The New Family

Your Child’s Early Months

In the Hospital: Things You Should Know

Right after delivery:

☐ Mom’s recovery and comfort care ......page 4

☐ Hospital security ...............................page 4

☐ Early breastfeeding ..........................page 29

☐ Skin-to-skin contact ........................page 29

Safety:

☐ Signs of jaundice ............................ page 13

☐ Shaken Baby Syndrome ...................page 23

☐ Safe sleep .........................................page 24

☐ Newborn safety ...............................page 24

Baby-care skills:

☐ Circumcision care ...........................page 16

☐ Cord care ........................................page 18

☐ Bathing ...........................................page 19

☐ Temperature taking .........................page 20

☐ Comforting a crying baby ...............page 22

☐ Breastfeeding ...................................page 30

☐ Diapers............................................page 52

Before You Leave: Things You Should Do

☐ Fill out paperwork for your baby’s birth certificate and social security card ...... page c

☐ Make sure you have a rear-facing car seat for your baby ........................................page 24

After You Go Home

☐ Get help if you have trouble breastfeeding ..................................... page a

☐ Schedule your baby’s first doctor visit ........................................ page a

☐ Know when it’s safe to resume sex .....page 5

☐ Choose a method of birth control .....page 5

☐ Know when to call: Your doctor ..................................page 6 Your baby’s doctor ......................page 25

☐ Watch for signs of depression ............page 8

☐ Schedule a postpartum visit with your doctor .............................page 10

Key Points for New Families

If you need more information about any of these topics, please tell your nurse before leaving the hospital.

1. Breastfeed your baby.

Breast milk is the perfect food for your baby in the first year. Breastfed babies have fewer illnesses (colds, ear infections). They are less likely to get dia-betes, childhood cancers and other serious diseases.

Your nurses will help you get started on breastfeed-ing. If you need help after you leave the hospital, please call one of our lactation consultants:

• FairviewLakes:651-982-7864

• FairviewNorthland:612-389-6329

• FairviewRedWing:651-267-5376

• FairviewRidges:952-892-2552

• UniversityofMinnesotaMedicalCenter, Fairview:612-273-2220

• FairviewAndoverClinic:763-392-4001

• FairviewChildren’sClinic:612-672-2350

• FairviewEaganClinic:651-406-8860

For support outside of Fairview, please call:

• MinnesotaDepartmentofHealth: In Minnesota:877-214-BABY[2229] In Wisconsin:715-485-8500

• LaLecheLeagueLeaders:612-922-4996

• NationalWomen’sHealthInformation Center(English and Spanish): 1-800-994-9662, www.womenshealth.gov/breastfeeding

For breastfeeding supplies:

• AskyourFairviewpharmacywhatsuppliestheymaycarry.Foralistofpharmacies,gotowww.fairview.org/pharmacy.

• Fairviewlactationconsultantsmaysellbreast-feeding supplies as well.

• Visitwww.medela.comorwww.ameda.com.

Formoreonbreastfeeding,readpages27–47orvisit www.llli.org.

2. Arrange a visit with your baby’s doctor soon.

Bring your baby to the doctor or clinic (or your dischargeclass)within2to5daysofleavingthehospital. Be sure to schedule this, if no one else has done so. See pages e–f for a list of clinics.

The clinic staff will help you set up future visits. They will tell you when to come in for the shots (vaccinations) that will protect your baby against serious illness. The first shot will likely be given in thehospital.Formoreaboutshots,seepage55orvisit www.health.state.mn.us/immunize.

If you worry about paying for clinic visits, tell your nurse.

3. Give your baby a safe place to sleep.

• Always place baby on his or her back to sleep.

• Neversmokearoundyourbaby.

• Thesafestplaceforyourbabytosleepisinacrib in your room.

• Checkthecrib at home to make sure it is safe.

– At most, cribslatsmustbe23/8inchesapart.

– Themattressshouldbefirm.Itshouldfittightly into the crib. There should be no space around the mattress.

– Nostuffedanimals,pillows,puffyblankets,or toys in the crib.

• Neversleepwithyourbabyinyourownbedifyouoryourpartner:

– Havebeendrinkingalcohol.

– Haveuseddrugsthatmakeyousleepy.

– Areveryoverweight.

You could roll onto your baby and not know it. Inthehospital,thebabywillsleepinacrib.

Formoreaboutsafesleep,seepage24,orvisitwww.cpsc.gov/CPSCPUB/PUBS/5030.html.

Tips to Keep Your Baby Safe and Healthy

a

4. Never shake your baby!

Parentscanfeeloverwhelmed,especiallywhentheir baby is cryingalotorisn’tsleepingmuch. Ifyoufeeltemptedtoshakeorhityourbaby:

1.Stop and step back.

2.Putyourbabyinitscrib or another safe place.

3.Dosomedeep-breathingorcallafriend.

Evenaverysmallshakeorslapcanharmyourbaby.Callyourbaby’sclinicifyoufeelfrustratedandthink you may harm your baby. This is a common feeling among new parents—your clinic will understand and take steps to help you. To learn more,gotopage23orvisitkidshealth.org.

5. Sign up for Fairview’s Mom and Baby classes.

Once a week for six weeks, new moms (with their babies) meet to talk about feeding, sleeping, parenting,andothertopics.Theclasscosts$35,butnooneisturnedawayiftheycan’tpay.Call612-672-7272tofindaclassnearyou.

You might also attend ECFE(EarlyChildhoodandFamilyEducation)classesofferedthroughyour local school district. To learn more, go to www.ecfe.infoorcall651-582-8402.

6. Take good care of yourself so you can care for your baby.

Being a parent is hard work. You need lots of rest, good food, and extra help from your partner and otherfamilyandfriends.Inspiteofallthesethings,you may feel sad, frustrated, and overwhelmed.

Formanywomen,thesefeelingspassquickly.Forafew, the sadness and other bad feelings keep getting worse.Ifthishappenstoyou,pleasecalladoctorrightaway.Heorshewillknowhowtohelp.Formoreinformation,seepages8–9orgotowww.womenshealth.gov/faq/depression-pregnancy.cfm.

7. Know when to call the doctor.

Seealsopage25(forbaby)andpage6(formom).

Call your baby’s clinicifyounotice:• Ahighfever—atleast100.4°F(38°C)inthe

rectumor99°F(37.2°C)underthearm.• Changesinbehavior (for example, your baby

is more or less sleepy or fussy than normal). • Vomiting(throwingup),diarrhea(loose,wa-

tery stools), or constipation (hard, dry stools).• Jaundice(yellowskin,eyes—seepage13).• Coughing,breathingchanges,orbluishskin.• Babyrefusestofeedformorethan6hours.• Fewerthansixwetdiaperswithin24hours.

Call your own clinicifyounotice:• Afeverover100.4°F(38°C)underyourtongue.• Heavybleeding from the vagina (soaking more

than one pad per hour), bright red bleeding or clots larger than a golf ball.

• Burningorpainwhenyouurinate (pass water), or a need to urinate often.

• Aredorpainfulareaonyourbreast.• Discharge(fluid)fromthevaginasmellsbad.• Pain,swelling,redness,arash,ordrainage

(leakingfluid)aroundanincision or scar that getsworseordoesn’tgoaway.

• Painorrednessaroundaveininyourleg, or youcan’tstandonthatleg.

• Extremeabdominal (belly) pain.• Increasednausea (feeling sick to your stomach)

or vomiting (throwing up).• Chestpain,coughing, or gasping for air.• Intensemoodchange,lowenergy,orlossof

interest lasting two weeks or more. • Changesinyoursleeping pattern, eating

habits, or use of alcohol or drugs.• Problemsfocusingormakingsimpledecisions.• Thoughtsabouthurtingyourbabyoryourself,

evenifyoudon’tactonthosethoughts.

b

Birth certificate and social security card

Duringyourstay,wewillgiveyouaformtocompletebeforeyouleavethehospital.Wewillusethisformtofileyourbaby’sbirthcertificate.Ifyourequestasocialsecuritynumberforyourchild,wewillhaveyourdetailssenttotheU.S.SocialSecurityAdministrationaswell.

Afterthreetoeightweeks,youshouldreceiveyourbaby’ssocial security cardinthemail.Ifyoudonot,call1-800-772-1213.

Inabouttwotothreeweeks,youwillreceivea“Par-entNotice”inthemail.(Ifyoudonot,callyourhospitalandaskfortheBirthCertificateOffice,orcallthecountyrecorder’sofficeinthecountywhereyour baby was born.) This letter contains the details that will appear on the birth certificate.

1. Pleasereviewtheletterandcorrectanyerrors.

2. Return the letter before the date listed at the top of the form. Ifthereareerrorsandyoumiss this deadline, you will need to pay a fee and send more information.

3. Whenyoureturntheletter,youmaybuythebirth certificate at the same time. There will be afee.Followthedirectionsontheletter.

– To order by mail: Take the letter to a notary public(atyourbank,forexample).Heorshe will notarize the letter (act as a witness when you sign it, then stamp the letter with aspecialseal).Afterthat,youcanreturntheletter.Includeacheckforthefee.

– To order in person: Take the letter to your countyrecorder’soffice.Youdonotneedto have it notarized. You will receive the birth certificate when you pay the fee.

Formoreinformation,ortofindyourcountyrecorder’soffice,gotowww.health.state.mn.us. Orcall651-201-5970.

Car seats

Minnesotalawrequirescarseatsforallinfantsandchildren.Ifpossible,secureyourbaby’scarseat in the middle of the back seat, facing the rear of the car.

Because there are so many different car seats, the workers at your hospital cannot help you install yourcarseat.Formoreinformation,seepage24or visit www.buckleupkids.state.mn.us.

Childcare

Forhelpfindingreliablechildcare, call the MinnesotaChildCareResourceandReferral Networkat1-888-291-9811.Orvisit mnchildcare.org.

Crisis nurseries

CalltheUnitedWay(dial211)ifyouareinacrisis and need a safe place for your baby.

Depression

Ifyouthinkyoumaybedepressedandyouneedhelpnow,callyourdoctor.Orcontact:

• CrisisConnection:1-866-379-6363 (TTY612-379-6377)

• FairviewCounselingServices:612-672-6999

Emergency services

Forhealthemergencies,dial911.

ToreachMinnesotaPoisonControl,call 1-800-222-1222.

Forotheremergencies(suchasfood,housing, anddomesticabuse),dial211tocontacttheUnitedWay.

Helpful Information

c

Health care providers

Forhelpfindingacareprovider,call:

• FairviewOnCall:612-672-7272

• UniversityofMinnesotaAmplatz Children’sHospital:1-888-KIDS-UMN (1-888-543-7866)

Health insurance – a reminder

Ifyouhavehealthinsurance, you must add your babytoyourpolicywithin30days.

Low-income families

Forprogramsthatmayhelpfeedyourfamilyorpay your medicalbills,contact:

• MinnesotaDepartmentofHumanServices:651-431-2000(TTY1-800-627-3529)orwww.dhs.state.mn.us

• Women,Infants,andChildren(WIC) Program:1-800-942-4030orwww.health.state.mn.us/divs/fh/wic

The milk bank

Ifyouhaveextrabreast milk, you may wish to donate it to the human milkbankatUniversityofMinnesotaMedicalCenter.Youandyourbabymust be healthy, and your baby must be at least four weeks old.

Donatedmilkisusedtohelpsickorpre-termbabies.Tolearnmore,callthemilkbankofficeat612-672-4122oremailmilkbank@fairview.org.

Poison control

Ifyouthinkachildorpethasbeenpoisoned, call 1-800-222-1222.

Parenting information and support

Ifyouhaveinfantcarequestions,calltheFairviewBabyConnectionLineat612-672-4789.Wewillreturnyourcallwithin24hours,exceptonSun-days or holidays.

OrsignupforFairview’sMomandBabyclassesat612-672-7272.Theseclassesareofferedatanum-berofFairviewhospitalsintheTwinCitiesarea.

To hire someone who can help with home breast-feeding,infantcare,andhouseholdtasks,contact:

• TheChildbirthCollective: childbirthcollective.org

• DONA(DoulasofNorthAmerica):1-888-788-DONA(1-888-788-3662)ordona.org.

Twins, triplets, or more

JoinaMothersofMultiplesClubforsupport.

• MinnesotaValley:www.mvmom.org

• St.Paul:www.stpaulmoms.org

This list is for information only. Fairview is not responsible for the quality of services or the actions of any person or organization.

d

AndoverFairviewAndoverClinic13819HansonBlvd.N.W.763-392-4001

Apple ValleyFairviewCedarRidgeClinic15650CedarAve.S.952-997-4100

Blaine FairviewBlaineClinic10961ClubWestParkwayN.E.763-268-0400

BloomingtonFairviewOxboroClinic600W.98thSt.952-881-2651

Brooklyn ParkFairviewBrooklynParkClinic10000ZaneAve.N.763-528-6999

BurnsvilleFairviewRidgesClinic303E.NicolletBlvd.952-460-4000

ChaskaFairviewJonathanClinic1447WhiteOakDr.952-448-3500

Chisago CityFairviewChisagoLakesClinic11725StinsonAve.651-257-8499

Columbia Heights FairviewColumbiaHeightsClinic4000CentralAve.N.E.763-782-8183

EaganFairviewEaganClinic1440DuckwoodDr.651-406-8860

Eden PrairieFairviewEdenCenter830PrairieCenterDr. 952-826-6500

EdinaFairviewCrosstownClinic6545FranceAve.S.,Suite150952-848-5600

Elk RiverFairviewElkRiverClinic290MainSt.N.W.763-241-5800

Ellsworth (Wis.)FairviewEllsworthClinic530W.CairnsSt. 715-273-5061

FarmingtonFairviewFarmingtonClinic19685PilotKnobRd.651-463-5100

FridleyFairviewFridleyClinic6341&6401UniversityAve.N.E.763-586-5700

HugoFairviewHugoClinic14712VictorHugoBlvd.651-466-1900

LakevilleFairviewLakevilleClinic18580JoplinAve.952-892-9555

Lino LakesFairviewLinoLakesClinic7455VillageDr.651-717-3400

Maple GroveFairviewBassLakeClinic6320WedgwoodRd.N.763-268-0400

FairviewMapleGroveClinic1450099thAve.N.763-898-1000

MilacaFairviewMilacaClinic15010thSt.N.W.320-983-7400

MinneapolisFairviewChildren’sClinic2535UniversityAve.S.E.612-672-2350

FairviewHiawathaClinic380942ndAve.S.612-721-6261

FairviewUptownClinic3033ExcelsiorBlvd.,Suite275612-827-4751

Fairview Clinics

e

New BrightonFairviewNortheastClinic1551SilverLakeRd.612-706-4500

North BranchFairviewNorthBranchClinic6413OakSt.651-674-8353

Pine City FairviewPineCityClinic 5102ndStreetS.E. 320-629-6721

PrincetonFairviewPrincetonClinic919NorthlandDr.763-389-3344

Prior LakeFairviewRidgeValleyClinic4151WillowwoodSt.S.E.952-226-2600

Red WingFairviewRedWingMedicalCenter701FairviewBlvd.651-267-5000

RogersFairviewRogersClinic14040NorthdaleBlvd.763-488-4100

RosemountFairviewRosemountClinic 15075CimarronAve. 651-322-8800

Rush CityFairviewRushCityClinic760W.FourthSt.320-358-4784

St. FrancisFairviewSt.FrancisClinic23671St.FrancisBlvd.763-502-3900

St. PaulFairviewHighlandParkClinic2155FordPkwy.651-696-5000

WyomingFairviewLakesClinic 5200FairviewBlvd. 651-982-7600

ZimmermanFairviewZimmermanClinic 25945GatewayDr. 763-856-6900

ZumbrotaFairviewZumbrotaClinic1350JeffersonDr.507-732-7314

f

The New FamilyYour Child’s Early Months

SecoNd editioN

By Fairview Health ServicesAffiliated with the University of Minnesota

Fairview Press, Minneapolis

tHe NeW FAMiLY: YoUR cHiLd’S eARLY MoNtHS, SecoNd editioN © 2004, 2010 Fairview Press. This volume was first published as part of Caring for You and Your Baby: From Pregnancy through the First Year of Life © 1997, 1999 Fairview Press. All rights reserved. No part of this publication may be used or repro-duced in any manner whatsoever without written permission, except in the case of brief quotations embodied in critical articles and reviews. For further information, please contact the publisher.

Published by Fairview Press, 2450 Riverside Avenue, Minneapolis, Minnesota 55454. Fairview Press is a division of Fairview Health Services, a community-focused health system affiliated with the University of Minnesota and providing a complete range of services, from the prevention of illness and injury to care for the most complex medical conditions. For a free current catalog of Fairview Press titles, call toll-free 1-800-544-8207. or visit www.fairviewpress.org.

Library of Congress Cataloging-in-Publication DataThe new family : your child’s early months / by Fairview Health Services, affiliated with the University of Minnesota. -- 2nd ed. p. cm. includes index. iSBN 978-1-57749-240-5 (alk. paper) 1. infants--development. 2. infants--care. 3. Parent and infant. i. Fairview Health Services. RJ134.N493 2010 618.92--dc22 2010006179

First edition: January 2004Second edition: March 2010Printed in the United States of America

Writer: Linda PiconeGeneral editor: Lora Harding-dundekBook designer: Jane dahms Nicoloillustrators: Barbara Beshoar and Jane dahms Nicolo

AcknowledgmentsMany individuals from Fairview Health Services contributed to this project. Special thanks for this edition goes to Laurie Frattallone, BA, icce; Pam Heggie, Md, iBcLc; Sheila Humphrey, BS, RN, iBcLc; casey McGuire, BA, icce; and Ann Shelp, BSN, icce. We thank our patients and their families and the many other people who helped move this book from conception to reality.

This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. it is sold with the understanding that the publisher is not engaged in the provision or practice of medical, nursing, or professional health care advice or services in any jurisdiction. if medical advice or other professional assistance is required, the services of a qualified and competent professional should be sought. Fairview Press is not responsible or liable, directly or indirectly, for any form of damages whatsoever resulting from the use (or misuse) of information contained in or implied by these documents.

SMARtworks 520014 – ReV 03/12

Contents

introduction ............................................................ 1

chapter 1: Postpartum care ................................... 3

chapter 2: Your Newborn ..................................... 11

chapter 3: Feeding Your Baby .............................. 27

chapter 4: Your Baby’s First Six Months ............... 49

Keeping track of Your Baby ................................... 63

index ..................................................................... 71

Introduction

This book—together with its companion volume, The Expectant Family: From Pregnancy through Childbirth—is designed to provide the basic information you need to make the best decisions possible about pregnancy, labor, birth, and parenting. For additional information, you will find recommended resources listed at the end of each chapter.

You may, at times, feel overwhelmed with all the information and resources available to help you prepare for and parent your baby. You may wonder, “What is it that i need to know?”

to answer this general question, try to imagine yourself in specific situations:

• Onceyourbabyisborn,doyouimagineyourself and your baby together throughout your hospital stay, or is the baby in the nursery? How do you picture yourself feeding your baby?

• Whenyoucomehomefromthehospitalwithyour baby, who do you picture being with you? Will you want extra help at home or time alone as a family?

• Howdoyoupicturethefirstweeksathomewith your baby? is the baby sleeping a lot? How often is the baby eating? What information do you need to make these images clearer?

Thinking about specific situations such as these will lead you to ask the questions that you really need answered. together, both The Expectant Family and The New Family will bring clarity to your thoughts and help you find the answers to your questions.

in addition to the advice offered in these books, you will also receive information and guidance from health care providers. Health care providers may include physicians, certified nurse-midwives, nurses, or nurse practitioners. You may also spend time with a childbirth educator or doula. The relationships you form with the people providing direct care to you and your baby are very important. together, these health care providers will give you the resources you need to have a healthy pregnancy and a healthy baby.

Postpartum Care Now that you have had your baby, you may feel happy, relieved, excited, and exhausted. You are ready to focus on caring for this tiny new life. But don’t forget to care for yourself as well.

Your body has been through a lot, and it will take time to heal. Also, many women get the blues in the first few weeks and months—you and your partner will need to watch for signs of depression. it’s important to nurture the health of your body and mind, so that you can be the best mother you can be.

SOME OF THE QUESTIONS ANSWERED IN THIS CHAPTER INCLUDE:

• How will you keep my baby safe in the hospital?

• How can I help my body heal after the birth?

• When is it safe to exercise again?

• What are the signs of postpartum depression?

• When should I see my care provider again?

1

4 tHe NeW FAMiLY

Your Hospital Stay

You may stay in the hospital only a couple of days, but even a short stay should be as comfortable as possible. Sleep and rest are very important after delivery. You may feel excited and wide awake for a while, but your body has been working hard and needs time to recover.

if you have visitors in the hospital, try to keep their visits short. don’t feel that you have to entertain them.

Safety and Security

You, your baby, and your birth partner will have matching id bands attached to your wrist and your baby’s wrist or ankle. The bands will be checked each time your baby is away from you and brought back to you.

Problems are very rare, but, for security reasons, do not hand your baby to anyone in the hospital who doesn’t identify himself or herself and who isn’t wearing an id badge. if you have any doubts, push your call button and wait for a nurse to arrive.

Your baby may stay in the room with you—keeping your baby with you as much as possible will help you learn more about the baby—but if you leave the room, even just to take a quick shower, do not leave the baby alone. if you need to use the bathroom, place your baby in the bassinet. Leave the bathroom door ajar so you can see your baby at all times. or bring the bassinet with you into the bathroom.

if you have trouble sleeping with your baby in the room, please tell your nurse. He or she can show you ways to make you and your baby more comfortable.

if you leave your room, bring your baby in the bassinet. Be sure to stay within the security zone.

Postpartum Care

After your baby is born, your body begins its recovery. it doesn’t recover all at once, but it does change noticeably right away. Just as you paid attention to the needs of your body during pregnancy, it’s important to pay attention to those needs now.

Activity

Rest is very important. Your baby’s needs will disrupt your sleep during a time when you could use a little more sleep than usual. Let other people—your partner, your mother, friends, relatives—help you.

You can do many of your daily activities at home, but do them one by one. Give yourself time for naps during the day when your baby is sleeping. Avoid lifting anything heavy or doing strenuous work or sports.

If you had a cesarean birth:

• Donotliftmorethan10poundsforthefirstmonth after surgery.

• Nodrivinguntilyouhavestoppedtakingyourpain medicine (usually two weeks after surgery).

• Noheavyexerciseoractivity.Don’tdoanythingthat will put a strain on your surgery site.

• Don’tstrainwhenusingthetoilet.Yourcareteam may prescribe a stool softener.

Perineal Care

Use the peri-bottle you got in the hospital and change sanitary pads every time you go to the bathroom. take as many warm tub baths as you like to ease any pain. do not use tampons until vaginal bleeding has stopped. do not douche unless your care provider says it’s okay.

PoStPARtUM cARe 5

Vaginal Flow, Menstruation

Right after a vaginal birth, your vaginal flow will be bright red. it should become dark red before you leave the hospital. if you see large clots (bigger than a golf ball or Ping-Pong ball) or smell a bad odor, be sure to tell the nursing staff.

Your vaginal flow may continue for 4 to 6 weeks after you give birth. Usually the amount decreases and the color turns brownish-red, then white or clear. if you have been too active, your flow may become a brighter red and grow heavier for a while. if you need more than one pad an hour, lie down, rest, and call your clinic.

Menstrual periods usually start again 6 to 8 weeks after delivery. if you are breastfeeding, your periods may be delayed. You can still get pregnant, however.

Incision Care

if you had a cesarean, the area around your incision (surgery wound) will feel numb. This is normal. The numbness should go away in less than a year.

to reduce the risk of infection, always wash your hands before touching your incision. (if your hands aren’t dirty, you may use an alcohol hand-rub.) You should also keep your nails clean and short.

to care for your incision:

• Keeptheincisionareacleananddry.

• Donotsoakyourincisioninwater.Noswimming or hot tubs until it has fully healed. You may soak in the bathtub if the water level is below your incision.

• Afterwashing,dryyourincisionwell.Includethe fold of skin that covers your incision.

• Donotuseanyperoxide,gel,cream,lotion,orointment on your incision.

• Adjustyourclothestoavoidpressureonyoursurgery site.

• Leavethesmallstripsoftape(Steri-Strips)inplace. They will fall off on their own, or you can remove them after one week.

You may see a small amount of clear or pink drainage. check with your health care provider if the drainage increases or has an odor, if the incision reddens, or if you have a fever.

Medicines

Your doctor or midwife may prescribe certain medicines. You may also choose to take over-the-counter medicines. See page 7 for possible side effects of common postpartum medicines.

Constipation, Hemorrhoids

to reduce your risk of constipation, drink 6 to 8 glasses of non-caffeinated liquids every day, and increase the amount of fiber in your diet. if hemorrhoids are a problem, warm tub baths are soothing. try not to strain when you have a bowel movement. Your care team can recommend over-the-counter medicine to help with constipation.

Nutrition

Keep up the good eating habits you enjoyed during pregnancy. eat a well-balanced diet that includes every food group. don’t try to lose your pregnancy weight quickly by cutting back on calories.

Kegels

Those Kegel exercises you were doing during pregnancy are still useful. (in fact, they are useful throughout your life.) After having a baby, you may barely be able to feel the muscles, but if you keep doing the Kegels, you are less likely to leak urine when you sneeze or cough.

6 tHe NeW FAMiLY

Sex

Avoid sexual intercourse for at least 3 to 4 weeks after delivery, or until the brownish-red vaginal flow is completely gone. Most health care providers recommend that you not have vaginal intercourse until after your post-delivery clinic visit (about 6 weeks after birth). if you do, however, and you do not want to become pregnant again, you should use birth control, such as a condom. it’s possible to get pregnant within a month after having a baby, even if you’re breastfeeding.

Exercise

Yes, you can start exercising soon after birth, but most health care providers recommend waiting about 6 weeks before starting any serious workouts. Begin exercising slowly, but make exercise a part of your daily routine. Remember, it took you months to gain your pregnancy weight and shape, and it will take months to lose them.

Start walking, a little bit at a time. This will help you feel better in general, although it won’t work on specific muscles like the exercises described below.

Abdominal Tightening

Lying on your back or side (or later, sitting or standing), take a deep breath in through your nose and feel your abdomen expand. Blow the air out slowly through your mouth while pulling your abdominal muscles in. do this 2 to 3 times to start. You can do this exercise 24 hours after birth.

Pelvic Tilt

Lie on your back with your knees bent. Flatten your lower back against the floor. While letting your breath out, tighten your abdominal muscles and then hold for 3 to 4 breaths. Relax and repeat.

When to Call Your Health Care Provider

• Ifyouhaveatemperature of 100.4° F (38° c) or higher when taken under the tongue.

• Ifyouhaveheavyvaginalbleeding, bright red bleeding soaking more than one pad an hour, or clots larger than a golf ball or Ping-Pong ball.

• Ifyouhavebleedingformorethan 6 weeks.

• Ifyouhaveburningorpainwhileurinating or a frequent or urgent need to urinate.

• Ifyouhavepaininonespotoraredarea on your breast.

• Ifyouhavevaginal discharge that smells bad.

• Ifyouhavepainthatincreasesordoesnot go away from an episiotomy or perineal tear.

• Ifyouhaveincreaseddrainage,swelling, pain, redness, or a rash around your incision from a cesarean birth. or, you have drainage that smells bad.

• Ifyouhaverednessorpainaroundavein in your leg, or if you can’t stand on that leg.

• Ifyouhaveextremeabdominal pain.

• Ifyouhavenausea and vomiting.

• Ifyouhavechest pain and cough or are gasping for air.

PoStPARtUM cARe 7

☐ Narcotic pain relievers: oxycodone (oxycontin, Roxicodone); acetaminophen with oxycodone (Percocet, Roxicet); acetaminophen with hydrocodone (Vicodin, Norco); acetaminophen with codeine (tylenol #3) • Reasons for use: Medium to severe pain • Possible side effects: Feeling drowsy or

dizzy, shallow breathing, upset stomach, vomiting (throwing up), constipation (hard, dry stools that are difficult to pass), blurred vision, itching, skin rash

• Notes: do not drive while taking this medicine. to prevent constipation, your doctor may give you medicine to soften your stools. to prevent dizziness, your doctor may reduce your dose or change your dosing schedule. Ask your doctor about the risk of addiction.

• If you take Percocet, Roxicet, Vicodin, Norco, or Tylenol #3: do not take tylenol, NyQuil, or other medicine that contains acetaminophen.

☐ Ibuprofen (Motrin, Advil) • Reasons for use: Mild to medium pain

and inflammation (redness, swelling)• Possible side effects: Upset stomach,

vomiting (throwing up), constipation (hard, dry stools that are difficult to pass), hives, itching, skin rash

• Notes: Your doctor will have you take this with food or milk. do not take more than 3,200 mg per day.

☐ Acetaminophen (tylenol)• Reasons for use: Mild to medium

pain, fever • Possible side effects: Upset stomach,

vomiting (throwing up), constipation (hard, dry stools that are difficult to pass), hives, itching, skin rash

• Notes: if you take this at home, do not take more than 4,000 mg per day (no more than 8 extra-strength tablets).

☐ Docusate (colace stool softener) or senna (Senokot-S stool softener plus laxative)• Reasons for use: Prevents constipation

(hard, dry stools that are difficult to pass)• Possible side effects: Rash, diarrhea

(loose, watery stools), upset stomach• Notes: drink plenty of fluids.

☐ Iron (ferrous sulfate, ferrous gluconate)• Reasons for use: treats or prevents low

iron levels in the blood• Possible side effects: constipation (hard,

dry stools that are difficult to pass), darker stools, nausea (feeling sick to your stomach); liquid iron may stain teeth

• Notes: Your doctor may have you take this with food or at bedtime. Vitamin c will help your body absorb the iron.

Possible Side effects of Postpartum Medicines

You need to know about the medicines you take. if you don’t, please ask your nurse or pharmacist, or read the information that comes with your medicine. For information about breastfeeding while taking medicine, see page 46.

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Postpartum Depression

Although postpartum depression is common, it is serious—and treatable. if you think you might have it, tell your doctor or another health care provider. With help, you can feel like yourself again.

The Baby Blues

Having a baby brings big changes in a woman’s life. These changes can be overwhelming. While most moms get past the “baby blues” within the first two weeks, some moms struggle for longer.

if the baby blues last longer than two weeks, you may have postpartum depression.

Depression

it is easy to confuse the symptoms of postpartum depression with normal hormone changes. How can you tell if it’s serious? Watch for these symptoms:

• Feelingsad,anxious,or“empty”

• Lackofenergy,feelingverytired

• Lackofinterestinyournormalactivities

• Changesinsleepingoreatingpatterns

• Feelinghopeless,helpless,guilty,orworthless

• Feelingmoodyandirritable

• Problemsconcentratingormaking simple decisions

• Thoughtsabouthurtingyourbaby,evenifyouwill not act on them

• Thoughtsaboutdeathorsuicide.

Things You Can Do

Being a good mom means taking care of yourself. if you take care of yourself, you can take better care of your baby and your family.

• Gethelp.Talkwithyourcareprovider,callanemergency support line, or ask a loved one to help you get the care you need.

• Askyourcareprovideraboutmedicinesthatcan be safely used for postpartum depression.

• Talktoatherapist,aloneoringrouptherapy.

• Askyourfaithorcommunityleadersaboutother support resources.

• Learnasmuchasyoucanaboutpostpartumdepression.

• Getsupportfromfamilyandfriends.Askforhelp when you need it.

• Keepactive by walking, stretching, swimming, and so on.

• Getenoughrest.

• Eatahealthydiet.

don’t give up! it may take more than one try to get the help you need.

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What You Should Know

it is very common for new moms to have the “baby blues.” They often start a few days after a baby’s birth. Usually, feeling sad and irritable will not stop you from taking care of your baby or yourself.

if symptoms interfere with your life or last longer than two to three weeks, you may have postpartum depression. This affects up to 2 out of 10 moms. it can occur any time in your baby’s first year.

Women who have a history of depression are more likely to become depressed during pregnancy or after birth. depression can be caused by stress, hormone changes, trauma, lack of support, and other factors.

if you are depressed, you need to get help. it will not get better on its own.

Who to Contact for Help

Fairview counseling Services (Specialists in postpartum depression offer individual, couples, and group therapy) 612-672-6999

crisis connection 1-866-379-6363; ttY 612-379-6377

Jenny’s Light www.jennyslight.org

National Suicide Prevention Lifeline 1-800-273-tALK [1-800-273-8255]

PPd Hope information center www.ppdhope.com

Pregnancy and Postpartum Support Minnesota www.pregnancypostpartumsupportmn.org

The Best Treatment

The most effective treatment for depression includes:

• Individualorgrouptherapy

•Medicinethatcanbesafelyusedwhile breastfeeding (prescribed by your doctor)

• Supportfromyourfamily,friends, and community.

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Clinic Visits

You will be asked to see your health care provider 2 to 6 weeks after giving birth. At this visit, you may have some blood drawn and your urine tested, and you’ll have a physical, including a pelvic exam. if you have not had a Pap smear for a year or more, your health care provider may take one.

At the exam, your health care provider will discuss family planning options with you and will answer any questions you have about exercise and other physical activities.

As noted earlier, most health care providers recommend that you not have vaginal intercourse until after your post-delivery clinic visit. if you do, however, and you do not want to become pregnant again, you should use birth control.

it’s possible to get pregnant within a month after having a baby, even if you’re breastfeeding.

For Partners

Your partner will need a lot of support after giving birth. She’s still recovering physically, and she also needs emotional support. She may get the “baby blues,” and she can use some reassurance from you.

After the birth you can help by burping the baby, changing diapers, giving the baby baths, and so on. if she is breastfeeding, your encouragement and support will mean a great deal to her. You and your partner can share caring for the baby, delighting in every little thing he or she does.

For More Information

MedEd for Postpartum Depression www.mededppd.org

Minnesota Parents Know www.parentsknow.state.mn.us

PPD Hope www.ppdhope.com

Your Newborn This tiny creature in your arms is your baby—an independent little person who is already capable of many things. You are excited and scared. Who is this little person?

New parents often think they need to know everything about caring for their baby before they leave the hospital. The exhaustion that comes with becoming a parent makes this impossible. However, you can learn a great deal simply by observing your newborn.

SOME OF THE QUESTIONS ANSWERED IN THIS CHAPTER INCLUDE:

• What can my baby see, hear, feel, and do?

• How do I give my baby a bath?

• How do I take my baby’s temperature?

• What does my baby’s crying mean?

• How do I keep my baby safe?

• When do I call my baby’s health care provider?

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A First Look at Your Newborn

You may think your newborn is the most beautiful baby—the most beautiful anything—you’ve ever seen. Then again, you might not. This baby may look very different from the baby you had imagined when you were pregnant. His or her head may have been squeezed into a long shape during the birth process. Maybe your baby has long, fine hair all over his or her body.

These characteristics are all completely normal—and temporary. Your baby’s head will round into a normal shape in a few days. The long, fine hair, called lanugo, will disappear in about a week. other things you may notice about your newborn:

Head

• Therearesoftspotsonthetopandattheback of your baby’s head, where the bones still haven’t grown together. These soft spots may make you a little nervous about touching your baby’s head. You need to be gentle, but you can still wash your baby’s hair or massage your baby’s head and scalp.

• Theremaybeasoft,spongyareaonyourbaby’shead, caused by the pressure of birth. This usually goes away in a few days. Some babies have a hard knot on the top of their head, called a cephalhematoma. This will also go away, although it may take 4 to 6 months. it does not cause any harm to your baby’s brain.

Eyes

• Light-skinnedbabiesusuallyhavegrayish-blueeyes when they are born. dark-skinned babies usually have grayish-brown eyes. Your baby’s true eye color may appear in a few months or may take as long as a year to develop. The color of your baby’s eyes doesn’t have anything to do with the ability to see.

Nose

• Somebabiesarebornwithanosethatlookssquashed. The nose will develop normally in a short time.

• Yourbabymaysneeze a lot. The inside of the nose is much smaller than the nostrils, so mucus catches easily. Sneezing clears the nasal passages so the baby can breathe.

Skin

• Smallwhitebumpscalledmilia are common on the face. Just leave them alone—don’t try to squeeze or pick at them. They will disappear in a few weeks.

• Somebabieswillhaveanewbornrash on their bodies. it will disappear in about a week.

• Somebabiesmayhaveanareaofskinthatcontains extra pigment. This area is called the Mongolian spot. The spot is often on the back or buttocks. it looks like a bruise but does not hurt and often remains for 4 to 5 years before disappearing.

• Jaundice, or yellowish skin, is common in newborns. Nearly two out of three babies will have some slight change in skin color. call your care team if your baby’s skin is very yellow or if the whites of his or her eyes are yellow.

Genitals

• Bothboyandgirlbabiesusuallyhaveswollengenitals. This is sometimes startling to parents, but it’s normal and the swelling goes down in a few days.

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checking for Jaundice in Newborns

take your baby to a window, but not in direct sunlight. Press your fingertip on your baby’s forehead, nose, or cheek (as if you were checking fruit to see if it is ripe). When you take your finger away, the spot where your finger was will look lighter for a few seconds. if it looks yellow, your baby has jaundice. Repeat these steps on the upper chest and tummy. Also check the whites of your baby’s eyes to see if they are yellow.

Jaundice often starts in the face and spreads down over the body toward the feet. if you think your baby has jaundice or if the jaundice is getting worse, call your baby’s doctor right away.

What causes jaundice?

All babies are born with red blood cells that they don’t need. As their bodies break down these cells, an orange color (called bilirubin) is released into the blood. Normally, this is flushed from the body when a baby soils his or her diapers. But if it is not, the orange color finds its way to the skin, causing jaundice.

Babies are more at risk for jaundice if they:

• Areborntwoormoreweeksearly.

• Werebruised during the birth process or helped by a vacuum.

• Haveadifferentblood type than their mother.

• Haveabrotherorsisterwhohadseverejaundiceorneededphototherapy.

• Donotfeed8to12timesina24-hourperiod.

Is it serious?

Most of the time, jaundice is not serious. But for some babies, jaundice can be harmful. if your baby has too much bilirubin, it can hurt the brain and cause hearing loss. (This is rare.)

We will do a simple blood or skin test to check your baby’s bilirubin level. if it is too high, we will ask if you are feeding your baby 8 to 12 times within 24 hours. We may also give you a special “bili-light” machine to put over your baby. This is called phototherapy.

if the test result is normal, you must watch your baby closely for the next few days. Call your baby’s clinic or hospital right away if your baby is very sleepy, does not wake up to eat, or seems very fussy and will not sleep or eat much. Call 911 (or your baby’s doctor) if your baby is limp and floppy, has stiff arms and legs, arches his or her back or neck, or has a high-pitched cry.

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What Your Baby Can Do

Your baby was born with the ability to do a number of things. You’ll enjoy watching and playing with your baby, and your attention will help your baby develop.

What Your Baby Can See

• Whenfirstborn,ababycanseeaboutafootaway. (Be sure to dim the lights—bright lights make it more difficult for your newborn to see.) By the time the baby is 4 to 6 months old, he or she can see as well as an adult. Babies like faces, so looking into your baby’s eyes and talking will often fascinate your baby.

• Babiescangetoverwhelmedbyhavingtoomuch to look at. Keep your baby’s sleeping area uncluttered. Very bright colors in decorating or bedding can be too exciting for a new baby.

What Your Baby Can Hear

• Whenyouwereabout24weekspregnant,your baby started to hear your voice inside the uterus. Most babies can hear as well as adults when they are born. Your baby’s care team will check his or her hearing in the hospital.

• Yourbabywillgetusedtothenormalsounds of your household; no one needs to tiptoe or whisper.

• Thehigh-pitched“babytalk”voiceweoftenusewith babies is something they seem to like. A baby will turn toward someone using that voice and study the speaker’s face.

What Your Baby Can Smell and Taste

• Newbornbabiescansmellaswellasadults,and their sense of taste is even stronger than that of adults.

• Ababywillturnawayfromsharp, unpleasant odors.

• Babieslikesweetthings;however,youshouldnever add sugar to a baby’s formula or water because it can cause diarrhea. Also, do not give your baby honey until he or she is 1 year old.

What Your Baby Can Feel

• Babiesneedtobeheld,tofeelclosetosomeone,and to be touched by loving hands. Fussiness with diaper changes or baths is normal; don’t let it keep you from holding your baby.

• Babiescannotbe“spoiled,” so hold and carry your baby often. The warmth of your body and your particular scent are very soothing.

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What Your Baby’s Behaviors Mean

• Babiesoftensuckontheirfingersorfisttocomfort themselves. if you place your finger in the palm of your baby’s hand, the baby’s fingers will curl around your finger. This is the grasp reflex. You can then bring your baby’s fist to his or her mouth.

• Whenyouchangeyourbaby’sdiaper or clean the umbilical cord, your baby may start to cry. You are not hurting your baby; your baby is simply cold. crying increases body temperature. You may want to keep your baby partially covered when you change a diaper, clean the umbilical cord, or give the baby a bath.

• Whenyoupickyourbabyup,thebabymayopen his or her mouth or turn his or her head from side to side. This is a natural reflex to help your baby search for the nipple. if you stroke your baby’s cheek, the baby’s head will turn toward the side you touched. Your baby may begin to suck, or he or she may wait until a nipple is offered. This is called the sucking and rooting reflex, which helps your baby attach to the nipple.

• Whenyourbabylooksorturnsawaywhilebeing held, flushes red, or grows pale around the lips, the baby may be ready to stop whatever he or she is doing. Your baby may start to yawn, frown, or sneeze to let you know that he or she is ready to do something else. Your baby may do these things before crying to let you know that he or she needs your help.

• Whenawake, your baby may turn and look right at you. The baby’s body will be still; his or her eyes will be wide and clear. These are signs that your baby is ready to engage with you. Your newborn will study your face, watch you speak, and appear to understand everything you say. during the first few weeks, this might occur only a few minutes each day.

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Circumcision

You may wish to have your baby boy’s penis circumcised. in this procedure, the foreskin—the skin that covers the head of the penis—is cut away. Some parents choose circumcision for religious reasons, others because they think it is the “usual” thing to do.

While many doctors used to recommend circumcision, most now see it as a choice. it is rarely needed for medical reasons. For more about the pros and cons of circumcision, see page 17.

if you choose to have your baby circumcised, check with your insurance company first. in some cases, insurance doesn’t cover it.

Sometimes, a circumcision will be done before you leave the hospital. But many care providers will ask you to wait until the baby is breastfeeding well and gaining weight. in that case, the circumcision is done at your baby’s clinic a week or two after birth.

The surgery uses local anesthesia (numbing medicine) and takes about 10 minutes. Healing takes about one to two weeks.

if your baby is circumcised:

• Hemaybefussyforafewdays.Hemayalsocry when he wets his diaper. Your care team will talk to you about pain control for your baby.

• Thepeniswilllookalittleswollen,red,andbruised. There may be some bleeding where the skin was cut.

• Donotcleanoffthecrustofbloodorpusthatforms on the head of the penis.

• Ifthereisacaponthepenis,don’tremoveit. it should fall off on its own within 3 to 10 days.

• Tokeepthepeniscleanandpreventinfection,change your baby’s diaper often during the first two weeks. For details, see “Genital care” on page 18.

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Pros and cons of circumcision

Should I have my baby circumcised?

This is a question that only you can answer. Some parents do it for religious reasons. others do it so their child will be like other boys.

talk with your doctor about the benefits and risks of this surgery. Ask questions about anything you don’t understand. Ask for more details if needed.

What are some of the medical reasons for circumcision?

• Maylowertheriskofaninfection. Such infections are rare and usually easy to treat.

• Maylowertheriskofcancerofthepenis. This is a rare cancer. Proper care may work as well.

• Maylowertherisklaterinlifeofgettingorpassingonsexuallytransmitteddiseases,includingHiV (the AidS virus). More studies need to be done on this.

• Willpreventcertainproblemsthatcanaffecttheforeskin. These problems are rare.

What are some of the medical reasons against circumcision?

• Theforeskinisnotanaccidentofnature.Itcanhelpprotectthetipofthepenisagainstirritation and even scarring. (Such scarring is rare.)

• Thesurgeryispainful.Painmedicinecanbeused,butthereisasmallriskofsideeffects.

• Thesurgeryispermanent(cannotbereversed).

• Thesurgery,whilemostlyverysafe,hassomerisks:

– As with any surgery, there is a risk of bleeding, infection, and problems that cannot be foreseen. These risks are very small (less than 1%).

– in rare cases, too much or too little of the foreskin can be removed.

– in rare cases, a band of scar tissue may form on the penis.

– if you wait more than a couple of months after birth, your baby will need general anesthesia (medicine to make him sleep) for the surgery. This medicine involves more risk than a local pain-killer.

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Keeping Your Baby Clean

Your newborn only needs to be bathed once or twice a week, but you need to clean his or her bottom throughout the day and comb the scalp once a day.

Cord Care

• Onceeachday,lookattheareawherethe cord is attached. if the cord looks red, you notice a bad smell, or you see pus in the cord area, call your health care provider. These are signs of an infection.

• Thecordwillfalloffinabout1to3weeks.during this time, keep the area around the cord clean and dry.

• Youdon’thavetocleanthecordwithalcohol,unless your provider tells you to.

• Tohelpkeepthecorddry,foldthediaperbelow the cord during the first few weeks.

Nail Care

• Babies’fingernails can be sharp. They are very soft and hard to cut for at least 2 to 3 weeks. You can gently file them.

Genital Care

• Girlssometimeshaveasmallamountofpinkorwhite discharge from the vagina. This is normal and nothing to worry about. Always wash a girl’s genital area from front to back.

• Ifyourbabyboyisnotcircumcised,cleanthe penis gently with water but do not pull on the foreskin.

• Ifyourbabyboyiscircumcised, change his diaper often. At each diaper change:

1. Gently pour warm water over the penis. Let the penis air-dry. (You don’t need to use soap unless your son soils his diaper. do not use chemical wipes until the penis has healed.)

2. cover the head of the penis with petroleum jelly (such as Vaseline). Your care team will tell you what kind to use.

3. call your baby’s clinic if:

– The penis is very red or very swollen.

– Your baby has trouble passing urine.

– The penis won’t stop bleeding, even after you put gentle pressure on it.

– The pus coming from the incision looks thick or green, or it lasts more than a week.

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Giving Your Baby a Bath

You may want to wait until your baby’s umbilical cord stump has dried up and fallen off before you bathe your baby in a bath. Until then, a sponge bath is fine. You don’t need to bathe your baby every day.

Whether your baby is being bathed in water or while lying on a safe surface, you should make sure he or she doesn’t get chilled. Keep the area warm, and wrap your baby in warm, dry clothes right after the bath.

1. Gather bath supplies together. These include:

• Mildsoap(althoughyoucanbatheyourbaby in warm water without soap)

• Combandbrush

• Cleandiaper

• Cleanclothes

• Washclothandtowels

• Panorsinkforwater

• Asafesurfacewithablanketorpad.

2. test the water for the bath. it should be warm, but not hot. Use your elbow to check for a safe water temperature. Never put your baby into a bath without checking the water first.

3. While supporting your baby’s head with your hand, lower your baby’s body into the water.

Support your baby’s head as you lower the baby into a basin or tub and as you gently bathe each part of your baby’s body.

4. Wash around the eyes first with plain water. Then wash the face with plain water. don’t use cotton swabs to clean your baby’s nose or ears.

5. Wash the baby’s hair with plain water or with water and a mild shampoo. After the bath, comb your baby’s scalp to remove oily build-up.

6. Wash your baby’s stomach, back, and hands with plain water. clean between your baby’s fingers, and pay special attention to creases in the skin, such as around the neck area or armpits.

7. Wash the legs and feet, including between the toes.

8. Wash the baby’s bottom from front to back with water and mild soap.

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Taking Your Baby’s Temperature

A mercury thermometer should not be used to take anyone’s temperature. You should use either an oral or rectal digital thermometer.

The best way to know if a baby has a fever is by taking a rectal temperature using a rectal thermometer. For a rectal temperature:

1. clean the end of the thermometer with rubbing alcohol or soap and water. Rinse with cool water.

2. Most digital thermometers come with disposable sleeves to cover the thermometer. if one is provided, apply the disposable sleeve.

3. Apply a small amount of petroleum jelly on the end of the thermometer.

4. Put your baby on his or her stomach with a diaper underneath. taking a rectal temperature may cause a bowel movement.

5. Hold your baby steady by putting the palm of your hand on the baby’s lower back.

6. With your other hand, turn on the switch and gently insert the thermometer into the anal opening, about a half inch.

7. Keeping your hand cupped around your baby’s bottom, hold the thermometer in place for about one minute or until you hear a beep.

8. Remove the thermometer.

9. An average rectal temperature is 99.6° F (37.5° c). A rectal temperature of 100.4° F (38° c) or more could indicate that your baby has a fever.

You can also take an axillary (underarm) temperature. However, it is not as accurate as a rectal temperature.

1. tuck the oral or rectal digital thermometer into your baby’s bare armpit and hold the arm gently against the chest.

Take an axillary temperature by tucking the thermometer into your baby’s bare armpit.

2. Hold the thermometer in place for about one minute or until you hear a beep.

3. An average axillary temperature is 97.6° F (36.4° c). An axillary temperature of 99° F (37.2° c) or more could mean that your baby has a fever.

if your baby is three months old or younger and has a rectal temperature of 100.4° F (38° c) or higher, call your baby’s doctor right away.

Take a rectal temperature by putting just the tip of a rectal thermometer into the baby’s rectum.

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Your Baby’s States of Consciousness

Your baby has six states of consciousness. Under- standing them will help you better respond to and care for your baby.

• Deep sleep. Breathing is steady and regular. You do not see any eye movement. Noise does not disturb your baby, although it may cause the baby to move in his or her sleep. Your baby is not available to you in this state.

• Light sleep. Breathing seems faster, and your baby’s chest rises and falls with each breath. You notice movement beneath his or her closed eyelids. The baby may move around and even suck in his or her sleep. Your baby is more available for feeding because he or she is closer to being awake.

• Drowsy or semi-dozing. Your baby’s eyes are open, but he or she stares into space, not focusing on anything in particular. Your baby may decide to wake up or go back to sleep.

• Quiet alert. Your baby’s eyes are wide open, bright, and alert. The baby will not move his or her body much and will stay focused on whatever he or she is looking at. Your baby is most available to you in this state.

• Active alert. Your baby is fussy. He or she moves around and may cry out briefly. in this state, your baby is more sensitive to hunger, sleepiness, or being handled.

• Crying. When your baby cries, the baby is telling you that he or she needs something. The baby may be ready to eat, have a diaper changed, be burped, or be held and comforted.

Newborns have the ability to shut out repeated noise and stimuli when they are in a deep sleep, light sleep, or drowsy state. This is called habituation. it allows families to carry on with their daily activities without disturbing their baby.

The first few hours after your baby is born, he or she will most likely be in a quiet-alert state. Your baby will want to spend time watching your face and listening to your voice.

For the next 24 to 36 hours, your baby will spend a lot of time sleeping. As feeding time approaches, look for signs that your baby is in a light sleep. if your baby is in a deep sleep, it will be difficult to get him or her to suck on the breast or bottle.

When your baby is 3 to 4 days old, he or she will start to cycle between deep and light sleep every 30 to 40 minutes. it will be easier to anticipate when your baby is available for feeding.

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Baby’s Crying

Newborn babies tell you what they want by crying. They cry when they’re hungry, tired, or uncomfortable. They cry when they’ve had too much excitement or not enough.

You can expect your baby to cry about 2 or 3 hours out of every day. Some days it may be more, and some days it may be less. Some things to remember:

• Your baby cries because that’s how he or she communicates.

• Responding to your baby’s cries now may mean less crying in the future. You may need to use more than one method to ease your baby’s crying. (See column at right.)

• A newborn baby can’t be “spoiled” if you pick him or her up. in some cultures, babies are held almost constantly by their mothers. Studies show that babies who are kept closer to mom or dad actually cry less.

• Your baby is different than anyone else’s baby. While some ways of dealing with crying may have worked for your sister’s baby or your next-door neighbor’s baby, you have to learn what your baby needs.

• Never handle your baby when you’re feeling angry or frustrated. Put the baby in a safe place, or let someone else hold the baby for a while, and then walk away and calm down.

• Never shake your baby. See page 23.

Things You Can Try to Ease Your Baby’s Crying

• Feed your baby. Yes, even if it’s only been a short time since the last feeding. Your baby has his or her own schedule that doesn’t always follow a clock. Frequent feeding is normal.

• Check the baby’s clothing. Add a layer if it’s chilly; take a layer off if it’s hot. Also, check to see if the baby’s diaper needs to be changed.

• Rub the baby’s tummy, or lay the baby over your arm or lap and rub his or her back.

• Wrap, or swaddle, the baby in a blanket. Some babies like to suck their fists, so try wrapping them with their hands close to their face.

• Hold the baby in your arms on his or her stomach. Swing or sway your baby gently from side to side.

• Get out the rocking chair. Rock the baby, or walk around the room while holding the baby.

• Run a fan, sound machine, or other “white noise” near your baby. You might also download a white-noise audio file from the internet.

• Take a ride in the car, with the baby safely buckled into the infant car seat in the back.

• Know that your baby may cry to “blow off steam.” This is normal. When this happens, stay with your baby. He or she needs to know you are there. You might put the baby down on the floor or couch while you sit next to him or her and observe how the baby tries to comfort him- or herself. For instance, if you see the baby trying to suck on his or her fist or fingers, you can assist the baby by using the grasp reflex. (See page 15.)

• If you feel overwhelmed, call a friend or neighbor to watch the baby until you feel better.

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Never Shake Your Baby

A baby has very weak neck muscles and a heavy head. When you shake a baby, even for a few seconds, his or her brain moves back and forth in the skull. This can cause serious damage or death. Shaking a toddler or young child can also cause serious injury.

What can happen if I shake a baby or young child?

Shaking a baby or young child can cause:

• Blindnessoreyedamage.

• Braindamage.

• Spinalcorddamage(paralysis).

• Seizures.

• Death.

Normal play (gently bouncing a baby on your knee, using an infant swing, or jogging with your baby in a backpack) does not cause these injuries.

What should I do if a baby’s crying makes me frustrated?

A crying baby that cannot be comforted can make you feel frustrated. And if you feel this way, you may feel like shaking the baby. if you begin to feel frustrated:

• Putthebabyinasafeplaceandleavetheroomforafewminutes.

• Callsomeonewhocancomeoverandhelptakecareofthebabyortalktoyouuntilyou feel calmer.

• Callthebaby’sdoctor—thebabymaybesick.

Asking for help is a sign of strength. If you are in a crisis and need help, call:

• 911

• CrisisConnection:612-379-6363

• TheFairviewBabyConnectionLine:612-672-4789

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Newborn Safety

You can help keep your baby safe by following these guidelines:

• Always use a federally approved car seat— even when you give your baby his or her first ride home from the hospital. The safest place for the car seat is in the middle of the backseat, facing the rear of the car. Yes, that can be awkward, but it is one of the most important things you can do for your baby. Never hold your baby on your lap in a moving car.

• Never leave your baby alone in a vehicle. Not even “just for a minute” as you run into the house or a store to pick something up.

• Never leave your baby alone on a high, flat surface, like the top of a dresser or changing table. even a very tiny baby can scoot across a flat surface if its feet find something to push against.

• Put your baby to sleep on his or her back, not on the tummy. The baby’s feet should be within a couple of inches from the foot of the crib. Recent research has shown that babies who sleep this way are less likely to have Sudden infant death Syndrome (SidS).

• Make sure your baby’s crib is safe. it should have slats that are no more than 23/8 inches apart, and the mattress should fit snugly against the edge of the crib—you should not be able to fit two fingers between the mattress and the side of the crib. if the crib is painted, make sure that lead-free paint was used. if you don’t know, it’s better to get a newer crib. don’t use bumper pads or pillows in the crib; their soft surfaces can suffocate babies. No toys should be left in the crib with a newborn. Keep the crib away from windows, plants, drapes, electric cords, or anything that the baby might be able to grasp.

• Make sure your baby’s sleeping arrangement is safe. Whether or not it is safe for a baby to share a bed with adults is a controversial subject. Supporters maintain that a mother and baby sharing a bed may help with breast feeding and sleep cycles. There is an increased risk in sharing a bed with your baby if you or your partner have been using alcohol or drugs, are overtired, overweight, or smoke. Having a toddler in bed also raises the risk of accidental suffocation. infants under 11 weeks are at greatest risk regardless of other factors.

There is growing evidence that the safest sleep setting for an infant under six months is a crib in the parents’ room. This may reduce the risk of SidS (Sudden infant death Syndrome). check with your health care provider if you have questions on where your baby should sleep.

• Only use store-bought pacifiers. This is one item that you should not try to make at home. check the pacifier often by pulling on the bulb to make sure it’s not loose, sticky, or cracked. if it is, replace it immediately.

• Never prop a bottle for the baby to eat. Always hold your baby while feeding.

• Never microwave formula or breast milk. it heats unevenly and may burn the inside of your baby’s mouth.

• Keep your baby out of direct sunlight, and don’t use insect repellent or sunscreen on your baby for at least six months. A newborn’s skin is very sensitive.

•Don’t drink hot beverages, eat hot food, or smoke while holding your baby.

•Don’t smoke around your baby. Secondhand smoke can cause illnesses, including ear infections and breathing problems.

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Call 911 if your baby:

• is limp and floppy.

• Hasstiffarms.

• Archeshisorherbackrepeatedly.

• Hasahigh-pitchedcry.

• Hasbluishskinorlooksverypale.

Call your baby’s doctor or go to the emergency room right away if your baby:

• Hasahighfever: Rectal temperature of 100.4° F (38° c) or higher or underarm temperature of 99° F (37.2° c) or higher.

• Hasskinthatlooksyellow, and the baby seems very sleepy.

• Hasaninfection(redness,swelling,pain)around the umbilical cord or circumcised penis or bleeding that does not stop after a few minutes of gentle pressure.

Call your baby’s clinic if you notice:

• Alowrectaltemperature(97.5°For 36.4° c).

• Changesinbehavior. For example, a normally quiet baby is very fussy and irritable all day, or an active baby is very sleepy and limp.

• Vomiting. This is not spitting up after feedings, which is normal, but actually throwing up the contents of the stomach.

• diarrhea (loose, watery stools) or constipation (hard, dry stools that are difficult to pass).

• Bloodormucusinthestools.

• coughing or breathing changes (fast breathing, forceful breathing, or noisy breathing after you clear mucus from the nose).

• Feedingproblemswithalotofspittingup.

• Yourbabydoesnotwanttofeed for more than 6 to 8 hours or has fewer than 6 wet diapers in a 24-hour period.

• Yourbabydoesnotgainweight.

When to call Your Baby’s care Provider

You may not be sure when your baby is sick and needs to see a health care provider, especially if this is your first baby. don’t wait to call your clinic if you are concerned about your baby’s health. No one will think you’re foolish if you ask for help.

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Clinic Visits

if you haven’t picked a health care provider for your baby before birth, you should pick one as soon as your baby is born.

Many care providers want to see babies within 3 to 5 days after birth. You will find a list of clinics at the front of this book.

At your first visit, the health care provider will give you a schedule for regular checkups for your baby, including the immunizations he or she will need.

Neonatal Intensive Care Unit (NICU)

if your baby needs special care, he or she will be taken care of in the intensive care nursery or special care unit, where the extra care gives your baby a better chance at a healthy future.

When you first look at the neonatal intensive care unit (NicU) you may think the machines and lights and sounds are frightening. The high-tech equipment doesn’t look like what you thought would be your baby’s first environment, but it’s all there to meet your baby’s special needs and to monitor his or her condition.

While your baby is in the NicU, the staff will provide you with information so you will understand what is happening to your baby and how well your baby is doing.

For Partners

except for breastfeeding, you can do everything your partner does now. You can hold, bathe, and diaper the baby. You can talk to your baby, hold him or her in your arms, or carry the baby in a front pack against your chest. You can make sure the baby is buckled into a baby seat when you’re in the car, and you can check the baby’s crib to make sure it’s safe.

Get to know your baby, and the basics of baby care, so you can be actively involved in caring for your child. This will give your partner some relief, and it will be good for your baby. You’ll find that it is good for you, too.

For More Information

Caring for Your Baby and Young Child by American Academy of Pediatrics

The Dad Book Fairview Health Services

The New Father: A Dad’s Guide to the First Year by Armin Brott

Touchpoints by t. Berry Brazelton

You and Your Newborn Baby by Linda todd

Your Amazing Newborn by Marshall H. Klaus, Md, and Phyllis Klaus

American Academy of Pediatrics www.aap.org

Kids Health (Nemours Foundation) www.kidshealth.org

Infant Sleep Safety Education www.health.state.mn.us (search for “safe asleep campaign”)

Minnesota Child Passenger Safety Program www.buckleupkids.state.mn.us

Feeding Your Baby Breastfeeding gives your baby all the food he or she needs for the first six months of life. Your breast milk is easy for your baby to absorb. it will help your baby grow and develop, protect against infection and other diseases, and reduce your baby’s chances of getting certain illnesses later on.

Breastfeeding is a special time when you and your baby can grow closer—both physically and emotionally. it is the most natural way to bond with your baby.

Although most women breastfeed their babies, some choose not to, and a very few cannot for physical and other reasons. With prepared formula, you can still provide your baby with a loving, warm experience while feeding. Please ask your nurse or doctor for information about formula feeding.

SOME OF THE QUESTIONS ANSWERED IN THIS CHAPTER INCLUDE:

• Why is breastfeeding important?

• How do I breastfeed?

• How will I know if my baby is getting enough milk?

• Who should I call if I have problems breastfeeding?

3

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For Mom

Obesity—women who breastfeed get their figures back faster

Breast cancer

Osteoporosis (weak bones)

Ovarian cancer

For Baby

Ear infections

Asthma

Eczema

Lung infections

Obesity

Gastrointestinal infections

Urinary infections

Childhood diabetes

What Does Breastfeeding Protect Against?

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After Your Baby Is Born

Hold your baby skin-to-skin right after birth. Skin contact calms your baby, steadies his or her breathing, and keeps your baby warm.

This is a great time to start breastfeeding. Your baby is alert and will want to feed within the first couple of hours. Your nurse will help you get started.

Keep your baby with you and breastfeed whenever he or she is hungry. offering the breast early and often helps you make lots of milk.

Babies enjoy being held skin-to-skin anytime by either parent. close contact helps them feel relaxed, comforted, and ready to feed.

Babies are born with reflexes that help them breastfeed. They can move toward the breast all by themselves. once there, they can often latch on by themselves, too.

When your baby lies on your chest, he or she may:

• Lifthisorherheadwhenlyingonthebelly.

• Wiggle,fall,orslidedowntowardthebreast.

• Bobandsweephisorhercheeksfromsidetoside while moving toward the nipple.

• Pushupwiththefeetiftoofarbelowthebreast.

Follow your baby’s lead and help your baby move toward the breast. You might lie back somewhat, letting gravity help.

talk to and encourage your baby. Bring your baby back up to your chest when he or she gets frustrated. calm your baby by rubbing his or her back.

Your Baby’s Second Night

Your baby misses the warmth and security of your womb. Now, the closest he or she can get is the comfort of your breast—your baby wants to spend as much time at the breast as possible.

Your baby may nurse for a while and then fall asleep. But if you move your baby to the bassinet, you may find that he or she starts crying and looking for you.

The best thing to do is let your baby fall asleep while nursing. Then, gently break the suction by placing your finger in the baby’s mouth and removing the nipple. Next, let the baby’s head rest against your breast. if you snuggle like this for a while, your baby will fall into a deep sleep. At that point you can move your baby without waking him or her up.

it might also help to remove your baby’s mittens and loosen the blanket. Babies often soothe themselves by sucking on their fingers. They may scratch themselves with their fingernails, but that’s okay—babies’ skin heals quickly.

Adapted from “Baby’s Second Night,” by Jan Berger, RN, MA IBCLC

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How to Breastfeed

Position Your Baby

There are lots of positions for breastfeeding. However you wish to hold your baby, check the following:

• Are your baby’s head and body in a straight line? Babies can latch and swallow if they do not have to turn their head to reach the breast. Make sure that the ears, shoulders, and hips are aligned. The baby’s entire body should face the breast.

• Are you holding your baby close to you? Support your baby’s back, shoulders, and neck. Your baby should be able to tilt the head back easily. He or she shouldn’t have to reach out to feed.

• Is your baby’s nose opposite your nipple? Your baby needs to get a big mouthful of breast. if your baby’s nose is level with your nipple, he or she will find it easier to reach up and attach to the breast. (See page 32.)

• Are you comfortable? once your baby is attached to the breast, it’s okay to change your position slightly.

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Breastfeeding Twins

if you have twins, start out nursing your babies one at a time. This allows you to get to know each one and check how well both are nursing.

once both babies are able to latch easily and nurse well, you may practice nursing both babies at the same time. The hardest part is getting each one started on a breast. You may need help at first.

All breastfeeding positions are basically the same. Remember:

• Tummytomommy

• Chesttobreast

• Nosetonipple

• Babytobreast(notbreasttobaby)

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How Your Baby Attaches to the Breast

1. Hold your baby close to you. Your baby’s nose should be level with the nipple.

2. tickle and stroke his or her top lip with the nipple. or gently touch his or her chin to the breast under the nipple.

Be patient. Wait until your baby opens his or her mouth really wide, with the tongue down. Your baby will tilt the head back and come to your breast chin-first.

3. As he or she digs the chin into your breast, hug your baby even closer to you.

Your baby should take a large mouthful of breast. Your nipple should go toward the roof of his or her mouth.

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When and How Long to Feed

Nurse your baby whenever he or she signals a wish to feed. At first, you should plan to feed 8 to 12 times per day. Let the baby finish the first breast before you offer the second.

Frequent feedings help prevent jaundice, and they will help keep your breasts from getting too full. (to read about engorgement, see page 41.)

Plan to breastfeed both day and night in the early months. Your body has already prepared you for nighttime feedings, waking you up at night in the last few months of your pregnancy.

Signs That Your Baby Is Feeding Well

• Yourbabyhasalargemouthfulofbreast.

• Yourbaby’schinistouchingthebreast.

• Itdoesn’thurt you to feed (after the first few sucks).

• Ifyoucanseethedarkskin around your nipple, you see more dark skin above your baby’s top lip than below the bottom lip.

• Yourbaby’scheeksstayroundedduringsucking.

• Yourbabytakeslong,rhythmicsucksand then swallows. it is normal for your baby to pause sometimes.

• Youareabletohearyourbabyswallowing.

• Yourbabyfinishesfeedingandcomesoffthebreast on his or her own.

• Rightafterfeeding,yournipple is the same shape as before. it should not be squashed or pinched.

How to Know if Your Baby Is Getting Enough Milk

After your baby is born, your breasts will produce colostrum (first milk) for several days. in about 2 to 5 days, your breasts will start to feel fuller and heavier as the volume of milk quickly increases.

• Inthefirstdayortwo,yourbabywillonlytake in about 1 teaspoon of colostrum at each feeding. This provides everything your baby needs until your milk increases. The more often you nurse, the faster your milk will increase.

• Byday5,yourbabyshouldpassatleast three yellow stools a day. By day 6, your baby should have at least six wet diapers a day.

• Yourbabyshouldstartgainingweightafterthe first week and be back to his or her birth weight by 2 weeks. Babies keep gaining at least a pound per month for the next 2 to 3 months. if your baby gains weight slowly, reassure yourself by taking the baby to the clinic for frequent weight checks.

• Yourbabymayappearcontentandsatisfiedafter most feedings. When a baby seems fussy and cries a lot, there may be many reasons for this, not just hunger. if you are concerned, call your baby’s clinic.

Number of wet diaper

Number of soiled diapers

Color of stool

day 1 1 1 Black

day 2 2 2 Black

day 3 3 3 Green–Black

day 4 4 3 Green–Yellow

day 5 5 3 Yellow

day 6 6 3 Yellow

day 7 6 to 8 3 Yellow

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Keeping Track of Breastfeeding

The First Two Weeks

After your baby is born, you should receive a breastfeeding log to use in the hospital and at home. This will help you keep track of the times you breastfeed and how many wet or soiled diapers you have.

You should breastfeed at least 8 to 12 times per day. Your baby should nurse vigorously for at least 10 minutes each time. offer both breasts.

Weeks Two to Six

Your baby will:

• Nurse8to12timesperday.

• Have6to8wetdiaperseachday.

• Have3ormoreyellowstoolseachday.

Beyond Six Weeks

Babies need only breast milk in the first six months. Until then, do not feed your baby solid foods. Babies should continue to breastfeed for at least the first year of life.

• Youwillneedtobreastfeed6to12times(ormore) daily to maintain your milk supply.

• Yourbabymayhavefewerwetdiapers,buttheywill be heavier. Urine should remain pale and have a mild smell at all ages.

• Yourbabymayhavefewersoileddiapers.Somebabies will go a week or more without a bowel movement. This is normal, as long as the stools are large and soft. (Stools become firmer and smell less pleasant if babies drink formula or start on solid foods.) if you are concerned, call your baby’s clinic.

Growth Spurts and Your Milk Supply

As your baby grows, there will be days when it seems like all you do is breastfeed. Your baby may seem unsatisfied and want to feed much more often than usual. You may even feel that you don’t have enough milk. All of this is normal.

Nursing mothers call these “frequency days” or growth spurts. They occur around 2 to 3 weeks, 6 weeks, 3 months, and 6 months. At these times, you can help get back to your usual schedule by frequent breastfeeding. to maintain your milk supply and ensure that your baby gets enough milk:

• Avoidpacifiers. Your baby should meet his or her sucking needs at the breast.

• Nurselongerandmoreoften.Aftertwoorthree days, your milk supply will increase and your baby will return to a more normal pattern.

• Letyourbabyspendasmuchtimeonthebreast as he or she wants.

• Avoidformula, as this can decrease your supply.

• Callalactationspecialistifyouareworriedabout your supply or have problems feeding.

You can burp your baby by sitting him or her on your lap, facing sideways, then rubbing or patting the baby’s back.

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Tips for Successful Breastfeeding

• Make sure your baby is deeply attached to your breast. This will:

– ensure a good supply of milk and help your baby get a good feeding.

– Help keep your breasts and nipples from getting sore. (Get help right away anytime it hurts to breastfeed.)

• Only give your baby breast milk.

– The more you breastfeed, the more milk you will produce. Giving other food or drink will reduce your supply.

– if your care team asks you to supplement breastfeeding, use expressed milk. (See page 36.) This will protect your milk supply.

• Avoid pacifiers. if your baby uses a pacifier:

– He or she may find it harder to master breastfeeding.

– He or she may not gain weight well (especially if using the pacifier a lot).

– it may be harder to establish your milk supply.

• Give your baby the breast whenever he of she wants to eat.

• Don’t be afraid to ask for help.

– it may take a while to feel confident with your newborn baby. You can ask your nurse or lactation consultant to help you with breastfeeding.

– if you think you are not making enough milk, or it is painful to breastfeed, get help right away. it is easier to fix a problem sooner rather than later.

• If you stop breastfeeding, it can be hard to re-start.

– Babies have reflexes that make it possible to bring them back to the breast.

– it is easier to bring your baby back to the breast when he or she is young.

– You may need to express your milk often every day until your baby is fully breastfeeding again.

Nursing a Sleepy Baby

to help wake a sleepy baby, sit up and place your baby skin-to-skin against your chest. The head should be high on your chest and feet should be in your lap. Rub your baby’s hands, feet, or back (between the shoulder blades) to help him or her wake up. if your baby does not start to look for the breast after 10 to 15 minutes, check the baby’s diaper. Then, bring the baby back to your chest.

At first, your baby may fall asleep while nursing, doze for a while, and then wake up to suck some more. if your baby falls asleep soon after latching and does not suck, check the latch. if the latch isn’t deep, remove the baby, awaken again, and relatch. if the latch is okay, try compressing the breast to make the milk flow: Hold the breast well back from the areola between the fingers and thumbs, and then gently but firmly squeeze. Hold the pressure. Your baby may start to suck more vigorously. Relax your hand, but be prepared to repeat this if your baby stops sucking again.

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Expressing Milk

What Does It Mean to “Express Milk”?

expressing milk means taking the milk out of your breast by hand or with a breast pump. This should not hurt. if it is uncomfortable, ask your nurse or lactation consultant for help.

You may wish to express milk if:

• Youneedtobeawayfromyourbaby,andyouwant to maintain your milk supply or keep feeding your baby breast milk.

• Yourbabyisillorcannotbreastfeed,andyouwant to establish or maintain your milk supply.

• Yourbreastsbecomesofullthatyourbabycan’tlatch on. You can express just enough milk to soften the breast, then latch your baby and let him or her empty the breast.

Why Express by Hand?

You may wish to use hand expression if:

• Yourbreastsareverytender.Expressingbyhand may be more comfortable than pumping.

• Youneedtogetafewdropsonthenipple. This may help your baby latch.

• Youwanttocollectcolostrum. You can express the drops into a spoon or small cup for feeding.

• Youcannotgetyourmilkflowingwithapump.

How to Express Milk by Hand

1. Wash your hands. Use a clean container to catch the milk.

2. Gently massage the breast for 1 to 2 minutes before starting. Warm packs will also help ready the breast to release milk.

3. cup your breast, moving your fingers back from the end of the nipple to where the texture of the breast feels different.

4. Using your thumb and index finger, press back against the chest wall. Then, gently squeeze the thumb and finger together.

5. Release the pressure, and then repeat again and again, building up a rhythm. don’t slide your fingers over the skin or pinch the nipple. Milk should start to flow.

6. When the flow slows down, express from the other breast. Keep changing breasts until the milk stops or drips very slowly.

if the milk does not flow, try moving your fingers slightly back from or toward the nipple. There are many ways to express milk—you will find what works for you. it should never hurt to express milk.

Expressing with a Pump: Getting Started

• Atfirst,pump for 10 to 15 minutes at a time. once you can release milk easily, you may pump up to 30 minutes. if you are pumping to increase supply, short, frequent sessions are best.

• Chooseabreastshieldthatfitsyou.Yournipples should move freely in the tunnel during pumping. if they rub against the sides, try a larger shield.

• Startwithlowsuction.Increasethesuctionasmuch as is comfortable. too much suction can make your breasts and nipples sore.

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Breast Pumps: Questions to Ask before You Buy

How Do You Plan to Use the Pump?

A hand pump may be all you need for occasional pumping. A double electric pump saves time and helps maintain your milk supply if you are working full time. if your baby is not breastfeeding yet, a rental pump is best.

What Can You Afford?

compared to the cost of formula, any pump is a bargain if it is comfortable and works well. if your insurance will pay part or all of the cost, buy the pump from a hospital pharmacy or pump company that can file the insurance claim.

Can You Easily Find Spare Parts?

check the pump company’s website. can you buy replacement parts? if so, keep spare parts handy.

You should also learn to express milk by hand. Your hands are the ultimate backup if a part fails.

Does the Pump Company Offer Different Kinds of Breast Shields?

• Agoodcompanyhasdifferentsizesandstylesto help you get a comfortable fit.

• Aboutathirdofallwomenfindthattheycanpump more milk with a larger breast shield.

• Siliconshieldsorinsertsaresometimesmorecomfortable.

Pumping Is a Skill

• Your body has to learn to respond to the pump. The first practice sessions often yield little or no milk. it may be harder to release milk when you under stress, have pain, or are pumping without privacy.

• To get your milk flowing:

– Hold your baby skin-to-skin, practice hand expression before pumping, or massage the breast before and while you pump. You might also do relaxation exercises, take a warm shower, or apply warm packs before pumping.

– if your baby is latching well, try pumping on one side while your baby nurses on the other. This way, your baby gets the milk flowing for you.

– it can help to have someone rub your back and shoulders while you pump.

• Make it comfortable: Start on the lowest suction level. if you increase the level, be sure to lower the suction again if it hurts. A very slow cycle also can cause discomfort—short, frequent pumping sessions may be better at first.

• If you cannot pump much milk:

– You may be pressing the shield too deeply into the breast. This will cut off milk flow.

– You may have a poor-quality pump, or the pump may not be working well. even high-quality pumps eventually wear out (lose suction power). if you suspect your pump is not working well, try renting a hospital-grade pump for a few days. This may tell you if your own pump needs to be replaced.

– if your baby has just breastfed, there may be no more milk to remove.

Anytime you feel that you aren’t making enough milk, talk to a lactation specialist.

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Collecting, Storing, and Thawing Milk

• Washyourhandswellbeforeyoubegin.

• Useadishwasher(orhot,soapywater)towashall items that will touch your breast or the milk. This includes bottles, cups, bags, teaspoons, and parts of your breast pump. Rinse the washed items and then air dry.

• Tostorebreastmilk,followtheseguidelines:

LocationSafe

Storage Time

Room temperature (69–72 °F) 10 hours

Room temperature (79 °F) 4–8 hours

cooler with ice packs 24 hours

Refrigerator (32–39 °F) up to 8 days

Freezer compartment of two-door refrigerator 3–4 months

deep freezer (0 °F) 6–12 months

• Transportbreastmilkinacoolerwithicepacks.

• Ifyouwon’tuseyourmilkrightaway:

– Freeze it in small amounts—2 to 5 ounces. it will thaw more quickly, and you will waste less.

– Leave a little room at the top of the container, so the frozen liquid can expand.

– Write the date on the container. Place it in the coldest part of your freezer, away from the freezer wall. Use the oldest milk first.

Never use a microwave to thaw or warm milk. Valuable nutrients may be destroyed, and hot spots created in the milk can burn the baby’s mouth and throat.

to thaw breast milk, set the container in a bowl of hot tap water for 20 minutes. if the milk has separated, swirl it to mix the layers. Do not refreeze breast milk.

Your baby may refuse thawed breast milk if it smells or tastes soapy. if so, freeze your milk right after pumping. if your baby still refuses it, try heating freshly pumped milk on the stove. (do not boil.) As soon as bubbles appear around edge of the saucepan (180°F), remove from heat, cool, and then freeze the milk. Feed at once after thawing.

Collecting Milk for an Ill or Premature Baby

Start expressing milk as soon as possible after your baby is born. This tells your breasts to start making a full supply. Ask your hospital staff about guidelines for storing your milk.

You will need to express at least 8 times per day, including at night. Pump milk as often as the baby would breastfeed.

Ask the hospital staff if you can hold your baby skin-to-skin. This can help with bonding, and it helps you express more milk. it may also help your baby breastfeed later on.

FeediNG YoUR BABY 39

Self-Care While Breastfeeding

• Rest when the baby sleeps, especially in the early weeks. don’t let yourself get too tired— nap whenever you can. Let others know how to help so you can focus on feeding your baby.

• Eat a varied diet with plenty of fruits and vegetables. Small, frequent meals will help keep your energy up. Your doctor may suggest a prenatal or multivitamin as well.

• Don’t try to lose weight too quickly. Breastfeeding helps you lose weight naturally. eat at least 1800 to 2000 calories a day. You will use 500 calories a day just by making milk.

• Drink to satisfy your thirst. drinking more fluids does not increase your milk. in fact, too much fluid may lower your supply. You do not need to drink milk to make milk.

• If you can’t quit smoking, you should still breastfeed. Feed your baby first, and then go outside to smoke. Make sure that your baby always breathes clean air.

• Use moderation in all things.

– too much caffeine or chocolate can make some young babies very fussy and difficult to get to sleep.

– A little alcohol is okay, but heavy drinking each day is not. For special occasions, limit yourself to two drinks, and drink slowly: one drink per hour. Alcohol will not build up in your breast milk—it clears from your milk within 21/2 hours. There is usually no need to pump and dump, but if you feel “woozy,” you should wait to breastfeed or use stored breast milk.

– if you smoke, you should have less than ten cigarettes per day. This way, you will be able to make enough milk for your baby.

• Do not use street drugs.

• Ask your care team before using any medicines, including over-the-counter drugs. While few drugs require weaning, some should not be used when breastfeeding. See page 46 for more information.

• If you take birth control pills, ask your doctor how it may affect your milk supply. Most pills with estrogen will lower your supply. Pills with progesterone do not often affect milk supply.

• If you have vaginal dryness during sex, use K-Y Jelly.

Where to Find Help

Successful breastfeeding means reaching your own goals for nursing your baby, not the goals that others have set for you.

Some women experience occasional problems while breastfeeding; however, with the right information and support, most of these problems can be overcome. Speak to your nurse, lactation consultant, or public health nurse. or contact La Leche League, a volunteer breastfeeding organization. For contact information, see page a at the start of this book.

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Tips for Breastfeeding after You Return to Work

• Make sure breastfeeding is going well. Seek help early if you have sore nipples or are worried about having enough milk.

• Don’t use bottles in your baby’s first month if you don’t need to. Also avoid pacifiers. Let your baby learn how to breastfeed, so you can build a good milk supply.

• Ease yourself back to work—start with a few hours at a time. You may feel tired and overwhelmed in the first few weeks.

• Go back to work on a Thursday or Friday. You may need the weekend to sort out what worked and what didn’t.

• Wear clothing that opens in the front. it helps to dress in layers. Bring nursing pads.

• If your baby will feed from a bottle:

– Use bottles only while at work. Breastfeed at all other times.

– Have someone else introduce your baby to the bottle. This way, your baby is more likely to accept it.

– Use nipples with a wide base and a slow flow.

– Make sure daycare providers know how to handle human milk properly. Milk can be kept in the refrigerator with other foods. Warm milk gently. do not microwave or shake vigorously.

• If you will pump at work:

– Get a quality breast pump. A double electric pump saves time. Your employer may provide a hospital-grade pump.

– Plan to pump two to three times during an eight-hour shift, about as many times as

your baby would nurse. Many states require employers to provide time and space for women to pump their breast milk. This lets mothers provide breast milk for their babies in daycare.

– Keep your milk chilled, so you can add to the container throughout the day.

– Wash your pumping equipment after each use, or keep it in a refrigerator so you don’t have to wash between pumpings. Some mothers invest in a second pump and wash everything at home.

– Be prepared. Bring extra batteries and other small parts for your pump. Practice hand expression, so you can quickly remove milk when you need to.

• Keep breastfeeding your baby in the morning, evening, night, and on your days off. A strong milk supply may depend on how often you nurse the baby when you are not at work.

• If you can’t express enough milk to meet your baby’s needs, call a lactation specialist. You should also:

– Breastfeed more often when at home.

– Pump extra milk to increase your supply.

– Rent a pump for a few days. Rental pumps are best at increasing milk supply.

• Don’t let your breasts get too full. This can lead to engorgement and a lower milk supply.

• If you decide to use formula when at work, be sure to keep breastfeeding at home. Any amount of breast milk is better than none at all.

• Talk to other women who are working and breastfeeding. Join an evening breastfeeding group to meet other working mothers. Read books and websites for ideas.

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Common Questions about Breastfeeding

Getting Started

Q: How often should I feed my baby?

A: in the early weeks, you should offer your breast 8 to 12 times within 24 hours. Some feedings will be short, and many will be long. Watch the baby, not the clock.

to make lots of milk, most women need their babies to nurse about every 2 to 3 hours. Some need to nurse less, but only a few can go 4 to 5 hours between feedings.

Some babies always want the second side, while others nurse on one side each session. At the start, always offer your baby the second breast after he or she finishes the first.

As your milk comes in and your baby’s stomach gets bigger, he or she may start nursing less often (6 to 8 times per day). Nursing less than this may decrease your milk supply. Keep nursing when your baby signals that he or she is hungry.

Q: Is it normal for my breasts to feel this full?

A: two to four days after the birth, your breasts will start to feel full as they begin producing large volumes of milk. it is normal for the breasts to feel tender at this time. Breastfeed often, so the breasts do not get overly full. You should feel more comfortable in a day or two.

engorgement, or over-fullness, occurs when not enough milk is removed. it is painful and can make latching more difficult. to prevent this:

• Avoidpacifiersandbottles.

• Breastfeedyourbabyoften,atleastevery 1 to 3 hours. Let the baby finish the first side, then offer the second side. if your baby does not want the second side, offer the fuller breast first at the next feeding.

• Besureyourbabyislatching properly onto the breast (see page 32). if your baby has trouble, get help as soon as possible. call a lactation consultant or the La Leche League.

• Togetyourmilkflowing, you may use a moist, warm compress for 5 minutes before feeding. or place the baby skin-to-skin on your chest before feeding. once your baby latches on, massage your breasts gently or stroke downward on the breast.

• Ifthebabydoesn’tnursewell,youmissafeeding, or your breasts are uncomfortably full after feeding, use a breast pump for 10 to 15 minutes to relieve the fullness.

Q: How do I remove my baby from the breast?

A: Slip your finger into the baby’s mouth to break the suction. Then, remove the breast. if you pull your baby off without first breaking the suction, it can make your nipples sore.

Milk Supply and Quality

Q: My milk supply is low. Should I supplement?

A: if you feel that you do not have enough milk, talk to your doctor or a lactation specialist. if he or she suggests a supplement, it is always best to use your expressed milk.

to increase your milk, increase milk removal.

• Ifyourbabyhasbeennursingwell8timesper day, increase feedings to 10 to 12 times per day. Be sure to feed both day and night.

• Ifyourbabyhasnotbeenfeedingwell,pumpafter feedings. This will increase your supply.

• Rentapump.Rentedpumpsare“hospitalgrade.” They are designed to establish and increase milk supply.

A lactation consultant will have other ideas to help you increase your supply.

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Q: Can I breastfeed my twins? Will I make enough milk?

A: Yes. Milk is made on a supply-and-demand basis. The more your babies feed at the breast, the more milk your body will make. Because you will nurse two babies instead of one, you will make twice as much milk.

Q: Is my baby allergic to my milk?

A: No. Babies are not allergic to human milk. But your baby may be allergic to proteins that pass into your milk from the foods you eat. He or she may spit up a lot, have blood in the stool, and seem fussy and unsettled.

if you think a food is causing a reaction, try to avoid that food for a week or two. if there is no change, talk to a lactation consultant.

Q: My baby spits up a lot and has a lot of gas and frothy green stool. Is my milk okay?

A: Your milk is fine, but your baby may need to nurse longer on one or both breasts. When your baby starts a new breast, he or she first gets “watery” milk, followed by “fatty milk.” if your baby doesn’t get enough fatty milk, there may be more gas, spit-ups, and frothy green stools.

Let your baby finish the first breast. Then, burp your baby and offer the second breast. if your baby won’t take it, offer the fuller breast at the next feeding. You can express a little milk between feedings, if your breast feels too full.

talk to a lactation consultant if there is no improvement after a few days.

Breastfeeding Problems

Q: What if it hurts to breastfeed?

A: in the first days, it is common to have nipple pain at the start of breastfeeding. it is not normal to have pain between feedings or pain that gets worse during a feeding. if the nipple looks pinched right after feedings, the baby needs to get more of the breast in the mouth.

check that your baby is in a good position (see pages 30–32). Wait for the baby to open really wide, as if yawning. Then, bring the baby to the breast, aiming the nipple toward the roof of his or her mouth. Make sure your baby has taken more than just the nipple. if it pinches or does not feel okay, use your finger to break the suction, and then start again.

if it still hurts, or if the nipples are getting damaged, do not wait to get help. it is easier to improve the latch in the early days of nursing.

other tips:

• Usepurifiedlanolinorhydrogelpadstosoothe and heal sore nipples.

• Washyourbreastswithplainwarmwater.Do not use soap on your nipples. The nipples have special glands that keep them supple and protected. Soap can interfere with this process.

• Feedyourbabyoften,startingonthesidethat is less sore. Your baby will be less vigorous if he or she is less hungry.

• Tryanewnursingposition at each feeding to lessen the pressure on any sore spots.

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Q: My baby has trouble latching onto my breast. What should I do?

A: to ensure a proper latch, follow the steps on page 32. it may help to hold your baby skin-to-skin.

Your baby may have trouble latching if your breast is very full and firm. try removing some milk to soften the breast. (See “My breasts are engorged. What can i do?” below). it may also help to express a few drops of milk onto your nipple.

if your baby seems very hungry and impatient, give your baby some expressed milk and then bring the baby back to the breast.

if your baby gets frustrated or starts crying, gently move the baby away from the breast and onto your chest. talk to your baby to help calm him or her down. Let your baby suck on your finger. When your baby searches for the breast or sucks on his or her hands again, move the baby back toward the breast.

Q: My baby chokes and pulls off when starting to feed. What is going on?

A: There may be a couple of reasons for this.

• Milk may come out so quickly that your baby can’t swallow it fast enough. The flow of milk is usually strongest when your baby starts sucking. try holding your baby in an upright position during feedings. When the milk starts to flow, remove the baby and let the first rush of milk go onto the cloth. When the flow slows down, relatch your baby.

A really hungry baby may suck harder and trigger a very strong release of milk. if this is the case, try nursing more often during the day. Always let your baby finish the first breast before you offer the second.

• Your baby may have a cold. This can make a baby irritable, and it can make it hard to breathe while nursing. Breast milk helps a baby recover sooner. try nursing your baby in a more upright position to help keep the nose clear. or gently clear the nose with a bulb suction before nursing.

There are many other reasons a baby may refuse to nurse. if you need help, talk to a lactation consultant.

Q: Can I breastfeed with flat or inverted nipples?

A: Yes. Babies latch onto the breast, not just the nipple. But if your nipples are flat or inverted, it can take a little longer to get the baby breastfeeding.

Rolling the nipple or pumping for a couple of minutes can help bring the nipple out. This may make the latch quicker and more comfortable.

if your baby cannot latch, a nipple shield may help. take care to dry any folds or dimples around the nipple after feeding.

Q: My breasts are engorged (too full). What can I do?

A: if engorgement develops, follow these tips.

• Ifyourbabyhastroublelatching,expressjust enough milk to soften the areola. Then, latch your baby onto the breast. Feed your baby as often as he or she is willing. Your breasts should feel more comfortable within 2 to 3 days.

• Useapumptocompletelyemptythebreast,then start breastfeeding again. Nurse often.

• Usecoldpacksfor20minutesatatime. try frozen washcloths, chipped ice, or bags of frozen vegetables.

• Considerapainmedicine, such as ibuprofen, to relieve some of the discomfort.

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if engorgement worsens or returns, get help from a lactation consultant. The baby may be having trouble removing milk. Anytime you are concerned about how your baby is feeding, call your baby’s doctor for a weight check.

Q: What are these lumps in my breast? What are plugged ducts?

A: When milk ducts become blocked, you will feel firm, tender areas on your breast. Warm showers, gentle massage, and frequent nursing should move the plugs out within a day or so.

Get help if the plugs are very painful or do not go away after 2 to 3 days.

Q: How can I tell if I have a breast infection?

A: call your doctor at once if you have any of these symptoms:

• Aredwedge-shapedareaonthebreastthatbecomes more red or sore.

• Yousuddenlyfeelill, like you have the flu.

• Youhaveafever higher than 101 °F (38 °c).

if you have an infection, you may need antibiotics (germ-killing medicine). Be sure to keep nursing.

Q: Why do my nipples feel itchy and burning?

A: This may be a type of infection called thrush, or candida. Thrush is a fungal infection that often occurs after antibiotic treatment. Your nipples may look normal, but they will burn and feel sore during and after feedings.

This infection can pass back and forth between you and your baby. Your doctor will prescribe medicine for both of you. call a lactation specialist if you still have pain after treatment.

Q: My baby is biting. How can I stop this?

A: Babies may bite even before they have teeth. You will feel a bite anytime your baby pulls back the tongue and compresses your breast between his or her gums. Babies will often do this when they start teething.

Babies cannot bite if they are properly latched. Watch closely toward the end of each feeding—if your baby’s latch changes, slip your finger between his or her gums to remove the baby from the breast.

if your teething baby bites, remain calm and take the baby off the breast. Say “no,” and then try again. if biting continues, remove your baby from the breast and give your baby a cold teething ring.

Q: My baby has a cleft lip or palate. How can I help my baby?

A: A baby with a cleft lip can sometimes breastfeed. A baby with a cleft palate cannot nurse before the palate is repaired.

These babies are at high risk for repeated ear infections. By feeding breast milk only, you will greatly reduce the chances of infection.

A lactation consultant or feeding specialist may suggest special tools to help your baby feed. You should also rent a hospital-grade pump to help establish a full milk supply.

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Starting Solid Foods

Q: When should I start feeding solid foods to my baby?

A: offer you baby solid foods after 6 months of age. Until then, your breast is best. introduce each new food slowly. Breast milk should still be the “main course,” and solid foods should be “side dishes” for a while. Babies may prefer breast milk for many more months.

Nursing the Older Baby

Q: My baby is teething. Can I still breastfeed?

A: Yes. The way babies nurse is different from the way they chew. As long as the tongue stays over the bottom gums and teeth, nursing should not be uncomfortable.

Q: My baby is starting to prefer the bottle and refuse the breast. I don’t want to wean. What can I do?

A: talk to a lactation specialist to find out why your baby might want the bottle—and what you can do to bring your baby back to the breast. There are many reasons that babies refuse the breast, as well as many ways to get them nursing again. in the meantime, you may want to pump to maintain your milk supply.

Q: How long will breast milk provide nutrition for my baby?

A: Your milk provides nutrients as long as you and your child choose to breastfeed. in fact, breast milk is a “super-food” for babies and toddlers.

The antibodies in your milk will increase as your milk supply decreases. So, when your baby starts nursing less often, your milk will still provide nutrients and immune protection.

Q: I am pregnant. Should I stop breastfeeding?

A: Not necessarily. There is no evidence to show that continued nursing will put a healthy pregnancy at risk. But if you are very concerned about the pregnancy or have risk factors that make miscarriage more likely, you may want to wean for peace of mind.

Keep in mind that older babies and toddlers can be very attached to nursing. Give them plenty of attention and close contact while you wean.

Q: How can I nurse my newborn without weaning my toddler?

A: it is common for mothers to breastfeed both a newborn and a toddler. if you choose to do this, know that your toddler will not be taking milk away from your newborn. Your body will make enough milk for both of them.

Nurse the new baby first. Be sure to praise your toddler for waiting. Sometimes a nursing toddler can help soften the breast, allowing the newborn to latch more easily.

call a La Leche League Leader for more tips.

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Weaning

Q: What should I know about weaning?

A: After 6 months of age, your baby can learn to drink fluids from a cup. But you should still keep breastfeeding—your milk continues to be the perfect food for your baby. experts advise breastfeeding through the first year and beyond.

Many babies start to nurse less often after 6 months, but not always. Most will keep nursing several times per day—and may also nurse at night—well into their second year.

A few babies choose to stop breastfeeding as young as 9 months. Younger babies may temporarily refuse to breastfeed for a number of reasons, but this is not true weaning. if you do not want to stop breastfeeding yet, call a lactation specialist for suggestions.

if you need to end breastfeeding, you can reduce the number of feedings as slowly as you like. Gradual weaning is easier on both you and your baby.

Q: I want to wean my baby quickly. Is there a safe way to do this?

A: to wean rapidly, drop about one breastfeeding session every 3 days until you have replaced nursing with cup or bottle feeding.

do not allow severe engorgement to develop. This can cause breast pain and infections. You may need to remove a little milk from your breasts just often enough to stay comfortable. Your milk supply will decrease because you are not emptying the breasts each time.

When Ill or Taking Medicine

Q: Should I breastfeed if I have a cold or the flu?

A: Yes. Your body is making antibodies to help fight off the cold or flu. These same antibodies are in your breast milk and are helping to protect your baby.

When ill, be sure to drink enough fluids, get plenty of rest, and let your baby nurse often.

Q: What should I do if I need to take medicine?

A: check with your care team before taking any medicines. (This includes prescribed medicines, over-the-counter drugs, herbal products, vitamins, minerals, and other supplements.) Avoid cold remedies that contain pseudoephedrine—these will lower your milk supply.

For most medicines, a tiny amount will pass into the milk, but this should not put your baby at risk. But some medicines may be a problem for babies.

Many commonly used medicines have been studied in breastfeeding women. There may be less information about newer medicines. Your doctor and lactation consultant will help you decide if a medicine is safe to take.

Q: Is it okay to breastfeed when depressed? What if I take medicine for depression or anxiety?

A: if you think you are depressed, tell your care team or call a counselor. it is very important to get proper treatment for depression.

in most cases, women can breastfeed while being treated for depression. You may need to call a lactation specialist for support, especially if your doctor suggests medicine.

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Some “mood” medicines are known to have side effects in nursing babies. Most are believed to be safe. if you will take any medicine for depression or anxiety, a lactation specialist will help you decide if it’s safe to keep breastfeeding.

Social Concerns

Q: I would like to go out, but I am not comfortable nursing in public. How have other mothers handled this?

A: Breastfeeding in public can be daunting at first. Practice at home until your baby can easily latch onto your breast.

You will want to wear loose tops that you can easily lift and drape around your baby. or use a baby blanket over your shoulder, covering both you and your baby. talk to other breastfeeding mothers for more tips.

Know your rights: The law says you have the right to breastfeed anywhere that you have a legal right to be.

Q: What can I do about leaking breasts?

A: once you’ve been nursing for a week or so, the sound of another crying baby can cause milk to leak from your breasts. This will become less of a problem with time. to handle leaking:

• Placenursingpadsorfoldedcottonhandkerchiefs inside your bra. carry extras with you. Avoid pads with plastic liners.

• Ifyoucannotfeedyourbabyrightaway,fold your arms across your breasts and press inward on your nipples. This should stop the leaking.

Q: When is the best time to introduce a bottle?

A: The best time to teach a baby to use a bottle is about 1 month of age. This gives your baby time to practice nursing before learning something new. it also helps you establish a full milk supply.

Your baby is more likely to accept the bottle if someone other than mom introduces it.

Q: My family does not understand why I want to breastfeed. What can I say to them? Where can I find support?

A: Family members want what is best for you and your baby, but they may not understand the benefits of breastfeeding or how challenging it can be in the first month.

Acknowledge their concerns while gently reminding them that, as the baby’s mother, you have chosen to breastfeed. Your partner can help educate family members as well.

if you need more support, contact a lactation specialist. You might also go to La Leche League meetings. This is a great way to learn how other mothers have handled their family members.

Q: My partner is feeling left out. What can we do?

A: only one parent can nurse, but both parents can participate in feedings.

Your partner can hold the baby skin-to-skin, bring him or her to mom for nursing, change dirty diapers, burp the baby, rock the baby to sleep, and more.

take a moment now and then to thank and encourage each other, knowing how essential each parent’s contribution is to your baby’s well-being.

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For Partners

if the baby’s mother is breastfeeding, you may think there’s not much you can do now. For some partners, this is a relief; for others, it feels like they’re missing out on something special.

Be sure to attend a breastfeeding class with your partner. You will be better able to support her if you are well informed about infant feeding. While it’s true you can’t nurse the baby, you can play an active role in caring for your baby.

Just as skin-to-skin cuddling is good for mothers and babies, it is also good for dads or partners and babies. You can be the one to pick up the crying baby in the middle of the night, change his or her diaper, and bring the baby to mom for nursing. This helps the nursing mother get a little more rest. You can also rock, hold, or burp the baby after feeding. or you might simply rejoice in the wonder of it all.

if friends or family are not supportive, speak up to defend the decision that you and your partner have made to breastfeed. Let your partner know how proud you are of her. Your support for her breastfeeding efforts is precious to her.

You may be a bit jealous, or upset, by seeing your partner’s breasts in a completely different way than you’re used to. or you may be somewhat aroused. These are all normal feelings. it may help to talk about them with your partner or other parents.

For More Information

Nursing Mother, Working Mother by Gayle Pryor

The Nursing Mother’s Companion by Kathleen Huggins, et al.

The Nursing Mother’s Herbal by Sheila Humphrey

The Womanly Art of Breastfeeding by La Leche League

Ameda Breastfeeding Products www.ameda.com; 1-866-99-AMedA [1-866-992-6332]

Breastfeeding.com www.breastfeeding.com

La Leche League www.lalecheleague.org; 1-847-519-7730

Medela, Inc. www.medela.com; 1-800-435-8316

National Women’s Health Information Center www.womenshealth.gov/breastfeeding

Your Baby’s First Six Months You wondered what your baby would be like, and now the baby is here, a separate person who needs a lot from you.

The early months of your baby’s life are important for physical, mental, and emotional development. You want to take care of your baby the best way you can, whether that means getting the proper immunizations or playing games that will help your baby’s development.

The first six months will be a busy time as your baby changes from a helpless newborn to a little person who smiles and actively explores the world.

SOME OF THE QUESTIONS ANSWERED IN THIS CHAPTER INCLUDE:

• How do I become a good parent?

• What changes will I see in my baby?

• How do I keep my baby safe?

• How can I help my baby develop?

• What immunizations will my baby need?

• When will my baby start eating solid foods?

4

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Becoming a Parent

A three-year-old girl is told that her mommy is going to have a new baby and that she “is going to be a big sister.” She looks forward to it for months. Then the new baby is born and the three-year-old is very upset. “You said i was going to be a big sister,” she cries. “But i’m still the same size!”

When you have your first baby, you may feel a lot like that three-year-old. Now you have a baby, but you’re still the same person. What does it take to be a parent?

We have to learn how to be parents the same way we learn most things: by getting information, by watching others, by doing.

• Getting information. While you were pregnant, you may have read books about pregnancy, childbirth, and babies. There are dozens of books about children and parenting available (see the list of resources at the end of this chapter, for example). Numerous videos and audiotapes are also available.

in most communities there are groups devoted to supporting and educating parents. one such group is La Leche League, which has chapters everywhere in the United States. it not only helps new mothers breastfeed, but also offers opportunities for sharing parenting information and concerns with other mothers. Ask your health care provider for information about this and other groups in your community.

• Watching others. The example set by your own parents for raising children has probably had the most influence on you. But now that you have your own baby, you need to stop and think about what kind of parents you had and what parts of their parenting style you want to keep—and what parts you don’t.

Your mother may have been wonderful at changing your diapers and keeping you fed and clean, but perhaps she was uncomfortable showing emotion, so she didn’t kiss or hug you often. or she may have been affectionate and warm, but missed appointments at the clinic and rarely cooked a meal.

Think about your friends and other relatives. What do you see about the way they raise their children that you like? What do you see that you don’t like? Whose children seem happy and loved? don’t be afraid to ask others about their ideas on being a parent, and don’t be afraid to ignore any ideas that don’t seem right to you.

decide what your priorities are—and what’s best for your child. No parent is perfect, but we all want to be the best parent we can be.

• Doing. No matter how much you’ve read about being a parent or watched other parents, you will learn most about how to be a parent simply by being one.

if you don’t know how to change a diaper, the nurses at the hospital will teach you before you go home. But you will only become good at changing diapers after you’ve changed a few by yourself.

if you’re nervous about breastfeeding, your health care provider, a nurse, or a lactation specialist will help you get started. But it’s only by doing it that you will find the positions that work best for you and your baby.

Because you will pay attention to your own child, you will learn the difference between your baby’s tired cry and your baby’s hungry cry. You will learn that your child is uneasy around other people and needs to be held when visitors are around—or you’ll learn that your child loves the attention of other people and may need your help in not becoming too excited.

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Spiritual Concerns

As a new parent, you will face a number of spiritual questions: What does it mean to love? What is self-sacrifice? How do you balance parenthood with other aspects of your life? take the time to think about these questions and discuss them with other parents, your family, your friends, and your partner. As you face the spiritual joys and struggles of parenting, you will learn profound lessons about who you are and how you live out your beliefs.

You Are The Most Important Person in Your Baby’s Life

A child’s first important connection is with his or her parents. it’s a connection that starts even before the baby is born. Recent studies show that babies can hear while they are still in the womb, and that they remember what they hear in some way. Since the sounds they will hear most often are their parents’ voices, newborn babies respond more to their parents’ voices than to other voices.

in some cultures, babies are strapped to their mothers’ backs or chests for most of the day and night during the first months after birth. This practice is uncommon in the United States, but American babies still need to sense the warmth, sounds, and smells of the mother. The more you hold your baby and talk to your baby and play with your baby, the better.

Being a parent is not a part-time job. it’s a lot of hard work—and it’s a lot of fun. There is nothing that can make you happier than watching your baby’s face when you walk into a room.

even if you work outside the home, you are still a full-time parent. other people may take care of your baby while you’re at work, but you are still the most important person in your baby’s life.

Although you may be tired when you get home, you need to make sure your child doesn’t miss your attention. Now is the time to pick up your baby or toddler, cuddle, sing a song, or read a story. Show your love. it’s a good way for you to relax after work, and it’s something your baby needs.

Parenting Problems

if you feel overwhelmed, tell someone. Your health care provider can help direct you to services or counselors when you think you just can’t handle your child or being a parent. Being a parent is hard, even when everything is fine. if you have a colicky baby who cries all the time, or a toddler who seems out of control, parenting can seem impossible.

don’t be embarrassed to admit that you don’t think you can handle the situation. Most parents have felt that way at one time or another. Sometimes a little reassurance is all you need to feel more confident.

Whatever you do, never take your frustration out on your child. if you feel in danger of losing control, get help immediately. Find someone to look after your child for an hour or two while you do what you need to calm down, whether that involves taking a nap, walking around the block, or talking to a friend or relative.

It is especially important that you never shake your baby. Shaking can cause permanent brain damage, even death. Make it clear to your daycare providers and babysitters that they should never shake your baby either, for any reason. Ask them to call you to pick up your baby if they feel that they’re “losing control.” See page 23 for more about the harm caused by shaking a baby.

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Your Baby: 2 Weeks to 2 Months

during the first 2 months of your baby’s life, you will see big changes in the way your baby looks, acts, and even “talks” to you. From a newborn who doesn’t seem to do much more than eat, sleep, and cry, your baby will grow very quickly into a little person who smiles and coos and examines the world.

Nutrition

• Theonlyfoodyourbabyneedsrightnowisbreast milk or iron-fortified formula. do not try to introduce any other foods when your baby is this young; the baby’s digestive system is not ready to handle them.

• Youwillbefeedingyourbabyevery2to4hours, although the schedule is likely to change from day to day.

• Ifyouarefeedingyourbabyformula,heorsheshould take 20 to 25 ounces of formula a day.

• Themoreoftenyourbabyeatsduringtheday,the more likely the baby is to sleep for a longer stretch (5 to 8 hours) at night.

Elimination

• Breast-fedbabiesusuallyhavesmall,seedy,yellowish or golden stools—and they have them fairly often, especially for the first 7 weeks. As the baby gets older, there should be fewer stools each day.

• Babiesthatarefedformulahave1to4stoolsaday. These stools should be soft, and the color will vary depending on the type of formula used.

• Youwilllearntorecognizeyourbaby’snormalstools. Watch for any big change in the color, frequency, or texture of your baby’s stools. it can be a sign of allergy (to formula or to something you may have eaten that is passed on through breast milk) or of illness.

• Yourbabyshouldhave6to8wet diapers every day, with small amounts of urine each time.

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Sleep

• Babiesatthisagesleep from 16 to 20 hours a day. Your baby’s sleep pattern will vary from day to day.

• Ifyourbabysleepslongerthan31/2to4hoursduring the day, wake the baby for a feeding. You want to save the longer sleep periods for night, when you can sleep, too.

• Whenyoufeedyourbabyatnight,doitwithalittle more peace and quiet than during the day, so the baby will go back to sleep rather than think it’s playtime.

• Babiesshouldbeputtosleep on their backs, not on their tummies. in time, your sleeping baby will start rolling over onto his or her tummy. When this happens, you don’t need to turn your baby over.

• Youcanhaveyourbabysleepinaseparateroomor in a cradle or crib in your bedroom. if you decide to let your baby sleep in a crib, review the safety measures described on page 24.

• Abedtimeroutinewillhelpyourbabylearnwhen to sleep as he or she grows. The routine might include washing the baby with a washcloth, putting on a fresh diaper and clean clothes, feeding and burping the baby, then rocking or sitting together in a quiet, dimly-lit room until the baby falls asleep.

Growth and Development

• Yourbabycanhear from the moment of birth. The baby may react to sounds by blinking, crying, getting quiet, or startling (a jerky motion). Your baby knows the sound of your voice at birth and will keep learning and responding to your voice.

• Anewborncansee about a foot away. By the time your baby is 2 months old, he or she will be able to see things about 10 feet away. At about 6 weeks old, your baby should start to follow things—especially you—with his or her eyes and to smile back at you when you are smiling.

• Atabout2to3weeks,yourbabymaybeginto have a period of crying, usually in the early evening. This is a normal fussy period, but it is sometimes hard on parents because it may seem like nothing you do helps calm your baby. try to soothe your baby by rocking, walking, or patting him or her on the back. You might want to wrap the baby snugly in a blanket or try feeding him or her again. it is not recommended that you allow your baby to “cry it out” at this age. Keep this up until the crying stops—the entire process can take as long as 2 to 3 hours. Babies eventually outgrow this fussiness.

• Colic is an extended period of crying, usually in the evening hours. Babies with colic appear to be in pain, and parents are often unable to soothe them. Use the calming techniques listed on page 22, and keep the baby close in a front-pack carrier or sling. try to go about your routine as much as possible. if you are very concerned, call your health care provider. This can be a stressful time for parents.

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Social

• Asthebabydevelops,heorshewillbegintosmile at people, usually parents, brothers and sisters, daycare providers, and others who are around often and are part of the baby’s life.

• Bythetimeyourbabyis2monthsold,heorshe will show excitement—moving arms and legs, making noises, smiling—and will be able to calm himself or herself by sucking on fingers or a pacifier.

• Yourbabywillshowthatheorshelikestobewith people, staying awake longer when people are around and even “showing off” for others.

Safety

• Alwaysuseanapprovedcar seat, and place it facing the rear of the car, preferably in the middle of the back seat.

• Neverleaveyourbabyaloneonahighplaceorin bath water, not even for a quick moment. Babies can roll off a dressing table or sink under the water in seconds.

• Alwaysholdyourbabywhenfeedingabottle. Leaving a bottle propped up so your baby can feed without you being there can cause choking, and it has been found to increase ear infections.

Activities to Help Your Baby’s Development

• Putyourbabyonhisorherstomach on a flat surface. talk, show toys, or hold up a mirror to encourage your baby to try to lift his or her head, thereby strengthening the shoulder and neck muscles. (don’t leave your baby on his or her stomach to fall asleep.)

• Holdyourbabyinasittingpositioninyourlap, facing you. Hold your baby’s shoulders forward, giving more support. From this position, your baby can see what’s going on around him or her and can look into your eyes.

• Putyourbabyonhisorherbackandencouragearm and foot movement by putting brightly colored or noise-making toys on a foot or hand.

Mobiles and other bright objects or pictures may attract your baby’s attention and interest.

YoUR BABY’S FiRSt Six MoNtHS 55

Clinic Visits

After your first clinic visit with your new baby, your health care provider will establish a schedule for health exams. The times you see the health care provider are usually planned to coincide with the schedule for immunizations.

You may also see your health care provider if your baby is ill with a cold or ear infection. The tiny body of your baby can get very sick quickly, so don’t wait to talk with your health care provider if your baby seems sick.

The immunizations given during the first 2 months are:

• Hepatitis B. This prevents infection of the liver caused by the hepatitis B virus. There are a total of three shots given during your baby’s first 18 months. The first shot is given in the hospital before your baby goes home. The second shot is given between the ages of 1 and 2 months, and the third shot is given after 6 months of age.

• Rotavirus vaccine (ROTA). This vaccine helps prevent the rotavirus, which can cause severe diarrhea in infants and young children. There are a total of three doses given by mouth in the first 6 months. The first dose is at 2 months, the second dose is at 4 months, and the third dose is at 6 months.

• DTaP. This combination vaccine protects against diphtheria, tetanus, and pertussis (whooping cough). There are a total of five shots given between 2 months and 6 years of age. The first shot is given at 2 months.

• Polio. There are four shots given between 2 months and 6 years of age. The first shot is given at 2 months of age.

• PCV. This vaccine protects against pneumococcal infections. These infections include pneumonia, bacterial meningitis, and blood infections. There are a total of four shots given between 2 months and 15 months of age. The first shot is given at 2 months of age.

• Hib. This vaccine protects against the Haemophilus influenza type B bacteria, which can cause brain damage, pneumonia, infection, and even death in young children. typically three shots are given between 2 months and 15 months of age. The first shot is given at 2 months of age.

The number of immunizations that your baby receives at his or her 2-month visit may change depending on current medical recommendations. Most babies cry when they get their shots, but the discomfort is brief. Ask your baby’s doctor about what you can do to make your baby more comfortable.

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Your Baby: 2 Months to 4 Months

This can be an easy-going time. Your baby cries less—the early-evening fussy period usually disappears by 3 months—and sleeps more. Your baby is more interested in the world and in other people, and he or she is easier to take with you to different places. Routines are becoming established, with more regular times for eating, sleeping, and playing.

Your tiredness and feelings of frustration are likely to be over as well. When you look at this happy little baby who smiles every time you come into the room, you forget that there may have been some difficult times during the first 2 months.

Nutrition

• Breastmilkoriron-fortifiedformulaisstillthe best nourishment for your baby, and other foods should not be introduced yet. if you think your baby needs cereal or other solids, talk about it with your health care provider before you feed them to your baby.

• Yourbabywillbreastfeed about 6 times a day.

• Ifyouarefeedingyourbabyformula, he or she should take 20 to 32 ounces of formula a day.

• Yourbabywilltakemostfeedingsduringtheday and sleep longer at night.

A few times a day, put your baby on his or her tummy and show toys or other interesting things. This will encourage your baby to lift his or her head and strengthen the neck and spine.

YoUR BABY’S FiRSt Six MoNtHS 57

Elimination

• Breastfedbabiesmayhavestools several times a day or as seldom as once a week. either, or any number in between, is normal if it is a regular pattern for your baby.

• Formula-fedbabiesusuallyhavefrom1stoolevery few days to 4 a day. These stools are soft.

• Mostinfantsurinate often, in small amounts.

Sleep

• Mostbabiesbegintosleep longer at night—7 to 8 hours. They may then wake up for a feeding and fall back asleep for another 3 to 4 hours. (Which means you get more sleep now, too.)

• Napsduringthedaycanvary.Yourbabymaytake one short nap, one long nap, or none at all. or your baby may take several naps.

• Youcanhelpyourbabylearnhowtogotosleepon his or her own now. When you notice your baby getting tired, try putting him or her in the crib while still awake, so he or she can learn how to go from being awake to being asleep.

• Givethelastfeedingabouthalfanhourtoanhour before putting your baby into the crib for the night, so your baby learns to separate the idea of eating from sleeping.

Growth and Development

• Yourbabywillbequietedbyfamiliarvoices. He or she may stop crying when talked to and will laugh during play.

• Yourbaby’svision is now like that of an adult, and the eye adjusts to objects at different distances.

• Yourbabywillplaywithhisorherfingers.

• Yourbabybeginstoreachforandgrabthings,although still clumsily. Your baby may be able to bear weight on his or her feet and to lift the chest up when placed on his or her tummy.

• drooling starts at about 3 months, although teething doesn’t usually start until 6 to 10 months.

• Yourbabylearnsbyputtingthingsinhisorhermouth, starting with his or her own fingers and then anything else in reach.

Social

• Yourbabysmiles,coos,andrespondstopeople—especially you. By the fourth month, your baby may be able to have a whole “conversation,” babbling and cooing sounds in a string. in a good mood, your baby may squeal, giggle, laugh, and grin for as long as 30 minutes.

• Ifpeoplearearoundtosocializewithyourbaby,he or she will play twice as long as when alone.

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Safety

• Keepusingtherear-facingcar seat in the back seat of your car.

• Donotleaveyourbabyaloneinahighplace or in the bath. Your baby is getting more active and can flip off a table, bed, or countertop very quickly.

• Don’teatordrinkhotitemswhileholdingyourbaby. Your baby is starting to grab at things and could get a bad burn.

Activities to Help Your Baby’s Development

• Afewtimesaday,putyourbabyonhisorhertummy when awake. This will help muscles develop, and your baby will learn to roll over.

• Letyourbabyplaywithoutanyclothesonsometimes. A good place is on a towel in the middle of a double bed, with you right there. At 2 to 3 months, a baby likes being naked. Since the baby learns about the world largely through touching things, being naked lets your baby feel different textures. Being without clothes also lets the baby find his or her own body parts.

• Yourbabylikeslookingatnewthings—andputting them into the mouth. toys or objects of varying color, weight, and texture will stimulate your baby. You don’t need anything fancy, but make sure that whatever your baby is playing with is safe.

• Holdyourbabysoheorshecanseeyourface,and talk gently. When your baby responds in some way, answer back as if you are having a real conversation.

• Continuetoread,tellstories,andtalktoyourbaby. Such activities can have dramatic effects on future learning.

Clinic Visits

The second series of immunizations for rotavirus, diphtheria-tetanus-pertussis (dtaP), polio, Hib, and the pneumococcal virus are usually given at 4 months.

YoUR BABY’S FiRSt Six MoNtHS 59

Your Baby: 4 Months to 6 Months

Your baby starts to get very active during these 2 months, learning to control more muscles, exploring the world more actively—and putting everything into the mouth.

Nutrition

Breast milk or iron-fortified formula will give all of the nourishment your baby needs, but you may see signs that your baby is ready to try solid foods.

• Signsthatyourbabyisreadyforsolid foods include:

– Suddenly taking more formula or nursing more

– Waking up hungry in the middle of the night

– Seeming to want to eat when others— you or other adults or children— are eating.

• Agoodfirstsolidfoodisricecereal;nextyoucan try oatmeal or barley. Start with about a tablespoon of dry cereal mixed with breast milk, formula, or water.

• Somebabiesliketheircerealthick,somelikeitthin. experiment to see what your baby prefers.

• Between4to8tablespoonsofdrycerealinoneor two meals is a day’s serving.

• Afteryourbabyhasbeeneatingcerealforaweek or two, you can begin to try feeding pureed fruits and vegetables. only do this if your baby seems to want more solids.

• Yourbabyshouldbenursing4to6timesadayor taking 20 to 35 ounces of formula a day.

Elimination

• Asyourbabystartstoeatsolidfoods,stools will change. if your baby has firmer stools, use oatmeal rather than rice cereal.

• Yourbaby’sbladderisgrowing,andyourbabywon’t need to urinate quite as often. You will not have to change diapers as often now, but they should be wetter when you do change them.

Sleep

• Mostbabiesnowsleep about 10 hours through the night.

• Ifyouhaven’tstartedasleeproutineforyourbaby, do it now. When your baby begins to look tired at night, get him or her ready for bed and put the baby in the crib while his or her eyes are open, so your baby can become familiar and comfortable with being in the crib and falling to sleep. once your baby can go to sleep at the beginning of the night, he or she will be able to go back to sleep if wakened in the middle of the night.

• Napsvary.Onaverage,yourbabywilltake 3 naps during the day.

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Growth and Development

• Yourbabydoesn’twanttomissaminuteoftheworld right now and may fuss when you put him or her on the tummy because it’s harder to see.

• Mostbabieswilllearntorollfromfronttobackand from back to front during these months.

Babies 4 to 6 months old enjoy grabbing and mouthing things. Give your baby a variety of safe objects to explore. After 6 months, even if your baby is not ready to walk, he or she will try to pull to a standing position to get a new view of the world.

• Startingatabout3months,babiesneed time to play independently, as well as to play with others.

• Yourbaby’sreachisgettingbetter,andeverything will go into the mouth.

• Withsupport,yourbabycansitforahalfhouror more.

YoUR BABY’S FiRSt Six MoNtHS 61

Social

• Yourbabyisverysocialnowandenjoysseeingnew places and new people. it’s a good time to use babysitters, if you haven’t already, because your baby is more likely to accept the occasional care of another person.

• Yourbabyisabletoplayalonenowandneedssome time to do that so he or she knows how to be alone.

Safety

• Keepusingtherear-facingchildseat in your car if your baby weighs less than 20 pounds dressed.

• Don’tleaveyourbabyaloneinhighplacesorinthe bath.

• Startchildproofing your house—your baby will be mobile soon. Go around your house at baby level and see what your baby will soon be able to get into. Are there uncovered outlets? electric cords to pull? Breakable items just inside cabinet doors? Heavy things that can be pulled or pushed over? cleaning supplies, insecticides, drain cleaners, or other poisonous materials? For the next few years, you will need to adapt your home for the safety of your baby. Get dangerous items or materials out of reach—or out of the house altogether.

• Feedyourbabysolid food when he or she is strapped in a sturdy infant seat or chair.

• Becarefulhandlinghotitemsaroundyourbaby; his or her hands are very quick to grab things now.

• Althoughyourbabycanuseawalker,thisisnotrecommended. it’s too easy for a baby to roll one right down a flight of stairs.

Activities to Help Your Baby’s Development

• Lotsoftummy time on the floor will help your baby develop upper-body strength and learn to roll over. Your baby may fuss, though, when placed on the tummy.

• Jump-upsarefineforshortperiods,aslongasyour baby is not standing on his or her toes too much.

• Spendtimelookingintoyourbaby’sfaceandtalking to him or her. Your baby will make sounds to try to keep your attention. Smile and talk as if you were having a conversation.

• Giveyourbabysafeobjectsandtoystograb,mouth, and shake. Show your baby different things to look at, from flowers in your garden to pictures on the wall.

• Yourbabymightbeveryinterestedinthesounds and images on television right now, but it’s not good for your baby to spend too much time in front of the television. infants need to be with real people who can respond to their needs and behaviors, not unresponsive images of people on a tV set.

• Readingsimpleinfantbookstoyourchildcontinues to be instrumental to his or her intellectual development.

Clinic Visits

At 6 months, your baby will have another rotavirus, dtaP, and pneumococcal vaccination. A flu vaccine may also be recommended. depending on the schedule used, a third polio immunization and hepatitis B vaccination may be given now also.

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For Partners

Babies form special relationships with all people who care for them. The more loving people there are in their lives, the better off they will be.

Almost everything the baby’s mother can do with the baby now can also be done by you. You can share the bathing and diapering and rocking. As the baby grows, you can share feeding.

Most important, you can share in activities that help the baby grow and develop. talk to the baby, play with the baby, hold the baby.

When your baby is old enough to get around independently, you and your partner should agree on what kind of limits you want in your house, and then keep those limits consistent.

You and your partner need to spend time alone together. Sometimes that seems impossible with a small baby in the house. And sometimes mothers are reluctant to leave their babies, even for a short time. You can encourage your partner to get out, with you and on her own, for some quality “adult” time. if you arrange for the child care, you can help make that evening out a reality.

For More Information

Games to Play with Babies by Jackie Silberg

The First Twelve Months of Life by Frank and Theresa caplan

The New First Three Years of Life by Burton L. White

The Magic Years by Selma Fraiberg

Taking Care of Your Child by Robert H. Pantell, Md, et al.

American Academy of Pediatrics www.aap.org

Buckle Up Kids www.buckleupkids.state.mn.us

Kids Health (Nemours Foundation) www.kidshealth.org

Fathering Magazine www.fathermag.com

Fathers.com www.fathers.com

Parenthood.com www.parenthood.com

Parenting www.parenting.ivillage.com

Keeping Track of Your Baby Questions You Have about Your Baby’s Development

When you think of something you want to remember to ask your health care provider, write it here. take this book with you each time your baby goes to the clinic.

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What Your Baby Is Doing

it helps your health care provider if you keep track of your baby’s regular eating, sleeping, and waking patterns:

How much does your baby sleep each day? When? What is the longest time your baby sleeps?

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How much does your baby nurse (or take bottles) each day?

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What kind of stools does your baby have? How often?

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How much does your baby cry? What kind of crying?

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How much of the day is your baby alert?

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Use this space to jot down anything that you think you might need to talk about.

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KeePiNG tRAcK oF YoUR BABY 65

Clinic Visits

Use this space to record each well-baby visit to your health care provider.

Date of visit

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Baby’s height or length Baby’s weight

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immunizations

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comments by health care provider about your baby’s development

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immunizations

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Date of visit

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Baby’s height or length Baby’s weight

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immunizations

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Date of visit

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Baby’s height or length Baby’s weight

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immunizations

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comments by health care provider about your baby’s development

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Date of visit

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immunizations

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KeePiNG tRAcK oF YoUR BABY 69

Baby’s Firsts

Use this space to record some of the important—or fun—first times in your baby’s life.

First Smile

date

Smiled at . . . occasion?

First Rolled Over

date

occasion

First Laughed

date

Laughed at . . . occasion?

First Haircut

date

First Sat Up

date

Index

abdominal pain, in mother, 6alcohol, 39allergies, 52areola, 33, 43asthma, 28axillary (underarm) temperature, 20

baby blues, 3, 8–9, 10. See also depressionbabysitters. See child carebathing a baby, 10, 14, 15, 18, 19, 58, 62birth control, 6, 10, 39birth, premature, 13

collecting breast milk after, 38biting baby, 44bleeding, vaginal, 4, 5, 6blood type, 13bonding, 27bottle-feeding, 54bottles, 24, 40bowel movements

baby’s, 34, 52, 57, 59, 64mother’s, 5

breastfeeding, 6, 46, 50, 56. See also expressing breast milk

and sleepy baby, 35breastfeeding positions, 30, 42, 50common questions about, 41–48during pregnancy, 45getting help with, 35, 39keeping track of, 34older children, 45removing baby after, 29, 41, 44twins, 31, 42

breastfeeding concernsbaby refuses or pulls away from breast,

25, 43, 45breast infection, 6, 44engorgement, 40, 41, 43feeding enough milk, 33improper latch, 36, 43milk supply, 35, 40, 41pain, 33, 35, 42plugged milk ducts, 44sore or burning nipples, 42, 44

breast infection, 44breast milk, 27, 34, 52, 59

benefits of, 27, 28, 45increasing flow of, 37, 41thawing, 38warming, 38

breast pumps, 36, 37, 40, 41breasts, 6, 46breathing, baby’s, 43bruising, of baby, 13bulb suction, 43burping your baby, 10, 48, 53

caffeine, 39candida. See thrushcar seats, 22, 24, 54, 58, 61cephalhematoma, 12cesarean, 4

incision care after, 5, 6chest pain, 6child care, 51, 61, 62childproofing, 61choking, 43, 54circumcision, 16–17

care after, 16, 18, 25cleft lip or palate, 44clinic visits, 10, 26, 55, 58, 61, 65colic, 51, 53colostrum, 33, 36constipation

in baby, 5in mother, 25

contraceptives. See birth controlcord care, 15, 18, 19, 25co-sleeping. See sleeping arrangementscoughing, 6, 25crib, 24, 53, 57, 59crying baby, 15, 21, 22, 29, 48, 50, 64

and parental frustration, 23, 51high-pitched, 13how to calm, 22, 43, 53

daycare, 40, 51. See also child caredepression, 3, 8–9development. See growth and

developmentdiabetes, 28diapers, 10, 15, 50, 52, 53, 62

and genital care, 18counting and observing stools and

urine, 25, 33, 34, 59diarrhea, in baby, 14, 25, 55doctor

when to call for baby, 13, 18when to call for mother, 6

drooling, 57drugs, recreational, 39dtaP (diphtheria, tetanus and pertussis)

vaccine, 55, 58, 61

ear infections, 24, 28, 44, 54, 55engorgement, of breasts, 33, 40, 41, 43episiotomy, 6exercise, 5, 6, 8, 10expressing breast milk, 35, 36–37, 40.

See also breast pumps

feverbaby’s, 20, 25mother’s, 6, 44

fingernails, 18, 29flu vaccine, 61foreskin, 16, 17, 18formula, 37, 40, 52, 56, 59

precautions with, 14, 34frequency days. See growth spurtsfrustration. See also shaking a baby

baby’s, 29, 43parent’s, 22, 51, 56

fussy baby, 13, 25, 33, 39, 42, 53, 56

gas, baby’s, 42genitals, 12, 16, 18grasp reflex, 15, 22growth and development, 53, 54, 57, 58,

60, 61, 62, 63growth spurts, 34

habituation, 21Haemophilus influenza type B, vaccine

for, 55head, baby’s, 12, 23, 54hearing, baby’s, 14, 51, 53hemorrhoids, 5hepatitis B vaccine, 55, 61Hib, 55, 58hospital security, 4

illnessbaby’s, 38, 43, 55mother’s, 44

72 tHe NeW FAMiLY

immunization. See vaccinationsinfection, in baby, 17, 18, 27, 28, 44.

See also ear infectionsinsurance, 16, 37intercourse, 6, 10

jaundice, 12, 13, 25, 33

Kegels, 5

lactation consultant, finding, 39La Leche League, 39, 48, 50lanugo, 12latching difficulties, 32, 35, 41, 43leg pain or swelling, 6

medicationsand breastfeeding, 39for baby, 44for mother, 7, 43, 44

meningitis vaccine, 55, 58menstruation, 5milia, 12milk supply, 34, 35, 36, 37, 40, 41Mongolian spots, 12

nail care, 18nausea, 6neonatal intensive care unit (NicU),

26, 38newborn

behavior of, 13, 15, 25, 52caring for, 15–19, 26crying, 13, 15, 21, 22, 23, 25, 29, 50,

51, 53safety, 4, 22, 24, 53, 54taking temperature of, 20

nipples, 33. See also sore nipplesflat or inverted, 43on bottles, 40

nutritionbaby’s, 45, 52, 56, 59mother’s, 5, 8, 39

pacifiers, 24, 34, 35, 40, 54parenting, 50–51partner, 4, 10, 26, 48, 62PcV, 55penis, 16, 17, 18perineal care, 4periods. See menstruationpertussis (whooping cough) vaccine, 55, 58phototherapy, 13pneumonia vaccine, 55, 58, 61polio vaccine, 55, 58, 61postpartum

care, 3, 4depression, 3, 8–9exercise, 6

prematurity. See birth, premature

rash, 12rectal temperature, 20, 25rooting reflex, 15rotavirus vaccine, 55, 58, 61

safety, 22, 24, 54, 58, 61sex. See intercourseshaking a baby, 22, 23, 51shots. See vaccinationsskin, baby’s, 12, 24skin-to-skin contact, 29, 35, 46sleep

baby’s, 21, 29, 53, 57, 59, 64mother’s, 4, 39, 53, 57

sleeping arrangements, 14, 24, 53sleepy baby, 13, 35smoking, 24, 39sneezing, baby’s, 12, 15solid foods, 34, 45, 52, 56, 59, 61sore nipples, 36, 40, 41, 42spirituality, 51spitting up, 25, 42spoiling a baby, 14, 22states of consciousness, 15, 21stools. See bowel movements; diaperssucking reflex, 15, 29Sudden infant death Syndrome (SidS), 24swaddling, 22swallowing, baby’s, 33, 43

tearing, perineal, 6teething, 44, 45, 57temperature, 15, 20, 25

for storing breast milk, 38.See also fever.

thrush, 44tummy time, 54, 58, 61twins, 31, 42

umbilical cord. See cord careunderarm temperature, 20urination

baby’s, 34, 52, 57, 59mother’s, 6

vaccinations, 26, 55, 58vagina

baby’s, 18mother’s, 6

vaginal dryness, 39vision, baby’s, 12, 14, 53, 57vomiting

in baby, 25in mother, 6

warming breast milk or formula, 38weaning, 46weight gain, baby’s, 25, 33, 35weight loss, mother’s, 5, 6, 28, 39whooping cough. See pertussis vaccinework, returning to, 37, 40

yeast infection. See thrush

The New Family is really several books in one: an infant and mother care book, a breastfeeding book, a baby keepsake book and a medical records book. Here you will find the answers to all your basic questions, from what to expect from your newborn to caring for your child through the first months of life.

The New Family—along with its companion volume, The Expectant Family—was prepared by the Birth and Family Education staff of one of the nation’s most respected health care systems. Together, these books present authoritative, up-to-date information in language and pictures that anyone can understand.

This volume includes:• Over 25 charts and illustrations • Record-keeping pages• Updated information on breastfeeding • Lists of resources• Advice on postpartum care • Advice for partners

Fairview is a not-for-profit, community-focused health system affiliated with the University of Minnesota. We provide a complete range of services, from prevention of illness and injury to care for the most complex medical conditions. Delivering over 11,000 babies each year, Fairview cares for more moms and babies than any other health care provider in the state. This book is a direct response to feedback from our patients and their families.

9 7 8 1 5 7 7 4 9 2 4 0 5

ISBN 978-1-57749-240-55 1 0 9 5

$10.95 U.S.

fairview.org

The New FamilyYour Child’s Early Months