Taking Care of Yourself
Congratulations!
Having a baby is an exciting and joyful event. The miracle of childbirth brings
feelings of happiness and excitement
However, it also can bring feelings of nervousness and insecurity. Now that your
baby has arrived, we have more information to share with you. You may feel
unsure of how to care for your new baby or feel that you may make a mistake.
You also may notice changes to your body and have questions about how to take
care of yourself.
We have created this guide to help answer your questions and to give you some
guidance. If you need more information, please feel free to ask your doctor,
midwife, or nurse. We are here to give you the best possible health care and
information. Let us know how we can help.
• Breastfeeding moms may have more
cramps during and after nursing.
• If you have had other children, your
cramps may be worse. This is because
your uterus has to work harder to get
back to its usual size.
Bleeding
After birth, you will have vaginal
discharge called lochia. This is made
up of blood and the tissue lining of
your uterus that is no longer needed.
• Your vaginal bleeding may increase
as you start to move around, and you
may have small clots. This is normal.
• The discharge usually changes color
over several weeks. It goes from bright
red, to pink, and then to white.
Activity and Rest
Giving birth to a baby is physically
exhausting. You may be very tired
and need to rest even if you are in
great shape. It can take four to eight
weeks after giving birth to feel like
yourself again.
We know that this is an exciting time
for you and your family. However,
think about limiting your visitors and
phone calls. This will give you a chance
to rest. It also will give you time to
learn how to take care of yourself and
your new baby.
Breast Care for Breastfeeding Mothers
• Wear a well fitted bra to support
your breasts (without an underwire)
to support your breasts.
• Your milk supply will increase
around day three to four with a feeling
of fullness. If you are uncomfortable,
start cool compresses to the breasts
for 10-15 minutes between feedings.
• This sense of fullness or
“engorgement” usually resolves in 2448 hours.
• Nipples may be tender in the early
days after delivery.
• The best way to prevent nipple
damage is in correct positioning of
your baby and their sucking or and
“latch” at the breast.
• Your baby should breastfeed as
often as 8-12 times per 24 hours.
• Pump your breasts if your baby
cannot breastfeed or your baby skips a
feeding.
• Contact your health care provider
or lactation consultant if soreness
continues.
Breast Care for Bottle-feeding Mothers
• Wear a well-fitting bra to support
your breasts.
• Use cool compresses if you have
discomfort.
Cramps
After your baby is born, your womb or
“uterus” will contract to return to its
usual size. When this happens, you will
have cramps. These are called “after
birth pains.” They usually stop in three
to four days.
Call your doctor if:
• You are soaking through a large pad
every hour.
• Your vaginal bleeding increases and
does not slow down when you rest.
• You are worried about the amount,
color, or how long you have been
bleeding.
Remember: do not put anything in
your vagina for six weeks.
Stitches
If you have stitches, they may still
feel uncomfortable when you first
go home. Your stitches do not need
to be taken out and will dissolve in
about three weeks. It will take about
two to four weeks for your skin to
heal completely. Use “witch hazel”
pads during this time to help with the
itching that comes with healing.
Perineal Care
Until you stop bleeding, use the “peribottle” we will give you each time you
use the toilet.
• Always wipe from front to back,
away from your vagina.
• For the first week at home, use soft
tissues and gently pat dry.
• Change your pads often.
Discomfort
If your perineum hurts or is swollen,
put cold compresses on the area for
the first 24 hours after birth. Then,
use the “sitz bath” three times a day
for 20 to 30 minutes. This is a special
basin filled with warm water and
either salt or baking soda to sooth the
skin. Sit in it to soak your bottom or
perineal area.
How to Take Care of Your Discomfort
• Be less active. Take time to rest. If
you have other children, read to them
or play a quiet game.
• Fix your pad so that it does not rub
against your stitches.
• Put Tucks® or witch hazel pads on
your stitches each time you change
your pad, after each sitz bath; and
whenever you are uncomfortable.
• Take acetaminophen, ibuprofen, or
prescription pain medicine the way
your doctor instructs.
Hemorrhoids
You may have “hemorrhoids” (swollen
blood vessels around your bottom)
in late pregnancy or after delivery.
Hemorrhoids usually get better and
disappear.
If they are bothering you:
• Try witch hazel pads, Tucks®,
sitz baths, or an over-the-counter
hemorrhoid cream.
• Avoid straining when you have a
bowel movement.
• Do not stay seated in the bathroom
for a long time.
Constipation
You may be constipated the first few
weeks after giving birth.
please speak with your doctor, mid wife,
nurse, or nurse practitioner.
Medicines
You may use over-the-counter medicines
for colds, headache, constipation,
hemorrhoids, and insomnia unless your
doctor tells you not to.
However, if you are breastfeeding, these
medicines may affect your baby. Before
taking these or other medications, please
check with your pediatrician, doctor,
midwife, or nurse practitioner.
For Cesarean Births
You will be asked to get out of bed
shortly after your cesarean birth. Your
Foley catheter and IV will usually be
taken out within 24 to 48 hours.
To avoid constipation:
• Eat foods high in fiber, like raw
fruits and vegetables, fruit juices, figs,
dates, prunes, whole grain bread, and
bran cereal.
• If needed, use a mild laxative or stool
softener, like Metamucil®, Colace®,
Milk of Magnesia®, Senokot®, or PeriColace®.
Eating and Drinking Well
• Be sure to eat breads, leafy
vegetables, and fruits, as well as milk
products, meats, and fish.
• Snack on fruit or low-fat dairy products
if you’re hungry between meals.
• Keep taking prenatal vitamins if you
doctor advises.
Normal Changes to Your Body
You may have some changes in your
body and your hormones after giving
birth .These changes are normal and
temporary. They should decrease as
your body returns to how it was before
pregnancy. You may have:
• Hot flashes or night sweating
• Frequent need to pee or “urinate”
• Dry and/or itching skin
• Mild hair loss
• Vaginal dryness
• Mood swings
How to Take Care of your pain
You will have some discomfort around
your incision. This is normal. The
discomfort should lessen each day.
The Baby Blues
Having a baby brings a lot of joy, but
it also can bring anxiety. Taking care
of your baby may make it hard to find
time for other things you need to do.
Even something as simple as taking a
shower may be difficult.
Your doctor or midwife will order pain
medicine for you. Your nurse will ask
about your pain. On your first day, ask
for the pain medicine at regular rime
periods to control the pain.
Your feelings may change quickly
after having a baby, such as trouble
concentrating.
As many as 80 percent of all new
mothers also have feelings of
depression called the “baby blues.”
The “baby blues” happen suddenly
in the first few days due to swings in
hormone levels.
If you have the baby blues, you may feel
sad and cry for no reason. You may feel
lonely, impatient, irritable, and anxious. If
these feelings do not pass in a few days,
There is more information in your
discharge instructions about how to take
care of yourself after a cesarean birth.
Taking Care of Your Baby
Caring for Your Baby in the Hospital
During your stay you will take care of
your baby, including changing your
baby’s diaper. Your nurses will help
you. They will answer your questions,
give you information, and teach you
important “mommy” skills.
Before you go home, please go to the
“bath and breastfeeding classes” we
offer. Also, we have a number of short
videos that you can watch. Ask your
nurse if you need help playing the videos.
If you have any questions, concerns or
worries, talk to your nurses. They are
here to help in any way they can.
Kangaroo or Skin-to-Skin Care
Skin-to-skin care in the first hours of life
brings your baby from the safety of your
womb to the comfort of your chest. It
gives your baby your warmth, the sound
of your heartbeat, and your scent.
Babies held skin-to-skin contact: cry
less, stabilized their temperature sooner,
soother more easily, and act less stressed.
Breastfeeding babies also breastfeed
sooner and may latch on better.
Mothers and babies have a natural
instinct to be close. Give your baby as
much skin-to-skin contact as you can.
Keeping your baby with you as much
as possible will promote skin­-to-skin
contact.
of weeks after they are born. Then,
they double it by six months and triple
it in one year.
Sleeping
Newborns are asleep more than they
are awake in the first days. As they
grow, they will sleep less and stay
awake longer.
Patient and Family Focused Care
After you have your baby, one adult
may stay overnight to help you take
care of your newborn.
Try to keep your baby in your room.
Having baby close will help you get to
know your baby. If your baby needs to
be watched for medical reasons or if you
would like us to care for your baby for a
short time, there is a nursery nearby.
Usually, you do not need to be
separated from your baby at any time.
Baby Safety in the Hospital
While you are in the hospital, do not
let anyone rake your baby unless you
know they are a staff person. Our staff
GRMC ID badges. Make sure the picture
on the badge marches the person with
the badge. Your baby will have an
electronic bracelet that will alarm if
they are taken near an exit.
Only parents, grandparents and
individuals with a GRMC ID can go into
the nursery. When you go to the nursery,
press the doorbell. Your ID will be
checked, and you will be allowed to go in.
Caring for Your Baby at Home
Once you bring your baby home, think
about limiting the number of people
who visit. This will help decrease the
chance of your baby becoming sick,
and is a special time for you to bond
with your new family and get to know
your baby. Let family and friends help
you by running errands and doing
household chores.
When you do have visitors:
• Ask them to wash their hands
before holding the baby; alcohol based
cleaners work best.
• Do not let anyone visit if they have
a cold or have been around someone
who is sick.
• Make sure siblings wash their hands
before touching the baby.
What to Expect
It is normal for your baby to lose
weight in the first few days. Most
babies regain their birth weight a few
To keep your baby safe while sleeping:
• Always put your baby on his or her
back on a firm mattress in an approved
“baby safe” crib.
• Do not put pillows, toys, stuffed toys,
or blankets in the bassinet or crib.
• Keep your baby warm but not
overheated.
• Do not share your bed with your
infant when you sleep (called “Cobedding”)
The American Academy of Pediatrics
states that these methods are proven
to lower the risk of Sudden Infant
Death Syndrome (SIDS).
Crying
The first cries of your baby may be
music to your ears. However, over the
next weeks and months your baby’s
crying may be upsetting and stressful.
This is especially true when you
cannot get your baby to stop crying.
Understanding why your baby cries
can help you deal with this stress in a
healthy way.
Tips for When Your Baby won’t stop
Crying
• Try skin-to-skin contact, swaddling,
a pacifier or allowing baby to suck on
your finger.
• Make sure your baby is fed and dry.
• Feed your baby slowly and burp
your baby often.
• Rock your baby gently.
• Use a baby carrier and go for a walk.
• Take your baby for a ride in a stroller
or car.
• Try a wind-up infant swing.
• Ask for help.
If you are feeling tense or angry (and
you think you may injure, shake or hit
your baby), put your baby in a safe
place, like the crib. Walk away for a
short break. Never yell at, hit, or shake
a baby.
Shaken Baby Syndrome is a severe type
of head injury. It caused by shaking
a baby hard. When a baby is shaken,
the baby’s brain hits the inside of the
skull. This causes bruising, swelling,
and bleeding of the brain. It leads to
permanent damage and even death.
Bathing
The first bath may seem a little scary,
but it also can be full of laughter.
Many babies come to bath time, and
it can become a relaxing routine.
Remember, bathing your baby gets
easier with practice.
Choose a time when you are not
hurried. Make sure the bath area is not
drafty. Put all of your supplies nearby,
including: a soft washcloth, clean or
warm water in a tub or sink, and mild
unscented soap. In the first year of
life, soap is rarely needed and warm
water, a wash cloth and towel work
great without drying your baby’s skin.
Never leave your baby alone during
bath time. If your baby is cold, try skinto-skin contact to warm your baby.
How to Give Your Baby a Bath
• Put your baby in the tub. Support
baby’s head.
• Wash your baby from top to bottom.
Clean the diaper area last. Be sure to
clean well between the skin folds.
• Wash your baby’s face with a
washcloth and no soap.
• Use clean water and gently wipe
from the inside to the outside corner
of each eye. Use a clean washcloth or
cotton balls.
• Wet baby’s hair and scalp with water.
Gently rub in baby shampoo. Pour
water over baby’s head to rinse. Try to
avoid getting soap in the baby’s eyes.
• Support your baby’s head and neck
with your hand under the chin. Lean
your baby forward to wash the back.
Rinse with clean water.
• Clean the diaper area: For girls wipe
from front to back; for circumcised
boys, clean the healed penis the
same way as the rest of the body; for
uncircumcised boys, do not pull back
the foreskin, just clean and rinse.
• Lay your baby on a clean towel.
Quickly dry off your baby before
diapering and dressing.
Cord Care
Your baby’s cord does not need any
special care. Just gently wash the area
every time you give your baby a bath.
Gently pat the area dry when you are
done.
Diapering
Before you diaper your baby, gather
your supplies including a clean diaper,
baby wipes, a diaper pail, and diaper
rash ointment.
How to Diaper Your Baby
• Lay your baby on the changing table.
Put a cloth under your baby to keep
the changing table clean.
• Gently hold your baby’s ankles and
lift as you take off the diaper.
• If your baby has a full diaper, use a
clean part of the diaper to wipe the
area. Then, wrap the used diaper into
a bundle to be thrown away.
• Clean the diaper area with wipes or
a damp washcloth.
• Always wipe from front to back. Be
sure to clean between the folds of the
skin.
• Ointment with zinc is best to treat
diaper rash. Do not use Vaseline.
• Put on a clean diaper. Hold your
baby’s ankles and lift his or her bottom.
Slide the back of the clean diaper
under your baby’s bottom. Lower your
baby’s legs.
• Pull the front of the diaper up
between your baby’s legs. Stick the
tabs down on each side. Redress your
baby and wash your hands.
• Never leave your baby alone during
diapering as they may roll off the table
and injure themselves.
Cutting Your Baby’s Nails
Cutting your baby’s nails may seem
scary at first. Try filing the nail with
a nail file during the first few weeks
when the nails are tiny and soft.
Taking Your Baby’s Temperature
There are two ways to measure your
baby’s temperature: under the arm,
which is called an axillary temperature
and in the backside in the fanny hole,
which is called a “rectal” temperature.
You do not need to take your baby’s
temperature regularly. Take it if your
baby feels warm or is not acting like
himself or herself. Take an axillary
temperature first, then call your baby’s
doctor if it is abnormal.
How to Take an Axillary Temperature
• Put the end of the thermometer in
your baby’s armpit.
• Hold your baby’s arm down at his or
her side.
• Press the “on” button. Keep the
thermometer in place until it beeps.
• Take it out and read the numbers
in the window. This is your baby’s
temperature.
• If your baby’s temperature is higher
than 99.0° F, your pediatrician may
want you to take a rectal temperature.
How to Take a Rectal Temperature
• Wash your hands and the
thermometer. Press the “on” button.
• Lay your baby on his or her back on
a firm surface. Lift your baby’s legs and
gently spread the cheeks. Use both
hands, one for the thermometer and
the other to hold your baby securely.
• Gently put the end of the
thermometer about 1/2 inch into your
baby’s rectum.
• Hold it in place until it beeps. Take it
out and read the numbers in the window.
This is your baby’s temperature.
Choosing to breast or bottle-feed is an
important decision. Parents choose each
method for different reasons. The one
that you choose should be the one that is
right for you, your baby, and your partner.
Breastfeeding
Breastfeeding has health benefits for
both you and your baby. Breast milk
contains all the nutrients needed for
your baby’s growth and development
and is perfectly marched to meet his
or her needs.
The following guidelines will help you
and your baby to have a successful
start to your breastfeeding experience.
Remember it is a skill that you and
your baby will learn together. Our staff
is committed to actively supporting
your decision to breastfeed.
• Call your pediatrician if your baby’s
rectal temperature is higher than
100.3°F.
Over bundling Your Baby
Over bundling a baby can make the
baby’s temperature go up. It has been
shown that a baby’s skin temperature
goes up when a baby is over-bundled.
Then when the baby is unbundled,
the baby’s skin cools down. When the
temperature is checked again with an
axillary thermometer, it is lower.
Did you know?
An axillary temperature of 99° F is
the same as a rectal temperature of
100.4 F
When you call your baby’s doctor
do not add or subtract the number
because of the where you took it. Just
tell the doctor:
• Your baby’s temperature
• How and where you took the
temperature
When to Call Your Baby’s Doctor
Call your baby’s doctor if your baby:
• Seems ill or is not acting like him or
herself.
• Is not eating well or won’t eat.
• Has a rectal temperature over
100.3° F.
• Has less than six wet diapers in 24
hours.
• Is still passing meconium at three
days of age.
• Has a yellow color to the skin.
• Is very sleepy and hard to wake.
• Is throwing up again and again.
• Is crying a lot with no known cause.
• Has an unusual or severe rash.
• Has frequent or very large, loose
stools.
• Has no stool in 24 hours during the
first week of life.
Feeding Your Baby
Feeding your baby is one of the nicest
experiences of early parenthood. It is
a time to be close and to nurture and
communicate with your baby in your
own special way.
What to Expect
• In the first few days, your baby will
receive colostrum which is a very
rich, thick liquid produced in small
amounts. It is the training wheels for
your baby to learn how to coordinate
sucking. This small amount is all your
baby needs at this time.
• Some babies nurse for five minutes
and others nurse for 25 minutes. All
infants establish their own individual
feeding patterns.
Some babies nurse one breast per
feeding and some nurse both. Many
times in the first day or so, they feed
one side per feeding. They may still be
tired from their journey of birth.
• By the second day, most babies are
more alert for feeding.
• Attempt breastfeeding your baby at
least every three hours in the first 24
hours of life. Feed your baby sooner
if they shows signs of hunger (feeding
cues). Feeding cues include hand-tomouth movements, licking lips, rolling
eyes, sucking movements and noises
or sucking on hands or fingers.
• Keep your baby with you as much
as possible so that you will be able
to see those feeding cues. Babies
feed better when they feed on cue. If
you miss the feeding cues and baby
begins to cry, calm your baby before
continuing to feed.
• Ways to calm might include: bringing
baby close, allowing baby to suckle on
your clean finger or pacifier, rocking,
walking baby, humming or “shushing.”
• If three hours have passed and your
baby has not shown any cues, you can
gently awaken them.
• Gentle awakening by unwrapping or
changing their diaper will save energy
for feeding. Any awakening techniques
should be pleasurable for your baby.
• Keep bright lights from his/her eyes
and keep the temperature in the room
at about 70 to 75 degrees. This will
help your baby to be more successful
at breastfeeding.
• If your baby has been sleepy but
suddenly is showing strong feeding
cues and acting hungry, you can skip
the diaper change at this time.
cramping, increased bleeding, thirst,
breast tingling, relaxation or sleepiness.
• A breastfeeding mother with blisters,
bruising or cracks on her nipples needs
to speak with her doctor or nurse.
• The nipple may be elongated but
should retain the original shape.
• Cracks, blisters or bruising may
indicate that the baby is not positioned
or latched on correctly.
Please call your health care provider,
pediatrician or lactation consultant
for help if you have any of these
symptoms.
• Sometimes breastfed babies “cluster
feed” or feed frequently at times as
they are waiting for your milk supply
to increase.
• Make sure your baby is latched
correctly and is swallowing. The nurses
can observe your latch and provide
helpful hints if needed. All mothers and
babies learn the skill of breastfeeding
by practicing. If there is ever any doubt
whether to feed or not, always try.
Positioning and Latch On Positioning
• Before breastfeeding make sure you
are relaxed and comfortable.
• Support your back and arms. If you
are in a chair, pillows may be helpful.
• Turn your baby completely on his
or her side with nose, chin, chest,
abdomen and knees touching you.
• Keep your baby close to you by
placing your hand and arm along your
baby’s shoulder and back for support.
Latch On
• First express drops of colostrum or
milk.
• Position your baby’s nose to your
nipple. When your nipple brushes
against your baby’s lips, they will root
and open their mouth wide.
• Bring your baby’s chin in toward
your chest.
• You should nor experience any
pain after your baby is latched on,
only a sensation of pulling, tugging or
pressure.
• Your baby’s lips should cover ¾ -1”
of areola and his/her lips should be
flanged outward.
• You should not hear any clicking
or smacking sounds throughout the
feeding.
• You will notice your baby’s cheeks
are round with no dimpling.
Suck and Swallow
• If your baby is sucking well, you will
see their jaw moving in a rhythmic
motion.
• Your baby should suck slow and
deep with short pauses and swallows.
• You may feel some of the following
while you are breastfeeding; uterine
In the Hospital
• You will be given feeding suggestions
based on the individual needs of your
baby.
• Feeding plans may change daily.
• Your baby’s urine and stool patterns
will be noted about every eight hours
and your baby will be weighed every
night. Weight loss is normal in the first
few days of life. Your nurse will ask you
about any diapers you have changed.
• Skin-to-skin care will continue to be
helpful at this time.
• Pumping may be recommended
if your baby requires a supplement
and also if you and your baby are
separated. Pumping mimics your
baby’s sucking to give your breasts
stimulation to make milk.
• Pumped milk is always used for
supplementation whenever possible.
• Decisions on anything other than full
breastfeeding will be made individually
based on your baby’s unique needs.
Breast Pumps
For some breastfeeding mothers
situations or circumstances may cause
the need for you to electronically
pump your breast for milk.
Tips for Using a Breast Pump
• Wash your hands thoroughly, get all
of your equipment ready, and make
sure all parts are correctly connected.
• Sit in a comfortable chair. Have a
glass of water within your reach.
• Moisten the flange with warm water
and center your nipple into the flange
opening.
• Turn the machine on and pump your
breasts for 10 to 20 minutes. Most
mothers pump both breasts at the
same time, but you may want to pump
your breasts one at a time.
• When you are finished pumping,
shut the pump off before taking the
flange away from your breast.
• After pumping, rub a few drops of
milk on your nipples and air dry.
Types of Breast Pumps
• There are different types of breast
pumps. Some are operated by hand.
Others use electricity or batteries.
• The right pump for you depends
on why you need it. If your baby has
a medical need or you are having
trouble breastfeeding, you may need
an electric pump. Your nurse will help
you decide.
If you need to pump, be patient. Learning
to pump your breasts takes practice.
Collection, Storage and Use of Breast
Milk
Only store breast milk that you have
just pumped. Do NOT store or reuse
leftover milk unused during a previous
feeding.
Mature breast milk looks bluish-white
and thin. When it is refrigerated or
frozen, the richer milk rises to the top.
Then it may look layered or curdled.
Stir it gently when it is defrosted, and
it will mix together.
Containers
The storage container should
be clean. If your baby is in the
hospital,check with the nurses to see
what type of container to use. Some
good containers are glass or plastic
bottles with solid caps. These have an
airtight seal.
• GRMC does not rent or sell breast
pumps. However, there are breast
pumps for you to use while you are
in the hospital. Check with your
insurance provider for possible breast
pump coverage.
towels. Let them air dry.
Where to Buy or Rent a Breast Pump
locally
Procreate Baby Boutique
Neni and Me
KMART
Ask your nurse for other options.
To take care of sore nipples:
• Pump more often and for shorter
periods of time.
• Massage your breasts before
pumping to start the milk flow.
• Start on the least sore side first.
• Use the lowest setting that removes
your milk. If it still hurts, turn down
the suction.
• Be sure the pump fits well, is
centered, and in the right position.
• After pumping, put a little milk on
your nipples and let them air dry.
If you are using disposable bottle liners:
• Be sure to double-bag the liners in
case of a tear.
• Fold over the edges, and use a twist
or rubber band to close.
• Freeze the bag in a paper cup to
keep it from spilling.
If your discomfort doesn’t go away or
gets worse, please tell your doctor or
nurse. Call your doctor if you have:
• Cracks, blisters, or bruising on your
breasts.
• Hot, tender, red, or swollen breasts.
• Chills or fever over 101 F.
Store your milk in smaller amounts. This
will make sure that you do not waste
any milk that your baby does not drink
at one feeding. For example, store two
ounces rather than six ounces. Then, if
your baby needs more, you can defrost
only what is needed.
How to Clean Your Breast Pump
We will give you one breast pump kit
while you are in the hospital.
Each time you finish pumping:
• Take apart all the pieces of the pump
that touched your milk. You do not
need to clean the tubing.
• Rinse the parts with cool water. Then
wash them in hot, soapy water. We will
give you Castile soap to use. Rinse well
several times.
• Put the cleaned parts on clean paper
towels. Cover with more clean paper
How to Take Care of Sore Nipples
Some women get sore nipples when
they pump. This usually goes away
with time.
How to Fill Containers
If you can, pump directly into the
container. Do not fill the container to
the top because the amount of milk
will increase when it is frozen.
How to Label Containers
Put you name on the label of each
container and the date you pump the
milk. The nurse will provide you with a
label for your containers.
How to Store your milk
Use your milk within one hour of
pumping it. Otherwise, refrigerate
it or freeze it as soon as you can. Put
the date and the time on the container
when you store the milk.
Always use the oldest milk first. Use
refrigerated breast milk before frozen
breast milk. Keep frozen milk as a
backup. Once home, make sure to date
and time the milk bottle.
Store milk in the back of the
refrigerator or freezer where it is the
coldest. If you are away from home,
use insulated food containers packed
with ice or cold packs.
• Milk will keep about 72 hours in
the refrigerator.
bottle. You do not have to do anything
to it before you feed it to your baby.
• Concentrated Formula
Concentrated formula comes in a can. It
must be mixed with an equal amount of
water before you feed it to your baby. For
example: A 13 ounce can of concentrate
must be mixed with 13 ounces of water.
This makes 26 ounces of formula. It can
then be poured into bottles.
• Powdered Formula
Powdered formula also comes in a
can. Follow the directions on the can
for the exact amounts of powder and
water to mix.
• Frozen milk will keep three months
in a refrigerator freezer or six months
in a deep freezer.
How to Use Stored Milk
When taking stored milk out of the
refrigerator or freezer, check the date
on the label. Always use the oldest
milk first. When you defrost frozen
milk, use it within 24 hours.
Thawing
To thaw frozen milk, put the container in
a pan of warm water. Do not put it on
the stove. Make sure the water does
not touch the bottle cap. Microwaves
destroy nutrients in the milk. They also
can heat the milk unevenly. This can
cause hot spots that can burn your baby.
If you have trouble breastfeeding
or have questions, please call your
health care provider, pediatrician, or
lactation consultant. There also are
resources in the back of this guide to
help you get started.
Bottle Feeding
If you have decided to bottle-feed
your baby, there are many things to
know about cleaning the utensils and
preparing the formula.
Types of Formula
GRMC uses prepackaged, ready to feed
formula made by formula companies.
Your nurse will ask you provide formula
for you to use for your baby.
• Do not thaw breast milk at room
temperature.
• Never heat bottles in a microwave
oven.
There are three types of formulas
for home use: “ready to feed,”
concentrate, and powder. Know which
type of formula you are using. Read
ALL the directions on the container.
How to Transport Your Milk
• To transport refrigerated or frozen
milk, use ice or a cold pack.
• Ready to Feed Formula
Ready to feed formula is already mixed
with water. It comes in a single can or
How to make formula
Follow these steps to clean your
equipment and to prepare bottles of
formula. You can make enough formula
for 24 hours or for one bottle at a time.
• Wash your hands. Then wash the
bottles and nipples with hot, soapy
water. Use a bottle and nipple brush.
Rinse well and air-dry.
• Wash the top of the unopened can of
formula and the can opener with hot,
soapy water. Rinse them with hot water.
• Stir (do not shake) concentrated and
ready to feed cans well before opening
or using
• Use a pointed can opener. Make
a complete opening on one side of
the can. On the opposite side, put a
smaller opening. This will let air our
when you pour.
• Add the formula to the clean bottles.
Remember:
• For powdered formula: Use the
instructions on the can for the amount
of powder and the amount of water
to use. For concentrated formula:
Use the same amount of formula and
water. For ready to feed formula: Just
pour. Do not add water.
• Store the bottles in the refrigerator
until your baby needs them. Do not
store them for more than 48 hours.
• If you have a dishwasher, you also
can use it to clean the bottles, nipples,
and utensils.
• Put the nipples on the top rack in the
dishwasher so that they do not melt.
• Do not use the energy saving or noheat cycle. You do not need to sterilize
your equipment.
Temperature of Formula
If you make formula for your baby
ahead of time, be sure it is refrigerated.
• Formula that has been refrigerated
does not have to be warmed up.
However, most infants like formula
that is not too cold.
• Remember that your baby will get
used to the formula temperature you
give him or her. That is what your baby
will expect for all feedings.
• To warm formula, stand the bottle in
a few inches of warm water for a few
minutes. Turn the bottle once or twice.
This will warm the bottle evenly.
• If your baby does not take much
formula and falls asleep before or
after burping, do not try to feed your
baby more.
• It is best to feed your baby on demand.
Do not try to get your baby to finish the
bottle if he or she does not want to.
• If your baby is still sucking hard
when the bottle is empty, offer more
formula. This is a good reason to get
several one-ounce bottles ready in
case your baby needs it.
• You do not need to wake you baby
at night for a feeding unless your
pediatrician has told you.
• Do not leave a bottle to warm at
room temperature. It will take too long.
This will let harmful bacteria grow.
• Microwaves can heat milk unevenly.
This can make hot spots that can burn
your baby. Never heat bottles in the
microwave oven.
• The easiest way to test the temperature
is to shake a few drops on the inside of
your wrist.
Feeding Position
It is important for your baby to be
close to your body while you bottlefeed. This is a time for bonding with
your baby.
• Cradle your baby with your baby’s
head and shoulders higher than their
waist. Support your baby’s head.
• Do not feed your baby when your
baby is flat or lying down.
• Never prop a bottle in your baby’s
mouth.
• Babies have a natural instinct called
rooting. This makes them turn toward
a touch on their lips or cheek.
• Touch your baby’s mouth or cheek with
the bottle nipple. This will cause a hungry
baby to root and open his or her mouth.
• Put the nipple in the baby’s mouth.
Make sure the nipple is on the tongue.
To keep your baby from swallowing air:
• Tilt the bottle so that the formula
fills the nipple.
• Look for bubbles in the bottle as the
baby sucks. This tells you that the baby
is getting the formula.
• If there are no air bubbles, loosen
the cap a little and try again.
Amount of Formula
In the beginning babies take about 10to-15 ml of formula at each feeding.
Their stomachs are about the size of
a walnut and cannot hold more than
that. 10-to-15 ml is the same.
• Ask your pediatrician how much
formula your baby should have.
• Small babies may want to rest every
three to four minutes. They may need
to take smaller amounts more often.
The amount of formula your baby
takes will increase slowly as your baby
grows.
• Feed your baby every three to four
hours during the day.
This is six to eight times in 24 hours.
How long will it take my baby to feed?
It should take your baby about 15-to20 minutes to finish a bottle. It may
take longer to feed a younger baby
who may need to rest while feeding.
An older baby will not tire from sucking
as quickly.
• Tell your pediatrician if it takes your
baby more than 30 minutes to feed
and this happens more than once.
• When your baby is very hungry, he
or she will suck faster. Later, when your
baby is almost full, sucking will be slower.
• Each week for the first month of life,
your baby will take about 1/2 to one
ounce extra in each bottle.
• Your baby will slowly decrease the
number of feedings in 24 hours. In the
first few days, your baby will feed six
to eight times each day. By the end
of three months, your baby will feed
four to six times each day.
Your pediatrician will ask how much
formula your baby takes. You will
know that your baby is getting enough
if your baby has:
• Six to eight wet diapers in 24 hours
by six days old.
• One to two bowel movements a day
Burping Bottle fed and Breastfed Babies
Babies may swallow air during feedings
so be sure to burp your baby.
• Burp bottle-fed babies after every ½
to ¾ of an ounce of formula in the first
few days.
• Burp breastfeeding babies before
you switch to the second breast and
also when your baby is done.
If your baby does not burp after a couple
of minutes of trying, restart feeding. A
few of the best burping positions are:
• Over the shoulder: Drape your baby
over your shoulder and gently pat or
rub your baby’s back.
• On the lap: Sit your baby upright,
lean his or her weight forward against
the heel of your hand. Gently pat or
rub your baby’s back.
• Lying down: Place baby stomachdown on your lap and gently rub or pat
his or her back.
Keep a clean burping cloth over your
clothing. This will help keep you clean
if your baby spits up.
Important Phone Numbers
Guam Regional Medical City
Billing Department
(671) 645-3595
Customer Relations
(671) 645-5500 ext. 3700/1
Physician Referral Service:
Contact your health insurance company
for a list of network providers
NetCare Insurance – (671) 472-3610
Calvo’s SelectCare – (671) 477-9808
StayWell Insurance – (671) 477-5091
TakeCare Insurance – (671) 647-3526
Resources
Parenting
Guam Regional Medical City Nutrition
Support Services
Help with prenatal or postpartum
problems. Call for consultation or class
schedule
(671) 645-5640
American Academy of Pediatrics
www.healthychildren.org
Family Planning
When to Have Sex Again
You may be wondering when you can
start to have sex again. This is usually
about six weeks after your baby is
born and if you are feeling ready. Talk
to your doctor about this at your sixweek postpartum visit.
Questions to Think About
Before your visit and before you have
sex, think about these questions:
• Are you ready to have another baby
right away?
• Are you sure that you want to have
more children?
• Do you have a medical condition
that limits your birth control choices?
• What birth control methods have you
tried in the past? Did you have side effects
from them? Were they easy to use?
Birth Control
There are many different choices when
it comes to birth control. It can be very
confusing trying to understand all of
them. Talk to your doctor or nurse at
your postpartum visit to help decide
which is best for you.
Sagua Managu / Marianas Physician
Group
Lamaze, Prenatal Care, Parenting and
Sibling Classes
(671) 647-1418
472 Chalan San Antonio PeMar Place,
Tamuning, Guam
Guam Moms Helping Moms and Families
(671) 977-0603 or (671) 685-8190
www.facebook.com/
GuamMomsHelpingMomsAndFamilies
Postpartum Support International
For women with postpartum mood
changes and depression Support
groups, education, and referrals (800)
944-4773 or www.postpartum.net
Breastfeeding
The Guam Regional Medical City’s
Lactation Support Service
For breastfeeding moms in the hospital
Group breastfeeding chat daily and
bedside help with breastfeeding.
Sagua Managu / Marianas Physician
Group
Lactation Consulting and Breastfeeding
Social
(671) 647-1418
472 Chalan San Antonio PeMar Place,
Tamuning, Guam
Procreate Baby Boutique Guam
Breastfeeding and Nutrition Support
Group
(671) 988-4521
Julale Shopping Center, Hagåtña, Guam
LaLeche League International
Phone counseling and support groups
(800) 525-3243 or www.llli.org
Medela
Breastfeeding supplies and support
(800) TELL-YOU
www.medela.com
Women Infant Children (WIC)
Guam Office
(671) 475-0290/0297
Car Seat Check
Help finding a car seat safety
inspection service
(866) 732-8243 or www.seatcheck.org
Hotlines and Helplines
Victim Advocates Reaching Out
(VARO)
(671) 477-5552
Department of Public Health and
Social Services Guam
Maternal and Child Health Program
(671) 735-7104
Poison Control Center
24-hour phone information telling you
what to do for accidental poisoning
(800) 222-1222
National Consumer Product Safety
Commission
Hotline for product safety
(800) 638-2772 or www.cpsc.gov
Postpartum Support International
Support groups, education, and
referrals for women with postpartum
mood changes and depression
(800) 944-4773 or www.postpartum.net
National Immunization Hotline
Department of Health and Human
Services - Centers for Disease Control
and Prevention Information about
immunizations, report problems
(800) 232-4636 or www.cdc.gov/vaccines
Other Resources
Auto Safety Hotline
For recalls, safety notices
replacement parts for car seats
(800) 424-9393
and
133 Route 3 Dededo, Guam 96929
Tel: (671) 645-5500
Fax: (671) 645-5501
Website: www.grmc.gu