You And Your Baby
a resource guide for
new parents
Welcome
At Lee Memorial Health System, we understand that mothers and
their babies need extra special care and attention. That is where
our talented Obstetric and Pediatric departments come in.
This is a momentous time in your life, and we honor that. From
the first days of your pregnancy until you are ready to take
your bundle—or bundles—of joy home, our highly skilled
team will make sure that you receive the best possible care.
Our obstetricians, midwives, pediatricians, pediatric nurse
practitioners, nurses, lactation consultants and technicians will
ensure that you are comfortable and well informed throughout
every step of your pregnancy and labor and delivery, as well as
any care that you receive afterward.
Childbearing is a family event. With our family-centered approach
to care, you and your loved ones can start caring for your
newborn right away with the guidance of our skilled team.
Please don’t hesitate to ask us any questions! It is our pleasure to
make sure that you know what is going to happen and why it is
necessary for the health and well-being of you and your infant.
Contents
While You’re With Us . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
When To Call Your Health Care Provider . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Taking Care Of Yourself After Your Baby Is Born . . . . . . . . . . . . . . . . . . . . . . . 5
Postpartum (After Delivery) Adjustments . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Caring For Your Newborn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Bottle Feeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Suggested Websites And Books . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Support And Community Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Shots For Tots Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
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While You’re With Us
In order to help protect the health of you and your baby, we encourage you to
follow these guidelines:
1. Be sure to have all people who are going to hold or touch your baby wash
their hands with soap and water.
2. Encourage anyone with a cold to wait for a few more days before coming to
visit.
3. In the interest of protecting your baby from communicable diseases, we
recommend that no children, except brothers or sisters of your baby, visit
while you are here. If your children come to visit, please do not let them
wander into other patients’ rooms. Any child with a cold, cough or any
other illness should not visit.
Activities Before Discharge
After delivery, your nurse will tell you the time and date of your expected
discharge. Please arrange transportation and have a car seat available before the
actual day of discharge.
Birth Notice: It is important for new parents to note that the National Center
for Missing and Exploited Children recommends that you do not put your
baby’s birth announcement in the newspaper. However, if parents wish, an
announcement of your baby’s birth can be published in the newspaper.
Baby Pictures: Pictures from Our 365 are available for purchase. The photo service
is available from 9 a.m. until approximately 1 p.m., seven days a week. End times
may vary due to the number of births. Pictures must be taken prior to the day
of your discharge. Please ask any staff member if you have questions about
scheduling your baby’s photo session.
Infant screening tests: Your pediatrician will recommend screening your infant for
various conditions before discharge. See Infant Screening section on page 14 for
more information.
When To Call Your Health Care Provider
Call Your Caregiver If You Experience Any of the Following:
1. Severe chills or temperature greater than 100 degrees, taken twice, six
hours apart
2. Burning or pain with urination
3. Bright red bleeding, soaking of pad in less than two hours, or if vaginal
discharge smells bad
4 — you and your baby
4. Severe headache or blurred vision
5. Red, hot, painful breast(s)
6. If you had a Cesarean section and see increased redness, drainage from the
incision or if you notice a bad smell
7. Painful, red, swollen, warm area on your leg
8. Baby Blues:
• If you are feeling down, depressed or hopeless
• If you have little interest or pleasure in doing things you
previously enjoyed
• If you are having trouble taking care of your baby or yourself
9. If you have any questions or concerns
Call Your Baby’s Caregiver For Any of the Following:
1. Fever greater than 100 degrees (or less than 97 degrees) taken under the
baby’s arm
2. Any redness, drainage, swelling or bad smell from eyes, cord or circumcision
3. Changes in your baby’s normal behavior
• Crying continuously for no obvious reason
• Unusually inactive
• Refusing to feed for more than two feedings
4. Vomiting forcefully
5.Diarrhea
6. Less than six wet diapers in 24 hours after your baby is 1 week old
7. Increasing yellow color of skin - See the “Jaundice in Newborns” section on
page 14
8. If you feel something is just not right
9. If you have any questions or concerns
Taking Care Of Yourself After Your
Baby is Born
Your General Hygiene Needs
Daily showering helps healing.
You should wash your bottom (perineum) with soap and water.
If you have had a Cesarean or tubal ligation, wash your incision with soap
and water daily. Dry it well. To help prevent infection, wash your hands before
touching your incision for any reason. Wash your hands again after touching
your incision.
Taking Care Of Your Bottom (Perineum)
Use the peri bottle with warm water to rinse your bottom after going to the
bathroom. Gently pat dry and use a clean sanitary pad.
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Clean your bottom (perineum) as long as any discharge/bleeding (lochia)
continues.
If you have stitches to repair an episiotomy or a tear, they do not need to be
removed - they will dissolve.
Wash your hands before and after you change your pad.
Always wipe from front to back after urination and bowel movements.
Medicated pads and sprays can be used as prescribed by your health care
provider.
Do not use tampons or douches until after your follow-up appointment with your
health care provider.
If you have trouble urinating:
• Run water in the sink while you are on the toilet. • Pour warm water over your bottom.
• Urinate while you are taking a warm shower.
To prevent constipation:
• Drink six to eight glasses of liquid daily.
• Eat plenty of fiber, such as fresh fruits, vegetables, whole grains and bran.
• Walk often.
• For hemorrhoids, use a sitz bath or sit in a tub with a few inches of warm
water for 10 to 15 minutes.
Your Vaginal Discharge/Bleeding (Lochia)
The appearance of vaginal discharge will change during the days and weeks
after birth. Typically you will see the following changes, but your pattern may be
different:
Day one to three after delivery – Bright red discharge with small clots similar to a
moderate to heavy menstrual period.
Day three to seven after delivery – Pinkish to brownish discharge, less heavy
bleeding.
One to six weeks after delivery – Pink, yellowish to white color, less and less
discharge/spotting.
Increased bleeding is usually a sign that you need to rest.
Your next menstrual period should come five to eight weeks after delivery, or
later if breastfeeding.
Caring For Your Breasts And Nipples
6 — you and your baby
If you are breastfeeding, refer to the breastfeeding section on Page 20.
If you are bottle feeding, wear a supportive bra both day and night for the
first week. Avoid directing hot shower water to your breasts, or stimulating or
pumping your breasts because this will increase milk production. Apply ice packs
to your breasts if they have become engorged (swollen and painful). Allow three
to four days for your milk supply to decrease.
Pain Relief
It is common to have mild to moderate discomfort after a vaginal or Cesarean
section delivery. If you are not allergic, it is safe to take acetaminophen or
ibuprofen as directed. Your health care provider may prescribe stronger pain
medication if indicated. Remember to rest and drink plenty of fluids.
After-Birth Pains
• After-birth pains may last one or two weeks and can be relieved by taking
pain medication and using a heating pad.
• Cramping or mild contractions are common after giving birth. This is how the
uterus (womb) returns to normal size.
• After-birth pains may increase if you’ve had more than one delivery.
• Cramping may be stronger during breastfeeding due to the release of a
hormone that causes contractions.
Good Eating… Making Healthy Choices
• Eat a variety of healthy foods. • Avoid alcohol and nicotine. Limit caffeine intake.
• If you are breastfeeding, you have additional nutritional needs. Do not diet
while breastfeeding.
• Drink plenty of fluids, such as water, juice and tea.
• You can get the calcium you need by consuming milk, yogurt, green
vegetables, cheese and vitamins.
Balancing Exercise, Rest And Other Activities
You should rest often during the first few weeks. Nap when your baby naps. Ask
for, and accept, help from relatives and friends.
You should exercise according to your health care provider’s recommendations.
Do not lift anything heavier than your baby for the first four to six weeks after
delivery.
Check with your health care provider about climbing stairs, driving a car or other
activities.
Check with your health care provider before sitting in hot tubs.
The following exercises are recommended for all women after delivery and may
be done immediately after birth:
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Pelvic Floor Exercises (Kegel)
May Start the Day of Delivery:
Position
Lie on your back, knees bent, feet flat, arms at side. Inhale.
Exercise
Tighten the muscles that you use when you have to urinate. You can be sure that
you are doing it correctly if you can slow or stop the flow of urine once it has
begun.
Reason
This strengthens muscles that support the uterus and takes strain off the
stitches when sitting. Strong muscles prevent leakage of urine when coughing or
laughing.
How Often
Tighten to a count of four, then relax. Repeat four times, twice daily, gradually
working up to 50 times per day.
How Long
Continue this exercise all your life. You may do this exercise in any position,
including standing and sitting.
Pelvic Tilt
May Start the Day after Delivery:
Position
Lie on back, knees bent, feet flat, arms at side. Inhale.
Exercise
Tighten your buttock muscles and pull your abdomen in so that your back is
pressed against the bed (do not hold your breath), count to six, then relax.
Reason
This strengthens abdominal muscles.
How Often
Five to 10 times a day.
Postpartum (After Delivery) Adjustments
After the birth of a baby, a mother can experience many feelings, including
excitement, joy, relief, anxiety, frustration and feelings of being overwhelmed.
Caring for an infant is hard work, no matter how much you prepared or looked
forward to your baby’s birth. This first year may include “highs” and “lows.” Time,
patience and support from family and friends are all helpful during this period
of adjustment.
8 — you and your baby
Emotions
Sometimes, even with help and support, women may feel confused and
concerned about themselves. These more confusing emotions are classified in
three ways:
Blues
A feeling of being let down is a very common reaction and usually appears on day
three or four. Symptoms may include crying for no reason, impatience, irritability,
restlessness and anxiety. These symptoms do not last long and usually disappear
by themselves.
Postpartum Depression
It can occur within days of the delivery or appear gradually, sometimes up to a
year later. Symptoms can be mild or severe. You can have good and bad days.
These feelings can make you wonder if you are “going crazy.”
You may experience one or more of the following:
• Lack of appetite
• Everything feels like it is an effort
• Depression
• Very tired, not sleeping
• Unhappy
• Lonely
• Lack of interest in the baby
• Not enjoying life
• Fear of harming the baby or self
• Hopeless
Postpartum Psychosis
This is the most severe but least common reaction. It usually occurs within two
weeks of your delivery.
Symptoms are very exaggerated and severe and may include:
• Insomnia
• Hallucinations
• Agitation and bizarre feelings or behavior
Postpartum psychosis is a serious emergency and requires immediate medical
help.
The cause of postpartum blues, depression and psychosis is unknown. It
is important to realize that these symptoms are not a sign of weakness or
inadequacy. Effective treatment is available.
Treatment varies, depending on the type and severity of symptoms. All of the
symptoms are treatable with support and skilled professional help.
If you have difficulty adjusting emotionally after childbirth, share your concerns
with your health care provider as soon as possible.
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Resources
• Depression After Delivery (DAD) support group is a national, non-profit
organization. You can contact (DAD) to request a new mom packet by
calling 800-944-4773.
• Postpartum Support International can be reached by calling
800-944-4773 or www.postpartum.net.
• Salus Care provides local mental health services at seven locations in
Southwest Florida. Call 239-275-3222 in Fort Myers, 239-772-1211 in
Cape Coral.
Resuming Sexual Intimacy
• We recommend you not have sexual intercourse until your healing is
examined by your obstetrician or midwife at your first post partum
appointment.
• You should not have sexual intercourse until your vaginal discharge has
stopped and your stitches are healed.
• If you do have sex before your appointment with your health care provider,
make sure to use contraceptive foam, cream or suppositories and condoms.
• You may use lubricating jelly if needed.
• If you bleed during or after sex, you need more time to heal. Do not have sex
for a few more days.
• You can get pregnant while breastfeeding.
Caring For Your Newborn
The Birth Experience
• After delivery, your newborn needs time to adjust to his or her new
environment and all the new things around him or her. Babies do give
signals when they need a break or are overstressed. These signals are how
your baby communicates with you.
The following are signals that indicate the baby’s reaction to over stimulation or
stress:
Coping Behaviors (Positive)Stress Signals (Negative)
Regular breathing and pink in color
Fast Breathing
Smooth rather than jerky movements
Color changes
Bringing hands to mouth
Gagging
Sucking fingers or pacifier
Unable to hold mouth closed
Making an “O” with mouth
Yawning
Staying calm
Frantic or panicked behavior
Flexing arms/legs close together to Spreading fingers (finger splay)/
resemble a ball shape
twitches/tremors
Having hands clasped together
Stiff arms and legs resembling startle
Smiling and looking into caregiver’s face Looking away and grimacing
Feet touching each other
Coughing, sneezing, sighing
10 — you and your baby
• In a few weeks your baby will adjust to the stresses of our world and cope
much better with increased stimulation.
• The first weeks are most important for allowing your baby time to adjust and
become accustomed to the environment.
• Every baby is different, so it is important to watch for signals and adjust your
interactions accordingly.
Skin-to-Skin Contact
Holding your naked infant next to your bare chest is called skin-to-skin contact. If
your infant is stable at birth, the health care team will place your infant directly on
your chest to begin skin-to-skin contact immediately. You will be encouraged to
keep your infant skin-to-skin for at least an hour and until the infant breastfeeds
(if you so desire).
Skin-to-skin has many health benefits for you and your baby:
• Promotes bonding and closeness between you and your baby.
• Helps your baby stabilize sooner and achieve a normal body temperature,
heart rate, blood pressure, and blood sugar.
• Decreases how much your baby cries.
• Decreases the amount of pain your baby experiences.
• Helps establish breastfeeding and promotes infant weight gain.
• Helps mothers stabilize sooner after delivery.
Hold your baby skin-to-skin often during the first few days of life. Have your baby
wear only a diaper and hat. Place your baby next to your bare chest. Then cover
with a blanket and enjoy!
Encourage your family to hold your baby skin-to-skin to help create this special
bond with the entire family.
Provide skin-to-skin before any painful procedures or tests.
What To Do When Your Baby Cries
Never Shake A Baby! Ever!
Crying is one of the important ways your baby communicates with you. All
babies cry often. As you and your baby get to know each other, you will begin to
recognize what your newborn’s different cries are trying to tell you. Check for the
possible causes of crying with the suggested comfort measures and remember –
Never Shake… Take a Break!
When an infant or toddler is shaken, their brain bounces back and forth against
their skull. This can cause bruising, swelling, pressure and bleeding in the brain.
This can easily cause permanent brain damage or death.
The following are possible reasons why your baby is crying:
Dirty diaper - Wash your baby’s diaper area and change diapers.
Hunger - Feed your baby.
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Lonely – Pick up your baby and snuggle.
Startled or frightened – Soothe or reassure by holding, talking or singing to your
baby.
Overstimulated by too much activity or noise – Swaddle your baby in a
receiving blanket and place in the crib. Reduce the lighting and noise in the
room.
Bored –Try entertaining your baby by playing games or talking, singing and
walking with your baby.
Tired – Rocking, swaddling or just holding your baby may help him or her to
relax and fall asleep. Some babies have a “fussy time” that occurs regularly every
day. Try taking the baby for a walk or car ride. Use a baby swing. Run a vacuum
cleaner or washing machine, which makes a noise that sometimes soothes
babies.
Discomfort – It is not recommended that you let your baby cry vigorously for an
extended time. If your baby continues to cry for no apparent reason, call your
baby’s health care provider. You cannot spoil your baby by holding him or her too
often.
Colic – Some babies cry more than others. If your baby cries hard for long
periods, usually in the evenings or around the same time every day, he or she may
have colic. The cause of colic is unknown. Frequent brief feedings, more burping,
walking and rocking may help. There is no medication proven to help. Colic
usually disappears when the baby is around 3 months old.
When everything fails, and you feel yourself tensing up or feel like you are losing
control, place your baby safely in a crib, close the door and take a break. Call a
friend or family member for support.
Shaken baby injuries can occur from as little as 5 seconds of shaking.
Positioning Your Baby For Sleep – “Safe To Sleep” (formerly
called “Back to Sleep”)
The safest position to place your baby for sleeping is on his or her back, not on
the baby’s stomach. Babies positioned on their backs have the best protection
against sudden infant death syndrome (SIDS).
• Sleeping on the back does not increase the risk of choking.
• Always place your baby on his or her back to sleep, for naps and at night.
• Never place your baby to sleep on soft surfaces, such as on a couch or
sofa, on pillows, comforters, or quilts. Do not place your baby to sleep on
a waterbed or soft mattress that allows the baby’s head to sink into the
surface.
• Remove stuffed toys, pillows and extra blankets from the crib.
12 — you and your baby
Learning about SIDS and safe sleep for babies is important for ALL caregivers,
not just for parents. Grandparents, aunts, uncles, babysitters, childcare providers,
and anyone else who might care for babies should learn more. Pediatricians
recommend short periods of supervised tummy time while your baby is awake
to increase the baby’s ability to turn over and to improve head and neck control.
Check with your pediatrician for the amount of time that your baby should be on
his or her tummy.
Bowel Movements
Bowel movement appearance and regularity varies with the type of feeding and
your baby’s individual nature. Initially, your baby’s stools are thick and blackgreen, changing to brown-green and then yellow-brown. Breastfed babies may
have a stool with every feeding, but should have at least two per day once your
milk comes in, which is around two to five days after delivery. The stool is soft and
yellow, with a seedy appearance. Bottle-fed babies may have fewer stools, which
look more formed and brown in color. Very hard or very watery stools should be
reported to your baby’s health care provider.
Diaper Changes
• Change diapers frequently to prevent diaper rash.
• Clean the baby’s bottom with baby soap and water or baby wipes that do
not contain alcohol.
• For baby girls, always clean from front to back.
• It is normal for baby girls to have some vaginal discharge.
• Remember to wash your hands after each diaper change.
Cord Care
•
•
•
•
Keep the diaper folded down away from your baby’s cord stump.
Allow the cord stump to air dry. Do not cover it with anything.
The cord stump will fall off in 10 to 14 days.
If the cord stump becomes soiled with urine or stool, cleanse the cord stump
with water and dry thoroughly.
• Tub baths can be given before the cord stump has fallen off. Tub bathing
does not delay cord healing or increase infection rate.
Circumcision Care
Circumcision is the removal of the foreskin of the penis.
• Gently wash the penis during baths with water only for the first 3-4 days to
prevent irritation.
• A white or yellowish crust may form on the end of the penis. This is normal
healing. Do not try to wipe it off.
• Apply white petroleum (Vaseline) to the penis at each diaper change until
it’s healed in seven to 10 days. Bacitracin or A&D Ointment may be used if
ordered by your pediatrician.
• If your baby has a plastic ring on the end of his penis, do not try to remove
it. The ring will fall off in seven to10 days. You will not need to apply any
ointment to the penis.
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• Follow any additional instructions from your doctor about the care of your
baby’s circumcision
If no circumcision was performed, just wash the penis with soap and water during
baths. No other care is needed. Do not try to pull foreskin back. The foreskin will
not be ready to pull back until your son is 3 or older.
Taking Your Baby’s Temperature
Axillary (armpit) temperature using a digital thermometer
• Make sure the armpit is dry and your baby has no clothing between its arm
and chest.
• Place the tip of thermometer high in the armpit.
• Hold the baby’s arm close to the body. When the thermometer beeps,
remove and read the temperature. See the guidelines listed on Page 5 for
when to call your doctor.
Infant Screening Tests
Your pediatrician will recommend screening your infant for various conditions
during the first few days or weeks of life. Your pediatrician will recommend which
specific tests should be performed on your infant. The most common testing
includes screening for jaundice, hypoglycemia (low blood sugar), hearing loss,
newborn blood screening (screens your baby’s blood for different diseases and
conditions), and critical congenital heart defects.
Jaundice in Newborns
Jaundice (JON-diss) is a yellowing of the skin and whites of the eyes. It is also
called hyperbilirubinemia (hi-per-bil-e-roo-bi-NEE-me-uh).
Jaundice is caused by the normal breakdown of your baby’s red blood cells, but
the liver cannot remove the bilirubin fast enough.
Jaundice usually happens during the first week of life.
Many times it will go away on its own, but some newborns may need to be
treated.
Some babies are more likely to have jaundice:
• Premature babies
• Babies with bruising to their head or body during birth
• Babies whose blood is different from their mother’s blood
• Babies with liver or other health problems
• Babies who are not getting enough liquids
• Breastfeeding babies
Blood tests and skin sensors can be used to learn how much bilirubin is in your
baby’s blood.
14 — you and your baby
Treatments may include:
• Increasing feedings
• Phototherapy (bili lights)
• If very serious, a blood transfusion may be considered
Critical Congenital Heart Defect Screening
Critical congenital heart defects (CCHD) are a birth defect that affects the
structure or the blood flow through the heart. Babies with CCHDs are at higher
risk of death or disability if they are not detected soon after birth. CCHDs usually
require surgery or other treatment in the first year of life.
Your infant should be screened for a CCHD before leaving the hospital using a
technology called pulse oximetry (ox-eh-mah-tree).
• Pulse oximetry can help detect if your infant has a CCHD before they begin to
develop any signs of the condition.
• Pulse oximetry is a simple painless test that measures the oxygen levels in
your Infant’s blood. Low oxygen levels can indicate a CCHD or other health
condition and your pediatrician will order additional testing, such as an
echocardiogram (ultrasound of the heart).
• Pulse oximetry is performed by placing a pulse oximeter sensor on your
infant’s hand and then on your infant’s foot using a small wrap. Oxygen
readings are obtained within seconds. If your infant is crying or restless, the
testing may take longer so it is best to perform the test when your infant is
quiet, still and warm. Pulse oximetry is typically done after the baby is 24
hours old.
• Pulse oximetrey does not detect all infants that have a CCHD. It is still
possible that your Infant has a CCHD or other serious heart condition.
Therefore, it is important for your infant to have regular examinations by
your pediatrician.
• For more information about CCHD screening, visit the Centers for
Disease Control and Prevention website at http://www.cdc.gov/ncbddd/
pediatricgenetics/pulse.html
Hearing Loss Screening
All newborns are offered the opportunity to receive a hearing screen before
leaving the hospital. Pediatrix Newborn Hearing Screening Program offers this
valuable service. Each year, approximately one to three out of every 1000 babies
are diagnosed with hearing loss. Babies are unable to tell us if they can hear or not
and without a newborn hearing screen, hearing loss may be missed. Studies has
shown that babies who are diagnosed with hearing loss and receive treatment
before 6 months of age are more successful at learning how to speak than
children with hearing loss found later.
Infant Safety
• Avoid smoking around the baby. Secondhand and thirdhand smoke
(smoking residue and carcinogens that remain on the smoker) exposure will
increase your baby’s risk of ear, nose, throat and lung infection, and SIDS. If
you are breastfeeding, smoking may decrease your milk supply and decrease
the level of vitamin C in your breastmilk.
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• Always lay your baby on his or her back on a firm surface to sleep. No
pillows, waterbeds, decorative comforters, bumper pads or anything soft
enough that your baby might suffocate in the folds because your baby does
not have good neck and head control, and he or she could suffocate. Stuffed
animals should not be left in the crib.
• Your baby needs his or her own place to sleep. A clean basket, box or dresser
drawer lined with a sheet will do if you don’t have a crib or if you’d like to
keep the baby close to you. If you have an old crib, be sure the slats are not
more than 2 3/8 inches apart because the baby’s head could get stuck. Make
sure that the mattress fits snugly against the rails of the crib to prevent your
baby’s head from being trapped.
• If your baby is choking, spitting or gagging, use the bulb syringe as
instructed in the hospital.
• Never leave your baby unattended on a changing table or other elevated
surface. Babies can wiggle, squirm and fall before you know it. Adjust front
carriers, slings and backpacks to hold the baby securely.
• Sides of the playpen or crib should never be left down with the baby inside.
• Never leave the baby alone in a car. The temperature inside a car can rapidly
rise to a dangerous level, especially here in Southwest Florida.
• To prevent burns, do not hold your baby when smoking, drinking hot liquids
or when cooking.
• Do not heat formula or breast milk in the microwave. • Your baby’s skin is very sensitive to the sun. Keep your baby out of direct
sunlight to prevent sunburn. It is recommended that you not use sunscreen
on your baby before 6 months of age.
• Keep small objects that may cause choking away from the baby. It is also
very important to keep plastic bags far from your baby’s reach. Never
place necklaces, cords or ribbons around the baby’s neck or near the baby,
including toys with ribbons.
• Protect your baby from pets.
• We strongly encourage you to take an approved CPR class. Call 239-343-5101
for more information.
Car Seats/Traveling Safely With Your Baby
Automobile crashes are the No. 1 preventable cause of death for children. Florida law
requires that all children less than 4 years of age and weighing less than 40 pounds
must be restrained in a federally approved car seat when traveling in a car.
• Be sure to follow the manufacturer’s specific instructions for installing your
baby’s car seat and use a car seat that is appropriate for the weight of your
baby.
• Clear everything from your dashboard and back shelf so nothing can fly off
and hit the baby if you have to stop suddenly.
• Drivers are responsible for buckling up infants and children.
• Appointments are available to have your car seat installed/inspected by a
certified car seat technician. For an appointment, call 239-343-5224.
• For more information, go to www.nhtsa.dot.gov, or www.ghsa.org/html/
stateinfo/laws/childsafety_laws.html
16 — you and your baby
How To Bathe Your Baby
Your baby should be stable for several hours before your baby has a first bath.
Bathing a baby immediately after birth can cause unnecessary stress, lower the
body temperature and lower the blood sugar level. Discuss with your nurse when
it is appropriate for your baby to have a first bath.
Sponge Bath
1. Lay your baby on a soft towel, or use a sponge-lined bath bed.
2. Clean around each eye with separate cotton balls dipped in warm water.
Wipe from the inner corner to the outer corner. Use a separate cotton ball
for each wipe.
3. Support your baby’s head and limbs while using a warm washcloth and a
little bit of baby cleanser. Wash and rinse the genital area from front to back.
With a clean washcloth, rinse your baby’s body until all the lather is gone
and repeat this step if necessary. Clean the cord stump with a cotton ball
dipped in clean water or mild cleanser. Keep the cord stump dry.
Lee Memorial Health System — 17
4. Clean your baby’s head with a small amount of baby shampoo. Rinse the
cloth and use it to remove the shampoo. Be careful to avoid the eyes.
5. When the baby is clean, dry thoroughly, but don’t rub vigorously. Then wrap
the baby from head to toe in a dry towel, preferably hooded.
How To Bathe Your Baby © 2003 Johnson & Johnson Consumer Companies, Inc.
Baby Bath
1. Fill a baby tub or a dish tub with a few inches of water that’s warm, not
hot— run the water over your wrist to check the temperature. With one
arm supporting the back or the neck and head, slip your baby into the tub.
Tub baths are not recommended for circumcised boys until the incision has
healed.
2. Support the baby with one hand while you wash the baby with your
other hand. Gently bathe the baby with a little bit of baby cleanser on a
washcloth.
18 — you and your baby
3. Rinse with small cupfuls of water. Clean the baby’s scalp with a wet
washcloth and a tiny amount of baby shampoo. Rinse the cloth and use it to
wipe off the shampoo. The baby may not be ready to have water poured on
its head.
4. Carefully lift the baby out and lay the baby on a towel. Fold the towel up
over the baby’s feet and across the middle, patting your baby dry as you go.
5. The use of baby powder is not recommended. The baby can inhale the
powder, which can cause breathing problems.
How To Bathe Your Baby © 2003 Johnson & Johnson Consumer Companies, Inc.
Lee Memorial Health System — 19
Breastfeeding
Benefits Of Breastfeeding
Good for you because:
• Your uterus returns to normal size faster.
• Milk production burns about 500 calories a day.
• Breastmilk is free.
• Breastmilk is convenient. You always have a supply, and it is always the right
temperature.
• Breastfeeding is good for the environment­—there’s no trash to discard.
• Breastfeeding is a way of giving something to your baby that no one else can
give.
• Moms who breastfeed have a lower risk of breast cancer, ovarian cancer, and
Type II diabetes.
Good for your baby because:
• It provides all the nutrients your baby needs for the first six months.
• Breastfed babies are healthier.
• Breastfed babies don’t get constipated.
• Breastfed babies have fewer allergies.
• Breastfed babies have fewer stomach problems.
• Breastfed babies have a lower incidence of juvenile diabetes.
• Breastfed babies have fewer dental and speech problems.
• Breastfed babies have fewer respiratory and ear infections.
• Breastfed babies are less like to develop asthma.
• Breastfed babies are less likely to become obese.
The First Days
• Place baby skin-to-skin after birth.
• Breastfeed within the first hour after birth.
• Nurse as long as your baby wants. Your early milk, or colostrum, is especially
good for your baby.
• A pacifier or bottle is not recommended until your baby has learned to nurse
well, which is usually about 4 weeks of age unless medically advised. If your
baby needs to suck, it is better to nurse.
• Call the Lee Memorial Health System Lactation Consultant’s office at
239-343-5186 whenever you have a breastfeeding question or problem.
Getting Started
• Make sure you are positioned comfortably. Use pillows to support your back
and arm. Elevate your feet on a stool.
• Hormone production during nursing frequently causes thirst, so have
something to drink with you and drink to satisfy your thirst.
• Relax, take a deep breath and let it out slowly.
20 — you and your baby
How To Tell A Good Latch On
• The baby should have the nipple and part of the areola (the dark area around
the nipple) in his or her mouth. Do not allow the baby to nurse on just the
nipple.
• When the baby is nursing, you should feel a pull on your nipple. If your
nipples are tender, it may feel uncomfortable at first, but after a few minutes
it should feel better. If it doesn’t feel better, remove the baby from your
breast and reattach.
• If your breast is very heavy, support it by placing your hand or fingers under
the breast, well back from the areola or use a rolled-up wash cloth under
your breast.
• The baby’s arms and shoulders should begin to relax during the feeding.
How Often To Feed
• Breastfeed your baby when he or she is hungry. You should breastfeed at
least 8 to 12 times in 24 hours. Look for hunger cues, such as putting fist
to mouth, moving tongue or opening mouth and looking for your nipple.
Babies who cry for a long time may become exhausted and go to sleep
without nursing, or before they have finished the entire feeding. Crying is a
late sign of hunger and infants may be too upset by this time to feed well. Do
not limit feedings. Frequent feeding assures an adequate number of feedings
and helps establish day/night routines. Try to offer both breasts at each
feeding, but don’t worry if the baby nods off after only one side. Alternate
the breast you start on. The more often the baby sucks at the breast, the
more milk is made, so frequent feedings help build your milk supply. See the
“How to Tell if Your Baby is Getting Enough Milk” section on page 22.
• Frequently, babies will cluster or bunch feed. That means they will nurse
very frequently at certain times of the day and go longer between feedings
at other times. Your baby may nurse briefly, stop, fuss, nurse again, stop,
fuss and continue this pattern for a few hours. This frequently occurs in the
evening and can be very tiring and frustrating. You may think your baby is
not getting enough milk. This is normal behavior and has nothing to do with
your milk. Supplementing with a bottle is not recommended. Giving the
baby a bottle of formula may make matters worse and tell your body that
you need to make less milk. Just let the baby nurse.
• All babies have “growth spurts.” The first one usually occurs when the baby
is between two to three weeks old. During this time, the baby will want to
nurse more frequently, sometimes twice as much. Do not worry that you are
losing your milk. This is your baby’s way of telling your body that he or she
is growing and needs more milk. Remember, removing milk from the breast
makes more milk. This feeding pattern may last two to three days and then
return to normal. Growth spurts will occur several times during the first six
months.
Lee Memorial Health System — 21
How Long To Breastfeed
The length of feeding will vary greatly. Initially your baby may feed only for a
few minutes or as long as 10 to 30 minutes on each breast. It is not necessary
to watch the clock or gradually build feeding time at the breast. Let the baby
set the pace. He or she will suck strongly and steadily at first, with a few pauses.
Gradually the baby will slow down with lengthy pauses, and finally come off the
breast. Allowing the baby to take his or her time will ensure that the baby gets
the thicker, high-fat, high-calorie hindmilk (the thicker milk that comes at the end
of the feeding). Remove the baby from the breast by inserting a finger between
the breast and the corner of the baby’s mouth. Break the suction by putting your
finger between the upper and lower gum, then remove the baby. Avoid pulling
the baby off your nipple without breaking the suction.
Your Milk Supply
You may not feel like you have any milk in your breast for the baby during the first
few days. You do! The concentrated nutrition your baby gets at the breast for the
first few days is colostrum, or “first milk.” It is creamy and yellow in color. Although
it is a small amount, one teaspoon to one tablespoon, it is important because of
its infection fighting and laxative properties.
After two to five days, the colostrum starts changing into “mature” milk.
Breastmilk is both food and drink to your baby. It is nutritionally balanced to meet
all your baby’s needs, and changes according to your baby’s age. It also changes
from the beginning of the feeding (foremilk) to the end of the feeding (hindmilk).
Foremilk is thinner to satisfy thirst, and hindmilk is thicker and has more fat to
satisfy hunger.
Milk supply is determined by the baby’s needs. The more your baby nurses,
the more milk you will produce. Some tips to help establish an adequate milk
supply include: feed early and often at the first signs of hunger, feed 8-12 times
in 24 hours -- although these feedings may not follow a regular schedule, avoid
pacifiers and bottles for about four weeks, sleep near your baby and learn to
nurse lying down. Drinking more liquids will not increase your milk supply. The
less your baby nurses, the less milk your body will produce.
Burping Your Breastfed Baby
Try to burp your baby after he or she has finished the first breast, and again at
the end of the feeding. If the baby hasn’t burped after about a minute, he or she
probably doesn’t have to. If the baby falls asleep at the second breast, he or she
does not need to be awakened to burp.
How To Tell If Your Baby Is Getting Enough Milk
Once your colostrum begins to transition to milk (about two to five days after
delivery), you should see an increase in wet and dirty diapers.
If your baby is nursing at least eight to 12 times in 24 hours, is alert, bright-eyed
and generally content after a feeding and obviously thriving, then he or she is
getting enough breastmilk. After an initial weight loss during the first week,
which is normal, he or she will gain weight, although not necessarily at the same
22 — you and your baby
rate each week. Your baby should regain birth weight by approximately two
weeks of life and gain approximately four to seven ounces per week. Use the chart
below to track your baby’s progress. Notify your pediatrician if your infant loses
more than 10 percent of his or her birth weight.
Baby’s birth date and time:____________________________________________________________
Baby’s birth weight:_________________________________________________________________
Baby’s discharge weight:_____________________________________________________________
10% weight loss would be:____________________________________________________________
(Use table below to detemine this)
Baby’s weight at first doctor check-up:__________________________________________________
Baby’s weight at second check-up:_____________________________________________________
Table: How to Determine 10% Weight Loss
Birth Weight
10% Weight Loss
Birth Weight
10% Weight Loss
4 lb 8 oz (2.04 kg)
4 lb 1 oz (1.84 kg)
7 lb 8 oz (3.40 kg)
6 lb 12 oz (3.06 kg)
4 lb 10 oz (2.10 kg)
4 lb 3 oz (1.89 kg)
7 lb 10 oz (3.46 kg)
6 lb 14 oz (3.11 kg)
4 lb 12 oz (2.15 kg)
4 lb 4 oz (1.94 kg)
7 lb 12 oz (3.52 kg)
7 lb 0 oz (3.16 kg)
4 lb 14 oz (2.21 kg)
4 lb 6 oz (1.99 kg)
7 lb 14 oz (3.57 kg)
7 lb 1 oz (3.21 kg)
5 lb 0 oz (2.27 kg)
4 lb 8 oz (2.04 kg)
8 lb 0 oz (3.63 kg)
7 lb 3 oz (3.27 kg)
5 lb 2 oz (2.32 kg
4 lb 10 oz (2.09 kg)
8 lb 2 oz (3.69 kg)
7 lb 5 oz (3.32 kg)
5 lb 4 oz (2.38 kg)
4 lb 12 oz (2.14 kg)
8 lb 4 oz (3.74 kg)
7 lb 7 oz (3.37 kg)
5 lb 6 oz (2.44 kg)
4 lb 13 oz (2.19 kg)
8 lb 6 oz (3.80 kg)
7 lb 9 oz (3.42 kg)
5 lb 8 oz (2.49 kg)
4 lb 15 oz (2.25 kg)
8 lb 8 oz (3.86 kg)
7 lb 10 oz (3.47 kg)
5 lb 10 oz (2.55 kg)
5 lb 1 oz (2.30 kg)
8 lb 10 oz (3.91 kg)
7 lb 12 oz (3.52 kg)
5 lb 12 oz (2.61 kg)
5 lb 3 oz (2.35 kg)
8 lb 12 oz (3.97 kg)
7 lb 14 oz (3.57 kg)
5 lb 14 oz (2.66 kg)
5 lb 5 oz (2.40 kg)
8 lb 14 oz (4.03 kg)
8 lb 0 oz (3.62 kg)
6 lb 0 oz (2.72 kg)
5 lb 6 oz (2.45 kg)
9 lb 0 oz (4.08 kg)
8 lb 2 oz (3.67 kg)
6 lb 2 oz (2.78 kg)
5 lb 8 oz (2.50 kg)
9 lb 2 oz (4.14 kg)
8 lb 3 oz (3.73 kg)
6 lb 4 oz (2.84 kg)
5 lb 10 oz (2.55 kg)
9 lb 4 oz (4.20 kg)
8 lb 5 oz (3.78 kg)
6 lb 6 oz (2.89 kg)
5 lb 12 oz (2.60 kg)
9 lb 6 oz (4.25 kg)
8 lb 7 oz (3.83 kg)
6 lb 8 oz (2.95 kg)
5 lb 14 oz (2.65 kg)
9 lb 8 oz (4.31 kg)
8 lb 9 oz (3.88 kg)
6 lb 10 oz (3.01 kg)
5 lb 15 oz (2.70 kg)
9 lb 10 oz (4.37 kg)
8 lb 11 oz (3.93 kg)
6 lb 12 oz (3.06 kg)
6 lb 1 oz (2.76 kg)
9 lb 12 oz (4.42 kg)
8 lb 12 oz (3.98 kg)
6 lb 14 oz (3.12 kg)
6 lb 3 oz (2.81 kg)
9 lb 14 oz (4.48 kg)
8 lb 14 oz (4.03 kg)
7 lb 0 oz (3.18 kg)
6 lb 5 oz (2.86 kg)
10 lb 0 oz (4.54 kg)
9 lb 0 oz (4.08 kg)
7 lb 2 oz (3.23 kg)
6 lb 7 oz (2.91 kg)
10 lb 2 oz (4.59 kg)
9 lb 2 oz (4.13 kg)
7 lb 4 oz (3.29 kg)
6 lb 8 oz (2.96 kg)
10 lb 4 oz (4.65 kg)
9 lb 4 oz (4.18 kg)
7 lb 6 oz (3.35 kg)
6 lb 10 oz (3.01 kg)
10 lb 6 oz (4.71 kg)
9 lb 5 oz (4.24 kg)
10 lb 8 oz (4.76 kg)
9 lb 7 oz (4.29 kg)
Lee Memorial Health System — 23
Six to eight wet diapers and two to 12 bowel movements every 24 hours are
normal after 1 week of age.
Rule of Thumb for Your Baby’s First Week:
Day 1 = One wet diaper Day 4 = Four wet diapers
Day 2 = Two wet diapers Day 5 = Five wet diapers
Day 3 = Three wet diapers Day 6 = Six wet diapers
After your milk comes in, you can tell that your baby is removing milk from your
breast by observing any of the following signs.
• Your breasts feel full before a feeding and softer afterward.
• A sensation or milk dripping from the other breast (called milk “let down”).
• Swallowing sounds are heard (no clicking or smacking sounds).
• Milk is visible in your baby’s mouth.
• Your baby has bowel movements and wet diapers.
• Baby is satisfied after the feeding.
Because every baby is different, it may be more difficult to tell how much milk
your infant is receiving during the first week after birth. An alert, bright-eyed
infant who is hungry for feedings and satisfied between them is a good clue.
Worrying about your milk supply may make it decline. Try to relax and be
comfortable at feeding times. Relaxation or visualization exercises or a warm
drink can help. If you have questions or concerns, contact your lactation
consultant (HealthPark Medical Center 239- 343-5186 or Cape Coral Hospital 239424-2246 or local WIC Office - Lee County office 239-332-9615 or Collier County is
239-252-5316) or your baby’s health care provider.
Some signs that breast feeding is
going well:
• Your baby is breastfeeding at
least 8-12 times every 24 hours.
• Your baby has at least 3 yellow
bowel movements every 24
hours by day 4 and 4 or more
wet diapers.
• You can hear your baby gulping
and swallowing at feedings.
• Once your baby latches, your
nipples do not hurt when your
baby nurses.
• Your baby is receiving only
breast milk.
Check with your pediatrician or
lactation consultant if:
• Baby is having fewer than 4
bowel movements every 24
hours by day 4.
• Baby is still having black tarry
bowel movements on day 4.
• Baby is not breastfeeding at least
8 times in 24 hours.
• Your nipples hurt during the
entire feeding, even after the
baby is latched on.
• You can’t hear your baby gulping
or swallowing, or your baby does
not seem satisfied after most
feedings.
Night Feedings
Night feedings are important for maintaining your milk supply and preventing
sore, full breasts in the morning. Keeping your baby’s crib next to your bed will
minimize your sleep loss. Your baby needs his or her own place to sleep. It is
recommended that you not sleep with your baby.
24 — you and your baby
Use Of A Pacifier
Pacifiers are not recommended until breastfeeding is well established—
approximately four weeks. Your finger or your baby’s own fist are good substitutes.
Sucking on a pacifier, like an artificial nipple, is different than suckling at the
breast. Some babies will become confused and suck poorly at the breast if given
pacifiers too soon.
Collecting Breastmilk
• Wash hands well with soap and water.
• Wash all the collecting bottles and breast pump parts that touch your breasts or
the milk. Use hot, soapy water or a dishwasher. Rinse carefully. Air dry on a clean
towel. If your baby is premature or ill, the hospital may ask you to sterilize your
pump parts.
• Milk can be removed from the breast using hand expression and/or a breast
pump. Use the following steps for hand expression:
1. It is helpful to apply warm compresses or apply gentle massage to your
breasts before you begin.
2. Press—Position your fingers behind the areola (your hand should be
shaped like the letter “C) and then press back forwards the chest.
3. Compress—Roll fingers inward, behind the areola. Do not rub the breast.
4.Relax
5. Repeat—You might not see any milk or colostrum at first. Repeat on the first
breast several times and then alternate between breasts. Rotate your fingers
around the areola to help empty the entire breast. Continue for about 20-30
minutes.
• If using a breast pump, read the instruction book that comes with your pump
and follow the suggestions. Sterilize your pump parts once a day as described.
• Practice pumping when you are rested, relaxed and your breasts feel full. Once
a day, try to nurse your baby only on one side and pump the other breast. Or
pump for a few minutes if your baby skips a feeding or nurses for only a short
while. Read the Storage Guidelines chart to learn how to store breast milk. Be
sure to use the right size breast shield so that your nipple fits comfortably.
• Employed moms can help their baby learn to take a bottle once breastfeeding
is going well. It is best to wait for three to four weeks to introduce bottles. If you
are having problems breastfeeding, ask for help.
• Begin to pump to store milk one to two weeks before returning to work. Many
employed moms use the fresh milk they pump at work for feedings the next
day. They refrigerate Friday’s milk for use on Monday. Save your frozen milk for
emergencies.
• Pump three times during an eight-hour work shift, or every three hours you are
away from your baby. Ten minutes of pumping during breaks and 15 minutes
of pumping during lunch with a good pump will help protect your milk supply.
If you can’t pump three times, pump as much as you can during each day.
Breastfeeding in the evening and over the weekend helps your milk supply and
protects your special bond with your baby.
Lee Memorial Health System — 25
Storing Breastmilk
• It is normal for pumped milk to vary in color, consistency and scent depending
on your diet. Stored milk separates into layers. Cream will rise to the top. Gently
swirl the warmed bottle to mix the milk layers. Do not shake.
Breastmilk Storage Guidelines (for Healthy Term Babies) • You can continue to add small amounts of
cooled breastmilk to the same refrigerated
Room
Cooler with Refridgerator Self-contained
Deep
Temperature 3 Frozen
Refridgerator
Freezer
container throughout the day. Avoid
Ice Packs
Freezer Unit
adding warm milk to already cooled milk.
Freshly
4-6 hours
24 hours
5-7 Days
3-4
6-12
expressed
breastmilk
at 66-720F
(19-220C)
at 590F
(150C)
at 32-390F
(0-40C)
months
months
at 00F
(-190C)
Thawed
breastmilk
(previously
frozen)
Do not
store
Do not
store
24 hours
Never
refreeze
thawed
milk
Never
refreeze
thawed
milk
• Store your milk in glass or plastic
containers, or in milk storage bags made
especially for breastmilk. Place smaller bags
inside a larger food storage bag to prevent
accidental punctures.
• Freeze milk in 2 to 5 ounce portions. Small amounts will thaw more quickly. You
will waste less milk this way and will avoid over-feeding. Liquids expand when
frozen. Be sure to leave some extra room at the top of the container so the
bottle or bag won’t burst.
• Seal containers tightly. Write the date on a piece of masking tape on the bag or
bottle. Use the oldest milk first.
• If you do not plan to use the milk within a few days, freeze it right away in the
coldest section of your freezer. Do not place the bottle or bag up against the
wall of the freezer.
Defrosting
• Thaw milk in the refrigerator, or hold the bottle under warm running water to
quickly thaw. You can also place the sealed container in a bowl of warm water
to bring it to body temperature.
• Thawed milk is safe in the refrigerator for 24 hours. Do not refreeze.
CAUTION: Never microwave breastmilk. Microwaving can cause severe burns
to baby’s mouth from hot spots that develop in the milk during microwaving.
Microwaving can also change the composition of breastmilk. Microwaves
destroy the living components of the milk.
Tips For Feeding Breastmilk With A Bottle
• Choose a slow-flow bottle nipple.
• Remove the bottle nipple out of the baby’s mouth periodically to let the baby
catch his or her breath.
• Pause to burp the baby when needed.
• If baby seems fussy in between feedings it may be because of thirst. Offer 1 to 2
ounces of milk.
26 — you and your baby
Leaking
Leaking milk from your breasts can be a nuisance, but it usually disappears after
the first few weeks. Some mothers have a lot of leaking and others have none.
Leaking is most likely to occur when your breasts become overly full, and is a
signal that it’s time to breastfeed your baby. Nursing pads inside your bra will
absorb the milk and should be changed often. If you do start to leak, gentle
pressure on your nipples will often stop it. Fold your arms in front of your chest
and press inward.
Medications And Drugs
Most medications pass into breastmilk to some extent, but most are also quite
safe with breastfeeding. Be sure your health care provider knows that you
are breastfeeding if you are prescribed any medications. Call our Lactation
Consultants at 239-343-5186 if you or your provider have any questions.
The Father’s Role
Keep your baby’s father from feeling left out by sharing the baby care and
cuddling with him. Encourage him to be with you, and discuss the baby while you
are nursing. Ask him to change, bathe, carry, walk and cuddle the baby. Fathers
should be aware of the benefits of breastfeeding and the basics of accomplishing
it. Have him read this booklet and other breastfeeding resources. His support and
encouragement are a vital part of breastfeeding success.
Breastfeeding On The Go
Some women hesitate to breastfeed away from home, in public places, for fear of
criticism. Just grab some diapers and go. With a little practice, nursing discreetly is
easy. Choose clothing that opens or lifts up in front or clothing that was designed
specifically for breastfeeding women. Use a small blanket over your shoulder to
promote privacy. As more people learn about the benefits of breastfeeding and it
becomes a more common sight, you will find that people appreciate your happy,
quiet, breastfed baby.
Note: Mothers/Babies Have The Legal Right To Breastfeed In Any Public Area
In The State Of Florida. (Fl. House Bill 231, 1993; Senate Bill 1668, 1994)
(http://www.flca.info/flbreastfeedinglaw.htm)
Going Back To Work:
You can continue to offer breastmilk if you return to work.
Begin to offer your baby breastmilk from a bottle when they are about 4 weeks of
age. Some babies do not want to take feedings from a bottle if you wait longer.
Give your baby a small amount of breastmilk each day by bottle. This is a great
opportunity for your partner to feed the baby.
It is helpful to collect and store some breastmilk before you leave your baby for
the first time. This way your baby will be sure to have an adequate amount of
Lee Memorial Health System — 27
breast milk for his or her feedings while you are at work. You can use a breast
bump or use hand expression. To build up a supply of breast milk, you can do any
of the following:
• If your baby only nurses at one breast at a feeding, try pumping or hand
expressing the other breast.
• Try pumping after the first morning feeding. Your milk supply is generally
greater in the morning.
• Try power pumping once a day. Pump 10 minutes on, 10 minutes off, for one
hour.
How to Determine How Much Breastmilk Your Baby Needs While You are Working
________________ X 2.5 = ________________÷________________ = ________________
(Baby’s Current Weight)
(# of ounces in 24 hours) (# of feeds in 24 hours)
(ounces per feeding)
For example, a 10 lb baby would need 3 ounces of breast milk at each feeding:
_____10_lbs______ X 2.5 = ____25__________÷_____8__________ = ________3_______
(Baby’s Current Weight)
(# of ounces in 24 hours) (# of feeds in 24 hours)
(ounces per feeding)
If You Are Ill
As a general rule, you should continue nursing if you get sick. Even before you
come down with symptoms of a cold or the flu, your body is making antibodies
to fight the infection and these antibodies will pass into your milk to protect your
baby. Check with your health care provider or lactation consultant before taking
any medication, including over-the-counter medication.
If Your Infant Is Ill
A change in nursing pattern may be the first indication that your infant is ill.
Breastfed babies with diarrhea recover more quickly if breastfeeding is continued.
Clear liquids are not necessary. Even babies with vomiting will keep breastmilk
down (brief, small volume nursings) better than other liquids. Sometimes babies
with stuffy noses or ear infections will have difficulty nursing. Because of all the
important immune factors in your breastmilk, your breastfed baby is less likely to
get sick.
Possible Problems Or Concerns
Tender Nipples - Don’t be alarmed if your nipples become a little tender. Some
mild tenderness can occur during the first one to two weeks that you breastfeed.
The peak soreness is usually around three to four days after nursing begins. The
tenderness should only be felt for the first 30 seconds to one minute after the
baby latches on and begins to suck. After the initial latch on, you should feel
some tugging, but no discomfort. See “How To Tell A Good Latch On” on page 21.
After each feeding, pat dry any remaining saliva, rub a little expressed breastmilk
on your nipples and allow them to air dry. Leave your nipples open to air as much
as possible. Avoid using soap, alcohol or creams on your breast or nipples. Water
is all that is needed during your daily shower or bath.
28 — you and your baby
If you do use a nipple cream, use only medical grade lanolin (such as Purelan® or
Lansinoh®) sparingly, and do not wipe off before nursing. Since an infant’s suck
is the strongest at the beginning of a feeding, you may want to start the feeding
with the least sore side. If the soreness persists beyond the first minutes of
feeding, cracking and bleeding occurs, or lasts longer than one to two weeks, call
your lactation consultant or health care provider.
Engorgement When Breastfeeding – When your milk starts coming in, your
breasts may become very firm and somewhat uncomfortable. This is due to
increased blood supply and some swelling, as well as the milk. This is called
engorgement. Frequent feeding, every one to three hours day and night, will
relieve the fullness. Expressing breastmilk by hand (refer to Collecting Breastmilk
section for how to perform hand expression on page 25), or using a breast pump
briefly to soften the nipple and areola can make it easier for the baby to latch
on. Cold compresses or a cloth-covered ice pack between feedings may also
help reduce swelling. The breast firmness will decrease after a few days as milk
production and emptying are fully established.
Blocked Milk Duct – Sometimes, especially when breasts are not emptied
regularly, a milk duct will get “stopped up,” just like a pipe. One small part of your
breast may become very hard and sore. Feed often, having your infant nurse
on the sore breast first. Position your baby so his or her nose or chin is pointed
toward the blocked duct. Apply a warm moist cloth to the area or shower while
you massage the area, and try to hand express milk to clear the duct. Remove any
tight clothing, such as underwire bras, which may prevent milk flow.
Breast Infection/Mastitis – Occasionally, a breast becomes red and painful. If
you have a fever and flu-like symptoms, you probably have a breast infection
(mastitis). You will likely need an antibiotic prescribed by your health care
provider. It is important to keep nursing your baby, as keeping your breast well
drained will help clear the infection and prevent a breast abscess. Your milk is still
safe for your baby.
Thrush – See Thrush section on page 32.
Breastfeeding Resources
Lee Memorial Health System’s Board-Certified Lactation Consultants provide
the following services:
1. Inpatient breastfeeding assistance in collaboration with Certified
Breastfeeding Counselors
2. Outpatient lactation consultations (by appointment) for:
• Infant failure to gain weight
• Poor latch
• Sore nipples
• Decreased milk supply
• Thrush
• Mastitis (breast infection)
• Fitting and use of a breast shield
• Supplemental nursing system
• Supplementation and weaning off formula
• Returning to work
• Use of the breast pump
Lee Memorial Health System — 29
• Breast pump rental and sales
• Breastfeeding aids, such as pillows, lanolin, and breast pads.
• Breastfeeding support groups
For an appointment call HealthPark Medical Center at 239-343-5186 or Cape Coral
Hospital 239-424-2246. There is charge for some of the services provided.
3. Phone consultations: You will find that friends, relatives and the hospital
staff will provide plenty of information about breastfeeding. Some of the
information will seem contradictory, which is not unexpected. Call the
Lactation Consultant for clarification.
WIC Breastfeeding Support:
Breastfeeding help is available FREE through the WIC Lactation Services to all
registered clients. The main breastfeeding office is located at 3920 Michigan
Avenue, Fort Myers, FL 33916. The phone number for the Lee County office is
239-332-9615 and Collier County is 239-252-5316. They provide the following
services:
•
Infant failure to gain weight
•
Poor latch
•
Sore nipples
•
Decreased milk supply
•
Thrush
•
Mastitis
•
Returning to work
•
Use of a breast bump
•
Breastfeeding support groups
•
Breastfeeding peer counselors
•
Breast pumps are available for mothers with infants in the NICU. Call the WIC
office as soon as possible to make an appointment to pick up the pump.
Bottle Feeding
Choosing A Formula
Your baby’s health care provider will suggest the formula that will be best for your
baby. Do not use any other milk product until 1 year of age, or as your baby’s
health care provider instructs.
There are three types of formula available:
Powder: This is the least expensive. Mix it with bottled water because there are
additives in tap water.
Mix it with boiled water if you use well water. Follow the instructions on the can.
Concentrated: This needs to be diluted with bottled water, or boiled water if you
use well water. Follow the instructions on the can.
Ready-To-Feed: This is the most expensive. Do not dilute it.
Formula is good for one hour at normal room temperature or 48 hours in the
refrigerator.
Never add more water than the instructions state.
30 — you and your baby
How Often To Feed
Follow your baby’s health care provider’s instructions. Most health care providers
recommend feeding every three to four hours. Do not wait longer than five hours
between feedings for the first weeks of life. Bottle-fed babies should take at least
one ounce of formula every feeding. They should increase their feedings by one
ounce every week. You may feed the baby on demand. Baby cues for hunger
include putting his or her hand to his or her mouth, sucking on fingers or being
fussy. If the baby is fussy, check for dirty or wet diaper and make sure the baby is
not cold.
Position
Always hold your baby when feeding him or her. Never prop a bottle for feeding
because this may increase risk of ear infection and choking. The baby needs to be
held. You will not spoil your baby by holding him or her.
After the feeding, be sure to place your baby on his or her back for sleep.
Warming Milk
Formula does not need to be warmed, but if you choose to warm it, it should
be warmed by placing the bottle in a pan of warm water. Do not use the
microwave to warm formula or breastmilk. The microwave heats the milk
unevenly and may have hot spots that can burn your baby’s mouth and throat.
Be sure to test the temperature of the milk on your wrist before offering it to your
baby.
Bottles And Nipples
Wash bottles and nipples with hot soapy water and allow them to air dry, or wash
them in an automatic dishwasher. Check nipples frequently for wear or stickiness,
and replace if needed.
Burping
Burping should be done halfway through the feeding and again at the end of the
feeding. Burping can be done in the following positions:
Over the Shoulder
Hold the baby under his or her bottom with his or her head resting on your
shoulder. With your free hand, rub or pat his or her mid to lower back.
Sitting Upright On Lap
Sit your baby sideways on your lap, facing to one side. Support your baby’s chin
with one hand, while you rub or pat his or her back with the other.
Food And Juice
Your baby does not need anything but formula the first six months. Check with
your baby’s health care provider for instructions about when to introduce water,
juice and food. Early introduction of cereal or baby food may increase the risk of
allergic reactions and childhood obesity.
Lee Memorial Health System — 31
Thrush
Thrush is a yeast infection in the baby’s mouth. You will see white patches on the
baby’s tongue, gums and inside of cheeks. The white patches will not wipe off.
Thrush must be treated with medication prescribed by your baby’s health care
provider.
Suggested Websites and Books
Association and WebsiteInformation Regarding the Website
Association of Reproductive
This Web site offers information
Health Professionals:
that guides you in contraceptive
www.arhp.orgdecisions.
Bridging the Gap Foundation:
www.managingcontraception.com
You can download handouts for various
contraceptive methods
American Academy of Pediatrics:
www.aap.org
www.healthychildren.org
National Association of Pediatric
Immunizations:
www.immunize.org
Information about vaccine preventable
diseases. It includes information on
vaccine safety.
LaLeche League International:
www.lalecheleague.org
Information about breastfeeding
Kellymom Parenting Breastfeeding Information about breastfeeding and http://kellymom.com/parenting.
Office of Women’s Health,
Information on topics including breast U.S. Department of Health &
cancer, breastfeeding, fitness &
Human Services
nutrition, menopause, mental health,
http://www.womenshealth.gov/
pregnancy and violence against
women.
General Pregnancy Information
American College of Nurse-Midwives
http://www.midwife.org
Childbirth Connection
http://www.chidbirthconnection.org
Post-Partum Depression Postpartum Support International
http://www.postpartum.net
Provides information about post-partum
depression
Books:
AAP, Caring For Your Baby and Young Child: Birth to Age 5, 4th Edition.
Sears, William MD & Sears, Martha RN, IBCLC, The Fussy Baby Book: Parenting Your
High-Need Child From Birth to Age Five.
Nugent, Kevin. Your Baby is Speaking to You. Houghton Mifflin Harcourt, Boston.
Leach, Penelope, Your Baby and Child, Alfred A. Knopf, New York.
32 — you and your baby
Karp, Harvey, M.D., The Happiest Baby on The Block: The New Way to Calm Crying
and Help Your Baby Sleep Longer.
Brown, Sylvia, The Post-Pregnancy Handbook, St. Martin’s Griffin, 2003.
Huggins, K.A., The Nursing Mother’s Companion, 25th Anniversary Edition, 6th
revised ed.,The Harvard Common Press, Boston, MA, 2010
The Womanly Art of Breastfeeding, La Leche League International, 8th revised Ed.,
Franklin Park, IL, 2010.
Eiger, M.S. & Olds, S.W., The Complete Book of Breastfeeding, The Classic Guide,
4rd Ed., Workman Publishing Co., New York, N.Y. 1999.
Newman, Jack, The Ultimate Breastfeeding Book of Answers, Prima Publishing,
Roseville, CA. 2006.
Pryor, Gale, Nursing Mother, Working Mother, Revised Ed, The Harvard Common
Press, Boston, MA, 2007.
Sunderland, Margot, The Science of Parenting, DK Publishing, New York, 2006
Support and Community Resources
Additional Resources
Healthy Start . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239-425-6920
Women, Infants & Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239-344-2000
Lee Memorial Home Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239-418-2900
Lee Physician Group Physician Referral . . . . . . . . . . . . . . . . . . 239-481-4111
Child Advocacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239-343-5890
Lactation Service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239-343-5186
HealthPark Medical Center, Ste. 450
National Breastfeeding Hotline Help . . . . . . . . . . . . . . . . . . . . 800-994-9662
Family Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239-343-5271
Abuse/Crisis Assistance
Abuse Hot-Line . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 800-962-2873
ACT Abuse Agency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239-939-3112
Children’s Home Society . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239-277-0096
Domestic Violence Unit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239-533-2884
Rape Trauma Crisis Line Act/Phoenix . . . . . . . . . . . . . . . . . . . . 239-939-3112
Personal Crisis Service HotLine . . . . . . . . . . . . . . . . . . . . . . . . . . 239-275-4242
Birth Control/ Family Planning
Lee County Health Department . . 239-332-9501 or Clinic 239-334-9555
Planned Parenthood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239-481-9999
Financial Services And Support
American Red Cross (Disaster Assistance) . . . . . . . . . . . . . . . . 239-278-3401
Lee Memorial Health System — 33
Department of Children and Families . . . . . . . . . . . . . . . . . . . . 239-332-2822
Lee County Human Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239-533-7930
Medicaid Program Office . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239-338-2620
Social Security Administration . . . . . . . . . . . . . . . . . . . . . . . . . . . 800-772-1213
United Way . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211
Legal Services
Florida Rural Legal Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239-334-4554
Legal Aid Society . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239-334-6118
Transportation
Good Wheels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239-768-2900
Lee Tran . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239-275-8726
Other
Birth Certificates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239-332-9572
State of Florida Adoptions . . . . . . . . . . . . . . . . . . . . 800-962-3678 (in Florida)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . or 904-353-0679 (out of state)
Fort Myers Housing Authority . . . . . . . . . . . . . . . . . . . . . . . . . . . 239-344-3220
Lee County Housing Authority . . . . . . . . . . . . . . . . . . . . . . . . . . 239-997-6688
Shots For Tots Program
Proper immunization is crucial to protect your child from a multitude of
diseases. The Lee County Health Department provides free immunizations
for infants and children from birth through 18 years old. No appointment
is necessary.
Central Fort Myers
Lee County Health Department
3920 Michigan Avenue
Mon-Thurs, 8 a.m.– 3:30 p.m., Friday, 1– 4:30 p.m.
Closed 11:30 a.m. -12:30 p.m. for lunch.
Bonita Springs
First Presbyterian Church
9751 Bonita Beach Road
1st Tuesday, monthly, 5 – 7:30 p.m.
Acknowledgements
Lee Memorial Health System would like to thank the following hospitals
that shared patient education materials:
Baptist Memorial Hospital for Women
• Feelings After Birth: Postpartum Adjustment
Sharp Mary Birch Hospital for Women
• New Beginnings: A Resource Guide For New Parents
34 — you and your baby
Discharge Information
Lee Memorial Health System — 35
LM
PA
HB
AC
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B
D
LV
VETERAN’S PKWY
EXIT
136
Mc
GR
EGO
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BLVD
COLONIAL BLVD
EXIT
131
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IN
ROAD
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Lee Memorial Health System Hospitals
Cape Coral Hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239-424-2000
636 Del Prado Boulevard, Cape Coral, Florida 33990
Gulf Coast Medical Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239-343-1000
13681 Doctor’s Way, Fort Myers, Florida 33912
HealthPark Medical Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239-343-5000
Golisano Children’s Hospital of Southwest Florida 239-343-KIDS (5437)
9981 S. HealthPark Drive, Fort Myers, Florida 33908
VETERAN’S PKWY
COLONIAL BLVD
Lee Memorial HospitalMcGREGOR
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239-343-2000
BLVD
VETERAN’S
PKWY
The Rehabilitation Hospital
. . . . . . . . . . . . . . . . . . . . . . . . . . . . 239-343-3900
PALM BEACH BLVD
2776 Cleveland Avenue,SUMMERLIN
Fort Myers,
Florida 33901
RD
Convenient Care Locations . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239-481-4111
Fort Myers (Page Field), 4771 S. Cleveland Avenue
Fort Myers (Summerlin and Bass Roads), 16230 Summerlin Road, Suite 215
Cape Coral, 1682 NE Pine Island Road
P.O. Box 2218 • Fort Myers, Florida 33902 • www.LeeMemorial.org
6500.01 2-14
120134409-8758