Javon Bea Hospital - Riverside - A New Beginning

Northwest Illinois Regional Perinatal Center at Javon Bea Hospital-Riverside ANew Beginning

Welcome to the Mercyhealth Birthing Center

At Javon Bea Hospital-Riverside, we support minimal separation of mother and infant and encourage bonding and attachment between parents and newborn. All this makes your baby feel safe, cry less and sleep better because they know their family is close to them. We will work closely with you to meet your needs and those of your baby. Rooming In Mothers and infants remain together throughout their entire stay at our hospital. Newborn care and teaching is done at the mother’s bedside by staff and includes the family. By staying close to your baby, you have the opportunity to learn your baby’s hunger cues, night behaviors and better prepare you to care for your infant at home. The doctor caring for your infant will do a daily check-up in your room and answer any questions you may have about your newborn. A newborn observation area is available if your baby needs to be out of your room for As a Baby-Friendly™ hospital, OB nurses have completed specialized training to assist you with breastfeeding. Breastfeeding is important for you and your baby. Breast milk provides baby with colostrum that helps stabilize blood sugar, encourages passage of meconium and can decrease the risk of jaundice. It also provides a decreased risk for infections, food allergies, Sudden Infant Death Syndrome (SIDS), and diabetes. The benefits to mother include post-delivery weight loss, quicker return of uterus to pre-pregnancy size and a reduced risk of breast, ovarian and uterine cancers. Safe Sleep One of the best ways to reduce the risk of Sudden Infant Death Syndrome (SIDS) is to place your infant on their back for every sleep time – nighttime and naptime. Baby should sleep in the same room as the parents, but NOT in the same bed, on a firm mattress WITHOUT loose blankets or stuffed objects. Keep baby’s head and face uncovered during sleep and do not overheat the sleeping environment. Security For safety and security purposes, we ask all visitors to request access to the unit at the entrance doors. To protect your newborn, all infants are monitored while in the hospital. Lactation Support Our facility offers a no-cost lactation follow up visit to all families within 48-72 hours of discharge. Our Certified Lactation staff will meet with you to evaluate feedings, check your infant’s weight, answer questions and provide breastfeeding support. health reasons. Breastfeeding

A guide for postpartum and newborn care A NEW BEGINNING

This book is dedicated to parents and to all who support them.

The birth of your baby is one of the most exciting events in your life and a moment that you will cherish and remember always. Birth experiences are something that will always be talked about with friends, family and even your children as they begin their families. Your journey will be filled with excitement, joy, and a little fear of the unknown. The purpose of this book is to help you understand and cope with the care of your family. The more knowledge you have, the better you will be able to begin your personal journey with confidence and a positive perspective. Thank you to the many people and organizations that participated in the production of this publication. Their willingness to share their personal experiences with us is beyond what words can express.

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This publication is designed to provide helpful information on the subjects discussed. The information provided in this book is not intended to replace the professional medical advice from your healthcare provider. Use this book as a resource only. For diagnosis, treatment and individual care contact your health professional. For the purpose of clear and concise writing, the term“he”will be used to reference the baby.

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Reviewed: 10/2017, 7/2018,10/2018 Revised: 7/2017, 12/2017, 03/2019 Visit us at: www.customizedinc.com • Email us at: cci@customizedinc.com

TABLE OF CONTENTS

4 Physical Changes After Birth The Uterus. 4 Lochia (Vaginal Discharge). 5 Bowel Elimination. 5 Hemorrhoids. 5 Bladder. 6 Skin Changes . 6 Varicose Veins. 6 Eye Hemorrhages . 6 Hair Loss. 6 6 Self-Care Managing Postpartum Pain. 6 Methods to Manage Pain. 7 Perineal Care. 7 Episiotomy Care. 8 Cesarean Birth Incision. 8 Baths and Showers. 8 Rest and Sleep . 8 Menstrual Cycle . 9 Resuming Sex. 9 Weight Loss. 9 Exercise. 9 Nutrition . 10 Healthy Eating While Breastfeeding. 10 11 Emotional Changes Postpartum Blues. 11 Coping with Postpartum Blues . 11 Postpartum Depression and Anxiety . 12 Postpartum Psychosis. 12 13 Caring for Your Family Siblings. 13 Pets. 13 14 Mother’s Warning Signs 15 To the New Father or Partner Sex. 15 16 Skin-to-Skin Contact Proper Position for Safe Skin-to-Skin Contact. 16 Benefits of Skin-to-Skin Contact. . . . . . . . . . . . . . . . . . . . . . 16 16 Rooming-In 17 Caring for Your Newborn Using a Bulb Syringe. 17 Newborn Screenings/Procedures. 18 Jaundice . 19 Umbilical Cord . 20 Circumcision. 20 Skin Care. 20 Bathing Your Baby. 21 Sponge Bath. 21 Swaddle Bath or Tub Bath. 22 Fingernails. 22 Diapering. 22 Cleaning Baby Girl. 22 Cleaning Baby Boy. 22

23 Baby’s Behavior What is Your Baby Saying? . 23 Soothing/Calming a Fussy Baby . 24 Shaken Baby Syndrome . 25 26 Keeping Your Baby Safe Safe Sleeping, SUID and SIDS. 26 What Does a Safe Sleep Environment Look Like?. 27 Taking Your Baby’s Temperature. . . . . . . . . . . . . . . . . . . . . . 28 Immunizations. 28 28 Baby’s Warning Signs Car Seat Safety. 29 30 Getting Ready to Go Home Do You Have the Help You Need?. 30 While You Are in the Hospital . 30 Day of Going Home. 30 Help at Home Tips . 30 Visitors. 30 31 Late Preterm Infant 32 Breastfeeding Exclusive Breastfeeding. 33 Anatomy of the Breast. 33 Physiology of the Breast. 33 Colostrum. 34 Mature Milk. 34 How Do I Know My Baby is Ready to Breastfeed?. 34 Breastfeeding Positioning. 35 Biological Nursing or Baby-Led Latch. 35 Latch-on . 36 Newborn Feeding Patterns. 37 Cluster Feeding. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Signs Your Baby is Getting Enough to Eat . 38 Sleepy Baby. 38 Burping. 39 Growth Spurts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 39 Breast Care Sore Nipples. 39 Engorgement. 40 Blocked Ducts. 40 Mastitis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Breastfeeding Questions. 41 Expressing Breast Milk. 42 Breast Pumps . 42 Hand Expression. 42 How Often to Express. 43 Storing Breast Milk. 43 Human Milk Storage Guidelines. 43 Feeding Log . 44 47 Glossary 48 Bibliography

Please Note: All words highlighted in PINK are clearly defined in the glossary.

Physical Changes After Birth The first 6 weeks following the birth of your baby is called the postpartum period. These weeks are important as your body returns to normal after labor and birth. At the same time, you are welcoming a new life into your world. Knowing what to expect and relying on the continuing support of your healthcare team will help you relax in the postpartum experience with as much confidence and comfort as possible. Your body gradually returns to its pre-pregnancy state during these 4 to 6 weeks. The amount of time needed for this process varies, depending on the type of birth you had and other medical conditions. The Uterus

A new mother needs to take good care of herself to rebuild her strength. Proper rest, good nutrition and accepting help from others during the first few weeks is important.

The normal changes of the pregnant uterus to hold a developing baby are not reversed overnight. During pregnancy the uterus increases to about 11 times its non-pregnant weight. Right after birth it weighs more than 2 pounds and measures about the size of a grapefruit. It can be felt just below the belly button. In about 6 weeks, the uterus will return to its normal weight of only 2 ounces.

Uterus

Cervix

Vagina

Pre-Pregnancy

Postpartum

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Lochia (Vaginal Discharge) You will have vaginal discharge while the area where the placenta was attached heals and the lining of the uterus is shed. This discharge, called lochia , is usually described as having a “fleshy, musty or earthy” smell. The smell should not be bad. You may notice your lochia is heavier when you stand up. This heavier flow is from the blood that collects in your vagina while you are sitting or lying down. Too much activity can also cause a heavier blood flow. This is your sign to slow down or rest. You may have less lochia if you had a cesarean birth . Wear pads until your lochia stops, not tampons. Tampons increase the chance for infection in your uterus.

About days 10 to 21 • Yellowish-white color. • Very light flow. • No clots, bright red color, or bad smell.

First 2 to 3 days • Bright to dark red.

About days 4 to 10 • Pink or brown-tinged. • Medium to light flow. • Very few or no clots.

• Heavy to medium flow. • May have small clots.

Be sure to tell your nurse or healthcare provider if you:

• Soak more than 1 pad / hour for 2 to 3 hours. • Pass large clots or bright red bleeding after day 4. • Notice your lochia has a bad smell.

• Have a fever over 100.4°F. • Have severe pain in your lower abdomen.

Bowel Elimination Hormones , medications, dehydration, perineal pain and decreased physical activity may make bowel function sluggish after birth. The first bowel movement usually happens within 2 to 3 days. It may be a little uncomfortable, and you may be a little afraid. When it is time: • Try to relax. • Put your feet on a stool and rest your elbows on your knees. • From the front you can hold a clean sanitary pad over your perineum for support. • Avoid straining. It can make hemorrhoids worse. What can help: • Don’t resist the urge. • Drink 6 to 8 glasses of water a day. • Eat fiber rich foods. • Keep moving – walk or do yoga stretches. • Take stool softeners. Hemorrhoids A hemorrhoid is a dilated blood vessel under the skin. They can be inside the rectum or outside on the anus. Hemorrhoids are not usually serious but can be painful. Symptoms: • Pain or discomfort. • Itching. • Irritation. What can help: • Avoid straining during bowel movements. • Avoid sitting or standing for long periods of time. • Try cold compresses and/or warm baths. • Use pre-moistened wipes instead of toilet paper. • Use topical creams, suppositories and pain medication as directed by your healthcare provider. • Small amount of bleeding. • Swelling around the anus.

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Bladder It is important for you to try to empty your bladder every 3 to 4 hours while in the hospital, especially right after giving birth. Your bladder may become full and push on your uterus. This may keep your uterus from contracting and cause you to bleed more. Your body will be getting rid of extra fluid that caused hand and leg swelling late in pregnancy. You will notice that you have large amounts of urine the first few days at home. If you had a cesarean birth: You will have a catheter in your bladder during your first day after surgery. This will let you rest and allow your nurse to measure your urine output. Skin Changes Many skin changes that developed during pregnancy are caused by an increase of hormones. The blotchy appearance of the face and dark line of the lower abdomen will gradually disappear over the next several months after childbirth. Stretch marks will gradually fade to silvery lines but will not disappear altogether. The tiny red blood vessel spots on the skin and red rashes will also clear up. Varicose Veins If you developed varicose veins during pregnancy, elevating your legs and wearing maternity support hose when walking or standing are good ideas for the first 6 weeks postpartum. Varicose vein surgery is not recommended during the first 6 months of recovery. The veins usually improve without treatment. Eye Hemorrhages Bleeding beneath the “whites” of the eyes can happen because of the forceful bearing down some people experience during labor and birth. It is not harmful to you and clears up by itself in a few weeks. Hair Loss • Have a frequent or urgent need to urinate. • Have severe pain or rectal bleeding. • Feel you need a laxative. Be sure to tell your nurse or healthcare provider if you:

During pregnancy your hair was actually in a resting phase and you lost less hair. A few weeks postpartum you may find that you are losing large amounts of hair. This is not unusual. Your hair will soon return to its normal growth cycle, but it may require several months. Self-Care

It is best to get up and move around soon after birth, but exactly when you start depends on the type of birth experience you had. Moving around lowers the risk of blood clots in the veins of your pelvis , legs, ankles and feet. It also helps with better bladder and bowel function and lessens your pain or discomfort, even with cesarean birth. Managing Postpartum Pain Pain after birth depends on several factors: the length of your labor, the type of birth and your personal style of dealing with pain. In the first 1 to 2 days following childbirth, you will feel muscle aches and fatigue, particularly in your shoulders, neck and arms. This is a result of the physical exertion during labor. Joint stiffness in the hands is also common. This is a result of intravenous (IV) fluids given during labor and a natural redistribution of fluid. As the uterus shrinks, its muscle fibers contract, causing afterbirth cramps. These mild contractions are most noticeable the first 3 to 4 days following birth. You may notice they are stronger when you are breastfeeding due to the hormone release during feeding. These contractions help to reduce blood loss and shrink the uterus to its pre-pregnancy state. There may be tenderness of the perineum (the area around the vagina and rectum). It may be worse if you had a tear or episiotomy .

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Methods to Manage Pain Comfort measures: • Massage and relaxation. • Deep breathing. • Music. • Ice packs for first 24 to 48 hours. • Warm pad on abdomen for cramps. • Warm sitz baths/herbal baths.

Medical pain relief options: • Topical creams or sprays to specific areas. • Over the counter medication like Ibuprofen. • Prescription medication.

Your nurse will review all your medications with you and explain their purpose, how often they will be given and possible side effects. Most medications are compatible with breastfeeding. To be safe check with your healthcare provider before taking over the counter or prescribed medications. Set your personal pain goal for pain management or identify the number at which you feel you need pain medication.

Be sure to tell your nurse or healthcare provider if your pain is:

• Constant. • Unusual.

Pain Rating Scale

• Worse than what it was before. • Keeping you from doing things you were able to do before. • Located in the right upper area of your abdomen or just below your breastbone. • A headache with ANY vision changes, OR confusion/mental changes OR dizziness OR new onset edema/swelling.

4

2

6

9

1

8

3

0

5

worst imaginable pain 10

7

no pain

Please let your nurse know any time you have pain and need medication. Your nurse will ask you for your pain rating number before giving you pain medication. They will ask you again about an hour after you took it to make sure it worked. Be sure to ask your nurse if you have any questions about the medications your healthcare provider has prescribed.

Managing your pain after a cesarean birth may be done through your epidural or IV tube until you can take pain pills. Some hospitals use PCA pumps (patient controlled analgesic) that will allow you to control the medication you get by pushing a button. It is important that only you push the button. The pump is set according to the prescription from your doctor so you won’t get too much medicine.

Perineal Care • Wash your hands often and carefully – both before and after changing sanitary pads. • Wash your perineum with mild soap and water at least once daily. • Rinse with lukewarm water 2 to 3 times daily and after urination and bowel movements.

• Wash and wipe from the front to back. • Apply your pad from the front to the back.

• Change your pad every time after urinating or a bowel movement. • Check the amount and color of your lochia with each pad change.

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Episiotomy Care If you had an episiotomy it may take 4 weeks to heal. The sutures do not need to be removed because they will dissolve. Use a hand-held shower, a squeeze bottle or sitz bath to cleanse the episiotomy. Sometimes using antiseptic spray or analgesic cream can provide relief. Use moist antiseptic towelettes or toilet paper in a patting motion to dry the perineum. Please call if pain increases or becomes intense. Cesarean Birth Incision

Many women have staples to close their incision with a dressing over it. The dressing and the staples are removed before leaving the hospital or during a follow up visit with your healthcare provider. Steri-strips are put over your incision to help keep it closed. They will be very loose after several weeks. That’s when you may gently remove them. It is important to check your incision daily. Baths and Showers Vaginal birth:

Be sure to tell your nurse or healthcare provider if your incision becomes:

• Red • Separated • Swollen

• Warm to touch • Tender or painful • Draining

Showers are usually allowed as soon as your epidural catheter is removed and you walk well. Sitz or tub baths are generally safe after the second day. They are preferred by many because of the episiotomy and discharge. Cesarean birth: You may shower after the first day. Your healthcare provider will need to remove the dressing over your incision and your epidural catheter. Be sure you are able to stand and walk without getting dizzy. It is okay to get your incision wet. You may use soap on the upper part of your body and allow it to rinse down over your incision. Tub baths are not recommended for up to a few weeks after a cesarean birth. Check with your healthcare provider first to see when they recommend taking a tub bath. Rest and Sleep There are several reasons for the extreme fatigue following the birth of a baby. Women do not sleep well late in pregnancy and are further exhausted by the physical work of labor. Excitement and a lot of visitors add to the problem. Hospital surroundings and being uncomfortable can make it difficult to rest. New parents are often unprepared for the conflict between their need for sleep and the infant’s need for care and attention. The joys of parenting can easily become blurred by the exhaustion and frustration that result. Sleep when the baby sleeps. This may mean several short naps during the day. When sleep is not possible, relaxation exercises may be helpful.

Suggestions to help you relax at home: • Simple meals and flexible meal times. • A relaxed, flexible home routine. • Help with shopping and cooking.

• Friends and family to care for other children. • Postpone other major household projects. • Avoid products containing caffeine (coffee, tea, cola and chocolates). • Ask for what you need, when you need it.

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Menstrual Cycle Most women will have their first cycle within 7 to 9 weeks after the birth. Nursing mothers frequently resume menstrual periods by 12 weeks, but some mothers don’t resume menstruation until they have completed breastfeeding. Egg production may return before the first menstrual period, which means you can become pregnant again. Resuming Sex Sexuality and recapturing closeness as a couple takes time. You and your partner may feel overwhelmed. You two should discuss resuming sex so that there will be few frustrations and misunderstandings. You may not be as interested in having sex as you were before pregnancy because of fatigue and the time demand by the baby. You may also have concerns about discomfort if you had a tear, episiotomy or cesarean incision. Tears and incisions can take a full 6 weeks to heal. You can expect vaginal dryness and reduced vaginal lubrication because of the hormones of pregnancy and/or breastfeeding. A water-based cream or jelly can solve this problem. If you experience difficulty with sexual intercourse, always discuss it with your partner. Set aside time for each other a few times each week without the baby to rebuild a satisfying sex life. Sharing feelings about sexuality is the most effective way to get back together both physically and emotionally. Weight Loss

You probably will not return to your pre-pregnancy weight for some time, but you will lose some weight after giving birth. Between the weight of the baby, placenta and amniotic fluid, most new moms are about 12 pounds lighter after giving birth. More weight loss should occur during the postpartum period as your body’s fluid levels return to normal. If you need to lose more weight, talk to your healthcare provider about healthy exercises and nutritious eating programs. Exercise Talk to your healthcare provider for ideas about when to start exercising and what is safe. Begin slowly and don’t push yourself too hard. Taking the time to exercise will: • Boost your energy. • Promote better sleep. • Relieve stress. • Be helpful in preventing postpartum depression. • Help your body get back to its pre-pregnancy shape. Guidelines: • Try to stay active for 20 to 30 minutes a day. • Try simple strengthening exercises that include abdominal and back muscles. • Walking is a great way to start. • Drink plenty of water.

Most women think their abdominal muscles will go back to normal after childbirth. That’s not usually the case. The abdominal muscles may actually separate and have a bulge between them. Ask your healthcare provider about an exercise program that can help you tone these muscles and when you can begin working out.

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Nutrition You may find it helpful to eat a variety of healthy foods for the energy you need and to lose extra weight you gained during pregnancy. You can visit ChooseMyPlate.gov to create a nutrition plan that’s right for you. • Eat a variety of foods to help you get all the nutrients you need. Your body needs protein, carbohydrates and fats for energy. • Eat a diet high in fiber. Include foods such as whole-grain breads and cereals, raw vegetables, raw and dried fruits, and beans. • Drink plenty of fluids, especially water. • Eat small snacks throughout the day to keep up your energy. Don’t skip

meals or go for long periods without eating. Healthy EatingWhile Breastfeeding • There are no special foods that must be eaten while you breastfeed. • Most breastfeeding mothers find they can eat anything in small amounts without any effect on their baby. However, some mothers notice a relationship between certain foods they eat and their baby’s behavior (irritability or fussy sleep). If you are suspicious of a certain food, avoid it and watch your baby’s response. • Your baby is likely to be okay with foods that you ate regularly during pregnancy. • The FDA warns lactating women to avoid eating the following fish due to their highmercury content: swordfish, shark, kingmackerel and tilefish. Albacore“white”tuna has more mercury than other light colored tuna so limit “white” tuna to 6 ounces or less per week. • When eating sushi, make certain that you know the source and preparation of the raw fish. Like any raw food, sushi can carry parasites or bacteria.

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Artificial Sweeteners Aspartame and Acesulfame-K are considered safe to use while breastfeeding. Saccharin should be avoided. Mothers with known phenylketonuria (PKU) should avoid aspartame. Avoid artificial sweeteners if you feel any discomfort, like headaches or dizziness.

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Emotional Changes Along with the joy and relief of giving birth to a baby, many mothers experience sadness. Some mothers may find themselves crying, irritable, impatient, feeling a lack of confidence or even unable to manage caring for themselves or their baby. Emotional changes can range from postpartum blues to clinical depression to psychotic depression. The difference lies in the nature and intensity of these feelings as well as how long they last. Studies have shown that women are more likely to develop these problems following the birth of their baby than at any other time in their lives. Postpartum Blues Many mothers doubt themselves and their ability to be a good mother and take care of their new baby. They may: • Wonder what is wrong with themselves. Such feelings occur in 9 out of 10 women who have given birth, whether this is their first or they have other children. The “blues” usually begin around the third or fourth day after birth and can last from a few hours to a week. Usually these feelings are short-lived and fade without any treatment. Coping with Postpartum Blues Keep your expectations realistic. Remember, you just delivered a baby. It takes time to learn about your baby and for your baby to learn about you. • Rest as much as possible. • Limit visitors. • Allow others to do things for you. • Let your partner know how you are feeling. • If you are single, find and develop a good support system. scan me! • Be tearful or easily irritated. • Be anxious or ultra-sensitive. • Be exhausted. • Have trouble concentrating or sleeping. • Feel overwhelmed by their responsibilities.

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Postpartum Depression and Anxiety When the “blues” last more than two weeks and get worse, you may have postpartum depression or anxiety. Many of the “blues” signs are present, but they are more severe or intense. This is not uncommon and happens to 1 to 2 of every 10 postpartum women. Postpartum depressive symptoms can appear any time during the first few months to one year after your birth. These feelings and experiences may lead you to become possessive of your baby or to disengage from and avoid your baby. This poses a risk to the physical and emotional safety of your baby. If untreated, these symptoms can last up to one year. There are several treatment options. Mothers who get treatment usually respond extremely well.

Contact your healthcare provider if you have any of these signs or symptoms:

• Loss of identity. • Complete loss of control. • Feeling withdrawn, isolated and lonely. • Change in appetite (either undereating or overeating). • Exhaustion, but unable to sleep. • Feelings of hopelessness, a sense of failure, or guilt. • Mood swings. • Constant crying.

• Constant anxiety or doubt. • Difficulty sleeping or sleeping too much. • Lack of interest in yourself, baby or others. • Overly concerned about cleanliness/germs and the health and safety of your baby. • The need to keep moving or pacing. • Feeling the need to “jump out of your skin’’. • Nightmares. • Difficulty focusing or concentrating.

Do not be afraid to be open and honest about how you are feeling. Providers can help connect you to therapy, support groups, and other resources that can help you get better. You are not alone!

Postpartum Psychosis Below are some signs of postpartum psychosis. In very rare cases, a new mom can experience symptoms of psychosis. These symptoms usually start within 3 to 14 days after birth. She may not have all of them. They can vary or change quickly.

If a new mother has any of these symptoms she should be taken to the nearest emergency department and not left alone with her baby.

• Can’t remember how to do things she has done in the past and is extremely confused. • Has so much energy she can’t sleep because her mind keeps going. • Has strange feelings, like something is crawling on her.

• Hears or sees things no one else does. • Feels like someone else is controlling her. • Agitation. • Rapid or nonsense speech. • She doesn’t like how she feels and is afraid. • Has thoughts of harming her baby or herself.

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Caring for Your Family Include your partner as much as possible. They are also going through changes, anxiety, fears, doubts, joys and stresses - just like you. This can be one of the closest emotional times in a relationship, so take time to discuss your expectations and fears. Try to make your partner part of your daily exercise, like an evening walk. As always, communication is important because your partner may feel left out. Talk about the fears, concerns and delights both of you are experiencing. Siblings

Having a baby is a huge adjustment for mom and her partner. This new little one can be a big adjustment for your other children as well. For a while, they were your focus of attention. Now that focus shifts, and they may have difficulty with their feelings. Although you may find that children will react differently to a new sibling, it is important to get them involved in the growing family. Reassure them that they are loved, secure and are now a big brother or sister. Suggestions to help siblings: • Let them choose a special gift for the new baby. • Read books to them about their new role as big brother or sister. • Let them help you take care of the new baby (getting diaper supplies, picking out an outfit or folding baby clothes for you). Welcome, but do not insist on, their help. • Let them know they can talk about their feelings (jealousy, anger, loneliness, or needing more attention from parents).

Make sure that you have special days for just you and your other children so that they can feel secure in your love for them . Today, families come in all different sizes, shapes and forms. Whether you are married, single, work, or are a stay-at-home caregiver, please know that parenting is not a “one size fits all” skill. Over time you will find what works best for you and your child. What is most important is the relationship you presently have with your family and the new bond you develop with your little one. Pets

Pets can become jealous too. They may have been your first baby. Introduce the scent of the baby before you go home. Have your pet smell some of the baby’s clothing or supplies. When you first arrive home, have someone else hold the baby while you greet your pet. Maintain a routine for your pet with walking, feeding and play. Never force your pet to interact with the baby. Install a sturdy barrier, if the baby’s room is off-limits. Never leave even the most trusted pet alone with your baby. Ask your veterinarian for more advice or suggestions.

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Mother’s Warning Signs

It is normal to have discomforts like soreness and fatigue after you give birth. You may have other symptoms that could mean you need to see your healthcare provider or go to the nearest emergency room.

Contact your healthcare provider if you have any of these signs or symptoms:

Call 911 if you have: • Bleeding that is not controlled or stopping. • Chest pain. • Trouble breathing. • Sudden onset of arm or leg weakness. • Sudden facial drooping (may be on one side). • Bleeding that soaks a pad every hour for 2 hours. • Bad smell coming from your vagina. • Fever of 100.4˚F or higher. • Incision or abdominal pain that will not go away. • Swelling, redness, discharge or bleeding from your cesarean incision or episiotomy site. • Your incision begins to separate. • Problems urinating including inability to urinate, burning while urinating or extremely dark urine. • No bowel movement within 4 days of giving birth.

• Any type of visual disturbance (double vision, blurring, etc). • Severe headache. • Excessive swelling of hands, feet or face. • Flu-like symptoms. • Pain or redness in one or both of your breasts. • Pain, warmth, tenderness or swelling in your legs, especially the calf area.

• Frequent nausea and vomiting. • Signs of depression or anxiety.

• Slurred speech, trouble speaking or unable to speak. • Chills, clammy skin, dizziness, fainting, racing heart beat. • Dramatic emotional changes like insomnia, severe agitation, confusion.

Do not ignore any of the symptoms below. You may think they are nothing, but they could mean something more.

• Headache. • Blurry or double vision, flashing spots or lights. • Extra swelling in your hands, feet or face. • Pain in your upper abdomen.

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To the New Father or Partner There is a lot of attention directed toward the mother and the baby at first. This attention along with the extreme closeness of a nursing mother and baby may contribute to feelings of isolation or jealousy for you. This is normal for some, but be patient with yourself and your partner. Talk about your feelings. Parenting takes patience, so communicating with each other about how to manage these new responsibilities will make it easier for both of you. Chances are that your baby’s mother is feeling every one of those same fears. Communication with one another is so important in easing fears and negative feelings and makes this time special. As a new father or partner, you may feel some emotional changes. It is natural for the combination of the new baby, the stress of the past nine months, and the new sense of responsibility to take their toll. There can be uncertainty that could lead to anxiety and eventually depression. In fact, 1 in 4 partners experiences a version of postpartum depression. Your responsibilities have changed and you may feel left out or overwhelmed. Discuss these feelings with your partner or talk with a trusted friend. If needed, seek professional help for the overall health and wellness of you and your family. You may feel somewhat unprepared. You may want to be involved but don’t know what being involved looks like. Here are some tips you can try:

1 1 Skin-to-skin contact It is good for both of you.

5 5 Your schedule will change

Be flexible and expect the unexpected.

2 2 Eye contact

6 6 Give yourself grace

Babies love it and can see about 12 inches away at first.

You may not enjoy every minute and it may be stressful.

33 Be patient It takes time to learn diapering, burping, bathing, etc.

7 7 Accept help when offered

Be specific, i.e. dinner, errands, laundry, etc.

4 4 Celebrate the new baby

8 8 Be confident

But guard the door so visitors don’t stay too long.

Mother and baby both need you.

Sex Healthcare providers generally advise waiting 4 to 6 weeks before resuming sexual intercourse. This does not mean you have to wait to resume intimacy. You may have your own fears and concerns about resuming sex. You may even be conflicted about being a father/partner and a lover. It shouldn’t be a surprise that the efforts of taking care of a newborn and the time constraints could be a deterrent. Be patient. You are both tired and she has been through a lot physically. Be sure to read the information on page 11 and 12 to better understand the emotional changes your partner may be experiencing. She may not recognize the symptoms. If you feel she needs care, contact her healthcare provider or take her to the nearest emergency room.

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Skin-to-Skin Contact At birth, your baby may be placed directly on your chest. While you are holding your baby skin-to-skin, a member of the healthcare team will dry your baby. They will check him over, and cover you and your baby with a warm blanket. Now the bonding can begin. The connection of your bare-skinned baby lying directly on your skin is called skin-to-skin contact and can give you and your baby time to get to know each other. This initial snuggling also has very important health benefits. According to the American Academy of Pediatrics (AAP), the best start for breastfeeding is when a baby is kept skin-to-skin with his mother immediately after birth and until the first feeding has finished, or as long as the mother wishes. The baby’s sense of smell allows him to find the breast to begin the initial latch- on. Research has shown that skin-to-skin babies breastfeed better and stay awake during the feeding. In addition, babies who had skin-to-skin contact are more likely to exclusively breastfeed.

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Proper Position for Safe Skin-to-Skin Contact

• You should be semi-reclined or upright and alert, or have an alert adult at the bedside helping. • Your baby is high up on your chest in a “kissable” position and laying in the middle of your chest. • Your baby’s head is turned to one side with mouth and nose visible and chin in a neutral position (not slouched). • Your baby’s arms and legs are flexed-in tight to the side of his body.

Benefits of Skin-to-Skin Contact

• Soothes and calms mom and baby. • Helps baby regulate his temperature, heart rate, breathing and blood sugar.

• Enhances bonding. • Supports breastfeeding. • Helps the uterus contract.

Rooming-In Rooming-in (keeping mothers and babies together in the same room) is beneficial to the health and development of infants. For many new mothers and their partners, the benefits of rooming-in include: • Facilitates feeding as parents learn the baby’s feeding cues. • Babies cry less and can be soothed more quickly. • Mothers make more breast milk, as breastfeeding occurs early and often. • Mothers get more rest. • Parents gain confidence in caring for their baby while experienced staff is available. • Babies can be monitored easily. Rooming-in is so valuable the AAP encourages parents to also do it at home. Rooming-in until the baby is at least six months old (ideally, a year) is part of the AAP’s strategies for preventing SIDS. Unless there is a medical issue with either you or your baby that requires you to be apart, rooming-in allows the hospital staff to care for you both at the same time. Skin-to-skin care is placing your unwrapped baby directly on your skin. Remember: Babies should always be pink in color and respond to stimulation. Babies are usually calm and relaxed while skin-to-skin. Babies receive these benefits from being skin-to skin with anyone, so don’t forget other family members.

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Caring for Your Newborn Welcoming a new baby into your life can be overwhelming. You will have so many new decisions to make at every turn. Plus, this tiny being will completely change the familiar routines in your life. Your baby’s health and safety are now your biggest responsibilities. Give yourselves time and as the days move forward, you and your partner will find increasing confidence and strength as you settle into routines with your new schedule. You will have many questions as the days go by, so have your important contact phone numbers listed and available for easy access. Using a Bulb Syringe Your nurse will show you how to use a bulb syringe before you are discharged from the hospital or birthing center. It is used to remove fluid from baby’s mouth or nose in case of spit-ups or runny noses. For the first few days of life, your baby may have lots of mucus which may make him gag. To help him when he gags, turn him on his side and pat his back like you are burping him. If he still gags, you may need to use the bulb syringe. • Always squeeze the bulb syringe before inserting it into your baby’s mouth or nose to create a vacuum. • Gently suction the mucus out of the lower cheek area, back of the throat or the nose. • Slowly release the bulb to suction out mucus. • Remove the syringe and squeeze the bulb forcefully to empty the mucus into a tissue. • Wipe the syringe and repeat the process, if needed. • Clean by squeezing and releasing the bulb in warm soapy water. • Keep the bulb syringe near your baby’s bed.

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Newborn Screenings/Procedures Newborn screenings test infants shortly after birth for medical conditions that are treatable, but not seen, in the newborn period. Every state in the U.S. requires certain newborn screening tests on all babies.

Metabolic Screening

How the Test is Performed

Metabolic screening is an essential preventive health measure. It tests for developmental, genetic and metabolic disorders in the newborn. These conditions may not be apparent immediately after birth. If identified early, many of these rare conditions can be treated before they cause serious health problems. Each state requires screening, but the specific test done may vary. Some disorders are more common in some states, making these screenings even more important. Of every 1,000 babies born, it is estimated that 1 to 3 will have serious hearing loss. Hearing screening for newborns before they leave the hospital or maternity center is becoming a common practice. It is recommended that all newborns be screened for hearing. If hearing loss is not caught early on, there will be a lack of stimulation of the brain’s hearing center. This can delay speech and other development in your newborn. Hearing Screening

A few drops of blood are taken from your baby’s heel. This is usually done on the day of discharge or no later than 2 to 3 days after birth. The sample is then sent to the lab for testing. Make sure the hospital and your baby’s healthcare provider have your contact information so you can be notified of the results.

How the Test is Performed

This test is painless and is performed using a tiny earphone, microphone or both while in the hospital. The test takes about 10 minutes and is done while your baby is sleeping.

Pulse Oximetry Screening for Congenital Heart Disease

How the Test is Performed

Pulse oximetry is a simple, painless test used to measure how much oxygen is in your baby’s blood. It is done when your baby is more than 24 hours old. It is useful in screening for some congenital heart diseases in newborns.

Sensors are placed on the baby’s hand and foot with a sticky strip and a small red light or probe. These sensors measure the baby’s oxygen level and pulse rate. The test takes a few minutes to perform while the baby is still, quiet and warm.

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Jaundice Jaundice is common in newborn babies. It gives a yellow color to the baby’s skin and eyes. Newborn babies have produced extra red blood cells for the birth process. One of the breakdown products of red blood cells is bilirubin . The liver in the newborn is fully developed, but not 100 percent efficient. Therefore, extra bilirubin in the blood is stored in the skin until the liver is able to break it down. This buildup of bilirubin in the blood and skin is called physiologic jaundice. Most cases of jaundice will go away without any medical treatment. Your baby’s healthcare provider will monitor his bilirubin and treat it if it is too high. You may need to make extra visits to the healthcare provider’s office or the lab in order to be certain that the bilirubin level is within an acceptable range. Left untreated, high levels of bilirubin can cause serious complications. It is important to take jaundice seriously and follow the instructions for appointments and recommended care.

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How the Test is Performed

Treatment

Phototherapy is treatment with a special light. The baby will be placed under the light wearing only a diaper and special eye protection. The lights will not hurt the baby. Another option for treatment is a fiberoptic blanket under the baby. The light and blanket are sometimes used together. The bilirubin levels will be checked by a blood test to ensure the treatment is working. Treatment can be done in the hospital or even at home. Make sure your baby is getting enough to eat. Babies will get rid of the bilirubin through the stool. Breastfeed your baby 8 or more times a day for the first few days. This will help you make enough milk for the baby and will help keep the baby’s bilirubin level down.

Transcutaneous bilirubin testing is a painless test done by placing a light meter on the baby’s skin. If the bilirubin level is high, a blood test can be done. A small sample of blood from the baby’s heel will be taken to measure the serum bilirubin levels. If these levels are high based on the baby’s age in hours and other risk factors, treatment will be ordered.

Dirty Diapers In the first week your baby will start with one wet and one dirty diaper for each day old they are. The first dirty diaper will be a black sticky stool called meconium . As the number of dirty diapers increase the color changes from dark brown or green to yellow. Wet Diapers A baby’s urine will be clear yellow. You may see a reddish- orange stain in your baby’s diaper in the first 3 days. These are uric acid crystals, sometimes called “brick dust”, because they resemble the color of bricks. New parents sometimes mistake this for blood in the diaper. It is normal and the more your baby eats the less of it you will see. Refer to page 37 for more information.

Contact your healthcare provider if your baby:

• Is very yellow. • Is hard to wake up. • Is very fussy or has a high-pitched cry. • Is not feeding 8 or more times in 24 hours. • Does not make enough wet or dirty diapers.

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Umbilical Cord As the umbilical cord dries it will look like a scab. Do not pick at it, cut it or pull it off. It will dry up and fall off on its own in about 10 to 21 days. Follow your healthcare provider’s instructions on how to care for the healing cord. Clear or slightly blood-tinged discharge can come from the area after the cord falls off. This is normal.

Contact your baby’s healthcare provider if:

The oozing lasts more than a couple of days and there is a bad smell, redness of the skin around the cord, or fever.

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Circumcision Circumcision is the removal of foreskin that surrounds the head of the penis. There are a few different techniques to do this. Discuss the benefits and risks of circumcision with your healthcare provider and make an informed decision about what is in the best interest of the child. The choice for circumcision is a personal one. The decision may be based on religious, cultural or traditional factors. Some other reasons may be health and hygiene issues. Benefits: • Easier hygiene. • Slightly lower risk of urinary tract infections. • Decreased risk of sexually transmitted infections. • Lower risk of penile cancer. Risks: • Bleeding and infection. • Pain. • Side effects from anesthesia . • Foreskin might be cut too short or too long. • The foreskin might not heal properly. This procedure is usually performed before discharge from the hospital. You will have to sign a consent form before the circumcision is done. Pain relievers have been found to be safe and effective to reduce pain associated with the procedure. After circumcision your baby will be watched closely by the nursing staff for bleeding. You should then check him often during diaper changes over the next few hours to look for any unusual bleeding (or as often as your nurse or healthcare provider tells you to). provider. It is applied to the tip of the penis with each diaper change for the first few days. The tip of the penis may look red and have yellow crusts in spots. Do not try to wash off this yellow crust. It is part of the healing process. Skin Care Newborn babies can have a variety of harmless skin blemishes and rashes. A common condition is newborn acne, caused by the mother’s hormones. It will get better in the first few weeks. Your baby’s skin may be dry and peeling, mostly on the feet, hands and scalp. This is simply the shedding of dead skin and is best left alone since lotions tend to slow the process down. Your baby’s delicate skin may be very sensitive to certain lotions or products that are highly perfumed. Anytime you are concerned about your baby’s skin, you should talk to your baby’s healthcare professional. • There is any unusual swelling, smell, oozing or bleeding. • Your baby does not urinate normally within 6 to 8 hours after the circumcision. • Bleeding doesn’t stop. • The redness around the tip of the penis gets worse after 3 to 5 days. • Yellow discharge lasts longer than a week. Contact your baby’s healthcare provider if: Your nurse will teach you how to take care of the penis as it heals. Sometimes petroleum jelly or an ointment will be recommended by your baby’s healthcare

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