After the Birth of Your Baby

• FAQs
• Newborn screenings
• Breastfeeding
• Choosing a doctor
• Buying a car seat

If you had a vaginal birth you will stay in your birthing room for about two hours after your delivery. Your nurse will check your blood pressure, your pulse and your fundus (the top of your uterus) frequently. She will push on your fundus to make sure it stays firm and monitor any bleeding. She will also teach you how to check your fundus.

If you plan to breastfeed your baby, this is an excellent time to start. Your nurse will help you get started and give you some good breastfeeding tips. If you have chosen to bottle feed your baby, then this is a good time to hold your baby and take a good look at him or her.

If you have had a cesarean section you will be taken to the recovery room. This is a special area where patients are monitored after surgery. Your nurse will check your blood pressure, pulse, temperature. You will be in the recovery room for about two to three hours. During the first hour after delivery, while you are in the recovery room, only your partner will be allowed to visit. Other family members may wait in the waiting room.

Partner's Notes for After Delivery

• This is a good time for you to take pictures of your partner and of the baby. Your nurse would be happy to take a picture of all three of you if you would like.
• Take time to hold the baby and look at him or her yourself.
• When your partner is ready you can phone family and friends and tell them the good news.
• If your partner is in the recovery room, you can go to the nursery to see how the baby is doing.
• You can also use this time to take a much needed break and get yourself something to eat or drink. The nurse will take good care of your partner while you are gone.

FAQs

Who will take care of me and my baby?

Unit nurses are trained to care for the needs of new mothers and their babies. It is likely that during most of your hospital stay, the nurses caring for you will also be caring for your baby. They will help as you learn to know your baby so you can begin to feel comfortable caring for him/her by the time you go home.

Can the baby stay in my room?

Rooming-in is encouraged. This means that you may have your baby in your room as much as you like, including during the night. If you prefer, the baby can be cared for in the nursery and brought to you for feedings. If you are breastfeeding we urge you to nurse during the night. This helps build your milk supply and prevents any possible confusion that some young babies may experience if they are offered a bottle before learning to breast feed well.

Who can visit?

Family including brothers/sisters of the baby, and other children who live in your household may visit with you in your room from 10 a.m. to 8 p.m. You will need to fill out a brief health survey on all children who visit. Children under 14 are not permitted to visit in mother's rooms unless they are brothers/sisters or live in the same household as the baby.

A second adult must be present if a new big brother or sister spends the night.

General visiting hours for friends are from 2 to 3 p.m. and 7 to 8 p.m.

When do we go home?

If there are no problems, you and your baby will be discharged about 48 hours after you deliver vaginally or three to four days after a cesarean section.

Breastfeeding

• Have you thought about breastfeeding?
• Beginning breastfeeding

Have you thought about breastfeeding?

Since the beginning of time, women have put their babies to breast. Extending the physical bond that begins at conception, they have fed and protected their babies with their bodies. These tender moments, in return, have brought pleasure and fulfillment to the task of mothering. If you are now pregnant, you are probably looking forward to the time when you will feed, comfort and protect your baby in the same way as others before you.

Perhaps you already feel committed to the idea of breastfeeding. Or perhaps, you have some uncertainties, but still feel it is worth a try. Your outlook depends on many things; the value you place on breastfeeding, how your partner feels about it, how your friends have fed their babies, your lifestyle, and your feelings about yourself and your body.

You probably have some ideas what breastfeeding will be like. Perhaps you think it will be easy and convenient. Maybe you worry that it might not fit in with your activities and plans. You may have concerns about your ability to breastfeed. Probably you know other women who tried to breastfeed but soon gave up. Exploring your attitudes, expectations, and concerns about breastfeeding are an important part of deciding what feeding method is best for you and your baby.

Myths about breastfeeding

• The milk wasn't rich enough.
• One day the milk supply dried up.
• The milk did not agree with the baby.
• The baby suddenly decided that he/she wanted a bottle instead.
• Women with small breasts aren't able to breastfeed.
• Women who are "nervous types" aren't able to breastfeed.
• Breastfeeding causes the breasts to sag. Whether you nurse or not, you may notice a change in the firmness or your breasts after you have a baby. Childbearing, not nursing, along with age and heredity, is a major determinant of the breasts' ultimate appearance.

Concerns about breastfeeding

• Worries about modesty: Although we all know making milk is the natural function of our breasts, many of us feel embarrassed about exposing them. At first you may be more comfortable breastfeeding in private, but most women find that with time and experience, breastfeeding in the presence of others can be discreet and comfortable.
• You may have heard that breastfeeding can be painful. Normally women find it comfortable and pleasurable. Some women worry about developing sore nipples during the early days of breastfeeding, but most soreness can be avoided by correctly positioning the baby at the breast.
• Leaking milk: If you leak breastmilk, press down on your nipple with the heal of your hand, through your clothing. Or, without drawing attention to yourself, cross your arms across your chest and apply pressure. You can also use store bought pads without plastic, or put clean handkerchiefs or cloth diapers in your bra.
• Preparing nipples: For most women, there is no need to prepare your nipples for breastfeeding your baby. Good skin care for all women includes no soap and no rubbing with a towel. All women should check for flat nipples in the last three months of pregnancy. If you are unsure, ask your health care professional at your next checkup. Your provider may recommend wearing breast shells to correct flat nipples.
• Returning to work or school: There are many ways that breastfeeding can be continued after you return to work or school. You will need to express or pump your milk, or arrange to have the baby brought to you to breast-feed during meal breaks, so that your breasts do not become overly full. You must also plan for your baby to be fed while you are apart, either with your own milk or formula. While it does require some planning ahead, many mothers who work outside the home or attend school, feel that breastfeeding offers emotional compensation for the hours that must be spent apart.

Advantages of breastfeeding for the baby

• Breast milk is the ideal food for the baby.
• Breast milk is easy to digest and absorb, causing less colic.
• The iron in breast milk is utilized more readily.
• Breast milk changes to meet the needs of the growing baby.
• Breast milk contains substances that promote nervous system development and brain growth.
• Breast-fed babies have fewer allergies. In families with a history of allergies, breast-fed babies experience less asthma, food allergies and eczema.
• Breast-fed babies have fewer illnesses, such as ear infections, colds, flu and GI upsets. They also have fewer doctor visits and hospitalizations, because of the special protective factors in breast milk.
• Breast milk may help babies to respond better to vaccines, as antibody levels have been found to be higher in breast-fed babies at seven and 12 months.
• Breastfeeding may decrease SIDS (crib death).

Advantages of breastfeeding for the mother

• Breast-feeding is inexpensive.
• Breastfeeding is always available.
• With breastfeeding, there is nothing to mix, measure, or heat, and no bottles to wash.
• Breastfeeding makes nighttime feedings quick and easy.
• Breastfeeding makes travel with baby easier.
• With breastfeeding there is often less vaginal bleeding after delivery.
• Breastfeeding promotes a faster return of uterus to its pre-pregnant size.
• Breastfeeding can help with weight loss.
• Breastfeeding may decrease osteoporosis, ovarian cancer and premenopausal breast cancer.

Beginning breastfeeding

Starting in the hospital

Keep the baby with you in your room so you will learn to tell when he/she is hungry. You will have many chances to practice breastfeeding.

Put your baby to your breast 10 to 12 times for each 24 hours you are in the hospital. Nursing soon and often will help your milk come in faster. Hold your baby in a cradle position. The baby's neck is resting in the bend of your elbow. Turn your baby so you are tummy to tummy. Your baby's mouth should be at your breast.

Next, use your other arm to help your baby put his mouth over your nipple and areola. With your palm toward your chest, put your fingers below your breast and put your thumb on top. Gently squeeze a few drops of milk flow over your nipple and touch his lower lip. When he opens his mouth wide, put your breast into his mouth above his tongue. Then quickly pull him close so his mouth closes on the nipple and areola.

Keep the baby on the breast until he is done. He will either come off by herself or will move into a gentle, sleepy "hanging out" type of suck. There is no magic number of minutes a baby should be at the breast. A sleepy baby is not necessarily a well-fed baby.

Use these five behavioral cues to know when to awaken your baby more fully and begin breastfeeding:

1. Rapid eye movements under the eyelids
2. Sucking movements of the mouth and tongue
3. Hand to mouth movements
4. Body movements
5. Small sounds

This works better than waiting a set number of hours before attempting each feeding. Also, trying to wake a baby from a deep sleep will prove frustrating for both of you.

Avoid covering the baby's hands with his undershirt cuffs or wrapping him in such away that his arms are pinned to his sides. This prevents him from sucking on his fist, which is comforting and also serves as a feeding cue.

If the baby is pokey at breast or falls asleep after a few sucks, use a method called "alternate massage" to help the baby keep sucking and take in a good deal of colostrum. Each time the baby pauses between sucking bursts, massage and compress your breast to get him/her started again. When he/she will no longer suck and swallow on the first side when you compress the breast, sit her up, burp her, and put her on the other breast. If she will not take the second side, she will cycle into a lighter sleep state in about 45 to 60 minutes and can be given the second breast then.

Learn to tell when your baby is swallowing milk. Just because his jaw is moving does not necessarily mean he is getting milk. You can tell a baby is swallowing by:

• Listening for a swallow after every one to four sucks
• Listening for a puff of air from their nose following the swallow
• Seeing or feeling their throat move with the swallow
• Seeing or feeling the areola drawn into the baby's mouth as her jaw drops down
• Feeling the back of the baby's head vibrate with the swallow

What if?

• What if your baby will not breastfeed?
• What if you cannot latch baby to breast by yourself?
• What if you are having trouble telling whether the baby is swallowing?
• What if the baby has not breastfed two times in a row?

This is good time to ask your doctor, midwife or your nurse for additional help and suggestions. Also make sure you have someone available to you who knows how to help you once you return home. You can always call the hospita atl 319-356-3049 or the clinic at 319-356-2294 for answers to your questions and concerns.

How do I know my baby is getting enough milk:

1. Does the baby nurse 7 to 10 times in 24 hours?
2. Does the baby have 6 to 8 good wet diapers and 1 - 2 dirty diapers every day?
3. Does your baby seem content for 1 to 2 hours between most feedings?
4. Is your baby gaining at least one pound every month?
5. If the answers are YES, your baby is getting enough milk. Relax and enjoy breastfeeding your baby.

Remember growth spurts occur around two weeks, six weeks, and three months of age. You will find that your baby wants to nurse more frequently. This is your baby's way of having you make more milk. Let your baby feed often and you will have more milk in a day or two.

Choosing your baby's doctor

• UI Family Care
• Department of Pediatrics

Choosing your child's doctor can be fun and exciting. It can also create some concerns, for you want to be sure your choice is a good one. Friends and relatives may offer suggestions. You may know a physician nearby, or look to your obstetrician or midwife as an excellent resource. He or she not only knows you and your family but works with physicians on staff at UI Hospitals and Clinics.

Plan to visit the physician you select for your child's care during your pregnancy. This is especially important if this is your first child or if you are new to the physician's practice. Pediatric prenatal visits are available at UI Family Care Pediatrics to interested parents and may be scheduled during the third trimester of your pregnancy. Topics discussed with the infant's doctor include:

• Care of the infant immediately after birth, in hospital and after discharge
• Infant feeding choices
• Circumcision
• Car seats
• Family history review

The pediatric prenatal visit may be scheduled by calling UI Family Care Pediatrics. There is no charge for this important visit.

You may want to interview a number of physicians before making your selection. Your choice should make you feel comfortable about your children visiting the doctor and assure you that communication will be open. The first visit should be the beginning of a long-term, supportive relationship.

Before your visit, decide what questions you want to ask. The following may serve as guidelines for the interview.

• What is the doctor's training, competency, communication skills, approach to child rearing and routine for well-child care? Does the doctor have any specific "parenting philosophy" for moms and dads?
• What is the doctor's hospital affiliation? If you choose a pediatrician who does not care for newborns at UI Hospitals and Clinics, a pediatrician from the Department of Pediatrics will be responsible for your infant's care after delivery. Your child will receive a complete physical exam after birth and again before discharge. The cost of your infant's stay includes daily care, physical exams, and treatment of special problems.
• How many partners, if any, does the doctor have? Are there other health care providers on staff, such as residents, pediatric nurse practitioners or child health associates? How are patients assigned?
• What are the office hours, and are there extended hours for working parents? What is the policy and coverage for after-hours care and telephone calls?
• What hospital emergency department do they recommend?
• If there are older siblings, will the physician care for them as well?

You may also want to ask other waiting parents what they like and dislike about the practice.

• UI Health Care has three levels of care for the needs of your baby:
  • Newborn care responds to the needs of most of the babies born at UI Hospitals and Clinics
  • Neonatal Intensive Care Nursery and an Intermediate Intensive Care Nursery. If your baby has been in the Neonatal Intensive Care or Intermediate Care Nursery, they will be cared by neonatologists (doctors who specialize in newborns).
  • After your baby's discharge, you may choose to continue with your neonatologist. This can be arranged before your baby's discharge.

Buying a car seat

The law throughout the United States mandates that babies and children must ride in child safety seats until they are old enough to wear seat belts.

In a crash at 30 miles per hour, a 10-pound baby could be ripped from an adult's arms with a force of almost 200 pounds and hurled into the dash or windshield.

WARNING

Never place a rear-facing child seat in the front seat of a vehicle with a passenger-side airbag. The airbag could strike the back of the safety seat causing serious or fatal injuries to your infant.

Choosing Your Baby's Car Seat

Preparing for your baby's arrival includes purchasing a car seat. it is a law in every state that infants and children must ride buckled up in car seats. You will be required to have a car seat to take your baby home from the hospital. The "best" car seat for your baby is one that fits your baby's size and weight, fits in your car and that you will use correctly on every ride.

For full term infants, an infant car seat (for use up to 20 pounds) or a convertible seat (for use up to 40 pounds) will fit well. For small or preterm infants, an infant seat is preferred. A car seat evaluation will be done by the nursing staff if your infant is preterm or a smaller infant. This will be done before you and your baby are discharged.

When first using a car seat, read the instructions carefully to understand how to place your baby in the seat as well as placement of the car seat in your car. The rear seat is the safest place for a child of any age to ride. Your nurse will be able to answer your questions about your baby's car seat if you need help.