mom and baby care book

Marian Maternal & Newborn Center

Mother and Baby CareWelcome to the Journey of ParenthoodYou are now the proud parents of a new boy or girl! You are beginning an amazing journey with this new little one. Take some time to read through this booklet and write down some questions that you may have. There will be time to get your answers either while you are still in the hospital or during your doctor visits.

Congratulations!

Marian may be the newest hospital on the Central Coast. But to us, good health care is more than a new building.

It’s a promise to provide our community with exceptional medicine, today and every day.

It’s about advancing the newest, most innovative treatments and technology to heal patients young and old.

That’s Marian Regional Medical Center. Harnessing the best that health care has to offer—for today and tomorrow.

Because medicine never stands still. And neither will we.

New. And Always Will Be.

Outline of Postpartum Program . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Safety, Hygiene, Other Important Information . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Caring for the Mother . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Rest, Perineal Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Vaginal Bleeding, Abdominal Cramping, Incision Care . . . . . . . . . . . . . . . . . . 6Hemorrhoids, Bowels and Bladder, Activities, Breast Care . . . . . . . . . . . . . . . 7Special Dietary Needs: Breastfeeding and Young Moms . . . . . . . . . . . . . . . . . 8Daily Food Guide for Nursing Moms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Gestational Diabetes, Baby Blues, Emotional Changes, Postpartum Depression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Caring for the New Baby . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Newborn Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Elimination: Bladder and Bowels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Behavior and Senses, Sleeping and Crying . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Harvey Karp’s “Five S” System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Bathing Your Baby . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Circumcision Care, Bulb Syringe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Temperature Taking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Breastfeeding Is Normal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18How Breast Milk Is Made . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19Bringing Baby to the Breast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20Correct Latch, Breastfeeding Holds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21Getting Enough Milk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22Breastfeeding Challenges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23Breastfeeding Made Easier at Home and Work . . . . . . . . . . . . . . . . . . . . . . . . . 27Breastfeeding and Pumping Accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28Storing Breast Milk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29What About Dad? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Car Seat Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32Using Your Infant Car Seat Correctly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Baby’s Second Night . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

Contact InformationWhen to Call Your Doctor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35Resources and Emergency Numbers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Mother and Baby Care

www.marianmedicalcenter.org 3

CONTENTS

Marian Regional Medical Center

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At Marian Regional Medical Center, all healthy babies stay with their mothers and roomin 24 hours a day. Take advantage of this time in the hospital for you and your baby to get to know each other. The more time you spend together here, the better you will know each other when you get home. We provide teaching and support for both parents so you can gain confidence and competence in your new roles. There are rare times that we will take your baby to the Nursery for special procedures, such as circumcision, lab work, or a doctor’s request.

Breastfed babies are on a flexible on-demand schedule unless otherwise specified by the pediatrician. Your nurse will give you assistance with the first feeding and be available on request or per her observation to help you further. The feeding should take about 3040 minutes. Be sure to burp your baby well during and after the feeding, report the feeding to the nurse, and document it on the feeding record.

The hospital pediatrician will typically make rounds in the morning, usually before 9:00 a.m. Your comfort is important to us; let us know if you need pain medica tion or have other comfort needs.

SafetyOur beds are much narrower than your bed at home. For this reason, we request that you place your baby in her/his crib when you become drowsy, plan on sleeping or when you are using the bathroom. Always keep an eye and hand on the baby when she/he is out of

the crib. Please call a nurse if you need help.

Safety call lights are available at your bed side, by the toilet and in the shower. If you are dizzy or need help, use your call light.

Your baby will be brought to your room in a bassinet. Each time your nurse will check your Baby ID band with the baby’s bands. Please keep your baby in your room at all times. Your baby will also be wearing a special “alarm band.” Should any of the bands fall off, notify your nurse immediately.

Remember to give your baby only to a nurse wearing an MRMC photo badge with a pink band across the bottom.

HygieneMothers and family members must wash their hands thoroughly before handling the baby or the baby’s supplies. A soap dispenser is above the sink in each room, and foam is available at the entrance of the room.

The bassinet contains supplies for

your baby. Please do not share supplies with your roommate. If you need more, please ask your nurse. A staff person will return soiled baby linen to the nursery. You can throw the diapers in the trash cans but report soiled wet and stool diaper to your nurse.

Receptacles are available for trash. Please place soiled sanitary pads, wrapped in a paper towel or toilet paper, into the bathroom trash can. Your nurse can instruct you on your pericare needs and medications.

Other Important InformationTo use your PHONE, dial “9” first and then the local number you wish to call. Our operator will assist you with long distance calls. Incoming calls may be received between 9:00 a.m. and 9:00 p.m. Family can reach you through the hospital operator at 7393000. You are welcome to use your cell phone in your room.

Meal times: breakfast served at 7:30 a.m.; lunch at 12:00 noon; and dinner at 5:30 p.m. Please ask your nurse for snacks or juice if you are hungry between meal times.

Photo Service: If you would like to have a professional photo session of your baby done while you are in the hospital, please notify your nurse and we will provide you will the photographer’s contact information.

Birth Certificate, Social Security and Paternity Papers: Your delivery nurse will give you the necessary paperwork

Outline of Postpartum Program



Caring for the MotherDuring the Postpartum Period

and explanations. Please complete them as soon as possible. A nurse must witness BOTH the mother’s and the father’s signatures on your paternity papers. Only use black or blue ink on the paternity papers. A typed Birth Certificate will be brought to you for a signature before you leave. You will also have an information sheet to order your official copy of the birth certificate.

Your doctor and nurse will be giving you a lot of written and verbal instructions and the opportunity to watch parenting skills via our video library. We encourage you to read this information book, ask questions, and practice your new parenting roles and skills. Remember that no one is an instant parent. It takes time and the willingness to learn.

Our NurtureLine (7393388) is a phone call away to help with any of your breastfeeding concerns. Your nurse will be most happy to give you more information on services provided by Marian Regional Medical Center.

Thank you for choosing Marian Regional Medical Center and congratulations on the birth of your new baby!

The weeks following the birth of your baby are challenging, and it is important to continue to care for yourself in a special way as your body returns to normal. As you are welcoming a new life into your world, you may find yourself happy and sad; energetic and exhausted; confident and not so confident in your new role!

Remember this is a physical and emotional transition time of 6 to 8 weeks for yourself, your infant and your family. The staff at Marian Regional Medical Center is here to help you with this step by step. The topics below are general guidelines, so read on and ask questions, but also follow your doctor’s advice. Because breastfeeding may be one your bigger challenges, we encourage you to use the NutureLine at 8057393388 for education and support from a lactation consultant.

RestRest, rest, REST! You need to take the time to rest when your baby does.

This should be one of your priorities in the first weeks. A rested mother can cope much better with a new baby’s demands.

Perineal Care for Women Who Have Had Vaginal BirthsYour doctor used selfdissolving stitches to repair the incision (episioto my) made between your vagina and rectum during the delivery. It takes about 3 weeks for them to dissolve. Itching is a normal complaint during the healing process.

Follow these instructions to promote healing and to decrease discomfort:

• Ice: The first 812 hours you will be encouraged to keep ice on the area if your are quite swollen. After that heat is encouraged.

• Sitz Bath: Soak in a tub of about 6" of warm water or use the hospital sitz bath for 1520 minutes, 34 times a day until your stitches no longer bother you, which should be less than 7 days. Do not use soap in the sitz bath.

• Hygiene: Wash your hands before and after using the bathroom and changing your pads. Change your sanitary pad each time you use the bathroom and whenever it is soiled. After urinating or having a bowel


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movement, be sure to wipe from front to back to prevent germs from around your rectum from getting into your stitches.

• Peri-Bottle: Use this plastic spray bottle from the hospital to rinse your stitches with warm water every time you use the bathroom. Continue to use it until you no longer have a discharge. Gently pat dry from front to back using toilet paper.

• In addition to these measures, your doctor may prescribe a medicated ointment, pads or spray which you can apply to your stitches as directed.

• Wash your hands before handling the baby and remind family members and guests to do the same.

• Do not douche, insert tampons, or engage in sexual intercourse until after your doctor’s appointment at 4 to 6 weeks postpartum.

• Kegel exercises are recommended for perineal conditioning. To perform Kegels, tighten the muscles around the vagina and rectum and hold the buttocks together. To learn exactly which muscles to use, try stopping the flow of urine when you urinate. Begin Kegel exercises, holding for a count of five, relax and repeat. Try starting with 5 every few hours and gradually building up to 100 each day. These exercises are to tighten stretched perineal muscles and heal your episiotomy and prevent weakness of tone and bladder and vaginal problems in the future.

Vaginal Bleeding after Vaginal or Cesarean BirthThis is called lochia. During the immediate few days after the birth, the discharge is bright red like a menstrual flow. The flow will decrease and change from red to pink to white over a period of six weeks. While the flow is bloody, you may pass a few clots. Overdoing it physically may cause a period of red bleeding again. If this occurs, getting rest and breastfeeding your baby will help. Call your doctor if you have bleeding that is heavy, profuse and persistent, when you saturate more than 1 pad per hour or passing clots greater than the size of an apricot, or there is a foul odor to the discharge.

Abdominal Cramping (called “after-pains”)Cramping is normal in the first few days as the uterus is contracting and returning to it prepregnancy size. The cramping will gradually go away. You may experience abdominal cramping during breast feeding the first few days also. This is the result of the hormone of breastfeeding affecting your uterus

and helping it return to its normal size and decrease bleeding. Your doctor will prescribe pain medication or suggest an overthecounter remedy, which will also be fine to take when breastfeeding.

Incision Care and Recovery for Women with Cesarean DeliveryYou may experience the most discomfort in the first 24 hours after surgery. Pain medications will help you through this time, so do not hesitate to ask for some. It is far better for you to be comfortable enough to get rest, take care of your baby, and get in and out of bed and walking, all which lead to your recovery.

The hospital caregivers will help you to get out of bed initially. Take it slow, using a pillow or rolled blanket placed against your abdomen for support.

The incision is closed with staples which your nurse or doctor will gently remove the day you go home. Steristrips will be placed to secure the incision. Leave them on as long as they stick well or you may remove them after 7 to 10 days. In the meantime, you may shower when your nurse tells you it is okay. You may find that bikini or nylon briefs irritate your incision. You are probably most comfortable in waist high cotton briefs.

Itching is normal as the incision heals. You can help relieve itching by placing a warm washcloth on the incision as needed.

Be sure to only touch the incision with clean hands, and occasionally “airing”

Moms need to take the time to rest when the baby does. A rested mother can cope much better with a new baby’s demands.



your incision will help it heal faster. When showering, avoid using perfumed soaps directly on the inci sion and wash over the incision with the clean washcloth, then the rest of the body. Afterwards, pat dry with a clean towel. Do not put lotions or powders directly over the incision.

Remember, frequent rest periods are important for your healing.

Call your doctor if your incision shows unusual redness, drainage, or if you have a fever. See “When to Call your Doctor.”

HemorrhoidsHemorrhoids are enlarged veins in the rectum that may be external or internal. They may have developed during your pregnancy or during the delivery process. Try the following measures to relieve the discomfort or itching of hemorrhoids. Your doctor may also give you a prescription.

• Apply ice.

• Sit in a tub with lukewarm water.

• Apply over-the-counter creams or wipes.

• Use creams or suppositories prescribed by your doctor.

• Keep your bowel movements soft. (See First Bowel Movement.)

Bowels and BladderIt may be 23 days after delivery before you have your first bowel move ment. Your doctor may prescribe a stool softener or a laxative. The best home remedy is a good diet, eating fresh fruit, vegetables, eating bran cereal or

muffins, and drinking at least 8 glasses of water each day.

You may be able to relieve gas pains by walking around or rocking in a rocking chair or your doctor may order a water enema to help pull the gas out, called a HarrisFlush.

The bladder may not empty well at first due to the pressure of pushing and certain medications. Try to empty your bladder every 34 hours. Because your body will be getting rid of extra fluid that caused hand and leg swelling late in pregnancy, you will notice that you will eliminate large amounts of urine in the first few days after delivery. Continue to drink adequate fluids, especially water.

Activities• Follow your doctor’s directions to

start exercising. In the meantime, once home start taking short walks in the fresh air. Remember, sleep is impor tant, so nap when your baby

sleeps during the day, anticipating that you will be up a few times at night.

• Delegate household chores to family and friends.

• Limit your activity to caring for yourself and baby the first few days and weeks at home, gradually increasing your activity as tolerated.

• Don’t lift anything heavier than your baby. If you had a cesarean birth, avoid driving for several weeks and avoid a lot of stair climbing.

Breast Care for Nursing Moms• Wear a supportive cotton bra as much

as possible for your comfort and protection of the muscles and ligaments of the breast. Avoid bras with underwires as they can lead to blocked milk ducts.

• Wash your nipples with soap and water during your daily shower.

• After nursing, express some breastmilk to apply to the nipples as a natural help with soreness, cracking and infection. Be sure to have clean hands when doing this.

• Use a quality brand lanolin cream if your nipples are sore and need extra protection.

• Call the NutureLine at 739-3388 for more information and products to help with sore and injured nipples.

• Hard, full breasts indicate that the baby needs to nurse more frequently

Limit your activity to caring for yourself and baby the first few days and weeks at home, gradually increasing your activity as tolerated.


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and that your milk supply is increasing with more water for your baby’s thirst. Try and nurse every 23 hours. Warmth applied before the feeding or removal of milk with a pump may help the baby to latch on. Ice packs can be helpful for engorgement with used after a feeding.

• Proper positioning, especially that of sitting upright to feed your baby will position the nipple in the comfort area at the back of the baby’s mouth. Also, when taking the baby off the breast, insert a clean finger into the baby’s mouth to break the suction and then cover the nipple as you guide it out of the baby’s mouth.

• During breastfeeding, remember it is important to be calm, comfortable, rested and keep your baby close to you.

• Refer to the Breastfeeding section in this booklet.

Special Dietary Needs While Breastfeeding• Drink plenty of fluids, 8–12 cups a

day, mostly water. Soups, juices and milk also count.

• Increase your daily calorie intake by 500.

• Avoid herbal remedies since the safety of these are unknown. (This does not mean the herbs you use in cooking.) Some herbal remedies are known to be harmful to your baby. If you have a specific question, ask your doctor.

• Decrease caffeine and give up alcohol while you are breastfeeding. Both can get into the breastmilk. Drink less than 300 mg of caffeine per day. (Note: 2.5 cups of brewed coffee has about 300 mg.)

• Avoid a lot of artificial sweeteners such as Nutra Sweet, SweetnLow, Equal and Saccharin.

• Eat a balanced diet with plenty of fruit, veggies and whole grain bread products. Don’t forget your protein (from chicken, eggs, meat, fish) and calcium (from milk, yogurt and cheese).

Special Dietary Needs for Young MomsIn addition to following the Daily Food Plan for nursing moms (see above), young moms have special needs for nutrition.

• A young mom needs more protein and calcium. Try to eat 3 servings of meat, poultry or fish a day. Eat 4 servings of milk, yogurt or cheese each day.

• Young moms need to eat well balanced meals. Avoid skipping meals. Bring snacks such as cheese, crackers, fruit, peanut butter and celery or yogurt if you have no time to prepare meals.

• Avoid “junk” food and “diet” sodas/drinks. Drink water, milk, or fruit juice. Eat healthy foods such as those on the Daily Food Guide.

• Avoid “fast food.” Often times these foods are full of empty calories with a small amount of nutrients.

Young moms have special needs for nutrition, including increased protein and calcium, and plenty of fruits and vegetables.



Daily Food Guide for Nursing MomsFood One Serving Best Choices

Bread, cereal 1 slice of bread Whole grain, enriched bread, Rye bread, Rice & pasta 1 ounce ready to eat cereal oatmeal, unsweetened cereal.(8 or more servings) 1/2 cup cooked cereal, rice or pasta

Veggies 1 cup raw leafy veggies Green and yellow veggies like spinach,(4 or more servings) 1/2 cup other veggies broccoli, romaine lettuce, carrots, 3/4 cup vegetable juice sweet potato.

Fruit A medium apple, banana or orange Eat whole fruit instead of juice.(3 or more servings) 1/2 cup chopped or canned fruit 3/4 cup fruit juice

Milk, yogurt & cheese 1 cup milk or yogurt Choose lowfat or non fat milk products.(2 to 4 servings) 1.5 ounce cheese Add cheese to casseroles, veggies, salads.

Meat, poultry, fish, 2-3 oz. cooked lean meat, fish Choose lean meat, poultry with no skinpeas, eggs and nuts or poultry; and fish more often.(2 or more servings) 1 egg, 1 Tbsp. Peanut butter or 1/2 cup cooked dry beans or peas is

equal to 1 oz. meat

Fats, oils, sweets 1 tsp. oil, margarine, sugar Use liquid oil like canola or olive.(3-4 servings) 1 Tbsp. salad dressing Choose fruit instead of dessert.

What Do I Need to Know If I Had Gestational Diabetes While I Was Pregnant?There is a good chance that your blood sugar levels will go back into the normal range after the birth of your baby. Even so, you will remain at a high risk for developing diabetes during any future pregnancies and later on in life. If you are overweight and continue to be overweight your chance of developing type 2 diabetes in later years may be as high as 50%. For this reason, it is important to try to lose any excess weight

after the birth of your child. Also, if you continue to breastfeed your baby, the chances of developing diabetes later in life can be reduced than if you choose to bottle feed your infant. Additionally, exercising on a regular basis will be good for you because exercise helps your body use energy better.

You should also have another glucose tolerance test around the time of your postpartum visit or shortly thereafter. Even if the test after pregnancy is normal, you should continue to have your blood sugar levels checked periodically. (Some diabetes specialists recommend yearly testing.) If you are considering having another child, it is also a good idea to be tested for diabetes prior to attempting another

pregnancy. Refer to the Daily Food Guide for Nursing Moms to give you a healthy diet plan.

Baby Blues, Emotional Changes, Postpartum Depression . . . Having a baby is often an emotional time for a woman. In the weeks after the baby is born, there seems to be a greater risk for becoming depressed. No one knows for sure what causes this. Baby Blues occur in about 5080% of new mothers. They usually


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start on the third or fourth day after birth and last about ten days or less.

Symptoms include: • Crying spells • Irritability • Worry about the baby • Mood swings • Sadness • Anxiety • Loneliness • Lack of confidence in mothering

abilities

What to Do:While waiting for the blues to pass, you might find it helpful to:

• Seek support, talk to your partner or a friend about how you feel. Ask for help and support. Join a new mothers group or get to know new mothers at church or in your neighborhood.

• Rest: lie down to rest or sleep when the baby sleeps.

• Eat well. Include plenty of whole grains, milk products, fresh fruits and vegetables, protein foods, and avoid caffeine, sodas.

• Play with your baby, take a walk, ask someone to babysit while you go shopping, get your hair done or do something you like to do.

• Trust yourself—remember most moms do what is best for their baby.

• Share this booklet with the baby’s father or other family or supportive friends. The more information they have the better they will understand your emotions and be able to help support you.

Postpartum Depression (PPD) occurs in about 10% of new mothers. It may start in the first week after baby’s birth

or take several weeks to develop. The symptoms of baby blues may get worse or one or more of these symptoms may develop:

• Loss of appetite• Feelings of helplessness or hopeless

ness• Feelings out of control• Over concern or no concern at all

about the baby• Inability to sleep• Thoughts of harming yourself or the

baby• Hearing voices or thinking people are

plotting against you

What to Do:You, a family member or friend should contact a health professional. A complete check up will help to find the cause for how you feel. Do not hesitate to get help! These feelings are beyond your control. Expecting you to “shape up” without help is not realistic.

Call Your Physician If You Have…• Fever of 100.4º or higher.

• Frequency, burning or pain with urination or decreased urine output.

• Heavy vaginal bleeding and saturating more than 1 pad in an hour.

• Persistent headaches, blurred vision or visual disturbances, fainting, seizures.

• Difficult or rapid breathing; chest discomfort, rapid pulse.

• Increased pelvic pain.

• Pain, tenderness, or swelling in any area of your legs.

• Increased pain, tenderness, redness, swelling or pus drainage from your episiotomy or incision.

• Swelling, redness, extra tenderness in any area of your breasts.

• Depression, feelings of inability to cope.

• Questions about your condition or care.

Be sure to keep followup appointments with your doctor.



Whether this is your first baby or fifth, it is important to remember that while the “baby basics” may be the same, all babies have their own personality. You will have the joy of learning all about your baby.

Make sure that you use all the help that you are offered. It will be very important for you to rest when your baby rests. There will be times when you start to feel over whelmed. There may be dishes in the sink, clothes on the floor and you haven’t had a chance to brush your teeth. Your baby may start crying and you join in. You may start to wonder if you can make it as a mother. Remember these feelings are normal. A baby changes your life complete ly. The normal routine you and your partner have become accustomed to is now part of the past.

As new parents, we tend to have such unrealistic expecta tions of our selves and our new baby. Remember they don’t come with an owner’s manual. Give yourself time to develop new routines and as you move forward you will find your confidence and strength. You may even look back upon these first crazy days and wonder why you were so over whelmed.

Newborn CharacteristicsYour Baby’s SkinIt’s important to remember that your baby has spent months in a fluid environment while in the womb. During the transition to a nonfluid environment, baby’s skin will look and feel different from that of older babies.

VernixVernix or vernix caseosa is the soft, greasy, white coating that protected your baby’s skin before birth and helped the baby slide through the vaginal canal during delivery. Some babies have quite a bit, others may have only a small amount in the skin folds. The vernix is usually wiped off, but small amounts may remain after the baby’s first bath. What is left is absorbed, and will soften and moisten baby’s skin.

LanugoLanugo is the fine, downy hair found on many newborns. It may be par tic ularly noticeable if your baby was born early. Lanugo will fall out over the next several weeks and you may even notice it on baby’s bedding and clothes.

MiliaMilia are the small, white “pimples” on baby’s forehead, nose or cheeks. They may have been present at birth, or could appear within a few days after birth. They will disappear without treatment in a few days. Do not squeeze or pick at them.

Newborn RashNearly 75% of newborns will have a red, blotchy rash with white centers on their arms, chest or stomach. The rash will disappear in a few days with out treatment.

MottlingMottling is the purplish, blotchy look of baby’s skin, especially when exposed to cool air. Mottling becomes less noticeable as your baby gets older.

Peeling, Dry SkinThis condition is very common in the first 24 weeks and may be especial ly noticeable on baby’s feet and hands. The dry skin will naturally rub off and the condition will disappear as baby grows. It is not generally advisable to use lotions or oil on newborn skin. If you feel the dryness needs attention, ask your baby’s doctor.

Cradle cap is a type of dry, scaly skin found on your baby’s scalp. It is harmless and doesn’t itch. No special treatment is necessary. Rubbing your baby’s scalp during baths may loosen flakes, then you can comb them out. You want to rub your baby’s scalp over the soft spots, just be gentle.

All of these conditions are very temporary and will disappear without treatment. If you continue to be concerned, consult with your baby’s doctor during your first visit.

Umbilical CordYour baby’s umbilical cord will be clamped with a plastic clamp that will be removed when it is dry. You will

Caring for the New Baby


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need to wipe around the base of the cord with alcohol during each diaper change. Avoid covering the cord with the diaper. The cord will dry and fall off approximately 12 weeks after your baby is born. As it heals it will have the appearance of a scab. Do not pick at it, cut or pull it off. You need to allow it to fall off . A clear or slightly bloodtinged discharge may emerge from the naval after the cord falls off. This should not be a concern for you. If the oozing persists more than a couple of days, is associated with a foul odor, has redness in the surrounding skin, or if a fever occurs, report it to your baby’s health care provider immediately.

Head and EyesMost babies delivered vaginally show some “molding” of their heads from the birth process. The temporary cone shape of the baby’s head happens because of two fontanelles or “soft spots,” one just above the forehead and the other toward the back of the head. These fontanelles may have closed and the bony plates of the baby’s skull may have overlapped to allow passage through the birth canal. The appearance of your baby’s head will return to normal in a few days. The flexible fontanelles will knit together to form a hard skull over the next 18 months. You will notice that your baby’s “soft spot” gradually disappears.

Your baby’s eyes may seem puffy and watery. This is caused by a combination of pressure during a vaginal delivery and medications placed in your baby’s eyes in the hospital nursery as requested by your physician. Some babies have broken blood vessels in the whites of their eyes, caused by pressure during delivery.

GenitalsBabies sometimes have some temporary physical characteristics caused by the female hormones from their mother’s body. Girls may have swollen genitals and both boys and girls may have swollen breast tissue. Girls may show a bloodtinged discharge of mucous from their vagina known as pseudomenses. Baby girls may even express liquid from the breasts (some cultures call this “witches milk”). Mother’s hormones soon clear from the baby’s body and these conditions disappear within a few days.

Elimination: Bladder and BowelsBladderBabies urinate frequently, and consequently need to have regular diaper changes to stay comfortable and avoid rashes. You can expect that your newborn will have six wet diapers per day by the end of the first week.

BowelsYour baby’s first bowel movement is called meconium. It is very sticky and may be dark green or black. “Normal” newborn bowel movements vary according to whether your baby is breast or bottle fed and vary widely depend

ing on the baby. Stool color and consistency can vary from day to day.

Most breastfed babies have more liquid, runny, mustard color stools that are seedy in consistency. Bottlefed babies generally have stools that are yellowishtan. On occasion, all babies can have stools that vary from gray, to green, to brown in color. The number of stools can vary from 68 each day to one every other day. Almost anything can be normal in terms of frequency; the key is the pattern for your baby.

Constipation in newborns is present when stools are small, firm and pebblelike. Babies often grunt, strain, and turn red in the face during normal bowel movements. This behavior is usually not an indication of constipation.

Diarrhea is characterized by stools that are unusually frequent and associated with excessive water. Call your baby’s health care provider if diarrhea persists more than one day or is associated with bleeding.

Diaper RashUrine, stool and soap residue can cause skin breakdown and diaper rash. Cleanse your baby’s genitals and buttocks with warm water and dry with each diaper change. Check the diaper before and after each feeding. Expose your baby’s bottom to air 24 times a day for 3060 minutes to heal any irritations that may occur. Diaper rash creams may also help. If the rash continues or gets worse, call your infant’s health care provider.



Behavior and SensesPersonality and PreferencesYou will probably be amazed at how quickly you will learn to understand your baby’s needs, preferences and unique personality. Despite their extreme dependence and lack of any language that we can understand, newborns are great little communicators! If this is not your first baby, you will see clear differences between this baby and your other(s). Allow for these differences and rely on what you are learning from this baby to guide you.

SensesBabies have use of all their senses from the moment of birth and some say, even before. The senses further develop as they grow, but the newborn can hear, see, taste, smell, and is highly sensitive to touch. Your baby’s hear ing is shown when they startle at a loud noise or are comforted by a soothing voice. Newborn vision is best with objects 68 inches away from their face. Clear vision at longer distances develops over the next few months.

Sneezing and HiccupsSneezing in newborns does not mean that your baby has a cold. Occa sion al sneezing is nature’s way of clearing baby’s nasal passages. Hiccups are also very common. They will go away on their own.

JaundiceJaundice is a condition that is common in many newborns. It appears as a yellowing of the skin and eyes and is caused by an excess of bilirubin, a yellow pigment that is a product in the

blood. All babies are born with extra red blood cells that undergo a process of being broken down and eliminated from the body. Bilirubin levels in the blood can be high because of higher production of it in a newborn, an increased ability of the new born intestine to absorb it, and a limited ability of the newborn liver to handle large amounts of it. Many cases of jaundice do not need to be treated—your baby’s doctor will carefully monitor your baby’s bilirubin levels. Sometimes infants have to be temporarily separated from their mothers to receive special treatment with phototherapy. The American Academy of Pediatrics suggests continuing frequent breastfeeding, even during treatment. If your baby is jaundiced or develops jaundice, it is important to discuss with your baby’s doctor all possible treatment options and share that you do not want to interrupt nursing if this is at all possible.


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Sleeping and CryingAmount and DurationSleep patterns of infants often cause concern to new parents who often end up tired and exhausted because of their lack of sleep. Most infants wake up for feedings every 23 hours until 68 weeks of age. On occasion a baby will sleep through the night much sooner, but this is uncommon. Each baby tends to establish its own pattern of sleep. Some drop off to sleep after feed ing, while others take only brief and occasional naps. Babies generally know how much sleep they require and virtually nothing you can do will change that pattern. You should plan your “rest periods” to match your baby’s.

Nighttime sleeping patterns will change at 48 weeks of age. The majority of babies will start sleeping through one or two nighttime feedings allowing you 58 hours of uninterrupted sleep. Finally, they will “sleep through the night.” Understand the time that the baby chooses to sleep may not coincide with your nighttime sleeping pattern. Feeding solid food does not alter this pattern. It is considerably more difficult to change the baby’s sleeping pattern than it is to change your own. At about 56 months of age some infants begin to awaken at night again. This may be relieved by the feeding of solid foods. Check with your baby’s health care provider before resorting to this technique. Be patient!

Sleep PositionsThe American Academy of Pediatrics recommends that newborns be placed on their backs or propped to their sides

to sleep. Recent research suggests that infants placed on their stomachs to sleep may be more prone to Sudden Infant Death Syndrome (SIDS). Back sleeping is the safest position for your baby and provides the best protection against SIDS. There are times when it is appropriate for “tummy time” when baby is awake and someone is watching. This position helps make baby’s neck and shoulder muscles stronger.

Crying: How to Comfort Your BabyBabies cry for many reasons: they may be hungry, wet, hot or cold, sick or in pain, tired or bored and even lonely. Your baby may also cry when he or she has had too much excitement and attention, but they often cry for no reason. Most babies have a “fussy” time of day, often in late afternoon or early evening. Babies outgrow this eventually.

When your baby cries for no apparent reason, try some of the following suggestions for soothing and comforting your baby:

• Check to see if your baby has a wet or soiled diaper; is too cold or too warm; wanting your attention; or in pain.

• Wrap the baby snugly in a light blanket to help him feel secure.

• Offer a pacifier or feeding.

• Gently rub baby’s back.

• Change baby’s position to over your shoulder or to an infant seat.

• Provide soothing sounds; use a lullaby tape (or any soft music with a gentle beat), hum, run the dishwasher, the clothes dryer, or a fan.

• Provide regular rocking motion by rocking baby in a chair, using a baby swing, rocking in a cradle, or placing baby in a front sling carrier and walking around with him or her. (See pages 15 and 16 for more suggestions.)

If your baby continues to cry, it may be necessary to put her down in her crib, swing or infant seat. While it is important to make your baby feel secure, you cannot hold your baby every minute that she is crying.

If baby continues to cry and you are feeling frustrated or annoyed, take a break—but don’t shake your baby.

• Take a deep breath and count to 10.

• Call someone who understands—your doctor, a counselor, a friend.

• Put the baby in a safe place and walk away for a few minutes.

• Remember, a little crying will not hurt a baby.

Know your limits and be patient. If you feel angry and frustrated, you could be experiencing the first stages of loss of control. This could lead to you harming your baby. Take a break. Let the baby cry if you need to. Seek some help, but never shake the baby. Shaking a baby c an cause blindness, eye damage, seizures, delays in development, paralysis, permanent brain damage or even death. Remember it is never okay to shake a baby.



What Your Baby’s Cry Means: Causes of CryingCrying plays an important role. It is your baby’s way of “talking” or communicating with you, as well as a way to release stress and tension. It is how babies express their needs and desires. Research has shown that a newborn may spend any where from 1–5 hours throughout the day crying. Understanding some of these causes may allow you to better handle your baby’s fussy times. Below are reasons why a newborn will cry.

I am hungry! The first and foremost reason for a newborn’s cry is usually hunger. Most babies will want and need 8–12 feedings in a 24-hour period. You will see this pattern of feedings up to or around three months of age. If this is truly why he or she is crying, he/she will nestle into the breast or readily take the bottle and be very happy and content.

Then there are the ones who wake up frenzied because they are so hungry. These babies are often so upset that they won’t eat well at all. The best thing to do is try to calm them before attempting to feed them. Gently rock or coo to them. Once they are settled and have caught their breath they will eat much better without gulping and swallowing so much air, which could lead to a belly ache. Crying is the last sign of hunger. Be watchful of hunger cues. There are some babies, though, who are “quiet babies” and you have to be aware of their hunger cues, which could be mild fussiness or hand to mouth sucking. These cues are messages to you that they are hungry.

I don’t feel well! Discomfort is another reason for crying. It could be intestinal gas or indigestion brewing. They often will draw their legs to their chest and have a more distinct cry that says pain. You will be amazed at how quickly you will be able to distinguish between the different cries.

Change my diaper! You would cry too! Do not let your baby sit in a soiled diaper for very long. A baby’s skin is very delicate and can break down quickly when their diaper is soiled.

I am too cold or too hot! A good rule of thumb is to dress a baby as you would dress yourself. If you are too hot, perhaps your baby is as well. The same goes for when you feel chilly.

I am bored! Sometimes babies just needs to change their position. Provide something else to look at, feel or hear.

I need to be held! Baby may want and need to be close to you, or hear your heartbeat. It may be a simple rocking back and forth that will soothe and comfort. After being inside of you all these months, baby feels secure in

your arms. You cannot spoil a newborn! There are neat devices on the market that allow you to carry your baby around in a “papoose” style sling. It induces a sense of security and comfort. Swaddling your baby in a blanket sometimes works as well.

I need to suck! Your baby needs to suck. It is a natural way of soothing and comforting himself. In the womb, baby sucked his fingers, toes or anything he could get into his mouth. Sucking also reduces stress and tension. If a baby is agitated or restless, sometimes you will see him looking for or trying to get his fist into his mouth. Regarding pacifiers, it is up to the new parents whether or not they choose to give one to their newborn. Consult your health care provider about pacifier use if you have questions.


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Bathing Your BabyThe first few times you bathe your baby at home, you may feel very awkward and nervous. Your baby may also cry and fuss, as the bath is an unusual experience for him or her. You will find that it may take you an hour to bathe this tiny little thing that is not even that dirty. Please know that in no time you will be able to do a bath in minutes. Your confidence and skills as new parents will kick in rather quickly.

Until your baby’s umbilical cord is healed and if you have a boy, the circumcision is healed, your health care provider may instruct you to sponge bathe your baby.

Bath Safety Tips:• Keep a firm grip on your baby for

every moment during the bath.

• Test the bath water temperature with your elbow or inside wrist; it should feel comfortably warm to you and never hot.

• Do not use cotton-tipped swabs in baby’s ears or nose for any reason.

Some Steps to Help You:• Bathe the baby before a feeding. With

all the jostling, a feeding will just come back up.

• Pick an area of the house where you will be comfortable bathing.

• Make sure that all of the bath supplies are in reach. NEVER leave your baby unattended near water.

• Choose an area that is draft fee.

• Lay baby on a towel and undress. Cover up with a second blanket and only expose the area you are washing.

Harvey Karp’s “Five S” SystemA crying newborn can be a challenge for new parents. They may blame themselves or believe they are doing something wrong. Dr. Harvey Karp, noted pediatrician and author, has researched what works best with fussy babies. He has found that recreating the reassuring sensations of the womb turns on a “calming” reflex that all babies are born with. Using different techniques combined with his own research, Dr. Karp has developed the “Five S” system that activates this reflex:

1. Swaddling. Snug wrapping provides the continuous touching the fetus experiences within the womb and keeps a baby’s hands from flailing.

How to swaddle your infant:

• Lay a lightweight blanket on a flat surface.

• Fold down a corner around 6 inches.

• Place your baby with the back of his head on the fold.

• Pull one corner across his body and tuck the edge under his back.

• Pull the bottom corner up on his chest.

• Bring the last corner over the other side of your baby and tuck it under the back.

2. Side/Stomach Position. Place the infant on his side or stomach to provide reassuring support. This switches on the calming reflex. Avoid overheating your baby and having loose blankets in bed with your infant. Also, never use the side or stomach position for putting your baby to sleep. Sudden Infant Death Syndrome (SIDS) is linked to stomach-down sleep posi tions. When a baby is in a stomach-down posi tion, do not leave him—not even for a moment.

3. Shushing Sounds. These imitate the continual loud whooshing sound made by the blood flowing through arteries near the womb.

4. Swinging. Newborns are accustomed to the swinging motions within their mother’s womb, so entering the gravity-driven world of the outside is like a sailor adapting to land after nine months at sea. Rocking, car rides, and other swinging movements all can help. “Of course, never shake a baby or swing him or her when you are angry,” cautions Karp.

5. Sucking. “Sucking at the breast or rubber nipple is deeply satisfying for babies,” notes Karp. “It releases natural chemicals within the brain and trig-gers the calming reflex.”

Thanks to Dr. Harvey Karp for his contribution and his study of what new parents can do to calm their fussy babies and help them sleep. For more information, please visit www.thehappiestbaby.com.



• Start with the eyes. With a clean corner of a wash cloth, wash from the inner aspect of the eye to the outer aspect using warm water. Repeat with the other eye, this time using another corner of the wash cloth.

• Wash the baby’s face with clean water. You may choose to use a wash cloth or your hand.

• Wash around the nose and ears. Remember, do not use cottontipped swabs in the nose or ears.

• Wash the baby’s body, making sure that you get into every fold and crevice.

• Check the umbilical cord for proper healing. Cleanse the area with clean, warm water and apply alcohol with diaper changes (at least three to five times per day). Make sure you are thoroughly swabbing the alcohol or water all around the base of the healing cord.

• Roll the diaper so that the edge is below the cord until the cord falls off and the area heals.

• Do not cut the fingernails for at least two weeks after delivery. If nails are long prior to that time, use a soft nail file and gently file baby’s nails down. After that, use a pair of baby scissors or clippers and very carefully trim them when your baby is sleeping. Be

careful to not cut the skin underneath the nails.

• Use clean water on the genitals. Little girls will have a lot of discharge. Always wash from front to back so you do not introduce infection into the bladder. Little boys that are circumcised need the penis cleaned with clean, warm water until the area is healed. If your son was not circumcised, do not force the foreskin back to clean the penis. Warm water and soap is all that is necessary. Ask your baby’s health care provider about the care if you have questions.

• If the baby has soiled the diaper, take an unsoiled corner of the diaper and wipe away the excess stool. Using a washcloth, wash the baby’s bottom with warm water to cleanse thoroughly.

• Wash your baby’s head last. The reason for this is, your baby loses the most heat from his head, especially when it is wet. By washing the head last, his head will be wet for the shortest time. To wash the hair, use clean water. Wrap your baby in a towel and place him in a “football” hold. Pour some clean water over the scalp. Place a small amount of shampoo on the scalp and wash making sure you stimulate the entire scalp even over the soft spots. By avoiding the soft spots and not stimulating the skin for proper circulation, cradle cap may occur.

• Newborn skin does not need lotions or powders; reduce skin dryness by using soap only for baths every third day. In between, wash the baby with water only. Do not use powder on your baby—particles can be inhaled and cause breathing difficulties.

• Bath time is a wonderful time for baby to learn your touch. This is also a great time to assess your infant’s skin, rashes, healing of the umbilical area and the overall general appearance of your baby.

• Dress your baby and swaddle him/her in a blanket to prevent chills.

Boys: Circumcision CareUntil it is healed, cleanse the area with plain water only. Avoid disturb ing the circumcision site. Rinse the area by gently squeezing a washcloth soaked with warm water over the area and then pat dry. Apply Vaseline with each diaper change for the first 2448 hours to keep the diaper from sticking to the site. Notify the doctor if you notice increased swelling, redness, continued bleeding or if your baby has not urinated for 12 hours.

Use of the Bulb SyringeUse the bulb syringe to remove secretions from your baby’s mouth or nose. You will take the bulb syringe home that was used on your baby while he was in the hospital.

To use the syringe:• Squeeze the bulb fully.

• Gently insert the tip of the syringe into either the side of the baby’s mouth or nasal passage until it fits snugly—do not force.

• Slowly release the bulb.

• Remove the syringe and briskly squeeze the bulb to get rid of any secretions.

• Repeat as necessary.


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CAUTION: Never depress the bulb while the syringe is in the baby’s nose or mouth. Clean the syringe after each use by submerging in soapy water and repeatedly squeezing the bulb. Rinse and air dry.

Temperature TakingYour baby’s health care provider may ask you to assess your baby’s tempera ture through the axillary method. Digital or mercuryfree ther mome ters are recommended for use.

Breastfeeding can be a wonderful experience for you and your baby. It’s important not to get frustrated if you are having problems. We encourage you to use the NurtureLine at (805) 7393388 for education and support from a lactation consultant.

Tips for Making It WorkWhat works for one mother and baby may not work for another, so just focus on finding a comfortable routine and positions for you and your baby. Here are some tips for making it work:

Get an early start. You should start nursing as early as you can after delivery (within an hour or two if it is possible), when your baby is awake and the sucking instinct is strong. At first your breasts contain a kind of milk called colostrum, which is thick and usually yellow or golden in color. Colostrum is gentle to your baby’s stomach and helps protect your baby from disease.

Your milk supply will increase and the color will change to a bluishwhite color about three to four days after your baby’s birth.

Nurse on demand. Newborns need to nurse often. Breast feed at least every 2 hours and when they show signs of hunger, such as being more alert or active, mouthing (putting hands or fists to mouth and making sucking motion with mouth), or rooting (turning head in search of nipple). Crying is a late sign of hunger. Most newborn babies want to breastfeed about 8 to 12 times in 24 hours.

Feed your baby only breast milk. Nursing babies don’t need water, sugar water or formula. Breastfeed exclusively for about the first six months. Giving other liquids reduces the baby’s intake of vitamins from breast milk.

Delay artificial nipples (bottle nipples and pacifiers). A newborn needs time

Breastfeeding Is Normal



to learn how to breastfeed. It is best to wait until the newborn develops a good sucking pattern before giving her or him a pacifier because artificial nipples require a different sucking action. Sucking at a bottle can also confuse some babies when they are first learning how to breastfeed.

Breastfeed your sick baby during and after illness. Oftentimes sick babies will refuse to eat but will continue to breastfeed. Breast milk will give your baby needed nutrients and prevent dehydration.

Air dry your nipples. Right after birth, you can airdry your nipples after each nursing to keep them from cracking. Cracking can lead to infection. If your nipples do crack, coat them with breast milk or a natural moisturizer, such as lanolin, to help them heal. It isn’t necessary to use soap on your nipples, and it may remove helpful natural oils that are secreted by the montgomery glands, which are in the areola. Soap can cause drying and cracking and make the nipple more prone to soreness.

Watch for infection. Signs of breast infection include fever, irritation, and painful lumps and redness in the breast. You need to see a doctor right away if you have any of these symptoms.

Promptly treat engorgement. It is normal for your breasts to become larger, heavier, and a little tender when they begin making greater quantities of milk on the 2nd to 6th day after birth. This normal breast fullness may turn into engorgement. When this happens, you should feed the baby often. Your body will, over time, adjust and produce only the amount of milk your baby needs. To relieve engorgement, you can put

warm, wet washcloths on your breasts and take warm baths before breastfeeding. If the engorgement is severe, placing ice packs on the breasts between nursings may help. Talk with a lactation consultant if you have problems with breast engorgement.

Eat right and get enough rest. You may be thirstier and have a bigger appetite while you are breastfeeding. Drink enough noncaffeinated beverages to keep from being thirsty. Making milk will use about 500 extra calories a day. Women often try to improve their diets while they are pregnant. Continuing with an improved diet after your baby is born will help you stay healthy. But, even if you don’t always eat well, the quality of your milk won’t change much. Your body adjusts to make sure your baby’s milk supply is protected. Get as much rest as you can. This will help prevent breast infections, which are worsened by fatigue.

If you are on a strict vegetarian diet, you may need to increase your vitamin B12 intake and should talk with your health care provider. Infants breastfed by women on this type of diet

can show signs of not getting enough vitamin B12.

Once your baby has finished the first breast and still wants more milk, you can offer the other breast. Signs that your baby has finished with the first breast are falling asleep at the breast and doing no more opening wide, pausing, then sucking. If the compression does not work at first, it does not mean that you have to switch breasts right away. If your baby comes off the breast by him or herself, you might want to try offering the first breast again to see if he or she will drink more. If not, or if your baby is getting fussy or sleepy because the milk flow is slow, you can change your baby over to the other breast. You can experiment with this technique and do a variation of it that works best for you.

How Breast Milk Is MadeKnowing how the breast is made and how it works to produce milk can help you understand the breast feeding process. The breast actually begins developing in the first few weeks of gestation, before birth. But the mamma ry gland, the gland that produces milk, does not become fully function al until lactation begins. When a woman’s breasts become swollen during pregnancy, this is a sign that the mammary gland is getting ready to work. The breast itself is a gland that is composed of several parts, including glandu lar tissue, connective tissue, blood, lymph, nerves, and fatty tissue. Fatty tissue is what mostly affects the size of a woman’s breast. Breast size does not have an effect on the amount of milk or the quality of milk a woman produces.


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Milk is secreted from the alveoli cells. When the alveoli cells are stimula ted by a hormone, they contract and push the milk into the ductules and down into larger milk ducts underneath the nipple areola. When the baby’s gums press on the areola and nipple, milk is squeezed into the baby’s mouth. The nipple tissue protrudes and becomes firmer with stimulation, which makes it more flexible and easier for the baby to grasp in the mouth. In the diagram, you can see that each mammary gland forms a lobe in the breast. Each lobe consists of a single branch of alveoli and milk ducts that narrow into an opening in the nipple. Each breast has about seven to ten lobes.

The Role of Hormones Hormones play a key role in breastfeeding. The increase of estrogen during pregnancy stimulates the ductules to grow. After delivery, estrogen levels drop and remain low in the first several months of breast feeding. The in

crease of progesterone during pregnancy also causes the alveoli and lobes to grow. Prolactin, also called the “mothering hormone,” is another hormone that is increased during pregnancy and adds to the growth of breast tissue. Prolactin levels also rise during feedings as the nipple is stimulated. As prolactin is released from the brain into the mother’s bloodstream during breastfeeding, alveolar cells respond by making milk. Oxytocin is the other hormone that plays a vital role because it is necessary for the letdown milkejection reflex to occur. It stimulates the alveoli cells to contract so the milk can be pushed down into the ducts. Oxytocin also contracts the muscle of the uterus during and after birth, which helps the uterus to get back to its original size and lessens any bleeding a woman may have after giving birth. The release of both prolactin and oxytocin may be responsible in part for a mother’s intense feeling of needing to be with her baby.

How to Bring Baby to the Breast

STEP ONE: Gently tickle your baby’s upper lip with your nipple until he opens his mouth.

STEP TWO: Point nipple to roof of ba-by’s mouth as he opens his mouth very wide like a yawn to take in your entire nipple. There may be more areola (the dark area around the nipple) showing above his mouth than below it.

STEP ThrEE: Quickly pull your baby in close—chin first—as he begins suck-ing. His lips should be flared around your nipple, and his chin should be pressed against your breast.

LobeEach mammary gland forms a lobe of the breast, which consists of a single

major branch of alveoli and milk ducts that end at the nipple pore

AreolaThe dark area

around the nipple

Milk ductThe tube through which milk travels

Alveoli cellsGrape-like clusters of tissue

which secrete milk

Nipple



Proper positioning for baby’s mouth when holding baby:

• You can support your breast with your thumb on top and four fingers underneath. Keep your fingers behind the areola (the darker skin around the nipple). You may need to support your breast during the whole feeding, especially in the early days or if your breasts are large.

• Hug the baby in close with his or her whole body facing yours. Your baby will need to take in the nipple and at least a half inch of the areola. The baby should never be latched onto the nipple only.

• Look for both of your baby’s lips to be turned out (not tucked in or under) and relaxed. If you can’t tell if the lower lip is out, press gently on the lower chin to pull the lower lip out. The tongue should be cupped under your breast.

• You may see your baby’s jaw move back and forth and hear lowpitched swallowing noises. Your baby’s chin may touch your breast.

• Breastfeeding should not hurt through the feeding. If it hurts, take the baby off of your breast and try again. The baby may not be latched on right. Break your baby’s suction to your breast by gently placing your finger in the corner of his/her mouth.

Correct LatchA good latchon is important for your baby to breastfeed effectively and for your comfort. During the early days and weeks during breastfeeding, it can take time and patience for your baby to latch on well.

Signs of a Correct Latch vs. an Incorrect Latch

COrrECT:

• Baby’s lips are around the nipple and the areola, not just the nipple.

• The top lip will be closer to the nipple, and some areola shows above top lip.

• More areola is taken in with the lower lip than the top lip.

• Baby’s chin is close against breast and baby’s nose rests on the breast.

• Baby’s lips are “flanged,” not tucked in.• You hear baby swallow after every

one or two sucks. Some babies swallow too quietly to hear, so listen for a slight pause in baby’s breathing which shows he or she is swallowing.

• You see a “wiggle” at the junction of baby’s temples and ears.

• Baby has enough wet and dirty diapers (beginning on the 3rd or 4th day after birth, there should be at least five to six wet disposable diapers (six to eight cloth diapers) and at least three to four bowel movements the size of a U.S. quarter or larger.

iNCOrrECT: • You feel pain after the first few sucks.• You hear clicking or sucking noises.• Your baby comes off easily from the

breast.• Your baby swallows little or not at all

at the breast.• Baby’s lips are tucked in instead of

turned out (flanged).• Your nipple is flattened or creased

after feeding.• Baby does not have enough wet or

dirty diapers.If you have difficulty breastfeeding, call a lactation consultant.

Breastfeeding HoldsOn the next page are pictured several common positions in which you can hold your baby while breast feeding. You can choose one or more in which you and your baby feel most comfortable. No matter which one you choose, make sure your baby’s mouth is near your nipple and he/she doesn’t have to turn his/her head to breastfeed. For most positions, your baby should be on his/her side with his/her whole body facing yours. This helps him/her to properly latch on to the nipple. Try using pillows under your arms, elbows, neck or back, or under the baby for support.

Remember that a relaxed feeling at nursing time encourages primitive neonatal reflexes that allow for a better latch and help relax Mom too!


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• Cradle Hold. This is a commonly used position that is comfortable for most mothers. Hold your baby with his head on your forearm and his/her whole body facing yours.

• Clutch or “Football” Hold. This is good for mothers with large breasts or inverted nipples. Also helpful for nursing twins simultaneously! Hold your baby at your side, lying on his/her back, with his/her head at the level of your nipple. Support baby’s head with the palm of your hand at the base of his/her head.

• Cross Cradle or Transitional Hold. This is good for premature babies or babies who are having problems latching on. Hold your baby along the opposite arm from the breast you are using. Support baby’s head with the palm of your hand at the base of his/her neck.

• Side-Lying Position. This allows mother to rest or sleep while baby nurses. Good for mothers who had a Cesarean birth. Lie on your side with your baby facing you. Pull baby close and guide his/her mouth to your nipple.

Getting Enough MilkMost new mothers are concerned about their babies getting enough milk. In the first few days, when you’re in the hospital your baby should stay with you in your room if there are no complications with the delivery or with your baby’s health. The baby will be sleepy. Don’t expect the baby to wake

you up when he or she is hungry. You will have to wake the baby every two to three hours to feed him or her. At first you will be feeding your baby colostrum, your first milk that is precious thick yellowish milk. Even though it looks like only a small amount, this is the only food your baby needs. In the beginning, you can expect your baby to lose some weight. This is very normal and is not from breastfeeding. As long as the baby doesn’t lose more than 7 10% of his or her birth weight during the first three to five days, he or she is getting enough to eat.

You can tell your baby is getting enough milk by keeping track of the number of wet and dirty diapers. In the first few days, when your milk is low in volume and high in nutrients, your baby will have only 1 or 2 wet diapers a day. After your milk supply has increased, your baby should have 5 to 6 wet diapers and 3 to 4 dirty diapers every day. Consult your pediatri cian if you are concerned about your baby’s weight gain. You should visit your pediatrician between three to five days after your baby’s birth and then again at two weeks of age.

After you and your baby go home from the hospital, your baby still needs to eat about every two to three hours and

This chart shows the minimum number of diapers for most babies. it is fine if your baby has more. Wet Dirty Diaper’sAge Diapers Color/TextureDay 1 (birth) 1 Thick, tarry and blackDay 2 2 Thick, tarry and blackDay 3 3 Greenish yellowDay 4 5-6 Greenish yellowDay 5 5-6 Seedy, watery

mustard colorDay 6 5-6 Seedy, watery

mustard colorDay 7 5-6 Seedy, watery

mustard color

home with Baby MeetingsOnce home with your newborn baby, you may have questions about the baby, breastfeeding, and how to survive the first few months. Join us for meetings facili-tated by an experienced perinatal nurse for educational and discussion time. Call 349-2229 or 739-3388.



should need several diaper changes. You still may need to wake your baby to feed him or her because babies are usually sleepy for the first month. In the early weeks after birth, you should wake your baby to feed if four hours have passed since the beginning of the feeding. If you are having a hard time waking your baby, you can try undressing or wiping his or her face with a cool washcloth. If your baby falls asleep while breastfeeding, you can try breast compression. As your milk comes in after the baby is born, there will be more and more diaper changes. The baby’s stools will become runny, yellowish, and may have little white bumpy “seeds.”

Overall, you can feel confident that your baby is getting enough to eat because your breasts will regulate the amount of milk your baby needs. If your baby needs to eat more or more often, your breasts will increase the amount of milk they produce. To keep up your milk supply when you give bottles of expressed breast milk for feedings, pump your milk when your baby gets a bottle of breast milk.

Other signs that your baby is getting enough milk are:

• Steady weight gain, after the first week of age. From birth to three months, typical weight gain is four to eight ounces per week.

• Pale yellow urine, not deep yellow or orange.

• Sleeping well, yet baby is alert and looks healthy when awake.

Remember that the more often and effectively a baby nurses, the more milk there will be. Breasts produce and supply milk directly in response to the baby’s need or demand.

For more information please see the U.S. Department of Health and Human Services Office on Women’s Health website on Breastfeeding at www.4woman.gov/breastfeeding.

Coping with Breastfeeding ChallengesSome women breastfeed without problems. But for many women, it is natural for minor problems to arise at first, especially if it is their first time breastfeeding. The good news is that most problems can be overcome with a little help and support. Some more serious problems may require you to see a lactation consultant or your doctor, and it is important to know the warning signs for these situations. Here are some of the most common problems that you might face, and some solutions to overcome them.

1. Challenge: Sore NipplesBreastfeeding should not hurt. There may be some tenderness at first, but it should gradually go away as the days go by. Poor latchon and positioning are the major causes of sore nipples because the baby is proba bly not getting enough of the areola into his or her mouth, and is sucking mostly on the nipple. If you have sore nipples,

you are more likely to post pone feedings because of the pain, but this can lead to your breasts becoming overly full or engorged, which can then lead to plugged milk ducts in the breast. If your baby is latched on correctly and sucking effectively, he/she should be able to nurse as long as he/she likes without causing any pain. Remember: if it hurts, take the baby off of your breast and try again. Ask for help if it is still painful for you.

Solution: • Check the positioning of your baby’s

body and the way she latches on and sucks. To minimize soreness, your baby’s mouth should be open wide with as much of the areola in his or her mouth as possible. You should find that it feels better right away once the baby is positioned correctly. See the section on Breastfeeding Know How for information on correct latch and positioning the baby at the breast (pages 2022).

• Don’t delay feedings, and try to relax so your letdown reflex comes easily. You also can handexpress a little milk before beginning the feeding so your baby doesn’t clamp down harder, waiting for the milk to come.

• If your nipples are very sore, it can help to change positions each time you nurse. This puts the pressure on a different part of the nipple.

• After nursing, you can also express a few drops of milk and gently rub it on your nipples. Human milk has natural healing properties and emol lients to soothe them. Also try letting your nipples airdry after feeding, or wear a softcotton shirt.

• Wearing a nipple shield during nursing will not relieve sore nipples. They


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actually can prolong soreness by making it hard for the baby to learn to nurse without the shield.

• Avoid wearing bras or clothes that are too tight and put pressure on your nipples.

• Change nursing pads often to avoid trapping in moisture.

• Avoid using soap or ointments that contain astringents or other chemicals on your nipples. Make sure to avoid products that must be removed before nursing. Washing with clean water is all that is necessary to keep your nipples and breasts clean.

• Try rubbing pure lanolin on your nipples after breastfeeding to soothe the pain.

• Making sure you get enough rest, eating healthy foods, and getting enough fluids also can help the healing process. If you have very sore nipples, you can ask your doctor about using nonaspirin pain relievers.

• If your nipples remain sore or you

suddenly get sore nipples after several weeks of unpainful nursing, you could have a condition called thrush, a fungal infection that can form on your nipples from the milk. Other signs of thrush include itching, flaking and drying skin, tender or pink skin. The infection also can form in the baby’s mouth from having contact with your nipples, and it appears as little white spots on the inside of the cheeks, gums, or tongue. It also can appear as a diaper rash on your baby that won’t go away by using regular diaper rash ointments. If you have any of these symptoms or think you have thrush, contact your doctor and your baby’s doctor, or a lactation consultant. You can get medication for your nipples and for your baby.

Important: If you still have sore nipples after following the above tips, you may need to see someone who is trained in breastfeeding, like a lactation consultant or peer counselor.

2. Challenge: EngorgementIt is normal for your breasts to become larger, heavier, and a little tender when they begin making greater quantities of milk on the second to sixth day after birth. Sometimes this fullness may turn into engorgement, when your breasts feel very hard and painful. You also may have breast swelling, tenderness, warmth, redness, throbbing and flattening of the nipple. Engorgement sometimes also causes a lowgrade fever and can be confused with a breast infection. Engorgement is the result of the milk building up, and usually happens during the third to fifth day after birth. This slows circulation, and when blood and lymph move through the breasts, fluid from the blood vessels can seep into the breast tissues.

All of the following can cause engorge ment:• poor latch-on or positioning• trying to limit feeding times or infre

quent feedings• giving supplementary bottles of wa

ter, juice, formula, or breast milk• overusing a pacifier• changing the breastfeeding schedule

to return to work or school • a change in the nursing pattern when

baby sleeps through the night or breastfeeds more during one part of the day and less at other times; or baby has a weak suck and is not able to nurse effectively; fatigue, stress, or anemia in the mother

• an overabundant milk supply• nipple damage• breast abnormalitiesEngorgement can lead to plugged ducts or a breast infection, so it is impor tant to try to prevent it before this happens. If treated properly, engorge ment should only usually last for one to two days.

Solution:• Minimize engorgement by mak

ing sure the baby is latched on and positioned correctly at the breast, and nurse frequently after birth. Allow the baby to nurse as long as he/she likes, as long as he/she is latched on well and sucking effectively. In the early days when your milk is coming in, you should awaken a sleepy baby every 2 to 3 hours to breastfeed. Breastfeeding often on the affected side helps to remove the milk, keep it moving freely, and prevent the breast from becoming overly full.

• Cold compresses in between feedings can help ease pain. Some women use



cabbage leaves to soothe engorgement. Although their effectiveness has not been proven, many women find them soothing. You can use either refrig er ated or room temperature leaves. Make sure to cut a hole for your nipple, apply the leaves directly to your breasts, and wear them inside your bra. Remove them when they wilt and replace with fresh leaves.

• If you are returning to work, try to pump your milk on the same schedule that the baby breastfed at home.

• Avoid supplementary bottles and overusing pacifiers.

• Try hand expressing or pumping a little milk to first soften the breast, are o la and nipple before breastfeeding, or massage the breast and apply heat.

• Get enough rest and proper nutrition and fluids.

• Also try to wear a well-fitting, supportive bra that is not too tight.

Important: If your engorgement lasts for more than two days even after treating it, contact a lactation consultant.

3. Challenge: Plugged Ducts and Breast Infection (Mastitis)It is common for many women to have a plugged duct in the breast at some point if she breastfeeds. A plugged milk duct feels like a tender, sore, lump in the breast. It is not accompanied by a fever or other symptoms. It happens when a milk duct does not properly drain, and becomes inflamed. Then, pressure builds up behind the plug, and surrounding tissue becomes inflamed. A plugged duct usually only occurs in one breast at a time.

A breast infection (mastitis), on the other hand, is soreness or a lump in the breast that can be accompanied by a fever and/or flulike symptoms, such as feeling run down or very achy. Some women with a breast infection also have nausea and vomiting. You also may have yellowish discharge from the nipple that looks like colostrum, or the breasts feel warm or hot to the touch and appear pink or red. Like a plugged duct, it usually only occurs in one breast. It is not always easy to tell the difference between a breast infection and a plugged duct because both have similar symptoms and can improve within 24 to 48 hours.

Solution:Treatment for plugged ducts and breast infections is similar, but most breast infections need to also be treated with an antibiotic.

• Soreness can be relieved by applying heat to increase circulation to the sore area and to speed its healing; you can use a heating pad or a small hotwater bottle. It also helps to massage the area, starting behind the sore spot. Use your fingers in a circular motion and massage toward the nipple.

• Breastfeed often on the affected side. This helps loosen the plug, keeps the milk moving freely, and the breast from becoming overly full. Nursing every two hours, both day and night on the affected side first can be helpful.

• Rest. Getting extra sleep or relaxing with your feet up can help speed healing. Often a plugged duct or breast infection is the first sign that a mother is doing too much and becoming overly tired.

• Wear a well-fitting supportive bra that is not too tight, since this can constrict milk ducts.

• If you do not feel better within 24 hours of trying these steps, and you have a fever or your symptoms worsen, call your doctor. You may need an antibiotic. Also, if you have a breast infection in which both breasts look affected, or there is pus or blood in the milk, red streaks near the area, or your symptoms came on severe and suddenly, see your doctor right away.

• Even if you need an antibiotic, continuing to breastfeed during treatment is best for both you and your baby. Most antibiotics will not affect your baby through your breast milk.

4. Challenge: Inverted, Flat, or Very Large Nipples Some women have nipples that naturally are inverted, or that turn inward instead of protruding, or that are flat and do not protrude. Inverted or flat nipples can sometimes make it harder to breastfeed because your baby can have a harder time latching on. But remember that for breast feed ing to work, your baby has to latch on to both the nipple and the breast, so even inverted nipples can work just fine. Very large nipples can make it hard for the baby to get enough of the areola into his or her mouth to compress the milk ducts and get enough milk.


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Solution: • Know what type of nipples you have

before you have your baby, so you can be prepared in case you have a problem getting your baby to latch on correctly.

• Talk with a lactation consultant at the hospital or at a breastfeeding clinic for extra help if you have flat, inverted, or very large nipples.

• Sometimes a lactation consultant can help inverted nipples to be pulled out with a small device before your baby is brought to your breast.

• In many cases, inverted nipples will protrude more as the baby starts to latch on and as time passes. The baby’s sucking will help.

• Flat nipples cause fewer problems than inverted nipples. Good latchon and positioning are usually enough to ensure that a baby latched to a flat nipple breastfeeds well.

• The latch for babies of mothers with very large nipples will improve with

time as the baby grows. In some cases, it might take several weeks to get the baby to latch well, but if a mother has a good milk supply, her baby will get enough milk even with a poor latch.

5. Challenge: Going Back to WorkMore and more women are breastfeeding when they return to work because they believe in the benefits of breastfeeding and can purchase or rent effective breast pumps and storage containers for their milk. Many employers are willing to set up special rooms for mothers who pump, but others are not as educated about the benefits of breastfeeding. Also, many women are not able to take off as much time as they’d like after having their babies and might have to return to work before breastfeeding is well established.

Solution: • After you have your baby, try to take

as much time off as possible since it will help you get breastfeeding well established and also reduce the number of months you may need to pump your milk while you are at work.

• If you plan to have your baby take a bottle of expressed breast milk while you are at work, you can introduce your baby to a bottle when he or she is around four weeks old. Otherwise, the baby might not accept the bottle later on. Once your baby is comfortable taking a bottle, it is a good idea to have dad or another family member offer a bottle of pumped breast milk on a regular basis so the baby stays in practice.

• Let your employer and/or human resources manager know that you

plan to continue breastfeeding once you return to work. Before you return to work, or even before you have your baby, start talking with your employer about breast feeding. Don’t be afraid to request a clean and private area where you can pump your milk. If you don’t have your own office space, you can ask to use a supervisor’s office during certain times. Or you can ask to have a clean, clutter free corner of a storage room. All you need is a chair, a small table, and an outlet if you are using an electric pump. Many electric pumps also can run on batteries and don’t require an outlet. You can lock the door and place a small sign on it that asks for some privacy. You can pump your breast milk during lunch or other breaks. You could suggest to your employer that you are willing to make up work time for time spent pumping milk.

• After pumping, you can refrigerate your milk, place it in a cooler, or freeze it for the baby to be fed later. Many breast pumps come with carrying cases that have a section to store your milk with ice packs. If you don’t have access to a refrigerator, you can leave it at these room tempera tures: 66º-72º F for up to ten hours or 72º-79º F for up to six hours.

• Many employers are not aware of state laws that require them to allow you to breastfeed at your job. Under these laws, your employer must set up a space for you to breastfeed and/or allow paid/unpaid time for breastfeeding employees. To see if your state has a breastfeeding law for employers, go to http://www.lalech-eleague.org/LawBills.html or call 1-800-994-WOMAN (9662).



6. Special Situations and Breastfeeding Some babies have conditions that may interfere with or make breastfeeding more difficult. But, in all of the following cases, breastfeeding is still best for a baby’s health.

Twins or MultiplesMothers of twins or multiples might feel overwhelmed with the idea of breastfeeding more than one baby at a time. The benefits of human milk to both these mothers and babies are the same as for all mothers and babies. But mothers of multiples get even more benefits from breastfeeding:

• Their uterus contracts, which is helpful because it has stretched even more to hold more than one baby.

• Hormones are released that relax the mother, which is helpful with the added stress of caring for more than one baby.

• Eight to ten hours per week are saved because there is no need to prepare formula or bottles and the mother’s milk is available right away.

• It is estimated that breastfeeding saves a mother of twins $2000 or more during the babies’ first year on feeding costs alone (La Leche League, 2003).

Breastfeeding early and often for a mother of multiples is important to keep up her milk supply. A good latchon for each baby is important to avoid sore nipples. Many mother find that it is easier to nurse the babies together rather than separately, and that it gets easier as the babies get older. There are many breastfeeding holds that make it easier to nurse more than one baby at a time. If you are having multiples, talk

with a lactation consultant about more ways you can successfully breastfeed your babies.

Breastfeeding after Breast SurgeryIf you have had had breast surgery, including breast implants, you might be worried about whether you will be able to breastfeed. The most important things that affect whether you can produce enough milk for your baby are how your surgery was done and where your incisions are, and the reasons for your surgery. For example, women who have had incisions in the fold under the breasts are less likely to have problems producing milk than women who have had incisions around or across the areola. Incisions around the areola can cut into milk ducts and nerves, where milk is produced and travels. And women who have had breast surgery to augment breasts that never fully developed may not have enough glands to produce a full milk supply.

If you had breast surgery and are worried about how it will affect breastfeeding, talk with a lactation consultant. If you are planning breast surgery and worried about how it will affect breastfeeding, talk with your surgeon about ways he or she can preserve as much of the breast tissue and milk ducts as possible.

Breastfeeding Made Easier at Home and WorkNo matter what type of job you have, if you go back to work after having your baby, it should be possible for you to take time to pump your breast milk. You can talk with your employer about why breastfeeding is impor tant, why pumping is necessary, and how you plan to fit pumping into your work schedule. Pumping while away from your baby on the same schedule that he or she breastfeeds ensures that you keep up your milk supply to meet your baby’s needs. If you are staying home to care for your baby, having an effective pump at home is also helpful. You can use it to help relieve engorgement, especially when your milk supply first comes in, or for when you need to be away from your baby for any amount of time, such as an evening out with your partner. If you have to temporarily take medication that may harm your baby, you can pump and discard your milk during this time. Call a lactation consultant and ask what medications are safe while breastfeeding.

• Prepare for pumping before you go back to work. Let your employer know that you are breastfeeding and explain that, when you’re away from your baby, you will need to take breaks throughout the day to pump your milk to give to your baby at a later time. Ask where you can pump at work, and make sure it is a private, clean, quiet area. Also make sure you have somewhere to store the milk. Discuss how you plan to fit pumping into your workday. You can offer to work out a different schedule, such as coming in earlier or leaving


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a little later each day to make up for any lost work time, if this comes up as an issue. If your day care is close by to your job, you may be able to arrange to breastfeed your baby during work time. Make sure to discuss the benefits of breastfeeding with your employer, especially that breastfeeding mothers miss fewer days from work. If your direct supervisor cannot help you with your needs, you should be able to go to your Human Resources department to make sure you are accommodated.

• Some mothers start pumping and storing their milk ahead of the time they will be returning to work in order to have a supply available for the first week when they are separated from the baby. The number of times you will need to pump your milk depends on the length of time you are away from your baby. But, it is usually not best to go for more than three hours without removing some milk from your breasts. If you are leaving a very young baby who eats very often, you may have to pump your milk more often at first so that your breasts do not become uncom fort able or leak.

• Expressing milk through pumping is a learned skill that’s both physical and psychological. It takes about the same time as breastfeeding, unless you are using a “double” automatic breast pump. The letdown reflex is important during pumping in order to express a good amount of milk. If you are having problems getting your milk to “letdown” at the start of pumping, you may find it helpful to have a picture of your baby closeby. You also can try other things to stimulate the letdown reflex, like applying a warm, moist compress to the breast, gently massaging the breasts,

or just sitting quietly and thinking of a relaxing setting. Try to clear your head of stressful thoughts. Use a comfortable chair or pillows. Once you begin expressing your milk, think about your baby.

• It is best to wash your hands before pumping your breast milk and to make sure the table or area where you are pumping is also clean. Each time you are done pumping, it is best to thoroughly wash your pumping equipment with soap and water and let it air dry. This helps prevent germs from getting into the breast milk.

Breastfeeding and Pumping AccessoriesClothing• You don’t have to buy a new ward-

robe to breastfeed. While no extravagant “breastfeeding clothing” is necessary, you should try to wear clothing that will make breastfeeding and/or pumping easier. Wearing jumpers or onepiece dresses are not as convenient as a blouse or twopiece outfits. Nursing bras and nursing clothes, like blouses that have hidden openings near your chest, are avail

able but are not necessary.

• You can buy disposable or cloth breastfeeding pads to line your bra. These help prevent any leaking from soaking through your blouse. The disposable pads can be thrown away, and the cloth pads can be tossed in the washing machine and used again.

• If you want to breastfeed your baby in public, you can use a receiving blanket or a breastfeeding blanket that discreetly covers your chest and your baby’s upper body.

Pumps• There are several types of breast

pumps available. Some are manual, or require you to use your hand and wrist to squeeze a bulbtype device to pump the milk. There also are automatic pumps that run either on battery or hook up to an electrical outlet and automatically simulate your baby’s natural sucking action. These pumps are easier to use, and do not require a lot of practice or skill. They can collect more milk in less time; however, they cost a lot more than manual pumps (around $150 to $200).

• Think about your pumping needs before you buy a breast pump. If you plan on going back to work, either fulltime or parttime, it may be worth investing in a automatic pump. If you plan to never be away from your baby except for an occasional outing, you may want to use a hand pump or hand express the milk without a pump. Both hand expressing and using a hand pump require practice, skill, strength and coordination.

• Pumps also come in “single” or “double,” meaning you can either



pump the milk from one breast or from both breasts at the same time. Most electric pumps are double pumps, but you can choose whether to pump one or both breasts at the same time.

• Although many breast pumps look different, they all operate in basically the same way. Each comes with a plastic “shell” that covers your nipple and breast, that is also connected to tubing that carries the milk from your breast to a bottle or bag that collects the milk. Experts caution against using the “bicycle horn” type of pump because it cannot be sterilized, can be ineffective, and can cause damage to breast tissue.

• Most automatic pumps come in convenient, discreet carrying cases that match your other accessories you may carry to work, such as your purse or briefcase.

• If you purchase a pump, make sure to follow the manufacturer’s instructions for cleaning and caring for the equipment. Some pumps can be purchased at baby supply stores or general department stores, but most highgrade, professional quality automatic pumps have to be purchased or rented from a lactation consultant at a local hospital, or from a breastfeeding organization

Storing Breast MilkIt is important to know the guidelines for storing breast milk properly so that you always give your baby fresh milk. Any container used to store milk should be clean and sterile. Always try to leave an inch or so from the milk to the top of the container since frozen

milk expands. After pumping your milk, it is helpful to label the storage container. Always use the oldest dated milk first.

It is helpful to freeze the milk in small amounts, such as 2 to 4 ounce servings, so there is less waste and you can choose the amount of milk depending on the baby’s hunger.

Bottles and ContainersYou can store breast milk in bottles that fit directly onto your breast pump. After pumping, simply remove the pumping tubing, cover with the bottle lid, label the milk, and put it in the refrigerator. Many breast pump carrying cases also come with builtin, coolertype compartments for storing ice pack and/or the freshly pumped bottles of milk. If used correctly, these do stay cold enough to leave your pumped milk in until you can get home to store the milk in the refrigerator or freezer.

Research is conflicting about the advantages and disadvantages of storing milk in glass versus plastic. However, glass bottles or containers are best for freezing breast milk because it offers the most protection from contamination. The second choice is clear, hard

plastic, and the last choice is the cloudy hard plastic containers. Wait to tighten the caps or lids until the milk is completely frozen.

Storage BagsIf you want to freeze your breast milk in bags, you can purchase storage bags that fit directly onto your breast pump and that are made for freezing milk. They are presterilized, thick, have an area for labeling, and seal easily. After pumping, simply remove the pumping tubing, fold the bag over, making sure all air is out of the bag, and seal it. Make sure to label the bag with the date before freezing. When you want to use the milk, you can cut the storage bag with sterile scissors. If the storage bag has a builtin pouring spout, it is easy to pour the milk into a bottle. Other storage bags can be used in the kind of bottle that uses disposable liners, so there is no need to transfer the milk.

Thawing and Handling Stored Breast MilkIt is normal for stored breast milk to separate in its container into two parts, what looks like cream and then

Breastmilk Storage (for Healthy Term Babies) Self- Cooler with contained Room 3 Frozen Refrigerator Deep Temperature Ice Packs Refrigerator Freezer Unit Freezer

Freshly 4 hours at 24 hours 5-7 days at 3-4 6-12 monthsexpressed 66-72ºF at 59ºF 32-39ºF months at 0ºFbreastmilk (19-22ºC) (15ºC) (0ºC) (–19ºC)

Thawed Do not Do not 24 hours Never Neverbreastmilk store store refreeze refreeze(previously thawed thawedfrozen) milk milk


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a lighter colored milk. Some human milk also varies in color and can be blueish, yellowish, or brownish. Just gently shake the milk before feeding to mix it back together.

Breast milk doesn’t take long to thaw or warm up. Never place a bottle or bag of breast milk in the microwave. Milk doesn’t heat uniformly in the microwave, so you won’t have control over the temperature and could burn your baby. All you have to do is hold the bottle or frozen bag of milk under cool and then warm water for a few minutes. If warm running water is not available, you can heat up a pan of water on the stove. Remove the pan from the heat and place the container into the warm water. Never warm the container directly on the stove. Shake the milk, then test it on your wrist to see if it’s warm enough for your baby. Once frozen milk is thawed, it can be refrigerated, but not refrozen.

What About Dad?Most fathers are in favor of breastfeeding, but they also say it sometimes makes them feel left out. Here are some tips that have helped other dads get involved with their babies right away. You may not know it, but simply being male gives you some readymade fathering instincts your baby is going to love.

Your deep voice is soothing. Babies really seem to respond and relax when they hear the deep, rumbling sound of a male voice. Talk and sing to your baby.

Your wide, flat chest is a great place for your baby to nap when you lie down to read or rest, and also makes carrying your baby in a soft baby carrier easy.

Your skin feels good to your baby, and he’s going to want lots of skintoskin contact. Make bath time your time. Change diapers often. Just hold him against your bare arms and chest.

Your strong arms and hands are perfect for the football hold, or colic hold, when your baby is fussy. Tuck her against your body like a football, her tummy on your forearm, head in the crook of your elbow. Grasp her diaper firmly while your arm and palm press on her tummy. Sway back and forth, rock, or dance.

Make room for private dadandbaby time. Spend time just watching his sounds and movements so you can learn to read his cues and understand what he wants.

Just hang out. Go for walks with the stroller, go shopping, take trips to the hardware store; do as much as you can to be together.

Have fun! Dads are usually more playful and physical, and, as your baby grows, he’ll look forward to that

special dadplay.

Just be yourself! Dads have their own unique ways of caring, and babies love it. Studies show that fathers who actively take care of their newborns can be just as nurturing as moms.

Take Care of MomStudies show that the more supportive their partners are, the longer women breastfeed and the more confident they feel. As one husband said, “I can’t breastfeed, but I can create an environment that helps my wife breastfeed better.”

Be her champion! Remember to tell her she’s doing a great job and that breastfeeding is getting your baby off to a good start in life. If lack of sleep or hormonal changes get her down, crank up your level of enthusiasm. Breastfeeding is hard work. Make it easy for her. Take on chores you usually don’t do. Run interference from any negative comments about breastfeeding from friends and relatives.

Later on, you can feed your baby with breast milk in a nurser, but wait at least four weeks before introducing a nurser so your baby will have a chance to get completely comfortable with breastfeeding.

What’s In It For You?Breastfeeding is not only healthier and better for your wife and baby; it’s easier for you:

• No preparation.• No bottles to wash.• Breast milk is free.• Breast milk never runs out.



• Less-smelly diapers.• No night feedings.• Less baby equipment (bottles,

cans) for you to lug around.• You’ll feel good. More and more

moms are telling dads, “I couldn’t do it without you.”

Spend Time Along With Your WifeHonest, open communication between you and your wife is the surest way to make breastfeeding joyful and positive for everyone. If you run into a problem, talk it out. Let each other know how you’re feeling, both good and bad, and how you can help each other. Don’t forget humor and patience.

Consciously plan adult time together when your baby is asleep. Spend time away from your baby, even if it’s just for an hour or two.

A Word To MomsYou can do a lot to help your husband get over feeling left out. Look for ways to involve him. Encourage private dadandbaby time. Be positive and encouraging. Don’t hover, criticize, or give unsolicited advice. Let dad discover his own inventive ways of nurturing.

Arrange support for dad, too. Let your mother or motherinlaw spoil him a little.

Courtesy of Playtex MOM Program


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Car Seat SafetyEvery state requires that infants and children ride buckled up. Using a car safety seat correctly can help prevent injuries to your infant. The biggest mistake new parents make is keeping the new car seat they received as a shower gift in the box.

It is a good idea to practice installing and adjusting the car seat before the birth of your baby. If you have trouble at first, you have time to practice and get the proper help that you need. Look for a Safety Inspection Site.

It is your responsibility to know the proper installation of your baby’s car seat. Go to a car seat safety class at your hospital or clinic. If they do not offer this class, check with your car dealership to see if they can guide you to a class. The National Highway and Traffic Safety website, www.nhtsa.gov, has child safety inspection station locations. Take the time to know how important it is for proper installation of the seat, harnesses and buckles, and how to position them. Car seats can be hard to install and use correctly without instruction and help. It is a good idea to practice installing and adjusting the car seat before the birth of your baby. If you have trouble at first, you have time to practice and get the proper help that you need.

A baby needs a safety care seat from the moment he takes his very first ride home from the hospital.

Although you may feel like it is safer to hold that baby in your arms, it is not!

An infant car seat should state that it complies with the Federal Vehicle Safety Standard 213.

The law states that all infants must ride rearfacing until one year and 20 pounds. The AAP and some safety advocates recommend that they continue to ride rearfacing as long as possible, and to the uppermost weight limits of the convertible seat, which is usually 30 to 33 pounds. This is to promote continued head and neck safety in the event of a crash.

The ‘best’ car safety seat is one that fits your newborn and can be set up in the right way for your car. You must use it every time you take your baby in the car. Using a car seat correctly makes all the difference in the world. It does not matter if it is the most expensive; if it is not installed properly, it may not protect your baby.

Take the time to review the following points and remember take a minute to check and be sure:

• An infant in a rear-facing seat should not be placed in front of an active airbag.

• The safest place is in the middle of the back seat (depending on the car).

• Infants should remain rear-facing to the upper limits of the car seat, or, at a minimum, until the child is over one year and over 20 pounds.

infant-only seats may come with more than one harness slot. This al-lows room for your baby to grow. in the rear-facing position, the harness should usually be in the slots at or be-low your baby’s shoulders. Check the car safety seat manufacturer’s instruc-tions to be sure.



Using Your Infant Car Seat CorrectlyTightly install child seat in back seat, facing the rear. The infant seat should not move more than an inch sidetoside at the seat belt pathway.

The infant seat should recline at approximately a 45degree angle.

Harness straps/slots at or below shoulder level (lower set of slots for most convertible child safety seats).

Harnesses should be a snug fit. You should only be able to fit one finger between your child and the harness.

Be careful about attaching toys to harness straps or using mobiles to keep the infant occupied. The addition of hard objects is not recommended, as they can injure the child in the event of a crash or sudden stop.

Are You Using A Second-Hand Car Safety Seat? Double-Check Everything!A new car safety seat is best. However, if you must get a used seat, shop very carefully. To tell if a used car safety seat is safe, keep the following points in mind.

Do not use a car safety seat that is too old. Look on the label for the date it was made. If it is more than five years old, it should not be used. Some manufacturers recommend that car safety seats only be used for five to six years. Check with the manufacturer to find out how long the company recommends using their seat.

Do not use a car safety seat if you do not know its full history. A car safety seat that has been in a crash may have been weakened and should not be used, even if it looks fine.

Do not use a car safety seat that does not have a label with the date of manufacture and seat name or model number. Without these, you cannot check on recalls.

Do not use a car safety seat that does not come with instructions. You need to know how to use the car safety seat. Do not rely on the former owner’s directions. Get a copy of the instruction manual from the manufacturer before you use the seat.

Do not use a car safety seat that has any cracks in the frame of the seat or is missing parts. Used car safety seats often come without important parts. Check with the manufacturer to make sure you can get the right parts.

Has the Car Safety Seat Been Recalled?You can find out if a car seat has been recalled by calling the manufacturer or the Auto Safety Hot Line at 888/DASH2DOT (888/3274236), from 8:00 am to 10:00 pm ET, Monday through Friday.

If the infant car seat has been recalled, follow the instructions to fix it or return it. Another good resource is NHTSA at www.nhtsa.gov. Get a registration card for future recall notices for your model. Send in your registration card.Courtesy of The Joy of Parenthood, Your Personal Journey Through Newborn Care.


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You’ve made it through your first 24 hours as a new mom. Perhaps you have other children, but you are a new mom all over again and now it is your baby’s second night.

All of a sudden, your little one realizes this is no longer the warm and comfortable (albeit a bit crowded) womb, home for the last nine months . . . and it’s scary out here! There’s no longer the familiar sound of your heartbeat, the swooshing of the placental arteries, the soothing sound of your lungs, or the comforting gurgling of your intestines. Instead, baby’s plopped in a crib, swaddled in a diaper, a teeshirt, a hat and a blanket. All sorts of people have been visiting, and there are so many new noises, lights, sounds and smells. The easiest way to react is to use that new little voice! Every time baby drifts off to sleep at the breast and you try that gentle transfer to the bassinet, it’s met with a loud protest!

So you put your baby back on the breast, and after nursing for a little bit, it’s back to sleep again. Try to put the drowsy little one back in bed, and the crying begins anew as baby starts rooting around, looking for you. This goes on seemingly for hours. A lot of moms are convinced it is because their milk isn’t “in” yet, and baby is starving. However, that isn’t it; it’s the baby’s sudden awakening to the fact that the most comforting and comfortable place to be is at the breast. It’s the closest to “home” baby can get. This

seems to be generally universal among babies. Lactation consultants all over the world have noticed the same thing.

So what do you do? When baby drifts off to sleep at the breast after a good feed, break the suction and slide your nipple gently out of that little mouth. Don’t move baby except to pillow that precious head more comfortably on your breast. No burping is necessary; just snuggle together until baby falls into a deep sleep and won’t be disturbed by being moved. Babies go into a light sleep state (REM) first, then cycle in and out of REM and deep sleep about every halfhour or so. If baby starts to root and act as if wanting to go back to the breast, that’s fine; this is a good way of settling and comforting.

Another helpful hint: In utero, baby’s best friends were those two little hands, with thumb or fingers handy to suck on any time there was any feeling of discomfort or anxiety. Now suddenly, that’s all taken away and

someone has put mittens on those hands! There’s no way to soothe yourself with those mittens on. Babies need to touch, to feel, and even baby’s touch on your breast will increase your oxytocin levels, which will help boost your milk supply! So take the mittens off and loosen the blanket so baby can get at those hands. Yes, there might be a scratch or two, but it will heal very rapidly. After all, baby had fingernails even when growing inside you, and no one put mittens on those hands then!

By the way, this might happen every once in a while at home too, particularly if you’ve changed the baby’s environment by going to the doctor, to church, to the mall, or to the grandparents’. Don’t let it throw you; sometimes babies just need some extra snuggling at the breast, because for the baby, the breast is “home.”

Baby’s Second Night by Jan Barger, RN, MA, IBCLC/Lactation Education Consultant



ResourcesMarian regional Medical Center homeCare . . . . . . . . . . . . . . phone number Postpartum Home Visit Program . . . . . . . . . . . . . . . . . . . . . . . .(805) 7393830

Marian regional Medical Center “NurtureLine” . . . . . . . . . . . . . . .(805) 7393388 Breastfeeding Information, Resources, Consultation Breastfeeding Consultant Monday through Friday 8:00 a.m. to 4:00 p.m.

Marian “Baby-Safe” infant Safety and CPr Classes . . . . . . . . . . (805) 349BABY

Parenting Classes (by Allan Hancock College) . . . . . . . . . . . . . . . (805) 349BABY

Marian home with Baby Class for New Parents . . . . . . . . . . . . . . (805) 349BABY

Marian NewLife Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(805) 3492273 Adoption, counseling, crisis pregnancy

Welcome Every Baby Program Newborn Home Visit/SOJOURN Services . . . . . . . . . . (805) 6149535, x13

WiC–Women, infant, Children (Santa Maria Clinic) . . . . . . . . . . (805) 3468450

Car Seat inspections CHP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (805) 3498728 Vandenberg Air Force Base Safety Office (Military personnel only) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (805) 6068806

Car Seat hotline: Santa Maria Police Dept. . . . . . . . . . . . .(805) 9283781, x993 Call for an appointment

Catholic Charities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(805) 9222059

Good Samaritan Services and First Steps . . . . . . . . . . . . . . . . . . . (805) 3468185 Assisting women and families with drug dependencies

Children’s resource and referral information Center . . . . . . . . .(805) 9251989

Depression After Delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18009444773 Support/help website: www.depressionafterdelivery.com

Emergency NumbersAmbulance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-1-1Poison Control Center . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-800-876-4766Marian regional Medical Center Emergency room . . . . . . . (805) 739-3200health Department . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (805) 346-7230Breastfeeding Assistance . . . . . . . . . . . . . . . . . . . . . . . . . (805) 739-338824-hour Crisis helpline . . . . . . . . . . . . . . . . . . . . . . . . . . (805) 928-5818 Crisis intervention and counseling, dealing with issues

such as suicide, addiction, family problems, depressionYour Pediatrician . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ______________(selected by you)

When to Call Your DoctorCall your baby’s health care provider if your baby:• Has a temperature of 101ºF rectally (or

above) or below 98º F rectally.• Has redness, pus or foul odor around or

from the umbilical cord stump.• Vomits forcefully, i.e., projectile vomit

ing—not just spitting up.• Refuses several feedings in a row.• Does not awaken or is difficult to awaken

for feedings.• Is listless or weak.• Continues to cry constantly, even after

being fed, changed, burped, cuddled and you are assured that your baby is warm enough.

• Has frequent, loose, watery and foul smelling stools (over 12 per day)

• Has obvious bleeding (other than vaginal spotting by baby girls).

• Has a convulsion (seizure).• Develops a rash (other than minor diaper

rash or newborn rash).• Has jaundice that becomes worse (skin

and whites of the eyes become more yellow).

• Has breathing abnormalities (continues grunting with each respiration, very rapid breathing, chest retractions, coughing).

• Changes in color—pale, flushed or blue.• Has not urinated in 24 hours.• Has yellow or green draining from one or

both eyes or eyes are red and/or swollen.• Circumcised baby boy:— Has redness surrounding his penis,

bleeding or pus from the circumcision site.

— Does not urinate within 12 hours after circumcision; or

— Has a plastic ring that does not fall off within 8 days or the ring slips on to the shaft of the penis.


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