on everything I’ve read and heard, early inductions can increase risks of complications to you and your baby, so that makes me worry for you. What does your healthcare provider say about wanting to schedule your baby’s birth for convenience?”

O FF ER SU PP O RT

One thing all new parents need is social support. In any of the scenarios you can do more than just listen and talk. You can also offer your support. You could lend Aly your favorite swaddling blanket, or ask Mia if she wants to come to a breastfeeding support group meeting with you. And your friend desiring the scheduled induction might be terrified to take care of a newborn without help. Ask if she’d feel better if you came to her house to help until her mother can get there. Having support from friends and family can make a big difference!

When we respect each other and our differing health choices we can talk about them in a supportive and caring way. Sharing your knowledge and experience with your friends and encouraging each other to make the healthiest choices for your families is part of creating healthier communities together.

ISSUE 17 / Summer 2015 Healthy Mom&Baby

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healthy

Join us on Facebook facebook.com/HealthyMomAndBaby

BY SUMMER HUNT

Pregnancy

Babymoon Travel Tips

Considering a babymoon getaway? Plan ahead with safety in mind! The best time to travel during pregnancy is between 14 and 30 weeks, when complications are less likely to occur and you may feel your best. Take a look at these transportation tips from Baylor OB/GYN expert Dr. Kelly Hodges: B Stretch frequently B Wear support hose on long flights to avoid blood clots B Protect your belly while moving about on a plane or boat B Stay hydrated and avoid sodas, which can make you feel bloated

SCALE BACK TO AVOID CHILDHOOD OBESITY LATER IN LIFE

B Get motion-sick? Ask your healthcare provider about acceptable meds

Too many pregnancy pounds can lead to chubby children, say experts who observed that women who gained too much in pregnancy were more likely to have obese kids. Starting pregnancy overweight is even riskier: Excessive pre-pregnancy weight gain packs a whopping 300% risk of childhood obesity for your baby. For moms:

B Keep car trips to 6 hours or less B Know the nearest hospital at your destination in case of emergency

Minimize weight-related risks: B Get to a healthier weight before conceiving B Gain only 15-25 pounds if you’re overweight; 11-20 if you’re obese B Don’t diet—you can deprive yourself and baby of essential nutrients B Eat balanced meals, get 30-60 minutes of activity most days of the week, like walking B Remember: You only need an extra 150-300 calories/day

IMAGES © 123RF

You Can Wipe Out Diaper Need When babies don ’t have enough diapers they can ’t go to childcare and mom or dad can ’t go to work. You can ’t buy diapers with food stamps. Childcare and laundromats won ’t allow cloth diapers. It ’s a vicious cycle.

Diaper need affects 1 in 3 families in the US. Help wipe out diaper need by joining with nurses to provide diapers or dollars-for-diapers for families right in your community as part of the Healthy Mom&Baby 2015 Wipe Out Diaper Need Drive at Health4Mom.org/diaper-drive. Organize a drive or pick up extra diapers when you ’re buying school supplies and drop them off at a local bank; then tell us about your efforts online!

ISSUE 17 / Summer 2015 Healthy Mom&Baby

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PREGNANCY | BIRTH | PARENTING

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27/07/2015 10:52

healthy pregnancy

Healthy ( Alternatives

)

TO PREGNANCY CR AVINGS

BY MADELINE HURST

Can’t pass Ben & Jerry’s without stopping? Willing to get out of bed at 2 am just to hit your favorite all-night drive-thru? Have you served pizza for dinner the last 5 nights?

There’s nothing more common in

pregnancy than cravings! Experts don’t know why women crave foods during pregnancy, but they do agree that it’s not typical to go through pregnancy without at least once bout of serious fixation and need for a particular food.

DOUGHNUTS:

SNACK HEALTHFULLY Tape this page to your refrigerator and find your next fix if you ’re jonesing for something sweet, salty or bubbly. We ’ve got the healthy alternatives for the top foods women say they couldn ’t get enough of in pregnancy.

Remember that these cravings are normal, so don ’t torture yourself and never eat a sweet treat again. It ’s okay to indulge in small amounts every now and then.

Oh yea, sweet, gooey, light and savory. Try whole-grain breads or bagels with low-fat spreads like regular or fruit-flavored cream cheese. Toast with jam may be that jelly-filling fix.

ICE CREAM: Umm, cold, smooth, creamy.

Try non-fat/reduced sugar frozen yogurt or ice cream, sherbet or sorbet.

CHIPS: CAKE: Banana or zucchini bread is nutritious while giving you that cake taste and feel.

COOKIES: Hello graham crackers; they ’re sweet by themselves.

Jazz them up with low-fat spreads like cream cheese or a bit of peanut butter.

IMAGES: 123RF

SODA:

MADELINE HURST

writes about food for Healthy Mom&Baby.

Sparkling water mixed with a small amount of fruit juice or with a dash of lemon or lime should do the trick.

Luckily, there ’s a pretty large selection of baked potato and tortilla chips to substitute for the greasy originals.

Go healthier with popcorn and pretzels, too.

CHOCOLATE: This may be an area where you can give in a little. It ’s okay to have a few small squares of chocolate, especially if it ’s dark chocolate. This is no license for a full-on candy bar. And remember chocolate also has caffeine, so don ’t go overboard. Try reduced sugar hot chocolate or hot cocoa with low-fat milk.

ISSUE 17 / Summer 2015 Healthy Mom&Baby

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Do These Signs Mean I’m Pregnant?

BY CAROLYN (CARRIE) J. LEE, PHD, CNE, RN

(

YOUR BODY HAS A LOT OF WAYS TO LET YOU KNOW YOU ’VE GOT A BABY ON BOARD

Nothing beats a pregnancy test when it comes to knowing if you’re pregnant, but your body may give you some early pregnancy signs that you’ve got a little one developing inside. Not all women experience these early signs or symptoms in the same way. These signs are typically caused by pregnancy hormones and can change as your pregnancy continues.

TENDER, SENSITIVE BREASTS If your breasts begin to feel tender, heavy, sensitive, increase in size or darken around the nipple, you may be pregnant. All of these signs are normal; just let your partner know if this affects your intimacy, and choose some cute new bras that will support your growing and changing breasts.

)

INCREASED URINATION

NAUSEA & GAS Does the world suddenly stink and really turn you off? You may find you ’re sensitive to certain smells and foods.

You may even feel “gassy ”, nauseated and experience vomiting. Extreme or persistent vomiting isn ’t normal; tell your healthcare provider if you can ’t keep food down. For most women, this gets better as the weeks pass.

A MISSED PERIOD The most obvious sign is missing your period, especially if your cycles are typically regular. This might be your first clue.

IMAGES: 123RF

EXHAUSTION! Perhaps you can ’t keep your eyes open —even after a full night ’s sleep.

You may have unrelenting fatigue or feel woozy. Not just an everyday kind of tired —we ’re talking feeling wiped out!

The hormone progesterone is thought to be the culprit, and your blood pressure may be dropping a bit in early pregnancy.

Respond to what your body is telling you with extra sleep, quiet time and staying well hydrated.

You may also notice you need to urinate more frequently as your uterus grows, but you should not have any other symptoms other than the urge to go. Any burning or irritation may actually be signs of an infection.

COPING THROUGH EARLY PREGNANCY If you ’re seeing these signs, it ’s time to grab a pregnancy test. If you experience bleeding, leaking fluid, cramping, headaches or feeling very sick please contact your care provider right away! Meantime, know that these early symptoms and signs are normal. Some women find enjoying smaller meals and snacks helps with the nausea and fatigue. Keeping active, following a healthy diet rich in protein and staying hydrated will also help you cope.

CAROLYN (CARRIE) J. LEE, PHD, CNE, RN, is a

professor at the University of Toledo College of Nursing in Toledo, OH, and an expert advisor to Healthy Mom&Baby.

ISSUE 17 / Summer 2015 Healthy Mom&Baby

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healthy pregnancy NU TR ITI ON KN OW-H OW Hydration is key; drink at least 8, 8-ounce glasses of water a day plus more during exercise Minimize heartburn by skipping spicy or heavy meals, acidic fruits like tomatoes or eating late at night

Your 2nd Trimester: 7 Weeks 13-2

ENJOY THE ENERGY BURST OF THE

Second Trimester

Welcome to middle pregnancy—soon you’ll be halfway to term! During 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! Other changes can include:

X An energy burst—ask your nurse what exercises you can continue or begin in pregnancy X Lower back pain as your uterus grows and changes your center of gravity

IMAGES: 123RF, THINKSTOCK

X Soreness or twinges along the sides of your belly as your uterus stretches and moves higher in your abdomen X Nasal stuffiness or even snoring from increased hormones and blood flow; soothe with saline nose drops and a humidifier X Varicose veins in your legs—even your vagina, from relaxed blood vessels and slower circulation; elevate your legs or wear support or compression stockings X Itchy skin or stretch marks; belly butters and balms can ease the itching

Around weeks 17-20 you may be surprised by flutters in your belly—that’s your baby moving!

More exciting is your 2nd trimester ultrasound. Will you try to learn whether you’re having a girl or boy?

Between weeks 24-28, you’ll be checked for the most common pregnancy complication: gestational diabetes. As many as 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 in infants. Also, get a flu shot in pregnancy before flu season—this vaccine is safe in any trimester.

Your baby’s heart is beating fast—about 140150 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.

Take in an extra 250 calories a day—up to 350 calories in the 3rd trimester—to maintain steady weight gain Pick highprotein snacks like eggs, nuts, cheese sticks or hummus Fill up on fiber in beans, bran or berries to keep your bowels regular

GO FULL TERM 9 REASON #15:

Give baby ’s development the benef it of time since you may not know exactly when you got pregnant

9 REASON # 22: Respond to requests to speed baby ’s birth with the facts that inductions of ten create more painful labors and lead to cesarean 9 REASON # 28: Shamelessly wear stretchy, comf y clothes Read all 40 reasons to go to term at GoTheFull40.com

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AWHONN Go the full 40.1.indd 1

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3rd

Trimester:

healthy pregnancy

BY JOANNE GOLDBORT, PHD, MSN, RN

SHOULD YOU TRY LABOR

Before a Planned Repeat Cesarean?

A trial of labor after a previous cesarean can, in the right circumstances, bring the benefits of waiting for labor and vaginal birth for both you and baby You had a cesarean birth with your first pregnancy, and now, after consulting with your healthcare provider, you’ve agreed that a repeat cesarean may only be needed if you have similar problems that caused your first pregnancy to end via surgery.

You’ve heard about the benefits of waiting for labor to start on its own, and trying to birth vaginally after a previous cesarean. You’d like to have that for both you and your baby, as possible.

You’ve also heard that newborns born less than 40 weeks gestation can have problems stabilizing their breathing, body temperature, and blood sugars, as well as risk jaundice. You’d like for your baby to go full term and to be as ready as possible to begin breastfeeding after birth, and to avoid the risks of birthing early. You’ve learned that spontaneous labor means baby triggers labor and picks the day and time that’s best for him or her to be born.

IMAGES © 123RF

TRIAL OF LABOR AFTER CESAREAN

Experts call birthing vaginally after having had a previous cesarean birth a “vaginal birth after cesarean,” or a VBAC. It all begins with a “trial of labor after cesarean,” (TOLAC) which means if your healthcare provider agrees, you can try to

birth vaginally following a previous cesarean.

TOLACs are helpful, particularly if you want to have more children and want to avoid the risks of multiple cesarean births. These risks can include hysterectomy, bladder or bowel injuries, and problems with your placenta in future pregnancies.

The good news is that waiting for your body to go into spontaneous labor can help prevent potential problems. Waiting for spontaneous labor, or at least a full 40 weeks, gives your baby the extra time to benefit from that big immunity boost that happens in the last weeks of pregnancy. Waiting also means you maximize baby’s lung, liver, and brain development, and baby gets to build up those extra fat stores needed for stable temperature and blood sugar after birth.

When spontaneous labor begins, stress hormones (known as catecholamines) help rapidly prepare your baby for life outside of the womb.

These stress hormones help your newborn’s lungs by absorbing fluid and releasing surfactant that’s needed to expand her lungs to help her successfully take her 1st few breaths. This reduces the need for your healthcare providers to intervene and help baby breathe on her own.

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Birthing Normally After Cesarean You ’re more likely to be successful going into labor on your own and birthing normally after a previous cesarean if the following is true for you, say experts at the American College of Obstetricians & Gynecologists:

B You have a side-to-side incision

B

Coordinating with your healthcare provider, you can rest assured waiting for labor to start on its own that you and your baby will continue to be monitored regularly for problems, and that your provider will intervene and perform a cesarean, should it become necessary.

Waiting until labor begins on its own, and birthing normally when possible, means your cervix is most ready for birth, your chances of birthing vaginally are greatest, and if successful, you and your partner will immediately be able to begin bonding and start breastfeeding with your baby as soon as possible after birth.

T R IA L OF B E N E FI T S OF A SA R E A N CE L A BOR A FT E R Waiting for labor to start on its own, and birthing vaginally, typically means the following benefits for you and your baby:

9 Benefits of a faster, easier recovery 9 Rooming together after birth so that you can bond and breastfeed 9 9 9 9 9

JOANNE GOLDBORT, PHD, MSN, RN, is an expert advisor to Healthy Mom&Baby.

30

as desired skin-to-skin right after birth, helping baby stabilize her temperature, breathing and blood sugar Beginning breastfeeding within the first hour after birth Avoiding pain medications that can slow your labor or dull baby ’s urge to feed right after birth Reduce your infection risks Reduce your risks of bleeding out (hemorrhage) after birth Maximize baby ’s in-womb prep time to fully prepare for life outside of your womb, particularly for baby ’s brain and lungs development Avoid NICU care for baby when all is well

9 Going

9

IMAGES © 123RF

B

(transverse) from your previous cesarean; these have the lowest risk of rupture compared to a vertical incision You have a low-risk pregnancy, without any other complicating health care issues or factors that would make vaginal birth risky, including the factors that led to a cesarean with your previous pregnancy Your birthing hospital can support a trial of labor after cesarean, and has the response team in place should the need arise

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23/07/2015 15/05/2015 12:31 10:57

healthy pregnancy

Top 5 (

)

FIND BREASTFEEDING SUCCESS WITH OUR ALL-TIME FAVORITE POSITIONS

Breastfeeding Positions

BY CYNTHIA LORING, MS, RNC, CLC

Breastfeeding is a time to relax, enjoy and get to know your baby. The right position will help your baby latch easily and correctly for nursing, reduce any nipple pain and help you produce more milk.

Sounds easy, right? It all begins with finding the right and best position for you and baby in each circumstance. These mom-tested, baby-approved positions are our top 5.

A few additional tips will find you bonding and breastfeeding like champs: X Support your back and arms with pillows and other soft props so that you’re comfortable, relaxed X Support your breasts with your hands, as possible, both above and below the nipple X Support baby’s body fully; her arms and legs should be flexed, relaxed X Align baby with your body: Baby’s head, shoulders, body and hips are all in a line facing your body X Keep baby’s head higher than his or her body (think on a slope) X You can always see baby’s nose and face while nursing X Nurse skin-to-skin with your bodies touching as close as possible X If you’re sleeping after nursing and can’t hold baby upright while he snoozes, always place him on his back in a safe, firm crib or bassinet—never on a soft surface like pillows or a sofa or chair

CRADLE HOLD (AKA MADONNA) Why we love it: It ’s one of the most recognizable positions and is best used when baby ’s at least a few weeks old, with better head control and more experience latching on to the breast.

How to do it B Sit upright, with good back/arm support B A footstool will help baby ’s body face you and reduce muscle strain B Lay baby across your lap, cradling his head in the crook of your arm, with your forearm underneath baby for support B Baby ’s head, body and hips face you B Add a pillow under baby to position him right at your breast B Guide baby to latch with your other arm

Why we love it: Try this position early on when baby is fresh born and while you can still use both hands to hold baby ’s head and support your breast.

CROSSCRADLE HOLD (CROSSOVER)

How to do it B Begin similarly to the Cradle Hold, only use your arm opposite your breast to hold baby —so you left arm supports baby at your right breast, and vice versa B If baby is nursing at your left breast, your right arm holds and supports baby against your body while also guiding his head to your nipple

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healthy pregnancy CYNTHIA LORING, MS, RNC, CLC, is an expert advisor to Healthy Mom&Baby.

LAID-BACK BREASTFEEDING Why we love it: This is a newly researched position that is gaining popularity. It uses your own body to support baby naturally into a comfortable position for both mom and baby, which is why some experts call this biological nursing.

FOOTBALL HOLD (CLUTCH) Why we love it: Moms with cesarean incisions like this position because there ’s no strain on your abdomen as you tuck your baby under your arm, on your nursing side, like a football or your favorite purse (remember those!). You also gain both hands to hold and adjust baby ’s head while supporting your breast and guiding baby ’s latch.

How to do it B Sit upright, with good back/arm support B Place your baby under your arm, face up and toward your side, as if you were carrying a football B Use your arm on the side from which baby is nursing to support his back and your hand to support his neck B Use your other arm to support your breast and help baby latch B Use pillows or blankets to support baby ’s body at the right height for comfortably breastfeeding

How to do it B Semi-recline on a sofa or bed, with pillows propped around your body for comfort and support B Lay baby on your body so that his mouth is at your breast B Baby should lay so that the natural curves of your body support his weight and position B You should always be able to see baby ’s face and nose while he ’s feeding B Your arms are free to cuddle and relax baby as he is naturally positioned at your breast

Laid-back breast fee din latest tren g is the d ex love; they perts call it ‘biologica l nu it comes so rsing ’ as both mom easy for and baby.

Why we love it: This is your go-to position when you ’re exhausted, medicated or uncomfortable, such as after cesarean or an episiotomy. Ask your nurse or partner to help you position baby so that you can always see his face and nose while nursing. If you start to feel sleepy, make sure baby returns to an alert adult or to his crib or bassinet, on his back, before you drift off to sleep.

How to do it B Lay on your side in bed, placing baby on the bed next to you, facing you, with his mouth opposite your breast B Prop your own head, neck and shoulder comfortably so that you ’re supported during the feeding B Use your lower arm to snuggle baby close to you, pressing from his back B Use your upper arm to support your breast and help baby latch

SIDE-LYING POSITION

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healthy pregnancy

BY ANNIE EVANS, BSN, RNC-OB

What ’s

Baby-

Friendly s e describe s r u n s i Th d designate finding a ndly® e Baby Fri s best for a e c a l p h t bir our little you and y one

ANNIE EVANS, BSN, RNC-OB, is the Clinical

Services Program Manager of Women ’s Health at Spectrum Health.

Birthing?

Aren’t all hospitals baby-friendly?

Well, yes—especially those with birthing centers. But there’s a difference between being baby-friendly and BabyFriendly® with a capital B, that is.

Getting a Baby-Friendly® designation means meeting the challenge set forth by the World Health Organization to support breastfeeding, promote skin-to-skin bonding, keep you and baby in the same room and provide excellent care based on your wants and needs as a new mother.

As a labor and delivery nurse who has helped many moms labor, birth and care for their newborns while recovering themselves, I’ve provided many different ways to meet the requests of new moms and little babies. Now that I work at a newly-designated Baby-Friendly® hospital, I’ve seen firsthand how the differences in these facilities benefit both you and your baby.

I have worked in the nursing profession for 8

years. Providing care to new mothers and their infants never gets old. And now, working at a BabyFriendly® hospital, I know that I am involved in providing an incredible environment for motherbaby bonding in their first days as parent and child.

Here’s what it looks like when it happens right: GET THE BIRTH EXPERIENCE YOU WANT This starts with discussing your desires with your support person, healthcare provider and nurses.

Would you like to have a natural birth? Do you plan on breastfeeding? Many things can happen during labor and delivery that are unplanned. A birth plan helps provide some stability in what might be a stressful and unpredictable environment.

SKIN-TO-SKIN TIME IMMEDIATELY AFTER BIRTH There’s nothing better for you or baby than going skin-to-skin right after birth. At birth, baby should be placed immediately on your skin, or your ▶

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healthy pregnancy partner or support person’s skin. This helps baby transition into life outside the womb by stabilizing baby’s body temperature, blood sugar and heart rate. It also helps give you both the best start at breastfeeding. Look for baby’s hunger cues and don’t be surprised when baby’s ready to eat within that first hour after birth!

GET EXPERT NEWBORN FEEDING HELP The clinical staff in a Baby-Friendly® birthing center has received extensive training on breastfeeding. They’re eager and ready to discuss the benefits of breastfeeding, support your nursing efforts and also troubleshoot issues you and baby may experience. Our goal is to get you both off to the best possible start. We also educate new moms about delaying bottles or pacifiers until breastfeeding is established, which is typically within 2-3 weeks. If you can’t or aren’t going to breastfeed baby, we’ll provide you with education and support for safely feeding infant formula.

LACTATION SUPPORT AFTER YOUR HOSPITAL STAY Most likely you’ll have questions about breastfeeding after you leave the hospital. Baby-Friendly®hospitals are required to provide ongoing support even after you’re safely back at home. This could be through support groups with lactation consultants available for 1-on-1s or through phone support—something we call a “warm line.” We encourage exclusive breastfeeding until your child is at least 1 year old, and we’re here with the resources to help you achieve that.

If this sounds like your ideal birth experience and support from your healthcare providers and nurses, here’s what you should remember: As you’re considering who will provide your prenatal care, and where you would like to birth, ask if your practice and birthing hospital or center is Baby-Friendly® designated, or if they follow any or all of the BabyFriendly® practices. This way, you can certainly make the best decision you think will give you and your baby the best start to your life together.

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IMAGES © 123RF

ROOM TOGETHER We focus on keeping you and your baby together as much as possible. This promotes bonding and helps you become familiar with each other. At home, you will be more likely to be comfortable with noises your baby makes in the middle of the night or his or her jerky movements. Don’t worry, we can provide all of the care you both need right in your room.

health4mom.org

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Byram Healthcare – A Leader in Medical Supply Delivery The Affordable Care Act (ACA) has directly benefited new and expecting moms by providing an electric breast pump that is FULLY paid for through their insurance plan.

This is accomplished by contacting a Durable Medical Equipment (DME) company. Byram Healthcare is one of those companies.

with the majority of insurance plans including Medicare and Medicaid. Their service does not stop there; Byram Healthcare also offers their customers educational and support programs so that individuals may better understand how to effectively use their supplies.

Byram Healthcare began providing medical supplies in 1968 to thousands of customers.

Over the years they have increased their product portfolio to include wound care, diabetes (gestational), urology, ostomy and incontinence supplies for adults and children.

Prior to the launch of the Affordable Care Act, Byram began supplying breast pumps.

Today, Byram Healthcare is one of the nation’s leading breast pump providers.

What began as a small company located along the Byram River in Connecticut has grown into an organization that employs over 750 people and operates 16 customer service locations and 5 distribution centers across the United States. Byram Healthcare is a Community Health Accreditation Program (CHAP) and HIPAA compliant company.

In 2008, Byram Healthcare was proud to become part of Mediq, an international provider of medical devices, pharmaceuticals and associated care. Mediq has 7,100 employees in 14 countries.

Byram Healthcare continues to attract customers from across the United States by delivering a wide assortment of high quality critical medical supplies in a timely fashion. They possess extensive insurance reimbursement expertise and are contracted

Byram Healthcare continues to fulfill its mission every day by keeping the customer at the center of everything it does.

Byram Healthcare is pleased to offer a selection of breast pumps at no cost* to you by leading manufacturers: Medela, Ameda, Hygeia, Spectra and Freemie We accept hundreds of insurance plans.

Your breast pump will conveniently arrive at your home with no additional shipping charges.

To find out more information or place an order online: www.byramhealthcare.com call: 1-877-773-1972 *Individual must have Byram accepted, valid insurance that covers breast pumps.

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healthy pregnancy

(

5 TIPS TO GET YOU COMFORTABLE AND BREATHING EASY AGAIN!

)

BY TAMER A NUT TER, RN, MSN

Manage Sinusitis in Pregnancy Just as it seems you’re dropping off to sleep, you bolt upright, unable to breathe; your mouth and nose are as dry as the Sahara. You check your pulse and your breathing—you’re fine, except you’re so stuff y.

Welcome to sinusitis in pregnancy, which happens when the mucous membranes in your sinus and nasal passages swell and become inflamed from the hormonal changes and increased blood volume. It’s the #1 reason women call their nurses during pregnancy, and once it starts, it can annoy you throughout your pregnancy.

Don’t suffer in silence. Stuffiness is the leading complaint among pregnant women, but its symptoms can also be a sign of infection. Call your healthcare provider if you develop a fever, have thick nasal mucous (often yellow/ green in color), a persistent cough or any other symptom that doesn’t get better on its own. Meantime, soothe the dryness with these 5 strategies:

IMAGES © 123RF

Stuffiness is the leading complaint among pregnant women, but its symptoms can also be a sign of infection

TAMERA L. NUTTER, RN, MSN, is an expert

advisor to Healthy Mom&Baby.

1. SALINATE B Saline sprays and nasal gels are available at most retailers or drug stores. These soothe swollen passages and loosen mucous.

Saline is safe in pregnancy and you can use saline rinses as often as you want daily.

2. HYDRATE B Drink plenty of water to reduce the effects of sinusitis. You need more water in pregnancy anyway, so strive for at least 48 ounces of water each day. Avoid drinks that dehydrate you, including those with caffeine, such as sodas, coffee and teas (even decaffeinated ones).

3. HUMIDIFY B Breathing moisture through a room humidifier, steamy shower or face steam mask device helps reduce the stuffiness you feel when your passages swell.

4. AVOID ALLERGENS B Stay indoors during high allergen days if you ’re prone to sinus problems when you ’re not pregnant. Smoke is dangerous anytime but even more so during pregnancy. Talk to your healthcare provider about which antihistamines are safe for use during pregnancy.

5. ASK FOR RELIEF B If you ’ve tried these top 4 tips without relief, ask your healthcare provider about both over-the-counter and prescription medications that can help you with your symptoms.

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healthy pregnancy

Anxiety in

Pregnancy

BY KAMI MOGENSEN, RNC, BSN

Are your emotions, fears or concerns causing you stress or worry in your pregnancy?

WHEN WORRYING BECOMES ANXIETY

If you begin to experience excessive feelings of dread, sweating, heart palpitations, shortness of breath, restlessness or irritability, let your healthcare provider know. Sure, some of these are symptoms in pregnancy but they should not be regularly occurring.

If these symptoms become regular and begin to interfere with your pregnancy, tell your healthcare provider as you may have a 42

complication emerging, including developing anxiety. Between 6%-15% of pregnant women will experience anxiety at some point in pregnancy.

IDENTIFYING ANXIETY IN PREGNANCY

Anxiety takes on many forms: nausea (especially after the 1st trimester), excessive worry, panic attacks, obsessions or compulsions, and even post-traumatic stress disorder (PTSD) are all forms of anxiety. Moms can experience different levels of anxiety in pregnancy and postpartum. You can manage mild anxiety with coping strategies like breathing, relaxation or meditation. When anxiety becomes more severe, you’ll need your healthcare provider’s help to find the best solution for you and your baby.

Remember that having a baby is both a happy and stressful time and anxiety in pregnancy can be managed with the right tools and resources. Reach out; help is out there and you are not alone.

KAMI MOGENSEN, BSN, RNC, is a labor and delivery nurse at Exempla Lutheran Medical Center in Wheat Ridge, CO.

IMAGE CREDITS

Having a baby is an emotional journey and expectant and new moms experience a range of emotions from uncertainty to anxiety and depression. Sometimes, in pregnancy, anxiety can increase from general feelings of uncertainty and worry to a true disorder, including an anxiety disorder.

Common things you may worry about include the health of your baby, how you will labor and birth your baby, whether you’ll be a good mom, and if you will struggle with breastfeeding or parenting. Most women worry about these things, and these are normal concerns. But these worries shouldn’t become overwhelming or be constantly in your thoughts.

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healthy pregnancy

R e focu s fro m A n xio u Be h a v io rss & Fe e li n g s

It ’s normal to feel anxious from time to time, and even when you don ’t have a serious case of anxiety it ’s healthy to reframe your thinking and reel in the physical symptoms you ’re experiencing.

Reduce those feelings and stress by relaxing your mind and body. When you find something that helps you relax and refocus, stick with it —all that matters is that it is healthy and that it works for you. Consider:

B Deep breathing: Close your eyes and breathe in/out your nose, counting for 4 seconds inhaling, and then counting 4 second exhaling; strive for at least 10 repetitions

COULD IT BE ANXIETY? Here ’s what different forms of anxiety can look like; these descriptions aren ’t the only possibilities. If you sense something just isn ’t right, always call your nurse to talk through your concerns, and gain a plan and muchneeded reassurance:

EXCESS WORRY

This isn ’t doing and redoing task lists; this is the kind of worry that keeps you up at night, leaves you exhausted even after you ’ve slept, and even causes physical pain in your back or neck

PANIC ATTACK

You may have a feeling that something bad is about to happen; that you might lose control. Your body responds with a typical stress response —your heart may race or beat quicker; you may breathe faster and more shallow; or you may feel sweaty, shaky or like you ’re going to vomit

OBSESSIONS, COMPULSIONS

This is more than an increased focus on your baby, your house or your nursery. This is focus so intense it gets in the way of everyday life. Some pregnant moms develop obsessions over eating or not eating the right things or organizing the house and baby ’s room before birth, even compulsively shopping for baby items out of concern instead of pleasure. You may even have fears of harming your baby or yourself

POSTTRAUMATIC STRESS DISORDER (PTSD)

If you struggled to get pregnant, have had a miscarriage or a previous pregnancy loss, you may find yourself obsessing over what happened. You may skip prenatal appointments out of fear for bad news or you may avoid sharing the news with others so that you don ’t have to talk about your pregnancy.

You may feel physically sick, sweaty and experience a rapid heart rate

B Prayer/meditation: Choose a quiet location and simply sit with your eyes closed, relaxed, for at least 10 minutes a day. It may help to pray or repeat a phrase or saying that ’s meaningful to you, such as “I am healthy. My baby is healthy. We are at peace. ” B Relaxation: Yoga, walking or simply laying down and tightening and releasing your muscles, starting at the face and moving toward your toes can help you refocus and relax B Journaling: Keep track of your emotions in a journal and note when you ’re feeling anxious or having symptoms that seem like anxiety. Rate your anxiety on a scale of 0-5, with 5 being the most anxious —do you see a pattern in the time of day, location or circumstances you can share with your healthcare provider B Counseling/group support: A moms ’ group is a great place to get insight and advice from other pregnant women; if you need more than a listening ear, consider seeing a counselor or psychologist

ANXIETY RISKS You ’re most at risk for experiencing anxiety in pregnancy if you have: B History of anxiety or depression B A current or previous high-risk pregnancy

IMAGES: 123RF

B Previous miscarriage or death of a baby B Previous traumatic birth experience B Problems with your partner B Financial or another major stressor

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Daddy Dearest

BY SUMMER HUNT

Take it fro m the dads o the 40 W f eeks documen tar y, babies ch ange ever y thin g!

First comes love, then comes marriage… then come those two little blue lines.

When you first realize you’re pregnant, there’s a range of emotions followed by body changes, a rounding belly, those unexpected flutters and kicks and fear of the impending unknown: birth. But it’s a very different time for dad.

When does it really sink in for the guy in your life? We chatted with a few of the fathers from the new 40 Weeks documentary, including its directordad Christopher Henze for the guy’s take on this full-term trip of a lifetime.

DAD DUTY “I went through pregnancy with my wife Dominique 8 years ago,” explains Christopher.

“I was always searching for men to talk to about how I saw it.” Coming up short, he knew he had a duty to dads (and moms) everywhere to paint the picture of what pregnancy is really like—all 40 weeks of it. Christopher struggles to describe how his own family changed when it expanded with daughter Gaia. “It was all way more profound than I could have ever imagined,” he says. “To hold my daughter, to feel her pull me toward her—so amazing. A person who isn’t a parent can never understand, but a parent can never fully describe it, either.”

As 40 Weeks followed more than a dozen families, movie-goers gained a glimpse into how the papas were also coming to terms. “At first, it’s like being an extra in a movie,” explains new dad Jared Balsky. “It’s all about the mom, and then the baby. You’re in the background being supportive,

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IMAGES: BIG BELLI/40 WEEKS

ON DISCOVERING WOMEN ’S STRENGTH:

“As a man, I feel like I have this stalwart nature, this physical strength.

But watching women go through pregnancy and birth...holy smokes.

I can ’t even begin to comprehend the strength a woman possesses. I went out and made a movie to do it and I still don ’t understand! That is a new definition for compassion and strength. ” Christopher Henze pictured here with daughter Gaia

but you don’t really have that active of a role.”

Jared and wife Kelly wanted children but were waiting for the right time. “We found out Kelly was pregnant almost right after we bought our first home. I was nervous at first, but I said, ‘You know what? I think we’re ready.’”

Chris Moody agrees that it’s a different experience for dads. “I’m not carrying the baby; I’m not going through all these changes she’s feeling.” He and wife Victoria were thrown when they first realized a baby was on the way. “Kids were definitely part of our long-term plan, but about a year into the future,” Chris laughs. “Once the initial surprise and anxiety melted away, we were both so incredibly excited.”

Lucien de Voux and his wife, Alex, were timing a pregnancy with his graduation from business school. “We got pregnant immediately, and it was kind of a shock at first.” When telling exactly how quickly it happened, Lucien recalls a funny moment: Alex was working on her PhD and had been in South Africa for a few months. The couple started trying upon her return and was surprised to see a positive test shortly after. “We figured up the due date, and Alex was 5 weeks along… but she had only been back in the states for 3 weeks. A little awkward! We must have conceived on the day she arrived, and it’s calculated a bit differently than we thought.”

A DAD ’S EVOLUTION Following the different families, Christopher noticed that women go through a fundamental shift as they become mothers, while the changes dads go through are more abstract. “We evolve and understand what it means to be in service,” he explains. “The most powerful archetype we have is the superhero; they are in service to the greater good. And watching these men learn what it’s like to be in service to their wives, to their families… they became more powerful. I didn’t quite understand it as concretely as I do now after finishing 40 Weeks.”

Chris says that his wife has always been very nurturing. “Seeing Victoria as a mother, it’s an incredible transformation, but also a very natural one,” he explains. “She was always prepared to make those sacrifices.” For new parents, he says the biggest fear is the unknown. “It’s what you don’t know that puts you on edge. It can be scary and unpredictable, but at the end of the day, there hasn’t been any situation where I’ve felt like, ‘we can’t do this.’”

While being a father is hard work, Jared

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JARED BALSKY

ON FEELING THAT FIRST KICK: “Everything just disappeared when I finally felt my daughter kick.

It was awesome.

Before, it was just seeing pictures and watching Kelly change and grow, and I had no actual physical connection to the baby, to this pregnancy. But at that moment, it became so real. ” Jared Balsky

acknowledges that it isn’t quite as difficult as he thought it would be. “It’s actually easier and a lot more enjoyable. Just getting to love this little girl is amazing. I can’t put it into words how much fun it is to be with my daughter, Marie.” Jared also commends his wife coming for being such a trooper. “It’s a good thing Kelly went through this and not me—I would never have survived it,” Jared marvels. “I would have constantly complained, and then the whole birth part… yeah, I’ll pass.”

Lucien began to change when he realized just how much his wife and daughter Madeline depended on him. “I started making better choices with my health, exercising and just taking better care of myself,” he says. Echoing Jared’s sentiments about the bond he feels with Madeline, Lucien adds: “It’s so fantastic to just be at our house on the weekends and blow bubbles.

She’s like my best friend; we hang out and do silly things together all day.”

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HOPELESSLY HELPLESS A common feeling that united these fathers was one of helplessness as they struggled to support their wives. Chris says Victoria’s pregnancy was relatively smooth, but the delivery proved to be slightly more complicated. She had hoped for a vaginal birth with daughter Vivian, but a fibroid tumor was blocking the baby’s exit—cause for a cesarean. “I may have been overbearing at first, trying to do everything I possibly could, but she didn’t need all of that,” says Chris. “The best thing I could do was comfort her and tell her everything would be okay… and be the butler she needed me to be,” he adds.

“It’s not in Kelly’s nature to complain, but I felt bad for her,” Jared says. “We started a ritual of me giving her massages and foot rubs.” He also found ways to inject humor when possible: “Kelly’s feet were so swollen; she told me, ‘I have whale feet!’ I politely reminded her whales don’t have feet,” he

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healthy pregnancy joked. Another tip for first-time dads looking to be useful? “Give her your socks when hers don’t fit anymore. Honestly, I thought Kelly was going to start wearing my shoes, too—and I would have given them to her if she asked.”

Lucien was similarly impressed with his wife’s resilience. “There were a few weeks when Alex wasn’t feeling too great, but she was a real superstar,” he says. “I tried to find ways to help: I picked up the slack at home, and I brought her food—that was a welcome treat!”

When Alex wanted to eat all the time, Lucien dutifully joined her. “I put on a few sympathy pounds, but it was fun,” he laughs. “I love Alex all the more for going through this. You’re so appreciative of your wife for taking this on to bring you both such joy. I have a whole new respect for women now.”

ON GOING FROM A TWOSOME TO A TRIO:

IMAGES: BIG BELLI/40 WEEKS

“Your capacity to love expands when you have a child —and that love translates to your partner, too.

To see Alex be a mom, and see her love and dote on our daughter … it ’s incredible. I ’m amazed when we talk about our lives together and how much more of a family we are now. ” Lucien de Voux

LUCIEN DE VOUX

CHRIS MOO

DY

ON THOSE AWKWARD INCIDENTS: “At one point she said she was dealing with all types of ‘roids: hemorrhoids, her thyroid, the fibroid. And her whole digestive system was doing some interesting stuff. She might let one rip, be all embarrassed and apologize. And I was like ‘I ’m a guy —I don ’t care! ’ ” Chris Moody

SUMMER HUNT is editorial coordinator at AWHONN and writer for Healthy Mom&Baby.

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healthy

Babies

Join us on Facebook facebook.com/HealthyMomAndBaby

BY SUMMER HUNT

BETTER BABY BABBLE?

You teach your babies lots of things, including her 1st words.

But moms don’t speak as clearly to their little ones as they do to adults. This is no surprise, but what researchers supported by the European Research Council have discovered is that in fact perhaps infants may even be better than adults at parsing particular sounds even when they’re not as distinct as the real words. Perhaps it’s because you’re effusive with your emotions as you chatter away with baby, they say.

What’s not clear to researchers is whether moms should speak more clearly to enhance learning. Reading aloud is a great way to introduce new words and emotions while practicing effective enunciation. Start early and encourage a love of language and communication—and take a breaky-wakey every now-and-then-y from the baby babble, okey dokey?

Breast milk isn’t just liquid nutrition—it also helps to create a healthy intestinal environment for the transition to solid foods. A new study at the University of North Carolina found that breastfed babies have more of the bacteria that are beneficial for digestion; authors also suggested that non-exclusively breastfed babies could potentially suffer more stomachaches and colic.

“This study provides yet more support for recommendations by the World Health Organization to breastfeed exclusively during the first 6 months of life,” said Amanda Thompson, PhD, the study’s first author. “Including formula in an infant’s diet does change the gut bacteria even if you are also breastfeeding.

Exclusive breastfeeding seems to really smooth out the transition to solid foods.”

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BUILD STRONG BONDS TO SUPPRESS SHYNESS

Babies with a close bond to their parents may be less likely to develop anxiety as teens, including shyness, say researchers from Canada’s University of Waterloo.

Watching children in a variety of situations beginning from 4 months, again as toddlers, and finally at 14 to 17 years old, researchers said children who stressed out in unfamiliar environments early on were more likely to be socially anxious teenagers, especially boys. Start that strong bond with baby early: Begin breastfeeding at birth, hold baby skin-to-skin frequently, and lavish your little one with warm, physical contact as he grows up.

)

IMAGE CREDITS

FROM MILK TO COOKIES

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Conception? Pregnancy? BIRTH! You’ve got questions but you’re between appointments—what should you do?

Ask a friend?

Wait it out?

Ask an AWHONN Nurse?

Yes! Visit Health4Mom.org, post your question and an AWHONN Nurse will answer.

You’ve got questions.

We’ve got expert answers.

health4mom.org/ask-our-nurses

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1 in 3 Babies

Don’t Have the Diapers They Need

You Can Change That!

Healthy Mom&Baby Drive To Wipe Out Diaper Need When babies don ’t have enough diapers: y They can ’t go to childcare y Mom or dad can ’t go to work

COMIN G THIS SUMM ER

You can ’t buy diapers with food stamps. Childcare and laundromats won ’t allow cloth diapers. It ’s a vicious cycle.

You can help change this!

Join with AWHONN nurses in your community this September during National Diaper Awareness Week by donating diapers or dollars for diapers as we work in partnership with the nonprofit National Diaper Bank Network to benefit families where you live.

Together, nurses and families can help wipe out diaper need.

Get involved at Health4Mom.org/diaper-drive.

wipe out diaper need

FOUNDING SPONSOR NATIONAL DIAPER BANK NETWORK

Donate Diapers for Families In Your Community Join the diaper drive Health4Mom.org/ diaper-drive

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Wipe Out Diaper Need

BY CAROLYN DAVIS COCKEY, MLS

AMONG 1 IN 3 FAMILIES A van pulls into a local Dallas Sam’s Club parking lot and 2 volunteers spring into action, handing out up to 2 packs of diapers and wipes to more than 500 qualified low-income families who depend on this diaper drop so that their children can go to childcare while the parents go to work.

In Pennsylvania, a diaper pantry keeps families from choosing between having enough food or putting diapers on their babies. In Los Angeles, 1 diaper depot hands out more than 1.5 million diapers a year.

In St. Louis, Nurses for Newborns recently gathered diapers for more than 2,600 families out of the passion that mother/baby nurses have for their smallest patients and their parents. All of these efforts made headlines in their local newspapers, but across the country there’s a larger unspoken and unmet need for 5.3 million children who don’t have enough diapers.

IMAGES © 123RF

UNDERSTANDING DIAPER NEED Th roughout the US, community diaper banks, religious and philanthropic organizations and individuals strive to meet the needs of the 1 in 3 families who struggle with diaper need—the inability to buy any or enough diapers for their child. When baby doesn’t have enough diapers to go to childcare mom or dad can’t go to work. And these wee ones need between 8 and 12 diapers a day.

Diaper need is not having enough diapers to keep your baby clean, dry and healthy. When diapers aren’t regularly changed, baby’s skin is exposed to urine and stool, which can lead to diaper rash. Left untreated (yes, diaper cream is another cost of diapering), skin breakdown can happen and lead to infection requiring medical care.

No state or federal programs help families buy the 3,000-5,000 diapers each baby needs. You can’t spend food stamps on

W IPE OU T DI APER NE ED B 5.3 million infants and toddlers live in poor or low-income families B 1 in 3 American families don ’t have enough diapers B $70-$80 is the typical monthly cost of disposable diapers per baby B Diapers costs triple when parents don ’t have transportation to “big box ” stores B Cloth diapers aren ’t accepted at most childcare centers B A day ’s or week ’s worth of extra diapers is typically required for each child in childcare

diapers.

The 1 bright spot is the growing National Diaper Bank Network, which connects and supports the country’s 240+ community-based diaper banks that collect and distribute free diapers to struggling families. Last year, the national network distributed more than 40 million free diapers, half of which were donated by founding sponsor Huggies® to some 1.2 million children in the US.

YOU CAN WIPE OUT DIAPER NEED Th is year, the nurses of AWHONN and families in communities including yours are working with the National Diaper Bank Network to launch Healthy Mom&Baby’s Drive to Wipe Out Diaper Need!

Nurses are with moms when they first learn they’re pregnant. Nurses give expert care and advice as moms go through prenatal visits.

Nurses help moms birth the 4 million babies born in the US each year, and nurses are also known for collecting and donating diapers to local groups in their communities, including the diaper banks that support struggling families.

Now, you can join with nurses to help families in need have enough diapers and wipes to properly care for their children. Organize a drive, donate dollars for diapers (your dollars will buy diapers at wholesale!) and take a big box of diapers to a diaper bank in your area. Then go online to Health4Mom.org/diaper-drive and tell us You can make what you did so that we can count your a difference efforts in with those from AWHONN for the 1 in 3 nurses. Together, with our partners at the families in your National Diaper Bank Network we can community who Wipe Out Diaper Need. need diapers

CAROLYN DAVIS COCKEY, MLS, is

editor of Healthy Mom&Baby

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If someone holding an infant is fatigued, distracted, or challenged in some way, safety issues arise. This is true whether the person is a parent, a family member, or a friend.

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22/07/2015 12:15

healthy babies

Prematurity & YOUR BABY ’S VISION

BY CANDY CAMPBELL, DNP, RN, CNL

Parents surprised by a very premature birth have a lot to think about, including the effects of prematurity on your baby’s vision.

IMAGE: 123RF

SOURCE: NATIONAL INSTITUTES OF HEALTH

BABY ’S DEVELOPING VISION

Your baby’s eyes begin to develop at 16 weeks gestation, but the real growth spurt doesn’t happen until the last 12 weeks of pregnancy, from week 28 on. Retinopathy of prematurity, or ROP, is a potentially blinding eye disorder that can affect babies born weighing less than 3 pounds or born before 31 weeks. The smaller your baby is, and the earlier he or she is born, the greater likelihood of ROP. Babies with ROP can also have other vision problems later in life including retinal detachment, nearsightedness (myopia), crossed eyes (strabismus), a lazy eye (amblyopia), or glaucoma, say experts at the National Institutes of Health.

RETINOPATHY OF PREMATURITY

ROP occurs when abnormal blood

vessels grow and spread throughout your baby’s retina, particularly on the periphery. These abnormal vessels are fragile and can leak, scarring his retinas, causing it to pull away. Retinal detachment leads to visual impairment and possibly blindness.

Typical problems of prematurity, including anemia, problems with breathing and the need for blood transfusions put preemies at risk for ROP. Experts “stage” the degree of ROP based on the amount of abnormal blood vessel growth. Typically, only stages 3 or more require more intensive treatment.

Most cases of ROP tend to be either Stage 1 or Stage 3.

The most common treatments for ROP are laser or cryotherapy in which experts burn or freeze the peripheral areas of the retina where the abnormal blood vessels grow. Sadly, these treatments destroy some peripheral vision but are essential to save your baby’s sight.

STAGES OF RETINOPATHY OF PREMATURITY STAGE 1

Mild abnormal blood vessel growth; typically resolves on its own without treatment or vision problems

STAGE 2

Moderately abnormal blood vessel growth; still, ROP at this stage resolves like stage 1 without treatment or vision problems

STAGE 3

Severely abnormal blood vessel growth. Vessels grow toward the center of the eye instead of the retina ’s surface. Some stage 3 infants will improve on their own, without treatment or vision problems. But if the retina ’s blood vessels have become enlarged and twisted, indicating a worsening of the disease, treatment is needed to prevent retinal detachment

STAGE 4

Partially detached retina; treatment needed to prevent full retinal detachment

STAGE 5

Completely detached retina.

If left untreated, the baby can have severe vision loss and impairment, even blindness

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Hit Those Milestones ELIZABETH T. JORDAN, DNSC, RNC, FA AN

)

Now that baby’s at least 4 months old you’re likely getting better at observing how he can engage with you and others around him—objects too! Skills coming soon include sitting up, crawling and rolling around on the floor. The fun is just beginning!

Remember, reaching milestones can occur at different times between babies the same age. You are the most important person when it comes to baby’s learning. We’ve listed fun things you can do to help your baby grow and learn during each stage.

The American Academy of Pediatrics recommends that all children be screened for developmental delays and disabilities during regular well-child healthcare visits at 1, 2, 4, 6, 9 and 12 months after baby’s birth.

Your baby may need more screening if he’s considered at risk for developmental problems from being born too early or having low birth weight, for example.

As a parent you know your child best. If you have questions about how your baby is behaving or growing, let your baby’s healthcare provider know immediately. Don’t wait—if indeed there is a problem, it’s important to get your baby help as soon as possible.

BABY ’S ACTIVITIES AGES 4-8 MONTHS Personal & Social Development

YOUR BABY MAY . . .

BABY MIGHT . . .

YOU CAN . . .

x Express comfort

x Show displeasures by

x Respond when the baby cries,

x

x Play side-by-side in front of the

and discomfort, enjoyment and unhappiness

x x x x Calm herself

x Suck thumb, fingers, or pacifier x Rock himself x Coo or babble

to reassure and comfort mirror

x Softly sing or hum familiar songs

x Provide calm, quiet environment

x Let baby calm himself; respond if needed

x Interact with baby by talking or singing

x Show interest

x Reach, smile, laugh, babble

x Respond to baby with eye

x Show

x Begin to recognize

x Use baby ’s name frequently x Let other children play with

in adults she knows

awareness of other children

x Demonstrate

attachment to individuals

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crying or whimpering Show pleasure by cooing, smiling, or making other noises Enjoy social play Laugh in response to a noise Smile at smiling face

or coo to get attention x Gaze intently at the face of a familiar person x Imitate sounds or noises

familiar children with facial expressions, noises or body language

x Turn his head toward a

familiar caregiver x Look in the direction of your voice x Imitate your smile x Track your movements

contact and smile, coo or gurgle x Talk to baby throughout the day x Use a happy tone when talking to baby x Describe action: “You are holding the red block! ”

baby in a supervised setting

x Limit time with unfamiliar

people; gradually introduce him to others x Provide familiar toys, blankets, other comfort items x Speak calmly to baby; provide reassurance x Speak directly to baby; make eye contact

IMAGES: 123RF

(

HERE ’S WHAT BABY CAN DO UP TO AGE 8 MONTHS!

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UNDERSTANDING & COMMUNICATING YOUR BABY MAY . . .

BABY MIGHT . . .

YOU CAN . . .

x Respond to

x Begin to react to his own

x Respond to the baby;

sounds and words heard often

name x Cry at loud noises or voices x Calm in response to a gentle familiar voice

promote conversation

x Use repetitive words or phrases

x Talk to baby throughout the day

x Repeat words and sounds x Use various

sounds and movements to communicate

x Use his voice to express

x Talk to the baby about what

x Babble using strings of

x Follow his lead; use his sounds

happiness/unhappiness

consonant sounds x Imitate the sounds of speech x Stop crying when you talk to him

you ’re doing

in real words, phrases or sentences x Introduce simple sign language signs for common words like nap, hungry, diaper, more

x Recognize

x Make sounds when he

x Read repetitive and rhyming

x Begin to respond

x Look intently at the pictures in

x Show baby the same simple

and react to the sounds of language

to some of the words in picture books

hears you x Imitate the sounds he hears around him

a book x React to colorful pictures x Hold a book with help

books to baby several times a day x Sing and say nursery rhymes such as “This Little Piggy ” when changing, putting baby down to nap, riding in a car

books often; point to the pictures using the words for what he sees x Help baby to pat and hold a book with your help

COORDINATING MOVEMENTS YOUR BABY MAY . . .

BABY MIGHT . . .

YOU CAN . . .

x Change the

x Push up on his arms and lift

x Give baby safe places on

position of his body

x x x x x Use his hands in

more coordinated movements

head and chest, arching his back when on his stomach Lift both arms and rock on his stomach Start to move forward or backwards, pulling or pushing with arms Get up on his hands and knees, rocking back and forth Move from lying down to sitting position

x Reach for objects with one hand x Move objects from hand to hand x Pick up a small object with a raking grasp

x Hold objects in both hands and bang them together

the floor to explore, while being supervised x Put baby on his stomach and extend his arms in front of him x Give the baby toys just beyond his fingertips and encourage him to reach for them

x Give baby a variety of toys that are easily grasped

x Give baby board books or

those made of cloth or vinyl to explore

x Wave bye-bye or imitate hand clapping

x Try to turn pages of a favorite book

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Babywearing

“Babywearing” has been shown to help babies reach age appropriate milestones by: developing core strength, engaging in their surroundings from the comfort and security of their caregiver’s space, and many find their babies actually sleep better – during naptime and at night.

Gracie and Sam, LLC Baby Carriers provide a variety of options to comfortably carry your baby, allowing for hands free movement while nurturing your child, all in fabrics that are natural, lightweight, and fashion-conscious.

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DISCOVERING AND LEARNING YOUR BABY MAY . . .

BABY MIGHT . . .

YOU CAN . . .

x Show

x Follow moving objects x Find an object that ’s partially

x Play hiding games with baby x Make sure everything in baby ’s

awareness of happenings in his surroundings

hidden

x Explore everything with his hands and mouth

x Try to reach objects just out of reach

x Look at an object in his hand for a longer period of time

reach is safe to touch or put in his mouth x Place objects just beyond his reach x Make silly faces for him to imitate

x Imitate actions such as waving bye-bye

x Remember what has happened recently

x Begin to understand that x x x x x

x Cause things to happen

things exist even if not physically present Look for an object he has thrown from high chair Put his arms up when you ask “How big is baby? ” Turn his face away from tissue Hold out his hand to play a game Begin to copy actions in familiar songs or finger plays

x Bang on his tray with a

spoon to hear the different sounds it makes x Hit the buttons on his busy box to make different noises x Pull a string to bring a toy closer

x Create and keep daily routines x Play repetitive games such as

“pat-a-cake ” and “how big is baby? ” x See how many times he will open your hand to see the toy you have hidden there

x Give baby various containers, wood blocks, large wooden beads to explore x Provide pull toys, especially ones that make noise when they move

ELIZABETH T. JORDAN, DNSC, RNC, FAAN, is an expert advisor to Healthy Mom&Baby.

ISSUE 17 / Summer 2015 Healthy Mom&Baby

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Stop guessing— eliminate gas and relieve colic instantly with the Windi® Has your baby been crying on end to the point where you just want to throw your hands in the air and shed a few tears yourself? These extended episodes of crying are known as colic, or your baby’s frustration may simply be related to baby being full of gas! An overly gassy baby can be caused by the baby’s brand new digestive system adjusting to mama’s milk or formula. This can ultimately lead to cramping, prohibiting baby from passing gas naturally. So how do you know if your baby’s crying is colic or a gassy tummy?

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healthy babies

B Bonding is for

ask our nurses Nurses explain why going skin-to-skin is essential: http://www.

bit.ly/skin2skinafterbirth

BY RITA NUT T, DNP, RN

You didn’t wait for baby to be born to begin bonding. Was it with the positive pregnancy test or the first flutter in your belly? You and baby have been bonding all along—as you spoke to baby, touched your belly and sang to her before birth. No wonder baby recognized you when she was born!

Was it “love at first sight” when you met baby?

Some moms and dads need more time to develop those strong attachments. Bonding is a process; there’s no time limit for this. Throw out a timeline knowing those bonds eventually develop when baby is raised in a loving and nurturing home.

BONDING IN BABY ’S DEVELOPMENT

Bonding is critical for normal development.

Your relationship with baby is the first intimate relationship for your child and it sets the stage for future healthy relationships. This is just as important for your partner and baby too. When your connection with your little one is strong and loving, it brings trust and makes her feel safe and protected. This sense of security fosters her strong sense of positive self-esteem.

One of the most powerful bonding tools is touch.

A baby’s soft, delicate skin is sensitive to sensations created by gentle stroking and caressing. Skin-toskin contact has been shown to improve infant sleep, decrease crying time, promote successful breastfeeding and fulfill baby’s need for human contact.

As you cuddle and snuggle with baby, you benefit too. Your body releases oxytocin—the “love” hormone—which relaxes you and also creates strong feelings of fierce protectiveness. No wonder so many mamas refer to themselves as grizzly bear mamas when it comes to their cubs! Oxytocin also calms you and generates feelings of overall wellbeing, reducing your risks of postpartum depression.

STRUGGLING TO CONNECT?

When bonding isn’t natural or smooth, seek help from your healthcare provider. Nurses have excellent advice for starting and sustaining bonding, and how to help the process should you get off track along the way.

Build That Bond X Gazing into your baby ’s eyes X Talk to your baby —it encourages speech and intelligence X Smile or make funny faces at her X Hold her skinto-skin X Sing your favorite lullaby or song X Read books — get started on this good habit X Make bath time fun

IMAGE: 123RF

My thbuste r: Can You Spoil a Ne wborn?

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ISSUE 17 / Summer 2015 Healthy Mom&Baby

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Forget wraps, straps or ties – babywearing has never been easier! %FTJHOFE GPS QSF BOE GVMM UFSN CBCJFT t /*$6 "QQSPWFE t "EIFSFT UP UIF TMJOH DBSSJFS TUBOEBSET XIJDI NFBOT JU T CFFO UFTUFE VQ UP QPVOET t .BDIJOF XBTIBCMF ESZFS TBGF t "WBJMBCMF JO 94 9Learn more about the benefits of Skin-to-Skin contact at nuroobaby.com and use code HMB for 20% off your purchase of the NuRoo Pocket.

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healthy babies

Sudden Compulsive Behaviors

Could it Be PANDAS/PANS?

IN YOUR CHILD AFTER INFECTION

Alert your little one ’s healthcare provider to any abrupt changes in your child, especially following an illness:

BY JENNIFER LEMOINE, DNP, APRN, NNP-BC

Could these out-of-the-blue behaviors actually be the sign of a bigger, more serious complication?

Regressive Behaviors: B Can ’t or won ’t leave

your side

Your child suddenly starts to wash his hands until they are raw, or refuses to eat at all when he normally asks for a second helping.

Abrupt changes in behavior that can be described as happening “overnight” or “out of the blue” should be reported to your child’s healthcare provider—especially if you can describe them as “obsessive” or “compulsive.” Compulsive or repetitive behaviors like endlessly opening and closing doors or asking the same questions over and again may be a sign of a syndrome known as PANDAS/PANS. EXPLORING PANDAS & PANS PANS stands for Pediatric Acute-onset Neuropsychiatric Syndrome and follows as a complication to an infection, such as walking pneumonia, viruses or Lyme disease. PANDAS stands for Pediatric Acute-onset Neuropsychiatric Disorders Associated with Streptococcus and is similar to PANS, but it’s triggered by the same bacteria that causes strep throat. Experts estimate the syndrome affects roughly 1 in every 200 children—mostly age 12 or younger and typically between ages 4 and 7—in the US, but its diagnosis has been controversial.

Researchers are just beginning to learn about this syndrome, but it typically follows a viral or bacterial infection. PANDAS/PANS develops when a misdirected immune response in your child’s body causes inflammation. Changes in behavior then

follow within 24-48 hours. Remember, because these changes occur very quickly, it’s important to contact his care provider as soon as possible for diagnosis and treatment.

PANDAS/PANS isn’t contagious; however, if the infection itself is contagious, like with strep throat, it’s possible for it to be passed among children. Keep in mind that most school-aged kids get infections from time to time, and almost all of them get better without any complications, including behavioral problems.

WHEN YOUR CHILD HAS PANDAS/PANS To ensure the behavioral changes are indeed caused by PANDAS/PANS, your child’s healthcare provider will likely order several tests, including blood tests, and possibly an MRI of the brain. You may also receive referrals to other specialists for your child.

PANDAS/PANS is typically treated with oral antibiotics, and other medications may be given to help control behaviors. After beginning treatment, most children begin to get better within 1 week; however, in some cases, further treatment may be needed to avoid future episodes. Depending on your child’s individual health, treatment can be continued for as long as 2 months to a full year.

JENNIFER LEMOINE, DNP, APRN, NNP-BC, is an expert advisor to Healthy Mom&Baby.

B Needs to sleep on

the floor next to your bed

B Needs to urinate

more frequently or starts bed-wetting

B Displays temper

tantrums

B Starts using “baby

talk ”

Compulsive Behaviors: B Excessive hand

washing

B Excessive licking or

smelling

B Irritability or

aggression

Sensory or motor problems: B Small motor skills

deteriorate, like handwriting

B Sudden sense

of restlessness or abnormal movements like “tics ”

B Becomes overly

sensitive to light or sounds

B Has problems

concentrating

ISSUE 17 / Summer 2015 Healthy Mom&Baby

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healthy babies

r e w o Sh That Adopted Baby!

BY NICOLE WIT T

Wondering how to treat parents of a newly adopted baby to a shower of their own? Before or after baby’s arrival, anytime is a great time to welcome a new little one with gifts, friendship and love offered at a gathering in a family and baby’s honor. Follow these 6 tried-and-true tips to do it just right when baby is adopted:

1. Ask for parent preferences Before or after adoption, just ask the prospective or new parents what they want. Some will want a baby shower prior to the birth so they can enjoy what other families get to enjoy, while others will prefer to have the shower after the placement when they no longer have to worry about the adoption falling through.

2. Celebrate the new child regardless of age Showering the new child may mean remembering to specify his or her age, gender and size, particularly if baby wasn’t a newborn when received by her adoptive parents. And don’t hesitate to offer to shower the new tike even if it has been some time since the child was placed in the family.

Find a fun, non3. pregnancy theme Find a non-pregnancy theme tied to either the expected baby or child, or the parents’ lives, such as where they were born or their favorite city. Match your theme to the design of the baby’s nursery or bedroom.

4. Go co-ed Make the party co-ed, particularly since it’s not completely a traditional baby shower. You can still be baby-centric while also celebrating the life of the family and their parenting journey.

5. Adult beverages or fancy non-alcoholic drinks are a must Serve mimosas or another specialty/themed cocktail (with alcohol or not) so that the occasion is festive like any party or celebration would be. Perhaps mom wants to celebrate the fact that she can enjoy her favorite beverage at this non-traditional baby shower.

Just skip the pregnancy-related games. Do baby shower games like nursery rhyme jeopardy or a baby item scavenger hunt for the fun and hilarity they can add.

NICOLE WITT is the executive director of The Adoption Consultancy at http://www.theadoptionconsultancy.com

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IMAGE CREDITS: 123RF

6. Games are still a must

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healthy babies

Diapering:

Change Is Good!

BY AWHONN EDITORIAL STAFF

Disposable and hybrid diapers top cloth when it comes to diaper recommendations for baby’s bum

You may be surprised to learn that many experts no longer recommend cloth diapers thanks to advances in diapering technology—everything from super high absorbent materials, wetness indicators, moisture-wicking properties to keep baby’s skin dry and even emollients like aloe to protect baby’s skin from irritants.

While disposable diapers or diaper shell inserts represent about 1% of all landfill trash, cloth is really no greener, they caution, as you use precious resources when you bleach cloth diapers in a high-temperature wash, dry them in the dryer, or have them delivered by a service that does the same, making their environmental impact comparable.

Unlike cloth diapers, the moisture-transporting capabilities of disposable diapers and diaper shell inserts may help prevent diaper rash in some infants, experts advise.

EX PLOR IN G DI APER OP TIO NS If you ’re comparing costs, say experts at ConsumerSearch, a diaper service comes in at about the same as buying and laundering your own cloth diapers. When it comes to the disposable categories, most makers offer mega boxes that help with cost savings, and most parents can now find choices among products with all natural fibers like bamboo, dermatologycertified or chlorine-free disposable options for about the same price. In the hybrid category, parents get a liner that fits into a washable outer shell with options among inserts from washable to flushable or disposable.

Whatever type of diaper you choose, you are going to need a lot of them —a baby goes through several thousand diapers from the time he ’s born until he ’s fully potty trained. Look for the following features:

B A foldable waist or notched top to keep the diaper away from baby ’s umbilical area

B Elastic or gathers at the waist and legs for the best fit (read leakproof!)

B Absorbent core that wicks moisture from baby ’s skin B Skin conditioners like aloe B Sensitive skin-friendly options like fragrance-free or chlorine-free

B A soft natural outer shell or cover B Easy, adjustable fasteners

HYBRID/GREEN

The best of these combine the convenience of a disposable (some even flushable!) inner liner with a cloth outer wrapper that looks more like clothing than a diaper.

Average $12 for an outer shell; $0.40 per disposable liner

IMAGES © 123RF; ISTOCKPHOTO

DISPOSABLE

Invented more than 60 years ago, today ’s disposable diapers may help prevent diaper rash with their super absorbent cores, breathable outer layers and wetness indicators that work together to keep moisture away from baby ’s skin. $0.25-0.40 each

CLOTH

It may seem cheapest to use cloth diapering, but as technology has improved disposable diapers, many experts no longer recommend cloth diapers, which expose baby ’s skin to irritants, including urine or stool. Average $2 each

ISSUE 17 / Summer 2015 Healthy Mom&Baby

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Nursingwear If you want to look uber stylish while nursing your baby, check out our chic nursing fashions that feature hidden openings for discreet breastfeeding anywhere, anytime. Shop stylish tops, dresses, sleepwear, bras and more at www.milknursingwear.com or call us at 877-344-6455 (MILK). Milk Nursingwear IS the freshest Nursingwear on the planet!

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Follow on Twitter @Health4Mom

Keep in Touch

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27/07/2015 10:41

There is nothing quite as

incredible as baby ’s skin!

Baby ’s brand new skin is at its most sensitive as it continues to grow during baby ’s first year. It takes a full year from birth for baby ’s skin to fully develop.

It is important to know the ins and outs of making sure that this precious tissue is given the outmost loving and care.

How often should you bathe baby? What types of products are safe for baby ’s skin? What ’s that red, blotchy rash?

Nurses answer these questions in our Newborn Skin Care Zone: everything you need to know and do from bathing and diapering to rash protection and prevention.

Visit: health4mom.org/zones/newborn-skin-care

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