Keeping Track To be sure each breast gets a chance to be stimulated, use a reminder such as a notation in your breastfeeding journal, a small scrunchie looped around your bra strap, or a bracelet on your wrist to indicate which side you nursed from last. At your next feeding, just start with the other side (and switch the scrunchie or bracelet to the other side, too).

[image]Don't let sleeping babies lie if it means that they'll sleep through a feeding. Some babies, especially in the first few days of life, may not wake often enough for nourishment. If it's been three hours since your newborn last fed, then it's time for a wake-up call. Here's one way to accomplish this. First, unwrap your baby if he or she is swaddled or heavily dressed; the cool air will help begin the waking process. Then try sitting baby up, one hand supporting the back and the other holding the chin, and rub the back gently. Massaging the arms and legs or dabbing a little cool water on the forehead may help, too. The moment baby stirs, quickly adopt the nursing position. Or lay your sleeping baby on your bare chest. Babies have a keen sense of smell, and the aroma of your breast may awaken him or her.[image] Don't try to feed a screaming baby. Ideally, you will feed your baby when he or she first shows signs of hunger or interest in sucking, which might include mouthing his or her hands or rooting around for the nipple, or just being particularly alert. Try not to wait until frantic crying-a late indication of hunger-begins. But if the frenzy has started, do some rocking and soothing before you put baby to breast. Or offer your finger to suck on until baby calms down. After all, it's hard enough for an inexperienced suckler to find the nipple when calm; when your newborn has worked up to a full-fledged frenzy, it may be impossible. Don't try to feed a screaming baby. Ideally, you will feed your baby when he or she first shows signs of hunger or interest in sucking, which might include mouthing his or her hands or rooting around for the nipple, or just being particularly alert. Try not to wait until frantic crying-a late indication of hunger-begins. But if the frenzy has started, do some rocking and soothing before you put baby to breast. Or offer your finger to suck on until baby calms down. After all, it's hard enough for an inexperienced suckler to find the nipple when calm; when your newborn has worked up to a full-fledged frenzy, it may be impossible.[image] Stay calm. Start out as relaxed as you can, and try to stay that way no matter how frustrating the nursing episode becomes. If you've allowed visitors, send them packing 15 minutes before a feeding, and use that time to chill out a little. Do some relaxation exercises before you begin (see Stay calm. Start out as relaxed as you can, and try to stay that way no matter how frustrating the nursing episode becomes. If you've allowed visitors, send them packing 15 minutes before a feeding, and use that time to chill out a little. Do some relaxation exercises before you begin (see page 142 page 142) or tune in to some soft music. As you nurse, try to keep your cool. Tension not only hampers milk letdown (your breasts' way of making your milk available for suckling), it can generate stress in your baby (infants are extremely sensitive to mom's moods). An anxious baby can't nurse effectively.[image] Keep track. Once your milk comes in and until breastfeeding is well established, keep a running written record of baby's feedings (when they begin and end) as well as of wet and soiled diapers produced each day. While that may sound obsessive, it'll really help give you a good sense of how breastfeeding is going-and also makes it possible for you to report progress to your baby's doctor more accurately (you will be asked). Continue to strive for at least 8 to 12 feedings in each 24-hour period, but never force your baby to suckle. Though the length of feedings may vary considerably, once engorgement and nipple soreness have leveled off, they'll average about half an hour each, usually divided between both breasts (though sometimes a baby will turn away or fall asleep before latching on to breast number two, which is fine as long as number one has been drained well). Your baby's weight gain and diaper record will give you an even clearer picture of baby's intake. There should be at least six wet diapers (the urine should appear clear and not dark yellow) and at least three bowel movements over a 24-hour period. No matter how long baby is suckling, if weight gain and output are satisfactory, you can assume the intake is, too. Keep track. Once your milk comes in and until breastfeeding is well established, keep a running written record of baby's feedings (when they begin and end) as well as of wet and soiled diapers produced each day. While that may sound obsessive, it'll really help give you a good sense of how breastfeeding is going-and also makes it possible for you to report progress to your baby's doctor more accurately (you will be asked). Continue to strive for at least 8 to 12 feedings in each 24-hour period, but never force your baby to suckle. Though the length of feedings may vary considerably, once engorgement and nipple soreness have leveled off, they'll average about half an hour each, usually divided between both breasts (though sometimes a baby will turn away or fall asleep before latching on to breast number two, which is fine as long as number one has been drained well). Your baby's weight gain and diaper record will give you an even clearer picture of baby's intake. There should be at least six wet diapers (the urine should appear clear and not dark yellow) and at least three bowel movements over a 24-hour period. No matter how long baby is suckling, if weight gain and output are satisfactory, you can assume the intake is, too.

Engorgement: When the Milk Comes In Just when you and your baby seem to be getting the hang of this whole nursing thing, milk gets in the way. Up until now, your baby has been easily extracting tiny amounts of colostrum (premilk), and your breasts have been easily handling the workload. Then it happens, suddenly and without warning: Your milk comes in. Within a few hours, your breasts become swollen, hard, and painful. Nursing from them can become frustrating for baby and seriously uncomfortable for you.

Fortunately, this miserable chapter in breastfeeding history is usually pretty brief, often lasting no more than 24 to 48 hours (though it can occasionally linger as long as a week). While it lasts, here are a variety of ways of relieving engorgement and the discomfort that comes with it: [image] Heat it. Use heat briefly to help soften the areola and encourage letdown at the beginning of a nursing session. To do this, place a washcloth dipped in warm, not hot, water on just the areola, or lean it into a bowl of warm water. Heat it. Use heat briefly to help soften the areola and encourage letdown at the beginning of a nursing session. To do this, place a washcloth dipped in warm, not hot, water on just the areola, or lean it into a bowl of warm water.[image] Massage it. You can also encourage milk flow by gently massaging the breast your baby is suckling. Massage it. You can also encourage milk flow by gently massaging the breast your baby is suckling.[image] Cool it. Use ice packs after nursing to reduce engorgement. And although it may sound a little strange and look even stranger, chilled cabbage leaves may also prove soothing (use large outer leaves and make an opening in the center of each for your nipple; rinse and pat dry before applying). Cool it. Use ice packs after nursing to reduce engorgement. And although it may sound a little strange and look even stranger, chilled cabbage leaves may also prove soothing (use large outer leaves and make an opening in the center of each for your nipple; rinse and pat dry before applying).[image] Dress for it. Wear a well-fitting nursing bra (with wide straps and no plastic lining) around the clock. Pressure against your sore and engorged breasts can hurt, however, so make sure the bra is not too tight. And wear loose clothing that doesn't rub against your sensitive breasts. Dress for it. Wear a well-fitting nursing bra (with wide straps and no plastic lining) around the clock. Pressure against your sore and engorged breasts can hurt, however, so make sure the bra is not too tight. And wear loose clothing that doesn't rub against your sensitive breasts.[image] Keep at it. Don't be tempted to skip or skimp on a feeding because of pain. The less your baby sucks, the more engorged your breasts will become-and the more you'll hurt. Keep at it. Don't be tempted to skip or skimp on a feeding because of pain. The less your baby sucks, the more engorged your breasts will become-and the more you'll hurt.

Next Stop: Easy Street Hit a breastfeeding bump or two? Stick with nursing and you'll soon be cruising down Easy Street (as you'll find out, once you get the hang of it, there's no easier way to feed a baby). In the meantime, get the help you need to fix any rough spots you've been facing-either from the tips here or from a lactation consultant. Also, don't let the bumps with a first baby discourage you from nursing your next. Thanks to mom's previous experience (and that of her breasts), nursing is typically second nature with second (and subsequent) babies, making engorgement, nipple soreness, and other problems a lot less common.

The Breastfeeding Diet It's the couch potato's dream-burning up the calories of a 5-mile run without leaving your lounge chair. And guess what? That dream is your reality now that you're breastfeeding your little Tater Tot. It's true. Milk production burns 500 calories a day, which means that you'll get to eat an extra 500 calories a day (up from your prepregnancy numbers-not your pregnancy allotment) to meet that need.

Hello, potato chips? Not exactly. Quality matters as much as quantity (remember, you're still-sort of-eating for two). The good news is that you're probably an old pro at eating well, what with all the practice you've had for the past nine months. The even better news is that eating well while breastfeeding is very much like eating well while expecting, but with (best news of all) more relaxed recommendations. Plus, while calories definitely count, you still won't need to count them. Just follow the Breastfeeding Diet as best you can: What to eat. As always, eating well is about getting the right balance of good-and good for you-food. Try to include the following each day while you're breastfeeding: As always, eating well is about getting the right balance of good-and good for you-food. Try to include the following each day while you're breastfeeding: [image] Protein: 3 servings Protein: 3 servings[image] Calcium: 5 servings (that's up 1 serving from your pregnancy requirement of 4) Calcium: 5 servings (that's up 1 serving from your pregnancy requirement of 4)[image] Iron-rich foods: 1 or more servings Iron-rich foods: 1 or more servings[image] Vitamin C: 2 servings Vitamin C: 2 servings[image] Green leafy and yellow vegetables, yellow fruits: 3 to 4 servings Green leafy and yellow vegetables, yellow fruits: 3 to 4 servings[image] Other fruits and veggies: 1 or more servings Other fruits and veggies: 1 or more servings[image] Whole-grain and other complex carbohydrates: 3 or more servings Whole-grain and other complex carbohydrates: 3 or more servings[image] High-fat foods: moderate amounts-you don't need as much as you did during pregnancy High-fat foods: moderate amounts-you don't need as much as you did during pregnancy[image] At least 8 glasses of water, juice, or other noncaffeinated, nonalcoholic beverages At least 8 glasses of water, juice, or other noncaffeinated, nonalcoholic beverages[image] DHA-rich foods to promote baby's brain growth (look for this fabulous fat in wild salmon, sardines, walnuts, flaxseed oil, as well as DHA-enriched eggs) DHA-rich foods to promote baby's brain growth (look for this fabulous fat in wild salmon, sardines, walnuts, flaxseed oil, as well as DHA-enriched eggs)[image] Prenatal vitamin daily Prenatal vitamin daily You may need to increase your caloric intake as your baby grows bigger and hungrier, or decrease it if you supplement nursing with formula and/or solids, or if you have considerable fat reserves you'd like to begin burning.

What not to eat. When you're breastfeeding, you have a lot more menu options than you did while you were expecting-served up with some caveats. It's fine to pop open the cork on that pinot noir you've been pining for (or flip the top on that ale you've been aching for). But drink within limits (a couple of glasses a week, preferably taken right after you nurse, rather than before, to allow a few hours for the alcohol to metabolize). You can use Milkscreen-simple test strips that detect the volume of alcohol in your breast milk, available at any drugstore-to know if it's safe for your baby. Time to pick up your coffee habit where you left off? Depends on how hefty your habit was. More than a cup or two of joe can make junior jittery and keep you both from getting any sleep. And though it's safe to reel in the sushi again, continue to avoid high-mercury fish, such as shark, tilefish, and mackerel, and to limit those that may contain moderate amounts of that heavy metal. When you're breastfeeding, you have a lot more menu options than you did while you were expecting-served up with some caveats. It's fine to pop open the cork on that pinot noir you've been pining for (or flip the top on that ale you've been aching for). But drink within limits (a couple of glasses a week, preferably taken right after you nurse, rather than before, to allow a few hours for the alcohol to metabolize). You can use Milkscreen-simple test strips that detect the volume of alcohol in your breast milk, available at any drugstore-to know if it's safe for your baby. Time to pick up your coffee habit where you left off? Depends on how hefty your habit was. More than a cup or two of joe can make junior jittery and keep you both from getting any sleep. And though it's safe to reel in the sushi again, continue to avoid high-mercury fish, such as shark, tilefish, and mackerel, and to limit those that may contain moderate amounts of that heavy metal.

What to watch out for. If you have a family history of allergies, check with the doctor to see if you should avoid peanuts and foods that contain them (and possibly other highly allergic foods). Also watch out for herbs, even some seemingly innocuous herbal teas. Stick to reliable brands and choose flavors that are considered safe during lactation, including orange spice, peppermint, raspberry, red bush, chamomile, and rosehip. Read labels carefully to make sure other herbs haven't been added to the brew, and drink them only in moderation. And when it comes to sugar substitutes, sucralose (Splenda) or aspartame are considered better bets than saccharine. If you have a family history of allergies, check with the doctor to see if you should avoid peanuts and foods that contain them (and possibly other highly allergic foods). Also watch out for herbs, even some seemingly innocuous herbal teas. Stick to reliable brands and choose flavors that are considered safe during lactation, including orange spice, peppermint, raspberry, red bush, chamomile, and rosehip. Read labels carefully to make sure other herbs haven't been added to the brew, and drink them only in moderation. And when it comes to sugar substitutes, sucralose (Splenda) or aspartame are considered better bets than saccharine.

What to watch for in your baby. A few moms find that their own diet affects their babies' tummies and temperaments. While what you eat does indeed change the taste and smell of your milk (that happens for all mothers), this is actually a good thing since it exposes your baby to many different flavors. But some babies can occasionally be sensitive to certain foods that end up in mom's milk. If you suspect that something in your diet is turning baby off his or her feed (or turning his or her tummy), try eliminating the food for a few days to gauge the response. Some of the more common troublemakers are cow's milk, eggs, fish, citrus fruits, nuts, and wheat. A few moms find that their own diet affects their babies' tummies and temperaments. While what you eat does indeed change the taste and smell of your milk (that happens for all mothers), this is actually a good thing since it exposes your baby to many different flavors. But some babies can occasionally be sensitive to certain foods that end up in mom's milk. If you suspect that something in your diet is turning baby off his or her feed (or turning his or her tummy), try eliminating the food for a few days to gauge the response. Some of the more common troublemakers are cow's milk, eggs, fish, citrus fruits, nuts, and wheat.

For more information on eating while breastfeeding, see What to Expect: Eating Well When You're Expecting. What to Expect: Eating Well When You're Expecting.

[image]Take matters into your own hands. Hand-express a bit of milk from each breast before nursing to lessen the engorgement. This will get your milk flowing, and soften the nipple so your baby can get a better hold on it.[image] Switch it. Change nursing positions from one feeding to the next (try the football hold at one feeding, the cradle hold at the next; see Switch it. Change nursing positions from one feeding to the next (try the football hold at one feeding, the cradle hold at the next; see page 438 page 438). This will ensure that all the milk ducts are being emptied and may help ease the ouch of engorgement.[image] Get some relief. For severe pain, take acetaminophen (Tylenol) or another mild pain reliever prescribed by your practitioner. Get some relief. For severe pain, take acetaminophen (Tylenol) or another mild pain reliever prescribed by your practitioner.

Leaking Milk The first few weeks of nursing can be very wet ones. Milk may leak, drip, or even spray from your breasts, and it can happen at any time, anywhere, without warning. All of a sudden, you'll feel the tingle of letdown-and before you can grab a nursing pad or a sweater to cover up with, you'll look down to see the telltale circle of dampness that gives new meaning to the term "wet T-shirt."

Medication and Lactation Besides those inopportune and public moments ("So that's why the delivery guy was looking at me funny ..."), you might find yourself springing spontaneous leaks when you're sleeping or taking a warm shower, when you hear your baby cry, when you think about or talk about your baby. Milk may drip from one breast while you nurse from the other, and if your baby has settled into a somewhat regular feeding schedule, your breasts may be dripping with anticipation before baby latches on.

Though it may be uncomfortable, unpleasant, and endlessly embarrassing, this side effect of breastfeeding is completely normal and very common, particularly in the early weeks. (Not leaking at all or leaking only a little can be just as normal, and in fact, many second-time mothers might notice that their breasts leak less than they did the first time around.) In most cases, as breastfeeding becomes established, the system eventually settles down and leaking lessens considerably. In the meantime, while you may not be able to turn off that leaky faucet, you may be able to make living with it a little less messy:

Medication and Lactation Many medications are known to be safe for use while you're breastfeeding; others are known not to be; and the scientific jury's still out on the rest. But just as you did while you were expecting, check all medications (prescription or over-the-counter) with your practitioner and your baby's pediatrician before taking them, and be sure any physician who prescribes a new medication knows that you're nursing. Keep in mind that it's usually best to take medication just after a feeding, so that levels in your milk will be lowest when you nurse next time.

[image]Stock up on nursing pads. If you're a leaker, you'll find that in the first postpartum weeks, you'll be changing your nursing pads as often as you nurse-sometimes even more frequently. Keep in mind that, like a diaper, they should be changed whenever they become wet. Make sure you use pads that don't have a plastic or waterproof liner; they'll just trap moisture and lead to irritated nipples. Some women prefer the disposable variety, while others like the feel of the reusable cotton ones.[image] Protect your bed. If you find you're leaking a lot at night, use extra nursing pads, or place a large towel under you while you sleep. The last thing you'll want to be doing now is changing your sheets every day or, worse, shopping for a new mattress. Protect your bed. If you find you're leaking a lot at night, use extra nursing pads, or place a large towel under you while you sleep. The last thing you'll want to be doing now is changing your sheets every day or, worse, shopping for a new mattress.[image] Don't pump to prevent leaking. Extra pumping won't control the leak; on the contrary, the more you stimulate your breasts, the more milk they'll produce, and the more leaking you'll have to contend with. Don't pump to prevent leaking. Extra pumping won't control the leak; on the contrary, the more you stimulate your breasts, the more milk they'll produce, and the more leaking you'll have to contend with.[image] Try to stop the overflow. Once nursing is well established and your milk production has leveled off, you can try to stop the leaking by pressing your nipples (though probably not in public) or holding your arms against your breasts when you feel a leak coming on. Don't, however, do this in the first few weeks because it may inhibit milk letdown and can lead to a clogged milk duct. Try to stop the overflow. Once nursing is well established and your milk production has leveled off, you can try to stop the leaking by pressing your nipples (though probably not in public) or holding your arms against your breasts when you feel a leak coming on. Don't, however, do this in the first few weeks because it may inhibit milk letdown and can lead to a clogged milk duct.

Sore Nipples Tender nipples can make nursing a miserable-and frustrating-experience. Fortunately, most women don't stay sore long; their nipples toughen up quickly and breastfeeding soon becomes a completely painless pleasure. But some women, especially those who have "barracuda babies" (babies with a vigorous suck) or who have been positioning their newborns incorrectly at their breasts, continue to experience soreness and cracking. To ease the discomfort so you can start enjoying breastfeeding: [image] Position the right way. Be sure your baby is correctly positioned, facing your breast (see box, Position the right way. Be sure your baby is correctly positioned, facing your breast (see box, page 438 page 438). Vary your nursing position so a different part of the areola is compressed at each feeding, but always keep baby facing your breasts.[image] Let your nipples breathe (try this at home). Expose sore or cracked nipples to the air briefly after each feeding. Protect them from clothing that rubs and other irritations, and if you're really sore, you might want to consider surrounding them with a cushion of air by wearing breast shells (not shields). Let your nipples breathe (try this at home). Expose sore or cracked nipples to the air briefly after each feeding. Protect them from clothing that rubs and other irritations, and if you're really sore, you might want to consider surrounding them with a cushion of air by wearing breast shells (not shields).[image] Keep them dry. Change nursing pads as soon as they become damp. Also, make sure the nursing pads don't have a plastic liner, which will only trap moisture. If you live in a humid climate, wave a blow dryer, set on warm, across each breast (about 6 to 8 inches away) for two or three minutes (no more) after feedings. This is very comforting, if slightly difficult to explain should someone walk in while you're doing it. Keep them dry. Change nursing pads as soon as they become damp. Also, make sure the nursing pads don't have a plastic liner, which will only trap moisture. If you live in a humid climate, wave a blow dryer, set on warm, across each breast (about 6 to 8 inches away) for two or three minutes (no more) after feedings. This is very comforting, if slightly difficult to explain should someone walk in while you're doing it.[image] Heal with milk. Breast milk can actually help heal sore nipples. So let whatever milk is left on the breast after a feeding dry there, instead of wiping it away. Or express a few drops of milk at the end of a feeding and rub it on your nipples, letting your nipples dry before you put your bra back on. Heal with milk. Breast milk can actually help heal sore nipples. So let whatever milk is left on the breast after a feeding dry there, instead of wiping it away. Or express a few drops of milk at the end of a feeding and rub it on your nipples, letting your nipples dry before you put your bra back on.[image] Rub it on. Nipples are naturally protected and lubricated by sweat glands and skin oils. But using a commercial preparation of modified lanolin can prevent and/or heal nipple cracking. After nursing, apply ultrapurified medical-grade lanolin, such as Lansinoh, but avoid petroleum-based products and petroleum jelly itself (Vaseline), as well as other oily products. Wash nipples only with water-never with soap, alcohol, or wipes-whether your nipples are sore or not. Your baby is already protected from your germs, and the milk itself is clean. Rub it on. Nipples are naturally protected and lubricated by sweat glands and skin oils. But using a commercial preparation of modified lanolin can prevent and/or heal nipple cracking. After nursing, apply ultrapurified medical-grade lanolin, such as Lansinoh, but avoid petroleum-based products and petroleum jelly itself (Vaseline), as well as other oily products. Wash nipples only with water-never with soap, alcohol, or wipes-whether your nipples are sore or not. Your baby is already protected from your germs, and the milk itself is clean.[image] Try tea for two. Wet regular tea bags with cool water and place them on your sore nipples. The properties in the tea may help soothe and heal them. Try tea for two. Wet regular tea bags with cool water and place them on your sore nipples. The properties in the tea may help soothe and heal them.[image] Treat them equally. Don't favor one breast because it is less sore or because the nipple isn't cracked; the only way to toughen up nipples is to use them. Plus, for both breasts to become good producers, they both have to get equal stimulation time. Treat them equally. Don't favor one breast because it is less sore or because the nipple isn't cracked; the only way to toughen up nipples is to use them. Plus, for both breasts to become good producers, they both have to get equal stimulation time.

If one nipple is a lot more sore than the other, nurse from the less tender one first because the baby will suck more vigorously when he or she is hungry. Try to do this only as long as you absolutely have to-and for no more than a few days-because it could keep the sore breast from getting the stimulation it needs and ultimately affect your milk supply. Fortunately, the worst of the soreness shouldn't continue longer than this (if it does, contact a lactation consultant; improper positioning may be the problem).

[image] Chill out before feeding. Relaxation will enhance the letdown of milk (which will mean that baby won't have to suck as hard), while tension will inhibit it. Chill out before feeding. Relaxation will enhance the letdown of milk (which will mean that baby won't have to suck as hard), while tension will inhibit it.[image] Seek relief. Take acetaminophen (Tylenol) before you nurse to ease soreness. Seek relief. Take acetaminophen (Tylenol) before you nurse to ease soreness.[image] Keep a watch. If your nipples are cracked, be especially alert to signs of breast infection (see next page), which can occur when germs enter a milk duct through a crack in the nipple. Keep a watch. If your nipples are cracked, be especially alert to signs of breast infection (see next page), which can occur when germs enter a milk duct through a crack in the nipple.

When Breastfeeding Gets Bumpy Once nursing is established, it's usually a smooth ride until baby's weaned. But once in a while, there's a bump or two along the way, among them: Clogged milk ducts. Sometimes a milk duct clogs, causing milk to back up. This condition-characterized by a small, red, and tender lump on the breast-can lead to infection, so it's important to resolve it quickly. The best way to do this is to offer the affected breast first and let your baby empty it as completely as possible. If baby doesn't finish the job, express any remaining milk by hand or with a breast pump. Keep pressure off the duct by making sure your bra is not too tight (avoiding underwires for now may help) and by varying nursing positions to put pressure on different ducts. Applying hot packs or warm compresses before nursing and gentle massage may also be helpful (baby's chin, if correctly positioned, can provide a clogged duct with an excellent massage). Do not use this time to wean the baby because discontinuing nursing now will only compound the clog. Sometimes a milk duct clogs, causing milk to back up. This condition-characterized by a small, red, and tender lump on the breast-can lead to infection, so it's important to resolve it quickly. The best way to do this is to offer the affected breast first and let your baby empty it as completely as possible. If baby doesn't finish the job, express any remaining milk by hand or with a breast pump. Keep pressure off the duct by making sure your bra is not too tight (avoiding underwires for now may help) and by varying nursing positions to put pressure on different ducts. Applying hot packs or warm compresses before nursing and gentle massage may also be helpful (baby's chin, if correctly positioned, can provide a clogged duct with an excellent massage). Do not use this time to wean the baby because discontinuing nursing now will only compound the clog.

Breast infection. A more serious and less common complication of breastfeeding is mastitis, or breast infection, which can develop in one or both breasts, most often during the early postpartum period (though it can occur anytime during breastfeeding). The factors that can combine to cause mastitis are failure to drain breasts of milk at each nursing, germs (usually from baby's mouth) gaining entrance into the milk ducts through a crack in the nipple, and lowered resistance in mom due to stress and fatigue. A more serious and less common complication of breastfeeding is mastitis, or breast infection, which can develop in one or both breasts, most often during the early postpartum period (though it can occur anytime during breastfeeding). The factors that can combine to cause mastitis are failure to drain breasts of milk at each nursing, germs (usually from baby's mouth) gaining entrance into the milk ducts through a crack in the nipple, and lowered resistance in mom due to stress and fatigue.

The most common symptoms of mastitis are severe soreness or pain, hardness, redness, heat, and swelling of the breast, with flulike symptoms-generalized chills and a fever of about 101F to 102F. If you develop such symptoms, contact your doctor right away. Prompt medical treatment is necessary and may include bed rest, antibiotics, pain relievers, increased fluid intake, and moist heat applications. You should begin to feel drastically better within 36 to 48 hours after beginning the antibiotics. If you don't, let your practitioner know; he or she may need to prescribe a different type of antibiotic.

Continue to nurse during treatment. Since the baby's germs probably caused the infection in the first place, they won't be harmful. The antibiotics prescribed for the infection will be safe, too. And draining the breast will help prevent clogged milk ducts. Nurse (if you can; it may be quite painful) on the infected breast, and express whatever baby doesn't finish with a pump. If the pain is so bad that you can't nurse, try hand pumping or using a manual breast pump on your breasts (whichever hurts less) while lying in a tub of warm water with your breasts floating comfortably; you can let the milk drip into the water. (Don't use an electric pump in the tub.) Delay in treating mastitis or discontinuing treatment too soon could lead to the development of a breast abscess, the symptoms of which include excruciating, throbbing pain; localized swelling, tenderness, and heat in the area of the abscess; and temperature swings between 100F and 103F. Treatment includes antibiotics and, generally, surgical drainage. The drain may stay in place after surgery. Breastfeeding on that breast usually can't continue in most cases, but you can keep nursing with the other breast until you wean your baby.

Breastfeeding After a Cesarean Delivery How soon you can breastfeed your newborn after a surgical delivery will depend on how you feel and how your baby is doing. If you're both in good shape, you can probably introduce baby to breast in the recovery room shortly after the surgery is completed. If you're groggy from general anesthesia or your baby needs immediate care in the nursery, this first nursing session may have to wait. If after 12 hours you still haven't been able to get together with your baby, ask about using a pump to express your premilk (colostrum) and get lactation started.

You'll probably find breastfeeding after a C-section uncomfortable at first. It will be less so if you try to avoid putting pressure on the incision with one of these techniques: Place a pillow on your lap under the baby; lie on your side; or use the football hold (page 438), again supported by a pillow, to nurse. Both the afterpains you experience as you nurse and the soreness at the site of the incision are normal and will lessen in the days ahead.

Breastfeeding Multiples Breastfeeding, like just about every aspect of caring for newborn multiples, seems as though it will be at least twice as challenging. However, once you've fallen into the rhythm of nursing your multiples (and you will!), you'll find that it's not only possible but doubly (or even triply) rewarding. To successfully nurse twins and more, you should: Eat well-and eat up. Fulfill all the dietary recommendations for lactating mothers (see the Breastfeeding Diet, Fulfill all the dietary recommendations for lactating mothers (see the Breastfeeding Diet, page 442 page 442), with these additions: 400 to 500 calories above your prepregnancy needs for each baby you are nursing (you may need to increase your caloric intake as the babies grow bigger and hungrier or decrease it if you supplement nursing with formula and/or solids, or if you have considerable fat reserves you would like to burn); an additional serving of protein (for a total of four) and an additional serving of calcium (six total) or the equivalent in calcium supplements.

Bottle Baby Chose the bottle, or the combo? Getting started bottle-feeding is usually a lot easier than getting started breastfeeding (especially because formula comes with instructions, but breasts don't). But there's still plenty to learn, and you can read all about it in What to Expect the First Year What to Expect the First Year.

Pump it up. If your babies are in the NICU and are still too small to breastfeed, or if you need some extra help getting your supply stimulated in the early going, consider using an electric double pump. Later, pumping will allow you to get a few precious extra hours of sleep while someone else feeds the babies. Don't get discouraged if the pump doesn't get you going-no pump can empty a breast as well as a baby can. But regular stimulation from a pump (and your babies) will pump up your milk supply eventually. If your babies are in the NICU and are still too small to breastfeed, or if you need some extra help getting your supply stimulated in the early going, consider using an electric double pump. Later, pumping will allow you to get a few precious extra hours of sleep while someone else feeds the babies. Don't get discouraged if the pump doesn't get you going-no pump can empty a breast as well as a baby can. But regular stimulation from a pump (and your babies) will pump up your milk supply eventually.

Nurse two at a time (or not). You've got two breasts and two (or more) mouths to feed. Are you up to feeding two babies at once? You just might be, especially with a little help (like from oversize nursing pillows for twins). An obvious-and big-advantage of tandem nursing two babies is that you don't spend all day and night nursing (first Baby A, now Baby B, and back to Baby A, and so on). To nurse two at the same time, position both babies on the pillow first, and then latch them on (or you can ask someone to hand the babies to you one at a time, especially while you're still getting used to the juggling act). You've got two breasts and two (or more) mouths to feed. Are you up to feeding two babies at once? You just might be, especially with a little help (like from oversize nursing pillows for twins). An obvious-and big-advantage of tandem nursing two babies is that you don't spend all day and night nursing (first Baby A, now Baby B, and back to Baby A, and so on). To nurse two at the same time, position both babies on the pillow first, and then latch them on (or you can ask someone to hand the babies to you one at a time, especially while you're still getting used to the juggling act).

Tandem Nursing Some mothers of multiples prefer to nurse one baby at a time, finding it easier and more satisfying. Others would rather not spend all day breastfeeding and find that nursing two babies simultaneously saves time and works well. Here are two positions you can use while nursing two at the same time: (1) Position both babies in the football (or clutch) hold. Use pillows to support your babies' heads. (2) Combine the cradle hold and the football hold, again using pillows for support and experimenting until both you and your babies are comfortable.

If tandem nursing doesn't appeal to you, don't do it. You can bottle-feed one (using either pumped milk or formula, if you're supplementing) while nursing the other (and then switch off), or nurse one baby after the other. Some babies are very efficient, taking a full feed in only 10 or 15 minutes. If this is the case with yours, count your little blessings-you won't spend any more time nursing than the average tandem feeder.

Got three (or more) babies to feed? Breastfeeding triplets (and even quads) is possible, too. Nurse two at a time, and then nurse the third one afterward, remembering to switch off which baby gets solo suckling time. For more information on breastfeeding higher-order multiples, check out mostonline.org or tripletconnection.org.

Enlist twice as much help. Get as much help as you can with housework, meal prep, and infant care, to conserve the energy you need to fuel milk production. Get as much help as you can with housework, meal prep, and infant care, to conserve the energy you need to fuel milk production.

Treat each diner differently. Even identical twins have different personalities, appetites, and nursing patterns. So try to tune into the needs of each. And keep extra-careful records to make sure each baby is well fed at each feeding. Even identical twins have different personalities, appetites, and nursing patterns. So try to tune into the needs of each. And keep extra-careful records to make sure each baby is well fed at each feeding.

Give both breasts a workout. Switch breasts for each baby at each feeding so both breasts are stimulated equally. Switch breasts for each baby at each feeding so both breasts are stimulated equally.

Give It Time So you've been a mom for a week (with the stretch marks, postpartum pains, and bags under your eyes to prove it), and by now you may be wondering: When am I going to feel like one? When will I be able to accomplish latch-on without 20 minutes of fumbling? Or finally get the hang of burping? Or stop worrying about breaking the baby every time I pick her up? When will I be able to coo without feeling like an awkward idiot? When will I figure out which cries mean what-and how to respond to any of them? How do I put on a diaper so it doesn't leak? Get the onesie over baby's head without a struggle? Shampoo that little patch of hair without dripping soap into those tender eyes? When will the job that nature just signed me up for start coming naturally?

The truth is, giving birth makes you a mother, but it doesn't necessarily make you feel like a mother. Only time spent on this sometimes bewildering, sometimes overwhelming, always amazing job will do that. The day-to-day (and night-to-night) of parenting is never easy, but it absolutely, positively gets easier.

So cut yourself some slack, pat yourself on the back, and give yourself time, Mom. Which, by the way, you are.

CHAPTER 18.

Postpartum: The First 6 Weeks BY NOW YOU'RE PROBABLY EITHER settling into your new life as a fledgling mom or figuring out how to juggle new baby care with the demands of older children. Almost certainly, much of your daily-and nightly-attention is focused on that recently arrived little bundle. Babies, after all, don't take care of themselves. But that doesn't mean you should neglect your own care (yes, moms have needs, too!). settling into your new life as a fledgling mom or figuring out how to juggle new baby care with the demands of older children. Almost certainly, much of your daily-and nightly-attention is focused on that recently arrived little bundle. Babies, after all, don't take care of themselves. But that doesn't mean you should neglect your own care (yes, moms have needs, too!).

Though most of your questions and concerns are likely to be baby-related right now, you're sure to have some that are a little more mommy-centric, too, from the state of your emotions ("Will I ever stop crying during insurance commercials?"), to the state of your sexual union ("Will I ever want to do 'it' again?"), to the state of your waist ("Will I ever be able to wear jeans that zip?"). The answers: yes, yes, and yes-just give it time.

What You May Be Feeling The first six weeks postpartum are considered a "recovery" period. Even if you sailed through your pregnancy and had the easiest labor and delivery on record (and especially if you didn't), your body has still been stretched and stressed to the max-and it needs a chance to regroup. Every new mom, like every expectant one, is different-so all will make that recovery at a different rate, with a different collection of postpartum symptoms. Depending on the type of delivery you had, how much help you have at home, and a variety of other individual factors, you may experience all, or only some, of the following: Physically [image] Continued period-like vaginal discharge (lochia), first dark red, then pink, turning brownish, then yellowish white Continued period-like vaginal discharge (lochia), first dark red, then pink, turning brownish, then yellowish white[image] Fatigue Fatigue[image] Some continuing pain, discomfort, and numbness in the perineum, if you had a vaginal delivery (especially if you had stitches) or labored before having a cesarean delivery Some continuing pain, discomfort, and numbness in the perineum, if you had a vaginal delivery (especially if you had stitches) or labored before having a cesarean delivery[image] Diminishing incision pain, continuing numbness, if you had a C-section (especially if it was your first) Diminishing incision pain, continuing numbness, if you had a C-section (especially if it was your first)[image] Gradual easing of constipation and, hopefully, hemorrhoids Gradual easing of constipation and, hopefully, hemorrhoids[image] Gradual slimming of your belly as your uterus recedes into the pelvis Gradual slimming of your belly as your uterus recedes into the pelvis[image] Gradual weight loss Gradual weight loss[image] Gradual decrease in swelling Gradual decrease in swelling[image] Breast discomfort and nipple soreness until breastfeeding is well established Breast discomfort and nipple soreness until breastfeeding is well established[image] Backache (from weak abdominal muscles and from carrying baby) Backache (from weak abdominal muscles and from carrying baby)[image] Joint pain (from joints loosened during pregnancy in preparation for delivery) Joint pain (from joints loosened during pregnancy in preparation for delivery)[image] Achiness in arms and neck (from carrying and feeding baby) Achiness in arms and neck (from carrying and feeding baby)[image] Hair loss Hair loss Emotionally [image] Elation, moodiness, or swings between the two Elation, moodiness, or swings between the two[image] A sense of being overwhelmed, a growing feeling of confidence, or swings between the two A sense of being overwhelmed, a growing feeling of confidence, or swings between the two[image] Little interest in sex or, less commonly, stepped-up desire Little interest in sex or, less commonly, stepped-up desire What You Can Expect at Your Postpartum Checkup Your practitioner will probably schedule you for a checkup four to six weeks postpartum. (If you had a cesarean delivery, you may be asked to come in at about three weeks postpartum to have your incision looked at.) During your postpartum visit, you can expect the following to be checked, though the exact rundown of the visit will vary depending on what your particular needs are and your practitioner's style of practice. Don't forget to write down all the questions that are sure to come up (and that you're sure to forget if you don't write them down).

[image] Blood pressure Blood pressure[image] Weight, which may possibly be down by about 17 to 20 pounds Weight, which may possibly be down by about 17 to 20 pounds[image] Your uterus, to see if it has returned to prepregnant shape, size, and location Your uterus, to see if it has returned to prepregnant shape, size, and location[image] Your cervix, which will be on its way back to its prepregnant state but will still be somewhat engorged Your cervix, which will be on its way back to its prepregnant state but will still be somewhat engorged[image] Your vagina, which will have contracted and regained much of its muscle tone Your vagina, which will have contracted and regained much of its muscle tone[image] The episiotomy or laceration repair site, if any; or, if you had a cesarean delivery, the site of your incision The episiotomy or laceration repair site, if any; or, if you had a cesarean delivery, the site of your incision[image] Your breasts Your breasts[image] Hemorrhoids or varicose veins, if you have either Hemorrhoids or varicose veins, if you have either[image] Questions or problems you want to discuss-have a list ready Questions or problems you want to discuss-have a list ready At this visit, your practitioner will also discuss with you the method of birth control that you're planning to use (if you're planning not to get pregnant again immediately, that is). If you plan on using a diaphragm and your cervix has recovered, you will be fitted for one (toss your old one, because it won't fit properly anymore); if you're not fully healed, you may have to use condoms until you can be refitted. Birth control pills may be prescribed now, too, though if you're breastfeeding, your oral contraceptive options will be limited to those that are safe during lactation, such as the progesterone- only minipill. For more on birth control options, see What to Expect the First Year. What to Expect the First Year.

What You May Be Wondering About Exhaustion "I knew I'd be tired after giving birth, but I haven't gotten any sleep in more than four weeks, and I'm so exhausted, it's not funny."

No one's laughing-especially none of the other sleep-deprived new parents out there. And no one's really wondering why you're so exhausted, either. After all, you're juggling endless feeding, burping, changing, rocking, and pacing. You're trying to tackle the mountain of laundry that seems to grow larger and more daunting each day and the pile of thank-you notes that never seem to get written. You're shopping (out of diapers-again?), and you're schlepping (who knew how much baby stuff you'd need to lug just to pick up milk at the supermarket?). And you're doing it all on an average of about three hours' sleep (if you're lucky) a night, with a body that's still recovering from childbirth. In other words, you have multiple good reasons to be calling yourself Our Lady of Perpetual Exhaustion.

Is there a cure for this maternal fatigue syndrome? Not really-at least not until your baby starts sleeping through the night. But in the meantime, there are many ways of regaining some of your get-up-and-go-or at least enough so you can keep getting up and going: Get some help. Hire help if you can afford to. If you can't, rely on volunteers. Now's a good time to let your mom, your mother-in-law, or your best friends lend their helping hands. Suggest they take baby out for a stroll while you grab a power nap or they pick up your groceries, dry cleaning, or that bag of diapers you desperately need. Hire help if you can afford to. If you can't, rely on volunteers. Now's a good time to let your mom, your mother-in-law, or your best friends lend their helping hands. Suggest they take baby out for a stroll while you grab a power nap or they pick up your groceries, dry cleaning, or that bag of diapers you desperately need.

Share the load. Parenting-when there are two parents-is a two-person job. Even if your partner-in-parenting is holding down a 9 to 5, he should be sharing the baby load when he's home. Ditto the cleaning, laundry, cooking, and shopping. Together, divide and conquer the responsibilities, then write down who's on for what and when so there's no confusion. (If you're a single parent, enlist a close friend to help out as much as possible.) Parenting-when there are two parents-is a two-person job. Even if your partner-in-parenting is holding down a 9 to 5, he should be sharing the baby load when he's home. Ditto the cleaning, laundry, cooking, and shopping. Together, divide and conquer the responsibilities, then write down who's on for what and when so there's no confusion. (If you're a single parent, enlist a close friend to help out as much as possible.) Don't sweat the small stuff. The only small stuff that matters right now is your baby. Everything else should take a distant backseat until you're feeling more energetic. So let the dust bunnies breed where they may (even if it's on top of those thank-you notes you don't have time to get to). And while you're ignoring those thank-you notes, buy some time by sending out a bulk e-mail with baby's picture attached. The only small stuff that matters right now is your baby. Everything else should take a distant backseat until you're feeling more energetic. So let the dust bunnies breed where they may (even if it's on top of those thank-you notes you don't have time to get to). And while you're ignoring those thank-you notes, buy some time by sending out a bulk e-mail with baby's picture attached.

Find deliverance. Now that you've delivered, it's time to find stores and restaurants that will deliver, too-whether it's the hot meal you'd never have time to cook, or the rectal thermometer you forgot to buy. Even groceries can find their way to your home via the Internet. Ditto all those baby essentials. Order in bulk so you don't run out of diapers so quickly (but don't buy so far in advance that baby outgrows the diapers before you get a chance to use them). Now that you've delivered, it's time to find stores and restaurants that will deliver, too-whether it's the hot meal you'd never have time to cook, or the rectal thermometer you forgot to buy. Even groceries can find their way to your home via the Internet. Ditto all those baby essentials. Order in bulk so you don't run out of diapers so quickly (but don't buy so far in advance that baby outgrows the diapers before you get a chance to use them).

Sleep when the baby sleeps. Yes, you've heard it before, and probably snorted at the thought. After all, baby's nap time is the only time you can tackle the 300 other things that never seem to get done. But stop snorting and start snoring. Lie down for even 15 minutes during one of the baby's daytime naps, and you'll feel better able to handle the crying when it starts again (in 15 minutes). Yes, you've heard it before, and probably snorted at the thought. After all, baby's nap time is the only time you can tackle the 300 other things that never seem to get done. But stop snorting and start snoring. Lie down for even 15 minutes during one of the baby's daytime naps, and you'll feel better able to handle the crying when it starts again (in 15 minutes).

Feed your baby, feed yourself. Yes, you're busy feeding baby-but don't forget to feed yourself, too. Fight fatigue by grazing on snacks and mini meals that combine protein and complex carbs to serve up long-term energy instead of the momentary rush: string cheese and crackers; trail mix; precut veggies with bean dip; a smoothie; a yogurt, banana, and a granola bar. Keep your fridge, your glove compartment, and your diaper bag stocked with such grab-and-go snacks so you're never running on empty. While sugar and caffeine (that king-size candy bar and that five-shot latte, taken in quick succession) may seem the obvious solution for the energy-challenged, remember this: Though they may give you the boost you crave in the short term, they'll quickly lead to an energy crash and burn. And don't just eat; drink plenty of water, too-not only because you've lost a lot of fluid during delivery, but because dehydration can lead to exhaustion. All of these tips apply to all new moms, but are especially important for nursing moms who are still eating for two. Yes, you're busy feeding baby-but don't forget to feed yourself, too. Fight fatigue by grazing on snacks and mini meals that combine protein and complex carbs to serve up long-term energy instead of the momentary rush: string cheese and crackers; trail mix; precut veggies with bean dip; a smoothie; a yogurt, banana, and a granola bar. Keep your fridge, your glove compartment, and your diaper bag stocked with such grab-and-go snacks so you're never running on empty. While sugar and caffeine (that king-size candy bar and that five-shot latte, taken in quick succession) may seem the obvious solution for the energy-challenged, remember this: Though they may give you the boost you crave in the short term, they'll quickly lead to an energy crash and burn. And don't just eat; drink plenty of water, too-not only because you've lost a lot of fluid during delivery, but because dehydration can lead to exhaustion. All of these tips apply to all new moms, but are especially important for nursing moms who are still eating for two.

If you're really beat, check with your practitioner to rule out any other physical cause responsible for your exhaustion (such as postpartum thyroiditis; see page 460 page 460). If you're feeling a little blue or depressed (see page 456 page 456), take steps to get that under control, too, because baby blues are tied to fatigue as well (and also to thyroiditis). If you get a clean bill of health, rest assured-that is, when you can rest at all-your zombie days are numbered. You will live to sleep again.

Hair Loss "My hair seems to be falling out suddenly. Am I going bald?"

You're not going bald-you're just going back to normal. Ordinarily, the average head sheds 100 hairs a day (just not all at once, so you don't usually notice them), and those hairs are being continually replaced. During pregnancy, however, the hormonal changes keep those hairs from falling out, which means your head hangs on to them (remember how thick your hair felt back in the pregnant days?). But all good things must come to an end, including your reprieve on hair fall. All those hairs that were slated to go during pregnancy will be shed sometime after delivery, usually in the first six months postpartum-and often in unsettling clumps. Some women who are breastfeeding exclusively report that hair fall doesn't begin until they wean their baby or supplement the nursing with formula or solids. You'll take comfort knowing that by the time your baby is ready to blow out the candles on that first birthday cake (and has a full head of hair of his or her own), your hair should be back to normal-and business as usual-too.

To keep your hair healthy, continue taking a vitamin supplement, eat well, and treat your mane humanely. That means shampooing only when necessary (as if you had time for any shampoos now), using a conditioner and/or a detangling leave-on spray to reduce the need to tug at tangles, using a wide-toothed comb if you do have to untangle wet, and avoiding frying your hair with curling or flat irons (as if you have the time to style it, anyway).

Talk to your practitioner if your hair loss seems really excessive.

Postpartum Urinary Incontinence "I thought I'd have more control over my bladder once my baby was born, but I gave birth nearly two months ago and I'm still peeing when I cough or laugh. Is it going to be like this forever?"

So your new-mom bladder is letting you-and your panties-down? It's completely normal to occasionally leak some urine involuntarily in the months (yes, months) following delivery, usually while laughing, sneezing, coughing, or performing any strenuous activity-and it's pretty common (more than a third of moms spring this particular leak postpartum). That's because pregnancy, labor, and delivery weakened the muscles around your bladder and pelvis, making it harder for you to control the flow of urine (it took a licking and therefore keeps on dripping). Plus, as your uterus shrinks in the weeks following delivery, it sits directly on the bladder, compressing it and making it more difficult to stem the tide. Hormonal changes after pregnancy can also batter your bladder.

It can take between three and six months, or even longer, to regain complete bladder control. Until then, use panty liners or pads to absorb leaking urine (no tampons, please-they don't block the flow of urine, because it's a different outlet, and they're off-limits postpartum period anyway), and take these steps to help regain control faster: Keep your Kegels up. Thought you were done with your Kegels now that your baby's delivered? Not so fast. Continuing those pelvic floorstrengthening exercises will help you recover bladder control now and preserve it later on in life. Thought you were done with your Kegels now that your baby's delivered? Not so fast. Continuing those pelvic floorstrengthening exercises will help you recover bladder control now and preserve it later on in life.

Keep your weight down. Start shedding those pregnancy pounds sensibly, because all those extra pounds are still applying pressure on your bladder. Start shedding those pregnancy pounds sensibly, because all those extra pounds are still applying pressure on your bladder.

Train your bladder to behave. Urinate every 30 minutes-before you have the urge-and then try to extend the time between pees, going (without going) a few more minutes each day. Urinate every 30 minutes-before you have the urge-and then try to extend the time between pees, going (without going) a few more minutes each day.

Stay regular. Try to avoid constipation, so full bowels don't put added pressure on your bladder. Try to avoid constipation, so full bowels don't put added pressure on your bladder.

Drink up. Keep drinking at least eight glasses of fluid every day. It might seem that cutting back on water might cut down on the leak, but dehydration makes you vulnerable to UTIs. An infected bladder is more likely to leak, and a leaking bladder is more likely to become infected. Keep drinking at least eight glasses of fluid every day. It might seem that cutting back on water might cut down on the leak, but dehydration makes you vulnerable to UTIs. An infected bladder is more likely to leak, and a leaking bladder is more likely to become infected.

Fecal Incontinence "I'm so embarrassed because I've been passing gas involuntarily lately and even leaking a little feces. What can I do about it?"

As a new mother, you definitely expected to be cleaning up after your baby-but you probably didn't count on cleaning up after yourself. Yet some newly delivered moms do add fecal incontinence and the involuntary passing of gas to that long list of unpleasant postpartum symptoms. That's because during labor and childbirth, the muscles and nerves in the pelvic area are stretched and sometimes damaged, which can make it difficult for you to control how and when waste (and wind) leaves your body. In most cases, the problem takes care of itself as the muscles and nerves recover, usually within a few weeks.

Until then, skip hard-to-digest foods (nothing fried, no beans, no cabbage), and avoid overeating or eating on the run (the more air you gulp, the more you are likely to pass it as gas). Keeping up with your Kegels can also help tighten up those slack muscles as well as the ones that control urine (which also may be leaking these days).

Help for Leaks That Won't Let Up Tried every do-it-yourself trick for dealing with postpartum urinary or fecal incontinence-including Kegel-ing until you're blue in the face-but you're still left with a leak? Don't let embarrassment keep you from talking to your practitioner. He or she might suggest biofeedback (a mind-body technique that can be surprisingly effective in relieving incontinence), other treatments, or in a particularly tough case, surgery. Fortunately, the situation most often resolves itself without that kind of intervention.

Postpartum Backache "I thought all my back pain would go away after delivery, but It hasn't. Why?"

Welcome back, backache. If you're like nearly half of all newly delivered moms, your old pal from pregnancy has returned for an unwelcome visit. Some of the pain still has the same cause-hormonally loosened ligaments that haven't yet tightened up. It may take time, and several weeks of soreness, before these ligaments regain their strength. Ditto for the stretched-out and weakened abdominal muscles that altered your posture during pregnancy, putting strain on your back. And of course, now that you've got a baby around, there's another reason for that pain in your back: all that lifting, bending, rocking, feeding, and toting you're doing. Especially as that cute little load you're carrying around gets bigger and heavier, your back will be up against growing stress and strain.

While time heals most things, including those postpartum aches and pains, there are other ways to get your back back on track: [image] Tone that tummy. Ease into some undemanding exercises, like pelvic tilts, that will strengthen the muscles that support your back. Tone that tummy. Ease into some undemanding exercises, like pelvic tilts, that will strengthen the muscles that support your back.[image] Mend when you bend. And lift. Give your back a break by bending from your knees to pick up that dropped diaper or lift that baby. Mend when you bend. And lift. Give your back a break by bending from your knees to pick up that dropped diaper or lift that baby.[image] Don't be a slouch on the couch. When feeding your baby, don't slump over (as tempting as that might be, given your state of exhaustion). Your back will thank you if it's well supported (using pillows, armrests, or whatever else lets you sit pretty). Don't be a slouch on the couch. When feeding your baby, don't slump over (as tempting as that might be, given your state of exhaustion). Your back will thank you if it's well supported (using pillows, armrests, or whatever else lets you sit pretty).[image] Get off your feet. Sure, you're running (and rocking) all the time, but whenever you don't have to, take a seat. When you have to stand, placing one foot on a low stool will take some pressure off your lower back. Get off your feet. Sure, you're running (and rocking) all the time, but whenever you don't have to, take a seat. When you have to stand, placing one foot on a low stool will take some pressure off your lower back.[image] Watch your posture. Listen to your mom, Mom-and stand up straight, even when you're swaying from side to side. Slouched shoulders result in an aching back. As your baby gets bigger, avoid resting that growing weight on one hip, which will throw your back off further, plus lead to hip pain. Watch your posture. Listen to your mom, Mom-and stand up straight, even when you're swaying from side to side. Slouched shoulders result in an aching back. As your baby gets bigger, avoid resting that growing weight on one hip, which will throw your back off further, plus lead to hip pain.[image] Put your feet up. Who deserves to put their feet up more than you? Plus, elevating your feet slightly when sitting-and baby feeding-will ease the strain on your back. Put your feet up. Who deserves to put their feet up more than you? Plus, elevating your feet slightly when sitting-and baby feeding-will ease the strain on your back.[image] Wear your baby. Instead of always holding your baby, wear him or her in a baby carrier or a sling. Not only will it be soothing to baby, it'll be soothing to your achy back and arms. Wear your baby. Instead of always holding your baby, wear him or her in a baby carrier or a sling. Not only will it be soothing to baby, it'll be soothing to your achy back and arms.[image] Pull a switch. Many moms play favorites with their arms, always carrying (or bottle feeding) their baby in one arm or the other. Instead, alternate arms so they each get a workout (and your body doesn't get a lopsided ache). Pull a switch. Many moms play favorites with their arms, always carrying (or bottle feeding) their baby in one arm or the other. Instead, alternate arms so they each get a workout (and your body doesn't get a lopsided ache).[image] Rub it. A professional massage, if you can spare the time and the change, is definitely what your muscles are aching for. But in a pinch, ask your spouse to step in and rub. Rub it. A professional massage, if you can spare the time and the change, is definitely what your muscles are aching for. But in a pinch, ask your spouse to step in and rub.[image] Turn up the heat. A heating pad can spell relief from back pain and muscle aches. Apply it often, especially during those marathon feeding sessions. Turn up the heat. A heating pad can spell relief from back pain and muscle aches. Apply it often, especially during those marathon feeding sessions.

As your body adjusts to pumping baby, you'll probably find that pain in your back (and arms, and hips, and neck) diminishing, and you may even find yourself sporting some brand-new triceps. In the meantime, here's something else that might help ease your aches by easing your load: Empty that diaper bag. Lug around only what you absolutely need, which is plenty heavy anyway.

Baby Blues "I was sure I'd be thrilled once my baby was born. But I'm feeling down instead. What's going on?"

It's the best of times; it's the worst of times. And it's how an estimated 60 to 80 percent of new moms feel after childbirth. So-called baby blues appear (appropriately) out of the blue-usually three to five days after delivery, but sometimes a little earlier or a little later-bringing on unexpected sadness and irritability, bouts of crying, restlessness, and anxiety. Unexpected because-well, for one thing, isn't having a baby supposed to make you happy, not miserable?

It's actually easy to understand why you're feeling this way if you step back for a moment and take an objective look at what's been going on in your life, your body, and your psyche: rapid changes in hormone levels (which drop precipitously after childbirth); a draining delivery, followed by an exhausting homecoming, and all compounded by the round-the-clock demands of newborn care; sleep deprivation; possible feelings of letdown (you were expecting motherhood to come naturally-it hasn't; you were expecting cute and round-you got puffy and cone-headed); breastfeeding stumbling blocks (sore nipples, painful engorgement); unhappiness over your looks (the bags under your eyes, the pooch around your belly, the fact that there are more dimples on your thighs than on your baby's); and stress in your relationship with your partner (what relationship?). With such an overwhelming laundry list of challenges to confront (and don't even get you started on the laundry that's on that list), it's no wonder you're feeling down.

The baby blues will likely fade over the next couple of weeks as you adjust to your new life and start getting a little more rest-or, more realistically, begin functioning more effectively on less rest. In the meantime, try the following tips to help lift yourself out of that postpartum slump: Lower the bar. Feeling overwhelmed and inadequate in your role as a newbie mom? It may help to remember that you won't be for long. After just a few weeks on the job, you're likely to feel much more comfortable in those maternal shoes. In the meantime, lower your expectations for yourself-and for your baby. Then lower them some more. Make this your mantra, even after you've become a parenting pro: There's no such thing as a perfect parent, or a perfect baby. Expecting too much means you'll be letting yourself down-and bringing your mood down, too. Instead, just do the best you can (which at this point may not be as well as you'd like, but that's okay). Feeling overwhelmed and inadequate in your role as a newbie mom? It may help to remember that you won't be for long. After just a few weeks on the job, you're likely to feel much more comfortable in those maternal shoes. In the meantime, lower your expectations for yourself-and for your baby. Then lower them some more. Make this your mantra, even after you've become a parenting pro: There's no such thing as a perfect parent, or a perfect baby. Expecting too much means you'll be letting yourself down-and bringing your mood down, too. Instead, just do the best you can (which at this point may not be as well as you'd like, but that's okay).

Don't go it alone. Nothing is more depressing than being left alone with a crying newborn, that mountain of spit-up-stained laundry, a leaning tower of dirty dishes, and the promise (make that guarantee) of another sleep-deprived night ahead. So ask for help-from your spouse, your mother, your sister, your friends, a doula, or a cleaning service. Nothing is more depressing than being left alone with a crying newborn, that mountain of spit-up-stained laundry, a leaning tower of dirty dishes, and the promise (make that guarantee) of another sleep-deprived night ahead. So ask for help-from your spouse, your mother, your sister, your friends, a doula, or a cleaning service.

Get dressed. Sounds trite, but it's surprisingly true. Spending a little time making yourself look good will actually help you feel good. So hit the shower and maybe even the blow-dryer before your spouse hits the commuter train, trade in the stained sweats for a clean pair, and consider applying a little makeup (and a lot of concealer). Sounds trite, but it's surprisingly true. Spending a little time making yourself look good will actually help you feel good. So hit the shower and maybe even the blow-dryer before your spouse hits the commuter train, trade in the stained sweats for a clean pair, and consider applying a little makeup (and a lot of concealer).

Get out of the house. It's amazing what a change of scenery can do for your state of mind-especially when the scenery suddenly doesn't include that pile of unopened mail (and unpaid bills). Try to get out of the house at least once a day: Take your baby for a walk in the park, visit with friends (and, if your friends are also moms, you can swap sob stories-and then laugh about them), stroll the mall. Anything that will keep you from hosting another self-pity party. It's amazing what a change of scenery can do for your state of mind-especially when the scenery suddenly doesn't include that pile of unopened mail (and unpaid bills). Try to get out of the house at least once a day: Take your baby for a walk in the park, visit with friends (and, if your friends are also moms, you can swap sob stories-and then laugh about them), stroll the mall. Anything that will keep you from hosting another self-pity party.

Treat yourself. Try a movie, a dinner date with your spouse, a 30-minute manicure (someone's bound to agree to watch the baby for that long), or even a long shower. Occasionally, make yourself a priority. You deserve it. Try a movie, a dinner date with your spouse, a 30-minute manicure (someone's bound to agree to watch the baby for that long), or even a long shower. Occasionally, make yourself a priority. You deserve it.

Get moving. Exercise boosts those feel-good endorphins, giving you an all- natural (and surprisingly lasting) high. So join a postpartum exercise class (preferably one that includes babies in the fun or at a club that offers child care), work out to an exercise DVD, step out for some stroller exercise (exercises that tone with the help of a stroller full of baby), or just simply step out for a walk. Exercise boosts those feel-good endorphins, giving you an all- natural (and surprisingly lasting) high. So join a postpartum exercise class (preferably one that includes babies in the fun or at a club that offers child care), work out to an exercise DVD, step out for some stroller exercise (exercises that tone with the help of a stroller full of baby), or just simply step out for a walk.

Be a happy snacker. Too often, new moms are too busy filling their babies' tummies to worry about filling their own. A mistake-low blood sugar sends not only energy levels plummeting but moods, too. To keep yourself on a more even keel, physically and emotionally, stash sustaining, easy-to-munch snacks within quick reach. Tempted to reach for a chocolate bar instead? Reach away-especially if chocolate really makes you happy-just not too often, because sugar-induced blood sugar highs have a way of crashing quickly. Too often, new moms are too busy filling their babies' tummies to worry about filling their own. A mistake-low blood sugar sends not only energy levels plummeting but moods, too. To keep yourself on a more even keel, physically and emotionally, stash sustaining, easy-to-munch snacks within quick reach. Tempted to reach for a chocolate bar instead? Reach away-especially if chocolate really makes you happy-just not too often, because sugar-induced blood sugar highs have a way of crashing quickly.

Cry-and laugh. If you need a good cry, go for it. But when you're done, turn on a silly sitcom and laugh. Laugh, too, at all the mishaps you're likely having (instead of crying over them)-you know, the diaper blowout, the breasts that leaked in line at the market, the spit-up that spewed only after you realized you left home without wipes. You know what they say: Laughter is the best medicine. Plus, a good sense of humor is a parent's best friend. If you need a good cry, go for it. But when you're done, turn on a silly sitcom and laugh. Laugh, too, at all the mishaps you're likely having (instead of crying over them)-you know, the diaper blowout, the breasts that leaked in line at the market, the spit-up that spewed only after you realized you left home without wipes. You know what they say: Laughter is the best medicine. Plus, a good sense of humor is a parent's best friend.

Still blue, no matter what you do? Keep on reminding yourself that you'll outgrow the baby blues within a week or two-most moms do-and you'll be enjoying the best of times, most of the time, in no time.