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STARTING OUT RIGHT
BE SWADDLED
This guide will help you through your pregnancy, labor, birth
and any questions you may have about your new bundle of joy!
Important phone numbers:
Clinic phone number:
Baby doctor’s (pediatric) phone number:
Pharmacy phone number:
Sign up for our weekly pregnancy and parenting e-mail
Our e-newsletter offers trusted advice and support from health care
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WELCOME!
You’re going to have a baby! “What now?” you may be thinking. This book may help by providing you
with information about your pregnancy, labor, birth and the early days at home with your newborn.
You and your baby are being cared for by a health care team. In addition to your doctor or midwife,
prenatal educators, dietitians, social workers, outreach nurses and home care nurses are available to
help care for you during your pregnancy. If complications or risk factors occur during your pregnancy,
you and your health care team will work together to determine what special needs you have and how
those needs can best be met.
Education is very important, and we strongly encourage you to begin preparing early in your
pregnancy. In addition to reading this book, you may want to keep a list of questions as they occur to
discuss with your provider.
Ask your provider about early pregnancy classes at your clinic. It is important to prepare for birth,
breast-feeding and infant care by attending classes. Register for classes as soon as possible—spaces
fill quickly. Visit our HealthEast website at healtheast.org for prenatal class options.
If you have any questions or concerns during your pregnancy or in the weeks after birth, call your
doctor or midwife.
This book was developed in cooperation with: HealthEast® Clinics, Metropolitan OB-GYN, Partners
OB-GYN, HealthEast® Maternity Care, East Metro Family Practice, Entira Family Clinics, North Suburban
Family Physicians Clinics and HealthEast® Home Care. To the many others who contributed to this
book—thank you!
HealthEast Care System supports the initiatives of the World Health Organization, Unicef and Baby
Friendly USA. All areas of our facilities will promote, protect and support breast-feeding as a healthier
choice for women and infants. Our facilities do not receive free infant formula or feeding equipment,
free gifts, materials, money or support from manufacturers of breastmilk substitutes. We do not provide
samples, marketing materials, or coupons for these items to our patients.
For additional information, visit babyfriendlyusa.org
© 2017, HealthEast® Care System
St. John’s Hospital
Maternity Care Center
651-232-7550
Social Service
651-232-7356
Outreach Nurse
651-232-7560
Tours
651-232-7550
Woodwinds Health Campus
Maternity Care Center
651-232-0022
Social Service
651-232-0337
Outreach Nurse
651-232-0778
Tours
651-232-0228
Other Resources
United Way 2-1-1 (formerly First Call for Help)
A comprehensive, multilingual resource for help.
Hearing impaired, please access through the
Minnesota Relay Service
WIC Minnesota 1-800-657-3942
HealthEast Resources
Ramsey County 651-266-1300
Outpatient Lactation Clinic
651-232-3147
Washington County
651-430-6658
Dakota County
952-891-7525
Perinatal Home Care
651-232-2895
TABLE OF CONTENTS
Table of contents.................................................................1
Labor and birth..................................................................74
Off to a good start............................................................. 2
After birth........................................................................... 78
Physiology of pregnancy.................................................3
Infant security in the hospital.......................................80
Changes in the first eight weeks of pregnancy........4
Minnesota newborn screening program..................80
Growth and development............................................... 6
Your baby’s birth certificate.........................................83
Lifestyle changes............................................................... 9
Mother’s physical changes and adjustments.........84
Weight gain........................................................................ 13
Postpartum depression:
Things you should know...............................................89
Drugs and medications.................................................. 14
Domestic violence............................................................ 17
Body mechanics..............................................................20
Exercise..............................................................................22
Body conditioning...........................................................23
The expectant partner...................................................25
Common discomforts of pregnancy..........................28
Strengthening exercises and stretches
for low back pain..............................................................31
Warning signs during pregnancy................................36
Miscarriage........................................................................ 37
Your health insurance coverage.................................39
Gestational diabetes follow-up...................................92
Diet and postpartum exercise.....................................93
Your newborn...................................................................95
Baby states........................................................................ 97
General baby care......................................................... 105
Your relationship as a couple.................................... 122
Breast-feeding: What to expect
during the first month....................................................124
Resources/Reference materials................................ 132
Birth plan...........................................................................137
Birth control options after delivery.......................... 139
Your prenatal care............................................................ 41
1
OFF TO A GOOD START
Be a partner in your care
You are beginning a professional relationship with your provider, their clinic staff and the staff at the hospital
you have selected for birth. We have responsibilities for your care and safety. We will use proven safe and
effective treatments for your care; our staff will be competent in their assigned roles and we will promote safe
use of medications, supplies and equipment.
If you have questions or concerns, you must speak up. If there is something you don’t understand – ask.
It’s your body and you have a right to know.
Participate in decisions about your care and treatment. Educate yourself about your condition, diagnosis and
your treatment plan. Don’t assume anything, pay attention and ask questions.
You are the center of the health care team.
2
PHYSIOLOGY OF PREGNANCY
To help you understand the many changes that occur within your body throughout pregnancy, it is important
to understand the pregnancy process.
Hormonal changes during pregnancy
As your baby grows and develops, many changes will occur in your body. You may also experience
emotional adjustments that affect you and your partner. Many of the changes that occur are caused by
changes in hormone production. Some of these changes are the result of the hormones listed below.
Human Chorionic Gonadotropin (hCG)
This important hormone is produced by the developing placenta. HCG assures that your ovaries produce
progesterone and estrogen until your placenta matures and takes over production of this hormone
(approximately 3 to 4 months).
Progesterone
This hormone helps relax the uterus (womb) to keep it from contracting excessively. It also relaxes the walls
of blood vessels which help in maintaining a healthy blood pressure. Progesterone stimulates secretion of
an ovarian hormone called “relaxin” which softens ligaments, cartilage and the cervix, helping them stretch
during birth.
Estrogen
Estrogen promotes growth of the uterine lining and blood supply. It increases the production of vaginal
mucus and helps in the development of the breast duct system and breast blood supply. Estrogen may
influence water retention and skin pigmentation.
3
CHANGES IN THE FIRST EIGHT WEEKS OF PREGNANCY
This is a very important time for your baby. This period is often called the “developmental period,” because
after the first 12 weeks, all fetal organ systems are formed and functioning. For you and your partner this is a
time of physical and emotional adjustment to being pregnant. During this period some important changes will
take place.
Conception
The union of the egg and sperm give the fertilized ovum a full set of 46 chromosomes (23 from the mother
and 23 from the father). These chromosomes combine to become the blueprint for the development of your
child. Your child’s physical appearance, blood type, some personality and mental traits, sex, body type and
more have already been determined.
After fertilization, the ovum quickly changes from one cell to many. By the end of two days this cluster of cells
is called a “morula.” By the end of the first week it implants itself in the upper part of the uterus and is now
called a “blastocyst.” The blastocyst develops root-like projections (chorionic villi) that grow into the uterine
lining and receive nourishment from it.
4
Pregnancy
During the early weeks of pregnancy, the uterine lining (endometrium) thickens and more blood flows to the
area. This provides a rich source of nourishment for the developing blastocyst. At the end of the first month,
the chorionic villi becomes a primitive placenta. Fetal blood circulates through this placenta while your blood
circulates around the villi. A thin membrane separates the two blood streams and normally they do not mix.
As the cells specialize, the fetus, placenta, amniotic sac and fluid are formed. The amniotic sac surrounds the
blastocyst; which later also protects the developing fetus.
During the next few weeks development continues rapidly. The blastocyst is now called an “embryo.” A
primitive nervous system with the brain and spinal column begins to form. Although the embryo is very small
(about the size of a pea), the head, with eyes, ears and a mouth is beginning to form. A simple liver, digestive
tract, umbilical cord and kidneys develop. The circulatory system develops, and by the end of day 25 the
heart is beating. By day 28, arm and leg buds appear.
The sex of your baby is determined at conception, and during the seventh week, your baby’s sex organs
begin to develop. By the eighth week the embryo is complete. During this period, you may feel tired and
require more sleep. You may also experience some nausea and vomiting, which is thought to be caused by
hCG (human chorionic gonadotropin), a hormone produced by the placenta.
As the levels of estrogen, progesterone and other hormones increase during pregnancy, the breasts change
in preparation for providing milk for the baby.
5
GROWTH AND DEVELOPMENT
First trimester
1 to 4 weeks
Baby’s development
6
5 to 8 weeks
9 to 13 weeks
1/4 inch long. Fertilized
egg implants in uterine
lining. Heart, brain, spinal
cord and digestive tract
begin
to form.
One inch long and weighs
1/30 ounce. Heart pumps
blood. Buds for arms and
legs appear. Eyes, ears
and face begin to shape.
Normal maternal
changes
Nausea, fatigue, breast
tenderness. Digestive
system slows. Sexual
interest may decrease.
Same as weeks one
through four plus
frequent urination.
Same as previous
weeks plus headaches,
increased blood volume
and nasal congestion.
Comfort tips
Small, frequent meals.
Avoid spicy and greasy
foods. Take time for
regular exercise. Wear a
supportive bra.
Same as weeks one to
four plus urinate as often
as needed.
Same as weeks one
to eight plus take time
for extra rest. Change
positions slowly and eat
small snacks.
All internal organs are
present in various stages.
Three inches long and
weighs one ounce. Sex
characteristics defined.
Blood cells and bones
form. First movements
occur. Organs begin to
function. Early breathing
and sucking. Buds for
teeth, fingernails and
toenails. May hear
heartbeat with doptone
(amplified stethoscope).
Second trimester
14 to 18 weeks
19 to 23 weeks
24 to 27 weeks
Baby’s development
Seven inches long and
weighs four ounces.
Mature muscles and
bones. Some nerve
control. Kicking. Pinkish,
transparent skin. Kidneys
produce urine. Sex organs
recognizable.
10 to 12 inches long
and weighs 1/2 to 1 lb.
Fine hair, eyebrows and
eyelashes. Swallows
amniotic fluid. Can suck
thumb. Glands in skin
secrete vernix (protective
coating for skin).
11 to 14 inches long
and weighs 1-1/2 lb.
Eyelids open and
close. Grasping. Skin
looks wrinkled and
red. Skin covered with
vernix. Footprints and
fingerprints appear.
Normal maternal
changes
Your pregnancy begins
to “show.” You will
experience increased
vaginal discharge. Heart
pounding may occur.
Sexual interest increased.
You will feel fetal
movement. You can
express colostrum from
your nipples. You may feel
faint or dizzy. Varicose
veins may appear.
Skin changes: Darkened
nipples, reddened palms.
You may experience
nosebleeds and your skin
may itch. Your gums swell
and bleeding may occur.
Comfort tips
Tub bath in warm water.
Cotton underpants.
Relaxation techniques and
slow breathing.
Rest with feet up. Change
positions slowly with
support. Avoid long
periods of standing or
sitting upright. Wear
support hose. No knee
high socks. Place a pillow
between your legs when
sleeping.
Use a humidifier. Apply
moisturizer to skin.
Maintain good dental
hygiene.
7
Third trimester
28 to 31 weeks
8
32 to 36 weeks
37 to 40 weeks
Baby’s development
14 to 16 inches long
and weighs 2 to 3 lbs.
Developing lung maturity.
Breathing movements.
Will settle into pelvis, head
down. Fat begins to form
under skin. May hiccup.
16 to 18 inches long and
weighs 5 to 6 lbs. Skin
wrinkles disappear. Fat
thicker under skin. Gain
1/4 to 1/2 lb. per week.
18 to 22 inches long
and weighs 7 to 9 lbs.
Received transfer of
mom’s antibodies against
measles, mumps, rubella.
Downy
hair disappears.
Normal maternal
changes
You may experience
muscle cramps. Heartburn
may become troublesome
as there is a delay in the
time it takes to empty the
stomach. You may fatigue
easily. Pressure on nerves
may become apparent.
You will experience an
increase in breast size
and colostrum. Stretch
marks on abdomen, breast
and thighs may appear.
Swelling, constipation and
hemorrhoids are common.
You may experience
shortness of breath.
The baby moves lower
into the pelvis. Backaches
and frequent urination
are common. You may
experience periods of
insomnia and unusual
dreams.
Comfort tips
Change your position
often. Rest with your head
and legs elevated. Point
your toes toward your
knees for leg cramps. Eat
small, frequent meals and
avoid high fat meals. You
may use an antacid such
as Tums® for heartburn.
Rest on left side using
two pillows. Increase
your protein, fluid and
fiber intake. Wear support
hose and loose clothing.
Exercise. May use a fiber
additive for constipation.
A warm tub bath is
relaxing.
Use relaxation techniques.
Wear low-heeled shoes.
Good posture and doing
the “pelvic tilt” can help
you feel more comfortable.
Alternate lovemaking
positions. Warm bath
or heating pad can be
relaxing and comforting.
LIFESTYLE CHANGES
You are able to control the environment in which your baby develops. Your lifestyle, the foods you eat,
smoking, drinking or any medication you take will make a difference in your health and your baby’s - now and
in the future. The following suggestions can help you to create a healthy environment for your baby.
Nutrition
Your eating habits before and during pregnancy affect your baby’s health. During pregnancy the food you
eat supplies all the nutrients for you and your developing baby. Your food choices will make a difference
in your baby’s health. The following guidelines will help you to make smart food choices. It is important to
include a variety of foods to supply nutrients and to make eating enjoyable.
Resources:
choosemyplate.gov
Academy of Nutrition and Dietetics - eatright.org
Food group
Daily servings
Milk and milk
products
(calcium rich foods)
Adult four to five
Protein sources
Adult six to seven ounces
Teen
Teen
Fruits and
vegetables
five to six
seven to eight ounces
Sources
Cheese, custard, milk, pudding, yogurt, ice
cream, fortified orange juice
Fish, legumes (dried beans, peas, etc.), lean
meat, lentils, nuts, peanut butter, poultry,
seeds, whole grains, cereal, eggs and tofu
Five or more with one high in folate Avocado, green leafy vegetables (chard,
parsley, romaine lettuce, spinach) kidney
One to two high in vitamin C
beans, legumes (dried beans, peas, etc.), lima
One high in vitamin A
beans, lentils, melons, oranges, peas, squash,
cauliflower, wheat germ, nuts and seeds
9
Food group
Fruits and
vegetables
Daily servings
Sources
Five or more with one high in folate Citrus fruits (grapefruit, kiwi, oranges, papaya)
berries, melons, tomatoes, chili peppers,
One to two high in vitamin C
green vegetables (broccoli, Brussels sprouts,
One high in vitamin A
kohlrabi), potatoes with skin
Green and yellow vegetables (broccoli, acorn
squash), apricots, tomatoes, carrots, sweet
potatoes (vitamin A is also found in milk and
egg yolks)
Carbohydrates
2 to 8 ounces
Bread and bread products, bulgar cereals,
pancakes, pasta, rice
Beverages
6 to 8 glasses of water
Limit caffeine containing beverages to 2 cups
per day; no alcohol
(8 to 12 cups total fluid)
Sugar substitutes
Moderation
Aspartame appears safe for use in pregnancy
but use in moderation; avoid saccharin
Special circumstances
Good nutrition in pregnancy is always important, but in some circumstances you need to be even more
conscientious about your diet. It may be helpful to have nutrition counseling with a registered dietitian in the
following circumstances:
Multiple pregnancy – If you are carrying two or more babies, you will require 300 extra calories per baby
per day.
Adolescent pregnancies – Teenagers are still growing and have greater requirements for most nutrients. It is
necessary to eat particularly well when pregnant to maintain your own growth while nourishing your baby.
Pregnancies close together – A pregnancy may deplete reserves of nutrients such as calcium and iron. If
there is sufficient time between pregnancies those reserves are replenished. Pregnancies close together
may require extra calories and nutrients. The length of time needed between pregnancies to correct
deficiencies depends on your overall nutritional status and diet.
10
Vegetarian diet
If you are a vegetarian, you can still follow a nutritious, well-balanced diet during pregnancy, especially if you
include milk and eggs in your diet. Your major concerns are the need to take in sufficient calories and the
possible need to supplement vitamin B12, most often found in animal meats. If you choose a vegetarian diet
during pregnancy, you may want to consult a registered dietitian. Call 651-232-7101 at St. John’s Hospital or
651-232-0647 at Woodwinds Health Campus.
Vitamin D
If you do not drink milk or get adequate sun exposure, consult your provider to be sure you are getting
sufficient amounts of vitamin D.
Safe food handling during pregnancy
Occasionally, the food we eat can make us sick. Precautions like hand washing, keeping surfaces clean, not
allowing cross contamination between cooked and uncooked foods, cooking foods to proper temperatures
and refrigerating foods promptly, are very important. Food contaminated by harmful bacteria can cause
serious illness. Lysteria monocytogenes is one type of bacteria that can cause an illness called listeriosis.
Listeriosis can be especially harmful to pregnant women and their unborn babies.
The symptoms of listeriosis may take several days or weeks to appear. Listeriosis may cause flu-like
symptoms like fever, chills, muscle aches and sometimes diarrhea or stomach upset. The severity of
symptoms varies. Consult your provider if you have these symptoms. Listeriosis is diagnosed with a blood test.
Treatment includes the use of antibiotics. Antibiotics are also given to babies who are born with listeriosis.
It is especially important to take food safety precautions during pregnancy. By carefully following food safety
precautions, people at risk for listeriosis can greatly reduce their likelihood of becoming ill. The USDA’s Food
Safety and Inspection Service and the US Food and Drug Administration offer the following advice:
• Do not eat hot dogs, lunch meats or deli meats unless they are reheated until steaming hot.
• Do not eat soft cheese like feta, brie, camembert, blue-veined cheeses and Mexican style cheeses
unless they are pasteurized.
• Do not eat refrigerated pâté or meat spreads.
• Do not eat refrigerated smoked seafood unless it is an ingredient in a cooked dish.
For more information visit the CDC web site at cdc.gov/foodsafety.
11
Sample daily menu during pregnancy
Breakfast
One slice of toast with margarine
Dinner
3/4 cup cereal with sliced banana
1/2 cup potatoes with margarine, sour
cream or yogurt
Two eggs
3 ounces of fish
4 ounces of citrus fruit or juice
Spinach salad (reduced calorie dressing
or oil and vinegar dressing)
8 ounces of milk or water
Melon slices
Lunch
8 ounces of milk
One whole wheat roll with margarine
Chef’s salad (2 to 3 ounces meat, 1 to 2
ounces cheese, carrot, tomato, lettuce,
reduced calorie or regular dressing)
8 ounces of milk
Snack
Options (one to two per day): milk shake,
bran muffin, apple or celery with peanut
butter, carrot sticks, water and juice,
cheese and crackers
Oatmeal raisin cookie
Water
Remember to drink water throughout
the day.
Salt and fluids
An adequate intake of salt during pregnancy is important to maintain a sufficient fluid balance. Extra fluid or
liquids are necessary during pregnancy to support the increased blood volume and amniotic fluid around
the baby. Fluids assist food digestion and absorption of nutrients as well as helping to regulate your body
temperature. Drink 8 to 12 glasses of liquid daily (water, milk, fruit juices, non-caffeinated). Do not drink less if
you are retaining fluid. Reducing your intake of salt is not necessary unless you are a heavy salt user.
Folic acid
Folic acid is a B vitamin found mainly in green leafy vegetables, beans, asparagus, citrus fruits, juices and
whole grain foods. Taking folic acid is especially important in the three months just before conception and in
the early weeks of pregnancy. Folic acid helps to protect your unborn baby from birth defects of the spine
and brain, such as spina bifida or “open spine.” The U.S. Public Health Service urges you to consume 0.4
milligrams of folic acid every day but no more than 1 milligram unless instructed by your provider.
12
WEIGHT GAIN
One of the best ways to protect your baby’s health is to gain a healthy amount of weight during your
pregnancy. “How much weight should I gain?” is a question most mothers ask. How much weight you need
to gain depends on whether you are underweight, average weight or overweight before becoming pregnant.
There is no single correct answer, but there are guidelines.
Approximate weight gain distribution
Baby Placenta
7 to 8 lbs.
1 lb.
Uterus 2 lbs.
Amniotic fluid
2 lbs.
Breasts
1 to 2 lbs.
Blood volume
3 to 5 lbs.
Fat 5 to 7 lbs.
Tissue fluid
4 to 6 lbs.
TOTAL
2011 March of Dimes guidelines state if your
pre-pregnancy weight was:
Below average, you should gain more weight
(approximately 28 to 40 lbs.) than women who
are of average weight.
Average weight, you should gain 25 to 35 lbs.
For overweight women, with a BMI of 30 or greater, you
may gain less weight (approximately 11 to 20 lbs.) and
benefit yourself and baby by eating high quality foods.
25 to 33 lbs.
Helpful hints
When you listen to your hunger cues and eat sensibly, you can trust that the amount of weight you gain is
right for you.
Don’t diet! Pregnancy is not the time to lose weight. On average, your body needs 200 to 300 additional
calories per day to support your growing baby. Low calorie diets simply cannot meet the needs of your body
and your growing baby. If there are not enough nutrients for both you and your baby, the nutrients will go to
maintain your body first.
In the last six months, your baby really begins to grow. For the remainder of your pregnancy, you may gain as
much as 1 pound per week. A sudden weight gain during pregnancy can be a sign of high blood pressure.
If you gain more than 6 pounds in one week, contact your provider.
13
DRUGS AND MEDICATIONS
Smoking: make a plan to quit now!
The American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, and the
American Lung Association all warn that smoking may complicate pregnancy. Tobacco smoking has been
widely studied and the evidence is clear: smoking is harmful to mothers and babies!
Smoking during pregnancy can cause:
• Increased risk of miscarriage and preterm labor.
• Smaller birth weight babies who may have more difficulties eating and keeping warm.
• Chronic respiratory problems and ear infections for your baby.
• Passive smoking or second-hand smoking (breathing in other people’s smoke) can be harmful to
you and potentially harmful to your unborn baby.
• The incidence of respiratory illness is higher in children from households where adults smoke.
• If anyone around you smokes, ask them to go outside to smoke both during pregnancy and after
the baby is born.
Liquor (alcohol) and pregnancy don’t mix
The Surgeon General of the United States has recommended that pregnant women do not drink any alcohol.
If you had an occasional drink – perhaps before you knew you were pregnant – talk with your provider.
Here are some facts about alcohol use and its effects:
• Alcohol quickly crosses the placenta and enters the baby’s blood in the same concentration as
yours.
• Babies born to mothers who use alcohol are at risk for suffering from Fetal Alcohol Syndrome (FAS)
or Fetal Alcohol Effect (FAE) - disabilities that include mental and physical retardation, tremors and
peculiar facial characteristics. FAS and FAE are the only birth defects that are totally preventable.
• No one has been able to determine a “safe” dose of liquor.
• Beer and wine are not less harmful than hard liquor.
• In any situation where you might drink alcohol, substitute fruit juice or mineral water.
• If you think you have a problem with drinking, call Alcoholics Anonymous, 651-227-5502 or speak
to your health care provider.
14
Caffeine
Coffee, tea, colas and other soft drinks (read the label), chocolate and some over-the-counter drugs contain
caffeine. Significant caffeine use by pregnant women may be associated with miscarriages in the late first
and second trimesters and low birth weight in term infants. The Journal of Obstetrics and Gynecology in an
article from July 2010, as well as the March of Dimes, recommend limiting your intake of caffeine to less than
200 milligrams a day. This is the amount of caffeine found in 2 to 8 ounces of brewed coffee or 25 ounces of
tea. Remember to include caffeine from all sources in your daily intake.
Cocaine, “crack,” amphetamines (speed, ice, crank) and other street drugs
NEVER take any street drugs! Most street drugs can seriously harm your baby during pregnancy and have
lasting effects. It is important to have an honest conversation with your health care provider about what
drugs or medications you use or have used in the past.
Drug use throughout pregnancy is associated with miscarriage, low birth weight, placental abruption
(separation of the placenta from the uterine wall,) premature birth, birth defects and an increased risk of
stillbirth. Your baby may even be born addicted to drugs.
Use of any form of cocaine, including crack, during pregnancy decreases the food and oxygen supply
to the baby. A lack of oxygen and nutrients can affect the growth or even result in the death of the baby.
Newborns who are exposed to drugs during pregnancy are often jittery and irritable, cry at the slightest noise
or gentlest touch, appear withdrawn or unresponsive and become difficult to console. Later in life, these
children may be permanently impaired: physically, behaviorally and emotionally.
Discuss this with your provider and/or contact the Narcotics Anonymous Referral Line at 952-939-3939.
You may visit the web site drugabuse.gov for more information.
15
Medications
Always check with your provider before using
any medication. During pregnancy, over-thecounter medications such as pain relievers,
antihistamines and cough suppressants may be
safe. Some medications are considered “safe” to
take during pregnancy; others can have minor
effects and a few may cause serious birth defects.
Nutritional supplements, herbs and dietary aids are
considered medications. It is important to discuss
the use of medications, herbs and supplements
with your health care provider before you use them
while pregnant or breast-feeding. Your provider
will know which prescribed and over-the-counter
medications are safe to use during pregnancy.
It is preferable to not use medication in the
first trimester unless medically necessary. The
following medications are considered acceptable
for use during pregnancy. This list is not complete,
just a guide. Your provider may know of other
medications that are safe.
Acceptable medications
Acetaminophen (such as Tylenol®) - may be
used throughout pregnancy; pain reliever.
Guaifenesin (such as Robitussin® plain,
not DM) - not advised if you have diabetes,
including gestational diabetes; expectorant.
Diphenhydramine (such as Benadryl®) antihistamine; allergy relief.
Chlor-Trimeton® – seasonal allergy relief.
Miconazole (such as Monistat® 7,
Micatin®) - vaginal creams for treatment of
yeast infections. Contact your health care
provider for accurate diagnosis before treating.
Hydrocortisone cream – minor skin irritations,
itching; topical steroid.
Maalox®, Mylanta®, Tums®, Riopan – heartburn,
indigestion; antacid.
Metamucil®, Fibercon®, Citrucel® – fiber
laxative, promotes regularity.
Anusol®, Anusol HC®, Preparation H® - for
temporary relief of pain and itching associated
with hemorrhoids.
Antibiotics: (penicillin, cephalosporins,
erythromycin and others) – to treat bacterial
infections.
16
DOMESTIC VIOLENCE
The problem of domestic violence is widespread. It happens in families of all races, social, economic and
religious backgrounds. Abuse can be emotional or sexual as well as physical or verbal. Abusive behavior
includes being verbally harassed, pushed or slapped, being punched, stabbed or having your life threatened.
Controlling the amount of time a woman spends with her friends or family and the activities she engages in
can also be abuse, as can controlling the amount of money she has to spend.
Abuse often occurs (or can escalate) during pregnancy. One study found that 37 percent of pregnant women,
regardless of race or other factors, were physically abused during pregnancy.
Women often remain in abusive relationships because they are financially or emotionally dependent on
their abuser. Sometimes religious or family values keep women with their abuser; other times women feel
powerless to change their situation or are simply too frightened to leave.
If you are being abused, you have choices. These include:
• Stay in the relationship.
• File a police report.
• Obtain an “Order For Protection” - a temporary restraining order that gives you legal protection
from your abuser. (See “Order For Protection” below.)
• Attend support groups with people who are in similar situations.
• Seek temporary safety with friends, relatives or in a safe home/shelter.
• Talk to your provider about your concerns. The information you discuss is confidential.
Order For Protection
What is an Order For Protection? An Order For Protection (OFP) is a court order that will help to protect
you from domestic abuse. An Order For Protection tells the abuser to stop harming or threatening you. If the
order is violated, it is easier for the police to arrest the abuser. Orders For Protection do work!
Who can get an Order For Protection? Any family or household member may ask the court for an
Order For Protection. A family or household member means married or divorced people; parents and their
children; persons related by blood (such as brothers, sisters, uncles, aunts or grandparents); and people who
live together or have lived together in the past. People who have never lived together may also ask for an
Order For Protection if they have a child together or have been involved in a significant romantic or
sexual relationship.
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Victims of abuse who are at least 16 years old may get an Order For Protection against an abuser they are, or
were, married to or have a child with. Other victims of abuse under 18 years of age must have another family
or household member or an adult (at least 25 years old) get an Order For Protection for them.
How do I obtain an Order For Protection? Go to the courthouse (you may want to call first to see if you need
an appointment or to get instructions) in the county where you live; in the county where the abuser lives; in
the county where the abuse happened; or in the county where you and the abuser had other family court
cases. There you will be instructed on how to file an Order For Protection. You do NOT need a lawyer and
there is no fee. Your Order For Protection is effective in all 50 states, the District of Columbia, Tribal Lands
and United States Territories. If you feel you, or someone you care about, is in immediate danger
call 911.
Domestic violence referral numbers
Minnesota Coalition of Battered Women
651-646-0994
Women of Nations Eagle’s Nest Shelter and Crisis Line
651-251-1601; crisis line 651-222-5836
Latinas Domestic Violence Line
Casa de esperanza: 651-772-1611
Domestic Abuse and Crisis Shelter
1-866-223-1111
24-hour domestic violence line for counseling, locating a shelter, advocacy services or legal services. All
programs are free and confidential.
United Way 2-1-1 (formerly First Call For Help)
651-224-1133 or 211
A free, 24-hour information and referral service to more than 2,200 community organizations whose focus
is on preventing violence and/or providing services to victims of violence.
Tubman
651-770-8544
Can refer women and children to support groups in Ramsey County and Washington County.
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People Incorporated - Parent Support Services
Ramsey County: 651-641-1300
Greater Minneapolis Crisis Nursery: 763-591-0100
Pillsbury Crisis Nursery: 612-302-3500
Crisis intervention and resource referral for families regarding child abuse prevention. Provides emergency
care for children, newborn through 6 years.
Domestic Abuse Project
612-874-7063
Provides counseling, crisis intervention and community outreach.
St. Paul Intervention Project
651-645-2824
Crisis intervention for women living in the St. Paul area.
Community University Health Care Center
612-638-0700
Provides counseling and social services in Southeast Asian languages, as well as other languages
Prevent Child Abuse MN
651-523-0099
Provides free support group meetings for parents.
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BODY MECHANICS
Posture
Good posture is especially important during pregnancy. As you gain weight and your body changes shape,
you will need to adjust your posture. When your posture is poor, your abdominal muscles relax causing the
curve of your back to be exaggerated. In turn, the small muscles of your lower back will shorten and tighten
to maintain your balance and alignment. This often causes backaches. During pregnancy your center of
gravity shifts as your baby and uterus grow larger. It takes effort on your part to maintain good posture.
You can improve your posture by:
• Standing as tall as possible and by keeping your chin level.
• Flat or low-heeled shoes are helpful and recommended during pregnancy.
• Exercises to maintain abdominal muscle tone and strength are also helpful.
Standing
Standing for a long time can slow the return of blood from your legs, back to your heart and brain, causing
you to feel light headed. To help the return of blood, tighten your leg muscles occasionally to stimulate flow,
rotate your ankles in small circles and rock back and forth from your toes to your heels. To help prevent
backaches while standing, place one foot on a low stool, alternating feet.
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Lying down
As your pregnancy advances it will become more difficult to find a comfortable position while lying down.
Many women find it helpful to use pillows. When lying on your side, place a pillow between your knees
and one under your head. Some women find it comfortable to bend the leg resting on top and support it with
a pillow.
Side lying is especially important if you have pregnancy-induced hypertension (high blood pressure). It is
advised that you lie on your left side, which increases placental circulation. It is also a position in which your
heart functions more efficiently. If possible, stay off your back, especially in late pregnancy. Women often find
that this position causes them to feel dizzy and short of breath. This is caused by the weight of the uterus
pressing on the large abdominal vein, which causes a drop in blood pressure and a feeling of being light
headed. Lying on your back for a prolonged period can cause a decrease in blood flow to the placenta and
oxygen to the baby.
Sitting
Avoid sitting for long periods of time, especially in late pregnancy. Sitting slows the return of blood from
your legs.
To assist your circulation:
• Do not cross your legs at the knees for long periods.
• Move and rotate your feet at the ankles.
• Later in your pregnancy, it is more comfortable to sit in, and get out of, a straight-backed chair.
• A small pillow at your lower back and a low stool to rest your feet increase comfort.
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EXERCISE
Regular exercise provides benefits for healthy women with routine pregnancies. What does this mean for
you? You will have more energy and feel better about yourself, you will be able to move easier and be less
likely to experience the aches and pains often associated with pregnancy. You will likely sleep better at night
and it may help your labor to be more efficient. Aerobic (“with oxygen”) exercises are especially helpful. The
entire time you exercise you should be able to hold a conversation. If you find yourself out of breath and
unable to talk, slow down.
Moderate exercise during pregnancy has many benefits:
• Some control over your changing shape.
• An increase in metabolic rate that enables you to burn more calories.
• Stronger respiratory and circulatory systems.
• Increased flexibility and muscle strength.
General guidelines for exercise in pregnancy
• Talk with your provider before beginning an exercise regimen or any time you have questions about
exercising.
• The American College of Obstetricians and Gynecologists has exercise guidelines at their website:
acog.org/Search?Keyword=exercise+pregnancy
• Exercise regularly, three to four times a week. Take time to warm up and cool down.
• Brisk walking is a wonderful alternative if you did not exercise before becoming pregnant.
Swimming, biking on a stationary bike or maternal fitness classes are also good choices.
• Wear appropriate, supportive footwear.
• Keep track of your pulse rate. It should not exceed 140 beats per minute.
• Stop the exercise if you feel pain. You may be straining muscles, joints or ligaments.
• Avoid strain and fatigue. Start with the easiest position, and then try others as your muscles
strengthen. Start with a few repetitions, gradually increasing the number.
• Don’t exercise vigorously in hot, humid weather, or when you are ill or have a fever.
• Be sure you have eaten and have had plenty of liquids before you exercise.
• If you join a maternal fitness class, check the qualifications of the instructor. The instructor should
have a degree in adult fitness and some experience with exercise in pregnancy.
• Do not do exercises that require you to lie on your back for long periods of time.
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BODY CONDITIONING
Pelvic tilt (pelvic rock)
Partial sit-ups or curls
Benefits: Strengthens/tones abdominal muscles,
stretches lower back muscles and eases backache.
When done on “all fours,” it takes the weight of baby
and uterus off the lower back and improves
circulation from lower extremities.
Benefits: Tones/strengthens abdominal muscles
used in pushing and for postpartum waistline
recovery.
Lie on your back, with your knees bent and feet flat
on floor. Flatten the small of your back onto the floor
by contracting your abdominal muscles. Hold for five
seconds, exhale and relax.
Get on your hands and knees. Keep your back
straight - not arched or swayed - and your knees
comfortably apart. Tighten your abdominal muscles
to arch your lower back. Hold for five seconds. Relax
and return your back to the starting position. Repeat
this exercise and each variation five times a day.
Lie on your back with your knees bent and feet flat
on the floor. Breathe in, tilt your pelvis and keep your
lower back pressed against the floor. While breathing
out, raise your head and shoulders from the floor,
reaching your outstretched arms toward your knees.
Keep your waist on the floor. When your shoulders
are raised about eight inches, hold this lift for five
seconds. Relax and gently lie back. Repeat about
five times a day.
Tailor-sitting
Benefits: Strengthens pelvic floor muscles and
stretches inner and outer thighs.
Sit on the floor with your legs pulled in and crossed
at the ankles. In this position you can also perform
a tailor press. Inhale; lift knees; exhale; press knees
towards floor with your hands while exerting upward
pressure with your legs.
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Shoulder circling
Breast support
Benefit: Help to relieve tension in shoulders, neck
and back.
Benefits: Tones your upper chest muscles.
Stand or sit with your back straight, arms relaxed
and chin level. Raise your shoulders towards your
ears, then slowly roll them forward, down, back and
up again, making large circles with your shoulders.
Finish with your shoulders back and down in a
relaxed position. Do five rotations, then repeat,
reversing the direction.
Grasp forearms with hands, elbows flexed at
shoulder level. Slowly press hands toward elbows
as if pushing up sleeves; hold to count of five and
release. Repeat three to four times per day.
Kegel
Benefits: Helps identify muscles involved in birth.
Tones and gives elasticity to pelvic floor. Promotes
circulation to pelvic floor. After an episiotomy,
kegeling will increase circulation to the episiotomy
site to promote healing and reduce swelling.
Provides support for pelvic organs.
The openings from your bladder, vagina or birth
canal and rectum pass through the pelvic floor
muscles. Kegel exercises tone your pelvic floor
muscles. This, in turn, controls bladder leaks, helps
the perineum heal and tightens vaginal muscles.
Upper body stretch
Benefit: Helps relieve upper body tension and
backaches.
Tailor-sit. Cross your arms at the elbow. Inhaling, raise
your hands toward the ceiling and gradually uncross
your arms. Reach upward so you feel the stretch in
your entire upper body. Exhale as you lower your
arms out to the side and behind you, palms up. Feel
the stretch across your chest and upper arms. With
your arms down and behind you, stretch further by
pressing your arms back. Drop your arms to your
sides and relax. Repeat five times.
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Squeeze the muscles that you use to stop the flow
of urine. Hold for up to 10 seconds, then release. Do
this 10 to 20 times in a row at least three times a day.
Practice this exercise as often as you can during the
day. Make it part of your daily routine by setting up
signals for yourself. For example, every time you stop
at a traffic light, do Kegels.
The expectant partner
Did you know that your diet, habits, lifestyle and attitude play a part in how healthy your baby will be? As an
expectant partner, you can take positive steps to help your partner have a healthy baby.
Because both parents aren’t going through the same physical changes as their pregnant partner, they may
be treated as though nothing very special is happening to them. Partners are more likely to be asked, “How
is she doing?” It is easy to feel left out. Partners get the message that their role is just to be supportive of their
partner. Partners do feel protective of their partners, but they are experiencing great changes as well.
Some common concerns are:
• Will I be able to financially support my partner and child?
• Do I really have control over any of these changes? How can I gain control?
• How will my relationship with my wife/partner change? Will we be the same?
• What if something happens to my wife/partner or the baby?
• Will I be a good parent?
To help with the changes that are coming, it is important to:
Seek out the help you need. Talk to friends who have children, read up on pregnancy, birth and parenting.
Ask questions. Your partner’s provider is a good resource – go with her to prenatal visits. At prenatal visits
you will be able to hear your baby’s heartbeat and experience the pregnancy with your partner. Attend
childbirth classes together.
Talk with each other about your upcoming birth and share in the decision making. Discuss fears and
concerns, medication use during labor, who will be there to support each of you and how you will support her
during labor.
Attend a class. Check the HealthEast website for class options. healtheast.org
Make a place in your heart and home for your new baby. Prepare a nursery, read about infant car seats and
purchase one for your baby. Begin baby-proofing your home.
Take good care of your health. It is wise to change unhealthy lifestyle habits. For example, if you smoke, this
is a great time to quit for your own health and that of your partner and baby.
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Practice good communication, patience and support. Be aware, especially during early pregnancy,
that significant mood swings are common due to hormonal changes. Be kind to each other and support
each other with loving understanding. You may need to take on the more difficult and strenuous household
chores.
Understand your role during labor and birth. Talk with your partner about how she sees your role. Does
she need an active coach, a support person or simply your physical presence? Many women in labor are
comforted by the presence of their loving partner – and we know that the presence of a loving partner will
make labor better.
After your baby is born
Birth is usually followed by a sense of relief and accomplishment. You made it through! You will discover a
new respect for your partner and wonder in her strength in giving birth to your baby.
You may find yourself expecting to feel the same way as you did before the baby was born. In reality, life is
not as it used to be. As you face the challenges of parenting, don’t be surprised if you have mixed feelings.
You may feel joy and pride along with apprehension and insecurity. You will find your way and learn how to
parent your baby. This re-orientation to life will happen each time a baby is born into your family.
Take advantage of every opportunity you have for interaction with your baby. Fathers can be very nurturing
to newborns. Don’t be afraid to touch, look at, talk to, kiss or hold your baby. It will be easier for you to feel
comfortable with your baby if you take an early, active role in your baby’s care. Give yourself permission to
make mistakes. Your baby does not recognize imperfections. As the weeks go by, your infant will grow and
become more responsive to you. The time you spend learning about your baby in the early weeks will be
rewarded with gurgles and smiles intended just for you.
Partners have a doubly important job in the newborn period. This involves caring for the baby directly and
caring for the mother. Do all you can to lighten the workload and arrange for help from others when you can’t
be there. If your job permits, take some time off. A period of uninterrupted “settling in” time with the baby is
important.
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Much attention has been given to new mother’s postpartum depression, but many partners experience
postpartum depression too. Many postpartum adjustments may be related to financial and lifestyle changes,
as well as emotional and sexual changes. Sleep interruption can also be a source of depression for new
fathers. Being aware of the possible causes of father’s baby blues may help you to modify the effects. If
depression starts to interfere with your functioning or your relationship with your partner or baby, speak to
your family physician or a counselor.
As you are building a new relationship with your newborn, you are also building a new relationship with
your partner. It is natural for both of you to be completely preoccupied at times with the baby. Purposely set
time aside for each other. Patience and understanding are important during this time in which you both may
feel vulnerable. The more you understand and share about your feelings, the more you will help each other
through this period.
The postpartum period is a season of life in which many adjustments occur in a very short period of time. As
time goes on, your family life will smooth out a bit, and the postpartum season of life will be followed by other
seasons enriched by what you have learned and experienced.
It is essential to view pregnancy as something that is happening to both of you.
Again, check the HealthEast website for class options for dads and partners. healtheast.org
Your positive involvement is very
important in the life of your partner
and baby.
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COMMON DISCOMFORTS OF PREGNANCY
Common physical changes of pregnancy
Pregnancy causes many physical changes in a woman’s body. Not all pregnant women experience the same
changes. Some changes may go unnoticed and may not cause any discomfort. For example, many women
will develop linea nigra (which is a dark line down the middle of the abdomen), small vascular “spiders” on
their skin and localized areas of numbness. Changes in sensory perceptions such as smells and tastes may
also occur. This information is not intended to describe all the physical changes you may experience but will
provide guidance in self-care activities for these changes. It is unlikely that you will experience all of these.
Common changes
Suggested self-care activities
Backache
Proper posture may help reduce or prevent
backache. Wear low-heeled shoes. Make sure your
bed and chairs give adequate support and use a
footstool when reaching overhead. Squat and use
your leg muscles when picking up objects or children.
Breast tenderness
Wear a bra that offers good support. A warm shower
may offer temporary relief.
Constipation
You can often prevent constipation by drinking 6 to
8 glasses of water daily and including whole grains,
fruits and raw vegetables in your diet. Daily exercise
is helpful. If constipation occurs, begin to add 1/4 to
1/2 cup of bran to your daily diet. You can mix it with
foods such as cereal, muffins or hot dishes. As with
all medications, do not use laxatives unless advised
to by your caregiver.
Edema (swelling in feet/ankles)
When sitting, try to elevate your feet and legs. When in
bed, resting on your left side will increase the return of
blood to your heart. Eat salty foods in moderation and
try to drink 6 to 8 glasses of water daily.
Fatigue
Naps can be very helpful. Good nutrition and gentle
exercise may help you feel more energetic.
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Common changes
Suggested self-care activities
Headaches
Headaches are common between 12 to 20 weeks
of pregnancy. However, third trimester headaches
(those after 26 weeks) should be reported to your
caregiver. Eat small but frequent meals throughout
the day as hunger can make headaches worse. Noise
and fatigue can also cause headaches. Increase fluid
intake and use acetaminophen as needed.
Heartburn
Greasy, spicy and hard to digest foods can often
cause heartburn. If they affect you, avoid them.
Eat small, frequent meals throughout the day. Eat
slowly and sit up for approximately 30 minutes after
meals. Sleeping with your head and chest elevated
may also help. Chewing gum for 30 minutes after
each meal may decrease the need for antacids. For
antacids that are safe to use during pregnancy (see
“Medications in Pregnancy” on page 16).
Leg/calf cramps
Wear low-heeled shoes and maternity support hose.
Stretching for 20 minutes before going to bed may
help prevent leg cramps during the night. Avoid
pointing toes as this may encourage leg cramps.
Adequate calcium intake may decrease leg cramps.
However, use calcium supplements only on the
advice of your caregiver.
Nose bleeds, nasal congestion
During pregnancy, the lining of the nose may
bleed or crack more easily. Humidifiers or cool mist
vaporizers will keep nasal passages moist. You can
coat nasal passages with a small amount of Vaseline
to add moisture. Nosebleeds should stop after
constant gentle squeezing of the nostrils for several
minutes. For managing nasal congestion, consult
your caregiver.
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Common changes
Suggested self-care activities
Stretch marks
These may occur over your abdomen, upper thighs
and breasts. There is no way to prevent them. Using
moisturizers can help relieve the feeling of tightness
and itching that can occur.
Nausea
This is common in the first trimester and is frequently
experienced after waking up. Dry toast or crackers
before rising may be helpful to you. Eat small but
frequent meals throughout the day. Drink liquids
after meals rather than with meals. Get plenty of rest
as fatigue may increase nausea.
Round ligament pain
Usually felt as quick, sharp pains on the right or
left side of abdomen, which last a few seconds to
several minutes. Caused by the stretching of the
ligaments that support the uterus. Avoid sudden
twisting, turning or stretching. To reduce pain, lean
toward the pain to enable the ligament to relax.
Shortness of breath
This may occur in the third trimester when the uterus
is larger, and your lungs can no longer inflate fully. Use
correct posture when sitting or standing and sleep
with extra pillows to elevate your head and shoulders.
Raising your hands over your head gives space for
lungs to expand and may provide some relief.
Tips for general physical care
Rest! Naps after work, or other times throughout the day, are important. Continue your daily hygiene. Tub
baths are fine, but you may experience difficulty getting in and out of the tub. Use rubber safety mats in your
tub or shower to reduce the risk of slipping. Try to have help available or install a tub safety grip. Extremely
hot baths or showers are not advised.
• Do not douche during pregnancy.
• Avoid tight clothing such as waistbands, socks or hose that restrict circulation.
• Visit your dentist as usual. Be sure to tell the dentist that you are pregnant.
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Strengthening exercises and stretches for low back pain
Developed by HealthEast® Optimum Rehabilitation
Partial curl up
Shoulder depression
Do only if there is no diastisis recti (abdominal
muscle separation) present. Reach toward knees and
curl trunk upward. Hold three to five seconds. Do five
to ten repetitions, two times per day.
While sitting in an armchair, press shoulder
downward while concentrating on holding shoulder
blades stable. Support part of your body weight with
legs as needed. Hold five seconds and slowly relax.
Do five to ten repetitions, two times per day.
Hip abduction isometric 1 and 2
Place hands on sides of knees. Try to spread legs
apart, but resist the motion with your hands. Hold
five seconds, slowly relax. Do five to ten repetitions,
two times per day.
Place hands on inside of knees. Squeeze thighs
together, but resist the motion with your hands. Hold
five seconds, slowly relax. Do five to ten repetitions,
two times per day.
Back stabilization
Begin with your spine straight. Lift one leg up. Hold
five seconds, alternate and lift other leg up. Hold five
seconds. Do five to ten repetitions, two times per
day.
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Back sidebending
Cat/cow
Tilt head and shoulder to one side as you tilt hips
toward head, making a curved shape with your trunk.
Hold five seconds. Do five to ten repetitions, two
times per day.
Find neutral position. Tighten abdominals and
squeeze buttock muscles. Alternate from arched to
sagged. Hold five seconds. Do five to ten repetitions,
two times per day.
Scapular retraction
Stand with arms at sides. Pinch shoulder blades
together and down. Hold five seconds. Do five to ten
repetitions, four times per day.
Neck retraction
Begin sitting or standing. Tuck your chin in and pull
your head straight back. Hold five seconds. Do five
to ten repetitions, four times per day.
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Back extension-sitting
Back sidebends
Roll a small towel so that it makes a firm roll two to
three inches thick. Sit with back against chair as
shown. Place rolled towel between chair and the
small of your back. Place hands behind neck and
lean backward until you feel a stretch. Hold five
seconds. Do five to ten repetitions, four times
per day.
Lean to each side until you feel a stretch. Hold
five seconds. Do five to ten repetitions, four times
per day.
Calf stretch
Back extension-standing
Place hands firmly against hips as shown. Bend
backward until you feel a stretch. Hold five seconds.
Do five to ten repetitions, four times per day.
Position your body against a wall as shown. Point
toes directly toward wall and hold heel down. Lean
into wall as shown so that you feel a stretch. Hold 15
seconds, repeat three times each leg.
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Hamstring stretch
Hip rotator stretch
Lie on back holding one leg with hands. Straighten
the knee as far as you can, keeping your other leg
straight on the floor. Hold 15 seconds. Do three
repetitions per leg, two times per day.
Lie on your back with one knee bent, foot flat on
floor and braced against other leg. Use your hands
to pull the outside of your knee inward. Hold 15
seconds. Do three repetitions per leg, two times
per day.
Hip adduction stretch
Hip flexor stretch
Sit with knees bent, feet together. Press knees
downward toward the floor, by leaning forward and
pressing with your elbows. Hold 15 seconds. Do
three repetitions, two times per day.
Assume position shown, with one knee on chair.
Bend the opposite knee so that you feel a stretch. Do
not allow your low back to arch. Hold 15 seconds. Do
three repetitions per leg, two times per day.
These exercises are intended to be used only when mild to moderate pain is present during pregnancy. Do
each exercise as instructed. If any exercise worsens your pain, discontinue doing it until you discuss your
condition with your health care provider or physical therapist. If you are in significant pain that is considerably
affecting your daily activities, consult your provider.
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HealthEast Optimum Rehabilitation
HealthEast Optimum Rehabilitation is a network of rehabilitation centers that provide the latest in outpatient
occupational, physical and speech therapy. Treatment plans are specifically designed to meet your needs
while helping to speed recovery and decrease the chance of recurrence. Specialized treatment programs
are also available for women to treat back pain during pregnancy, rehabilitation of pelvic floor weakness/
incontinence, pelvic pain, lymphedema management and osteoporosis. Consult your provider for referral to
HealthEast Optimum Rehabilitation at any of the following locations:
Maplewood
Markham Pond Professional Center
1570 Beam Ave., Suite 200
651-232-7820
Markham Pond
Professional Building
Spine Center (Maplewood)
1747 Beam Avenue #100
651-326-5569
St. Paul Midway
1690 University Ave., Suite 430
651-232-5412
Oakdale
Tessar Professional Bldg.
1099 Helmo Ave., Suite 110
651-232-5075
Spine Center
Tessar
Professional
Building
Stillwater
University Park
Professional Bldg.
Woodwinds Oak Center
Woodbury
Oak Center
1825 Woodwinds Drive, Suite 100
651-232-6767
Stillwater
2900 Curve Crest Blvd.
651-471-5630
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WARNING SIGNS DURING PREGNANCY
When you are pregnant some of the changes your body experiences can feel a little strange. Usually these
are normal sensations but sometimes they can be an indication that there may be a problem. Report
anything unusual. If you have a concern, a phone call to your provider may be all that is needed to restore
peace of mind.
Call your provider if you experience any of the following:
• Vaginal bleeding (even a small amount)
• Abdominal pain or cramping
• Constant, or intermittent, painful firmness of the abdomen, with or without vaginal bleeding
• Leaking or gushing of fluid from the vagina
• Sudden puffiness or swelling of the hands, feet or face
• Severe, persistent headache
• Disturbance of vision including spots, flashes, blurring or blind spots
• Dizziness, light-headedness
• Noticeable reduction in fetal activity
• Painful, warm, reddened area in the leg
• Severe pain in the pubic area and hips with difficulty moving legs
• Pain or burning when urinating
• Irritating/itching vaginal discharge or genital sores
• Persistent nausea or vomiting
• Fever - oral temperature more than 100 degrees F
You do not have to wait for a scheduled appointment to ask questions!
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Bleeding in early pregnancy
ANY bleeding in pregnancy should be reported to your provider, but not all bleeding means you are having
a miscarriage. Nearly 25 percent of all pregnant women experience some spotting or bleeding in early
pregnancy. In more than half of these cases, it goes away, and a normal, healthy pregnancy continues.
Light bleeding or spotting that is brown or pink in color and not accompanied by cramping can occur at
these times:
• During implantation, when the fertilized egg attaches itself to the uterine wall.
• After sexual intercourse or a pelvic exam, due to the increased blood supply to the cervix.
Cramping in early pregnancy
As your uterus grows and expands, some cramping may occur. Cramping accompanied by bleeding may be
a sign of a miscarriage. Call your provider immediately.
MISCARRIAGE
One in five confirmed pregnancies will end in miscarriage. This estimate may, in fact, be low. A miscarriage
can occur before a woman knows she is pregnant. She may only notice a period that is later and heavier
than normal, with stronger than normal cramps and never realize that she is miscarrying. Most miscarriages
happen during the first trimester, although a woman can miscarry any time before 20 weeks. Unfortunately,
there is little that can be done to prevent a miscarriage once it has started. Though a miscarriage can be
emotionally difficult, it is a natural, inevitable process that occurs when the body recognizes that a pregnancy
is not progressing normally.
Possible signs and symptoms of miscarriage
If you experience any of the following signs and symptoms, contact your provider:
Heavy bleeding: Bright red vaginal bleeding that is as heavy as or heavier than a menstrual period.
Significant cramping: Cramping pain that is stronger than menstrual cramps and may be very intense.
Cramping may be constant or intermittent.
Passing of large clots or whitish or grayish tissue: This may mean a miscarriage has already begun.
If you pass any tissue, place it in a plastic bag, store it in the refrigerator and bring it with when you see
your provider.
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Medical intervention for a miscarriage
Your provider may advise you to observe symptoms at home and report back, or you may be asked to come
to the clinic. Once a miscarriage is confirmed, a surgical procedure is sometimes required to remove tissue
that has not passed. Although a miscarriage is not generally a serious medical condition, it can be very
frightening. Keep in contact with your provider as you need to.
After you’ve had a miscarriage
Some women wonder if they did something to cause the miscarriage. In the overwhelming majority of
miscarriages, that is not the case. Sexual intercourse, vigorous exercise, falls or emotional upsets do
not cause a miscarriage. Most women who have one or two miscarriages go on to have normal, healthy
pregnancies. The likelihood that the next pregnancy will be successful is as high as 85 percent. Generally,
further medical tests aren’t considered until three or more losses have occurred.
Deep feelings of loss and sadness often occur when a pregnancy ends in miscarriage. The baby who was to
be is gone; hopes and plans for the future have been erased. This is a time to share your feelings with your
partner, grieve as you need to and ask for support from others. Feel free to call your provider, midwife or the
Infant Loss Coordinator facilitator at 651-232-3192.
Ectopic or tubal pregnancy
This type of pregnancy occurs when the fertilized egg becomes implanted outside the uterus, usually in the
fallopian tube. Left untreated, the tube could burst, creating a potentially life threatening condition. Signs and
symptoms that should be reported to your provider include sharp pain on the left or right side which is not
relieved when you lie down, often associated with spotting or bleeding. Medical intervention is necessary
and may include surgery.
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YOUR HEALTH INSURANCE COVERAGE
Maternity care coverage varies with individual health insurance plans. It is your responsibility to know your
coverage in advance. The following questions will assist you when you talk to your insurance carrier.
Insurance company:
Policy number:
Phone number for benefits:
Person spoken to:
1. Do I need pre-approval for my hospital stay? r Yes
Date/time of call:
r No
If yes, how do I get this approval:
2. If I have an uncomplicated vaginal delivery, what is the normal postpartum hospital stay for
which I do not need a provider’s reason to stay longer?
3. If I have an uncomplicated Cesarean birth, what is the normal postpartum hospital stay for
which I do not need a provider’s reason to stay longer?
4. Does my authorized hospital stay begin with: r Admission to hospital
r Time of birth
5. If I have complications, will additional hospitalization time be authorized? r Yes
6. Will insurance cover a Home Care visit after I leave the hospital? r Yes
r No
r No
7. What physicians are covered (in network) under my insurance plan for the baby’s care?
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8. How do I add my new baby to my insurance plan?
9. If I have a boy and want him circumcised, is that a covered procedure? r Yes
r No
10. What coverage is provided if my baby requires additional hospitalization?
11. Will my plan cover an outpatient lactation visit if I need breast-feeding help after my baby is
born?
r Yes r No
Who is covered? Myself or my baby?
12. Does my plan cover the cost of a personal use, double electric breast pump?
r Yes
r No
13. If my insurance plan benefits change, will I be notified? r Yes
14. Other questions you may have
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r No
YOUR PRENATAL CARE
Regular, thorough prenatal care helps ensure that your baby will be born healthy. Soon after you become
pregnant, it is important to begin seeing your midwife or provider regularly.
During these prenatal visits, you will have an opportunity to discuss concerns. You will have routine
examinations to monitor your pregnancy. As your pregnancy progresses, routine screening/diagnostic tests
are offered or performed to detect any problems with mother or baby. While these tests are reassuring when
the results are normal, if a potential problem is discovered, intervention can take place as soon as possible
You will also have opportunities to begin to work with your provider in planning your birth experience and
making a birth plan. It is helpful to have your partner accompany you to one or more of your prenatal visits.
This allows your partner to experience the pregnancy first hand and to discuss their role during labor and
birth. It is also helpful to meet the other providers or midwives, since one of them might be on call when you
are in labor.
Prenatal visit #1
8 to 11 weeks
Date of visit
Weight
Blood pressure
Height
Estimated due date
Physician examination to include:
• Head, ears, eyes, nose, throat
• Heart and lungs
• Lymph nodes
• Breasts
• Abdomen
Pelvic (vaginal) examination to check:
• Cervix, vagina, ovaries and fallopian tubes.
• Uterus - The uterus is checked to confirm your pregnancy and due date.
• Bony pelvis - This is done to assess the pelvic structure for size and shape.
• A speculum examination is done to visualize the cervix and to take a pap test to screen for abnormal
changes or signs of cervical cancer. A vaginal culture may be needed if there are signs of vaginal
infection. Depending on your sexual history, a culture of your cervix may be taken to test for Chlamydia
or gonorrhea.
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Routine tests during pregnancy
There are routine lab tests that are done on all pregnant women. These tests may help your provider spot
possible problems during your pregnancy. They will provide clues about how your baby is developing.
Other tests may be performed depending on your medical history, family background, ethnic background
or exam results.
Urine
Tested for levels of sugar and protein. May be repeated throughout pregnancy and for infections.
Blood Tests
• Hemoglobin: Test for anemia
• Type and Rh factor
• RPR: Test for syphilis (an STD)
• Rubella: Immunity to German Measles
• Hepatitis B antibodies: To determine exposure
• HIV: To detect the AIDS virus
• Other blood tests may be needed depending on your health history.
Risk screening assessment
It is very important that your provider is aware of your past history and present lifestyle. This risk assessment
includes physical, mental, emotional and genetic factors. Some of the questions will be assessed through a
written worksheet and others will be asked by your provider.
A risk assessment includes:
• Substance abuse (tobacco, drugs and alcohol)
• Physical activity
• Violence and domestic abuse
• Sexual practices
• Use of medication
• Nutrition
• Previous medical, surgical and obstetrical history
• Genetic history
• Complications from previous pregnancies
• Infectious disease
• Accurate recording of menstrual dates
• Environmental or work concerns
Education
• Physiology of pregnancy and warning signs of problems
• Plan of care and practice policies
• Relief measures for common complaints of pregnancy
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Blood type and Rh factor
You will have a blood test to find out your blood type. Just as there are major blood groups, such as A and
B type blood, there is also an Rh factor. The Rh factor is a type of protein (antigen) found on red blood cells.
If blood lacks the Rh antigen it is called “Rh negative.” If it has the antigen it is called “Rh positive.” The Rh
factor does not affect a person’s general health, but problems may arise when the unborn baby’s blood has
the Rh factor and mother’s blood does not.
During pregnancy, mother and baby do not share blood systems. However, blood from the baby may
cross the placenta into the mother’s system. Should this occur, a small number of pregnant women with Rh
negative blood who carry an Rh positive baby will react as if they were allergic to the baby’s blood. They
become sensitized by making antibodies which go back and enter the baby’s blood. There they break down
the red blood cells and produce anemia (iron deficiency). This condition is called hemolytic disease which
can be a serious disease for an unborn or newborn baby.
Once formed, the antibodies do not go away. There is a drug that may help – rho(D) immune globulin. If
a woman with Rh negative blood has not been sensitized, her provider may suggest she receive rho(D)
immune globulin around week 28 of pregnancy to prevent sensitization for the remainder of the pregnancy.
Shortly after birth, if the baby has Rh positive blood, the mother should receive another dose of rho(D)
immune globulin. This treatment is only effective for the pregnancy in which it is given. Each pregnancy and
delivery of an Rh positive baby requires repeat doses of rho(D) immune globulin.
Prenatal Testing
Description: Prenatal testing is part of nearly every pregnancy. Your provider can give you information about
testing that may benefit you, however, the choice is yours.
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Who should be tested:
Women who already may be at increased risk of having a baby with one of the birth defects mentioned
above or women with the following risk factors:
• maternal age of 35 or older when the baby is due
• family or personal history of birth defects
• previous child with a birth defect
• use of certain medicines around the time of conception
• insulin-dependent diabetes prior to pregnancy
Tests in early pregnancy used to rule out abnormalities:
Ultrasound
Your provider may use ultrasound information to verify due date, check on the cause of bleeding in
pregnancy, detect normal growth and development or to confirm the number of babies in a multiple birth. An
ultrasound uses sound waves instead of radiation to create an image of your baby. A special scanning device
is placed over the uterus or in the vagina and a picture of your baby is produced on a screen.
Amniocentesis
This test is most useful between 14 and 18 weeks of pregnancy and is done with the aid of ultrasound. A
needle is passed through the abdomen and uterus into the amniotic sac and a small amount of amniotic
fluid is withdrawn. The cells from the fluid are examined for genetic birth defects, such as Down syndrome.
It is generally offered to women who will be 35 years of age or older at the time of delivery, or with a family
history of genetic disorder. Your provider will carefully explain the risks involved with this procedure.
Screening tests for fetal well-being
Maternal Serum Screening tests use a sample of the pregnant mother’s blood to give information about
her chances of having a baby with certain birth defects such as Down syndrome and spina bifida, or “open
neural tube defect.” Spina bifida is a condition where the coverings around the fetus’ brain or spinal cord do
not form properly. A screening test can only assess your risk of having a baby with certain defects. If your
screening test shows a higher than average risk for having a baby with a certain defect, further diagnostic
tests may be offered. Most women with abnormal screening tests have normal babies. It is your decision to
have the test. While some women find it reassuring, others would rather not have the information. The results
of these tests can help women and their partners make decisions about their options.
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Harmony Prenatal Testing
Some providers use the Harmony Prenatal Test. It is a blood test that is available to check for trisomy
disorders. A trisomy is a chromosomal condition that occurs when there is three copies of a particular
chromosome instead of the expected two. Harmony Prenatal testing can screen for trisomy 13 (Patau
syndrome), trisomy 18 (Edwards syndrome) and trisomy 21 (Down syndrome). The test does not rule
out all fetal abnormalities.
Nuchal Translucency screening
This is a non-invasive screening that may be performed in the first trimester. It involves the use of ultrasound
and a blood draw from mother.
This test can confirm how far along the pregnancy is, and can take a measurement of fluid underneath the
skin fold along the back of the baby’s neck. This measurement is called nuchal translucency. The blood
sample from mother will be analyzed for chemicals and proteins that are found in all pregnant women’s
blood. The combination of these two tests can help identify pregnancies with a high risk of Down syndrome
and other chromosomal abnormalities.
Alpha-fetoprotein test
Alpha-fetoprotein (AFP) is a protein made by your unborn baby. It is present in baby’s blood and the mother’s
blood and, in smaller amounts, in amniotic fluid (liquid that surrounds the baby in the mother’s uterus). A small
amount of AFP crosses the placenta and enters the mother’s blood.
The AFP test is usually done at 15 to 18 weeks of pregnancy. A small amount of blood is taken from a vein in
the mother’s arm and tested in a lab. Results are usually available in about a week.
AFP levels are higher than normal in the maternal serum of many women (80 percent) carrying fetuses with
open neural tube defects. A high level of AFP can signal a risk of neural tube defects (such as spina bifida). A
low level can signal a risk of Down syndrome.
Positive results don’t always indicate there’s a problem. For this reason, an abnormal screening test result
is followed up with other tests. Other causes of high AFP levels may be that the fetus is older than was
thought or twins.
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Multiple marker screening (MMS) tests
Combining other tests with the AFP test can give more information about your risk of having a baby with
Down syndrome than the AFP test alone. These are called multiple marker screening (MMS) tests. MMS tests
are also performed at 15 to 18 weeks of pregnancy. These tests can be done at the same time as the AFP,
using the same blood sample. The results come back in one to two weeks.
The best combination of tests is not yet known. Most providers who use multiple tests use two or three tests
together. Besides measuring AFP, MMS tests measure other levels in the woman’s blood that change with
pregnancy.
Other levels that might be measured are human chorionic gonadotropin (hCG) and estriol.
HCG is a hormone produced by the placenta. Levels of hCG are higher than normal in most pregnancies if
the unborn baby has Down syndrome.
Estriol is produced mostly in the placenta and in the baby’s liver. Estriol levels are lower than normal in most
pregnancies with a baby with Down syndrome. Routine tests can be followed up with other tests if the results
raise concerns. Your provider also may suggest special tests if you have certain risk factors.
Chorionic villus sampling (CVS)
This is used to diagnose genetic birth defects and involves sampling placental tissue. The advantage of CVS
is that it can be performed earlier than amniocentesis, between 9 and 11 weeks, and results can be obtained
faster. However, the test also poses a higher risk of complications. The perinatologist who would perform the
CVS will discuss the risks and benefits of this test.
Bacterial vaginosis screening during pregnancy
Bacterial vaginosis is a common vaginal infection caused by an imbalance of the bacteria normally found
in the vagina. Bacterial vaginosis affects 12 to 22 percent of pregnant women and half of these women will
not have symptoms. Bacterial vaginosis significantly increases the risk of preterm birth and low birth weight
babies. Women can be screened for bacterial vaginosis with a simple test during a pelvic exam. Rescreening
later in pregnancy may be recommended. Antibiotics are used to treat bacterial vaginosis during pregnancy.
Treatment with antibiotics can reduce pregnancy complications related to bacterial vaginosis, such as
preterm labor and low birth weight babies, by 40 to 50 percent.
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HIV/AIDS
As a routine part of your prenatal care, it is recommended that you have a confidential HIV test. Many women
do not know that they have been exposed to HIV because they do not feel they have put themselves at risk.
You are at risk for HIV if you have had unprotected sex (without use of a latex condom) even one time with
someone who may be infected. You are also at risk if you have shared needles or syringes with someone
who is infected with the virus. An HIV test can let you know if you have the virus so you can make the best
decisions for yourself and your baby. If you are infected, you will be able to start treatment early, which may
help you live a longer, healthier life and may help prevent transmission to your unborn baby. If you are not
infected, you should continue to protect yourself. There are three ways to avoid infection and protect yourself
and your baby:
• Do not have sex at all.
• If there is any chance that your sex partner has ever had sex with anyone else or, ever used
injected drugs, you should use a latex condom every time you have sex to reduce the chance of
transmission.
• Do not use injected drugs or share needles and syringes.
If you are infected, you might give HIV to your baby during pregnancy, at delivery or by breast-feeding. Early
detection allows for early treatment. Without treatment, about one out of every four babies born to HIV
infected mothers are born with HIV infection.
Prenatal visit #2
12 weeks
Date of visit
Weight
Blood pressure
Fundal height
Fetal heart tones
Height
Education
• Fetal growth
• Decision on genetic screening tests for next visit
• Infant feeding
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Infant Feeding Policy
One of the most important choices you will need to make as new parents is how to feed your baby. The
American Academy of Pediatrics recommends exclusive breast milk feeding for the first six months of your
baby’s life and ideally until baby is one year old.
Breast milk feeding has many benefits. If you can only breast-feed for a short time, your baby’s immune
system will still benefit.
Breast surgery
If you have had breast surgery of any kind, inform your provider. Breast surgery may affect your ability to
produce milk in an amount that would enable you to exclusively breast-feed your baby.
Prenatal visit #3
16 to 18 weeks
Prenatal classes fill quickly - register NOW to ensure taking the classes that fit your schedule.
Visit healtheast.org for class information.
Date of visit
Weight
Blood pressure
Labs and tests:
• Genetic screening tests
• OB ultrasound
48
Fundal height
Fetal heart tones
Education – second trimester growth
Childbirth education classes
Classes provide valuable labor, birth and parenting information. Your clinic will have information about
childbirth preparation classes. It is best to register early to ensure that you can attend the classes of your
choice. You may want to schedule a tour of the Maternity Care Center. Check the HealthEast website for
tour information.
Quickening
Quickening, the first awareness of fetal movement, may occur around this time. It will first feel like flutters,
then gradually over a few weeks become more distinct kicks. Make note of the day you felt the baby three
days in a row. For many first time mothers, quickening is not noticed until around 20 weeks.
Backache
Backache is very common during pregnancy. Activities like vacuuming, leaf raking and shoveling are
particularly aggravating and should be done carefully or not at all.
Blood volume expansion
Blood volume increases by as much as 40 percent while pregnant. Because of that increase, the hemoglobin
in the blood is diluted and usually falls slightly during pregnancy. Headaches, varicose veins, hemorrhoids
and bleeding from the nose and gums may also occur.
Faintness
It is common to feel slightly dizzy during pregnancy. Frequent meals, layered clothing, adequate fluid intake
and avoiding prolonged standing may be helpful. Tell your provider if you have severe dizziness or fainting
episodes to your provider.
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Prenatal visit #4
22 weeks
Date of visit
Weight
Blood pressure
Fundal height
Fetal heart tones
Education
Have you registered for childbirth, breast-feeding or newborn care classes? If not, check on this now.
Gestational diabetes screen
Your next visit may include a glucose challenge test.
What is gestational diabetes?
Your body converts the food you eat into glucose, or sugar. As your blood sugar level rises, your pancreas
secrets insulin. Insulin helps the body use the glucose for energy. During pregnancy the placenta secretes
hormones that are needed for baby’s growth and development. Those hormones can block the action of
insulin in the mother. Sometimes too much insulin is blocked (this is called “insulin resistance”) and mother’s
blood sugar rises above a normal level.
Pregnant women who have never had diabetes before but who have high blood sugar (glucose) levels during
pregnancy are said to have gestational diabetes. Gestational diabetes affects about 4-7% of all pregnancies.
How gestational diabetes can affect your baby
Some mothers ask why testing for gestational diabetes is delayed until early in the 3rd trimester for most
women. It’s because gestational diabetes affects the baby most at this time of rapid growth.
When mother’s blood sugar is elevated, the extra sugar crosses the placenta and causes the baby to gain
excess weight (“macrosomia”.) Some babies are too big to be born vaginally so their mother will have a
cesarean birth.
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Babies of mothers with uncontrolled gestational diabetes may have difficult births that result in injury to the
mother and sometimes to the baby. These babies usually have difficulty maintaining their own blood sugar
after birth and they may also have trouble adapting to life outside the womb.
Recent research indicates that babies of mothers with uncontrolled or undiagnosed gestational diabetes are
at risk for obesity and type 2 diabetes. Women who develop gestational diabetes are more likely to develop
type 2 diabetes within 15 years after their pregnancy.
Testing for Gestational Diabetes in Pregnancy
The American Diabetes Association and the American College of Obstetricians and Gynecologists (ACOG)
recommend testing all pregnant women for gestational diabetes. Testing occurs between 26-28 weeks of
pregnancy. You will be tested earlier in your pregnancy if you have risk factors. The test is called a glucose
(sugar) challenge test.
How do I prepare for the test?
Eat normally on the day of the test; a diet rich in protein, whole grains and vegetables would be best. Avoid
simple sugars, white flour products and juices prior to testing.
You will be asked to drink a 10 oz glucose beverage (50 gm, about the same as a can of root beer.) The
beverage is not carbonated and it needs to be consumed within 5 minutes. During the next hour, you will
often have your regular prenatal visit. You will be asked to limit your activity around the clinic. Feel free to
bring a book or your computer.
Test Results
Any blood sugar level less than 140 for this test is considered normal. If your blood sugar level is 140 to 185,
a second test will be recommended. If the level is 185 or above, this confirms the diagnosis of gestational
diabetes and a referral to a diabetic educator will be made without additional testing.
If you require additional testing it is a three hour glucose tolerance test. If two or more readings are abnormal,
the diagnosis of gestational diabetes is confirmed and a referral to a diabetic educator will be made.
Additional Information
You can visit the American Diabetes Association website diabetes.org for additional information and to
purchase their book, “Gestational Diabetes: What to Expect”.
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A brochure from the American College of Obstetrics and Gynecology is available at: acog.org/publications/
patient_education/bp051.cfm
rho(D) immune globulin
If you are Rh negative, expect a rho(D) immune globulin vaccination at your next visit. This will prevent your
body from making antibodies against your baby, in the event your baby is Rh positive. (see “Blood type and
Rh Factor” – Visit #1 on page 43)
How will you feed your baby?
The American Academy of Pediatrics recommends you breast-feed for your baby’s first year of life. If you
cannot commit to one year, any amount of breast-feeding is beneficial to your baby. We have listed the
advantages of breast-feeding for mom and baby.
Advantages to mother
• Women who breast-feed have less vaginal bleeding and less risk of hemorrhage (excessive
bleeding) after birth. Breast-feeding (infant suckling) causes the release of oxytocin, a hormone
produced in the body that makes the uterus contract. This helps return the uterus to its normal size
sooner.
• Milk production requires an additional 300 calories each day. One half of the calories come from
the body fat mothers deposit during pregnancy. The remaining calories come from foods eaten
each day. While many mothers lose unwanted pounds easily, high calorie foods with no nutritional
value (junk food) should be avoided.
• Breast-feeding lowers a woman’s risk of developing:
-- breast and ovarian cancer
-- cardiovascular disease
-- type 2 diabetes
-- osteoporosis
-- postpartum depression
• Breast-feeding requires no mixing, measuring or clean up, making nighttime feedings quick
and easy.
• Breast milk is inexpensive. It is always available and requires no sterilization or refrigeration.
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• Breasts and babies are portable, making travel easier. With a little practice, mothers can breast-feed
anywhere.
• Breast-feeding produces a special relationship between a mother and baby, a closeness that comes
with time and touch.
The feeding choice you make will be supported by our caring, competent staff.
Advantages to baby
• Breast milk is nutritionally perfect for nearly all infants. Human milk changes to meet the needs of a
growing baby, something formula cannot do.
• Healthier Baby / Immune System Benefits
• The cells, hormones and antibodies in breast milk protect babies from illness. As a result, breast-fed
babies have fewer illnesses, doctor visits and hospitalizations. For parents, this means fewer days
away from work to care for a sick infant.
• Breast-fed babies immune systems respond better to immunizations.
• Stem cells have been discovered in colostrum as well as mature milk. These are the very important
cells that heal and repair all over the body.
• Breast-feeding lowers the baby’s risk of the following:
-- Developing Type 1 and Type 2 Diabetes
-- Sudden Infant Death Syndrome (SIDS), the leading cause of
death in infants after one month of age
• Breast milk contains important nutrients as well as special protective factors. It’s natures way of
safeguarding the newborn against infections.
• Breast-feeding lowers the risk of asthma, colic, food allergy and eczema in those infants with a
family history of allergy.
• Breast milk may contain nutrients or other substances that promote nervous system development
and affect intelligence.
• Breast-feeding gives babies a chance to touch, to smell, to hear, to see, to taste and to know their
mother from the first moment of birth.
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HealthEast Maternity Care Centers are advocates for breast-feeding and are committed to providing
accurate, up-to-date information. You will be supported in breast-feeding by:
• Competent Maternity Care Center nurses, including lactation specialists and, when needed,
lactation consultants.
• The Outpatient Lactation Clinic. You can get help after discharge by telephone or by scheduling an
appointment (provider order needed) with our lactation consultant. Call 651-232-3147.
• Education. It is often helpful to attend a breast-feeding class before your baby is born. Check the
HealthEast website for class information.
Prenatal visit #5
28 weeks
Date of visit
Weight
Blood pressure
Fundal height
Fetal heart tones
• Cervix check if indicated
• rho(D) immune globulin antibody status: (see visit #1 and visit #4). If your blood type is Rh negative,
you will receive an injection of rho(D) immune globulin.
• Gestational diabetes screen: Gestational diabetes is defined as glucose intolerance during
pregnancy. It occurs in approximately 4 to 7 percent of pregnancies and is easily controlled with
dietary changes. All pregnant women are screened using the GCT (glucose challenge test). If
your blood sugar is too high, another test will be done to determine the presence of gestational
diabetes.
See information in Prenatal visit #4, page 50.
• Flu shot - seasonal.
• Re-screen for bacterial vaginosis if indicated.
• Preterm labor risk assessment.
• Criteria that were previously evaluated are reviewed for any significant changes.
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Education
Being a legal father
If you are unmarried, you will be asked if you want to sign a Recognition of Parentage (ROP) form after your
baby is born. By signing this form, a father establishes the legal relationship between himself and his child
when he is not married to the child’s mother. The staff will discuss this important matter with you, and offer a
booklet and video that explains the process and your rights and responsibilities as a parent. The father of the
baby will need a picture ID for this process.
Baby’s Birth Certificate
Minnesota Statutes that affect the birth certificate.
First, under Minnesota Statute the baby’s birth certificate must be completed within 5 days of birth, whether
the parents have a name for the baby or not.
Parents should never leave the hospital without handing in a yellow Birth Certificate Information sheet.
Second, parents now have one year from the date of birth to make changes, additions, or corrections to the
birth certificate free of charge provided they have not purchased a Certified copy of the birth certificate.
Third, “Civil Marriage” will recognize marriage between same sex partners. Because the spouse of a married
mother is the legal parent of any child born during the marriage, her spouse (male or female) will be entered
on the birth certificate. However for married male partners the mother and biological father must complete
an ROP form and the father’s partner must adopt the baby.
Work
Many women continue to work until the day the baby is born. You need not stop working, except for
medical or personal reasons. Check into your employer’s benefit policies both during pregnancy and
after birth. For information about your legal rights during pregnancy or for family leave information,
call the Minnesota Commission on Economic Status of Women at 651-296-9002 or visit
commissions.leg.state.mn.us/lcesw.
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Physical discomforts
The increasing size of your baby and uterus affects your comfort. Allow yourself extra time to complete tasks
and be sure you get enough rest. Daily naps are recommended.
Hospital pre-registration
To make your admission to the hospital more efficient, ask your clinic for pre-registration forms to complete
and mail to your birth hospital. You can also pre-register online at healtheast.org/maternity.
Fetal growth
Your baby is growing rapidly at this point in the pregnancy. Your baby can open and close its eyes, suck its
thumb and cry. It exercises by kicking and stretching and responds to sounds like your voice or music. Your
baby is now about 15 inches long and weighs about 3 pounds.
Fetal well-being: counting your baby’s movement
It is important to be aware of your unborn baby’s movement each day. Counting your baby’s movements is
an easy way to check your baby’s health and well-being. Follow these steps:
• Choose a time when you have most often felt your baby move. Make sure you choose the same
time each day, when you feel calm and relaxed. This is usually after eating a meal.
• Lie down on your left side, or place yourself in a reclining position.
Call your provider if you:
• Feel less than five movements in one hour.
• Notice any change in your baby’s usual pattern of movements.
Preterm (premature) labor
What is premature labor?
A full term pregnancy takes about 40 weeks. Premature labor is labor that occurs before week 37.
Contractions or tightening of the uterus may cause the cervix to open too early. This could result in the birth
of a premature baby who may have problems breathing, eating and keeping warm.
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Why does it happen?
The cause of premature labor is unknown. However, it is known that certain risk factors may increase a
woman’s chance of having a premature labor. Some of the more common risk factors include: premature
rupture of membranes (water breaking), infection (urinary/uterine), multiple gestations, history of previous
preterm labor/birth and drug use.
Can we prevent it?
No, but often labor can be stopped. Early recognition of preterm labor signs can allow the use of medication
and other treatments to stop labor and possibly prevent your baby from arriving too early.
Signs of preterm labor
While usually not painful, look for these signs to call your provider. It is important to call early as there are
medications available that may stop labor!
1. Uterine contractions occurring every 10 minutes or more frequently—six or more contractions in
one hour.
What is a contraction? When a muscle contracts it becomes tight or hard to the touch. When your
uterus contracts you will feel it get tight or hard. When the contraction stops, your uterus becomes
soft. It is normal for your uterus to contract at various times in your pregnancy, such as when you first
lie down, after sex and when you go up and down stairs. It is not normal to have frequent uterine
contractions before your baby’s due date. If you feel a contraction every 10 minutes, or more often,
for one hour then your uterus is contracting too much.
How to check for contractions: Drink a glass of water. Lie down in a comfortable position on either
side. Do not lie on your back; this may cause contractions to occur more often. Put a pillow at your
back for support. Place your fingertips on the top of your uterus. If your uterus is contracting, you
will actually feel your abdomen get tight or hard and then feel it relax or soften when the contraction
is over.
2. Bleeding, spotting or leaking of fluid from your vagina including watery or bloody discharge.
3. Menstrual-like cramps in your lower abdomen or above your pubic bone.
4. Backache or feeling of pressure below waist level.
5. Pelvic pressure—feels like baby is pushing down. Pressure can be felt in your upper thighs, back
and lower abdomen. Pressure may come and go or remain constant.
6. Abdominal cramping, with or without diarrhea.
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Prenatal visit #6
32 weeks
Date of visit_________________________________
Weight_____________________________________
Fundal height________________________________
Blood pressure_______________________________
Trust
your instincts.
If something doesn’t
feel right or just feels
different, call your
provider.
Fetal heart tones_____________________________
Education – travel
There are no general restrictions on travel during pregnancy. The most comfortable time for most pregnant
women to travel is during the second trimester. By this time your body has adjusted to pregnancy, and you
probably have more energy. Toward the end of your pregnancy, it may be more difficult to move around or
sit comfortably for long periods. You may also not want to travel during the final weeks of your pregnancy so
you will be close to your provider for delivery. Although travel is safe in most cases, it is not recommended for
women who have serious health problems and need special medical care.
Car travel
During any car trip, always wear your seat belt. Air bags do not replace seat belts. Plan to make frequent
stops to stretch, move around and empty your bladder. If you are traveling a long distance or will be away for
a long period of time, you should take a copy of your pregnancy record with you. This information will then be
available in case you need medical care while you are away from home.
How to wear your seat belt
For best protection, wear a lap-shoulder belt every time you travel in a car. If only a lap belt is available, use it.
Place the lap belt under your abdomen and across your upper thighs so that it fits as snugly and comfortably
as possible. Put the shoulder belt between your breasts and across your shoulder. Adjust your seat if
necessary to prevent chafing your neck. Never slip the shoulder belt off your shoulder. Seat belts worn too
loosely or too high on the abdomen can cause broken ribs or injure your abdomen.
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Air bags
If you are driving, keep the steering wheel pointed towards your face, not abdomen. Sit about 12 inches from
the steering wheel.
Airline travel
Flights in airplanes with pressurized cabins (such as commercial airlines) are safe, but check with the airlines
about their policies on pregnant passengers. Flights in small planes without pressurized cabins are not
recommended due to the pressure changes during flight. Metal detectors used for airport security checks
are not harmful to the baby.
Foreign travel
Foreign travel raises unique concerns during pregnancy. Talk to your provider. They can help you decide if
foreign travel would be safe for you and offer advice for advance planning. If you do travel, bring a copy of
your medical records.
The Centers for Disease Control and Prevention has an International Travelers’ Hotline for information on
disease and world travel. The number is 1-800-232-4636.
There are groups that can help you find a physician or hospital in a foreign country. Contact International
Association for Medical Assistance to Travelers (Lewiston, NY), 716-754-4883 or International SOS
Assistance (Philadelphia, PA), 215-244-1500. Contact them in advance of your trip for further details.
Sexuality
Pregnancy, with its many physical and emotional changes, may contribute to great variations in your need
and desire for sexual expression. Generally, sexual intercourse is permitted throughout your pregnancy
unless your provider advises against it.
You may have intercourse UNLESS:
• Vaginal or abdominal pain occurs or vaginal bleeding is present.
• Amniotic membranes have broken or may be leaking.
• There is a possibility of preterm labor.
If your provider prohibits intercourse, ask for clear and specific instructions. If the aim is to prevent premature
labor, you should avoid all methods of reaching female orgasm, because orgasm causes uterine contractions.
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In the second and third trimesters, many physical symptoms subside, but a growing baby and enlarging
abdomen make other adjustments in intercourse necessary. To avoid physical discomfort, you and your
partner may need to try new positions. Side-by-side or rear vaginal entry positions may be more comfortable.
Avoid introducing air into your vagina since this can cause problems during pregnancy.
Usually, sex is as enjoyable as, or even more so, than any other time. Keep in mind that the need for intimacy,
not necessarily intercourse, is important throughout pregnancy. Talking, planning and dreaming about the
baby and the future you share is essential. Massage, hugs and other kinds of sexual stimulation are all ways
you and your partner can physically express your affection for one another. Let your partner know how you
are feeling. Talk openly and share your needs and concerns with each other.
Gestational Hypertension—formerly called Pregnancy Induced Hypertension (PIH)
Gestational Hypertension is a condition that can develop in late pregnancy. Signs of gestational hypertension
are increased blood pressure, excessive edema (fluid retention) and protein in the urine. The causes are
unknown and the incidence is relatively rare. However, if you experience the following symptoms, contact
your provider:
• Severe headache
• Blurred vision
• Increased facial swelling
• Severe abdominal pain
Preeclampsia
Preeclampsia, a complication of pregnancy, occurs in 5 to 8 percent of pregnancies. Most cases are mild,
occur near the end of the pregnancy and have healthy outcomes. But sometimes it can progress and
pose a serious threat to mother and baby. Preeclampsia may cause your baby to be small and to be born
prematurely. Sometimes women with preeclampsia are put on bed rest. If needed, medication to lower
mother’s blood pressure is prescribed.
Some risk factors are:
• First pregnancy
• Preeclampsia in a prior pregnancy
• Mother 40 years of age or under 18
• High blood pressure before pregnancy
• Diabetes before or during pregnancy • Poly cystic ovarian syndrome
Symptoms of preecplampsia include high blood pressure, protein in the urine, headaches, swelling in hands,
feet or face, and nausea.
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Report symptoms to your provider because early diagnosis and careful management will help keep mother
and baby safe.
Talk with your provider about your concerns or symptoms; you may also find information at
preeclampsia.org
Tour of Maternity Care Center
It often helps you feel prepared for birth if you’ve been able to tour the Maternity Care Center. Check the
HealthEast website at healtheast.org for tour information.
Labor and birth issues
When to go to the hospital (active labor vs. early stages of labor)
It is important for you to follow the advice of your provider, but the following guidelines are supported by
HealthEast Maternity Care Centers.
Active labor contractions generally start in the back, radiate to the front and down the abdomen. They will
increase in length and discomfort as the time span between them shortens. Changing positions will not
cause contractions to stop.
Time your contractions for one hour. If this is your first baby, come to the hospital when contractions occur
every three minutes, lasting 45 to 60 seconds. If this is not your first baby, come to the hospital when your
contractions are approximately five minutes apart.
Please call the hospital when you think you are in labor. Call your provider and go to your hospital’s Maternity
Care Center (labor and delivery) if you have any of the following:
• Rupture of membranes or leaking of fluid from the vagina. (Note time and color of fluid.)
• Vaginal bleeding.
• Sharp abdominal pain.
• Fever of more than 100 degrees Fahrenheit.
• Headache or blurred vision.
• Decreased fetal movement.
• If you feel something just isn’t right.
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Premature rupture of membranes
In about 15 percent of women, the amniotic sac will break before labor begins and in some of these women,
labor will not begin within a short period of time. This is called premature rupture of membranes and is the
most common cause of infection. Bacterial infections can be serious for both mom and baby. It is important
to contact your provider if you think you are leaking amniotic fluid. Although many women will begin labor on
their own after the membranes rupture, induction may become necessary.
Induction
What is a labor induction?
As a woman nears the end of her pregnancy and labor has not started on its own, providers may use
medications to start labor. When your care provider suggests a labor induction for your health or the health of
your baby, it is called an indicated labor induction.
When labor is induced for non-medical reasons, like for your convenience or preference, it is called an
elective induction.
Elective labor induction is not always a good idea for your baby. Inducing labor before you are at least 39
weeks along in your pregnancy, or before your cervix is ready, has risks.
When is elective labor induction okay?
You should have an elective labor induction only if it can be determined, with reasonable certainty, that
neither you nor your baby would be at an increased risk by doing so.
The following guidelines help determine if and when elective labor induction is okay for you and your baby:
Your due date
When you became pregnant your provider gave you an estimated due date for your baby. This is the date
your baby is expected to be full term (40 weeks along) and ready to be born. Your due date is based on:
• The date of your last menstrual period.
• Results from various lab tests.
• The size of your baby based on ultrasound exams.
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Guidelines from the American Congress of Obstetricis and Gynecologists (ACOG).
This is a professional organization for providers who deliver babies. The following guidelines are based on
guidelines from this organization.
• Your provider must be certain of your due date so labor isn’t started too early, before your baby is
fully developed.
• You must be at least 39 weeks along in your pregnancy.
• Your cervix must be soft and ready to open (dilate). Your provider will know this by examining
your cervix.
• Your provider must confirm that you do not have a past history of Cesarean section or major
surgery on your uterus.
• The office record of your pregnancy must be available in the Maternity Care Center.
If you do not meet these guidelines, your provider may recommend that the birth of your baby take its natural
course. If your provider denies your request for an elective induction, don’t be upset. Be assured that the
decision to let your baby come naturally is the best one for both you and your baby. You will want to discuss
the situation fully with your care provider. You need to know the risks and benefits of your induction.
When labor is electively induced before 39 weeks of pregnancy
• Your baby is two to three times more likely to be admitted to intensive care. This will mean a longer
and more difficult hospital stay for your baby. It may also make it harder for the two of you to breast
feed or bond.
• Your baby may have trouble breathing and need to be connected to a breathing machine.
• Your baby may have trouble maintaining body temperature and need to spend time in a warming
area to keep a stable temperature.
When labor is induced and the cervix is not ready
• You are more likely to have a longer labor, maybe more than two times as long. A longer labor
means increased risks for you and your baby.
• You are three to six times more likely to need an unplanned Cesarean birth. This increases the risk
of serious problems for you and your baby with your current pregnancy and any future births.
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Indicated labor induction
Common reasons to induce labor are: no onset of labor beyond baby’s due date, membranes that have been
ruptured for a long time; gestational hypertension-formerly PIH; problems with the baby’s well being; medical
conditions in the mother, or if mom or baby may be harmed by the pregnancy continuing. If labor induction is
suggested, be sure to ask why it is necessary and discuss all risks and benefits with your provider.
There are several ways to start (induce) labor:
• Medication for cervical ripening - The medication is placed in your cervix or your vagina. This is
done in the hospital and usually by a nurse. The baby will be monitored afterwards. This medication is
primarily used to soften or ripen the cervix before an induction planned for the next day, but occasionally
it will also start labor. Depending on which medication you receive, you may go home after one to two
hours or you may stay overnight for induction the next day.
• Cervical Ripening with a Balloon Catheter / Cooks Catheter. This catheter is inserted into the cervix
and the balloon is inflated with sterile saline. This applies pressure to the cervix. The pressure should
soften and open the cervix, preparing your body for labor. When the catheter is in place, you will need to
stay in hospital but you will be able to move around normally.
• AROM (artificial rupture of membranes or amniotomy) - Sometimes labor is started (or augmented,
if your labor stalls) simply by breaking your water. Most women start labor a few hours after the water is
broken, but this method is not always reliable for starting labor. You may also need Pitocin.
• Pitocin - Pitocin is a synthetic form of a woman’s natural hormone, oxytocin, which causes the uterus to
contract. Pitocin helps increase the strength of each contraction and makes them more effective. Most
commonly, it is given intravenously to stimulate labor. During induction, your baby and your contractions
will be monitored. You may still be able to move around and can change positions as needed for
comfort.
Labor augmentation
Prolonged labor increases a woman’s risk of exhaustion, infection and heavy bleeding after delivery. Once
you are in labor, if your labor stalls and your cervix changes too slowly (less than 1 centimeter in two hours),
your labor may be augmented with Pitocin.
Fetal heart rate monitoring during labor and birth
St. John’s Hospital and Woodwinds Health Campus require that all women admitted in labor have an
admission monitor strip. After you arrive at the hospital in labor, two monitors will be attached to your
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abdomen with belts in order to assess the baby’s heartbeat and your contraction pattern. Electronic fetal
monitoring, or EFM, uses a machine that detects and prints out a graph of fetal heart beats and uterine
contractions. The type and amount of monitoring you will have throughout the remainder of your labor will
depend upon your provider’s preferences, your labor and the baby.
Pain in labor and birth
The perception of pain in labor is different for each woman, just as each labor is different and unique. Some
factors that may influence your perception of pain are past experiences, cultural background and your
expectations for your entire birth experience.
When childbirth is normal, the pain is not a sign of injury, rather, it is “pain with a purpose” (Sheila Kitzinger,
British Childbirth Educator). Women have different pain tolerance levels and some labors are longer and
harder than others. Many factors contribute to what level of pain relief a woman needs. Discuss pain relief
options with your partner and provider. Understand your options and you will make the choice that is right
for you.
Non-medicinal pain relief options
A wide variety of methods are used to help women through labor. Some of these include: one-on-one
support from your labor partner and/or a certified doula, relaxation and breathing techniques, aromatherapy,
massage, acupressure and healing touch, position changes, walking, rhythmic movement or sounds, showers
and baths and the use of water to birth in.
Aromatherapy
Aromatherapy is a natural therapy and healing art, using essential oils extracted from aromatic botanical
sources, to balance and treat the mind, body and spirit. The oils can be used by inhalation, in baths,
compresses, creams or through massage to the skin. The sense of smell is especially heightened during
pregnancy and labor, so use your favorite oils to relax and soothe. This will also make the environment
gentler and create a happy place in which to welcome your baby. Make an appointment at the Natural Care
Center on the Woodwinds Health Campus to select the essential oils right for you. You can purchase the
oils at the Natural Care Center. Some of the common essential oils used for labor and birth are available
through the pharmacy at Woodwinds. Nurses may order them for your use during your labor and birth. Some
commonly used oils are: tea tree oil, lavender, rosehips, jasmine, sage and chamomile.
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Hydrotherapy/waterbirth
Soaking in a tub of warm water sounds inviting to many women. Women who find water comforting often
wish they could labor or birth in water. Laboring in water offers comfort, relaxation and often facilitates the
progression of labor. When relaxing in a tub of water, your body is free from the pull of gravity. This reduces
sensory stimulation which, in turn, may reduce the production of stress related hormones and a reduction in
perceived pain.
The Maternity Care Centers at St. John’s Hospital and Woodwinds Health Campus offer the opportunity to
experience a waterbirth. Mothers who want a waterbirth should talk with their provider.
Contraindications to waterbirth
• Active genital herpes.
• Presence of any infection that is transmittable by exposure to blood/body fluids
(HIV, Hepatitis B and C).
• Maternal fever.
• Excessive vaginal bleeding.
• Prior Cesarean birth.
• Intrathecal or epidural analgesia.
• Gestation under 37 weeks (unless approved by provider/midwife).
• Meconium stained amniotic fluid/fetal distress.
• Malpresentations of the baby, such as breech position.
• Any condition the provider considers unsafe for mother and/or baby to labor or birth in water.
Medicinal pain relief options
These include narcotic-like analgesics administered by a nurse or epidural anesthesia administered by an
anesthesiologist. It is important to know that narcotic-like analgesics and epidural anesthesia are not
without risk.
Narcotic analgesics are commonly given into a vein by a nurse. It reduces the pain and can help you relax or
sleep between contractions. If given too early in labor, it can slow down your labor.
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An epidural is anesthesia given through a space in your spine. It is placed and administered by an
anesthesiologist. Additional interventions are required. You have an IV, blood pressure monitor, continuous
fetal heart rate and contraction monitoring and, sometimes, a tube in your bladder to drain your urine. The
epidural numbs you from the waist down, usually providing excellent pain relief, but also prevents you from
walking or changing positions easily. Studies show that if you receive an epidural before your cervix is about
four centimeters, your chances of having a Cesarean birth increase. Other risks include blood pressure
drop and decrease in baby’s heart rate immediately after giving the epidural, spinal headache or infection,
difficulty feeling the urge to push or a slowing of labor. Although epidurals are not without risk, there are
some situations in which an epidural is appropriate and provides effective pain relief. You need to discuss
medication concerns or questions with your provider.
A newer method of pain management is intrathecal medication. It is administered by an anesthesiologist
in a manner similar to an epidural. It requires accompanying interventions. Pain relief usually lasts about
two hours.
Episiotomies
An episiotomy is the surgical cutting of the perineum to widen the space through which the baby comes. An
incision is made into the perineum from the vagina toward the rectum (midline) or off to the side (mediolateral)
just before the birth of the baby’s head. Some of the reasons for an episiotomy include to speed delivery of
the baby by a few minutes, or to help prevent a tear from occurring. Some care providers do an episiotomy
routinely and some do not. Talk to your provider about their philosophy and your wishes.
Your baby’s provider
Your newborn’s care can be provided by either a pediatrician or a family medicine physician. Decide who
you want to take care of your baby before you go to the hospital. Call that clinic to be sure the provider
participates in your health insurance plan and is accepting new patients. Call HealthEast Care System at
651-326-CARE (2273) or go to healtheast.org and click on “provider search” for information about providers
in your area.
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Getting ready to bring baby home
The postpartum period is the first six to eight weeks after childbirth. It is a time of physical and emotional
adjustment as your body returns to its pre-pregnant state and the family incorporates a new person into the
home. The way each family adjusts is unique. Some preparation that most families find helpful:
• Discuss role expectations and be sure to include other children in the home.
• Look into community and family resources which may be needed.
• Choose a provider for your baby’s care after birth. Some things to consider are the distance the
office is from your home, qualifications and insurance requirements, if applicable. Get referrals from
friends with children or your provider.
• Pack your bag for the hospital. Include items for labor and postpartum, clothes and a car seat for
the baby’s trip home.
• Purchase or borrow the necessary clothing, supplies and equipment for the baby.
• Buy a supply of diapers or sign up with a diaper service.
• Create a convenient baby care area and sleeping area in your home.
• Wash borrowed baby clothes. New clothes also need washing to clean and to soften.
• Borrow or buy a book on infant care and one on breast-feeding, if appropriate.
• Consider planning for two weeks of meals; prepare some meals in advance and freeze them.
• Purchase nonperishable items before the baby is born and make a list of perishable items that will
need to be purchased.
• Clean your house. Discard unwanted piles of papers, magazines and clothing to provide extra
space for the baby and baby supplies.
• Arrange for help with chores when you are home from the hospital. This will help you to establish
successful feedings, care for your baby, get adequate rest and nutrition and to have some time as a
family.
• If your maternity leave will be less than three months, begin to interview day care providers.
• Make a list of important phone numbers that includes your provider, hospital and your
baby’s provider.
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Your baby’s layette
Use the following as a guide in getting what you need before coming home from the hospital.
Bedding
Baby clothing
Two to four crib sheets
Four to eight undershirts
Three to six receiving blankets
Three to six gowns with drawstring closure
One to two lightweight crib quilts
One hat for newborn
Two to four waterproof pads for crib and lap
Two to four stretch suits with feet
Diapers
Four dozen cloth diapers, or
Four dozen disposable diapers
Three to six waterproof pants for use with
cloth diapers (newborn size)
Two to four small bibs
Two blanket sleepers (depends on season)
One to three pairs of booties or socks
One to two sweaters (depends on season)
Baby equipment
Diaper ointment (check with baby’s provider)
Crib
Washcloths or diaper wipes
Changing table (optional)
Bath
Car seat (mandatory)
Two to four hooded towels or soft towels
Digital thermometer
Two to four baby washcloths
Blunt-tipped nail scissors or baby
nail clippers
Baby soap and shampoo
Baby bathtub (optional)
Large foam pad to place beneath baby in
the tub or sink (optional)
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Prenatal visit #7
36 weeks
Date of visit
Weight
Fundal height
Blood pressure
Fetal heart tones
Cervix check
Confirm fetal position
Education
Postpartum care
Care in the hospital will be focused on your physical recovery, learning parenting skills and identifying and
solving any problems. It is your opportunity to gain confidence in the care of your baby.
Management of late pregnancy/signs and symptoms
• Backache - Be particularly careful about lifting and activities like vacuuming, raking and shoveling.
Do them carefully, or not at all.
• Difficulty sleeping - Use pillows for propping, you may need to find time for naps.
• Heartburn Eat small, frequent meals; avoid lying down immediately after eating. May use antacids
listed under Medication.
• Increased Braxton Hicks - These are often called “rehearsal” or “practice” contractions. These
contractions help the uterus prepare for labor. Changing positions or a warm tub bath may help if
they interfere with sleep.
• Loss of the mucous plug (also called “bloody show”) - Loss of a pink or red streaked piece of
mucous; may indicate the cervix is changing; labor may occur within the next few days.
Body mechanics
It is important to protect your back and joints with proper body mechanics. Good lifting techniques and
observing an approximately 25 pound lifting limit will minimize your risk of backache. Pay close attention to
good posture and you’ll be more comfortable.
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Frequent urination
This is common during this stage of pregnancy when the uterus puts increased pressure on the bladder. It is
important to report any burning, increased odor or blood in your urine because those symptoms may indicate
a bladder infection.
Group B Streptococcus (GBS) screening in pregnancy
GBS is a common bacteria found in the intestine, urinary tract and vagina in many healthy women. The
bacteria can come and go without symptoms and antibiotic treatment does not completely eliminate the
bacteria. GBS is not a sexually transmitted disease. A baby can be exposed to GBS during birth and this
can cause serious newborn illness requiring hospitalization. GBS is the most common cause of newborn
infection, affecting one to three babies per 1,000 deliveries in the U.S. Based on the results of the GBS
screening, antibiotic treatment may be prescribed during labor. This reduces GBS transmission to the baby
and lowers the chance for newborn infection. If you have any concerns, discuss them with your provider.
Contraception or birth control
Keep in mind that you can get pregnant whether or not menstruation has resumed; breast-feeding is not
birth control. It is important to plan about contraception if you want to prevent pregnancy or to space your
pregnancies. Talk about options with your provider.
Prenatal visits #8-11
38 to 41 weeks
Date of visit
Weight
Blood pressure
Fundal height
Fetal heart tones
Cervix check
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Education
Postpartum vaccination
If you are not immune to rubella (German measles), you may be vaccinated postpartum.
Infant CPR
This is a simple and potentially life saving skill to learn. Anyone responsible for the care of infants or children
(parents, grandparents, babysitters, relatives and friends) should take this important class! Classes are offered
through community education, the American Red Cross and hospitals.
Post dates management (going overdue)
The due date you are given is only an approximation of your baby’s birth date. A baby is considered ready to
be born anytime between 38 and 42 weeks past the first day of your last menstrual period. Your due date is
placed at 40 weeks.
There are several tests used to assess your baby’s well-being at about one to one and a half weeks past your
due date. If you feel that there has been a significant decrease in your baby’s activity level then you should
contact your provider. They may recommend you do a fetal kick count or another form of evaluation.
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These tests are:
• Non-stress test (NST) - This involves monitoring the baby’s heartbeat (usually in the office) on a
fetal monitor. A good pattern of the baby’s heartbeat usually means the placenta is healthy enough
to supply the baby with adequate oxygen. An NST is often planned at about 41 weeks.
• Ultrasound - This is usually done at 41-1/2 weeks. There are various indicators of baby well-being,
including the amount of amniotic fluid, the muscle tone of the baby and breathing movements.
Based on these findings, your baby will get a score and if the score is high, you may safely await the
onset of labor.
Because labor could occur at any time, it is important to stay well rested, eat well
and be sure to drink plenty of fluids.
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LABOR AND BIRTH
During your hospital stay: What to expect for a vaginal birth
Admission: Labor
and birth
First four hours after
birth
Four to 48 hours
after birth
Discharge
Tests
Lab work will be
done, requested by
your provider.
Cord blood is sent
to the lab for Rho
Immune Globulin
Screen if Rh negative.
Blood is drawn for
hemoglobin test.
You may plan to be
discharged by noon.
Routine
Admission interview:
Collect medical
information, complete
admission assessment.
You may have an IV
to control bleeding,
give medication or
replace fluids.
Take a bath three
times a day.
You will need to
sign a discharge
form for yourself
and your baby.
Nurses will monitor
your blood pressure,
pulse, temperature
and bleeding. You
may need an ice pack
on your perineum for
up to six hours after
delivery.
Rinse perineum
with squeeze bottle
during and after
emptying bladder.
Your IV will
be removed.
You are encouraged to
take a bath.
Breast care for breastfeeding:
• Apply colostrum
to nipple
• Wear supportive
bra as needed
• Feel free to
ask questions
Diet
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Light labor diet
Regular diet
Regular diet
Regular diet
Meds
Activity
Admission: Labor
and birth
First four hours
after birth
Four to 48 hours
after birth
Once an active labor
pattern is established,
you may have IV pain
meds as needed
if ordered by your
provider. Epidural is
available per request,
if ordered by your
provider. Discuss
request for pain
medication with
your nurse.
Oral pain pills may be
given as needed for
discomfort according
to provider’s order.
Oral pain pills may be
given as needed for
discomfort according
to provider’s order.
You will be given
rho(D) immune
globulin if needed.
You are on a fetal
monitor for 20 to 30
minutes.
The nurse will
assist and instruct you
with baby care and
self-care. The nurse
will help you feed
your baby.
Attend a postpartum
discharge class if
offered; look over
the materials in your
patient education
folder; ask your nurse
questions.
You may be up and
about as you are
able to tolerate it.
Your nurse will review
your individual needs
and assist you with
any requests.
Teaching is based on
your needs. Review
education folder and
written instructions
on self and baby
care.
The nurse will
give you written
instructions
regarding self-care
and baby care.
With a fetal monitor
strip, you may walk,
shower, sit in rocking
chair or move about
as desired.
Teaching
Feel free to ask your
nurse any questions.
Discharge
You will be given
Rubella and other
immunizations if
needed.
The nurse will
give you written
instructions regarding
resuming intercourse
and tampon use.
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During your hospital stay: What to expect for a Cesarean birth
Before surgery
Tests
Lab tests including
hemoglobin and blood
type and screen will
be done so that blood
will be available as
needed.
Routine
Arrive 1-1/2 hours prior
to scheduled surgery
time. Check in at
Maternity Care
nurses station.
An IV will be started.
You will be asked
to sign a surgical
consent form.
The nurse will collect
medical information
and history.
Diet
Have nothing to eat
or drink.
You will drink an
antacid called Bicitra
to decrease acid in
your stomach.
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Recovery to six hours
after delivery
Following surgery,
you will return to your
room to be with your
baby.
A nurse will monitor
your blood pressure,
pulse and bleeding.
A catheter will drain
the urine from
your bladder.
The next day
Discharge
Blood is drawn for
hemoglobin test.
As needed.
Your catheter will be
removed.
You may plan to be
discharged by noon.
Your dressing on
the incision will
be removed.
You will need to
sign a discharge
form for yourself and
your baby.
Your IV will be
removed when you
are able to take
fluids.
You will have an IV for
fluids and medications.
Have nothing to
drink for the first hour
after surgery.
When you return to
your patient room, you
can drink liquids.
Continue to drink
clear liquids.
As your appetite
and bowel function
returns, you may
have regular foods.
Regular diet.
Before surgery
Meds
Activity
Recovery to six hours
after delivery
You will be able to
discuss your method
of anesthesia,
epidural or general,
with a provider
who specializes in
anesthesia.
Medication may be
added to your IV or
you may be given pain
pills for pain control
after surgery.
You may be up in your
room as desired.
You will be up at
bedside within eight
hours.
The next day
Pain pills will be
available
for discomfort.
Rubella immunization
if needed.
You may shower
if desired.
You may walk as
much as desired.
You will be
encouraged to walk
in the hallway four to
six times a day.
No lifting anything
heavier than your
baby for six weeks.
Your nurse will
instruct you on care
of incisions and signs
of infection.
The nurse will
give you written
instructions
regarding self-care
and baby care.
You will take deep
breaths and try
to cough.
Your nurse will review
the birth with you and
answer any questions.
Rho(D) immune
globulin will be given
if needed.
You may be given a
prescription for pain
pills if you need it.
You may walk or be
taken by wheelchair to Your nurse will assist
the operating room.
you in turning from
side to side or sitting
up.
Teaching
Discharge
Your nurse will
help you with baby’s
first feeding.
Your nurse will assist
and instruct you with
self and baby care.
The nurse will
give you written
instructions
regarding resuming
intercourse and
tampon use.
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AFTER BIRTH
Neonatal Intensive Care Unit (NICU)
Most babies are born healthy and never need extra care. But for those who do, it’s reassuring to know that
the NICU staff at St. John’s Hospital is there to offer expertise and support. The NICU cares for babies who
are premature or need extra medical care after birth. The NICU is a level IIIa nursery. This means we treat
babies as premature as 28 weeks gestation and care for sick newborns. The NICU is staffed around the clock
by specially trained registered nurses, neonatal nurse practitioners and neonatologists.
Our NICU has implemented a holistic developmental model of care. This means we care for baby’s total
health – body, mind and spirit. Your baby will receive sensitive, individualized care that focuses on baby’s
cues rather than on tasks and schedules. This supportive care enhances family bonding. As a complement
to baby’s medical care, infant massage, healing touch, essential oils (prepared especially for newborns) or
music therapy may also be used. The amount of light and noise around baby is altered to decrease stress
and maintain a calm environment.
The nursery at Woodwinds is designed for infants who are born 4-6 weeks prematurely or who need extra
care after birth. Babies who require additional care will be transferred to the NICU at St John’s or to another
hospital determined by your baby’s provider.
Family Centered Care (Rooming in)
Our Maternity Care Centers offer family-centered care. This means your baby stays in the room with you and
we care for the whole family. We want families to be involved in the care of their baby. There is research that
tells us the benefits of rooming in.
Some benefits are:
• When babies are close to their mom, it is easier for them to get used to life outside the womb.
• When babies feel their mom’s warmth, hear her heart beat and smell mom’s smell - they feel safe.
• Babies get to know their mom by using their senses. One of the senses babies use is smell. Babies
are able to tell the difference between their mother’s smell and that of another woman by the time
they are one to two days old.
• Bonding and attachment are words that mean “getting to know” or “falling in love with” your baby.
The sooner parents and babies spend time together, the sooner this can start. Baby’s attachment
instinct is highest during the first days of life. Early attachment has a positive effect on baby’s brain
development. It also helps baby feel safe.
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• Rooming in helps mother to quickly learn baby’s cues. Cues are a baby’s way of telling you what
he or she wants. Babies have many cues. There are cues that will tell you when they want to eat.
When you know the cue, you will learn how to respond. Mother, baby and the whole family will learn
baby’s cues.
• Maintaining a good milk supply. When baby shows hunger cues, he or she should be put to breast.
Frequent breast-feeding will help mother to produce milk and keep up her milk supply. Babies need
to breast-feed eight to 12 times in 24 hours.
• Rooming in encourages families to be baby’s main caregivers - before they go home. This will
increase parents’ confidence to care for their new baby.
• Rooming in helps babies regulate their body rhythms. This includes baby’s heart rate, body
temperature and sleep cycle. Nurseries have lights, noise and other distractions. This can interfere
with cues regarding the development of baby’s rhythms.
• Mothers usually sleep better when their baby is in the room. Mom saves energy by not getting up to
go to the nursery. Mom can check on baby and feed baby easily. And, mothers won’t worry about
their baby in the nursery.
Questions you may have about rooming in
What is rooming in?
Rooming in is when your new baby stays with you in your Maternity Care room.
What if I am unable to care for my baby
Talk to our staff and we will create a plan together to meet your needs.
If I have a Cesarean birth, should my baby still room in with me?
It would help you if a family member stays with you. They can help you care for your baby. You and your baby
would still have the benefits of rooming in and spending time together.
What if I don’t know how to care for my baby on my own?
Teaching is an important part of your stay in the Maternity Care Center. You will not be alone. Our staff will
help you learn to care for your baby.
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Infant security in the hospital
It is important to be watchful over your newborn at all times.
• You, your partner and baby will be given hospital identification (ID) bands. These bands have the
same number. The band numbers are checked by staff every time you receive your baby. Keep your
ID band on the whole time you are in the hospital.
• Never leave your baby alone. If you want to nap or keep baby with you during the night, place the
crib near your bed on the side of the room away from the door. Close the door to your room. You
may bring your baby’s crib into the bathroom when you take a bath.
• Ask your nurse about daily newborn procedures, feeding, visiting hours and newborn security.
• DO NOT give your baby to anyone who is not wearing proper hospital ID. Hospital staff who are
approved to care for newborns have a colored stripe on each side of their hospital ID badge.
• Know where your baby will be taken for tests or procedures. Ask how long your baby will be away
from you. Ask if you are able to go with your baby.
• Babies are always transported in their crib – never carried. If anyone tries to take your baby without
a crib, immediately use your call light to call a staff person.
• Remember the nurses caring for you and your baby. Be careful with unfamiliar people entering your
room or asking about your baby – even if they are dressed in hospital clothes. If you have concerns
or questions, immediately use your call light to get a staff person to come.
Minnesota newborn screening program
The Minnesota Newborn Screening Program is a public health screening program for all infants born in
Minnesota. This Minnesota Department Health laboratory and follow up program provides high quality,
timely, low cost laboratory screening and referral resources in order to prevent or minimize the long term
effects of disorders that can lead to death, developmental disability, or other serious medical conditions .
Newborn screening
Between 24 and 48 hours of age, your baby will be screened for more than 50 rare, metabolic diseases. The
screening is important! If any of these diseases are found and treated, serious problems may be prevented.
Minnesota state law requires screening on ALL newborns for these diseases. Parents may choose not to
have their baby screened. If parents do not want their baby screened, they must complete and sign the
“Parental Refusal of Newborn Screening” form. This is a formal and legal way to state that you voluntarily
choose not to do the newborn screen.
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How is your baby screened?
A few drops of baby’s blood is sent to the Minnesota Department of Health to test for more than 50 rare,
metabolic diseases. The discomfort to your baby is small, and the benefits of testing for these diseases is
great. Test results are sent to your baby’s provider. Ask about your newborn screening results at the two
week visit.
Newborn hearing screen
Universal Newborn Hearing Screening (UNHS) / Early Hearing Detection and Intervention (EHDI)
The Minnesota EHDI program ensures that all infants and toddlers with hearing loss are identified as early as
possible and provided with timely and appropriate audiological, educational and medical intervention. The
program includes three basic components: newborn hearing screening, audiological diagnosis and early and
ongoing support and services.
After birth, while your baby is in the hospital, our staff will give your baby a hearing test. This test is painless
and is done while your baby is asleep. You will be given the results of the hearing test right away. If your
baby failed the test you will be referred to your baby’s provider or an audiologist for follow up. Failing the
test does not necessarily mean your baby has hearing problems. Sometimes babies fail the test because
there is amniotic fluid or debris remaining in the ear canals. Your provider or audiologist will know for sure.
Information on newborn screening can be found at health.state.mn.us/newbornscreening.
Pulse Oximetry Screening for Critical Congenital Heart Disease (CCHD)
This is a newborn screen where we look for congenital heart problems.
What is Critical Congenital Heart Disease (CCHD)?
CCHD is a problem in the structure of the heart or its major blood vessels. It is the most common birth defect.
Some forms of CCHD are very serious (critical). These can cause a baby to become sick soon after birth.
How do you check for CCHD?
Before your baby goes home, we will check for:
• A sound in the baby’s heart, called a heart murmur
• Abnormal heart rate, breathing or blood pressure
Babies with CCHD don’t always have these symptoms right after birth. But if your baby has any of these
symptoms, we will need to do more tests. We will also do a pulse oximetry [ox-EH-mah-tree] test to check for
low oxygen levels.
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What is pulse oximetry?
Pulse oximetry [ox-EH-mah-tree] is a simple bedside test that measures the amount of oxygen in the blood.
The test is done when your baby is between 24 and 48 hours old. The machine we use is called a pulse
oximeter. Sensors are placed on the baby’s skin to measure oxygen levels. The test is painless and takes only
a few minutes.
Why should my baby have pulse oximetry?
Low levels of oxygen in the blood can be a sign of a serious CCHD. If your baby has CCHD, this test may
tell us before your baby becomes sick. If your baby has low oxygen, we will do more tests to find out if your
baby’s heart is normal.
Low oxygen may also occur if:
• Your baby’s lungs and heart are still adjusting after birth
• Your baby has a lung problem
Where can I get more information?
Your baby’s provider or nurse is a great resource. You may visit: Congenital Heart Defects:
cdc.gov/ncbddd/heartdefects/ index.html
Screening for Critical Congenital Heart Defects:
cdc.gov/ncbddd/pediatricgenetics/ CCHDscreening.html
Cord blood banking
Cord blood banking allows parents to store stem cells from baby’s umbilical cord. The stem cells would be
used in the future if the baby or child develops a disease that may be helped with the use of stem cells.
• Families purchase a cord blood collection kit from the Cord Blood Bank. The kit is brought to the
hospital when mother is in labor. Mother’s provider or hospital staff is asked to collect the blood.
This must be approved in advance by your provider.
• The blood is then mailed to the Cord Blood Bank for storage.
• Fees for collection and processing in the first year range from $1,000 to $2,000.
• There is also a yearly storage fee of about $100.
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The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists state
there are no accurate estimates of the likelihood that children would need their own stored cells. This makes
it hard to recommend that parents store their children’s cord blood. There is no guarantee that the cells will
ever be used.
Banking may be considered if there is a family member with a current or potential need to undergo a stem
cell transplant. You may consider donating your cord blood to a public bank, such as the American Red
Cross. Questions about cord blood banking should be discussed with your provider.
More information may be found at:
• American Red Cross of the Twin Cities Area at 612-627-5800 or redcrosstc.org
• PharmaStem Therapeutics, Inc. at pharmastem.com
• National Institute of Health, search “stem cells” at nih.gov
• American Academy of Pediatrics at aap.org
• Cord Blood Information at cord-blood.org
YOUR BABY’S BIRTH CERTIFICATE
Your baby needs a birth certificate. Everyone must have a birth certificate. A birth certificate is your baby’s
official birth record. A birth certificate is needed to get a social security number. Later it is needed to get a
driver’s license, passport or pension benefits.
Birth certificates also:
• Give health researchers data.
• Help find mothers and babies who may have special health needs. By identifying these needs early,
we can help mothers and babies become healthier.
In our hospitals you will be given a handout that explains everything you need to know about your baby’s
birth certificate. You will be given a form to fill out. You will be asked to complete this before you go home.
The birth record will be registered with the Minnesota Department of Health.
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MOTHER’S PHYSICAL CHANGES AND ADJUSTMENTS
Afterpains
After birth your uterus will continue to have contractions that facilitate the process of involution – returning
the uterus to its pre-pregnant size. These contractions are called afterpains and are much milder than those
during labor. Afterpains often occur when breast-feeding and are more common if you’ve had a baby before.
Pain medication may be prescribed by your provider, but most women experience adequate relief with
over-the-counter medications like ibuprofen (Motrin® or Advil®) and acetaminophen (Tylenol®). Emptying your
bladder, warm tub soaks or a heating pad may provide additional comfort.
Vaginal bleeding
Normal vaginal discharge is heavy and bright red the first few days after your baby’s birth (vaginal or
Cesarean) and may contain small clots. When you get out of bed or stand after breast-feeding, you may
experience a gush of blood. Usually within 10 days of birth the bleeding decreases in amount and turns pink
in color. Within a few weeks it becomes yellow, white or brown. There may be a light or spotty flow for six to
eight weeks after birth.
When the flow is heavier, change your pad after each voiding or every four hours to prevent the growth of
bacteria. Use sanitary pads, not tampons, and delay sexual intercourse until your provider advises. Call your
provider if you have excessive bleeding, large clots, unusual tenderness, foul smelling discharge or a fever.
Menstruation – when will your periods resume?
It is difficult to predict exactly when your periods will resume. If you are not breast-feeding, your period may
begin in five to eight weeks. If you are breast-feeding, you may begin your period in two to four months, or it
may not begin until you are finished breast-feeding. Breast-feeding is not a means of birth control.
Episiotomy – stitches
If you have had stitches for an episiotomy or tear, the stitches will dissolve and do not have to be taken out.
Initially, this area may feel painful and bruised, but will heal over a period of three to four weeks. The goal is to
prevent infection, decrease pain and promote healing.
• Ice the perineum as soon after birth as possible. Ice will minimize swelling and decrease pain.
Ice can be used for the first 24 hours.
• Use a squeeze bottle filled with warm water to rinse your stitches after you urinate.
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• Pat your bottom dry, from front to back.
• Soak in a clean tub of warm water two to four times a day for at least 15 minutes.
• Use witch hazel pads (like Tucks®) by holding them in place with a sanitary pad. Change pads
frequently during the day. Store Tucks® in the refrigerator for cooling comfort.
• To help your stitches from pulling, sit squarely on your bottom and do Kegel exercises.
• Rest as much as possible.
• Don’t use tampons, douches or have intercourse before advised by your provider.
Third or fourth degree laceration
The above suggestions will be helpful. Also recommended are the following:
• Continue with a high fiber diet. Drink 6 to 8 glasses of water daily.
• Use a stool softener as ordered by provider.
• Do not use rectal suppositories or enemas.
• If you don’t have a bowel movement within three days, or if you have increased tenderness in the
perineal area, call your provider.
Incision care - Cesarean birth
Before you leave the hospital, the staples or long stitches will usually have been removed. There may be
strips of tape across your incision called steri-strips; you can leave these on until they become loose and are
easy to remove or they simply fall off on their own. It is important to keep the incision clean. Your provider
will let you know if you can take a shower or bath. It is normal for the incision to itch as it heals. Report to your
provider any drainage, redness or increase in pain in the incision.
Deep Vein Thrombosis (DVT)
One small, but potential risk during pregnancy and up to six weeks after birth, is that of a venous thrombosis
or blood clot. About 1 to 2 women in 1000 will get a blood clot during pregnancy or just after birth. DVT, or
deep vein thrombosis, is when a blood clot forms in a deep vein, usually in the leg or pelvis. Anyone can
develop a blood clot, but pregnancy and birth place you at greater risk.
The symptoms of DVT are pain, tenderness and swelling of the leg. There may be a slight discoloration of the
skin on the effected leg. If the clot is in the thigh, the whole leg may be swollen. Call your provider if you have
any of these symptoms.
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DVT is confirmed by an ultrasound exam of the leg. It is treated with a medication called heparin. Heparin is
an anticoagulant - it “thins the blood”. It cannot break up the clot, but will keep it from getting bigger. Then
your body will be able to dissolve the clot and it will go away. You will also be given compression stockings to
wear. These special elastic stockings improve blood flow and decrease swelling of the legs. They should be
worn for several months.
Your provider will know your risk factors and will advise you on ways to avoid, or minimize your risk of, DVT.
Being up and walking about, staying active, can help prevent DVT.
Bowel management
After birth, you might feel apprehensive about having a bowel movement or you may feel constipated due
to tenderness of the perineum, an episiotomy, uncomfortable hemorrhoids or weak abdominal muscles.
You may also have some constipation from iron supplements. Drink fluids (especially water) and include
plenty of whole grain cereals, fresh vegetables and fruits in your diet. Exercising your abdominal muscles,
walking and responding when you feel the urge to have a bowel movement (rather than avoiding it) will
assist in the return of your normal function. It may help to support your perineum by gently pressing toilet
paper at the episiotomy site during a bowel movement. The relaxation techniques you learned in childbirth
class will also help.
Vaccination against Pertussis (Whooping Cough)
Pertussis or Whooping cough is usually a mild illness for adults, but can be severe, even deadly, for infants
less than 1 year of age. Since this disease is still present in the United States, the Centers for Disease Control
and Prevention recommends parents have vaccination against Pertussis to protect the newborn until the
vaccine the baby receives (which starts at 2 months) is effective. Parents who have not had the Tetanus shot
which contains the Pertussis immunization prior to the baby’s birth, should receive ADACEL® or BOOSTRIX®.
The vaccine is commonly referred to as the “Tdap”. It is recommended to find out when your last vaccination
was received and if it contained the Pertussis part. Prior to May, 2005, the vaccine was only for Tetanus and
Diphtheria and provided no protection against whooping cough.
Pregnant women should get a dose of Tdap during every pregnancy, to protect the newborn from pertussis.
Infants are most at risk for severe, life-threatening complications from pertussis.
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Mothers can be vaccinated after delivery, before discharge, but partners should seek vaccination anytime
before birth from a clinic of their choice or a public health clinic. Other family members who will have close
contact with the newborn should be vaccinated, too. The immunization can cause some painful swelling at
the injection site, general body aches, tiredness, and/or headache.
Have you received the Tdap vaccination? If “yes”, on what date? Insert date
Hemorrhoids
Allow some time to pass for hemorrhoids to improve. Most go away in two to six weeks. Some specific things
you can do to promote healing and reduce discomfort include:
• Soak in a warm tub several times a day.
• Avoid constipation by eating extra dietary fiber, drink plenty of fluids and use stool softeners as
needed. A mild laxative may help.
• Use witch hazel pads (like Tucks®).
• Talk with your provider for additional suggestions.
Breast care for non-breast-feeding mothers
Even though you are not breast-feeding, your breasts still experience changes and will need care in the days
and weeks after birth.
• A supportive bra worn 24 hours a day provides comfort for some women. You decide what feels
best.
• Your breasts will likely feel full and uncomfortable two to five days after your baby is born. This is
due to circulatory changes in your breasts. Ice packs to your breasts (try a package of frozen peas
wrapped in a wash cloth and tucked in your bra) will ease the discomfort.
• You may experience leaking of breast milk. Express just to the point of comfort. Expressing more
will stimulate your breasts to make more milk, which may add to your discomfort.
• Tylenol® may be used to ease discomfort.
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Breast care for breast-feeding mothers
Breast changes occur in each woman after giving birth. Breast-feeding mothers may find the following helpful:
• A well fitting, supportive bra will offer comfort.
• Gently wash your breasts each day and avoid using soap on your nipple area.
• Wash your hands before each feeding.
• Drink enough fluids. Have a glass of water nearby when you feed your baby.
• Nipple tenderness or soreness is common around four to five days as your nipple stretches. Latch
on discomfort should be temporary, breast-feeding should not be a painful experience. Apply
expressed colostrum or breast milk to your nipples or pure lanolin (PureLan™ or Lansinoh®) to help
heal.
• Call HealthEast Outpatient Lactation Clinic at 651-232-3147 and talk with our lactation consultant
or call your provider if pain is severe or nipples are cracked or bleeding.
Rest and activity
Getting enough rest is essential to recovery after your baby’s birth. Here are some suggestions:
• Rest or sleep when your baby sleeps. Go to bed early if possible, especially if you are getting up for
night feedings.
• Don’t overtire yourself with every day chores. Avoid too much entertaining when you first get home.
Encourage visitors to come for short periods of time. Accept the help of friends and family for basic
household tasks and cooking.
• Avoid heavy lifting for two weeks after a vaginal delivery and six weeks after a Cesarean birth.
When lifting, remember to bend your knees and use your leg muscles. Have older children climb
onto your lap.
• Exercising can usually be resumed four to six weeks after delivery. Daily walks can be taken as
soon as you feel ready.
• Overall, gauge your activity by how you feel, follow your provider’s guidelines and take advantage
of offers of help.
Postpartum warning signs: When to call your provider
• Fever or chills with a temperature of 100.4 degrees F or higher
• Pain, redness, warmth or swelling in any part of your leg(s), or pain when you point your toes toward
your head
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• Pain or burning when urinating, any change in frequency or not being able to empty your bladder
• Hard, red, painful areas in your breast accompanied by a fever or chills
• Passing golf-ball sized (or larger) clots, clots containing whitish tissue or bright red bleeding that
soaks through a pad in one hour or less
• A foul smelling or greenish vaginal discharge
• Constant back, abdominal or pelvic pain. Abdomen that is tender to touch – other than usual
tenderness around a Cesarean incision
• Stitches that have become painful, red or separated – or that have pus-like discharge, with or
without a fever
• Any difficulty breathing, headache, double or blurred vision
• A feeling of extreme sadness or depression that lasts longer than a week; not having enough
energy to care for yourself or baby
Postpartum depression: Things you should know
Women adjust to the role of motherhood in a variety of ways. Most women have a few tough or weepy days,
balanced by days that go fairly well. The “baby blues” commonly occur in the first weeks after birth and are
usually short-lived and temporary. Often the blues can be decreased by some extra self-care such as a walk
without the baby, extra rest, a long bath, improving nutrition or a visit with a good friend. However, if the
common symptoms of the baby blues continue or worsen, professional help is needed. Be aware of your
feelings and emotional health for the entire year after your baby is born.
Postpartum depression is a serious disorder that affects 10 to 20 percent of mothers who have recently given
birth. It is commonly confused with the “baby blues,” a less serious problem characterized by sadness and
tearfulness that usually begins within a few days after delivery, and lasts from hours to days. In contrast, the
symptoms of postpartum depression are more severe and persist for weeks to months.
These symptoms do not have to be severe before you seek help. Call your provider for professional help.
You may call the Maternity Care outreach nurses for information regarding postpartum support groups.
At HealthEast Maternity Care we screen for postpartum depression. Women are given the Postpartum Mood
Assessment tool. It is a self assessment. When complete, give the tool to your nurse for scoring. A high score
will be referred to a HealthEast social worker for follow up.
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Symptoms of postpartum depression
To diagnose depression, five or more of these symptoms should be present nearly every day for at least
two weeks:
• Feeling down, depressed
• Having decreased interest or pleasure in activities
• Having decreased or increased appetite/weight
• Sleeping poorly, or wanting to sleep more than usual
• Feeling agitated, edgy or slowed down
• Being fatigued, having little energy
• Feeling worthless or guilty without good reason
• Having difficulty thinking or concentrating
• Having recurrent thoughts of death or suicide or of harming your baby: If you have this symptom,
call your physician immediately.
Common myths about depression
Myth: ”Depression is caused by a weakness in my personality, or something I did wrong.” This is not
true; rather, it is caused by a change in brain chemistry. Women who have recently given birth are more
susceptible to such changes, given their dramatic hormonal shifts, the demands of caring for an infant and
their frequent lack of sleep. Remember that depression is not your fault.
Myth: ”There is nothing I can do to make my depression better. I just have to wait it out.” There are
medications and other treatments that are very effective in treating depression. They will usually help to
decrease the severity and duration of symptoms.
Myth: ”People will look down on me if they find out that I am depressed.” Most of the time, people will
respect you for recognizing your symptoms and seeking help. This is true of the health care workers at
your clinic and it is also often true of your close friends and family members. If those who are close to you
understand the problem, they will be in a better position to help you.
Myth: ”I will never be the same again. I will always struggle with this feeling of sadness.” Interestingly,
depression itself can produce thought patterns that make you believe you will always be depressed.
However, most people who are depressed do get better. It may take awhile - weeks to months - before you
are completely back to normal, but medications and other treatments can speed the process. Nearly all those
who become depressed recover.
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Some questions about depression treatment and recovery
• What types of treatment are available for postpartum depression? The most commonly used
treatments are antidepressant medications and counseling, used either separately or together.
Other treatments might include group therapy, hormone therapy or even light treatment.
• What are some of the side effects of antidepressant medications? Although most people tolerate
these medications quite well, they may experience some nuisance effects. Selective serotonin
reuptake inhibitors (SSRIs) can produce sleepiness or insomnia, nervousness, nausea, vomiting,
diarrhea or sexual difficulties. Tricyclic antidepressants (TCAs) may cause tiredness, dizziness, dry
mouth, constipation, weight gain, palpitations, blurred vision and urinary retention. If you are breastfeeding, discuss the risks and benefits of antidepressant medication with your physician.
• How long will the treatments last? Antidepressant medication is usually given for several months,
and may be continued for a year or longer. If you receive counseling, several visits are usually
recommended.
• What can I do to help myself recover from postpartum depression? See your physician as soon as
possible, and follow through on prescribed treatments and follow-up visits. If a treatment disagrees
with you or is not making you feel better, don’t just stop it on your own. Rather, talk to your
physician about what to do next.
Be sure to eat nutritious foods, get regular exercise (taking your baby for a stroller ride counts), and
allow yourself adequate rest and time for fun and relaxation, even if it is for only a few minutes a
day. Parents with infants tend to have very heavy work demands that include childcare, household
work, and often, employment. Try to find ways to cut back on some of these demands while you are
recovering from your depression, by getting help from friends and family members with household
chores, childcare and nighttime feedings. You may also want to cut back on your paid work time
for awhile.
• What should I do if I feel so desperate that I might hurt myself? Call 911, your physician or a crisis
line immediately. You may call the Crisis Connection at 612-379-6363 for assistance.
For spouses or partners of a depressed person
• You are very important to your partner’s recovery.
• You can help by being supportive, both emotionally and practically, by being there, listening,
helping to care for the baby and any other children during the day and at night, and sharing in the
housework. In addition, encourage your partner to keep follow-up appointments with physicians
and therapists, and to take prescribed medications.
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• Having a depressed partner requires extra effort on your part, so make sure you get the support
that you need from family and friends, support groups, etc. If you yourself feel depressed, see
your physician.
• It is common for parents with infants to have decreased sexual activity, sexual enjoyment and
partner satisfaction. Although these changes tend to smooth out over time, depression may make
them worse. If you are having problems in these areas, please discuss them with your physician.
For additional information about postpartum depression, go to postpartum.net. See our other resources
listed at the back of this book. If you have a spouse or partner, please share this information with that person.
GESTATIONAL DIABETES FOLLOW-UP
Most women’s blood sugar will return to normal after delivery. But, gestational diabetes is a warning sign that
you are at risk of getting diabetes later in life. You are also more likely to have gestational diabetes with your
next pregnancy.
Even if your blood sugar is back to normal you still have to take care of yourself. This will help prevent
diabetes later in life.
How can you lower your risk of diabetes later in life?
Maintain a healthy weight
Follow simple guidelines, like eating foods that include whole grains, fresh fruits and vegetables, protein
found in meat, dairy and eggs. Limit your fat intake to 30% or less of your daily calories. Limit sweet treats and
watch portion size. You can find additional information at choosemyplate.gov
Exercise
Regular exercise helps lower your blood sugar. It also helps you maintain a healthy weight.
Breast-feed
Breast milk is the best food for most babies. Breast-feeding may help lower your blood sugar. This decreases
your risk of getting diabetes later in life. It also decreases your baby’s risk of getting diabetes later in life.
Follow Up Care
It is recommended to have your blood sugar tested at your postpartum check up. There are different types of
tests. Test options include: fasting blood sugar; hemoglobin A1C; 2 hour glucose tolerance test. Your provider
will do a fasting blood sugar.
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If your follow-up test is normal, you should be retested at least every 3 years. More frequent testing is
important if you plan to become pregnant again, or if you have other risk factors. Risk factors may be obesity,
high blood pressure, high cholesterol or a family history of diabetes.
At your postpartum check up, ask your provider if you will need additional testing for diabetes.
Resources: The American Diabetes Association diabetes.org
DIET AND POSTPARTUM EXERCISE
Continue to eat a well-balanced diet. Do not crash diet. Your body needs extra nutrients to heal and to
produce milk for your baby if you are breast-feeding. Drink plenty of fluids and if you are breast-feeding,
continue taking your prenatal vitamin.
Pregnancy greatly affects the abdominal and pelvic floor (perineum) muscles. After birth the abdominal
muscles need to be firmed and the pelvic floor muscles need to be toned to provide support for the
pelvic organs, to control urination and to promote sexual pleasure. The lower back muscles may need to
be stretched if you had a swayed posture during pregnancy. Check with your provider before starting to
exercise.
Guidelines for exercising
• Do fewer repetitions if you need to.
• Don’t exercise to the point of pain.
• Stop and rest if you feel dizzy.
• Split the exercises into groups and do them throughout the day rather than doing them all at once.
• Watch your breathing. Exhale during the most difficult part of the exercise; don’t hold your breath.
• Walking is an excellent conditioning exercise and can also help lift your spirits.
The American College of Obstetricians and Gynecologists has exercise guidelines at their website:
acog.org/Search?Keyword=exercise+pregnancy
Stretching
To help the uterus and other pelvic organs return to good posture and prevent back strain, lie on your
stomach with a pillow under your hips and with your arms above your head. Feel the stretch from head to
toe as you make yourself as long as possible. Squeeze your buttocks together and tighten your abdomen for
more toning. Relax and repeat. Try to lie on your stomach for 10 minutes.
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Kegel exercise
To strengthen and tone pelvic floor muscles and increase circulation, squeeze the muscles that you use to
stop the flow of urine. Hold for up to 10 seconds, then release.
Knee to chest
To relieve backache, lie on your back with your knees bent, feet flat and pelvis tilted. Breathe out as you bring
one bent knee toward your chest. Hold the position for three seconds and feel the stretch in your lower back.
Repeat with the other knee. Do five repetitions.
Partial sit-ups or curls
To strengthen abdominal muscles and improve back posture, lie on your back with your knees bent and
feet flat on the floor. Breathe in, tilt your pelvis and keep your lower back pressed against the floor. While
breathing out, raise your head and shoulders from the floor, reaching your outstretched arms toward your
knees. Keep your waist on the floor. When your shoulders are raised about 8 inches, hold this lift for five
seconds. Relax and gently lie back. Repeat about five times a day.
Heel slides
To increase strength and circulation following a Cesarean birth, lie on your back with your legs straight. Slide
heels alternately toward and away from your buttocks. Start doing three to five repetitions four or more times
per day.
Abdominal tightening and breathing
To enhance abdominal muscle tone, while lying on your back with bent knees, place your hands on your
stomach. Inhale deeply through your nose allowing the abdomen to rise up and keep the ribs as still as
possible. Exhale slowly through pursed lips while tightening your abdominals. Imagine that you are touching
your abdominals to your spine. Hold for five seconds and relax. Do five repetitions three times a day.
Pelvic tilt
To strengthen abdominal muscles and release backache, while lying on your back with bent knees, breathe
in slowly. Tighten your abdominals and buttocks and tilt or rock your pelvis so you feel the small of your
back flatten against the floor or bed. Don’t push with your feet. Hold for five seconds, then relax. Do five
repetitions three times a day.
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YOUR NEWBORN
General newborn appearance
You may find yourself staring in amazement at your new baby as you take in all of the unique features of your
newborn. Although no other baby will look exactly like yours, there are some characteristics common to most
newborns.
Body
Baby’s shoulders are narrow, the abdomen protrudes, the hips are small and the arms and legs are relatively
short and flexed. Baby may have fine, downy hair on his or her back, shoulders, ears and cheeks.
Head
Baby’s head may be misshapen as a result of squeezing through the birth canal. It will become more rounded
within the first days of life. Baby’s head may seem large in proportion to the rest of his or her body. There may
be some swelling or bruising of the scalp. This is also due to the birth process and will vanish with time.
There are two soft spots on baby’s head, called fontanels. These are areas where the skull bones have not
completely joined. The smaller fontanel usually closes within two to six months and the large one closes
by the time the baby is 18 months old. These areas are covered by a tough membrane so that washing or
brushing the scalp will not hurt your baby.
There may be puffiness around the eyes or facial bruising. Babies usually display crossed eyes. This
disappears at around four months of age when the muscles controlling the eyes become stronger.
Skin
At the time of birth, baby’s skin is grayish-blue, it’s wet and there may be some streaks of blood and a white
creamy coating called vernix. The skin tone will become normal within a minute or two after the baby begins
breathing. There may be red areas on the back of the neck, eyelids, nose or forehead. These are collections
of superficial blood vessels, not true birthmarks, and usually fade away by 9 months of age.
Newborn rash is very common and is characterized by red blotches that come and go. This does not require
any treatment. Many babies have peeling skin around their hands, wrists, ankles and feet. If your baby was
overdue, you will probably notice this. Using unscented lotions may be helpful.
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Breasts and genitals
Due to the mother’s hormones, both male and female babies may have swollen breasts. This will go away
within a few days. Female babies may have swollen labia and there might be milky or blood tinged mucus
that comes from the vagina. Male babies may have swelling and redness of the scrotum. These conditions
are temporary and do not require any treatment.
A red or pink “brick dust” appearance on the diaper suggests your baby may not be getting enough milk.
“Brick dust” on the diaper results when uric acid crystals form in concentrated urine. It is not an uncommon
occurrence with breast-fed babies during the first day or two, when the quantity of colostrum the baby drinks
is low. Once your milk comes in, however, your baby should be able to drink enough milk to produce
clear urine.
Umbilical cord
At delivery, the cord is covered with a white, jelly-like substance. This will dry, turn black, and the entire cord
will usually detach within 10 to 21 days.
If you notice a protruding belly button, this could be a hernia and should be evaluated by your provider.
Breathing
Newborns have periods of time when their breathing is irregular. They also make gasping, groaning or
snorting noises when they are asleep. They may even pause in their breathing. These can all be frightening
to new parents.
It may help to know that this is not a concern unless baby’s skin turns blue. These irregularities usually
disappear around 2 months of age.
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BABY STATES
Your baby has different levels of sleeping and waking states. Babies behave in certain ways during each
state. If you can tell the state your baby is in, you can get to know your baby better. For example, being
able to tell when your baby is fully awake will help you know the best time for feeding or playing. When you
understand sleep states, you can know the times to let your baby sleep. Your baby cannot be spoiled by
being picked up when crying, but will feel secure and loved.
Most babies move smoothly between states and may move up and down one or two states at a time.
In newborns, this change can happen very quickly.
Baby state
Sleep – quiet
Characteristics
• Baby is lying still
• May make jerky movements or
may startle
What it means for you
Baby is difficult to awaken. Not a good
time to eat. Allow baby to sleep.
• Mouth may be making
sucking movements
Sleep - active
• Makes occasional face or
body movements
• May suck, smile; eyelids flutter
Easy to awaken. Wait until baby is fully
awake to eat. Do not assume noises
mean baby’s fully awake.
• Makes brief fussy or crying sounds
• Body movements are smooth
Sleepy
• May gently startle
• Eyes open and close because they
are heavy, dull and sleepy
• Some facial movements
This state occurs just before waking; you
may think your baby is awake when you
see his or her eyes open and close, but
wait to see if baby will awaken or wants
to sleep. To wake up your baby provide
something to look at or listen to.
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Baby state
Alert - quiet
Characteristics
• Baby’s eyes are open and bright
• Moves arms and legs
• Face has bright, alert look
• Baby will focus on your face, voice or
moving objects
Alert - active
• Baby’s eyes are open, but less bright
• Moving arms, legs and head - a lot
• Baby is more sensitive to noise
and hunger
• Not really able to focus
What it means for you
Baby signals readiness to be with you.
Talk in a soothing, gentle tone; provide
stimulation in the form of sounds or
objects to look at; gently, but firmly, touch
or hold your baby - this will keep baby in
an
alert state.
Your baby is telling you it is time for a
change. Feed baby if you think he or
she may be hungry; you may need to
slow the pace a little – stop what you
were doing for baby, and try something
different. Be calm and reassuring.
• May appear to be fussy
Crying
• Baby is crying
• Face is tight - may squeeze eyes shut
• Moving arms and legs a lot
Crying is a signal that your baby’s had
enough; you need to stop what you
were doing and help soothe him or her.
Try walking, or gently rocking, talk in
soothing voice. Repeat a soothing action
over
and over.
Baby behavior
Generally, babies have many of the same ways of letting us know what they want and need; but each baby
has a unique own way of acting that makes him or her quite unlike every other baby. You will learn your
baby’s behavior by looking at what your baby does. Knowing your baby’s behavior will help you care for your
baby in a way that is best for him or her. For example, you can learn which things are upsetting and which
things are soothing for your baby. Behavior, as well as crying, is baby’s way of communicating with you.
The chart describes common ways babies behave and also gives hints to help you learn about your own
baby’s behavior. Remember, knowing baby behavior is one way to learn about your baby’s special language.
All babies have their own behavior. The state your baby is in will affect how your baby behaves.
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Behavior
Characteristics
What it means for you
Looking (visual)
Babies see best when objects are
7 to 12 inches from their face. They
especially like human faces, patterns
and contrasting colors like black and
white. Babies can follow objects and
faces with their eyes and head.
When your baby is in an alert state, hold
the baby 7 to 12 inches from your face.
Slowly move your head side to side, but
don’t talk. Watch as your baby follows
with his or her eyes or head. Now do the
same thing with a bright object and watch
baby track the object.
Hearing
Babies can hear at birth. They will listen
to all kinds of sounds - but they enjoy
human voices best! When babies listen,
they turn their heads toward the sound
and search with their eyes to find where
the sound is coming from.
When your baby is quiet and alert, be
near the baby and talk in a steady, soft
voice. Watch how your baby reacts.
Babies enjoy soothing, repetitive sounds.
Holding, cuddling
and snuggling
Babies cuddle by snuggling into
the curve of your arm or neck, your
shoulder or chest. They love to snuggle
- but some babies like to snuggle more
than others.
Snuggle often with your baby during
the day. Find the way your baby likes to
snuggle best. If your baby stiffens when
being held close, find other times to
snuggle such as when feeding, falling
asleep or when baby needs comforting.
Remember, all babies have likes
and dislikes.
Smiling and moving
When your baby is very young, his or
her smile is a reflex occurring both in
sleep and awake states. Your baby may
move his or her arms and legs a lot, or a
little. Movements may be smooth or
appear jerky.
Watch for your baby’s smiles. When he or
she smiles, smile back, coo and talk. Let
the baby know you’re happy. At around
3 to 4 weeks old, your baby will begin to
purposefully smile back at you.
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Behavior
Crying as an
indicator of pain
Characteristics
Although babies cry when they are
bored, fearful and hungry, the pain
cry is high pitched, tense, harsh, nonmelodious, short, sharp and loud.
It may be accompanied by an increase
in breathing rate, sweaty palms,
randomly moving hands and feet, facial
grimace with eyes tightly closed and
mouth open.
What it means for you
Because of your excellent observational
skills with your baby, you can determine
when your baby is in pain. The cry, along
with facial expression, body movements
and changes in eating/sleeping patterns
will help you decide when you need to
call baby’s provider.
See page 102 for ways to try to soothe
your baby.
Baby cues
What are baby cues? Cues are your baby’s way of telling you what he or she wants. When your baby is
very young, most of these cues will be non-verbal. For example, if your baby wants to play he or she will
turn toward your voice or look at you. These signals are called engagement cues. The word engage means
“to hold or attract.” So, your baby is trying to “hold and attract” you. Cues may or may not be easy to see.
Knowing about baby cues will make caring for your baby more enjoyable.
Babies can also tell parents when they need a break or a rest period. These are called disengagement cues.
The word disengage means “to withdraw.” Your baby needs to withdraw from you for awhile. He or she may
turn away from you, grimace or even cry.
Usually when your baby is with you, he or she will display a mix of engagement and disengagement cues.
Look for the cues that occur most often to decide what your baby is trying to communicate. This helps you
decide what to do with your baby.
Feeding cues and feeding
Parents feel differently about the time spent feeding their baby. Most view feeding time as a special time
for feeling close to their baby, and others see feeding as a chore. During the early days and weeks it may
be one of the few times your baby is awake. The time you spend feeding your baby gives your a wonderful
opportunity to get to know your baby and for your baby to get to know you!
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Message
Feed me
Characteristics
• Mouthing
• Crying
• Sucking motions
What you should do
Feed baby. If baby does not feed, change
positions, reposition breast in baby’s
mouth.
• Hands in or near mouth
I need a break
• Crying
• May spit up
• Choking
Give baby a rest period. May be full, or
just wants a rest period; stop feeding and
watch for baby to resume feeding cues.
• Looking away
• Arching back
• Pauses during feeding
I’m full
• Arches back
• Falls asleep
• Pushes away
Stop feeding baby. If baby just needed a
break, feeding cues will resume after a
brief rest.
• Arms relaxed along side
I want you
• Smiling
• Looking at your face
Make sure you allow time during feeding
to play and talk to your baby.
• Head turned toward you, reaches out
to touch you
If your baby is a poor eater, does not suck or eat at all, call or see your baby’s provider right away. Babies who
do not eat well can become very sick.
You may also call:
• HealthEast Outpatient Lactation Clinic,
talk to a lactation consultant (M – F, 9 a.m. to 2 p.m.) 651-232-3147
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Baby state variations
During a 24-hour period a baby wakes up, goes to sleep and cries many times. The change in sleep, wake
and crying is called state variations. Usually babies can wake up, go to sleep and stop crying on their own.
They can change their own state.
Sometimes babies need help from their parents in order to make these changes. One baby may be sleepy
and hard to wake up to feed. Another baby may have greater trouble being soothed and going to sleep.
Knowing how to help your baby change sleep/awake states is another way to learn your baby’s special
language. Try the hints that follow and see what works best for your baby.
To awaken baby
An awake baby may eat better. Babies also like
hearing your voice and looking at your face. Try
these to awaken your baby:
• Take baby’s blankets off
• Undress your baby, change the diaper
• Place baby about 7 to 8 inches from your face
and talk gently
To soothe baby
It may be difficult to calm a tired, fussy and crying
baby. Begin with one soothing action at a time.
Repeating it over and over seems to work best.
If something you’re doing is not working, try
something else.
• Let baby see your face
• Pick up and hold baby close
• Alter the pitch of your voice, high or low
• Talk to baby in a steady, soft voice
• Give your baby something to grasp
• Walk, rock or take baby for a stroller ride (car rides
often work)
• Place baby on your shoulder
• Gently rub your baby’s tummy or back
• Hum or sing to your baby
• Wrap baby snugly in a blanket (swaddling)
• Gently hold baby’s arms close to his or her body
• Stroke an area of baby’s body like the back, foot
or head
• Place baby in a baby swing (but do not leave
baby unattended)
• Try carrying baby in a front pack or sling
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Crying - Never shake a baby
Crying is one of the more obvious ways your baby has of communicating with you, telling you what he or she
needs. Cries can indicate your baby is tired, hungry, cold, hot, sick, bored, scared or just wants you. After your
baby is born and you are still in the hospital, your baby may cry very little or a lot. We know, based on studies
of babies’ behavior, that babies begin to cry more at around 4 to 6 weeks of age.
In the first several days at home with your newborn, he or she may be fussy as he or she adjusts to the new
rhythm of your family. Also, if you’re breast-feeding, baby may be fussy until your milk comes in. Frequent
nursing will stimulate milk production.
Crying can be very difficult for parents, especially if it occurs for long periods of time. Babies tend to cry less
when you respond quickly to their crying with soothing actions. Try some of the hints listed on the previous
page. Sometimes a little change, like moving your baby from the bedroom to a room you are in, can offer
comfort to your baby and may stop the crying. Other times a bigger change is needed, like a walk outdoors
or a ride in the car.
Occasionally, your baby may simply need to cry. Be sensitive to your baby and the need to cry. Do not,
however, let your baby cry for long periods of time. If you have ruled out other causes for crying (sick, wet,
hungry, tight clothing, need to burp, too hot or too cold) and you feel baby may just need to cry, try this: Allow
your baby, safely in her crib, to cry for no more than 10 minutes. Set a timer if you have one. Then pick up
your baby. Try to calm your baby for at least 10 minutes. If your baby continues to cry, let him/her cry 10 more
minutes. This may allow your baby to handle the tension and give you a break. Get help from family and
friends for a “time out” from your baby. Call a relative or friend to come and give you a break from your baby.
It is NEVER OK to hit or shake your baby. If you feel you may harm your baby from constant crying – get help
immediately!
You may call the following:
• HealthEast Care Connection (24 hours) 651-326-CARE (2273)
• People Incorporated Parent Support Services 651-641-1300
• Greater Minneapolis Crisis Nursery 763-591-0100
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Crying as an indicator of pain
Long periods of crying may mean your baby is sick or in pain. You play an important role in the assessment
and management of your baby’s pain. You know what is usual versus unusual behavior for your baby and you
know how your baby expresses pain. Consider the following in assessing pain:
• Has there been a recent event that would cause or increase your baby’s pain?
• Have you done anything to lessen baby’s pain such as rocking, soothing, a favorite toy or given a
pain medication?
• What is happening when the pain seems to be increased or lessened?
• Is baby’s pain lessened or increased when he or she is held in a particular position: lying down or
sitting up?
• Has there been a change in baby’s usual eating or sleeping patterns?
Call or visit your baby’s provider when your baby cries a lot. The information you get from answering the
above questions is important information to give to baby’s provider when you call for advice.
Colic
Colic is another reason babies cry. The exact cause of colic is unknown so it can be difficult to confirm. The
diagnosis of colic should only be made by your baby’s provider. You may suspect colic if your baby cries
inconsolably at about the same time every day, often between 6 and 10 pm or after most feedings; or if your
baby will not stop crying when the usual ways of comforting are tried. Consult your baby’s provider for the
advice that is best for your baby and situation.
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A colicky baby may display
How to help your baby
Remember
• Arched back
• Cuddling and snuggling baby
• Colic is not your fault.
• Clenched fists
• Car ride or stroller ride
• Flailing arms and legs
• Pacifier (extra sucking can
be soothing)
• Your anger and frustration
are normal.
• Draws legs up
towards abdomen
• Your baby is not angry at you.
• Tense or bulging abdomen
• Play soft music or tapes
of heartbeat
• Your baby is healthy in spite of
excess crying.
• Struggling and angry when
held
• Carry baby in a front pack or
sling
• Do not feed your baby every
time he or she cries.
• Screams loudly
• Run the vacuum cleaner or
washer. (The monotonous sound
may be comforting to baby.)
• Caution: Never shake your
baby – even the slightest
shake. Shaking will not stop the
crying and could cause serious,
permanent brain injury or death.
• May pass gas
GENERAL BABY CARE
Diapering
Changing the diaper with each stool and when it is moderately wet will help your baby remain comfortable
and prevent diaper rash. Wash the diaper area with each change. Avoid using powder, which can lead to
rashes, or cornstarch, which can promote fungal infections. Until the cord falls off, fold the diaper below the
cord. Remember, don’t leave your baby unattended.
Bathing
• Stay with your baby at all times during a bath and when dressing.
• It’s best to give baby a bath prior to feeding; baths before bedtime may promote sleep.
• Give your baby a complete bath every two to three days. Areas that should be washed every day
include head, neck (under chin) and diaper area.
• Choose a place that is safe, warm and free from drafts.
• If your baby cries when naked, undress and wash one area at a time.
• Keep the household water heater set at no more than 130 degrees F. Always test water with your
elbow. It should feel lukewarm, not hot.
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• Have needed bath and dressing items within reach.
• Do not use cotton-tip swabs for ears or nose.
• Do not use powder.
• Do not pull back the foreskin of the penis when bathing an uncircumcised boy.
Before you begin, gather all the items you will need for bathing baby:
• Soft washcloth
• Two towels
• Diaper
• Clean clothes
• Cotton balls
• Mild soap (bar or liquid) and baby shampoo
• Tub with 3 inches of lukewarm water and a liner to keep baby from slipping
Typically, babies are bathed beginning with the cleanest area of the body, and progressing to the dirtiest.
The following is the recommended order of washing.
To begin either a sponge bath or a tub bath, start by using a soft cloth or cotton ball dipped in cool water.
Wipe around the eyes, and wipe the outside of the nose and ears. Wipe the rest of the face with plain,
warm water and a washcloth (no soap).
Then, for a sponge bath
1. Shampoo the head and squeeze water over it from the washcloth to rinse. If your baby cries
when washing his head, wash it last, but use clean water.
2. Wash the front of your baby with your free hand lathered with soap. Go from front to back
between the legs. Rinse well with the wet washcloth.
3. Wash the back of your baby with your hand lathered with soap. Rinse well with the
wet washcloth.
Or, for a tub bath
1. Hold your baby safely. Have your fingers under your baby’s armpit, with your thumb around the
shoulder. Your other hand supports your baby’s bottom and legs.
2. Shampoo baby’s head and squeeze water from the washcloth to rinse. Wash the front of your
baby. Go from front to back between the legs. Rinse with the wet washcloth.
3. Wash the back of your baby with your free hand lathered with soap. Rinse well with the
wet washcloth.
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Then, after the bath, you’re ready to dry your baby. Gently dry in between baby’s folds of skin to avoid
chafing and skin irritation. Lotions and powders are not needed unless recommended by your baby’s
provider. Dress your baby in soft, comfortable clothing. Always launder new clothes before allowing your
baby to wear them.
Dressing
Newborns’ ability to regulate their body temperature develops with age. Because their circulation is not fully
mature, their hands and feet will often feel cool and are not good indicators about how warm to dress the
baby. If babies are overdressed, they may develop a heat rash. Use layers of clothes and blankets that can be
added or removed as needed.
Nails and hair
Newborn nails are very soft. As babies get older, they can easily scratch themselves. You may use a baby
nail clipper or baby nail scissors. It works best to trim nails when baby is sleeping. Gently pull back the skin
from the nail and carefully trim nail. Even if your baby doesn’t have much hair, brush or comb it every day to
stimulate the scalp and prevent a build-up of cells called cradle cap.
Taking baby’s temperature
The American Academy of Pediatrics does not recommend the use of glass thermometers. Glass thermometers
present a potential hazard. The glass can break if dropped or hit on a hard surface. When broken, mercury
(the silver line) is released. Mercury is toxic to you and the environment. Use a digital or electronic
thermometer. Electronic ear thermometers are not accurate until your baby is more than 6 months old.
The methods used for babies are axillary (armpit) or rectal. Many providers and nurse practitioners prefer the
rectal temp. Ask your provider which they prefer.
Axillary (armpit)
Normal range: 97.6 degrees F to 99.6 degrees F
1. Remove baby’s arm from clothing; be sure armpit is dry.
2. Carefully place tip of thermometer high up in baby’s armpit.
3. Hold baby’s arm snug against the body.
4. Thermometer should remain in place until temperature reads out.
5. Remove thermometer and take reading.
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Rectal (preferred by most providers)
Normal range: 98 degrees F to 100.4 degrees F
1. Lubricate the end of the thermometer with a water soluble lubricant (like K-Y®).
2. Lay baby on tummy (across your lap works well) and spread buttocks so anus is easily seen.
3. Hold thermometer between thumb and index finger so that palm can easily rest on the buttocks.
Slowly and gently insert thermometer slightly less than 1 inch into the anus.
4. Hold thermometer in place until temperature reads out. Hold baby still with other hand.
5. Remove thermometer and take reading.
6. Clean the thermometer with alcohol after each use.
Bulb suctioning
Bulb suctioning is used to remove mucus from baby’s mouth and nose. Use the technique taught in the
hospital or by your provider. Remember to lightly squeeze bulb before inserting in baby’s mouth or nose
and be gentle. When suctioning baby’s mouth, insert the tip of the bulb syringe into the side pockets in
the cheeks. Never put the tip of the bulb syringe in the back of the throat. Be very gentle throughout the
entire procedure. Empty bulb into tissue and repeat as needed. Clean bulb after each use in warm, soapy
(antibacterial) water. Rinse and air dry. Discard bulb when no longer needed. Do not use on other children
or family members.
Cord care
Your baby’s umbilical cord will dry, shrink and darken. Usually it falls off within one to three weeks. It is
important to keep the cord clean. Using soap and water on a lightweight washcloth, cleanse around the base
of the cord at baby’s bath time. When diapering, fold the diaper away from the cord to allow air to dry it. Do
not cover the cord with the diaper. If you notice signs of infection like bleeding, redness, pus-like discharge or
foul odor, call your provider.
Bowel movements
Your newborn’s stool pattern is different from an adult’s. The first bowel movements are large, sticky, black/
green stools called meconium. In the first week following birth, stools will be a mixture of meconium and milk
by-products. The stool changes to a yellow/green, soft or even liquid seedy stool (if you are breast-feeding)
or a mustard/yellow soft stool (if the baby is on formula) within 10 days. These transitional stools will range in
color and be quite soft.
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Constipation is a hard, dry, formed stool. Call your provider if you think your baby is constipated. Diarrhea
stools are mucousy, watery and foul smelling, and occur more frequently than usual. The diaper will show a
water ring around the stool. Call your provider for advice.
Facial rashes
Newborns commonly develop mild facial rashes in the first months of life. These rashes may look like smooth
pimples, small red spots or rough red spots. The rashes seem to come and go and rarely
require treatment.
Jaundice
Jaundice is caused by large amounts of bilirubin in the blood. Bilirubin forms normally as red blood cells
mature and die. The liver typically clears the bilirubin, but because your baby’s liver is not mature, the bilirubin
builds up, causing the skin to look yellow. Sometimes, if not treated in a timely manner, very high levels of
bilirubin may become dangerous to the baby and lead to varying degrees of brain damage and/or hearing
impairment.
Newborn jaundice affects more than half of all newborns in the United States. Jaundice usually appears in
the first few days of life (around 72 hours old) and causes your baby’s skin, and sometimes the whites of the
eyes, to look yellow. This mild jaundice is considered harmless; however, because a small fraction of infants
(about 1:3 in 10,000) is at significant risk of developing very high bilirubin levels, all infants need to be
watched for signs of jaundice. It is important for your baby to be feeding well. This will help reduce the risk
of jaundice (yellow skin). All jaundice should be reported to your baby’s provider so the cause and treatment
can be identified.
Newborn Circumcision
The American Academy of Pediatrics (AAP) says that circumcision has some medical benefits and some
risks. After reviewing research on circumcision, in September of 2012, the AAP determined that the medical
benefits outweigh the risks. The AAP believes that the decision to circumcise should be made by the infant’s
parents after a discussion with their doctor. It is important to think about medical, religious, cultural traditions
and personal beliefs as you make this decision.
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What is circumcision?
The skin that covers the head of the penis is called foreskin. Circumcision is surgery to remove that skin.
Removing that skin will expose the tip of the penis. Circumcision is usually performed by a doctor in the first
few days of the infant’s life. The infant must be healthy to be safely circumcised.
Some insurance will not pay for it. Be sure to call your insurance and ask.
Is circumcision painful?
Yes. But there are pain medicines that are safe and effective.
Medical benefits of circumcision
• Greatly reduced risk of getting and transmitting HIV, the virus that causes AIDS.
• Lower risk of getting a number of sexually transmitted infections (STIs), including genital herpes
(HSV), human papilloma virus (HPV) and syphilis.
• A slightly lower risk of urinary tract infections (UTIs).
• A lower risk of getting cancer of the penis. This type of cancer is very rare in all males.
• Prevents foreskin infections.
• Prevents the foreskin from attaching to the penis so it can no longer retract. This condition is called
phimosis.
• Easier to keep the penis clean.
Reasons you may choose to circumcise
• The other men in the family are circumcised, and they don’t want their son to feel “different”.
• Some groups, such as followers of Jewish or Islamic faiths, practice circumcision for religious or
cultural reasons.
Reasons you may choose not to circumcise
• Fear of the risks of surgery. Complications are rare but may include: bleeding, infection, cutting the
foreskin too short or too long, and problems healing.
• Some people think:
-- the foreskin is needed to protect the tip of the penis; removing the foreskin may irritate the
tip of the penis and cause the opening of the penis to become too small. This may cause
problems urinating that may need to be corrected with surgery.
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-- circumcision will make the tip of the penis less sensitive so there will be a decrease in sexual
pleasure later in life.
-- that personal cleanliness can lower health risks. Boys can be taught how to clean their penis
and that can lower their chances of getting infections, cancer of the penis and STIs.
What if I choose NOT to have my son circumcised?
Talk with your provider about how to keep your son’s penis clean. Use care. The foreskin will not fully retract
for several years and should never be forced. When your son is old enough he can learn how to keep his
penis clean just as he does other parts of his body.
Parents’ Choice
• Circumcision is your choice. If you have questions, talk with your doctor or nurse practitioner.
Care of the penis after circumcision
The glans (or head) of the penis has been exposed now that the foreskin has been removed. The foreskin
has been cut and needs to heal.
• A small amount of bleeding is normal.
• The redness and swelling will go away as healing occurs within a few days after the circumcision.
• As part of the normal healing process, a yellow film may form over the area.
• Be sure your baby is urinating (peeing).
• Until the penis heals, apply a moderate amount of petroleum jelly to the glans each time you
change a diaper. This keeps it from sticking to the diaper. As healing progresses, a white film may
form over the glans. This is normal. Don’t try to wash this off.
• Your baby may be sleepy, irritable and obviously uncomfortable, especially when the penis is
handled and cleaned.
• Gently clean the penis with clear water as healing occurs. Don’t be too rough, as the area could bleed.
• It is OK to give your baby a tub bath. Continue cleaning the genitals with soap and water each day.
• If you see a ridge of foreskin after the circumcision is healed, talk to your provider.
Call your doctor if you notice signs of infection (persistent redness, pus like drainage) or if your baby is
not peeing.
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Care of the uncircumcised penis
The foreskin of an uncircumcised newborn is normally attached to the glans. Do not force it back (retract)
over the end of the penis. Gradually it will loosen and between 3 and 5 years of age, most boys’ foreskins are
fully retracted. Routine bathing will adequately cleanse the penis during infancy.
Premature Infants and RSV (respiratory syncytial virus)
RSV (respiratory syncytial virus) is a common virus that causes infections of the lungs and respiratory tract.
The peak RSV season begins in the fall and ends in the spring.
RSV can infect adults, children and infants. In adults and older, healthy children, the symptoms of respiratory
syncytial virus are mild, like the common cold. Infection with respiratory syncytial virus can be severe in some
cases, especially in premature babies and infants with other health problems.
Babies born at 35 weeks or less are at risk of having health problems. They are at greater risk of having
severe lung infections from RSV. Usually these infections must be treated in the hospital.
Call your baby’s provider right away if your baby has any of these symptoms:
• Persistent coughing
• Wheezing (a whistling sound when breathing)
• Rapid breathing; problems breathing, or gasping for breath
• A bluish color around the mouth or fingernails
• A fever. In the first few months, even a fever as low as 100.4 F rectally is a concern.
Treating severe cases
In cases of severe infection, baby will be hospitalized. This is needed to provide intravenous (IV) fluids and
humidified oxygen. Hospitalized infants and children may also be hooked up to mechanical ventilation — a
breathing machine — to ease breathing.
No vaccine exists for respiratory syncytial virus. But common-sense precautions can help prevent the spread
of this infection:
• Wash your hands frequently. Do so particularly before touching your baby, and teach your children
the importance of hand washing.
• Avoid exposure. Limit your infant’s contact with people who have fevers or colds. This is especially
important in premature babies and all infants in the first 2 months of life.
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• Keep things clean. Make sure countertops are clean in the kitchen and bathrooms, especially when
someone in your family has a cold. Discard used tissues right away.
• Don’t share drinking glasses with others. Use your own glass or disposable cups when you or
someone else is sick. Label each person’s cup.
• Don’t smoke. Infants who are exposed to tobacco smoke have a higher risk of contracting RSV and
potentially more severe symptoms. If you do smoke, never do so inside the house or car.
• Wash toys regularly. Do this especially when your child or a playmate is sick.
• If your baby was born prematurely and has risk factors for RSV, it may be recommended that
s/he receive a vaccine called Synagis. Your provider will tell you if your baby would benefit
from Synagis.
Safety
Your baby will enjoy being in the same room with you. If the baby is in another room, check him or her
periodically. Do not leave any baby unattended for long periods of time. Make sure the crib sides are secure.
Never leave a baby alone on a high surface; he or she may wriggle and fall off. If you are busy, put baby in a
crib or playpen near you. Never hold your baby on your lap when you are riding in the car. In a sudden stop
or a crash, your baby can be badly hurt or killed.
Car seats
Always use an approved baby car seat when traveling with baby (and older children). Read and follow the
manufacturer’s directions to properly secure the seat in your car. The seat must be used properly. Babies
weighing less than 20 pounds, and younger than 2 years old, should ride in a rear-facing child seat. The seat
must be in the back seat and face the rear of the van, car or truck.
Do not place your baby in the front seat of your car, especially if your car has a passenger side air bag. Air
bags present a life threatening danger to babies and small children.
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Checklist for car seat safety:
• Bring the car seat with you to the hospital for your baby’s first ride home.
• Household “baby carriers” and car beds do not provide adequate protection in a crash.
• Use the safety harness to secure the baby inside the seat. For very small babies, a small towel
rolled up and placed at each side of the baby’s body may make the car seat fit better.
• A baby car seat should be placed facing backward until the baby is 2 years old.
• Put your baby in the car seat correctly every time you travel.
• Wear your seat belt to set a good example.
• Remember, your baby depends on you to help keep him or her safe.
Baby’s first toys
Your baby’s hands and mouth will soon become the center of his or her world of discovery. Use this checklist
to help you select safe and appropriate toys for baby.
• A toy that is safe for an older child may be dangerous for a baby. Be sure older sibling’s toys are
kept away from baby.
• Avoid toys with small parts, including stuffed toys with ears or noses that could be pulled off and
swallowed. If a toy or toy part can fit through the center of a roll of toilet tissue, your baby could
choke on it.
• Rattles, teethers and rubber toys in their most compressed size should still be too large to fit
through a roll of tissue. If a squeeze toy contains a squeaker, it should not be detachable from
the toy.
• Crib gyms and mobiles should be securely fastened so they can’t be pulled down. They should be
removed when your baby is 5 months old or when he or she can push up on hands and knees.
• Avoid attaching or hanging crib toys, rattles, pacifiers, etc. to crib, stroller or playpen with elastic,
string or ribbon. They may entangle the baby.
• Avoid toys with glass, brittle plastic, sharp edges or parts that could entrap tiny fingers.
Toys can be a world of fun and learning for your baby. The best way to keep your baby safe is through careful
toy selection and proper supervision. For information about toy safety or toy recalls check the Consumer
Product Safety Commission web site at cpsc.gov.
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Baby walkers
Walkers are associated with more injuries than any other baby equipment. Walkers give babies mobility
before they or you are ready. Babies in walkers travel at a rate of 3 feet per second, faster than you can react.
The most common way a baby is injured is by falling down stairs in the walker. Head injuries can occur as well
as broken legs or arms.
A walker does not help a baby learn to walk earlier. Babies in walkers may actually be delayed in crawling
or sitting. Because the data indicate considerable risk of injury and even death from the use of walkers, and
since there is no obvious benefit from their use, the American Academy of Pediatrics recommends a ban
on the manufacture and sale of mobile baby walkers. Stationary (without wheels) activity centers are a safer
alternative to mobile walkers. Before using, be sure your baby has developed sufficient upper body strength
to remain upright in a stationary activity center.
Sudden Infant Death Syndrome (SIDS) – babies sleep safest on their backs
SIDS is the sudden and unexplained death of a baby under 1 year of age. Sometimes SIDS is called crib
death. Providers don’t know what causes SIDS, but they have found some things you can do to make your
baby safer. Healthy babies should sleep on their back. Place your baby on his or her back when putting him
or her down for a nap or for bed at night. Check with your baby’s provider to be certain this sleep position is
right for your baby.
Make sure your baby sleeps on a firm mattress or other firm surface. Don’t use fluffy comforters or blankets
under your baby. Don’t place your baby on a sheepskin, pillow or waterbed to sleep. Don’t place soft stuffed
toys or pillows in the bed with a very young baby. Some babies have been smothered with these soft
materials in their crib or bassinet.
Babies should be kept warm but comfortable. Keep the room temperature so that it feels comfortable to you.
Have baby sleep in light clothing to avoid overheating. If you use a blanket, make sure baby’s feet are at
the bottom of the crib, that the blanket comes up no higher than baby’s chest and that it is tucked in on the
bottom and two sides of the crib. You may consider using a sleep sack or a wearable blanket instead.
Do not allow anyone to smoke around your baby and make sure your baby receives the needed “well baby”
check-ups and immunizations. Call your provider or clinic right away if your baby seems sick. Consider breastfeeding your baby. Breast milk helps keep your baby healthy.
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Back to sleep, tummy to play
Tummy time is for babies who are awake and being watched. Your baby needs tummy time to develop
strong upper neck and chest muscles. Being placed on their tummies prepares babies for the time when they
will be able sit up and crawl. As babies grow older they will need more time on their tummies to build their
own strength.
Begin tummy time on your first day at home with your baby. Play, sing or talk to your baby while she or he
is awake and on the tummy two to three times each day for a short time. You can increase the time as baby
shows enjoyment of it. A good time for this may be after a diaper change or when baby wakes from a nap.
Some babies may not like tummy time at first. Having you or a toy in easy reach of baby will help tummy time
become more pleasant.
The majority of babies are born healthy and most stay that way. Don’t let a fear of SIDS keep you from
enjoying your baby. If you have questions about SIDS, talk with your baby’s provider.
Shaken baby syndrome
Parenting a newborn can be a wonderful experience. It can also be very frustrating and overwhelming.
Babies cry and sometimes you won’t know exactly why. This can be upsetting, especially when you’re tired
from lack of sleep. It’s OK to feel upset, that is normal. But it’s NEVER OK to shake a baby because of how
you feel.
Shaking babies can cause a number of injuries:
• Brain damage
• Blindness
• Mental retardation
• Seizures
• Paralysis
• Death
Shaking a baby is very dangerous. Shaking a baby is child abuse. Everyone who cares for your baby must
know this. To soothe your baby, refer to the guidelines in this book. Know your limits. Seek help from friends
or relatives if you are feeling frustrated or angry. Take a time out when you feel frustrated or angry.
Remember: It is OK to lay your baby safely in a crib for 10 minutes while she is crying until you feel less
frustrated and can call for help. Get away before you hurt your baby.
Tell your baby’s sitters that if they feel frustrated or angry by your baby’s behavior to call you anytime so
you can come and give them a break from your baby. Tell people who care for your baby about shaken
baby syndrome.
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Baby CPR (cardiopulmonary resuscitation)
TotSaver is an important class developed by the American Heart Association and is designed for anyone who
gives care to babies and children – parents, grandparents, older siblings, uncles, aunts and baby sitters. The
program consists of baby and child safety, discusses causes of cardiac and pulmonary arrest, group practice
of single rescuer CPR and foreign body airway obstruction or the Heimlich maneuver. The program is taught
by trained American Heart Association instructors and the goal is to provide an atmosphere of learning and
open discussion. Registration is required and there is a program fee.
Visits to your provider
You will bring your baby to the provider frequently during the first year of life for well baby visits. During
these visits, your provider will monitor your baby’s physical and mental development, give immunizations and
answer any questions you may have about your baby’s care and development. These visits are extremely
helpful.
You will also need to bring your baby in when he or she is sick. Sometimes it is difficult to determine if your
baby is sick. You will get to know your baby’s cues and you will be the best person to determine if there is
a problem. Trust your instincts. Call if you have any questions or concerns, especially if you are worried that
your baby may be sick. Before you call, think about your baby’s symptoms and write them down on paper.
This may be helpful when speaking on the phone to the provider.
You may want to consider the following when deciding if your baby is sick.
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Physical symptoms
Behavioral symptoms
• Fever
• Decrease or loss of appetite
• Difficulty breathing
• Listlessness, sleepier than
usual, hard to wake up
• Yellow or pale skin; skin that is a
different color from what you’ve
seen before
• Coughing
• Vomiting
• Diarrhea
• Constipation
• Unusual fussiness or irritability
• Change in usual activity level
(example – not able to smile,
loss of interest in surroundings)
• Continuous crying that cannot
be comforted
• Fewer wet diapers
• Dark urine
• Rashes
General considerations
• How long has baby been
sick and what are the signs
and symptoms?
• What have you done to treat
the illness and how has your
baby responded?
• Have you given your baby
any medication?
• Has your baby recently been
exposed to a known illness?
• Have your pharmacy phone
number ready if provider
prescribes a medication.
• Sunken or dry eyes
• Sunken look to the soft spots on
top of the head
When to call your baby’s provider
• Breathing difficulties like breathing too fast or too slow, grunting or whistling. A newborn normally
breathes about 40 to 60 times a minute.
• Blue skin color around the lips and tongue.
• A temperature of 100 degrees F (axillary or in the armpit) or 101 degrees F (rectally) or a temperature
lower than 97.6 degrees F.
• A change in activity level: becoming unusually listless and tired or restless and fussy.
• Crying inconsolably for more than two hours.
• Yellow or pale skin that is different that what you’ve seen before. Jaundice (yellow skin) that
increases or progresses downward on your baby’s body. Also, jaundice shows in the white part of
your baby’s eyes. Any jaundice must be reported.
• Bleeding of more than a few drops or foul drainage or swelling at the umbilical cord site or from a
healing circumcision. Reddened skin on the shaft of the penis.
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• Unusual skin rashes, especially blisters; drainage from the eyes.
• Refusing to eat for two or three feedings.
• Recurrent or forceful vomiting. Vomiting differs from spitting up. It is normal for babies to spit up
small amounts of some of their feedings.
• Frequent liquid stools that contain mucus or blood. More than five liquid stools per day if bottle fed
or more than eight liquid stools per day if breast-fed. Breast-fed babies normally have frequent,
loose stools but they do not contain blood or mucus.
• Fewer than four to six wet diapers in a day. Babies, whether breast or bottle fed, should have six to
eight pale yellow, wet diapers per day by 6 days of age.
• Dry, hard pebbly stools. The frequency of stooling is not an indicator of constipation, but excessive
straining while passing hard stool is.
Immunizations
Immunizations are shots babies gets to protect them from illnesses like diphtheria, tetanus, pertussis
(whooping cough), polio, measles, mumps, rubella (German measles), chicken pox, hepatitis B and Hib
(haemophilus influenzae type b). Some of these diseases are much more serious for babies and children
than they are for adults. Babies can get these diseases from other children and adults who have not been
immunized. Babies will receive most of these shots before the age of 2.
Hepatitis Vaccination for baby
The American Academy of Pediatrics, the American Academy of Family Physicians, and the Centers for
Disease Control and Prevention recommend the first dose of a series of 3 Hepatitis B vaccines be given to
the newborn before discharge from the hospital. HealthEast recommends the immunization be given within
the first 12 hours of birth. This vaccination will help protect your baby against the Hepatitis B virus that could
cause liver damage, even liver cancer. This virus could be passed through blood and certain body fluids
of an infected person. This could occur from birth, if mother was exposed to Hepatitis B and didn’t know it.
Exposure may be unknown, for example, the Hepatitis B virus can live in dried blood for 7 days. Protection by
vaccination can prevent this disease.
Four Hepatitis B shots may be needed if your health care clinic provides combination vaccines. Minor risks
of the vaccine are outweighed by the benefits of disease prevention. Talk to your baby’s provider about the
Hepatitis B vaccine for further information.
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It is very important to get baby’s shots at the right ages, when the shots are most effective. They usually
do not have to be delayed if your baby has a cold. For questions about immunizations, talk to your baby’s
provider.
Baby massage
Your baby will thrive in your loving care. Babies respond to your gentle touch and are soothed by massage.
Massage can be used at bath time, bed time or anytime. There are books on baby massage and classes
in the community. Baby massage classes are offered at the Natural Care Center on the Woodwinds Health
Campus. Please call the Natural Care Center at 651-232-6830 for more information.
Visitors
In the first few weeks at home with your baby, it is a good idea to limit the number of visitors, especially
children, who handle your baby. People will bring bacteria and viruses to your baby. Since the ability to fight
infection is not mature in babies, they may become sick. You may want to avoid large crowds for the same
reason. People who are obviously sick should wait until they are healthy before visiting. Request that visitors
wash their hands before picking up and holding your baby.
Anyone with the following diseases or symptoms should not visit your baby:
• Cold or cough
• Flu or diarrhea
• Cold sores (herpes typeI)
• Recent exposure to chicken pox
• Rashes
• Draining wounds
• Fever or other infectious problems such as strep, mumps, measles, scarlet fever
Here are some suggestions to help reduce baby’s risk of getting sick:
• Limit the number of visitors in the first few weeks at home.
• Avoid large crowds.
• People who are obviously sick should wait until they are healthy before visiting your baby.
• Ask visitors to wash their hands before picking up and holding your baby.
• Siblings should be current with their immunizations.
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Taking care of baby is obviously more than simply staying home
Frequently parents underestimate the time they will spend caring for a new baby. You will be feeding,
changing diapers and clothes, bathing, comforting and playing with your newborn. Not to mention laundering
baby’s diapers and/or clothing, as well as bedding. Baby care is an around-the-clock job. The average time
spent on baby tasks is a grand total of nine to 20 hours each day. This does not leave much time for your
meal preparation, house cleaning, shopping or time for yourself or time with visitors.
Taking care of your baby is a wonderful challenge and yet, to be able to meet that challenge, you must take
care of yourself. In the course of your day, be sure to set aside some time just for you.
You need time to rest. This helps heal your body and your mind. Sleep when your baby sleeps. Resist the
urge to keep your home spotless. Accept offers of help from relatives and friends. For example, they can
come and vacuum while you care for your baby, or watch your baby while you shower or nap.
Eat nutritious foods. Your body is recovering from your baby’s birth and needs nutrient rich foods to heal.
If you are breast-feeding, your body needs nutrients to make breast milk. Drink water and fruit juices to
replenish lost fluids in your body.
Exercise reduces stress and strengthens your body. Don’t take on too difficult of an exercise routine right
away. Go slowly and build up your tolerance for exercise. A walk around the block or at the mall (baby can
come, too) may be all you need at first.
If you are raising your baby without a partner, try to make contact with others for emotional support and help
in emergencies. Neighbors, relatives, friends, parents’ support groups or your church or synagogue can be
especially helpful. The group, Parents without Partners may be helpful. Visit their website at
parentswithoutpartners.org.
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YOUR RELATIONSHIP AS A COUPLE
You may find it difficult to ensure that while your love for your baby grows, the relationship with your partner
doesn’t suffer. It has been said that the greatest thing parents can do for their children is to love each other.
Your baby will enjoy the benefits of having two parents who love each other and are committed to each
other.
While giving your baby as much attention and love as you can, be careful to guard your own time and privacy.
Make time to be together. Share as many of the household chores and baby care as possible. Try to see that
no one person is responsible for the same chores all the time, unless you have talked and agreed to that
arrangement.
Keep in touch with your friends. Allow trusted relatives or friends to care for your baby while you get out
together. Dinner or a movie can do wonders for the spirit and your relationship. Try to hold conversations that
include topics other than your baby.
Acknowledge how tiring it is to raise a baby. Help each other during these physically exhausting times.
Sexual intercourse may not be a priority for a while. Help your partner understand this is not a rejection.
Communicate and express intimacy in other ways.
Going home
It is often helpful to feed your baby a short time before your discharge. This eliminates some of the stress
associated with your homecoming. Enjoy your baby. It is extremely important that your baby is aware of your
love and delight. The baby who is talked to and smiled at gains inner security.
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Baby’s stools and wet diapers
The following guidelines can help you know if your baby is getting enough to eat.
It is OK for your baby to have more wet or soiled diapers than listed.
First day of life
Second day of life Third day of life
one wet diaper, one stool
two wet diapers, two stools
three wet diapers, three stools
Fourth day of life
four wet diapers, three stools
Fifth day of life
five wet diapers, three stools
Sixth day of life
six wet diapers, four stools
Seventh day of life
six wet diapers, four stools
If your baby is having less than these numbers of wet diapers and stools, call your baby’s provider.
No cow’s milk during baby’s first year
Until your baby is a year old, breast milk should be the main food. Cow’s milk is fine for older children, but it is
too hard on your baby’s digestive system, and it won’t meet nutritional needs during the first year.
Cow’s milk has too much protein
Cow’s milk has two to three times the protein of breast milk or baby formula. The type of protein in cow’s milk
forms tough, hard to digest curds in the baby’s stomach. Cow’s milk protein is linked to intestinal blood loss
and allergies in babies.
Cow’s milk has too much sodium
Cow’s milk has three to four times the sodium of breast milk or baby formula. Excess sodium can be hard on
the baby’s delicate digestive system.
Cow’s milk differs from breast milk and baby formula in vitamin, mineral and fat content
The levels of vitamin C, copper and zinc in cow’s milk are too low for growing babies. The type of fat in cow’s
milk is not absorbed well.
Cow’s milk has too little iron
Not only is the level of iron low in cow’s milk, but the iron is not absorbed well. Feeding cow’s milk to babies
can lead to iron deficiency. This is a common health problem in babies today.
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BREAST-FEEDING: WHAT TO EXPECT DURING THE FIRST MONTH
Day one - birth to eight hours
Breast-feed within the first hour after delivery if possible. Early breast-feeding decreases difficulties and
helps mothers breast-feed longer. During the first two hours after delivery, you and your baby are in an alert
state. However, your baby will soon go to sleep for about eight hours. This is a time when your nipples are
maximally everted. Both you and your baby have a heightened sensitivity to each other. Your baby will begin
to recognize your smell and taste, which helps him or her more effectively latch on to your breast for feeding.
Skin to skin contact is very important as it helps your baby stay warm. Rooting, nuzzling and suckling are a
very important part of this first breast-feeding experience and will lead the way to successful breast-feeding.
Colostrum is the first breast milk your baby will receive, and it is a warm, thick, sweet fluid which is very easy
to swallow. It is also rich in white blood cells, which protect against infections, and has immune properties to
help immunizations work better. Colostrum is made in small amounts and is not overwhelming to a newborn,
whose stomach holds about 1/2 ounce.
Make sure you are comfortable when you breast-feed. Use pillows and sit up as straight as possible. You may
also try lying on your side to breast-feed in bed. Hold your baby at the level of your breast and facing you
with his or her arms and legs flexed so both of you will be comfortable. Remember that breast-feeding is a
learning experience for both of you, so be patient when your baby is latching on to your breast. Being in the
same room with your baby and frequent breast-feeding are needed to establish a good milk supply.
Prematurity, failure to latch on effectively, excessive sleepiness or separation from your baby for medical
reasons interfere with adequate milk production. Start pumping every three hours if there has been no latch
on within six hours after birth, due to the above situations.
Newborn Stomach Size (approximate)
Days 1-2
2-15 ml
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Days 3-5
15-30 ml
Days 5-10
60-80 ml
Eight to 24 hours after birth
Your baby will become more awake again between eight and 24 hours after birth. With frequent breastfeeding, he or she will start to develop a more coordinated suck and swallow pattern. Breast-fed babies need
to feed every one-and-a-half to three hours, and there will be times during the first few weeks when you are
not sure when one feeding ends and the next begins. Feeding schedules were designed for formula-fed
babies and not breast-fed babies. Do not compare your breast-fed baby to a formula-fed baby as breast milk
is digested easier and your baby’s stomach can empty every 90 minutes. Nighttime feedings are very good
for your milk supply due to increased levels of prolactin at night.
Keep your baby in your room as much as possible so you can learn his or her hunger cues. Hunger cues
include rapid eye movements, small muscle movements, hand to mouth movements and rooting. Crying is a
late hunger cue, and then you will have to calm your baby before he or she will latch on correctly.
Your baby may want to breast-feed 8 to 12 times in 24 hours. You should listen for swallow sounds during
much of the feeding. Watch for changes in your baby’s suck pattern from a non-nutritive suck of two sucks
per second to nutritive suck or one suck per second as he or she begins receiving milk from your breast.
Also, watch your baby and not the clock so you will know when your baby is full. A spontaneous release of
the nipple, a relaxed body and open hands are all signs of fullness.
Start to record feedings, as well as wet and soiled diapers in a breast-feeding log. Begin in the hospital and
continue the log at home for at least one week. Your first night home may be a sleepless one as you and your
baby adjust to each other. It will take a few days for him or her to adjust to your day and night schedule. Also
remember that baby care is a 24 hour responsibility.
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Day two
Some babies are very alert while others seem disinterested in breast-feeding. Try feeding every 90 minutes
to three hours even if your baby is sleepy. Be patient and persistent and make decisions for your baby’s
benefit. Breast-feeding needs to be mother-led at this stage. Breast-feeding can be baby led when your baby
is more alert and is giving you feeding cues every 90 minutes to 3 hours.
How to wake a sleepy baby:
• Remove baby’s clothing down to diaper only
• Tickle lower lip
• Rub baby’s arms, legs and back
• Touch your skin to baby’s skin
• Tickle feet
• Dim any bright lights
• Drip milk on lips
• Sit baby on your lap holding under chin
• Place a cool cloth to baby’s face or chest
Signs of adequate milk intake for breast-fed babies:
• Moist skin
• Slippery, moist oral mucous membranes
• Six to eight wet diapers every 24 hours
• Two to three stools every 24 hours
• Audible swallows
• Weight loss should be less than 10 percent
• Eight to 12 feedings every 24 hours
• Return to birth weight by two weeks
• Average weight gain of two-thirds to 1 ounce each day after first week
• Yellow, semi-liquid seedy stools after 3 to 4 days old
Your breast milk will come in within two to five days and will gradually change in composition from colostrum
to mature milk within 14 days. Just before your milk comes in, your baby will want to nurse more frequently,
telling you that your milk is coming in. As your baby becomes more efficient at breast-feeding, he or she
may decrease the amount of time spent at the breast and may only suckle on one breast each feeding.
Keep in mind that 10 to 20 minutes on each breast is sufficient. Empty the first breast before going to the
second breast to increase the hindmilk, or richer milk, received by your baby. This increases the amount of fat
received and helps your baby grow and sleep better.
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Days three, four and five
Your baby will be alert and awake for longer periods. Milk usually comes in between the third and fourth
day. Your breasts will feel full and heavier and you will hear your baby swallow and even gulp with the milk
ejection reflex (MER) or “let down.” The yellow color will start to change to pale white and will be more watery
and thin instead of thick like colostrum. It will take time for your milk production to match your baby’s needs.
Missing feedings or introducing a bottle at this time could cause problems with your milk production and also
confuse your baby between the breast and bottle, which is called nipple confusion.
Offer your breast frequently or as often as your baby will nurse, every 90 minutes to three hours. One four to
five hour sleep cycle is fine, remembering your baby will need to nurse eight to 12 times every 24 hours. You
may notice a decrease in your own appetite and fatigue may set in. Eat at least three well-balanced meals,
drink plenty of water and nap as much as possible when your baby sleeps. As your milk comes in, you may
notice temporary swelling due to increased fluid and blood flow to your breasts. Untreated engorgement of
your breasts is an urgent problem and can cause a decrease in your milk supply.
Treatment for engorgement
• Place warm, moist packs or cold packs on your breasts.
• Massage your breasts.
• Initiate breast-feeding every 90 minutes to three hours.
• You may want to pump your breast milk for comfort.
• Call a lactation consultant if engorgement prevents adequate latch on or milk let down.
Nipple tenderness or soreness is common around four to five days after delivery as your nipples stretch.
Latch-on discomfort should be temporary as breast-feeding should not be a painful experience. Apply
expressed breast milk to your nipples or pure lanolin (PureLan™ or Lansinoh®) to help heal. There is no need
to clean lanolin off before feeding as it will not hurt your baby and there is no taste or smell. Severe pain,
bleeding or cracked nipples are not normal. Call a lactation consultant for help if these conditions occur.
Signs of adequate intake on fourth and fifth days
• Eight to 12 feedings every 24 hours
• Four to five wet diapers every 24 hours
• Two to three stools every 24 hours
• Yellow, seedy stools
• Audible swallows
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Signs of milk ejection reflex (MER) – Caused by release of oxytocin
• Uterine cramping
• Increased flow of milk
• Tingling sensation
• Sleepiness
• Leaking on one side while feeding
• Rapid sucking pattern changes to slower,
on the other breast more rhythmic suck/swallow pattern
Red flags – Call lactation consultant for help
• No or infrequent stools
• Progressive weight loss
• Persistent meconium stools
• Dehydration, jaundice, sleepiness
• Few wet diapers (low output reflects inadequate intake)
One week to one month
Babies who are taking adequate amounts of breast milk will have many wet diapers and stools every day.
Some babies have small yellow liquid stools with every diaper change or feeding. Frequent stools at this age
is normal. Stools will decrease in amount around 4 to 6 weeks. Continue with frequent feedings every two to
three hours during the day.
Try to nap when your baby sleeps. Limit visitors and make visits short. Around 10 days after delivery, you
may begin to feel overwhelmed with 24 hour newborn care. This is also the time when your baby will go
through his or her first growth spurt. Growth spurts are common at 7 to 10 days and 2 to 4 weeks. Your baby
will nurse frequently for 48 to 72 hours, which stimulates your body to increase your milk supply and ensure
adequate milk for your baby’s growth.
About this same time, between 10 to 14 days, your breasts will suddenly soften and you may be concerned
that your milk supply is disappearing. This softening is normal. You will only feel fullness with missed feedings
or if the interval between feedings is longer than usual. Your milk supply is stabilizing to match your baby’s
needs. Call your provider for a weight check at 10 to 14 days or sooner if needed.
Fussiness
Fussiness usually peaks at 2 weeks as your baby begins to sleep less. Limit visitors to avoid overstimulating
baby. It is very important that you are available to respond to your baby’s needs so he or she will develop
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trust in you as parents. Bringing your baby’s hands to the middle of his or her body is very consoling for your
baby. Walking, rocking, music and even warm baths are very comforting for both of you. You may need to
take a break for short periods each day and get away while someone else plays with your baby.
Always remember, babies cry for a reason. They may be tired, bored, lonely or uncomfortable as well
as hungry. Evening fussiness is also very normal. Decreased prolactin levels towards evening causes a
decreased milk supply and frequent feedings are needed. The milk fat content is also at its lowest between 4
and 8 p.m., causing your baby to want to breast-feed more frequently.
At 3 months, as the digestive tract becomes more developed, your baby will be less fussy, less gassy and
easier to console. Three months is not the optimum time to wean to a bottle as your baby will be changing his
or her suck from a reflex action to a conscious suck pattern. Your breast-fed baby may begin to sleep through
the night at 8 to 12 weeks old. But remember breast milk is digested in two to three hours, so frequent
feedings are still normal.
Facts about breast milk
Colostrum
17 to 19 calories
Breast milk
20 to 21 calories
Glucose
6 calories
Breast milk is 88 percent water, so additional water is not necessary.
Growth spurts typically occur at these intervals and babies may eat more often for two to three days during a
growth spurt. Growth spurts normally resolve in 48 to 72 hours.
• 7 to 10 days
• 3 months
• 2 to 3 weeks
• 6 months
• 6 weeks
If you have had breast surgery of any kind, inform your provider. Breast surgery may affect your ability to
produce milk in an amount that would enable you to exclusively breast-feed your baby.
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Pacifiers and nipple confusion happens
Babies suck differently on a pacifier or bottle nipple than they do when breast-feeding. A baby’s tongue, jaw
and mouth move differently at your breast than when using a pacifier or bottle nipple. When breast-feeding, a
baby’s jaw and tongue work together in a coordinated rhythm, and the gums gently compress the areola and
massage the milk out of the breast. The baby stretches the nipple to the back of the mouth, and the front part
of the tongue goes forward and backward in a wave-like motion. The baby’s lips will be flanged, or spread
out, to make a tight seal and hold the nipple in the mouth.
When trying to nurse from a bottle, a baby is immediately met with a flow of milk. The baby blocks the
flow with his or her tongue to prevent choking. The baby does not need to move the jaw, because gravity
increases the milk flow and the baby does not need to compress the nipple to start the milk flowing. The front
of the tongue does not move out and in to milk the bottle and the lips are relaxed. Babies do not need to
work as hard to obtain their reward. The same sucking pattern occurs when using a pacifier.
When pacifiers are used in the first few weeks of life, the baby spends too much time meeting their sucking
needs with non-nutritive sucking when they should be getting nutrition.
After some babies have had only one bottle or a pacifier, and they return to breast-feeding, they will try to
suckle the breast nipple the same way they did the artificial nipple. They will push forward with their tongue
as they search for the hard rubber nipple and push the breast nipple out of their mouth, leading to difficulty.
This type of incorrect sucking is called flutter suck or tongue thrusting.
Artificial nipples lessen the baby’s instinctive efforts to open his or her mouth wide for correct latch on.
Babies may become conditioned to wait until they feel the firm artificial nipple in their mouth before they will
suck. Babies may also become frustrated when breast-feeding, as the milk does not flow as rapidly as it does
from the bottle. This could interfere with their ability to suckle effectively when they are at your breast and
may lead to refusal to breast-feed altogether. Kittie Franz, a researcher (1985) estimated that 95 percent of all
babies will become nipple confused if given artificial nipples during the first 3 to 4 weeks of life.
Are there good uses of pacifiers? After about three to four weeks, when breast-feeding has been wellestablished, moderate cautious use of pacifiers may be all right for short periods of time. Pacifier use can
help sooth a fussy baby. You may also find a pacifier convenient when you are in situations where you
absolutely cannot breast-feed and your baby needs brief satisfaction. The pacifier should never be used as
an easy way out. Determine why your baby is crying/fussy and attempt to meet his/her needs.
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Breast-feeding resources
HealthEast Outpatient Lactation Clinic, 651-232-3147. A lactation consultant is available for telephone
counseling, assessment, intervention, support and education Monday through Friday from 8 am to 4 pm,
except for holidays. Phone calls are answered between 9 am and 2 pm, Monday through Friday. After hours
you may leave a message or be transferred to a HealthEast triage nurse. HealthEast Outpatient Lactation
Clinic carries a limited quantity of breast-feeding supplies.
Your HealthEast hospital will be able to get you off to a good start with breast-feeding. Some nurses, called
lactation specialists, have additional training and are available for assessing and treating problems.
• HealthEast Home Care, 651-232-2800 for a home visit if necessary or desired.
• LaLeche League of Minnesota and the Dakotas, lllofmndas.org/st-paul-metro.html a breastfeeding advocacy organization. Your local WIC clinic has breast-feeding help. There are breastfeeding peer counselors and nurses who can answer questions and help you succeed.
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RESOURCES/REFERENCE MATERIALS
Parenting resources
Day care/nanny services/sitters
Child care involves careful planning and investigating and cannot wait until your maternity leave. Request a
list of day care providers from the Department of Health located in the county in which you reside. Visit and
interview potential day care providers. Nanny services are available in the Twin Cities area (see the yellow
pages under “Nanny Services” for local agencies and phone numbers). Ask for and check out references.
Also check on the credentials of day care providers.
Once you make a selection, make unannounced visits at various times to see firsthand the operation of the
center. Teenage sitters require an orientation to your home and an opportunity to meet and play with your
baby before they are asked to baby-sit. Ask for references, and observe the teen’s interaction with your baby.
Day care resources and referrals
Resources for Child Caring (serves the seven county Metro area)
651-641-0332
When you call you will receive a customized list of current openings for the type of care requested and a
handbook with information about how to choose child care, including a checklist of interview questions to
ask when meeting with potential caregivers.
Community resources and referrals
Minnesota Poison Control Center
1-800-222-1222 or mnpoison.org
National Child Safety Council distributes literature on safety, household dangers, electricity and drug abuse.
1-800-222-1464 or nationalchildsafetycouncil.org
Birthright counseling and support for pregnant women
St. Paul: 651-646-7033; Minneapolis: 612-338-2353
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Helpful websites
lamaze.org
A site for expectant and new parents to increase their knowledge regarding pregnancy, birth and parenting.
hypnobirthing.com
Provides information on the Mongan Method of hypnobirthing. This method is taught at HealthEast.
marchofdimes.org
Excellent information on pregnancy, prenatal testing, newborn care and parenting.
parentsknow.state.mn.us
This site was developed by the MN Department of Education; it contains useful parenting information.
gucchd.georgetown.edu
A site maintained by Georgetown University Child Development Center for families with children who have
special needs.
mediafamily.org
Sponsored by the National Institute on Media and the Family, this site offers resources on movies, TV and
video game ratings.
acog.org
American Congress of Obstetrics and Gynecology
aap.org
American Academy of Pediatrics web site
dona.org
Doulas of North America (DONA); broad information about doulas, listing of DONA certified doulas
by state.
midwife.org
American College of Nurse Midwives, click on “consumer” for midwife overview and resources.
133
familyprovider.org
Great source for health information about babies, children and adults. Endorsed by the American Academy of
Family Practice.
askdrsears.com
This web site contains useful information on newborn and child care, as well as information about
vaccinations. The site is maintained by respected author Dr. William Sears, a pediatrician, and his three sons,
who are also pediatricians.
parenting.ivillage.com
Parenting information, consumer news
safekids.org
National Safe Kids campaign
cpsc.gov
Consumer Products Safety Commission - product recalls
breastfeeding.com and lalecheleague.org
Breast-feeding information and resources
postpartum.net
A web site with good information about the signs, symptoms and treatment for postpartum depression, “baby
blues” and postpartum psychosis.
sparkaction.org
A web site with accurate information about product safety alerts and public health initiatives, offers many
resources.
fatherhood.org
Information for dads on fathering and kids
nichd.nih.gov/sids
National Institute for Child and Human Development Back to Sleep Campaign
buckleupkids.state.mn.us/
Car seat safety information - State of Minnesota
134
References
Depression, Major, in Adults in Primary Care (Guideline) This guideline is an evidence-based document based
on best care, and has also evolved to include information on best practice systems for implementation. ICSI
(Institute for Clinical Systems Improvement) Released 05/2008
Postpartum Depression Screening: Importance, Methods, Barriers, and Recommendations for Practice,
Dwenda K. Gjerdingen, MD, MS, and Barbara P. Yawn, MD, MSc; JABFM May–June 2007 Vol. 20 No. 3
synagis.com
thrombosis-charity.org.uk
nlm.nih.gov/medlineplus
Institute for Clinical Systems Integration (ICSI) Health Care Guidelines: Routing Prenatal Care, 14th edition July
2010,
Bloomington, MN.
Williams Obstetrics, 21st Edition, 2001; F. Gary Cunningham, MD, John C. Hauth, MD, Norman Gant, MD,
Kenneth Leveno, MD, Larry Gilstrap, III, MD, Catharine D. Wenstrom, MD, Appleton and Lange,
Stanford CT.
Simpkin, Whalley, Keppler, Pregnancy, Childbirth and the Newborn, 4th edition, 2010.
St. Paul, Children’s Health Care, What Happens When You Shake a Baby.
Minnesota Safe Kids Buckle Up, Better Safe.
Lawrence, R.A., Breast-feeding: A Guide for the Medical Profession, St. Louis, CV Mosby Co., 2011.
Kenner, C. & McGrath, J. M. (2004). Developmental care of newborns and infants. St. Louis, MO: Mosby, Inc.
Sears, W. (2004). Bonding with your newborn. The Journal of Attachment Parenting International, 1, 1-5.
The Nursing Mother’s Companion, Kathleen Huggins, R.N., M.S., 2006.
135
The Breast-feeding Answer Book - 3rd Edition, La Leche League International, 2003, Mohrbacher and Stock
Back to Sleep Campaign; National Institute of Health; 2010.
American Academy of Pediatrics web site: aap.org.
diabetes.org
American College of Obstetricians and Gynecologists website: acog.org
acog.org/publications/patient_education/bp051.cfm
Diabetes and Pregnancy, June 2009
136
BIRTH PLAN
A way of communicating your labor and birth preferences to your provider and to the nurses at the Maternity
Care Center is to develop a written birth plan. Simply put, a birth plan is a listing of the choices and
preferences you and your partner have about labor, birth and your hospital stay.
It is easier to make these choices now rather than when you are in labor. Take the time to discuss your
options together and talk with your provider about the choices.
Give a copy of your birth plan to your provider at a clinic appointment and bring a copy with you to the
hospital. The staff will work to with you to follow the plan you’ve drafted. However, your safety and your
baby’s safety is their priority. Depending on the course of your labor and your baby’s reaction to it, some
of your requests may not be possible. Be flexible as you draft your birth plan and look on it as a list of
preferences that may need to be adjusted as labor progresses.
Sample birth plan
For (mother’s name)
Your provider
What would you like the environment in your labor room to be like?
(calm, quiet, dark, brightly lit, noisy)
Who do wish to be present during labor and at your baby’s birth?
How can the nurses best help you? Should they stand in the background and let your partner
help, offer suggestions, help with comfort measures?
137
What concerns or frightens you most about your labor and birth?
(pain, medications, injections, etc.)
What relaxation techniques help you most?
What do you feel about pain medications during labor and birth?
Does your labor partner have any special desires (cutting umbilical cord)?
(Circle one) r Yes r No
Does your labor partner have any fears or concerns?
How are you planning to feed your baby? (Circle one)
r Breast r Bottle
If breast-feeding, do you want to breast-feed soon after birth? (Circle one) r Yes
If bottle feeding, what kind of formula do you prefer?
r No
What kinds of questions do you have about infant care that we can answer while you are in the
hospital?
If you have a boy, do you want him to be circumcised? (Circle one) r Yes
r No
Would you or your partner like to be present at the circumcision? (Circle one) r Yes
r No
Is there anything else you would like us to know about your preferences, concerns or your wishes
for your labor, birth and hospital stay?
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BIRTH CONTROL OPTIONS AFTER DELIVERY
Type
Natural family planning - Periodic abstinence
based on identifying fertile times utilizing body
temperature, vaginal discharge and menstrual
calendar.
Failure rates (per 1000 women/year)
2 to 10% ideal use
20% typical use
Advantage: Inexpensive.
Disadvantage: May be difficult to learn and/or use
during postpartum and/or breast-feeding.
Condom - Latex or animal tissue sheath for penis.
2% ideal use
Advantage: Easy to obtain, inexpensive, method of
choice by many breast-feeding women.
12% typical use
Disadvantage: May interfere with sensation.
May break during intercourse (best to use with
spermicidal foam for back up). Animal tissue doesn’t
prevent HIV transmission.
Spermicidal foam, cream, gel - Product to place in
vagina prior to intercourse.
3% ideal use
21% typical use
Advantage: Easy to obtain, inexpensive,
adds lubrication.
Disadvantage: High failure rate if used alone, best if
used with diaphragm or condom. May be messy.
Diaphragm - Latex cup placed in vagina as barrier.
3% ideal use
Advantage: Can be used with breast-feeding.
18% typical use
Disadvantage: Should not be fit before eight to 12
weeks postpartum. Should be fit by provider after
each birth. Needs to be used with spermicide.
139
Type
Pill - Tablet taken each day. Contains estrogen
and progesterone.
Failure rates (per 1000 women/year)
0.1% ideal use
3% typical user
Advantage: Excellent protection from pregnancy.
Disadvantage: Expensive.
Mini pill - Tablet taken each day - contains
only progesterone.
Slightly higher failure rate than the pill
Advantage: May be used by breast-feeding moms.
Disadvantage: Expensive. May have spotting and/or
weight gain, unpredictable periods.
Depo Provera - Injection of a hormone done every
three months.
0.3% all users
Advantage: Convenient, highly effective, can be
used when breast-feeding.
Disadvantage: Long acting, frequent spotting,
weight gain.
IUD - A flexible device placed in the uterus.
1 to 2% ideal use
Advantage: Convenient, one time expense.
6% typical user
Disadvantage: Inserted at six to eight weeks
postpartum by provider, may increase risk of
pelvic infection.
Sterilization - Surgical altering of sperm (vasectomy)
or egg (tubal) carrying tubes.
Advantage: Permanent contraception.
Disadvantage: Permanent, expensive, surgical risks
associated with procedure, especially tubal.
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0.2% women
0.1% men
Type
Essure® Procedure – is a non-surgical procedure
that makes a woman sterile (unable to have
children). There is no cutting of the body. A trained
provider inserts spring-like coils through the vagina,
cervix and uterus and then into the fallopian tubes.
Failure rates (per 1000 women/year)
0% pregnancies in clinical trials
About 3 months after the procedure the coil and
the body form a tissue barrier. This prevents the
egg from passing into the uterus and sperm from
reaching the egg.
During the first 3 months another form of birth
control must be used to prevent pregnancy.
Advantage: no hormones, no surgery, procedure
performed in provider’s office, very low pregnancy
rate
Disadvantage: requires additional testing
(hysterosalpingogram)
At 3 months to determine if coil is in correct location
and whether both fallopian tubes are blocked.
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