Going Home Booklet
Essential information on Mother Care,
Newborn Breastfeeding and Newborn Care
HOSPITAL TO HOME
Channel 5
Information on mother care after, newborn breastfeeding and newborn
care (approximate length: 35 minutes)
English viewing times:
6:15 a.m.
8:50 a.m. 11:10 a.m. 1:30 p.m. 3:50 p.m
6:10 p.m.
8:30 p.m. 10:50 p.m. 12:00 a.m. 1:10 a.m.
2:20 a.m.
3:40 a.m. 4:50 a.m.
Spanish viewing times:
6:50 a.m.
9:25 a.m. 11:45 a.m. 2:05 p.m. 4:25 p.m.
6:45 p.m.
9:05 p.m. 11:25 p.m. 12:35 a.m. 1:45 a.m.
2:55 a.m.
4:15 a.m. 5:25 a.m.
SAFE SLEEP
Channel 4 or www.firstcandle.org
This program provides education that ‘back is best’ for baby’s sleep and offers other tips for parents. (approximate length: 16 minutes)
English viewing time:
12:55 p.m.
Spanish viewing time:
No showing-currently under repair
GOING HOME
BOOKLET
Congratulations...............................................1
Resources..........................................................1
Lactation...........................................................1
Enloe Health Learning Center...................... 2
MOTHER CARE
General Information.......................................2
Typical Physical Changes...............................2
Uterus................................................................3
Bleeding............................................................3
Pericare.............................................................3
Episiotomy........................................................3
Hemorrhoids....................................................3
Activity, Rest, Driving & Exercise................ 3
Cesarean Birth.................................................4
Recognizing Postpartum Depression &
Postpartum Blues............................................4
Sexual Activity & Birth Control................... 7
Diet.....................................................................7
Pain Management...........................................7
When to Call Your Obstetric Provider....... 7
NEWBORN BREASTFEEDING
General Information.......................................8
When to Feed..................................................8
Baby Behaviors & Feeding Cues.................. 8
Positioning........................................................9
Latching.............................................................9
Engorgement....................................................9
Tender Nipples...............................................10
Is My Baby Getting Enough to Eat?..........10
Hand Expressing Breastmilk.......................10
Pumping & Storage of Breastmilk.............10
Breastfeeding Resources.............................13
NEWBORN CARE
Umbilical Cord Care.....................................13
Circumcision Care.........................................13
Congenital Heart Disease Screening........14
Care of the Uncircumcised Penis..............14
Jaundice (Yellow Skin)..................................14
Diaper Care....................................................14
Stools / Soiled Diapers.................................15
Urination / Wet Diapers..............................15
Temperature Taking......................................15
Reducing the Risk of Sudden Infant Death
Syndrome (SIDS)
& A Safer Sleep Environment.....................15
Carseat Safety...............................................16
Preventing Shaken Baby Syndrome..........17
Bath & Skin Care...........................................17
Behaviors: Crying & Sleeping.....................18
RSV Prevention.............................................19
Bulb Suctioning.............................................19
Newborn Screening......................................20
Newborn Hearing Screening......................20
Sibling Adjustment........................................20
When to Call Your Baby’s Provider...........21
Your Baby Night Owl...................................22
Breastfeeding Log............ Inside Back Cover
Learning Menu.............................. Back Cover
CONGRATULATIONS ON THE BIRTH
OF YOUR NEW BUNDLE OF JOY!
Bringing a new baby home from the hospital can be a very exciting and possibly an overwhelming
experience. We at Enloe Medical Center are happy to provide you with this Going Home booklet, which
offers information designed to help guide you through your first few weeks after delivery. The booklet
includes basic information on caring for yourself, newborn breastfeeding and newborn care.
As you journey into your new role as a parent, many questions and concerns about caring for yourself,
your baby and your family will arise. We encourage you to attend Enloe’s “Baby and Me” parenting
education class series. The six-class “Bittie Baby and Me” series is free of charge to mothers who deliver
their baby at Enloe Medical Center. For details on Enloe’s parenting education classes, please refer to the
“Bittie and Bigger Baby and Me” class calendar provided.
RESOURCES
Enloe Mother & Baby Education Center
530-332-3970
Enloe provides a full and rich education program that includes classes for before and after your baby is
born. We offer classes that help you prepare for childbirth, the care of your newborn and breastfeeding.
In addition, our safety classes include infant and pediatric CPR techniques for parents, grandparents
& babysitters. When your baby is born, you may want to take advantage of our classes that provide
information, techniques and tips on positive parenting in the first year of life, which is an essential time
in a child’s healthy and lifelong development. Please refer to the Mother & Baby Education brochure
attached to your Bittie Baby & Me gift certificate for class dates, times and information.
Enloe Mother & Baby Boutique
530-332-3970
You will find items designed for before and after baby’s birth. Upon arrival you will be greeted and
assisted by trained personnel ready to help you with the selection of that perfect bra, breast pump,
pillow and other items you may want or need.
Northern Valley Indian Health
530-332-6000
In partnership with Chico pediatricians, the Northern Valley Indian Health strives to keep children
healthy. Pediatric nurse practitioners care for newborns, children and adolescents through 18 years of
age. All insurances are accepted, including Healthy Families, as well as Medi-Cal.
LACTATION
Inpatient
All RN’s in the Enloe Mother & Baby Care Center have extensive breastfeeding education, to assist you
and your baby getting off to the best start possible. If needed, lactation specialists are available.
Outpatient
At Enloe Mother & Baby Education Center, we offer lactation assistance before and after the birth of
your baby. Our outpatient setting is staffed by International Board Certified Lactation Consultant, who
can provide private consultation.
1
Fees
$65 for initial consult (approx.1 hour)/ $40 for follow-up. If you would like to schedule an appointment,
please call 530-332-3970. *At this time we are not able to provide direct billing through your insurance,
however, we will provide you with documentation that you can submit for possible reimbursement.
Additional breastfeeding support resources available are:
Butte County Public Health Department
530-891-2732
Better Babies (Medi-Cal clients only)
530-894-5585
La Leche League of Chico
530-893-2890 or 530-966-5391
WIC (Qualifying clients only)
Chico
530-891-2767
Marysville 530-749-4830
Orland 530-865-8791
Oroville 530-538-7455
Red Bluff
530-527-8791
Willows
530-865-8791
Yuba City 530-822-7224
Websites for General Breastfeeding Information:
www.lalecheleague.org
www.breastfeeding.com
www.kellymom.com
www.4women.gov/breastfeeding
www.ilca.org
www.helpcentral.org
ENLOE HEALTH LEARNING CENTER
The Enloe Health Learning Center is a community library that provides health care information through
books, Internet access, multimedia resources and more. The library is free and open to the public. The Health
Learning Library is located at 1465 Esplanade (at 5th Avenue), open Monday – Friday 8 a.m. – 5 p.m. For more
information about the Enloe Health Learning Center, call 530-332-7323 or visit www.enloe.org/library.
MOTHER CARE
GENERAL INFORMATION
Now that you have become a new mother, you may notice many physical and emotional changes. The
following information is to help guide you through these normal physical changes as you heal from the
birth of your baby and move into your new role as a parent.
TYPICAL PHYSICAL CHANGES
•
•
•
•
•
•
•
•
Dry skin
Mood changes
Night sweats and hot flashes
Swelling
Hair loss in the early months after delivery
Vaginal dryness
Increased amounts of urine
Slow, gradual weight loss
2
UTERUS
After delivery, your uterus begins to return to its pre-pregnancy position and size. This is known as involution.
Avoid lifting anything heavier than your baby for approximately four to six weeks after delivery. You may notice
intermittent uterine cramping, especially during and after breastfeeding your baby. Medications such as: Tylenol, 2
tablets every 3-4 hours or Motrin (Ibuprofen) 2 tablets every 6 hours can be taken for pain or cramping as needed.
It is normal to have vaginal bleeding that is similar to a heavy period for about one to three days after delivery. After
delivery, vaginal blood flow, known as lochia, usually decreases in amount, and changes in color from dark red to pale
red to light brown to clear. Typically, lochia lasts up to six weeks after delivery. Please call your Obstetric Provider
if you saturate more than one peri-pad in one hour or have blood clots larger than the size of a quarter. If you are
breastfeeding, you may notice increased blood flow and uncomfortable cramping when your baby nurses. Do not
use tampons, douche or have sexual intercourse for about four to six weeks after birth. Also, avoid using swimming
pools and hot tubs for approximately six weeks after delivery. Always follow your Obstetric Provider’s instructions.
PERICARE
For approximately 10 to 14 days after birth, fill a peri-bottle with plain warm water and spray it onto the outside and
around your vaginal area to keep area clean. Staying clean lowers the chance of infection and helps the healing process.
EPISIOTOMY
If you had an episiotomy or tear due to the birth of your baby, your Obstetric Provider may have used
stitches to repair your vaginal area. These stitches will typically dissolve in about fourteen days after
delivery. To decrease swelling and pain, place ice packs against the outside of your vaginal area for about
6 to 12 hours after delivery. If your Obstetric Provider instructs you to soak in a bathtub after delivery,
make sure not to add any perfumes, soaps or bubble bath ingredients to the water. Placing these
chemicals into your bath water could increase your chance of infection to the area around your vagina or
to your uterus. You can take Tylenol, 2 tablets every 3-4 hours as needed for pain.
HEMORRHOIDS
It is not unusual during pregnancy or after the birth of your baby to have hemorrhoids. Hemorrhoidal pain
can be relieved by using ice packs, cold pads with witch hazel or hemorrhoidal pads, such as Tucks to your
rectal area. Consult your Obstetric Provider before using any creams, suppositories or stool softeners.
Maintain a diet high in fiber, such as: whole grain cereals, bran muffins, fruits and vegetables. Also, make sure
you drink plenty of fluids to maintain proper hydration. Eventually, your hemorrhoids will shrink or decrease
in size and become less uncomfortable. If not, inform your Obstetric Provider. If needed for hemorrhoid pain
or discomfort, try taking stool softeners such as: Metamucil or Dialose. If that does not work, take Senekot,
Milk of Magnesia or other similar laxatives, which can be used occasionally. Your first bowel movement
may not occur until the third or fourth day after delivery. For persistent problems with hemorrhoids or
constipation, use a fiber laxative such as: Metamucil, Fibercon or Citracel daily for 2-4 weeks.
ACTIVITIES, REST, DRIVING & EXERCISE
Activity and rest are very important for all new moms. The physical efforts of labor, birth and caring for
your newborn, along with the emotional challenges that a new baby places on your family, can be tiring.
Rest as much as you can and try to nap when your baby naps.
If weather permits, try taking short walks outside every day. Take care of yourself and your baby, only doing
light housework if you feel up to it. Allow friends and family members to help with meals, laundry, vacuuming,
and heavy cleaning. Do not lift anything over 10 pounds, including your baby, for two weeks after vaginal
delivery and six weeks after cesarean section. Obstetric Providers recommend not driving a car except in an
emergency for the first week after a vaginal delivery and after two weeks or more for a cesarean section.
3
MOTHER CARE
BLEEDING
CESAREAN BIRTH
The steri-strips on your abdominal incision usually fall off within one to two weeks after the surgery.
Please notify your Obstetric Provider if you notice any signs of infection at your incision site, such as foul
smelling drainage, chills and fever over 100.3°F, or separation at your incision site.
RECOGNIZING POSTPARTUM DEPRESSION
AND POSTPARTUM BLUES
There is help and you are not alone.
Having a baby can bring many changes into a new mother’s life and
sometimes these changes can be overwhelming.
It is common for new mothers to have the “baby blues” or mood
changes within the first two weeks after delivery; however, some
mothers struggle for a longer period of time. Postpartum blues
can begin between the third and tenth day after delivery. If you have
postpartum blues, you may experience mood swings, loss of appetite
and crying spells for no known reason. These feelings are normal and
typically go away after about two weeks. It is recommended to keep
your daily activities simple. It will also be helpful to eat nutritious meals,
including plenty of vegetables, fruits, whole grain cereals, protein, and
dairy products. Additionally, share your feelings and thoughts with
others whom you trust, and attend one of Enloe’s “Baby and Me”
classes for parenting education and support.
If your mood changes or lasts for longer than two weeks, then you
may have postpartum depression, and should contact your Obstetric
Provider.
Signs of Postpartum Depression
It is easy to confuse the symptoms of postpartum depression with normal hormonal changes.
How can you tell if it’s serious?
Watch for these symptoms:
• Feeling anxious, sad and alone
• Without energy and very tired
• Without interest in normal activities
• Changes in sleeping or eating patterns
• Feeling hopeless, helpless, worthless or guilty
• Irritable and moody
• Problems concentrating and a hard time making simple decisions
• Thoughts about hurting and/or killing yourself or your baby (even if you will not act on these thoughts)
What you should know
Postpartum depression affects approximately 10 percent to 15 percent of new mothers in the United States.
It can occur any time in your baby’s first year, not just within the first few weeks after birth.Women who have
a personal or family history of depression are more likely to become depressed during pregnancy and/or after
birth. Depression can also be caused by lack of support, stress, hormonal changes, trauma and other factors.
Although postpartum depression is common, it is serious and treatable. If you think you have postpartum
depression, you need to get help. It will not go away or get better on its own, but with treatment, you
can feel like yourself again.
4
Things you can do
It is important to take care of yourself, so you can enjoy your baby and family. Here are some ways to
take care of yourself.
• Ask for help. Talk to your Obstetric Provider, attend a support group and ask a loved one to help you
get the care you need. If it is an emergency, call the Butte County Crisis Line at 530-891-2810
• Ask your Obstetric Provider about medications that can be safely used for postpartum depression
• Talk to a therapist, alone or in group therapy
• Ask your faith or community leaders about other support resources
• Learn as much as you can about postpartum depression
• Ask family or friends for support and help when you need it
• Keep active by walking and stretching
• Get plenty of rest
• Eat healthy foods and drink plenty of healthy fluids
DON’T GIVE UP!
It may take more than one try to get the help you need!
Edinburgh Depression Screening Test
Please complete the questionnaire by circling the answer that most closely matches how you have
felt in the last seven days. After you are done, add up your results and compare them to the score
interpretation.
1.
I have been able to laugh and see the funny side of things:
As much as I always could
0
Definitely not so much now Not quite so much now
1
Not at all
2
3
2.
I have looked forward with enjoyment to things:
As much as I ever did
0
Definitely less than I used to
A little bit less than I used to
1
Hardly at all
2
3
3.
4.
5.
I have blamed myself unnecessarily when things went wrong:
No, never
0
Yes, some of the time
Not very often
1
Yes, most of the time
2
3
I have been anxious or worried for no good reason:
No, not at all
0
Yes, sometimes
Hardly ever
1
Yes, most of the time
2
3
I have felt scared or panicky for no good reason:
No, not at all
0
Yes, sometimes
No, not much
1
Yes, quite a lot
2
3
6.
Things have been getting on top of me:
No, I’ve been coping as well as ever No, most of the time I’ve coped well
Yes, sometimes I haven’t been coping as well as usual
Yes, most of the time I haven’t been able to cope
7.
I have been so unhappy, that I have had difficulty sleeping:
No, not at all
0
Yes, sometimes
Not very often
1
Yes, most of the time
5
0
1
2
3
2
3
8.
I have felt sad and miserable:
No, never
0
Not very often
1
Yes, some of the time
Yes, most of the time
2
3
9.
I have been so unhappy that I have been crying:
No, never
0
Yes, quite often
Only occasionally 1
Yes, most of the time
2
3
10.
The thought of harming myself has occurred to me:
Never
0
Sometimes
Hardly ever
1
Yes, quite often
2
3
Score Interpretation
1-10 No further screening required
11-14 Repeat test in two weeks
15+ Contact your physician
1. Source: Cox, J.L., Holden, J.M., and Sagovsky, R. 1987. Detection of postnatal depression: Development of the 10-item Edinburgh Postnatal
Depression Scale. British Journal of Psychiatry 150:782-786.
2.Source: K.L. Wisner, B.L., Parry, C.N. Piontek, Postpartum Depression, N Engl J Med vol. 347, No 3, July 18, 2002. 194-199.
The Best Treatment
The most effective treatment for depression includes:
• Individual or group support and therapy
• Medicine that can be safely used during pregnancy and breastfeeding (prescribed by your Obstetric
Provider)
• Support from family, friends and community
If you suspect that you have depression, what should you do?
• Contact your physician
• Participate in a support group
• Refer to resources listed below
Community Resources
Enloe Mother & Baby Education Center
Enloe Behavioral Health
Butte County Public Health
Butte County Crisis Line
Counselors
Lisa Jellison, LCSW
Vicki Tullius, LCSW
Karen Rose, MFT
530-332-3970
530-332-5250
530-891-2732 / 530-538-7553
530-891-2810
530-898-9008
530-342-2558
530-680-0178
National Resources
Postpartum Support International
800-944-4773
Depression After Delivery
800-944-4773
Postpartum Depression Online Support www.ppdsupportpage.com
http://ww.2020mom.org
6
SEXUAL ACTIVITY AND BIRTH CONTROL
Please follow your Obstetric Provider’s recommendations on when you can begin sexual activity and
what birth control options are available. It is important to note that you can become pregnant while
breastfeeding, even when you are not having a typical menstrual cycle.
DIET
After giving birth, it is important to maintain a healthy
varied diet that includes leafy green vegetables, foods
high in protein, whole grain cereals and breads, dairy
products and fruit. Drink plenty of fluids, making sure
you have at least 6 to 10 glasses of water, juice or milk
each day. Try to limit the amount of empty calories
that you eat each day, such as: sugar, soda, saturated
fats, processed foods and excessive carbohydrates.
To prevent anemia, or low blood levels of iron, eat
foods that are high in iron. Some excellent sources of
iron-rich foods are: red meats, chicken, clams, oysters,
pork and turkey. Some good sources of iron rich
foods are: iron-fortified bread and cereals, leafy green
vegetables, dried beans and peas, nuts (almonds,
cashews, peanuts and pecans), and dried fruits (raisins,
figs, prunes, apricots, peaches and pears).
Please note that your body absorbs iron from animal-based foods better than from plant-based foods. To help
your body absorb plant iron, include a source of Vitamin C with your iron rich meal. Sources of Vitamin C are:
citrus fruit or juice, melons, strawberries, tomatoes, broccoli, and most deep-colored fruits and vegetables.
PAIN MANAGEMENT
Follow your Obstetric Provider’s instructions on the use of pain medications and pain management. If
you are not experiencing adequate pain relief, please call your Obstetric Provider.
WHEN TO CALL YOUR OBSTETRIC PROVIDER
If you have any of these warning signs:
• Postpartum blues that do not go away after several weeks or postpartum depression
• Fever at or above 100.3°F
• Worsening perineal pain
• Infection of your uterus symptoms such as: a foul-smelling odor, constant pain in your lower abdomen
or severe cramping
• Urinary tract infection symptoms such as: increased frequency of urination and pain or burning with
urination
• Breast infection symptoms such as: a painful red lump or hardened area in the breast, along with a
fever and flu-like symptoms
• Heavy bleeding, where more than one peri-pad is saturated within one hour or if there are clots
larger than the size of a quarter
• Persistent headaches, dizziness or seeing spots in front of your eyes
• Red, tender or swollen area in leg
• Cesarean incision becomes reddened, separated or has a foul-smelling odor
• You feel as if you may hurt yourself or your baby
7
NEWBORN BREASTFEEDING
The American Academy of Pediatrics (AAP) encourages moms to exclusively breastfeed their babies for
the first six months of life.
The AAP also recommends that breastfeeding continue into the child’s second year of life.
GENERAL INFORMATION
• Wear a well-fitting bra for comfort
• Wash your hands prior to breastfeeding your baby
• Use pillows to support your arm and baby during
nursing, especially in the first few weeks
• Baby should lay with his/her tummy facing mom’s
tummy
• Baby should be brought to breast, not breast to
baby
• Baby’s nose should be at nipple level
• Good latch starts with lower jaw first
• Baby’s nose and chin should touch mom’s
breast (A baby’s nose is designed to breathe and
breastfeed at the same time.)
• If supporting the breast is necessary, simply roll up
a washcloth or small receiving blanket and wedge it
under the breast for “hands free” support
• Avoid pacifiers, especially in the first three weeks
after your baby is born. Pacifiers can cause nipple
confusion and interfere with milk production. They
have also been linked to ear infections
WHEN TO FEED
If possible, start breastfeeding within the first hour
after birth. The skin-to-skin contact that results from
keeping your baby close to you will increase your
baby’s interest and success with breastfeeding. Offer
your breast at least 8 to 12 times within a 24-hour
period, or whenever your baby shows feeding cues.
This is an important reason to have your baby room in
with you.
BABY BEHAVIORS & FEEDING CUES
•
•
•
•
•
•
Licking lips
Clenched hands
Flexed arms and legs
Rooting
Sucking fists and fingers
Crying is the last sign of hunger. (it’s best not to wait for this to occur, as baby may be too upset to
latch on.)
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POSITIONING
Correct positioning is important in preventing sore nipples and to ensure that your baby receives plenty
of breastmilk. The most common breastfeeding positions are:
Cradle Hold: Mother sits up straight and places a pillow across her lap. Baby is brought to the breast in
a “tummy-to-tummy” position with his or her arms straddling the breast. Care is taken to keep the baby
tucked close to mother’s body. Baby’s head can be supported in the center of mother’s forearm or by the
opposite hand and wrist (cross-cradle). The cross-cradle position often helps improve latching.
Football Hold: Mother sits up straight with support for her back. She then stacks pillows at her side to
the nipple level. Baby is placed on the pillow(s) and brought back to where baby’s nose is in alignment
with mother’s nipple. Mother then uses her hand and forearm to support baby’s neck and back as she
brings baby to the position for latch.
Side Lying: Mother and baby both lay on their sides so they are both “tummy-to-tummy.” Baby’s arms
straddle the breast.
Reclined: In a lying back position bring baby to you with baby’s whole front touching your whole front
(tummy to tummy). Baby’s arms straddle the breast and gravity will keep him/her in position.
When your baby opens his mouth wide: point nipple to roof of baby’s mouth and latch him or her onto
as much areola (darker brown area around nipple) as possible. Also, make sure you place your finger
between the baby’s mouth and your breast to break suction before removing your baby from the breast.
Consult your physician or lactation consultant if sore nipples persist.
ENGORGEMENT-TREATMENT
Engorgement is a natural process that typically occurs as mother’s milk
comes in. This usually happens around the 3rd to 5th day postpartum. The
swelling that occurs with engorgement is 50% milk and 50% soft tissue
swelling. The soft tissue swelling typically reduces dramatically in 24
hours and is totally gone by 2 weeks postpartum. Mild analgesics, such as
Tylenol, 2 tablets every 3-4 hours can be taken as needed for pain.
Prevention
• Frequent unlimited feedings
• Close attention to proper latching and positioning
• Evaluation and guidance if diagnosed with inverted or flat nipples
Treatment
• Feed every 2-3 hours especially in the early weeks (at least 8-12 times a day)
• Allow baby to suckle at least 15-20 minutes on the first side before switching sides
• Assure latching and positioning techniques are good to facilitate effective draining of the breast (not
nipple sucking)
• Apply warm moist compress to breast 2-3 minutes prior to nursing to induce let down of milk
• Use your hand or breast pump to express milk prior to latch, if areola is firm and baby is having
difficulty with latch
• Massage in small circles around perimeter of breast while infant nurses to increase milk transfer
• Use cool compresses after feedings for comfort
• May pump after feedings if necessary; pump only the milk that flows easily then stop
• Take warm showers and allow breasts to drain naturally
• Call a lactation specialist or your Obstetric Provider if these suggestions do not help
9
NEWBORN BREASTFEEDING
LATCHING
TENDER NIPPLES
Tenderness is normal for the first few days; however, pain throughout breastfeeding is not. Blisters,
cracking or bruising on the nipples or breasts are all signs of latching difficulty. If any of these occur,
notify your Obstetric Provider or lactation specialist. Try hand expressing a small amount of colostrum or
breastmilk on the end of your nipples and allow to air dry. Pure lanolin cream can be used to keep nipples
from getting dry and cracked. Pure lanolin cream does not need to be washed off before breastfeeding.
Do not use deodorant soap on your breasts or nipples. The Montgomery glands, which are the bumps
on your breast areola (darker brown area around the breast nipple), secrete a natural lubricant and
antibacterial substance that decreases the chance of breast infection and helps keep the breast skin soft.
IS MY BABY GETTING ENOUGH TO EAT?
In the beginning it may be difficult to tell if your baby is getting enough breastmilk. Here are some
guidelines: Satisfied babies appear very relaxed after breastfeeding (Fists will unclench and arms will
hang loose down by their sides). Your baby’s wet and dirty diapers will change in number, color and
consistency over the first seven days. (Please see the breastfeeding log located on the inside back cover
of this book for a day-to-day reference guide). Listen for swallows. These may sound like exaggerated
exhales and may be hard to hear in the beginning. Once your mature milk comes in (usually three to
five days), your breasts should feel softer after feedings. In the early days after birth, it is encouraged to
awaken your baby at least every two to three hours during the day and night for feedings. If your baby
is feeding well during the day and night, then feedings can be spaced out a bit at night. The American
Academy of Pediatrics recommends 8 to 12 feedings per day.
HAND EXPRESSING BREASTMILK
• Massage your breasts in circular motions down and toward the nipple, and/or
apply warm, moist washcloths to your breasts 3-5 minutes before expressing
• Support your breast between your fingers and thumb placed 1-1½ inches back
from the nipple
• Push inward, straight back, toward your chest wall to get behind the milk ducts.
• Roll your thumb and finger toward the nipple, make a rolling motion as though
you are making thumb and fingerprints
• Do not compress the nipple - only the areola
• Repeat the process, rotating your hand around the breast to empty different
milk reservoirs
• Switching breasts every few minutes will increase effectiveness
PUMPING & STORAGE OF BREASTMILK
Expressing milk regularly is the key to maintaining a milk supply. Pumping routines should simulate a
baby’s feeding schedule. After 3 weeks of age, a newborn should nurse every 2-3 hours during the day,
and at least once during the night (8-12 times in 24 hours). Working mothers will need to express milk at
the same times at which they would feed their baby.
Getting Ready to Pump
• Wash hands before handling any of the breastpump parts, breasts or expressed milk. Wash all parts
of the breastpump that touch the breast or the expressed milk with hot soapy water and rinse.
Storage containers for milk should also be washed thoroughly.
• Read all instructions before using the pump and use according to manufacturer directions. Center the
breast shield over the nipple. The nipple should move comfortably.
• If using an electric pump, plug it in and check the suction before placing it on the breast. Always
10
begin pumping by turning the pump suction regulator on minimum. Bring the breast shield to the
breast then GRADUALLY INCREASE TO A COMFORTABLE LEVEL (if the suction is too strong, the
tension on the breast will decrease the amount of milk you are able to pump).
• Make yourself comfortable before pumping. Sit with your shoulders relaxed and back supported. Have
everything you need, including something to drink, within reach. It is important to relax in order to get a “letdown”. Many women find that their milk lets down when they think about or look at a picture of their baby
while pumping. It is also helpful to listen to relaxing music or use childbirth breathing exercises to relax.
• Try breast massage or warm compresses on the breasts before pumping. Some women gently
stimulate the nipple before using the pump. Moistening the breast with breastmilk before placing the
shield on the breast can help create a seal.
Pumping
• Pumping is most efficient when done on a regular schedule at the same time each day, or at a time
when your baby normally nurses.
• Pumping in addition to nursing: a good time to pump is within 30 minutes after the baby nurses, as
the pump will ride off the letdown created by the baby.
• Random/periodic pumping: good times to pump are early in the day or when your baby has only
partially nursed and is satisfied.
• The amount of milk that can be pumped in one session depends on many things: how long it has
been since your baby last nursed, how practiced you are at pumping, how comfortable you are with
pumping, the time of day, and how established your milk supply is.
• Human milk can vary in color, consistency and smell depending upon: the time of day the milk was
expressed, the age of your baby at the time of pumping and your diet.
• Be assured that a nursing baby will always be more effective at let down than a pump.
• Pumping and hand expression of breastmilk is not difficult, but takes practice.
How to Pump
Single Pumping (one breast at a time): Pump each breast for 15-20 minutes, switching breasts when flow decreases.
More milk will be expressed if each breast is pumped at least 2-3 times. A typical routine is 7 minutes on one side
and 7 on the other, then 5 minutes on one side and 5 on the other, then 3 minutes on one side and 3 on the other.
Double Pumping (both breasts at the same time): plan to pump for 10-15 minutes. Double pumping is an
effective option for mothers who have a limited time for pumping breaks.
How to Store
Storage of Breastmilk
Breastmilk
Freezer
Freshly Expressed
(in sealed container)
• 3 months in freezer compartment
• 6 months in separate door refrigerator/freezer
• 1 year or longer in deep freeze / 0 degrees
Previously Frozen
(thawed in refrigerator
or under running water)
DO NOT REFREEZE
Refrigerator
Room
Temp.
3 days
4 hours
24 hours
1 hour
There is no research indicating whether it is acceptable to save reheated breastmilk
11
Fresh breastmilk should be stored in plastic or glass containers when at the hospital. When using
disposable bottle bags, always double bag to protect from punctures or splits. Remove as much air as
possible from the plastic bags and close tightly with twist tie or rubber band. Place bags in another rigid
sealed storage container to reduce incidence of freezer burn.
Place containers in the back of the refrigerator or freezer – never place in the door. Cool fresh milk in
the refrigerator before adding to a container or to frozen milk. *Glass or hard-sided plastic containers are
recommended for use with preterm infants. Antibodies have been known to adhere to thin plastic bags.
Always label containers with the date and time pumped. Add the baby’s name if taking breastmilk to the
hospital or childcare provider.
Calculating Quantity / Intake Guidelines
Average intake by weight for preterm and full term infants less than 1 month old:
5 lbs.
6 lbs.
7 lbs.
8 lbs.
13.3 oz. in 24 hours
16.0 oz. in 24 hours
18.8 oz. in 24 hours
21.4 oz. in 24 hours
9 lbs.
10 lbs.
11 lbs.
24.0 oz. in 24 hours
26.7 oz. in 24 hours
29.4 oz. in 24 hours
Freeze milk in small quantities to minimize waste and for easier thawing. How much breastmilk should
you leave your baby for each feeding? It depends on the individual infant, but generally a baby older than
1 month and less than 6 months will consume 2.5oz per pound of body weight every 24 hours.
Defrosting
DO
Thaw breastmilk in its container under warm
water (needs only to be at room temperature).
Gently rotate the container of thawed breastmilk
before feeding your baby to mix the layers that
have separated.
DO NOT
Defrost
breastmilk in
boiling water
or in the
microwave.
NEVER
DISCARD
Refreeze
thawed
breastmilk.
Any breastmilk
not used during
a feeding.
References
Auerbach, K. & Guss. (1984). Maternal employment and breastfeeding: A study of 587 women’s
experiences. Am J Dis Child 138: 958-60.
Auerbach, K. & Ruerdan, J.: Breastfeeding & Human Lactation; 1999.
Barger, J. Bull, P. (1987). A comparison of the bacterial composition of breastmilk at room temperature
stored in the refrigerator, Int J Childbirth Educ 2:29-30.
The John Hopkins Hospital – Harriet Lane Handbook: A Manual for Pediatric House Officers (1996) 14th
Edition, Mosby, St. Louis, MO. PP 215-217, 378-379.
Lauwers, J. & Shinske, D.: Counseling the Nursing Mother, 2000.
Nwanko, M.U. et al (1988) Bacterial growth in expressed breastmilk. Ann Trop Ped 8:92-95.
Pittard, W. et al (1989) Bacteriostatic qualities of human milk, J Pediatr 107:240-43.
Sigman, M et al (1989). Effects of microwaving human milk: Changes in IgA content and bacterial count. J
Am Diet Assoc 89:690.
Williamson, M. and Murti, P. (1996) Effects of Storage, Time, Temperature, and Composition of
Containers on Biologic
Components of Human Milk. J. Hum Lact 12(1):31-35.
Jones, S. (2011). Best Practice of expressing, Storing and Handling Human Milk, Human Milk Banking
Association of America
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BREASTFEEDING RESOURCES
If you have any breastfeeding questions, concerns or would like to set up a private consultation with
an Enloe’s International Board Certified Lactation Consultant, please call 530-332-3970. Appointments
are available. Research has shown that when a breastfeeding mother has assistance from a lactation
specialist and having many breastfeeding experiences in a row, the likelihood of continuing to breastfeed
her baby significantly increases.
Enloe also offers a Mother & Baby Boutique. Our boutique has before and after baby items in a calm,
private shopping atmosphere with professional support. Open five days a week for your convenience:
Monday through Friday, from 11 a.m. to 4:30 p.m. (closed on holidays).
Additional breastfeeding support resources available are:
Better Babies (Medi-Cal clients only)
530-894-5585
La Leche League of Chico
530-893-2890
WIC (Qualifying clients only)
Chico
530-891-2767
Marysville 530-749-4830
Orland 530-865-8791
Oroville 530-538-7455
Red Bluff
530-527-8791
Willows
530-865-8791
Yuba City 530-822-7224
Websites for General Breastfeeding Information:
www.lalecheleague.org
www.breastfeeding.com
www.kellymom.com
www.4women.gov/breastfeeding
www.ilca.org
Consult with your Baby’s Provider or nurse practitioner before you choose to change your infant’s feeding choice.
NEWBORN CARE
UMBILICAL CORD CARE
Keep umbilical cord clean and dry. It is not necessary to apply alcohol to your baby’s umbilical cord.
Fold the diaper below cord until it dries and falls off. Do not use a cord-binder or bellyband. Expect
the umbilical cord to fall off within one to three weeks. Please notify your Baby’s Provider if his or her
umbilical cord area becomes reddened, has a foul odor, discharge, or starts to bleed.
The American Academy of Pediatrics supports circumcision of male newborns, because of some health benefits
outweighing the risks of the procedure. The benefits include: less risk of heterosexual transmission of HIV and
other sexually transmitted infections. Newborn circumcision is the removal of the foreskin that covers the head
of the penis; it is typically performed for religious, cultural or social reasons. After the circumcision procedure, it is
normal for the end of the penis to be reddened and have a yellowish appearance. However, please call your Baby’s
Provider if you notice any signs of infection, such as: increasing redness, yellow-green (pus-like) drainage, swelling
or a strong foul-smelling odor. If your Baby’s Provider used a plastibell for your newborn’s circumcision, the plastic
rim is left on after the procedure and typically drops off after five to eight days. Call your Baby’s Provider if the
plastibell does not fall off after eight days. Bathe your baby as normal, but do not rub the circumcised area. Please
follow the instructions from your Baby’s Provider on how to care for your son’s circumcision site.
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NEWBORN CARE
CIRCUMCISION CARE
CONGENITAL HEART DISEASE SCREENING
Approximately 8 of every 1,000 infants are born with a form of Congenital Heart Disease (CHD), proven
to be the most common birth defect. It is recommended that all newborns have a non-invasive screening
called Pulse Oximetry, which helps identify low levels of oxygen in their blood. Pulse Oximetry is not a
painful procedure and takes only a few minutes when a newborn is quiet, warm and not moving. If you
have any questions or concerns about this screening, please speak with your Baby’s Provider.
CARE OF THE UNCIRCUMCISED
PENIS
It is not recommended for your baby boy’s foreskin to be
retracted or pulled back for cleaning. Wash your baby boy’s
penis with warm, soapy water just as you would with any
other part of his body. Between one to five years of age,
your son’s foreskin around the end of the penis will separate
naturally. Tearing and scarring of skin tissue can occur, If one
tries to separate the foreskin from the penis before ready.
Your Baby’s Provider will recommend when it is best to start
retracting or pulling back your son’s foreskin.
JAUNDICE (YELLOW SKIN)
Newborn jaundice is the yellow color seen in the baby’s skin, inside the mouth and in the whites of the
eyes, due to bilirubin build up in the blood. Everyone’s blood contains bilirubin, even before birth. In
utero, the mother’s liver removes the bilirubin for her baby. Most babies develop jaundice within the first
few days after birth because it takes a few days for the baby’s liver to get better at removing bilirubin.
Most infants have mild jaundice that is harmless, but in certain situations the bilirubin level can get very
high and might cause brain damage. This is why newborns should be checked carefully for jaundice and
treated to prevent a high bilirubin level.
If your baby looks jaundiced or yellow in the first few days after birth, your baby’s nurse or physician
may use a skin test or blood test to check your baby’s bilirubin level. A bilirubin blood level test is
typically needed if jaundice develops before the baby is 24 hours old. Whether a test is needed after that
depends on the baby’s age, the amount of jaundice, and whether the baby has other factors that make
jaundice more likely or harder to see.
The best way to check your baby for jaundice is in good lighting, such as daylight. Jaundice or a yellow
color usually appears first in the face and then moves to the chest, abdomen, arms and legs as bilirubin
level increases. Jaundice may be harder to see in babies with darker skin color. Please call your Baby’s
Provider if any of the following occurs: the white part of your newborn’s eyes become yellow, the yellow
discoloration of your newborn’s skin spreads below the waist toward his or her legs, or if the newborn is
very sleepy and will not wake up for feedings every two to three hours during the day.
DIAPER CARE
For the first few weeks of life, newborn girls can have pink or white mucous discharge and possibly redbloody discharge from her vagina. Also, in the few weeks of life, swollen breast-buds can be normal in
both newborn boys and girls. This is due to hormones from the mother. If you notice that your baby’s
diaper area is reddened, change his or her diapers more frequently and allow the skin to air dry. You can
also apply a thin layer of diaper cream to the reddened area to protect the skin from the baby’s urine and
stool. However, if the diaper rash does not improve, call your Baby’s Provider. The American Academy of
Pediatrics does not recommend the use of baby powders, because they are connected to the increased
risk of Sudden Infant Death Syndrome (SIDS).
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STOOLS / SOILED DIAPERS
For the first three to four days of age, your newborn will have meconium stools. Meconium stools are
very thick, tar-like and green to black in color. After four days of age, many breast-fed babies have a bowel
movement after each nursing that is loose, yellowish or mustard-like in color. A breast-fed baby rarely
becomes constipated; it can be normal for a breast-fed baby to go two to three days without a bowel
movement. Formula-fed babies typically have more formed stools. Each baby’s stool can vary in color,
number and character. Please inform your Baby’s Provider if you notice blood in the stool, or if the stools
become dry and hard. Do not use laxatives or suppositories without the permission of your Baby’s Provider.
URINATION / WET DIAPERS
The number of wet and soiled diapers will vary greatly among babies. Starting at 7 days of age, both
breast-fed and formula-fed babies should have at least six to eight wet diapers per day.
Every 24 hours
Day 1 - 1 Wet Diaper
Day 2 - 2 Wet Diapers
Day 3 - 3 Wet Diapers
Day 4 - 4 Wet Diapers
Day 5 - 5 Wet Diapers
Day 6 - 6 Wet Diapers
Day 7 and thereafter - 6 to 8 Wet Diapers
Uric acid crystals are common in the first few
weeks of life. The uric acid crystals typically leave
a brick-colored or salmon-colored spot where the
urine soaked into your baby’s diaper.
TEMPERATURE TAKING
If you think your baby is sick, apply a thermometer
under his or her armpit (This is known as the
auxillary method.)
Hold your infant’s arm gently against his or her
body according to the time recommended on the
thermometer instructions. The normal range for
an axillary temperature is 97.7°F to 99.5°F. An
electronic digital thermometer is recommended
because it is easy to read and has proven
accuracy.
REDUCING THE RISK OF SUDDEN INFANT DEATH
SYNDROME (SIDS) & A SAFER SLEEP ENVIRONMENT
SIDS is the sudden death of an infant younger than one year of age. Research has not shown exactly
what causes SIDS, however; some things have been found to reduce the incidence:
• Place your baby on his or her back to sleep
• Breastfeed your baby
• Do not expose your baby to second-hand cigarette smoke at home or in the car
• Do not use heavy or fluffy blankets, pillows, stuffed animals, toys, sheep skins, waterbeds or down
comforters in your infant’s bedding. In addition, no bumper pads, wedges or positioners
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•
•
•
•
•
•
•
•
•
•
Use a firm mattress covered with a tight-fitted sheet for your baby to sleep on
Keep your baby’s sleep area warm, but not overheated
Have your baby wear a one piece sleeper, instead of blankets to keep warm
Move your baby to a crib as soon as possible if he/she falls asleep in the carseat, bouncer or other
baby gear
Make sure your baby has a safe place to sleep when visiting or traveling
The safest place for your baby to sleep is in a crib, placed near your bed
Do not use baby powder on your baby’s skin
After breastfeeding has been established within about three to four weeks of age, it is recommended
to place a clean, dry pacifier in your baby’s mouth when placing your infant down to sleep, but never
force your infant to take a pacifier
Do not have your baby sleep with you if you are a “heavy sleeper”, using pain pills or alcohol, if you
or your partner are overweight, if you sleep on a soft bed or waterbed or if you have other adults,
children or pets sleeping in the bed with you
Do not fall asleep with your baby on a couch or in an armchair
To learn more information about SIDS, please contact the National Institutes of Health Back to Sleep
Campaign at 1-800-505-CRIB (2742) or www.nichd.nih.gov/SIDS; or contact the First Candle/SIDS
Alliance at 1-800-221-SIDS (7437) or www.sidsalliance.org. If you need assistance in creating a safer
sleep area for your baby, please call Butte County Public Health Department at 1-800-339-2941 and
ask to speak with a public health nurse.
CARSEAT SAFETY
California State law requires that all children traveling in a vehicle must be secured in a federally
approved safety carseat until they are at least 8 years of age or 4 foot 9 inches. Never hold a baby or
child in your lap while in a moving automobile. This is not only very dangerous, but also a violation of
California law, and may result in a citation.
Enloe Medical Center employees are not trained or certified to install carseats or place your baby in a
safety carseat at the time of discharge. Therefore, it is important for you to purchase and install an infant
carseat before your baby is discharged from the hospital.
Listed below are community resources to help answer any questions or concerns you may have in regard
to safety carseats and installation:
“Kids in Safe Seats” Resources
• Butte County Public Health 530-891-2732
• California Highway Patrol - Chico 530-879-1999
• Chico Police Department 530-897-4900
• Gridley Police Department 530-846-5670
• Northern Valley Indian Health 530-899-5156
• Oroville Fire Department 530-538-2487
• Oroville Police Department 530-538-2469
To obtain low cost car seats and booster seats: 530-891-2732 (Butte County Public Health) or
www.buttecounty.net/publichealth
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PREVENTING SHAKEN BABY SYNDROME
Caring for a crying baby can be very frustrating, however; never shake a baby! Sudden shaking motions
can cause a baby’s fragile brain to hit against the skull wall, frequently resulting in: brain bleeding,
swelling, tissue tears, blindness and possibly even death. Suggestions to help cope with a crying baby
when you are feeling angry, anxious or overwhelmed are:
Take your baby for a walk in a stroller outside
Go for a ride in a car
Give your baby a warm bath
Massage your baby
Sing and gently dance with your baby
Swaddle your baby with a blanket or wrap
Gently move your baby in a rocking chair
Allow other adults to care for your baby while you get a break
Place your baby in a safe place, such as a crib and take a few deep breaths, or go to another area in
the home until you feel more in control of your emotions
• If you have trouble caring for your baby in a calm manner, let your baby cry until you can cope.
• For more tips on soothing your crying baby, please refer to page 18 of this guide
For information about normal baby crying, visit www.purplecrying.info
If you need any additional help or more suggestions, please call Child Help at 1-800-4A-CHILD (1-800-422-4453).
•
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•
•
•
•
•
•
•
BATH AND SKIN CARE
Preparing for your baby’s bath
• Make sure the room is warm and free of drafts
• Check to make sure the temperature of the bath water
is not too hot or too cold
• Have all bathing supplies within reach. Never leave
your baby on a high surface unattended
• Use mild baby soap, and avoid lotions, oils or powders.
If skin irritations occur, clean your baby gently with
plain warm water and keep skin area exposed to air
• Never use cotton-tipped applicators (Q-tips) in the
baby’s ears or nose
Procedure for giving your baby a bath:
• Sponge-bathe your baby until the umbilical cord has
fallen off (usually within one to three weeks). Once the umbilical cord has fallen off and healed, you
can bathe your baby in a tub bath or basin.
• Before undressing your baby, begin the bath by washing his or her eyes with plain warm water, no
soap. Gently wipe each eye from the inside corner to the outside corner, using a clean part of the
washcloth or cotton ball for each eye. Then wash the rest of the baby’s face with clean warm water,
and towel dry.
• Remove your baby’s clothes, and wash the rest of the body with mild soap all at once, moving from
the baby’s trunk, arms, hands, legs, feet, and back, making sure that you clean in and around your
baby’s creases and folds. Rinse with plain warm water and dry thoroughly.
• For newborn girls, use a clean part of the washcloth each time you wash her genital area from front
to back.
17
• Make sure you clean all the genital area folds.
• For newborn boys, gently wash the penis with mild soap and rinse well. Do not pull the foreskin back
on an uncircumcised penis.
• Save shampooing the baby’s head and hair for last. First, wet the scalp with warm water and apply a
small amount of gentle soap or gentle shampoo, avoiding his or her eyes. With your fingertips, gently
massage and rub the scalp.
• Rinse with clear water, making sure all soap or shampoo are rinsed out. Remember that babies chill
easy, so dry and cover him or her completely after the bath with a dry towel or blanket.
BEHAVIORS: CRYING AND SLEEPING
Crying is your baby’s way of telling you what he/she needs. Following are some common reasons why
babies cry:
Hungry
In the early days and weeks of life, hunger is the most common
reason why babies cry. New babies need to feed at least 8 to 12
times per 24 hour period (every 2-3 hours) when breastfeeding.
Wet and Soiled Diapers
Babies are uncomfortable in wet or soiled diapers, so change
your baby’s diaper often.
Overtired
It is common for babies to become tired from being overstimulated throughout the day. Crying may be a way of
releasing tension, especially in the late afternoon and evening
hours. Babies tend to cry less when they have predictable daily
routines (order of events, not timed schedules of events). Be
consistent with routines, patient and ask for help when needed.
Typically, it takes about 14-21 days before new habits and
routines are established by your baby and the family.
Helpful tips on soothing your crying baby:
• Feed baby when he/she is showing hunger cues (licking lips, clinched hands, flexed arms and legs,
rooting, sucking on fists and fingers)
• Check to see if your baby needs to burp
• Change wet or soiled diaper if needed
• Make sure your baby is not too hot or cold
• Call your baby’s Baby’s Provider, if you suspect possible pain and/or illness
• Change uncomfortable clothing if necessary
• Hold your undressed baby next to your bare chest. Babies stay warm & are calmed by your heartbeat
when held “skin-to-skin”, with a light blanket over the two of you. Make sure his/her nose is not
covered and the skin stays pink. While in the hospital, if you are sleepy or asleep, your baby will be
safer when placed in the bassinet, on back for sleep.
• Swaddle your baby in a blanket snugly (not loose). Most babies will stay calmer longer & sleep better
if arms are swaddled straight down along his/her body.
• Hold your baby in your arms so he/she is on his/her side. When a baby is upset, holding or placing
them on their back can make them more upset. Babies should always be placed on their backs for
sleep or when left unsupervised.
18
• Offer him/her something to suck on (mother’s breast
or a clean finger). Sucking causes endorphins or “feelgood” hormones to be released in babies’ brains. Avoid
pacifiers in the first three weeks of life.
• Rock & sway your baby, pat his/her back while holding
closely. Babies miss the constant movement & floating
they experienced in the uterus.
• Say “Shhhhh,” talk & sing to him/her, or play soft
music. Babies are used to the noises of their mother’s
heartbeat, pulsing vessels & intestines.
As you get to know each other better, you will be able to
understand why your baby is crying. It is not possible to
“spoil” a newborn. One of the most important things you
can provide your baby is loving care.
RSV PREVENTION
With winter comes the cold and flu season. For adults and many children, a mild cold may be caused by
the Respiratory Syncytial Virus (RSV). Newborns, especially babies with breathing or heart problems and
premature babies, are at high risk for getting a serious illness from this virus.
RSV is spread very easily by any physical contact, such as: touching, kissing or shaking hands. It is
also spread by sneezing and coughing. The virus can live for hours on countertops, tissues, and other
surfaces. An exposure to the illness can occur in crowded living areas, such as: a childcare center, grocery
stores, shopping centers and places of worship.
Since RSV is very contagious and easily spread from person to person, here are a few tips to help
prevent the spread of the virus infection:
• Wash your hands. Make sure that all hands (yours or anyone else’s) are washed with warm water and
soap before coming in contact with your baby.
• Avoid crowded places. If you must take your baby shopping, do so when the crowds are at a
minimum.
• Protect your baby from contact with anyone who has a cold. Ask people who have a cold to visit
when they have recovered. Continue to encourage good hand washing.
• Do not allow anyone to smoke in the house. Passive smoke can increase the problems of the virus.
By following these tips carefully, you will help provide your infant with a healthier winter and spring season.
BULB SUCTIONING
If your baby has a lot of mucus in his/her mouth, it is recommended to follow these steps
using the bulb syringe:
1. Away from your baby’s face, squeeze the air out of the bulb syringe
2. Gently insert the tip of the bulb syringe into one side of the baby’s mouth (pocket of cheek)
3. Release the pressure and remove any mucus
4. Remove the syringe from your baby’s mouth and empty the mucus by squeezing the bulb onto a
clean cloth
5. Repeat in the cheek pocket of the other side of your baby’s mouth if needed
19
Follow these steps to clear mucous from your baby’s nostrils:
1. Away from your baby’s face, squeeze the air out of the bulb syringe
2. Gently insert the tip of the bulb syringe into one of your baby’s nostrils.
3. Release the pressure and remove any mucous
4. Remove the syringe from your baby’s nostril and empty the mucus by squeezing the bulb onto a clean cloth
5. Repeat in the other nostril if needed
Cleaning the bulb syringe:
• Clean the bulb syringe by flushing out with warm soapy water and rinsing well with plain warm water
after each use
• Do not wash in the dishwasher
• Do not use your baby’s bulb syringe with other children
NEWBORN SCREENING
California law requires that your baby have a blood test that screens for certain illnesses that can affect your
baby’s health. Babies can look very healthy at birth and still have a disorder. That is why routine newborn
testing of all babies in California is done. Before discharge from the hospital, your baby will have this blood
test. Blood is drawn with a gentle pinprick from your baby’s heel. This procedure is simple and safe. The
blood is then sent to a state-approved lab for testing. If you choose to refuse this required newborn testing,
you must sign a special form stating that your hospital and Baby’s Provider are not responsible if your baby
develops problems from any one of these disorders. Your Baby’s Provider will receive the test results in about
two weeks. If your baby needs further testing, you will be notified. Make sure your Baby’s Provider has your
current address and phone number. If you are planning to go home in less than 12 hours after delivery, the test
must be repeated within six days. For more information about newborn screening, please visit the California
Department of Public Health’s California Newborn Screening Program website at http://cdph.ca.gov/nbs
NEWBORN HEARING SCREENING
The State of California requires that your baby participate in the Newborn Hearing Screening Program.
Hearing is important for your baby’s development. Much of this development occurs in the first three
years of life . Babies learn to speak by listening, and the child who is unable to hear may not develop
typical speech and language. Therefore, early detection and
treatment of babies with hearing loss allows your baby to develop
normally and develop good social relationships. The test is safe
and painless. In fact, most infants sleep through it. For more
information, please call the California Newborn Hearing Screening
Program’s Information Line at 1-877-388-5301.
SIBLING ADJUSTMENT
Bringing a new baby home from the hospital can bring up many
mixed feelings to an older brother or sister. The older sibling/s
may feel like the family’s attention is all on meeting the newborn
needs and may bring up emotions of feeling left out. In order to
cope with these mixed up feelings, an older sibling may become
aggressive (show acting out behaviors) or regressive (acting more
like a baby). For example, the sibling may ask for a bottle and wet
or soil their underwear.
20
Following are some suggestions that can be helpful for your older child as he/she adjusts to the new
addition to the family.
• Talk positively about his/her new role as a big brother or big sister.
• Read your child books on being a big brother or sister. Make sure the books are age appropriate and allow
your child opportunities to ask questions, voice concerns and share feelings inspired from the books.
• Look at your older child’s baby pictures together and talk about memories of when he/she was a
baby. Tell your child how excited you were when he/she was born and how everyone wanted to see
and hold him/her.
• Explain that babies take a lot of time from grown-ups, because the baby can’t do anything for
themself yet. Tell your child that when he/she was a baby, they did not know how to eat on their
own, go to bathroom on their own or even dress themselves. Reinforce how much your child has
learned since he/she was a baby and how they can teach the baby all these big boy or girl things
when the baby gets older.
• Have your child practice holding a doll, supporting the head. Teach him/her how to touch and hold a
baby very gently.
• Tell your child that the baby will not take their place, how there is enough love to go around for him/
her and the new baby.
• Have your child pick out or make the new baby a gift, given to the baby as a celebration birthday gift.
• Set aside special time for your older child. Each parent should spend some one-on-one with the older
child every day. It is amazing how much even just 10 minutes of uninterrupted one-on-one time can
mean to your child (and help their behavior). Let your child choose the activity and follow their lead.
• Listen carefully to how your child feels about the baby and the changes in your family. If they express
negative feelings, acknowledge them. Help your child put their feelings into words. Never deny or
discount your child’s feelings.
• Even though this may be a hard time for an older child to deal with, he/she may eventually learn that
having a new brother or sister addition in their life can be one of the greatest gifts.
WHEN TO CALL YOUR BABY’S PROVIDER
Never hesitate to call your Baby’s Provider if you have any questions or concerns about your baby.
These are signs and symptoms that would warrant a call right away:
• Unusually irritable or overly sleepy
• Stools with blood or mucous present
• Less than 6 wet diapers within a 24 hour period at six days of age
• Excessive or forceful vomiting
• Has difficulty breathing, is wheezing or grunting
• Swelling, bleeding or foul-smelling drainage from the circumcision site
• Diaper area has a red rash that does not heal or has white patches on the skin
• Not feeding well, missed feedings or refusal to feed
• White patches inside the mouth that won’t wipe off
• Umbilical cord has foul smelling drainage, is swollen or is bleeding
• Skin is yellow, blotchy, moist and hot, or has a red blister-like rash
• Axillary temperature (taken under the arm) is less than 97.7°F or higher than 100°F
This publication does not substitute professional medical advice from your Obstetric Provider or Baby’s
Provider. If you have a medical question, please consult your Obstetric Provider or Baby’s Provider .
21
• Ifyournewbornhasjustfedandisshowingnohunger
cues yet still seems unhappy, then try the soothing
techniqueslistedatright.
• Whenyournewborndisplayshungercues(suckingon
fists,lip-smackingetc.),latchhim/herontothebreast
evenifhe/shejustfed.Yournursewillbecheckingto
seethatyourbabyislatchingwell.Don’thesitatetocall
forhelp!
• Newbornscrymoreduringthenighttoassuretheywill
receive adequate nutrition when their moms are sleepy.
Themilkproducinghormonesarehigheratnighttherefore
nighttimefeedingsareimportant.Smartbabies!Therefore,
weencourageyoutotakeadvantageofour“familynap
time”,offeredfrom2p.m.to4p.m.daily.
• Duringthe2nd&3rdnights,mostbabieswillwakeup&
crymoreoften.Theymayseemtobehungryconstantly
and/orappeargassy.Babiesare“hardwired”todothis
asitistheirjobtobringthemilkin.Thisnormalbehavior
isdisplayedbybothbreastfed&formula-fedbabies.
• Newborns sleep soundly between feedings for most of
their first 24 hours as they recover from the delivery
(Therearealwaysexceptions).
Adapted from the UCSD Medical Center “Your Baby Night Owl”
• Say“Shhhhh,”talk&singtohim,orplaymusic.Babiesareusedtotheloud
noisesoftheirmother’sheart,pulsingvessels&intestines.
• Rock & sway your baby or pat his/her back while holding them closely.
Babiesmisstheconstantmovement&floatingtheyexperiencedintheuterus.
• Offerhim/hersomethingtosuckon(mother’sbreastoracleanorgloved
finger).Suckingcausesendorphinsor“feel-good”hormonestobereleased
inbabies’brains.AVOIDPACIFIERSINTHEFIRSTTHREEWEEKS!
• Holdyourbabyinyourarmssohe/sheisonhis/hersideortummy.When
a baby is upset, holding or placing them on their back can make them
moreupset.Babiesshouldalwaysbeplacedontheirbacksforsleepor
whenleftunsupervised.
• Swaddleyourbabysnugly(notloose!).Mostbabieswillstaycalmerlonger
&sleepbetterifarmsareswaddledstraightdownalongbody.
• Hold your undressed baby next to your bare chest. Babies stay warm &
arecalmedbyyourheartbeatwhenheld“skin-to-skin”withalightblanket
overthetwoofyou.Makesurehis/hernoseisnotcovered&theskinstays
pink.Ifyouaresleepyorasleep,yourbabywillbesaferwhenplacedin
thebassinet.
HOWTOSOOTHEYOURBABY
Your Baby
Night Owl
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DAY OF BIRTH (Date: ______________________ / Time: ___________ A.M. P.M.
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First Week of Life
Feeding
Goal:
Your
baby
needs
to
times
every every
24 hours24
for the
first 6-8
First Week of Life Feeding Goal: Your baby needs to eat
eat8 to
8 12
-! 12
times
hours
forweeks
the first 6 - 8 weeks Instructions:
1. Circle the hour when your baby nurses.
INSTRUCTIONS:
1. Circle
2.the
Check
theyour
boxes
for wet & soiled diapers, averages are shadowed. Add more boxes as needed.
hour when
baby nurses.
2. Check
3. the
Please
ask
your
nurse
about
anyare
questions
or more
concerns
may have, and after discharge
boxes for wet and soiled diapers,
averages
shadowed. Add
boxes asyou
needed.
3. Please ask
feelyour
free
to
call
our
Lactation
Consultant
at
(530)
332-3970.
nurse for any questions or concerns you may have, and after discharge feel free to call our Lactation Consultant at (530) 332-3972.
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DAILYBREASTFEEDINGLOG
Daily Breastfeeding Log
S6167001 06/15
4
‰‰ Infant-Pediatric CPR
classes
‰‰ Bittie Baby & Me classes
RESOURCES
‰‰ After Baby Instructions
‰‰ Diet
‰‰ Birth Control
‰‰ Sexual Activity
‰‰ Emotions & Coping
(Baby Blues &
Postpartum Depression)
4
7
7
7
7
‰‰ Cesarean Care
3
10
10
‰‰ La Leche League
‰‰ WIC
‰‰ Lactation Consultant
‰‰ Support Groups
RESOURCES
Breastfeeding Warning Signs
‰‰ Prevention of Nipple
Soreness
‰‰ Prevention of Plugged Ducts
& Breast Infection
‰‰ Prevention of Engorgement
‰‰ Pumping & Storage of Breast
Milk
‰‰ Hand Expression
‰‰ Activity (Kegels,
exercise, driving &
getting rest)
10
9
3
10
‰‰ Positioning & Latching
8
‰‰ Hemorrhoid
Care & Avoiding
Constipation
Is Baby Getting Enough to Eat?
‰‰ Suck-swallow pause & breathe
pattern
‰‰ How Often & How Long?
‰‰ Feeding Cues, Rooming-In &
Baby Behaviors
‰‰ Reasons for Avoiding Pacifiers
19
‰‰ Infant-Pediatric CPR
classes
‰‰ Bittie Baby & Me classes
RESOURCES
‰‰ Sibling Adjustment
‰‰ Bulb Suctioning
19
20
‰‰ Preventing Infections
18
‰‰ Bathing and Skin Care
‰‰ Safety: SIDS (Back to
Sleep), Carseats & CPR
‰‰ Temperature Taking
Understanding My Crying Baby
‰‰ How to Calm with the
5S’s
‰‰ Watching for Need
Behaviors
‰‰ Setting Up Predictable
Routines
17
15
15
‰‰ Urination Frequency &
Signs of Dehydration
‰‰ Stool Consistency &
Frequency
15
15
‰‰ Diapering & Preventing
Bottom Rashes
14
‰‰ Yellow Skin (Jaundice)
14
22
‰‰ Night Owl: Infant Feeding
Patterns
8
‰‰ Circumcision Care
‰‰ General Information
13
Topic
‰‰ Skin to Skin
Page
‰‰ Umbilical Cord Care
Nurse
Initial
NEWBORN CARE
13
Topic
8
Page
8
Nurse
Initial
‰‰ Perineum Care &
Emptying Bladder
‰‰ After Pains
‰‰ Bleeding (lochia)
‰‰ Hygiene (handwashing
& visitors)
Topic
NEWBORN BREASTFEEDING
3
3
3
Page
MOTHER CARE
Since the delivery of your baby, nurses and the “Hospital to Home” DVD have educated you and your family on
important Mother Care, Newborn Breastfeeding and Newborn Care Information. Please check off those topics listed, for more
information needed from your nurse and/or Provider.
Learning Menu
Nurse
Initial