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THE MOM’S BOOK L A B O R A N D B I RT H welcome ARE JUST THE BEGINNING! Congratulations on the birth of your new baby! We know that being a new mother can be difficult at times, especially in your baby’s first few weeks, so we’ve written this guide to give you lots of useful information and helpful hints about caring for yourself and your baby. Whether this is your first baby or your fifth, this guide is an easy-to-use reference to postpartum. It is not intended to replace the advice of your obstetrician, midwife or pediatrician. If you have questions or concerns about your health or your baby’s health, please contact your care provider. Table OF CONTENTS C ARIN G FOR YOURSELF . . . . . . . . . . . . . . . . . . . 1 Mothering the mother. . . . . . . . . . . . . . . . . . . . . . . . 2 How your body has changed. . . . . . . . . . . . . . . . . . 3 Staying well. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 F E E DI N G YO U R N EW B O R N . . . . . . . . . . . . . . . . . 1 2 Breastfeeding. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Nutrition while breastfeeding. . . . . . . . . . . . . . . . 19 Troubleshooting breastfeeding. . . . . . . . . . . . . . . 19 Pumping and storing breast milk. . . . . . . . . . . . 21 Feeding your baby. . . . . . . . . . . . . . . . . . . . . . . . . . . 22 CA R I N G F O R YO U R N EW B O R N. . . . . . . . . . . . . 2 6 Baby sleeping positions. . . . . . . . . . . . . . . . . . . . . . 27 Caring for your baby . . . . . . . . . . . . . . . . . . . . . . . . 27 Crying. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Immunizations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Screening tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 CAT H OL I C M ED I C A L S ERV I C ES. . . . . . . . . . . . 3 8 ASK-A-NURSE® . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Breast Care Center . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Outpatient Medication Management and Counseling Program . . . . . . . . . . . . . . . . . . . . . . . . 39 Pregnancy Care Center . . . . . . . . . . . . . . . . . . . . . . 40 West Side Neighborhood Health Center. . . . . . 40 Women’s Cardiac Center. . . . . . . . . . . . . . . . . . . . . 40 Primary Care Practices . . . . . . . . . . . . . . . . . . . . . . 41 Additional resources. . . . . . . . . . . . . . . . . . . . . . . . . 45 Caring F O R YO U R S E L F MOTHERING THE MOTHER H OW YO U R B O DY H A S C H A N G E D S TAY I N G W E L L MOTHERING THE MOTHER It took 9 long months to get your body ready to birth your baby and it’s going to take a while for you to feel like yourself again. Babies require LOTS of care, but you can’t take care of your baby until you first take care of yourself. Your body has just been through a marathon event so be sure you give yourself time to rest and heal from the work of birth! This is a great time for friends and family to care for you, so don’t be shy about accepting help wherever you can get it. Meal preparation, housework and laundry are wonderful ways that family and friends can help care for you so that you can better care for your baby. There are lots of resources available to help you with questions and concerns about your baby. CATHOLICMEDICALCENTER.ORG 2 HOW YOUR B ODY HAS CHANGED UTERUS During pregnancy your uterus grew from about 3 ounces to almost 3 pounds! Right after birth, your uterus began the process of shrinking back to its pre-pregnant size (called involution), but the whole shrinking process takes about 4-6 weeks. Afterbirth Pains As your uterus shrinks, you might feel some mild cramps called “afterbirth pains,” especially in the first few days after birth. Uterine cramping is a normal part of postpartum recovery. Cramps seem to be more painful for women who have previously given birth. You might notice them more if your baby is breastfeeding because your uterus contracts every time your baby latches on and nurses. Breastfeeding is nature’s way of helping your uterus to shrink, which helps minimize blood loss after birth. Uterine discomfort can be relieved by using a heating pad, warm tub baths and attempting to urinate every 3-4 hours. You may want to consider taking over-the-counter medications that your provider has recommended for discomfort. Avoid the use of aspirin. Vaginal Flow When the placenta detaches from your uterus after the birth of your baby, it creates a wound that bleeds. After a few days, the vaginal flow becomes thinner and more brown in color and, after a couple of weeks, it becomes yellowish and more like a heavy vaginal discharge. Depending on your activity level, your flow may last up to 6 weeks. A sudden or slow increase in flow is your body’s way of reacting to excessive activity. Continue to use your peri bottle as long as you have vaginal flow and change your pads frequently. Refrain from using tampons or douching until discussion with your provider at your 6-week postpartum visit. You may resume sexual intercourse after your vaginal flow stops completely. Call your provider if you have any of the following symptoms: Persistent, heavy bleeding (more than 1 pad in an hour) n n Pass a clot larger than a plum Fever n 603.663.MOMS (6667) 3 Signs of Infection You may have an infection if you are experiencing any of the following: Fever that is over 100.4 degrees n n Redness, heat, drainage, foul odor or pain from Cesarean section incision Chills n n Generalized achiness and flu-like symptoms Headache n n Tenderness, heat, redness in breast with fever Return of your period Most women who do not breastfeed have a period within 2 months following the birth of their baby, however, women who breastfeed may not have a period until their baby is weaned. Remember that even if you don’t have a period, breastfeeding does not prevent pregnancy. VAGINA If you had a vaginal birth, your vagina will take a few weeks to get back to normal. Your vaginal and pelvic floor muscles may take 6 to 7 weeks to return to pre-pregnant condition. Vaginal discomfort may be relieved by using your peri bottle or taking warm tub baths (sitz baths). You may also continue to use Benzocaine spray, Cortisone cream, witch hazel pads or ice. Over-the-counter pain relievers recommended by your provider may also be helpful. Call your provider if vaginal pain is unrelieved or increases. When you go to the bathroom it may be painful to wipe yourself. Use the peri bottle to wash your vagina after you urinate instead of wiping yourself. Continue to use the peri bottle until your vaginal flow has stopped. After using the peri bottle, pat yourself dry from front to back. Change peri-pads often. Do not use tampons as they may cause infection. n n Do not douche. Use sitz baths to help with swelling and soreness; sit in a clean tub of warm water for 15-20 minutes. n CATHOLICMEDICALCENTER.ORG 4 Kegels You may help your vagina regain some of its tone by doing Kegel exercises. These exercises may be started as soon as you feel able. Kegels are the contracting and relaxing of your pelvic floor muscles, and are easy to do: tighten the muscles as you would if you were going to stop the flow of urine. Hold that for 10 seconds and then release. Repeat this 3-5 times and work up to holding the Kegel for 20-30 seconds and repeating that 10-20 times. Kegels will help you for the rest of your life; they help you maintain bladder control when you get older, so do them every day! BLADDER It’s important to try to urinate every 3-4 hours. Your body will be getting rid of excess fluid for the first week or so, so you’ll be urinating often. You might find that you don’t feel an urge to urinate, so to help remind you to empty your bladder, urinate before you feed your baby. Sometimes women experience urinary tract infections following birth so watch for the following symptoms: Fever, chills n n Burning or pain with urination F eeling like you have to urinate but not much urine comes out n n Lower back pain If you suspect that you might have a urinary tract infection, call your provider. BOWEL MOVEMENTS AND HEMORRHOIDS Hormones, medications and lack of activity after birth can all be players in making you constipated. Ways to avoid constipation include eating a diet high in fiber such as whole grain breads, cereals, fruits and vegetables. You may also drink fluids to satisfy your thirst. Water is the best source of fluid for your health and well-being. Try to avoid sodas and caffeinated drinks. Use a stool softener, as directed by your provider to prevent straining. If you have not had a bowel movement by 3-4 days, notify your provider. 603.663.MOMS (6667) 5 Many women experience hemorrhoids during pregnancy and birth. Hemorrhoids may be uncomfortable and even painful, but they will usually go away within a month or so. Hemorrhoids are usually treated in several different ways: cold compresses, topical ointments and medication. Be sure to ask your nurse for help with this. BREASTS Your breasts will begin to make milk after your baby is born. Even if you choose not to breastfeed your body will make milk, and most new mothers experience some breast engorgement as their breasts produce milk. If you’re not going to breastfeed, then you’ll want to wear a tight bra and use cold compresses to help with the engorgement. It will take your body a little while to get the message that it doesn’t need to make milk, so in the meantime don’t do anything to stimulate your breasts/nipples. If you are breastfeeding, see the section on breastfeeding for more details. CESAREAN BIRTH INCISION If you had a Cesarean birth, you will be recovering from major surgery as well as from giving birth and you’ll need to take extra care. Rest and gradually increase your activity as tolerated. Shower daily and air dry your incision. Inspect your incision daily and report any redness, heat, pain, drainage or foul odor to your provider. If you have steri strips over your incision allow them to fall off on their own. Consider pain relievers as prescribed by your provider. SEXUAL ACTIVITY Some midwives and doctors advise women to wait 6 weeks before having sexual intercourse and others say that you may resume sexual activity whenever you’re ready. Avoid placing anything in the vagina until your vaginal flow stops. Check with your provider to see what they recommend is best for you. CATHOLICMEDICALCENTER.ORG 6 STAYING WELL NUTRITION A new mom not only needs to take care of her baby, she also needs to take care of herself. Remember that good nutrition and a healthy diet are very important in the postpartum recovery period. Women with special needs may be referred to a registered dietitian. Good nutrition will help you to recover, regain strength and stay healthy and active. The weight gained during pregnancy provides stores for recovery and for breastfeeding. A woman’s need for water, energy, protein, vitamins and minerals are increased. The following are some general nutrient guidelines: Fluid Drink plenty of liquids. Drink to satisfy thirst or enough to keep urine pale yellow or clear. Energy Calories are important to maintain energy to care for your baby and lose the excess weight gained in pregnancy. Typically 1800-2000 calories a day meet the daily requirements for new moms. Protein Additional amounts are needed in the diet to replenish maternal protein stores. Following a C-Section, protein can aid in healing. Good sources of protein include meat, fish, poultry, eggs, cheese, soy milk, yogurt and tofu. Calcium Whether breastfeeding or not, calcium stores must be replenished. Consumption of at least 1000 mg per day is required. When breastfeeding, if a mother’s calcium levels are low, calcium from her bones will be used for milk production. Good sources of calcium include dairy products, cheese, calciumfortified orange juice, almonds, leafy greens, broccoli, legumes (beans) and blackstrap molasses. 603.663.MOMS (6667) 7 Other Vitamins and Minerals Eat a variety of foods to assure maternal stores are replenished and maintained. If you are not eating well, talk to your provider about a multivitamin supplement. Nutrition Pearls n Eat a wide variety of foods with high nutrient density. Avoid high fat fast foods. n n Drink plenty of liquids such as water, milk and soups. Avoid fad diets for weight loss. n n Avoid harmful substances – tobacco, alcohol, illegal drugs. Avoid excessive intakes of salt, sugar, fat, caffeine, artificial sweeteners. n n Avoid mega-doses of vitamins and minerals. Use caution with herbal supplements. n EXERCISE Having a new baby in the house can be difficult in the beginning. New parents often feel overwhelmed by the amount of work a new baby creates. Therefore, it is essential to try not to overdo it. Focus on caring for yourself and the baby the first 2 weeks. It is okay to let others do for you. Limit stairs and don’t lift anything heavier than your baby. Avoid driving a car for 1-2 weeks and drive only when you feel comfortable. Try to sleep when the baby sleeps. It’s okay to gradually resume your pre-pregnancy fitness routine based on your personal capabilities, although your doctor or midwife may ask you to wait until your six-week postpartum checkup. Take it easy at first! Start out slowly to help conserve your energy, which will help you recover more quickly. Here are some basic exercises that can be done right after birth, with your provider’s okay. Pelvic Tilts Lie on your back, knees bent and feet flat. Contract abdominal muscles and tilt your tailbone under you until your hips come off the floor. Finish the move by contracting your buttocks. Release in reverse: buttocks, hips and abdominal muscles. Repeat. You can do 5 sets of 5 repetitions each. Strengthens your abdominal muscles and stretches the muscles of your lower back. CATHOLICMEDICALCENTER.ORG 8 Single Knee to Hamstring Stretch Lie on your back, right knee bent, right foot flat and your left knee pulled in towards your chest. Place your hands behind the thighs above the left knee. Gently pull your left knee towards your chest, stretching buttocks. Hold for 3 breaths. Now extend the left leg in the air, still holding your thigh, flex the left foot and hold for 3 breaths. Repeat with the other leg. Stretches buttocks and rear of thighs. Walking You can begin walking as soon as you feel able, even if it’s only 10-15 minutes at first. The intensity of your walk may allow you to talk but not sing. As you get stronger, you may walk longer and faster. As you walk, don’t over-stride, let your arms swing naturally by your sides. Before walking, do 5-10 minutes of warm-up activities such as marching, side to side lunges, shoulder rolls and arm circles. 603.663.MOMS (6667) 9 EMOTIONS This is a big topic! There are lots of things to talk about concerning your emotions following birth. The Baby Blues About 3 days after birth your body will experience a hormonal crash; the hormone levels in your body will fall dramatically and the result can be quite an emotional rollercoaster! You may feel sad, you may cry easily, you may feel overwhelmed by even the smallest decision and of course you’re sleep deprived. Sometimes it’s hard to believe that such a little baby can require SO MUCH CARE! This is called the “baby blues” and it usually occurs 3 to 5 days after birth and can last 7 to 10 days. Postpartum Mood Disorders (PPMD) There are 4 emotional conditions that women can experience during the year following birth and these are all kinds of PPMD: n Postpartum Anxiety and Panic Disorder Symptoms of this PPMD are the common symptoms for panic/anxiety: rapid heartbeat, shortness of breath, chest pain, and lightheadedness. You may feel an overwhelming fear of being alone, of dying, of your baby dying or of leaving your house. Postpartum Obsessive-Compulsive Disorder (OCD) Women who experience OCD in postpartum have recurring thoughts and rituals that they repeat over and over. Obsessive thoughts in postpartum might include a fear of harming the baby, of being a bad mother, of germs or things that might harm the baby. Obsessive rituals are things like compulsive house cleaning, excessive hand washing, and constant and excessive checking on the baby. Obsessive rituals interfere with daily living. n n Postpartum Depression Somewhere around 10% of all women who give birth experience postpartum depression, and it’s totally different than the “baby blues.” Postpartum depression is more serious, longer lasting and is a physiological as well as a psychological disorder. If you have experienced depression in the past you may be at a higher risk of becoming depressed after your baby is born. Postpartum depression most commonly occurs between the sixth week and the sixth month following birth. Symptoms of postpartum depression include: loss of interest in the baby, feelings of hopelessness, extreme feelings of inadequacy/low self-esteem, thoughts of hurting yourself or your baby, inability to sleep, extreme weight gain/loss, and constant crying. CATHOLICMEDICALCENTER.ORG 10 n Postpartum Post-Traumatic Stress Disorder (PTSD) A traumatic birth experience can cause postpartum PTSD, as can a traumatic experience during pregnancy or after birth. Women who have frightening or difficult births, insensitive care providers, illness during pregnancy and unexpected problems after birth are more likely to experience postpartum PTSD. Birth can also trigger memories of a traumatic experience from your past; physical or sexual abuse, a difficult or frightening hospitalization or any other traumatic event in your life. Symptoms of postpartum PTSD include: recurring nightmares, recurrent memories of the trauma, anger, feelings of anxiety or panic, and overprotecting the baby to the extreme. Do you have risk factors for PPMD? n A history of depression, obsessive-compulsive disorder, post-traumatic stress disorder or emotional problems. n A history of physical, sexual or emotional abuse. A history of drug or substance abuse or living with someone who is currently abusing alcohol or drugs. n A difficult pregnancy and/or birth experience. n n A lack of support from partner, family and friends. An unplanned or unwanted pregnancy. n n Recent stresses such as marriage, separation, divorce, death in the family, change in jobs, moving, change in/loss of job, financial pressures, etc. n Low self-esteem. If you’re an over-achiever with high expectations of being perfect. n n Thyroid disease. If you have had an eating disorder. n Treating PPMD It’s important to treat PPMD as soon as possible; waiting may make symptoms worse which can rob you, your baby and your partner of quality time together. Talk to your provider about your symptoms and ask if they can give you the name of a therapist who specializes in PPMD, or you can contact Catholic Medical Center’s Outpatient Psychiatric Medication Service at 663.6200. 603.663.MOMS (6667) 11 Feeding YO U R N EW B O R N BREASTFEEDING NUTRITION WHILE BREASTFEEDING TROUBLESHOOTING BREASTFEEDING PUMPING AND STORING BREAST MILK F E E D I N G YO U R B A B Y BREASTFEEDING Breastfeeding provides the best nutrition for your baby and has long lasting benefits for both of you. During pregnancy and right after birth, your breasts will contain colostrum, a yellowish substance that is your baby’s first food . Colostrum is a protein and antibody-rich fluid . Your body makes colostrum in small amounts, which is exactly right for your baby’s marble-sized stomach . DEMAND FEEDING Breastfeeding is best done “on demand.” This doesn’t mean nursing every time your baby cries, but instead learning to recognize your baby’s feeding cues. These cues may include licking his/her lips or putting his/her hands to his/her mouth . Your baby may also become more awake and alert . Crying is a late sign of hunger . Feed as often and for as long as your baby shows signs of feeding cues . This will help establish a good milk supply supply . HOW OFTEN DOES A NEWBORN FEED? Babies feed 8-12 times a day, although they may be sleepy a few days after birth and feed less. Babies may feed every few hours or every hour (cluster feeding) . These are normal variations . Babies are typically more interested in feeding at night . W Waking the baby every 2 to 3 hours during the day may help to reverse this feeding pattern . Feeding your baby frequently does not mean you have an inadequate milk supply, or that you are spoiling him/her, it is the way breastfeeding works . You will know your baby is getting enough to eat by watching for 6-8 wet or soiled diapers a day day . 603 .663 .MOMS (6667) 13 HOW WILL I KNOW IF I HAVE ENOUGH MILK? This can be a little frustrating at times but there will be lots of signs that your baby is getting enough: You can hear your baby swallowing during feedings. n n Your breasts feel less full after a feeding. The baby is satisfied and falls away from your breast at the end of a feeding. n n Your baby is gaining weight – your provider will follow your baby’s weight gain but if you have any concerns, call The Mom’s Place and ask to bring the baby in for a weight check. Your baby is eating frequently (8-12 times in 24 hours). n n Your baby is having regular wet/soiled diapers (6-8 times in 24 hours). You may expect that your baby will initially lose a little weight after birth. Once the feedings are more regular, babies will usually gain 4-7 ounces, so your baby’s weight may be back to birth weight by the second week. BREAST CARE, COLOSTRUM AND BREAST MILK A mother’s milk transitions from colostrum to milk on day 3 to five, although it may be earlier if you’re not a first time mother. Engorgement Some women experience engorgement or hard swollen breasts. Feeding the baby frequently, using cool compresses and over-the-counter medication recommended by your provider may help to relieve discomfort. You may also express milk by hand or with a pump to soften the nipples if the baby is having difficulties latching. Engorgement is caused not just by milk in the breasts, but also by blood or lymph fluid in the breast tissue. The discomfort of engorgement usually subsides within 24-48 hours. CATHOLICMEDICALCENTER.ORG 14 During engorgement, your areola may become swollen, making it difficult for your baby to latch on. Soften your breasts by standing in a warm shower for a few minutes or applying warm, moist compresses to your breasts before you begin feeding your baby. n Massage your breasts gently to express a little milk, making the nipple softer and latch-on easier. n Cold raw cabbage leaves may ease the discomfort of engorgement; just slip the leaves into your bra against your skin. n Breast milk is produced by supply and demand, meaning what you remove your body replaces. Nurse your baby on one side until the baby pulls off. This will provide opportunity for baby to receive the rich creamy hind milk at the end of the feeding. Once your baby falls off the breast, burp or change the diaper and offer the second breast. If the baby falls asleep within a few minutes, start the next feeding on the breast you last fed with. BASICS OF BREASTFEEDING Calm and Quiet If possible, nurse in an atmosphere of calm and quiet. This will help you relax and help your baby focus on the feeding without being distracted. Comfortable Position Take the time to find a comfortable position with your back well supported. Use pillows to support your arms and your baby or use a breastfeeding pillow. 603.663.MOMS (6667) 15 Feeding Begin feeding with the fuller breast. Cup your breast with your free hand against your body below your breast, lift your breast, bring your baby toward you with the mouth level to your nipple. n n Stroke your baby’s lower lip with your nipple until the mouth is open wide. When open wide, pull or roll the baby gently towards you and hold close so the mouth latches onto your breast and the belly is against your belly. Be patient, sometimes it takes many tries to open wide enough to latch onto your breast. Just keep stroking the lower lip. Once latched on, check to be sure the jaw is open wide and the mouth is full of your breast. The baby should take as much of your areola into the mouth as possible. The baby’s nose may be touching your breast, but unless your breasts are very large he/she will still be able to breathe. n Let your baby nurse at the first breast for as long as you hear swallowing and then offer the other breast. Watch your baby for end-of-feeding signals such as drifting off to sleep and slipping off your breast. n POSITIONS FOR BREASTFEEDING Cradle Hold Your baby’s head is “cradled” in the bend of your arm. Your forearm supports the body and your hand is under his/her bottom or upper legs. Your baby is facing your breast and the tummy and chest are turned towards your abdomen. Use your other hand to support your breast – your fingers cup your breast underneath. Cross or Alternate Cradle Hold Put a pillow under the baby’s body for support. If you’re feeding from the right breast use your right hand to cup your breast and your left hand under the nape of the baby’s neck with your fingers below the baby’s ears. Your left forearm supports the baby’s back and bottom. CATHOLICMEDICALCENTER.ORG 16 Football Hold Place a pillow under the baby’s body for support. If you’re feeding from the right breast your right hand cradles the nape of your baby’s neck and your left hand supports your breast. The baby’s body is tucked beside your body, under your arm, with the bottom against what you’re resting your back against, and feet up in the air. Use your right hand to move the baby’s head and chest towards your breast. Side Lying Lie on your side and place a pillow between your knees for comfort. Place another pillow or rolled blanket behind your baby’s back to tilt the tummy towards your abdomen. Your lower arm is either behind your baby’s back or supporting you behind your head. Your upper arm supports your breast. BREASTFEEDING LOG FOR THE FIRST WEEK Circle the hour when your baby nurses. Circle the W when your baby has a wet diaper. Circle the S when your baby has a soiled diaper. During the first week, you will increase the number of diapers you use each day. Birth Date:____________________ Birth Time:_________________ DAY ONE GOAL 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 6 – 8 Wet diaper W 1 Black tarry soiled diaper S 1 DAY TWO GOAL 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 8 – 12 Wet diaper W W 2 Brown tarry soiled diaper S S 2 603.663.MOMS (6667) 17 DAY THREE GOAL 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 8 – 12 Wet diaper W W W 3 Green soiled diaper S S 2 DAY FOUR GOAL 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 8 – 12 Wet diaper W W W W Yellow/Green soiled diaper S S S DAY FIVE 4 3 GOAL 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 8 – 12 Wet diaper W W W W W 5 Yellow soiled diaper S S S 3 DAY SIX GOAL 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 8 – 12 Wet diaper W W W W W W Yellow soiled diaper S S S DAY SEVEN 6 3–4 GOAL 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 8 – 12 Wet diaper W W W W W W 6 – 8+ Yellow soiled diaper S S S 3 – 12 It is OK for your baby to have more wet diapers or more soiled diapers. Call our Lactation Consultant at The Mom’s Place at 663.6686 if your baby has less than the number on the log. CATHOLICMEDICALCENTER.ORG 18 NUTRITION WHILE BREASTFEEDING During your pregnancy, your body prepared for breastfeeding in the form of 5-7 pounds of extra fat that you don’t lose initially after birth. Your body will draw from those stores for the first few weeks as you nurse your baby. You’ll also find that you’ll probably be very thirsty and it is best to drink to satisfy that thirst. Your body takes water from your system to make breast milk, so if you don’t replenish that fluid, you could become constipated. No foods are routinely restricted when you breastfeed; your baby will let you know if something you are eating is not tolerated. Food that you eat affects your milk 4-24 hours after it is eaten, so if your baby is especially fussy, you may try eliminating the foods that you think might be causing the problem (if this happens consistently). Your diet while breastfeeding needs to include extra protein, some calcium-containing foods, extra vitamins and extra fluids. Water is the best fluid for your health and well being. TROUBLESHOOTING BREASTFEEDING Here are some common situations that may arise for breastfeeding mothers. If any of these persist or if you have questions, please don’t hesitate to call a Lactation Consultant at The Mom’s Place at 663.6686. BREASTS LEAKING MILK During the first few weeks after birth, your breasts may leak milk. This will usually slow down and stop altogether as your body figures out just how much milk your baby needs. It’s not uncommon to have a let down when you hear your baby or another baby crying, it’s just your body responding to your baby’s needs. Sometimes when you’re sexually aroused, your breasts may leak…this is normal and a little unsettling but don’t worry; leaking usually becomes less of a problem with time! 603.663.MOMS (6667) 19 What to do When you feel the milk let down, press your hands or forearms firmly against your breasts. This slows the milk flow and can be done in public if you’re discreet! n If one breast leaks while your baby is nursing from the other, press the heel of your free hand on the nipple for a minute or two. n W ear pads to absorb the leaking milk, changing them when they get wet or damp. Keeping wet or damp pads close to your skin can cause your nipple tissue to break down, which can cause nipple soreness. n n Avoid the use of breast pads with plastic liners, instead choose thin, flexible silicone pads or washable cotton ones. Ask your nurse or Lactation Consultant. SORE NIPPLES/CRACKED NIPPLES Some women experience tenderness by the second or third day of breastfeeding, but it may resolve by day 7 to ten. Usually extreme soreness is caused by improper positioning or an ineffective latch, both of which are easy to fix. Don’t let the soreness persist – call a Lactation Consultant at The Mom’s Place at 663-6686. Try some of these suggestions to correct the situation: n Check the baby’s latch – make sure the baby is taking as much of the areola into the mouth as possible and the lower lip is full. n Feed often – putting off feedings makes your breasts fuller and that makes it harder for the baby to latch on. n Hand-express or pump a little milk before the baby latches on to soften the areola and make latching on easier. n Begin nursing on the side that is the least sore, since babies nurse more vigorously at the start of a feeding. n Remember to take the baby off the breast by putting your finger into the mouth to break the suction so your nipple comes out easily. n Air dry your nipples after nursing. Wash your breasts with water only. Soap may dry your skin, perfume may irritate it. n n Rub a little breast milk onto your nipples after each feeding. Change breast pads when they become wet, or dab some expressed breast milk onto the area and allow it to air dry. n CATHOLICMEDICALCENTER.ORG 20 PUMPING AND STORING BREAST MILK Expressing milk from your breasts may be done by hand or with a breast pump. Talk to a Lactation Consultant at The Mom’s Place about selecting a pump that best fits your needs. The ability to pump your breasts gives you great flexibility and allows others to share in the experience of feeding your baby. It’s also important if you are trying to build or rebuild your milk supply, or if you need to return to work or to travel. 5 hours on the counter, 5 days in the refrigerator, 5 months in the freezer (See below) REFRIGERATOR STORAGE FREEZER STORAGE Expressed Store for 5 days in the coldest Breast milk part of refrigerator. Do not store in door of refrigerator. Store for 5 months in the back of freezer. Do not store in door of freezer. Store for up to 6 mos. in deep-freezer. Frozen Breast milk Do NOT refreeze breast milk Thawed breast milk that is unopened or unused is fine in the refrigerator for 24 hours. Be sure to throw out any breast milk that is left over or not used from a feeding after it was thawed and warmed, or if it comes into contact with the baby’s mouth. NEVER MICROWAVE BREAST MILK! Store pumped milk in clean glass or plastic bottles or in plastic bags designed for breast milk storage. Leave room at the top of the bottle or bag for expansion of milk as it freezes. n n Label the container with the date the milk was collected. Use the oldest milk first. Thaw frozen milk by placing the container in warm water. As the water cools, change it for warm water until the milk is at room temperature or slightly warmer. Shake before using to mix fat which rises during storage. n WHEN SHOULD I INTRODUCE A BOT TLE? Babies drink from a breast or bottle for at least the first 6 months of their lives. If you want to add a bottle of breast milk or formula, it’s best to wait 3-4 weeks until your milk supply has been established. n 603.663.MOMS (6667) 21 n Feeding milk from a bottle is very different for your baby than feeding milk from a breast, and some babies may have difficulty adjusting to those different sucking patterns. Some babies won’t accept a bottle from a breastfeeding mother. Once your milk supply is well established and your baby is nursing well, try letting your partner offer the baby a bottle when you are not in the room. n FEEDING YOUR BABY GOOD NUTRITION FROM THE START One of the most important aspects of caring for your new baby is to provide wholesome nutrition. Since your baby will be growing and developing rapidly during the first year, nutrient needs will be high. A diet appropriate for your baby’s level of development is the cornerstone of future good health. Weight gain will be one of the best indicators of an adequate intake. While every baby is a unique individual, there are some general guidelines for feeding during the first twelve months. BREAST MILK Breast milk is an excellent food for the first year. Advantages to breastfeeding are many including nutritional, immunological, psychological and economical. Breast milk provides 100% of your baby’s nutritional needs through the first 4-6 months. Your baby may nurse 8-12 times per day (on demand). By 4 months, your baby will likely cut back to 4-6 times per day taking more at each feeding. At the beginning, fluid needs are met with breast milk. If extra fluids are required, talk to your pediatrician. FORMULA FEEDING Formula fed babies usually eat every 2-4 hours, and your pediatrician or family care doctor will advise you about which formula to feed your baby and how much your baby is likely to eat at each feeding. Formula is available in ready-to-feed, concentrated and powdered form. Powdered formula is the most economical way to bottle-feed your baby. Always read the label for preparation directions. CATHOLICMEDICALCENTER.ORG 22 BOT TLE FEEDING GUIDELINES n Check expiration date on the formula before use. n Always follow formula manufacturer’s directions carefully. City water may be safely used to prepare formula, whereas well water should be tested for arsenic prior to using. n We recommend boiling the water and slightly cooling prior to adding to the powdered formula. Be sure to cool the formula and test the temperature before feeding your baby. n n Newborn babies may take between 1 to 3 ounces every 3 to 4 hours. Always prepare more than your baby is taking and increase as needed. n Make bottles for use within 24 hours, cap the bottle and refrigerate. Warm formula by placing in a pot of warm (not boiling) water, do not microwave. n n Always test the temperature of warmed formula on the inner arm, before feeding your baby. Test temperature of the formula on your wrist by tilting the bottle. If the formula runs out, the hole in the nipple is too big and the baby could choke. Formula should drip out of the nipple when you tilt the bottle. n Always throw away any formula left over at the end of a feeding – bacteria in the baby’s saliva will contaminate the formula. n Discard unused opened powered formula after 1 month. Consult with your baby’s provider before changing formula or for any suspected intolerance to formula. n SOLID FOODS – WHEN AND WHAT By age 6 months your baby may be ready to be introduced to solid foods. When making this transition, it is important to not start too soon. Your baby’s gastrointestinal tract may not be ready and food allergies may develop. Babies younger than 4 months use an in-and-out tongue movement for sucking which makes it very difficult for them to swallow from a spoon. Some developmental milestones to look for before starting your baby on solids include: birth weight doubled, good head and neck control, ability to sit up with some support and interest in food when others are eating. Around 6 months of age, solid foods are added to the diet. By adding food, however, the number of breastfeedings or the amount of formula may not decrease. The first food is typically iron-fortified rice cereal. 1 to 2 tablespoons mixed with breast milk or formula may be offered twice a day. Have your baby in an upright position and offer the cereal with a spoon. When rice cereal is taken regularly, other fortified cereals may be tried at an interval of 1 new cereal per week while watching for food allergies. Signs of food allergies are intolerance of food, hives or rash. 603.663.MOMS (6667) 23 INTERACTIVE PARTICIPATION – ADDING MORE FOODS By age 6-8 months, your baby will take a more active role with eating. At this stage of development, he/she will have better posture through the neck and shoulders and will be able to coordinate hand movements to start self-feeding. Begin with pureed foods and then offer soft-textured ones. Start pureed vegetables first and then add pureed fruits. Offer finger foods in small amounts, such as soft cooked vegetables, peeled fruits, Melba toast or cooked noodles. Your baby will now take more solid foods and less breast milk or formula (nursing 3-5 times a day or consuming 24-32 oz. formula/day). INDEPENDENCE By age 9-12 months, your baby will take a more independent role with eating. Because a baby has a small stomach capacity, 3 meals plus 3 snacks should be offered daily. Your child may get messy while eating. He or she is just experiencing the food. Give small soft pieces of foods, but avoid those foods that can fully block the opening to the airway. Examples of foods to avoid are whole grapes, hot dogs, peanuts, nuts, raw carrots and raisins. Cups of breast milk, formula or water should be given at meal time. This can aid in the transition from bottle to cup use. Small amounts of juice or water can also be offered by cup. Introducing your child to new foods may be a challenge and can take as many as 10 trials of a food to do so. As your baby grows, so does the need for good nutrition. Follow the cues and developmental milestones when progressing with eating during the first year. You and your baby have a special bond. Enjoy the process from the start. CATHOLICMEDICALCENTER.ORG 24 NUTRITION PEARLS When combining breast and formula feeding, do not introduce formula until a few weeks before returning to work. If your baby is not eating enough during the day or is underweight, waking to feed at night may be needed. Check with your doctor. n Too much plain water can be harmful. n n Commercially bottled “baby water” with fluoride is not to be used for babies less than 6 months old. n Never put your baby to bed with a bottle. It may cause “bottle mouth” resulting in tooth decay. n Do not feed cereal in a bottle. Safe and sanitary food preparation techniques are very important. n n Fat is not to be restricted for babies. Pasteurized whole cow’s milk or goat’s milk should not be introduced until about 12 months of age. n Un-pasteurized milk has viral and bacterial contamination risk. n n Formula should not be made with evaporated cow’s milk, soy milk or rice milk as none meet the requirements of babies less than 1 year old. n After 12 months of age, 12-16 oz. of whole milk or other 500 mg calcium equivalent per day should be provided. n Give whole milk until age 2 to provide the needed calories for proper growth. n Avoid added sugar and salt when preparing food. Honey and corn syrup are not recommended for children under 2 years old. They may contain Clostridium Botulinum spores. n Delay feeding orange juice until 9 months if there is a family history of allergy present. n Some babies may be sensitive to egg whites thus give yolk only until 1 year old. n For families with history of food allergies, delay introduction of the following for 12-18 months: egg whites, cow’s milk, citrus, wheat products, chocolate, fish, shellfish, tree nuts, peanuts, and peanut butter. n 603.663.MOMS (6667) 25 Caring F O R YO U R N EW B O R N BABY SLEEPING POSITIONS C A R I N G F O R YO U R B A B Y BABY SLEEPING POSITIONS REDUCING THE RISK OF SIDS (Sudden Infant Death Syndrome) n ALWAYS PLACE YOUR BABY TO SLEEP ON HIS/HER BACK. Babies sleep on a firm mattress, not on a waterbed, sofa or other soft surfaces. n n Pillows, comforters or sheepskins are not to be used under a baby or anywhere in the crib. n Remove all stuffed animals and toys from the sleep area. Keep your baby’s head and face uncovered during sleep. n n If you use a blanket, be sure that your baby’s feet are at the bottom of the crib and that the blanket is no higher than the baby’s chest. Tuck the blanket in around the mattress. Maintain your baby’s sleep area at a room temperature that should be comfortable for an adult, be sure not to overheat the room. n The 2005 AAP recommendation states that babies should sleep in a crib or bassinet in the same room as the parents. Babies may be brought into bed for nursing or comforting, but should be returned to their own crib or bassinet when the parents are ready to return to sleep. If parents choose to have their baby in bed, remember to never sleep with your baby if you have been drinking alcohol, smoking, using drugs or medications that make it difficult to become awake, are obese or extremely exhausted. n n Sometime between 3-4 months of age your baby will begin to roll to the side on his/her own. CARING FOR YOUR BABY BATHING YOUR NEW BABY It is not necessary to bathe your newborn every day; twice a week is ideal. However a bath at the same time each day can be relaxing and provide a routine in your day. Babies may be immersed in warm water up to the chin even if the cord hasn’t fallen off. Use a mild soap or plain water. Start with the eyes, then wash the face and end with the diaper area. Powders, creams and lotions are not necessary. Remember to be ready before you start the bath including towels and a clean diaper! 603.663.MOMS (6667) 27 CORD CARE Your baby’s umbilical cord will dry and fall off usually within 7-10 days. Try to keep the cord dry by keeping it out of the diaper. When the cord falls off there may be a few drops of blood and some yellowish drainage for a day or two afterwards. If you notice redness, swelling or puss-like drainage, notify your baby’s provider. FINGERNAILS/TOENAILS Babies’ fingernails usually need cutting right after birth, but it’s not a good idea. Cutting may damage a membrane that is growing there, so for the first few weeks, use an emery board to keep nails short. Since babies love to clench their hands into fists, wait until they are sleeping and their hands are relaxed before trying to trim his/her nails! BABY ’S TEMPERATURE Obtain your baby’s temperature if you suspect that your baby is sick. Signs of illness may include excessive sleepiness, irritability or feeding poorly. You may notice that your baby feels hot to the touch. Use a digital thermometer and place under the newborn’s armpit. Make sure you have good skin contact. Hold the baby’s arm down gently while waiting. A normal newborn temperature is between 97.6 and 99.6 degrees. If your provider requests a rectal temperature, use the sleeve provided with the thermometer, lubricate the probe tip with Vaseline and insert gently, about ½ inch into the rectum. The baby is positioned on his/her back with the feet held up. Notify your baby’s provider if the rectal temperature is greater than 100.4 degrees. CATHOLICMEDICALCENTER.ORG 28 DIAPERING The baby’s diapers need to be changed when soiled. This may be frequent in the beginning. Use alcohol-free, fragrance-free wipes or warm water when changing the diaper. Ointments may be used if a diaper rash is present. Daily use of creams and powders is not needed. If a diaper rash persists for more than a few days, notify your baby’s provider. A girl baby is wiped from front to back. It is not necessary to separate the labia and clean discharge unless stool is present. A mucous or blood tinged discharge in a baby girl is normal. Boys that are not circumcised need no special care in the beginning. Your provider will discuss care when your child is older. Breastfed babies generally have mustard-like yellow stools with a mild odor. Bottle fed babies have firmer stools with a stronger odor. CIRCUMCISION CARE After your baby boy has been circumcised, the glans of the penis will have a long piece of Vaseline gauze wrapped around it and a “tent” made out of gauze and Vaseline over the top. The long piece stays on the penis for the first 24 hours and the “tent” is changed with every diaper change. Your nurse will show you how to do this. After 24 hours, all the gauze is removed and you may continue to apply Vaseline for a day or two to prevent the glans from sticking to the diaper. During the 24 hours after surgery, if your baby is fussy or irritable, you may give him pain medication. Your nurse will tell you how much to give him based on his weight. Call your baby’s provider if you notice bleeding, drainage, swelling, redness, fever or no urination within 24 hours. USING THE BULB SYRINGE Babies are nose-breathers for the first 3-4 months and they often need assistance to clear their noses. To use the bulb syringe, depress the bulb, insert it in one nostril while blocking the other nostril. Release bulb. Once or twice into each nostril is adequate. Do not force the bulb and use only as needed, excessive use can irritate the baby’s nasal mucosa. 603.663.MOMS (6667) 29 CAR SEATS Always buckle your baby in an approved car seat according to the manufacturer’s recommendations, even for short trips. If the baby is in the car, the seat should be secured and buckled up. Newborns need to be in a rear-facing seat until they are 1-year-old and 20 pounds. A 5-point safety harness restraint is recommended. The car seat is never placed in front of an airbag. Accessories that do not come with the car seat are not to be added, as the seats are not safety tested with added-on items. Never use a seat that has been in an accident or one that you do not know the age or history. Refrain from using a seat that is 6 years old or more. Plastics break down over time and are not strong. Always read all directions carefully before installing the seat including the car’s operating manual. Many cities and towns in New Hampshire have safety technicians in their police and fire departments. They are trained to check the seat and instruct parents in correct installation and proper newborn placement in the seat. Before you leave the hospital, The Mom’s Place staff will check to see if your baby is correctly placed in his/her car seat. You will need to perform any adjustments to obtain proper fit, so knowledge of how to do so is imperative to ensure your baby’s safety in the car. JAUNDICE Jaundice is the yellow color seen in the skin of many babies. It is caused by the buildup of bilirubin in the blood as a result of the normal breakdown of fetal red blood cells. Bilirubin is removed by the mom’s liver prior to birth. After birth, the new baby’s liver sometimes takes a few days to effectively remove the bilirubin. Low levels of bilirubin are harmless for your baby and may even have some antioxidant effect. Very high levels however may be harmful and are watched carefully. Your baby’s provider and your nurse will observe your baby’s color and perform lab tests to determine the bilirubin level. Since jaundice usually peaks on day 4 or 5, your provider will request you follow up with them within 2-4 days of discharge. Bilirubin is excreted in the bowel and urine. Feeding your baby frequently means more output and more bilirubin excreted. Sometimes, however, increasing levels of bilirubin may make your baby sleepier and harder to feed. If you are breastfeeding and your baby will not latch, express your breasts and feed expressed milk in a bottle. When your baby is home, observe frequently. Holding your baby up to light may make jaundice easier to see. Call your baby’s provider if your baby’s skin turns more yellow, including the abdomen, arms, legs and eyes. Also, call if your baby is hard to wake, fussy or not feeding well. When your baby’s jaundice levels are high your provider may order phototherapy. Your baby will be treated with special lights. This may be done either at home or in the hospital. Phototherapy works fairly quickly and usually only lasts 1-2 days. CATHOLICMEDICALCENTER.ORG 30 CRYING Crying is the way babies communicate with us. They may cry for many reasons. They may be too hot or cold, hungry, sick or need their diaper changed. Sometimes you’ve checked all these things and your baby still cries. Here are some techniques you can try to soothe your baby. n Wear your baby Many different styles of slings are available now and your baby will love being close to you. n Skin to skin Place your undressed baby on your bare chest. n Swaddling Wrap your baby securely in a blanket with his arms down. n Movement Babies love movement, a rocker ride, swing, stroller or car ride. n Massage Massage your baby’s lower abdomen in a clockwise manner. n Warm bath Move your baby back and forth in the water or get into the bathtub with him and lay him on your chest. n White noise Make a shushing noise near your baby’s ear or turn on a hair dryer away from the baby. Sometimes babies will cry no matter what you do . If your baby’s crying is upsetting to you or you feel yourself becoming angry or frustrated, you need to stay calm and separate yourself from your baby baby . Your baby should be laid gently on her back, in her crib . Call a friend, have a warm drink, do something for yourself yourself . Remember never shake a baby . Babies can have serious medical consequences from being shaken . IMMUNIZATIONS Infants and children need to be vaccinated because they are more likely to develop complications or die from vaccine-preventable diseases. Immunization is one of the most important things a parent can do to protect their children’s health. Today we can protect children from 14 serious diseases. Failure to vaccinate may mean putting children at risk for serious diseases. Source: United States, Department of Health and Human Services, Centers for Disease Control and Prevention. National Infant Immunization Week Frequently Asked Questions. Questions 603 .663 .MOMS (6667) 31 COMMON QUESTIONS ABOUT INFANT IMMUNIZATIONS Is it okay for my baby to have so many shots at once? Yes. Studies show that kids’ bodies – even infants – can handle many shots at once. Having several vaccines at once is safe, even for a newborn. Combination vaccines protect your child against more than one disease with a single shot. This reduces the number of shots and office visits your child would need. It’s not your imagination; there are a greater number of shots now than even a few years ago. That’s because as science advances, we are able to protect your child against more diseases than ever before. Don’t infants have natural immunity? Babies get some temporary immunity (protection) from mom during the last few weeks of pregnancy – but only for the diseases mom is immune to. These antibodies do not last long, leaving the infant vulnerable to disease. Haven’t we gotten rid of most of these diseases in this country? Thanks to vaccines, most diseases prevented by vaccines are no longer common in this country. Even the few cases we have in the U.S. could very quickly become tens or hundreds of thousands of cases if we stopped vaccinating. It’s not uncommon to have measles outbreaks, whooping cough outbreaks, chickenpox outbreaks, and other diseases when vaccination rates drop. Kids that are not fully vaccinated can become seriously sick and spread it through a community. I heard that some vaccines can cause autism. Is this true? No. Scientific studies and reviews have found no relationship between vaccines and autism. Groups of experts, including the American Academy of Pediatrics and the Institute of Medicine (IOM), also agree that vaccines are not responsible for the number of children now recognized to have autism. Can’t I just wait until my child goes to school to catch up on immunizations? Many of the diseases vaccines protect against can be very dangerous to infants. Newborns, babies and toddlers can all be exposed to diseases from parents and other adults, brothers and sisters, on a plane, at child-care or even at the grocery store. International travel is easier than ever – your baby can be exposed to diseases from other countries without you knowing. Don’t wait to protect your baby and risk these diseases when he or she needs protection now. It is easier to stay up to date than to catch up! CATHOLICMEDICALCENTER.ORG 32 Why does my child need a chickenpox shot? Isn’t it a mild disease? Chickenpox can actually be a serious disease for kids if the blisters become infected. Before vaccines were available, about 50 kids died every year from chickenpox, and about 1 in 500 kids who got chickenpox were hospitalized. My child is sick right now. Is it okay for her to still get shots? Yes, usually. Talk with the doctor, but children can usually get vaccinated even if they have a mild illness like a cold, earache, mild fever, or diarrhea. If the doctor says it is okay, your child can still get vaccinated. Where can I get more information? Centers for Disease Control and Prevention (CDC) www.cdc.gov/vaccines or 800-CDC-INFO (232-4636) American Academy of Pediatrics www.aap.org The Children’s Hospital of Philadelphia www.vaccine.chop.edu Immunization Action Coalition (IAC) www.immunize.org Every Child By Two www.ecbt.org Source: United States, Department of Health and Human Services, Centers for Disease Control and Prevention. Common Questions Parents Ask About Infant Immunizations. 603.663.MOMS (6667) 33 RECOMMENDED IMMUNIZATION SCHEDULE FOR PERSONS AGED 0-6 YEARS UNITED STATES 2008 n Age 1 2 4 6121518 19-23 2-34-6 Vaccine Birth monthmonthsmonthsmonthsmonthsmonthsmonthsmonths years years Hepatitis B HepB HepB Rota HepB Rotavirus Rota Rota Diphtheria, Tetanus, Pertussis DTaP DTaP DTaP aemophilus H influenzae type b Hib Hib Hib Hib Pneumococcal PCV PCV PCV PCV I nactivated Poliovirus IPV IPV DTaP DTaP PPV IPV IPV Influenza Influenza (yearly) Measles, Mumps, Rubella MMR MMR Varicella Varicella Varicella Hepatitis A HepA (2 doses) Meningococcal Range of recommended ages HepA Series MCV4 Certain high-risk groups This schedule indicates the recommended ages for routine administration of currently licensed childhood vaccines, as of December 1, 2007, for children aged 0 through 6 years. Additional information is available at www.cdc.gov/vaccines/recs/schedules. Any dose not administered at the recommended age should be administered at any subsequent visit, when indicated and feasible. Additional vaccines may be licensed and recommended during the year. Licensed combination vaccines may be used whenever any components of the combination are indicated and other components of the vaccine are not contraindicated and if approved by the Food and Drug Administration for that dose of the series. Providers should consult the respective Advisory Committee on Immunization Practices statement for detailed recommendations, including for high risk conditions: http://www.cdc.gov/vaccines/pubs/ACIP-list.htm. Clinically significant adverse events that follow immunization should be reported to the Vaccine Adverse Event Reporting System (VAERS). Guidance about how to obtain and complete VAERS form is available at www.vaers.hhs.gov or by telephone, 800-822-7967. Source: United States, Department of Health and Human Services, Centers for Disease Control and Prevention. The Recommended Immunization Schedule for Persons Aged 0-6 Years 2008. CATHOLICMEDICALCENTER.ORG 34 NEWB ORN SCREENING TESTS Why does my baby need newborn screening tests? n Most babies are healthy when they are born. n We test all babies because a few babies look healthy but have rare health problems. n If we find problems early, we can help prevent serious problems like mental retardation or death. How will my baby be tested? n n Before you leave the hospital, a nurse will take a few drops of blood from your baby’s heel. The hospital will send the blood samples to a newborn screening lab. How will I get the results of the test? n Parents are notified of test results if there is a problem. n Ask about results when you see your baby’s health professional. Why do some babies need to be retested? n Your baby may be retested if you leave the hospital before 24 hours. n Some states require a second test on all babies. n Some babies need to be retested because there is a problem with the blood sample. n A few babies need to be retested because the first test showed a possible health problem. What if my baby needs to be retested? n n n Your baby’s health professional or the State Health Department will contact you if your baby needs to be retested. They will tell you why the baby needs to be retested and what to do next. If your baby needs to be retested, get it done right away. Make sure that your hospital and health professional have your correct address and phone number. 603 .663 .MOMS MOMS (6667) 35 There may be other tests besides those required in your state. More helpful information is available by contacting: National Newborn Screening and Genetics Resource Center 512.454.6419 www.genes-r-us.uthscsa.edu or NH Department of Health & Human Services Division of Public Health Services Maternal & Child Health Section New Hampshire Newborn Screening Program 29 Hazen Drive Concord, NH 03301 603.271.4225 1.800.852.3345 ext. 4225 LEAD POISONING Effects of lead poisoning n Learning disabilities Difficulty with memory n n Trouble paying attention Behavioral problems in children n n Slowed growth rate Hearing loss n n Coma or death in serious cases Those at risk for lead poisoning Pregnant women n n Children under six Adults exposed at home or work n n Pets Children are at risk for lead poisoning n Growing bodies absorb more lead. Lead paint dust gets on small hands and toys. Children put hands and toys into their mouths. n Children may eat lead paint chips that peel off the wall. n n Children can eat lead dust created by opening and closing windows and doors. CATHOLICMEDICALCENTER.ORG 36 Protect yourself and your family if you are exposed to lead on the job Call the Northern New England Poison Center at 1.800.222.1222 for information. Sources of lead poisoning n Lead paint used in homes or buildings built before 1978 Water that runs through plumbing with lead solder n n Older toys and furniture with lead paint Dust created when furniture with paint is sanded n n Hobbies that use lead (pottery, stained glass and reloading shotguns) Food or liquids stored in lead crystal or lead-glazed pottery n n Firing ranges Lead dust on clothes and shoes carried home from work n Risk factors in homes built before 1978 Peeling or chipped paint n n Hard-to-open doors or windows Home remodeling n Testing your home for lead: New Hampshire: Call 1.800.698.3624 or visit www.dhhs.nh.gov/DHHS/CLPPP?default.htm Protect your family if your house has lead paint Talk to your doctor about a blood test for lead. n n Do not let children/pets chew on painted surfaces. Wash hands, children’s bottles, pacifiers and toys often. n n Avoid vacuuming or sweeping areas that may contain lead dust. Mop or wipe down surfaces with water instead. n Report chipping or peeling paint to your landlord if you rent a house, condominium or apartment. n Hire a certified lead renovator if you plan to remodel or disturb lead paint. If you choose not to use a certified professional, call the Northern New England Poison Center at 1.800.222.1222 for safety information. 603.663.MOMS (6667) 37 Catholic Medical Center SERVICES ASK-A-NURSE® BREAST CARE CENTER O U T PAT I E N T M E D I C AT I O N MANAGEMENT AND COUNSELING PROGRAM PREGNANCY CARE CENTER WEST SIDE NEIGHBORHOOD H E A LT H C E N T E R WO M E N ’ S C A R D I AC C E N T E R PRIMARY CARE PRACTICES ADDITIONAL RESOURCES CMC SERVICES ASK-A-NURSE® a community health service of Catholic Medical Center 603.626.2626 ASK-A-NURSE is CMC’s 24-hour health care information hotline. When you call, you will speak directly with a specially-trained registered nurse who will listen carefully to your questions and help you make an informed decision about you or your baby’s health care question. All ASK-A-NURSE services are free and confidential, 24-hours a day, 7 days a week. BREAST CARE CENTER at Catholic Medical Center 100 McGregor Street, Manchester, NH 03102 n 603.663.5270 The Breast Care Center at Catholic Medical Center serves as a comprehensive, streamlined place of comfort offering treatment, care, support and education for women all under one roof. Services include prevention, clinical breast exams, screenings, diagnosis, treatment, consultation and educational resources. High quality, comprehensive breast health care services are easily accessible and cost effective. The Breast Care Center is committed to creating an integrated and focused system of care in a compassionate environment, providing hope and healing. The Breast Care Center is located inside Catholic Medical Center To make an appointment, call the Breast Care Center at 663.5270. OUTPATIENT MEDICATION MANAGEMENT AND COUNSELING PROGRAM at Catholic Medical Center 88 McGregor Street, Manchester, NH 03102 n 603.663.6200 The Outpatient Medication and Counseling Program is staffed by 2 psychiatrists, an advanced registered nurse practitioner and a licensed clinical social worker. This outpatient program offers evaluation, assessment, psychopharmacologic management and treatment of a broad range of psychiatric disorders. The Outpatient Counseling Program assists individuals needing help with personal changes, stress, anxiety or other life challenges. Patients are seen by appointment. To schedule an appointment, please call 663.6200. Office hours: Monday through Friday, excluding holidays. 603.663.MOMS (6667) 39 PREGNANCY CARE CENTER 88 McGregor Street, Manchester, NH 03102 n 603.663.6661 At the Pregnancy Care Center at Catholic Medical Center, we provide comprehensive, supportive prenatal care to all women and their families regardless of their ability to pay. Prenatal care has been identified as playing a significant role in improved pregnancy outcomes. Our mission is to serve those most in need and those unable to access services in traditional prenatal settings. The Pregnancy Care Center is located in the medical office building adjacent to Catholic Medical Center. Office Hours: Monday through Thursday, 8 AM to 4 PM, by appointment. WEST SIDE NEIGHBORHOOD HEALTH CENTER at Catholic Medical Center 88 McGregor Street, Suite 302, Manchester, NH 03102 n 603.663.5382 Catholic Medical Center and Dartmouth-Hitchcock Manchester have come together to create a full-service primary care setting on the West Side of Manchester. As the new home for the Family Center for Pediatric and Adolescent Care, the West Side Neighborhood Health Center specializes in caring for the entire family, from newborns to elderly. We continue to provide comprehensive, supportive well-baby and well-child care, ill child care and adolescent care to the age of 18. Our expanded services will include general internal medicine for those over the age of 18. The West Side Neighborhood Health Center is located in the Medical Office Building adjoining Catholic Medical Center. Office Hours: Monday through Friday, 8 AM to 5 PM by appointment. WOMEN ’S CARDIAC CENTER New England Heart Institute of Catholic Medical Center 100 McGregor Street, Manchester, NH 03102 n 603.663.5299 The Women’s Cardiac Center offers a comprehensive program that identifies a woman’s risk for heart disease and provides recommendations for reducing these risks. One out of every 2-1/2 women die from cardiovascular disease and nearly 60 percent of women experiencing a heart attack have no prior symptoms. Factors used to determine a woman’s risk of cardiovascular disease include age, smoking habits, HDL CATHOLICMEDICALCENTER.ORG 40 cholesterol, total cholesterol and systolic blood pressure. Women may self-refer or be referred by their physician to the Center for a risk assessment and screening. To sign up for better heart health, call the Women’s Cardiac Center at 663.5299. PRIMARY CARE AT CATHOLIC MEDICAL CENTER At Catholic Medical Center, we understand how important your relationship is with your doctor. You want a doctor who not only understands your specific medical needs, but who will take the time to listen to your concerns and make you a full partner in your care. AMOSKEAG PRIMARY CARE GROUP a department of Catholic Medical Center 16 High Street, Manchester, NH 03101 603.623.3343 n Amoskeag Primary Care Group, as a family practice, specializes in caring for the entire family, from newborns to the elderly. We provide hospital care at Catholic Medical Center and have spent several years in specialized medical training to provide you with expert, personal care. We appreciate the opportunity to serve your health care needs. For provider information, visit catholicmedicalcenter.org. Office Hours: Monday through Friday, 8 AM to 5 PM. In an emergency, our answering service will contact us after regular business hours. DARTMOUTH-HITCHCOCK BEDFORD 25 South River Road, Bedford, NH 03110 n 603.629.1793 Dartmouth-Hitchcock Bedford is a primary care practice that includes family practice, internal medicine and pediatrics. We specialize in caring for the entire family. We have quick and easy access to specialty care from within the Dartmouth-Hitchcock system, including Norris Cotton Cancer Center and CHaD, the Children’s Hospital at Dartmouth. Our providers also have privileges at Catholic Medical Center to see their patients when hospitalization is needed. For provider information, visit Dartmouth-Hitchcock.org/Manchester. Office Hours: Monday through Friday, 8 AM to 5 PM. 603.663.MOMS (6667) 41 FAMILY HEALTH & WELLNESS CENTER AT BEDFORD a department of Catholic Medical Center 188 Route 101, Bedford, NH 03070 n 603.663.8052 The Family Health & Wellness Center at Bedford specializes in family medicine and general internal medicine with an emphasis on holistic and complementary care. Our philosophy is to treat the whole person, mind, body and spirit. Our practice cares for the entire family, from newborns to the elderly, and provides hospital care at Catholic Medical Center. We have spent several years in specialized medical training to provide you with expert, personal care. We appreciate the opportunity to serve your health care needs. Office Hours: Monday through Friday, 8 AM to 5 PM. In an emergency, our answering service will contact us after regular business hours. FAMILY PHYSICIANS OF MANCHESTER a department of Catholic Medical Center 57 Webster Street, Suite 110, Manchester, NH 03102 n 603.622.6491 Welcome to Family Physicians of Manchester, where our purpose is to provide you with the best health care possible. Our providers are certified by the American Board for Family Medicine. We specialize in caring for the entire family, from newborns to the elderly, and provide hospital care at Catholic Medical Center. We have spent several years in specialized medical training to provide you with expert, personal care. We appreciate the opportunity to serve your health care needs. For provider information, visit catholicmedicalcenter.org. Office Hours: Monday through Friday, 8 AM to 5 PM. In an emergency, our answering service will contact us after regular business hours. GOFFSTOWN PRIMARY CARE a department of Catholic Medical Center 17A Tatro Drive, Suite 201, Goffstown, NH n 603.314.4500 Goffstown Primary Care is a group of health care professionals who specialize in general internal medicine and provide hospital care at Catholic Medical Center. We have spent several years in specialized medical training to provide you with expert, personal care. We appreciate the opportunity to serve your health care needs. For provider information, visit catholicmedicalcenter.org. Office Hours: Monday through Friday, 8 AM to 5 PM. In an emergency, our answering service will contact us after regular business hours. CATHOLICMEDICALCENTER.ORG 42 GRANITE STATE INTERNAL MEDICINE a department of Catholic Medical Center 53 Goffstown Road, Manchester, NH 03102 n 603.206.1380 Granite State Internal Medicine is a primary care practice with 2 physicians and one nurse practitioner certified by the American Board of Internal Medicine. We have spent several years in specialized medical training to provide you with expert, personal care. We appreciate the opportunity to serve your health care needs. For provider information, visit catholicmedicalcenter.org. Office Hours: Monday through Friday, 8AM to 5PM. MEDICAL GROUP OF MANCHESTER a department of Catholic Medical Center Dartmouth Commons, 775 South Main Street, Manchester, NH 03102 n 603.663.7300 The Medical Group of Manchester is a group of physicians certified by the American Board of Internal Medicine. We specialize in general internal medicine and provide hospital care at Catholic Medical Center. We have spent several years in specialized medical training to provide you with expert, personal care. We appreciate the opportunity to serve your health care needs. For provider information, visit catholicmedicalcenter.org. Office Hours: Monday through Friday, 8 AM to 5 PM. In an emergency, our answering service will contact us after regular business hours. QUEEN CITY MEDICAL ASSOCIATES a department of Catholic Medical Center Dartmouth Commons, 769 South Main Street, 3rd Floor, Manchester, NH 03102 603.625.6198 n Welcome to Queen City Medical Associates, where our purpose is to provide you with the best care possible. Our physicians specialize in general internal medicine and are certified by the American Board of Internal Medicine. We provide hospital care at Catholic Medical Center. We have spent several years in specialized medical training to provide you with expert, personal care. We appreciate the opportunity to serve your health care needs. For provider information, visit catholicmedicalcenter.org. Office Hours: Monday through Friday, 8 AM to 5 PM. In an emergency, our answering service will contact us after regular business hours. 603.663.MOMS (6667) 43 WEBSTER STREET INTERNAL MEDICINE a department of Catholic Medical Center 57 Webster Street, Manchester, NH 03104 n 603.668.6489 Webster Street Internal Medicine is a group of physicians who specialize in general internal medicine and who provide hospital care at Catholic Medical Center. We have spent several years in specialized medical training to provide you with expert, personal care. We appreciate the opportunity to serve your health care needs. For provider information, visit catholicmedicalcenter.org. Office Hours: Monday through Friday, 8 AM to 5 PM. In an emergency, our answering service will contact us after regular business hours. WILLOWBEND FAMILY PRACTICE a department of Catholic Medical Center 20 Washington Place, Bedford, NH 03110 n 603.663.8060 Welcome to Willowbend Family Practice, where our purpose is to provide you with the best health care possible. Our providers specialize in family medicine and are certified by the American Board for Family Medicine. We provide hospital care at Catholic Medical Center. As a family practice, we are specialized in caring for the entire family, from newborns to the elderly. We have spent several years in specialized medical training to provide you with expert, personal care. We appreciate the opportunity to serve your health care needs. For provider information, visit catholicmedicalcenter.org. Office Hours: Monday through Friday, 8 AM to 5 PM. In an emergency, our answering service will contact us after regular business hours. OBSTETRICS & GYNECOLOGY Dartmouth-Hitchcock Physicians and Nurse Midwives 88 McGregor Street, Suite 301, Manchester, NH 03102 603.629.1799 n CATHOLICMEDICALCENTER.ORG 44 PEDIATRIC OFFICES Bedford Pediatrics Pine Tree Place, 360 Route 101, Unit 7-B, Bedford, NH 03110 n 603.471.0831 Dartmouth-Hitchcock Bedford Pediatrics 25 South River Road, Bedford, NH 03110 603.695.2572 n Dartmouth-Hitchcock Manchester Pediatrics 100 Hitchcock Way, Manchester, NH 03104 603.695.2750 n ADDITIONAL RESOURCES Child and Family Services 800.640.6486 cfsnh.org n Children’s Alliance of NH 603.225.2264 childrennh.org n Early Hearing Detection and Intervention Program, State of New Hampshire Health and Human Services 603.271.1037 dhhs.nh.gov/DHHS/MCH/ehdi.htm n Family Resource Connection of the NH State Library 800.298.4321 nh.gov/nhsl/frc/maindirectory.html n Mental Health Center of Greater Manchester 603.668.4111 Available 24 hours/7 days a week n n mhcgm.org NH Family Voices – Families and friends speaking on behalf of children with special health needs. 800.852.3345, x4525 nhfv.org n NH Healthy Kids Corporation 877.464.2447 nhhealthykids.com n Parent Information Center 800.947.7005 parentinginformationcenter.org n USA National Suicide Hotline 1.800.SUICIDE (784.2433) VNA Child Care and Family Resource Center 603.666.5982 manchestervna.org/childcare.asp n 603.663.MOMS (6667) 45 MAKING A TRIBUTE TO YOUR BABY OR A CAREGIVER Remember your special experience at The Mom’s Place. Some families like to recognize a caregiver they have had during their time at The Mom’s Place. The nurses and staff at The Mom’s Place are highly qualified, compassionate people who focus on providing a positive birthing experience for you and your family. Donations can be made in honor of your favorite nurse or caregiver. Your donation will be used in support of advanced training opportunities for nurses. The “Legacy of Children” program is another way to commemorate a child’s birth and support The Mom’s Place at Catholic Medical Center. With a gift of $500, a commemorative plaque is permanently installed on the “Legacy of Children” display, part of The Mom’s Place giving wall located on the unit. As names are added, a visual story of birth at Catholic Medical Center is created, reminding all who see it of our rich and long history. Your gift will directly support the ongoing delivery of exceptional care that has become the standard at The Mom’s Place. If you would like to make a donation to The Mom’s Place or any other area of Catholic Medical Center, you can call the Philanthropy Office at 603.663.6056, send a check made payable to Catholic Medical Center, or donate online by visiting www.catholicmedicalcenter.org. Send your check to Philanthropy Office, Catholic Medical Center, 100 McGregor Street, Manchester NH 03102. CATHOLICMEDICALCENTER.ORG 46 NOTES 603.663.MOMS (6667) 47