Getting Started with Breastfeeding A newborn will nurse best in the first hour after birth when she is awake and alert. The mother may be more comfortable if she lies on 553 Pregnancy and Birth Sourcebook, Third Edition her side with pillows under her head. The mother and baby should be face-to-face and belly-to-belly.

The baby will also nurse better if they are skin-to-skin. The mother should place her nipple and breast against the baby's lips. The baby will lick and try to nurse. The mother needs to help out by placing her nipple into the baby's open mouth. It may take a few tries before the baby can start sucking. If the baby is sleepy, rub her belly and back firmly to wake her up. If the baby is too sleepy, try uncovering her for a short time and rubbing the mother's nipple against the baby's lips. If the mother gets tired, take short breaks and start again. Once the baby nurses for the first time it gets easier.

If the baby sucks a few times and then lets go and the mom has large b.r.e.a.s.t.s, mom may need to help the baby breathe by using her finger to hold some breast tissue away from the baby's nose.

What to Avoid * Don't use a pacifier or a bottle to start the baby sucking. It confuses some babies because they do not suck the same on the mother's breast and a bottle or pacifier.

* Do not separate the mother and baby for very long. The more they stay together, including when they sleep, the sooner breastfeeding will be well established.

Care of the Mother If you still cannot get to the hospital or birth center to be checked, the mother should go to the bathroom within an hour after the baby is born.

If the room is cold, you can use the hot water bottle to help keep the baby warm. Just wrap the warm bottle in a blanket and place it next to the baby's back.

After birth in a hospital, women are usually offered Tylenol or Advil for pain every 3 to 4 hours as needed. This would be a good choice at home if the mother does not have an allergy to this medication.

When a new mother gets out of bed for the first time, she may feel dizzy. It is important to have her leave the baby on the center of the bed and get up slowly: * Sit up on the side of the bed to see how she feels.

* Have an adult take her to the bathroom and wait to be sure that she is not feeling faint.

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How to Perform an Emergency Delivery * If she says she is going to faint, believe her and have her lie down on the floor. Do not attempt to walk her back to bed. You have about 10 seconds to get her down on the floor before she pa.s.ses out and bangs her head on the way down. Once she is down flat, she will wake up and feel better. Just wait a few minutes and then carefully help her back to bed.

In a couple of hours the mom may want to take a shower. Be sure she has had something to eat and is not dizzy when she gets up. It is good to have someone close by because dizziness can return quickly.

What to Do for the Mother and Baby in the First 2 to 3 Days If you still are unable to get professional health care for several days, you can take care of yourself and your baby during this time by remembering the basic needs: eat, drink fluids, rest, and feed and care for the baby.

Keep someone with you as a helper so you can rest most of the time.

The helper should see that you always have plenty of fluids at your bedside and something to eat each time you breastfeed the baby.

Keep ice on the v.a.g.i.n.a where the baby came out for the first 24 hours. To keep the area extra clean, pour warm water over the v.a.g.i.n.a every time you go to the bathroom.

Check the uterus for firmness every few hours until the gushes of blood and/or clots stop and the baby is breastfeeding every 2 to 3 hours.

Change the baby's diaper every few hours. The baby's first bowel movements will be black and sticky (meconium), so be sure that the diaper is snug. The baby needs to wet at least once every 24 hours until the mother's milk comes in. After the milk is in, the baby will wet six to eight diapers a day. If the baby is not wetting, nurse the baby more often.

Each time you change the diaper, clean off the umbilical cord with cotton b.a.l.l.s soaked with alcohol. The diaper should be placed below the umbilical cord to help keep it clean and dry (it turns dark as it dries). If the cord has a bad smell, a sign of infection, clean it with alcohol until the smell is gone.

What If the Baby Is Coming Bottom First?

A few babies are born bottom first. You will probably not know this is the case until mom pushes and you see a bottom or feet and not a head coming out. At that time you must: 555.

Pregnancy and Birth Sourcebook, Third Edition * Bring the mom's bottom to the edge of the bed and have her legs pulled up to her chest.

* Prepare a soft landing spot for the baby on the floor.

* Let the baby's body (arms too) come out without touching the baby. You will be looking at the baby's back. Yes, you have to let her little bottom hang down toward the floor even if you are afraid she will fall. If you have to touch something, grab another pillow for the landing zone.

* When the head slips out, grab the baby under the arms and bring her up to the mom.

* If the baby's arms are out but the head does not come with the next contraction, you should have the mother get out of bed, squat, and push.

Key Points All parents-to-be should go to: * childbirth education cla.s.ses; * infant/child CPR (cardiopulmonary resuscitation) cla.s.ses; * breastfeeding cla.s.ses.

Parents-to-be should keep the family car: * in good repair; * filled with gas.

If you have to labor at home during a terrorist attack or other emergency: * Call your midwife or physician.

* Call for an ambulance.

* Call a neighbor to help you.

* Unlock the front door.

* Keep these instructions and the birth supplies handy.

Women in labor need lots of encouragement and need helpers who are calm, positive, and caring. No matter what is happening in the rest of the world, it is important to keep the room peaceful and to focus on 556 How to Perform an Emergency Delivery the mother's needs. She needs support and rea.s.surance to do the hard work of labor. Be there for her and her baby.

Disclaimer The information provided in this chapter is not a do-it-yourself guide for a planned home birth, nor is it all the information you need for every emergency. Following these directions will not replace the knowledge and skills of a doctor or midwife and cannot ensure a safe outcome. The information is a basic guide for parents-to-be who want to be ready in case they have to give birth before they can get to a hospital or birth center. In all cases, it is critical that you attempt to make contact with a trained health care professional.

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Part Seven

Postpartum and Newborn Care

Chapter 69.Recovering from Delivery: Physical and Emotional Concerns Your baby's finally here, and you're thrilled-but you're also exhausted, uncomfortable, on an emotional roller-coaster, and wonder-ing whether you'll ever fit into your jeans again. Childbirth cla.s.ses helped prepare you for giving birth, but you weren't prepared for all of this!

What to Expect in the First Few Weeks After your baby arrives, you'll notice some changes-both physical and emotional.

Physically, you might experience: * Sore b.r.e.a.s.t.s: Sore b.r.e.a.s.t.s: Your b.r.e.a.s.t.s may be painfully engorged for several days when your milk comes in and your nipples may be sore. Your b.r.e.a.s.t.s may be painfully engorged for several days when your milk comes in and your nipples may be sore.

* Constipation: Constipation: The first postpartum bowel movement may be a few days after delivery, and sensitive hemorrhoids, healing episiotomies, and sore muscles can make it painful. The first postpartum bowel movement may be a few days after delivery, and sensitive hemorrhoids, healing episiotomies, and sore muscles can make it painful.

* Episiotomy: Episiotomy: If your perineum (the area of skin between the v.a.g.i.n.a and the a.n.u.s) was cut by your doctor or if it was torn during If your perineum (the area of skin between the v.a.g.i.n.a and the a.n.u.s) was cut by your doctor or if it was torn during "Recovering From Delivery," June 2008, reprinted with permission from www.kidshealth.org. Copyright 2008 The Nemours Foundation. This information was provided by KidsHealth, one of the largest resources online for medically reviewed health information written for parents, kids, and teens. For more articles like this one, visit www.KidsHealth.org, or www.TeensHealth.org.

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Pregnancy and Birth Sourcebook, Third Edition the birth, the st.i.tches may make it painful to sit or walk for a little while during healing. It also can be painful when you cough or sneeze during the healing time.

* Hemorrhoids: Hemorrhoids: Although common, hemorrhoids (swollen a.n.a.l tissues) are frequently unexpected. Although common, hemorrhoids (swollen a.n.a.l tissues) are frequently unexpected.

* Hot and cold flashes: Hot and cold flashes: Your body's adjustment to new hormone and blood flow levels can wreak havoc on your internal thermo-stat. Your body's adjustment to new hormone and blood flow levels can wreak havoc on your internal thermo-stat.

* Urinary or fecal incontinence: Urinary or fecal incontinence: The stretching of your muscles during delivery can cause you to inadvertently pa.s.s urine when you cough, laugh, or strain or may make it difficult to control your bowel movements, especially if a lengthy labor preceded a v.a.g.i.n.al delivery. The stretching of your muscles during delivery can cause you to inadvertently pa.s.s urine when you cough, laugh, or strain or may make it difficult to control your bowel movements, especially if a lengthy labor preceded a v.a.g.i.n.al delivery.

* "After pains": "After pains": After giving birth, your uterus will continue to have contractions for a few days. These are most noticeable when your baby nurses or when you are given medication to reduce bleeding. After giving birth, your uterus will continue to have contractions for a few days. These are most noticeable when your baby nurses or when you are given medication to reduce bleeding.

* v.a.g.i.n.al discharge (lochia): v.a.g.i.n.al discharge (lochia): Initially heavier than your period and often containing clots, v.a.g.i.n.al discharge gradually fades to white or yellow and then stops within 2 months. Initially heavier than your period and often containing clots, v.a.g.i.n.al discharge gradually fades to white or yellow and then stops within 2 months.

* Weight: Weight: Your postpartum weight will probably be about 13 Your postpartum weight will probably be about 13 pounds (the weight of the baby, placenta, and amniotic fluid) below your full-term weight, before additional water weight drops off within the first week as your body regains its sodium balance.

Emotionally, you may be feeling: * "Baby blues": "Baby blues": Up to 80% of new moms experience irritability, sadness, crying, or anxiety, beginning within days or weeks postpartum. These baby blues are very common and may be related to physical changes (including hormonal changes, exhaustion, and unexpected birth experiences) and the emotional transition as you adjust to changing roles and your new baby. Up to 80% of new moms experience irritability, sadness, crying, or anxiety, beginning within days or weeks postpartum. These baby blues are very common and may be related to physical changes (including hormonal changes, exhaustion, and unexpected birth experiences) and the emotional transition as you adjust to changing roles and your new baby.

* Postpartum depression (PPD): Postpartum depression (PPD): More serious than the baby blues, this condition is evident in 10%25% of new moms and may cause mood swings, anxiety, guilt, and persistent sadness. More serious than the baby blues, this condition is evident in 10%25% of new moms and may cause mood swings, anxiety, guilt, and persistent sadness.

Your baby may be several months old before PPD is diagnosed, and it's more common in women with a history of depression, multiple life stressors, and a family history of depression.

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Recovering from Delivery: Physical and Emotional Concerns In addition, when it comes to s.e.xual relations, you and your partner may be on completely different pages. He may be ready to pick up where you left off before baby's arrival, whereas you may not feel comfortable enough-physically or emotionally-and may be craving nothing more than a good night's sleep. Doctors often ask women to wait several weeks before having s.e.x in order to allow healing to occur. In addition, when it comes to s.e.xual relations, you and your partner may be on completely different pages. He may be ready to pick up where you left off before baby's arrival, whereas you may not feel comfortable enough-physically or emotionally-and may be craving nothing more than a good night's sleep. Doctors often ask women to wait several weeks before having s.e.x in order to allow healing to occur.

The Healing Process It took your body months to prepare to give birth, and it takes time to recover. If you've had a cesarean section (C-section), it can take even longer because surgery requires a longer healing time. If unexpected, it may have also raised emotional issues.

Pain is greatest the day (or two days) after the surgery and should gradually subside. Your doctor will advise you on precautions to take after surgery, and give you directions for bathing and how to begin gentle exercises to speed recovery and help avoid constipation.

Things to know: * Drink 810 gla.s.ses of water daily.

* Expect v.a.g.i.n.al discharge.

* Avoid stairs and lifting until you've healed.

* Don't drive until you can make sudden movements and wear a safety belt properly without discomfort.

* If the incision becomes red or swollen, call your doctor.

Some other things to consider during the healing process include: * Birth control: Birth control: You can become pregnant again before your first postpartum period. Even though this is less likely if you are ex-clusively breastfeeding (day and night, no solids, at least 8 times a day, never going more than 6 hours without feeding), have not had a period, and your baby is younger than 6 months old, it is still possible. If you want to protect against pregnancy, discuss your options with your doctor. This may include barrier methods (condoms, diaphragms, spermicidal jellies, and foams), IUDs [intrauterine devices], pills, or shots. You can become pregnant again before your first postpartum period. Even though this is less likely if you are ex-clusively breastfeeding (day and night, no solids, at least 8 times a day, never going more than 6 hours without feeding), have not had a period, and your baby is younger than 6 months old, it is still possible. If you want to protect against pregnancy, discuss your options with your doctor. This may include barrier methods (condoms, diaphragms, spermicidal jellies, and foams), IUDs [intrauterine devices], pills, or shots.

* Breastfeeding: Breastfeeding: You need adequate sleep, fluids, and nutrition. You need adequate sleep, fluids, and nutrition.

An easy way to stay on top of drinking enough fluids is to have a gla.s.s of water whenever your baby nurses. Until your milk supply is well established, try to avoid caffeine, which causes loss of 563 Pregnancy and Birth Sourcebook, Third Edition fluid through urine and sometimes makes babies wakeful and fussy. If you have any breastfeeding problems, talk to your doctor or a lactation specialist. Your clinic or hospital lactation specialist can advise you on how to deal with any breastfeeding problems. Relieve clogged milk ducts with breast ma.s.sage, frequent nursing, feeding after a warm shower, and warm moist packs applied throughout the day. If you develop a fever or chills or your breast becomes tender or red, you may have an infection (mast.i.tis) and need antibiotics. Continue nursing or pumping from both b.r.e.a.s.t.s. Drink plenty of fluids.

* Engorged b.r.e.a.s.t.s: Engorged b.r.e.a.s.t.s: They resolve as your breastfeeding pattern becomes established or, if you're not breastfeeding, when your body stops producing milk-usually within a few days. They resolve as your breastfeeding pattern becomes established or, if you're not breastfeeding, when your body stops producing milk-usually within a few days.

* Episiotomy care: Episiotomy care: Continue sitz baths (sitting in just a few inches of water and covering the b.u.t.tocks, up to the hips, in the bathtub) using cool water for the first few days, then warm water after that. Squeeze the cheeks of your bottom together when you sit to avoid pulling painfully on the st.i.tches. Use a squirt bottle to wash the area with water when you use the toilet; pat dry. After a bowel movement, wipe from front to back to avoid infection. Reduce swelling with ice packs or chilled witch hazel pads. Talk to your doctor about taking an anti-inflammatory drug like ibuprofen to help with the pain and swelling. Continue sitz baths (sitting in just a few inches of water and covering the b.u.t.tocks, up to the hips, in the bathtub) using cool water for the first few days, then warm water after that. Squeeze the cheeks of your bottom together when you sit to avoid pulling painfully on the st.i.tches. Use a squirt bottle to wash the area with water when you use the toilet; pat dry. After a bowel movement, wipe from front to back to avoid infection. Reduce swelling with ice packs or chilled witch hazel pads. Talk to your doctor about taking an anti-inflammatory drug like ibuprofen to help with the pain and swelling.

* Exercise: Exercise: Resume as soon as you've been cleared by your doctor to help restore your strength and pre-pregnancy body, increase your energy and sense of well-being, and reduce constipation. Begin slowly and increase gradually. Walking and swimming are ex-cellent choices. Resume as soon as you've been cleared by your doctor to help restore your strength and pre-pregnancy body, increase your energy and sense of well-being, and reduce constipation. Begin slowly and increase gradually. Walking and swimming are ex-cellent choices.

* Hemorrhoids and constipation: Hemorrhoids and constipation: Alternating warm sitz baths and cold packs can help. Ask your doctor about a stool softener. Alternating warm sitz baths and cold packs can help. Ask your doctor about a stool softener.

Don't use laxatives, suppositories, or enemas without your doctor's OK. Increase your intake of fluids and fiber-rich fruits and vegetables.

* s.e.xual relations: s.e.xual relations: Your body needs time to heal. Doctors usually recommend waiting 46 weeks to have s.e.x to reduce the risk of infection, increased bleeding, or re-opening healing tissue. Begin slowly, with kissing, cuddling, and other intimate activities. Your body needs time to heal. Doctors usually recommend waiting 46 weeks to have s.e.x to reduce the risk of infection, increased bleeding, or re-opening healing tissue. Begin slowly, with kissing, cuddling, and other intimate activities.

You'll probably notice reduced v.a.g.i.n.al lubrication (this is due to hormones and usually is temporary), so a water-based lubricant might be useful. Try to find positions that put less pressure on 564 Recovering from Delivery: Physical and Emotional Concerns sore areas and are most comfortable for you. Tell your partner if you're sore or frightened about pain during s.e.xual activity-talking it over can help both of you to feel less anxious and more secure about resuming your s.e.x life. sore areas and are most comfortable for you. Tell your partner if you're sore or frightened about pain during s.e.xual activity-talking it over can help both of you to feel less anxious and more secure about resuming your s.e.x life.

* Urinary or fecal incontinence: Urinary or fecal incontinence: This often resolves gradually as your body returns to its normal prepregnancy state. Encourage the process with Kegel exercises, which help strengthen the pelvic floor muscles. To find the correct muscles, pretend you're trying to stop urinating. Squeeze those muscles for a few seconds, then relax (your doctor can check to be sure you're doing them correctly). Wear a sanitary pad for protection. Let the doctor know about any incontinence you experience. This often resolves gradually as your body returns to its normal prepregnancy state. Encourage the process with Kegel exercises, which help strengthen the pelvic floor muscles. To find the correct muscles, pretend you're trying to stop urinating. Squeeze those muscles for a few seconds, then relax (your doctor can check to be sure you're doing them correctly). Wear a sanitary pad for protection. Let the doctor know about any incontinence you experience.

What Else You Can Do to Help Yourself You'll get greater enjoyment in your new role as mom-and it will be much easier-if you care for both yourself and your new baby. For example: * When your baby sleeps, take a nap. Get some extra rest for yourself!

* Set aside time each day to relax with a book or listen to music.

* Shower daily.

* Get plenty of exercise and fresh air-either with or without your baby, if you have someone who can babysit.

* Schedule regular time-even just 15 minutes a day-for you and your partner to be alone and talk.

* Make time each day to enjoy your baby, and encourage your partner to do so, too.

* Lower your housekeeping and gourmet meal standards-there's time for that later. If visitors stress you, restrict them temporarily.

* Talk with other new moms (perhaps from your birthing cla.s.s) and create your own informal support group.

Getting Help from Others Remember, Wonder Woman is fiction. Ask your partner, friends, and family for help. Jot down small, helpful things people can do as they occur to you. When people offer to help, check the list. For example: 565 Pregnancy and Birth Sourcebook, Third Edition * Ask friends or relatives to pick things up for you at the market, stop by and hold your baby while you take a walk or a bath, or just give you an extra hand.

* Hire a neighborhood teen-or a cleaning service-to clean once a week, if possible.

* Investigate hiring a doula, a supportive companion professionally trained to provide postpartum care.

When to Call the Doctor You should call your doctor about your postpartum health if you: * experience an unexplained fever of 100.4 degrees Fahrenheit (38 degrees Celsius) or above; * soak more than one sanitary napkin an hour, pa.s.s large clots, or if the bleeding level increases; * had a C-section or episiotomy and the incision becomes more red or swollen or drains pus; * have new pain, swelling, or tenderness in your legs; * have hot-to-the-touch, reddened, sore b.r.e.a.s.t.s or any cracking or bleeding from the nipple or areola (the dark-colored area of the breast); * find your v.a.g.i.n.al discharge has become foul-smelling; * have painful urination or a sudden urge to urinate or inability to control urination; * have increasing pain in the v.a.g.i.n.al area; * develop a cough or chest pain, nausea, or vomiting; * become depressed or experience hallucinations, suicidal thoughts, or any thoughts of harming your baby.

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Chapter 70.Your Baby's First Hours and Newborn Screening Tests After months of waiting, finally, your new baby has arrived. Mothers-to-be often spend so much time in antic.i.p.ation of labor, they don't think about or even know what to expect during the first hours after delivery. Read on so you will be ready to bond with your new bundle of joy.

What Newborns Look Like You might be surprised by how your newborn looks at birth. If you had a v.a.g.i.n.al delivery, your baby entered this world through a narrow and bony pa.s.sage. It's not uncommon for newborns to be born bluish, bruised, and with a misshapen head. An ear might be folded over. Your baby may have a complete head of hair or be bald. Your baby also will have a thick, pasty, whitish coating, which protected the skin in the womb. This will wash away during the first bathing.

Once your baby is placed into your arms, your gaze will go right to his or her eyes. Most newborns open their eyes soon after birth.

Eyes will be brown or bluish-gray at first. Looking over your baby, you might notice that the face is a little puffy. You might notice small white b.u.mps inside your baby's mouth or on his or her tongue. Your baby might be very wrinkly. Some babies, especially those born early, are covered in soft, fine hair, which will come off in a couple of weeks. Your Excerpted from "Your Baby's First Hours of Life," by the Office of Women's Health (www.womenshealth.gov), part of the U.S. Department of Health and Human Services, March 2009.

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Pregnancy and Birth Sourcebook, Third Edition baby's skin might have various colored marks, blotches, or rashes, and fingernails could be long. You might also notice that your baby's b.r.e.a.s.t.s and p.e.n.i.s or v.u.l.v.a are a bit swollen.

How your baby looks will change from day to day, and many of the early marks of childbirth go away with time. If you have any concerns about something you see, talk to your doctor. After a few weeks, your newborn will look more and more like the baby you pictured in your dreams.

Medical Care for Your Newborn Right after birth babies need many important tests and procedures to ensure their health. Some of these are even required by law. But as long as the baby is healthy, everything but the Apgar test can wait for at least an hour. Delaying further medical care will preserve the precious first moments of life for you, your partner, and the baby. A baby who has not been poked and prodded may be more willing to nurse and cuddle. So before delivery, talk to your doctor or midwife about delaying shots, medicine, and tests.