Birth
and Baby
Prepared as resource material for use during the
Birth and Baby Classes offered by
Women’s Hospital
I N T R O D U C T I O N
welcome
Welcome to Birth and Baby
We are glad you enrolled in a Birth and Baby Childbirth Class sponsored
by Women’s Hospital. The Perinatal Education Department and Childbirth
Educators are excited to be a part of this important time in your life.
Birth is a normal, healthy experience, but it can be challenging, both
physically and emotionally. The most important goal for labor is a healthy
mom and healthy baby. Your classes will guide you through the birth
process and teach you how to use breathing and relaxation techniques
during your child’s birth. Other topics discussed during the series include
partner support, birth plan options, possible medical interventions,
pain relief choices and Cesarean birth. One class session is devoted to
information on caring for your newborn.
With knowledge of the birth choices available and the process of labor, you
will gain confidence in your ability to handle labor. This added confidence,
along with the support and encouragement of your partner and the
expertise of your caregiver, will make this experience even more special.
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T A B L E
O F
C O N T E N T S
table of contents
Birth and Baby
Prenatal Care Plan................................................................................ 2
Growing Your Baby.............................................................................. 3
Healthy Eating...................................................................................... 5
Pregnancy Diet..................................................................................... 6
Exercise During Pregnancy................................................................... 9
Checklist of Things to Do Before Your Due Date............................... 10
Anatomy and Physiology.................................................................... 13
Posture and Body Mechanics............................................................. 14
Preterm Labor.................................................................................... 16
What is Preterm Labor........................................................................ 18
Build Up to Labor............................................................................... 19
Your Labor Begins.............................................................................. 21
Process of Labor................................................................................. 23
Stages of Labor.................................................................................. 24
Back Labor.......................................................................................... 25
Family-Centered Maternity Care........................................................ 26
Coaching Support.............................................................................. 27
Breathing Techniques in Labor and Birth........................................... 29
Self-Management of Pain................................................................... 31
When You Want to Relax.................................................................... 33
Suggested Relaxation Techniques..................................................... 34
Positions for Labor and Pushing......................................................... 37
Pushing/Second Stage of Labor......................................................... 38
Medical Management of Pain............................................................ 40
Medical Interventions......................................................................... 42
Birth Plan Options.............................................................................. 44
Our Birth Plan..................................................................................... 45
Cesarean Birth.................................................................................... 46
Recovery After Labor and Delivery..................................................... 50
Now You’re Home.............................................................................. 51
Feelings After Birth............................................................................. 52
Taking Care of Baby........................................................................... 53
Feeding Your Baby............................................................................. 56
Crying is Normal................................................................................. 60
Taking Care of Mom and Dad............................................................ 62
Vocabulary.......................................................................................... 63
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P R E N A T A L
prenatal
care plan
C A R E
P L A N
These are tests/procedures and screenings that
will be done during your pregnancy. Please ask
your provider if you are unsure if you have had them
completed. Please do not hesitate to ask about the
tests/results. Generally, you can expect to be seen
every 4 weeks until 28 weeks, every 2-3 weeks until 36
weeks, then weekly until delivery.
FIRST TRIMESTER
ROUTINE
• Blood Tests to include:
Blood type and screen
SCREENINGS/INFORMATION
SELECTED PATIENTS MAY RECEIVE
• Nutrition Assessment/Body Mass Index
• Sickle Cell Trait Test
• Life Stress Screening
Complete Blood Count
• Toxoplasmosis Test
• Depression Screening
Syphilis
• Chicken Pox Titer Test
• Substance Abuse Screening
Rubella
• Domestic Violence Screening
Hepatitis B
• Tobacco Use Screening
• Urinalysis
• Childbirth Education Recommendations
• HIV Test
• Hepatitis C Test
• Ultrasound
• Early Genetic Screening
• Pre-term Labor Screening
• Pap Smear (if due)
• Cystic Fibrosis Test
• Amniocentesis
• Early Gestational Diabetes Test
• Gonorrhea/Chlamydia Culture
• Maternal Care Coordinator Referral
• Flu Shot (October - March)
• WIC Referral
SECOND TRIMESTER
ROUTINE
•
SCREENINGS/INFORMATION
Diabetes Screen – 1 hour glucose tolerance test (If abnormal, will need Diabetes Confirmation Test – 3 hour glucose tolerance test)
• Life Stress Screening
• Depression Screening
• Substance Abuse Screening
• Ultrasound
• Domestic Violence Screening
• Genetic Screen (Blood test optional)
• Tobacco Use Screening
• Preterm Labor Education/Information Provided
• Childbirth Education Recommendations
THIRD TRIMESTER
ROUTINE
SCREENINGS/INFORMATION
• Group B Strep Culture
• Life Stress Screening
• Gonorrhea/Chlamydia Culture
• Depression Screening
• Hemoglobin/Hematocrit Test
• Substance Abuse Screening
• Syphilis Test
• Domestic Violence Screening
• HIV Test
• Tobacco Use Screening
• Antibody Screen (if Rh-) Test
• Breastfeeding Information
• Rhogam (if Rh-) Injection
• Safe Infant Sleep/SIDS information
• Childbirth Education Recommendations
POST PARTUM FOLLOW-UP
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• Depression Screening
• Safe Infant Sleep/SIDS
• Birth Control Discussion
• Preventive Health Measures
T I M E L I N E
O F
your
P R E G N A N C Y
growing baby
Here is a look at the weekly development of your growing baby:
Week 4 – 5
The menstrual period is missed. A cluster of cells is multiplying rapidly.
A watertight sac forms around it, filling with fluid. The placenta is also
beginning to develop. The cell cluster is now a hollow structure that
contains what will be the baby’s lungs, heart, and central nervous
system. It is about 1/100 of an inch in diameter.
Week 6
The face starts to develop. Large dark circles are where eyes will
appear. Internal organs are developing. The heart will begin to beat
by the end of the week. It has grown 10,000 times bigger than when
it started. Medically, the baby is called an embryo. It is now 3/16 of an
inch in length.
Yolk Sac
Medical workers count pregnancy in weeks. A “due date”
is calculated at 40 weeks. To some people, this is confusing
because by the time the period is missed, the pregnancy is
already 4 weeks along. This is because the count begins with the
first day of the last period. Usually, the baby is conceived about
two weeks after the last period starts.
By counting in weeks, the prenatal caregiver can keep up with
the many milestones that the baby is expected to achieve.
timelineof
pregnancy
Week 8
The heartbeat can be seen with an ultrasound. The digestive tract
is developing. There is a skeleton forming, although it is made of
cartilage, not hard bone.
Week 9 – 11
Now called a fetus, little buds are developing that are the beginning
of fingers and toes. Teeth are forming. The weight is 1/30 of an ounce.
The face is formed. The fetus is about 1 inch in length and is starting to
resemble a miniature human.
Small
Intestines
Weeks 12-14
Amniotic Sac
Developing
Placenta
Umbilical Cord
Bladder
The baby can open and close his or her mouth. Fingernails are present.
Most of the time, the heartbeat can be heard with a doppler (the tool
used by healthcare providers to hear the heartbeat). Little structures
on the sides of the neck are starting to look like ears. The inside of the
ear is forming. The first day of the fourteenth week is the beginning
of the second trimester. The baby is about 3 inches long and weighs
about an ounce.
Fundus
Placenta
Week 7
Mucus Plug
Amniotic Fluid
Primitive blood vessels are starting to function. The brain, spinal cord
and nervous system are well established.
Symphysis
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3
T I M E L I N E
O F
P R E G N A N C Y
Weeks 15-18
Weeks 31-34
The baby’s sex organs begin to look distinctly male or female. Hair
begins to grow all over the baby’s body (called lanugo). Eyebrow and
eyelashes are growing. Muscles are growing, which means the baby
can flex his or her arms and legs.
Most babies get in the “head-down” or vertex position around this
time. The amniotic fluid reaches its biggest volume at about 2 pints.
Hiccups can sometimes be felt. The baby is receiving important
antibodies from the mother, which will help protect him from some
dangerous infections after birth. This immunity will last a few months
after birth when the baby starts developing his own resistance to
infections. The baby should weigh close to 5 pounds and be about 17
inches long.
Small Intestines
Umbilicus
Placenta
Peritoneum
Descending Colon
Weeks 35-Birth
Pelvic Colon
The baby gains much needed weight to prepare for birth. The baby’s
lanugo is disappearing. Even in close quarters, the baby is stretching
and wiggling just as much as ever. Sometimes the uterus will have
“practice” contractions, known­­­­­as Braxton-Hicks contractions, before
labor actually starts. The baby may slip into a lower place in the
pelvis (referred to commonly as “the baby has dropped” or medically
speaking as “lightening”). This can make it a little easier to take a deep
breath. An average baby weighs 7-1/2 pounds at birth and is about
20 inches long.
Symphysis
Bladder
Weeks 19-22
The bones are harder, and the muscles are stronger. The first
movement is usually felt around this time (quickening). The hair that
the baby will be born with begins to grow on the head. The brain
grows a lot during this time. The number of nerve cells increases
rapidly, especially in the front of the brain where thinking takes place.
The baby can hear now. The baby may suck his thumb.
Xiphoid Cartilage
Weeks 23-26
Plug of Mucus
The baby is thin but will gain weight rapidly now. The lungs undergo
important changes. Cells inside the lungs start to develop surfactant
(that helps the baby breathe when he is born). The baby is about 9
inches long and weighs about 1-1/2 pounds.
The eyes can open and close. The baby is filling out and does not have
as much room to move around in the uterus. The baby’s legs are bent
toward the chest. This is what is typically called “the fetal position.”
Alveolus
Lactiferous Sinus
Lactiferous Duct
Stomach
Lower Colon
Umbilicus
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Cervix
Urethra
Vagina
Perineum
Weeks 27-30
Xiphoid
Fundus
Liver
Diaphragm
Stomach
H E A L T H Y
E A T I N G
healthy eating
Pregnancy Diet
On average, your body only needs about 300 extra calories a day
during pregnancy. Three small meals and snacks in between are
ideal. You should not go longer than 12 hours without eating. Take
a vitamin with folic acid every day, as directed by your medical
provider.
Healthy Snack Ideas:
• Add no more than 300 extra calories a day to your usual diet.
• Eat or drink something at least every two hours while awake.
• Limit caffeine in your diet because it could cause dehydration.
• Limit (ideally avoid) soda because there is too much sugar/calories.
• Low-fat yogurt.
• Low-fat cottage cheese.
• Do not go more than 12 hours without eating.
• Half of a sandwich made with lean meat and cheese.
• Fresh fruit (banana, orange, apple pear, plum, peach, Tips for Healthy Eating and Weight Gain:
• Do not skip meals.
blueberries, etc).
• Keep healthy snacks available.
• Dried fruit and nut mix (1/4 cup).
• Take a vitamin with folic acid every day.
• Graham crackers with peanut butter.
• Exercise daily. Talk to your medical provider to determine what is best for you.
• Peanuts and raisins (1/4 cup).
• Rice cakes with peanut butter.
• Celery with cream cheese.
• Low-fat milk.
• Multigrain toaster waffle with apple butter.
• Small tortilla with melted cheddar cheese.
• Half ear (frozen) corn on the cob.
• Hard-boiled egg.
• Applesauce.
• Sweet potato.
• Pickle.
• Grape or cherry tomatoes.
• Raw veggies dipped in low-fat dip.
• Low-fat zucchini or banana bread.
• Small bowl of whole grain cereal.
• Pretzels.
• String cheese.
• Fig bar.
• Animal crackers (8-10).
• Vegetable soup (1 cup).
• Frozen yogurt and strawberries.
• Oatmeal.
• Low-fat popcorn.
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H E A L T H Y
E A T I N G
pregnancy
diet
General Information
• Foods that cause food-borne illness:
What is a healthy diet during pregnancy?
• A healthy diet during pregnancy contains a variety of foods that
provide the amount of calories and nutrients you need. During
pregnancy, your body needs extra calories and nutrients to support
your growing baby. Some extra nutrients you need include protein and
certain vitamins and minerals. Following a healthy diet can help you
to gain the right amount of weight during your pregnancy. It can also
decrease your baby’s risk of birth defects, low birth weight and certain
health problems. The amount of weight you should gain may depend
on your weight before pregnancy and if you are carrying more than one
baby. Your caregiver will tell you how much weight you should gain.
• The number of calories you need depends on your daily activity, your
weight before pregnancy, and current weight gain. Your calorie needs
also depend on your stage of pregnancy. Caregivers divide pregnancy
into three blocks of time called trimesters. In the first trimester, you
usually do not need extra calories. In the second and third trimesters,
most women should eat about 300 extra calories each day.
• Unpasteurized food: Unpasteurized foods are foods that have not gone through the heating process (pasteurization) that destroys bacteria. You should not drink unpasteurized milk or juice. Cheese made from unpasteurized milk can also be harmful. This includes Brie, feta, Camembert and blue, or Mexican cheeses. These
cheeses contain bacteria that can harm your growing baby.
What foods can I eat while I am pregnant? Eat a variety of foods
from each of these food groups every day. Your dietitian or
nutritionist will tell you how many servings you should have from
each food group each day. Each item listed counts as one serving.
What should I avoid eating and drinking while I am pregnant?
Breads and starches:
• Alcohol: You should not drink beer, wine, liquor (such as whiskey or
gin) or any other mixed drinks. Drinking alcohol can increase your risk of
having a miscarriage (losing your baby). Your baby may also have health
problems, such as being born too small and having learning problems.
- Whole grains:
• Caffeine: It is not clear how caffeine affects pregnancy. Limit your intake
of caffeine to avoid possible health problems. Caffeine may be found in
coffee, tea, cola, sports drinks and chocolate.
• Foods that contain mercury: Mercury is naturally found in almost all
types of fish and shellfish, and is not harmful to most people. However,
some types of fish absorb higher levels of mercury that can be harmful
to an unborn baby and young children. During pregnancy it is important
to carefully select the kind of fish that you eat. You should avoid certain
types of fish, and eat fish and shellfish that are lower in mercury.
• One-half of a cup of cooked brown rice.
• One-half of a cup of oatmeal.
• One slice of 100 percent whole wheat or rye bread.
• Three-fourths of a cup (1 ounce) of whole-grain dry cereal.
• One-half cup of cooked rice or pasta.
• One-half of a hot dog or hamburger bun.
• Do not eat shark, swordfish, king mackerel or tilefish.
• One-half of a small bagel.
• You may eat up to 12 ounces of fish or shellfish that have low levels of mercury each week. These include shrimp, canned light tuna, salmon, pollock and catfish. Because albacore tuna has more mercury than canned tuna, eat only 6 ounces of albacore (white) tuna per week.
• One six-inch tortilla or pita bread.
• One small dinner roll.
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- Other breads and starches:
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• Raw and undercooked foods: You should avoid eating undercooked or raw meat, poultry, eggs, fish or shellfish (shrimp, crab, lobster). You should also avoid eating cooked foods that have been near raw foods. Cook leftover foods and ready-to-eat foods such as hot dogs until steaming hot. Avoid processed lunch meats.
Fruits: Eat a variety of fruits each day. Choose fresh, canned or dried fruit
instead of fruit juice as often as possible.
• One half-cup (4 ounces) of a cup of fruit juice.
• One half-cup of chopped, cooked or canned fruit.
• One medium size apple, peach, orange or banana.
H E A L T H Y
Vegetables: Eat dark green and orange vegetables several
times a week.
E A T I N G
controls body temperature. You need about eight to ten (eight-ounce) cups
of water each day. This amount includes water, other liquids, and water
from foods.
A serving of vegetables is:
• One half-cup of cooked or raw vegetables.
• One half-cup of vegetable or tomato juice.
• One cup of raw or leafy vegetables (such as a tossed salad).
What vitamin and mineral supplements might I need to take? Most women
can get the extra nutrients they need from food if they eat a healthy,
well-balanced diet. However, some women do need vitamin and mineral
supplements to meet their extra nutrient needs during pregnancy. Your
caregiver will tell you if you need a supplement, and the type you should
use. Talk to your caregiver before taking any other kind of drug, including
herbal (natural) supplements.
• Dark green vegetables: Broccoli, spinach, romaine lettuce, collard, turnip and mustard greens.
• Folic acid: The amount of folic acid you need before you get pregnant is at least 400 micrograms each day. Folic acid helps to form your baby’s brain and spinal cord in early pregnancy. During pregnancy, your daily need for folic acid increases to about 600 mcg. Include folic acid in your diet each day by eating citrus fruits and juices, green leafy vegetables, liver, and dried beans. Folic acid is also added to foods such as breakfast cereals, bread products, flour and pasta.
• Iron: This mineral is important because it helps the baby’s blood and your blood carry oxygen. Good sources of iron are meat, liver, poultry, oysters, and fish. Other sources are beans, vegetables (spinach, peas, broccoli), and fortified cereals and breads. Your body will absorb iron better from non-meat sources if you have a source of vitamin C at the same time. Drink tea and coffee separately from iron-
fortified foods and iron supplements. You need about 30 mg of iron during pregnancy.
• Prenatal vitamins: Eat a healthy diet, even if you take a prenatal vitamin. You may forget to take your vitamin for a day. If you forget, do not take double the amount the next day.
• Calcium and vitamin D: Your need for calcium and vitamin D does not increase during pregnancy. However, women who do not eat milk products may need a calcium and vitamin D supplement. Talk to your caregiver about calcium supplements if you do not regularly eat good sources of calcium. The amount of calcium you need is about 1,300 mg if you are between 14 and 18 years old and 1,000 mg if you are 19 to 50 years old.
• Orange vegetables: Carrots, sweet potatoes, winter squash and pumpkin.
• Other vegetables: Tomatoes, lettuce, green beans, and onions.
• Starchy vegetables: White potatoes, corn, and green peas.
Dairy Foods: Choose fat-free or low-fat dairy foods.
• One and one-half ounces of low-fat cheese.
• One cup (eight ounces) of low-fat or fat-free milk or yogurt.
• One-half of a cup of low-fat frozen yogurt.
Meat and other protein sources: Choose lean meats and poultry (chicken
and turkey). Bake, broil, and grill meat instead of frying it. Eat a variety of
protein foods.
• One and one-half ounces (about two tablespoons) of nuts or two tablespoons of peanut butter.
• One-half cup of soy tofu or tempeh.
• One large egg.
• Three-fourths of a cup of cooked dried beans, peas or lentils
• Three to four ounces of any lean meat, fish, or poultry.
Fats:
• One-eighth of an avocado.
• One teaspoon of oil (canola, olive, corn, safflower, soybean).
• One teaspoon of tub, stick or squeeze regular margarine.
• One tablespoon of low-fat margarine (30 to 50 percent vegetable oil).
• One teaspoon of regular mayonnaise or one tablespoon of low-fat mayonnaise.
• One tablespoon of regular salad dressing or one and one-
half of a tablespoon of low-fat salad dressing.
How much water do I need to drink each day? Water makes up a large part
of your body, including your blood. During pregnancy, the amount of blood
in your body increases up to twice as much as usual. The water you drink
makes up part of this fluid. Water protects and cushions your baby, and
What diet changes may help if I have morning sickness? Morning sickness
is common during the first few months of pregnancy. You might feel
nauseated (sick to your stomach) or you could vomit (throw up) many times
a day. To improve symptoms of morning sickness, eat small, frequent meals
instead of three large meals. Foods high in carbohydrate such as crackers,
dry toast, and pasta may be easier to eat for some women. Drink liquids
between meals rather than with meals. Avoid foods that have a strong
smell and foods that make you feel sick. Avoid having an empty stomach.
Call your caregiver if you have very bad nausea and vomiting with other
symptoms. These symtpoms may include constant nausea and vomiting,
not eating or drinking, weight loss, and trouble doing daily activities.
What diet changes may decrease the problem of constipation? Many
women have problems with constipation during pregnancy. Being
constipated means having hard stools that are difficult to pass. A high fiber
diet can improve the symptoms of constipation. Some breakfast cereals,
whole grain breads and prune juice are high in fiber. Raw fruits, vegetables
and cooked beans are also good fiber sources. Increasing your intake of
fluids and getting regular physical activity may also be helpful. Be sure to
check with your caregiver before you begin any exercise program.
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7
P R E G N A N C Y
What diet changes may decrease my heartburn? Pregnancy hormones
cause food to move more slowly through your digestive system, which
sometimes causes heartburn. To improve the symptoms of heartburn, avoid
lying down right after eating. When you do lie down, sleep with your head
slightly elevated. Eat small, frequent meals instead of three large meals.
Avoiding caffeine, chocolate, or spicy foods may also be helpful.
How can I get calcium in my diet if I cannot tolerate milk? Some women
cannot eat milk or milk products (milk intolerance). Milk intolerance may
cause gas, stomach cramping, bloating, and loose stools (BMs) after eating
or drinking milk products. Some people can tolerate at least one cup (8
ounces) of milk with meals. If you cannot drink milk, lactose-free or lactosereduced milk and calcium-fortified soymilk are good choices. Hard, aged
cheeses and yogurt may be easier to digest than milk. Ask your caregiver
about pills you can take to help you digest milk products.
What other healthy guidelines should I follow?
• Cravings: Many women have cravings for certain foods during pregnancy. They may crave foods such as chocolate,
citrus fruits (oranges, grapefruits, tangerines), pickles, potato chips, and ice cream. Foods that are high in
calories, fat and sugar should not replace healthy food
choices. Some women have cravings for unusual
substances such as clay, dirt, laundry starch, freezer frost,
ice, and chalk. This condition is called pica. Eating these
things may lead to health problems such as anemia and
cause illness. Tell your caregiver about your cravings.
Caregivers can make sure that you are eating the right
foods that you need during pregnancy.
D I E T
• Smoking and drug use: Do not smoke cigarettes,
marijuana (pot) or use other illegal drugs during pregnancy.
These substances are harmful to your baby. For example,
smoking increases the chances of your baby being born
at a low birth weight or being born too early. It is never too
late to quit smoking if you smoke. Smoking harms your
heart, lungs, and blood. You are more likely to have a
heart attack, lung disease, and cancer if you smoke­­. You
will help yourself and your baby by not smoking. Your
caregiver can give you information on how to stop
smoking or using illegal drugs.
• Vegetarians and vegans: Vegetarians and vegans need
to be careful to include enough protein, vitamin B12, and
iron during pregnancy. Some non-meat sources are
fortified cereals, nut butters, soy products (tofu and
soymilk), nuts, grains, and legumes. These nutrients are
also found in eggs and milk products.
Risks: Not eating a healthy diet can cause problems for you and your
baby. You may not be able to gain the weight needed for a healthy
pregnancy. A healthy weight gain is important for having a baby with a
healthy weight. Babies who are born at a healthy weight have a lower
risk of having certain health problems at birth and later. Following
a healthy diet may help you avoid gaining too much weight during
pregnancy. Gaining too much weight can also cause problems during
pregnancy and delivery.
CARE AGREEMENT: You have the right to help plan your care. To help with
this plan, you must learn about your diet. You can then discuss treatment
options with your caregivers. Work with them to decide what care may be
used to treat you. You always have the right to refuse treatment.
© 1974-2008 Thomson MICROMEDEX. All rights reserved.
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E X E R C I S E
D U R I N G
P R E G N A N C Y
exercise
during pregnancy
The American College of Obstetricians and Gynecologists
recommends that pregnant women should try to exercise
risk for getting hit in the belly, such as soccer or
basketball.
moderately for at least 30 minutes on most, if not all, days unless
• Do not choose activities that require a lot of jumping or
there are medical reasons to avoid it.
jarring movements.
• Do not scuba dive because that can lead to dangerous
Why Exercise During Pregnancy
• Helps you feel better physically and emotionally.
• Helps prevent excessive weight gain.
• May help prevent gestational diabetes.
gas bubbles in the baby’s blood system.
• Do not choose an activity that you have to lie flat on
your back to do.
• Do not over-do exercise.
• If you have diabetes or gestational diabetes, it can help
control blood sugar.
Danger Signs
• Relieves stress.
• Vaginal bleeding.
• Improves posture.
• Dizziness or feeling faint.
• Helps you sleep better.
• Chest pain.
• Builds stamina for labor and delivery.
• Severe headache.
• Will help you get back into shape easier after the baby
• Uterine contractions.
is born.
We love
Fit 4 Two!
• Decreased fetal movement.
• Fluid leaking from the vagina.
Exercise Do’s
• Discuss exercise with your medical provider. Some
medical conditions such as heart disease or pregnancy
If you experience any of the above symptoms, call your physician
immediately.
conditions may make it dangerous to exercise during
pregnancy.
• Pick activities you enjoy.
• Exercise with a buddy.
• Pay attention to your body and how you feel.
• Choose activity wisely. Some good examples are:
swimming, walking, stationary or recumbent biking, and
prenatal exercise or yoga classes.
• Drink plenty of water during exercise.
• Warm up your muscles and stretch before getting started.
• Cool down at the end of your workout (reduce your
activity slowly).
• Dress comfortably.
• Wear a supportive bra.
Exercise Don’ts
• Do not choose an activity that puts you at high risk for
injury, such as horseback riding or downhill skiing.
• Do not choose a contact sport or activity that puts you at
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C H E C K L I S T
O F
T H I N G S
T O
D O
B E F O R E
Y O U R
D U E
D A T E
checklist
of things to do before your due date
r
Choose a pediatrician or family doctor for
your baby.
r
• Arrange for child care while you are in
Sample questions to ask;
• Can I call you day or night?
the hospital.
• Include your soon-to-be big brother or big • Who is the physician on call when you are sister while preparing for the new baby’s not available?
• Why is breastfeeding so important for my baby?
If you have other children or pets:
arrival.
• Attend a sibling class if possible.
• Make sure your pet’s vaccinations are current.
• Discuss how your pet interacts with children with
r
Get organized.
• Get baby furniture set up, cleaned and ready to your veterinarian.
• Arrange care for your pet.
use. Make sure any baby products you borrow
meet all safety regulations.
• Launder all baby clothing. It is important to use the
same detergent consistently to avoid allergic
reactions to the soap.
• Enlist help for after your baby is born. You will need
more help with the house than with your little one.
• Begin by going room to room to create a baby-safe
environment.
• Put medicine, cleaning products and personal care
items in a locked or child-proof cabinet.
• Block used outlets with plug covers.
care as you become more comfortable as a
• Remove all hazardous items from underneath
• Pre-register for the hospital. Go to
www.conehealth.com to complete pre-admission
forms.
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Safety check your home.
Helpers should be there to assist you with baby
new parent.
10
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all sinks.
• Post all emergency numbers by your phone,
including your local pharmacy’s number.
• Consider taking an infant CPR class.
C H E C K L I S T
O F
T H I N G S
T O
D O
B E F O R E
Y O U R
D U E
D A T E
√ √ √ √ √ √ √
r
Decide how you are going to feed you baby.
Breast milk has been shown to be the ideal food for babies
and is far superior to infant formulas. The health outcomes
for babies have shown that breast milk and formula are not
equal alternatives. However, the decision on how to feed
your baby is a very personal one.
r
Pack your suitcase.
Ideally you should be packed two to four weeks prior to
the birth. Plan for a two to three day hospital stay. Pack
your “labor goody bag” in a separate bag from the items
you will need after the baby is born.
r
Your “labor goody bag” should include such
items as:
• Focal point (picture or special object to
concentrate on while you labor)
• Playing cards, magazines or books to help pass the time
• Camera/Video camera with chargers or extra batteries
• Cellphone, Laptop with chargers (wifi is available)
• Watch/clock with a second hand
• Birth and Baby handbook
r
Items for your hospital stay:
• Clothes for you to wear home - allow extra room in
bust & waist
• Bras - nursing bras should be fitted as close to your due date as possible.
• Nursing pads
• Gown/Pajamas (2-3 sets)
• Insurance card
• Robe
• Lip balm
• Underpants (3-4 pairs)
• Lotion or oil for massage
• Sanitary pads
• Hand-held massagers
• Toiletries
• 2 bed pillows with pillow cases in colors other
• Cosmetics
than white
• Hair-care equipment (comb, brush, shampoo, mirror)
• Toothbrush/Toothpaste
• Clothes for baby to wear home, including blankets
• Breath Mints/Lollipops
• Baby book
• Music/iPod/CD player
• If desired, your own gown/sports bra, bathing suit
top, etc
• Bathrobe and slippers
• Several pairs of dry socks
• Hand fan
• Hair clips/rubber bands
• Eye glasses/Contact lens products
B I R TH
A N D
B A B Y
11
C H E C K L I S T
O F
T H I N G S
T O
D O
B E F O R E
Y O U R
D U E
D A T E
√ √ √ √ √ √ √
r
Purchase a car seat for the baby.
If you own two cars, it is a good idea to buy a seat for each vehicle. The car seat should be installed before coming to
the hospital. Have the car seat checked by a certified person. Log on to www.safeguilford.org for community car seat
safety checks and certified Child Passenger Safety Technicians in your area.
12
BIRTH
A N D
B A B Y
A N A T O M Y
anatomy
and
Pre-Pregnancy
A N D
P H Y S I O L O G Y
physiology
36 Weeks Pregnant
B I R TH
A N D
B A B Y
13
P O S T U R E
A N D
B O D Y
M E C H A N I C S
D U R I N G
P R E G N A N C Y
posture and body mechanics
during pregnancy
Correct posture helps decrease common pregnancy discomforts, such as
backache and strain, and strengthens the muscles that support the body. It also
makes you look and feel better. Try the following:
Posture While Standing
Place your feet about shoulder distance apart. Soften your knees and tuck your
buttocks and tailbone under. Lift your rib cage and square off your shoulders.
Imagine there is a string pulling your head up straight, and notice the back of your
neck lengthening. Remind yourself to check these points throughout your daily
activities. If you must stand for long periods of time, place one foot on a stool to
reduce back strain.
Posture While Sitting
The seat of your chair should support the entire length of your thighs when your
lower back is pressed against the back of the chair. Keep shoulders in proper
placement over hips. Place feet flat on the floor and knees at hip level or slightly
lower. Rest your feet on a stool if they do not touch the floor while sitting.
This sitting position allows room for your enlarged uterus and does not put
additional strain on the lower back. Avoid crossing your legs because this reduces
circulation. Also, stand up and walk around, get water or go to the bathroom
every 30 minutes to help with circulation.
Posture While Lying
Lying on your side is usually more comfortable, especially during the second half
of your pregnancy. This position also allows the maximum blood flow to your
baby. Place a pillow between your knees for proper hip alignment when lying on
your side. You can separate your legs for added comfort if desired. You also can
place another pillow under your abdomen and against your lower back for added
comfort and support.
14
BIRTH
A N D
B A B Y
P O S T U R E
A N D
B O D Y
M E C H A N I C S
D U R I N G
P R E G N A N C Y
Moving from a Lying Down to
an Upright Position
Changing positions from lying down to sitting or
standing upright can be difficult during the latter
part of your pregnancy. It also can cause stress
on the stomach and back muscles if not done
correctly. Change positions as described below
to avoid straining, and use gentle movements to
promote necessary circulatory adjustments.
1. Roll to one side. Bend both kneeds to
that side.
2. Raise yourself with your upper arms while
slowly swinging your legs over the side of
the bed.
Lifting an Object
1. Stand close to the object and squat with your
knees bent when lifting an object from the
floor. Then place one foot in front of the
other. Keep your back straight and rise from
your knees.
2. Carry heavy objects close to your body.
Lower your body by bending your knees when
placing an item on the floor. Remember to
keep your back straight.
3. Pick up small children from a stool or chair to
avoid having to squat so low.
B I R TH
A N D
B A B Y
15
P R E T E R M
preterm
labor
General Information
What is preterm labor? Preterm (premature) labor occurs when the
uterus (womb) contracts and the cervix opens earlier than normal. The
cervix is the opening of your uterus. Labor brings changes to prepare
the baby to move from the uterus through the vagina (birth canal). This
includes tightening and relaxing of your uterus, which causes the cervix
to get thinner and open. Preterm labor happens after the 20th week of
pregnancy but before the 37th week of pregnancy. An early labor could
cause you to have your baby before he is ready to be born.
What causes preterm labor? No one knows for sure what causes
preterm labor. The following are some factors that may cause
early labor:
• Abnormal uterus: The shape of your uterus may cause preterm labor. A large uterus or a short cervix can cause you to go into labor early.
• Chronic illness: Illnesses such as high blood pressure, diabetes or obesity can cause early labor.
• Infection: Infections, such as urinary tract infections or bacterial vaginosis, can weaken the membranes (linings) that surround the amniotic sac your baby lies within. The amniotic sac contains the fluid around your baby. This could lead to premature rupture of the membranes and preterm labor.
• Problems with the placenta: Problems with the placenta, such as placenta previa or placental separation, may cause preterm labor. The placenta is the tissue (like skin) that joins you to your baby.
• Trauma: Injury to your abdomen (stomach) or uterus also may cause some cases of preterm labor.
What are my risks of having preterm labor? You may be at an
increased risk if:
16
• You are pregnant with two or more babies.
• You are younger than 17 or older than 35 years of age.
• You get pregnant again in less than six months.
• You had a preterm labor or preterm birth in the past.
• You have had no prenatal check-ups with your caregiver.
BIRTH
A N D
B A B Y
L A B O R
• You smoke, drink alcohol or use street drugs during pregnancy.
• You weigh less than what your caregiver recommends before getting pregnant. Poor weight gain during pregnancy also may increase your risk of having early labor.
What are the signs and symptoms of preterm labor? You may not know
that you are having preterm labor. It is common for some women to
have preterm contractions (tightening and relaxing of the uterus) and
not notice them. The following are signs and symptoms that suggest a
preterm labor:
• Abdominal pain or menstrual-like (period-like) cramping.
• Change in vaginal discharge, such as an increase in the amount or the discharge becomes watery or bloody.
• Low back pain.
• Pressure in the lower abdomen.
• Vaginal spotting or bleeding.
How is preterm labor diagnosed? You may have one or more of the
following tests to check if you are having a preterm labor:
• Fetal fibronectin test: This test checks for a protein called fetal fibronectin in the cervix or vagina. Normally, there is no protein in cervical and vaginal secretions from the 20th week of pregnancy until near term.
• Pelvic exam: This is also called an internal or vaginal exam. During a pelvic exam, your caregiver gently puts a warmed speculum into your vagina. A speculum is a tool that opens your vagina. This lets your caregiver see your cervix (bottom part of your uterus). With gloved hands, your caregiver will check the size and shape of your uterus and ovaries.
• Vaginal ultrasound: This simple test uses sound waves to show pictures of the inside of your uterus (womb) and ovaries. A small tube is placed into your vagina. Pictures of your uterus and ovaries are seen on a TV-like screen.
P R E T E R M
How is preterm labor treated?
• Bed rest: You may need to drink lots of fluids and rest in bed on your left side, which improves circulation to the uterus. Your caregiver will tell you when it is OK to get out of bed.
• Medicines:
L A B O R
Contact the following for more information about preterm labor:
• American Academy of Family Physicians
PO Box 11210
Shawnee Mission, KS66207-1210
Phone: 1-913-906-6000
Web address: http://www.aafp.org
• The American College of Obstetricians and Gynecologists
- Corticosteroids: These medicines may be given if your preterm labor cannot be stopped and your caregiver thinks you may deliver the baby early. This medicine may help your child’s lungs to mature ­­and decrease the chance of breathing problems after your baby is born.
409 12th Street, SW
Washington, DC 20090
Phone: 1-202-638-5577
Web address: http://www.acog.org
- Tocolytics: Tocolytics are given to try to stop contractions if your baby is not ready to be born. Contractions are when the muscles of your uterus tighten and loosen.
Care Agreement
- Antibiotics: Antibiotics may be given to help treat or prevent an infection caused by germs called bacteria.
With treatment, including medications and bedrest, you may be able to
stop preterm labor.
You have the right to help plan your care. To help with this plan, you must
learn about your health condition and how it may be treated. You can then
discuss treatment options with your caregivers. Work with them to decide
what care may be used to treat you. You always have the right to refuse
treatment.
Where can I find more information? Having preterm labor may be lifechanging for you and your family. Accepting that you have preterm labor
may be hard. You may feel afraid, sad or scared. Talk about your feelings
with your caregiver or someone close to you.
© 1974-2008 Thomson MICROMEDEX. All rights reserved.
B I R TH
A N D
B A B Y
17
W H A T
I S
P R E T E R M
L A B O R ?
what is
preterm labor?
Preterm labor is labor that begins before the end of 36 weeks of pregnancy. It happens when the uterus (womb) contracts (tightens)
and makes the cervix (opening of the womb) expand. The baby is pushed out too soon. Babies born too early risk major illness and
may not live. Babies born from 20 to 37 weeks are considered premature and may need special care in a neonatal intensive care unit
(NICU).
Pregnancy Timeline
Preterm
Early Term
Full Term
Late Term
Post Term
20-36 weeks
and 6 days
37-38 weeks
and 6 days
39-40 weeks
and 6 days
41 weeks
and 6 days
42+ weeks
What Does Preterm Labor Feel Like?
Learn to recognize these signs of preterm labor to protect yourself
and your baby.
Contractions: You have regular contractions that are 10 minutes
apart or closer. You may or may not experience pain during
contractions.
Low, dull backache: You feel backache below your waistline. It
may come and go, or it may be constant.
Menstrual-type cramps: You may feel cramps, low or near your
pelvic bone, like before or during your period. They may come
and go, or they may be constant.
Leaking or gushing fluid: If your water breaks, you will feel a
continuous light or heavy flow of fluid from your vagina.
Changes in discharge: You notice watery, mucousy or bloody
(pink or brownish) discharge from your vagina.
Stomach cramps: You may or may not experience diarrhea.
Pressure: The baby feels heavy or as if it is pushing down low in
your pelvis. The pressure comes and goes.
Call your healthcare provider immediately if you notice any of these signs and/or flu-like symptoms or any severe pain.
18
BIRTH
A N D
B A B Y
B U I L D U P
T O
L A B O R
buildup to labor
S I G N S
T H A T
Y O U R
B O D Y
I S
P R E P A R I N G
You may experience all or none of these symptoms:
F O R
T H E
“ M A I N
E V E N T ”
Diarrhea or loose stool: A heavy uterus pressing on the
intestines can cause diarrhea or loose stools. This is also
nature’s way of cleaning out a path for the baby’s head to
Braxton-Hicks contractions: These are contractions that come
descend.
and go, occurring from the top to the bottom of the uterus.
They may happen more often in late pregnancy as the uterus
prepares for labor. If you have five or more Braxton-Hicks in an
Mucus plug: This is a plug of heavy mucus, which blocks the
hour before 37 weeks, please call your physician or midwife to
cervix during pregnancy. The mucus comes out in one mass
rule out premature labor.
or in “strings” of pink-tinged mucus. It can occur from a few
hours to a few days before labor begins.
Burst of energy or “nesting”: You may develop an urge to
clean, cook, organize or otherwise prepare for the baby’s
Show: Show is a small amount of dark, blood-tinged vaginal
arrival. It is important not to overdo since you never know
discharge that may coincide with the onset of labor or
when you will need the energy for labor.
precede contractions by many hours. The discharge may
increase slightly as labor begins.
Lightening or the “baby dropping”: Two to four weeks prior
to delivery, the baby settles deeper into your pelvis. It may be
Water breaking: The amniotic sac is a protective cushion
gradual or occur suddenly (see page 27). You may feel a need
for the baby to prevent bacterial exposure. The amniotic
to urinate more frequently afterward, but it may become
sac may break prior to or any time during labor. When your
easier to breathe. This happens less frequently with each
water breaks, you want to notice the Time it occurs, Amount,
additional pregnancy.
Color of the fluid and if it has a foul Odor to it. (T.A.C.O.) If you
question whether your water has broken, and you are not
sure, call your doctor.
Weight loss: You may lose one to three pounds about a week
before your labor begins. This weight loss is the result of
changes in hormone levels, which cause fluid to shift.
B I R TH
A N D
B A B Y
19
B U I L D U P
T O
L A B O R
­­­When to call your caregiver
• Contractions 5 minutes apart for an hour after 37 weeks ­gestation
unless otherwise advised by your physician.
• If your water breaks or you question if the amniotic sac is leaking.
Call your caregiver immediately if you experience the following:
• Bright red bleeding.
• There is a decrease in fetal activity
• You are not feeling “right.”
• You are experiencing such symptoms as blurred vision, severe
headache, significant pain or difficulty with nausea or diarrhea.
20
BIRTH
A N D
B A B Y
Y O U R
L A B O R
B E G I N S
your labor begins
Believe in your power to do this. The only goal of labor
and delivery is a healthy mom and baby.
Signs of Labor
Contractions
• Regular, recurring contractions that last for at
least 30 seconds.
• Stronger than Braxton-Hicks contractions.
• They may feel like pressure, pulling or cramping
in the lower abdomen or back.
• They may feel like gas or strong menstrual cramps.
• They become stronger, longer and closer together.
• Contractions often strengthen with walking or
changes in position.
Discuss with your physician when you should leave for
the hospital. As a general rule, most women should
call their physician when contractions are five minutes
apart for one hour. If you have had a baby before or
have had concerns during your pregnancy, you may
need to leave sooner.
511 Rule
• 5 - minutes apart.
• 1 - contractions last about a minute.
• 1 - for at least one hour.
B I R TH
A N D
B A B Y
21
Y O U R
L A B O R
B E G I N S
How to Time Contractions
As soon as you question whether contractions have started, begin
timing them. Jot down the time they begin and finish to see if there is
“If you believe
you can or
believe you
can’t, you’re
right.”
- Marge Cooper
a pattern. You want to monitor the frequency, duration and intensity
of the contraction.
Frequency - the time interval between the beginning of one
contraction to the beginning of the next contraction.
Duration - the time, in seconds, from the beginning to the end of one
contraction.
Intensity - the strength of a contraction.
Example: A contraction begins at 5:10 p.m.; the next contraction
begins at 5:20 p.m. These contractions are 10 minutes apart. The
duration or length of the contraction is 45 seconds.
First Stage of Labor- From the first contraction until 10cm dilation.
Second Stage – 10cm dilation until the birth of the baby.
Third Stage – The birth of the baby until the placenta is delivered.
22
BIRTH
A N D
B A B Y
P R O C E S S
O F
L A B O R
process of labor
Lightening or “Baby
Dropping” into pelvis.
Artwork taken from Your Child’s First Journey: A Guide to Prepared Birth From Pregnancy to Parenthood by Ginny Brinkley,
Linda Goldberg and Janice Kukar.
B I R TH
A N D
B A B Y
23
STA GE I
ST A GE II
PHASE 1
PHASE 2
PHASE 3
Stage
Early (Latent)
Labor
Active Labor
Transition
Pushing to
Deliver Bab y
Delivery of
Placenta
0-3
cm
4-7
cm
8-10
cm
Remains
10cm
Closes
after
placenta
out
Regular,
becoming
stronger, about
3-5 minutes
apart, averaging
45-60 seconds each
May be irritable, desiring
to escape, may be very
difficult to relax during
contractions. May
experience nausea and/or
vomiting, chills, trembling,
hot flashes, or cramps
in legs.
More serious, no
longer wants to chat,
may need to use
breathing techniques.
May desire medication
for pain relief.
May feel excited,
talkative, unsure if
this is labor.
Assist her with the various
pushing positions. Encourage
her with each push. Help her
relax and rest between
contractions. Refer to
pushing section in this book
for more detailed tips on
techniques of pushing.
Establish eye contact and do the
breathing patterns with her. If she
panics or loses control, use a firmer
tone of voice and/or hand signals to
help her concentrate on breathing.
Continue to encourage her and take
contractions one at a time.
Drive carefully to the
hospital. Reassure her, assist with
breathing, and provide comfort
measures such as wet washcloths,
assistance with various positions, ice
chips, counter-pressure to back and
massages to keep her relaxed.
Be calm and confident.
Relaxation tends to spread.
Encourage her to stay rested
and drink fluids. Be generous
with encouragement and
comfort measures.
Partner
Regular, very
strong, about
every 1-3 minutes,
lasting 60-90
seconds or longer
Intense pressure on the
rectum or bladder causing
her to bear down. Burning
or prickling sensations on
the perineum as it
stretches. Pushing usually
brings relief from the pain
of contractions.
Congratulations on your
hard work.
Enjoy your baby!
Mom
Regular, very
strong, about 3
minutes apart,
slightly longer
intervals between
contractions
Relieved, happy and tired.
May not even notice the
few mild contractions
present. May feel slight
need to push as the
placenta is expelled.
May be
irregular,
about 5-20
minutes
apart, about
30-45 seconds each
Average Time
7-8 HRS.
3-5 HRS.
30-90 MIN
1st baby: avg. 2 hrs;
2nd baby: avg. 1 hr
about 20 min
or less
Will have
cramps, but not
nearly as
strong as labor
contractions
B A B Y
A N D
BIRTH
24
stages of labor
ST A GE III
L A B O R
O F
S T A G E S
B A C K
L A B O R
back labor
Back labor
Technique: Position yourself on all fours. Take a breath in and
Back Labor is caused when the back of the baby’s head rests
toward the mother’s back.
while you release your breath, lift your back into a C-shaped
position or a rainbow shape by tightening the buttocks and
tucking the tailbone under. Hold the stretch for five counts.
1. If you are experiencing back labor, you need to change
position more frequently. Think about your position - you
should be off your back. (See illustrations on page 41.)
Take in another breath as you slowly release into a flat-back
Hand-knees“Slow dancing”
5. Apply hot water bottle, heating pad or ice bag. Don’t do
this if you have received medication.
Sitting backwards in chair Kneeling
Side-lyingLunge
StandingPelvic rock
WalkingRocking
2. Massage lower back and buttocks with lotion. Use rolling
pressure over lower back with paint roller, rolling pin or an
empty frozen juice or cola can.
or table-back position. Do not let the back sag or hollow as
this may cause stress to the pelvic joints.
6. Try the double hip squeeze. The mother kneels and leans
forward (or on hands and knees). Partner, press on both
sides of her buttocks from behind with the palms of your
hands. Apply pressure toward the center (pressing her hips
together). Do this during contractions. Apply as much
pressure as she needs.
7. Take a bath or shower.
8. Use positive encouragement.
3. Use counter pressure.
4. Use the pelvic tilt during labor to decrease pain and help
rotate baby from a posterior position to a more favorable
anterior position. It also decreases pregnancy back
discomfort. It can be performed in a variety of positions,
including all fours, side-lying, sitting and standing against a
wall. The back-lying position is not a good choice during
pregnancy but can be used after birth.
Thigh pain/trembling legs:
1. Use inner thigh massage or support.
2. Apply warm compresses to the leg/groin area.
Think in terms of how much contractions will accomplish rather
than how much they will hurt. Remember: No matter how
intense, it is a relatively brief duration.
B I R TH
A N D
B A B Y
25
F A M I L Y - C E N T E R E D
M A T E R N I T Y
C A R E
family-centered
maternity care
It was not so long ago that Dads held their newborns while
As you pack for the hospital, you need to plan your stay.
wearing yellow gowns, and babies were whisked off to the
nursery before visiting hours began. Grandparents only saw
• Do not overdo before your baby is born. Get to sleep
the new baby through glass windows, and brothers and sisters
early and nap as often as you can. While you’re in the
waited anxiously at home for the return of Mom and their new
hospital, take advantage of the quiet times offered in
sibling. Only parents were allowed to hold the baby in the
hospital.
the afternoon from 2 to 4 p.m. and from 8:30 p.m. to 5 a.m. Tell family and friends that you, your baby and
your support person will be spending this time
With the introduction of Family-Centered Maternity Care,
together focused on education, bonding and rest.
Women’s Hospital focuses on the needs of the mother,
infant and family. The same nurse provides care and teaches
• Discourage extended family and friends from visiting
parenting skills as bonding between the infant and family
during your hospital stay so you can rest. Discuss
begins. Studies have shown that an infant who stays in the
visiting once you are home and have had a few days to
room with his or her mother will cry less, startle less frequently
become accustomed to the demands of your new
and stay warm and stable. Breast milk often “comes in” sooner.
family member.
For the average mother, the hospital stay is 48 hours following
• Limit your phone calls and turn your cell phone off. Ask
a vaginal birth and 72 hours after a Cesarean delivery. This
one person to call everyone about the birth or send out
hospitalization marks the transition to parenting at home. For
an e-mail with pictures.
first-time mothers, it is a chance
to practice hands-on baby care with a group of medical experts
• If Dad or your support person cannot stay with you,
close by for assistance when needed. No matter how many
consider asking another family member or friend to
books you read before delivery, you learn from direct care
spend the day with you.
of your little one. With each diaper change or feeding, you
become more confident as a parent. Nurses are part of the
• Hold your baby skin-to-skin as much as possible. This support team.
helps your baby learn to adjust her body temperature,
blood sugar, and it gets breastfeeding off to a good start.
The birth of a baby represents the birth of a family. The
26
postpartum period is a time when we help you to learn about
Pre-arrange help and meals at home. When you have extra
your new arrival and support you as a family. The goal is for
people helping at home, their priority should be the household
you and your family to leave the hospital more confident and
chores. You want to continue building your confidence caring
comfortable with the care of your newborn.
for the baby. When you need a hand, they can jump in.
BIRTH
A N D
B A B Y
C O A C H I N G
S U P P O R T
coaching support
Prepared childbirth focuses on the benefits of breathing,
relaxation and coaching support.
No one in the delivery room knows you like your Coach. This inside
knowledge allows him or her to be your greatest support and
advocate.
Special Notes for Partners
1. Maintain a supportive environment.
2. Touch, if she finds it comforting.
3. Talk her through contractions with the help of a fetal monitor.
4. Breathe through difficult contractions with her.
5. Use hand signals or song rhythms to help Mom stay on track
with breathing patterns.
6. Praise and encourage Mom throughout labor.
7. As she begins focusing inward, reduce outside stimulation,
such as dimming the lights, talking in a softer voice or closing
the door.
8. As labor progresses, make sure you give directions in slow,
simple repetitive words and phrases.
9. Mom may be sleeping during the rest periods between active
and transition labor. As the monitor indicates a contraction is
beginning, say “Contraction begins” so she can start
breathing and not be caught off guard.
10. Be firm, but kind.
B I R TH
A N D
B A B Y
27
C O A C H I N G
S U P P O R T
S U P P O R T
E N C O U R A G E
P R A I S E
11. Encourage Mom to walk and change positions
frequently.
12. Remind Mom to empty her bladder every hour
to take pressure off her uterus.
13. You may try resting a hand on her shoulder with
your other hand at her wrist. Keep your hands
there during contractions. Massage her hands.
14. During later labor, remind her about the baby.
As labor progresses Mom may tend to focus on
the contraction and forget about the baby.
15. Talk her through pushing contractions if it is
helpful. “Inhale...exhale...inhale...exhale” “Hold
and push,” etc.
16. Act as a go-between for Mom and the hospital
staff. Be her advocate.
17. Let Mom know you are leaving and have
someone else stay with her if you need a break.
Bring a lunch so you can limit the amount of
time you are away from Mom.
18. Rely on your nurse for support and ideas.
Remember, you are never alone.
28
BIRTH
A N D
B A B Y
B R E A T H I N G
T E C H N I Q U E S
breathing techniques
during labor and delivery
Purpose of the breathing technique:
Breathing tips:
• Enhances relaxation.
1. If labor begins in the middle of the night, try to take
catnaps between contractions.
• Increases oxygen to the baby.
• Increases concentration.
• Keeps you in control of your labor.
• Helps to decrease pain.
Breathing Basics:
1. “Contraction Begins.”
2. Relax and take a deep, cleansing/signal breath.
2. Try relaxation techniques such as a massage or listening to
music as you begin your Level 1 slow chest breathing.
3. Use your Level 1 breathing until it is no longer helpful and
you are exceeding the appropriate rate. Never go faster
than twice your normal rate.
4. Choose an external focal point, such as a picture or special
object. Otherwise, you may choose to close your eyes and
use an internal focal point, such as the baby’s nursery or
favorite vacation spot.
5. Practice frequently so the breathing techniques become a
conditioned response.
3. Find a focal point.
4. Use a breathing technique appropriate for the stage
of labor.
5. During the entire contraction, identify and relax any
tense areas.
6. “Contraction Ends.”
6. Advance to Level 2 and Level 3 breathing patterns as
needed. Remember to match the breathing pattern to the
intensity of the contraction. Use the more complex pattern
for the more intense contractions.
7. Some women create their own breathing
pattern/technique in labor. It is fine as long as you do not
go too fast or too slow.
7. Take a deep, cleansing/signal breath.
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29
B R E A T H I N G
T E C H N I Q U E S
breathing techniques
Prepared childbirth is accomplished through preparation and practice as well
as education. You can enhance your experience by reviewing and practicing
breathing and relaxation.
Visualization/Imagery
Level 1:
Cleansing/signal breath to begin.
Breathe in through nose and out through mouth.
Quiet, slow breathing (as in relaxation).
Rate should be half your normal rate (about six to nine breaths
per minute).
Cleansing/signal breath to end.
Level 2:
(Combination of Level 1 and light shallow breathing.)
Cleansing/signal breath to begin.
Begin Level 1 breathing.
As contraction increases in intensity, increase pace and use light,
shallow breathing.
Do not breathe faster than twice your normal rate.
Return to Level 1 breathing as contraction eases.
Cleansing/signal breath to end.
Level 3:
Cleansing/signal breath to begin.
Use shallow, upper-chest breathing.
Add puffs or blows in rhythmic pattern.
Practice like this: Make sounds like he...he...he...whoo.
Slow breathing rate as contraction eases.
Cleansing/signal breath to end.
Additional Tips:
To control urge to push - blow, blow, blow.
Signs of hyperventilation - tingling or numbness around mouth
and tips of fingers. Cup hands over mouth and breathe slowly.
30
BIRTH
A N D
B A B Y
S E L F - M A N A G E M E N T
O F
P A I N
self-management
of pain
Techniques to Use During Labor
Labor and birth are challenging. However, there are many
things you and your partner can do to ease or cope with the
intensity of your labor.
1. Be prepared.
• Have the support of a person you love.
• Discuss what is important to your birth experience.
• Be well-rested during the last month of your pregnancy.
• Know the process of labor, prepared childbirth skills, methods of self-management of pain and methods of medical
management of pain.
• Practice breathing and relaxation at least three times per week. As you practice, include other self-management of pain techniques.
2. Concentrate on relaxing.
• Learn different techniques.
• Identify which techniques work best for you.
3. Focus on breathing (see pages 33-34) and pushing techniques.
4. Massage: back massage, counter-pressure, inner thigh
massage and effleurage.
5. Use music and CD player/iPod.
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31
S E L F - M A N A G E M E N T
O F
P A I N
6. Use imagery (putting positive thoughts into mental pictures or images).
7. Find a focal point.
8. Establish eye-to-eye focus with partner.
9. Change positions.
10. Take a warm bath (if water has not broken).
11. Shower.
12. Apply moist washcloths to face, neck and mouth.
13. Apply a heating pad/hot water bottle, warm compresses to back, thighs, etc.*
14. Apply ice packs.*
15. Apply lip balm (Chapstick).
16. Eat ice chips.
17. Sip water/ginger ale/apple juice.
18. Wear warm socks for cold feet.
19. Freshen up by washing your face, brushing your teeth or brushing your hair.
20. Apply warm compresses to perineum during pushing.
21. Watch birth in mirror to check progress of baby lowering and to encourage
effective pushing.
* These comfort measures are not encouraged after you have
received pain medication. Pain medication can alter your
perception of hot and cold.
32
BIRTH
A N D
B A B Y
W H E N
Y O U
W A N T
T O
R E L A X
when you want
to relax
1. Find a comfortable position. Support each area of the
body with pillows.
neck is supported
by pillow
flexed knees
supported by
pillows
elevate feet if
possible
2. Find a focal point or close
your eyes. Don’t let your
attention wander away from
relaxation.
3. Concentrate on relaxing
each part of your body, one
muscle group at a time.
pillow
supports
lower back
pillows
support arms
feet flop
outward
uterus is tipped
forward
4. Take a deep, cleansing
breath and let go of the
tension as you exhale.
legs spread
apart flat on
floor
5. Imagine a restful place.
place arm behind you to
lie farther over on side
pillow supports
elbow and arm
pillows
support
baby
toes point
downward
pillows support
flexed knees
sitting upright
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33
S U G G E S T E D
R E L A X A T I O N
T E C H N I Q U E S
suggested relaxation
techniques
The last component to the management of labor is relaxation.
Fear creates tension, which promotes fatigue leading to pain.
Progressive Relaxation
Progressive relaxation helps to relax the whole body by
locating and then releasing each muscle group, one at a
time.
9. Release all the tooth-grinding energy it takes to tense your jaw. Take a deep cleansing breath and relax your jaw and your lips. Your tongue feels heavy, loose and thick.
Your lips fall open.
10. Your shoulders are heavy, limp and loose.
11. Your arms are limp, loose and comfortable.
Signs of progressive relaxation:
1. Find a comfortable position.
12. Relax your hands. Let your fingers fall open. Let all of the
tension flow away from your shoulders, down your
elbows and out the fingertips.
2. Eliminate all the confusion.
3. Find a focal point on the wall above eye level or on the
ceiling. Or, if you wish, close your eyes and imagine a calm
scene, a number or word, and concentrate on the image
until the edges of your vision are hazy, dim and blurred.
4. Take a deep cleansing breath. Become aware of the space
around you. Become aware of your breathing (regular,
deliberate, slow and steady).
14. Your lower body is heavy, your feet fall outward. Your legs,
thighs and buttocks are limp and warm.
15. You feel completely relaxed as all of the tension flows out
of the buttocks, hips, legs and toes.
5. As you inhale, scan your body for any remaining tension
and relax as you exhale. Repeat as needed.
16. Affirm this state by saying to yourself, “My mind and
body are at peace. I am totally relaxed without any effort
at all.”
6. Use your cleansing breath as a signal for relaxation.
(Partner, check relaxation effort by observing respiratory rate,
7. Let your body sink deeper into the pillows. Think about
how your body feels. Your muscles feel heavy, limp, loose
and warm. Your body is heavy. Let all the cares of the day
drift away. Let all the tension slip away. Eliminate all the
confusion, all the business, all the hurt feelings.
8. The folds of the skin in your forehead are getting looser,
larger and heavier. It is difficult to keep your eyes open as
your eyelids relax.
34
13. Relax the muscles of your back as you inhale and sink
deeper into the pillows.
BIRTH
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B A B Y
gently lifting arm or leg with two hands that support the limb or
watching the face for signs of tension.)
S U G G E S T E D
R E L A X A T I O N
T E C H N I Q U E S
touch relaxation
Touch relaxation is another technique used to aid in relaxation.
You will learn to release tension in your muscles in response to
your partner’s touch. Your partner will touch, stroke or massage
contracted muscles as a signal to release that tension.
6. Tense your left leg. Contract the muscles in your leg.
Partner, stroke down her leg to release the tension.
7. Tense your back. Partner, touch and massage her back to
release the tension. Feel the tension release.
Find a comfortable position. Close your eyes. Take a minute
to mentally scan each part of your body starting at the top
How to use touch relaxation in labor:
of your head. Release tension in all your muscle groups all
breath. Now you are ready to start.
1. Partner, visually scan her body and look for any signs of
tension. Touch that area as a signal for her to release her
tension toward her hand. As you stroke, feel the
tension release.
Practice exercise
2. Partner, touch her shoulders, arms and legs to feel for
muscle tightness. As you feel tension in a muscle, stroke or
massage that area until you feel the tension release.
the way down to your toes. Put your mind at ease as you
put your thoughts and cares aside. Take a deep, cleansing
1. Frown and contract the muscles in your forehead. Partner, rest your hand on her forehead. Feel the tension and
release.
2. Tense your shoulders. Partner, massage her shoulders until
you feel the tension release.
Partner: Let Mom guide you in how firmly to massage or stroke.
With practice, you will become able to look for tension and feel
tension in each part of her body. Touch relaxation is a wonderful
technique to use during labor.
3. With your right hand, make a fist. Tighten the muscles in
your arm. Partner, stroke down her arm and hand until you
feel the tension release.
4. With your left hand, make a fist. Tighten the muscles in
your arm. Partner, stroke down her arm and hand to
release the tension.
5. Tense your right leg. Contract the muscles in your leg.
Partner, stroke down her leg until you feel the
tension release.
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35
S U G G E S T E D
R E L A X A T I O N
T E C H N I Q U E S
“Birth is a mind-body experience, an intense physical process whose outcome is
closely tied to emotions and mental attitude.”
-William Sears, MD, and Martha Sears, RN
Visualization or imagery is used alone or with other
Listen to the sounds of children playing, seagulls
techniques. The technique involves thinking about
calling, the ocean tumbling by in and out. Let
a place where you feel comfortable and at ease, and
the sounds lull you peacefully into a state of total
then picturing yourself in that place and imagining
relaxation. You are completely relaxed. Lie still and
the things that you might see, hear, feel, smell or taste.
become aware of how good it feels to be completely
relaxed. Remain in this state as long as you are
Example:
comfortable. When you wish to return, slowly allow
Picture a scene in nature. Perhaps you are at the
your eyes to focus, but do not get up until you are
beach. Notice the smells of the salty air. Feel the warm
completely ready. Take a deep, cleansing breath.
summer breeze as it caresses your skin. Feel the warm
sunshine envelop you in relaxation.
“Because I can relax, I can labor and give birth better.”
-Carl Jones
36
BIRTH
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B A B Y
P O S I T I O N S
F O R
L A B O R
A N D
P U S H I N G
positions
for labor and pushing
standing
sitting upright
slow dancing
sitting on commode
kneeling over chair seat
the lunge (standing)
semi-sitting
the lunge (kneeling)
sitting, leaning forward with support
kneeling, leaning on raised head of bed
kneeling over birth ball
Illustrations by Janis Dougherty 2009.
hands and knees
standing, leaning forward
side-lying
squatting
supported squat
the dangle
B I R TH
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37
P U S H I N G / S E C O N D
S T A G E
O F
L A B O R
pushing
second stage of labor
Pushing techniques
• You may begin pushing once you are 10 cm dialated and your caregiver instructs you to begin. If you do not have an urge to push, you may be advised to allow the contractions
to move the baby down the birth canal.
• Take two deep cleansing/signal breaths as the contraction begins.
• Breathe in a third deep breath... hold... while bearing down... PUSH.
• Take additional breaths as needed, about every six to 10 seconds, and bear down again.
pushing
• Try to average at least three to four strong pushes per contraction.
• When the contraction ends, take another deep cleansing/signal breath.
OR
• Take two deep cleansing/signal breaths as the contraction begins.
• Breathe in a third deep breath, RELEASE AIR SLOWLY (instead of holding your breath)...
bear down... PUSH.
expulsion
• Low grunting or “working noises” can be helpful while pushing.
• Take additional breaths as needed, about every 6-10 seconds, and release air slowly as
you bear down again and push.
• Try to average at least three to four strong pushes per contraction.
• When the contraction ends, take another deep cleansing/signal breath.
Positions
• Use gravity to help you.
• Use “C” shape – chin toward chest, back rounded, elbows out, pelvis tilted up.
• Try semi-sitting, side-lying, squatting, all fours, kneeling over back of bed, using squat bar or rope for “traction.”
• Change positions every 30-45 minutes (unless good progress is being made).
“C” position
38
BIRTH
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B A B Y
hands and knees
side-lying
supported squat
P U S H I N G / S E C O N D
S T A G E
O F
L A B O R
“So the uterine contraction now has a new sense; it is no longer a sign of
destiny that has to be obeyed, but a signal for adapting oneself.”
–Author unknown
Pushing tips
• Visualize baby’s descent.
• Relax the face, jaw and perineum.
• Think “RELEASE” and “OPEN” while pushing.
• Utilize your “basement Kegels.”
• Push baby down and out.
• Push only with contractions.
• Rest and relax between contractions.
• Try low grunting or “working noises,” which can
be helpful.
• Warm packs/perineal massage for Mom’s bottom may
decrease need for episiotomy.
• Caution: Holding your breath for an extended length of
time can lower your blood pressure and oxygen levels in
the baby.
Exercises to help pushing
Kegel Exercise: Kegel exercises tone the pelvic floor
muscles. These muscles provide strength, elasticity and
support the pelvic floor organs. These are the muscles you
will use to push your baby out. Practice before baby’s due
date. You can ask your care provider to do an exam to
confirm you are doing a kegel correctly if needed.
- Super Kegel: Tighten pelvic floor muscles and hold for 20 seconds. If muscles tend to release, consciously re-tighten and continue holding.
- Elevator Kegel: Imagine the pelvic floor muscles are opening with gradual lifts like an elevator moving from floor to floor. Start on the first floor and tighten to move “up” to the second floor, and
then even tighter to the third floor. Release
gradually from third to second to first. For pushing,
you will lower these muscles to the basement.
Taylor Sitting: Sit on the floor with your knees bent and
feet together. Pull your feet in as close to your bottom as is
comfortable. The long muscle that runs between your pelvis and
your knee helps to pull your pelvis open wider while pushing.
Tone these muscles by sitting with your feet together while
resting or watching television.
Squatting Practice: Use the back of a chair or a door for support
and practice squatting with feet flat and back straight. You may
be able to do this for only a few seconds at first, so try to gradually
increase your “squat time.” This will strengthen your upper legs
and help you feel more comfortable pushing in this position.
B I R TH
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B A B Y
39
M E D I C A L
M A N A G E M E N T
O F
P A I N
medical management of pain
WHEN GIVEN
IV MEDICATIONS
Usually during Active
Labor, 4-8 cms. dilated.
Ex. Stadol, Phenergan,
Nubain, Fentanyl
In certain cases, can be
given during Early labor
(Phase I).
EPIDURAL
Ex. A local agent like
Marcaine, with or without
Fentanyl added
INTRADERMAL
STERILE WATER BLOCK
During Active Labor
(Phase 2), 4-8 cms.
dilated
In certain cases, can
be given during
Early labor
(Phase 1).
During Early and
Active Labor
BENEFITS
1. Drowsiness.
1. Takes effect within
one minute and lasts one 2. May speed up, slow
down, or cause no
to two hours.
change in the time
of your labor.
3. If given within
2. Promotes relaxation.
one hour of birth,
may cause drowsiness in infant,
causing decreased
breastfeeding effort at birth.
1. Continuous relief
for labor and delivery
by numbing body from
waist down.
2. Takes effect within
15 minutes and can last
through delivery using
pump.
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B A B Y
1. Decreased maternal blood pressure,
which may result
in decreased blood
flow to baby.
2. Backache.
3. Requires patient
stay in bed.
4. Inability to urinate:
may have foley
catheter placed.
5. Decreased pushing
effort which may result in use of vacuum
or forceps.
6. Possible fever not
related to infection.
7. May speed up, slow
down, or cause no
change in the time
of your labor.
8. May take effect on
one side or in patches.
9. Small risk of spinal
headache, itching or
buzzing in ears.
10. May affect infant's
initial attempts at
breastfeeding.
- Sterile water injected 1. Relief of “back
labor” only, does
under skin surface
not affect contraction
in back.
pain.
- Blocks back pain
for 30 - 90 minutes.
- No side effects to
mom or baby.
40
TRADEOFFS
M E D I C A L
LOCAL AND
PUDENDAL
ANESTHESIA
M A N A G E M E N T
O F
P A I N
WHEN GIVEN
BENEFITS
During pushing
and delivery
1. Works within one to two
minutes and lasts approximately 30 minutes.
2. Local numbs only
perineal area for pushing,
episiotomy or repair.
TRADEOFFS
Only relieves pain immediately prior to delivery,
not during labor.
3. Pudendal numbs vagina
and perineum for
possible forceps, vacuum,
episiotomy or repair. Also
used for perineal pain.
SPINAL
ANESTHESIA
Ex. One of
various local
agents
GENERAL
ANESTHESIA
1. Rapid onset of two to 1. Decreased maternal
Can be used for C-section five minutes and lasts up blood pressure, which
to two hours.
may result in decreased
blood flow to baby.
2. Complete pain relief
by totally numbing the
2. Small risk of headache.
body from breast level
down
3. Backache.
Usually for emergency
C-section
1. Rapid onset.
2. Total unconsciousness,
therefore no awareness
of procedure.
3. Drug is injected into
bloodstream to induce
“sleep.” Then breathing tube is placed into
windpipe for ventilator for mom to breathe
during procedure.
Breathing tube will be
removed when patient
is awake immediately
after procedure.
1. Drowsiness for several
hours after procedure.
2. Unable to be awake for
baby’s birth.
3. Sore throat and mouth,
hoarseness.
4. Nausea and vomiting.
5. Risk of aspiration
(breathing vomit into
lungs.)
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41
M E D I C A L
I N T E R V E N T I O N S
medical interventions
Various interventions and procedures may or may not be used
in assisting you in your delivery. However, a good knowledge
Vacuum extractor:
of your options will help you in making decisions while you
A cap-like device, which uses suction to attach to the baby’s
are in labor. We will discuss each of these terms in class.
head to assist with the delivery.
External fetal monitor:
Episiotomy:
An electronic device that measures contractions and/or the
An incision made into the perineum between the vaginal
baby’s heartbeat.
opening and the anus prior to delivery in order to widen the
Internal uterine pressure catheter (IUPC):
A pressure-sensitive catheter inserted through the vagina to
the uterus to measure the strength of contractions.
Internal fetal scalp electrode:
An internal device, which is placed beneath the skin of the
baby’s head to monitor the baby’s heartbeat.
Intravenous fluids (IV):
A sterile fluid continuously injected into a vein for the purpose
of nutrition, hydration or medication.
Forceps:
A tong-like obstetrical instrument occasionally used to aid
delivery.
opening to ease the baby’s passage.
External version:
A procedure done in the hospital by a physician to manually
turn the baby to a head-down position.
Urinary catheter:
Either a one-time (straight) or continuous (Foley) tube
inserted into the bladder to drain out urine.
Induction and augmentation:
There are circumstances in which your doctor may advise you
to come to the hospital before you are in labor to start labor
artificially. Some of these circumstances might include too
much amniotic fluid, too little amniotic fluid, the baby being
too small in connection to your due date or too big, going
weeks past your due date or medical conditions like diabetes
or high blood pressure.
42
BIRTH
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B A B Y
M E D I C A L
I N T E R V E N T I O N S
A number of different techniques are
used to start labor. Some frequently used
techniques are listed below:
Cervical ripening agent:
A medication in suppository form, which is
placed into the vagina to soften the cervix.
Amniotomy:
The artificial rupture of membranes (breaking
the bag of water).
Pitocin:
An oxytocic hormone (artificial oxytocin) used
to start or stimulate uterine contractions.
Foley induction:
A catheter is introduced through the vagina to
the cervix. A balloon is inflated to put pressure
on­the cervix to encourage tissue to soften and
dilate.
Augmentation:
Your doctor may feel that your labor is not
progressing and may want to augment (speed
up) your labor by breaking your bag of water
(amniotomy) or starting pitocin to make your
contractions stronger.
Intradermal sterile water bock:
An intervention to relieve back pain in labor
where sterile water is injected just under the
skin surface of the lower back.
B I R TH
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B A B Y
43
B I R T H
P L A N
O P T I O N S
birth plan
options
You may choose to incorporate some of the following options into your personal plans for childbirth. A birth plan is only as good as
the conversations you have with your partner, healthcare provider, pediatrician and labor nurse. Let them know how these plans are
important in helping you achieve a joyful, satisfying birth experience. Also remember that your plans must remain flexible, as unexpected
circumstances may arise before, during and after birth.
Suggestions for Labor:
For Delivery:
• Your favorite music (bring CDs and players
• Dim lights.
or iPods).
• Foot pedals versus stirrups while pushing.
• Personal belongings, such as pillows, gown, focal point
• Partner assists with cutting the cord or drying off baby.
and goody bag.
• Camera/video camera for recording before and after
• Breastfeeding as soon as possible after birth.
• No episiotomy.
the birth. Your provider may agree ahead of time to
• Banking or donating your baby’s cord blood.
allow recording of the birth.
• Not pushing until there is an urge to push.
• Presence of support person(s) for labor and birth.
• Absence of non-essential observers.
For Cesarean Birth:
• Position of choice for labor, such as sitting in a chair, bed • Being awake with spinal/epidural anesthesia.
adjusted, walking, rocking, shower, birthing ball.
• Partner present at the birth.
• Negotiated routines for labor, such as:
• Breastfeeding as soon as possible.
- Walking in labor when possible
• Banking or donating baby’s cord blood.
- Choice of medication in labor (analgesia, epidural).
• Birth Tissue Donation
- Intermittent monitoring if labor is uncomplicated and the baby is doing well.
• Position of choice for pushing, such as semi-sitting, sidelying, squatting, all fours or kneeling over the bed.
• Perineal massage and/or compresses.
After Birth for Mom and Baby:
• “No Visitors” sign on the door if requested.
• Holding calls if requested.
• No circumcision versus circumcision.
• Pacifier allowed or withheld during hospital stay.
44
BIRTH
A N D
B A B Y
B I R T H
P L A N
O P T I O N S
our labor and
birth plan options
For suggestions/options, refer back to birth plan options.
For Labor:
____________________________________________________________________________________________________________
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____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
For Delivery:
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
For Cesarean Birth:
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
After Birth for Mom:
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
For Care of My Baby:
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Share your birth plan with all your providers as early as possible in your pregnancy.
PLEASE remember to be flexible as unexpected circumstances may arise.
B I R TH
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B A B Y
45
C E S A R E A N
B I R T H
cesarean birth
A Cesarean birth is when the baby is delivered through a surgical
cut in the abdomen and the uterus rather than through the
vagina. The mother is given regional or general anesthesia to
prevent pain during the surgery. It is not a sign of failure if you
have a Cesarean birth, and you can still use what you learn in
childbirth classes to help you through the procedure.
According to the national average, almost one in three births are
now Cesarean births. There are many reasons why a Cesarean
birth is necessary. These include:
46
• Umbilical cord prolapse: A loop of umbilical cord slips through the cervix, decreasing the blood flow to the baby.
• Abruptio Placenta: The placenta has come loose from the uterus before the baby is born, causing bleeding inside the uterus. Heavy vaginal bleeding may or may not be present.
• Repeat Cesarean. If you had a previous Cesarean section, ask your obstetrician if you are a candidate for a VBAC (Vaginal Birth After Cesarean).
• Breech presentations: The baby’s head is not presenting first in the pelvis.
• Cephalopelvic Disproportion or CPD: The baby’s head cannot fit through the mother’s pelvis.
Anesthesia Options for Cesarean Birth
• Fetal distress: Fetal monitoring detects labor that is too stressful for the baby.
Depending upon the circumstances of your delivery, there are
three choices of anesthesia for a Cesarean.
• Failure to progress: No significant change in cervical dilation despite adequate labor
contractions with or without labor-inducing
medications. This is the reason for as many as one
out of three Cesareans. This is more common with
inductions.
Epidural:
• Placenta Previa: The placenta is partially or completely blocking the cervical opening. This would be diagnosed by ultrasound in early pregnancy. Vaginal bleeding may or may not be present.
• Active genital herpes: If a mother has an out break of lesions when labor begins, a Cesarean must be done to prevent the baby from coming in contact with vaginal lesions.
• Worsening maternal complications of pregnancy, such as high blood pressure or diabetes.
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• Allows you to be awake for the birth. Numbs your lower body so that you may be aware of pressure sensations but not pain.
• Medication is injected in the epidural space outside the spinal cord.
• Epidural anesthesia takes approximately 15-20 minutes to take effect before surgery is performed.
• Partners attend the surgery with this type of anesthesia.
Spinal:
• It is very similar to epidural anesthesia, but it takes effect much faster, within five minutes.
• Medication is injected directly into the sac of fluid below the spinal cord.
• Partners can attend the surgery with this type of anesthesia.
C E S A R E A N
General:
Surgery:
• This type of anesthesia is used in an emergency situation to completely put the mother to sleep.
• She will not be aware of the procedure and will wake up when the C-section is finished.
• If condition permits, partners will be allowed in the recovery room but not in the operating room with this type of anesthesia.
• Mom may wake up and go back to sleep several times in recovery with this type of anesthesia. She may be nauseated in recovery.
B I R T H
What happens in a Cesarean birth?
1 hour prior to surgery
• You and your partner will be taken to an operating room. Usually only one support person is allowed in the OR. If you desire to have more than one person present, discuss it with your physician ahead of time.
• Anesthesia will be given.
• A catheter will be placed in your bladder to keep it empty.
• You will be monitored to track breathing, heart rate, blood pressure and the amount of oxygen in your blood.
• You may be given extra oxygen by face mask.
• Your abdomen will be washed with a sterile cleanser, and hair between the pubic bone and the navel will be shaved.
• Sterile drapes will be placed around your belly and a cloth drape is usually placed at chest level.
• Check into admissions for a scheduled Cesarean.
• You will go to Day Surgery, where you will have an IV started for fluids.
• Ask the anesthesiologist any questions you have about medications.
• Notify your nurse of any serious medical conditions or drug allergies.
• You may be given an antacid to drink to reduce the acid content of your stomach.
• Your blood will be drawn for lab work if this has not previously been done.
• If you would like special music played during the procedure, you should discuss it with your physician or nurse.
• A 4 to 6-inch incision will be made right above the pubic hairline on the abdomen. This is only through the top layers of skin and fatty tissue. The abdominal muscles will be gently spread apart. While it may feel strange to mom, there is no pain. The uterus is underneath these muscles.
• An incision will be made in the uterus and the baby lifted out. The cord will be cut but usually left long. The nurse may assist the partner in trimming the cord.
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C E S A R E A N
• The placenta will be removed, and the uterus will be repaired with dissolvable stitches. The skin incision will be repaired with stitches or staples, and a dressing applied.
• The baby will be taken to a warmer to be assessed by nursery staff. The nurse will help you hold your baby skin-to-skin on your chest. Your partner can hold your baby skin-to-skin if you are unable to
do so.
• You may take pictures or videos of the baby after birth. The nurse will tell the partner when video is allowed.
• Your partner and baby will remain with you during the surgery.
B I R T H
Second hour:
Moms will go to the Mother-Baby Unit following post-op
recovery and stay for 48-72 hours. Partners are also
encouraged to stay. It is important that someone stay with
you at least the first 24 hours after surgery.
What happens afterward?
Your hospital stay on the Mother-Baby Unit will last about
two or three days. Visitors, including your other children, are
welcome, but try to limit their visits so that you can get the
much-needed rest necessary after a Cesarean. An average
hospital stay after a Cesarean birth would proceed as follows:
First Day Post-op:
Recovery:
• Mom will go to the recovery room for one to four hours for monitoring as the anesthesia wears off.
• Mom must be able to lift her bottom off the bed and move her feet to leave recovery. Blood pressure and bleeding must be stable.
• Your partner and baby will go to the recovery room with you. Your nurses will help you begin breastfeeding as soon as possible.
• When leaving recovery you may be given Duramorph for pain, which lasts up to12 hours.
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• The nurse will help you get up six to eight hours after your surgery. The sooner you start moving, the quicker you will heal. Use a pillow to splint your belly when you sit up.
• The Foley catheter will be removed from your bladder, allowing you to go to the bathroom to urinate. If you have difficulty, run the faucet or use warm water in your peri-cleansing bottle.
• Get up the first few times with assistance. Walk or rock as much as you can. It will get easier. Stand up straight and avoid looking at the floor.
• Your IV will be taken out, and your dressing will be removed from your incision after your shower.
• Take pain medication as needed. Do not wait until you are really uncomfortable to ask for medication.
C E S A R E A N
B I R T H
• You will have vaginal bleeding that may be heavy at times.
• If you have staples, they may be removed and steri- strips may be used.
• The nurses will help you shower.
• You may begin with a soft diet and advance as food is tolerated.
• You will be given a prescription for pain medication
to use at home. Get it filled even if you feel great.
• Remember to cough and take deep breaths. Splint your incision by holding a pillow over it for coughing and breathing.
The second and third days after your Cesarean birth:
• It is very common for abdominal gas to build up after a C-section, resulting in a very bloated, distended abdomen. The gas must pass through your rectum, which can be embarrassing but very necessary for your recovery. Activities such as walking or rocking in a rocking chair are the most effective ways to help the gas pass, but occasionally suppositories or enemas may be needed.
• Avoid carbonated and very hot or cold beverages because they tend to cause gas pain to be worse. Do not drink from a straw.
• As your intestines resume their normal activity, you will move to a regular diet.
• You are encouraged to walk longer distances in the halls.
• Baby care, breastfeeding and rest periods will take up the majority of your day.
• Walk or rock and drink lots of fluids.
• Vaginal bleeding should be less.
• Your nurses will complete your discharge instructions, and you may go home.
Once you’re at home, it is important to have someone available to
help you the first week. Be sure to follow your doctor’s discharge
instructions. Don’t lift anything heavier than the baby. Let
someone else do the laundry, housework and cooking. Rest will
be important. Taking care of your new baby will be rewarding
and, at times, frustrating. Be patient and, with time, you will settle
into your new role. Take advantage of the many helpful resources
from your doctor, hospital and community if needed.
Home:
• Remember to rest, rest and rest!
• Take your prescription as needed for pain.
• Discuss with your provider when it might be safe for you to resume driving.
• Do not pick up anything heavier than the baby.
• Drink lots of fluid while breastfeeding. Eat a well- balanced diet to help avoid constipation.
• Accept help from friends and family.
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R E C O V E R Y
A F T E R
L A B O R
A N D
D E L I V E R Y
recovery after
labor and delivery
Call your doctor if:
• Normal vaginal bleeding continues for four to six weeks and should get lighter with time. If you are soaking a pad in less than an hour, contact your doctor immediately.
• You are lightheaded or dizzy.
• You are experiencing calf pain in the back of your leg.
• You are experiencing burning with urination.
• There is redness, pain or drainage around the
incision site if you had a caesarean.
• If you have a fever.
• You have difficulty breathing.
Your Hospital Stay
Following a vaginal birth, Moms typically stay for 24-48 hours.
If your baby is delivered by Cesarean section, your stay is
approximately 48-72 hours. At Women’s Hospital, we practice
Family-Centered Maternity Care. This allows for one nurse to
care for both Mom and infant. Your postpartum hospital stay is a
transition period to caring for your little one at home. Rooming
in with your child encourages teaching of parenting skills,
hands-on baby care and family bonding.
After delivery, you will experience physical changes. Your
postpartum care will be personalized to meet your specific needs.
Episiotomy care following a vaginal birth
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• It is important to keep the site clean and dry to promote healing.
A N D
B A B Y
• Your nurse will discuss episiotomy care and demonstrate the use of a sitz bath.
• Continue care until the site is no longer tender. The stitches will be absorbed when the site is healed.
Bleeding is called lochia, or flow after delivery.
• You will have uterine bleeding as your uterus heals.
• It will be heavy and dark red at first. Over time, the flow will become lighter, going from red to tan
in color.
• Lochea may last four to six weeks. It can increase in volume and darken in color with increase activity.
• Your physician and nurse will check your fundus (the dome or top of your uterus) to check that it is firm and returning to its pre-pregnancy size. If your uterus is soft, you will have increased vaginal bleeding. Breastfeeding your baby will help keep your
uterus firm.
• Notify your caregiver if you pass clots or if the flow is more than a pad an hour.
Cramping:
• You may experience abdominal cramping as your uterus heals and begins to shrink back to pre-
pregnancy size.
• This discomfort may increase with breastfeeding, or if you have had another child.
• Your physician will prescribe medication to ease discomfort.
• Cramping will subside within a week of delivery.
N O W
Y O U ’ R E
H O M E
now you’re home
Taking care of Mom at home
vitamin C is needed to help absorb it. Eat a meal rich in vitamin
C when you take your supplement. These foods include
After the birth of your baby, you begin your fourth trimester.
tomatoes, baked potatoes, citrus fruit and streamed broccoli.
The next three months is a period of healing after delivery and
Foods rich in iron are lean red meats, spinach and egg yolks,
transitioning to motherhood.
although they should be limited to three to four eggs per
week. Avoid taking your iron supplement with calcium since it
When to call your physician:
interferes with iron absorption.
It is important that your doctor examines you four to six
weeks after delivery. Notify your obstetrician or clinic if you
experience any of these symptoms before your appointment:
Make good nutrition simple and easy. Stock up on nutritious
foods such as raw fruits, vegetables, cheese, yogurt, raisins and
• Increased bleeding - bleeding more than your normal period or frequently passing clots.
low-fat granola bars. Ask a friend or relative to cut your favorite
fruits and vegetables to make munching easier.
• Unusual abdominal pain or tenderness, other than
uterine cramping.
• Burning, painful or frequent urination.
The recommended number of food servings from each food
• Painful, reddened or hot areas on your breasts.
group varies slightly postpartum depending on the new
• Chills, accompanied by fever greater than 100 degrees.
mother’s needs. A woman’s age, body size, activity level,
• Foul-smelling vaginal discharge.
weight before and after pregnancy, and breastfeeding status
• Severe headaches or fainting.
should be taken into consideration. Your specific needs should
be discussed with your physician prior to discharge.
Postpartum nutrition
Exercise
Following the birth of your baby, you need to continue to drink
Discuss with your Physician as to when you can begin or return
plenty of fluids. You should consume according to your thirst.
to an exercise routine.
Good fluid choices are water, low-fat milk and juices. Increase
your intake during warm weather or while exercising.
Postpartum anemia results from having fewer red blood cells
than is ideal to supply the body with oxygen. Anemia may
result from blood loss during birth or continued anemia from
pregnancy. If your doctor prescribes an iron supplement,
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F E E L I N G S
A F T E R
B I R T H
feelings after birth
The first year after the birth of your baby is a period filled with
Women’s Hospital offers a Mother-to-Mother Support
the life changes of becoming a new Mom.
Group facilitated by registered nurses. The Feelings After
Baby blues
As many as 80 percent of mothers experience these feelings,
Birth group meets every Tuesday at 10 a.m. You may
call (336) 832-6682 between 8 a.m and 4 p.m. for further
information.
which generally peak within a few days of birth and are caused
by hormonal changes. Symptoms usually go away within two
Successful parenting takes teamwork
weeks after birth and may include:
Parents’ roles used to be clearly defined. Moms were
responsible for the care of the children and the home while
• Weepiness.
Dads were the “breadwinners.” Changing times bring changing
• Irritability.
roles. Today, most parents work and sometimes it is Dad who
• Sleeplessness.
acts as the main caregiver.
• Sadness.
• Anxiety.
Postpartum depression
If the symptoms you experience in the first few weeks do not
subside, you may be experiencing postpartum depression. It
With the arrival of a child, how do you decide who does what?
This period of transition can be very challenging to new
parents. There are three points for new Moms and Dads to
accept:
can occur anytime in the first year following the baby’s birth.
1. You will never be able to split the responsibility 50/50. It will
You may experience one or more of the following symptoms:
always tilt a little one way or another. Do your best to be fair to
each other.
• Sleep disturbances.
• Change in appetite.
2. Staying at home with a baby is work. Babies are amazing, but
• Irritability.
caring for a little one can be tough. Being at home makes the
• Extreme apathy or lack of concern.
day unpredictable and does not always include a lunch break
• Anxiety, panic attacks or hyperventilating.
or adult communication.
• Loss of interest/pleasure in activities, including sex.
• Recurrent frightening thoughts.
3. No one should work 24 hours a day, seven days a week. You
need to support and look out for each other. Sleep when you
If at anytime you have thought of harming yourself or your
child, please contact your doctor or healthcare provider
immediately. Or you may contact Cone Health Behavioral
Health Center at (336) 832-9600.
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can sleep and worry less about the house.
T A K I N G
C A R E
O F
B A B Y
taking care of
Bath
Give infant a sponge bath until cord site is completely healed
(usually within three weeks). Full baths can begin then.
Wash the baby’s face, hands and neck daily, drying well.
Do not use soap on baby’s face.
Bathe every other day unless otherwise advised by physician.
Equipment
• Mild soap.
• 2 wash cloths, towel.
• 2 small basins of warm water.
• Large cup of warm water.
• Diaper.
• Clothing.
Bathing tips
• Keep room thermostat set between 68 and 72 degrees.
• Bath time is a great way to become comfortable
handling the baby and work as a team.
• Never leave the baby unattended. Consider bathing baby on the floor on a beach towel. Maintain the onehand rule of always keeping one hand on the baby.
• Use two small basins of water for the sponge bath. Fill
one basin with plain warm water and the other with
soapy water. Use only mild soaps.
• Begin by using just a plain wet washcloth, washing the
eyelids from the inside of the eye out and then the rest
of the face. (Do not use soap on baby’s face.)
• Use warm water (no soap) to clean around the base of the umbilical cord.
• Continue washing using the soapy water to wash the
trunk (front and back) followed by the arms and legs. Wash the diaper area last.
• Save the baby’s head for last. A baby’s head has the
greatest source of heat loss and you don’t want him or
her to become cold. Use a small amount of shampoo
and rinse.
baby
Nail care
While newborn nails are soft, peel or file nails. File nails after
a bath or while the infant is sleeping. Avoid the use of nail
clippers until the child is older. If you are still concerned about
your baby scratching his or her face, consider using hand
mittens.
Cord care
Clean the cord with every diaper change, unless otherwise
advised by the baby’s doctor. Use a washcloth with warm
water to clean the base of the cord, making sure the site is
dry before covering it with clothing. The diaper should be
turned down from the cord to prevent the site from getting
wet.
Don’t try to pull or remove the cord. The cord will usually
fall off within three weeks. Monitor the umbilical cord for
signs of infection, such as redness, drainage or foul odor. If
the cord stump falls off early, your pediatrician may need to
assess the site.
Circumcision care
Gently clean the area with plain warm water until the
circumcision is healed, about seven to 10 days. During
this time, it is normal for a sticky film to develop over the
healing area.
Petroleum jelly placed on the tip of the penis will prevent it
from sticking to a diaper. Your doctor will show you how to
retract the foreskin after the circumcision is healed.
Watch for bleeding, foul odor or drainage from the site. Contact
your physician if you notice any signs of infection.
Diapering
By the fifth day of life, a newborn should have at least five wet
diapers a day, gradually increasing to between six and 10 each
day. If you are concerned about dehydration (fewer than five
diapers in 24 hours), place a paper towel or cotton ball in the
diaper. It will be easier to see if the baby has urinated. If the
paper towel or cotton ball is not wet within a couple of hours,
contact your pediatrician.
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T A K I N G
C A R E
Breastfed infants may have three or more bowel movements
daily. Bottle-fed children may have one bowel movement daily,
sometimes less. Breastfed babies may have a bowel movement
after every feeding that is yellow, soft and even watery with a
seedy appearance. Bottle-fed infants’ bowel movements are
pale yellow to light brown, more formed with an increased
odor.
Diarrhea stools are not formed, very watery and can be foul
smelling. Contact your physician if diarrhea persists. If a rash
develops, be sure to dry the baby’s bottom well or expose area
to the air. If the rash does not resolve in a day or two, contact
your pediatrician. Sometimes a rash may be caused by yeast.
Equipment for diaper changing
• Diapers. Less expensive diapers may be a better choice during the first week or two of life because they are less absorbent. This will make it easier to see if a diaper is wet while the baby is urinating in smaller amounts.
• Washcloth or wipes. Wipes should not be used if the circumcision is not healed.
• A&D ointment or Vaseline can be used for dry skin. Powder is not recommended since it may harm the baby’s lungs
Never leave the baby unattended while changing or bathing.
Always remember to keep one hand on the infant during these
activities.
Boys versus girls
If your son is circumcised, the physician will show you how to
retract the skin once it is healed. If he is not circumcised, do not
retract the foreskin as it may tear. It should retract on its own by
age 3-4. For girls, gently separate the labia and clean from front
to back.
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O F
B A B Y
Dressing infant
Dress your child similarly to the way you are dressed or add a
single additional layer. Keep your baby’s head and feet covered
in cool or cold weather. Remember: The baby’s head is the
greatest source of heat loss. Wash all clothing in the same mild
detergent before your little one wears them.
Jaundice
Jaundice is the accumulation of bilirubin. Bilirubin is the
byproduct of old red blood cells after they have been
destroyed. The liver of a newborn can be slightly immature
causing the bilirubin to build up rather then being excreted
in bowel movements. As the baby’s intake increases, bowel
movements become more regular and bilirubin levels decline.
The baby having a different blood type than Mom can also
cause jaundice.
As a baby develops jaundice, the infant’s skin begins to yellow
- first in the face, then on the chest, abdomen, hands and
feet. The bilirubin level usually peaks by the third day. Your
pediatrician will monitor blood levels of bilirubin. Frequent
feedings will help. If levels become high, phototherapy may be
used. Phototherapy is fluorescent light placed over the baby to
help with the breakdown of bilirubin to decrease jaundice.
Use of bulb syringe
• Keep a bulb syringe in a convenient location, such as your diaper bag.
• Clean with warm soapy water and sterilize for 10 minutes in boiling water daily after use.
• Compress bulb prior to placing it in nose or infant’s mouth. Repeat as needed.
• Using a bulb syringe on the nasal passages can cause nasal stuffiness and inflammation.
T A K I N G
C A R E
O F
B A B Y
Checking temperature
Purchase a digital thermometer because mercury
thermometers can pose an environmental risk. Oral
temperatures are not used with babies. Rectal temperatures
should only be taken when your pediatrician tells you to take it
rectally.
Safety
Position your baby for sleep to avoid any possibility of Sudden
Infant Death Syndrome (SIDS). • Use the phrase “back to sleep” to help you remember to always put the baby on his or her back when going to sleep..
• Use a firm mattress.
Axially temperatures - taken under the arm - are the easiest • Do not put blankets, fluffy comforters, pillows, method for this age group. The normal range is 97.6 to 98.6 bumper pads (for at least first six months), degrees. Place the thermometer under the armpit against the
positioners or stuffed animals in the crib.
chest. Hold the arm securely until the temperature is displayed. • Maintain a smoke-free environment.
• The temperature of the house should be Reasons to call the physician
between 68 and 72 degrees.
• Changes in eating habits. Call the doctor if the • Breastfeed when possible.
baby’s appetite decreases, if feedings are missed • Your baby should not sleep in your bed.
or if the baby is vomiting.
Current research suggests the use of a pacifier at • Signs of umbilical cord or circumcision site times of sleep reduces the chance of infection.
SIDS. Pacifier use should not begin until • Changes in baby’s behavior, whether extremely breastfeeding is well established.
sleepy and lethargic, or excessively fussy • Do not use a drop sided crib.
and crying.
• Fever of 100.4 degrees or greater, or a low body Tummy time
temperature of 97.4 degrees or less.
• Tummy time begins at 2 or 3 weeks of age after • Vomiting or diarrhea.
the cord site is healed.
• Cough with or without nasal drainage.
• Tummy time is done ONLY when your baby is • Unusual rash.
awake. Your baby can lie on your lap or chest or on a blanket on the floor with supervision.
• Tummy time should occur several times a day to help strengthen the baby’s neck and shoulder muscles.
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F E E D I N G
feeding
Breast milk provides complete nourishment for the first six months
of life. The American Academy of Pediatrics recommends that an
infant continue to breastfeed exclusively for the first six months
without supplemental water, formula or other foods. It is also
recommended that the infant breastfeed for one year of life or
longer, while beginning other foods.
Extensive research documents the advantages for the infants,
mothers, families and our society when infants breastfeed.
Benefits for baby:
• Easily digested
• Perfectly matched nutrition
• May have protective effect against SIDS
• Less gastrointestinal disturbances, ear infections and allergies
• Stimulates senses of taste and smell
• Filled with antibodies that protect against infection
• Skin-to-skin, eye and voice contact
Benefits for the mother:
• Convenient
• Economical
• Helps the uterus return to its normal size faster
• Helpful with weight loss
• Reduces the risk of osteoporosis
• Less likely to develop uterine, endometrial or ovarian cancer
• Reduces the risk of breast cancer.
Benefits for Baby and Mother
• Contributes to a very special and loving relationship
• A beautiful and intimate way for a mother to bond with her baby
Benefits to the community:
• Lower healthcare costs.
• Decreased employee absenteeism and associated loss of family income.
• More environmentally friendly.
Getting Started
Breastfeeding gives you the assurance of giving your baby the very
best, so relax and enjoy these special times with your new baby.
Learning to nurse takes time, practice and patience. So, don’t get
discouraged. You can do it!
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your baby
Feeding Your Baby
Y O U R
Your baby will be placed skin-to-skin at delivery so you
can give your baby the opportunity to start breastfeeding
immediately. Frequent feedings will establish your milk supply
and decrease the risk of jaundice. Ask your nurses to help
you if you are having trouble getting started or at any time
during your hospital stay. Don’t hesitate to call the Lactation
Consultant after you go home if you have any questions or
problems.
Newborns sleep a lot during the first 24 to 36 hours. You may need
to wake and encourage your baby to nurse every 11/2 to 3 hours.
Keep your baby with you in the hospital so that you can hold him
or her, get to know his or her needs and respond to his or her
feeding cues.
There may be times that your baby wants to “cluster feed”
with small breaks between each feeding. Afterward, your baby
will usually have a longer sleep stretch. This is normal and
usually occurs right before your milk comes in and during a
growth spurt.
Newborn feeding cues let you know that it is time to feed your
baby:
• Sucking movements of the mouth and tongue.
• Small baby sounds.
• Hand-to-mouth movements (avoid wrapping your baby’s arms in blankets).
• Rapid eye movements under the eyelids.
• Body movements.
• Crying is a late hunger cue. Don’t wait for your baby to cry before you feed him/her.
Avoid supplementing with formula or using a bottle or pacifier,
unless it is medically necessary, for at least three to four weeks.
This will ensure that you and your baby are getting off to a good
routine. Supplementing or using artificial nipples can lead to
nipple confusion as well as decreased milk supply.
Most babies lose weight in the first few days. Be sure to check to
see what your baby’s weight is just before leaving the hospital.
Usually, when your milk volume increases, your baby will begin to
gain again. When gaining appropriately, your baby will be back
to birth weight by 2 weeks of age and will gain 4 to 8 ounces each
week.
F E E D I N G
Y O U R
B A B Y
Breastfeeding Positions
Under the arm or football
This is the easiest position when learning to
breastfeed. Use a pillow to support the baby
at breast-level. Hold the baby’s back and
shoulders in the palm of your hand. Place
the baby’s bottom at the back of the chair.
Tuck the baby under your arm, lining up
the baby’s nose with your nipple. Hold your
breast until the baby nurses easily.
Lying down
Lie on your side with a pillow at your back
and lay the baby so you are facing each
other. To start, prop yourself up on your
elbow and support your breast with the
opposite hand. Pull the baby close to you,
lining up the baby’s nose with your nipple.
Once the baby is nursing well, lie down.
Hold your breast throughout the feeding so it does not slide out of the
baby’s mouth.
To latch on, touch the baby’s lips with your nipple until the baby’s
mouth opens wide and the tongue is down. Pull the baby quickly onto
the breast.
If nursing hurts after the first minute or so, break the suction with your
finger between the baby’s gums and take the baby off. Reposition the
baby if needed and start again. Make sure the baby’s mouth is wide
open (like a yawn) and the tongue is down before pulling the baby
close.
You should feel a tug on your nipple as the baby nurses, not a pinch
or pain throughout the feeding. Most of the time, sore nipples occur
when the baby is not latched on well. Be sure to take enough time to
get the baby latched on correctly. Call a Lactation Consultant for help
if nursing still feels painful.
Allow your baby to complete the feeding on one side, softening the
breast. Wake your baby, if needed, and offer the other breast if he/she
is interested.
Cradling
Cradle the baby in the arm closest to the
breast, with the baby’s head in the crook of
your arm. Have the baby’s body facing you,
tummy to tummy. Use your opposite hand to
support the breast. This is for an older baby
Across the Lap
Lay your baby on pillows across your lap.
Turn the baby facing you, tummy to tummy.
Reach across your lap to support the baby’s
back and shoulders with the palm of your
hand. Support your breast from underneath
to guide it into the baby’s mouth.
Breastfeeding Tips
Use lots of pillows or folded blankets to make you and your baby
comfortable and help with latch-on.
Before the baby latches on, gently massage your breasts to make
the milk release more easily and soften your breasts. Express a few
drops of milk before nursing to let your baby taste the milk.
Gently support the breast with a C-hold (four fingers underneath
the breast and thumb on top). This will help your baby get and
keep enough of the dark area around the nipple in his/her mouth
and ensure a deep latch.
Incorrect Latch On
Correct Latch On
Breastfeeding is usually a comfortable, pleasant time for both you and
your baby. However, some new mothers experience tender nipples
for the first few days of nursing. This usually goes away within a week
or so. If you are experiencing discomfort, ask
for help.
To prevent nipple soreness, start with correct positioning and
latch-on. (Refer to diagrams on this page for tips on positioning and
latch-on procedures.)
Other prevention measures include:
1.Breastfeed frequently every 11/2 to 3 hours. If your baby does not nurse frequently, he/she may become frantic with hunger. This increases the possibility of over-vigorous nursing and may cause nipple soreness.
2.Always release suction before you remove the baby from the breast. Do this by placing a clean finger in the side of the baby’s mouth or between the gums.
3.After a feeding, express a little colostrum or breast milk onto the nipple and areola. Massage it into the nipple so it will absorb into the area. Then air-dry the nipples.
4.Do not use soap or alcohol on your breasts. Water is all that is needed to clean your breasts when you shower or bathe.
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F E E D I N G
If your breasts become sore:
• Place baby skin-to-skin to help milk let down.
• Check positioning carefully.
• Check the baby’s latch.
• Pump breasts for three to five minutes before feeding to initiate milk flow.
• Alternate nursing positions.
• Use analgesics as prescribed by your doctor. Products containing aspirin are not recommended for the nursing mother.
• Apply expressed milk to your nipples after feedings to help prevent irritation.
• Use breast shells to increase circulation of air and healing.
• Consult a Lactation Consultant for assistance.
During your first few days at home, your breasts will begin to
feel fuller and firmer. This is a normal, positive sign. However, if
your breasts are very full, hard and uncomfortable, they may be
engorged. Engorgement is caused by increased flow of blood
and fluid in the breast, which leads to the swelling of surrounding
tissue. This fluid is in addition to the accumulation of milk.
To prevent engorgement, nurse your baby early and
frequently over the first few days. Avoid formula feedings,
unless medically indicated.
If your breasts do become engorged:
• Apply ice packs for 15 to 20 minutes to reduce swelling, warmth and pain before nursing and/or between feedings. (Moist heat just before feeding may help some mothers with milk letdown.)
• If needed, hand express or pump for a few minutes to soften the areola before feeding. If your breast is still full after feeding, pump to soften.
• Wear breast shells, if needed.
• If baby will not latch onto the breast, pump for 15 to 20 minutes, and give the pumped milk to baby using another feeding method. (Ask a Lactation Consultant for suggestions.)
• If you smoke, do not smoke for 15-20 minutes before nursing, as smoking inhibits milk letdown.
• Take mild analgesics for pain. Products containing aspirin are not recommended for nursing mothers.
• If you develop a fever, body aches and chills, red streak(s) on the breast, or if you are unable to nurse your baby, call the Lactation Consultant or your healthcare provider.
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Warning Signs: Call your baby’s doctor or a Lactation
Consultant if:
• Your baby refuses to feed more than two consecutive feedings.
• Your baby has fewer than six wet diapers each day (from the fourth day on).
• Your baby has fewer than two to three yellow liquid stools each day (by the fourth day and through four weeks).
• Your baby has not had a wet or a stool diaper in 24 hours.
• You milk is “in,” but you don’t hear gulping or swallowing when the baby breastfeeds.
• Your nipples are painful throughout the feeding. • Your breasts have painful areas or lumps.
• Your baby is routinely breastfeeding fewer than eight times in 24 hours (from 3 to 4 days of age).
• Your baby seems to be breastfeeding all the time and never seems to be content after feedings.
• You don’t feel as though your milk has “come in” by the fifth day.
• Your baby hasn’t regained birth weight by 10 days to two weeks or is gaining less than 1/2 to 1 ounce per day.
How to tell if your breastfed baby
is getting enough to eat:
WET DIAPERS
DIRTY DIAPERS
Day 1
1-2
1
Day 2
2-3
2
Day 3
3-4
At least 3
Day 4
4-5
At least 3
Day 5
4-5
At least 3
Day 6-45
6 or more
At least 3
After 6 weeks
6 or more
May decrease
FIRST 6 WEEKS
(per day)
(per day)
Your baby should also gain weight.
Your baby needs to be seen by a healthcare provider for a weight
check 2-3 days after discharge. It is your responsibility to contact
the doctor to schedule office visits, and to call your baby’s doctor
or a Lactation Consultant if you believe that breastfeeding is not
going well.
F E E D I N G
Y O U R
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Breast Milk Storage Guidelines for Baby
Freshly Expressed
Breast Milk
Thawed Breast Milk
(Previously Frozen and
Thawed in Refrigerator)
ROOM TEMPERATURE
REFRIGERATOR
HOME FREEZER
DEEP FREEZER (-20°C)
6-8 hours
5 days
3-6 months
6-12 months
Do not store
24 hours
Never refreeze
thawed milk
Never refreeze
thawed milk
Breast Milk Storage Guidelines for Baby in NICU
Freshly Expressed
Breast Milk
Thawed Breast Milk
(Previously Frozen and
Thawed in Refrigerator)
ROOM TEMPERATURE
REFRIGERATOR
Ideal: Refrigerate
immediately.
2-4 days
Acceptable: Up to 4 hours if
refrigeration not available.
Up to 4 hours
Defrosting
To thaw frozen human breast milk
• Use oldest milk first.
• Place sealed container in a bowl of warm water for 20 minutes or place under warm running water. Don’t use hot water because this can destroy some of the protective properties of the milk.
Up to 24 hours
HOME FREEZER
DEEP FREEZER (-20°C)
Ideal: 4 weeks
Acceptable: 3 months (Store in the back of
freezer. Do not store
in freezer door.)
Up to 12
months
Do not refreeze
Do not refreeze
Hand Expression of Breast Milk
All mothers need to know how to hand express their breastmilk.
Hand expression is an easy, cost-free way to remove milk from
your breast. Frequent hand expression early after delivery has
been proven to increase a mother’s milk supply.
To Hand Express Your Breastmilk:
• Place milk in the refrigerator the night before you will use it. Refrigerator defrosting takes 8 to 12 hours.
• Sit up and lean forward
• Thawed refrigerated milk is safe for 24 hours, if kept refrigerated. Do not refreeze.
• To express milk, place your thumb and index finger about 1-2
inches back from the areola (the brown area around your
nipple) making a “C” or “U’ shape around your breast.
• Sometimes babies do not completely finish bottles of breast milk. Any bottles not finished within 1 hour should be discarded.
• Gently massage the breast for 1-2 minutes
1) Gently push back toward the chest
2) Compress the breast gently
• The cream in breast milk may rise to the top of the container. The separation of the cream is not a problem. Gently shake the container to mix the layers together.
3) Then release the breast tissue
CAUTION: Never microwave breast milk. Microwaving can cause
severe burns to the baby’s mouth from hot spots that develop in
the milk during microwaving. Microwaving also can change the
composition of breast milk.
• Express milk into a clean container
• Do this several times, switching back and forth between breasts,
until the milk begins to flow.
• Rotate the hand around the breast and continue to express.
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C R Y I N G
crying is
normal
I S
N O R M A L
The Period of Purple Crying
For new parents, the first few months are filled with many
challenges as they adjust to their new roles. Often, the most
stressful time is when the baby cries. Frustration can build
when they try everything yet nothing seems to comfort the
child. Moms and Dads begin to wonder if these difficult
periods of crying mean their child has colic, or they have
poor parenting skills. The most important thing to remember
is crying is normal. It is the baby’s way to communicate.
Research now shows there is more to the crying spells.
We now refer to this period as “The Period of Purple
Crying.” Each of the letters in the word PURPLE stands for
one of the properties.
P - Peak of Crying Usually occurs at 2 months 60
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and then decreases at 3-5 months.
U - Unexpected Crying can come and go without knowing why.
R - Resists Soothing Crying may not stop despite comfort.
P - Pain-Like Face They look like they are in pain when they are not.
L - Long Lasting Crying can be as long as five or more hours a day.
E - Evening Periods of crying often occur in the late afternoon or evening.
C R Y I N G
I S
N O R M A L
Crying is normal
Develop a coping and support plan
• Crying increases at 2 weeks.
• Do not leave your baby with someone who is easily
• Infants cry more during the second month than any
other time.
frustrated.
• Do not be afraid to ask for help.
• Babies can cry five hours a day or more.
• After two months, crying will decrease each week.
Use this three-step action plan to respond to a crying infant.
1. Comfort, carry, walk and talk to the infant.
Shaking a baby is the most dangerous thing you can
do. It can cause permanent brain damage and even
death.
2. It is OK to walk away. Put the baby safely in the crib.
3. It is never OK to hurt a baby.
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T A K I N G
C A R E
O F
M O M
A N D
D A D
taking care
of mom and dad
Both Mom and Dad need to take time for themselves daily, at
Understand that your baby does not come with instructions
least 20-30 minutes to relax. Remember to make time for each
and no expert knows your child. Realize you will never know all
other. Schedule a date night, even if it is just “take out” and a
you need to, but each day you will become a little wiser in your
movie at home. Accept help from others, especially with meals.
new role. Parenting is the most difficult yet rewarding job you
When family and friends come by to lend a hand, remember that
will ever have. The rewards start in the delivery room when your
as parents you are the “A” team to the baby. You are learning
baby grasps your finger for the first time. Hold on and enjoy as
how to care for and comfort your little one. Visitors are the “B”
you learn to parent your new arrival.
team to the baby. If you need a break or are going out, then
they take over the baby’s care. Allowing too much help with
direct baby care can delay the development of confidence and a
routine.
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V O C A B U L A R Y
vocabulary
Abruptio placenta: Premature separation of the placenta from
the uterus.
Baby blues: Short period of mild depression after
childbirth.
Active labor: The second phase of the first stage of labor; cervix
dilates from 4 to 8 centimeters.
Bag of waters: Lay term for amniotic sac and fluid.
Afterbirth: Term used to describe the placenta and membranes
that are delivered following birth of the baby.
Amnihook: Instrument used to break the bag of waters.
Amniotic fluid: Water-like fluid contained in the membranous
sac (bag of waters) surrounding the baby.
It helps support the baby, permits movement of the baby,
prevents loss of heat, absorbs shocks, and serves as a barrier
against infection.
Amniotomy: The artificial rupture of membranes (breaking the
bag of waters).
Analgesics: Drugs which help relieve pain without causing
unconsciousness.
Anesthetic: Agent used to induce loss of feeling with or without
loss of consciousness.
Anus: Outlet of rectum, located directly behind birth outlet.
Bilirubin: Product of the breakdown of red blood cells, which
can cause jaundice.
Bloody show: A blood-tinged vaginal discharge seen at the
beginning of or during labor.
Braxton-Hicks contractions: Intermittent contractions of the
uterus. Increasingly noticeable in late pregnancy as the uterus
is preparing itself for labor.
Breech: Position of the baby in which the buttocks or legs are
presented first.
Catheterization: Emptying the bladder by insertion of a small
pliable tube through the urethra.
Centimeters: Unit of measure used to describe progress in
dilation of the cervix during labor.
Cephalopelvic disproportion (“CPD”): A condition in which the
baby’s head will not fit through the pelvic opening, usually an
indication for a Cesarean delivery.
Apgar score: Evaluation of the newborn’s condition at one
minute and five minutes after birth. The scoring reflects color,
cry, muscle tone, reflex and respiration. Scores range from 1 to
10.
Cervadil or cervical ripening agent: A medication in suppository
form that is placed in the vagina to soften the cervix.
Areola: The pigmented area surrounding the nipple of the
breast which darkens during pregnancy.
Cesarean birth: Delivery of the baby by surgery through an
incision made in the abdomen. (“C-section” and “section” are
hospital jargon.)
Cervix: The narrow, neck-like opening of the uterus.
Circumcision: The surgical removal of the foreskin of the penis.
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V O C A B U L A R Y
Colostrum: Sticky, yellowish fluid secreted by the breasts in
small quantities during late pregnancy and for several days
following birth before the milk comes in.
“Complete”: Indicates complete dilation of the cervix.
A woman is said to be “complete” when the cervix is sufficiently
dilated for the baby to pass through, usually 10 centimeters. In terms of inches, the completely dilated cervix usually
measures about 4 inches in diameter or 13 1/4 inches in
circumference.
Contraction: Tightening and shortening of the uterine muscles
during labor, causing thinning and opening of the cervix and
contributing to the downward and outward descent of the
baby.
Enema: Placement of a solution into the rectum and colon
to empty the lower intestine.
Engagement: The presenting part of the baby has secured
itself into the upper opening (inlet) of the pelvic canal and
is in its beginning position for passage through this circular
bony structure. May be noticed by the mother as “lightening.”
Baby is sometimes said to have “dropped.“ Breathing is usually
easier.
Episiotomy: An incision made into the perineum between the
vaginal opening and the anus prior to delivery for the purpose
of easing the baby’s passage by widening the opening.
Crowning: Appearance of the baby’s head at the perineum
during the second stage of labor.
Dilation: Gradual opening and drawing up of the cervix to
permit passage of the baby. Progress in dilation is measured by
estimating the diameter of the opening of the cervix in terms
of centimeters after performing a sterile cervix check.
Duration of contraction: The time, in seconds, from the
beginning to the end of one contraction.
Early labor: The first phase of the first stage of labor; cervix
dilates from 0 to 4 centimeters.
Effacement: Thinning of the cervix occurring before or during
dilation, expressed in terms of percentage (from 0 to 100
percent).
Effleurage: A light circular stroking of the abdomen with the
fingertips in rhythm with breathing during labor.
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External version: A procedure done in the hospital by
the physician to manually turn the baby to a head-down
position.
False labor: Regular or irregular contractions of the uterus
strong enough to be interpreted as true labor, but have no
dilating effect on the cervix.
Fetal distress: A term describing a condition where the oxygen
supply of the fetus is threatened, which is detected by change
in fetal heart rate and/or meconium-stained fluid.
Fetal heart rate (FHR): The baby’s heartbeat as heard through
the abdominal wall in the latter part of pregnancy (average
120-160 beats per minute).
V O C A B U L A R Y
Fetal monitor: An electronic machine that is used to detect
and record the fetus’ heartbeat in relation to contractions
of the uterus.
Fetal scalp electrode: An internal device that is placed beneath
the skin of the baby’s head to monitor the baby’s heartbeat.
Fetus: Scientific term for Baby from the end of the third month
of pregnancy until delivery.
First stage of labor: The period of labor when the cervical
opening effaces and dilates to let the baby pass through.
It is the longest part of labor (about 90 percent of the total
labor time) and ends when the cervical opening is dilated 10
centimeters.
Foley induction: A catheter is introduced through the vagina to
the cervix. A balloon is inflated to put pressure on the cervix to
encourage tissue to soften and dilate.
Fontanels: The spaces in the infant’s head where the skull
bones are not yet grown together; also known as the “soft
spots.”
Hyperventilation: Breathing too rapidly and causing an
imbalance between the oxygen and carbon dioxide ratio in
the bloodstream. Signs include dizziness, light-headedness
and tingling of the face and/or extremities.
Induction: Artificially initiating labor by use of medication and/
or mechanical techniques (such as Pitocin, amniotomy, cervical
ripening agents, Foley catheter).
Intensity of contraction: The strength of a contraction.
Internal uterine pressure catheter: A pressure-sensitive catheter
inserted through the vagina to the uterus to measure the
strength of contractions.
Intravenous (IV): Used to give a sterile fluid into a vein for
purpose of nutrition, hydration or medication.
Involution: Return of the uterus to the nonpregnant size and
position, taking approximately six weeks.
Kegel: Refers to a set of exercises devised by Dr. Arnold Kegel to
strengthen the pelvic floor muscles.
Forceps: A tong-like obstetrical instrument occasionally used to
aid in delivery.
Lamaze: An emotional and physical preparation for childbirth;
named after Dr. Fernand Lamaze.
Foreskin: The fold of skin covering the head of the penis.
Lanugo: Fine downy hair on the body of the fetus after the
fourth month; sometimes apparent after birth.
Fourth stage of labor: The first hours after birth; the recovery
period.
Frequency of contractions: The time interval between the
beginning of one contraction to the beginning of the next
contraction.
Fundus: Top or upper portion of the uterus.
Lightening: Moving of baby and uterus downward into pelvic
cavity. Also called “dropping” and engagement.
Lochia: Discharge of blood, mucus and tissue from the uterus
after the birth of the baby. May continue several weeks and
vary in amount.
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V O C A B U L A R Y
Meconium: The dark green or black tarry-like substance present
in the baby’s large intestine that makes up his first stools after
birth.
Milia: Tiny white bumps, which sometimes appear on a
newborn’s face.
Molding: The shaping of the baby’s head to adjust itself to the
size and shape of the birth canal.
Perineal massage: Massaging the perineum prior to baby’s
birth to help the tissues to stretch for delivery.
Perineum: External tissues surrounding the anus and vulva.
“Pit drip”: Hospital slang for intravenous solution containing
pitocin, an oxytocic, which is a labor-inducing medication.
Pitocin: An oxytocic hormone used to induce or stimulate
uterine contractions.
Placenta: The vascular structure developed in pregnancy
through which the nutrition, excretion and respiration take
place between mother and baby; also called “after-birth”
following delivery.
Mongolian spots: Temporary purplish-brown discoloration
sometimes found on the backs of dark-skinned babies.
Monitor (fetal monitor): A machine that measures and records
on paper the contractions of the uterus.
Mucus plug: A plug of heavy mucus, which blocks the cervical
canal during pregnancy; is sloughed off during the last days of
pregnancy or during labor.
Oxytocin: The hormone produced by the pituitary gland that
stimulates the uterus to contract. It also causes the let-down
reflex during breastfeeding, which provides the sensation of
the milk coming into the breasts.
Pelvic floor: Hammock-like ligaments and muscles supporting
the reproductive organs.
Pelvis: The bony ring that joins the spine and legs. In the female, its
central opening encases the walls of the birth canal.
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Placenta previa: Placenta that is implanted in the lower uterine
segment; it may partially or completely cover the cervical
opening.
Posterior presentation: The back of the baby’s head is toward
the mother’s back, usually causing “back labor.” Position also
referred to as “sunny-side up.”
Postpartum: Refers to the time following birth.
Postpartum depression: A period of melancholy or “blues” that
about 20 to 30 percent of women experience after childbirth.
Prenatal: Refers to the time after conception and before the
birth of the child.
Prep: Shaving or trimming of pubic hair.
V O C A B U L A R Y
Relaxation: A state of lessened tension. Active or
controlled relaxation refers to consciously concentrating
on attaining a relaxed state in order to reduce unnecessary
tension in the body.
Ripe: Word used to describe the softened condition of the
cervix when ready for the onset of labor.
Second stage of labor: Period of time from complete dilation
of the cervix until the birth of the baby. The pushing stage of
labor can last a few minutes or a few hours.
Vagina: Curved, very elastic canal, 4-6 inches long, from the
uterus to the vulva. Also referred to as “the birth canal.”
Vernix: Protective material covering the skin of the newborn;
white in color, cheese-like in consistency; “baby cold cream.”
Vertex: The top or crown of the head.
Vulva: The external female reproductive organs; generally
understood as the external lips or folds which precede the
vaginal entrance.­­
“Show”: See “bloody show.”
Station: The location of the presenting part in relation to the
woman’s pelvic bones.
Third stage of labor: The period of time from the birth of the
baby until the placenta is delivered. Lasts on average from one
to 10 minutes.
Transition: The last phase of the first stage of labor; dilation of
the cervix from 8 to10 centimeters.
Umbilical cord: Cord-like structure containing two arteries and
one vein that connects the baby and placenta.
Urethra: The tube that carries the urine from the bladder to the
outside of the body.
Uterus: Muscular, pear-shaped organ of gestation; includes
the fundus and a narrower lower portion called the cervix; also
called the womb.
Vacuum extractor: A cap-like device which uses suction to
attach to the baby’s head to assist with the delivery.
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N O T E S
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C H I L D B I R T H
C L A S S
C A N C E L L A T I O N S
childbirth class
cancellations
Childbirth Class Cancellations
In case of bad weather, your class may be cancelled.
To get information about the possible cancellations
of your class, check online at www.conehealth.com.
Sometimes road conditions vary considerably across our
service area. Please use your best judgment in deciding
whether or not to attend class. Usually, classes resume
on your regularly scheduled day the following week.
Your instructor will make every effort to provide you
with information you may miss.
Class cancellations will also be listed on
Fox 8 News and WFMY. You can check online at
www.myfox8.com or www.digtriad.com.
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www.conehealth.com