Book One - Pregnancy Through Age 1

Happy Birthday Baby Book OneA New and Improved Happy Birthday Baby Book

An updated, pocket-size Happy Birthday Baby Book that’s expanded to include all of the topics mothers and mothers-to-be have told us they wanted.

The book guides you through your journey from pregnancy to age one with helpful information on everything from nutrition, doctor visits, bringing baby home and caring for your new baby. 

Almost 400,000 Arkansas and western Tennessee women have requested the Happy Birthday Baby Book since its inception in 1992.

A Word to Moms...

Congratulations! Having a baby is one of the most exciting yet difficult journeys you will ever take. This book will help guide you through the ups and downs of pregnancy and new motherhood. It gives you tips on taking care of yourself and your baby. Begin by seeing your doctor regularly during pregnancy. This is called prenatal care. 

The things you do or don’t do will make a big difference in your baby’s health. This book explains what you should do during each stage of pregnancy and what to expect once your little one arrives. While no one can be sure you will have a perfect baby, here are some things you can do:

  • See your doctor early in your pregnancy and keep regular checkups. 
  • Ask your doctor before taking any medication. 
  • Drink plenty of water each day.
  • Eat a balanced diet of fruits, vegetables, whole grains, low-fat milk products and lean meats, fish or other proteins.
  • Take your prenatal vitamins every day.
  • Cut back on coffee, switch to decaf or try herbal or decaffeinated tea.
  • Do not drink alcohol, smoke or take illegal drugs.
  • Wash your hands often to avoid infections. 
  • Don’t stress out! Find ways to relax.
  • Take care of your teeth.
  • As soon as possible, find someone you trust who can help you take care of yourself and, later, your baby. You will need support throughout your pregnancy and after your baby is born.

Your baby depends on you. Make good choices for both of you.

A Word to Dads...

Dad with babyFatherhood is a wonderful adventure that begins the moment you bring your little one home. But it also can be a demanding job and difficult adjustment. Many new fathers express concerns about their relationship with their wife or partner, worry about changes in their routines and fears that they won’t be able to pay for everything a newborn needs. Whether you live with the mother or not, you may also find that it is a struggle to cope with the hours of newborn crying.

For more information on how to cope with crying, see the “Crying Plan” section here.

It is essential that you learn to cope with the crying because the role of the father is extremely important in the care of your newborn. Being involved from the start helps you contribute positively to the growth and development of your baby. Once you adapt to the role of caregiver, you will find the time you spend with your child is quite special. Men should be proud to be good and involved fathers.

Still, some fathers are not ready for the responsibility and may decide to wait until their baby is older before they get involved. You should understand that your wife or partner and your baby need you. After delivery, mothers need time to recover, and they may be just as inexperienced at caring for a child as the fathers. Sharing in this new responsibility will bring you closer together as parents and will help build a bond between you and your child that will last a lifetime. 

Resources

 

Insurance for You and Your Baby

Medicaid

Many women in Arkansas and Tennessee, along with their babies, qualify for medical coverage under Medicaid (an insurance program funded by state and federal governments).

Medicaid covers the cost of:

  • All checkups during pregnancy and immediately afterward.
  • Baby's delivery at the hospital.
  • All the checkups your baby will need during his first year.

If you are an Arkansas resident already covered by Medicaid, you may need a primary care physician (PCP). To get a list of PCPs, or for more information about Medicaid, call the ConnectCare hotline at 1-800-275-1131 or go to www.seeyourdoc.org.

Four different babies in a row.

ARKids First (for Arkansas residents)

ARKids First is Arkansas’s Medicaid program providing health insurance to uninsured children. The program offers two coverage options. ARKids A offers children in low-income Arkansas families a comprehensive package of benefits. ARKids B provides coverage for children in families with slightly higher incomes. You can apply for ARKids A or B through the mail or online without having to visit a Department of Human Services (DHS) office. For more information or to get an application, call 1-888-474-8275 or go to ARKidsFirst.com or access.arkansas.gov.

TennCare (for Tennessee residents)

TennCare is Tennessee's Medicaid-managed care health insurance program. Many low-income pregnant women in Tennessee, and their babies, may qualify for TennCare. Children under age 21 may also qualify. Under TennCare, members enroll with a managed care organization (MCO). Once you are enrolled, your MCO will help you find a prenatal care provider. If you think you may qualify, contact your local health department as soon as possible for information and an application. In Shelby County, call 901-545-8722 for assistance or go to www.tn.gov/tenncare/.

Health Insurance Marketplace

Many people may qualify for affordable health care through the Health Insurance Marketplace. Financial assistance may even be available to help cover the cost. To find out if you are eligible in Arkansas, visit www.arhealthconnector.org (http://www.arhealthconnector.org) or call 855-283-3483. In Tennessee, visit https://www.healthcare.gov/marketplace/individual or call 1-800-318-2596.

 

WIC

WIC is a special nutrition program for women, infants and children that:

  • Helps pregnant, postpartum and breastfeeding women, new babies and children up to age 5 get the good foods they need.
  • Provides encouragement and support for breastfeeding.
  • Provides foods such as milk, eggs, cheese, juice and cereal.
  • Gives tips on planning and eating healthy meals.

How do I qualify?

  • Meet income guidelines 
  • Have a nutrition risk such as anemia (low iron), poor diet or diabetes 
  • Be pregnant and/or have children under age 5

WIC can be a very important resource for you and your family, so make an appointment today. To find out more about WIC and the clinic nearest you in Arkansas, call 1-800-235-0002; in Tennessee, call 901-222-9750 for Shelby County information. Outside Shelby County, call 1-800-DIAL-WIC (1-800-342-5942).

 

Helping Your Baby Grow

Healthier eating means a healthier pregnancy 

ChooseMyPlate.gov graphicThere are so many resources available to help you do the right things throughout your pregnancy and after. You can get your own interactive Daily Food Plan for Moms by visiting www.choosemyplate.gov. Your plan will show you the foods and amounts that are right for you. Enter your information for a quick estimate of what and how much you need to eat. 

Or, go to the Food Planner for Moms to see how your food choices compare to what you need.

Feet on scale

When it comes to food choices, remember that women who eat well and avoid known risks tend to have fewer complications during pregnancy and labor, and are more likely to deliver larger, healthier babies.

Gaining some weight

Weight gain is an important part of a healthy pregnancy. The nutritious food you eat helps your body support your growing baby. During your pregnancy, you’ll probably gain 25 to 35 pounds. If you’re very thin, you may need to gain a little more.

Usually, you will gain about 3 to 4 pounds during the first three months of pregnancy and will have gained about 10 pounds halfway through your pregnancy (20 weeks). After that, you will gain about one pound a week for the rest of your pregnancy. 

Where the weight goes chart

Food cautions

Certain raw or undercooked foods can make you ill and hurt your growing baby. While you are pregnant, don’t eat:

  • Alfalfa sprouts.
  • Raw eggs, raw fish, raw clams or raw oysters.
  • Unpasteurized milk and soft cheeses such as Brie and feta.
  • Hot dogs and deli meats.
  • Rare ground beef, chicken or sausage. 
  • More than 6 ounces per week of (white) tuna, due to high levels of mercury.

Fish that are low in mercury include shrimp, canned light tuna, salmon and catfish.

Danger Signs In Pregnancy

Call your doctor or nurse or go to the emergency room right away if the following danger signs occur:

  • Bleeding, no matter how little, from the vagina, rectum or nipple, or coughing blood
  • Blood pressure above 140/90 with sudden swelling or puffiness of the face or hands
  • A sudden, large weight loss or weight gain
  • Dimness, blurred vision, flashes of light or spots before your eyes
  • Sharp or prolonged pain in your abdomen
  • Severe or continued vomiting
  • Chills and/or fever over 100.5°F
  • A sudden release of fluid from the vagina
  • Painful urination
  • A watery or smelly vaginal discharge

Substance Use/Abuse in Pregnancy

During pregnancy, nearly everything you ingest passes from your blood to your baby. Many moms-to-be don’t realize that nicotine, alcohol and other drugs (legal or illegal) go straight to their unborn babies and can cause great harm. Use of tobacco, alcohol and other drugs (marijuana, cocaine, heroin, crack, speed, etc.) by a pregnant woman can cause birth defects and health issues, as well as learning and emotional problems in her baby. 

You should avoid all alcohol, recreational drugs, over-the-counter and nonprescription drugs (even ibuprofen). You should only take prescription drugs that are prescribed to you by a doctor who knows you are pregnant. Talk with your doctor or nurse for more information about the effects of smoking, drugs and alcohol on you and your baby. 

 

Smoking: Quit Now, Quit for Good

If you are a smoker, stop smoking now. Studies have shown babies born to mothers who smoke tend to be premature, have a lower birth weight and are more likely to die of sudden infant death syndrome (SIDS). 

In addition, women with exposure to secondhand smoke are more likely to have babies with low birth weight.

If you’re ready to quit smoking, call this toll-free Quit Line: 1-800-QUIT-NOW or 1-800-784-8669.

 

Abuse

Hands forming heart over pregnant bellyArguments are common, but violence is never OK. Still, many women experience physical or mental abuse at the hands of their boyfriends or spouses. Pregnancy likely won’t protect you from abuse. In fact, the stress associated with having a new baby can sometimes trigger violent behavior. If your partner is physically or emotionally abusing you, know that you are not alone. Studies show that one in six pregnant women is abused. The first step toward getting out of an abusive relationship is admitting that your partner or spouse is abusive. Call the National Domestic Violence hotline at 1‑800‑799‑SAFE (7233) for help.

Ask yourself, does your partner:

  • Always put you down or make you feel bad about yourself?
  • Cause harm or pain to your body?
  • Threaten you, the baby, your other children or himself?
  • Tell you it’s your own fault he hit you?
  • Promise never to hurt you again, but still does?

If any of these things is happening, you may need to seek help. It is important that you and your children are safe. Abuse can cause long-lasting physical and emotional problems for both you and your unborn baby. Physical violence during pregnancy can cause vaginal bleeding, premature labor, miscarriage, fetal injury or even death. Children who witness abuse are at risk of becoming violent themselves or being in a violent relationship when they get older.

Protect yourself and your unborn baby.

Miscarriage

A miscarriage is the sudden, natural loss of a fetus before the 20th week of pregnancy. Most miscarriages are caused by genetic problems that make it impossible for the baby to develop. 

About 15 to 20 percent of women who know they are pregnant will miscarry. Most miscarriages occur during the first seven weeks of pregnancy. The rate of miscarriage drops after the baby’s heartbeat is detected. The risk for miscarriage is higher in women between 35 and 40 years old, and highest with women who are older than 40 and have had previous miscarriages.

Couple holding handsThe primary symptom of miscarriage is vaginal bleeding – sometimes accompanied by period-like cramps or more severe abdominal pain. However, many women experience vaginal bleeding (spotting) in early pregnancy and most do not miscarry. Contact your doctor if you experience any bleeding. 

Don’t attempt to become pregnant again until you are physically and emotionally ready. Medically, it appears safe to conceive after a woman has had one normal period (if she is not undergoing tests or treatments for the cause of her miscarriage), but emotionally, it may take much longer.

You and your partner may react differently to the loss of a baby, but you both need the support of each other, your families and friends. You may want to speak to others who have shared the same experience. Talk to your doctor if you think professional counseling may be needed. You can also visit www.nationalshare.org to find a support group in your area. 

Almost all women go on to have a healthy pregnancy after a miscarriage. 

 

Due Dates and Trimesters

Due dates and trimesters. Your doctor will help you determine your expected due date at your first prenatal visit. Your due date is 40 weeks from the first day of your last period. It’s important to remember that your due date is only an estimate – most babies are born between 38 and 42 weeks from the first day of their mom’s last period, and only a small percentage of women actually deliver on their due date. 

Another term you’ll hear throughout your pregnancy is trimester. A pregnancy is divided into trimesters:

  • First trimester is from week 1 to the end of week 12 (months 1–3).
  • Second trimester is from week 13 to the end of week 28 (months 4–7).
  • Third trimester is from week 29 to your delivery (month 8–delivery).

Your First Trimester

Your lifestyle

An average pregnancy lasts 280 days or 40 weeks. Take good care of yourself by eating well and exercising safely, to help provide for your baby’s good health and your own for the next nine months. Here are few other lifestyle tips to consider:

Woman showing safe exercise techniqueExercise. If you exercise regularly, keep it up, but talk to your doctor about how much is too much. If you don’t exercise, talk to your doctor about getting started. After your first trimester, don’t do activities that make you lie flat on your back.

Sex. Let your partner know how you feel about sex during pregnancy. Many women feel an increased interest in sex during some stages of pregnancy. Tell your doctor if you or your partner have a sexually transmitted disease.

Some STDs, like syphilis, can infect a baby while in the womb. Others, like gonorrhea, can be transmitted to the baby as he passes through the birth canal. So it is important you get treatment for STDs.

Car Safety. Always wear your seat belt, even during the late months of pregnancy. To provide the best protection for you and your baby, the shoulder harness should go between your breasts, and the lap belt should go snugly (yet comfortably) under your belly. 

Lifestyle cautions

Over-the-counter medicines. Don’t take aspirin, ibuprofen, laxatives or any over-the-counter medicine (including nasal spray) without your doctor’s permission.

Hot tubs. Sitting in hot tubs any time during pregnancy can cause you to overheat and lower your blood pressure, which can harm your baby’s oxygen supply.

Cat litter. Cat litter can contain a parasite that causes an infection called toxoplasmosis, which causes birth defects. To be safe, let someone else change the cat litter during your pregnancy.

 

Woman drinking from water bottle

Your body

Your body is making some big changes to nurture the baby you will carry for the next nine months. Some of these changes will go unnoticed; others will be very clear and present. By the end of your first trimester, your body will be producing more pregnancy hormones, and as your blood volume increases, people may begin saying you have a certain glow about you. 

Nausea. Also called “morning sickness,” nausea may occur off and on all day. Most women do not experience any morning sickness after the first trimester (or week 13).

To ease nausea:

  • Eat crackers or dry toast before you get out of bed. 
  • Avoid greasy or spicy foods, and cut back on caffeine in teas, coffee and soft drinks.
  • Eat several small meals a day. 
  • Call your doctor for help if your nausea is severe. 

Tender breasts. Increased hormones may make your breasts more sensitive. They may feel heavier and fuller. Wearing a supportive bra may make you more comfortable. 

Fatigue. You will probably feel very tired in the first few months of pregnancy. Rest when you can to protect yourself and your baby.

Constipation. Your digestion has slowed to allow nutrients to reach your baby. Bowel movements may become less frequent and hard to pass.

To avoid constipation:

  • Eat a high-fiber diet.
  • Drink eight to 10 glasses of water a day.
  • Get regular exercise, even if only a short, brisk walk.

Working pregnant: Your rights and responsibilities

It is your right to continue working during pregnancy. Women who like their jobs, are in good health, work in safe jobs and are having healthy pregnancies often continue working right up to their due dates. Others report that working becomes too difficult or uncomfortable. Here are some tips:

  • Go to bed early.
  • Allow more time in the morning to get ready for work.
  • Snack often to help ward off morning sickness.
  • Avoid things that make you queasy.
  • Avoid fatigue, muscle tension and fluid buildup in your feet and legs by taking short “moving” breaks every so often. 
  • Cut back on after-work activities.
  • Exercise and eat foods rich in iron and protein.
  • Avoid lifting heavy objects. Ask for help.
  • Control stress by relaxing and sharing frustrations with a partner or friend.

Workplace risks to avoid

Certain working conditions may increase your risk of complications during pregnancy – especially if you’re at high risk of preterm labor. Avoid:

  • Exposure to harmful substances.
  • Excessive working hours.
  • Prolonged standing.
  • Heavy lifting.
  • Excessive noise.
  • Heavy vibrations, such as from large machines.
  • High stress.
  • Activities that require agility and good balance may become more difficult later in pregnancy.

If you’re concerned about any of these issues, talk to your doctor. 

Talk to your employer or human resources department about maternity leave and the Family and Medical Leave Act (FMLA). This act requires companies to allow up to 12 weeks of unpaid leave for employees (of companies with more than 50 employees) to care for a newborn or newly adopted child. 

Eating well

A healthy pregnancy and a healthy baby depend on eating the right foods. Many women are fearful of gaining weight (and losing their figures) during pregnancy. It is critical to your health and your baby’s to eat well during pregnancy. The weight you gain supports your pregnancy and developing baby and will come off after the baby is born, especially if you eat healthy foods and breastfeed your baby. 

But diet alone, even a balanced one, won’t give you all the vitamins and nutrients your baby needs. So, when you see your doctor at your first prenatal visit, he or she probably will prescribe folic acid and a prenatal vitamin high in iron, calcium and other vitamins and minerals. You will take these throughout your pregnancy. 

Month 1: Weeks 1-4

Doctor visits

Your first exam…what to expect 

Regular visits to your doctor help make sure you and your baby stay healthy. Your first appointment is likely to last longer than any other. You may feel excited and nervous at this first visit. It’s OK to bring someone with you to the appointment.

You should be prepared to talk about:

The date of your last period so a due date and later testing schedule can be made.

Your medical history, including any chronic conditions, allergies, previous pregnancies or miscarriages, and medications you’re taking.

Your family medical history, including diseases such as diabetes or kidney disease, as well as genetic defects like Down syndrome.

Your lifestyle, including whether you smoke, drink alcohol or are around toxic substances at home or at work.

If you have health insurance, find out what expenses are covered. If you don’t have health insurance in Arkansas, check with ConnectCare at 1-800-275-1131 (www.seeyourdoc.org) for additional help during your pregnancy. Tennessee residents should contact their local health department, contact Cover Kids at CoverTN (1-866-CoverTN) or go to covertn.gov/web/cover_kids.html or the TennCare website at tn.gov/tenncare. In Shelby County, call 901-545-8722 for assistance.

Testing and planning

Getting your pregnancy off on the right foot requires a lot of tests, planning and information, such as:

  • A physical exam – including pelvic and breast exams; checking your heart, lungs, eyes, ears, nose and throat; measuring your height and weight.
  • Tests of your blood and urine, checking of your blood pressure and a Pap test. 
  • Setting a plan of care (including scheduling of appointments, diet, exercise and special things to do) designed to help you and your baby stay healthy.
  • Being checked for several conditions that can harm you and your baby. These can include anemia (low iron), bladder infections, syphilis, gonorrhea, chlamydia, HIV*, cervical cancer, hepatitis B, vaginal infections and other problems.

*HIV is the virus that causes AIDS. A mother can unknowingly pass this disease to her baby before it is born. But today there is medication that reduces the chances of this occurring, so it is even more important to know if you are infected with HIV. Talk to your doctor or nurse about your HIV status.

High-risk pregnancy

Every pregnancy has some risk of problems. Risk factors for a high-risk pregnancy can include:

  • Being older than age 35 or being a teen or younger
  • Being overweight or underweight
  • Having had problems in previous pregnancies
  • Having preexisting or chronic health conditions such as heart disease, high blood pressure, kidney problems, autoimmune disorders, sexually transmitted diseases, diabetes, cancer or infections

If you have a chronic condition, you should talk to your doctor about how to minimize your risks.

Your baby

Soon after fertilization, the zygote (your one-cell baby-to-be) travels down the fallopian tube toward the uterus. It will divide rapidly to form a cluster of cells resembling a tiny raspberry. The inner group of cells will become the embryo. The outer group of cells will become the membranes that nourish and protect your baby.



 

Month 2: Weeks 5-8

Doctor measuring pregnant bellyDoctor visits

You will probably see your doctor once every four weeks until month eight, when you’ll begin having appointments every two weeks. Your doctor will check your blood pressure and weight at every visit.

Your baby 

Month 1 baby development illustration

So much is happening so fast during these important weeks. By the end of the second month, your baby’s arms and legs have begun to form. All the major internal organs, including the kidneys, heart and liver, are developing. Your baby’s circulatory system is functioning, and digestive and respiratory systems are beginning to form. Your baby’s facial features are becoming more defined. Overall, your baby is still only about one-half inch long.

Month 3: Weeks 9-12

Doctor visits

Throughout your pregnancy, your doctor will chart your weight, your blood pressure, and the protein and glucose levels in your blood. She will also measure the size of your uterus at each visit. 

Near the end of your first trimester, you may be able to hear your baby’s heartbeat.

Be sure to tell your doctor if you notice any unusual changes or symptoms between appointments. 

Month 3 baby progress illustrationYour baby 

Your baby’s fingers, toes, ears and eyelids are formed during the third month, and his brain is producing about 250,000 new cells every minute. By the end of your first trimester, your baby weighs about one-half ounce and has grown to about 2-and-a-half inches long. 

 

Resource

Your Second Trimester

Your lifestyle

By the end of the third month, many women feel a burst of energy and emotional well-being. This is often called “the golden period of pregnancy.” Take advantage of that energy by getting some things done while you feel like it. For example, now may be a good time to begin looking for a pediatrician for your baby, preparing the nursery and looking for childbirth classes. If you plan to return to work or school after your baby is born, start looking now for a good sitter or child care center for your baby. You’ll want to refer to the Better Beginnings section later in the book for more information on child care choices. 

Don’t forget to take time for yourself:

  • Take time to relax and enjoy your pregnancy. 
  • Start a journal to record your thoughts about your baby and motherhood. 
  • Pamper yourself in simple ways, such as having your partner rub your feet, spending time with a good book or sitting on the porch and watching the sunset. 

Healthy fish and broccoli dinnerEating well

During pregnancy, you will need more iron and protein to nourish your baby’s growth. Protein is crucial, especially during the second and third trimesters. Your body uses iron to make hemoglobin, a protein in the red blood cells that carries oxygen to your tissues. During pregnancy your blood volume expands to accommodate changes in your body and help your baby make his entire blood supply – doubling your need for iron.

If you don’t get enough iron, you may become fatigued and could be more susceptible to infections. The risk of preterm delivery and low birth weight also may be higher.

  • Eat lean meats, dried fruits, beans and green leafy vegetables like spinach for iron. 
  • Find good sources of protein such as, fish, chicken, lean meat, peanut butter, beans, peas, eggs and low-fat dairy products such as milk, yogurt and cheese. If you eat fish for protein, choose fish that are low in mercury, such as shrimp, canned light tuna, salmon and catfish. 
  • Wash fresh fruits and vegetables to protect yourself against harmful chemicals. 
  • Use salt in moderation.
  • Drink plenty of water. 
  • Continue taking your prenatal vitamins.
  • Avoid spicy foods to help prevent indigestion and heartburn. 
  • Eat foods such as ice cream or chocolate in moderation. 
  • Choose low-fat foods, such as low-fat cottage cheese or yogurt. 

If you crave ice, clay, dirt, laundry starch or other non-food items, tell your doctor right away. These cravings may indicate health concerns.

Your body

You’re probably beginning to look pregnant now and should expect to gain about 4 pounds a month until delivery. Maternity clothes may be a comfortable choice when waist extenders like rubber bands just don’t do the trick anymore. Other changes you may experience include:

Increased urination. As your uterus grows, it begins to push on your bladder, causing you to use the bathroom more often. 

Larger breasts. The milk-producing glands inside your breasts are getting larger.

Dizziness. Low blood pressure can make you feel dizzy when standing. 

To relieve dizziness:

  • Drink more fluids. 
  • Rise slowly from sitting or lying down. 
  • Lie on your left side to restore your blood pressure.

Skin changes. Sunscreen is critical since your skin may become more sensitive to the sun. 

Stretch marks. There is no avoiding these streaks, but they will fade eventually. Use moisturizer or vitamin E oil if they itch.

Urinary infection. If you find you are urinating more often than usual, have a burning sensation when urinating or have a fever, abdominal pain or backache, call your doctor right away.

Vaginal discharge. A thin, white vaginal discharge is normal. Call your doctor if your discharge has a strong odor, turns yellow or green, or causes redness or itching.

Nasal and gum problems. The lining of your nose and airway may swell as more blood flows through your body’s mucous membranes. This may lead to snoring, congestion and nosebleeds. Increased blood circulation also can soften your gums, which may cause minor bleeding with brushing or flossing. Proper care and regular cleaning are important because studies show that women with gum disease may be at higher risk for preterm births and babies with low birth weight. Some dental insurance policies have special benefits for pregnant women, so be sure to check with your insurance provider or human resources department at work. 

Woman brushing her teethTo protect your teeth and gums:

  • See your dentist regularly for scheduled cleanings, and call if you have any tooth pain or problems with your teeth between cleanings. 
  • Brush teeth and tongue twice a day with fluoride toothpaste and use dental floss regularly. 
  • Use a softer toothbrush to help lessen irritation.
  • Take Vitamin C and B-12 for good oral health and rinse with an antiplaque, fluoride mouthwash if brushing causes nausea.

 

Braxton-Hicks contractions may occur in the 3rd trimester. Sometimes referred to as “false labor,” this is simply your uterus getting ready for the real labor to come. Unlike true labor, Braxton-Hicks contractions aren’t painful and don’t get stronger and closer over time. Contact your doctor if your contractions become regular or painful. This may be a sign of preterm labor.

Gestational diabetes

This condition can be identified through a blood test. Gestational diabetes starts when your body is not able to make and effectively use all the insulin it needs for pregnancy. Without enough insulin, blood sugar (glucose) cannot leave the blood, be digested  and be changed into energy, so it builds up to high levels. There are no outward signs of gestational diabetes, so every pregnant woman is tested for it toward the end of the 2nd trimester. Pregnant women who have never had diabetes but who have high glucose levels during pregnancy are said to have gestational diabetes.

Gestational diabetes does not cause birth defects, but it can lead to infant death. It also can cause complications at delivery. Your baby stores the extra energy as fat, causing the baby to be unusually big. Wider shoulders and bigger overall size can cause serious birth injury to both baby and mother. 

Gestational diabetes is usually managed through diet, exercise and monitoring blood glucose levels several times a day. If blood glucose levels remain high, you may need to take insulin injections or an oral medication. 

Some women are at higher risk (African-American, Hispanic and Native American women, women older than 30, women who are obese or have a family history of diabetes). For most women, gestational diabetes goes away after pregnancy. 

 

Month 4: Weeks 13-16

Doctor visits

Woman in lab doing blood work

In addition to the usual charting of your weight, blood pressure, protein and glucose levels; measuring the size of your uterus; and listening to your baby’s heartbeat, your doctor may do a test to see how well your baby is developing.

Quad screen

Your doctor will test your blood to measure four substances that normally come from a baby’s blood, brain, spinal fluid and amniotic fluid. The test tells whether the baby has an increased risk of developmental or chromosomal conditions, such as spina bifida or Down syndrome. The test results indicate only whether you have an increased risk of these conditions, not whether your baby actually has the condition. An ultrasound or amniocentesis may be recommended to confirm or rule out a diagnosis.

The optimal time for quad screening is during weeks 16 to 18.

Your baby

Month 4 baby progress illustration

There is a lot of growing going on during the second trimester! By the fourth month, all of your baby’s organs, muscles and nerves are well developed and working together. The reproductive systems are developing quickly now: the prostate in boys and the ovaries in girls. Bone and bone marrow are developing, and transparent skin is beginning to form. You should be able to hear your baby’s heartbeat during your prenatal visit this month. At the end of the fourth month, your baby is about 4 to 5 inches long but weighs only around 3 ounces.  

 

Month 5: Weeks 17-20

Doctor visits

During the second trimester, your doctor will be doing several procedures to evaluate your health, determine your baby’s position in the womb and identify any potential complications.

Doctor performing ultrasound on patient

Ultrasound

Woman holding ultrasound photo over tummyA gel is applied to your tummy and a computer mouse-like tool is rolled over the gel, producing photos of your baby. An ultrasound will show your doctor a two-dimensional view of the baby’s shape and position in the womb. Seeing your baby for the first time is very exciting and often emotional. You will be able to take a copy of the ultrasound picture with you when you leave. This is the first glimpse fathers and family members will get, and it makes a perfect first entry in your baby book.

Your baby

Month 5 baby progress illustrationYou should begin feeling your baby move by the end of the fifth month. Those first feelings of movement are similar to “butterflies” in your stomach. As your baby grows, the movements will be stronger, even causing your abdomen to “jump” or “kick” as your baby becomes more active. Your baby has developed a regular pattern of sleeping and moving, and might even suck his thumb. He now weighs about one-half pound and is about 6 inches long.

 

Month 6: Weeks 21-24

Doctor visits

Tracking your baby’s growth and monitoring your health for signs of trouble are the focus of this month’s doctor visit. Make a list of questions you have about your body or your baby’s development, and make sure you understand the answers before you leave the doctor’s office.

Month 6 baby progress illustrationYour baby 

By the end of this month your baby should be about 8 inches long and weigh a pound and a half. He is probably moving around a lot and can respond to noise, such as your voice or music. By the sixth month, your baby also can open and close his eyes. The lungs and brain still need to develop more before he is ready to leave the womb.

Month 7: Weeks 25-28

Doctor visits

Female doctor examining pregnant womanYou will undergo several important tests during this month’s visit. These tests will help your doctor identify potentially dangerous conditions that could cause problems for you or your baby. 

Fetal kick count 

Fetal kick count is a method of measuring your baby’s movement. 

  • You should time how long it takes to feel 10 kicks, flutters, swishes or rolls. 
  • You want to feel at least 10 movements within two hours. 
  • Many women feel 10 movements in much less than two hours. 

Glucose challenge testing

This test is usually done within weeks 26–28, although your doctor may have done it earlier if she had some reason to think you are a candidate for gestational diabetes. You will drink a full glass of a sweet glucose solution one hour before having some blood drawn. After one hour, if your blood work shows elevated levels of glucose, it’s possible that not enough insulin is being produced to process the extra glucose. For more information about gestational diabetes and glucose testing, go to www.uamshealth.com/healthlibrary/Default.aspx?ContentTypeId=85&ContentId....

Rh antibody testing

Your doctor will test your blood to check for Rh incompatibility, a very serious but treatable condition in which a baby’s blood type and Rh factor are incompatible with the mother’s. If you’re Rh negative, you’ll need an Rh immune globulin injection before delivery.

Your baby 

Month 7 baby progress illustrationBy the end of the seventh month, your baby weighs around 2 pounds and is about 10 inches long. You may notice he has developed a sleep pattern. Babies in the womb usually sleep for 20 to 30 minutes at a time. His hands are fully developed and functional; he has fingerprints and footprints; and his eyes are beginning to open and close. Although his brain is developing rapidly, his lungs, liver and immune system need more time to develop before delivery. 

Do your Kegel exercises every day

Kegels are a simple exercise to increase circulation and strengthen and tone muscles, which can help your body prepare for labor and recover after you give birth.

To do Kegels:

  • Firmly tense the muscles around the vagina and anus
  • Hold them as long as possible
  • Slowly release the muscles

For a complete discussion of Kegel exercises for women and how to do them correctly, go to www.mayoclinic.com/health/kegel-exercises/WO00119.

Inducing birth before 39 weeks is not OK!

Too often the decision to induce labor or deliver by C-section before a woman reaches 39 weeks is made for the convenience of the mother or doctor. Convenience (or impatience) is not a good enough reason to sacrifice the life of your baby or his long-term health. Unless you’re having twins or triplets, or there’s a medically indicated reason to deliver early, don’t even think about it! Cutting your pregnancy short can have very serious, even fatal, consequences for your baby. Babies born before 39 weeks are more likely to have vision and hearing problems after birth and need special medical care. And because brain development is not complete, they are at higher risk for learning and behavioral problems later. For more information on the dangers of premature birth, go to www.marchofdimes.com/pregnancy/getready_atleast39weeks.html.

Preterm labor

Preterm labor means you go into labor before the 37th week of pregnancy. Preterm labor can lead to preterm birth. Death and serious, long-term illness are often seen when babies are born too early. Be alert to signs of preterm labor.

Call your doctor immediately or go to a hospital emergency room if any of the following signs appear before the 37th week:

  • Uterus or womb tightens or gets hard every 10 minutes or less. (This may be painless, or it may feel like the womb is tightening or the baby is curling up into a ball.)
  • Period-like cramps felt in lower abdomen; may come and go or be constant.
  • Low, dull backache felt below waist; may come and go or be constant.
  • Pressure that feels like the baby is pushing down; pressure comes and goes.
  • Stomach cramping with or without diarrhea.
  • Vaginal discharge increases or changes into watery or light bloody discharge.
  • Bladder or kidney infection.

Premature birth 

A birth is considered “premature” when the baby is born before 37 weeks of pregnancy have been completed. This is a serious complication. It happens most often with twins, triplets and other multiple deliveries. 

Premature (also called preterm) babies are born before their brains and their digestive and respiratory systems are developed enough to survive outside of the womb. They need special care and will stay in the hospital for a few days or weeks in the neonatal intensive care unit (NICU). Premature babies require special care, so it would be a good idea to read up on how to care for your premature baby. If you would like to know more, the March of Dimes, the American Congress of Obstetricians and Gynecologists, and the American Academy of Pediatrics are excellent sources of information on preterm labor and birth.

 

Getting Ready for Baby

Couple preparing baby nurseryThere are a lot of things you need to think about and decisions you need to make during your last trimester. 

A word about the nursery: Your baby will need a safe, quiet, comfortable place to sleep. He’ll need diapers (a lot of diapers) and wipes, clothes, blankets, bottles, breast pump if you are breastfeeding, formula if you’re not able to breastfeed and more. Don’t worry if you don’t have all the expensive bells and whistles that may make a “picture-perfect” nursery. More than anything else, your baby needs your love to feel safe, secure and happy. 

You can save money on your baby needs by shopping at consignment stores for gently used clothing or gear. Be sure to see “Safe home for baby” in the following pages to check on the safety of any furniture, toys or car seats. Many chain stores offer discount or reward cards, and you can get printable coupons or even shop from your computer at home. 

Childbirth and breastfeeding education

Childbirth education classes are the very best way you can prepare for labor and delivery. In these classes you will:

  • Learn about labor, delivery and postpartum care.
  • Learn and practice effective methods for coping with contractions, such as breathing techniques, relaxation and visualization, as well as the pros and cons of medications, such as narcotic analgesics and epidural blocks.
  • Get information on the care of newborns. 

The hospital where you deliver may also offer classes regarding breastfeeding and newborn care. Ask your doctor about free classes or go to lamaze.org to locate providers in your area. 

Safe home for baby

Your baby will grow and thrive in a safe environment. It’s up to you to be prepared for emergencies. There are hundreds of things, big and small, that you can do to help make your home safer. We’ve included additional sources at the end of this section. But for now, here are just a few to get you started. 

  • In emergencies, call 911 first! 
  • Make sure you have the phone numbers of your pediatrician, the poison control center (1-800-222-1222), your spouse or partner at work, and your ambulance service (if you don’t have 911) in your phone and easily accessible. 
  • Set your water heater to 120°F to prevent burns.
  • Make sure every area of your house has a smoke detector and a carbon monoxide detector. Check them monthly.
  • Get a baby monitor and test it before you bring your baby home.
  • Do not allow anyone to smoke in your house, in your car or near your baby. 
  • Check to see that no safety recalls have been issued on equipment and toys you have bought or received for your baby. Call the U.S. Consumer Product Safety Commission at 1-800-638-2772 to check for a recall on your used equipment. 
  • Make sure cleaning supplies and other chemicals are out of reach. 

Safe baby gear 

Woman with baby in baby carrierEvery year, tens of thousands of children are injured or killed by defective products. Before you use a “hand-me-down,” check with the Consumer Product Safety Commission at www.cpsc.gov/cgi-bin/prod.aspx for a list of the most important recalls and product hazards. 

Be sure to mail in the registration cards on all your new baby gear. The manufacturers will contact you if the product is recalled. 

Cribs

Secondhand cribs are a leading cause of infant injuries in America. In June 2011, stricter guidelines went into effect for the manufacture, sale and resale of cribs. Here are a few important things to keep in mind when choosing and using a crib. 

  • A full-size crib is best for your baby. 
  • The Consumer Product Safety Commission (CPSC) is reviewing safety standards on cribs and urging parents to avoid drop-side cribs (cribs with sides that move up and down). Many of these kinds of cribs have been recalled. It’s best to have a crib with sides that don’t move. 
  • To keep your baby from getting his face stuck between the mattress and crib and suffocating, crib slats should be no more than 2 3/8 inches apart. Crib mattresses should be firm and tight fitting. You shouldn’t be able to put more than two fingers between the mattress and the crib frame.
  • Sheets should fit snugly.
  • Don’t use bumper pads on cribs. They pose a suffocation risk.

Bassinets and cradles

Bassinets are usually lightweight and portable. Typically cribs and cradles stay in one place. Bassinets and cradles are covered only by voluntary safety standards, not mandatory federal standards. The March of Dimes recommends that you use a full-size crib if you can.

Strollers

  • Buy or borrow a stroller that reclines fully, so your infant can lie flat. When the stroller is reclined fully, the leg openings should close off so your baby cannot slip through.
  • Strollers should have a five-point harness or a sturdy safety belt and a crotch strap.
  • Make sure there is a canopy to protect your baby from sunlight, rain and wind.
  • Check that the frame is sturdy. 
  • When buying new, look for stickers from ASTM International (American Society for Testing and Materials) and Juvenile Products Manufacturers Association. Strollers with these stickers meet voluntary safety standards.
  • Do not run with an infant younger than 6 months old in a jogging stroller. Infants do not yet have good head and neck control, so this could be dangerous for them.

Car seats

Couple with child in car seat

The law requires that your baby must always ride in an approved safety seat when traveling. That means you must bring your baby home in a car safety seat that is marked “federally approved,” and the hospital will not allow you to leave without one. Ask your doctor, the hospital where you deliver or your health department about programs that loan federally approved car safety seats. 

Your baby should ride rear-facing until he is about 2 years old. When he reaches the highest weight or length allowed by the manufacturer for its infant-only seat, he should continue to ride rear-facing in a convertible seat until he outgrows the manufacturer recommendations.

To see a list of car safety seats and safety seat manufacturers, go to the American Academy of Pediatrics website at aap.org/healthtopics/carseatsafety.cfm.

Arkansas residents can visit carseatsar.org to find a certified technician who can help answer your car seat questions.

If you’re considering a used car seat for your child, make sure the car seat:

  • Comes with instructions and a label showing the manufacture date and model number.
  • Hasn’t been recalled (go to www.cpsc.gov/cgi-bin/prod.aspx).
  • Isn’t more than 6 years old.
  • Has no visible cracks or missing parts.
  • Has never been in a moderate or severe crash.

If you don’t know the car seat’s history, don’t use it! 

Resources

Finding quality child care 

Selecting a child care provider is one of the most important, emotional and difficult decisions you will make as a parent. Even though your baby is not born yet, it’s never too early to begin researching and decide which child care facility is best suited to you and your family. High-quality child care and early childhood education set the stage for how well your child will learn and how he will think of himself and others.

Make sure that anyone caring for your child knows that shaking a baby is not OK and can cause serious harm. Never leave your baby with someone you suspect has anger problems.

Better Beginnings, Arkansas’s quality rating system for licensed child care facilities, will be a great resource in helping you select the best child care for your baby. The Better Beginnings website (www.ARBetterBeginnings.com) in Arkansas and www.parentsknowkidsgrow.org/choosingchildcare in Tennessee make it easy for you to:

  • Learn what to look for in a child care facility.
  • Know what questions to ask about child care.
  • Find licensed Arkansas child care providers in your area using a convenient online tool.
  • Compare child care providers based on their quality ratings.

Child care checklist from Better Beginnings

The Child Care Checklist is a comprehensive listing of everything you should consider when choosing a child care provider. Print it out and take it with you: arbetterbeginnings.com/downloads/ChildCareChecklist.pdf.

Family planning

Medical experts recommend that women not have sex for at least six weeks after giving birth and not become pregnant again within six months. Since getting pregnant again too soon can be dangerous, it is important to decide early which form of family planning you will use.

  • Talk to your doctor and partner about the best method of family planning for you. Is the method easy to use? Is it safe? Does it work?
  • Methods that don’t work include withdrawal, douching, makeshift condoms, feminine hygiene products and breastfeeding.

Resource

  • Mayo Clinic Guide to a Healthy Pregnancy, Roger W. Harms, M.D., 2004

Preparing for the hospital

Plan ahead. Check with your hospital to see if you can fill out admission papers early. Decide who will care for your pets, plants or other children. Who will support you during labor and delivery? Pack a bag and leave it in the closet or under the bed until it’s time to go. Pack lightly but include:

  • Insurance papers or identification cards
  • Preregistration forms from the hospital
  • Robe, slippers and underwear
  • Nursing bras
  • Toiletries, hair clips, hard candy for dry mouth
  • Sanitary pads (for heavy flows)
  • Going-home outfits for you and baby
  • Baby blanket, hat, booties or snowsuit if it is cold
  • Newborn diapers and wipes
  • Two soft, clean towels to roll up for padding the sides of your baby’s head in the car seat

Leave all cash, jewelry and credit cards at home. And remember, all babies must leave the hospital in a car safety seat. You must always use a car seat when you travel with your baby.

 

Your Third Trimester: Weeks 29 Through Delivery

Your lifestyle

Your baby could come anytime between 37 and 42 weeks of pregnancy. Most women do not have their babies on the actual due date, so be patient. With the delivery so near, you are likely to feel excited and happy, anxious and afraid. All of these feelings are normal. 

Smoking and drinking alcohol

If you haven’t quit smoking yet, it’s better late than never. Medical experts agree that smoking and drinking can pose serious threats to your baby’s health and can be a significant factor in low birth weight. 

  • If you need help quitting tobacco, call the Tobacco Quit Line at 1-800-QUIT-NOW (1-800-784-8669). It’s confidential, and it’s free. 
  • If you drink during pregnancy, you place your baby at risk for fetal alcohol syndrome, a condition that includes serious physical, mental and behavioral problems, though they vary from one child to another.

Circumcision

If your baby is a boy, you should consider whether he should be circumcised prior to discharge from the hospital. Circumcision is the surgical removal of most or the entire foreskin of the penis. This decision is made for social or religious reasons. Many people think circumcision is necessary for good health. Talk to your doctor or go to healthychildren.org, the American Academy of Pediatrics’ website, for more information on the pros and cons of circumcision.

Woman eating a saladEating well

In the last few months of pregnancy, your baby will grow rapidly, and this will put more pressure on your stomach. For this reason you may not feel like eating much, but you must continue eating well so your baby will get all he needs to grow. 

  • Eat smaller, more frequent meals to help avoid heartburn. 
  • Eat calcium-rich foods such as greens and sardines, and low-fat dairy foods such as cheese, yogurt and milk to help your baby build strong bones and teeth.
  • Eat plenty of fruits, vegetables and whole-grain breads and cereals each day to help you with any constipation problems you might be having now and after your baby is born. 
  • Drink lots of water and other fluids.

Your body 

The good news is that you’ve entered your third and final trimester. The bad news is that the changes in your body through the final months of your pregnancy may be unpleasant. Where possible, we’ve given you some ways to make yourself feel better.

Weight gain. You will probably gain around a pound a week each week throughout the remainder of your pregnancy. By the time you deliver, you will have gained 25–35 pounds. Remember that most of the weight you’ve been gaining is not fat; it’s the baby, the placenta, the amniotic sac and water weight in your own body tissues. You will, quite literally, shed most of this weight when you deliver. If you have been eating right, it won’t be long before you’re back to your prepregnancy weight.

Breasts. As delivery nears, colostrum, the thin, sticky, yellow fluid secreted by the breasts before the production of true breast milk, may begin leaking from your nipples.

Shortness of breath. Because your baby is growing and crowding your lungs, it might be harder for you to breathe comfortably. If so, slow down, stretch your arms overhead and breathe deeply to relax. 

Back pain. As your baby continues to grow, you might have trouble sitting or lying for long periods of time. 

To relieve back pain:

  • Soak in a warm (but not hot!) bath. Take time to really relax your muscles.
  • Lighten your purse and try using a backpack or fanny pack instead.
  • If you sit for long periods during the day, get up and move around or stretch every 30 minutes.
  • Use good, straight posture with shoulders back and your head up.
  • Avoid any heavy work or lifting to protect your back and your baby. 

Sciatica. You may feel a tingling or numbness down the backs of your legs from pressure on your sciatic nerve, the largest nerve in your body. Rest, massage or a heating pad may ease the pain. 

Carpal tunnel syndrome. Numbness, tingling, and pain in the hand caused by the compression of a nerve in the wrist. Carpal tunnel syndrome caused by pregnancy swelling usually goes away after delivery.

Swelling. Swelling may occur in your ankles and feet and is caused by fluids in your tissues. Slight swelling is natural during pregnancy, but if you experience sudden swelling, headaches, blurred vision, disorientation, dizziness or severe abdominal pain, contact your doctor immediately.

To avoid swelling of your feet and ankles:

  • Wear low-heeled shoes. 
  • Put your feet up as often as you can. 
  • Avoid sitting or standing for long periods of time without a break. 
  • Wear shoes that are shaped like your feet: Wide in front and narrow at the heel. Don’t expect shoes to stretch. You’ve gained weight and fluid in your feet too. You may need a couple of new, inexpensive pairs of shoes to see you through the remainder of your pregnancy.
  • Be sure your shoes (even temporary ones) provide proper arch support to help your legs and back.

Couples hands holding pregnant bellySleep and fatigue. Sleeping will likely continue to be difficult as your body grows. Your anxieties about labor and delivery might also be adding to your inability to sleep well. 

  • Talk to your partner about how you are feeling. 
  • Ask your doctor to discuss the stages of labor and delivery with you to help you feel surer of what will happen.

For better rest:

  • Try relaxing in a warm (not hot!) bath for a few minutes before lying down. 
  • Limit your intake of caffeine, which may rob you of good sleep. 
  • Sleep on your left side to improve the flow of blood, place pillows between your knees, under your abdomen and behind your back, and avoid lying on your back for extended periods of time.

For more information, visit the National Sleep Foundation at www.sleepfoundation.org.

Frequent urination. As your baby grows and moves, you’ll feel more pressure on your bladder. You may begin leaking urine, especially when you laugh, cough or sneeze. During your third trimester, you remain at risk of urinary tract infections, which can trigger preterm labor and do serious damage to your kidneys. If you think something is wrong, call your doctor right away.

Vaginal discharge. As you near your delivery date, you will likely have increased vaginal discharge.

Varicose veins. These are swollen veins that may bulge near the surface of the skin. As your uterus grows, it puts pressure on the large vein on the right side of your body, which in turn increases pressure in the leg veins. 

Woman on bed laying downTo avoid varicose veins: 

  • Exercise to increase your circulation.
  • Elevate your feet and legs whenever possible.
  • Don’t cross your legs or ankles, and don’t sit or stand for long periods.

Hemorrhoids. Hemorrhoids are varicose veins in the rectum. To lessen hemorrhoids, avoid constipation by eating high-fiber foods and drinking several glasses of water each day.

Braxton-Hicks contractions. Unlike true labor, Braxton-Hicks contractions aren’t painful and don’t get stronger and closer over time. Contact your doctor if the contractions become painful or regular. This may be a sign of labor.

Signs of labor

The way labor begins and progresses is different for each pregnancy. 

There are three main signs that labor has started:

  • Blood-tinged discharge or mucus from your vagina, called a “bloody show.”
  • Contractions as your uterus starts squeezing to move the baby down the birth canal. Begin timing your contractions from the beginning of one until the beginning of the next one.
  • Digestive upset such as diarrhea or nausea.
  • A gush or trickle of fluid from your vagina (the amniotic sac breaking) that feels like a painless flow of warm water. Call your doctor if you think your water has broken!
 

Month 8: Weeks 29-32

Doctor visits

Month 8 baby progress illustrationThis month, you’ll see your doctor every two weeks, then once a week as you approach your due date. As you near the end of your pregnancy, monitoring the baby’s overall health, movement and heart rate will be very important.

Your baby 

Feeling jabs and punches from your baby (some can be pretty strong) is normal at this stage in your pregnancy. Your baby is adding important layers of fat to keep him warm after birth. By the end of the eighth month, your baby is 11 inches long and weighs about 4 pounds. For more information about your baby’s development at this stage in your pregnancy, go to www.uamshealth.com/healthlibrary/default.aspx?ContentTypeID=85&ContentID....

 

Month 9: Weeks 33-Delivery

Doctor visits

As your due date approaches, you will be seeing your doctor every week, and your prenatal visits may include pelvic exams. These exams help your doctor check the baby’s position and evaluate your cervix for dilation and thinning.

Your baby should be positioned head down. If your baby is positioned bottom first or feet first, this is called breech. If your baby remains in a breech position, you may need a C-section delivery.

Your doctor will screen you for group B streptococcus, or GBS. GBS can be life threatening in newborns. If you test positive, you’ll receive antibiotics during labor and delivery.

Month 9 BabyYour baby 

Your baby is experiencing his most rapid period of weight gain during this month. Your baby is now about 16 inches long, weighing 6 to 6½ pounds. His lungs have matured completely by week 35. He can suck his thumb and has the ability to cry. At 40 weeks of pregnancy, your baby will be “full term,” having gone through the full length of pregnancy. He will be 19 to 21 inches long and weigh 6 to 9 pounds. 

Overdue pregnancy 

Most babies don’t arrive on their due date. In fact, your pregnancy must continue two weeks past your due date to earn the official label of overdue pregnancy or post-term pregnancy.

You may be more likely to have an overdue pregnancy if:

  • The exact date of the start of your last menstrual period isn’t accurate.
  • This is your first pregnancy, you’ve had prior overdue pregnancies or they run in your family.

After two weeks past your due date, the size of your baby (who continues to grow) could complicate a vaginal delivery. You and your doctor may decide to begin your labor, particularly if your doctor is concerned about your health or your baby’s.

Cesarean birth (C-Section)

This a surgical procedure used to deliver a baby through an incision in the mother’s abdomen and a second incision in the mother’s uterus. Most C-sections happen unexpectedly, so you should learn what you can to be prepared in case your doctor decides to deliver your baby by C-section. There are risks associated with cesarean deliveries, so the decision should always be based on medical necessity. 

Your doctor may decide to deliver your baby by C-section because:

  • Your labor is progressing too slowly or has stopped completely.
  • Your baby’s heart rate is abnormal, suggesting he is not getting enough oxygen.
  • Your baby is in breech position going into the birth canal. 
  • You or your baby has a serious health problem. 
  • Your baby’s head is in the wrong position.
  • You are delivering twins, triplets or other multiples.
  • There are problems with your placenta or umbilical cord.
  • Your baby is too big to safely deliver vaginally.
  • You’ve had previous cesarean births.

Unless you’re having twins or triplets, or there’s a medically indicated reason to deliver early, it is not healthy to induce labor or deliver by C-section before you reach 39 weeks of your pregnancy. See Month 7: Weeks 25-28 for more information.

Resource

Protect your baby from hepatitis B

Hepatitis B is a very serious disease of the liver. It is caused by a virus that can grow in blood, semen and vaginal fluids. Babies can get hepatitis B from their mothers during pregnancy and delivery. The hepatitis B vaccine is recommended for all babies so that they will be protected from this serious but preventable disease. 

Hepatitis vaccination schedule:

  • Infants should receive the hepatitis B vaccine in the first 12 hours after birth.
  • The second dose must be given at least one month after the first dose.
  • The third dose must be given at least two months after the second dose and at least four months after the first. 
  • The third dose should not be given to infants younger than 6 months of age.

If you have hepatitis B: 

  1. Tell hospital staff and your baby’s pediatrician that you tested positive for hepatitis B. 
  2. You should not breastfeed your baby, because hepatitis B can be passed along in breast milk.
  3. Make sure your baby receives the second and third doses of vaccine on time.
  4. Take your baby for a blood test three months after the third shot to be sure the vaccine worked.

For more information on hepatitis and its effects on children, go to www.uamshealth.com/HealthLibrary/Default.aspx?ContentTypeId=90&ContentId....

UAMS ANGELS program 

The UAMS ANGELS Pregnancy Call Center operates 24 hours a day, seven days a week to serve as a statewide resource for women in Arkansas who have high-risk pregnancies and for doctors outside of the UAMS system who want to consult a maternal-fetal medicine specialist about a patient. 

The call center is staffed by registered nurses, and a Spanish interpreter is available to aid callers on most evenings and weekends. If a pregnant woman requires immediate medical treatment, the call-center nurse arranges for emergency transport or facilitates transport to a high-risk OB facility for expert care. The UAMS Pregnancy Call Center is a unique service for pregnant women and their doctors who need education, information or guidance for prenatal care. You can contact the UAMS ANGELS Pregnancy Call Center at 1-866-273-3835.

 

Special Delivery

Special Delivery

Your newborn’s body

You may be surprised by a few things about your newborn that are really quite normal.

Birthmarks. These common spots are usually harmless, and many eventually disappear on their own.

Blood. It’s not uncommon to see a tiny bit of blood in your daughter’s diaper for the first couple of weeks. The withdrawal of mom’s hormones after birth causes this tiny bit of vaginal bleeding.

Breasts. Your hormones are still in your baby’s system. These hormones may cause breast tissue to grow slightly, in both girls and boys. These baby breasts may last for a few months but then should go away.

Cord color. Your baby’s umbilical cord stump will turn yellow and then brown or black before falling off on its own.

Jaundice. This is a condition that makes a newborn’s skin and the white part of the eyes look yellow. It happens because there is too much bilirubin in the baby’s blood. Bilirubin is a substance made when the liver breaks down old red blood cells. Jaundice is easily treated by placing the baby under a special bilirubin light for a few minutes. If your baby is diagnosed with jaundice, he will need a follow-up exam within the first five days after birth. Call your doctor if the yellow color gets brighter after your baby is three days old.

If you think your child may be ill, or if something just doesn’t seem right, trust your instincts and call your doctor.

special deliveryOdd movements. Newborns’ bodies are ruled by reflexes. His chin, arms or legs may seem shaky, especially when crying.

Other skin conditions. Rashes and other skin conditions are common in newborns. Typically, they go away in a few weeks without treatment.

Rapid breathing. Your newborn’s breathing may pause for up to 10 seconds and then resume normally. This is normal. Healthy newborns average 40 breaths a minute (adults take 12 to 18).

Soft spots. The two soft areas on your baby’s head are known as fontanels. When your child cries, they may bulge. The soft spots may pulse along with his heartbeat. Despite the lack of a bony layer, they are well protected from regular gentle baby handling.

Handling a newborn

  • If this is your first baby, you might be surprised by how tiny and fragile your little one really is. Here are a few important tips for protecting your newborn:
  • Don’t let anyone smoke around your baby. Secondhand smoke is dangerous.
  • Wash your hands (or use a hand sanitizer) before handling your newborn, and make sure everyone else who handles your baby also has clean hands.
  • Do not shake your newborn, and don’t let anyone else shake him. If you need to wake your infant, don’t do it by shaking. Instead, tickle your baby’s feet or blow gently on his cheek.
  • Support your baby’s head and neck. Cradle the head when carrying your baby, and support the head when carrying the baby upright or when you lay him down.
  • Make sure your baby is securely fastened into the carrier, stroller or car seat. Limit any activity that might be rough or bouncy.
  • Your newborn is not ready for rough play, like being jiggled on the knee or strolled at more than a walking speed.
  • Never let anyone throw your baby in the air and catch him. This can cause irreversible brain damage.

Resources

Newborn genetic screening

Newborn screening tests take place before your newborn leaves the hospital. Identifying serious conditions early, before symptoms begin, is the best way to make sure babies grow up healthy. Serious or life-threatening diseases are rare, but the cost of treating them later is emotionally and financially high.

Vision and Hearing Screening

Vision

Dad bonding with babyYour baby’s eyes will be checked for infections, defects, cataracts or glaucoma before he leaves the hospital. All states require that shortly after your baby is born, he will have antibiotic ointment placed in his eyes. This ointment will protect him from serious effects of gonorrheal eye infections. It doesn’t hurt and will protect him from blindness caused by this sexually transmitted disease.

Hearing

Babies with hearing problems have trouble learning and developing language skills. Many states, including Arkansas and Tennessee, require that infant hearing be tested before babies leave the hospital. These tests take about 10 minutes and are done while your baby is sleeping. 

Healthy Hearing

The sound of your voice is comforting to your baby. Talking, singing or reading out loud to your newborn will help the baby recognize your voice. Newborns are very interested in new sounds. And just like older children, they also get used to noises quickly and can tune them out. 

Signs your baby is responding to a new sound:

  • Pauses in sucking or fussing 
  • Widening of the eyes

Check with your baby’s doctor if your baby:

  • Does not respond to noises like a whistle, hand clap or horn.
  • Does not begin looking around for the source of a sound by age 3 months.

Resources

  • Taking Care of Your Child: A Parent’s Illustrated Guide to Complete Medical Care, Robert H. Pantell, M.D. et al, 2006.
  • American Academy of Pediatrics

Healthy Vision 

Your newborn’s eyes will continue growing in size through his first year. Because his eyes are not fully developed, his sight is very limited. He won’t be able to fully control his eye movements or focus clearly for a while. Most newborns are nearsighted and focus on things that are 8 to 12 inches from their faces. By giving your baby simple things to look at, you can help strengthen his eye muscles. Newborns most like seeing your face, so give your baby plenty of face time.

Check with your baby’s doctor if:

  • Your baby’s eyes increasingly cross or one eye drifts.
  • Your baby’s eyes appear cloudy or filmy.
  • Your baby’s eyes don’t seem to focus on objects near his face or they wander randomly.

Resources

Homecoming

Mother and small daughter with new babyBringing your baby home for the first time will be one of your life’s most exciting and memorable experiences. It’s also a time when you are still exhausted from delivery, and taking care of your baby and yourself may seem overwhelming. Consider some of these tips to help make homecoming more enjoyable:

  • Ask your partner to limit the number of visitors.
  • Don’t be shy about asking friends and family who are ill to postpone their visits.
  • Put baby updates on your Facebook page or voice mail message. 
  • Sleep when your baby sleeps. 
  • Let your baby set the pace. 
  • Crying is your baby’s only means of communication. He is making adjustments too.
  • Leave the housekeeping to someone else.
  • Accept that it is normal to be emotional. If you feel stressed, ask for help. Remember that the relaxation techniques you learned in childbirth classes aren’t just for labor. Use them in any stressful situation.
  • If you have other children, be sure to spend some quality time with each of them. At first, you can expect some jealousy, so encourage your children to “help” you care for your newest family member.
  • If you have a pet, ask your partner to take home a blanket with the baby’s scent on it and place it near the pet before you and your baby leave the hospital. Then, when you come home, the pet will already be somewhat familiar with the baby. But remember never to leave pets alone with newborns.
 

Emotions, Depression and Baby Blues

Baby blues

Woman holding baby suffering from depressionThe time right after your baby’s birth is physically and emotionally exhausting. Your hormones and body chemistry are a long way from normal and will be that way for a while. Add lack of sleep to the mix and it’s easy to understand why many new mothers report feeling depressed, on the verge of tears all the time and very tired. This is called baby blues. The baby blues are a well-documented, hormone-induced condition often appearing 48 to 72 hours after delivery and lasting up to two weeks. This is a temporary, short-term condition. Keep that in mind, and it may make your emotions less overwhelming. Remember, even the most together moms need support at one time or another.

Helpful coping tips

  • Ask your partner, family and friends for help with the baby’s needs.
  • Don’t hide your feelings. Talk about them with your partner, family and friends.
  • Don’t make any major life changes during pregnancy or right after giving birth.
  • Don’t try to do too much or to be perfect.
  • Make time to go out, visit friends or spend time alone with your partner.
  • Rest as much as you can. Sleep when the baby is sleeping.
  • Talk with other mothers or join a support group.

Postpartum depression

The baby blues is normal. However, if the blues don’t lift after about two weeks or get worse, you may be suffering from a more serious problem called postpartum depression. Postpartum depression is characterized by frequent crying, irritability, sleep problems, restlessness, feelings of hopelessness, feeling disconnected from life and an inability to care for the baby. This is a serious and potentially life-threatening condition that requires professional treatment. 

Two mothers with babies

Mothers with postpartum depression also report:

  • Being afraid to be alone with their babies
  • Having negative feelings toward the baby or thinking about harming the baby (Although these feelings are scary, they are almost never acted on. Still you should tell your doctor about them right away.)
  • Worrying intensely about the baby or having little interest in the baby

If you have any of these symptoms, call your doctor right away. He or she can refer you to a mental health professional for treatment that may include antidepressant medication, talk therapy or both.

 

Safe Sleeping and Preventing Sudden Infant Death Syndrom (SIDS)

Many infant deaths involve unsafe sleeping environments and locations. Parents and caregivers may be familiar with the Back to Sleep program that instructs parents to always place infants on their backs for sleeping as a precaution against SIDS, the unexplained death of an infant in the first year of life. No one knows what causes SIDS, but there are several things you can do to reduce the risk of SIDS and other sleep-related infant deaths. There is some evidence that breastfeeding may reduce the risk of SIDS.  

Sleeping baby

Be sure to discuss these procedures with everyone who is taking care of your baby:

Always place your baby on his back to sleep, even for naps. 

  • Place your baby on a firm mattress, such as in a safety-approved crib.
  • Remove bumper pads and soft, fluffy bedding, pillows and stuffed toys from your baby’s sleep area.
  • Make sure your baby’s head and face remain uncovered during sleep.
  • Place your baby’s crib in the same room where you sleep, but do not place your baby in the same bed with you.
  • Make sure your baby sleeps alone, not in the bed or on the sofa with other children or adults.
  • Do NOT use blankets or comforters under your baby.
  • Do NOT let your baby sleep on a waterbed, sheepskin, pillow or other soft material.
  • Do NOT let your baby get too warm during sleep.
  • Do NOT allow smoking around your baby.
  • Have people wash their hands before holding or playing with your baby. Respiratory infections increase the SIDS rate.
  • Talk to child care providers, grandparents, babysitters and all caregivers about SIDS risk.

Tummy time

Baby resting on its tummyExperts agree you should never put your baby to bed on his tummy. They also agree that supervised tummy time, beginning within the first month after birth, is important to a baby’s physical development. Strong neck and upper back muscles allow babies to control their head movements. So encourage the development of head control by giving your infant a lot of supervised time on his stomach while he’s awake. Tummy time also seems to promote a well-shaped head that has fewer flat spots. Five or 10 minutes, a couple of times a day during supervised play breaks should do it. Your lap is a good tummy time location, as is any smooth, flat surface with no loose items like toys, blankets or pillows nearby that could interfere with breathing. 

Newborn Sleep and Crying

Sleep

Tired mother with babyNewborns may sleep as much as 16 hours in a 24-hour period, usually four-and-a-half hours at a time.

To help your baby adjust to sleeping at night:

  • Keep lights dim and your voice low to reinforce the message that nighttime is for sleeping. 
  • Start a bedtime routine by reading, singing or having quiet time before putting him in bed. 
  • Resist the urge to play with or talk to your baby during late-night diaper changes.
  • Be consistent in your routine because it may take several weeks for your baby’s brain to recognize the difference between night and day.

By the time your baby is 2 months old, he should be sleeping six to eight hours through the night. If your baby isn’t sleeping through the night by 4 months, talk with your doctor. 

Crying

Crying is your baby’s only real form of communication. It’s the only way he can let you know that something in his little world isn’t right. If he cries, pick him up. Newborns can’t be “spoiled” by too much attention. Answering his cries for help promptly will make him cry less. 

Within a 24-hour period, newborns usually cry for two hours or more. It’s a normal part of adjusting, and he will cry less as he gets more accustomed to the sights and sounds of his new surroundings. Of course we don’t know for certain, but it appears that babies sometimes cry as a way of releasing tension or to block out sensations that are too intense. In fact, some babies cannot fall asleep without crying.

If your baby cries more than three hours a day, at least three days a week, for at least three weeks in a row, he may have colic. Episodes of colic usually begin suddenly and for no apparent reason late in the afternoon or evening. Try the following suggestions if your baby is colicky or has afternoon crying episodes:

  • Swaddle your baby snugly in a blanket, leaving one arm free and the other tucked inside.
  • Gently rock your baby while rubbing his head, chest or back.
  • Position your baby tummy down on your lap or upright on your shoulder or against your chest.
  • Give your baby a warm bath.
  • Play soft music or a continuous sound like the clothes dryer or a recording of the ocean.
  • Take your baby for a walk.
  • Offer a pacifier or your finger to suck on.
  • Turn down the lights and noise in the room.

Don’t take your baby’s crying personally. He can feel your tension and will only cry more. Visit www.cryingplan.com for more information on handling the stress of a crying baby.

Shaken Baby Syndrome (SBS) 

Anyone who has ever taken care of a fussy baby, or a baby who cries endlessly, knows how stressful this can be. Sometimes, usually out of frustration, a caregiver may shake the baby forcefully, trying to make him stop crying. This is never the right thing to do! Your baby’s tiny, fragile brain can be severely damaged. It takes only a few seconds of shaking to cause irreversible brain damage in an infant. 

Ways to cope with the stress of crying include:

  • Placing your baby in a safe place (crib, car seat), walking away and take a few minutes to calm down. As long as your baby is safe, has eaten and has a clean diaper, it is OK to let him cry until you feel better. 
  • Sit on the front porch, step into the backyard or spend some time listening to music. 
  • Call a friend or relative for help. 

Visit www.cryingplan.com for more information on shaken baby syndrome and handling the stress of a crying baby. Call 911 immediately if you think your baby has been shaken.

Crying plan

To help cope with crying, create a “Crying Plan.” This should include a list of friends or family and phone numbers of people you can call for help or comfort during periods of crying.

If you know he is not hungry, sick or uncomfortable, you might try: 

  • Rocking, either in a rocking chair or in your arms as you sway from side to side.
  • Gently stroking his head or patting his back or chest.
  • Swaddling (wrapping him snugly in a receiving blanket).
  • Playing soft music, singing or talking.
  • Walking him in your arms, a stroller or a carriage.
  • Rhythmic noise and vibration.
  • Burping him to relieve any trapped gas bubbles.

If the crying becomes too much for you to handle:

  • It’s OK to walk away. 
  • Place your baby in a safe place (crib, car seat) and then take a few minutes to calm down. As long as your baby is safe, has eaten and has a clean diaper, it is OK to let him cry until you feel better. 
  • Sit on the front porch, step into the backyard or spend some time listening to music. 
  • Call a friend or relative to relieve tension. 
  • Find ways to relieve your stress so you will be a better parent and a better partner.

Some newborns cry more often during the day than others. The period when they cry most often typically begins when your baby is 2 weeks old and continues until he is 3 or 4 months old. During this time, your baby may cry for what seems to be no reason, and he likely will be difficult to soothe. Many parents and caregivers would feel better if they could just “fix” whatever was “bothering” their little ones. But that’s not always possible.

Dads, don’t take it personally

Dad holding baby on shoulderCrying one to four hours a day is quite normal for newborns. Even so, it can be frustrating. The crying usually peaks in the afternoon and evening hours – right when many fathers are returning home from work. You may feel like you are doing something wrong or that your baby doesn’t like you. Please know that you are not alone. Many parents, especially fathers, feel this way, even though that’s simply not the case.

Remember, this is a normal part of development for many infants, and the crying doesn’t last forever. It diminishes significantly after the first couple of months. The crying also won’t last all day and night, so you will have many cherished moments with your newborn. So take time to enjoy your little one. They grow up faster than you can imagine. It’s more important to stay calm than it is to stop the crying.

Most importantly, never shake your baby. That can cause permanent injury or even death.

Resources

 

Family Caregivers

Grandmother holding babyMany parents are fortunate to have extended family members who will help take care of the baby. This is a happy time for all of you, but it may have been a long time since your mother or others have taken care of an infant. So take the time to discuss with family caregivers the information in this book about crying plans, good nutrition, tummy time, the importance of putting babies to sleep on their backs and how they should never shake your child. Encourage them to spend time each day reading, singing and talking to your baby. You also may want to recommend that family members order their own free copies of the Happy Birthday Baby Books at healthyfamiliesnow.net

 
 
 
 

Bonding With Your Newborn

Mother bonding with babyBonding is the intense attachment that develops between a parent and child. Mothers and fathers both bond with their baby. Bonding is a very powerful survival mechanism that motivates parents to protect their vulnerable newborns. Don’t worry if you don’t feel an immediate bond. You may be exhausted and worried about taking care of your newborn. These feelings are normal, especially for first-time moms.

Tips for bonding:

Provide a warm and loving environment. Helping your baby feel safe and secure is critical to healthy growth and development. When you give your baby a lot of affection, you are telling him he is safe and protected.

Talk, sing and read with your child. You could say newborns are hard-wired to respond to sounds, which are the building blocks of speech and language. When you talk to your newborn, you are helping create a deep and enduring emotional connection.

Establish routines. Feeding and bedtime routines help create a predictable world for your baby. Routines provide a sense of comfortable sameness and stability that babies can trust and rely on. If your child feels that his world is safe, he will be able to put his energy into exploring and learning.

Resource

Early Learning

Your child is born learning. Right from birth his brain is making new connections and associations, working to understand the world around him. Children learn something from everything they do or see. As your child’s first and best teacher, you can help his developing brain by:

  • Talking, singing and reading as often as possible, even to newborns.
  • Letting him see what you do for fun and at work.
  • Making special trips to parks, museums or libraries.
  • Encouraging healthy, imaginative play and playing with him.
  • Creating opportunities for fun. 

Father playing with baby

Resource

Mom, Take Care of Yourself

Taking care of yourself means you’re more likely to have all the energy and enthusiasm it takes to care for your baby. Here are a few things to keep in mind:

Your postpartum checkup

Mother getting a check upMake an appointment to see your doctor for your postpartum visit. This appointment should be between two to six weeks after your baby is born. If you have questions or problems before then, call your doctor. 

Things to talk to your doctor about:

  • Ask if you are protected against rubella. If not, get a shot to protect yourself before you leave the doctor’s office.
  • Ask about family planning. Your body is not ready for another pregnancy right now. You can get pregnant again even if you are breastfeeding.  

Breastfeeding. It’s best for your baby, and it’s good for you, too. It will help get your uterus (womb) back in shape. For help or advice about breastfeeding, call:

  • The hospital where you gave birth. They may have a lactation consultant.
  • The Arkansas Department of Health at 1-800-445-6175 
  • La Leche League at 1-877-452-5324 or visit the 
  • La Leche League at www.llli.org.

Avoid alcohol, cigarettes and drugs. They are not healthy for you and can harm your baby if passed through your breast milk.

Your diet. Eat a variety of healthy foods and drink six to eight glasses of water and other liquids each day.

Postpartum care

Postpartum discomfort may include:

Sore breasts or engorgement. Several days after delivery, your breasts may become heavy, swollen and tender. This means your breasts are overfull or engorged. You also may have a low-grade fever.

To ease engorgement:

If you are breastfeeding, nurse your baby or use a breast pump to express milk. You also may want to apply cold washcloths or ice packs to your breasts, or take a warm bath or shower. Over-the-counter pain relievers may help, too.

If you’re not breastfeeding, wear a firm, supportive bra. Compressing your breasts will help stop milk production. In the meantime, don’t pump your breasts or express milk because this will signal your breast to produce more milk.

Leaky breasts. Unfortunately, you can’t stop the leaking, but wearing absorbent nursing pads inside your bra can help keep your clothes dry. Avoid pads that are lined or backed with plastic, which can irritate your nipples. Change pads after each feeding or whenever they get wet.

Constipation. Your first bowel movement after birth may take a couple of days. Hemorrhoids you developed during pregnancy, healing episiotomies and sore muscles may make it a painful event. 

To prevent constipation and straining:

  • Eat foods high in fiber – including fruits, vegetables and whole grains. 
  • Drink plenty of water. 
  • Remain as physically active as possible.
  • Try using a stool softener or fiber laxative. 
  • Contact your doctor if you do not have a bowel movement after several days.

Hemorrhoids. Your doctor may recommend a topical hemorrhoid medication, a soak in a warm tub or chilled witch hazel pads applied to the affected area.

Episiotomy. If the area of skin between your vagina and anus was cut by your doctor or torn during birth, the stitches may make it painful to sit or walk for a little while. While it is healing, it also may be painful when you cough, sneeze or laugh. 

For relief:

  • Apply cold packs to that area for the first 24 hours after delivery, and then use warm packs.
  • Avoid infection and promote healing by rinsing the area with warm water after you urinate or have a bowel movement. Use anesthetic sprays and creams, or clean the area with witch hazel pads (Tucks).
  • Sit in a sitz bath (a small basin that fits on top of the toilet) or bathtub three or four times a day. 

Urinary or fecal incontinence. If you had an unusually long labor or a vaginal delivery, you may experience urinary or fecal incontinence because of the stretching and weakening of the muscles of your pelvic floor. This means you may accidentally pass urine when you cough, laugh or strain, or may find it difficult to control your bowel movements. Get those muscles back in shape by doing your Kegel exercises. 

If you continue having trouble controlling bowel movements, call your doctor.

Pains. After giving birth, your uterus will continue having contractions for a few days. These are most noticeable when your baby nurses or when you are given medication to reduce bleeding. Your doctor may recommend an over-the-counter pain reliever.

If you have a fever or if your abdomen is tender to the touch, call your doctor. You may have a uterine infection.

Vaginal discharge. At first you may have a bloody discharge that could be heavier than your period and may contain clots. It’s normal, so don’t be alarmed. This bloody vaginal discharge will gradually fade to white or yellow and then stop completely within two months. To reduce the risk of infection, use sanitary napkins rather than tampons. 

Contact your doctor if:

  • You soak a sanitary pad within an hour while lying down.
  • The discharge has a foul odor.
  • You pass clots larger than a golf ball.
  • You have a fever of 100.4°F or higher.

Weight. It’s not unusual to feel flabby and out of shape after pregnancy. You may even look like you’re still pregnant. This is perfectly normal. Your abdominal muscles probably separated during pregnancy and will take at least six weeks to heal. 

  • Eating a healthy diet and exercising regularly will help you gradually regain your pre-pregnancy figure. 
  • The recommended amount of calories varies from woman to woman. Check with your doctor about what’s right for you.
  • Do your Kegels, but wait until you have completely stopped bleeding before swimming or taking extended walks. 

Recovery from cesarean section

If you had a C-section, it may take longer for you to recover. 

The worst pain will probably be in the first day or two after surgery, but it will subside gradually. Your doctor will tell you about postsurgical precautions and give you directions for bathing, how to begin gentle exercises to speed recovery and how to help avoid constipation.

You should:

  • Drink 8 to 10 glasses of water daily.
  • Expect vaginal discharge.
  • Avoid stairs and lifting until you’ve healed.
  • Avoid driving until you can make sudden movements and wear a safety belt properly without discomfort.
  • Call your doctor if the incision becomes red or swollen.

 

Going Back to Work

For most companies six weeks is considered the normal length of maternity leave following delivery. That may be too few for some new mothers and too much time for others. The Family and Medical Leave Act (FMLA) requires companies to allow up to 12 weeks of unpaid leave for employees (of companies with more than 50 employees) to care for a newborn or newly adopted child.

If you’re trying to decide whether you’re ready to go back to work, here are some things to think about:

  • How much support can you expect to get at home with household chores and child care? 
  • How many hours a week do you work? 
  • What are the demands of your job?
  • How much flexibility do you have at work? 
  • Will you be able to take rest breaks, if necessary? 

Making the transition from home to work

Most mothers have to go back to work within six to eight weeks after the birth of a baby. Although it’s always an emotional time, there are ways to make your transition back to work easier.

Have an efficient, organized daily routine and practice it for a few days before you actually go back to work. Allow enough time to get yourself and your baby ready so you don’t get (or stay) stressed. If you can, have your child care arrangements begin a few days early so you can get emotionally prepared for your first real day away from your baby.

Have a backup plan for those times (and they will come) when your child care provider isn’t available.

Get as much rest as you can so you will be able to cope with stress better. If that means letting some household responsibilities slide, then so be it. Ask your partner to help if he doesn’t already.

If you’re going to continue breastfeeding, plan ahead. Buy a breast pump and begin pumping and freezing milk two weeks before you go back to work. Frozen milk is good for at least one month in a freezer. See Storing and Preparing Expressed Breast Milk in the Feeding Baby section of this book.

Let someone else bottle-feed your baby so he will get used to being fed by someone other than you.

Talk with your employer to work out a break schedule, and find a private place to pump milk. Pumping sessions will probably require 15-20 minutes, two or three times a day. You’ll also need to find a way to refrigerate the milk and get it home at the end of the day. For more on pumping milk at work, go to the La Leche League International website at www.llli.org/faq/pumpfreq.html. 

 

For Dad

Dad playing with babyDads and other important men like grandfathers and uncles can make significant contributions to a child’s development. When fathers with a positive attitude are affectionate, spend time with their children and are involved in their children’s daily activities, their children have fewer behavioral problems, perform better in school, are more sociable and have better self-esteem. Some things you can do include:

Define your role. There are plenty of opportunities for hands-on dads as playmates, diaper changers, bathers and soothers. The key is to play, touch and talk with a baby as much as possible.

Create your own rituals. Turn activities like running weekend errands into regular routines for father and child. Although they may seem mundane, simply having consistent one-on-one time will make the activity special.

Take on responsibilities. A dad can pick up his child from child care, help him get dressed in the morning, prepare his meals and take him to the doctor. Directly caring for a child will make dads feel good about themselves and their fathering skills.

Try to balance work and family. While being involved is critical, be careful not to overdo it. Dads should have some time for themselves so that they can refuel and have something to offer their child.

Dad working while holding baby

Resource

Taking Care of Baby

Feeding baby

Mother holding hungry babyFor the first six months of your baby’s life, the only nutrition he needs is breast milk or formula.

The American Academy of Pediatrics recommends breastfeeding as the best form of infant feeding. Formula is not identical to breast milk, but formulas do provide an appropriate level of nutrition. Both approaches are safe and healthy for your baby, and each has its advantages. 

  • Newborns need to be fed every two to three hours, but a strict feeding schedule isn’t necessary. 
  • Breastfed babies need to eat more often because breast milk digests more quickly. 
  • Don’t be alarmed if you notice your baby has lost weight in the first week; most infants lose several ounces of weight during their first week, but they should be back up to their birth weight by the end of the second week. 
  • If your baby sleeps for periods longer than four hours in the first two weeks, wake him for a feeding. If your baby will not stay awake long enough to eat at least eight times per day, call your pediatrician.

Breast or bottle? 

Before your baby arrives, you’ll want to consider whether you’re going to breastfeed or use formula. Regardless of which you choose, rocking, cuddling, stroking and gazing into your baby’s eyes while you feed him will enhance the experience for both of you. 

Formula feeding is not identical to breastfeeding, although formulas do provide appropriate nutrition. Nevertheless, the American Academy of Pediatrics recommends breastfeeding as the healthiest form of infant feeding, and there’s evidence it’s good for you, too. 

Signs your baby is hungry

  • Moving his head from side to side while opening his mouth
  • Sticking out his tongue
  • Placing his hands and fists to his mouth
  • Puckering his lips as if to suck
  • Nuzzling against your breasts
  • Showing the rooting reflex (moving his mouth in the direction of something that’s touching his cheek)

Is baby getting enough?

You’ll know your baby is getting enough to eat if by the time your baby is a week old, he has:

  • At least six or more wet diapers each day (urine should be pale yellow).
  • Three or more bowel movements each day (stool will be soft, yellow and seedy-looking).
  • Steady weight gain – most babies are back to their birth weight in about a week and gain 4 to 8 ounces per week for the next few months.
  • Periods of happiness or calm for an hour or two after most feedings.

If you think your baby is not getting enough to eat, call your doctor right away.

Breastfeeding 

Breastfeeding: Good for baby

  • Breast milk contains at least 100 ingredients not found in formula or cow’s milk. 
  • Breast milk is easier to digest.
  • Breast milk has antibodies that help babies fight infection and disease.
  • Breast milk coming directly from mother’s breast is sterile.
  • Breastfed babies may have a lower risk of childhood obesity. 

Breastfeeding: Good for you

  • Breastfeeding reduces the risk of breast, ovarian and uterine cancers.
  • Breastfeeding promotes emotional bonding with your baby.
  • Breastfeeding promotes postpartum weight loss.
  • Breastfeeding costs less than formula.

Woman breastfeeding babyTalk to your doctor about the advantages and challenges of both breastfeeding and formula feeding long before you go to the hospital to deliver. Both approaches are safe and healthy for your baby, and each has its advantages. 

Tips for getting breastfeeding off to a good start:

  • Learn about breastfeeding during pregnancy, via classes, videos, books or the Internet. 
  • Breastfeed as soon as possible after delivery.
  • Ask for help to get correct positioning and latch on. Many hospitals and birthing facilities have lactation specialists on staff who can help you.
  • Nurse often, at least every three hours or eight to 12 times each 24 hours.
  • Listen for swallowing sounds during the feeding to make sure everything is going down well.
  • Let your baby be the judge of when he’s had enough. He should seem satisfied and look relaxed.
  • Baby should wet and soil at least six diapers every day.
  • The number of wet and soiled diapers should increase each day during the first week of life.
  • If you are breastfeeding, your baby needs to be seen by his pediatrician within 48 to 72 hours after you leave the hospital. During this visit, your baby will be weighed and examined, and your breastfeeding technique can be evaluated. It’s also an opportunity for you to ask questions.

If you need help or advice about breastfeeding, call your local WIC clinic, the Arkansas Department of Health at 1-800-445-6175 or La Leche League at 1-877-452-5324. You also can go to their website at www.llli.org.

What happens if you get sick while you’re nursing?

Most experts agree that the best thing for you and your baby is to continue nursing. Your body will produce antibodies to the bug causing your illness, and you will pass those along to your baby through your breast milk. If your baby does get sick, he will probably only get a very mild case of the illness.

Very few diseases or illnesses require breastfeeding to stop. If you’re sick, talk to your doctor. 

Some over-the-counter medications are considered safe for nursing mothers, and others are not. Always ask your doctor before taking any medication while you’re nursing.

Storing and preparing expressed breast milk

Breast milk is very versatile. It is perfect straight from your breast, or it can be expressed and stored for later use. Follow these safe storage and preparation tips to keep your expressed milk healthy for your baby:

  • Wash your hands before expressing or handling your milk.
  • Use only clean containers to store milk. 
  • Freeze milk if you do not plan to use it within 24 hours. Frozen milk is good for at least one month in a freezer.
  • Carefully label the milk with the date and time that you expressed it. Use the oldest milk first. 
  • Freeze 2 to 4 ounces of milk per container, to avoid wasting milk after you thaw it.
  • Do not refreeze your milk.
  • Do not add fresh milk to already frozen milk in a storage container.
  • Thaw milk in the refrigerator.
  • Use milk thawed in the refrigerator within 24 hours.
  • Do not save unfinished milk from a partially used bottle to use at another feeding.
  • Never use a microwave to heat bottles. Uneven heating can scald your baby and excessive heat can destroy important proteins and vitamins in the milk. 

Feeding formula

All formulas manufactured in the United States must meet strict nutritional standards set by the U.S. Food and Drug Administration (FDA), so don’t be fooled into thinking that expensive, brand-name formula is any better for your baby than a generic brand. But make sure to check the expiration date on all cans and bottles of formula, and don’t use formula from leaky, dented or otherwise damaged containers. 

Sometimes you may need to change the formula you feed your baby. Reasons for switching baby formula include food allergies, a baby’s need for more iron, extreme fussiness or diarrhea. These symptoms can also be signs of something unrelated to the baby’s formula. In that case, a change may not help or could make the baby’s symptoms worse. That’s why you should always talk to your baby’s doctor before changing infant formulas. And call your doctor if your baby has any of these symptoms:

  • Dry, red and scaly skin
  • Diarrhea
  • Extreme fatigue or weakness
  • Forceful vomiting

For more information on feeding your baby, visit www.askbaby.com, kidshealth.org or marchofdimes.com.

Bottle basics

Woman bottle feeding babyBaby bottles certainly have their place, even if you are breastfeeding. Moms who breastfeed often express their milk by pumping and then storing it in the freezer or refrigerator for times when they can’t nurse.

  • Always hold your baby when feeding.
  • Keep plenty of formula and ready-to-use bottles on hand.
  • Sterilize bottles and nipples before first use and after every use.
  • Throw away bottle contents that sit at room temperature for more than one hour to reduce the risk of infections due to salmonella or other bacteria.
  • Never use the microwave to warm your baby’s bottle. Dangerous “hot spots” can burn your baby.

 

Your Baby's Oral Health

Healthy gums (and later, teeth) are important for your baby’s overall health and development. 

  • Begin cleaning your baby’s mouth during the first few days after birth. 
  • After every feeding, wipe your baby’s gums with a clean soft cloth or a soft infant toothbrush and water to remove plaque and residual milk that can harm new teeth that may be coming through.
  • Do not use fluoride toothpaste until your child is 2 to 3 years old. 

 

Taking Baby's Temperature

The most accurate way to take an infant’s temperature is to use a digital thermometer rectally or orally. Make sure you carefully read the instructions that came with your thermometer.

Lubricate the tip of the thermometer with petroleum jelly. Place your baby on his back, lift your baby’s thighs, and insert the lubricated thermometer ½ to 1 inch (1.3 to 2.5 centimeters) into the baby’s rectum. If you feel any resistance stop immediately. Hold the thermometer in place for about a minute or until the thermometer signals that it’s done. Remove the thermometer, and read the number.

If your infant is 3 months or younger and has a rectal temperature of 100.4°F or higher, call your doctor or go to the emergency room immediately.

Resource

Fever

In infants 3 months of age or younger, an increase in body temperature of even a couple of degrees can be a sign of a potentially serious infection and should be taken very seriously. 

Causes of fever

Infection. Most fevers are caused by infection or other illness. Researchers believe fever helps the body fight infections by stimulating natural defense mechanisms.

Overdressing. An infant’s brain has not developed fully enough to regulate his body temperature. Babies may develop fevers if they’re too bundled up or are in a hot environment. 

Immunizations. Babies and children sometimes get low-grade fevers after getting vaccinated.

Teething. Although teething (starting at approximately 4 months of age) sometimes leads to a slight rise in body temperature, it’s probably not the cause if an infant’s temperature is higher than 100F. Call your doctor to be sure.

Resources

When To Call Your Baby's Doctor

Couple with sick baby on the phoneChances are you’ll be able to tell when something isn’t quite right. If you think your baby needs medical attention, call his doctor. Not everything is an emergency, but there are some conditions that simply can’t wait for regular office hours.

Call your doctor immediately if your baby:

  • Has a temperature above 100.4°F.
  • Has trouble breathing or is hard to waken.
  • Has blood in his vomit or stool.
  • Has yellowish skin or eyes.
  • Is having a seizure (jerking or trembling movements in infants are fairly common and are not usually seizures, but if you are concerned, consult your pediatrician).

 

Resource

Taking Care of Minor Problems

Care of umbilical cord:

  • The end of the cord will fall off a couple of weeks after birth. Until then, keep it clean and dry.
  • Keep your baby’s diaper below the cord so it stays dry.
  • In the past, parents were told to swab the base of the cord with alcohol one or two times a day. But research shows the cord heals faster when it is left alone. If you’re unsure, ask your doctor.
  • Call your baby’s doctor if the cord stump looks red or irritated, bleeds or oozes, or has a bad odor.

Care of circumcision:

  • Clean the penis gently with mild soap and water during diapering.
  • If the tip of the penis is irritated by the diaper, put a little bit of petroleum jelly on the irritated area each time you change your baby’s diaper. 
  • A circumcision should heal in 7 to 10 days.

Preventing diaper rash:

  • Change diapers often.
  • Wash your baby’s bottom with mild soap and water at each change. Avoid scented wipes and soaps.

Treating diaper rash:

  • Let your baby go without a diaper for a few hours each day, and avoid using plastic pants. (You may want to place several folded cloth diapers under your baby.)
  • Keep his skin as dry as possible.
  • Use zinc oxide or diaper rash cream on irritated areas after washing.
  • Do not use talcum powder or cornstarch on your baby’s skin.

Treating diarrhea: 

Diarrhea can be a very serious problem for newborns and infants because it can cause them to become dehydrated (lose body fluid) quickly. If your baby will nurse or take a bottle, continue feeding as usual.

Call your baby’s doctor if your baby:

  • Won’t take liquids.
  • Can’t keep them down.
  • Has a lot of diarrhea or has diarrhea for longer than 12 hours.

Treating colic:

Refer to the section on crying earlier in this book.

Treating a cold:

Adult colds make us feel bad for a while, but they’re no big deal. For newborns, a common cold can quickly develop into croup, pneumonia or another serious illness. If your baby is younger than 3 months old, contact the doctor at the first sign of illness or before giving your child any medicine.

  • Use a suction bulb to remove mucus from your baby’s nose. Squeeze the bulb part of the syringe, gently place the tip inside one nostril and slowly release the bulb. Suction bulbs are available at most drug stores.
  • Keep nasal passages moist by running a cool-mist humidifier in your child’s room.
  • Children age 4 and under should not take cough or cold medicines unless prescribed by your doctor.

Bathing Baby

Bathing your baby too often will cause dry skin. Many doctors recommend sponge baths until the umbilical cord falls off, and then bathing one to three times a week with warm water and a soft cloth. 

Baby getting a bath

When using a tub or sink:

  • Collect everything you may need to bathe your baby before you begin.
  • Make sure the room is nice and warm.
  • Place a towel or large sponge under your baby to keep him from slipping from your grasp. Use only 2 or 3 inches of water. 
  • Wait until the bath water is completely ready before undressing your baby so he won’t get chilled.
  • Wash your baby’s face and eyes first before putting him in the tub to prevent eye infections. 
  • Use mild soap sparingly to avoid dry skin. Wash your baby’s scalp with a wet, soapy cloth. You will need to wash your baby’s hair with shampoo only once a week. 
  • Rinse your baby thoroughly with a clean soft cloth or sponge.
  • Wrap your baby in a towel and pat him dry.
  • Never leave your baby alone in the sink or tub even for a second.

 

Preventing Injury & Vehicle Safety

Preventing Injury 

 

Arkansas and Tennessee have some of the highest rates of child and adolescent injury in the nation. Arkansas Children’s Hospital has made reducing the rate of childhood injury a high priority. Download the Home Safety Checklist from www.archildrens.org/ documents/ipc-homesafety.pdf or visit the Tennessee Department of Health at health.state.tn.us/healthyhomes/injury.shtml, and begin making your home safer as soon as possible.

Vehicle Safety

Vehicle crashes are a leading cause of death in Arkansas and Tennessee for children and youth ages 1–19. Many of these deaths and injuries can be prevented. The Injury Prevention Center at Arkansas Children’s Hospital offers programs to educate parents on the importance of vehicle safety. For a detailed list of vehicle safety tips, visit www.archildrens.org and type “injury prevention” in the search window or visit the Tennessee Department of Health at health.state.tn.us/healthyhomes/injury.shtml. 

Resource

 

The Well-Child Checkup & Immunizations/Vaccinations

Unless your child shows outward signs of illness or some other health problem, you may not know anything is wrong. Some conditions require blood tests or a doctor’s practiced eye to detect. Well-child checkups are the best way we have of finding potential problems early when they can be more easily and successfully treated. 

The well-child checkup includes:

  • Getting a health history and developmental assessment
  • A complete physical exam
  • Vision and hearing checkups
  • Laboratory tests
  • Age-appropriate immunizations
  • Health education
  • A dental referral

Baby at the doctor getting a checkup

Immunizations/vaccinations

The Centers for Disease Control and Prevention publishes a schedule of age-appropriate immunizations for infants from birth through age 6. Immunizations will protect your child from getting many serious illnesses (like polio, measles, mumps and others) that can cause lifelong problems. So it’s important that your child be up to date on shots. If you have questions about which immunizations your baby received in the hospital, call your doctor. 

Flu (or influenza) kills many newborns, infants and children every year. Talk to your doctor about getting your child immunized for flu. 

NOTE: If your child misses a shot, you don’t need to start over. Just go back to your child’s doctor for the next shot. The doctor will keep your child up to date on vaccinations. Talk with your doctor if you have questions. 

Put your copy of the “Well-Child Checkups and Immunization/Vaccinations” chart where you can refer to it easily. Making and keeping appointments with your child’s pediatrician will help keep your baby healthy and happy.

 

 

 

 

 

 

 

 

 

This schedule applies to healthy children. Parents of children who are born more than two months premature, with chronic diseases (like sickle cell disease, anatomic or functional asplenia, HIV or other immunodeficiencies) or who have cochlear implants should talk to the doctor about additional needed vaccines.

For more information about diseases that can be prevented by a vaccine, call 1-800-CDC-INFO (1-800-232-4636) or visit http://www.cdc.gov/vaccines/parents/downloads/parent-ver-sch-0-6yrs.pdf

Visit HealthyFamiliesNow.net/resources to print out a copy of this chart to hang on your refrigerator or somewhere that you can refer to it easily.

FOOTNOTES

1. HepA vaccination is recommended for high-risk children older than 2 years. Children with certain medical conditions may also need a dose of meningococcal vaccine (MCV4) and pneumococcal vaccine (PPSV). HepA vaccination may be administered to any child older than 2 years for whom immunity is desired. See vaccine-specific recommendations at http://www.cdc.gov/vaccines/pubs/ACIP-list.htm.

2. Two doses given at least four weeks apart are recommended for children aged 6 months through 8 years of age who are getting a flu vaccine for the first time. Children who only got one dose in their first year of vaccination should get two doses the following year. 

Baby's First Year

Baby trying to walk

Developmental milestones 

It’s important to remember that babies develop at their own pace. There’s a fairly wide “window” for when it is normal for a baby to reach a particular developmental stage. If you have concerns about your baby’s development, talk to his doctor. If there is a problem, addressing it early is the best way to decrease the effects on his future. For a complete month-by-month description of developmental milestones, go to The American Pregnancy Association website at www.americanpregnancy.org/.

Birth to two months

Development

During this first development stage, babies’ bodies and brains are learning to live in the outside world.

  • Most babies gain about 2 pounds each month during the first few months.
  • They will sleep most of the time. 

Parenting 

Take your baby to the doctor within the first two weeks and at two months for a well-baby checkup and shots. 

  • Touch, hold and talk to your baby to help you bond with each other. 
  • Babies learn to depend on and trust those who care for them. 
  • Always place your baby on his back to sleep, even for naps.
  • When you take your baby out, protect his skin from strong sunlight and keep a blanket handy to prevent him from getting chilled. Babies need their heads covered in cool weather because they lose a lot of heat through their heads. Woman holding young infant

Feeding 

  • Feed your baby only breast milk or iron-fortified formula at this age, and burp him frequently. 
  • Do not give your baby any juices, sugar water, honey or solid foods at this age. 
  • Do not heat your baby’s bottle in the microwave.
  • Always hold your baby when feeding him, and do not prop the bottle up for feeding. 

Two to four months

Development

  • Your baby will begin to smile and make some squealing, cooing noises now. 
  • Your baby might begin to hold his head up while on his stomach and will soon roll over. 
  • Your baby might begin to move around and will put things in his mouth. Watch your baby closely so that he does not choke on small objects.

Parenting 

Baby sitting in a lapTake your baby to the doctor at 4 months for a well-baby checkup and shots. 

  • Your baby will begin to stay awake for longer periods of time and will be interested in the things around him. 
  • He will discover his hands with wonder. 
  • Your baby will like to be carried and will enjoy cuddling and playing with you. 
  • Your baby should always be secured in a baby seat with safety straps.

Feeding 

  • Continue to breastfeed or bottle-feed. No solid foods are needed yet. 
  • At your baby’s four-month checkup, ask the doctor for advice on starting your baby on solid foods. 
  • Wipe your baby’s gums with a soft, wet cloth after feeding. 

Four to six months

Development

  • Most babies gain about 1 pound per month for the next six months.
  • Your baby will enjoy people and begin to show emotions such as laughing or fussing. 
  • Your baby also will begin to play with rattles and other small toys. 
  • He also will stretch his arms out to be picked up. 
  • He may begin teething. 

Parenting 

  • Take your baby to the doctor at 6 months for a well-baby checkup and shots. 
  • Use a stroller or infant seat to take your baby with you. 
  • Your baby will enjoy seeing you, being in different rooms, hearing you talk and seeing you smile. 
  • If you haven’t made your home safer yet, you’d better get started.

Child surrounded with toys

Feeding 

  • You may begin feeding your baby solid foods. Start solid foods by reducing the amount of breast milk and introducing cereals (rice first, then barley and oatmeal). 
  • You should feed cereal only with a spoon and never in a bottle or infant feeder. If your baby is teething, he might not be hungry. If he has a fever of 101°F or higher, contact your doctor. 

Six to nine months

Development

  • Your baby will be able to play peek-a-boo and patty-cake soon. 
  • He may reach out to loved ones and show shyness to strangers. 
  • He can hold or pick up toys by himself. 
  • He should be crawling soon. 
  • He may begin stringing sounds together like “Mama” and “Dada.”

Parenting 

Take your baby to the doctor at 9 months for a well-baby checkup and shots. 

  • Talk with your baby and tell him simple words for the objects and actions in his life. 
  • Read him simple and short bedtime stories. 
  • Let your baby move around on the floor and explore his abilities. 
  • Use safety locks on all cabinets and drawers within his reach to protect him from small objects and dangerous chemicals. Child with sippy cup

Feeding 

  • You can feed your baby strained fruits and cooked vegetables and also strained meats. Continue to provide breast milk or formula to your baby as well. 
  • Begin cup feeding slowly with juice and water, but do not leave a bottle in the crib with your baby to help him sleep. The sugars in juices can cause tooth decay. If you choose to give juice, limit to no more than four ounces per day.

Nine to 12 months

Development

  • Your baby will be moving around the room and later walking. This usually happens right around one year, but it can vary greatly.
  • Your baby will begin to drink from a cup and eat small pieces of food with his fingers. 
  • He understands “no” and will show many emotions. 
  • You should talk to your baby’s doctor about switching to cow’s milk at 12 months.

Parenting 

Take your baby to the doctor at 12 months for a well-baby checkup and shots. 

  • Your baby will learn much through play. Provide some balls, dolls, bathtub toys and a jack-in-the-box for your baby. 
  • Keep his world safe by putting small objects, breakable items and dangerous liquids out of your baby’s reach. 
  • Baby in bath tubPlay with your baby as often as possible. Share his excitement and help or comfort him when needed. 

Feeding 

  • Feed your baby small finger foods and some table foods. 
  • Avoid hot dogs, raisins, peanuts, popcorn, peanut butter, whole grapes or other food that will be hard to chew or could cause your baby to choke. 
  • Replace your baby’s bottle with a drinking cup. 
  • Continue wiping your baby’s gums with a soft, damp cloth or soft brush after eating.
  • Continue to breastfeed if you and your baby both desire.
 

Glossary of Terms

Your pregnancy and delivery

Amniocentesis. Also called an amnio. Test of the amniotic fluid to detect birth defects or genetic problems.

Anemia. A decrease in the number of red blood cells, usually due to a shortage of iron. The condition causes such symptoms as fatigue, weakness, breathlessness or fainting spells.

Apgar test. Done on babies at birth to check heart rate, breathing, muscle tone, reflexes and skin color.

Back labor. Intense lower back pain during birth.

Bloody show. Bleeding from your vagina at the beginning of labor.

Braxton-Hicks contractions. Also called “false labor.” Unlike true labor, Braxton-Hicks contractions aren’t painful and don’t get stronger and closer over time.

Breech baby. When the baby’s bottom or feet, rather than the head, face the mother’s cervix as labor nears.

Carpal tunnel syndrome. Numbness, tingling and pain in the hand caused by the compression of a nerve in the wrist. Usually goes away after delivery.

Cervix. The narrow, lower end of the uterus. During labor, the cervix softens, thins and opens to allow the baby to leave the uterus.

Cesarean delivery. Surgical procedure to deliver a baby through a cut in the abdomen and uterus. Also called a C-section.

Contractions. The strong, rhythmic tightening of the uterus during labor.

Crowning. Point during labor when baby’s head has reached the external vaginal opening and can be seen from the outside.

Depression. Feelings that include sadness, loss of interest or pleasure in activities you used to enjoy, difficulty sleeping or oversleeping, loss of energy and thoughts of death or suicide.

Doppler. Ultrasound that measures fetal blood flow in the umbilical cord and certain blood vessels.

Edema. Swelling in the ankles and feet caused by fluids in the tissues.

Effacement. Term referring to the thinning of the cervix.

Embryo and fetus. Terms used to describe stages of development before birth.

Engagement. Also called lightening or dropping. When the baby descends into the pelvic cavity in preparation for birth.

Epidural. Anesthesia given at the base of the spine to numb the lower body and reduce pain.

Episiotomy. An incision made between the rectum and vagina to make room for the emergence of the baby’s head.

Family Medical Leave Act (FMLA). Legislation requiring up to 12 weeks of unpaid leave for employees (of companies with more than 50 employees) to care for a newborn or newly adopted child.

Fetal monitoring. Tracking a fetus’s heartbeat and a woman’s uterine contractions during labor.

Folic acid. A and B vitamins found in prenatal vitamins and green, leafy vegetables that helps prevent serious birth defects.

Fundal height. The distance between the top of a pregnant woman’s uterus (fundus) to her pubic bone. The fundal height is measured to determine fetal age.

Gestational diabetes. A condition that develops during pregnancy when a woman’s blood sugar levels become too high. Usually disappears after pregnancy.

Glucose challenge test. Usually done within weeks 26–28 to detect elevated levels of glucose.

Hemorrhoids. Swollen and inflamed veins in the anus and lower rectum.

Hepatitis B. A serious disease caused by a virus that attacks the liver.

High-risk pregnancy. A pregnancy that is likely to have problems.

Induced labor. Labor started by medical intervention.

Jaundice. Yellow eyes and skin caused by buildup of bilirubin in the liver.

Kegel exercises. Simple exercises to increase circulation in the rectal area and strengthen the muscles around the anus, vagina and urethra to resolve urinary or bowel incontinence and hemorrhoids.

Lactation. The production of breast milk beginning between two and seven days after a woman gives birth.

Lanugo. The fine, temporary hair covering a fetus from about 26 weeks.

Listeriosis. An illness caused by bacteria found in certain foods, including unpasteurized milk products, undercooked meats, fish, shellfish, poultry, deli meats and unwashed vegetables.

Low birth weight. Weight at birth of less than 5 pounds, 8 ounces. Babies with low birth weight are at increased risk for serious health problems as newborns, lasting disabilities and even death.

Miscarriage. The spontaneous and involuntary loss of a pregnancy before 20 weeks.

Morning sickness. Nausea and vomiting triggered by food and smell aversions. Usually begins at four to eight weeks into the pregnancy and subsides by week 14 or 16.

Newborn screening. Blood and hearing tests babies get before leaving the hospital.

Pap test. A routine medical test to check for abnormalities in the cells of a woman’s cervix.

Pasteurized. A food or drink that’s been heated to kill bad germs. Milk and juice often are pasteurized.

Placenta. A pancake-shaped organ that develops in the uterus and provides nutrients and oxygen for the fetus and eliminates its waste products.

Preeclampsia. A serious condition of pregnancy marked by high blood pressure and excess protein in the urine after 20 weeks of pregnancy. Can be fatal.

Premature baby. A baby born before 37 weeks of pregnancy.

Prenatal vitamin. A vitamin made specifically for pregnant women to support fetal development.

Preterm labor. Labor that occurs after 20 weeks but before 37 weeks of pregnancy. Sometimes caused by smoking, drinking alcohol, using drugs and poor prenatal care.

Quickening. Time during the fourth month of pregnancy when the baby begins moving.

Reflux (acid reflux, heartburn). A burning sensation that often extends from the bottom of the breastbone to the lower throat.

Rh incompatibility. A very serious but treatable condition in which a baby’s blood type and Rh factor are incompatible with the mother’s.

Sciatica. A tingling or numbness down the backs of the legs from pressure on the sciatic nerve.

Stages of labor. Labor is divided into three stages. Stage 1 begins at the onset of contractions and ends when the cervix is completely dilated. Stage 2 is the delivery of the baby. Stage 3 is delivery of the placenta.

Toxoplasmosis. A dangerous parasitic infection spread by cats and contaminated food.

Ultrasound. A test that uses sound waves to produce images of your baby.

Uterus. The hollow, pear-shaped, muscular organ in which a baby grows.

Vaginal discharge. An odorless or mild-smelling milky discharge causing itching or burning.

Varicose veins. Swollen veins that bulge near the surface of the skin.

Yeast infection. An odorless, whitish discharge that can cause itching or burning.

When you and your baby come home

After pains. Postpartum cramping triggered by contractions of the uterus.

Baby blues. Mild depression that follows childbirth. Usually the result of hormonal imbalance.

Breast pump. An electric or manual pump used to collect breast milk and relieve engorgement.

Circumcision. Surgical removal of the foreskin, a double-layered sleeve of skin and tissue that covers the head of the penis.

Colic. Continuous crying that continues for more than three hours at least three days a week for three months. Usually occurs in infants between three weeks and three months of age.

Colostrum. The protein-rich, sticky, yellow fluid leaked by the breasts before the production of true milk.

Contraception. Methods to prevent becoming pregnant.

Cradle cap. A condition in which a baby’s scalp has flaky, dry skin that looks like dandruff, or even thick, oily, yellowish or brown scaling or crusting patches.

Developmental milestones. Skills that identify particular levels of development.

Developmental screenings. Examinations and screening tests for age-appropriate reflexes and behaviors.

Diaper rash. Irritated and red skin in your baby’s diaper area, often caused by prolonged exposure to wetness.

Diarrhea. Loose, watery stools. Call your baby’s doctor if your infant has not eaten any food in three hours and has had more than three watery stools in 24 hours or more than seven loose stools and/or episodes of vomiting in 24 hours.

Engorgement. Overfull, swollen and tender breasts after childbirth.

Expressing breast milk. Removing breast milk from the breasts.

Fetal alcohol syndrome (FAS). A set of physical and mental birth defects resulting from drinking alcohol during pregnancy. Symptoms include brain damage, facial deformities, heart, liver and kidney defects and vision and hearing problems.

Growth curve. The progress of a baby’s physical development.

Immunizations/Vaccinations. A series of vaccines, often by injection, which make a child resistant to certain bacteria or viruses. See pages 140-141 for the well-child checkup and immunizations/vaccination chart. Vaccinations prevent the following diseases:

  • Hepatitis B. A virus that infects the liver.
  • Rotavirus. Most common cause of severe diarrhea among infants and young children. It is one of several viruses that cause infections often called stomach flu, despite having no relation to influenza.
  • Diphtheria. A highly contagious upper respiratory tract illness.
  • Tetanus. An infection characterized by a prolonged contraction of skeletal muscle fibers. This infection generally occurs through wound contamination and often involves a cut or deep puncture wound.
  • Pertussis. A highly contagious bacterial disease also known as “whooping cough.”
  • Haemophilus Influenzae Type B. Lives in the body without causing disease, but causes problems when other factors create an opportunity like viral infections.
  • Pneumococcal. Causes blood infections, pneumonia, and meningitis, mostly in young children. Although pneumococcal meningitis is relatively rare (less than 1 case per 100,000 people each year), it is fatal in about 1 of 10 cases in children.
  • Polio. A contagious viral illness that in its most severe form causes paralysis, difficulty breathing and sometimes death.
  • Influenza. A viral disease commonly referred to as the “flu.” The most common symptoms of the disease are chills, fever, sore throat, muscle pains, severe headache, coughing, weakness, fatigue and general discomfort. Typically, influenza is transmitted through the air by coughs or sneezes, creating aerosols containing the virus.
  • Measles. An infection of the respiratory system caused by a virus that is highly contagious; 90% of people sharing living space with an infected person will catch it.
  • Mumps. A contagious viral disease. Symptoms include fever, headache, testicular swelling and rash.
  • Rubella. A common childhood, airborne infection. Symptoms include a rash on the face that spreads all over the body.
  • Varicella. An extremely contagious viral infection, also known as chickenpox, causes extremely itchy blisters all over the body.
  • Hepatitis A. An acute infectious disease of the liver. Symptoms include fatigue, fever, abdominal pain, nausea, appetite loss, jaundice, bile and clay-colored feces.
  • Meningococcal. A bacterial infection that can result in death if untreated.

Mastitis. Infection of a milk duct in the breast.

Nasal aspirator. A bulb-type syringe used to clear nasal congestion.

Postpartum depression. More severe than the baby blues; characterized by crying, irritability, sleep problems, restlessness, feelings of hopelessness and the inability to care for the baby. Many women suffering from postpartum depression need professional treatment.

Shaken baby syndrome (SBS). A serious condition caused by trauma to the brain from being shaken. About half the babies who have SBS die.

Sudden infant death syndrome (SIDS). The sudden, unexplained death of an infant in the first year of life. See “Preventing Sudden Infant Death Syndrome” in the “Taking Care of Baby” section of this book.

Thrush. A yeast infection that looks like cottage cheese or milk curds on the sides, roof and sometimes the tongue of a baby’s mouth.

Umbilical cord. The flexible cord of tissue connecting the fetus to the placenta that brings oxygen and nutrients from the expectant mother to the fetus and removes waste products.

Vernix. A greasy, white substance that protects the fetus in utero.

Well-child checkups. Scheduled doctor visits to check for normal, healthy development. This is also when immunizations will be given. See pages 140-141 for the well-child checkup and immunizations/vaccination chart.