More Things to Think About

(while waiting)

North Shore Associates

In Gynecology and Obstetrics, S.C.

Debora Lesnick CNM

Gaye Koconis CNM

Carrie Hanson CNM

Barbara Minnich CNM

Kendria Oliver-Hudson CNM

2500 Ridge #301	2550 Compass Road Unit J

Evanston, IL 60201	Glenview, IL

847-475-1224	847-998-9600

Debi Lesnick CNM ** Gaye Koconis CNM ** Carrie Hanson CNM ** Barbara Minnich CNM ** Kendria Oliver Hudson CNM **

Certified Nurse Midwives

In association with Board Certified Obstetrician-Gynecologists:

H. Jacob Saleh, MD Pamela Goodwin MD Gail Goldberg MD

Kim Johnson MD Abbe Kordik MD

2500 Ridge Ave Suite 301, Evanston, IL 60201 847-475-1224

2550 Compass Road, Unit J, Glenview, IL 60025 847-998-9600

More things to think about in this second half of your pregnancy include formulating a more concrete idea of how you’d like your birth to be (a birth plan), how you’d like your baby to be cared for after it’s born, and how you will care for your baby after birth. Remember, labor, like life, rarely goes exactly how we expect it to (which is probably why it’s so wonderful), so it’s important to be flexible, keep an open mind and enjoy the ride.

Hospital Tour Information: Evanston Northwestern Hospital, 847-570-2881

Sibling Tours also available

Don’t forget to pre-register .

You can do so online @ https://www.northshore.org/apps/maternity/default.aspx?lid=57061

When To Call

If you are a month or more before your due date:

Call if you are having regular contractions every 10-12 minutes that persist in spite of drinking lots of fluids and resting. Call if you think your bag of waters is leaking or broken. Call if you are having bleeding or if you have not felt your baby move for 5-6 hours in spite of eating, lying down and paying attention.

If you are 36 weeks pregnant or more (within a month of your due date):

Call when your contractions are about 5 minutes apart and lasting at least 45 to 60 seconds. If you live far away, call sooner. Call if you think your bag of waters is broken or leaking. Call if you do not feel your baby moving for 5 or 6 hours in spite of eating, lying down on your left side, and paying attention. The quality of babies movement often change at the end of pregnancy, and you may feel less large movements, but you should still feel baby as frequently. Most babies have their own pattern of movement, where you have realized your baby is more active at some times of the day than others. Most babies maintain this pattern.

Do not call for red, pink or brown spotting. This is very common towards the end of the pregnancy, especially if we have examined your cervix recently, or you have been sexually active. It may or may not be a sign that labor will start soon. You should call if the bleeding is like a period or associated with significant pain or discomfort.

Of course, call if there is anything that troubles you or if you are nervous and wondering if you should call or not.

To reach us, call the office 847-475-1224 or 847-998-9600 at any time. The office staff will page us if we are not there. If the office is closed, you will get the answering service, and they will page us promptly.

If we do not get back to you within 10-20 minutes and you feel you must go to the hospital, please call the answering service and tell them you are heading to the hospital and ask them to page us again.

Perineal Massage

Perineal massage is a controversial issue. It is one of the oldest and surest ways of improving the health, blood flow, elasticity, and relaxation of the pelvic floor muscles and, if practiced in late pregnancy, this technique improves the chances of birthing your baby without a tear. However, if done too vigorously, it can cause swelling of the perineum, which will hinder its ability to stretch. Perineal Massage can be a fun activity for you and your partner/husband! In fact, it is most easily and more beneficially accomplished with someone else performing it. If mom is performing the massage alone, the thumbs will be the easiest to use. Before you begin your perineal massage, please read the following and decide for yourself if you wish to proceed:

Many studies show that prenatal perineal massage protects against perineal trauma in first-time mothers. No benefits were found in women who had already given birth at least once.

Other studies show no benefits of perineal massage in any mothers.

The results of a homebirth study associated perineal massage during labor with higher rates of damage. It is well-known that swollen tissue during delivery [which can be caused by perineal massage during labor] increases the likelihood of tearing.

One midwife encourages her clients to use prenatal perineal massage to help get the mother and her support person attuned to the perineum. Relaxation under pressure is one of the perceived benefits of prenatal perineal massage. It can convey a certain awareness of the perineal area that may help during delivery.

(Excerpted from "Everything You Need to Know to Prevent Perineal Tearing," by Elizabeth Bruce, Midwifery Today Issue 65. The remainder of the article will be excerpted in E-News Issue 5:25)

Perineal Massage

Be sure that fingernails are smooth and short, and that hands are washed well.

2. Get into a comfortable position for the massage: semi-sitting, squatting against a wall or standing with one foot raised and resting on tub, toilet or chair. Some women prefer to have the massage performed on them while lying in bed, try different positions to find what works best for you.

Lubricate your index, second finger and thumb with enough oil or jelly to allow your fingers to move smoothly, using any of the following: Vitamin E - Wheat Germ Oil - Mineral Oil - Virgin Olive Oil – Almond Oil - Lubricating Gel (such as KY). Pouring, rather than dipping, the oil over the fingers reduces risk of contamination. DO NOT use baby oil, petroleum jelly, hand lotion, or perfumed oils as these are believed to be less well absorbed by the body than are vegetable or water-based products, and could give an allergic reaction. Beginning three weeks before your due date, you can use Evening Primrose Oil, with permission of your caregiver. EPO can help to ripen the cervix, so do not use before the pregnancy is term (37+ weeks).

4.	First massage diagonally on either side of the top of the Vestibule, just below the Urethra. Concentrate on relaxing the muscles of the vagina, and upon the feeling of openness. This helps to better prepare you for the sensations of childbirth.

5. Then, insert the fingers into the vagina approximately 1-2” or no farther than your first knuckle of your index finger. As you maintain steady, but gentle pressure, press downward on the area between the vagina and the rectum and upward along the sides of the vagina in a "U" sling-type motion. This pressure will stretch the vaginal tissue, the muscles surrounding the vagina, and the outer rim of the perineum. Be sure to gently stretch the inner portions as well as the outer rim by the perineum. If it hurts, you’re doing it too hard. You should however, feel some pressure and uncomfortable stretching/burning. If it is not uncomfortable to some extent, you are not doing it properly. The idea behind perineal massage is to get used to the burning sensation that occurs when the fetal head presses against the perineum.

6. Then, start at the FOURCHETTE edge of the perineum and massage the outer layer of the perineum, traveling towards the anus. Once at the anus, the massage pattern is complete. Take precaution to not bring bacteria from the rectum into the vaginal cavity.

7. A perineal massage should take at least five minutes, longer if you and your partner are enjoying it. The vaginal and perineal sensations will be of tightness at first, but as the weeks progress, daily massage will relax and stretch the tissue.

Reprinted with permission from Jennifer A. McFarland, www.mybirthbydesign.com

What if I am Group B Strep Positive?

Group B strep infection

Group B streptococcus (also called Group B strep or GBS) is a common type of bacteria (tiny organisms that live in and around your body) that can cause infection. Usually GBS is not serious for adults, but it can hurt newborns.
Many people carry Group B strep bacteria and don’t know it. It may never make you sick. GBS in adults usually doesn’t have any symptoms, but it can cause some minor infections, like a bladder or urinary tract infection (UTI).
While GBS may not be harmful to you, it can be very harmful to your baby. If you’re pregnant, you can pass it to your baby during labor and childbirth.
About 1 out of 4 pregnant women (25 percent) carry GBS bacteria. The best way to know if you have GBS is to get tested. If you do have GBS, though, there’s good news: your health care provider can give you treatment during labor and birth that protects your baby from GBS.
How do you get GBS?
GBS bacteria live in the intestines and the urinary and genital tracts. It lives in the body naturally. As an adult, you can’t get it from food, water or things you touch. You can’t catch it from another person, and you can’t get it from having sex.
How do you know if you have GBS?
Your provider tests you for GBS at 35 to 37 weeks of pregnancy. Testing for GBS is simple and painless. Your provider takes a swab of your vagina and rectum and sends the sample to a laboratory. Your test results are usually available in 1 to 2 days.
Your provider also can use some quick screening tests during labor to test you for GBS. But these should not replace the regular GBS test that you get at 35 to 37 weeks of pregnancy.
How can you protect your baby from GBS?
If your GBS test at 35 to 37 weeks shows you have the infection, your provider gives you medicine called an antibiotic during labor and birth through an IV (through a needle into a vein). You also may be treated if you have any risk factors for GBS and you don’t know your GBS test results or you haven’t been tested yet. Treatment with antibiotics helps prevent your baby from getting the infection.
Penicillin is the best antibiotic for most women. Another antibiotic called ampicillin also can be used. These medicines usually are safe for you and your baby. But some women (up to 1 in 25 women, or 4 percent) treated with penicillin have a mild allergic reaction, like a rash. About 1 in 10,000 women have a serious allergic reaction that needs to be treated right away. If you’re allergic to penicillin, your provider can treat you with a different medicine.
If your test shows you have GBS, remind your health care providers at the hospital when you go to have your baby. This way, you can be treated quickly. Treatment works best when it begins at least 4 hours before childbirth.
If you have GBS and you’re having a scheduled cesarean birth (c-section) before labor starts and before your water breaks, you probably don’t need antibiotics.
It’s not helpful to take oral antibiotics before labor to treat GBS. The bacteria can return quickly, so you could have it again by the time you have your baby.
If you have GBS, what are the chances that you can pass it to your baby?
If you have GBS during childbirth and it’s not treated, there is a 1 to 2 in 100 chance (1 to 2 percent) that your baby will get the infection. The chances are higher if you have any of these risk factors:

Your baby is premature. This means your baby is born before 37 weeks of pregnancy.

Your water breaks (also called ruptured membranes) 18 hours or more before you have your baby.

You have a fever (100.4 F or higher) during labor.

You’ve already had a baby with a GBS infection.

You had a UTI during your pregnancy that was caused by GBS.

If you have GBS and you’re treated during labor and birth, your treatment helps protect your baby from the infection.
If your baby gets GBS, do signs of infection or other problems show up right after birth?
Not always. It depends on the kind of GBS infection your baby has. There are two kinds of GBS infections:

Early-onset GBS: Signs like fever, trouble breathing and drowsiness start during the first 7 days of life, usually on the first day. Early-onset GBS can cause pneumonia, sepsis or meningitis. If you have GBS, you can pass this kind of infection to your baby. But treatment with antibiotics during labor and birth can help prevent your baby from getting it. About half of all GBS infections in newborns are early-onset.

Late-onset GBS: Signs like coughing or congestion, trouble eating, fever, drowsiness or seizures usually start when your baby is between 7 days and 3 months old. Late-onset GBS can cause sepsis or meningitis. If you have GBS, you can pass this kind of infection to your baby during or after birth. Treatment with antibiotics during labor and birth does not prevent late-onset GBS. After birth, your baby also can get GBS from other people who have the infection.

What problems can GBS cause in newborns?
Babies with a GBS infection can have one or more of these illnesses:

Meningitis, an infection of the fluid and lining around the brain

Pneumonia, a lung infection

Sepsis, a blood infection

Pneumonia and sepsis in newborns can be life-threatening.
Most babies who are treated for GBS do fine. But even with treatment, about 1 in 20 babies (5 percent) who have GBS die. Premature babies are more likely to die from GBS than full-term babies (born at 39 to 41 weeks of pregnancy).
GBS infection may lead to health problems later in life. For example, about 1 in 4 babies (25 percent) who have meningitis caused by GBS develop:

Cerebral palsy (A group of disorders that can cause problems with brain development. These problems affect a person's ability to move and keep their balance and posture.)

Hearing problems

Learning problems

Seizures

If your baby has GBS infection, how is he treated?
It’s important to try and prevent a newborn from getting GBS. But if a baby does get infected with early-onset GBS or late-onset GBS, he is treated with antibiotics through an IV.
If you’re treated for GBS during labor, does your baby need special treatment?
Probably not. But if you have a uterine infection (an infection in your uterus) during labor and birth, your baby should be tested for GBS. Your baby’s provider can treat your baby with antibiotics while you wait for the test results.
Can GBS cause problems for mom during and after pregnancy?
GBS can cause a uterine infection during and after pregnancy. Symptoms of a uterine infection include:

Fever

Pain in your belly

Increased heart rate (During pregnancy, it also can cause your baby’s heart rate to increase.)

If you have a uterine infection, your provider can give you antibiotics, and the infection usually goes away in a few days. Some women have no symptoms, so they don’t get treatment. Without treatment, infection during pregnancy may increase your chances of:

Premature rupture of the members – When the amniotic sac breaks after 37 weeks of pregnancy but before labor starts

Preterm labor – Labor that happens too early, before 37 weeks of pregnancy

Stillbirth – When a baby dies in the womb before birth, but after 20 weeks of pregnancy

If you’re treated for GBS during labor and birth, you probably won’t get a uterine infection after your baby is born.
GBS also can cause a UTI during pregnancy. A UTI can cause fever or pain and burning when you urinate. Sometimes a UTI doesn’t have any symptoms. If you have a UTI, you may find out about it from a urine test during one of your prenatal visits.
If you have a UTI caused by GBS, your provider gives you antibiotics to take by mouth during pregnancy. You also get antibiotics through an IV during labor and birth, because you may have high levels of GBS in your body.
Is there a vaccine for GBS?
No. But researchers are making and testing vaccines to prevent GBS infection in mothers and their babies.

http://www.marchofdimes.org/pregnancy/group-b-strep-infection.aspx# (12/28/14)
Centers for Disease Control and Prevention (CDC) cdc.gov

Cord Blood Banking Versus Donation

With cord blood banking, parents save stem cells from their baby’s umbilical cord blood/placental blood and pay a private cord blood bank to save the stem cells and store them for personal use at some future point. These stem cells can be used for the child they came from, or possibly for a family member for whom they match.

With cord blood donation, patients have arranged with a cord blood banking facility to donate the umbilical cord blood/placenta blood for public use. These donations can usually not be retrieved for personal use, very similar to current methods of blood donation.

Stem cells are the primary source of all the cells of our body and eventually differentiate into all the different cells of our body. Unlike adult cells, which have already differentiated into specific cells and cannot change (for example, heart cells cannot turn into spinal cord cells), stem cells have the potential to turn into any cell type: brain, spinal cord, blood cells, etc.. Researchers believe that stem cells may eventually be used to repair and treat damaged cells and organs, such as brain damage after a stroke, spinal cord injuries, and to repair damaged organs due to Alzheimer’s, Parkinson’s and diabetes. Current diseases treated with stem cell transplantation include cancers, blood disorders, genetic diseases such as leukemia, Hodgkin’s disease and aplastic anemia.

Cord blood collection for either banking or donation is safe for mom’s and babies. Normally, after the umbilical cord has stopped pulsing, it is cut, and both the placenta and the remaining blood in the placenta (the cord blood) are discarded. With cord blood collection, after the cord has been cut, the cord is drained into a container, and this is the cord blood that is sent to the cord blood bank. From this blood, the bank removes and saves the stem cells.

Banking and donating cord blood is a personal choice. Some families bank their baby’s cord blood as an insurance policy for the possibility that future diseases will be treatable with cord blood stem cells, and with the assumption that the cord blood match is better for members of the same family. Some families don’t feel such an insurance policy is necessary or financially feasible, but would like the stem cells to be available for transplant or research, rather than simply be discarded.

We have additional information on both cord blood banking and cord blood donation. You can also research the issue independently.

More information on donation: ITxM Clinical Services, 1-877-GIV-CORD

More information on banking: Cord Blood Registry, www.cordblood.com, 1-888-CORDBLOOD

Via Cord, www.viacord.com, 1-866-668-4897

Choosing a Pediatrician

It is a good idea to begin thinking of what type of provider you would like to care for your baby after birth. Before interviewing providers, it is helpful to ask yourself some questions first. For example, do you feel strongly about delaying or avoiding childhood immunizations, would you like to try to wait illness out when possible, or would you like to treat quickly? Would you like a large group of providers, or would you like to always have contact with the same person? Remember also, during that first year of your baby’s life you will have lots of questions, and office visits – choose a provider with an office that is convenient to reach, and whom you feel comfortable contacting (sometimes this will be at inconvenient hours).

Some questions you might want to ask a provider:

What hospitals does she have privileges at?

Will she see the baby at the hospital prior to discharge?

How will you reach her for questions during and after office hours?

Where is the office located?

What type of insurance does the office accept?

We have many providers in different locations that we enjoy working with, but another nice source of referrals, is asking friends and family who their providers are and how they like them.

Tdap in Pregnancy

What is whooping cough (pertussis)?

Whooping cough (pertussis) is a highly contagious bacterial infection that can cause severe coughing and trouble breathing. It can be serious for anyone, but life-threatening in newborns and young babies. The current recommendation for immunization of children against whooping cough begins at 2 months of age, but most deaths occur before this first dose.

How can I protect my baby from whooping cough?

The best strategy to protect your baby from whooping cough is to get vaccinated with each and every pregnancy. When the adult whooping cough vaccine (Tdap) is given in pregnancy, the mother creates antibodies against whooping cough, which cross the placenta and help protect the newborn. The amount of antibodies against whooping cough decreases quickly in adults, which is why women should be vaccinated during every pregnancy, and not before pregnancy. Tdap is preferred at 27-36 weeks to pass along high levels of antibodies. By breastfeeding, you may pass some antibodies you have made in response to the vaccine to your baby. When you get a whooping cough vaccine during your pregnancy, you will have antibodies in your breast milk that you can share with your baby as soon as your milk comes in. However, if you wait to get a whooping cough vaccine until after delivering your baby, then it will take 2 weeks for your body to create protective antibodies and pass them to your baby through your breast milk. You should also help protect your baby by making sure everyone who will come into close contact with your newborn is up-to-date with Tdap. This will limit baby’s exposure to others who may have come in contact with the disease or are not immune. Your baby should have his or her first children’s whooping cough vaccine (DTaP) at 2 months of age.

How common is whooping cough in the United States?

In recent years the number of whooping cough cases in the United States has risen dramatically. In 2012, 48,277 cases were reported, which is a marked increase from the low of 1000 cases reported in the 1970s. The death toll in 2012 was 20 people, 15 of whom were children less than 3 months of age.

Is whooping cough vaccine safe during pregnancy?

Yes, whooping cough vaccine is safe and recommended during pregnancy, but side effects can occur. Most side effects are mild or moderate, meaning they do not affect daily activities. Most women will have pain at the injection site. Experts have carefully reviewed Tdap safety data and have concluded that it is safe for pregnant women and their unborn babies. The chance of serious harm or severe side effects from the whooping cough vaccine is less than the complications from being infected with whooping cough. Also, you cannot get whooping cough from the vaccine since it does not contain any live bacteria.

ADDITIONAL RESOURCES

American College of Nurse-Midwives http://ourmomentoftruth.midwife.org/OMOT-Vaccines-for-Women

www.cdc.gov/vaccines/adults/rec-vac/pregnant.html

www.cdc.gov/pertussis/pregnant

Car Seat Safety

Soon the day will come when you will take your new little baby home from the hospital or birthing center. You'll dress her in something new—or something old and traditional—wrap her in a blanket, and put on a hat. Then you'll put your new precious bundle in car seat for the ride home.
We don't mean to scare you, but the facts are frightening. According to the National Safe Kids Campaign, in 1999 1,765 children under the age of 14 died in auto accidents, and almost 300,000 were injured. Over 60 percent of the children who died were not using car seats or safety belts at the time of the accident.
The good news is that car seats are extremely effective at protecting your baby when installed correctly and used each and every time baby is a passenger. Use of a car seat reduces the risk of death for infants by 71 percent and for children ages one to four by 54 percent. They reduce the need for hospitalization after a crash by 69 percent for children under four years. In 1999 over 300 young lives were saved because of car seats.

Age Group​	​Type of Seat	​General Guidelines
​Infants/ Toddlers	​Rear-facing only seats and rear-facing convertible seats	​All infants and toddlers should ride in a Rear-Facing Car Seat until they are at least 2 years of age or until they reach the highest weight or height allowed by their car seat's manufacturer.
​Toddlers/ Preschoolers	​Convertible seats and forward-facing seats with harnesses	Any child who has outgrown the rear-facing weight or height limit for their convertible car seat should use aForward-Facing Car Seat with a harness for as long as possible, up to the highest weight or height allowed by their car seat manufacturer.​
​School-Aged Children	​Booster seats	​All children whose weight or height is above the forward-facing limit for their car seat should use a Belt-Positioning Booster Seat until the vehicle seat belt fits properly, typically when they have reached 4 feet 9 inches in height and are between 8 and 12 years of age.
​Older Children	​Seat belts	​When children are old enough and large enough for the vehicle seat belt to fit them correctly, they should always use Lap and Shoulder Seat Belts for optimal protection. All children younger than 13 years should be restrained in the rear seats of vehicles for optimal protection.

Installation Information: Seat Belts & LATCH

LATCH Update: New LATCH rules are scheduled to take effect in 2014.

Car seats may be installed with either the vehicle's seat belt or the LATCH (Lower Anchors and Tethers for Children) system. These systems are equally safe, but in some cases, it may be easier to install the car seat using LATCH.

LATCH is an attachment system for car seats. Lower anchors can be used instead of the seat belt to install the seat and many parents find them easier to use in some cars. The tether improves the safety provided by the seat and is important to use for all forward-facing seats, even those installed using the vehicle seat belt. Read the vehicle owner's manual and the car seat instructions for weight limits for lower anchors and tethers.

Vehicles with the LATCH system have anchors located in the back seat, where the seat cushions meet. Tether anchors are located behind the seat, either on the panel behind the seat (in sedans) or on the back of the seat, ceiling, or floor (in most minivans, SUVs, and hatchbacks). All car seats have attachments that fasten to these anchors. Nearly all passenger vehicles and all car seats made on or after September 1, 2002, are equipped to use LATCH.

Seat belts: If you install the car seat using your vehicle's seat belt, check the vehicle owner's manual to see if you need a locking clip to keep the belt locked into position. Locking clips are not needed in most newer vehicles, but you may need to fully extend the seat belt first and then allow it to retract in order to keep the seat belt tight around the car seat. Many car seats have built-in lock-offs to lock the belt.

The safest place for all children younger than 13 years to ride is the back seat. If possible, it may be best to ride in the middle of the back seat. However, it is sometimes difficult to install a car seat tightly in the middle if the vehicle seat is narrow or uneven. Also, most vehicles do not have LATCH anchors for the middle seating position. It is safest to put the car safety seat in a position where you can install it tightly with either the LATCH system or the seat belt; in some cases, this may be on either side of the back seat rather than the middle. A child passenger safety technician (CPST) can help you decide which place is best to install your child's car seat in your vehicle.

Infants & Toddlers: Rear-Facing

The AAP recommends that all infants should ride rear facing starting with their first ride home from the hospital. All infants and toddlers should ride in a rear-facing car seat until they are at least 2 years of age or until they reach the highest weight or height allowed by their car seat's manufacturer.

Types of Rear-Facing Car Seats

There are 3 types of rear-facing car seats: rear-facing only seats, convertible seats, and 3-in-1 seats.

When children reach the highest weight or length allowed by the manufacturer of their rear-facing only seat, they should continue to ride rear-facing in a convertible seat or 3-in-1 seat.

Rear-Facing Only Seats

Are used for infants up to 22 to 40 pounds, depending on the model.

Are small and have carrying handles (and sometimes come as part of a stroller system).

Usually come with a base that can be left in the car. The seat clicks into and out of the base so you don't have to install the seat each time you use it. Parents can buy more than one base for additional vehicles.

Should be used only for travel (not for sleeping, feeding, or other uses outside the vehicle).

Convertible Seats (used rear-facing)

Can be used rear-facing, then "converted" to forward-facing for older children. This means the seat can be used longer by your child. They are bulkier than infant seats, however, and do not come with carrying handles or separate bases so are not routinely used outside of the vehicle.

Many have higher rear-facing weight (up to 40-50 pounds) and height limits than rear-facing only seats, which make them ideal for bigger babies.

Have a 5-point harness that attaches at the shoulders, at the hips, and between the legs. Convertible car seats with overhead shields are no longer made. However, if you have one you can use it safely until its expiration date.

Should be used only for travel (not for sleeping, feeding, or other uses outside the vehicle).

3-in-1 Seats (used rear-facing)

Can be used rear-facing, forward-facing, or as a belt-positioning booster. This means the seat may be used longer by your child.

Are often bigger in size, so it is important to check that they fit in the vehicle while rear-facing.

Do not have the convenience of a carrying handle or a separate base; however, they may have higher rear-facing weight (up to 40-45 pounds) and height limits than rear-facing only seats, which make them ideal for bigger babies.

Installation Tips for Rear-Facing Seats

When using a rear-facing seat, keep the following in mind:

Place the harnesses in your rear-facing seat in slots that are at or below your baby's shoulders.

Ensure that the harness is snug and that the harness clip is placed at the mid-chest level.

Make sure the car seat is installed tightly in the vehicle. If you can move the seat at the belt path more than an inch side to side or front to back, it's not tight enough.

Never place a rear-facing car seat in the front seat of a vehicle that has an active front passenger air bag. If the air bag inflates, it will hit the back of the car seat, right where your baby's head is, and could cause serious injury or death.

If you are using a convertible or 3-in-1 seat in the rear-facing position, make sure the seat belt or lower anchor and tether is routed through the correct belt path. Check the instructions that came with the car seat to be sure.

Make sure the seat is at the correct angle so your infant's head does not flop forward. Check the instruction manual to find out the correct angle for your seat and how to adjust the seat angle if needed. All rear facing seats have built-in angle indicators or adjusters.

Still having trouble? There may be a certified CPST in your area who can help. If you need installation help, see the end of this article for information on how to locate a CPST.

Common Questions About Rear-Facing Car Seats

What if my baby's feet touch the back of the vehicle seat?

Your child can bend his legs easily and will be comfortable in a rear-facing seat. Injuries to the legs are rare for children facing the rear.

What do I do if my baby slouches down or to the side in his car seat?

Blanket rolls may be placed on both sides of the infant and a small diaper or blanket between the crotch strap and the infant. Do not place padding under or behind the infant or use any sort of car seat insert unless it came with the seat or was made by the manufacturer of the seat.

Why should I dress my baby in thinner layers of clothing before strapping her into a car seat?

Bulky clothing, including winter coats and snowsuits, can compress in a crash and lead to increased risk of injury. Ideally, dress your baby in thinner layers and tuck a coat or a blanket around your baby over the buckled harness straps if needed.

Do preemies need a special car seat?

The car seat should be approved for the baby's weight. Very small babies who can sit safely in a semi reclined position usually fit better in rear-facing only seats. Premature infants should be tested while still in the hospital to make sure they can sit safely in a semi reclined position. Babies who need to lie flat during travel should ride in a crash-tested car bed.

http://www.healthychildren.org/English/safety-prevention/on-the-go/Pages/Car-Safety-Seats-Information-for-Families.aspx

Sudden Infant Death Syndrome

Sudden infant death syndrome (SIDS) is the unexplained death of a baby younger than 1 year old. SIDS can happen without warning to a baby who seems healthy.

SIDS is the leading cause of death in babies between 1 month and 1 year old. Most SIDS cases happen in babies between 2 and 4 months old.

SIDS is sometimes called crib death. Cribs don’t cause SIDS, but other sleep issues can increase your baby’s risk for SIDS.

What causes SIDS?

We don’t know what causes SIDS. But some things can put babies at higher risk of SIDS than others, including:
Sleeping

Sleeping on his tummy or on his side

Sleeping on pillows, soft surfaces or soft bedding

Wearing too many clothes to sleep or sleeping in a room that is too hot. These things can cause your baby to overheat.

Co-sleeping. This means that your baby sleeps with you in your bed. Half of all babies who die of SIDS are babies who share a bed, sofa or sofa chair with another person.

Individual characteristics

Being a boy. SIDS happens in boys more often than in girls.

Being black or Native American. These babies are more likely to die of SIDS than other babies.

Being born prematurely or with low birthweight

Having parents who smoke, drink alcohol or use street drugs

Can you lower your baby’s risk of SIDS and other sleep-related dangers?

Yes, follow these sleeping tips:

Safe sleep for your baby

Newborns sleep about 16 hours a day. So it’s important to make sure that where and how they sleep are safe. Safe sleep can help protect babies from sudden infant death syndrome (SIDS) and other sleep-related dangers, like suffocation (not being able to breathe).

How can you lower your baby’s chances of SIDS or other sleep-related dangers?

Here are some things you can do to help keep your baby safe when she sleeps:

Where to put your baby to sleep

Put your baby to sleep on his back on a flat, firm surface, like a crib mattress covered with a fitted sheet. Use only the mattress made for your baby’s crib. The mattress should fit snugly in the crib so there are no spaces between the mattress and the crib frame. The mattress shape should stay firm even when covered with a fitted sheet or mattress cover.

Use a bassinet, crib or play yard that meets current safety standards. Don’t use cribs with drop-side rails. Don’t try to fix a crib that has broken or missing parts. Visit U.S. Consumer Product Safety Commission (CPSC) to learn more about product safety standards or product recalls.

Keep crib bumpers, loose bedding, toys and other soft objects out of your baby’s crib. They put babies in danger of getting trapped, strangled or suffocating. If your baby sleeps in your bed, never place pillows, comforters, quilts or other soft items beneath your baby, nor on top of him.

Share your bedroom with your baby but not your bed. Co-sleeping means that babies and parents sleep together in the same bed. The American Academy of Pediatrics (AAP) and the CPSC warn that babies should not co-sleep with their parents. Instead, put your baby to bed in his own crib or bassinet. Keep it close to your bed so your baby’s nearby during the night.

If you put your baby to sleep in your bed, never leave him alone. Don’t put him to sleep on a waterbed, sofa, soft mattress or other soft surface. Portable bed rails don’t always prevent a baby from rolling out of bed. Babies can get stuck in these devices and choke. Cover the mattress with a tight-fitting sheet. The mattress should fit snugly in the bed frame so that there are no spaces around your headboard or footboard. Check that there are no spaces between the bed and the wall or other furniture.

Don’t let your baby sleep in his carrier or sling, car seat or stroller. Babies who sleep in these items can suffocate. If your baby falls asleep in one of them, take her out and to her crib as soon as you can.

Remove any hanging window cords or electrical wires near where your baby sleeps. Babies can get tangled in them and choke.

How to put your baby to sleep

Put your baby to sleep on her back every time, until she’s 1 year old. It’s not safe for babies to sleep on their side or tummy. If your baby can roll over from her back to her side or tummy, and over to her back again, don’t worry if she changes positions while sleeping.

Dress your baby in light sleep clothes. Remove any strings or ties from his pajamas and keep his head uncovered. A blanket sleeper can keep your baby warm without covering his head or face. Keep the room at a temperature that’s comfortable for you. If your baby is sweating or his chest feels hot, he may be overheated.

Give your baby a pacifier for naps and at bedtime. Pacifiers may help protect against SIDS. If you’re breastfeeding, wait until your baby is 1 month old or until she’s used to breastfeeding before giving her a pacifier. If your baby won’t take a pacifier, don’t force it. It’s OK if the pacifier falls out of your baby’s mouth during sleep. Don’t hang the pacifier around your baby’s neck or attach the pacifier to your baby’s clothing or a stuffed animal.

Don’t use products, such as special mattresses or wedges, that claim to reduce the risk of SIDS. There is no evidence that they do.

Don’t use home cardiorespiratory monitors as a way to reduce the risk of SIDS. Very rarely some babies need a monitor because of medical problems. There’s no evidence that the monitors help reduce the risk of SIDS in healthy babies.

Mom and baby care

Feed your baby only breast milk for at least 6 months. Continue breastfeeding your baby until at least her first birthday.

Don’t smoke, drink alcohol or use drugs during pregnancy and until you stop breastfeeding. Don’t let anyone smoke in your home or around your baby.

Take your baby to all his well baby visits and make sure he gets his vaccinations on time.

Give your baby tummy time every day. Tummy time helps your baby develop his neck, shoulder and arm muscles.

During pregnancy, go to all of your prenatal care checkups, even if you feel fine.

For more information

First Candle/SIDS Alliance
National Sudden and Unexpected Infant/Child Death and Pregnancy Loss Resource Center
The Compassionate Friends

Last reviewed March 2012

http://www.marchofdimes.org/baby/safe-sleep-for-your-baby.aspx (12/28/2014)

Circumcision Information for Parents

What is Circumcision?

At birth, baby boys have loose skin that covers the head of the penis. This is called the “foreskin.” When all or part of the foreskin of the penis is cut off, it is called “circumcision.”

Why is Circumcision Done?

Circumcision is done for religious, cultural, appearance, or health reasons. Some religious groups circumcise boys. Persons who are Jewish believe that circumcision of baby boys at 8 days old is a commandment from God and therefore, circumcision is a faith-based practice.

Muslim people also believe that circumcision of boys is a way to be more faithful to God. In the Muslim faith, circumcision can be done at any point in a boy’s life, depending on local traditions.

Some parents choose circumcision so that their son will have a penis that looks like his father’s. Other people choose circumcision because they believe it is cleaner or will protect the boy or man from infection or cancer.

Is Circumcision Cleaner? Does it Protect from Infection or Cancer?

Regular washing with soap and water will keep any penis clean. Circumcision does not make the penis cleaner. Uncircumcised boys do need to be taught to clean beneath their foreskin, just like they need to be taught to wash their hands or brush their teeth.

Circumcision does seem to protect against some types of infection or cancer. Cancer of the penis is one type of cancer that circumcision may prevent. However, cancer of the penis is very rare. Three hundred thousand circumcisions would need to be done to prevent one case.

What Happens During A Circumcision?

Your health care provider will typically perform the circumcision in the hospital before you go home. Religious circumcisions are most often done at home or in a synagogue.

Before the procedure, some providers inject a small amount of anesthesia at the base of the penis to block the pain. If you have a Jewish religious circumcision, your baby may be given a few drops of sweetened wine in a nipple just before the procedure.

There are different ways to do a circumcision. In one type, a clamp placed around the head of the penis cuts off the blood supply to the foreskin and the foreskin above the clamp is cut off. The clamp is left on the penis until area heals and it falls off a few days later. In another type of circumcision, the foreskin is cut off with scissors or a scalpel.

After the circumcision, petroleum jelly and sometimes gauze may be put over the wound. This protects the end of the penis while it heals.

How Do I Decide if I Should Have My Son Circumcised?

The American Academy of Pediatrics says that you do not need to circumcise your baby for health reasons. They recommend that you talk to your health care provider to decide if circumcision is the right choice for your family. You may also wish to discuss the question with your family or spiritual advisor.

http://www.midwife.org/acnm/files/cclibraryfiles/filename/000000000627/circumcision.pdf (12/28/2014)

Post Partum Advice or What Do We Do Now?

Breast Feeding: You are going to get all sorts of conflicting advice. This is not because nobody knows The Truth, but because there are many right ways to do things. Your job will be to figure out over the next few weeks what works for you and this baby. There is plenty of time for trial and error, as long as your baby has at least 6 wet diapers every 24 hours, and at least one BM in that time. If there is less, you need to rest, drink lots of fluids and nurse more frequently. If the number of wet diapers doesn’t improve, call your baby’s doctor. Your baby is not going to dehydrate all of a sudden- but obviously you want to be sure that he/she is getting enough. Don’t be panicked into giving bottles and undermining your breast milk supply. Call us, the postpartum nurses at Evanston (847)570-2224 or St. Francis (847)316-6340, or La Leche League if you have any questions at all.

Continue multivitamin and iron supplements for as long as you are nursing.

Breasts: Ideally with frequent nursing there will be a gradual transition from the colostrum to breast milk itself. Usually breast feeding whenever your baby “requests” it works best. Be sure he/she is latching on well- this is enormously important for your comfort and his/her nutrition. Sometimes the “milk comes in” dramatically. If your breasts get hard and full try massaging some milk out in the warm shower, or use a breast pump to gain relief if the baby has had enough. You may have a low grade fever (99-100 F) if you get engorged. You should call us if there are any red, tender or hard areas on your breasts, or if your fever goes over 100.4 F. Be sure to drink, drink, drink.

If you are bottle feeding, use a firm bra, lots of ice packs and pain relievers like Tylenol or Ibuprofen. Avoid any stimulation of your breasts—keep them away from the impact of the shower, avoid the temptation to pump “just a little,” and avoid any recreational stimulation, too.

Belly: You will probably get contractions when you breastfeed, but you should call us if you have abdominal pain that persists, especially if associated with a foul smelling vaginal discharge and a fever over 100.4 F. Do not be depressed if you still look pregnant with your newborn in your arms. This is normal. Very few women look unpregnant by the 6 week checkup, and most find that it takes four to six months at least to get back to “normal”. You may exercise as soon as you feel comfortable doing so-usually after at least two weeks- but if you have more bleeding or feel sore afterwards, wait a while before trying again. Start slow. By six weeks your uterus is usually back to its pre-pregnant size.

Bottom: With or without stitches your bottom will probably be sore and swollen. For the first 24 hours ice is helpful to reduce swelling; after that usually warmth facilitates healing. Sit in a warm bathtub full of water (use the plastic ring for comfort) or use a sitz bath conveniently placed over your toilet bowl. Baths are fine immediately after birth and very relaxing. You don’t need to use soap on your bottom; just soak. This idea is to keep the area clean and the warm, water encourages circulation to promote healing.

Baths are also the best treatment for hemorrhoids, along with hemorrhoid cream. Tucks, suppositories, or analgesics if you want. In general, if it feels good, do it. If you had stitches they will dissolve in 10-14 days, so the area needs to be healed by then, which is one of the many reasons you need to rest, eat well, and baby yourself a bit too. Start doing Kegal exercises right away; to remember, try doing ten of them every time you feed your baby.

Bleeding: Bleeding varies a lot, and will vary from day to day, depending on how active you are. An increase in bleeding is usually a sign that you should be doing less. It is normal to pass a few blood clots the first couple of days- these can seem quite awesome, the size of an olive or an egg, but they are better out then in, and are usually quite normal. If you think your bleeding is excessive, rest, nurse your baby, and drink lots of fluids. If your bleeding continues to soak a pad every half hour in spite of doing these sensible measures, call.

Women often think the bleeding is over by 4-5 weeks, and then have another bleeding episode almost like a period. This is also usually normal, and may represent delayed bleeding at the placental site. Occasionally women will have spotting for months after childbirth, but this is less common. Do not hesitate to call if you are concerned.

Bowels and Bladder: You will probably have a bowel movement two or three days after birth, and rarely is it any problem. Hopefully you are drinking lots of fluids for breast feeding reasons, and this will help keep your bowels soft. If you are worried, usually bran cereals, prunes, lots of fruit and vegetables are enough to insure normal BM’s. Stool softeners are okay if you want. Call if you have any urinary frequency or burning that might indicate a bladder infection.

Behavior: You will be exhausted, and if this is your first baby, astounded by how much time and energy this little soul requires. Rest. Lower your standards for the house and meals. Accept help. Ask for help. Your proper focus is your own healing and milk supply, getting to know and care for your baby, as well as your other children if you have them. Husbands, partners, family should be babying you.

Lack of sleep, hormonal roller coasters, fussy baby, thyroid changes, aching belly, breasts, and bottom as well as high expectations and fantasies about what it should be like, all contribute to dramatically undermining your coping skills and pleasure at finally becoming a mom. Hang in. Usually the chronic fatigue and depression are short-lived. But don’t hesitate to call if you feel too overwhelmed. Postpartum depression is very real and very scary, and is more common than most people realize, as are postpartum thyroid disorders. Help is out there, but you have to let us know how you are feeling.

Birth Control And Sex: Theoretically it’s OK to be sexually active once your bottom is healed and bleeding has stopped. In practice, most women are too exhausted, nervous, dry, and estrogen deprived to feel very sexy. While you are breastfeeding, the estrogen levels are very low, so the vagina doesn’t lubricate or stretch very well; use lots of lubricant and go slow. Full time breastfeeding gives 98% contraceptive protection for most people up to about three months, after that, the effectiveness regrettably decreases.

For peace of mind and lubrication use contraceptive cream (at least, feel free to add condoms) when you resume sex. Some couples like to wait until the six week check up before attempting intercourse. At this appointment you can also decide what other form of birth control you want if any.

Back to the Office: Traditionally, doctors and midwives expect to see you for a checkup at six weeks postpartum, when your bottom should be well healed, the uterus back to its non-pregnant size and the need for birth control is more likely. However, for some couples, especially new parents, that seems like a long time full of a great many changes, and they would like to add a visit around two or three weeks after birth. We think this is an excellent idea, and you are more than welcome to do so. Remember, too, that we are available to you by call and by page, just like before the baby was born.

Being parents: Enjoy the journey. Laugh at your mistakes; you’ll learn. Don’t forget to baby yourself as well as your infant. Remember, always remember, that one of the most important things that you can ever do for your child is to have a good relationship yourselves.

The Comprehensive Benefits of Breastfeeding

The benefits of breastfeeding your baby are varied and numerous. The important thing to remember is that even if you are able to breastfeed for only a short time, your baby will experience numerous benefits from breast milk. Here are many of the benefits of breastfeeding for a baby, the mother, and others.

6 Hints for Getting Breastfeeding Off To a Good Start Breastfeed as soon as possible after birth, ideally within the first 2 hours. Keep your baby with you; ask your hospital about rooming-in. Breastfeed "on demand" - any time your baby seems hungry. Breastfeed often, without a time limit (8-12 times in 24 hours) Avoid breast milk substitutes or a pacifier until your milk supply is well established. Ask for help whenever you need it!

Health Benefits for Baby

Breast milk is the most complete form of nutrition for infants. A mother's milk has just the right amount of fat, sugar, water, and protein that is needed for a baby's growth and development.

Most babies find it easier to digest breast milk than they do breast milk alternatives.

Breast milk contains antibodies, which help protect infants from illness. Breastfed babies are more able to fight off infection and disease, are sick less often, and require fewer visits to health care providers.

When you breastfeed, there are no bottles and nipples to sterilize. Human milk straight from the breast is always sterile.

Health Benefits for Mom

Some of the normal weight gain during pregnancy is done to lay down fat stores for nursing. Nursing uses up those calories, making it easier to lose the weight you put on during pregnancy. It also helps the uterus to get back to its original size and lessens any bleeding a woman may have after giving birth.

Breastfeeding lowers the risk of breast cancer and may lower the risk of ovarian cancer.

Other Benefits for Baby and Mom

Convenience

Breastfeeding saves time and money.

A mother can give her baby immediate satisfaction.

Breastfeeding requires you to take some quiet relaxed time for yourself and your baby.

Emotional Benefits

Breastfeeding can help you to bond with your baby. Physical contact is important to a newborn and can help them feel more secure, and warm and comforted.

Societal Benefits

Total medical care costs for the nation are lower for fully breastfed infants than never-breastfed infants. This is because breastfed infants typically need fewer sick care visits, prescriptions, and hospitalizations.

Employers benefit because breastfeeding mothers do not miss as much worktime caring for sick babies. Employer medical costs are also lower and employee productivity is higher.

Breastfeeding is better for our environment because there is less waste compared to that produced by formula cans and bottle supplies.

Trust your body: Breastfeeding Confidence

Many women lack the confidence to even attempt breastfeeding for fear of failure. But, what they may not understand is that nine months of anxiety cannot undo what nature has equipped humans to do since the dawn of time.

Though breastfeeding is natural, it is not necessarily instinctive to every first-time mother. The very best way to be prepared for the challenges and joys of breastfeeding is to "be prepared."

Kim Cavaliero of La Leche League, Intl. recommends that all pregnant mothers find resources, organizations, and people with similar concerns and a history of success. "Most women can breastfeed, but they just need to know that they can, and that there are a lot of myths."

Allison, 25, has a four year old child she tried to nurse, but gave up a few days into it because she didn't think she could make enough milk.
Myth #1: I cannot create enough milk for my baby.

A woman's body gives her the direction she needs in this area, it's called supply and demand. The more a woman breastfeeds, the more supply her body will create.

"This is a common misperception because many think that because the baby is fussy that she isn't making enough," says nurse-midwife Nicole Rouhana. "Early on, your body is getting used to the baby, and the milk may produce at irregular intervals, but with time (typically 2 weeks) your body will begin to recognize when more milk is needed, and produce all that your baby will ever need."

How do you know baby is getting enough? A good rule of thumb is if she is producing 6-8 wet diapers per day, she is getting enough milk. While the experts agree that there is no sure "formula for success," woman would do well to listen to their bodies and their babies. "Your baby will help you figure out when and how to nurse," says Claire Westdahl a nurse-midwife based at Atlanta's Emory University, and breastfeeding expert.

Delia, 21, is expecting her first child and believes that since her mother couldn't breastfeed, she cannot.
Myth #2: Since my mother, sister, and aunt didn't breastfeed, I can't either.

There is no research to suggest a genetic link between women's ability to breastfeed. In fact, science has shown that the great majority of women are able to breastfeed. Sometimes moms don't know what to expect because many have never done it before, but there are people who can help and women must always remember that they are not alone.

The chart below gives a brief overview of what woman can expect from their breasts. What may begin as frustration, can blossom into a mutually enjoyable relationship.

www.gotmom.org

Breast Milk Development
2-3 days postpartum	7-10 days postpartum	11-14 days postpartum
Colostrum- filled with antibodies, immunoglobins and all the vitamins baby needs to protect against infections and clean her digestive tract. Within 72 hours, an abundance of breast milk may cause engorgement, when breasts are full, and swollen.	Transitional Milk- Less antibodies and immunoglobins than colostrum, but higher in fat and calories for baby's development. Engorgement ceases and feedings become more regular.	Mature Milk- higher in water, fats, and carbohydrates (lactose), as well as antibodies. Both mother and baby are adjusting and the body begins is producing all the "supply" to meet baby's "demand."

Your body did a great job of growing the baby. Trust your breasts to do their work. Trust baby to help things along as well. Each baby is unique, but the typical breastfed baby will nurse every 2-3 hours while formula fed babies feed every 4-5 hours. Why the difference? Breasts fed babies nurse longer because of the work required; and more frequently because the proteins found in breast milk are more readily digestible. Because the nipple on a bottle is different and less work is required the process is often quicker; but the proteins in formula are not as quickly digested and processed by the baby's body, so feedings are less frequent.

"Be patient, be prepared, be knowledgeable," says Rouhana. "Much in the way women learn to do anything from trial, error, and eventual success, so too can a woman's confidence can grow through seeing her baby grow and develop appropriately, and from the knowledge that she is giving him the best nutrition possible."

Help is Available

Many women feel overwhelmed with how hard initiating breastfeeding can be. Don’t give up! It is normal to have sore nipples; it is normal for breasts to be very full and sore when your milk comes in; it is normal to feel at times as if you are nursing constantly. Don’t give up! Nursing gets easier, and it is a very nice relationship to have with your baby.

There are many resources available to women. Finding the closest La Leche League near you and maybe going to a meeting late in pregnancy is a great resource. Also, Northshore University Health System has great lactation consultants that will see you for a fee individually; are happy to try to trouble-shoot problems over the phone; and they also have a free breastfeeding drop in class on Mondays from 10-11:30 am in room 1650 at Northshore University Health System.

Some pediatric offices have lactation help in their office, so as your pediatrician if that resource is available. In addition, Nancy Holdsworth, a family nurse practitioner and lactation consultant is a wonderful resource that might be covered under your insurance. Nancy is available at the 909 Davis Building, in Evanston, IL. 847-866-3700. Please also consult your first trimester book for other lactation consultant resources.

How to tell whether your breastfeeding bay is getting enough milk

Even though you can’t see how much milk your baby takes while nursing, you can tell whether breastfeeding is off to a good start if you know what to look for. This is what should be happening when breastfeeding is going well:

Your milk should “come in” at two to four hours days after delivery. If your baby seems hungry afer most nursings and you do not think your milk has come in by the fifth day, consult your baby’s provider and have your baby weighed.

Your baby should latch on correctly to your breast and suck rhythmically for at least 10 minutes on each breast. He or she may pause periodically but should nurse vigorously throughout most of the feeding. A baby usually gets more milk from nursing at both breasts than from nursing on one side only. Alternate the side on which you start feedings, so both breasts receive comparable stimulation and emptying.

Your baby should appear satisfied after nursings and probably will fall asleep at the second breast. If your baby falls asleep and will not take the second breast, try to divide the baby’s effective suckling time between the two sides. A sleepy baby will get more milk by nursing for five minutes at each breast than 10 minutes at one. Breastfed infants who appear hungry after most feedings, who chew their hands after nursing, and who often require a pacifier may not be getting enough milk.

Your newborn baby should nurse at least eight times in each 24 hours. A pattern that works well for many infants is nursing at one and a half to three hour intervals throughout the day, with a single five-hour stretch during the night. Time the feedings from the beginning of one nursing to the beginning of the next. Four-hour intervals (six nursings in 24 hours) are too long for a newborn; very few breastfed babies will gain adequate weight that way. Don’t be surprised if you need to wake your baby up to feed; it’s not uncommon. Some babies just don’t demand to be fed as often as they need to.

Your breasts should feel full before each feeding and softer after your baby has nursed. You should hear your baby swallow regularly while breastfeeding. One breast may drip milk while your baby nurses on the other side. After your longest night interval, your breasts should feel particularly full.

Your baby should urinate six or more times a day. Most breastfed babies wet their diapers after every feeding. The urine should be colorless, not yellow. Dark urine or a red “brick dust” appearance on the diaper could suggest that your baby is not getting enough milk. You may have difficulty telling whether a super-absorbent diaper is wet; put a piece of toilet tissue between baby’s bottom and the diaper surface, to help you be sure.

Your baby’s bowel movements should look yellow – somewhat like a mixture of cottage cheese and mustard – by the fourth or fifth day of life. These are called “milk stools.” If your baby is still having dark meconium or greenish brown “transition” stools by 5 days of age, he or she may not be getting enough milk.

Your baby should have four or more bowel movements each day. Many breastfed ifants pas a stool with every nursing during the first four week sof life. If your newborn baby is having fewer than four stools each day, it might mean he or she is not getting enough milk.

Your nipples may be slightly tender for the first several days of nursing. Usually, tenderness is present only at the beginning gof the feedings and discomfort is gone by the end of the first week. Severe nipple pain, pain that lasts throughout a feeding, or pain persisting beyond one week probably means your baby is nursing incorrectly. If your baby is not latched on properly to nurse, not only will your nipples hurt, but your baby not obtain enough milk. If your nipples are very sore, as your baby’s doctor to check your infant’s weight and refer you to a breastfeeding specialist who can evaluate your nursing technique.

After two or three weeks, you may be aware of the sensations associated with the milk ejection or milk let-down reflex. The feeling can be described as a tingling, pins-and-needles, or tightening sensation in your breasts as milk begins to flow. When let-down occurs, your baby may start to gulp milk, and milk may drip or spray from the other breast. Just hearing your baby cry can cause your milk to let-down, even before your baby latches on. Although soe women breastfeeding just fine without noticing signs of the milk ejection reflex, failure to perceive let-down sensations could mean that your milk supply is low. If you are in doubt, ask your baby’s doctor to weigh your infant.

Once your milk has come in, your breastfed baby should gain about 1 oz each day for the first few months of life. The only way to be absolutely certain that your baby is getting enough milk is to have her weighed regularly. If your baby is not gaining weight appropriately, it is possible that your milk supply is low or that your baby is not nursing effectively. Such breastfeeding difficulties are easier to remedy if they are recognized and treated early. Your baby’s doctor can work with a breastfeeding specialist to develop a feeding plan tailored for you and your baby.

Contemporary Pediatrics

Breastfeeding Resources

Northshore University Health System Lactation Associates	Be Bye Baby

Drop-In Breastfeeding in Room # 1605	1654 West Roscoe

Women’s Hospital	Chicago, IL 60657

2650 Ridge Avenue	773-404-2229

Evanston, IL	Drop In Breastfeeding Help

Every Thursday 10 am – 11:00 FREE	Mondays 12-2pm

1:1 Assistance by Lacation

Consultant $45.00 fee

Nancy Holdsworth	Chicago Breastfeeding Center

Family Nurse Practitioner and Lactation Consultant	4709 West Golf, Skokie, IL

909 North Davis	847-676-5394 773-250-6232

Evanston, IL	(Kids First Pediatric Partners)

847-866-3700	www.kidsfirstpediatricpartners.com

(If difficult to reach through receptionist, ask to	(must be patient w/ practice)

Leave Nancy a message)

Accepts private insurance

La Leche League

lalecheleague.org

website lists meeting areas in Chicago and Evanston

JOC Lactation Consultants	New Mother New Baby

Jane O’Connor	3115 Dundee Road

773-508-1767	Northbrook, IL

newmothernewbaby.com

Lactation Partners	847-272-1500

847-679-5358

Faith Fairclough

847-867-3218

available for private consults

Postpartum Depression

Bringing a new baby home is a major event. Although it is often a joyful period, there may be times when your emotions and moods are not what you have expected. Many women experience “baby blues”. These are some tips to help you understand feelings of sadness and when you should call your care provider about them.

Maternity Blues

As many as 3 out of 4 women will have short periods of mood swings, tearfulness, or irritability during the first week after birth, which can be worse when ou are tired or anxious. If you are not sleeping, or you are becoming increasingly upset, you should call to talk with your care provider.

Postpartum Depression

About 1 out of every 10 women will develop serious depression during the first year after birth, more often in the first few months. Symptoms include:

Feeling like a failure as a mother

Feelings of panic

Loss of appetite

Fear that you will hurt yourself or your baby

Feeling guilty

Feelings of anxiousness and insecurity

Feeling overwhelmed

Cryig a lot

Feeling like you are not normal or real anymore

Difficulty sleeping – you can’t sleep, even when the baby is sleeping

Angry, feeling like you might explode

Feeling lonely

Can’t make decision

Inability to concentrate or focus

Thinking the baby might be better off without you

Don’t wait – if you have any of these symptoms call us or Northshore University’s Perinatal Family Support Hotline 866-364-MOMS (24 hour hotline, answered by mental health professional).

Postpartum Psychosis

A very small number of women will experience a more severe postpartum reaction in which they lose touch with reality. Women who develop postpartum psychosis may hear or see things that are not there, or exhibit strange and sometimes dangerous behavior. This is a true emergency and help must be sought immediately.

Who Will Become Depressed After Childbirth?

Postpartum depression affects women from all walks of life. The exact cause is probably a combination of factors, including hormone changes that occur after birth, which can affect how the brain functions. Women with a past history of depression, even times of just “feeling low,” a family history of depression, or stressful life events are more likely to develop postpartum depression. Childbirth is a major life event, and it can trigger reactions to past trauma. If you think that any of these risks apply to you, talk with your care provider before your labor and birth. Planning ahead can help prevent problems that occur

during depression after birth.

Postpartum Depression Resources:

Northshore University Health System

888-ENH-MOMS

Susan Feingold	Libby Rosencrans

Highland Park and Skokie	Evanston, IL

847-831-7731	847-997-5664

Brooke Laufer

826 South Madison Street

Evanston, IL

847-440-7361

Revised 1/7/14

What is a Doula?

The word "doula" comes from the ancient Greek meaning "a woman who serves" and is now used to refer to a trained and experienced professional who provides continuous physical, emotional and informational support to the mother before, during and just after birth; or who provides emotional and practical support during the postpartum period.

Studies have shown that when doulas attend birth, labors are shorter with fewer complications, babies are healthier and they breastfeed more easily.

A Birth Doula

Recognizes birth as a key experience the mother will remember all her life

Understands the physiology of birth and the emotional needs of a woman in labor

Assists the woman in preparing for and carrying out her plans for birth

Stays with the woman throughout the labor

Provides emotional support, physical comfort measures and an objective viewpoint, as well as helping the woman get the information she needs to make informed decision

Facilitates communication between the laboring woman, her partner and her clinical care providers

Perceives her role as nurturing and protecting the woman's memory of the birth experience

Allows the woman's partner to participate at his/her comfort level

A birth doula certified by DONA International is designated by the initials CD(DONA).

Research evidence shows that the quality services of a postpartum doula can ease the transition that comes with the addition of a baby to a family, improve parental satisfaction and reduce the risk of mood disorders.

A Postpartum Doula

Offers education, companionship and nonjudgmental support during the postpartum fourth trimester

Assists with newborn care, family adjustment, meal preparation and light household tidying

Offers evidence-based information on infant feeding, emotional and physical recovery from birth, infant soothing and coping skills for new parents and makes appropriate referrals when necessary

A postpartum doula certified by DONA International is designated by the initials PCD(DONA). http://www.dona.org/mothers/

Doula List

Rita DiRito	Chicago Volunteer Doulas

Mother Me Inc.	http://www.chicagovolunteerdoulas.org/#!

www.mothermeinc.com	708-263-3134

773-525-MAMA	Offers sliding scale classes/doula services

Birthways	Nancy Cowans

773-506-0607	847-404-9405

www.birthwaysinc.com	www.nancysbirthandbalance.net

Sharon Dreifuss	Ohana

847-212-7665	ohanaparents.com

847-222-9234

Natalie Evans

773-5510-6230

www.natalieannevans.com

Leah Lichy	Rose Campbell

847-989-5591	postpartum doula

www.mamassagedoula.com	847-626-5492

www.rosecampbelldoula.com

Malik Turley

847-328-5767

www.hipcirclestudio.com

Juli Billings Walter	Holly Barhamand

773-876-7014	312-613-1734

Juliwalter.billings@gamil.com	www.hollyhelps.us

www.juliwalter.com

Jennifer Barron Fishman	Barb Lindgren

Sweet Pea’s Studio	847-566-6511 or 847-404-0551

773-248-YOGA	www.birthbabynaturally.com

Abigail Lynn

773-991-7968

abidoula@aol.com

Birthlink

847-733-8050

www.birthlink.com

Pediatricians

Shana N Christian, MD	Susan J. Nelson MD

2530 Ridge Ave, Suite 201	572 Lincoln Avenue Suite 3

Evanston, IL 60201	Winnetka, IL 60093

847-869-0892	847-501-4040

847-869-1070 fax	847-501-4075 fax

susannelsonmd@gmailcom

1431 McHenry Road, Suite 107

Buffalo Grove, IL 60089	Sharon M. Robinson MD

847-913-9120	1000 Central Street # 765

847-913-9173 fax	Evanston, IL 60201

847-570-1507

Cathy A DiVencenzo, MD – pediatrics	847-570-1577 fax

4611 W Golf Rd, Suite 200	srobinson2@enh.org

Skokie, IL 60076

847-676-5394	Lori Walsh, MD

847-676-7183 fax	Glenbrook Pediatrics

2551 Compass Road Unit 100

Frederic M Ettner, MD – family practice	Glenview, IL 60026

7126 N Lincoln Avenue	847-729-6445

Lincolnwood, IL 60712	847-729-9707 fax

847-733-2229	www.glenbrookpediatrics.com

Nancy Holdsworth, NP

909 Davis Street

Evanston, IL 60201

847-866-3700

Robert J Minkus, MD - pediatrics

6810 N McCormick Blvd

Lincolnwood, IL 60712

847-663-8163

847-663-1024 fax

9977 Woods Dr, Suite 250

Skokie, IL 60077

847-663-8163

847-663-1024 fax

r-minkus@northshore.org