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Childbirth Class

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Samantha Grillos

on 2 April 2015

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Transcript of Childbirth Class

Baby of Mine
Childbirth Class

About Me:
Samantha Grillos
Registered Nurse since 2006.
Labor and Delivery Nurse from 2007-2010.
Worked at Hoag Memorial Hospital in Newport Beach, California where we delivered 500 babies on average per month.
Mother of 2 beautiful baby girls and have experienced one vaginal delivery and one cesarean section.
Registered Nurse vs Doula
Registered Nurse
defined by wikipedia
OB/GYN vs Midwife
Birth in the United States
This presentation is for information purposes only. It is not intended as medical advice. Please consult your Physician if you have any questions regarding your pregnancy or any other medical condition that may arise. It should not replace any information or advice that your Physician has given you.
A registered nurse (RN) is a nurse who has graduated from a nursing program at a college or university and has passed a national licensing exam.[1] Registered nurses help individuals, families, and groups to achieve health and prevent disease. They care for the sick and injured in hospitals and other health care facilities, physicians' offices, private homes, public health agencies, schools, camps, and industry. Some registered nurses are employed in private practice.[2] Many first become a licensed practical nurse (LPN) or licensed vocational nurse (LVN).[3] A registered nurse's scope of practice is determined by the regional college or association, as well as by the government responsible for health care in the region
defined by wikipedia
A doula (pronounced "doó la",[1] also known as a labour coach[2] and originating from the Ancient Greek word meaning female servant or slave[3]) is a nonmedical person who assists a woman before, during, or after childbirth, as well as her partner and/or family by providing information, physical assistance, and emotional support.[1] The provision of continuous support during labour by doulas (as well as nurses, family, or friends) is associated with improved maternal and fetal health and a variety of other benefits.[1][4]

A variety of organizations offer certification and training to doulas, though there is no oversight to their practice and the title can be used by anyone.[5] In contrast to the goal of medical professionals (a safe childbirth), the goal of a doula is to ensure the mother feels safe and confident before, during, and after delivery.[6] Doulas can be controversial within medical settings due to pressure on mothers to avoid medical interventions and pursue natural childbirth without an epidural or medically necessary caesarean sections.[7]
Let's have a laugh before we get started
defined by the medical dictionary
defined by wikipedia
A commonly used abbreviation. OB is short for obstetrics or for an obstetrician, a physician who delivers babies. GYN is short for gynecology or for a gynecologist, a physician who specializes in treating diseases of the female reproductive organs. The word "gynecology" comes from the Greek gyno, gynaikos meaning woman + logia meaning study, so gynecology literally is the study of women. These days gynecology is focused largely on disorders of the female reproductive organs. An obstetrician/gynecologist (OB/GYN) is therefore a physician who both delivers babies and treats diseases of the female reproductive organs.
Midwifery is a health care profession in which providers offer care to childbearing women during pregnancy, labor and birth, and during the postpartum period. They also help care for the newborn and assist the mother with breastfeeding.

A practitioner of midwifery is known as a midwife, a term used in reference to both women and men, although the majority of midwives are female.[1] In addition to providing care to women during pregnancy and birth, many midwives also provide primary care to women, well-woman care related to reproductive health, annual gynecological exams, family planning, and menopausal care.

.Midwives are specialists in low-risk pregnancy, childbirth, and postpartum, although they are trained to recognize and deal with deviations from the norm as well as certain high risk situations. Obstetricians, in contrast, are specialists in illness related to childbearing and in surgery.[3] The two professions can be complementary, but may be at odds in some countries, where obstetricians are taught to "actively manage" labor, while midwives are taught not to intervene unless necessary. Most midwives are familiar with the process of physiological management and the use of gravity in aiding the process of labor.[4]

Midwives refer women to general practitioners or obstetricians when a pregnant woman requires care beyond the midwives' area of expertise. In many parts of the world, these professions work together to provide care to childbearing women. In others, only the midwife is available to provide care. Midwives are trained to handle certain more difficult deliveries, including breech births, twin births and births where the baby is in a posterior position, using non-invasive techniques.

For low risk births, compared with obstetricians, midwives offer lower maternity care cost, lower intervention rates, reduced mortality and morbidity as a result of fewer interventions, and fewer recovery complications.[5]
Hospital Birth
The vast majority of women in the U.S. give birth in a hospital. If you have a high-risk pregnancy or want to try having a vaginal birth after a cesarean delivery (VBAC), then a hospital is the safest -- and often the only -- place you can deliver your baby. Even if you have a low-risk pregnancy, you may want to give birth in a hospital where you have ready access to the latest in medical technology.
Birthing Center
Birth centers have become more popular in recent years. Typically, a certified nurse-midwife will deliver your baby. Birth centers are affiliated with a local hospital where you can be transferred if a problem occurs during childbirth.
Home Birth
You should only consider having a home birth if
you are healthy, have a normal pregnancy, and ideally, have given birth before. Women who attempt to have their first child at home are 25%
to 37% more likely to need to go to a hospital because of complications.

ACOG strongly recommends against home birth
in the following situations:

You have health problems such as diabetes or
high blood pressure
You are having twins or multiple births
You want to attempt a VBAC
You have a high-risk pregnancy
Anatomy and Physiology of Labor
Cervical Effacement
Dilation and Effacement
Fetal Station During Labor
Fetal Positioning During Labor
False vs True Labor
Stages of Childbirth
The time of the onset of true labor until the cervix is completely dilated to 10 cm.
First Stage
Early Labor Phase
A: Not effaced
B: 50% effaced
C: 80% effaced
D: 90% effaced
E: 100% effaced
It is common for first time mothers (primigravida)to efface first then dilate. A mother that has delivered a baby before (multiparous) will typically efface and dilate at the same time.
Left Occiput Anterior
Occiput Posterior
Ideal position
Can fit, but I have often seen this position lead to a cesarean section.
False Labor "Prelabor"
o Irregular contractions
o Frequency and intensity decrease or remains the same
o Discomfort in lower abdomen and groin
o Activity change alters UCs
o UCs stop when sleeping
o No appreciable cervical change
o Sedation decreases UCs
o Show usually not present
True Labor
Regular Contractions
Increase in frequency and intensity.
Discomfort is in the back and lower abdomen.
Cervical dilation
Discomfort is not relieved by sedation.
First Stage:
Second Stage:
The period after
the cervix is dilated
to 10 cm until the
baby is delivered.
Third Stage:
Delivery of
the placenta.
The first stage of labor is the longest and involves 3 phases.
Early Labor Phase:
The time of the onset of labor until the cervix is dilated to 3 cm.
Active Labor Phase:
Continues from 3 cm until the cervix is 7 cm.
Transition Phase:
Continues from 7 cm until the cervix is fully dilated to 10cm.
You will experience different emotions and physical challenges throughout each stage.
What to Expect:
Early labor will last approximately 8-12 hours.
Your cervix will efface and dilate to 3 cm.
Contractions are usually 30-45 seconds in duration and can be anywhere from 5-30 minutes apart.
Contractions are mild and somewhat irregular, but slowly become more intense and regular.
Contractions can feel like aching in your lower back, menstrual cramps, and pressure or tightening in the pelvic area.
Your water might break.
Tips for the Support Person:
Practice timing contractions.
Be a calming influence.
Offer comfort, reassurance and support.
Suggest simple activities to keep her mind off of labor.
Active Labor Phase
What to Expect:
Transition Phase
What to Expect:
You will be taken to your room and given a hospital gown to wear.
Most often you will give a urine sample and vital signs will be taken.
Once you are in bed comfortably they will place the external monitors on your belly. One is for the heart tones and one is for monitoring uterine contractions.
The nurse will then begin to register you into the system and you will have papers to sign given to you by the RN.
An IV will be started with Lactated Ringers and at this time they will draw blood.
Cervical exam if one has not already been performed.
Orientation to the room and the unit.
Fetal Monitoring
Packing for the Hospital
Active labor will last 3-5 hours.
Your cervix will dilate from 4-7cm.
Contractions are usually 45-60 seconds in duration and can be 3-5 minutes apart.
Contractions will be stronger and longer.
This is usually the time to head to the hospital or birth center.
Tips for the Support Person:
Offer verbal reassurance and encouragement.
Massage her lower back and abdomen.
Go through breathing and relaxation exercises with her.
Help make her comfortable.
Transition will last 30 minutes to 2 hours.
Your cervix will dilate from 8-10 cm.
Contractions usually are 60-90 seconds in duration and 30 seconds to 2 minutes apart.
Contractions are long, strong, intense, and can overlap
This is the hardest phase but also the shortest
You might experience hot flashes, chills, nausea, vomiting, or gas
Tips for Support Person:
Offer lots of encouragement and praise
Continue breathing with her
Help guide her through her contractions with encouragement
Encourage her to relax between contractions
Don't think that there is something wrong if she seems to be angry. It is a normal part of transition.
Artificial Rupture of Membranes
Spontaneous Rupture of Membranes.
When your water breaks note the color, odor, amount and time of rupture.
Being Admitted to the Hospital
Pain Relief Options
Vaginal Deliveries
Birth Plan
Hospital Checklist
Second Stage of Labor
The second stage of childbirth involves pushing and the delivery of your baby. Until this point your body has been doing all the work for you. Now that your cervix has fully dilated to 10 cm it is your time to help by pushing.
Can last up to 2 hours
Contractions are usually 45-90 seconds with an average of 3-5 minutes in between to rest.
You will have a strong natural urge to push
You will feel strong rectal pressure.
You are likely to have a bowel movement or urinate.
You feel a burning, stinging sensation during
Once you are crowning it is important to listen to your health care provider whether or not to push.
Walking, rocking, position changes.
Sitting on a birthing ball and swaying.
Peaceful surroundings such as dim lights and music.
Shower or bath tub
Focusing on your breath or structured breathing patterns.
Massage: counter pressure against lower back.
Positive encouragement from others.
IV medication:
Live Birth: Epidural
Live Birth: Natural
Live Birth: Water birth
The most frequently used narcotic medications are:
For a spinal epidural or combined spinal epidural, a catheter is placed in the epidural space to allow continuous anesthesia.
The epidural provides temporary, but near complete loss of sensation in the lower half of the body without significantly affecting your muscle strength; thus, it usually allows for adequate pushing.
A spinal block may cause one or more of the following conditions:
•Hypotension (low blood pressure)
•Difficulty pushing during the second stage of labor
•Pruritus (itching)
•Baby might have trouble breastfeeding after birth, sleepier
General Anesthesia:
Rarely used. An emergency cesarean is one reason why this would be needed.
Third Stage: Delivery of the Placenta
The third stage is the delivery of the placenta and is the shortest stage. The time it takes to deliver your placenta can range from 5 to 30 minutes.
Fetal Resuscitation
Commonly asked Questions
Cesarean Section
Cesarean Section Continued
After the Surgery:
After the surgery, you might begin to experience some nausea and trembling. This can be caused by the anesthesia, by the effects of your uterus contracting or from an adrenaline let down. These symptoms usually pass quickly and can be followed by drowsiness. If your baby is healthy, this is normally when the baby can rest on your chest and you can start breastfeeding and bonding. You and your baby will continually be monitored for any potential complications.

When you are discharged from the hospital you will be advised on the proper post-operative care for your incision and yourself.
Welcome Baby!
Lateral Position
O2 delivery by face mask
IV fluid bolus
What can I expect in a Cesarean procedure?
The normal cesarean procedure averages 45 minutes to an hour. The baby is usually delivered in the first 5-15 minutes with the remaining time used for closing the incision.

Pre surgery
Before surgery, you will be given an anesthetic (general, spinal, or epidural) if you have not already been given one earlier in your labor. A general anesthetic is normally only used for emergency cesareans because it works quickly and the mother is sedated. The spinal and epidural anesthesia will numb the area from the abdomen to below the waist (sometimes the legs can be numb also), so that nothing can be felt during the procedure. In this procedure you will probably receive a catheter to collect urine while your lower body is numb.

The health care provider will make an incision in the abdomen wall first. In an emergency cesarean this will most likely be a vertical incision (from the navel to the pubic area) which will allow the health care provider to deliver the baby faster. The most common incision is made horizontally (often called a bikini cut), just above the pubic bone. The muscles in your stomach will not be cut. They will be pulled apart so that the health care provider can gain access to the uterus.
The health care provider will then suction out the amniotic fluid and then deliver the baby. The baby’s head will be delivered first so that the mouth and nose can be cleaned out to allow it to breathe. Once the whole body is delivered, the health care provider will lift up and show you your baby. Most health care providers will then pass the baby on to the nurse for evaluation. Finally, your placenta will be delivered (you may feel some tugging) after which the surgical team will begin the close up process.
Immediately after the baby is born the cord will be cut and placed directly on mom's chest for skin to skin.
Baby is given an Apgar score at 1 and 5 minutes.
If the baby needs resuscitation the baby will be brought to the warmer for the proper care and either given to the parents once they are stable or transferred to NICU.
The baby RN will get a set of vitals, weight, height, head circumference, and initial assessment on your newborn.
Vitals will be taken every 30 minutes while in L&D.
Try to place the baby on the breast after you are sutured up and the bed is put back together.
IV Pitocin will be running wide open to help the uterus contract.
Before the 2 hours is up in L&D the baby will be given a Vitamin K shot for clotting and Erythromycin ointment in the eyes to prevent any possible infection in your baby's eyes from the trip down the birth canal.
Once 2 hours is up you will all be transferred to the Mother/Baby Unit for the remainder of your stay.
In a c-section you are in recovery for 1 hour usually.
Post Partum
Vaginal Delivery
Vaginal Bleeding after Delivery
Your body will change during the days and weeks after delivery (postpartum period) as it returns to its nonpregnant condition. While most women move through the postpartum period without serious health problems, some women may have vaginal bleeding that lasts longer than normal or is heavier than normal.

Like pregnancy changes, postpartum changes are different for every woman. By knowing what normally occurs during the postpartum period, you will be able to identify a problem sooner.

Immediately after delivery, you will have a bloody discharge (lochia) from your vagina. This will turn pinkish within a week and become white or yellowish after about 10 days. Lochia may last for 2 to 4 weeks and can come and go for about 2 months.

Do not worry if you pass a few blood clots, as long as they are smaller than a golf ball in diameter. Use pads, not tampons, during this time. Change the pad at least every 4 hours to prevent irritation and infection.

Do not have sex until the lochia is almost gone. If sex causes pain, wait a few days because your body is still healing.
Getting to Know You
What you would like to know activity

Breastfeeding Video and Positions
The Golden Hour
In that first hour after birth, you will have an opportunity to provide benefits to your baby that can have a lasting impact. The first hour of life is a very special time; it’s a period experts call the Golden Hour. During this first hour of life your baby can gain tremendous benefit from skin-to-skin contact, starting breastfeeding and bonding with you and your partner.
Saigon International Mother Baby Association
SIMBA-babies is a mother led volunteer organization that provides information, support, and companionship for pregnant women and mothers of small babies until 6 months of age. We also currently have two SIMBA-growing up for children 0-5 years.
You are welcome to join us every Monday 9:00-11:30
Family Medical Practice D2

Benefits of Breastfeeding
Benefits for baby
Breast milk provides the perfect mix of vitamins, protein and fat that your baby needs to grow.
The colostrum that your breasts make after the first few days of childbirth helps your newborns digestive system grow and function.
Breast milk contains antibodies which will help your baby fight off viruses and bacterias.
Breastfeeding reduces the risk of SIDS.
If your baby is born preterm, breast milk can help reduce the risk of the short-term and long term health problems that preterm babies face.

Benefits for Mommy
During breastfeeding the hormone oxytocin is released. Oxytocin caused the uterus to contract and return to its normal size more quickly.
Breastfeeding may help with postpartum weight loss.
Women who breastfeed have lower rates of breast and ovarian cancer than women who do not breastfeed. It has also been shown to reduce the risk of heart disease and rheumatoid arthritis.
Saves time and money.
For how long should I breastfeed?
ACOG recommends that you exclusively breastfeed your baby for the first 6 months of life. Your baby can continue to breastfeed beyond his or her first birthday if you and the baby want to.
Breastfeeding Continued
When your baby empties one breast, offer the other. Do not worry if your baby does not continue to breastfeed. The baby does not have to feed at both breasts in one feeding. At the next feeding, offer the other breast first..
Let your baby set his or her own schedule. Many newborns breastfeed for 10–15 minutes on each breast, but some may feed for longer periods. A baby who wants to breastfeed for a long time—such as 30 minutes on each side—may be having trouble getting enough milk or may be just taking his or her time to feed.
It is recommended that you breastfeed at least 8–12 times in 24 hours, or about every 2–3 hours, in the baby’s first weeks of life.
While research overwhelmingly shows that breast milk is better for your baby's overall health and development, the decision about how you wish to feed your baby should be based on an informed choice of what you feel is right for you and your baby in the first few months.
Is it Really Labor???
Your body will usually give you a sign that labor is beginning.
Getting Ready
These are signs that labor may be approaching, although they are not necessarily predictors of labor. Do not worry if you do not notice these signs.
A sudden burst of energy or the "nesting instinct."
Lightening or dropping of the baby (you may be able to breathe easier and urinate more).
An upset stomach.
Bloody show (this could be from the cervix changing, or from sex or a cervical exam).
Loss of your mucous plug.
Breaking of Water
It can sometimes be hard to tell if your water has broken, especially if you are having mild bladder incontinence too. If it smells like urine then it is unlikely to be your water.
If your water has broken, but only produced a trickle of clear or light fluid, it may be a while before labor begins. If you are unsure phone your Doctor.
If you have a big gush of fluid call your Doctor right away.
If you notice that your waters are dark green or muddy color this could be a sign of meconium. If this happens go to the hospital right away and call your Doctor.
Suggested Positions For The First Stage of Labor
1. Walking or Standing
This shortens the labor and increases the efficiency of contractions. In the early part of the first stage, try to walk around leaning forward during the contractions. You may want to use a wall for support, or let yourself hang onto someone as they support most of your weight during contractions.
2. Squatting
This is the most physiologically efficient position for labor and birth. Squatting opens the pelvis, gravity is helping, and contractions are intensified due to increased pressure from the baby's head on the cervix. Remember to rest completely during contractions using a stool, the support of another person, a firm cushion, etc. so you are not tired from squatting.
3. Sitting
Sitting upright on a chair, a bed, on the floor. Some women find that on a toilet.is most comfortable or birthing stool. It leaves the pelvic floor free.
4. Sidelying
Good resting position. Helpful if you have elevated blood pressure. Fine with epidural. Helps get Oxygen to baby.
5. Kneeling/Knee to chest
Many women find kneeling the most comfortable in the last part of the first stage, 6-10cm including transition. This can be done sitting backward on a chair, on the toilet, a bean bag chair, a pile of pillows. Some women also use some sort of rocking or rhythmic motion while kneeling. This position is good for posterior babies that are causing pain with back labor. The swiveling of the hips can help encourage the baby to turn.
Gravity is your friend!
Labor Positions Video
Labor Positions
Promoting Comfort During Early Labor
Take a shower or bath.
Listening to music.
Have a gentle massage.
Try slow, deep breathing or relaxation techniques.
Change positions.
Drink fluids.
Eat light, healthy snacks.
Apply ice packs for heat packs to your lower back.
Promoting Comfort in Active Labor
Change positions.
Use birthing ball.
Take a warm shower or bath.
Take a walk stopping to breathe with contractions.
Have a gentle massage during contractions.
Room temperature.
Reasons to Call Your Doctor (WebMD)
At any time during your pregnancy, call your doctor or midwife immediately if you:
Have signs of preeclampsia such as: Sudden swelling of your face, hands, or feet.
Visual problems (such as dimness or blurring).
Severe headache.
Have pain, cramping, or fever with bleeding from the vagina.
Pass some tissue from the uterus.
You have a fever.
Vomit more than 3 times a day or are too nauseated to eat or drink, especially if you also have fever or pain.
Have an increase or gush of fluid from your vagina. It is possible to mistake a leak of amniotic fluid for a problem with bladder control.

At any time during your pregnancy, call your doctor or midwife today if you:

Notice sudden swelling of your face, hands, or feet.
Have any vaginal bleeding or an increase in your usual amount of vaginal discharge.
Have pelvic pain that doesn't get better or go away.
Have itching all over your body, especially soles and palms, with or without dark urine, pale stools, or yellowing of skin or eyes.
Have painful or frequent urination or urine that is cloudy, foul-smelling, or bloody.
Feel unusually weak.

If you are between 20 and 37 weeks pregnant, call 911 or other emergency services immediately if you:
Experience severe vaginal bleeding.
Have severe abdominal (belly) pain.
Are in your third trimester and have had fluid gushing or leaking from your vagina (the amniotic sac has ruptured) AND you know or think the umbilical cord is bulging into your vagina (cord prolapse). If this happens, immediately get down on your knees so your buttocks are higher than your head to decrease pressure on the cord until help arrives. Cord prolapse can cut off the fetus's blood supply. (These measures apply to you if you are as early as 24 weeks pregnant.)

If you are between 20 and 37 weeks pregnant, call your doctor immediately or go to the hospital if you:
Have signs of preterm labor, including: Mild or menstrual-like cramping with or without diarrhea.
Regular contractions for an hour. This means about 4 or more in 20 minutes, or about 8 or more in 1 hour, even after you have had a liter of water and are resting.
Unexplained low back pain or pelvic pressure.
Have noticed that your baby has stopped moving or is moving much less than normal. See Pregnancy: Kick Counts for information on how to check your baby's activity.
Have uterine tenderness or unexplained fever (possible symptoms of infection).

Clock Activity
Used for Augmentation or Induction
Usually given after the cervix has ripened to cause the uterus to contract.
Given in small amounts through your IV.
Nipple stimulation is natural way to release the hormone oxytocin.
Epidural for pain relief
An epidural is often used for pain relief during labor and delivery. A small flexible tube is placed into the lower back. Medicine is injected into the tube to provide pain relief in the lower abdomen, legs and birth canal. A special doctor called an anesthesiologist will place the epidural.
You may be asked to sit on the side of your bed and lean forward with support by your significant other or the doctor will ask you to lay down on your left side and bring yours knees up to your chest as far as you can.
Take home thinking about the future activity and fill it out. We will discuss it next class.
Thinking about the future review

Life for my partner

Changing Responsibilities
Let's Practice!!
Parenting Alphabet


Sudden Infant Death Syndrome
American SIDS Institute: SIDS was first defined in the late 1960s and was refined in 1991 as “the sudden death of an infant under one year of age which remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of the death scene, and review of the clinical history”.
How to prevent SIDS
Back to Sleep:
Always place your baby on back to sleep.
Feet to Foot:
Place babies feet at the foot of the bed.
Don't smoke:
Do not expose your baby to smoke before or after birth.
Don't bed share:
Never fall asleep with your baby in a bed, sofa or chair.
Place baby in bare crib:
The baby should be placed in a crib with no cover, pillows, bumper pads or positioning devices. Mattress should be firm.
Baby in room with parents:
Up to 6 months of age, until baby can turn both ways.
Offer baby a pacifier:
Studies have shown a reduced risk of sleep related deaths with use of pacifier.
Cord Care
The umbilical will go from a greenish yellow to a brown black color and fall off in about 2 weeks.
Keep it clean:
Use clean water only when dirty or sticky. You can either fan it dry with a piece of paper or by holding a clean, absorbent cloth around the stump.
Stick with sponge baths:
You can bathe your baby in a tub after the stump falls off.
Let the stump fall off on its own

During the healing process, it's normal to see a little crust or dried blood near the stump. Contact your baby's doctor if your baby develops a fever or if the umbilical area:
•Appears red and swollen around the cord
•Continues to bleed
•Oozes yellowish pus
•Produces a foul-smelling discharge

If your baby has an umbilical cord infection call your Pediatrician. Prompt treatment can stop the infection from spreading.

Signs of Infection
Newborn pees and poops in 1st 24 hours
Newborn feeding
Because their tummys are so tiny, newborns need to eat small amounts frequently. Usually about 1-3 ounces at a time. They could show signs that they want to eat every 2-3 hours and some more frequently than that.
Hunger Signs
Crying (late sign)
smacking lips
sucking on their hands
turning head towards breast or bottle and pursing their lips.
In their first few days, newborns typically lose about 7 percent of their body weight. While this is normal, you'll want to feed your baby every 2-3 hours or so until she's back at her birth weight.
8-12 times per day
Some newborns burp on their own while others need assistance. Try burping your baby after feeding on each breast. Switch breasts every 10-15 minutes. Burping is recommended before a feeding, during a feeding and after a feeding.
Spit up is normal. Excessive amounts however could mean that your newborn has GERD and will need treatment.
A breastfed newborn will have at least five wet diapers a day. A formula-fed baby may have even more than that.
Breastfed babies tend to poop more than formula-fed ones, since formula takes a bit longer to digest. Breastfed babies vary widely, going as seldom as once every four or more days to as often as once per feeding. Formula-fed babies typically poop a few times a day, but it can also go from one poop every other day to several poops per day.

"If you're confused, just remember this," says Jennifer Shu. "Whether we're talking about pooping, eating, sleeping, or crying, every baby is different. Normal is actually a big range. What matters most are sudden changes – and that's when you should contact your doctor."
Baby Blues versus Postpartum Depression
Baby Blues
Totally normal. Most moms (60- 80%) experience them.
Begin within the first few days and last no more than 2-3 weeks.
The symptoms are mild. Frequent teariness, feelings of dependance and stress.
Postpartum depression
Can begin immediately or within the year after delivery.
Difficulty sleeping at night.
Change in appetite.
High anxiety
Irritability or anger
Low self esteem.
Lack of energy.
Frequent crying.
Diaper change
Baby girls always wipe from front to back to avoid urinary tract infections. Be sure to clean all the folds of the skin to prevent diaper rash. Change frequently, keeping area clean and dry.
Do not use baby powder or cornstarch.
For diaper rash:
Clean with mild soap and warm water instead of wipes.
Let air dry as much as possible.
Use medicated ointment.
Clean face, neck ears and hands at least once a day with warm water. A full bath with mild soap and warm water once a week is all that is needed for your newborn.
Never leave your baby unattended in the bath even for a second.
Water should be no warmer than what is comfortable on the inside of your forearm.
Circumcision care
Clean penis with warm water after each diaper.
Ask Pediatrician about the use of vaseline.
Usually takes 7-10 days for the penis to heal.
Place silver tip of thermometer in the middle of the babies armpit and hold firmly in place until you get a reading. Do not use ear thermometers for babies under 6 months.
Your newborn is getting enough to eat if:
He/She is satisfied after nursing.
Is gaining weight. Should be back to birth weight by 10-14 days old.
Has a wet diaper for each day old until day 6. Then expect 6-8 wet diapers/day.
Formula Feeding
Baby will eat 8-12 times in a 24 hour period the first few days, then will feed less frequently and and take in more at each feeding. Follow your baby's Physician directions for amount to avoid over feeding.
2-3 ounces the first few days than gradually increase as you get to know your baby.
Never prop a bottle.
Do not use a microwave to warm the formula.
Reason to Call you Doctor Continued
Fetal Kick Counts
Significant changes in your baby’s movement pattern may help identify potential problems with your pregnancy before the baby's heart rate is affected.

The American College of Obstetricians and Gynecologists (ACOG) recommends that you note the time it takes to feel 10 kicks, jabs, turns, swishes, or rolls (not hiccups). A healthy baby should have 10 kicks in less than 2 hours. Most babies will take less than 30 minutes.

Count the time it takes for your baby to make 10 movements. A movement includes kicks, rolls, jabs, twists, turns, and switches. Hiccups are not considered a movement. Your baby should move 10 times in less than 2 hours. Count the Kicks everyday, preferably at the same time.
Pick your time based on when your baby is usually active, such as after a snack or meal.
Make sure that your baby is awake first; walking, pushing on your tummy or having a cold drink are good wake-up calls.
To get started, sit with your feet up or lie on your side. Count each of your baby's movements as one kick, and count until you reach 10 kicks or movements.
Most of the time it will take less than a half-hour, but it could take as long as two hours.
Log your recorded times into a Count the Kicks chart.
Drinking juice, lying on your side and listening to loud music will often wake your baby up if you are not feeling much movement. If you still do not feel much movement after trying these steps, contact your doctor.
How do I Count the Kicks?
Typically you start monitoring fetal movements during the third trimester, or at 28 weeks.
Most healthy babies should take less than 2 hours for 10 kicks. Pick their most active time of the day.
Timing Contractions
Time from beginning to end of contraction.
Time from beginning of one contraction to beginning of next contraction.

After 37 weeks, call 911 or other emergency services immediately if you:

Have had fluid gushing or leaking from your vagina (the amniotic sac has ruptured) AND you know or think the umbilical cord is bulging into your vagina (cord prolapse). If this happens, immediately get down on your knees so your buttocks are higher than your head to decrease pressure on the cord until help arrives. Cord prolapse can cut off the fetus's blood supply. (These measures apply to you if you are as early as 24 weeks pregnant.)

After 37 weeks of pregnancy, call your doctor Immediately or go to the Hospital if:
You have vaginal bleeding
Have had regular contractions for an hour. 4 in 20 minutes or 8 in an hour.
You have sudden release of fluid from the vagina.
Decreased fetal movement. (Fetal Kick count sheet).
Reasons to call your Doctor Continued
Internal Monitors
Reasons for Augmentation/Induction
Your pregnancy has gone 1 to 2 weeks past the estimated due date.
You have a condition (such as high blood pressure, placenta abruptio, infection, lung disease, preeclampsia, or diabetes) that may threaten your health or the health of your baby if the pregnancy continues.1
Your water (amniotic sac) has broken but active labor contractions have not started.
Your baby has a condition that needs treatment, and the risks of vaginal delivery are low. Induction and vaginal delivery are not attempted if the baby may be harmed or is in immediate danger. In such cases, a cesarean delivery (C-section) is usually done.
cleansing breath
slow breathing
light breathing
Hee hee who
Vocalized breathing

Stork Bite (nevus simplex)
A stork bite is a vascular lesion quite common in newborns consisting of one or more pale red patches of skin. It is caused by a stretching of blood vessels. Most often stork bites appear on the forehead, eyelids, tip of the nose, upper lip or back of the neck. They are usually gone within 18 months of birth. (Medline Plus Dictionary)
Milia are tiny white bumps or small cysts on the skin. They are almost always seen in newborn babies. Milia occur when dead skin becomes trapped in small pockets at the surface of the skin or mouth. They are common in newborn infants. Similar cysts are seen in the mouths of newborn infants. They are called Epstein's pearls. These cysts also go away on their own. (Medline Plus Dictionary)
12 reasons babies cry
1. Hunger
2. A dirty diaper
3. Tired and needs to sleep
4. Wants to be held by someone
5. Tummy troubles
6. Has the need to burp
7. Something small is bothering them
8. Teething
9. Too hot or too cold
10. Wants less stimulation
11. Wants more stimulation
12. Not feeling well
What to do when baby cries for no reason
1. Something to suck on
2. Snuggling or swaddling
3. Music and Rhythm
4. White noise
5. Fresh air
6. Warm water
7. Motion
8. Massage
9. Give yourself break
A common condition in newborns, jaundice refers to the yellow color of the skin and whites of the eyes caused by excess bilirubin in the blood. Bilirubin is produced by the normal breakdown of red blood cells. Jaundice occurs when bilirubin builds up faster than a newborn's liver can break it down and pass it from the body
What they call it when the tissue in your breast becomes painfully inflamed. The area may be red, sore, hard to the touch, or unusually warm. The swelling may or may not be caused by an infection. Signs of an infection include chills, a fever of 101 degrees Fahrenheit or higher, and fatigue.

How can I treat mastitis?
Try applying moist heat a few times a day, and nurse your baby frequently to keep the affected breast empty. (This may also help clear up any infection more quickly.) In the meantime, you can take ibuprofen to ease the pain.
If your symptoms don't improve within 24 hours of trying these measures, see your healthcare provider. She may prescribe antibiotics, rest, and pain relievers in addition to hot compresses.
Breast engorgement is the painful overfilling of the breasts with milk. This is usually caused by an imbalance between milk supply and infant demand. This condition is a common reason that mothers stop breast-feeding sooner than they had planned.
You can prevent breast engorgement by closely managing the milk your breasts make and keeping milk moving out of your breasts. During your body's first week or two of adjusting to breast-feeding, take care not to let your breasts become overfilled.
Breast-feed your baby whenever he or she shows signs of hunger. If your breasts are hard and overfilled, let out (express) enough to soften your nipples before putting your baby to the breast.
Make sure that your baby is latching on and feeding well.
Empty your breasts with each feeding. This will help your milk move freely, and your milk supply will stay at the level your baby needs.

•Write important information at the top such as the hospital and the number, Doctor’s name and number, partner’s name and number, and name of of other support person if you plan to use one.

•Keep it short (1 page preferably)

•Be specific

•Bold what is the most important to you

•Have it translated to Vietnamese

Share some examples and discuss

Birth Plan
6:1:1, 5:1:1, 4:1:1
Laughing Gas

It is an anesthetic gas that has been used since the beginning of the last century


•Provides some pain relief for some women

•Women remain awake and in control of their own pain relief

•Does not interfere with contractions

•The time Nitrous Oxide remains effective is short and there are no obvious short term effects on mother and baby that have been noted to date. www.pregnancy.com/au


•Nausea and/or vomiting

•Not a reliable form of pain relief

•Women can become drowsy, confused or disorientated. Some women experience these feelings as quite unpleasant

•The face mask can make some women feel claustrophobic

Ice and Breathing activity

Forceps and vacuum extractors are often used if your baby is not tolerating labor well and needs to be delivered rapidly. Another reason would be if you were totally exhausted and unable to push the baby out yourself.

Theses instruments are only used if your baby is far enough down your birth canal. If the previously mentioned problems occur and your baby is too high up, they are not deemed safe. At this point a cesarean section might be recommended.

A vacuum has a soft plastic suction cup that is applied to the baby’s head. A suction is then initiated, allowing the cup to stick firmly on your baby’s head. Your doctor will then pull the handle that is attached to the vacuum cup while you are pushing.

Assisted Delivery
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