Caring for your New Baby

This text was taken from a Kaweah Delta Hospital pamphlet. This is very good information that should be out among the public. Sincere apologies if this is copyright infringement.

Newborns

A newborn baby?s body does not function the same as that of an older baby or child.

During the first two weeks of life, the baby may display all kinds of ?normal? color changes, spots, blotches, swellings and secretions.

The following list will describe the most common of these characteristics. Remember, these are normal or unimportant only in a newborn baby. If you notice one of them after your baby is two or three weeks old, consult your physician.

Hair

Any amount of hair on the head, from almost none to a luxuriant growth, is normal. Babies born late, after extra time in the womb, may have a great deal of rather coarse hair.

Whatever it is like at birth, most of the newborn hair will fall out and be replaced. The color of the new hair may be quite different.

Body Hair: In the womb, babies are covered with a fine fuzz of hair. Some, especially premature babies, still have some, usually across shoulder blades and down the spine. It will rub off in the first week or two.

Head

Oddities of shape: These are almost always the result of pressure during birth and will right themselves over a few months. The head may become slightly flattened if the baby is always put to sleep on one particular side. It is worth making sure that new babies are put on alternate sides, at least until they learn to roll themselves over.

Fontanelles. These are the soft areas where the bones of the skull have not yet fused together. The most noticeable lies toward the back of the top of the baby?s head. It is covered by an extremely tough membrane and there is no danger whatsoever of damaging it with normal handling.

In a baby without much hair, a pulse may be seen beating under the fontanelle. This is normal.

If that fontanelle ever appears sunken, so that there is a visible ?dip? in the baby?s head, it is a sign of dehydration (usually because of very hot weather or a fever). The baby should be offered fruit juice or water.

If the fontanelle should ever appear to be tight and tense and to bulge outward, the baby should see a doctor immediately, because it could be a sign of illness.

Eyes

Swollen, puffy or red-streaked eyes: These are often noticed soon after birth and result from pressure during it. Swelling and inflammation resolve over a few days. Any recurrence of trouble with the eyes, once newborn problems have resolved, should be promptly reported to the doctor.

Yellowish discharge and/or crusting on lids and lashes: This is the results of a very common mild infection known as ?sticky eye.? It is not serious but the baby should be seen by the doctor who will recommend drops or a solution for bathing the eyes.

Squinting: Many babies whose eyes are perfectly normal have a squinting appearance in the early days of life.

If you look at your baby closely you will probably find that it is the marked folds of skin at the inner corners of the eyes that make you think he is squinting.

These folds of skin are perfectly normal and become less and less noticeable during the baby?s first few weeks. Until the baby has strengthened and learned to control the muscles around the eyes, it is quite usual for there to be difficulty in holding both eyes in line with each other so that they can both focus steadily on the same object.

As your baby looks at your face, you may suddenly notice one eye has ?wandered? out of focus. A ?wandering eye? almost always rights itself by the time the baby is six months old. But point it out to the doctor at your next visit so that a check can be made on its progress.

A true squint means that the baby?s eyes never both focus together on the same object. Rather than moving together and then one off, the eyes are permanently out of alignment with each other.

If you are the first to notice that your baby has a ?fixed squint,? you should report it at once to the doctor. Early treatment is both essential and highly successful.

Skin

Bluish hands and/or feet: These mean that the baby?s circulation is not yet efficient at getting the blood around to the extremities, especially after a long period asleep and still. They turn pink again when the baby is moved.

Half red, half pale: The blood pools in the lower half of the baby?s body so that the lower half is red and the upper half pale. Again this is the result of immature circulation. The color difference will go when you turn the baby over.

Blue patches: Called ?Mongolian blue spots,? these are just temporary accumulations of pigment under the skin. They are more usual in babies of African or Mongolian descent but can also be seen in Italian or Greek babies or in any baby whose skin is going to be dark.

They have nothing to do with Mongolism (despite the name) nor have anything to do with bruising or blood disorders.

Spots or rash: New babies get many kinds of spots. The kind that parent often worry about are red spots with yellowish centers. They are called ?Neonatal urticaria.?

These spots form because the baby?s skin and its pores do not yet work efficiently. The spots need no treatment, are not infected (although they look as if they are) and they vanish after the first couple of weeks. They look like ?flea bites.?

Birthmarks: There are many kinds of birthmarks; only a doctor can say whether the mark that worries you is a birthmark and if so, whether it is the kind that will vanish on its own. But remember that red marks on the skin often arise from pressure during the birth. This kind will vanish within a few days.

Peeling: Most babies? skin peels a little in the first few days. It is usually most noticeable on palms and soles.

Scurf on the scalp. Cradlecap: This is normal as skin peeling elsewhere; it is nothing ?dandruff? and does not suggest lack of hygiene. A really thick cap-shaped layer is called ?cradlecap.? If it upsets you, your doctor may suggest an ointment or oil. From the baby?s point of view it is best left alone. Oily hair is irritating. Cradlecap will not bother the newborn at all.

Sex organs

The genitals of both boys and girls are larger, in proportion to the rest of their bodies, at birth than at any other time before puberty.

During the first few days after birth they may look even larger than normal because hormones from the mother have crossed the placenta, entered the baby?s bloodstream and resulted in temporary extra swelling. The scrotum or the vulva may also look red and inflamed.

All in all, the baby?s sexual parts may look conspicuous and peculiar. But don?t worry. The doctor who delivered the baby will have checked that all is normal. The inflammation and swelling will rapidly subside during the baby?s settling period and he or she will rapidly ?grow into? those apparently over-large organs.

Tight foreskin (Phimosis): The penis and the foreskin develop from a single bud in the fetus. They are still fused at birth and they only gradually become separate during the first few years of the boy?s life.

A tight foreskin is therefore a problem that a new baby cannot have. You cannot retract his foreskin because it is not made to retract at this age. You cannot wash underneath it because it is not meant to be cleaned from outside in babyhood.

Abdomen

Umbilical cord: The umbilical cord, which has been your infant?s nutritional lifeline in the uterus, is clamped at birth.

The stump that remains will fall off sometime between one and three weeks of age. Never pull the cord or try to loosen it. Until it falls off, you will need to keep it as clean and dry as possible (see Cord Care).

Although uncommon, the most serious cord problem is infection. The infected cord is usually foul smelling and oozes yellow pus. The surrounding skin may be red and hard. Report this to your pediatrician.

Umbilical hernia: A small swelling close to the navel, which sticks out more when the baby cries, cannot actually be called ?normal,? but is very usual indeed.

It is the result of a slight weakness of the muscles in the wall of the abdomen, which allows the contents to bulge forward.

Most such hernias right themselves completely by one year and most doctors believe that they heal more quickly if they are not strapped up. Very few ever require an operation.

Elimination and secretions

Meconium: This is a greenish black sticky substance that fills the intestines of babies in the womb and has to be evacuated before ordinary digestion can take place.

Almost all babies pass meconium in the first 24 hours. If a baby is born at home, the nurse must be told if none is passed by the second day. Failure to pass meconium might mean an obstruction in the bowel.

Blood in stools: Very occasionally, blood is noticed in the stools in the first day or two. It is usually blood from the mother, swallowed during the delivery. (Keep the diaper to show to the nurse.)

Frequency of urination: Once the urine flow is established, the baby may pass water as often as 30 times in 24 hours. Baby should have a least 4-6 wet diapers a day.

Reddish urine: Very early urine often contains a substance called ?urates,? which looks red on the diaper. (Because it looks like blood, you may prefer to keep the diaper to show the nurse.)

Vaginal bleeding: A small amount of vaginal bleeding is common in girls at any time in the first week of life. It is due to maternal hormones passing into the baby just before birth.

Vaginal discharge: A clear or whitish discharge from the vagina is also quite normal. It wills stop in a few days.

Nasal discharge: Many babies accumulate enough mucus in the nose to cause sniffles or some visible ?runniness.? This does not mean that the baby has a cold or other infection.

Tears: Most babies cry without tears until they are 4-6 weeks old. Although some babies may shed tears from the beginning. It does not matter either way.

Sweating: Most babies sweat a great deal around the head and neck. This is not important unless the baby shows other signs of being feverish or ill. It is a good reason, though, for rinsing the head and hair frequently because the sweat may irritate the skin in the folds of the neck.

Vomiting: Bringing up a little milk after feedings is normal. If the baby seems ill, spurts milk out with real force, has any fever or any sign of diarrhea, consult your physician.

Taking the baby?s temperature

Take your baby?s temperature if:

* Your baby is especially irritable.

* Baby?s skin is hot, or there is excessive sweating or a rash.

* Complexion is either very pale or flushed.

* Baby?s breathing is unusually fast or slow or especially noisy.

* Baby has a runny nose, is sneezing or coughing.

* Baby?s appetite is poor ? refuses more than one feeding.

* Baby rubs ear(s), rolls head or screams sharply.

* There is vomiting or diarrhea or the stool has an unusual color or odor. (If there is diarrhea, take an axillary temperature.)

Directions

Follow the directions that come with your thermometer. The following directions are for a glass thermometer.

* An oral thermometer has an elongated tip.

* A rectal thermometer has a short stubby tip.

Oral thermometers can be used in a school-aged child?s mouth or under the armpit (axillary). Do not try to take a baby?s temperature by mouth.

Caution: Do not use an oral thermometer to take a rectal temperature. The long tip could accidentally break off inside the baby?s body. If you do not have a rectal thermometer, use the oral thermometer to take an axillary (armpit) temperature.

To begin

* Shake the thermometer until the mercury line is below 96 degrees F (35.6 degrees C).

* Keep your child as still as possible.

Axillary

* Carefully place the bulb of the thermometer high in the baby?s dry armpit.

* Hold the baby?s arm snugly against the body or across the chest.

* Keep the thermometer in position 3-4 minutes.

Rectal

* Use only a rectal thermometer. Coat the bulb with petroleum jelly or similar lubricant.

* Place the baby on it abdomen. Separate the baby?s buttocks with one hand so you can easily see the rectum.

* Gently insert the thermometer no more than one inch ? it should move easily. Never force a thermometer.

* Hold the thermometer gently with one hand and keep the baby still with the other hand.

* Keep the thermometer in place 2-3 minutes then gently pull it out.

Reading the thermometer

* Wipe off the lubricant.

* Hold the thermometer in good light.

* Slowly rotate the thermometer until you can see the mercury.

* Read the number where the line of mercury ends.

Caution: You do not need to take your baby?s temperature routinely. Do it only when you suspect your infant is sick.

Overdressing, overexertion or too hot a room can result in an elevated temperature. If the infant is overdressed, remove some clothing and retake the temperature in 30 minutes.

Cleaning the thermometer

After each use, clean the thermometer in lukewarm, soapy water and wipe it with rubbing alcohol. Do use hot water. Store it carefully in its container to prevent breaking.

Call your baby?s doctor if your baby has:

* Fever of 100 degrees F or above or a temperature less than 97 degrees F.

* Vomiting with force.

* Constant crying for no apparent reason (cannot be quieted by food, diaper change, cuddling, etc.).

* Listlessness. Sleeps longer than 6 hours between feedings.

* Loose watery stools (for more than 3 bowel movements in a row).

* Obvious bleeding.

* Convulsions or jerky movements.

* An unusual rash.

* Jaundice (a yellowish discoloration).

* Abnormal breathing (labored breathing, very rapid breathing, grunts when breathing).

* Runny nose or coughing.

* A bluish discoloration especially of the lips or mouth.

* Cord has a discharge, foul odor or develops redness or pustules on abdomen around it.

* Drainage from eyes which is yellowish or greenish.

Breastfeeding

The American Academy of Pediatrics recognizes breast milk as the idea food for healthy, full-term babies. It is the only food necessary for the first 4-6 months.

If you are learning to breastfeed for the first time, you may have lots of questions. Your nurse will be happy to help you get started.

Like any new skill, breastfeeding will become easier with practice. It may take 2-4 weeks for you and your baby to develop comfortable breastfeeding patterns. Having a reassuring family and a supportive physician is a big help.

During the hospital stay many new mothers may find that the unfamiliar routine makes it difficult to relax and, therefore, to breastfeed.

However, the advantage of having the nurses close by as a resource proves invaluable. Feeding your infant is a special time for closeness and cuddling.

You may have nursed your baby right after the birth. The colostrum, or first milk that your body produces before your milk comes in, helps protect your baby against infection.

When you nurse, a hormone (Oxytocin) is released that stimulates milk flow. After delivery, this hormone also help your uterus contract back to its non-pregnant size. You will probably feel this cramping when your baby nurses for the first few weeks after the birth.

Getting started

Wash your hands carefully before each feeding.

Find a comfortable position for yourself. Most mothers say sitting up in a chair works well. Pillows can support your back, head and arms. Your nurse can show you positions that have worked well for other mothers. If you have had a Cesarean birth, placing a pillow over your incision will protect your abdomen.

Help yourself relax. You may wish to think of something beautiful, tune in soothing music or sit in a favorite chair. Do whatever works for you.

A shower during which warm water flows over your breasts before a feeding may help the milk flow more easily. This technique also can decrease discomfort from swollen or engorged breasts.

Massage your breasts starting from the outside and moving toward the nipple. (Ask your nurse to demonstrate.) Gently try to express a drop of colostrum just before the baby begins to nurse.

Alert baby. During the first few days of life, your baby may seem more interested in sleeping than nursing. Take a few minutes to play with your baby to wake him up.

Place baby in a position for feeding. Your nurse can demonstrate the cradle hold and the football hold, two popular positions.

Gently guide your nipple to baby?s mouth. Tickling the baby?s lower lip with your nipple may make him open his mouth wide.

For the first few times the baby may only lick or mouth your nipples. Remember, you are both learning. Sometimes it takes several feedings before the baby sucks vigorously. Even if the baby only licks, mouthing the nipple still stimulates milk production.

Start the baby on the breast you offered last at the previous feeding. Some mothers use a safety pin on the bra strap of the breast used last as a reminder.

Check to see that your baby?s mouth covers part of the areola (the darker skin around the nipple) as well as the nipple. Don?t allow the baby to chew on the nipple.

When you are ready to offer the second breast, gently insert a finger into the baby?s mouth to break the suction.

Burp your baby in a comfortable position. Popular positions include holding the baby over your shoulder, placing the baby tummy down on your lap, or supporting the baby in a sitting position on your lap. Your nurse will be happy to demonstrate.

Many babies suck and rest, suck and rest. Soon you will become familiar with your baby?s pattern of feeding.

How long? How often?

We used to think that limiting feeding times and slowly building up the amount of time the baby nursed would prevent nipple soreness.

Now it is believed that nipple soreness is most often caused by an improper grasp of the nipple by the baby and allowing him to suck on the nipple only. Air drying your nipples after each feeding also can help prevent soreness.

Your baby?s interest is a good guide for how long to nurse. During the first few weeks, most babies nurse every 2-3 hours, day and night. Nurse up to 20 minutes on the first side, then offer the other side if your baby will take it.

* Allow your nipples to air dry for 15-20 minutes after each feeding.

* Many mothers feel more comfortable wearing a supportive nursing bra.

* A good indication that your baby is getting enough milk is at least 6 wet diapers a day. 1-1/2 pounds/month weight gain is normal.

If you are away from your baby for a feeding, you can express breast milk and leave it in a bottle for your baby. Ask the nurse for information.

The American Academy of Pediatrics recommends avoiding routine supplemental feeding with formula. Your physician may prescribe supplemental formula or water feedings if your baby needs them.

Good Nutrition

Eating nourishing foods and drinking plenty of liquids is especially important for the nursing mother. A well-balanced diet will contain fruits and vegetables, milk and other dairy products, breads and cereals, and protein foods, such as meat and poultry, eggs, beans and peanut butter.

Almost everything a nursing mother eats or drinks will be in her milk. Alcohol, medicine or drugs are all passed on to the baby. Check with your baby?s physician about your eating or drinking habits if you are using any medicine or drugs.

Troubleshooting

Engorgement - swollen breasts: This temporary condition usually occurs between the second to fifth day after delivery. The breast can be red, hard, warm and painful.

* May be accompanied by a slight fever, less than 100.4 degrees F.

* Often can be avoided by frequent feedings, every 2-3 hours.

* Wear a well-fitting bra with wide strap 24 hours/day.

* Apply mild heat to breast 15-20 minutes before nursing. A warm shower is ideal.

* Massage breasts before each feeding. Even better - try this in a warm shower. Gently hand express a small amount of milk so that the baby can adequately grasp the nipple.

* Apply ice packs after nursing for 20 minutes.

* Ask your nurse or physician about taking a mild pain reliever.

Sore/tender nipples: Make sure baby?s grasp on breast is 1 inch back from the tip of the nipple and not just at the end of the nipple.

* Start with the least sore nipple and switch breasts when milk starts flowing.

* Hand express milk to start flow so baby doesn?t suck so vigorously.

* Rotate feeding positions so baby puts pressure on different parts of the nipple.

* Feed baby more frequently for shorter periods (less strain on nipples).

* Let nipples dry in the air.

* Wear special nursing cups inside bra to allow air circulation when fully dressed. Ask your nurse or childbirth educator for details.

* Make sure you are not using soap, alcohol or other irritating substances on nipples. This includes breast creams with alcohol.

Breasts leaking milk between feedings:

* Gently apply pressure to nipples with clean pad or cloth to stop the flow.

* Wear clothes with a print so wetness is less noticeable.

Mastitis ? a breast infection:

Symptoms include:

* Tender, red, hot breasts

* Body aches ? flu-like discomfort

* Nausea

* Fever more than 100.4 degrees F

* General weakness

To help prevent breast infections, be sure anyone touching your breasts (including yourself) has clean hands.

* Consult your physician promptly. Usually antibiotics are given.

* It is usually not necessary to stop breastfeeding.

Sleepy baby ? won?t nurse:

* Don?t be discouraged ? baby is still learning about the outside world.

* Unwrap baby, change diaper or tickle his feet.

* Burp baby to relieve full feeling.

* Express a drop of milk and touch to baby?s lips.

* If you can?t awaken baby, try again in one hour. If he misses two feedings, call your doctor.

Flat or retractile nipples:

* Stroke side of nipple to stimulate or roll nipple between thumb and finger to make it stand out.

* Apply ice to nipple briefly.

* Ask for breast pump and pump briefly to draw out nipple.

* Breast cups may be helpful. Ask your nurse for details.

Cracked nipples:

* Try all the solutions under sore/tender nipples above, plus the following:

* Expose nipples to 60-90 watt light bulb (18? away) for 5-10 minutes, 2-3 times a day.

Bathing

Choose a warm, draft-free place to bathe your baby. A good time to bathe the baby is prior to a feeding time, but before the baby is overly hungry.

Give your newborn sponge baths until the cord stub falls off at about 7-10 days of age. It is not necessary to bathe baby every day. However, the baby?s face, genitals and scalp should be washed daily.

Caution: Never wash your baby under a faucet of running water. The water temperature could change and scald the baby.

Hold your baby firmly for the entire bath.

Do not leave your baby alone, even for a minute, during a bath. If no one else is available to answer the phone, let it ring or take it off the hook before you begin bathing the baby.

Sponge baths

Your nurse will be happy to demonstrate a sponge bath while you are in the hospital. It may be given in the infant?s crib or on the table or counter.

Assemble everything you will need beforehand so you will not have to leave your baby alone. You can use a small basin or bowl for water, mild soap, cotton balls or cotton swabs, a clean wash cloth and a firm baby brush for the baby?s scalp.

Keep your baby partially dressed during the bath to avoid chilling. Small or preterm babies can wear knit caps after their heads have been washed and dried. Have clean clothes and a receiving blanket ready to rewrap the baby after the bath.

Bathe your baby from head to toe, bathing the diaper area last.

Start with the eyes. Use a clean cloth - water only, no soap. Wipe each eye from the nose toward the ear, using separate corners of the cloth for each eye.

Wash the face with the same clean wash cloth. Hold the baby in the football position over the basin. Your nurse can demonstrate this secure way to hold a baby.

Wet the scalp, lather with baby shampoo or soap. Use the brush to gently scrub the scalp and rinse in clear water. Dry the baby?s scalp. If the room is cool or your baby is preterm, you may wish to put a knit cap on the baby?s head at this point. (Scrubbing the scalp helps prevent cradle cap.)

Clean the outer ear with a wash cloth or cotton balls. Do not clean inside the ear with a cotton swab.

Place the baby back in the crib or on the table for the rest of the sponge bath.

Lather the wash cloth and wash the baby?s body being sure to clean all the skin folds and creases. Use a mild soap. Avoid deodorant soaps.

For girls, separate the lips of the vagina and clean front to back with wash cloth.

For boys, gently clean the penis. Do not try to pull back the foreskin if the baby is not circumcised. See ?Care of Penis.?

Rinse and dry the baby as each portion is cleaned. Do not used powder, baby lotion, or baby oil.

Cord Care

The cord stub can be cleaned with alcohol at bath time and with each diaper change. You may use a cotton ball or cotton swab, taking care to clean area where cord attaches to body. Notify doctor if there is any drainage, odor, red streaking or rash on abdomen around cord.

* Keep the cord uncovered by the diaper to promote drying.

* Give your baby sponge baths until the cord stump falls off.

* Swab the cord stump with alcohol at least twice per day or as your baby?s physician directs.

* Never pull the cord or try to loosen it. When the cord stump falls off, continue to put alcohol on the naval until it heals.

Use of the bulb syringe

The hospital places a bulb syringe in the crib of all newborns. During the first few days of life, newborns often have an excess of mucus in their noses and mouths. Since they haven?t learned how to clear their throats, the bulb syringe is used to remove the excess mucus. Do not use the same bulb syringe for other children.

To use:

* Squeeze the bulb, compressing it completely. Insert the narrow tip into the baby?s mouth.

* Release the pressure on the bulb.

* Repeat the procedure for the nose.

* Take care not to irritate baby?s sensitive membranes.

* Clean the bulb syringe regularly by washing with hot water. Do not wash in a dishwasher.

Your nurse will be happy to demonstrate use of the bulb syringe.

Tub baths

Always test the water temperature with your elbow or wrist to be sure it will not scald the baby. Use the same general procedure as for a sponge bath except place the baby in a few inches of warm water. A plastic baby bathtub is handy. The kitchen sink can also be used and is easier on your back than the bathtub. Place a towel, bath sponge, or rubber mat in the bottom of the tub if it is slippery. Hold the baby securely with one hand and wash with the other.

Nail care

Often babies are born with long fingernails. They?ve been growing long before birth. If left untrimmed, these long nails can cause scratches on the baby?s face from random hand movements. To trim, use blunt-tipped baby nail scissors and cut the nails straight across.

Helpful hint: Trim nails when your infant is sleeping.

Dressing baby

Use your own comfort as a guide for how to dress your baby. Usually three light layers of clothing are adequate indoors for a room that is 60-70 degrees F.

Watch your baby?s behavior. An irritable baby may be too cool. A baby who is too warm will appear flushed and damp at the back of the neck.

Choose clothing carefully for warmth and comfort.

Is the baby?s clothing soft? Turn clothes inside out and test them on your cheek. Scratchy seams and stiff fabric can irritate tender skin.

Wash clothing before putting it on your baby for the first time.

Preventing Diaper Rash

The best way to prevent diaper rash is to change the baby?s diaper often. Check frequently and change when wet or soiled.

* Wash baby?s bottom with soap and water after a bowel movement.

* Wipe the baby with a damp cloth after a wet diaper.

* Leave your baby?s diaper off completely for a few minutes several times each day to expose the baby?s bottom to air. Be careful not to let your baby become chilled or get sunburned.

* If a rash develops, it is best not to use rubber pants or plastic-backed diapers until the rash is healed.

* Wash the baby?s clothes separately in a mild detergent and rinse well. Avoid fabric softeners.

Immunizations

6 weeks - 2 months	4 months	6 months	12 months	15 months	4-6 years, school entry
DPT Polio HIB Hep	DPT Polio HIB Hep	DPT HIB	Hep	DPT Polio MMR HIB	DPT Polio MMR

Your baby?s physician will schedule some well-baby checkups for your infant to check your baby?s growth and development and to give immunizations to protect your infant from common diseases. The danger of these diseases, recommended vaccine schedule, benefits and side effects of the vaccines are listed.

These immunizations are required for entry to school in California. Keep a record of the immunizations in a safe place.

Diphtheria, Pertussis and Tetanus (DPT)

Diphtheria: Occurs primarily in children. It attacks the throat and interferes with breathing. It can produce a poison that damages the heart, kidneys and nerves and can result in death.

Petussis (whooping cough) is usually most severe in young infants. Spasms of severe coughing occur. It can result in pneumonia, seizures and death.

Tetanus (lock jaw) is the result of bacteria found in dirt getting into cuts or puncture wounds. It results in painful muscle contractions and death.

DPT Vaccine: Given to children under 6 years. The benefits are that almost all children will be protected after 3 doses. Side effects: Can result in fussiness, sleepiness, soreness, fever or a lump at the injection site. Occasionally (1 in 100,000), irritation of the brain occurs and, rarely, permanent damage results.

Oral Polio Vaccine (OPV)

Polio can result in paralysis that affects arms, legs and/or the breathing muscles. Polio can also result in death.

OPV: Benefits: 90 percent of persons receiving all recommended doses will be protected. Given by drops (no shots).

Side effect: No common reactions.

Muscles, Mumps, Rubella (MMR):

Measles is a very common childhood disease. It results in high fevers (103 degrees - 105 degrees) and a rash may last 10 days. It can result in pneumonia or an ear infection. Children with measles can develop deafness, seizures or a brain disorder.

Mumps is a common childhood illness that usually results in fever and swelling of salivary glands. It may result in inflammation of the testicles in teenage boys and men. It may result in irritation of the heart, pancreas and thyroid. It can result in permanent deafness and a temporary brain disorder.

Rubella usually results in a mild illness with a low fever, rash and swollen glands. If a woman is pregnant, it can result in miscarriage, stillbirth and birth defects.

MMR: Benefits 95 percent of persons protected after 1 dose.

Side effects: May result in mild fever, rash, swollen glands, or temporary joint pain.

Haemophilus Influenzae (HIB)

Haemophilus influenzae type b is the most significant disease-causing bacterium in childhood. It causes severe infections in more than 80,000 children in the U.S. each year. It cause several serious illnesses, including meningitis, epiglottitis, septic arthritis, pneumonia and infections of the skin and heart.

Side effects: A small percentage of children develop swelling, tenderness and a low-grade fever.

Hepatitis (Hep)

Hepatitis B virus is a major cause of serious liver diseases such as viral hepatitis and cirrhosis, and a type of liver cancer called primary hepatocellular carcinoma. It can affect infants, children and adults.

Side effects: Soreness at site of injection and rarely allergic reactions, aches or pains in the joints, skin rash and muscle weakness.

For mother:

After you leave the hospital, your practitioner will want you to come in the office for a checkup in 4-6 weeks. Feel free to call your physician or nurse if you have health concerns before your appointment.

Some mothers need immunizations while they are still in the hospital.

Rubella (German measles): If you have never had rubella, your physician will give you a shot to limit the risk of German measles during a possible future pregnancy.

If a woman is pregnant, rubella can result in birth defects in the unborn child. Your physician knows whether you need this immunization from the blood work done during your pregnancy.

RH Immunoglobulin: A mother whose blood type is Rh-negative and whose baby is Rh-positive needs this immunization after the baby?s birth. This shot is necessary to minimize blood incompatibility problems for both mother and baby for any future pregnancies.

Jaundice & Colic

Jaundice

Newborn jaundice may occur during the first week of life. ?Jaundice? describes the yellowish appearance of the whites of the eyes and the skin.

It is a result of presence of bilirubin, a normal blood waste product. If jaundice is suspected, your baby?s physician may request a blood test for the baby.

Prior to the baby?s birth, the mother?s liver gets rid of the bilirubin for both her and her baby. After birth, the baby?s liver must take over this job.

Frequently, it takes several days for the infant?s liver to work effectively. When the bilirubin accumulates, the baby becomes jaundiced.

Treatment for jaundice calls for extra fluids and phototherapy (placing the baby under a special light which breaks down bilirubin).

If your baby becomes jaundiced, your physician and nurse will explain the condition and its treatment more fully.

Be sure to keep your baby?s health care appointments after you leave the hospital so your care givers can check your baby for jaundice. This is especially important if you leave the hospital within 24 hours after the birth.

The best prevention is to follow your doctor?s instructions about how much fluid to give your baby during the first few days of life.

Call your doctor any time you think the baby is jaundiced, that is if his skin or the whites of his eyes become yellow.

Colic

Colicky babies often cry almost every evening, usually between 6 p.m. and midnight. They may grimace with pain, draw up their knees to their abdomen and pass gas.

The cause of colic is unknown. Colicky babies usually feed well and gain weight normally.

Having a colicky baby is difficult for parents. Fortunately, the condition usually disappears by the time a baby is four months old. If you baby cries excessively, check with your doctor to rule a physical cause.

The following techniques may be helpful, but they will not cure the condition:

* Cuddling infant in your arms.

* Placing the infant stomach down across your knees.

* Rocking.

* Warm water bottle under baby?s abdomen (do not use a heating pad).

* When feeding the baby, do so slowly in a relaxed manner.

* Positioning the infant upright for half an hour after feeding.

* Car or stroller rides.

* Appliance sounds (washing machine, vacuum cleaner, etc.).

* Pacifier.

* Singing or playing music.

* If bottle feeding, let formula come to room temperature to feed, do not ?heat? formula.

Care of the Penis

Routine newborn circumcision (removal of the skin that covers the head of the penis) is performed for religious, social and cultural reasons.

It is not medically necessary. If you choose to have your baby circumcised, you should discuss this with your baby?s physician.

After a circumcision, an infant may be fussy and not interested in eating for a few hours. Often a yellowish ?crust? appears around the head of the penis. This appearance is normal and is not a sign of infection.

The two devices most commonly used for circumcision are the Gomco and the Plastibell.

Warning: Call your physician if there is swelling of the penis, pus in the incision or more than a few spots of blood on the baby?s diaper. If the circumcision is oozing blood constantly, apply a clean cloth or gauze and hold the circumcision incision firmly for five minutes. This should stop the flow of blood. Notify your baby?s doctor immediately.

Care of the Gomco Circumcision

A special gauze and/or petroleum jelly dressing is placed on the penis after the circumcision. This surgical dressing usually dissolves after 4 hours, but should never be pulled off because this may result in bleeding.

At each diaper change, petroleum jelly is applied directly to the circumcision to keep it from sticking to the diaper. For cleanliness, use a separate jar or tube of petroleum jelly for the baby?s circumcision.

Notify your baby?s physician or nurse if your baby is not urinating regularly (6 wet diapers/day) or if there is blood in the baby?s urine.

During the diaper changes, the penis can be gently washed, if soiled with stool, and patted dry. Apply new petroleum jelly.

Care of the Plastibell Circumcision

A plastic rim is left on the baby?s penis after the circumcision. The plastic rim usually drops off 5-8 days later.

Call your doctor if the rim has not dropped off eight days after the circumcision or if the rim has slipped down the shaft of the penis.

No special dressing is necessary. Do not use petroleum jelly. Check the circumcision for swelling. Be sure the plastic ring is not tight.

Notify your physician or nurse if your baby is not urinating regularly (6 wet diapers/day) or if there is blood in the baby?s urine.

A dark brown or black ring encircling the plastic rim is normal; it will disappear after the rim drops off.

You may bathe and diaper the baby normally.

Care of the Uncircumcised Penis

No special care of the uncircumcised penis is required. The American Academy of Pediatrics states that ?it is not necessary to retract any part of the skin in order to wash under it.?

External washing is sufficient. The foreskin and glans (area covered by the foreskin) will separate normally over time. Most foreskins are retracted by the time the child is five.

To test retraction occasionally, hold the penile shaft with one hand and with the other hand gently (never forcibly) push the foreskin back. Stop if you feel resistance or if the baby experiences discomfort. Try again in a few months.

Once the foreskin has been fully retracted, boys can be taught to retract the foreskin and clean beneath during bathing.

Infant Safety

Car Seats

Automobile accidents are the No. 1 preventable cause of death in children. California state law requires that children less than age 4 or weighing less than 40 pounds be restrained in a federally approved car seat. Set a good example for your children by wearing your own seat belt.

Helpful hints

* Never let your baby ride in your arms.

* Secure infants under 20 pounds facing the rear of the car.

* Children over 20 pounds should face forward in the back seat.

* Use only federally approved, dynamically tested car seats. Do not use lightweight infant carriers, travel beds, backpack carriers, etc.

* A 3- or 5-point harness on the car seat is recommended.

* Cover a vinyl car seat to protect baby?s skin. (Vinyl seats may become hot enough to burn a child in summer, and they are cold in winter.)

* Be consistent. Use the car seat every time. Make every ride a safe ride.

Crib safety

* Be sure the crib slats are not more than 2 3/8? apart to prevent baby?s head from getting caught. Older cribs may have an unsafe, wider space between slats.

* Be sure the mattress fits snugly against the sides and edges of the crib.

* Use bumper pads that fit snugly.

* Check to see there are no sharp edges or cracked, chipped paint.

* Do not use paint containing lead for baby furniture.

* Avoid pillows and large floppy toys that could smother a child.

* Never use plastic bags from the cleaners on a crib mattress.

* Keep the mattress in the lowest position and the side rails up and locked when the baby is in the crib.

Changing Area

* Never leave your baby alone on a high surface such as a counter or changing table.

* Keep sharp objects, such as diaper pins, nail scissors, and glass thermometers, out of your baby?s reach.

* Rubbing alcohol, powders, lotions and creams should all be kept out of your baby?s reach.

Walkers

* Check for sharp or rough surfaces.

* If you use a walker, do not keep your baby in for very long periods. Many infant specialists feel that overuse of ?walkers? can delay a baby?s development.

* Supervise a baby in a walker. Many accidents have occurred from the walker tipping over a rug edge or falling down stairs.

Infant seat

* Check to see that the seat is sturdy and has no sharp edges.

* Use the safety strap each time.

* These seats are not intended to be used in place of an approved infant car seat.

* Do not leave your baby unattended in an infant seat in a high place.

Strollers

* Check for stability and sharp or rough edges.

* If you use a folding stroller, be sure all parts are firmly locked into position before placing the baby in the stroller.

Playpen

* A wooden playpen should have slats no more than 2 3/8? apart.

* Buttons on the baby?s clothing should be larger than the netting holes on mesh playpens to prevent a button being caught, leading to choking of the baby.

* Check to see there are no sharp edges, especially on hinges and that the playpen is sturdy.

* Keep the sides up when your baby is in a playpen.

* Provide close supervision.

Pacifiers

* Use only a commercial pacifier. These are specially designed to meet government safety standards. Homemade pacifiers can separate, and baby could choke.

* Never tie a cord to a pacifier. Your baby could strangle on the cord.

High chair

* Always secure the safety strap. Be sure there is a strap between the baby?s legs, as well as a waist strap, to prevent the baby from slipping out.

* Check for sharp edges and rough surfaces.

* Keep high chairs away from stoves, electrical cords, and other areas where the infant could be hurt.

Birth to 4 months

* Never leave your baby alone with a child under school age (children this age are too young to understand infant safety).

Burns:

* Don?t smoke or drink any hot substance (such as coffee) while carrying your baby.

* Install smoke alarms in your home.

* Turn your hot water heater down to 130 degrees F.

* Use flame-retardant sleepwear for your baby.

Choking/ Smothering:

* Avoid toys with cords. Never put the baby?s pacifier on a cord.

* Do not use a homemade pacifier.

* Keep cradle gyms high out of your baby?s reach.

* Keep small toys that might be suitable for an older child away from the baby to avoid choking.

* Never leave your baby alone on a high surface, such as a changing table or counter top.

* When bathing an infant, plan ahead to avoid interruptions by either taking the phone off the hook or having someone else in the house answer it.

* If you must do something else for a moment, either take the baby with you or place the infant in a crib (side rails up) or on the floor.

Over 4 months General safety:

* Remove items babies can pull down on themselves, such as dangling tablecloths, glass knickknacks, etc.

* Keep outside doors closed so a young child cannot go outdoors alone.

Burns

* Keep electrical cords out of reach.

* Use safety caps on electrical sockets.

* When cooking, turn pot handles away from the front of the stove.

Falls

* Use gates/barriers to block danger areas, such as stairs, and to keep the baby out of certain areas.

Poisoning

* Put poison center phone number next to your phone.

* Keep a 1 ounce bottle of syrup of ipecac on hand for every child less than 5 years of age.

* Put safety locks on lower cabinets that contain household chemicals and other poisons. * Place household chemicals in higher cabinets out of reach.

* Use child-resistant caps on any medicines.

* Keep indoor plants out of reach. (Many are poisonous if eaten.)

Drowning

* Keep toilet lids closed and bathroom door closed.

* Never leave your baby unattended in the bathtub.

* Never leave a small child alone outdoors, especially if there is a pool or spa.

Choking

* When a child is able to eat finger foods, offer dry cereal, crackers or cutup soft fruits. Avoid popcorn, nuts, grapes and other foods on which baby could choke.

EMERGENCY NUMBERS

Emergencies: 911

Poison Control Center

(800) 876-4766

Infant Temperament

Each baby is an individual. Some babies are much more difficult to care for than others. You cannot choose your baby?s temperament any more than you could have chosen his or her sex.

You are also unique individuals with years of experiences behind you. This will play a part in what you expect your baby to be like and how to react to him or her. Observe your baby?s behavior and how you react to him or her.

If your expectations and reactions match the reality of your baby, then the interactions between you will be comparatively smooth and easy.

If not, then you and the baby will have some adjusting to do. Here are some different baby behavior styles you may recognize and tips on living with them.

Jumpy babies

Typical behavior: Overreacts to any kind of stimuli. Hunger sends him rapidly into a frenzy of desperate crying. Picking him up makes him tense; putting him down makes him jump. Any change in surroundings alerts and may alarm him.

Living with it: The baby is not going to learn to not be frightened by being frightened. He is going to be calmer only by a combination of maturing and being handled so gently that he finds less and less in his daily life to upset him.

* Never hurry when you are handling a baby. Move slowly and smoothly, carefully supporting his head so that it does not wobble and he feels secure.

* Keep handling to a minimum.

* Cut down on physical stimulation by careful wrapping.

* Make sure that everyone who handles baby is quite gentle.

Sleepy babies

Typical behavior: The baby is ?no trouble.? He may make almost no demands and probably has to be awakened for most feedings.

He may fall asleep during feedings. He does not seem interested in his surroundings.

Living with it: Although the baby?s lack of responsiveness may disappoint you, you can use this period of time to regain your strength and collect your wits in readiness for the active mothering that will come when the baby matures a little.

Make sure that the baby wakes up enough to eat, at least every 4 hours. Add extra feedings if his sleepiness means that he sucks for only 5 minutes at a time.

Don?t let him sleep through a 12-hour night without eating. Wake him for a feeding at your bedtime.

Don?t take the baby?s sleepy isolation for granted. Make opportunities to cuddle and talk to him. Try to get him interested in looking at things and being talked to.

Wakeful babies

Typical behavior: The baby rarely sleeps for more than 12 hours out of a 24-hour day and seldom for more than 1 or 2 hours at a time, even during the night. He isn?t especially miserable, he just isn?t sleepy. He may fall asleep after feeding and awaken after an hour or two. He loves to be entertained and is interested in things around him.

Living with it: This is not the kind of baby you can care for in short bursts of time and then forget about in between. He requires your attention almost all day and for a good deal of the night, too. The problem is that he is spending a lot of hours awake at an age when it is difficult to find entertainment for him. Find easy ways of carrying your baby because although you obviously can?t carry him around all the time, it is perfect entertainment. Try a sling or a canvas carrier.

Give the baby interesting things to look at. Hang bright objects above the crib or stroller and change them often. Make or buy a mobile or two. Sit him in front of a window.

Postpartum Recovery

The postpartum recovery period includes the first six weeks after the birth of your infant. During this period, your body gradually returns to its nonpregnant state.

Uterus: Your uterus should return to is normal size within 3-6 weeks.

Vaginal Flow: You will probably have a vaginal flow (similar to menstrual bleeding ? your period) for 3-6 weeks after delivery.

It will be dark red at first then pinkish/brown and finally yellowish/white. The amount will gradually decrease.

Episiotomy: Your episiotomy will heal in about 3 weeks. Until then, you will need to keep it very clean.

Fill your peri-bottle with warm water and spray your episiotomy every time you urinate or have a bowel movement. Blot dry from front to back.

Change your pad often. Wash your perineum with soap and water daily during your shower.

Dermaplast spray or Epifoam will be provided for you to help ease any discomfort.

Bowels: While in the hospital, you will receive a stool softener or laxative each day. After you return home, try to drink plenty of fluids and increase the fresh fruit, vegetables and bran in your diet to prevent constipation.

Breasts: Nursing mothers should wear a good support bra at all times. Refer to breast-feeding sheet for more information.

Non-nursing mothers should wear a good support bra for at least two weeks. If your breasts become engorged, you can place ice packs on them for 15-20 minutes, 3-4 times a day.

Do not rub or massage your breast, because this will increase engorgement.

Warning Signs

Call your doctor if:

* Fever greater than 101 degrees F

* Heavy vaginal bleeding

* Severe perineal pain

* Pain or burning

* Fainting

* Redness, swelling, extra tenderness or bleeding from any area of the breast or nipple

* Redness, swelling or pain in your calves or thighs

* Inability to cope with daily activities

Bouncing Back Physically

Your body needs rest

Having a baby is a major physical and emotional life event for a woman. The physical demands of labor and birthing require a great deal of energy.

The emotional exertion is also tiring. Immediately after the baby?s birth, you may have felt extremely excited and ?hyper.? This euphoria can mask your body?s need for rest.

Try to stay tuned to your body?s needs. Many women use the same relaxation techniques they learned in prepared childbirth classes. Some advanced planning can help ensure that you get enough rest.

Rest when your baby rests. Plan an extra two hours every day for uninterrupted rest. Don?t hesitate to restrict phone calls or visitors. Go to bed early whenever possible.

Take advantage of help offered from family and friends. Allow them to cook, do laundry and help with the care of other children.

Utilize the relaxation techniques learned in your prepared childbirth classes. They will help you rest and help reduce stress.

Pamper yourself. Remember you have accomplished something very special and deserve it.

Set realistic goals for yourself. Remember that it takes about six weeks before full activity can be resumed.

Your body needs exercise

Basic postpartum exercises can help prevent complications, restore muscle tone, and lift your spirits.

You can begin exercising your abdominal and pelvic floor muscles as early as one hour after a vaginal delivery, or 1-2 days after a Cesarean section. Always start gradually and never overdo.

Pelvic floor contraction ? Kegel?s

Goal:

Maintain tone of pelvic floor muscles, support internal organs and prevent urinary problems.

Position:

Sitting, standing or lying down.

Exercise:

Gently tighten and relax the muscles of your perineum.

Repetition:

Start with 2-3 contractions every hour. As your muscles get stronger, add more contractions. You can begin this exercise shortly after a vaginal or Cesarean section delivery.

Abdominal tightening

Goal:

Tone abdominal muscles, relaxation.

Position:

Lie flat with knees bent or taylor sit. Rest your hands on abdomen.

Exercise:

Take a deep breath. As you inhale, expand your abdomen, feel your hands rise. Now exhale and tighten your abdominal muscles toward your back, feel as your hands fall. Breathe slowly, in through your nose, out through your mouth.

Repetition:

Start with 2-3 breaths every hour. You can begin this exercise shortly after a vaginal or Cesarean section delivery.

Abdominal curl

Goal:

Tone abdominal muscles.

Position:

Lie on your back with a firm pillow under your head. Draw up your knees and rest your hands on your thighs.

Exercise:

Raise your head and stretch your arms toward your knees. Count five, then gently relax.

Repeat, but stretching both arms first to the outside of one knee, relax, then to the outside of the other knee.

Repetition:

Start with 2-3 curls each hour. Gradually increase as your strength increases. You can begin this exercise shortly after a vaginal delivery.

Pelvic tilt

Goal:

Tone abdominal muscles, relieve backache, and aid the return of pre-pregnant posture.

Position:

Lie flat with your knees bent. Press your lower back into the bed.

Exercise:

Tighten your abdominal muscles and tilt your pelvis by squeezing your buttocks. Remember to keep your lower back pressed to the bed. Hold for a count of 3, then relax.

Repetition:

Start with 2-3 tilts every hour. Gradually increase. You can begin this exercise shortly after a vaginal or Cesarean section delivery.

Shoulder curls

Goal:

Increase circulation to breasts and encourage milk flow.

Position:

Sitting or standing.

Exercise:

Roll one shoulder slowly backward in a complete circle. Repeat with the opposite shoulder.

Repetition:

Repeat 10 complete rolls each shoulder. You can begin this exercise shortly after a vaginal or Cesarean section delivery.

Ankle circles

Goal:

Increase circulation to legs and help prevent blood clots.

Ankle circle exercise:

Position:

Lying or sitting.

Exercise:

Slowly roll one foot in a circular motion, then gently reverse and roll in the opposite direction. Repeat with other foot.

Repetition:

Repeat 10 times each direction, each foot. You can begin this exercise shortly after a vaginal or Cesarean section delivery.

Walking

For the first six weeks after your baby is born, you must avoid strenuous exercise. Until that time, walking is the best form of exercise. It not only helps strengthen your abdominal muscles, but the fresh air will lift your spirits and sometimes calm your baby.

Emotional Adjustment

Having a baby is much more than a physical experience. It is the beginning of a parenting role, which will continue for a lifetime.

A new little person has entered your lives. Things will never again be quite the same.

Adjusting to such a big change does not happen overnight. Parents are not suddenly struck with instant love for their infant. Like many relationship, love for the new baby grows and blossoms with time.

The experience is modified for each woman by the number of children she has had, her own childhood and parenting, experiences during pregnancy, the strength of her relationship with her child?s father, her own self-concept and many other things. Yet, there is some common pattern.

Parental Stages

Research has shown that families go through the following stages after the birth of a baby.

Taking-in phase

For the first day or two after the birth, new mothers need extra food and sleep. Cesarean mothers need even more rest.

All new mothers also need ?mothering? themselves so they can successfully mother their new babies.

New fathers also may have difficulty adjusting to parenting. Partners can make a special effort to support each other during this big change in their lives.

Taking-hold phase

The timing to this phase depends on the individual woman.

During this phase, parent focus on learning to care for their new baby. Temporary mood swings and feelings of vulnerability on the part of the new mother are not uncommon.

Mothers may feel neglected as the father becomes more involved with his baby and overlooks his partner?s feelings.

Letting-go phase

During this phase, the family begins to settle into a system of interaction, and the couple resumes many qualities of their pre-baby relationship. The baby?s relationship to older brothers and sisters becomes better established.

Of course, each family?s adjustment to a new baby is different. This process is affected by many things, such as the health of the mother and baby, maturity of the parents, family support and how successfully parents combine their personal goals with their new responsibilities.

Parental Needs

Common needs of parents after their baby?s birth include:

* The need to reconcile the actual baby with the fantasy baby. Real babies have their own personalities. They also cry, demand to be fed in the middle of the night and dirty their diapers.

During pregnancy, you have imagined a baby with a different personality. You may also have focused on the fun parts of taking care of a baby rather than the difficult aspects.

* The need to establish the newborn as a separate individual. During pregnancy it may have been difficult for you or other family members to view the baby as a separate individual from the mother.

Each human being is unique with a distinct personality. Establishment of this separate identity continues as the baby grows.

* The need to learn infant care skills. As you master skills, such as feeding, diapering and bathing your baby, you will become more self-confident as a parent.

* The need to understand your baby?s way of communicating. Because newborns have not yet learned to talk, parent must learn to interpret their baby?s body language or ?infant cues.?

Behaviors such as opening the eyes wide, turning the head or looking away are ways babies communicate before they talk. Ask your nurse to point out some of these infant cues.

* The need to establish a place for the newborn within the family. Suddenly, there is a new member of the family. His or her presence requires adjustments from not only parents, but all other family members, including brothers or sisters, grandparents and others.

* The need to maintain adult relationships with other adults. They must learn to balance the needs of their new baby with their need for adult contact. Filling this need is the most difficult for the primary care giver who, in most cases, is the new mother.

Ways to help yourself

* Get plenty of rest and sleep.

* Eat well.

* Drink plenty of fluids, especially if you are breastfeeding.

* Arrange for time away from the baby.

* Spend time with your partner as a couple, without the baby.

* Get out of the house at least once a day for a walk.

* Talk about your feelings with your spouse, friend or relative.

* Ask others to help with housework, baby-sitting and caring for other children so you can get away for a while.

* Seek support from your family, your friends, your church, your physician, your clinic or mental health center. Keep their phone numbers next to your telephone.

* Try to postpone other major life changes, such as moving to a new home, whenever possible.

* Be good to yourself ? meet your needs. Treat yourself to a good book, leisurely bath or new hairstyle.

Attend our New Mom?s group every Wednesday morning at 10 a.m. in the Family Birth Center.

Postpartum Blues

Many new mothers experience what is called ?postpartum blues? between the third and tenth day after their baby?s birth.

When one thinks about it, it?s not surprising this letdown should occur. Contributing factors include fatigue, adjustment to a major life change, and shift in hormone levels in the body.

Women may feel isolated and alone, weighed down by the great responsibility of caring for a helpless baby, and cut off from pre-baby pleasures, such as adult friendships and outside activities. Unexplained crying, mood swings, loss of appetite and feelings of being trapped are common.

Such feelings are normal and usually go away after a week or two. If they continue, you should seek help from family, friends, health care professionals and community agencies.

Cesarean Childbirth

Cesarean childbirth is the delivery of a baby through surgical incisions in the mother?s abdominal wall and uterus.

It is done when vaginal delivery might endanger the mother or the baby. It is also called ?C-section? or ?abdominal birth.? Knowing what to expect if a Cesarean is necessary can make a big difference in the birth of your baby.

Preparations before birth

Blood urine samples: Are taken to assess your general health. These will be done the day before a scheduled Cesarean.

IV (intravenous infusion): A needle is inserted into a vein in one of your hands or arm. Before delivery, you will be given fluids through this needle to keep you from becoming dehydrated during surgery.

You will be given a medication through the IV after the baby?s birth to aid uterine contraction. The IV will remain for approximately 24-48 hours after your delivery or until you are able to take nourishment well by mouth.

Urinary Catheter: A thin tube that drains urine from your bladder. Having a catheter inserted can be uncomfortable, but you shouldn?t feel it once it is in place.

A catheter is necessary to keep your bladder, which rests right over your uterus, empty during delivery. A catheter eliminates the need for either a bedpan or trips to the bathroom in the hours immediately following the birth. It is usually left in place for 24 hours.

Shave/Prep: Some of your abdominal and pubic hair will be shaved before surgical delivery. This is done because it is impossible to remove all bacteria from hair, and the area surrounding the incision site must be sterile.

Anesthesia: Your anesthesiologist will discuss your options. One of these will be used:

Spinal: Needle is inserted into spinal fluid; anesthetic numbs legs and abdomen within minutes.

Epidural: Anesthetic is administered through a catheter into area outside spinal cord casing. The lower half of your body will be numb, but you will be able to move.

General: Given by mask or injection, to make mother unconscious.

During your Cesarean birth

A Cesarean delivery takes only about 10-15 minutes. Stitching the abdominal and uterine incisions after birth takes about 35-45 minutes.

Family

Mother: May feel a tugging sensation as the baby is born. You?ll hear several kinds of noises during the procedure (suctioning, cauterizing).

Finally, you?ll hear the baby?s first cry and have the answer to, ?Is it a boy or a girl??

Father: Is encouraged to accompany you for the delivery, if you are awake and if he wishes and your anesthesiologist approves it.

He will change into hospital ?scrubs? in your room. After you are given anesthesia and draped for delivery, he will be guided to a spot near your head.

He will share the birth with you and after you both hold the baby, may accompany him/her to the nursery.

Baby: After birth, fluid is suctioned from mouth and nose. He/she is placed under a warmer and examined by the pediatrician and the nursery nurse.

Name bands are put on and foot prints taken. The baby is bundled and, after visiting with mom and dad, taken to the nursery.

Delivery Team

The obstetrician and assisting physician make the incisions, deliver the baby, cut the umbilical cord, remove the placenta and close the incisions.

The anesthesiologist administers the anesthesia and monitors the mother?s condition.

The delivery nurse attends all phases of delivery and post-delivery care. The pediatrician and nursery nurse monitor the baby?s health.

Recovery

After delivery, the mother will be moved to the Recovery Room.

The nurse will check your temperature, blood pressure and respirations frequently. She will check the size of your uterus to make sure it is contracting properly after birth.

You will be monitored carefully for two hours as the anesthesia wears off and you recover from the surgery.

The nurse will ask you to move your legs and toes and to take long, deep breaths and cough. Tell the nurse when you need medication for pain.

After leaving the recovery room, the mother will move back to her hospital room.

After your Cesarean birth you:

* May feel sleepy from pain medication.

* May be with your baby when you wish.

* Will have the IV for 24-48 hours and catheter for 24 hours.

* May usually start drinking fluids right after 24 hours.

* Will be encouraged to turn, cough and take deep breaths. After about 24 hours, you should get up and walk as much as possible.

* You may have visitors ? father, anytime; family, noon-8 p.m. as soon as you feel up to it.

* May shower after 2-3 days.

* Will have vaginal discharge that may last for several weeks.

* Will be discharged after 3-4 days.

Guidelines for recovery at home

Recovery time varies with the individual. Several weeks is normal. Take it easy at first and build up strength gradually.

* Keep baby and necessary supplies close to your bed.

* Eat nutritious meals and snacks.

* Nap at least once a day. Limit trips up and down stairs. Don?t lift heavy objects.

* Invite guests, but don?t overdo it. Let friends help with meals, chores, etc.

* Do only a few light chores. Have the father, a relative or a friend help with cooking, cleaning, etc.

* Notify your physician if you develop a temperature more than 101 degrees or notice redness, swelling or drainage from your incision.

Questions and answers

Can I breastfeed my baby?

YES. Breastfeeding is natural and can help speed recovery by helping the uterus to contract.

Will our next child have to be a Cesarean?

Not necessarily. It depends on the reason for the original Cesarean, type of incision, your physical condition, etc. Check with your physician.

When can we resume sexual intercourse?

Cesarean parents are usually advised to wait 4 to 6 weeks, until the cervix is closed, to protect against infection. Check with your physician.

Can I take a tub bath?

Showers or sponge baths are recommended until all the vaginal flow has ceased and you can comfortably get into and out of the tub - approximately 2-3 weeks.

When can I become physically active again?

Usually you can begin mild exercise within 2 to 3 weeks and resume normal activity after about 6 weeks. Check with your physician.

Older Siblings

For some children, the experience of having and becoming a sibling can be a stressful event.

Familiar routines and relationships change. Young children may be upset and miss their mother while she is away from home in the hospital.

Suggestions to ease the distress:

* Take child to visit mother and baby in the hospital.

* Try to do as many things as possible with the child as you did before. Don?t make the baby the excuse too often.

* Accept any offers of help from the older child.

* Offer the child chances to behave in a ?babyish? way for a bit, maybe a sprinkle of powder, rocking in the chair.

* Work to make the child feel the baby likes him.

Ways an older brother or sister can help

Holding the baby: Sit cross-legged on a chair or on the floor. Support the baby?s head and back.

Feeding the baby: Only mom can breastfeed, but older children can help burp babies. Pat them gently. Big brothers and sisters can help bottle feed a baby.

* Changing the baby?s diaper.

* Showing the baby how they use a car seat for safety.

* Helping choose clothes for the baby.

* Pushing the baby?s stroller.

* Reading to the baby.

* Ask your older child(ren) to suggest other ways to help.

Dealing with Sibling Rivalry

* Praise positive behavior toward the new baby.

* Ignore inappropriateness behavior unless it endangers the baby.

* Emphasize the special relationship between the older child(ren) and the baby.

* Encourage the older child?s desire to help take care of the baby.

* Teach the older child how to safely hold the baby.

* Try to spend time alone with the older child(ren). A good time is when the baby is sleeping or when another adult is caring for the baby.

* Take care of yourself. You cannot give proper attention to your older child(ren) or the new baby is you are overly tired or overwhelmed. See the cards on physical and emotional adjustment.

FAMILY PLANNING

Method/How does it work?	How effective is it?	Prescription	Advantages	Disadvantages
Coitus Interruptus ?Withdrawal? The man pulls his penis out of the vagina before ejaculating so that the sperm will not reach to vagina.	Consistent user 90% Typical user 84%	No	No health risks. Requires no supplies and is always available.	High failure rate. Must be done during each act of intercourse. Sperm-containing fluid can escape during sexual arousal and intercourse, prior to ejaculation. Requires self-control. The man may not ejaculate far enough away from the vulva (outer lips of the vagina).
Sterilization Male: Vasectomy Female: Tubal litigation Closing of tubes in either male or female prevents sperm from reaching the egg.	Consistent user 99+% Typical user 99+%	Yes. Surgery can be done on an out-patient basis.	Permanent protection against pregnancy for those who do not desire further children. A one-time risk of surgery as compared to continual risks and side effects (including pregnancy) of temporary methods.	This method is only reasonable for people who are absolutely certain that no more children are desired in the future. 2-3 days recovery time required following surgery. Contraceptive protection is delayed after vasectomy until stored sperm is gone; backup method of birth control must be used for a short time after surgery.
Oral Contraceptive ?The Pill? Stops egg development in woman?s ovaries.	Consistent user 99+%	Yes. Regular check-ups also required.	Not used at time of intercourse. Easy to learn to use. Menstrual flow often lighter, less cramping.	Annoying side effects for some (weight gain, spotting, missed periods, nausea, increased susceptibility to yeast infections). Rare serious complications (blood clots, stroke, heart disease, liver or gall bladder disease). Must be taken daily. May alter body chemical balance.

Diaphragm Used with Cream Jelly Inserted into the vagina, the diaphragm holds the jelly or cream over the cervix to kill sperm and prevent them from entering. The diaphragm must always be used with jelly or cream to be effective.	Consistent user 98% Typical user 87%	No	No serious health risks. Some protection against sexually transmitted diseases. During menses, hold back discharge. May provide some vaginal lubrication.	Must be inserted correctly each time user has sexual intercourse (with additional cream or jelly inserted into the vagina prior to each subsequent act of intercourse). Irritation or allergic reaction to either diaphragm, cream or jelly in rare cases. May increase susceptibility to bladder infections. Must be removed and washed at least every 24-36 hours.
Condom ?Rubber? Fits over man?s penis to prevent sperm from entering the woman?s uterus.	Consistent user 98% Typical user 90%	No	No serious health risks. Effective protection against sexually transmitted diseases. Can be purchased without a prescription. Woman experiences little or no ?drippiness? following intercourse. Compact size. Easily disposable. Relatively inexpensive.	Must be used during each act of intercourse. Some people feel that sensitivity is reduced. Irritation or allergic reaction in rare cases (try switching brands). May require additional lubrication (do not use petroleum jelly).
Foam, Jelly or Cream Placed deep into the vagina, the spermicidal foam, jelly or cream blocks the opening of cervix and kills sperm.	Consistent user 96%	No	No serious health risks. Some protection against sexually transmitted diseases. Provides vaginal lubrication. Can be purchased without a prescription.	Irritation or allergic reaction in rare cases (try switching brands). Must be inserted prior to each act of intercourse. Only effective for about ½ hour.
Condom Used with Foam Condom blocks sperm from entering uterus. Foam blocks and destroys sperm.	Consistent user 99%	No	Effectiveness rate of this ?combination method? should be about equal to that of the pill. No serious health risks. Effective protection against sexually transmitted diseases. Relatively inexpensive.	Same as those listed under condom and foam.

Contraceptive Sponge Inserted in the vagina. It fits over the cervix and prevents the sperm and egg from meeting. It also continuously releases spermicide.	Typical user 85%	No	No serious health risks. Some protection against sexually transmitted diseases. One size fits all. Can be purchased without a prescription.	Irritation or allergic reaction in rare cases. Some researchers suspect increased risk of toxic shock if used during menstrual periods.
Vaginal Contraceptive Tablets Placed deep into the vagina, the spermicidal tablet or suppository blocks the opening of the cervix and kills sperm.	Consistent user 86-99% Typical user 85%	No	No serious health risks. Some protection against sexually transmitted diseases. Provides vaginal lubrication. Compact, easy to carry and store.	Irritation or allergic reaction in rare cases (try switching brands). Must be inserted prior to each act of intercourse. Only effective about ½ hour. Foaming tablets or melting suppositories may fail to melt or fizz (or the user may not wait long enough, at least 10 minutes, after inserting a tablet).
Fertility Awareness By observing natural signs, a woman can identify her fertile time and either abstain from sexual intercourse or use a barrier method (condom, diaphragm, foam, jelly or cream).	Consistent user 85-99% Typical user 85%	No. Most attend a fertility awareness instruction course.	No serious health risks. Helpful to know when either planning or preventing pregnancy.	Requires high degree of motivation and knowledge. May restrict sexual spontaneity. Requires daily record keeping.
Norplant Norplant is made of six small, soft, thin tubes called implants. These implants are placed just under the skin in your upper arm. They slowly release a small amount of hormone to keep you from getting pregnant.	99-100%	Yes	It works for as long as five years. Once it is in, a woman does not have to do anything else to keep from getting pregnant. It does not cause major health problems.	Most women have changes in their periods. You may bleed at odd times or have no periods at all. Norplant must be put in and taken out by a health care provider.
DMPA (Depo-Provera) DMPA is a shot that keeps you from getting pregnant for 12 weeks. The shot has a hormone that keeps the woman?s eggs from leaving her ovaries. It also thickens the mucus at the opening of the uterus so the man?s sperm cannot get inside.	99-100%	Yes	It works very well to prevent pregnancy and lasts for 12 weeks at a time. There are no pills to take every day. There is nothing to do right before sex to make it work. No one call tell if you are using it.	It causes changes in your periods. You may have other side effects that won?t go away until the shot wears off. You have to go to the doctor/clinic every 12 weeks to get another shot. It may take as long as 18 months to get pregnant after you stop using it.