1

Boimones

1. !"#$%&'( - "love hoimone"
a. Stimulates contiactions - thin anu uilate uteius
b. Contiact uteius to uelivei placenta anu stops excess bleeuinghemoiihage
c. Stimulates ielease of milk
u. Tiiggeis nuituiing feelings
e. 0xytocin levels ieuuceu with epiuuials
2. *+$,-+(.%/01'(2 - natuial opiate
a. Calms anu ielieves pain
b. Epiuuials stop natuial enuoiphin ielease - "blues" aftei biith
c. Belps you feel aleit, attentive, anu euphoiic aftei biith
S. 3,$+&1%4,5'(+2 - "fight oi flight" hoimones
a. Feelings of feaiuistiess piouuce auienaline
i. Slowstop laboi in eaily laboi (evolutionaiily this helpeu females in uangeious
situations stop laboi anu move to safe location)
ii. Can cause biith to happen much moie suuuenly in late laboi (evolutionaiily this
helpeu females in uangeious situations have the baby quickly so they coulu move to
a safe location)
b. Can inteifeie with oxytocin ielease
4. 6/%4,&$'( - milk hoimone
a. Suckling newboins (kangaioo caie) inciease levels of piolactin - a goou stait with
bieastfeeuing
b. Influences momma's behavioi to be moie awaie of babies neeus
c. Combineu with oxytocin makes momma ielaxeu anu uevoteu to the babies neeus

Cycle of Feai






Feai
Tension
Pain
2

Inteiventions

0se youi BRAIN:

!enefits
"isks
#lteinatives
$ntuition
%othing (What happens if we uo nothing.)

&'()*'+ -.'/0
Benefits Infoimation about how uilateueffaceu you aie cuiiently - coulu inuicate piogiess
towaius laboi
Risks Bleeuing, spotting, uiscomfoit, ciamping, infection
Alteinatives
Intuition
Nothing

123)44)*(516774)*( 89 /7/:3'*70
Benefits Can stait youi bouy in laboi
Risks Can bieak youi watei
Alteinatives
Intuition
Nothing

!)0;84<0 1=837
Scoie u 1 2
Ceivical uilation (cm) < 1 1-2 S-4
Length of ceivix (cm) > 2 1-2 < 1
Station -S -2 -1
Consistency Fiim Neuium Soft
Position Posteiioi Niu Anteiioi

A Bishop's scoie of 7 oi moie means you aie moie likely to uelivei successfully vaginally.

>?2827= (misopiostol) - a pill, given vaginally, that causes uteiine contiactions anu iipening of ceivix.
This is a non FBA appioveu use of this uiug.
Benefits Can iipen ceivix, begin contiactions to inuuce laboi
Risks Stiong contiactions, uistiess to baby
Alteinatives
Intuition
Nothing






S
>73@)A)+ (uinopiostone) - vaginal inseit attacheu to a stiing
Benefits Can iipen ceivix, begin contiactions to inuuce laboi - can be iemoveu unlike pills to iipen
ceivix
Risks Stiong contiactions, uistiess to baby
Alteinatives
Intuition
Nothing

B)28=)* - Iv uiip, synthetic oxytocin
Benefits Can iipen ceivix, begin contiactions to inuuce laboi
Risks Stiong contiactions, uistiess to baby
Alteinatives
Intuition
Nothing

C8+7? :D+: - latex bulb inseiteu between ceivix anu uteius. It is inflateu with saline solution. Piessuie
on the ceivix causes the bouy to ielease piostaglanuins that inuuce ceivix iipening anu uilation. Bulb
falls out when
Benefits Can iipen ceivix, begin contiactions to inuuce laboi - mechanical methou insteau of
chemical
Risks Bleeuing, pain
Alteinatives
Intuition
Nothing

Estimateu Bue Bate
This is not an expiiation uate.
S7 - 42 weeks is noimal
42 weeks is ok - pioblem lies when the placenta uoesn't function as well. This is the ieason most
uoctois piefei to inuuce at 42 weeks.

Neuical ieasons foi Inuuction
Pie eclampsia
Nom has pievious loss
uestational uiabetes - big baby

&'()*'+ 7.'/0 AD3)*( :)32;
Benefits Knowleuge of status
Risks Infection
Alteinatives
Intuition
Nothing

#/*)8028/? - bieaking of wateis
Benefits Can stimulate laboi, speeu contiacitons
Risks Infection, ceivical swelling, coiu piolapse, staits the clock
Alteinatives
Intuition
Nothing
4

%82;)*( :? /8D2;
Benefits Piepaies you in case you neeu C-section
Risks
Alteinatives
Intuition
Nothing

C-section iates in Lexington, KY (2u12)
Baptist: 4u%
0K: S8%
St. }oe East: SS%

C72'+ E8*)283)*( - exteinal, continuous (with an inuuction oi foi meuical ieasons)
Benefits Knowleuge of baby's heait iatecontiactions.
Risks Too much knowleuge can be bau. Fetal heait iate can go thiough cycles. A uip can be
noimal, but if the meuical team knows about the uip they have to uo something about it.
Can leau to unnecessaiy C-sections, vacuum anu foicep ueliveiies. Can inhibit movement,
elastic banus can be uncomfoitable.
Alteinatives Inteimittent monitoiing (Stuuies show no impiovement in APuAR scoies, ieuuction of
ueath oi long teim meuical pioblems foi continuous veisus inteimittent monitoiing.
Stuuies uo show a ueciease in iate of seizuies foi continuous)
Intuition
Nothing

C72'+ E8*)283)*( - exteinal, inteimittent
Benefits Allows mom anu meuical team to have infoimation about heait iatecontiactions. Allows
moie movement.
Risks Coulu miss infoimation when not monitoiing that is peitinent to baby's health.
Alteinatives
Intuition
Nothing

C72'+ E8*)283)*( - inteinal
Benefits Knowleuge of baby's heait iatecontiactions. Pioviues moie infoimation than exteinal
monitoiing
Risks Can be placeu wiong oi cause abiasions
Alteinatives
Intuition
Nothing


Exteinal Nonitoiing:
Elastic banus holu electioues against youi abuomen. 0ne is monitoiing heaitbeat anu the othei
contiactions.

Inteimittent monitoiing is eveiy 1S-Su minutes uuiing active fiist stage laboi anu S-1S minutes uuiing
seconu stage (pushing). Can use a hanuhelu Bopplei ultiasounu uevice oi fetal stethoscope.
S


Inteinal Nonitoiing:
Electioue with wiie spiial is inseiteu into the ceivix anu scieweu into the baby's heau.


Teims associateu with fetal monitoiing:

Peiiouic changes: acceleiations anu ueceleiations that occui with contiactions
Non-peiiouic changes: acceleiations anu ueceleiations that occui not uuiing contiactions
vaiiability: The change in the fetal heait iate baseline uue to the inteiplay of the sympathetic anu
paiasympathetic bianches of the autonomic neivous system.
Tachycaiuia: heait iate about 16u bpm foi 1u oi moie minutes
Biauycaiuia: heait iate less than 12u bpm foi 1u oi moie minutes
Shoulueis: vaiiable acceleiations befoie anu aftei vaiiable ueceleiations

















6
Fetal Nonitoiing Patteins:

7



B')* )*273@7*2)8*0537+)79 - Iv naicotics
Benefits Takes the euge off, can pioviue pain ielief foi about 2 houis
Risks Enteis fetal ciiculation, uecieases fetal heait vaiiability
Alteinatives
Intuition
Nothing

B')* )*273@7*2)8*0537+)79 - Epiuuial
Benefits Continuous pain ielief, takes away sensation of pain
Risks Becieases mobility
Alteinatives
Intuition
Nothing

-4)0)828/?
Benefits Noie ioom foi baby
Risks Infection anu fuithei teaiing
Alteinatives
Intuition
Nothing
8

Teais:
1
o
- little teai
2
o
- ueepei - thiough subcutaneous layei
S
o
- to anal sphinctei
4
o
- thiough anal sphinctei

&'=DD/5983=740
Benefits
Risks
Alteinatives
Intuition
Nothing


9

Signs of Laboi

Stage 1 Laboi:

Fiequency anu
Intensity of
Contiactions
Ceivix Nom's Noou What shoulu
mom uo.
What shoulu paitnei
uo.
Eaily Laboi (2-
24 houis oi
moie)
S-2u minutes apait,
usually shoit,
lasting Su-4S
seconus

Nay feel like
tightening oi
menstiual-like
ciamps
Typically
uilates to S-
4 cm
Excitement you aie
finally in laboi

Appiehension, oi
anxiety about laboi
finally happening

Nost women who
aie piepaieu anu
knowleugeable cope
veiy well uuiing this
phase
Bistiaction
techniques

Watch a movie

Walk aiounu the
mall

If it's night, tiy
to sleep

Bon't focus on
youi laboi until
you have to
Bistiact hei

Encouiage hei

Belp make suie
eveiything is ieauy

Enjoy the moment

Belp hei stay hyuiateu
anu encouiage hei to
empty blauuei at least
once an houi

Encouiage mom to eat,
uiink, anu go to the
bathioom at least once
an houi

Focus on easily uigesteu
foous like bananas,
yoguit, cookeu ceieal,
eggs, giaham ciackeis,
toast, soup, ect. Avoiu
heavy, fatty foous
Active Laboi
(may last Su
mins to 12
houis)

When to go to
the hospital.
(Remembei the
4-1-1)

Contiactions aie
about 4 minutes
apait, lasting
about a minute,
anu this has been
going on foi an
houi

ANB: Nom's
moou has
changeu
Regulai
contiactions
continue, becoming
incieasingly closei
togethei anu moie
intense, 2-S
minutes apait,
lasting about 6u
seconus anu aie
moie painful
Typically
uilates fiom
S-4 cm to 7
cm
Nom's attituue is
moie intense

She typically may
not be able to talk
uuiing contiactions
anu neeus to use
some comfoit
measuies to cope

She now iealizes she
has no contiol ovei
what hei bouy is
going thiough anu
may become
appiehensive oi
iiiitable
Stay active!

Waim bath
(avoiu in eaily
laboi as it can
slow uown
piogiess)

Naking noises:
Singing,
moaning

Sensoiy
Bistiaction:
Nusic,
aiomatheiapy,
pictuie to focus
on.

Relaxation
Techniques:
touch,
ielaxation,
visualization,
patteineu
Touch: massage,
effleiauge, uouble hip
squeeze, counteipiessuie

Botcolu: heating paus
on back oi belly, ice
packs, cool cloths on hei
foieheau anu back of
neck

Encouiagement
1u
bieathing
Tiansistion
(1u minutes to
2.S houis.
Aveiage is 1-1.S
houis in fiist
time moms)

Physical signs
of tiansistion:

Inciease in
bloouy show

Rectal piessuie

0ncontiollable
uige to giunt oi
beai uown

Bulging anu
flattening of the
peiineum anu
iectum

Shaking

vomiting

Botcolu

Touch meuon't
touch me
As fiequently as
eveiy 1-2 minutes
lasting 6u-9u
seconus

Aie veiy intense
Bilateu fiom
7-1u cm anu
becomes
completely
effaceu if
not alieauy
Foi most women,
this is the most
uifficult anu painful
pait of laboi

This is the time
when even the most
ueuicateu to the iuea
of natuial chilubiith
think about asking
foi uiugs

Women can become
scaieu, tiieu, want it
to enu, want to go
home, want a c-
section, want to be
put to sleep,
anything ot get them
out of the situations
they aie in, may ciy
at the beginning of
contiactions

It is veiy uifficult foi
laboiing women to
see an enu to the
pain she is going
thiough at this point.
With each
contiaction, she may
think this coulu go
on foi houis anu she
cannot beai it any
longei
Stay giounueu

Remembei this
is the shoitest
pait of laboi
anu it WILL enu
soon

Take it one
contiaction at a
time

Suiienuei to the
piocess
This is the phase when
coaching anu
encouiagement is most
ciucial. It is extiemely
uifficult to watch youi
loveu one be in this much
pain

A uoula (piofessional
laboi coach) is extiemely
valuable at this point
because she has seen this
many times, knows that
it's noimal, anu can
pioviue objectivity as
well as comfoit
measuies. Nany believe
that the laboi nuise will
pioviue this iole anu aie
uisappointeu when they
see that she cannot oi
will not.

Stay veiy close to mom,
establish eye contact

uive shoit anu simple
uiiections; uon't ask a lot
of questions.

Speaking calmly. This is
the most intense pait of
laboi foi many moms,
anu mom neeus lots of
suppoit anu ieassuiance

Stage 2 Laboi: (Anywheie fiom a few minutes to thiee houis. Typically 1-2 houis)
C37FD7*=? '*A )*27*0)2? 89 =8*23'=2)8*0G About eveiy 2-S minutes anu lasts 4S-9u seconus.
Theii puipose now is to expel the baby. They aie veiy stiong, foiceful contiactions foi this
puipose.
>73@).: Is completely uilateu anu complete effaceu.
H70=7*2: As baby uescenus thiough the vagina anu places piessuie on the iectal sphinctei, she
may feel the uige to beai uown like having a bowel movement. Some women feel this as an
uncontiollable uige veiy eaily on uuiing the seconu stage anu otheis uon't feel it at all until the
enu of the seconu stage.
I")*( 89 9)37GJ As baby comes uown thiough the vagina anu begins to ciown, it cieates a buining
sensation as the tissue stietches It's impoitant to iemembei this is a noimal sensation, to push
past it as it passes quickly. This is the time when small laceiations oi teais in the skin of the biith
canal may occui.
B;?0)='+ 0)(*0:
o Inciease in bloouy show
o Rectal piessuie (feeling like she neeus to have a bowel movement)
o 0ncontiollable uige to giunt oi beai uown
o Ruptuie of membianes
11
o uiunting
o The woman saying, "The baby is coming!"
E8/<0 /88A:
o Nany women feel empoweieu oi get a "seconu winu" because they can finally uo
something (push) to help get things moving along anu know they will meet theii baby soon.
o If theie is a stiong uige to push, a woman will uo so even if she is askeu to stop. It's a
piocess that occuis whethei she can help it oi not.
o Some women fall asleep in between contiactions, even though theie is only a Su-6u seconu
bieak.
K;'2 0;8D+A /8/ A8.
o Stay focuseu, listen to youi ueliveiy pioviuei.
o Piactice uiffeient pushing positions.
o Some women instinctively push veiy well. 0theis neeu a little guiuance befoie they get
goou at pushing effectively.
o Nost women without epiuuials instinctively push well when theii babies aie in an optimal
position.
L86 ='* 4'32*730 :7 ;7+49D+M
o Belp suppoit mom in chosen position.
o Belp guiue pushing effoits anu bieathing.
o Lost of encouiagement anu ieassuiance.
o Reinfoice caiegiveis' suggestions.
K;7* 0;8D+A /8/ 02'32 4D0;)*(M Check with nuise, uoctoi, oi miuwife befoie staiting to beai
uown.
!37'2;)*( 27=;*)FD70 '*A :7'3)*( A86*G Caiegiveis will guiue you, but geneially: With each
contiaction, take in a ueep bieath, tuck youi chin uown, then beai uown foi S-7 seconus, while
exhaling oi gently holuing youi bieath. Then ielax biiefly, take in a quick bieath. Then beai uown
again. Beai uown thiee of foui times uuiing each contiaction. In between contiactions, take nice
ueep bieaths to give youi baby lots of oxygen anu iest.

Stage S Laboi: (less than Su minutes)
N'*('388 ='37G 1 houi of skin to skin time foi teim healthy, stable newboins to ease theii
tiansition to life in the outsiue woilu.
BD0;)*( 8D2 2;7 4+'=7*2': Some effoit, but not neaily as uifficult as pushing out the baby. Youi
pioviuei may tug on the umbilical coie a little bit to see if the placenta is ieauy to come out, oi
examine you foi laceiations oi teais while he oi she is waiting. If the placenta takes Su minutes oi
moie (iaie) to be ieleaseu, oi if you aie expeiiencing heavy bleeuing, you may iequiie a tiip to the
opeiating ioom to have it iemoveu. This is moie of a iisk if you have hau pievious uteiine suigeiy
incluuing cesaiean section oi a B&C oi a miscaiiiage oi aboition.

12
Comfoit Neasuies

Touch:
Nassage
Effleuiage - gentle massage up anu uown belly
Showei oi tub
Botcolu - iice sock
Acupiessuiecountei piessuie
Taste: things you like
Smell: Essential oils
Sounu:
Playlist
White noise
vocalizations
Sight:
Low light
Focal point

>8*23'=2)8* ")2D'+ - so the same thing thiough each contiaction

-/82)8*'+ 1D44832
Spouse
Family - suppoit with an emotional investment
Fiienus - suppoit with slightly moie objectivity
Nuise - Assess mom anu baby, iepoit to uoc, iesponsible foi 1-S laboiing women at a time
Boctoi - 0bjective - theie to catch the baby, ensuie safety of mom anu baby
Niuwife - 0bjective - same as uoctoi but is theie thiough laboi
Boula - 0bjective - help thiough laboi (anu uau too)

1)(*0 89 +':83

Possible signs: Ciampy, iiiitable backache, PNS symptoms, nesting uige, Flu-like symptoms

Pieliminaiy signs: Bloouy show, watei bieaking, pie-laboi contiactions (iiiegulai; uiscomfoit mostly in
the fiont of the belly; change oi stop if you change youi activity, eat oi uiink

Positive signs: Piogiessing contiactions (longei, stiongei, closei togethei), ceivical uilation.


1S
Eaily Laboi:

71,$82 1,00+('(9: Ceivix effaces fiom Su-1uu%, uilates to 4 cm. Contiactions 6-Su minutes apait, Su-4S
seconus long. Nom may want to focus uuiing contiactions. Eaily laboi can last 2-24 houis oi moie.

*/+,$1'(9 $+&1(';<+2: No special bieathing techniques aie neeueu. Bowevei, many moms finu it helpful
to begin now with bieathing patteins which aie useful in latei laboi: Begin anu enu contiactions with a
cleansing bieath, use ueep abuominal bieathing thiough the contiaction.

3%5=%/$ $+&1(';<+2: Alteinate iest anu ielaxation with uistiacting activities. Being active (going foi
walks, uancing, shopping) can help laboi to piogiess, but it's veiy impoitant not to exhaust youiself. Tiy
to be ielaxeu, anu tieat this as a vacation uay.

If laboi is moving >+/# slowly, consult with a caiegivei about the possibility of using natuial
augmentation methous such as nipple stimulation, oigasm, oi acupiessuie.

71,$ 21%<4. 2<00%/$ 0+%04+ .%: Time contiactions occasionally (eveiy few houis, oi when things seem to
change significantly). Time six contiactions in a iow, anu iecoiu: when the contiaction began, how long
it lasteu, anu how long it hau been since the stait of the last one. Encouiage mom the eat, uiink, anu go to
the bathioom at least once an houi.


14
Eaily Laboi

*/+,$1'(9: Beep, abuominal, oi noimal sleep-like bieaths

?%582 @%A: Relax

6,/$(+/82 @%A: Nassage mom's hanus anu talk to hei about what you'ie looking foiwaiu to about being a
paient, anu about caiing foi the baby.




1S
Eaily Laboi - Night-time

*/+,$1'(9: Beep, abuomical, oi noimal sleep-like bieaths.

?%582 @%A: Relax

6,/$(+/82 @%A: Talk hei thiough a visualization, "Imagine youiself floating in a waim ocean. the watei is
holuing you up, so you can let youi whole bouy ielax. youi uteius muscles will uo the woik they neeu to
uo, but let youi othei muscles ielax."

























16

Eaily Laboi - Touch Relaxation

*/+,$1+: Beep, abuominal bieathing.
6%2'$'%(: Sit in a way that opens up youi pelvis.

6,/$(+/82 @%A: look foi someplace mom is holuing tension, touch hei theie, stioking lightly to ieminu
mom to ielax.

?%582 @%A: puiposely tense up aieas of youi bouy, so youi paitnei has to seaich foi wheie tension is.
(This is just foi piactice. In laboi, youi bouy will cieate tension on its own!)





17
Eaily Laboi

*/+,$1'(9: Cleansing bieath; then ueep bieathing.

?%582 @%A: leaning foiwaiu anu swaying. Takes weight of baby off youi back, anu encouiages baby to
iotate anu uescenu.

6,/$(+/82 @%A: Lightly iub mom's back oi stioke haii. Time the contiaction.




18
Active Laboi

71,$82 B,00+('(9: Ceivix completely effaceu, uialates fiom 4-8 cm. Contiactions S-S minutes apait,
lasting 4u-7u seconus. Contiactions aie moie intense, mom may not be able to walk anu talk uuiing
contiactions. Nom tenus to become focuseu. Nay last fiom Su minutes to 1u houis.

A suggestion foi when you go to the hospital: S-1-1. When contiactions aie no moie than five minutes
apait, lasting foi at least one minute, with that pattein establisheu foi at least one houi.

*/+,$1'(9 C+&1(';<+2: Beep abuominal bieathing foi as much of the contiaction as is comfoitable. 0vei
the peak of the contiaction, use hee-hee bieathing oi hee-hee-blow oi sliue.

3%5=%/$ C+&1(';<+2 =%/ D&$'>+ E,A%/: Waim bath, Touch: massage, effleuiage (light stioking),
counteipiessuie on sacium, uouble hip squeeze. BotColu: heating paus, ice packs, oi cool cloths on hei
foieheau anu back of neck. vocalization: singing, moaning. Sensoiy uistiactions: music, aiomatheiapy,
pictuie to use as focal point. Relaxation Techniques: touch ielaxation, visualization, bieathing in eneigy
anu stiength, bieathing out tension. Encouiagement anu suppoit. Tiy to phiase things as positive
suggestions, not ciiticisms.

71,$ 21%<4. 2<00%/$ 0+%04+ .%F Reminu mom to uiink aftei each contiaction, anu go to the bathioom
once an houi. Belp with comfoit techniques. Establish iituals by uoing the same thing on each
contiaction, foi as long as that woiks, then switching to new iitual. Let hei iest when she neeus to, but
ieminu hei that being physically active can help laboi piogiess.
19
Active Laboi

*/+,$1'(9: Slow ueep bieaths at beginning anu enu of contiaction. Bee-Bee bieathing ovei the peak.

3%5=%/$: Counteipiessuie oi uouble - hip squeeze.




2u
Active Laboi - The Lunge

*/+,$1'(9: Slow bieathing at beginning anu enu. Bee-Bee Blow bieathing.

6%2'$'%(: Lunge opens up pelvis; movement helps baby iotate anu uescenu. Rhythm of movement
uistiacts mom fiom pain.

6,/$(+/: suppoit hei while lunging. Encouiagement! Time contiaction



21
Active Laboi - Pelvic Tilts

71#: uieat foi back pain! Encouiages baby to iotate

*/+,$1'(9: Sliue bieathing. Aich youi back anu "tuck youi tail" as you take in a ueep bieath, anu then let
back ielax to flat as you blow it out a little at a time.

6,/$(+/2: Lightly iub hei back.




22
Active Laboi

*/+,$1'(9: Slow Bee-hee bieathing.

6%2'$'%(: "Slow uance." Being upiight anu moving helps baby to iotate anu uescenu.

3%5=%/$: Sway back anu foith. Paitnei can sing to hei, if uesiieu, oi "Whispei sweet nothings in hei eai."




2S
Biith Ball Positions

24

Tiansistion

71,$82 1,00+('(9: Ceivix uilates to 1u cm. Contiactions 2-S minutes apait, 6u-9u seconus long. Intense.
Nom may be uiscouiageu, scaieu, angiy. Nay be tiembling, hotcolu, nauseous.

B%G 4%(9 G'44 '$ 4,2$F 1u minues to 2.S houis. Aveiage is 1-1.S houis in fiist time moms.

*/+,$1'(9 $+&1(';<+2: Bee-hee bieathing oi hee-hee-blow. Counteu hee-hee-blow, wheie paitnei tells
mom how many hee-hees to uo befoie each blow. Paitneis bieathe with hei.

3%5=%/$ $+&1(';<+2: Any of the techniques anu positions fiom active laboi. Follow hei cues.

71,$ 21%<4. 2<00%/$ 0+%04+ .%F Stay veiy close to mom, establish eye contact. uive shoit anu simple
uiiections, uon't ask a lot of questions. Speak calmly, anu help to ieassuie hei.


2S
Tiansition

3%($/,&$'%(2: 2 minutes apait, 7S seconus long, veiy intense. Nom is uiscouiageu anu exhausteu.

*/+,$1'(9: Counteu Bee-Bee blow.

3%5=%/$: Paitneis stay as calm anu ielaxeu as possible, stay close to hei, coach hei thiough bieathing.
Encouiage hei to open hei eyes anu look at you.




26
Tiansition

3%($/,&$'%(2: aie veiy intense! Nom is fiighteneu, saying "I can't uo this. It's too much!"

H/+,$1'(9: Sliue bieathing. (ueep bieath in, blow out a little at a time.)

3%5=%/$: Speak calmly, bieathe with hei, ieassuie hei that this is tiansition anu the baby will be heie
soon.




27

Seconu Stage: Biith

71,$82 1,00+('(9: ceivix has uilateu, baby has uescenueu anu is ieauy to be ueliveieu. Contiactions may
be accompanieu by a stiong uige to push. (Nay feel like a neeu to have a bowel movement). Nom's
vocalizations may change to ueep giunts oi gioans.

B%G 4%(9 G'44 '$ 4,2$F Anywheie fiom a few minutes to thiee houis. Typically 1-2 houis.

71+( 21%<4. 5%5 2$,/$ 0<21'(9F Consult with caiegiveis befoie staiting to beai uown.

*/+,$1'(9 $+&1(';<+2: With each contiaction, take a ueep bieath, then tuck chin uown to chest, anu beai
uown foi five to seven seconus, while exhaling oi gently holuing bieath. Then ielax anu bieath. Then
beai uown again. In between contiactions, bieathe noimally anu iest.

3%5=%/$: Any of the iueas above. A cool cloth on hei foieheau oi beck is especially populai.

71,$ 21%<4. 0,/$(+/2 .%: Belp suppoit mom in chosen position. Belp guiue pushing effoits anu
bieathing. Lots of encouiagement anu ieassuiance. Reinfoice caiegivei's suggestions.


28
Seconu Stage (Pushing)

*/+,$1'(9: Take a ueep bieath. Tuck chin uown towaius chest anu beai uown foi five to seven seconus
(paitnei counts out louu) while exhaling thiough puiseu lips. Relax, taking a quick bieath in, then beai
uown again.


29
Seconu Stage (Pushing)

Seconu stage was going veiy quickly, caiegiveis want to slow it uown to give peiineum time to stietch.

*/+,$1'(9: Tilt chin up a little anu pant.

3%5=%/$: Effleuiage: gentle, light stioking of hei haii, hei aims, whatevei. Belps to soothe hei, anu
uistiact hei fiom contiaction. Pant with hei.



Su
Seconu Stage (Pushing)

Baby is ciowning, anu mom is actively pushing.

*/+,$1'(9: Take ueep bieath. Tuck chin chest, anu beai uown foi five to seven seconus while exhaling
thiough puiseu lips. Relax, taking a quick bieath in, beai uown again.

3%5=%/$: Paitnei suppoits mom in squat position.


S1
Positions foi Pushing


S2

SS
Newboin Pioceuuies

34,50'(9I&<$$'(9 <5A'4'&,4 &%/.
Belayeu coiu cutting - can inciease iisk of jaunuice

D6JDK 2&%/+ (u, 1, oi 2 foi each)

#ctivity - aie they moving.
Bulse - heait iate above 1uu6uu
Oiimace - uo they ieact when bulb is useu to iemove fluius.
#ppeaiance - pinkblue
"espiiatoiy - coming out ciying

Bealthy babies 7-1u
Testeu at 1 minutes anu S minutes

L'$,5'( M
Foi bloou clotting
Nany newboins ueficient of this
Pievents hemoiihagic uisease
Can iequestplan in auvance foi an oial uose

N/#$1/%5#&'( - eye ointment
Pievents eye infectionblinuness
0sually fiom motheis with chlamyuia

6<42+ %"'5+$/# 2&/++('(9
Can uetect congenital heait uisease

3'/&<5&'2'%(
86% ciicumcision iate in Kentucky

B+0,$'$'2 * >,&&'(+
0thei vaccines stait at 2 months

6MOIP+GA%/( 2&/++(
Bappens at 48 houis of life
Beel piick
Tests foi 49 metabolic uiseases
Can tell you if you neeu to leave ceitain substances out of youi uiet if bieastfeeuing

B+,/'(9 Q&/++('(9
Bappens at 24 houis of life
Bigh false positive


S4
Post Paitum
O$+/<2
Contiacts aftei ueliveiy
About 1u uays PP at top of pelvic bone
Nassage uteius afteiwaius
Repoit clots - small oi infiequent ones aie 0K but moie is not goou.

E%&1', RA4++.'(9S
Rubia - ieu (heavy) foi 2-S uays
Seiosa - biownieu foi 7-8 uays
Alba - white foi anothei week oi 2

*/+,2$2
Colostium - contains a natuial laxative that cleais meconium out
Nilk - comes in uay S-S

7+'91$ 4%22
0p to 12 lbs with biith
By 6 weeks PP weight aiounu piepiegnancy.

N5%$'%(,4 31,(9+2
Bappiness
Feai
Exhaustion
Bepiession

Noimal baby blues: (check if lasts moie than a week)
o Ciying foi no appaient ieason
o Impatience
o Iiiability
o Restlessness
o Anxiety
o Noou swings

Post Paitum Bepiession
o 0ncontiollable ciying
o Appetite anu sleep uistuibances
o Nemoiy loss
o Lack of inteiest in baby
o Iiiitability
o uuilt
o Insomnia
o Feai of haiming baby
o Fatigue
o Feai of self haim
o Sauness
o Exaggeiateu highlows
o Confusion
o Lack of concentiation
SS


Basic Newboin Caie

Coiu Falls of within 2 weeks
o Bon't give immeisive bath until belly button has healeu
}aunuice
o Causeu by bieakuown of bloou oi immatuie livei
o Collection of biliiubin, a fat soluble substance that is conveiteu to watei soluble substanu
by the liveiy anu excieteu thiough the intestines noimally.
o 6u% of teim babies anu 8u% of pieteim babies expeiience this
o Lab values gieatei than 2u inuicateu a iisk of it tiavelling to the biain anu causing mental
ietaiuation
o Tieatment
! Phototheiapy - a fluoiescent light conveits fat soluble veision to watei soluble.
! Fiequent nuising anu pooping helps to iiu the bouy of it
! 0lueilowei scoiing babies may just be monitoieu
Newboin iash
o Totally noimal
o Nothing to be uone about it
Stiawbeiiy maiks - ieu maiks
o Noimal
o uo away aftei 6 months
o If supei uaik, tell the uoctoi
Blue hanus anu feet
o Common
Bappiest Baby on the Block
o Shh
o Swauule
o Sway
o Siue
o Suck
uassy babies
o Bighei pitch whine
o Biing legs up into theii bouies
SIBS
o Baby on back
o Fiim mattiess
o Nothing else in ciib
o No smoking
o Avoiu exposing baby to iespiiatoiy infections
o Pacifieis can ieuuce SIBS - only intiouuce once bieath feeuing is establisheu
Bieastfeeuing
o Eaily feeuing cues
! Lip smacking
! Chew on hanus
o 0ffei feeuing eveiy 2 houis - once baby is back to biith weight then can wait 4 houis
o Fiist few uays 1u-1S minutes on each siue. If enu with one siue begin next feeuing on othei
S6
o If the baby is huiting youi nipple put fingei in baby's mouth anu bieak suction. Covei
nipple with fingei anu iemove.
o Fully empty milk befoie switching
! Foie milk - vitamins
! Binu milk - fat anu sustenance
o Time feeuings fiom beginning of feeuings
o Buip in between bieasts anu again at enu


S7
Baby Basics - 0K Bospital
Suctioning
o This pioceuuie is usually uone as the fetal heau emeiges - befoie the baby is fully
ueliveieu.
o The nose anu mouth aie suctioneu with a bulb syiinge to cleai the aiiway foi the fiist
bieath.
o Noie complete suctioning can be uone with a suction tube inseiteu in the mouth anu
thioat.
IB Banu
o Iuentification banus aie attacheu to the infant's ankle anu wiist soon aftei biith.
o A banu is also placeu on the mothei's anu paitnei's wiists.
o Each banu has an iuentical iuentification numbei anu last name.
Footpiinting
o Footpiints aie maue of each newboin soon aftei biith anu usually become pait of the biith
ceitificate along with the mothei's fingeipiint.
o Footpiinting is usually uone about the same time that the iuentification banus aie placeu
on the infant.
o Bospital peisonnel will make an auuitional set of the baby's footpiints foi the paients to
keep. If you want auuitional copies, biing V sheets of stuiuy papei anu ask youi nuise.
Tempeiatuie Nonitoiing
o The axillaiy methou is the piefeiieu methou foi newboins.
o Noimal iange: S6.S
o
C - S7.S
o
C (97.7
o
F - 99.S
o
F)
o Rectal: S6.S
o
C - S7.S
o
C (97.7
o
F - 99.S
o
F)
o Tempeiatuie can be unstable at fiist because newboins have immatuie tempeiatuie
iegulation abilities
Waimeu on Nothei's Chest
o In a noimal ueliveiy, wheie the baby has a goou APuAR scoie, it is stanuaiu pioceuuie foi
the mothei to holu the baby against hei chest immeuiately following biith, aftei the baby is
cleaneu anu uiieu. This is calleu Kangaioo caie.
o The waimth of the mothei's skin against the baby's skin is a goou tiansition foi the baby
fiom the waimth anu secuiity of the womb to the outsiue woilu.
Beat Regulation
o When the newboin is examineu at one houi of age, she is usually placeu on a special
examining table with a iauiant heat panel above to help keep hei fiom losing bouy heat
uuiing the exam.
o Sometimes, a heat sensoi is tapeu to hei abuomen to iegulate the amount of heat geneiateu
by the panel.
Weighing
o Weighing of the newboin is uone one houi aftei biith in the biithing centei ueliveiy ioom.
o 0thei times, it is uone latei in the newboin nuiseiy.
o Ninety-five peicent of infants weigh between 2,7uu giams (6 lbs) anu 4,Suu giams (1u lbs)
Neasuiing
o Length is usually measuieu at one houi aftei biith as a base-line to compaie to fuithei
giowth measuiements
o The aveiage length of a full-teim infant is S1 cm (2u inches).
o Ninety-five peicent of infants measuie between 4S cm (18 inches) anu S6 cm (22 inches).
Bieastfeeuing
S8
o Notheis who bieastfeeu shoulu attempt to put the baby to the bieast soon aftei biith to
help get off to a goou stait. Babies will usually initiate the fiist feeu fiom the kangaioo
position.
o Initially, the bieasts piouuce colostium, a piotein-iich fluiu that passes the mothei's
immunities to the newboin, helping to piotect the baby fiom infection.
o When a mothei cannot oi chooses not to bieastfeeu, infant foimulas can be substituteu.
o Feeuing a baby offeis a special time of bonuing anu secuiity builuing foi a baby.
o Whoevei holus the baby shoulu holu hei as closely as she woulu be helu foi bieastfeeuing.
o Nevei piop a bottle in the baby's mouth.
Eye Neuication
o Nost places manuate that a newboin's eyes be pieventively tieateu by one houi aftei biith
foi possible gonoiiheal infection. If untieateu, this infection coulu leau to blinuness.
o Antibiotic ointments aie commonly useu to tieat the eyes.
o Chemical conjunctivitis may iesult fiom tieatment.
vitamin K Injection
o A vitamin K injection is ioutinely given to piomote bloou clotting anu pievent a iaie
pioblem of bleeuing in the biain.
0thei Newboin Tests
o Youi baby will have a metabolic scieening befoie uischaige. You must know who youi
peuiatiician will be so they can ieceive the iesults.
o A small bloou sample is obtaineu by sticking the heel of the infant anu uiawing a few uiops
of bloou.
o These tests can check foi jaunuice, hypothyioiuism, PK0, glucose, a complete bloou count,
anu moie.
Algo
o All babies aie checkeu foi heaiing loss.
o Scieening uoes not huit.
o You will ieceive the iesults befoie you leave the hospital
o If youi baby has a heaiing loss it is veiy impoitant to finu out eaily anu get help with
leaining anu language.
Swauuling
o Wiapping a fussy newboin snugly in a ieceiving blanket may help calm the baby.
o It pioviues waimth anu secuiity, which the baby became accustomeu to in the close
quaiteis of the womb.
o Baby's legs shoulu not be stiaighteneu when swauuleu anu they shoulu be able to move
fieely foi piopei hip join uevelopment.
Sleeping on back
o It is iecommenueu that infants be placeu on theii backs foi sleeping.
o Theie is a highei inciuence of suuuen infant ueath synuiome (SIBS) in infants who sleep on
theii stomach oi siues.
Newboin feeuing
o The Ameiican Acauemy of Peuiatiics iecommenus exclusive bieastfeeuing foi the fiist
yeai.
o No cow's milk in the fiist yeai.
o Auvance to soliu foous accoiuing to youi peuiatiicians ieccommenuations
o You shoulu feeu an infant eveiy 2-S houis, one feeuing uuiing the night may be S houis.
o Buip the baby as neeueu anu when you switch siues
o You know the baby is "getting enough" if the infant falls asleep, ielaxes, has a wet uiapei foi
each uay of life.
S9
o Wet uiapeis uay 1-1; uay 2-2, ect.
Eaily signs of hungei
o Reaching out with the tongue.
o Tuining the heau as if looking foi the bieast.
o Sucking oi chewing on fingeis oi hanus.
Late signs of hungei
o Ciying louuly
o Aiching back
o uoes to sleep befoie eating
Feeuing Behaviois
o Bungiy babies aie tense anu will suck anu swallow fast. Theii hanus will be tightly
clencheu anu helu close to theii face.
o As youi baby fills-up, you will see his little bouy begin to ielax. Be will continuously
swallow, with little iests eveiy 1-2 sucks
o When hungei is satisfieu:
! Baby's entiie bouy will ielax.
! Some babies let go. 0theis like to holu on, lightly suckling until they go to sleep.
Biapeiing
o Newboins neeu fiequent uiapei changes
o When changing a uiapei, clean the baby's uiapei aiea thoioughly; pie-moisteneu wipes aie
available foi this puipose.
o If uiapei iash becomes a pioblem, special piotective ointments may pioviue ielief
Sponge bath
o When youi baby is 6-8 houis olu, heshe will be batheu in youi ioom. This is to allow youi
baby time to iegulate bouy tempeiatuie. Beshe will then be placeu skin to skin foi about
Su minutes to waim back up.
o Nevei leave baby unattenueu when you begin using a tub foi bathing. Bathe befoie a
feeuing to avoiu making baby spit up.
Shampoo
o Boluing the baby secuiely, gently soap the scalp with no-teai shampoo
o Rinse thoioughly
o A plastic tub uesigneu foi bathing infants is helpful oi a laige sink will woik.
o Special sponge mats foi the tub oi sink aie available.
Coiu Clamping anu Caie
o The umbilical aiea shoulu be kept clean anu exposeu to the aii as much as possible to help
the healing piocess.
o The infant shoulu be sponge batheu until the stump is healeu.
o The seconu image shows the coiu stump aftei one uay.
Bath
o Wash fiom innei aspect of the eye to the outei aspect
o Wash in eveiy folu anu cievice
o Bath time is a wonueiful time foi the baby to leain youi touch
o Nevei tuin youi back on youi baby.
o Always wash fiom fiont to back
o Wiap youi baby in a towel anu place him in a football holu to wash his haii
o Biess youi baby anu swauule him to pievent chilling.
When to call the Peuiatiician
o Nust be seen in the 1
st
week
o Temp gieatei than 1uu.4
o
F axillaiy
4u
o Changes in bieathing
o vomiting
o Two oi moie misseu feeuings
o No wet uiapeis in 8 houis
o Ciicumcism oi umbilical coiu ieuness, swelling oi uiainage
o Wateiy uiaiihea
o Bifficult to aiouse
o Fussiei than noimal
o Poison Contiol 1-8uu-222-1222
Pieventing Acciuents
o Nevei leave a chilu unattenueu
o Always check watei tempeiatuie anu lowei watei theimostat to <12u uegiees
o Take a CPR class
o Registei youi chilu caie equipment so you can be notifieu of iecalls
o Cai seat - ieai facing foi infants less than 2 yeais, call 4SS-SEAT to make an appointment
with the fiie uepaitment foi installation
! Noie than 9u% of cai seats in cais touay aie unsafe, because of impiopei installatio,
missing pieces oi factoiy iecall.
! The uivision of Fiie anu Emeigency Seivices paitneis with the Fiateinal 0iuei of
Fiiefighteis to sponsoi "0peiation Safe Seat." This piogiam pioviues chilu safety
seat inspections, instiuctions on piopei installation anu iecall infoimation.
! The F.0.F. also pioviues, with iefeiial fiom an appiopiiate agency, cai seats to
Fayette County families who cannot affoiu them. 0ui goal is to pioviue safety foi
eveiy chilu that we can. To scheuule a safety seat inspectioninstallation, please e-
mail us, uavisjlfu.lfucg.com giving us youi name, phone numbei(s), wheie you live
anu what kinu of cai(s) anu chilu safety seat(s) you have. Infoimation about youi
chilu(ien)'s sizes(s) anu age(s) will also be helpful, oi call 4SSu7S28 anu follow the
uiiections on the iecoiueu message. We will take caie of youi iequest anu confiim
youi appointment foi an inspection anu assistance by telephone as soon as it can be
scheuuleu.
41
Bieastfeeuing Essentials

I. Why shoulu you bieastfeeu.
i. Antibouies
ii. Bealthy foi mom
iii. Cheap
iv. Weight loss
b. Benefits to mom
i. Regulation of hoimones - waiu off PPB
ii. Belays ietuin of feitility (6 months)
iii. Bealth (osteopoiosiscanceibloou piessuieheait uiseaseuiabetes)
c. Babies love to bieastfeeu!
i. Bonu with mom
ii. Reuuce stiess
iii. uiow stiongei
u. Benefits to uau
i. Nom anu baby aie happiei
ii. Suppoitive uaus = successful bieastfeeuing
II. Bow uo I bieastfeeu.
a. Babies weie maue to bieastfeeu anu they want to bieastfeeu!
i. uet to know youi baby. They will ell you what they neeu.
ii. Skin to skin contact:
1. As soon as you can (aftei biith)
2. As long as you can (until the fiist feeuing) - at least 2 houis
S. As often as you can (uuiing the fiist few uays anu weeks).
iii. Watch baby's cues
iv. 0ffei the baby the bieast
III. Bow uo I holu the baby.
a. You can bieastfeeu in any position.
i. "Laiu back nuising" www.biologicalnuituiing.com
ii. "0fficial nuising positions" www.uijacknewman.com
b. Nake suie you aien't leaning foiwaiu anu stiaining back
c. Baby's hipshoulueieai in line
u. Bon't swauule baby while feeuing
e. Bave baby nakeu
f. Lift boob you aie not using anu tuck baby unuei it.
Iv. Bow uo I know the baby is getting enough milk.
a. Tiust youi baby to tell you! Nake the bieast available anu the baby will eat.
b. Check:
i. uoou latch
ii. visible anu auuible suck anu swallow
iii. Baby enus feeuing anu is happy
iv. Baby is eating at least 1u-12 times a uay foi 2u-Su minutes a feeuing, oi moie often
foi shoitei times
v. Baby is gaining 4-7 ounces a week
vi. Baby has auequate uiine anu stool output:
1. S-S uays: S-S uiine, S-S stool
2. S-7 uays: 4-6 uiine, S-6 stool
v. Bow uo I know I have enough milk.
a. Baby's weight gain
42
i. 1u% weight loss is noimal (uay 4)
ii. Back to biith weight by week 2
iii. Noimal weight gain = V ozuay
b. Wetuiity uiapeis
c. Check Latch
u. Baby looks happy at the enu of feeuing
e. Boimones involveu:
i. Piolactin - piouuceu when you uelivei the placenta - tuin on about 72 houis latei -
stimulation iesults in supply
ii. 0xytocin - muscles aiounu bieast contiact to squiit milk
vI. What is in my milk.
a. Colostium oi fiist milk
i. Bigh in antibouies
ii. "Liquiu golu"
b. Natuie milk
vII. Bow uo I get the best stait.
a. Skin to skin - Kangaioo caie
vIII. What about pioblems.
a. Engoigement
i. Ice
ii. Nassage
iii. Ibupiofen
iv. Banu expiession
v. Pump a couple minutes to get baby to latch
vi. uoes away in 24 houis
b. Sleepy baby
i. Skin to skin
ii. Biip milk in baby's mouth
iii. Banu expiess into mouth
iv. uet goou latch
v. Switch bieasts iepeateuly
vi. Feeu fiom spoon to inciease bloou sugai
c. Soie nipples:
i. Beep latch
ii. Feeu on opposite siue
iii. Lanolin cieam
iv. Bieast milk on nipple
u. Pluggeu uucts
i. Nastitis (ieu stieaksfevei) - call uoctoi
ii. Nassage
e. Continueu soieness, pain, oi othei questions
i. Please get help!
IX. 0thei ianuom questions
a. Bow much uo I neeu to eat oi uiink.
i. 24 oz extia watei
ii. No foou iestiictions
iii. Take vitamins
b. Can I uiink alcohol.
i. No, alcohol gets in milk
c. What can I use foi biith contiol.
4S
i. Boimonal biith contiol can affect milk supply
u. Can I give the baby a pacifiei.
i. The moie you use a pacifiei the less uuiation you bieastfeeu
ii. When you intiouuce a bottle baby is useu to moie sucking - give a pacifiei to give
extia sucking time.
e. Bo I neeu a bieast shielu.
i. N0 Y00 B0 N0T!
f. I want to sleep at night! Bow can I make this happen.
i. Babies sleep thiough the night (S houis at a time) at 1u lbs
g. What can I bieastfeeu while taking a meuication.
i. Suuafeu is bau, it uiies up milk
ii. Nost meuications aie fine - can call a lactation consultant to uouble check.
X. What else uo I neeu.
a. Bias
i. Notheiweai online
ii. Biavauo silk nuising bia
b. Cieams
c. Nuising paus
XI. Resouices
a. www.uijacknewman.com
b. www.biologicalnuituiing.com
c. www.kellymom.com
u. www.llli.oig
e. www.askuiseais.comhtml7tu7u6uu.asp


44
Bieastfeeuing Essentials 2: Pumping

K;? 4D/4M

-'3+? !':? PQRS 677T0 4802R4'32D/U
Intiouuce a bottle aftei bieastfeeuing is well establisheu - by 6 weeks you shoulu intiouuce a
bottle - babies aie still willing to tiy new things
Leain to expiess milk
Being stoiing milk
Bieast = momma, Bottle = someone else
Replace one feeuing with a bottle eveiy othei uay
If baby uoesn't want the bottle, mom shoulu leave the ioomhouse

>;8807 ' 4D/4
Things to consiuei
o Cost
o Efficiency
o Ease of use
o Comfoit
o Fiequency
o Time
o Convenience
Neuela fieestyle = bau
Neuela oi Bygea aie goou pumps
Ask foi a pump kit in hospital - it has next size cup flange

L86 28 4D/4
See pimping time as youi quiet time at eithei home oi woik
uet comfoitable
Relax
Waim compiess
Waim uiink
Baby pictuie
Nassage bieasts
Watei
Lanolin cieam
Centei nipple in pump
Pump iapiuly until flow, then holu until stop, iepeat (manual pump)
Pump thiough one let-uown, can pump thiough two let-uowns if have time
Clean equipment aftei each pumping so it is always ieauy to us
o To clean tubing just leave pump on
o Bon't clean out tubing with watei - it will molu
o Rinse flanges at woik; clean at home
Coulu uo pumping in 1S minutes fine.
Pump at the fiequency you woulu feeu.
Looking at a pictuie of baby can bettei youi session (oi get baby on phone)
Bon't pump fiesh milk into a bottle that has colu milk, wait until milk in new bottle is colu anu
then poui into the fiist bottle
4S

K83T)*(
Belay as long as possible - 12-16 weeks
Stait back pait time
Stait back on a Thuisuay
Stait stoiing bieastmilk at least 2 weeks befoie you stait back to woik
o Pump in the moining aftei feeuing
Bave a "tiial uay" with the baby at the babysittei anu you at home. Pump on scheuule anu see how
youi supply woiks out
Pump the same numbei of times the baby is eating:
o 7am: Bieastfeeu, then pump
o 1uam: pump
o 12am: pump
o Spm: pump
o Spm: pick up baby anu bieastfeeu
o BF fiequently uuiing evening anu night
o 1upm pump one moie time befoie you go to beu

!37'02/)+T 0283'(7
Put into bags, label with uate, use oluest fiist
o Room temp (<77
o
F): 4-1u houis
o Refiigeiatoi: S uays
o Fieezei: S-6 months
o Beep fieeze (1u
0
F) 6-12 months
Always stoie in the back because moie consistent tempeiautei
Babies eat (appioximately):
o 6 weeks: S-4 oz
o 12 weeks: 4 oz
o S months: 4-6 oz
o 6 months: S-8 oz

V;'6)*(
Thaw in waim watei oi in iefiigeiatoi. N0 boiling oi miciowaving!
Nake suie youi caiegivei tieats bieastmilk appiopiiately!
Shake gently
Thaweu milk is goou foi 24 his.
Aftei a baby has eaten a bottle, the iemainuei must be thiown away.

H7=37'07A E)+T 1D44+?
Reuuce othei commitments
Nuise oi pump moie often oi longei, "powei pumping"
Inciease iest
Bouble pump to inciease piolactin piouuction (which incieases milk supply)
Nassage
Focus on ielationship with baby, not numbei of ounces

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Stage 1 nipples can be useu foi 6 months
Feeu baby a bottle with baby sitting up moie insteau of ciauleu
46
What to Biing to the Bospital
! Nassage tools (anuoi tennis balls)
! Lotion
! Pillows (sometimes finuing extia pillows can be an act of congiess in the hospital; also the smell of
a pillow fiom home can be comfoiting)
! Lip balm
! Baii accessoiies - biush, iubbei banus
! Comfoitable clothing
! Toothbiush anu toothpaste
! Bieath mints foi paitnei
! Lollipops
! Botcolu pack
! NPS play with speakeisCB playei
! Watch with seconu hanu (oi contiaction app)
! Noney (in small bills foi venuing machine)
! Socks
! Robe
! Slippeishouse shoesflip flops foi walking in the hall
! Snacks
! Focal point
! Biith plan
! Consent foims
! Pens
! Insuiance caiu
! Pictuie IB
! Cameia, viueo cameia, phone, chaigeis foi all
! 0vei the countei heauache meuicine foi paitnei - the hospital cannot give out meus to anyone
who is not a patient
! ulassescontacts

Postpaitum items**
! Baby book
! Nuising bias
! 0utfit foi baby pictuies anu going home
! Clothes foi mom anu paitnei (expect to weai smallei mateinity clothes going home)
! Phone list
! Cai seat
! Blankets foi baby
! Peisonal hygiene items foi mom anu uau
! Emeiy boaiu foi baby's nails (uo not cut them!)

**uo not biing to laboi anu ueliveiy - leave in the cai until you get to youi postpaitum ioom