The following guidelines will help you on your way to becoming a breastfeeding mother.

Before the birth:

• Let your midwife know that you plan on breastfeeding

• If you plan on returning to work and pumping for the baby, you can start looking for the pump that is right for you and talking to your work about places to pump and store your milk.

Immediately after the birth:

• You should be able to breastfeed almost immediately after the birth. This helps your uterus go back to its normal size by causing it to contract and decrease your bleeding. This is the time the baby is most alert and most ready to achieve a good latch.

• The baby will get colostrum for the first few days. This milk is full of protein, healthy fats, and antibodies that coat the baby’s stomach and provides nourishment for the baby until your milk supply comes in.

• Try and spend as much time as you can “skin to skin” with the baby. This will help trigger your milk supply.

Postpartum and at home:

• Feed the baby on demand, or at least every 2-3 hours for the first few days

• Look at the babies diapers as an indicator for how much the baby is getting from breastfeeding. By the third day of life they should have 5-6 diapers and the baby’s stool should look like

• Take the time to make yourself comfortable. You will be spending lots of time feeding the baby. Choose positions that help you relax and enjoy the time together with your baby. “Side-lying” can be great at night, and “football hold” works well for women with larger breasts.

• Stay hydrated – Every time you sit down to nurse try and drink an 8 oz glass of water. This will help keep you milk supply up.

• Importance of a good diet – You will need to continue to eat well, and even increase your caloric intake by another 500 calories while you breastfeed. Your body is transferring vitamins and minerals into the breastmilk for your baby, so it is important to keep taking your prenatal vitamin so your calcium and iron stores are in good shape.

If you notice a hot, reddened, tender area on your breast, you may have a plugged duct. If this duct becomes infected it may progress to mastitis.

• Symptoms include:
  • Fatigue
  • Muscle aching
  • Chills, shivering
  • Fever
  • “just feels like the flu”
• Call the office, and you may be put on an antibiotic. Warm compresses and massaging the area assist to unclog the duct. Be sure to completely empty the breast while feeding.
• You can continue to breastfeed throughout the diagnosis and treatment of this infection

Benefits for baby:

• Breast milk is the most complete form of nutrition for infants. A mother’s milk has just the right amount of fat, sugar, water, and protein that is needed for a baby’s growth and development. Most babies find it easier to digest breast milk than they do formula.

• As a result, breastfed infants grow exactly the way they should. They tend to gain less unnecessary weight. This may result in being less overweight later in life.

Benefits for mom:

• Nursing uses up extra calories, making it easier to lose the pounds of pregnancy. It also helps the uterus to get back to its original size and lessens bleeding a woman may have after giving birth.

• Breastfeeding, especially exclusive breastfeeding (no supplementing with formula), delays the return of normal ovulation and menstrual cycles. (However, you should still talk with your doctor or midwife about birth control choices.)

• Breastfeeding lowers the risk of breast and ovarian cancers, and possibly the risk of hip fractures and osteoporosis after menopause.

• Breastfeeding makes your life easier. It saves time and money. You do not have to purchase, measure, and mix formula. There are no bottles to warm in the middle of the night!

• Breastfeeding can help a mother to bond with her baby. Physical contact is important to newborns and can help them feel more secure, warm and comforted.

Benefits for society:

• Breastfeeding saves on health care costs. Total medical care costs for the nation are lower for fully breastfed infants than never-breastfed infants since breastfed infants typically need fewer sick care visits, prescriptions, and hospitalizations

• Breastfeeding is better for our environment because there is less trash and plastic waste compared to that produced by formula cans and bottle supplies.

Internet resources

Evidence based lactation information – http://www.kellymom.com/index.html

US Department of Health and Human Services – http://www.4woman.gov/breastfeeding

La Leche League – http://www.llli.org

Waterbirth found its way to the United States a little over 22 years ago. In 1998 waterbirth International was formed to meet the need for up to date and accurate information regarding the use of water in labor and birth. Barbara Harper’s personal experience with waterbirth helped her decide to create Waterbirth International with the goal that she continues to work toward today “to make waterbirth an available option for all women”. Barbara also states that “option is the key word in knowing that this method of birth is not for every woman, but every woman should be given an informed choice of whether it makes sense for her”.

In the early 2000’s while practicing midwifery at Bridgeton Hospital I started having women request waterbirth. We had been very successful in offering women the choice of a “drug free birth” by using warm tubs for easing pain and deepening relaxation in labor. However, laboring women would have to leave the tub to give birth. I found many women pleading with me to let them stay in the tub. Unfortunately, the tub was not large enough for birth, and hospital protocols did not allow for the option of waterbirth.

The administration at South Jersey Hospital was very receptive to my request to offer women in southern New Jersey the choice of waterbirth. With the opening of South Jersey Hospital, Elmer Division in the fall of 2003, and it’s “water birth room” with a tub designed especially for birth, and the development of specific waterbirth protocols, I have been able to offer low risk women the choice of waterbirth.

Known benefits of water labor and waterbirth

• Facilitates mobility and enables the mother to assume any position which is comfortable for labor and birth

• Speeds up labor

• Reduces blood pressure

• Gives mother more feeling of control

• Provides significant pain relief

• Promotes relaxation

• Conserves her energy

• Reduces the need for drugs and intervention

• Gives mother a private protected space

• Reduces perineal trauma and eliminates episiotomies

• Reduces cesarean rates

• Is highly rated by mothers – typically stating they would consider giving birth in water again

• Is highly rated by experienced providers

• Encourages an easier birth for mother and a gentler welcome for baby

• Facilitates mobility and enables the mother to assume any position which is comfortable for labor and birth

• Speeds up labor

• Reduces blood pressure

• Gives mother more feelings of control

• Provides significant pain relief

• Promotes relaxation

• Conserves her energy

• Reduces the need for drugs and interventions

• Gives mother a private protected space

• Reduces perineal trauma and eliminates episiotomies

• Reduces cesarean section rates

• Is highly rated by mothers – typically stating they would consider giving birth in water again

• Is highly rated by experienced providers

• Encourages an easier birth for mother and a gentler welcome for baby

There is a waterbirth tub available for use at Elmer Hospital – talk to Karen about the possibility of using it for your birth.

For additional information regarding waterbirth visit www.waterbirth.org

Drink plenty of fluids throughout the day. At least 8-10 glasses (64-80 ounces) of water per day are recommended or more if you are sweating or active. Dehydration can be dangerous in pregnancy. It can cause preterm contractions and/or cause the baby’s heart to beat too fast (fetal tachycardia). The baby depends on you for heat regulation and hydration. The baby’s temperature is 2 degrees Fahrenheit greater than yours and has no mechanism to lower his or her body temperature. Signs that you are dehydrated may include thirst, dry or cracked lips, fatigue, decrease in the baby’s movements, lightheadedness, dizziness and/or an increase in Braxton Hicks contractions. If you experience any of these symptoms find a cool place to sit down. If you feel lightheaded or are experiencing contractions, you should lie down on your left side and drink cool water or a sports drink and rest. If the lightheadedness or dizziness does not resolve you should call you doctor or midwife.

Call your doctor or midwife immediately if you experience any of the following:

• More than 5 contractions or menstrual like cramping in 1 hour

• Pelvic pressure

• Change in vaginal discharge

• Bright red vaginal bleeding

• Change in the baby’s movement

Keep cool by spending as much time in air conditioning as possible. Pregnant women have less tolerance for heat, so be sure to check the local forecast for heat advisories. If the heat index is in the 90’s it is best to stay indoors with air conditioning. If you do not have access to air conditioning, a fan in a shaded room can help but may not be enough if temperatures are in the high 90’s or above. Try eating in an air conditioned restaurant, visiting the mall, taking a cool shower or bath, or a swim in the pool. A cool damp cloth on your forehead and the back of your neck can also help you keep cool.

Wear loose comfortable clothing made of natural fibers such as cotton or linen in light colors. Breathable loose clothing allows air flow and decreases sweating. Wearing a wide brimmed hat will help keep you cool and protect your face from the sun.

Limit the time you spend in the direct sun between 10am and 4pm. Take walks, exercise, or run errands in the morning or evening when it is cooler. It’s a good idea to drink 8 ounces of water or sports drink every hour that you are out in the sun. A spritz of cool water from a spray bottle feels great and helps keep you cool.

Take care of your feet and legs. Keep your feet elevated whenever possible to reduce swelling and increase circulation. Wear flat, comfortable supportive shoes or sandals. Lie on your left side for 30 minutes at lunch time and again at the end of the day to further help reduce swelling. Avoid salty foods and soak in a kiddie pool or a cool tub. Use a cooling foot gel to ease swelling in your feet and legs. Exercise is also important for maintaining good circulation. Going for a walk or swimming most mornings or evenings will help.

Protect your skin by wearing SPF 15 sunscreen, or 30 if you have fair skin. Pregnant women are more likely to get sunburned. It is best to apply sunscreen 20 minutes prior to going out in the sun and to reapply it throughout the day. Hormonal changes in pregnancy can increase the pigment production of your skin and cause cholasma, or “pregnancy mask”. Exposure to the sun can make this discoloration more pronounced. Prevent dry, itchy skin by applying a fragrance free moisturizing lotion as you get out of the shower or bath. Oatmeal baths can be very soothing for dry, itchy skin. Staying well hydrated also helps prevent dry skin.

Nutrients to include in your diet

Folate and folic acid: Folate is a B vitamin if taken before conception and during the first three months of pregnancy helps prevent serious abnormalities of the brain and spinal cord such as spina bifida. Lack of folate throughout pregnancy may increase the risk of babies having low birth weight, poor growth and/or preterm delivery. In addition to the 400-800 micrograms in your prenatal vitamin, choose foods high in folic acid. These include fortified whole grain cereals, leafy green vegetables, citrus fruits, dried beans, legumes and nuts.

Calcium: Both you and your baby need calcium for strong bones and teeth. In addition, your baby needs calcium to develop a healthy heart, nerves and muscles. If you are not getting adequate calcium, 1000 milligrams a day, the baby will take the calcium from your bones, which may negatively impact your own health. The best food sources of calcium are milk, skim is best, and other dairy products. Additional sources are dark green leafy vegetables, and calcium fortified whole grain cereals and breads. Vitamin D is very important in helping your body absorb calcium. Adequate amounts can be found in fortified milk, eggs, fish and sunshine.

Iron: Your need for iron doubles during pregnancy. 30 milligrams of iron is recommended daily. Your body uses iron to form red blood cells that carry oxygen to your tissues and the baby. Without enough iron you may become fatigued, more prone to infections, develop anemia and increase your risk of preterm delivery and low birth weight. Good food sources of iron include lean red meat, poultry, fish, spinach, broccoli, collard greens, lima beans, lentils, iron enriched whole grain breads and cereals, nuts and dried fruits. Cooking in an iron skillet also adds up to 80% more iron to foods.

Vitamin C: Vitamin C is important to aid in the body’s ability to absorb iron, be sure to add a source of vitamin C along with foods that contain iron and iron supplements. Vitamin C is also important in maintaining healthy gums, teeth, and bones. Foods high in vitamin C are citrus fruits, strawberries, broccoli, and tomatoes.

Protein: Protein is essential to your baby’s growth, especially during the second and third trimester when the baby is growing more rapidly. During pregnancy you need an average of 70 grams of protein a day. Great sources of protein include lean meat, poultry, fish, eggs, dried beans and peas, dairy products, tofu and peanut butter.

Food items to limit during pregnancy

Seafood: Fish and shellfish are an excellent source of protein, omega- 3 fatty acids, and iron. Omega-3’s are present in oily fish such as salmon, tuna and sardines. Recently there have been studies that have shown that Omega-3 fatty acids may promote your baby’s brain development, eyes, and nervous system. However, some fish and shellfish contain dangerous levels of mercury that may damage your baby’s developing nervous system. It is recommended by the U.S. Food and Drug Administration that you eat up to 12 ounces (2 average meals) a week of a variety of fish and shell fish that are lower in mercury. Examples of fish with lower mercury are salmon, shrimp, and catfish. Choose canned light tuna, which has less mercury than albacore.

Food items to avoid during pregnancy

Seafood choices high in mercury: Do not eat shark, swordfish, king mackerel, tilefish, or striped bass; these fish are high in mercury. To avoid harmful bacteria or viruses avoid raw fish, raw sushi and shell fish, and anything caught in polluted waters.

Unpasteurized Dairy Products: Avoid any unpasteurized products. Soft cheeses to avoid: brie, feta, blue veined cheeses, camembert, and Mexican-style cheeses like queso blanco, queso fresco. They can harbor listeria, a rare bacteria, especially harmful to pregnant women and their unborn babies.

Undercooked meats and poultry: Avoid undercooked meats and poultry, and practice good kitchen hygiene. Heat hotdogs and lunch meat to steaming hot to avoid listeria infecton.

Caffeine: Recent studies suggest that pregnant woman should avoid caffeine altogether. Caffeine crosses the placenta and can affect your baby’s heart rate. Some studies suggest that too much caffeine can be associated with decrease in birth weight, and others show an increased risk of miscarriage.

Today is the perfect day to start making healthier choices for you and your baby.

Things to look for:

Organic Milk

• Skim is best

Water

• Drink 64 oz a day (8 big glasses or 6 little water bottles)

Unprocessed foods

• Eat whole grains – stay away from white, processed flour
• No artificial sweeteners
• Lots of green leafy veggies
• Have a calcium and protein at each meal

Flax seed or Fish oil – 1000mg capsule twice a day with meals helps with:

• Help the baby’s brain development
• Keeps your skin healthy
• Decreases pre-term labor
• Softens your stool
• Decreases your chance of preeclampsia (high blood pressure)

Take a look at on the web

• http://www.mypyramid.gov
• click on “pregnancy and breastfeeding” for ideas about how to choose and plan your meals.

Things to avoid:

Certain types of fish to avoid -

• Striped Bass, Tilefish, Mackerel, Shark, Swordfish
• Albacore tuna (light tuna is fine – no more that 2 cans a week)
• Limit seafood to 2 meals a week

Juice – limit to one glass a day

• A piece of fruit instead
• Add some water to the glass first

Certain types of cheese to avoid

• Anything unpasturized
• Feta, Brie, camembert, blue-veined cheeses
• Mexican-style queso blanco fresco

Lunch meat and hot dogs

• Choose meats without nitrates
• May contain bacteria called listeria. You can kill the bacteria if you heat the meat to steaming hot.
• Be sure to cook all meat to well done
• Avoid all sushi or other raw fish.

“Empty” calories

• Foods high in sugars and fats
• Look for snacks and meals with protein and fiber

Internet Resources

http://www.mypyramid.gov/mypyramidmoms/pyramidmoms_plan.aspx

Bringing home a new baby is a major event, and while it is often a joyful time you may find your emotions and moods are not what you expected. As many as 3 out of 4 women experience short mood swings, tearfulness, or irritability during the first week after birth. These symptoms may worsen when you are tired or anxious. If you are not sleeping, or you are becoming increasingly upset, you should talk with your health care provider.

Postpartum Depression

Postpartum depression may be indicated by the following symptoms:

• Feeling like a failure as a mother
• Feelings of panic
• Loss of appetite
• Fear that you will hurt yourself or your baby
• Feeling guilty
• Feelings of anxiousness and insecurity
• Feeling overwhelmed
• Crying a lot
• Feeling like you are not normal or real anymore
• Difficulty sleeping – you can’t sleep, even when the baby is sleeping
• Angry; feeling like you might explode
• Feeling lonely
• Can’t make decisions
• Inability to concentrate or focus
• Thinking the baby might be better off without you

If you have any of these symptoms, please don’t wait – call your health care provider.

Postpartum Psychosis

A very small number of women will experience a more severe postpartum reaction in which they will lose touch with reality. Those who develop postpartum psychosis may see or hear things that do not exist, or they may exhibit strange and potentially dangerous behavior. This is an emergency, and help must be sought immediately for women experiencing these symptoms.

Who Will Experience Postpartum Depression?

Postpartum depression is caused by a combination of factors, and can affect women from all walks of life. Hormone changes after childbirth, a self or family history of depression, and stressful life events are just some of the factors that contribute to postpartum depression. Childbirth is a major life event, and it can trigger sources of trauma from the past. If you think any of these risks might apply to you, you should talk to you health care provider before your labor and birth.