Mom(me)Focusing on the me in mommy

Inspiring healthy moms and moms-to-be

Taking time to take care of you is the healthy choice. We hope that this kit offers you information that will be helpful before and after your baby is born. As always, check with your doctor or health care professional before you begin or change any health routine.

If you have questions or would like to speak to a maternity consultant, call 1-800-411-7984 24 hours a day, 7 days a week. Or, visit us online at www.healthy-pregnancy.com.

Helping you make healthy choicesduring and after your pregnancy

Choosing an OB/GYN 2

Make way for baby: creating a birth plan 4

The right moves: fitness during pregnancy 6

Good nutrition for you and your baby 8

Preparing for an induction or a C-section 11

Selecting a doctor for your baby 13

Caring for your newborn 15

What you need to know aboutpostpartum depression 17

Getting your groove back 19

Mom(me)Focusing on the me in mommy

Choosing anOB/GYN

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You’re pregnant, which means you want the best care for yourself and your baby right away. You’ll need prenatal care — medical attention received before giving birth. This care can be provided by a doctor who practices obstetrics/gynecology, also called OB/GYN. An obstetrician/gynecologist specializes in the diagnosis, prevention and medical care of the female reproductive system in addition to the daily management of pregnant women. This care may also be provided by a family practice doctor. A family practice doctor offers comprehensive health and medical care to people of all ages, including preventive care, diagnostic services and treatment of illness and disease. Here are some tips to help you find a doctor who’s right for you and your baby.

Care throughout pregnancy Before becoming pregnant, some women already see an OB/GYN for routine care. Others may see their family doctor or other specialists. You may choose to have an OB/GYN care for you during pregnancy. Or, your family practice doctor may be able to provide care at this time.

Remember that this doctor will be seeing you throughout pregnancy, labor and delivery. You’ll also visit him or her for checkups right after the baby is born. You’ll work together closely for the next nine months, so be sure your doctor fits all your needs.

Finding a doctor Ask friends, family members or your doctor for referrals. Once you have some names of physicians, visit www.myuhc.com to make sure they are covered by your health insurance plan. Also, look for the UnitedHealth Premium® designation, which provides quality and cost efficiency information about physicians and facilities in your area.

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The following guidelines may be helpful when you’re ready to select a doctor:

Look at the doctor’s education/certification. A board-certified doctor is one who has passed all of the official tests required for a certain medical specialty. You can find out if a doctor is board-certified by contacting the American Board of Medical Specialties. Call 1-866-ASK-ABMS (1-866-275-2267) or visit www.abms.org. You also can ask the doctor when and where he or she was educated and trained.

Research the doctor’s history. Find out if the doctor has had any complaints filed against him by contacting your state medical licensing board. Make sure any information you find online is from a reliable source, such as a government Web site or medical organization. Visit www.ama-assn.org and search “Links to state medical boards.”

Call the doctor’s office. Are the people who answer the phone helpful? Are you comfortable talking with them? Ask:

•Withwhichhospitalisthedoctorconnected?Checkwithyourinsurance carrier or visit www.myuhc.com to make sure it is covered by your plan.

•Willyoumeetallthedoctorsinthepracticeduringyourpregnancy?Intheevent your doctor is not on call the day you deliver, will you be familiar and comfortable with all the doctors in the practice?

•Willyoubeabletogetanappointmentrightaway?Oristhedoctorsobusythat you’ll have to wait several weeks?

Set up an interview. When you’ve narrowed down your list, consider making an appointment to meet the doctor. Ask yourself:

• Ishefluentinyourpreferredlanguage?

•Whatisyourgutfeelingabouther?Doyourpersonalitiesclick?

• Isheeasytotalkto?Doeshelistenclosely?Doyoufeelcomfortable asking questions?

• Doessheseeminarush?

• Isheavailablebetweenvisits,byphoneore-mail,toanswerquestions?

• Doesshehavepartnersornursingstaffthatcanseeyouifsheisn’tthere?

•Whatifyouhavequestionswhentheclinicisclosed?Whocanyoucall?

Making a confident choice.It’scrucialthatyoufeelhappywiththedoctoryou see during your pregnancy. You’ll want someone you trust during this exciting and wonderful time.

Sources: American Board of Obstetrics and Gynecology, American Pregnancy Association,HealthAtoZ.com, The Cleveland Clinic, University of Virginia Health System

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Make wayfor baby:creating a birth plan

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You’re having a baby. You’re thrilled, excited and maybe a little giddy. Before long, practical thoughts will settle in. You’ll be considering names, furnishing the baby’s room and buying baby clothes. But in the midst of your preparations, and sooner rather than later, you may want to consider a birth plan.

What is a birth plan? Abirthplanoutlinesyourpreferencesforthebirthofyourbaby.Itallowsyoutoputinwriting what is most important to you during labor and delivery. Remember that your top priorityisasafedelivery.Keeptheplansimpleandflexiblesoyoucanadjustitif circumstances change during delivery. You can access a template to create your own birth plan at www.healthy-pregnancy.com.

As soon as possible, talk with your doctor or midwife about a birth plan. A nurse-midwife is a specially trained nurse who focuses on the care of pregnant women and delivery of their babies. Not all doctors or midwives are comfortable with birth plans. They may see your plan as a list of demands, not preferences. By discussing it early, you can work out how to include your wishes during labor, delivery and beyond.

Every birth is different. Your doctor will consider your situation with safety as the top priority. By communicating with your doctor, you’ll develop a level of trust and understanding. This will increase your confidence. You’ll also feel like an active partner in planning for the birth of your baby, even if an emergency arises.

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Ideas to consider for your birth plan When creating a birth plan, ask yourself questions like:

Where do you want to have the baby? Inatraditionalhospitalsettingorata birthing center? A birthing center is not attached to a hospital and offers amenities and personalized birth experiences not usually found in a hospital setting. Whichever you select, you will want to tour the facility and understand your options. Be sure to visit www.myuhc.com to see if your facility of choice is part of your coverage network.

Who would you like to assist with the birth? An OB/GYN? Your family doctor? A nurse-midwife? Be sure to visit www.myuhc.com to see if your provider of choice is part of your coverage network.

What kind of atmosphere do you want? Soft music and low lighting? The freedom to wear what you want and to walk around during labor?

Will you want pain management? Should you have an epidural? Would Lamaze, massage or other relaxation techniques work better for you?

Which procedures are acceptable? When is an episiotomy OK? What about Caesarean section or induced labor? The goal for all pregnancies is to have a vaginal delivery at full term (37 to 42 weeks), giving baby and mother a healthy start. However, sometimes a medical reason exists that makes a Caesarean section (C-section) the bestoptionforasuccessfuldelivery.Discussallbirthprocedureswithyourdoctor.

What about the care of your newborn? Where do you want your baby to be right afteryougivebirth?Howdoyouwantyourbabyhandled?Doyouwanttobeabletohold your baby immediately following birth? Will the baby stay in the room with you? Will your spouse or partner be able to bathe the baby? Can your spouse or partner cut the umbilical cord?

You can’t control everything about your labor and delivery, but a well-thought-out birth plan can help make it a beautiful, comfortable and memorable experience.

To learn more about creating a birth plan, visit www.healthy-pregnancy.com.

Sources:American Academy of Family PhysiciansAmerican Pregnancy Associationbabycenter.com

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The right moves: fitness during pregnancy

Pregnancy changes your body. Regular exercise can help you adapt to those changes by:

• Improvingyoursleep• Promotingflexibilityandstrength•Raisingyourenergyandmood•Strengtheningyourheart

Itdoesn’tmatterifyou’remanymonthsalongoryou’vejusthadyourbaby;it’snevertoo late to start. Here are some do’s and don’ts to help you develop a pregnancy fitness program.

Fitness DO’sDo talk to your doctor before starting a fitness program.

Do think of fitness as fun. Walk the dog, play with your older children, or work activities with family or friends into your day.

Do start slowly if you’re a beginner. Exercising for 15 to 20 minutes three times a week is a good way to start.

Do drink plenty of water before, during and after exercise.

Do knowyourtargetheartrate.Ifyoucan’ttalkwhileexercising,you’reworkingtoohard.Visit www.americanheart.org and search for “target heart rates.”

Do eat a balanced diet that includes fruits, vegetables and whole grains. They provide the fuel your body needs to be active.

Do wear loose clothing, a good exercise bra, and proper footwear to support your feet and ankles.

Do watch your balance. As the baby grows, your steadiness changes.6

Fitness DON’TsDon’t ignore your doctor’s instructions or warnings about exercising.

Don’t exercise if you have experienced preterm labor during this or a previous pregnancy. Preterm labor is when labor occurs before 37 weeks of pregnancy.

Don’t exercise if you have constant vaginal bleeding, a weak cervix, your water breaks, or there’s any indication that the baby is not growing as quickly as it should.

Don’t participate in sports that could cause a fall, such as hockey, skiing, soccer or basketball.

Don’t exercise at elevations above 6,000 feet, and don’t scuba dive.

Don’t do sit-ups in the second and third trimesters. Lying on your back may decrease bloodflowtothebaby.

Don’tdodeepkneebendsandsquats.Thesecanstrainyourjointsandligaments.

Don’t exercise if it’s too hot.

For more information on fitness do’s and don’ts, visit www.healthy-pregnancy.com.

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Safe exercises for pregnant womenThe following exercises are safe for most pregnant women. Make sure to check with your doctor before starting any exercise program.

Swimming improves your cardiovascular fitness and exercises muscles without stressingjoints.

Walkinghelpskeepyoufitwithoutjarringjoints.Itcanbedoneanywhere,anytime,and only requires a pair of supportive walking shoes.

Low-impact aerobicsclassesorDVDsdesignedforpregnantwomenofferacardiovascular and endurance workout that is fun and safe.

Prenatal yogacanhelpkeepyourmusclesstrongandflexiblewithminimalimpactonjoints.Italsocanrelievestressandpromoterelaxation.

Weight trainingcanbecontinuedtohelpstrengthenmusclesandjoints.However,you may want to reduce the amount of weight you use and increase the repetitions.

Sources: American Pregnancy Association, babycenter.com, HealthAtoZ.com

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Fitness is one of the best things you can do for yourself during pregnancy. It helps you sleep better, is good for your heart, and keeps your energy and your mood up. Exercise also improves flexibility and strength, which will help during delivery. Talk to your doctor about which exercises are right for you.

“”DonnaBlock,MD

Clinic Sofia OBGYN

Good nutrition for you and your baby

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“I’meatingfortwo”seemstobeamantraforexpectantmothers.Butthefocusshouldbeon eating for health. Making smart food choices is one of the best things you can do for yourself and your baby.

The pregnancy 300 Ifyou’repregnantandnotoverweight,youonlyneedtoadd300caloriesaday.Thesecalories can come from a small baked potato, a low-fat, low-sugar blueberry yogurt and a canofvegetablejuice.That’snotverymuch.Youmaycravesodasandsnacks,butthoseempty calories can add up to a lot of extra weight for you. They don’t offer any nutrition for your developing baby, either.

Eating the right foods helps your baby get the nutrients to grow, and helps you maintain your health and energy. The right kind of food is much more important than the amount you eat. Also, there are some nutrients, like folic acid, that are hard to get in adequate amounts from food alone. That’s why many doctors prescribe a daily multivitamin.

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”DonnaBlock,MDClinic Sofia OBGYN

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It’sbesttogetyournutrientsfromfood,butmostdoctorswillprescribeprenatalvitaminsto help you get the right amount. Be sure to take the vitamin prescribed, and don’t add othersupplementswithouttalkingwithyourdoctor.Ifyougettoomuchofacertainnutrient, it could hurt your baby and affect your health.

Calcium 1,000 milligrams Helps form and grow baby’s heart, muscles, bones and teeth

•Yogurtandlow-fatmilk•Calcium-fortifiedappleandorangejuice

•Tunaandsardines•Broccoli•Beans•Prunesanddriedapricots•Nutsandseeds

Iron 27 milligrams Helps form blood cells for both you and baby

•Leanredmeat•Spinach•Wholegrainbreadsandcereals

Building mom and baby power Folic acid, calcium and iron are important nutrients for mom’s health and baby’s growth. Here’s what you need, why you need it and how to get it.

Nutrient

Folic acid

How much daily

400 milligrams

Why you need it

Helps develop baby’s nervous system

How to get it

•Greenleafyvegetables—spinach,greens, romaine lettuce, broccoli, asparagus

•Wholegrainbreadsandcereals•Strawberriesandoranges•Driedbeansandpeas—lima

beans, black-eyed peas, chickpeas, pinto beans

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Know your portions Itcanbehardtofigureoutwhat’sanounceoracupwithoutmeasuringeverything you eat. Here are some easy guidelines:

• 1cupofsaladgreens=thesizeofabaseball

• ½cupofchoppedfruitsandvegetables=thesizeofalightbulb

•1½ouncesofcheese=thesizeoffourdice

•3ouncesofmeatorfish=thesizeofadeckofcards

•2tablespoonsofpeanutbutter=thesizeofaPing-Pongball

A new mantra Make your mantra eating for health, and eating for two will fall into place. Your body and your baby will thank you.

Sources:cdc.gov – Nutrition for Everyone: Iron DeficiencyHealthAtoZ.commypyramid.gov – Pregnancy and Breastfeeding – My Pyramid Plan for Moms

Build a healthy pyramid The food guide pyramid was created to help people choose the right kinds of food each day. Here are recommendations for pregnant women:

Food group

Fruits

Vegetables

Grains

Meats and beans

Milk

1st trimester

2 cups daily

2½cupsdaily

6 ounces daily

5½ouncesdaily

3 cups daily

2nd and 3rd trimesters

2 cups daily

3 cups daily

8 ounces daily

6½ouncesdaily

3 cups daily

Source: mypyramid.gov, My Pyramid Plan for Moms

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Preparing for an induction or a C-section

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Most women have a normal labor and delivery. Sometimes, however, giving birth requires somehelp.Ifyourhealth,oryourbaby’shealth,isindanger,thedoctormayinducelaboror perform a Caesarean section (C-section). He or she will talk with you about these options. Knowing the basics can help prepare you.

Induced labor Inducedlaborislaborthatisstartedbymedicalmeans.MedicationssuchasPitocin® and oxytocinwillinducelabor.Inanothermethod,thedoctorstripsthemembranethatconnectsthe amniotic sac to the uterus to induce labor. The American College of Obstetricians and Gynecologists estimates that one in five labors is induced. However, induction carries an increased likelihood of a Caesarean delivery, so it should only be done for medical reasons:

• Apregnancythathasgoneonetotwoweekslongerthanthenormal40weeks• Preeclampsia,orseverehighbloodpressurecausedbypregnancy• Existinghealthproblemsthatcouldharmyouoryourbaby• Chorioamnionitis,oraninfectionintheuterus• Notenoughnutrientsandoxygenreachingthebabyfromtheplacenta

Inductiondonefornon-medicalreasonsisnotrecommended.Forwomenwhohavenevergivenbirth,thelikelihoodofneedingaC-sectionisabout8percent,butthatjumpsto almost 18 percent if an induction is involved, according to one study. Your doctor can explain how induction is done, why it is done, and the risks associated with it.

Once labor is induced, it usually proceeds naturally. Sometimes, however, induction medicationcanoverlystimulatethelaborprocess.Ifcontractionsbecometoofrequentorintense,checkwithyournursetomakesurethemedicationdoesn’tneedtobeadjusted.Ifyournursesaysthelaborpatternisfine,thenyoucantryrelaxationorbreathingtechniques.Ifthisdoesn’thelp,youcanaskformedicationtoeasethepain.

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Caesarean section A Caesarean delivery is a surgical procedure. The baby is delivered through an incision in the abdominal wall. One in three births is Caesarean, according to the Centers for DiseaseControlandPrevention.

A Caesarean delivery should only be performed for medical reasons. A full-term pregnancy is 37 to 42 weeks, and every effort should be made to allow the baby to grow to full term before delivery.

Research has shown that babies born before 39 weeks gestational age without a medical reason for early delivery are at increased risk for complications. Common complications include breathing problems, infections, low blood sugar and the need for theneonatalintensivecareunit(ICU).Ifyouarescheduledtodeliverbefore39weeksgestational age, be sure to talk with your doctor about the risks and benefits to both you and your baby.

Your doctor may recommend this type of delivery for the following reasons:• Multiplebirths—althoughsomewomenareabletodelivertwinsvaginally• Laborisn’tprogressingnormally• Contractionsdon’topentheuterusfarenoughforthebabytobeborn• Thebaby’shealthisatrisk• Thebaby’spositionisfeetfirstorbreech• Activegenitalherpesispresent• You’vebeendiagnosedwithpreeclampsia• Theplacentablocksthebaby’sexitorseparatesbeforethebabyisborn• You’vehadapreviousCaesarean,andareatriskforauterinerupture

What to expect from a Caesarean birth First, a nurse prepares you for surgery. Anesthesia is given so there is no pain during the procedure. The three types are general anesthesia, epidural block or spinal block. Mothers who have general anesthesia are not awake during surgery. Those with an epidural or spinal block are awake and able to see the baby right away.

Acutismadehorizontally,justabovethepubicbone.Inanemergency,theincisionmaybe vertical for a faster delivery in case of complications or if the baby is having health problems. After a C-section, recovery is usually two to four days in the hospital.

Being prepared can make all the difference. Learning about induced labor and Caesarean birth can help you understand what is happening if either procedure becomes necessary. Be sure to discuss any questions you have with your doctor. For more information on childbirth, visit www.healthy-pregnancy.com.

Sources: American College of Obstetricians and Gynecologists, American Pregnancy Association, Centers for Disease Control and Prevention, March of Dimes, Obstetrics & Gynecology – Risk of Cesarean Delivery with Elective Induction of Labor at Term in Nulliparous Women.

Selecting a doctor for your baby

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Your new baby will arrive soon. Preparing as much as possible before your baby is here can help make those first few months go much more smoothly. One way is to start looking for a doctor for your newborn — someone who will be your partner in taking care of your child’s health and well-being. Pediatricians and family physicians are doctors who treat children’s medical needs.

Pediatric physicians specialize in the development, growth, care and diseases of children. But they also are a great resource for behavior, development, growth and social issues.

Getting started It’sagoodideatolookforapediatricianorfamilyphysicianaboutthreemonthsbeforeyour baby is due. You’ll feel more relaxed once you choose a doctor. Plus, you’ll be ready if your baby arrives early. Finding a doctor that fits your needs means that the relationship can last into your child’s teen years.

Duringyoursearch,considerwhat’simportanttoyouandyourfamily.Doesitmatterifyouhaveamaleorfemaledoctor?Doyouwantadoctorwhohasaformalmanner? Or, do you want someone who is more down-to-earth?

Explore your options One of the best ways to find a pediatrician or family physician is to ask family, friends or your doctor for recommendations. You can visit www.myuhc.com to make sure your pediatrician is covered by your health insurance plan. Look for the UnitedHealth Premium® designation, which provides quality and cost efficiency information about physicians and facilities in your area.

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You should schedule an appointment to meet the doctors you’re interested in. An initial meeting allows you time to ask questions and get to know your doctor. Ask if there’s a charge for this first appointment so there are no surprise fees.

You’ll want to know some background, including:

•Whatlevelofcertificationdoesshehold?Aboard-certifieddoctorisonewhohaspassed all of the official tests required for a certain medical specialty, in this case pediatrics. Find out at www.abms.org or call 1-866-ASK-ABMS (1-866-275-2267). Ifinterested,youalsocanaskthedoctorwhenandwhereshewaseducated and trained.

• Doesshepracticeatthehospitalyou’relikelytouse?Checkwithyourinsurance carrier to make sure the hospital is covered by your plan.

• Howlonghasshebeenpracticingmedicine?Whereelsehassheworked?• Hastherebeenanycorrectiveactiontakenagainsther?Findthisoutbycontacting

your state medical licensing board. Visit www.ama-assn.org and search “Links to state medical boards.”

These questions can help you learn more about the doctor, his staff and his clinic:

• Ishefluentinyourpreferredlanguage?•Whataretheclinichours?Doestheclinicofferextendedhoursonspecificdaysof theweek?Isthecliniclocatednearyourhomeorwork?

•Whatifyouhavequestionsorconcernswhentheclinicisclosed?Dotheyhavean after-hours nurse line? Can physicians on call be reached through a messaging service? Who should you contact?

• Howmanydoctorsarepartofthepractice?Ifyourchild’sdoctorisnotavailable, can you see someone else?

Save your work Once you choose a doctor, save your research. Your notes may be handy if you need to find a new doctor later — for example, if your insurance changes or your doctor relocates.Or,ifyou’rejustnothappywiththedoctoryou’vechosen.Referringbacktoyour notes can help you be prepared to make smart health care decisions for your family.

Sources:American Academy of Pediatrics American Pregnancy AssociationFamilyDoctor.orgHealthAtoZ.comUniversity of Virginia Health System

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Caring for your newborn

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There’s nothing more precious than your newborn. As a new parent, you want to do your best.Onceyoulearnthebasics,you’llgainconfidenceandbegintoenjoyyourbundle ofjoy.Herearesomehelpfultips.

Sleeping Most newborns sleep 16 to 18 hours a day. By age 2 months, their sleep schedule may regulate, with more hours spent awake. By age 3 months, many babies sleep 8 to 10 hours a night. Bedtime routines can encourage healthy sleep. They can include:• Creatingadark,peacefulenvironmentinthenursery• Followingbathtimewithreading,rockingorsingingbeforebed• Swaddlingorsnugglywrappingyourbabyinablanket

It’scommonfornewbornstomixuptheirdaysandnights.Mostbabiesadjustafteramonth or so. When your baby cries, wait a few minutes to see if he soothes himself. Let him start to learn how to fall back to sleep on his own upon awakening. To protect your babyfromsuddeninfantdeathsyndrome,orSIDS,alwaysplacehimonhisbacktosleep. Also, avoid putting anything else in the crib, including pillows.

Crying and colic For new parents, a crying baby can be distressing. But take heart — your baby is communicating the only way she knows how.

Babies cry because they may be hungry, tired, sick, uncomfortable or in pain. Some good first steps are:• Seeifshe’shungry,andburpwhenfinishedfeeding.• Checkherdiaper.• Makesureshe’snottoohotorcold.• Sootheherwithsnugglesorquietsinging,thentryputtingherdowntosleep.

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Sometimes, babies cry inconsolably, even when you’ve exhausted all possible reasons. This may be colic — crying that lasts for at least three hours at about the same time of day, three days a week. Colic usually starts at around 3 weeks of age, peaking at about 4 to 6 weeks of age. You probably feel worried if your baby has colic, but you are not alone. As many as 2 out of 10 babies may have it. To soothe a colicky baby:• Holdhimasmuchaspossible.• Afterfeedings,burphimoftentoreleaseuncomfortablegas.•Walkhimaroundthehouseoroutsideinasling.• Swaddlehim.• Takehimforarideinthecar.• Bathehimduringhighcolickytimes.

You may need to try many tactics until you find something that works. Colic generally ends around 12 weeks of age. Be sure to take a break and ask for help from your partner or family members.

Bathing Sponge baths are best until the umbilical stub falls off within a few weeks after birth. While that area is healing, keep it clean, dry and uncovered. After that, bathe your baby in water 2 inches deep. Consider using a baby tub or basin in the kitchen sink. Other bath tips are:• Neverleaveyourbabyaloneinthetub.• Usewarmwater—testthetemperaturewiththeinsideofyourwristorelbow.• Supportyourbaby’shead,andwashherfromthetopdown.• Shampoohairwithawashcloth.Protectyourbaby’seyeswhenyourinse.

Diaper rash Sometimes, no matter how careful you are, babies develop diaper rash — red, irritated bumps caused by damp diapers. Here’s how to protect your little one’s bottom:• Changediapersoften.•Washyourbaby’sbottomwithplainwarmwater.• Useadiaperrashcreamorlotiontoprotecttheskin.

Talk with your pediatrician or family practitioner if you notice the following: • Therashpersistsafterthreedaysoftreatingathome• Fever• Signsofinfection• Arashappearsoutsidethediaperarea

The most important tip Every new parent is nervous. So, don’t be too hard on yourself. Shower your baby with love and the rest will come in time.

Sources: babycenter.com, HealthAtoZ.com, Medline Plus/NIH

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What you need to know about postpartum depression

Baby blues — feeling weepy, exhausted, nervous — can come and go during the first week or two after delivery. Up to 80 percent of women go through it, but if these feelings continue for more than the first few weeks after giving birth, you may have postpartum depression. This condition can affect about 10 to 15 percent of new mothers.

Postpartum depression is more serious and debilitating than the baby blues. You may feel as though you’re never going to get better or feel happy about your life again. Here are some warning signs to watch for:

•Overwhelmed •Hopeless •Helpless •Deepsadness,cryingalot •Restless,irritable •Nervousorjumpy •Unabletoeat/weightloss •Nointerestinyourbaby •Sleepingtoomuch •Unabletododailytasks •Overlyworriedaboutyourbaby •Nointerest/pleasureinactivities •Notenoughsleep/unabletosleep •Sluggish,exhausted,noenergy •Feelingworthlessorguilty •Withdrawingfromfamilyandfriends •Thoughtsofdeath,suicide,orharmingthebabyoryourself

Many women have baby blues — feelings of sadness the first few days after birth. This is not unusual as your body and hormones recover from pregnancy, labor and delivery. About 13 percent of women have ongoing sadness, anxiety and despair. This is called postpartum depression, and it’s important for women to receive treatment. There’s no need to suffer.

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”DonnaBlock,MDClinic Sofia OBGYN

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What can put you at risk The risk factors for postpartum depression fall into two categories:

Outside influences—includinginfantmedicalproblemsorcomplications;family,life or social stress that occurs during or after pregnancy

Biological factors — including pre-existing psychiatric or medical conditions

Outside influences

• Pretermbirth/multiplebirth,suchastwins or triplets

• Deathofalovedoneorclosefriend

• Strainedrelationshipwithspouse or partner

• Lackofsocialsupport

• Traumaticexperienceduringchildbirth

Biological factors

• Historyofdepression

• HistoryofseverePMS(premenstrual syndrome)

• Postpartumdepressionaftera previous pregnancy

• Hormonalshifts

• Lowthyroidlevels

Help is available The good news is postpartum depression can be treated. The type of treatment needed depends on the severity of the depression. Treatment can include counseling,antidepressantsorboth.Ifyou’rebreast-feeding,beawarethatsomemedications affect breast milk and should not be used. Talk with your doctor about the treatment that will work best for you.

Other ways to cope Many women go to support groups to talk with other women in similar situations. Here are some other tips for taking care of yourself:

Sleep when you can. Try to nap when your baby naps. Ask your partner or a family member to handle housework, laundry, cooking and other chores so you can rest. Don’ttrytodoitall.Sleephelpsyourbodyre-energize.

Express your feelings. Talk with your spouse or partner about what’s going well and what isn’t. Keeping those lines of communication open is crucial right now.

Get out and about.Ifyouspendtimealonewithonlythebaby,youcanfeel isolated and overwhelmed. Connecting with other people can help you put things in perspective and keep your sense of humor. Call your friends and family. Take a walk outside with your partner. Take breaks and remain active.

Tell your doctor how you feel. Your doctor can’t treat you unless he or she knows yoursymptoms.Itmighthelptocirclethewarningsignsandriskfactorsthatapplytoyou and bring it along to your appointment.

Sources: American Board of Obstetrics and Gynecology, HealthAtoZ.com

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Getting your groove back

It’sawholenewworldwithababyinthehouse.Yourformerspontaneouslifelikelyhasbeen replaced with schedules based on your newborn’s needs. But these changes don’t mean you can’t do things you did before baby entered your world. Here are some common questions and answers to help you get back in the groove of everyday life.

When is it safe to start having sex? Most doctors recommend waiting until after your postpartum exam before you resume having sex. This exam is usually about six weeks after giving birth. Generally, you need to wait until bleeding stops and your uterus is healed. Whether you give birth vaginally or by Caesarean section, or C-section, this can take up to several weeks.

You may not be in the mood for sex for a little while after your baby is born. That’s normal. You’ll know when you’re ready and the time is right. Talk with your spouse or partner aboutwhatyou’refeeling.Keepinmind:Intimacyisn’taboutintercourseonly.Youcanbephysical by showing affection — caressing, cuddling on the couch, holding hands, kissing.

When you are ready for sex again, don’t forget — it’s possible to get pregnant, even if you’re breast-feeding. Talk with your doctor about which birth control method is right for you.

How do I get my body back? Exercise can help get your body back in shape, as well as enhance your mood and energy levels. Walking is a good start — and you can take your baby with you on a stroll. Even after a C-section, short walks at an easy pace will help healing. However, your body needs about six to eight weeks before you can begin any exercise.

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Ifyouhadavaginaldelivery,startwitha30-minutewalkatanaveragepace,threetimesa week. As you gain strength, you can increase the pace and length of time. Many doctors prefer that you wait to begin exercising until after your postpartum checkup. So, for safety’s sake, talk with your doctor before beginning any new exercise program.

Good nutrition also is key to healing and maintaining energy levels. Give your body time. Don’ttrytolosemorethanapoundaweek,especiallyifyou’rebreast-feeding.Askyourdoctor about appropriate weight loss goals and how to achieve them.

How and when can I strengthen my stomach muscles? Duringpregnancyandlabor,aboutone-thirdofwomendevelopdiastasisrecti.Thiscondition is when the left and right sides of the main abdominal muscle separate, leaving a gap between. The growth of the baby in the uterus causes this to happen.

Simple abdominal exercises, such as sit-ups or stomach crunches, can help treat separated muscles.Ittakessixtoeightweeksafterdeliveryfor this gap to close. So, talk with your doctor about when you can begin working on your stomachmuscles.Ifyouexercisetoosoon,youriskinjury,whichcanfurtherdelayyourrecoveryand ability to exercise.

Will I ever catch up on my sleep? To say that getting enough sleep is difficult with a newborn is an understatement. One way to catch a few winks is to nap when the baby naps. You also can ask your spouse or partner and friends and family to help with chores and housework so you can take time to rest.

Will I have time to kick back and relax? Havinganewborncanbeexciting,joyful,tiringandoverwhelming—allatonce.Withyour busy life, you may worry that your pre-child, carefree days are over. But there are ways to make sure that fun isn’t a thing of the past. This is important for your overall well-being. Here are some ideas:

• Invitefriendsover.• Joinaplaygrouptomeetothernewmoms.• Askfriendsorfamilymemberstobabysitsoyoucan

have a date night with your spouse or partner.

When baby arrives, your new family life begins, focused on baby’s routine. But what about the ‘Me’ in Mommy? Be open and honest about what you need, what makes you feel better, and what makes you happy. A happy, healthy you means a happy, healthy baby and family.

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”DonnaBlock,MDClinic Sofia OBGYN

Sources:babycenter.com HealthAtoZ.comwomenshealth.gov – Pregnancy – Childbirth and Beyond

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Mom(me)Focusing on the me in mommy

Inspiring healthy moms and moms-to-be

If you have questions or would like to speak to a maternity consultant, call 1-800-411-7984 24 hours a day, 7 days a week. Or, visit us online at www.healthy-pregnancy.com.

Donna Block, MD, founded Clinic Sofia OBGYN, PA in 2004 and is board-certified by the American Board of Obstetrics and Gynecology. She received her medical education at the University of Minnesota MedicalSchoolandcompletedherresidencyinobstetricsandgynecologyattheUofM’sDepartmentofObstetrics,GynecologyandWomen’sHealth.SheisconsistentlynamedasoneoftheTwinCities’TopDocsby Mpls.St.Paul Magazine and is listed in the Guide to America’s Top Obstetricians and Gynecologists by the Consumers’ Research Council of America.

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The Healthy Pregnancy Program follows national practice standards from the Institute for Clinical Systems Improvement. The Healthy Pregnancy Program cannot diagnose problems or recommend specific treatment. The information provided is not a substitute for your doctor’s care.

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