Keep it loose. Tight clothing, especially underwear, can rub and irritate the area, plus slow healing. Let your perineum breathe as much as possible (for now, favor baggy sweats over spandex leggings). Tight clothing, especially underwear, can rub and irritate the area, plus slow healing. Let your perineum breathe as much as possible (for now, favor baggy sweats over spandex leggings).

Exercise it. Kegel exercises, done as frequently as possible after delivery and right through the postpartum period, will stimulate circulation to the area, promoting healing and improving muscle tone. Don't worry if you can't feel yourself doing the Kegels; the area will be numb right after delivery. Feeling will return to the perineum gradually over the next few weeks-and in the meantime, the work's being done even if you can't feel it. Kegel exercises, done as frequently as possible after delivery and right through the postpartum period, will stimulate circulation to the area, promoting healing and improving muscle tone. Don't worry if you can't feel yourself doing the Kegels; the area will be numb right after delivery. Feeling will return to the perineum gradually over the next few weeks-and in the meantime, the work's being done even if you can't feel it.

When to Call Your Practitioner Postpartum Few women feel their physical (or emotional) best after delivering a baby-that's just par for postpartum. Especially in the first six weeks after delivery, experiencing a variety of aches, pains, and other uncomfortable (or unpleasant) symptoms is common. Fortunately, what isn't common is having a serious complication. Still, it's smart to be in the know. That's why all recent deliverees should be aware of symptoms that might point to a postpartum problem, just in case. Call your practitioner without delay if you experience any of the following: [image] Bleeding that saturates more than one pad an hour for more than a few hours. If you can't reach your practitioner immediately, call your local emergency room and have the triage nurse assess you over the phone. He or she will be able to tell you whether or not you should come into the ER. While waiting or en route to the ER, if necessary, lie down and keep an ice pack (or a ziplock plastic bag filled with ice cubes and a couple of paper towels to absorb the melting ice) on your lower abdomen (directly over your uterus, if you can locate it). Bleeding that saturates more than one pad an hour for more than a few hours. If you can't reach your practitioner immediately, call your local emergency room and have the triage nurse assess you over the phone. He or she will be able to tell you whether or not you should come into the ER. While waiting or en route to the ER, if necessary, lie down and keep an ice pack (or a ziplock plastic bag filled with ice cubes and a couple of paper towels to absorb the melting ice) on your lower abdomen (directly over your uterus, if you can locate it).[image] Large amounts of Large amounts of bright red bright red bleeding any time after the first postpartum week. But don't worry about light menstrual-like bleeding for up to 6 weeks (in some women as many as 12) or a flow that increases when you're more active or when you're nursing. bleeding any time after the first postpartum week. But don't worry about light menstrual-like bleeding for up to 6 weeks (in some women as many as 12) or a flow that increases when you're more active or when you're nursing.[image] Bleeding that has a foul odor. It should smell like a normal menstrual flow. Bleeding that has a foul odor. It should smell like a normal menstrual flow.[image] Numerous or large (lemon-size or larger) clots in the vaginal bleeding. Occasional small clots in the first few days, however, are normal. Numerous or large (lemon-size or larger) clots in the vaginal bleeding. Occasional small clots in the first few days, however, are normal.[image] A complete absence of bleeding during the first few postpartum days A complete absence of bleeding during the first few postpartum days[image] Pain or discomfort, with or without swelling, in the lower abdominal area beyond the first few days after delivery Pain or discomfort, with or without swelling, in the lower abdominal area beyond the first few days after delivery[image] Persistent pain in the perineal area, beyond the first few days Persistent pain in the perineal area, beyond the first few days[image] After the first 24 hours, a temperature of over 100F for more than a day After the first 24 hours, a temperature of over 100F for more than a day[image] Severe dizziness Severe dizziness[image] Nausea and vomiting Nausea and vomiting[image] Localized pain, swelling, redness, heat, and tenderness in a breast once engorgement has subsided, which could be signs of mastitis or breast infection. Begin home treatment ( Localized pain, swelling, redness, heat, and tenderness in a breast once engorgement has subsided, which could be signs of mastitis or breast infection. Begin home treatment (page 446) while waiting to reach your practitioner.[image] Localized swelling and/or redness, heat, and oozing at the site of a C-section incision Localized swelling and/or redness, heat, and oozing at the site of a C-section incision[image] After the first 24 hours, difficult urination; excessive pain or burning when urinating; a frequent urge to urinate that yields little result; scanty and/or dark urine. Drink plenty of water while trying to reach your practitioner. After the first 24 hours, difficult urination; excessive pain or burning when urinating; a frequent urge to urinate that yields little result; scanty and/or dark urine. Drink plenty of water while trying to reach your practitioner.[image] Sharp chest pain (not chest achiness, which is the usual result of strenuous pushing); rapid breath or heartbeat; blueness of fingertips or lips Sharp chest pain (not chest achiness, which is the usual result of strenuous pushing); rapid breath or heartbeat; blueness of fingertips or lips[image] Localized pain, tenderness, and warmth in your calf or thigh, with or without redness, swelling, and pain when you flex your foot. Rest, with your leg elevated, while you try to reach your practitioner. Localized pain, tenderness, and warmth in your calf or thigh, with or without redness, swelling, and pain when you flex your foot. Rest, with your leg elevated, while you try to reach your practitioner.[image] Depression that affects your ability to cope or that doesn't subside after a few days; feelings of anger toward your baby, particularly if those feelings are accompanied by violent urges. See Depression that affects your ability to cope or that doesn't subside after a few days; feelings of anger toward your baby, particularly if those feelings are accompanied by violent urges. See page 458 page 458 for more on postpartum depression. for more on postpartum depression.

If your perineum becomes very red, very painful, and swollen, or if you detect an unpleasant odor, you may have developed an infection. Call your practitioner.

Delivery Bruises "I look more like I've been in a boxing ring than in a birthing room. How come?"

Look and feel like you've taken a beating? That's normal postpartum. After all, you probably worked harder birthing your child than most boxers work in the ring, even though you were only facing a 7- or 8-pounder. Thanks-or no thanks-to powerful contractions and strenuous pushing (especially if you were pushing with your face and chest instead of your lower body), you might be sporting a variety of unwelcome delivery souvenirs. These may include black or bloodshot eyes (dark glasses will do a cover-up job in public until your eyes return to normal, and cold compresses for 10 minutes several times a day may help speed that return) and bruises, ranging from tiny dots on the cheek to larger black-and-blue marks on the face or upper chest area. You may also be bringing home soreness in your chest and/or difficulty taking a deep breath, due to strained chest muscles (hot baths, showers, or a heating pad may ease it), pain and tenderness in the area of your tailbone (heat and massage may help), and/or general all-over achiness (again, heat may help).

Difficulty Urinating "It's been several hours since I gave birth, and I haven't been able to pee."

Peeing doesn't come easily for most women during the first 24 postpartum hours. Some women feel no urge at all; others feel the urge but are unable to satisfy it. Still others manage to urinate, but with accompanying pain and burning. There are a host of reasons why basic bladder function often becomes too much like hard work after delivery: [image] The holding capacity of the bladder increases because it suddenly has more room to expand-thus your need to pee may be less frequent than it was during pregnancy. The holding capacity of the bladder increases because it suddenly has more room to expand-thus your need to pee may be less frequent than it was during pregnancy.[image] The bladder may have been traumatized or bruised during delivery. Temporarily paralyzed, it may not send the necessary signals of urgency even when it's full. The bladder may have been traumatized or bruised during delivery. Temporarily paralyzed, it may not send the necessary signals of urgency even when it's full.[image] Having had an epidural may decrease the sensitivity of the bladder or your alertness to its signals. Having had an epidural may decrease the sensitivity of the bladder or your alertness to its signals.[image] Pain in the perineal area may cause reflex spasms in the urethra (the tube through which the urine exits), making urination difficult. Swelling of the perineum may also stand between you and an easy pee. Pain in the perineal area may cause reflex spasms in the urethra (the tube through which the urine exits), making urination difficult. Swelling of the perineum may also stand between you and an easy pee.[image] The sensitivity of the site of a tear or episiotomy repair can cause burning and/or pain with urination. Burning may be alleviated somewhat by standing astride the toilet while urinating so the flow comes straight down, without touching sore spots. Squirting warm water on the area while you pee can also decrease discomfort (use the squirt bottle the nurse probably gave you; ask for one if she didn't). The sensitivity of the site of a tear or episiotomy repair can cause burning and/or pain with urination. Burning may be alleviated somewhat by standing astride the toilet while urinating so the flow comes straight down, without touching sore spots. Squirting warm water on the area while you pee can also decrease discomfort (use the squirt bottle the nurse probably gave you; ask for one if she didn't).[image] Dehydration, especially if you didn't do any drinking during a long labor, and didn't receive any IV fluids. Dehydration, especially if you didn't do any drinking during a long labor, and didn't receive any IV fluids.[image] Any number of psychological factors may keep you from going with the flow: fear of pain, lack of privacy, embarrassment or discomfort over using a bedpan or needing assistance at the toilet. Any number of psychological factors may keep you from going with the flow: fear of pain, lack of privacy, embarrassment or discomfort over using a bedpan or needing assistance at the toilet.

As difficult as peeing may be after delivery, it's essential that you empty your bladder within six to eight hours to avoid urinary tract infection, loss of muscle tone in the bladder from overdistension, and bleeding (because an overfull bladder can get in the way of your uterus as it attempts the normal postpartum contractions that staunch bleeding). Therefore, the nurse will ask you frequently after delivery if you've accomplished this important goal. She may even request that you make that first postpartum pee into a container or bedpan, so she can measure your output, and may palpate your bladder to make sure it's not distended. To help get things flowing: [image] Be sure you're drinking plenty of fluids: What goes in is more likely to go out. Plus, you lost a lot during delivery. Be sure you're drinking plenty of fluids: What goes in is more likely to go out. Plus, you lost a lot during delivery.[image] Take a walk. Getting up out of bed and going for a slow stroll as soon after delivery as you're able will help get your bladder (and your bowels) moving. Take a walk. Getting up out of bed and going for a slow stroll as soon after delivery as you're able will help get your bladder (and your bowels) moving.[image] If you're uncomfortable with an audience (and who isn't?), have the nurse wait outside while you urinate. She can come back in when you've finished and give you a demonstration of perineal hygiene, if she hasn't already. If you're uncomfortable with an audience (and who isn't?), have the nurse wait outside while you urinate. She can come back in when you've finished and give you a demonstration of perineal hygiene, if she hasn't already.[image] If you're too weak to walk to the bathroom and you have to use a bedpan, ask for some warm water to pour over the perineal area (which may stimulate the urge). It will also help to sit on the pan, instead of lying on it. Privacy, again, will be key to success. If you're too weak to walk to the bathroom and you have to use a bedpan, ask for some warm water to pour over the perineal area (which may stimulate the urge). It will also help to sit on the pan, instead of lying on it. Privacy, again, will be key to success.[image] Warm your perineal area in a sitz bath or chill it with ice packs, whichever seems to induce urgency for you. Warm your perineal area in a sitz bath or chill it with ice packs, whichever seems to induce urgency for you.[image] Turn the water on while you try. Running water in the sink really does encourage your own faucet to flow. Turn the water on while you try. Running water in the sink really does encourage your own faucet to flow.

If all efforts fail and you haven't peed within eight hours or so after delivery, your practitioner may order a catheter (a tube inserted into your urethra) to empty your bladder-another good incentive to try the methods above.

After 24 hours, the problem of too little generally becomes one of too much. Most new moms usually begin urinating frequently and plentifully as the excess fluids of pregnancy are excreted. If you're still having trouble peeing, or if output is scant during the next few days, it's possible you have a urinary tract infection (see page 498 page 498 for signs and symptoms of a UTI). for signs and symptoms of a UTI).

"I can't seem to control my urine. It just leaks out."

The physical stress of childbirth can put a lot of things temporarily out of commission, including the bladder. Either it can't let go of the urine-or it lets go of it too easily, as in your case. Such leakage (called urinary incontinence) occurs because of loss of muscle tone in the perineal area. Kegel exercises, which are recommended for every postpartum mom anyway, can help restore the tone and help you regain control over the flow of urine. See page 454 page 454 for more tips on dealing with incontinence; if it continues, consult your practitioner. for more tips on dealing with incontinence; if it continues, consult your practitioner.

That First Bowel Movement "I delivered two days ago and I haven't had a bowel movement yet. I've actually felt the urge, but I've been too afraid of opening my stitches to try."

The passage of the first postpartum bowel movement is a milestone every newly delivered woman is anxious to put behind her (so to speak). And the longer it takes you to get past that milestone, the more anxious-and the more uncomfortable-you're likely to become.

Several physiological factors may interfere with the return of bowel- business-as-usual after delivery. For one thing, the abdominal muscles that assist in elimination have been stretched during childbirth, making them flaccid and sometimes temporarily ineffective. For another, the bowel itself may have taken a beating during delivery, leaving it sluggish. And, of course, it may have been emptied before or during delivery (remember that diarrhea you had prelabor? The poop that you squeezed out during pushing?), and probably stayed pretty empty because you didn't eat much solid food during labor.

But perhaps the most potent inhibitors of postpartum bowel activity are psychological: worry about pain; the unfounded fear that you'll split open any stitches; concern that you'll make your hemorrhoids worse; the natural embarrassment over lack of privacy in the hospital or birthing center; and the pressure to "perform," which often makes performance all the more elusive.

Just because postpartum constipation is common, though, doesn't mean you can't fight it. Here are some steps you can take to get things moving again: Don't worry. Nothing will keep you from moving your bowels more effectively than worrying about moving your bowels. Don't worry about opening the stitches-you won't. Finally, don't worry if it takes a few days to get things moving-that's okay, too. Nothing will keep you from moving your bowels more effectively than worrying about moving your bowels. Don't worry about opening the stitches-you won't. Finally, don't worry if it takes a few days to get things moving-that's okay, too.

Request roughage. If you're still in the hospital or birthing center, select as many whole grains (especially bran cereal) and fresh fruits and vegetables from the menu as you can. Since those pickings may be slim, supplement with bowel-stimulating food brought in from outside, such as apples and pears, raisins and other dried fruit, nuts, seeds, and bran muffins. If you're home, make sure you're eating regularly and well-and that you're getting your fill of fiber. As much as you can, stay away from bowel-clogging foods (like those gift boxes of chocolates that are likely piling up on your bedstand or coffee table-tempting but, sadly, constipating). If you're still in the hospital or birthing center, select as many whole grains (especially bran cereal) and fresh fruits and vegetables from the menu as you can. Since those pickings may be slim, supplement with bowel-stimulating food brought in from outside, such as apples and pears, raisins and other dried fruit, nuts, seeds, and bran muffins. If you're home, make sure you're eating regularly and well-and that you're getting your fill of fiber. As much as you can, stay away from bowel-clogging foods (like those gift boxes of chocolates that are likely piling up on your bedstand or coffee table-tempting but, sadly, constipating).

Keep the liquids coming. Not only do you need to compensate for fluids you lost during labor and delivery, you need to take in additional liquids to help soften stool if you're clogged up. Water's always a winner, but you may also find apple or prune juice especially effective. Hot water with lemon can also do the trick. Not only do you need to compensate for fluids you lost during labor and delivery, you need to take in additional liquids to help soften stool if you're clogged up. Water's always a winner, but you may also find apple or prune juice especially effective. Hot water with lemon can also do the trick.

Chew, chew, chew. Chewing gum stimulates digestive reflexes for some people and could get your system back to normal, so grab a stick of gum. Chewing gum stimulates digestive reflexes for some people and could get your system back to normal, so grab a stick of gum.

Get off your bottom. An inactive body encourages inactive bowels. You won't be running laps the day after delivery, but you will be able to take short strolls up and down the halls. Kegel exercises, which can be practiced in bed almost immediately after delivery, will help tone up not only the perineum but also the rectum. At home, take walks with baby; also, see An inactive body encourages inactive bowels. You won't be running laps the day after delivery, but you will be able to take short strolls up and down the halls. Kegel exercises, which can be practiced in bed almost immediately after delivery, will help tone up not only the perineum but also the rectum. At home, take walks with baby; also, see page 465 page 465 for postpartum exercise ideas. for postpartum exercise ideas.

Don't strain. Straining won't break open any stitches you have, but it can lead to or aggravate hemorrhoids. If you already have hemorrhoids, you may find relief with sitz baths, topical anesthetics, witch hazel pads, suppositories, or hot or cold compresses. Straining won't break open any stitches you have, but it can lead to or aggravate hemorrhoids. If you already have hemorrhoids, you may find relief with sitz baths, topical anesthetics, witch hazel pads, suppositories, or hot or cold compresses.

Use stool softeners. Many hospitals send women home with both a stool softener and a laxative, for good reason. Both can help get you going. Many hospitals send women home with both a stool softener and a laxative, for good reason. Both can help get you going.

The first few bowel movements may be a pain to pass, literally. But fear not. As stools soften and you become more regular, the discomfort will ease and eventually end-and moving your bowels will become second nature once again.

Excessive Sweating "I've been waking up at night soaked with sweat. Is this normal?"

It's messy, but it's normal. New moms are sweaty moms, and for a couple of good reasons. For one thing, your hormone levels are dropping-reflecting the fact that you're no longer pregnant, as you might have noticed. For another, perspiration (like frequent urination) is your body's way of ridding itself of pregnancy-accumulated fluids after delivery-something you're bound to be happy about. Something you might not be happy with is how uncomfortable that perspiration might make you, and how long it might continue. Some women keep sweating up a storm for several weeks or more. If you do most of your perspiring at night, as most new moms do, covering your pillow with an absorbent towel may help you sleep better (it'll also help protect your pillow).

Don't sweat the sweat-it's normal. Do make sure, though, that you're drinking enough fluids to compensate for the ones you're losing, especially if you're breastfeeding but even if you're not.

Fever "I've just come home from the hospital and I'm running a fever of about 101F. Should I call my doctor?"

It's always a good idea to keep your practitioner in the loop if you're not feeling well right after giving birth. A fever on the third or fourth postpartum day could possibly be a sign of postpartum infection, but it could also be caused by a nonpostpartum-related illness. Fever can also occasionally be caused by the combination of excitement and exhaustion that's common in the early postpartum period. A brief low-grade fever (less than 100F) occasionally accompanies engorgement when your milk first comes in, and it's nothing to worry about. But as a precaution, report to your practitioner any fever over 100F that lasts more than a day during the first three postpartum weeks or that lasts more than a few hours if it's a higher fever-even if it's accompanied by obvious cold or flu symptoms or vomiting-so that its cause can be determined and any necessary treatment started.

Engorged Breasts "My milk finally came in, leaving my breasts three times their normal size-and so hard and painful that I can't put on a bra. Is this what I have to look forward to until I wean my baby?"

Just when you thought your breasts couldn't get any bigger, they do. That first milk delivery arrives, leaving your breasts swollen, painfully tender, throbbing, granite hard-and sometimes seriously, frighteningly gigantic. To make matters more uncomfortable and inconvenient, this engorgement (which can extend all the way to the armpits) can make nursing painful for you and, if your nipples are flattened by the swelling, frustrating for your baby. The longer it takes for you and your baby to hook up for your first nursing sessions, the worse the engorgement is likely to be.

Happily, though, it won't last long. Engorgement, and all its miserable effects, gradually lessens once a well-coordinated milk supply-and-demand system is established, typically within a matter of days. Nipple soreness, too-which usually peaks at about the 20th feeding, if you're keeping count-generally diminishes rapidly as the nipples toughen up. And with proper care (see page 444 page 444), so does the nipple cracking and bleeding some women also experience.

Until nursing becomes second nature for your breasts-and completely painless for you-there are some steps you can take to ease the discomfort and speed the establishment of a good milk supply (read all about it starting on page 435 page 435).

Women who have an easy time getting started with breastfeeding (especially second timers) may not experience very much engorgement at all. As long as baby's getting those milk deliveries, that's normal, too.

Engorgement if You're Not Breastfeeding "I'm not nursing. I've heard that drying up the milk can be painful."

Your breasts are programmed to fill (or make that overfill) with milk around the third or fourth postpartum day, whether you plan to use that milk to feed your baby or not. This engorgement can be uncomfortable, even painful-but it's only temporary.

Milk is produced by your breasts only as needed. If the milk isn't used, production stops. Though sporadic leaking may continue for several days, or even weeks, severe engorgement shouldn't last more than 12 to 24 hours. During this time, ice packs, mild pain relievers, and a supportive bra may help. Avoid nipple stimulation, expressing milk, or hot showers, all of which stimulate milk production and keep that painful cycle going longer.

Where's the Breast Milk?

"It's been two days since I delivered, and nothing comes out of my breasts when I squeeze them, not even colostrum. Is my baby going to starve?"

Not only is your baby not starving, he isn't even hungry yet. Babies aren't born with a big appetite or with immediate nutritional needs. And by the time your baby begins to hunger for a breastful of milk (on the third or fourth day postpartum), you'll undoubtedly be able to serve it up.

Should I Stay or Should I Go Now?

Wondering when you'll be able to bring baby home? How long you and your baby stay in the hospital will depend on the kind of delivery you had, your condition, and your baby's condition. By federal law, you have the right to expect your insurer to pay for a 48-hour stay following a normal vaginal delivery and 96 hours following a cesarean delivery. If both you and your baby are in fine shape and you're eager to get home, you may be able to arrange with your practitioner for an early discharge. In that case, plan on having a home nurse visit (your insurance plan may pay for it) or taking your newborn for an office visit to the doctor within a few days, just to be sure no problems have cropped up. The baby's weight and general condition will be assessed (including a check for jaundice). There should also be an evaluation of how feeding is going-keeping and bringing along a feeding diary will help.

If you do stay the full 48 or 96 hours, take advantage of the opportunity to rest as much as possible. You'll need that energy stash for when you get home.

Which isn't to say that your breasts are empty now. Colostrum, which provides your baby with enough nourishment (for now) and with important antibodies his or her own body can't yet produce (and also helps empty baby's digestive system of excess mucus and his or her bowels of meconium), is definitely present in the tiny amounts necessary. A teaspoon or so per feeding is all your baby needs at this point. But until the third or fourth postpartum day, when your breasts begin to swell and feel full (indicating the milk has come in), it's not that easy to express by hand. A day-old baby, eager to suckle, is better equipped to extract this premilk than you are.

Bonding "I expected to bond with my baby as soon as she was born, but I'm not feeling anything at all. Is something wrong with me?"

Moments after delivery, you're handed your long-anticipated bundle of joy, and she's more beautiful and more perfect than you ever dared to imagine. She looks up at you and your eyes lock in a heady gaze, forging an instant maternal-child bond. As you cradle her tiny form, breathe in her sweetness, cover her soft face with kisses, you feel emotions you never knew you had, and they overwhelm you in their intensity. You're a mom in love.

And most likely, you were dreaming-or, at least, pregnant daydreaming. Birthing-room scenes like this one are the stuff dreams-and sappy commercials-are made of, but they don't play out for a lot of new moms. A possibly more-realistic scenario: After a long, hard labor that's left you physically and emotionally drained, a wrinkled, puffy, red-faced stranger is placed in your awkward arms, and the first thing you notice is that she doesn't quite resemble the chubby-cheeked cherub you'd been expecting. The second thing you notice is that she doesn't stop squalling. The third, that you have no idea how to make her stop squalling. You struggle to nurse her, but she's uncooperative; you try to socialize with her, but she's more interested in squalling than in sleeping-and frankly, at this point, so are you. And you can't help wondering (after you've woken up): "Have I missed my opportunity to bond with her?"

Absolutely, positively not. The process of bonding is different for every parent and every baby, and it doesn't come with a use-by date. Though some moms bond faster than others with their newborns-maybe because they've had experience with infants before, their expectations are more realistic, their labors were easier, or their babies are more responsive-few find that attachment forming with super glue speed. The bonds that last a lifetime don't form overnight. They form gradually, over time-something you and your baby have lots of ahead of you.

So give yourself that time-time to get used to being a mother (it's a major adjustment, after all) and time to get to know your baby, who, let's face it, is a newcomer in your life. Meet your baby's basic needs (and your own), and you'll find that love connection forming-one day (and one cuddle) at a time. And speaking of cuddles, bring 'em on. The more nurturing you do, the more like a nurturer you'll feel. Though it may not seem like it's coming naturally at first, the more time you spend cuddling, caressing, feeding, massaging, singing to, cooing to, and talking to your baby-the more time you spend skin to skin and face to face-the more natural it will start feeling, and the closer you'll become. Believe it or not, before you know it, you'll feel like the mother you are (really!), bound to your baby by the kind of love you've dreamed of.

"My new son was premature and was rushed to the NICU right away. The doctors say he'll be there for at least two weeks. Will it be too late for good bonding when he gets out?"

Not at all. Sure, having a chance to bond right after birth-to make contact, skin to skin, eye to eye-is wonderful. It's a first step in the development of a lasting parent-child connection. But it's only the first step. And this step doesn't have to take place at delivery. It can take place hours or days later in a hospital bed, or through the portholes of an incubator, or even weeks later at home.

And luckily, you'll be able to touch, talk to, or possibly hold your baby even while he's in the NICU. Most hospitals not only allow parent-child contact in such situations, they encourage it. Talk to the nurse in charge of the NICU and see how you can best get close to your newborn during this trying time. For more on the care of premature babies, see What to Expect the First Year. What to Expect the First Year.

Keep in mind, too, that even moms and dads who have a chance to bond in the birthing room don't necessarily feel that instant attachment (see the previous question). Love that lasts a lifetime takes time to develop-time that you and your baby will start having together soon.

Rooming-In "Having the baby room in with me sounded like a great idea when I was pregnant. But back then I had no idea how tired I was going to be. What kind of mother would I be, though, if I asked the nurse to take her?"

You would be a very human mother. You've just completed one of life's greatest challenges, childbirth, and are about to begin an even greater one, child rearing. Needing a little bit of rest in between is completely normal-and completely understandable.

Full-time rooming-in is a wonderful option in family-centered maternity care, giving new parents the chance to start getting to know their new arrival from minute one. But it's not a requirement, and it's not for everyone. Some women handle it easily, of course-maybe because their deliveries were a breeze or because they came on the job with previous newborn experience. For them, an inconsolable infant at 3 a.m. may not be a joy, but it's not a nightmare, either. However, for a new mom who's been without sleep for more hours than she can count, who's drained from labor and delivery, and who's never been closer to a baby than a diaper ad (sound familiar?), such predawn bouts can leave her feeling overwhelmed and underprepared.

If you're happy having your baby room with you, great. But if you committed to this sleeping arrangement only to realize you'd really rather get some sleep, don't feel you can't opt out. Partial rooming-in (during the day but not at night) may be a good compromise for you. Or you might prefer to get a good night's sleep the first night and start rooming-in on the second. Just make sure that baby is brought to you for feedings-and not given any supplementary bottles-if you're nursing.

Be flexible. Focus on the quality of the time you spend with your baby in the hospital rather than the quantity, and don't feel guilty about factoring your own needs into the equation. Round-the-clock rooming-in will begin soon enough at home. Get the rest you need now and you'll be better equipped to handle it later.

Recovery from a Cesarean Delivery "What will my recovery from a C-section be like?"

Recovery from a C-section is similar to recovery from any abdominal surgery, with a delightful difference: Instead of losing an old gallbladder or appendix, you gain a brand-new baby.

Of course, there's another difference, arguably less delightful. In addition to recovering from surgery, you'll also be recovering from childbirth. Except for a neatly intact perineum, you'll experience all the same postpartum discomforts over the next weeks (lucky you!) that you would have had if you'd delivered vaginally: afterpains, lochia, perineal discomfort (if you went through a lengthy labor before the surgery), breast engorgement, fatigue, hormonal changes, and excessive perspiration, to name a few.

As for your surgical recovery, you can expect the following in the recovery room: Pain around your incision. Once the anesthesia wears off, your wound, like any wound, is going to hurt-though just how much depends on many factors, including your personal pain threshold and how many cesarean deliveries you've had (the first is usually the most uncomfortable). You will probably be given pain relief medication as needed, which may make you feel woozy or drugged. It will also allow you to get some needed sleep. You don't have to be concerned if you're nursing; the medication won't pass into your colostrum, and by the time your milk comes in, you probably won't need any heavy painkillers. If the pain continues for weeks, as it sometimes does, you can safely rely on over-the-counter pain relief. Ask your practitioner for a recommendation and dosing. To encourage healing, also try to avoid heavy lifting for the first few weeks after the surgery. Once the anesthesia wears off, your wound, like any wound, is going to hurt-though just how much depends on many factors, including your personal pain threshold and how many cesarean deliveries you've had (the first is usually the most uncomfortable). You will probably be given pain relief medication as needed, which may make you feel woozy or drugged. It will also allow you to get some needed sleep. You don't have to be concerned if you're nursing; the medication won't pass into your colostrum, and by the time your milk comes in, you probably won't need any heavy painkillers. If the pain continues for weeks, as it sometimes does, you can safely rely on over-the-counter pain relief. Ask your practitioner for a recommendation and dosing. To encourage healing, also try to avoid heavy lifting for the first few weeks after the surgery.

Possible nausea, with or without vomiting. This isn't always an aftereffect of the surgery, but if it is, you may be given an anti-nausea medication. This isn't always an aftereffect of the surgery, but if it is, you may be given an anti-nausea medication.

Exhaustion. You're likely to feel somewhat weak after surgery, partly due to blood loss, partly due to the anesthetic. If you went through some hours of labor before the surgery, you'll feel even more beat. You might also feel emotionally spent (after all, you did just have a baby-and surgery), especially if the C-section wasn't planned. You're likely to feel somewhat weak after surgery, partly due to blood loss, partly due to the anesthetic. If you went through some hours of labor before the surgery, you'll feel even more beat. You might also feel emotionally spent (after all, you did just have a baby-and surgery), especially if the C-section wasn't planned.

Regular evaluations of your condition. A nurse will periodically check your vital signs (temperature, blood pressure, pulse, respiration), your urinary output and vaginal bleeding, the dressing on your incision, and the firmness and level of your uterus (as it shrinks in size and makes its way back into the pelvis). She will also check your IV and urinary catheter. A nurse will periodically check your vital signs (temperature, blood pressure, pulse, respiration), your urinary output and vaginal bleeding, the dressing on your incision, and the firmness and level of your uterus (as it shrinks in size and makes its way back into the pelvis). She will also check your IV and urinary catheter.

Once you have been moved to your room, you can expect: More checking. The nurse will continue to monitor your condition. The nurse will continue to monitor your condition.

Removal of the urinary catheter. This will probably take place shortly after surgery. Urination may be difficult, so try the tips on This will probably take place shortly after surgery. Urination may be difficult, so try the tips on page 426 page 426. If they don't work, the catheter may be reinserted until you can pee by yourself.

Encouragement to exercise. Before you're out of bed, you'll be encouraged to wiggle your toes, flex your feet to stretch your calf muscles, push against the end of the bed with your feet, and turn from side to side. You can also try the exercises on Before you're out of bed, you'll be encouraged to wiggle your toes, flex your feet to stretch your calf muscles, push against the end of the bed with your feet, and turn from side to side. You can also try the exercises on pages 466 pages 466 and and 467 467. They're intended to improve circulation, especially in your legs, and prevent the development of blood clots. (But be prepared for some of them to be quite uncomfortable, at least for the first 24 hours or so.) To get up between 8 and 24 hours after surgery. With the help of a nurse, you'll sit up first, supported by the raised head of the bed. Then, using your hands for support, you'll slide your legs over the side of the bed and dangle them for a few minutes. Then, slowly, you'll be helped to step down on the floor, your hands still on the bed. If you feel dizzy (which is normal), sit right back down. Steady yourself for a few more minutes before taking a couple of steps, and then take them slowly; the first few may be extremely painful. Though you may need help the first few times you get up, this difficulty in getting around is temporary. In fact, you may soon find yourself more mobile than the vaginal deliveree next door-and you will probably have the edge when it comes to sitting. With the help of a nurse, you'll sit up first, supported by the raised head of the bed. Then, using your hands for support, you'll slide your legs over the side of the bed and dangle them for a few minutes. Then, slowly, you'll be helped to step down on the floor, your hands still on the bed. If you feel dizzy (which is normal), sit right back down. Steady yourself for a few more minutes before taking a couple of steps, and then take them slowly; the first few may be extremely painful. Though you may need help the first few times you get up, this difficulty in getting around is temporary. In fact, you may soon find yourself more mobile than the vaginal deliveree next door-and you will probably have the edge when it comes to sitting.

A slow return to a normal diet. While it used to be routine (and still is in some hospitals and with some physicians) to keep women on IV fluids for the first 24 hours after a cesarean delivery and limit them to clear liquids for a day or two after that, starting up on solids much sooner may be a better bet. Research has shown that women who start back on solids earlier (gradually, but beginning as early as four to eight hours post-op) have that first bowel movement earlier and are generally ready to be released from the hospital 24 hours sooner than those kept on fluids only. Procedures may vary from hospital to hospital and from physician to physician; your condition after the surgery may also play a part in deciding when to pull the plug on the IV and when to pull out the silverware. Keep in mind, too, that reintroduction of solids will come in stages. You'll start with fluids by mouth, moving on next to something soft and easily tolerated (like Jell-O), and on (slowly) from there. But your diet will have to stay on the bland and easily digested side for at least a few days; don't even think about having someone smuggle in a burger yet. Once you're back on solids, don't forget to push the fluids, too-especially if you're breastfeeding. While it used to be routine (and still is in some hospitals and with some physicians) to keep women on IV fluids for the first 24 hours after a cesarean delivery and limit them to clear liquids for a day or two after that, starting up on solids much sooner may be a better bet. Research has shown that women who start back on solids earlier (gradually, but beginning as early as four to eight hours post-op) have that first bowel movement earlier and are generally ready to be released from the hospital 24 hours sooner than those kept on fluids only. Procedures may vary from hospital to hospital and from physician to physician; your condition after the surgery may also play a part in deciding when to pull the plug on the IV and when to pull out the silverware. Keep in mind, too, that reintroduction of solids will come in stages. You'll start with fluids by mouth, moving on next to something soft and easily tolerated (like Jell-O), and on (slowly) from there. But your diet will have to stay on the bland and easily digested side for at least a few days; don't even think about having someone smuggle in a burger yet. Once you're back on solids, don't forget to push the fluids, too-especially if you're breastfeeding.

Referred shoulder pain. Irritation of the diaphragm, caused by small amounts of blood in your belly, can cause a few hours of sharp shoulder pain following surgery. A pain reliever may help. Irritation of the diaphragm, caused by small amounts of blood in your belly, can cause a few hours of sharp shoulder pain following surgery. A pain reliever may help.

Probably constipation. Since the anesthesia and the surgery (plus your limited diet) may slow your bowels down, it may be a few days until you pass that first movement, and that's normal. You may also experience some painful gassiness because of the constipation. A stool softener, suppository, or other mild laxative may be prescribed to help move things along, especially if you're uncomfortable. The tips on Since the anesthesia and the surgery (plus your limited diet) may slow your bowels down, it may be a few days until you pass that first movement, and that's normal. You may also experience some painful gassiness because of the constipation. A stool softener, suppository, or other mild laxative may be prescribed to help move things along, especially if you're uncomfortable. The tips on page 427 page 427 may help, too. may help, too.

Abdominal discomfort. As your digestive tract (temporarily put out of commission by surgery) begins to function again, trapped gas can cause considerable pain, especially when it presses against your incision line. The discomfort may be worse when you laugh, cough, or sneeze. Ask the nurse or doctor to suggest some possible remedies. A suppository may help release the gas, as may strolling up and down the hall. Lying on your side or on your back, your knees drawn up, taking deep breaths while holding your incision can also bring some relief. As your digestive tract (temporarily put out of commission by surgery) begins to function again, trapped gas can cause considerable pain, especially when it presses against your incision line. The discomfort may be worse when you laugh, cough, or sneeze. Ask the nurse or doctor to suggest some possible remedies. A suppository may help release the gas, as may strolling up and down the hall. Lying on your side or on your back, your knees drawn up, taking deep breaths while holding your incision can also bring some relief.

To spend time with your baby. You'll be encouraged to cuddle and feed your baby as soon as possible (if you're nursing, place the baby on a pillow over your incision or lie on your side while nursing). And yes, you can even lift your baby. Hospital regulations and your condition permitting, you'll probably be able to have modified or full rooming-in; having your spouse bunking with you, too, will be a big help. Don't push the rooming-in agenda, though, if you're not up to it-or just want some rest. You'll be encouraged to cuddle and feed your baby as soon as possible (if you're nursing, place the baby on a pillow over your incision or lie on your side while nursing). And yes, you can even lift your baby. Hospital regulations and your condition permitting, you'll probably be able to have modified or full rooming-in; having your spouse bunking with you, too, will be a big help. Don't push the rooming-in agenda, though, if you're not up to it-or just want some rest.

Removal of stitches. If your stitches or staples aren't self-absorbing, they will be removed about four or five days after delivery. The procedure isn't very painful, although you may have some discomfort. When the dressing is off, take a good look at the incision with the nurse or doctor; ask how soon you can expect the area to heal, which changes will be normal, and which might require medical attention. If your stitches or staples aren't self-absorbing, they will be removed about four or five days after delivery. The procedure isn't very painful, although you may have some discomfort. When the dressing is off, take a good look at the incision with the nurse or doctor; ask how soon you can expect the area to heal, which changes will be normal, and which might require medical attention.

In most cases, you can expect to go home about two to four days postpartum. But you'll still have to take it easy, and you'll continue to need help both with baby care and self-care. Try to have someone with you at all times during the first couple of weeks.

Coming Home with Baby "In the hospital, the nurses changed my baby's diaper, gave him a bath, and told me when to nurse him. Now that I'm home with him, I feel underprepared and overwhelmed."

It's true that babies aren't born with how-to's written on their cute, dimply bottoms (wouldn't that be convenient?). Fortunately, they do typically come home from the hospital with instructions from the staff about feeding, bathing, and changing diapers. Already lost those? Or maybe they ended up smeared with mustardy poop the first time you tried to change baby's diaper while simultaneously trying to read the instructions for changing baby's diaper? Not to worry; there's a wealth of information out there to help you tackle your new job as new parent both in books and online. Plus, you've probably already scheduled the first visit to the pediatrician, where you'll be armed with even more information-not to mention answers to the 3,000 questions you've managed to accumulate (that is, if you remember to write them down and bring them along).

Of course, it takes more than know-how to make a parenting expert out of a new parent. It takes patience, perseverance, and practice, practice, practice. Luckily, babies are forgiving as you learn. They don't care if you put the diaper on backward or forgot to wash behind their ears at bath time. They're also not shy about giving you feedback: They'll definitely let you know if they're hungry, tired, or if you've made the bathwater too cold (though at first you may not be able to tell which complaint is which). Best of all, since your baby's never had another mom to compare you with, you definitely stack up really well in his book. In fact, you're the best he's ever had.

Still suffering from a crumbling of confidence? What might help most-besides the passing of time and the accumulation of experience-is to know that you're in good company. Every mom (even those seasoned pros you doubtless eye with envy) feels in over her head in those early weeks, especially when postpartum exhaustion-teamed with nightly sleep deprivation and the recovery from childbirth-is taking its toll on her, body and soul. So cut yourself plenty of slack (and while you're at it, cut yourself a piece of cheese and maybe a slice of bread, too-low blood sugar can contribute to that overwhelmed feeling), and give yourself plenty of time to adjust and to get with the parenting program. Pretty soon (sooner than you think), the everyday challenges of baby care won't be so challenging anymore. In fact, they'll come so naturally, you'll be able to do them in your sleep (and will often feel as though you are). You'll be diapering, feeding, burping, and soothing with the best of them-with one arm tied behind your back (or at least, one arm folding laundry, catching up on e-mail, reading a book, spooning cereal into your mouth, or otherwise multitasking). You'll be a mother. And mothers, in case you haven't heard, can do anything.

Getting Started Breastfeeding There's nothing more natural than nursing a baby, right? Well, not always, at least not right away. Babies are born to nurse, but they're not necessarily born knowing how to nurse. Ditto for moms. The breasts are standard issue, they fill with milk automatically, but knowing how to position them effectively in baby's mouth, well, that's a learned art.

Truth is, while breastfeeding is a natural process, it's a natural process that doesn't necessarily come naturally-or quickly-to some mothers and babies. Sometimes there are physical factors that foil those first few attempts; at other times it's just a simple lack of experience on the part of both participants. But whatever might be keeping your baby and your breasts apart, it won't be long before they're in perfect sync. Some of the most mutually satisfying breast-baby relationships begin with several days-or even weeks-of fumbling, bungled efforts, and tears on both sides.

Learning as much as you can about breastfeeding ahead of time-including how to deal with those inevitable setbacks-can help speed that mutual adjustment. Doing lots of reading up or even taking a prenatal class in breastfeeding will be invaluable, as will the following: [image] Get off to an early start. Right in the birthing room is ideal, if that's possible (see Breastfeeding Basics for a how-to, Get off to an early start. Right in the birthing room is ideal, if that's possible (see Breastfeeding Basics for a how-to, page 438 page 438.) Let your practitioner know that you'd like to begin breastfeeding as soon after delivery as you can (and while you're at it, write down that request in your birth plan, if you're using one). Don't be disappointed if either you or baby (or both of you) isn't up to nursing right away. That doesn't mean you won't be able to start successfully later. And keep in mind that even the earliest of starts won't guarantee a smooth first nursing experience. You both have a lot to learn.[image] Keep the nursing team together. Arrange for full or partial rooming-in, if you feel up to it, so you'll be ready to nurse when baby's ready. If you'd rather rest between feedings-you've earned it-ask for a demand-feeding schedule (your baby will be brought to you when he or she is hungry). Keep the nursing team together. Arrange for full or partial rooming-in, if you feel up to it, so you'll be ready to nurse when baby's ready. If you'd rather rest between feedings-you've earned it-ask for a demand-feeding schedule (your baby will be brought to you when he or she is hungry).[image] Enlist as much help as you can. Ideally, a lactation specialist will join you during at least a couple of your first baby feedings to provide hands-on instruction, helpful hints, and perhaps some reading materials. If this service isn't offered to you, ask if a lactation consultant or a nurse who is knowledgeable about breastfeeding can observe your technique and redirect you if you and your baby aren't on target. If you leave the hospital or birthing center before getting this help, your technique should be evaluated by someone with breastfeeding expertise-the baby's doctor, a home nurse, or an outside lactation consultant-within a few days. You can also find empathy, advice, and referrals to lactation consultants by calling your local La Leche League chapter. Or contact the International Lactation Consultant Association (ILCA), (919) 861-5577, ilca.org, for a lactation consultant in your area. Enlist as much help as you can. Ideally, a lactation specialist will join you during at least a couple of your first baby feedings to provide hands-on instruction, helpful hints, and perhaps some reading materials. If this service isn't offered to you, ask if a lactation consultant or a nurse who is knowledgeable about breastfeeding can observe your technique and redirect you if you and your baby aren't on target. If you leave the hospital or birthing center before getting this help, your technique should be evaluated by someone with breastfeeding expertise-the baby's doctor, a home nurse, or an outside lactation consultant-within a few days. You can also find empathy, advice, and referrals to lactation consultants by calling your local La Leche League chapter. Or contact the International Lactation Consultant Association (ILCA), (919) 861-5577, ilca.org, for a lactation consultant in your area.[image] Don't let well-wishers get in the way. Consider limiting visitors (maybe even to just your spouse) while you and baby are getting the hang of breastfeeding. As anxious as you are to show your new arrival off, you'll need to maintain a relaxed atmosphere-and complete concentration-during those learning-to-nurse sessions. Don't let well-wishers get in the way. Consider limiting visitors (maybe even to just your spouse) while you and baby are getting the hang of breastfeeding. As anxious as you are to show your new arrival off, you'll need to maintain a relaxed atmosphere-and complete concentration-during those learning-to-nurse sessions.[image] Be patient if your baby gets off to a slow start. He or she may be just as tuckered out from delivery as you are, maybe even more so. Newborn babies are sleepy babies, and yours is likely to be especially drowsy and sluggish at the breast if you received anesthesia or had a prolonged, difficult labor. That's no problem because newborns need little nourishment during the first few days of life. By the time your baby starts needing some serious chow, he or she will be ready to do some serious chowing down. What babies do need even early on, though, is nurturing. Cuddling at the breast is just as important as suckling. Be patient if your baby gets off to a slow start. He or she may be just as tuckered out from delivery as you are, maybe even more so. Newborn babies are sleepy babies, and yours is likely to be especially drowsy and sluggish at the breast if you received anesthesia or had a prolonged, difficult labor. That's no problem because newborns need little nourishment during the first few days of life. By the time your baby starts needing some serious chow, he or she will be ready to do some serious chowing down. What babies do need even early on, though, is nurturing. Cuddling at the breast is just as important as suckling.[image] Keep your baby bottle-free. Make sure your baby's appetite and sucking instinct aren't sabotaged between nursings by well-meaning nurses wielding bottles of formula or sugar water. First, because it doesn't take much to satisfy a newborn's tender appetite. If your baby is given even a small supplementary feeding in the nursery, he or she will be too full for your breast when it's time to nurse. If your baby doesn't nurse, your breasts won't be stimulated to produce milk, and a vicious cycle-one that interferes with the establishment of a good demand-and-supply system-can begin. Second, because a rubber nipple requires less effort, your baby's sucking reflex may become lazy when a bottle's offered. Faced with the greater challenge of tackling the breast, baby may just give up. Pacifiers might also interfere with nursing (though not in all cases). So issue orders-through your baby's doctor-that, as recommended by the American Academy of Pediatrics, supplementary feedings and pacifiers should not be given to your baby in the nursery unless medically necessary. Keep your baby bottle-free. Make sure your baby's appetite and sucking instinct aren't sabotaged between nursings by well-meaning nurses wielding bottles of formula or sugar water. First, because it doesn't take much to satisfy a newborn's tender appetite. If your baby is given even a small supplementary feeding in the nursery, he or she will be too full for your breast when it's time to nurse. If your baby doesn't nurse, your breasts won't be stimulated to produce milk, and a vicious cycle-one that interferes with the establishment of a good demand-and-supply system-can begin. Second, because a rubber nipple requires less effort, your baby's sucking reflex may become lazy when a bottle's offered. Faced with the greater challenge of tackling the breast, baby may just give up. Pacifiers might also interfere with nursing (though not in all cases). So issue orders-through your baby's doctor-that, as recommended by the American Academy of Pediatrics, supplementary feedings and pacifiers should not be given to your baby in the nursery unless medically necessary.[image] Nurse on demand. And if the demand isn't there yet, nurse frequently anyway, getting in at least 8 to 12 feedings a day. Not only will this keep your baby happy, it will stimulate milk production and increase your milk supply to meet his or her growing demand. Imposing a four-hour feeding schedule, on the other hand, can worsen breast engorgement early on and result in a baby who's not getting enough to eat later. Nurse on demand. And if the demand isn't there yet, nurse frequently anyway, getting in at least 8 to 12 feedings a day. Not only will this keep your baby happy, it will stimulate milk production and increase your milk supply to meet his or her growing demand. Imposing a four-hour feeding schedule, on the other hand, can worsen breast engorgement early on and result in a baby who's not getting enough to eat later.[image] Nurse without limits. It used to be thought that keeping initial feedings short (five minutes on each breast) would prevent sore nipples by toughening them up gradually. Sore nipples, however, result from improper positioning of the baby on the breast and have little to do with the length of the feeding. Most newborns require 10 to 45 minutes to complete a feeding (it's not as easy as it looks). As long as your positioning is correct, there's no need to put time limits on nursing sessions. Nurse without limits. It used to be thought that keeping initial feedings short (five minutes on each breast) would prevent sore nipples by toughening them up gradually. Sore nipples, however, result from improper positioning of the baby on the breast and have little to do with the length of the feeding. Most newborns require 10 to 45 minutes to complete a feeding (it's not as easy as it looks). As long as your positioning is correct, there's no need to put time limits on nursing sessions.

Nursing and the NICU Baby If your baby has to be in the neonatal intensive care unit (NICU) for any reason and can't go home with you, don't give up on breastfeeding. Babies who are premature or have other problems do better on breast milk, even when they're not ready to tackle a breast. Talk to your baby's neonatologist and the nurse in charge to see how you can best feed your baby in this situation. If you can't nurse directly, perhaps you can pump milk to be given to your baby via tube feeding or bottle. If even this isn't possible, see if you can keep pumping milk to keep your supply up until your baby is ready to feed from you directly.

[image]Go for empty. Ideally, at least one breast should be "emptied" at each feeding-and this is actually more important than being sure that baby feeds from both breasts. When a breast isn't sufficiently drained, baby doesn't get to the hind milk, which comes at the end of a feeding and contains more of the calories baby needs to gain weight than the milk that comes first (foremilk is baby's thirst quencher; hind milk's the body builder). Hind milk is also more satiating, which means it keeps baby's tank fuller longer. So don't pull the plug just because your baby has fed for 15 minutes on breast number one-wait until he or she seems ready to quit. Then offer the second breast, but don't force it. Remember to start the next feeding on the breast that baby nursed from last and didn't empty completely.

Breastfeeding Basics 1. Pick a quiet location. Until you and baby have breastfeeding down pat, set yourselves up in an area that has few distractions and a low noise level. Pick a quiet location. Until you and baby have breastfeeding down pat, set yourselves up in an area that has few distractions and a low noise level.2. Have a beverage at your side so you can drink as baby drinks. Avoid anything hot (which could scald you or your baby if it spilled); if you're not thirsting for a cold drink, opt instead for something lukewarm. Add a healthy snack, if it's been a while since your last meal. Have a beverage at your side so you can drink as baby drinks. Avoid anything hot (which could scald you or your baby if it spilled); if you're not thirsting for a cold drink, opt instead for something lukewarm. Add a healthy snack, if it's been a while since your last meal.3. As you become more comfortable with breastfeeding, you can keep a book or magazine handy to keep you busy during marathon feeding sessions. (But don't forget to put your reading matter down periodically so you can interact with your nursing infant.) In the early weeks, turning on the TV could be too distracting. So can talking on the phone; turn down the ringer and let voice mail pick up messages-or have someone else answer. As you become more comfortable with breastfeeding, you can keep a book or magazine handy to keep you busy during marathon feeding sessions. (But don't forget to put your reading matter down periodically so you can interact with your nursing infant.) In the early weeks, turning on the TV could be too distracting. So can talking on the phone; turn down the ringer and let voice mail pick up messages-or have someone else answer.4. Get comfy. If you're sitting up, a pillow across your lap can help raise your baby to a comfortable height. Make sure, too, that your arms are propped up on a pillow or chair arms. Trying to hold 6 to 8 pounds without support can lead to arm cramps and pain. And put up your legs, if you can. Get comfy. If you're sitting up, a pillow across your lap can help raise your baby to a comfortable height. Make sure, too, that your arms are propped up on a pillow or chair arms. Trying to hold 6 to 8 pounds without support can lead to arm cramps and pain. And put up your legs, if you can.5. Position your baby on his or her side, facing your nipple. Make sure baby's whole body is facing you-tummy to tummy-with ear, shoulder, and hip in a straight line. You don't want your baby's head turned to the side; rather, it should be straight in line with his or her body. (Imagine how difficult it would be for you to drink and swallow while turning your head to the side. It's the same for your baby.) Proper positioning is essential to prevent nipple soreness and other breastfeeding problems. Position your baby on his or her side, facing your nipple. Make sure baby's whole body is facing you-tummy to tummy-with ear, shoulder, and hip in a straight line. You don't want your baby's head turned to the side; rather, it should be straight in line with his or her body. (Imagine how difficult it would be for you to drink and swallow while turning your head to the side. It's the same for your baby.) Proper positioning is essential to prevent nipple soreness and other breastfeeding problems.

Lactation specialists recommend two nursing positions during the first few weeks. The first is called the crossover hold: Hold your baby's head with the opposite hand (if nursing on the right breast, hold your baby with your left hand). Rest your hand between your baby's shoulder blades, your thumb behind one ear, your other fingers behind the other ear. Using your other hand, cup your breast, placing your thumb above your nipple and areola (the dark area) at the spot where your baby's nose will touch your breast. Your index finger should be at the spot where your baby's chin will touch the breast. Lightly Lightly compress your breast so your nipple points slightly toward your baby's nose. You are now ready to have baby latch on (see step 6). compress your breast so your nipple points slightly toward your baby's nose. You are now ready to have baby latch on (see step 6).

Crossover hold Football hold The second position is called the football hold. This position, also called the clutch hold, is especially useful if you've had a C-section and want to avoid placing your baby against your abdomen; or if your breasts are large; or if your baby is small or premature; or if you are nursing twins: Position your baby at your side in a semisitting position facing you, with his or her legs under your arm (your right arm if you're nursing on the right breast). Support your baby's head with your right hand and cup your breast as you would for the crossover hold.

As soon as you're more comfortable with nursing, you can add the cradle hold, in which your baby's head rests in the crook of your arm, and the side-lying hold, in which you and your baby lie on your sides, tummy to tummy. This position is a good choice when you're nursing in the middle of the night.

6. Gently tickle your baby's lips with your nipple until his or her mouth is opened very wide, like a yawn. Some lactation specialists suggest directing your nipple toward your baby's nose and then down to the upper lip to get your baby to open his or her mouth very wide. This prevents the lower lip from getting tucked in during nursing. If your baby turns his or her head away, gently stroke his or her cheek on the side nearest you. The rooting reflex will make baby turn his or her head toward your breast. Gently tickle your baby's lips with your nipple until his or her mouth is opened very wide, like a yawn. Some lactation specialists suggest directing your nipple toward your baby's nose and then down to the upper lip to get your baby to open his or her mouth very wide. This prevents the lower lip from getting tucked in during nursing. If your baby turns his or her head away, gently stroke his or her cheek on the side nearest you. The rooting reflex will make baby turn his or her head toward your breast.7. Once that little mouth is opened wide, move your baby closer. Do not move your breast toward your baby. Many latching-on problems occur because mom is hunched over baby, trying to shove breast into mouth. Instead, keep your back straight and bring your baby to your breast. Once that little mouth is opened wide, move your baby closer. Do not move your breast toward your baby. Many latching-on problems occur because mom is hunched over baby, trying to shove breast into mouth. Instead, keep your back straight and bring your baby to your breast.8. Don't stuff your nipple in an unwilling mouth; let your baby take the initiative. It might take a couple of attempts before your baby opens his or her mouth wide enough to latch on properly. Don't stuff your nipple in an unwilling mouth; let your baby take the initiative. It might take a couple of attempts before your baby opens his or her mouth wide enough to latch on properly.9. Be sure baby latches on to both the nipple and the areola that surrounds it. Sucking on just the nipple won't compress the milk glands and can cause soreness and cracking. Also be sure that it's the nipple and areola that the baby is busily milking. Some infants are so eager to suck that they will latch on to any part of the breast (even if no milk is delivered), causing a painful bruise. Be sure baby latches on to both the nipple and the areola that surrounds it. Sucking on just the nipple won't compress the milk glands and can cause soreness and cracking. Also be sure that it's the nipple and areola that the baby is busily milking. Some infants are so eager to suck that they will latch on to any part of the breast (even if no milk is delivered), causing a painful bruise.10. If your breast is blocking your baby's nose, If your breast is blocking your baby's nose, lightly lightly depress the breast with your finger. Elevating baby slightly may also help provide a little breathing room. But as you maneuver, be sure not to loosen his or her grip on the areola. depress the breast with your finger. Elevating baby slightly may also help provide a little breathing room. But as you maneuver, be sure not to loosen his or her grip on the areola.11. Check for swallowing. You can be sure that milk is flowing if there is a strong, steady, rhythmic motion visible in your baby's cheek. Check for swallowing. You can be sure that milk is flowing if there is a strong, steady, rhythmic motion visible in your baby's cheek.12. If your baby has finished suckling but is still holding on to the breast, pulling it out abruptly can cause injury to your nipple. Instead, break the suction first by depressing the breast or by putting your finger into the corner of the baby's mouth to let in some air. If your baby has finished suckling but is still holding on to the breast, pulling it out abruptly can cause injury to your nipple. Instead, break the suction first by depressing the breast or by putting your finger into the corner of the baby's mouth to let in some air.

Cradle hold Side-lying hold