A Guide To Your New Family's First Weeks - Meriter Health Services

A Guide To Your New Family’s First Weeks 

Did you receive this book in a birthing class 

Please remember to bring it with you to the hospital!

Signs of Illness 

Infant 

Mother 

• Yellow skin color 

• Temperature greater than 100.4° F 

• Umbilical cord: foul-smelling or skin around base • Bright red vaginal bleeding or a bleeding that 

becomes reddened 

soaks a large pad in less than two hours 

• Rectal temperature greater than 100.4° F or less • Breasts are red, hot to the touch or have painful 

than 97° F 

lumps 

• Poor feeding 

• Severe stomach or leg pains 

• Diarrhea (foul smelling, watery stools) 

• Pain with urination or inability to urinate 

• “Limpness” or “floppiness” 

• Vaginal discharge gives off foul odor 

• Repeated forceful vomiting or vomiting green fluid • Cesarean incision opens, becomes red or hot to 

• Labored or difficult breathing 

the touch, has a foul odor, or drains in increasing 

• Blue lips or very pale skin 

amounts 

• Difficulty arousing, loss of consciousness or Signs of depression (see pages 57-58) 

seizure activity 

For more information, see pages 45 and 46. 

Doctor/Phone Number 

When to Call the Doctor 

Most new parents feel unsure about when they should call the doctor. Listed below are signs of illness. These lists 

can be helpful when you are deciding whether you need to call your health care provider. 

Doctor/Phone Number 

Rely on your instincts. If your baby seems sick or you feel that you are having problems, contact your 

health care provider for advice. 

Community Resources for Parents 

African American Breastfeeding Alliance of Dane County .............................................................. (608) 243-0377 

Community Coordinated Child Care (4-C)........................................................................................... (608) 271-9181 

Dane County and Madison Public Health............................................................................................ (608) 266-4821 

Depression after Delivery.....................................................................................................................1-800-944-4PPD 

Domestic Abuse Intervention Services. (DAIS)................................................ 1-800-747-4045 or (608) 251-4445 

Family Enhancement................................................................................................................................ (608) 241-5150 

Kohl Safety Center (Car Seats)............................................................................................................... (608) 890-8043 

Meriter Birthing Center Triage................................................................................................................ (608) 417-6228 

Meriter Breastfeeding Helpline............................................................................................................... (608) 417-6547 

Outside Dane County......................................................................................................................... 1-800-261-4449 

Meriter Community Education Classes................................................................................................. (608) 417-8446 

Meriter Hospital (ask for Birthing Center)........................................................................................... (608) 417-6000 

Meriter Physical Therapy Central .......................................................................................................... (608) 417-8250 

Meriter Website.....................................................................................................................................www.meriter.com 

Parental Stress Center............................................................................................................................... (608) 241-2221 

Poison Control..............................................................................................................................1-800-222-1222 or 911 

Respite Center .......................................................................................................................................... (608) 244-5700 

Ronald McDonald House-Madison....................................................................................................... (608) 232-4660 

United Way 211 (24 hour help) (Food & Housing).............................................................................. In Dane: 211 

Outside Dane or cell phone: ............................................................................................................. (608) 246-4357 

Welcome Baby Program (Support for first-time Moms).................................................................... (608) 241-3434 

WIC (Dane County) (Nutrition)............................................................................................................. (608) 267-1111 

Wisconsin First Step (Special Needs). ............................................................................................... 1-800-642-STEP 

Wisconsin Tobacco Quit Line............................................................................................................... 1-877-270-7867

If You’re Expecting.... 

We look forward to making your baby’s arrival everything you want it to be... a warm, secure and memorable 

experience. Begin talking to your doctor or nurse midwife about your birth experience, and take the next 

steps today! 

Visit www.meriter.com/birthingcenter to: 

• Fill out Meriter’s secure hospital pre-registration form. 

• Register online for our childbirth and parenting classes. 

• Create a Birth Plan for your family. 

• Sign up for our Parent Review, a free weekly e-mail newsletter for expecting and new moms. 

• Learn more about Serendipity Newborn Photography. 

• Take a virtual tour of the Birthing Center and NICU. 

• Visit our Healthy Living section, which contains a due date calculator, informative articles 

and more. 

• Print out directions and information for your Birthing Center visitors. 

• Read about other families’ birth experiences. 

• Learn about our Birthing Center, Newborn Intensive Care Unit and Perinatal Clinic. 

When to Call the Doctor: Signs of Illness.................................................. inside front cover 

Community Resources for Parents..................................................................... inside front cover 

Welcome to Meriter’s Birthing Center.......................................................................................6-7 

• Safety/Security 

• Hospital Safety 

The First Days: How to Plan..............................................................................................................8-9 

• Your Care from Delivery to Eight Hours 

After Birth 

• Your Care from Eight Hours to 24 

Hours After Birth 

Table of Contents 

• Information for Moms 

• Information for Fathers and Partners 

• Your Care from 24 Hours Until You Go 

Home 

• Your Family Checklist 

You should not consider the general health information provided in this publication as individual medical 

advice. If you have specific health questions, please talk with your health care provider. 

©The Birthing Center, Meriter Hospital – All rights reserved, 2010. 

1

Your Baby’s First Few Hours.........................................................................................................10-12 

• Routine Newborn Exams/Measurements 

• Your Baby’s Appearance 

• Reflexes 

• Newborn Hypoglycemia (low blood sugar) 

• Newborn Medications 

• Vitamin K 

• Erythromycin Eye Ointment 

• Neonatal Screening 

• Immunizations 

• Hepatitis B Vaccine 

• Holding Your Baby Skin-to-Skin 

Mother Care......................................................................................................................................................13-18 

• Rest 

• Pain Management 

• Medication Information 

• Vaginal flow 

• Urination 

• Perineal Comfort 

• Hemorrhoids 

• Swelling (Edema) During and After 

Pregnancy 

• What To Do For Swelling During and 

After Pregnancy 

• Breasts 

• Nutrition and Weight Loss 

• Sexual Intercourse 

• Birth Control 

Recovery from Cesarean Birth.......................................................................................................19-20 

• Pain Relief 

• Respiratory 

• Incision 

• Signs and Symptoms of Infection 

• Urinary Catheter 

• Activity 

• IV Fluids 

• Diet 

• Bath/Shower 

• Postpartum Check 

• Caring for Your Baby 

• Going Home After a Cesarean Birth 

• Feeling After Unplanned Cesarean Birth 

Nutrition and Feeding: Breastfeeding.....................................................................................21-31 

• Benefits of Breastfeeding: For Baby 

• Benefits of Breastfeeding: For Mom 

• Additional Assistance 

• Steps to Promote Successful Breastfeeding 

• Breastfeeding Positions 

• Helping Your Baby Latch to the Breast 

• Signs of a Good Latch 

• Signs of an Incorrect Latch 

• How Often and How Long to Feed 

• Feeding Cues 

• How Your Milk Changes 

• How Do I know if my Baby is Getting 

Enough Milk 

• Ways to Tell if Your Baby is Getting 

Enough Milk 

• Your Milk Supply 

• The Sleepy Baby 

• The Fussy Baby 

• Nipple and Breast Problems 

• Introducing a Bottle 

• Expressing and Storing Breast milk 

• Lifestyle Issue 

Nutrition and Feeding: 

Common Feeding-Related Concerns for Both Breast and Formula Fed Babies............... 32 

• Burping 

• Hiccups 

• Thumbs and Pacifiers 

2

Nutrition and Feeding: Formula Feeding...........................................................................33-35 

• Types of Formula 

• Preparing Formula 

• Water Supply 

• Agencies That Can Test Your Water 

• Bottle Feeding Your Baby 

• Frequency and Amount of Feedings 

Diapers and Bowel Movements......................................................................................................... 36 

• Diapers 

• Diapering 

• Urine 

• Bowel Movements 

• Diarrhea 

• Gas 

Common Skin Conditions and Cord Care.........................................................................37-38 

• Newborn Skin 

• Newborn Rash 

• Newborn Acne 

• Milia 

• Stork Bite Birthmarks 

• Mongolian Spots 

• Drooling Rashes 

• Pustular Rashes 

• Diaper Rashes 

• Yeast Infection 

• Cradle Cap 

• Fingernails 

• Umbilical Cord Care 

Caring for the Foreskin and Deciding About Circumcision...........................39-41 

• What is Circumcision 

• Why Do Some Parents Choose Circumcision 

for Their Sons 

• Why Do Some Parents Choose Not to Have 

Their Sons Circumcised 

• What Are the Potential Benefits of 

Circumcision 

• What Are the Risks of Circumcision 

• Are There Reasons Why a Circumcision 

Should be Delayed 

• Pain Control for Circumcisions 

• How is Circumcision Done 

• Caring for the Circumcised Penis 

Bathing Your Baby.....................................................................................................................................42-43 

• Tips for Bathing Your Baby 

• Bath Supplies 

• Sponge Bath 

• Tub Bath 

Jaundice...................................................................................................................................................................... 44 

Recognizing Illness....................................................................................................................................45-46 

• Taking Temperatures 

• Common Signs of Illness in a Newborn 

• Using a Bulb Syringe 

3

The Crying Baby...........................................................................................................................................47-49 

• Why and When Do Babies Cry 

• The Unusually Fussy Baby 

• The Baby With Colic 

• Tips to Help Settle a Fussy Baby 

• The Five “S’s” of Settling 

• Parent’s Response 

• Shaken Baby Syndrome 

Infant Safety......................................................................................................................................................50-51 

• Safety for Your 0-2 Month Old 

• Preparing Your Pet for the Baby 

• Finding Childcare 

• Car Seats 

Infant Sleep........................................................................................................................................................52-53 

• Sleeping 

• Reducing the Risk of Sudden Infant Death 

Syndrome (SIDS) 

• Infant Sleep and Awake States 

Playing/Development.................................................................................................................................. 54 

• Importance of Tummy Time 

• Touch 

• Motion 

• Hearing 

• Vision 

• Smell 

Sibling Relationships................................................................................................................................55-56 

• In the Hospital 

• At Home 

• Helping Your Child Adjust to the Baby 

• Siblings and Safety Issues 

• Common Adjustment Feelings and Behaviors 

Feelings After Birth...................................................................................................................................57-59 

• Baby Blues 

• Postpartum Depression 

• Postpartum Psychosis 

• Treatment and Resources 

• Feeling Safe 

• Edinburgh Postnatal Depression Scale 

Postnatal Exercises and Body Mechanics................................................. 60-62 

• Strengthening Your Pelvic Floor Muscles 

• Babies Can Get Heavy! 

• Strengthening Exercises 

• Physical Therapy Options 

“Remember to take 

care of yourself.” 

RN, NICU 

4

Postpartum Medication Log and Information...............................................................63-64 

Newborn Feeding Record..................................................................................................................65-69 

How Is Breastfeeding Going.............................................................................................................. 70 

Mother and Baby Teaching Checklist.......................................................................................... 71 

Index.........................................................................................................................................................................72-74 

Notes........................................................................................................................................................................75-76 

Parenting Classes.................................................................................................................. Inside Back Cover 

Editors: Women’s Health Patient Education Committee 

Jan Deitte, RN 

Julie Rice, RN 

Kathy Gerhardt, RN 

Sharon Wiedenfeld, CNS 

Lori Hughes, RN 

Mary Buechner 

Kathleen Koedam, RN, IBCLC 

Beth Craig 

Esther Nam, RN 

4/5 North, 6 North and NICU Unit Councils 

Lactation Department 

Cover photo by Serendipity Photo Studio 

“Cherish the present, the future is near and the 

challenges of today will not linger long. This time 

is precious beyond measure and will slip away 

without honor if your attention dwells elsewhere.” 

Susan, Community Health 

Education Center 

5

Welcome to Meriter’s Birthing Center 

At Meriter’s Birthing Center, we are committed to family centered care by involving patients and families in the 

planning, delivery and evaluation of their health care needs. A family centered approach to wellness focuses on 

supporting and respecting family choices, values, beliefs and cultural backgrounds. We are proud to welcome you 

and your family to Meriter and we are committed to making your baby’s birth a safe and satisfying experience. 

Please refer to the directory by your bedside for details about your room and other aspects of your hospital stay. 

We have designed A Guide to Your New Family’s First Weeks to help you care for yourself, your baby and your 

family in your first weeks together. 

Safety/Security 

Madison has a reputation for being one of the safest 

cities in the country. However, we feel it is good 

common sense to take precautionary measures to 

ensure the safety of our patients. That is why all 

Meriter staff members are required to wear photo ID 

cards while on duty, and why we will never ask you 

to give your baby to someone you do not 

recognize. 

As a new parent, it is important that you are 

watchful over your baby to keep your baby safe. 

This practice should start in the hospital and 

continue throughout your child’s life. 

Please know that—although we have installed 

security cameras near all Birthing Center exits, 

and an electronic security system is in place—it is 

essential that you follow these safety guidelines. 

Hospital Safety 

Never give your baby to anyone who does not have 

proper hospital photo identification. All Birthing 

Center staff members have a pink band on their 

photo ID badge. 

• You can name one person who can escort your 

baby outside your room. This person will wear an 

armband just like the one on you and your baby. 

Your baby must be with you, the person you 

designate as an escort or an identified hospital 

staff person at all times. 

• If you leave your room for any reason, take your 

baby with you or arrange with your nurse to take 

your baby to the nursery. 

• When you nap, close the door to your room and 

place the crib next to the head of your bed. 

• When using your bathroom, close the door to your 

room and place the crib in a place where your 

infant is in view. 

• Question anyone you don’t know who enters your 

room or asks about your baby. 

• Be sure you know the nurse on each shift who is 

assigned to take care of you and your baby. 

• Question any unfamiliar people, even those with 

proper hospital clothes and identification, who come 

to take your baby for unusual tests or examinations. 

We can do routine lab work in your room. 

Meriter Security Services works closely with medical 

staff and local law enforcement agencies to ensure 

your safety. 

In an emergency, dial extension 5555, and we 

will dispatch an officer immediately to assist you. 

For less urgent matters, such as missing or damaged 

property, call the operator (0) who will contact an 

officer for you. 

Information For Moms 

Following the birth of your baby, a wide range of 

emotions is common. There are the expected feelings 

of excitement, joy and relief. Regardless of how well 

prepared you are or how much you have looked 

forward to your baby’s birth, you may feel 

overwhelmed, uncertain, frustrated or anxious. 

At the same time, your body is going through 

many changes. 

6

Turn to this book and your doctor, nurse and 

support people to learn more about what you can 

expect and how to care for yourself while caring for 

your new baby. 

Additionally, Meriter offers classes and support 

groups designed for new parents. Refer to the back 

cover for more information. 

Information For Fathers and Partners 

Because you are an essential part of your baby’s life, 

all information in this book will be useful to you 

as you care for your baby. However, you may 

experience a different set of emotions. After the 

birth of your baby, you may experience: 

• Excitement, pride and joy. 

• Anxiety about how your baby will affect your 

lifestyle, finances and relationship. 

• A sense of feeling left out or jealous because of 

mom’s time spent with the new baby. 

• A change in your partner’s sexual desires. 

Here are some suggestions as you transition into 

parenthood: 

• Talk with each other about your feelings and 

needs. 

• If you feel left out because mom is breastfeeding, 

realize you can help with other aspects of baby 

care. This can include cuddling, comforting and 

diapering. 

• Help make breastfeeding a success by cooking 

mom nutritious meals, bringing her something to 

drink while she’s nursing and bringing a hungry 

baby to her at night. 

• When possible, take time off from work after 

delivery to be home with your new family. 

• Take on some of the household tasks that will be 

more difficult for the new mother. 

• Follow a lifestyle that will be healthy for your 

family. Eat and sleep sensibly, exercise, use alcohol 

responsibly and don’t smoke. 

• Get support from other parents. Your parents, 

siblings and friends are all resources for support 

during this period of adjustment. 

“Make a date with your 

significant other in two weeks, 

even if it is only for an hour.” 

Teresa, RN, Birthing Center 

7

The First Days: How to Plan 

This section provides an overview of the care you and your baby can expect to receive during your stay at Meriter Hospital. 

In addition, it reviews what you can do to prepare for going home. When you go home, it is our goal that: 

• You and your baby will be healthy. 

• You will be able to feed your baby with success. 

• If you are breastfeeding, you will have at least two successful 

feedings. 

• If you have pain, you will know how to manage it. 

Your Care From Delivery to Eight 

Hours After Birth 

Baby 

• Your baby will get to know you and be fed. 

• Your nurse will check your baby. 

• Your baby will receive newborn medications. 

• Your baby will receive a first bath. 

• Your baby will remain with you. 

Mom/Family 

• You will get to know and feed your baby. 

• Your nurse will massage your uterus and check your 

perineum (your bottom), vital signs and bleeding. 

• You will talk to your nurse about your needs for 

pain management, comfort, sleep and food. 

• Your nurse will help you to the bathroom and to 

the shower. She will instruct you on how to care for 

your perineum. 

• After a cesarean birth, you will initially need to stay 

in bed. Your nurse will assist you with walking 6-8 

hours after your birth, and show you how to turn and 

take deep breaths. A catheter will drain your bladder. 

• You will begin the “Mother and Baby Teaching 

Checklist (see page 71)” and talk to your nurse about 

concerns and needs in caring for yourself and 

your baby. 

• Your nurse will explain medications that have been 

ordered to reduce your pain and increase your 

comfort. You will find medication information on 

page 15. 

Your Care From Eight to 24 Hours 

After Birth 

Baby 

• Your baby will need to eat at least eight times a 

day (every two to four hours). Try to feed your baby 

• You will be able to care for yourself and your baby 

safely. 

• You will know who to call and when to get help with 

your questions and concerns. 

when you see that he is wakeful and alert. 

Sometimes, you may need to wake your baby for 

a feeding. 

• The doctor will examine your baby. 

• Your baby will receive his hearing screen when he 

is asleep. 

• Your nurse will check your baby routinely, and 

whenever you have concerns and questions. 

• You will receive information about the Hepatitis 

B vaccine. 

• If you wish, a professional photographer is available 

to take photographs of your family. 

• We will weigh your baby between 7 p.m. and 10 p.m. 

daily. 

Mom/Family 

• Your nurse will encourage you to plan your day to 

get enough rest. 

• You will be encouraged to be out of bed and walk in 

your room or hallway to regain your strength. If you 

had a cesarean birth, your nurse will help you with 

walking about six to eight hours after your delivery. 

• You will order your meals from a menu in your 

room. 

• You will be able to eat from the family kitchen if 

you are hungry between meals. If you had a cesarean 

birth, your nurse will discuss how and when you will 

gradually increase your food choices. 

• If you had a cesarean birth, our staff will remove 

your catheter, take a blood sample and discontinue 

your IV. You will begin taking medications by 

mouth. 

• You will feed your baby at least eight times per day 

(every two to four hours). 

• Your nurse will review the “Mother and Baby 

Teaching Checklist (see page 71)” with you. 

• Your doctor/midwife will examine you daily. 

8

• Your nurse will check on you routinely and respond 

to your concerns and questions. 

• You and your nurse will discuss whether your pain 

medication is effectively controlling your pain. 

• You will complete the birth certificate information 

before going home. 

Your Care From 24 Hours After Birth 

Until You Go Home 

Baby 

• Your baby will need to eat at least eight to 10 times a 

day or every two to four hours. Try to feed your 

baby when you see the baby is wakeful and alert. 

However, you may sometimes need to wake your 

baby for a feeding. 

• Your doctor will examine your baby every day. 

• Your nurse will check your baby routinely, and 

whenever you have concerns and questions. 

• Your baby will have a blood test called the Newborn 

Screen. 

• Prior to discharge, it is recommended that your baby 

receive the Hepatitis B vaccine. 

• Your nurse will take your baby’s blood pressure. 

• If you choose to have your son circumcised, your 

baby’s doctor will discuss the procedure with you 

and ask you to sign a consent form. The doctor will 

perform the circumcision before you leave the 

hospital. 

• Your baby will want to be near you, either in your 

arms or nearby in the crib. We encourage you to 

room-in with your baby so you become familiar 

with feeding cues and how to care for your baby. 

• While in the hospital, infants are required to sleep 

independently in their bassinet. 

Mom/Family 

• You will talk to your nurse about your needs for 

pain management, comfort, rest and food. 

• If you had a cesarean birth, our staff will remove 

your bandages. You will be able to shower, and 

should spend time out of bed to regain strength. 

• You should feel comfortable requesting any help 

you need to care for your baby. 

• Your nurse will check on you routinely and respond 

at any time to your concerns and questions. 

• You will complete the “Mother and Baby Teaching 

Checklist (see page 71).” 

• Your doctor/midwife will examine you daily until 

you go home. Remember to ask about follow-up 

appointments, birth control, prescriptions/ 

medications, activity and other concerns you have. 

• Your nurse will ask if you have questions about your 

labor and/or birth. 

Your Family Checklist 

Day One 

___ Bring your car seat and instructions to the hospital. Practice 

placing your baby in the car seat in your room. Adjust the 

harness straps snugly. If your car seat has a base, secure it 

facing the rear in the back seat of your vehicle. 

___ There is a car seat DVD available, ask your nurse 

to get it for you. 

___ Identify who will help you at home. 

___ Discuss with your nurse how the baby will affect your family 

and her siblings. 

___ Read the information in your bedside folder. 

___ Begin the “Mother and Baby Teaching Checklist 

(see page 71).” 

___ Complete the birth certificate information. 

___ Make a list of questions you have to discuss with your 

doctor, midwife or nurse. 

___ Make arrangements to go home. Talk to your 

doctor/midwife about a going-home date. 

Day Two or Until You Go Home 

___ Plan a going-home time with your family and nurse. The 

usual checkout time is at or before 1 p.m. 

___ Have all your questions answered by your doctor, 

midwife or nurse. 

___ Talk with your nurse about supplies to take home. 

___ Schedule follow-up appointments for you and 

your baby. 

___ Complete the “ Mother and Baby Teaching Checklist 

(see page 71)” with your nurse. 

___ When you are ready to leave the hospital, your 

nurse will sign you and your baby out, escort you 

to the lobby, and check your car seat. 

9

Your Baby’s First Few Hours 

The first few hours following birth are an eventful time for both you and your baby. Unless there are medical situations 

that need attention, we will place your baby on your abdomen shortly after birth. The nursing/medical staff will 

examine your baby soon after the birth. You can usually keep your baby right next to you as your doctor or nurse 

cares for both of you. We usually give your baby his first bath within eight hours after delivery, most times within 

the first two to four hours. 

Routine Newborn Exams/Measurements 

Apgar Scores 

Immediately after birth, we will measure your baby’s 

Apgar Score. Apgar Scores reflect your baby’s 

transition at one and five minutes of age. This 

measurement considers a score of 7 to 10 as normal. 

The Apgar Score measures your baby’s heart rate, 

respiration, muscle tone, color and reflexes. It lets 

the health care providers know how your baby is 

responding to life outside of you. 

Vital Signs/Temperature 

We will monitor your baby’s temperature, pulse and 

breathing frequently in the first hours. 

Length/Weight 

We will measure and record your 

baby’s length/weight. 

Complete Physical Exam 

Your baby’s doctor will do a complete 

physical exam within the first 24 

hours, usually at your bedside. The exam will include 

the following assessments 

• Color 

• Reflexes 

• Fontanels (soft spots on the head) 

• Eyes 

• Heart rate 

• Breath sounds 

• Internal organs 

• Genitalia 

• Hips and legs for orthopedic abnormalities 

• Skin 

Hearing Screening 

Good hearing is important if a child is to develop 

good speaking, listening, reading and writing skills. 

The learning of language starts the moment the 

child is born. 

“You can’t spoil newborns; 

they’re completely 

dependent on you.” 

10 

Hearing loss in infants is much more common than 

most people realize. Hearing loss is the most frequent 

birth defect for which babies are screened. One of 

every 300 babies is born with a hearing loss, yet few 

babies are totally deaf. For newborns with certain 

complications, the risk is much higher. Since hearing 

loss is “hidden,” a baby’s hearing loss can go 

unnoticed for two or more years. 

Meriter performs hearing screening quickly and 

comfortably while your baby sleeps or rests. Nursing 

staff screens babies for hearing loss shortly after birth, 

using a computer that measures your baby’s ears and 

brain response to quiet tones. The screening takes 

about 15 minutes. 

A “Pass” on the hearing screening 

means your baby has good hearing 

at this time. 

A “Refer” on the hearing screening 

does not mean your baby has a hearing 

loss. It means your baby needs to be 

re-screened. Many things can cause a baby to fail the 

screening when she has good hearing. There might 

be fluid in the ear, or your baby may have been active 

during testing. Further testing will determine your 

baby’s true hearing levels. If further testing finds 

hearing loss, support is available to help your baby 

develop normally. 

Your Baby’s Appearance 

Skin 

Your baby may be born covered in vernix, a cheesy 

substance that protects the skin before birth. You can 

easily wipe off vernix. Lanugo (body hair) may also 

be present, but will fall out soon after birth. Skin may 

look wrinkled or even peel. For further information 

about your baby’s skin, please refer to page 37.

Head 

The bones of your baby’s head are not fully fused 

together. For this reason, there are two fontanels, or 

soft spots, on the head. Pressure on the skull during 

labor and delivery or the use of forceps or a vacuum 

may change the appearance of your baby’s head. This 

can be either from movement of skull bones or from 

swelling. Such swelling is temporary and goes down 

shortly after birth; skull bones will eventually “round 

out” to their normal state. 

You may see marks on the face and/or head if 

forceps or vacuum extraction were used to ease your 

baby through the birth canal. These may appear as 

bruises or lumpiness in the fat tissue. These marks 

usually heal on their own, without specific treatment, 

unless the skin is broken through. 

Genitalia 

Babies often have swollen genitalia (scrotum or labia) 

at birth; this usually lasts a day. Girls often have a 

clear to white or pink discharge within the first few 

weeks after birth. This is a normal response to the 

mother’s hormones. 

Chest 

Maternal hormones that cross over to your baby 

before birth may result in swollen breast tissue in 

both boys and girls. The swelling will disappear on 

its own. 

Eyes 

Eyes may appear puffy at birth, but this swelling 

will subside in a few days. Eyes are often blue at 

birth. True eye color may not become apparent 

until six to twelve months of age. 

Reflexes 

Healthy babies are born with several normal reflexes 

including: 

Startle Reflex 

Newborns stiffen and thrust out both arms and 

legs when they hear a loud noise or feel they are in 

danger of losing their balance. 

Rooting Reflex 

When you stroke a newborn’s cheek, she will 

instinctively turn in the direction of the stroke. This 

reflex helps your baby find food. If you put your 

baby to your breast, she will instinctively turn her 

head toward the nipple and try to latch on and suck. 

Gag Reflex 

If babies have extra mucous from the birth process, 

they automatically gag to work it out of their throat 

and mouth. Additionally, if babies take too much 

milk at once, they will gag and possibly spit up. It is 

normal for newborns to do this in the first days of 

life. Most babies can handle getting rid of this extra 

mucous themselves; but there is a bulb syringe 

available in the crib. Your nurse will assist you with 

the use of the bulb syringe. 

Newborn Hypoglycemia 

(Low Blood Sugar) 

In the first few hours of life, some newborns need 

to have their blood sugar levels checked. A small 

prick to the heel allows us to test a single drop of 

your baby’s blood. Most newborns do not require 

any blood sugar monitoring or support. If your baby 

has low blood sugar, the nurse will either encourage 

feeding your baby or contact your baby’s doctor for 

further planning. In an otherwise healthy infant, low 

blood sugar is easily correctable. 

Newborn Medications 

As part of the Birthing Center’s newborn admission, 

every infant routinely receives vitamin K and 

Erythromycin Eye Ointment. If you have questions 

about either, after reading the following descriptions 

about each medication and the reason we use it, talk 

to your health care provider. 

Vitamin K 

Vitamin K helps blood to clot properly, and infants 

are not born with enough vitamin K in their bodies. 

If infants do not receive a vitamin K supplement, 

they are at risk for a severe bleeding disorder. This 

can cause bleeding in an infant’s mouth, nose, 

stomach, intestines, skin or brain. Severe illness or 

death can sometimes occur. For this reason, the 

American Academy of Pediatrics recommends that 

all newborns receive vitamin K. 

11

Erythromycin Eye Ointment 

We apply Erythromycin Eye Ointment to the 

newborn’s eyes within the first hour after delivery. The 

ointment protects the newborn from bacteria that may 

be present in a mother’s birth canal. These bacteria can 

potentially infect babies’ eyes as they pass through the 

birth canal, causing eye swelling and discharge. 

Erythromycin ointment causes temporary blurring of 

your infant’s eyes, until the ointment is absorbed. For 

this reason, our nurses usually wait until you have had 

a period of face-to-face contact with your newborn 

before applying the ointment. 

Neonatal Screening 

Babies, when they are at least 24 hours old, or before 

discharge from the hospital, will have a blood test 

called the Neonatal Screen. This test screens for 

congenital conditions that, if not treated, can lead to 

serious health problems. We report all results of the 

screen to your baby’s doctor. If you are interested in 

the conditions that are screened, ask your health care 

provider or refer to the newborn screening brochure. 

Immunizations 

When babies are born, they have an immature 

immune system that helps fight off disease. Part 

of this immunity comes from antibodies that the 

mother passes to her infant through the placenta. 

This immunity is temporary. 

Vaccines provide a way to extend immunity. 

Immunizations work by stimulating the immune 

system to fight off specific infections. 

Hepatitis B Vaccine 

The Center for Disease Control and the American 

Academy of Pediatrics recommend that vaccination 

against Hepatitis B begin in the newborn period. 

Your nurse will provide current information about 

the Hepatitis B vaccine while you are in the hospital. 

Holding Your Baby Skin-to-Skin 

Holding your baby skin-to-skin is a special way of 

holding your baby upright against your chest, with 

skin-to-skin contact. The baby is tucked in and safely 

wrapped against you. 

What Are the Benefits of Skin-to-Skin Holding 

Many moms and dads say that skin-to-skin contact 

helps them feel especially close to their babies and 

more confident about caring for them. Research 

has uncovered many other benefits of skin-to-skin 

contact, including that it: 

• Helps stabilize babies’ temperature and blood 

sugars, so they can direct their energy to feeding. 

• Helps with breastfeeding, because your baby is 

more alert and it helps increase a mother’s milk 

supply. 

• Improves your baby’s overall growth and 

development. 

• Provides a special way for babies and parents to 

get to know each other. 

• Helps parents adjust to baby’s birth and need for 

care around the clock. 

How Do I Hold My Baby Skin-to-Skin 

As you recline in a bed or chair, place your baby 

(wearing only a diaper) upright beneath your clothes. 

Then cover both of you with one blanket. Allow 

your baby one to two hours in this position, or until 

she shows she is ready to feed. You can hold your 

baby skin-to-skin at any time. 

“Think of your baby’s 

growth and development 

as a journey, not a race.” 

Lori, Childbirth Educator 

12

Mother Care 

The first weeks after giving birth are a time of change and adjustment for a woman and her family. Fatigue is a real 

problem for new mothers. This can remain for months after the birth. Along with fatigue, a woman faces new 

responsibilities. By taking care of herself, a woman is able to meet the challenges and appreciate the joys of parenting. 

Rest 

While in the Hospital 

• Take naps as often as you can. 

• Use the “do not disturb” sign. 

• Use the phone shut-off feature. (Read your room 

binder for more information.) 

• Encourage friends and family to visit you at home 

after you have rested. 

• Keep your baby with you and rest together. Most 

new moms rest and sleep better when they are 

close to their babies. 

At Home 

Some new parents find it easier to rest once they 

return home. Others find it more difficult. Rest, 

along with eating, feeding your baby and caring for 

your baby should be your priorities. As for all other 

responsibilities of life at home, it would be best 

to leave these for a while. Ask someone else to do 

them or, minimally, share those responsibilities with 

someone else. Discuss these responsibilities early 

with your husband, partner, family and friends. 

New parents will find that temporarily adapting their 

sleep and awake patterns to their baby’s patterns 

allows for much more rest than struggling to change 

a baby’s schedule to fit mom’s and dad’s. This is 

also much healthier for your baby. It is healthy 

and normal for babies to wake and feed frequently 

(especially at night). If you find at times you can 

only settle your baby by holding her, remember this 

is normal and good for both of you. 

As you proudly share your new child with the world, 

remember that you are parents first and hosts last. 

Make sure to take time just for you and your baby. 

Pain Management 

If you are experiencing pain after delivery, your nurse 

will provide you with appropriate pain medication. 

Do not be afraid to ask! She will ask you to assess 

your pain by assigning it a number from zero (no 

pain) to 10 (worst pain). Based on your report she will 

help you decide on a plan for pain control. Please tell 

your nurse if your medication is not helping relieve 

your pain or if you are experiencing bad side effects 

from it. 

If you need pain medications to take at home, your 

provider will write you a prescription that you should 

fill at a pharmacy. Review the medication information 

listed so that you are familiar with how often you may 

request a certain medication, know its potential side 

effects and know why you are using it. 

Medication Information 

A list of medications that may be prescribed for 

you to take while you are in the hospital or at home 

are listed on page 15. The information will help 

you know more about the medications you may be 

taking. If you have questions, you can ask your nurse 

while in the hospital or call your provider’s office 

or pharmacist after you go home. We’ve included a 

medication log worksheet at the end of this book so 

that you can record the medications you are taking 

and when you take them. 

Since it is very important to keep track of when your 

pain medication is due, your nurse will write the next 

time it is due on the white dry-erase board in your 

room. If you are experiencing pain before your next 

medication dose is due, call your nurse to re-assess 

your pain. 

13

Warning 

Applies to all oxycodone and hydrocodone 

containing products. 

• While taking this medication, we advise you 

not to drive or do other activities that require 

you to be alert and clearheaded. 

• You should not take these medications with 

alcohol or any other narcotics. 

• If you take these medications frequently, or 

over a long period, they can be habit forming. 

• These medications may cause constipation. 

Applies to Acetaminophen (Tylenol) 

• Medications that contain Acetaminophen are 

marked on the next page with an *. 

• Acetaminophen can cause liver damage if too 

many tablets are taken. Do not take more than 

4,000 mg/day which would equal twelve – 

325 mg single tablets. 

Applies to Ibuprofen (Motrin and Advil) 

• Medications that contain ibuprofen are marked 

on the next page with a **. 

• Ibuprofen can cause bleeding and kidney 

problems. 

• Do not take more than 3,200 mg/day. Which 

would equal sixteen - 200 mg tablets. 

Medication Reminders When You Go Home: 

Share the list of medications that you receive at 

discharge with each provider you see. 

• Always read the label before taking any 

medication. Take the exact amount ordered. 

• If you experience any bad side effects from 

medications you take (such as nausea, vomiting, 

headache, rash or dizziness), call your care 

provider or pharmacist. 

• If the medication you take is not helping relieve 

your pain, call your provider. Once you go home 

from the hospital, you should be rating your pain 

as a “3” or less on a regular basis. 

• Call the Poison Control Center 1-800-815-8855 

or 911 in the event of a drug overdose. 

How to Wean from Pain Medications 

You should continue to take the medication 

prescribed for you as long as you are experiencing 

discomfort. When you have less discomfort, you 

can wean yourself from your narcotic medication 

by taking only 1 tablet instead of 2 and/or increasing 

the time between doses. You may also alternate 

or switch to acetaminophen or ibuprofen alone, 

rather than using medications containing 

hydrocodone or oxycodone. Eventually you will 

find that you will no longer need any medication. 

If you notice that the pain you are feeling is not 

getting any better or is getting worse, you should 

contact your provider. If you have additional 

questions about how to manage your pain medication 

once you get home, call your provider or pharmacist. 

14

Postpartum Medication Information 

Below is a list of medications that may have been prescribed for you while you are in the hospital or may be prescribed for you to take at home. 

The information provided in the chart below will help you know more about the medications you will be taking. If you have any questions, ask your nurse, 

call your provider’s office or your pharmacist after you go home. 

Medication Dose Per Tablet How Many How Often Potential Side Effects What Does It Do 

To Take To Take 

**Ibuprofen (200mg) 200 mg 1-2 tablets Every 4 hours Stomach discomfort. Helps relieve mild- 

(Motrin, Advil) Max 16 as needed for pain Take with food or milk moderate pain, especially 

tablets/day uterine cramps 

*Acetaminophen 325 mg 2 tablets Every 4 hours Side Effects Helps relieve mild- 

(Tylenol) Max 12 as needed for pain are uncommon moderate pain and 

tablets/day reduces fever 

*Acetaminophen 325 mg 1-2 tablets Every 4 hours Hydrocodone can cause Helps relieve 

with Hydrocodone acetaminophen Max 12 as needed for pain drowsiness, nausea moderate/severe pain 

(Lortab, Vicodin) + 5 mg hydrocodone tablets/day or constipation 

Oxycodone 5 mg 1-2 tablets Every 4 hours Oxycodone can cause Helps relieve 

Max 12 as needed for pain drowsiness, nausea, moderate/severe pain 

tablets/day vomiting or constipation 

*Acetaminophen 325 mg 1-2 tablets Every 4 hours Oxycodone can cause Helps relieve moderate 

with Oxycodone acetaminophen Max 12 as needed for pain drowsiness, nausea, to severe pain 

(Percocet) + 5 mg oxycodone tablets/day vomiting or constipation 

Docusate 100 mg 1 capsule Every 12 hours as Cramping A stool softener, 

(Colace) needed for constipation not a laxative 

Polyethylene Glycol 17 grams Dissolve dose Daily Nausea, bloating, Helps relieve constipation 

3350 (Miralax) in 8 ounces cramping and flatulence 

of water 

Benzocaine ointment 20% 2 inch strip Apply to perineum Rash, burning, swelling Helps relieve discomfort 

(Americaine ointment) (External use only!) as needed for pain. in affected area. If these from episiotomy 

Keep in bathroom symptoms are present, 

and apply to clean discontinue use and 

vaginal pad. notify your nurse 

or physician. 

Hydrocortisone 2.5% Thin layer gently Apply to hemorrhoids Skin irritation Helps relieve 

topical rubbed into skin every 6 hours hemorrhoidal pain 

as needed 

*Acetaminophen. Do not take more than 4000 mg/day (from all sources combined) 

**Ibuprofen. Do not take more than 3200 mg/day 

PAIN SCALE 

No pain 0…1…2…3…4…5…6…7…8…9…10 Worst pain 

Moderate pain 

15

Vaginal Flow 

Your vaginal flow (lochia) will be bright red 

following birth. Your flow may seem like a moderate 

to heavy period. Because of the hormones you 

release while breastfeeding, you may have cramping 

and a change in vaginal flow. We can provide 

medications that may help relieve cramping 

discomfort. (See page 13-15 for more information 

about these medications.) 

Your nurse will check your flow often after delivery, 

and then about every eight hours until you go home. 

The nurse will also press on your lower abdomen 

to check to see if the top of your uterus (fundus) is 

firm. 

Your vaginal flow will slowly fade from pink to 

brown to clear, and last about 4-6 weeks after birth. 

If the bright red color returns or the quantity of 

flow increases, you are doing too much and should 

rest more. Call your health care provider if: 

• The bright red color or flow continues after 

resting, saturating a pad in 1 hour 

• You pass blood clots golf ball sized or larger 

• The flow has a foul smell 

• You are concerned about your flow and want 

to talk to someone 

Urination 

It is important to empty your bladder at least every 

six hours. When your bladder is empty, your uterus 

stays in its normal position more easily. Urinating 

often also prevents bladder infections. If you are 

unable to urinate the first six to eight hours after 

birth, we may need to insert a catheter to drain your 

bladder. 

In the first week after birth, you will urinate more 

often because you will be getting rid of fluids you 

may have retained during pregnancy. (You also get 

rid of extra fluids by sweating more.) 

Women are prone to urinary tract and bladder 

infections after birth because of the swelling, 

stretching and possible tearing to the pelvic area. 

Call your health care provider if you experience signs 

of an infection, which include: 

• Burning, itching or painful urination 

• Difficulty starting to urinate 

• A feeling of having to go “right away” 

• Cloudy or foul-smelling urine 

• If you are having urinary or stool incontinence 

after six weeks, tell your health care provider. 

Physical therapy may be helpful for you. 

Perineal Comfort 

You may have stitches from an episiotomy (an 

incision from the vaginal opening toward the rectum 

used to assist or speed delivery), or a small tear that 

did not need stitches. You may want to examine the 

area and stitches with a mirror, as the stitches are 

often smaller than you may imagine. These stitches 

will dissolve on their own. 

Your nurse will check this area for swelling and ask 

about discomfort. Again, nurses do these checks 

often at first and then about every eight hours or less 

if you have no concerns. To speed healing: 

• Use ice packs to help reduce swelling within the 

first 24 hours. 

• Use the peri bottle your nurse gives you to rinse 

every time you urinate or change pads. Doing so 

helps soothe swollen tissue and keeps the area 

clean. Until you have stopped bleeding, continue 

to use your peri bottle prior to using toilet tissue. 

• Your nurse will also give you an ointment to use 

to reduce discomfort. 

• Do not use tampons, douche or have intercourse 

until instructed by your provider. 

• After 24 hours, take a whirlpool or tub bath 

(a few inches of warm water in a clean tub) several 

times a day. Avoid using bath oils. 

• Change your position every 20 minutes. Sitting 

with your legs crossed under you or on a donut 

cushion may reduce pressure on the area. Do not 

over inflate the donut cushion; it should feel soft 

and flexible when you sit on it. 

• Your nurse will tell you about medications your 

health care provider has prescribed. Tell your 

nurses how the medications are working. 

• Stitches may feel uncomfortable for about seven 

to 10 days and heal in three to four weeks. 

16

Hemorrhoids 

Hemorrhoids are varicose veins (swollen blood 

vessels) in the rectum. You will be able to feel the 

hemorrhoids and may notice itching, bleeding or 

pain while having a bowel movement. Hemorrhoids 

are common during pregnancy because the uterus 

increases pressure on the pelvic vessels, which 

causes the vessels to swell. The strain of pushing 

during your baby’s birth may cause more swelling. 

Hemorrhoids are usually most painful the first 

few days following your baby’s birth. Here are 

several things you can do to make yourself more 

comfortable: 

• Sit on a donut-shaped pillow. 

• Take warm tub baths after 24 hours. (Use the 

donut cushion in the tub for comfort, if 

necessary.) 

• Use Tucks ® Medicated Witch Hazel pads or other 

medications your doctor has prescribed for this 

area. 

• Avoid constipating foods such as cheese, bananas, 

etc. Eat high-fiber foods such as whole grains, 

fresh fruits and vegetables. Drink extra fluids. 

Take a stool softener as needed. See medications 

on page 15. 

• Try not to put off a bowel movement or be 

concerned about your stitches. (During a bowel 

movement, press a clean peri pad to your vaginal 

area to support your stitches.) 

• If you have not had a bowel movement by three 

days after delivery, contact your health care 

provider. 

Swelling (Edema) During and After 

Pregnancy 

Swelling during and after your pregnancy is quite 

common. It is caused by the extra blood and fluids 

circulating through your body during your pregnancy. 

The swelling will gradually disappear within a week 

as your body gets rid of the extra fluid you retained 

during your pregnancy. Your kidneys will do most 

of this, which means you’ll be urinating more than 

usual. Your skin pores will also work to shed the 

extra water, so you’ll sweat more, too. 

Is it ever serious 

Postpartum swelling is rarely serious and will go away 

on its own. However, if the swelling does not resolve 

within a week or if you have bad headaches or pain 

in your legs, call your health care provider. Also, call 

immediately if the swelling is in only one leg or ankle 

and is accompanied by severe pain; it could be a sign of 

deep vein thrombosis (a blood clot). 

What To Do For Swelling During and 

After Pregnancy 

The best thing you can do to minimize swelling is 

drink plenty of fluids and eat foods low in sodium 

and high in potassium. Here are some other things to 

help lessen swelling: 

• Keep moving throughout the day. If you have to 

stand for long periods, shift your weight between 

your legs and stretch your legs periodically. 

• Wear support hose to help promote circulation in 

your legs. 

• When sitting or resting, raise your feet and legs. 

• Avoid wearing clothes that are too tight or 

uncomfortable. 

• Drink plenty of water throughout the day. 

• Exercise regularly if possible. 

Breasts 

• Non-nursing mothers may feel engorged. Cold 

compresses, a supportive bra or acetaminophen 

may help with breast discomfort. Your milk 

production will naturally stop in seven to 10 days. 

• For information about breast infections, see 

page 28. 

Breast Self-Exam 

Whether or not you are breastfeeding your baby, 

continue to do monthly breast self-examination. 

Pregnant and lactating women should follow the 

recommended guidelines for breast cancer screening: 

• Monthly breast self examination 

• Clinical breast exam by a trained health 

professional every three years 

• Baseline mammogram done at the age of 40 

• Women between the ages of 40-49 should have a 

mammogram every one to two years 

Note: these recommendations are for women who are 

low risk and have no symptoms of breast cancer. Ask 

your provider for specific guidelines if you have risk 

factors. 

17

Nutrition and Weight Loss 

Most new mothers find it helpful to eat smaller, more 

frequent meals. Eat moderate amounts of healthy 

foods such as fruits, vegetables and protein sources. 

If you are breastfeeding, more diet information is 

available on page 31. 

It is normal to lose 10 to 15 pounds immediately 

after childbirth, depending on how much you gained. 

Although it may be discouraging to have given birth 

and still “feel pregnant,” do not go on a strict diet 

after giving birth. All mothers need a nutritious, wellbalanced 

diet to recover from childbirth. 

Sexual Intercourse 

For most postpartum mothers, the suggested waiting 

period before resuming sexual intercourse varies 

from three to six weeks. You will be physically ready 

for intercourse when your flow is no longer bright 

red and when you can insert a finger or tampon 

into your vagina without pain. (Otherwise, you 

should not use tampons during this time unless you 

discuss it with your care provider.) The time required 

before you are mentally and emotionally ready for 

sexual intercourse is highly individual. Remember, 

intercourse is not the only way to express physical 

affection. 

You may find it helpful to use a water-soluble 

lubricant, like K-Y Jelly, Liquid Silk or Astro Gel. 

Have some on hand before you attempt lovemaking 

in case you need it. You might begin by using a 

position with the woman on top or side. There is 

less pressure on an episiotomy or cesarean incision 

and the woman can control the speed and depth of 

penetration. If you have continued pain with sex, call 

your provider. Physical therapy may be helpful. 

Birth Control 

It is possible to become pregnant soon after giving 

birth, regardless if you are bleeding or breast 

feeding. 

• Talk to your health care provider about birth 

control before you go home. 

• Foam and condoms used together is usually the 

preferred form of contraception right after birth. 

• While breastfeeding can postpone the return 

of your menstrual period, it does not guarantee 

pregnancy prevention. 

• Diaphragms used before pregnancy will no longer 

fit correctly. 

• Some hormone shots and pills can affect a 

breastfeeding mother’s milk supply. If you choose 

birth control shots or pills, consider waiting at 

least six weeks to start this method. 

• Talk to your provider about a birth control 

method that won’t affect your milk supply. 

18

Recovery From Cesarean Birth 

Because a cesarean birth is surgery, there is more involved in your recovery. The information in this section will help 

you understand what you are experiencing, and help you recover more quickly. 

Pain Relief 

You usually use Patient-Controlled Analgesia (PCA) 

for approximately 12-24 hours. We connect the 

PCA to your IV; it allows you to control your pain 

medication. Talk with your nurse about your plan for 

pain control. You can begin oral pain medications 

when you can tolerate liquids without nausea. 

Respiratory 

We will encourage you to turn, cough and 

“deep breathe” frequently until you are walking 

independently. This will help keep your lungs clear 

and prevent pneumonia. 

Incision 

We usually remove dressings 24 hours after surgery. 

We often remove skin staples on the third day after 

surgery prior to going home, or later at 

a clinic visit. Your provider may then 

place small pieces of tape called 

“steri-strips”, over your incision. These 

may be washed and will wear off in 

about seven to 10 days after surgery. 

If not, you may remove them. 

“Let others help you, so 

you can rest and get to 

know your baby.” 

Audrey, RN 

Signs and Symptoms of Infection 

The first few days after surgery, you may experience 

pain or discomfort. The wound may appear mildly 

reddened or swollen and have some clear or bloodtinged 

drainage. This is normal and will decrease 

gradually each day. 

Notify your surgeon if you experience any of the 

following: 

• Fever higher than 100.4 degrees, or chills. (Make 

sure you are drinking plenty of fluids.) 

• Increased surgical site pain or swelling not related 

to activity. 

• Increased drainage from the incision, particularly if 

it has changed color or smells foul. 

• The incision opens up and/or becomes hot, red 

and tender. 

Urinary Catheter 

We will insert a small tube, called a 

urinary catheter, into your bladder 

before surgery. This is usually done 

after your spinal anesthesia and will stay 

in until the next day. 

Keep your wound clean and dry. This allows faster 

healing and helps prevent infections. Follow your 

surgeon’s instructions. 

If you did not receive wound care instructions, 

follow these steps: 

• Using a clean washcloth, wet the wound with clean 

water. 

• Wash with soap, cleaning any soil or drainage, 

gently but completely. 

• Pat dry with a clean towel. 

• Apply a fresh clean dressing, if needed. 

• Repeat the above steps, if needed during the day. 

Activity 

After your cesarean birth, your nurse will help you 

get up to the bathroom about 6 hours after you 

return to your room. Changing position every two 

hours will help with your recovery. The nursing staff 

will assist you in getting out of bed or repositioning 

until you are able to do this on your own. Patients 

who are out of bed and moving sooner recover 

more quickly. Walking and changing to oral pain 

medication as soon as possible helps bowel function 

return. We encourage you to walk at least every six to 

eight hours. 

19

IV Fluids 

We insert an intravenous (IV) tube before surgery to 

provide needed fluids. We will remove it once you 

are able to drink enough fluids on your own and take 

oral pain pills. 

Diet 

As you recover from your surgery, your diet will be 

increased as you are able to tolerate more food. It is 

important to not eat too much too soon. We usually 

give ice chips and/or clear liquids (Jell-o, juice, broth 

and tea) on the operative day. We will increase your 

diet as you are able to tolerate more foods. 

Bath/Shower 

Showering and bathing depends on how you feel 

and what your health care provider suggests. Most 

patients are able to shower 24 hours after their 

surgery. Check with your provider on when to bathe. 

Postpartum Check 

We will check your vital signs (blood pressure, heart 

rate, breathing rate, temperature and pain levels) 

frequently during the first six hours to monitor your 

early recovery after surgery/birth. We will also check 

the bleeding from your vagina often. A firm uterus 

means that bleeding is slowing down. A nurse checks 

this by pressing on your lower abdomen. After the 

initial recovery period, we make these checks about 

every eight hours (more often if needed) during the 

rest of your stay. 

Caring For Your Baby 

We encourage you to keep your baby with you as 

much as possible and will assist you in caring for 

your new baby in your room. We encourage you and 

your husband or partner to let us know how we can 

help you. If you are medically unable to care for your 

baby, talk to your nurse about nursery care. 

Going Home After Cesarean Birth 

• Keep your incision clean and dry. 

• Increase your activity slowly; rest frequently. 

• Climb stairs slowly at first; limit trips up and 

down. If your baby’s room is upstairs, set up 

a changing station downstairs to help limit the 

number of trips. 

• Talk to your health care provider about lifting 

restrictions. A general rule is not to lift anything 

heavier than 10 pounds for a few weeks. 

• Talk to your health care provider about when you 

can resume driving. You should wait until you 

are no longer taking prescription pain medication. 

The average time to wait before resuming driving 

is about two weeks following surgery. 

• See the inside front cover of this book for signs of 

illness and when you should call your health care 

provider. 

Feelings After An Unplanned Cesarean 

Birth 

An unplanned cesarean birth sometimes leaves 

questions and unresolved feelings. It can take time 

to work through these feelings. We recommend you 

ask for answers to your questions and share your 

feelings with your health care provider, nurse, friends 

and family. 

20

Nutrition and Feeding: Breastfeeding 

The American Academy of Pediatrics recommends exclusively breastfeeding babies during the first six months in order 

to provide optimal growth and development. The academy also recommends continuing to breastfeed through the first 

year of life and as long as both mom and baby would like beyond the first year. 

Benefits of Breastfeeding: For Baby 

• Provides protection from many illnesses including 

diarrhea, pneumonia, meningitis, ear infections and 

Sudden Infant Death Syndrome (SIDS). 

• Provides long-term health advantages, such as 

fewer allergies, decreased risk of obesity, and lower 

incidences of diabetes and other autoimmune 

system disorders. 

• Breast milk changes to meet your baby’s 

nutritional needs as he grows—from day to day 

and month to month. 

• Breast milk is easy to digest and never 

constipating. Mother does not need a special diet. 

• Breast milk tastes different every time your baby 

eats. This helps develop your baby’s sense of taste 

and smell. 

• Breast milk is always ready and available. 

Benefits of Breastfeeding: For Mom 

• Breastfeeding helps the uterus contract, which 

limits the bleeding experienced after delivery. 

• Breastfeeding causes the release of prolactin, the 

“mothering” hormone, which helps mothers feel 

more relaxed. 

• Women who breastfeed also tend to lose their 

pregnancy weight more quickly. 

• Studies show that breastfeeding reduces a woman’s 

risk of breast and ovarian cancer, and decreases 

the risk of osteoporosis. 

Additional Assistance 

If you ever have questions or concerns about 

breastfeeding, call Meriter’s Breastfeeding Helpline 

at (608) 417-6547 or 1-800-261-4449, or speak with 

your infant’s physician or nurse. Always feel 

comfortable asking for help—it is better to address 

breastfeeding concerns early on than to wait for a 

serious problem to develop. You can easily correct 

most breastfeeding challenges if you handle them 

early. We offer book and Web site suggestions in the 

Healthy Living section of www.meriter.com. 

Breastfeeding Your Baby 

As with any new skill, it may take practice for breastfeeding 

to become “second nature” for both you and 

your baby. Your nurse is an excellent resource; ask 

her for help. We hope this information also supports 

your breastfeeding experience. 

Steps to Promote Successful 

Breastfeeding 

• Breastfeed “on cue”—Feed your baby when he 

shows early feeding cues (see page 24) and until 

content. Breastfeed for as long as your baby is 

actively nursing. 

• Breastfeed your baby at least 8-12 times per 

day—This gives babies the fluid and nutrition they 

need, and encourages a good milk supply. 

• “Room-in” with your baby—Keep your baby 

with you as much as possible, which allows you 

to identify early feeding cues. Spend as much 

time with your baby skin-to-skin as possible 

(see page 12). 

• Make sure your baby latches correctly—Look 

for a wide-open mouth, flared upper and lower 

lips and absence of pain while nursing. Your baby 

should be facing you, tummy against your body, 

her chin deep into the breast and her nose close. 

• Avoid giving your baby a pacifier in the early 

weeks—This decreases the time your baby gets 

to learn how to breastfeed, and may affect your 

milk supply and baby’s weight gain. Some babies 

can also have a hard time learning how to suck 

at your breast if using a pacifier. By waiting until 

breastfeeding is well established, your baby will be 

better able to learn how to nurse correctly. 

• Unless medically indicated, avoid giving your 

baby any supplements (water, sugar water, 

formula)—Giving fluids other than breast milk 

will fill up your baby and decrease the feeding time 

at your breast. 

21

• Nurses will directly observe some feedings while 

you are in the hospital—After you go home, 

schedule an appointment to see your baby’s 

physician within one to three days. Bring your 

feeding log to this appointment. The physician 

will be able to reassure you if all looks well and 

help correct any difficulties you encounter. 

Breastfeeding Positions 

There are several different ways to breastfeed, 

described below. You may find one position that suits 

you and your baby right away. If not, experiment 

with other positions. In all positions, your baby 

should be directly facing the breast, with the 

nose in front of the nipple. The ear, shoulder 

and hip should be in a straight line. In addition, 

supporting your breast throughout the feeding 

will help your baby maintain a deeper latch. The 

cross cradle hold and football hold positions are 

excellent when just learning to nurse your baby. Once 

your baby learns to latch well, many mothers switch 

to other positions, such as cradle and side-lying hold. 

Experiment and do what works best. 

When sitting up while breastfeeding, find a place 

that is comfortable and supports your back well. 

Use pillows behind your back, shoulders, arms— 

anywhere needed to help you feel more comfortable. 

Use pillows also under your baby so you do not have 

to support her weight. Your feet should be flat on 

the floor and knees slightly raised—a footstool may 

be helpful. Always bring your baby to your breast, 

instead of bringing your breast to baby, as leaning 

can cause neck and back pain. 

Cradle Hold 

The cradle hold is the 

traditional nursing position. 

Hold your baby in the arm 

that is on the same side as 

the breast you will be using. 

Bring your baby up to your 

breast, and support your baby’s 

head with your forearm. 

Cross-Cradle Hold 

The cross-cradle hold allows you 

to have good control of how your 

baby is latching. Hold your baby 

with the arm opposite of the 

breast that you will be feeding 

with. Support your baby’s neck 

and upper back with this hand. 

Support your baby’s bottom 

and legs in the crook of your 

arm. 

Football Hold 

The football hold is useful for 

mothers who have had a 

cesarean birth, will be 

nursing twins or have 

large breasts. Hold your 

baby tucked closely to 

you, as if clutching a 

football, using the hand 

and arm on the same side 

as the breast you will be using. 

Support his upper back with your arm. Your baby’s 

buttocks and legs will go around beside your body. 

Side-Lying Position 

This position allows you 

to get some extra rest while 

nursing your baby, and is 

especially helpful if you had 

a cesarean delivery or if you 

are tired. Get comfortable 

lying on your side, by having 

pillows supporting your head, 

behind your back and under 

the knee of your upper leg. 

Use your lower arm to bring 

your baby close to you, making sure that your baby’s 

mouth is at breast level. You can use your lower arm 

or a pillow to support your baby’s back. Use your 

upper arm to support your breast and direct the 

nipple into your baby’s mouth. 

22

Helping Your Baby Latch to the Breast 

Some babies latch onto the breast easily and know 

what to do. Other babies need more assistance. 

Properly positioning your baby at the breast can 

help you achieve better success when latching. 

The cross-cradle and football hold are excellent 

positions to experiment with during the first few 

days, because you have better control of the latch. 

Refer to the diagram showing cross-cradle and 

football holds. 

When positioning, “wrap your baby around you” 

so that you and your baby are close to each other. 

Remove bulky blankets and clothing so your baby 

will be able to get close. Your forearm will be holding 

your baby’s body and supporting her weight. Your 

baby’s ear, shoulder and hip should be in a straight 

line. Support your baby’s neck and shoulders with the 

web between your thumb and index finger. Line up 

your baby’s nose (not mouth) with the nipple, and tilt 

the head back slightly. 

With your other hand, support your breast with your 

fingers underneath your breast and your thumb on 

top (C – hold) or rotate your hand with your 

fingers and thumb on either side of the breast 

(U – hold). Use the hold that gently compresses 

the breast to match the shape of your baby’s mouth. 

To illustrate, an adult taking a bite from a sub 

sandwich would compress it horizontally to better 

match up with their horizontal mouth. 

Be sure your fingers are well 

behind the areola so your 

baby will be able to latch 

deeply. Push gently into the 

breast with the thumb to help 

the nipple point slightly upward 

towards the roof of the mouth as your 

baby latches. 

Stroke your baby’s lips with your nipple until her 

mouth is wide open, as if yawning. Timing is 

important. As the mouth is open, aim the nipple to 

the roof of your baby’s mouth and gently, quickly, 

bring your baby onto the breast, with the chin 

touching first so that your baby takes the breast 

deeply into her mouth. Do this by using your arm 

(not just hand or wrist). The nipple is the last part 

Photos courtesy of medela.com 

of the breast to go into your baby’s mouth. As your 

baby’s upper lip covers the nipple and before the 

mouth begins to close, pull baby in even closer to get 

a good deep latch. The nipple should reach the back 

of your baby’s mouth, which will trigger suckling. The 

nose should be close or lightly touching the breast. 

Your baby’s lower jaw does most of the work during 

feedings; you should position the lower jaw as far 

away from the base of the nipple as possible, with the 

chin pressed into the breast. This is an “off-center” or 

“asymmetrical” latch. 

When properly latched, your baby will have drawn as 

much breast tissue into his mouth as possible. Continue 

to support your breast gently, as needed, for the 

duration of the feeding to maintain a good latch. You 

should see a wide latch with the lips turned out. You 

should feel a rhythmic tugging sensation of the breast 

and will occasionally hear soft swallowing sounds. Your 

baby’s cheeks should appear smooth, without dimpling. 

If you are having pain, check to see if your baby’s lips 

are turned out. If not, try to gently pull them out or 

take your baby off the breast by inserting your finger 

into the corner of your baby’s mouth to beak the seal. 

Latch again with the mouth open wider. If you are still 

having pain, or if your baby is not feeding in the ways 

described above, continue to reattach as needed until 

your baby latches well. Be consistent—a good latch will 

pay off! You will feel more comfortable with feedings 

and your baby will get more milk, creating a good milk 

supply. 

Signs of a Good Latch 

• Baby’s mouth is wide open, like a yawn 

• The entire areola or as much of the breast tissue as 

possible is in the mouth 

• Baby’s lips are out, curled around the breast 

• Baby’s chin, chest, hips and knees are facing and 

touching your body 

• Baby’s chin is firm against the breast 

• Baby’s nose is close to the breast or lightly 

touching it 

23

• Baby’s tongue is over the lower gum and around the 

nipple and areola 

• The only sounds heard while feeding is swallowing, 

you can see the jaw or ear moving as baby swallows 

• Baby’s cheeks are puffed out while feeding, relaxed 

• Your nipples may appear longer after a feeding, but 

are not creased or flattened 

• You may have some discomfort at the beginning of 

the feed, but it quickly disappears 

Signs of an Incorrect Latch 

• Baby’s mouth is barely opened 

• Areola, or breast tissue is not in the mouth, only the 

nipple 

• Baby’s lips are turned/curl in 

• Baby’s chin, hips, chest or knees are not touching or 

facing your body 

• Baby’s chin barely touches the breast 

• Baby’s tongue is behind the lower gum, not around 

the nipple 

• Baby is making a clicking sound when feeding 

• Baby’s cheeks are dimpled 

• Your nipples are creased or flattened after you 

breastfeed 

• You have pain or discomfort throughout the entire 

feeding 

• You don’t hear swallowing or feel tugging on 

the breast 

How Often and How Long to Feed 

The first hour after birth is when babies generally are 

alert, awake and have a strong desire to suck. Some 

babies will latch on immediately and nurse. Other 

babies will just lick at the breast, and then spend some 

time looking around. Whatever your baby does, allow 

your baby time at the breast to give you time to get to 

know each other. 

Once your baby latches, allow her to breastfeed as long 

as she desires. It is normal for your baby to breastfeed 

often and long in the early days. Many babies want to 

nurse almost continuously for an hour or more at a 

time, sleep for a while and repeat this pattern. It is not 

necessary to “watch the clock.” As a general guideline, 

many babies nurse for a total of 20-40 minutes, but 

some nurse for a longer time and some for a shorter 

time. This varies as your baby grows. Every baby’s 

nursing pattern is unique. 

Your baby should have a rhythmical suck, with good 

jaw movement. At the start of the feeding your baby 

will suck quicker; as feeding progresses the suck will 

become slower as your baby becomes more content. 

At the end of the feeding, your baby will come off 

the breast on her own, or will fall asleep. Detach your 

baby if she is sleeping. Offer the second breast, and 

again allow your baby to nurse as long as she wants. By 

following your baby’s lead as to when she is done with 

each side, your baby will receive the right amount and 

balance of nutrients. 

For the next feeding, start on the breast you finished 

with during the last feeding. This will help establish 

your milk supply equally between both breasts, and 

allow your baby to learn how to latch on both sides. 

Breastfeeding at least eight to 12 times per day will 

encourage a good milk supply and should provide all 

the fluid and nutrition your baby needs. 

Feeding Cues 

Breastfeed whenever your baby begins to show early 

feeding cues, which include: 

• Early wakefulness from sleep 

• Sucking sounds, making other noises 

• Bringing hands to mouth 

• Rooting around, licking lips 

• Alertness, looking around 

By taking advantage of these early feeding cues, your 

baby will learn to breastfeed when interested and calm. 

If you miss these cues, your baby may cry and become 

frantic. Crying is a late stage of hunger and can make it 

more difficult for your baby to latch properly. 

The more breastfeeding practice your baby gets in the 

early days, the sooner she will learn to latch well and 

effectively nurse. Allowing your baby to breastfeed 

when she is hungry and until she is content will help 

decrease the risk of jaundice, low blood sugar and 

excessive weight loss. It will also encourage your milk 

to come in sooner, help prevent engorgement (overfullness 

of the breasts) and help you establish a good 

milk supply. 

A healthy, full-term baby with a good suck eventually 

falls into a nursing pattern that is best suited to him. 

Let your baby be the guide. Record feedings in the 

feeding log we have included at the back of this book. 

Call your baby’s provider or the Breastfeeding Helpline 

if you have questions or concerns. 

24

How Your Milk Changes 

Your body makes colostrum for the first several days 

after giving birth. Colostrum is low in volume but has a 

high concentration of nutrients and is rich in infectionfighting 

antibodies. For most healthy full-term babies 

who are nursing well, colostrum provides all of the 

nutrition and fluid they need in the first 

few days. 

Your breast milk will start coming in by day three or 

four, and fully transition to mature milk by 10-14 days. 

Your breasts will start to feel fuller and heavier, and 

the milk supply becomes more plentiful. You may also 

notice the following: 

• Warmth or tingling in your breasts before or during 

nursing. 

• Leaking from one side while nursing on the other. 

• Hearing your baby swallowing or gulping. 

• Your baby will be content for longer periods 

between feedings. 

How Do I Know If My Baby Is Getting 

Enough Milk 

Milk production follows the principal of supply and 

demand. The amount of milk you produce depends 

on the amount of breastfeeding your baby does, and 

how much milk she removes. The more your baby 

breastfeeds, the more milk your body will make. 

The opposite is also true. A mother whose baby 

breastfeeds less frequently and instead sucks on a 

pacifier or feeds by bottle will make less milk. During 

the early weeks, it is important to try to nurse whenever 

your baby is interested to develop a good milk supply. 

It is normal for a baby to lose weight after birth due to 

shedding excess fluids and passing meconium (the first 

stool). A weight loss of 5-7% is considered normal. 

After several days (when your milk comes in), your 

baby should begin to gain weight, averaging about 6 

ounces per week. Your baby should be at or above his 

birth weight by 2 weeks of age. We will check your 

baby’s weight while you are in the hospital and your 

baby’s health care provider will continue to check it 

after discharge. 

Ways to tell if your baby is getting 

enough milk. 

• Your baby is eating 8 or more times in 24 hours 

• You baby is wetting and stooling enough diapers 

within 24 hours (see feeding log on page 65-69) 

• Your baby is alert and active between feeds or 

sleeping well (Not fussy or restless) 

• Your breasts feel heavy and full before a feeding, 

lighter and “empty” after a feeding 

• Your baby has not lost more than 7% of the 

birth weight in the first days after birth 

• Your baby appears satisfied after a feeding. 

• Your baby is back to birth weight by 2 weeks 

Your Milk Supply 

As long as your baby is nursing eight to 12 times per 

day, is meeting the goals for wet and soiled diapers, 

and is gaining weight well, your milk supply is fine. 

Talk with your health care provider if your baby is 

not meeting the goals for wet or stool diapers on 

your feeding log, or you are concerned about how 

your baby is growing. 

Growth Spurts 

Sometimes mothers think their milk supply has 

decreased due to their baby wanting to nurse more 

often than usual. This may occur during baby’s fussy 

periods. Your baby may also want to feed more often 

because he is going through a growth spurt. Growth 

spurts commonly occur during the second to third 

week, around six weeks and at three months. Feeding 

routines for your baby—as far as frequency and length 

of feedings—change over time. The fullness of your 

breasts will vary, this is normal. 

If you are concerned that your milk supply is low: 

• Nurse more frequently. Nurse your baby every 1 1 ⁄2-2 

hours. Try to switch sides so that you are feeding 

from each breast twice during a feeding. Massage 

your breast before and during a feeding. 

• Reduce your stress and workload as much as 

possible. Rest, relax, eat and drink well. 

• Avoid bottles and supplements, unless 

recommended by your health care provider. If 

recommended, try offering supplements after 

breastfeeding. 

• Consider pumping 5-10 minutes after breastfeeding 

to empty your breasts more fully, which will tell 

your body to make more milk. (See pages 29-30 on 

expressing your breast milk.) 

• Eliminate the use of pacifiers. Allow your baby to 

suckle at your breast whenever he wants to suck. 

25

• Keep in mind that medications (prescription, over 

the counter or herbal supplements) may affect 

your supply. Check with your care provider or 

pharmacist. 

• Talk with a health care provider about your concerns 

and ask about other options. 

Your milk supply should typically increase within 48-72 

hours after starting the above suggestions. 

The Sleepy Baby 

Some babies are sleepy or not interested in nursing the 

first few days, especially if your baby is 

small, was born early, you had a difficult 

labor and/or delivery, you received 

narcotic pain medication during labor 

or other reasons. Try to encourage your 

baby to nurse at least 8-12 times in 24 

hours. Keep your baby close to you and 

do lots of skin-to-skin. Whenever your 

baby shows early feeding cues, he is 

more likely to wake more fully to nurse. 

If your baby has been sleeping more 

than three hours during the day, wake 

him and try to breastfeed. The following 

techniques may help wake him: 

• Keeping just the diaper on, remove blankets and 

clothing if the room is warm 

• Change your baby’s diaper 

• Talk to him 

• Gently rub your baby’s back or hands and feet 

• Try expressing a little milk to your baby’s lips to 

entice your baby 

If your baby falls asleep at your breast after suckling for 

only several minutes, try the above measures to wake 

her. Try switching to the other breast to see if your 

baby will wake up. If sleepiness occurs every time your 

baby feeds, have a health care provider watch you nurse 

your baby. Some babies choose to fall asleep instead of 

nursing if they are having difficulty getting milk from 

the breast. You will want to make sure your baby has 

been getting enough milk by recording feeding and 

diaper details in the log found on page 65. 

The Fussy Baby 

Many parents worry that their baby may not be 

receiving enough milk if they are fussy or frequently 

feeding. Use your feeding log to determine if your baby 

is having enough feedings and wet and stool diapers. 

“Try to not worry 

so much about breastfeeding 

– soon you will 

be able to nurse your 

baby, make out a 

grocery list and talk on 

the phone, all at the 

same time!” 

Rita, RN, Birthing Center 

26 

All babies fuss at times, and it is normal and healthy 

for your baby to breastfeed frequently during the first 

weeks of life. Mothers should follow baby’s feeding 

cues rather than watching the clock. Nursing comforts 

babies, even though they may not be hungry. It is fine 

to nurse your baby as often as he wants. 

If your baby is having a hard time latching or becomes 

fussy at the breast, try to calm your baby by talking 

quietly, rocking or walking with your baby. Hand 

express some colostrum to your nipple before trying 

to latch. Try holding your baby, skin-toskin, 

when your baby is not feeding (see 

page 12). Keep your room calm and dimly 

lit to provide a soothing environment. 

If your baby seems hungry, latches and 

suckles briefly and then becomes fussy, 

have your health care provider watch you 

feed your baby. He or she will be able to 

assess if your baby is latched properly and 

getting your breast milk effectively. If your 

baby is extremely fussy and you are not 

able to calm him down, call your health 

care provider. 

Nipple and Breast Problems 

Sore Nipples 

The first week you breastfeed, it is not unusual to have 

some discomfort for the first minute or two of the 

feeding or until your milk starts to flow. Positioning or 

latching problems are the most common causes of sore 

nipples. After you finish nursing, look at your nipples. 

They should look round, slightly elongated and pink. 

Creases, cracking or a white nipple are signs of an 

improper latch. If you have soreness throughout the 

feeding or have cracked, bleeding, bruised or blistered 

nipples, speak to your health care provider. 

To help prevent or treat sore nipples, follow these 

suggestions. Talk to a health care provider if your 

nipple soreness does not improve when you follow 

these suggestions. 

1. Refer to the section on latch and positioning. Be 

persistent in making sure your baby latches on well, 

and stays latched well throughout the feeding. 

2. Break the seal. If you suspect your baby has not 

latched well, insert your finger into the corner 

of your baby’s mouth to break the seal. Detach and 

then try again. The more practice your baby gets

latching correctly, the easier and more automatic it 

becomes for both of you. 

3. Feed your baby frequently. By following early 

feeding cues, your baby will be calmer while 

latching. 

4. If one nipple is more tender than the other is, 

start with the less tender side. 

5. Initiate “let down.” Before feeding, massage 

your breasts and hand express a few drops to help 

get milk to let down so your baby will not be so 

aggressive at first latch. 

6. Relax while nursing. Your milk flows better and 

your baby will not have to suck so strongly. 

7. After each feeding, express a few drops of 

colostrum/milk and coat your nipples with it. 

Allow your nipples to air-dry afterward. 

8. Applying purified lanolin (e.g. Purelan, 

Lansinoh) to nipples after nursing is soothing 

and safe. Apply enough to keep your nipples 

moist between feedings. Lanolin acts as a moisture 

barrier that keeps the internal moisture of your 

nipples high, which reduces pain and speeds 

healing. 

9. Do not use other creams, oils or ointments for 

your nipples. They may not be safe for your baby, 

or cause nipple dryness or irritation. 

10. If you are leaking, change your breast pads and 

your bra when they are wet. Avoid plastic-lined 

breast pads, which prevent air circulation and 

cause soreness. 

11. Speak to your health care provider about taking 

pain medication compatible with breastfeeding. 

Engorgement 

Normally your breasts become larger, heavier and a 

little tender within 2-6 days after birth as they start to 

produce more milk. This engorgement is a result of 

your milk “coming in,” and hormonal changes that 

increase the amount of blood supply and fluid in your 

breasts. If engorgement occurs, it usually begins on 

day 3-5 and usually lasts 12-48 hours. You can avoid 

or minimize this by breastfeeding your baby frequently 

and without restrictions after birth, and by being sure 

your baby is positioned and latched well. Symptoms 

may include breast swelling, warmth, redness, 

throbbing and pain. Your baby may have difficulty 

latching due to flattening of the nipple. 

Recent research shows that the best way to reduce 

engorgement is to: 

• Try to nurse your baby at least every two hours. 

Get as deep of a latch as possible. The deeper the 

latch, the more milk your baby will be able to remove. 

Allow your baby to nurse on the first side until he 

comes off on his own. Then offer the second side. 

• Your health care provider may suggest you use an 

anti-inflammatory medication. 

Although not medically proven, many women report 

improvement in their symptoms by experimenting 

with the following suggestions: 

• Help your milk “let down.” Apply warm packs to 

your breasts or take a warm shower 10-15 minutes 

before feedings. Try to relax. 

• Gently massage the breast before nursing. Use 

your fingertips to knead the breast gently from the 

chest wall toward the nipple in a circular motion. 

Results may be more effective if combined with 

warm pack/shower. 

• Soften your breasts further if needed. If your baby 

does not nurse often enough for your breasts to 

soften, either hand express or use an effective breast 

pump until your breasts feel comfortable. 

• Use an effective breast pump one to two times 

to drain the breast fully. This reduces breast 

congestion, and milk and extra fluids will drain more 

effectively. 

• Cold compresses between feedings can soothe and 

reduce swelling. 

• Try using green cabbage leaves if the above steps 

do not help. Rinse refrigerated or room temperature 

cabbage leaves. Strip the large vein and cut a hole 

for the nipple. Apply the leaves directly to the 

breast, inside the bra. When they wilt, usually within 

two to four hours, remove them. You can reapply 

fresh leaves. Stop using them when engorgement 

diminishes because prolonged use may decrease your 

milk supply. 

Plugged Milk Ducts 

Occasionally, a milk duct in your breast may not empty 

effectively and the area becomes inflamed. This may 

lead to a plugged duct (an accumulation of milk in a 

milk duct). A plugged duct is a tender area, redness or 

sore lump in the breast. You will not have a fever and 

you will otherwise feel well. 

27

Your milk is still the healthiest milk for your baby. 

These suggestions should help: 

• Apply warm packs to the breast for 10-15 minutes 

before feeding or stand in a warm shower to help 

your milk “let down.” 

• Massage the plugged duct while it is warm. Gently 

massage from the outside of the breast, through the 

lump and toward the nipple during feedings. You 

may also try this during a shower or bath. 

• Feed your baby frequently and start feeding on the 

affected side. Try to breastfeed at least every two 

hours. 

• Be sure your baby latches deeply onto the breast. 

The jaw should be as far from the nipple as possible 

with a large mouthful of breast tissue (use the offcenter 

latch). 

• Position your baby so that her chin or nose aims in 

the direction of the lump. 

• Alternate your baby’s position as long as you are still 

able to latch him well. 

• Avoid tight clothing, tight bras and underwire bras. 

When possible, remove your bra during feedings so 

your milk will be able to flow freely. 

• Rest. Try to go to bed with your baby and nurse 

frequently. Try to eliminate extra activities. 

These measures will relieve, in most cases, the plugged 

duct within a couple of days. If not, or if you develop 

fever or any flu-like symptoms, contact your health care 

provider. 

Breast Infection 

You may have a breast infection if you develop a 

painful, hot, red area in your breast, and have a fever 

and flu-like symptoms. Call your health care provider 

if you have any of these symptoms. Factors that can 

contribute to a breast infection are nipple damage due 

to poor latching, poor emptying of the breast during 

feedings, pressure on the breast (tight bra) that affects 

the ability of milk to flow, missed feedings or changes 

in your baby’s feeding patterns, plugged ducts, fatigue 

and stress. 

Your milk is still the healthiest milk for your baby when 

you have a breast infection—this is not the time to 

wean. In addition to the recommendations listed in the 

“Plugged Duct” section on page 27, breast infection 

treatment includes: 

• Antibiotics—if prescribed be sure to take the full 

amount. The antibiotics should be safe for your 

baby. 

• Apply warm, moist compresses as often as possible, 

to activate infection fighting cells. 

• Express milk or pump a few extra minutes after 

nursing if the breast still feels full. 

• Take care of yourself by going to bed and resting as 

much as possible. Drink plenty of fluids and eat a 

well-balanced diet. 

• Take pain medication as needed for fever and pain. 

Leaking Breast Milk 

In the early weeks, many mothers leak milk from their 

breasts. This is more common the first weeks, but 

may continue for months. Some mothers never leak 

but still produce enough milk for their babies. Leaking 

can occur by the sight, sound or even the thought of 

a baby. It is more likely when mother’s breasts are full. 

Mothers may also leak from one breast while nursing 

on the other. 

• You can temporarily stop the leaking by putting 

gentle pressure on the nipple. Cross your arms 

across your chest and press the heels of your hands 

against your nipples. 

• Wear cloth nursing pads and change your nursing 

pads frequently. 

• Nurse your baby more often so your breasts will not 

become overly full and more likely to leak. 

• Wear clothing that conceals wetness. Wear tops 

with print designs, or have an extra jacket/sweater 

available. 

Introducing a Bottle 

Many breastfeeding mothers occasionally want to give 

their baby a bottle. When you are separate from your 

baby or return to work, your baby will be able to 

benefit from your breast milk while you are away, yet be 

able to enjoy the closeness of breastfeeding when you 

are together. 

If you decide to give your baby a bottle, it is best 

to wait until breastfeeding is going well. Generally, 

waiting until your baby is 3-4 weeks old will not 

interfere with breastfeeding. At that time, your baby 

should be able to easily breastfeed and bottle feed. 

28

Expressing and Storing Breast Milk 

Having stored breast milk available is convenient 

for occasions when you are separate from your baby 

or when you return to work. (Please note: These 

guidelines for milk expression and storage are for 

healthy full-term babies.) 

• Press your thumb and fingers straight into the 

chest wall and then move them together in a 

pressure-release rhythm. You may need to do this 

a few times to get the milk to flow. 

Ways to Express Your Milk 

You may choose to hand express your milk or use a 

breast pump: 

• If you do not anticipate being separated from your 

baby very often, hand expressing or using a hand 

pump works well. 

• If you plan to return to work or be away from 

your baby for a period, using an electric breast 

pump is a good idea. A single 

pump is meant for occasional 

use, and pumps one breast at a 

time. Double pumps (pumping 

both breasts at one time) are more 

efficient, and are often the most 

effective way to pump and increase 

your milk production. 

You may purchase or rent a breast pump. Since there 

are many varieties of pumps available, it may be a 

good idea to discuss your options with a health care 

provider. 

Helping Your Milk “Let Down” 

Having your baby at the breast helps trigger the 

hormones that allows your milk to “let down” or 

flow. Such natural cues are missing when you express 

your milk, so you need to create other cues that 

signal your body to let the milk down. The following 

suggestions should help. 

• Get into a comfortable position. 

• Minimize distractions. 

• Warmth is relaxing. Apply heat to your breast, or 

put a sweater or blanket around your shoulders. 

• Stimulate your nipples by gently rubbing or rolling 

them. 

• Relax. Think about nursing your baby. Look at 

your baby’s picture. Listen to something relaxing. 

Hand Expression 

• Wash your hands before expressing milk. 

• Place your thumb and first two fingers on either 

side of the nipple, approximately 

1- 1 ⁄2 inches behind the nipple. 

Please note these guidelines 

for milk expression 

and storage are for 

healthy full-term babies. 

29 

Push Roll Finish Roll 

• Continue to do this until the flow of milk slows 

down, usually 3-5 minutes. 

• Switch to the other breast and repeat. 

• Go back to the first breast and rotate your hand so 

you are expressing milk from other parts of your 

breast. 

• Repeat again, switching between 

breasts as the milk flow slows. 

• Hand expression usually takes 20-30 

minutes. Your breasts should be 

softer. With practice and patience, it 

gets easier to do and the amount you 

are able to express will increase. 

Pumping 

Read the pump instructions carefully before use. 

The first time you use the pump, adjust the suction 

regulator to minimum. You may increase the suction 

as you become comfortable using the pump, but it 

should not cause nipple soreness. Center the shield 

over the nipple so it draws the nipple in and out 

without rubbing against the sides. When you start the 

pump, you should feel a tugging similar to how your 

baby nurses. You should not be uncomfortable when 

you pump. If pumping is causing discomfort, a larger 

breast shield may help. 

If you are using an electric pump, keep it at breast level 

to reduce the possibility of milk moving back into the 

pump. If you are pumping instead of nursing, double 

pump for 15 minutes. 

If you are using a single pump, pump for a total of 

30 minutes and switch breasts when the milk flow 

decreases, or about every 5 minutes.

General Guidelines 

• Wash your hands before expressing or pumping 

milk. 

• After pumping, clean pump equipment and 

containers using dish soap and hot water. 

• Minimize waste by storing expressed milk in small 

portions. Most breastfed babies take between 

2-4 ounces of milk when beginning with a bottle. 

Storing in 2-ounce amounts and offering an 

additional bottle if your baby is still hungry prevents 

you from having to throw away unfinished milk. 

With time, it will be easier to determine how much 

to store in a container. 

• Consider storing smaller size portions (1-2 ounces 

each) for unexpected situations. A small amount 

of milk can keep your baby happy until mom can 

nurse. 

• You may combine several expressions throughout 

the day to get the desired volume in a container. 

Chill the newly expressed milk before adding it to 

previously chilled milk. 

• You may add cold fresh breast milk to frozen as 

long as the frozen milk is more volume than the 

fresh. 

• Keep milk from one day separate from other days. 

• Fill container up to 3 ⁄4 fill, as breast milk expands as 

it freezes. 

• Label containers clearly with the date you expressed 

the milk, and the child’s name (for daycare). 

• Your milk will separate during storage because it 

is not homogenized. The cream will rise to the top 

of the milk, and look thicker and whiter. Before 

feeding, swirl the container of milk gently to mix 

the cream back through again. 

• Your milk color may vary from day to day, 

depending on your diet. It may look bluish, 

yellowish or brownish. Frozen breast milk may also 

smell different from fresh breast milk. 

Storage Containers 

Hard-sided containers, such as hard plastic or glass, 

are the preferred containers for human milk storage. 

Containers should not contain the chemical 

bisphenol A (BPA). Standard baby bottles, small 

canning jars such as jelly jars and clean food storage 

containers with solid fitting lids all work well. Some 

breast pumps are capable of pumping milk directly 

into baby bottles, reducing risk of contamination. 

If you use a baby bottle to store milk, be sure to use a 

solid lid and not a nipple. Additionally, there are 

disposable bags specifically designed to store 

breast milk. 

Milk Storage Guidelines for Healthy 

Term Infants 

Milk Storage Guidelines* 

Where Temperature Time 

At room 66° to 78°F 4 hours (ideal) up to 

temperature (19° to 26°C) 6 hours (acceptable)** 

(fresh milk) 

(Some sources use 8 hours) 

In a refrigerator

Lifestyle Issues 

Nutrition for Mother 

A nursing mother’s diet should be similar to the healthy 

diet of any woman. There are no foods that you must 

eat or avoid in order to produce excellent milk for your 

baby. Fresh fruits and vegetables, whole grain breads 

and cereals, calcium-rich and protein-rich foods are 

great choices. Try to eat foods in as natural of a state as 

possible, avoiding processed foods. 

It is normal for nursing mothers to consume more 

calories than non-nursing women do. It is best to “eat 

to hunger” and in moderation. Moms should recover 

from birth and establish a good milk supply (6-8 weeks) 

prior to considering weight loss. If a 

nursing mom would like to lose weight, a 

gradual weight loss of up to 1 pound per 

week is safe and has not been shown to 

affect milk supply. 

Many mothers wonder if a baby’s fussy 

behavior is due to something in the 

diet that transfers to mom’s milk. This is not usually 

the case. It is more likely that medications, nutritional 

supplements, alcohol or caffeine in mother’s diet would 

be the cause. It may also be due to medication your baby 

takes, formula use, solids or juice. A sensitive baby may 

be affected by the food her mother eats. If you feel your 

diet is causing your baby to be fussy or gassy, call your 

baby’s health care provider. 

Alcohol 

The American Academy of Pediatrics considers 

alcohol consumption compatible with breastfeeding, 

although side effects may occur if taken in large 

amounts. An occasional drink, or up to one or fewer 

drinks per day, has not been shown to be harmful. The 

amount of alcohol in breast milk depends primarily on 

the type and amount of alcohol consumed. Alcohol 

enters the bloodstream quickly and the level of alcohol 

in the blood at one moment matches the level of alcohol 

in the milk at that time. As your body eliminates alcohol 

from the bloodstream, it also reduces the level in your 

breast milk. 

If you are concerned about the amount of alcohol in 

your milk, feed your baby stored milk for a feeding and 

pump your breasts for comfort. Discard the pumped 

Your milk is the perfect 

food for you to feed 

your baby 

milk. Moderate to heavy alcohol consumption may 

affect the amount of milk your baby takes or cause low 

weight gain, developmental problems and other side 

effects. Speak to your health care provider if you have 

other questions. 

Smoking 

Smoking affects your health, your baby and the milk 

that you make. Ideally, if you smoke, it is best to quit. 

If you cannot or do not choose to quit, experts believe 

that the benefits of breastfeeding still outweigh the risks 

of smoking. These suggestions will reduce the impact of 

smoking on breastfeeding: 

• Reduce the number of cigarettes you smoke per day. 

• Smoke shortly after nursing so there will be less 

nicotine in your milk by the next feeding. 

(Nicotine levels are highest after smoking, 

and decrease over time.) 

• Smoke outside to avoid exposing your 

baby to second-hand smoke. 

• Talk with your doctor about ways to 

quit. 

• Call the Wisconsin Tobacco Quit Line 

(1-877-270-7867) for additional support. 

Medications 

Consult a health care provider before taking any 

medications, even though most prescription and overthe-counter 

medicines are safe in moderate doses. If 

you do require a medication, take the safest one available 

and in the lowest dose. To decrease the amount that 

gets to your baby, take the medicine just after your baby 

nurses or before your baby begins sleeping. If you need 

to take medicine that is not safe for your baby, continue 

to express your milk while taking the medicine. Discard 

this milk and feed your baby milk that you expressed 

previously or use formula, if necessary. 

Herbs 

While breastfeeding, consult with your health care 

provider prior to using any type of medication or herbal 

preparation for yourself. Although the general use can 

be safe, the effect on your milk supply or infant may not 

be beneficial. If you have questions about herbs contact 

your doctor or pharmacist. 

31

Nutrition and Feeding: 

Common Feeding-Related Concerns For Both Breast 

and Formula-Fed Babies 

Burping 

Some babies need to burp during and following a 

feeding. At first, try to burp your baby after 1 ⁄2 to 1 

ounce. For breastfed infants, if needed, try burping 

between breasts, as you switch your baby over. 

Burping helps to prevent your baby from feeling full 

before the feeding is finished. It will help your baby 

spit up less. Some babies may spit up a mouthful 

with a burp or when laid down to rest with a full 

stomach. Time spent burping your baby after the 

feeding is worthwhile and should reduce the amount 

of cramping. 

You should also burp babies after excessive crying 

episodes, which causes them to swallow air. If it 

takes longer than a few minutes to get the burp up, 

put your baby down. Often a burp will come up on 

its own. You may also try holding your baby upright 

for 5-10 minutes, then try for a burp. 

There are different ways to burp your baby. You can 

sit your baby on your lap and gently rub her back 

while supporting the chin. You may also hold your 

baby on your shoulder or place her across your lap 

and gently rub the back. Remember, a small amount 

of gentle rubbing is all the movement necessary for 

a burp. It is not necessary to pat your baby or rub 

vigorously to produce a burp. Each baby and each 

feeding is different as to the amount of burps you 

will hear and the motion required to produce a burp. 

Hiccups 

Hiccups are normal and began long before your baby 

was born. A hiccup is a sudden contraction of the 

diaphragm. Sometimes giving a little extra liquid will 

extract a burp or cause hiccups to stop. Over time, 

they will go away without any help. 

Thumbs and Pacifiers 

Many babies want more sucking time between 

feedings, and if your baby is showing feeding cues, 

consider that your baby may want more food at that 

time. Babies also like to suck for comfort, called nonnutritive 

sucking, even though they are not hungry. 

Babies may like to suck on their fists or fingers. If 

you choose, you can give a pacifier to your baby. 

For breastfed infants, it is best to wait until 

breastfeeding is going well before introducing a 

pacifier. Studies show that regular pacifier use in 

breastfed infants may cause a decrease in mom’s milk 

supply, change the way a baby sucks and decrease the 

duration of breastfeeding. Considering whether to 

introduce a pacifier If breastfeeding: 

• It is best to wait until your baby is 3-4 weeks old. 

• You should have established your milk supply. 

• Your nipples and breasts will be comfortable with 

nursing. 

• Your baby will be gaining weight well. 

If you do choose to use a pacifier, never put it on 

a string to hold around your baby’s neck. As your 

baby’s sucking needs decrease, so will the need for a 

pacifier. 

32

Nutrition and Feeding: Formula Feeding 

If you have decided that formula is the choice for you and your baby remember—love that you give during feeding does 

not come from the milk. Holding, cuddling and the time you spend with your baby nurtures your baby, along with the 

milk you provide. 

For non-breastfeeding infants, the American Academy of Pediatrics recommends iron-fortified infant formula for the 

first year. There are a variety of infant formulas to choose from. Most formulas are made from cow’s milk; however, 

soy-based formulas are available for infants with milk allergies or sensitivities. Homogenized cow’s milk is not safe for 

infants in their first year. If there is a family history of milk allergies, please tell your baby’s doctor. You and 

your baby’s doctor can choose the brand and type of formula that is best for your baby. 

Types of Formula 

Formula is available in three forms. Preparation time 

and cost may be factors in your decision on which 

form to use. 

1. Ready to Feed 

• Most expensive 

• Easiest to prepare 

• Needs no refrigeration until opened 

• Convenient when traveling or uncertain of 

water supply 

2. Concentrated 

• Must be mixed before feeding 

• Requires safe water source 

• Mix according to directions 

• Can be stored open in refrigerator for up to 24 

hours if not diluted 

• Needs to be used within 24 hours once diluted 

• Discard within 1-2 hours after preparation if 

not refrigerated 

3. Powder 

• Mix according to directions on can 

• Requires a safe water source 

• Needs no refrigeration until mixed, then it is 

stable refrigerated for 24 hours 

• Least expensive 

Preparing Formula 

It is important to mix the formula according to the 

manufacturer’s directions. In the hospital, you will 

be using ready-to-feed formula, which requires no 

special preparation. You should discard each bottle 

within one hour of beginning the feeding. Do not 

reuse bottles for feedings. Always wash your hands 

before preparing formula and beginning a feeding. 

No warming is necessary; babies can take cold 

formula. If your baby prefers it warm, place the 

bottle of formula in a container of warmed water. 

NEVER MICROWAVE THE FORMULA. 

Water Supply 

Preparing formula with a safe and appropriate 

water supply is important for your baby’s health. 

When choosing the water source for infant formula 

preparation, levels of nitrates, bacteria, copper, lead 

and fluoride should be considered. Parents should 

consult their baby’s provider on the most appropriate 

water source for formula preparation. 

Tap Water 

• Do not use softened water for formula 

preparation, because it contains salt. 

• Use only fresh water directly from the cold-water 

tap. 

• Let water run for about a minute before using. 

• You do not need to boil city water unless a water 

advisory is in effect. 

Well Water 

• If you have well water, you should have it checked 

for bacteria, nitrates, minerals and fluoride. 

• You should not use water with elevated nitrate 

levels for infants under 6 months of age. 

• Bacteria in water can cause vomiting and diarrhea. 

Boiling water will kill bacteria but increase nitrate 

levels. 

• Speak with your doctor about the need to provide 

your baby with a fluoride supplement. 

Water Testing: Recommendations for Testing 

• If your home is less than 6 months old, have your 

water tested for copper. 

33

• If your home was built in 1985 or earlier, have 

your water tested for lead. 

• Have your well water tested every 6 months. 

Agencies That Can Test Your Water 

• State Lab of Hygiene – (608) 224-6202 or 

1-800-442-4618. Water testing kits for well 

and city water are available for a small fee. 

• Public Health for Madison and Dane County – 

(608) 266-4821. Water testing kits for well and 

city water are available for approximately $40. 

Fees are waived for Dane County residents who 

meet income eligibility standards. 

• City of Madison – For city residents only. (608) 

266-4821. You can pick up test kits at Room 507, 

City-County Building, Martin Luther King Blvd., 

Madison, WI 53703. Fee is approximately $15-$25. 

Bottle Feeding Your Baby 

Feed when your baby shows signs of hunger (early 

feeding cues) and until content. The feeding pattern 

will vary at first, but will become more predictable as 

the weeks go by and your baby matures. Sometimes 

newborns are sleepy or still learning how to feed. It 

is likely that your newborn will awaken multiple times 

during the night to feed. It is not necessary to wake a 

full-term, healthy, formula-fed baby during the night 

for a feeding unless your physician otherwise directs 

you to do so. 

• There are many types of bottles and nipples 

available for you to use with your infant. You may 

want to start with a smaller supply until you find 

one that works well for your baby. 

• Find a comfortable position so you can see your 

baby easily and you support your back and legs. 

• Hold your baby so the head is a little higher than 

the body. Do not feed your baby lying down. 

• Stroke the lower lip with the nipple to encourage 

your baby to open her mouth wide. 

• Place the nipple on the top of your baby’s tongue. 

Your baby will start sucking when she feels the 

nipple on the roof of the mouth and the middle of 

the tongue. 

• Keep the bottle tipped so the nipple is always full 

of formula and there is a steady rise of air bubbles. 

(Adjust the nipple ring so air will rise but no 

formula leaks around the edges of the ring.) 

• Watch your baby’s face and talk to him while you 

are feeding. Your baby may pause in sucking to 

listen to your voice. Over time, your baby will be 

able to suck, swallow and listen all at the same time. 

• Burp your baby frequently, about every 1-2 ounces 

and at the end of the feeding. 

• It is not necessary to sterilize bottles and water 

if you use a city water supply. Be sure to wash 

bottles and nipples in hot soapy water and 

thoroughly rinse them. 

Important: 

• Do not prop your baby with a bottle for feedings. 

• Do not warm formula in a microwave. 

• Do not add solids to bottle. 

Frequency And Amount Of Feedings 

Feed your baby “on cue”—Feed your baby when he 

shows early feeding cues such as: 

• Early wakefulness from sleep 

• Sucking sounds, making other noises 

• Bringing hands to mouth 

• Rooting around, licking lips 

• Alertness, looking around 

By taking advantage of early feeding cues, your baby 

will be able to feed when interested and calm. If you 

miss cues, your baby may cry and become frantic. 

Crying or fussing are later signs of hunger, but do 

not always mean it is time for a feeding. As you get to 

know your baby you will learn his “hunger cries.” 

Feed your baby at least 8-12 times per day—This 

gives your baby the fluid and nutrition he needs. 

Each baby needs a different amount of formula to 

feel satisfied. Let your baby’s behavior guide you as 

to how much to feed your baby. When your baby is 

satisfied, she will turn her head and settle. However, 

if she is still hungry she will fuss even with a pacifier. 

Each baby is different and every day will be different 

depending on activity level, your baby’s age and rate 

of growth. (See guide on page 32.) 

“Room-in” with your baby—Keep your baby with 

you as much as possible. This allows you to identify 

early feeding cues. Spend as much time with your 

baby skin-to-skin as possible (see page 12). 

34

During the first days of life, a baby takes 1 ⁄2 to 1 

ounce of formula each feeding. As your baby gains 

weight, you will need to offer more formula each 

feeding. You must consider age and weight when 

determining how much your baby needs, however, 

there are general guidelines for formula amounts. 

Below is a guide for how much your baby will drink, 

based on your baby’s weight. Talk to your baby’s 

doctor if you have questions about how much 

formula your baby needs to grow. 

Baby’s Weight How much formula each Amount formula in 24 hours 

feeding (based on feeding 

your baby every 3 hours or 

8 times/day) 

5 pounds 1 1 ⁄4-2 ounces each 3 hours 10 – 15 ounces/24 hours 

6 pounds 1 1 ⁄2-2 1 ⁄4 ounces each 3 hours 12 – 18 ounces/24 hours 


8 pounds 2 – 3 ounces each 3 hours 16 – 24 ounces/24 hours 



12 pounds 3 – 4 1 ⁄2 ounces each 3 hours 24 – 36 ounces/24 hours 


35

Diapers 

As part of Meriter Hospital’s commitment to a 

healthy environment, the Birthing Center uses pinless 

cloth diapers covered by nylon diaper wraps. Cloth 

diapers help staff see when your baby is urinating. 

Disposable diapers are also available upon request. 

At home, you should wash cloth diapers in a gentle 

detergent, such as Dreft or Ivory Snow. Heavy-duty 

detergents or enzyme products may irritate your 

baby’s skin. Do not add perfumed fabric softener 

sheets to the dryer, because they can cause skin 

irritation. Presoaks such as Borax generally pose no 

problems. Bleach is okay if you double-rinse diapers. 

Diapering 

Lay your baby on his back on a changing table, bed 

or other clean safe spot. Remove the soiled diaper. 

Wash your baby’s diaper area with a clean moist 

cotton cloth or baby wipe. Be sure to clean hidden 

areas inside folds. Do not try to pull back a baby boy’s 

foreskin to clean underneath. When cleaning a baby 

girl, be sure to wipe from front to back 

to make sure you do not wipe stool 

into the urinary tract. Girls may have a 

clear to white or pink discharge from 

the vagina shortly after birth. This is 

normal and a reaction to the mother’s 

hormones. 

After you thoroughly clean the diaper 

area, slip a clean diaper underneath your 

baby, pull the front into place and secure it with tapes, 

pins or Velcro, depending on the type of diaper you 

use. Keep 

diaper folded below the cord to prevent rubbing 

and allow the cord to air dry. 

For convenience, arrange a diapering area with all 

necessities on hand: diapers, diaper pad, wipes or 

cotton cloths. If you live on two floors, you may want 

to set up a diapering area on each floor. 

Diapers and Bowel Movements 

“As long as you get the 

diaper on and it stays 

in place, there is no 

right or wrong way.” 

Katie, RN, Birthing Center 

Urine 

Your baby should have at least one wet diaper in the 

first 24 hours of life. Refer to the feeding log for wet 

and stool goals. In the first one to two days of life, it 

is normal to see dark orange spots (uric acid crystals) 

in the urine. Please discuss with your baby’s doctor if 

you note orange spots after going home. 

Bowel Movements 

• Babies’ first bowel movements are called 

meconium and are greenish black and tar-like. 

• Stools change in the first days. 

• Breastfed babies’ bowel movements become 

yellow and pasty or “seedy.” There is no “normal” 

number of bowel movements. Breastfed babies 

may have a few stools a day or a stool every 

feeding. 

• Formula-fed babies’ bowel movements become a 

greenish brown or tan color. Bowel movements 

can be pasty or formed. 

• Straining during bowel movements or when 

passing gas is normal, especially when feeding. 

However, excessive and persistent 

straining may indicate a problem. If you 

are concerned, check with your baby’s 

doctor. 

Diarrhea 

Green, foul smelling, watery diarrhea 

or other similar changes in frequency, 

amount, color or consistency 

of stools can be an indication of intestinal infection 

or milk intolerance. Contact your baby’s physician 

for advice. 

Gas 

To the surprise of many parents, babies pass a lot of 

gas, but this is no need for concern. This decreases as 

the intestinal tract matures. 

However, if in addition to passing gas, your infant is 

drawing up his legs, cramping and crying for extended 

periods, contact his doctor for advice. 

36

Common Skin Conditions and Cord Care 

Newborn Skin 

Newborns frequently have dry, flaky skin, especially 

on the hands, feet and abdomen. This is nature’s way 

of removing old skin. It is not necessary to apply 

baby oils, lotions and creams, as they frequently 

create more problems than they solve. 

Newborn Rash 

This rash is a red, blotchy spotting on the face and 

trunk. It is common during the first few weeks. This 

type of rash is of no concern. In the center of the 

red blotches is a small, white lump that looks much 

like an insect bite. The cause is unknown and it 

disappears without treatment in a few weeks. 

Newborn Acne 

This skin condition on the face affects about 1/3 of 

newborns and seldom needs treatment. It appears at 

approximately one month of age and lasts until four 

to six months. 

Milia 

These tiny white bumps appear mostly on the nose 

and face of the newborn. These are skin pores that 

are trying to break through the final layer of skin. 

When they do, the milia disappear. 

Stork-Bite Birthmarks 

These common hemangiomas (a collection of blood 

vessels) usually seen on the nape of the neck, the 

eyelids and above the nose. These tend to clear 

within a year or two and require no treatment. Fairskinned 

babies are more likely to have stork bites. 

Mongolian Spots 

This skin condition is bluish, pigmented birthmarks 

seen in Native American, Asian, Hispanic and 

African-American newborns. They are often present 

over the lower back and buttock area. Size varies and 

although they may fade somewhat after a few years, 

they are often present into adult life. Also, note that 

babies of dark-skinned parents may appear light. 

Their pigment will soon darken. 

Drooling Rashes 

This commonly occurs on the chin, brought on by 

milk and stomach acid “spit-up.” Although they 

require no specific treatment, it helps to wash off the 

milk and spit-up with plain water. A soft cloth under 

your baby’s face helps catch the drool or spit up. 

Pustular Rashes 

Large pimples or boils and blisters frequently indicate 

infection. You should report them to your baby’s 

doctor. 

Diaper Rashes 

This skin condition is common. Changing diapers 

regularly can minimize diaper rash frequency and 

severity. Carefully wash urine and stool from the skin. 

It is okay to use diaper wipes, unless they irritate your 

baby’s skin. 

If a diaper rash develops, leave the diaper off to 

air-dry the rash. To speed drying, use a hair dryer. 

Remember to keep the hair dryer 18-24 inches away 

from your baby’s skin and to use only cool or gently 

warm heat. You can use this system for 5 minutes or 

so a few times each day. 

Preparations such as A&D ® or, Desitin ® may help. 

If the rash does not improve after several days, call 

your doctor’s office. 

Yeast Infection 

Diaper rashes that fail to heal after many days may 

be due to a yeast infection that is characterized by a 

large, bright red area with a sharp outer edge and an 

assortment of smaller red areas nearby. This rash is 

usually on your baby’s front side, and includes the 

skin folds. You need a special medication to clear 

this type of rash. Contact your doctor if you feel this 

type of rash is present. 

Cradle Cap 

Cradle cap is normal skin peeling on a baby’s scalp. It 

does not mean your baby is dirty. Bathe your baby’s 

head as usual and brush the scalp daily with a soft 

gentle brush. 

Fingernails 

Newborn babies often keep their hands near their 

face for comfort. Sometimes, newborn fingernails 

can be sharp and may scratch the face. For the first 

few trimmings, keep nails short by gently peeling 

37

the nail or using a nail file. Take care not to trim too 

close to the delicate skin at the end of the nail. After 

the nails have hardened, you may use a blunt tipped 

baby scissors or gently peel the nail away. 

Umbilical Cord Care 

The stump of the umbilical cord takes 2-4 weeks 

to fall off. Until then keep it clean, dry and exposed 

to air. 

• Secure the diaper under the belly button to keep 

the cord free of urine and stool. 

• If the cord comes in contact with urine/stool 

cleanse it with a damp wash cloth. 

• Until the cord falls off sponge bathe the baby. 

Do not give the baby a tub bath until the cord 

falls off. 

• Allow some air exposure by folding up the t-shirt. 

This will help the cord dry up and fall off. 

• You may notice a few drops of blood on the 

clothing as the cord begins to separate; this is 

normal. 

Although an infected cord is rare, call your baby’s 

doctor if you see these symptoms of infection: 

• Foul smelling, yellowish discharge from the cord 

• Red skin around the base of the cord 

• Crying when you touch the cord or the skin 

next to it 

38

Caring for the Foreskin and Deciding About Circumcision 

Baby boys are born with foreskin, a skin covering the end of their penis. The foreskin helps to protect the penis and the opening 

(urethra) from stool and other irritants. The foreskin normally clings to the head of the penis for the first years of life and then 

naturally separates. 

By age three or four, most boys will have foreskins that fully retract (pull back). Until then, you may clean the foreskin just like the 

rest of the baby’s skin. If the foreskin is not yet retractable, you should not force it away from the head of the penis. This can cause 

scarring and further difficulties with retraction. 

Once the foreskin is retractable, you can clean the head of the penis and inside of the foreskin easily with soap and water after first 

gently pulling the foreskin back from the head of the penis. After cleaning, gently pull the foreskin back over the head of the penis. 

you leave the foreskin retracted, the foreskin can swell which makes it harder to pull back over the head of the penis. When a boy is 

old enough, he can learn how to keep his penis clean just as he will learn to keep other parts of his body clean. Good hygiene of the 

foreskin will help prevent problems with infection or difficulty retracting the foreskin. 

What is Circumcision 

Circumcision is a surgical procedure that 

permanently removes the foreskin, exposing the end 

of the penis. There is some evidence of potential 

medical benefits for circumcision. The evidence, 

though, is not enough to recommend that all 

newborn boys be circumcised, as there are also risks 

and disadvantages to circumcision. 

You are the best person to determine what is in 

the best interest of your son, and we have included 

the following information to help you in making 

an informed decision. You can also talk to your 

baby’s doctor before deciding. If you do decide to 

have your son circumcised, we will ask you to sign a 

consent form. 

Why Do Some Parents Choose 

Circumcision For Their Sons 

Parents choose to have their sons circumcised for 

various reasons. In some cultures, circumcision is 

a religious practice. In other cultures, parents want 

their sons to look like the other men in their family 

or community. Some parents may be concerned that 

cleaning the foreskin will be difficult. Other parents 

choose to have their baby circumcised as a newborn 

as they know that a circumcision done in the first few 

months of life avoids the risks of general anesthesia, 

which is generally needed if the procedure is done 

later in life. 

Why Do Some Parents Choose Not To 

Have Their Sons Circumcised 

Most cultures do not commonly perform 

circumcision. The majority of boys with families 

from Asia, South America, Central America and 

most of Europe are not circumcised. Some parents 

believe the benefits of circumcision are not enough 

to warrant the surgery, or that the risks are too high. 

Some parents prefer that their sons choose for 

themselves when they are older. There has also been 

a concern that removing the foreskin will interfere 

with a man’s sexual experience. Recent research, 

however, shows this is not a concern. 

What Are the Potential Benefits of 

Circumcision 

There are several potential medical benefits of 

circumcision. In the first year of life, circumcised 

boys have a decreased risk of urinary tract infections. 

After the first year, however, the risk of a urinary 

tract infection is so low that circumcision provides 

no additional benefit. Removing the foreskin 

prevents the chance that the foreskin could cling 

to the head of the penis for too long or that the 

foreskin could stay in a retracted position. Although 

there is a slightly decreased risk of cancer of the 

penis or sexually transmitted diseases in adult 

circumcised men, the overall risk is very low if a 

boy/man cares for his foreskin properly and has low 

risk-taking behaviors. 

39

What Are the Risks of Circumcision 

As with any surgical procedure, there are risks 

associated with circumcision. These risks are low, 

however, when a skilled physician performs the 

circumcision. The possible risks include: 

• Inflammation of the Glans (Head of the Penis) 

or Urethra—There is a slightly increased risk of 

having inflammation of the glans or urethra. This 

is most common in boys in their first year. Chronic 

inflammation of the urethra can lead to scarring and 

difficulties urinating. 

• Bleeding—Less than 1% of circumcisions. Most 

bleeding is minor and managed easily by applying 

pressure to the penis. Occasionally, a special clotting 

material is applied. Sutures are rarely needed. 

• Infection—Less than 1% of circumcisions. We 

can easily treat most infections with topical or 

oral antibiotics. Rarely, intravenous antibiotics are 

required. 

• Surgical Error—Some cases involve removal of too 

much or too little foreskin, which causes problems 

with adhesions or the need to have a second 

circumcision. Rarely, there can be serious problems 

including damage to the head of the penis. 

• Death—A few babies in the United States have 

died following complications of a circumcision. 

Are There Reasons Why a Circumcision 

Should Be Delayed 

Reasons you should not perform a circumcision 

during infancy include: 

• Problems with Blood Clotting—If there is a 

family history of a bleeding problem, such as 

hemophilia, you should test your baby to make sure 

his blood clotting is normal. A vitamin K 

shot given prior to the circumcision can help 

prevent bleeding. 

• Abnormal Anatomy—If your child has an 

abnormality of the foreskin, urethra or penis, 

your baby’s physician may recommend delaying 

circumcision. In some cases, doctors will not 

discover the abnormality until they begin the 

circumcision. If this is the case, it is best to stop 

the circumcision. In these cases, the doctor will 

suture the foreskin or allow it to heal on its own. 

Your doctor will then refer your child to a pediatric 

urologist and the circumcision will be done at a 

later date. 

• Unstable or Sick Baby—Circumcision should not 

be performed if your baby is not healthy or stable. 

This means that a circumcision should not be 

done if your baby is having feeding, temperature 

or breathing problems. It should also be delayed if 

it the doctor suspects your baby has an infection. 

Pain Control For Circumcision 

All research studies show that newborns feel pain 

during circumcision. Research also shows that 

newborns can remember painful events. If your baby 

is going to have a circumcision, he should be given 

the best pain control available. Current research 

shows that a small amount of lidocaine, injected 

at the base of the penis, is the best method of 

pain control. There may be a small bruise from the 

injection. 

We will restrain your baby’s legs with Velcro straps, 

but swaddle his arms and upper body in a warm 

blanket. We will offer your baby sugar water on a 

pacifier or gloved finger, as it has also been found 

to reduce a baby’s discomfort during circumcision. 

We encourage parents to be there during the 

circumcision to help comfort their newborn. 

After the circumcision, babies may be fussy, sleepy, 

not feed as well or show mild elevations in their 

heart and breathing rates. These problems are most 

often short-lived, however. Offer your baby a feeding 

as soon as he returns from his circumcision, as he 

will likely become sleepy for several hours after the 

procedure. 

How Is Circumcision Done 

There are three different techniques used to perform 

a circumcision. Each method involves estimating the 

amount of skin to be removed, dilating the opening 

of the foreskin, checking for normal anatomy, 

placing an instrument over the end of the foreskin, 

crushing the tissue, and then cutting away the 

foreskin. No particular circumcision method is better 

than the other is. 

If you choose to have your son circumcised, your 

baby’s physician will discuss the risks and benefits 

of circumcision and which method will be used. 

Your doctor will examine your baby’s health before 

performing circumcision; he must be considered 

healthy. The procedure is usually performed within 

40

the first few days of life, but can be delayed several 

weeks if the infant is having medical problems. 

Caring For the Circumcised Penis 

After the procedure, we will apply petroleum jelly 

to the end of the penis. Your nurse will check the 

circumcision site for bleeding within an hour of the 

procedure. A small amount of bleeding is 

normal. If there is excessive bleeding, your nurse will 

apply pressure and/or a special clotting material. 

The circumcision should be well healed within a 

week to 10 days. Until the skin is completely healed, 

you should: 

• Clean the area with warm water during diaper 

changes. 

• Avoid applying friction or using diaper wipes, 

which may irritate the unhealed skin. 

• Gently push back the shaft skin if it has slid up 

onto the head of the penis. 

• Apply petroleum jelly to the head of the penis. Do 

not apply petroleum jelly if a Plastibell ® is used. 

It is normal for a yellow film to form as part of the 

healing process. Do not remove this yellow film, as it 

will delay healing. At the first clinic visit, your baby’s 

physician will be able to look at the circumcision site 

to make sure it is healing properly and not infected. 

If your baby had the Plastibell ® circumcision, a 

plastic ring will remain on the tip of the penis. This 

ring usually falls off within five to eight days. Notify 

your doctor, if you notice that: 

• Your baby does not urinate normally within eight 

to 12 hours of the circumcision. 

• There is persistent or increased bleeding. 

• A yellow fluid (pus) oozes from the circumcision 

site. 

• Redness at the head of the penis worsens after 

several days, or spreads from the incision to other 

areas of the penis. 

41

Bathing Your Baby 

Every day, wash your baby’s face, neck folds and hands. You should cleanse the diaper area with every diaper change. 

A full head-to-toe bath is only necessary one or two times a week. If you wish to bathe your baby more often, just 

omit using soap for some baths. Too much soap can dry your baby’s skin. 

Tips For Bathing Your Baby 

• Wash hands before handling your baby. 

• Give the bath in a warm, draft-free area. 

• Give the bath when your baby does not have a full 

stomach. 

• Pick a time when you have energy and are not 

hurried. 

• Collect all your supplies before you begin. 

• Test for a comfortable water temperature with the 

inside of your wrist. 

• Never leave your baby unattended on a flat surface 

or near water. 

• Minimize shampoo and detergent soaps in the 

bath water, as they can cause irritation. 

• Your baby may cry during the bath; it is an 

unfamiliar experience. Comfort your baby by 

talking in a soothing voice, 

singing and using smooth 

movements. 

Bath Supplies 

• Mild soap, shampoo and 

scalp brush. 

• Washcloth and towels. 

• Warm water in a tub, basin or 

sink. 

• Clean baby clothing, diaper and blanket. 

• Lotions, oils and powders are not necessary. Just 

keep your baby clean and dry. 

Sponge Bath 

Until the umbilical cord falls off and circumcision 

heals, you should bathe your baby by sponge bath. 

You will need a basin or sink full of warm water. 

Place your baby on a safe, flat surface, which you 

have covered with a towel. Before undressing your 

baby, wash these areas: 

Eyes 

Use the corner of a clean washcloth to wipe from 

the inner to outer corner of your baby’s eye. Use 

another clean corner for the other eye. 

Face 

Wash her face with water only. You do not need to 

use soap on the face. 

Ears 

Wrap the washcloth around your finger to clean your 

baby’s outer ear and behind the ears. Do not use a 

Q-Tip ® in the ear. 

Hair 

Lean your baby back slightly and wet his hair with 

the washcloth. Apply a drop or two of shampoo to 

your baby’s hair. Work it through the hair with 

a scalp brush, gently massaging the scalp. 

Remember that normal handling will 

not harm the soft spots. Hold your 

baby over the sink or basin and 

rinse out the shampoo using a cup 

of water or a saturated washcloth. 

Use a dry washcloth or towel to 

dry your baby’s head well. 

Next, undress your baby to the waist. 

• Wash the folds of the neck, the chest, abdomen, 

arms and hands. Roll your baby onto the side 

and wash her back. 

• Dry above the waist and cover that area with a 

towel to keep your baby warm. 

Next, remove the diaper and clothing below 

the waist. 

• Remember, it’s common for babies to urinate 

when the diaper comes off! 

• Wash the legs and feet. 

• Wash the diaper area. 

• Dry your baby and redress. 

42

Tub Bath 

When the cord has fallen off, you may place your 

baby in a basin or tub of water. Wet babies can 

be slippery, so it’s easier to start with a small tub 

designed for babies. Place a towel or bath sponge 

on the bottom of the tub to help keep 

your baby steady as you support her 

in the tub. Test the water temperature 

before using it. Before undressing your 

baby, wash her eyes, face and ears as 

described in the sponge bath section. 

“This is your baby; 

hold him and snuggle 

whenever you want.” 

Next, undress your baby and securely lower her into 

the tub. Always hold onto your baby with one arm 

supporting her back. Wash your baby’s hair following 

the instructions in the sponge bath section. Then: 

• Using your soapy hand or a small washcloth, wash 

the neck folds, chest, stomach, arms, 

hands, legs and feet. Rinse. 

• Lean your baby slightly forward and 

wash the back. Rinse. 

• Finish up by washing and rinsing the 

diaper area. 

• Dry your baby and redress. 

43

Jaundice 

Jaundice is a yellow discoloration of the skin often seen in newborns. The newborn’s red blood cells release bilirubin, 

the pigment that causes jaundice. Jaundice is most noticeable two to four days after birth. You will first see jaundice 

on a baby’s face. It then moves down the body to the chest, stomach and legs. Jaundice usually disappears within one 

week, but it can sometimes take several weeks to disappear. 

Most babies have mild jaundice and will not have 

problems. When bilirubin levels get high, babies 

can get sleepy and have a difficult time feeding. 

Extremely high levels of bilirubin can cause brain 

injury. Full-term healthy infants are at low risk for 

injury from jaundice unless these levels get very high. 

Premature and sick babies, however, may be affected 

by jaundice at lower bilirubin levels. If your baby 

seems more jaundiced than what is normal, the 

doctor may order a test to check his bilirubin level. 

Babies with the following risk factors are at increased 

risk of developing significant jaundice and should be 

followed closely. 

• Blood group incompatibility 

• Jaundice observed in the first 24 hours 

• Gestational age 35-37 weeks 

• A sibling who received treatment for jaundice 

• Significant bruising 

• Poor feeding 

• East Asian race 

If your baby appears jaundiced, or is at risk 

of becoming jaundiced, you can follow these 

suggestions to prevent the jaundice from increasing: 

• Feed baby frequently. Feed your baby at least 

every two to three hours, and until she is content. 

The more your baby feeds, the more she will stool. 

More frequent stools help clear the bilirubin. 

• Continue to breastfeed your baby. Breast milk 

is rarely a cause of jaundice. Breastfeed your baby 

more frequently, at least eight to 10 feedings a day. 

• Have your baby seen one to two days after you 

leave the hospital. Your baby’s physician will 

determine if the jaundice is increasing. If your baby 

is more yellow, more sleepy or feeding poorly, call 

for an earlier appointment. 

We can use phototherapy to treat significant jaundice. 

Phototherapy is a special blue light that breaks down 

bilirubin in the skin, making it easier for babies to get 

rid of the bilirubin through their stool. 

When your baby has more jaundice than normal, 

your baby’s physician may choose to use a 

“biliblanket” or bilibed. This may be used at home. 

If your baby’s jaundice is more severe, the doctor 

may recommend using special phototherapy lights 

at the hospital. 

44

Recognizing Illness 

Illness in a newborn can be a serious and life-threatening event. It is important to recognize the early signs of 

illness (see the inside cover for signs) and report these to your doctor. 

Taking Temperatures 

Ask your nurse to demonstrate how to take your 

baby’s temperature, both rectally and under the arm. 

Practice each method before you go home with your 

baby. 

Types of Thermometers 

You will go home with a digital thermometer. 

Digital thermometers are inexpensive and accurate. 

Ear thermometers may be expensive and difficult 

to use. They are not recommended for infants. 

Fever strips placed on the forehead and pacifier 

thermometers are not accurate and are not 

recommended. 

How to Take a Baby’s Temperature 

To take an underarm temperature, turn the 

thermometer on, slip the thermometer underneath 

your baby’s clothes and place the bulb end in your 

baby’s armpit (skin to skin). Hold your baby’s arm 

down over it. Wait for the thermometer to beep. 

Your doctor may ask you to take a rectal temperature 

if your baby is ill. Lubricate the end with a petroleum 

jelly product. Place a diaper under your baby’s 

bottom. Lay your baby on his tummy. Use your free 

hand to hold and gently separate your baby’s bottom 

while inserting just the silver tip of the thermometer 

into the rectum. Once inserted, hold your baby and 

thermometer securely. Use a plastic thermometer 

sleeve or wash thoroughly when finished. Nursing 

staff will demonstrate temperature taking before you 

go home. An underarm temperature is slightly lower 

than a rectal temperature. 

When to Take a Baby’s Temperature 

If your baby seems uncomfortable and warm, do not 

rely on touch; take your baby’s temperature. 

Normal temperatures ranges: 

Rectal: 97.9° to 100.4° F (36.6° to 38° C) 

Axillary (under arm): 97.5° to 99.1° F (36.4° 

to 37.3° C) 

You should report a rectal temperature greater 

than 100.4° F during your baby’s first two 

months. A low temperature may also be a sign 

of illness; report a temperature less than 97°F. 

Using A Bulb Syringe 

We suggest you keep a bulb syringe handy in your 

home, and bring it with you when you leave your 

house with your baby. You may use a bulb syringe 

to clean your baby’s nose and mouth of formula or 

mucus on occasions when your baby spits up, has a 

stuffy nose or sneezes. (Babies sneeze to try to clear 

their noses.) 

To use a syringe: 

• First, squeeze the bulb until you collapse it. 

• Place it in one nostril and quickly release the bulb. 

This will bring the spit-up or mucus into the bulb. 

• Remove the bulb syringe from the nose and 

squeeze the bulb quickly into a tissue to get rid of 

collected material. Repeat for the other nostril and 

mouth, if necessary. 

To clean a syringe: 

• Each day you use the bulb syringe, clean it with 

hot soapy water. 

• Rinse in hot water. 

• Be sure to clean the inside of the bulb by 

squeezing the bulb while the tip is in the soapy 

water. 

• Rinse by repeating the procedure with clean hot 

water. 

• Discard after any illness and use a new syringe. 

45

Common Signs Of Illness In A Newborn 

Infants have a number of ways to signal that they are 

ill. Call your baby’s doctor if you notice any of the 

following: 

• Rapid or changed breathing pattern—Infants 

frequently have irregular breathing patterns. It 

can be normal to take several rapid short breaths, 

followed by a short pause of up to 10 seconds. 

You should report longer pauses of non-breathing, 

particularly those associated with color changes. 

A consistent respiratory rate of more than 60 per 

minute, and grunting or flaring of the nostrils can 

indicate breathing difficulty. You need to report 

this to your baby’s doctor. 

• Difficulty arousing—Newborns tend to be 

sleepy, and you may have to wake 

your baby even to feed. If she sleeps 

for more than four or five hours 

and you are unable to wake her with 

reasonable stimulation, call your 

doctor. 

• Poor feeding—Infants vary in their 

frequency, duration and interest in 

feeding. If you feel that you are having problems, 

refer to the Nutrition and Feeding section starting 

on page 21 for helpful hints. Notify your physician 

if there is a sudden change in your child’s ability to 

feed or the feeding does not improve when you try 

some of the recommendations. 

• Floppiness—You need to report a reduced 

amount of movement or loss of muscle tone. 

• Repetitive vomiting—Frequent forceful vomiting 

can indicate an illness such as an infection or 

an obstruction. You need to distinguish it from 

common spitting, which may be effortless or 

forceful, is frequently associated with burping and 

is not serious. 

Trust your instincts. If 

you suspect that your 

infant is ill, seek advice 

from your doctor. 

• Diarrhea—Healthy infants may have loose, seedy 

stools as frequently as every feeding. If the stool 

is bloody or completely watery, contact your 

physician. This may indicate an intestinal infection 

or feeding intolerance. 

• Color Changes—A change in skin color can 

indicate a health condition. Be sure to contact your 

doctor if you notice any of the following: 

Blueness of the lips, gums or tongue—Report these 

as it can indicate a heart problem. However, a blue 

color to the hands and feet is very common, not 

dangerous and is produced because infants have 

thick blood and poor circulation. 

Paleness—Illness or anemia (low red blood cell 

count) can cause this. 

Yellowness—This coloration, called 

jaundice (see page 44), is common 

and starts at the head and progresses 

downward. If the yellow color 

progresses to the lower abdomen and 

thighs, you need to report this to your 

baby’s doctor. 

• Boils, Pustules, Blisters—These can be seen with 

significant skin infections that need to be evaluated 

and treated. 

• Foul-smelling or reddened umbilical cord— 

Serious infections can enter the body through the 

umbilical cord. The first signs of infection are 

redness and swelling around the umbilical cord 

and a foul smell. See page 38 for instructions on 

how to clean the cord to reduce the likelihood of 

an infection. 

46

Why And When Do Babies Cry 

Crying is one way that newborns communicate 

their need for attention. Newborns cry an average 

of one to three hours per day. Most of the crying 

is associated with a need to communicate hunger, 

although crying is a late hunger cue. By responding 

early to feeding cues, you can help reduce the amount 

of crying in newborns (see page 24). Since babies 

are hungry at least every two to four hours, delayed 

response can result in increased crying. 

By the second or third week, babies 

begin to have periods when they are 

awake and fussy. This is often mistaken 

for hunger, but you may find that 

offering food does not interest your 

baby. Offering your baby a pacifier or 

thumb for non-feeding sucking may calm him down. 

Your baby’s fussy periods may become predictable. 

It is common for babies to be fussy in the late 

afternoon and evening. This is often a result of 

missed feeding cues. Babies often need to cluster 

feed during those times. The fussy period peaks at 

about six weeks old but may last up to three months. 

The Unusually Fussy Baby 

Normal babies can create unusual levels of anxiety 

or frustration in a family through long periods of 

crying. They are not constantly fussy like the “colicky 

baby” who is inconsolably fussy for much of the day. 

There is often no identifiable cause for this behavior. 

Some babies seem to be extraordinarily sensitive to 

their entire environment. They overreact to hunger, 

wetness, heat, cold, too much noise and even too 

much handling. Special techniques are required in 

such cases, but first you must be assured that this is 

not a cry of pain or illness. A discussion with your 

health care provider may help. 

The Crying Baby 

A baby’s cry is a way of controlling his environment, and represents a call for help. Studies show that responding early 

to a crying infant eventually reduces total crying time. Trust your intuition. If your baby’s crying is of unusual length 

or intensity, or if you are concerned the fussiness is due to illness, contact your baby’s doctor. 

An unsettled, fussy baby who cries inconsolably despite parents’ efforts to help can be frustrating. We offer these tips 

to help, yet sometimes there is no “cure.” 

“All babies are good 

babies, some are just a 

little easier to live with 

than others.” 

The Baby With Colic 

The truly colicky baby creates an especially stressful, 

but temporary, situation. These babies are unhappy 

“around-the-clock” day after day. A colicky baby’s 

entire body is tense. Often he pulls his legs toward 

his belly, clenches his fists and has a look of agony 

on his face. The crying is often very high pitched. If 

nothing seems to give your baby comfort, call your 

baby’s doctor to seek advice. 

Tips To Help Settle A Fussy 

Baby 

First, check to see if your baby is 

hungry, has a soiled diaper, or needs a 

position change. 

Other Suggestions: 

• Place your baby skin-to-skin (see page 12). This 

contact with your body, so that she can feel your 

warmth, heartbeat and breathing, is often enough 

to calm your baby. 

• Swaddle him in a light blanket. 

• Try burping. Babies swallow air after long periods 

of crying. Burping relieves the ache. 

• Stroking, patting or massaging can be soothing. 

• Try soft music, swings, rockers, fans or walking 

with the baby. 

• If crying is due to over stimulation, reduce 

stimulation by darkening the room, turning off 

the TV or radio and setting your baby down. 

Sometimes white noise, like the sound of a fan 

or vacuum cleaner, a swooshing sound with 

your voice or a radio station with static will help 

re-center your baby. 

• Use a baby sling. It can provide comfort while 

leaving your arms free to do other things. 

• Offer a warm bath. 

47

The Five “S’s” Of Settling 

Another recommended approach is outlined in the 

book and DVD, The Happiest Baby on the Block, by 

Dr. Harvey Karp, MD. This approach combines the 

following system of five “S’s”. 

1. Swaddling—Tight swaddling stops your baby’s 

uncontrolled arm and leg movements and satisfies 

his longing for the continuous touch of the 

womb. 

2. Side/Stomach position—Although babies should 

not sleep on their sides or stomachs, this position 

can help calm your fussy awake baby. 

3. Swinging—Stillness can be unsettling for babies. 

Rhythmic, monotonous, jiggling or swinging helps 

to settle babies. 

4. Shhhhing—Loud, hard shushing that mimics the 

whooshing of blood flow through your arteries is 

like music to your baby’s ears. 

5. Sucking—Sucking helps babies relax. 

Parent’s Response 

Being responsive to a crying newborn will not 

spoil the child. Responding to your baby’s cry is 

comforting and helps her learn that the world is 

safe. She will feel protected and learn to trust in you. 

When you are sure the crying is not from hunger, 

use comforting measures other than food. This helps 

your baby learn to communicate different needs 

to you. 

If you have looked for all of the causes, and tried all 

the “cures,” it can become increasingly stressful for 

the entire family. Take time for yourself: take a bath, 

get outside, go shopping or call a friend. 

No matter how impatient or angry you feel, 

NEVER SHAKE A BABY, EVER. Be patient. Your 

baby is not crying to irritate you. Crying is your 

baby’s response to an internal need to cry. 

“The fussing noise 

won’t seem so loud if 

you both go outside.” 

Shaken Baby Syndrome 

What is Shaken Baby Syndrome 

Babies or small children who suffer injury from 

severe shaking or jerking are victims of Shaken Baby 

Syndrome. Sometimes a young child’s cry can be 

more than a parent can cope with. In frustration, 

they may shake their baby to get his attention or to 

make him stop crying. Babies can die from being 

shaken. 

The Children’s Trust Fund (Child Abuse and Neglect 

Prevention Board) has information related to shaken 

baby syndrome. 

What injuries does shaking cause 

Shaking a baby can cause injury to the brain and may 

result in: 

• Impaired motor and 

cognitive skills 

No matter how 

• Blindness 

impatient or angry 

• Cerebral palsy 

• Hearing loss 

you feel, never, ever 

• Spinal cord injury 

shake your baby. 

• Paralysis 

• Seizures 

What are some signs that my baby may have 

been shaken 

• Trouble sucking or swallowing 

• Decreased appetite 

• Trouble sleeping 

• Increased fussing or irritability 

• Vomiting 

Severe symptoms of shaking include: 

• Difficulty breathing or turning blue 

• Unresponsive or lethargic 

• Convulsions or seizures 

• Loss of consciousness 

If your baby has been shaken, call 911 or 

take your baby to the emergency room right 

away. It is important that your baby receive 

immediate care. 

Beth, RN, NICU 

48

What Do I Do If I Feel Like I Am Losing 

Control With My Baby 

Have a plan for how you will keep your cool. If you 

feel so stressed that you fear you may harm your 

baby, seek support from your family, friends, health 

care provider and community groups such as the 

Parental Stress Center (608) 241-2221. 

If You Feel Like You Are Going To “Lose It” 

Use The “Rule Of 10” 

• Put your baby in a safe place. 

• Stay 10 feet away for 10 minutes. 

• Slowly count to 10 or take 10 deep breaths until 

you calm down. 

• Check on your baby and repeat as necessary. 

49

Infant Safety 

Issues about safety and childproofing your home will continue to change as your baby grows. The following tips are 

helpful during your baby’s first few months. 

Safety For 0-2 Mounth Old 

• Preventing Infant Abduction 

Consider that it is no longer as safe as it once was 

to place your baby’s birth announcement in the 

newspaper or display outdoor decorations on your 

home. Never leave your baby unsupervised for any 

reason. Keep him in view at all times in public places, 

and do not leave him alone in a parked car. 

• Emergency Numbers 

Place emergency numbers by your telephone 

(doctor, poison control center and ambulance). In 

Dane County, dial 911 to contact the police, fire 

department or ambulance. 

• Smoke Alarms/Carbon Monoxide Detector 

If you don’t already have them, now is a good time 

to install smoke alarms and a carbon monoxide 

detector in your home. Regularly check and change 

the batteries. 

• Window Blind Cords 

Long, dangling pull cords for window coverings 

can present a danger for young children. Check 

cords to be sure there are no dangerous loops in 

which a curious child could become entangled 

or possibly strangle. You can easily correct this 

problem by installing tassels especially designed 

for this purpose. Tassels are available from some 

window-covering retailers. For more information, 

check with your health care provider. 

• Cribs 

Some older cribs have large openings between 

slats and are not safe. When babies begin to move 

about, they may become trapped and badly injured 

between the slats. For your baby’s safety, measure 

the space between the slats. There should be less 

than 2 3/8” between each slat. 

• Smoking 

We advise all mothers of newborns and young 

children to stop smoking, and not expose an 

infant or child to smoke in your home or car. 

Children exposed in their early ages to the effects 

of nicotine and cigarette smoke are more likely to 

develop breathing and asthma problems. If you 

need help to quit smoking, please talk to a health 

care provider. The Wisconsin Tobacco Quit Line 

offers free support and information about how 

to quit smoking. Call 1-877-270-7867 for more 

information. 

• Alcohol 

Drinking alcohol can impair your ability to care for 

your baby safely. Have a back-up plan when you 

are unable to provide safe care for your infant. 

• Bath Safety 

Set your water heater to a maximum of 120° F to 

prevent hot water burns. Bath water should not 

be more than 100° F. Always provide direct adult 

supervision when children are near water. 

Preparing Your Pet For Baby 

Although most pets adjust to having a new baby in 

the household, many initially experience something 

like sibling rivalry. The following suggestions may 

help your pet adjust to your new baby. 

• Before you bring your baby home, have your 

husband/partner take something (such as a 

blanket) with the baby’s scent on it for your pet to 

investigate. 

• Be prepared for a pet that is eager to greet you 

and receive attention when you return home from 

the hospital. If possible, have someone other than 

mom carry your baby into the house. 

• Less attention or increased scolding may make 

your pet feel stressed as it adjusts to your new 

baby. Spend quality time with your pet each day. 

• Reward your pet with treats for appropriate 

behavior. 

Closely supervise your pet around the baby not only 

in the early weeks, but also as your baby becomes 

more mobile and curious about the pet. 

For more information go to www.petsforlife.org. 

50

Finding Childcare 

(The City of Madison Office of Community Services 

provided some of the following information.) 

Choosing quality care for your child is an important 

decision. Make sure to begin looking for childcare 

early and take time to visit and talk with many 

providers before choosing one. Some questions you 

can ask are: 

• Will my baby be safe (Safe and clean toys, 

stairways, outlets, etc.) 

• Will they treat my baby as a special person with 

her own needs, feelings and personality 

• Will they respect our cultural and 

family values 

• Is the provider patient, open, trained, experienced 

• Will they smile at, talk to, play with, cuddle and 

hold my baby 

• Will they focus on what my baby should do rather 

than on what my baby should not 

• Will they feed my baby as I ask them to, and 

provide healthy meals and snacks 

• Will they welcome me to visit at any time 

• Will my child have active playtime, quiet playtime, 

reading and story telling, music and art 

• Are children there happy and relaxed 

Community Resources for Finding Childcare 

• Community Coordinated Child Care (4C) 

................................................................(608) 271-9181 

• Madison Child Care Assistance Program 

................................................................(608) 267-4996 

• Dane County Parent Council............(608) 275-6740 

Car Seats 

For months, you have been careful to keep your 

unborn child safe. Continue to do this by using a 

car seat correctly. You must have a car safety seat 

and know how to use it for the ride home from the 

hospital. 

State of Wisconsin law requires all children who 

weigh less than 80 pounds, are shorter than 4-foot-9 

or under age 8 to sit in child safety seats. 

Four out of five car seats are used incorrectly. 

Be sure yours is not one of them! Read car seat 

instructions and your automobile manual to 

understand how to use your car seat properly. Also, 

refer to the Safe Ride News fact sheet located in 

your patient folder, titled “This is the Way the Baby 

Rides.” 

Car seats keep infants safe while traveling in the car 

but they can be unsafe if they are used for sleeping. 

It is recommended that you move your sleeping baby 

to their crib when you arrive home. 

Beware of used car seats. Do not use a car seat that 

has been in a crash or is more than 5 years old. Many 

car seats have been recalled. Call 1-800-424-9393 to 

get recall information. 

Prior to going home view the car seat DVD which is 

available from your nurse. 

To schedule a FREE car seat inspection before or 

after your baby’s birth, contact (608) 890-8999 

51

Sleeping 

Newborns sleep an average of 13-14 hours out of 24 

hours. They will usually have one sleep stretch of four 

to five hours. Their sleep pattern is irregular during the 

early weeks. Between six weeks to three months, they 

may begin to sleep more hours during the night. 

Your baby may have her days and nights mixed up. To 

encourage more nighttime sleep, try the following: 

• Wake your baby up at least every three hours during 

the day and evening. This reduces the number of 

hours slept and will allow your baby to eat more 

frequently during these hours. 

• During the night, minimize stimulation when your 

baby awakes. Keep lights low, feed your baby in the 

same room she sleeps in, talk softly and minimally, 

keep baby warm and change her diaper only if 

necessary. 

Reducing The Risk Of Sudden Infant 

Death Syndrome (SIDS) 

What is SIDS 

• It is the sudden death of an infant under 1 year, 

which remains unexplained after a thorough case 

investigation that includes a complete autopsy, 

examination of the death scene and review of the 

clinical history. 

• It is rare during the first month, peaks between the 

second and third months, then decreases. 

• Since 1994, when the Back-to-Sleep program was 

introduced, there has been a 50% reduction in SIDS. 

Risk Factors for SIDS 

• Maternal smoking during pregnancy and exposure to 

cigarette smoke in infancy 

• Sleeping on stomach 

• Sleeping on a soft surface and/or blankets/bedding 

over face 

• Overheating due to warm environmental 

temperature or over-bundling 

• Late or no prenatal care 

• Young maternal age 

• Preterm or low birth weight infants 

Infant Sleep 

Although we associate the phrase “sleep like a baby” with good sleep, your newborn’s sleep behaviors will likely leave 

you yearning for more sleep! Usually it takes months for your baby to develop a sleep pattern and begin to sleep long 

hours during the night. 

While in the hospital, infants are required to sleep 

independently in their crib 

Reducing The Risk Of SIDS 

1. Place infant to sleep on his back. Side or stomach 

sleeping are not considered safe positions for 

infants. 

2. Use a firm sleep surface. 

3. Keep soft objects and loose bedding out of the crib. 

4. Do not smoke during pregnancy. 

5. We recommend a separate, but proximate, 

sleeping environment. 

• The American Academy of Pediatrics recommends 

that the infant’s crib, bassinet, or co-sleeper be 

placed in the parents’ bedroom. 

• Sharing the bed with your baby is not 

recommended. 

• While in the hospital, infants are required to 

sleep independently in their crib. 

• Parents of multiples should place babies in 

separate cribs. 

6. Consider offering a pacifier at naptime and 

bedtime. 

• One SIDS death can be prevented for every 2,700 

infants who use a pacifier when placed for sleep. 

• Use the pacifier when placing the infant down for 

sleep and do not reinsert it once the infant falls 

asleep. 

• If the infant refuses the pacifier, do not force your 

baby to take it. 

• Do not coat pacifiers in any sweet solution. 

• Clean pacifiers often and replace them regularly. 

• Delay pacifier introduction for breastfed infants 

until one month of age to ensure that breastfeeding 

is firmly established. 

7. Avoid overheating. 

8. Avoid commercial devices marketed to reduce the 

risks of SIDS. 

9. Do not use home monitors as a strategy to reduce 

the risk of SIDS. 

10.Avoid development of flat head by encouraging 

tummy time, avoiding excessive time in car carriers 

and bouncers and alternating the side of the head 

your infant sleeps on. 

52

To prevent flat head molding due to back 

sleeping, remember the slogan: “Back to Sleep 

Tummy to Play” see page 54 for more information 

on the importance of Tummy Time in 

play section. 

Infant Sleep and Awake States 

Your baby has different levels or “states” of waking 

and sleeping. When you can recognize the state your 

baby is in, you will know the best time for feeding, 

holding and interacting with your infant. Babies go 

through many states each day. 

Deep Sleep 

This is the most restful sleep state. In this state, your 

baby is still and may be hard to wake. Breathing is 

very regular and facial expression is relaxed. Studies 

show that brain growth is at its maximum during 

deep sleep. 

Light Sleep 

In this state, your baby moves more and breathing is 

not as regular. You might notice a grimace, frown or 

twitch. Your baby may also smile, sigh or whimper. It 

is easier to wake your baby up from this sleep state. 

Drowsy State 

In this state, your baby is just starting to wake up or 

move toward sleep. The eyes may be open or closed. 

Your baby may move around some, whimper and 

grimace, and will look tired in this state. 

Quiet Alert 

This state is most enjoyable for you and your baby. 

Your baby’s eyes are wide open and bright. The baby 

is quiet but looks very interested. You almost feel 

as if your baby is saying, “Please talk to me, I want 

some attention.” When babies begin getting into an 

alert state it will be for short periods. As they get 

more mature, their alert periods get longer. This is a 

good time to start a feeding. 

Active Alert 

In this state, your baby is awake but is more active 

and may be somewhat fussy. The eyes may or may 

not be open. 

Crying 

In this state, your baby is crying intensely, more than 

just fussing or whimpering. 

53

Playing/Development 

Take time every day to enjoy and play with your baby. 

This can be a fun time for you and your baby, and 

can enhance your baby’s development. Playing with 

babies helps them gain weight faster, smile, roll over, 

crawl and walk sooner. Play with your baby when he 

is awake and quiet. 

When your baby’s attention is on you, he will turn 

toward you or an attracting object, stretch fingers 

and toes, and slow down his body actions. Soon your 

baby will smile or make happy sounds and let you 

know this time is enjoyable. Watch and listen to your 

baby—when he is ready to finish playing, you will see 

him yawn, look away or cry. 

Here are some key points to remember as you 

promote your baby’s healthy development. Keeping 

these in mind, you can raise healthy, happy children. 

• Be warm, loving and responsive. 

• Respond to your baby’s cues and clues. 

• Talk, read and sing to your baby. 

• Remember that your child is unique. 

• Take care of yourself. 

The Importance Of Tummy Time 

Babies spend so much time on their backs while 

sleeping and while in their car seats that they are 

at risk of developing flat heads and delaying neck 

muscle development. To help prevent this, start 

“tummy time” right away by placing your baby on 

his tummy often when he is awake. Do not delay. 

Some babies spend their tummy time while being 

held. Others are content to be flat on the floor. Some 

prefer to be propped on a pillow or boppy. If your 

baby is unhappy with tummy time, find ways to make 

it more interesting by adding colorful toys, music and 

other distractions. 

Touch 

Hugs, kisses, cuddling and holding are the best 

touches to your baby. Do not be afraid to do these 

things—you will not spoil your baby. 

Massage and stroke your infant. Your baby enjoys 

the skin-to-skin contact. You can do this during bath 

time or any time. Touch and stroke your baby’s skin 

with different textures or materials. Your baby will 

also like to suck on a finger, thumb, fist or pacifier. 

Motion 

Rocking, carrying and swinging feels good to babies. 

Take your baby for a ride in a carriage or stroller. 

The ride and the fresh air are good for both of you. 

These activities also encourage the development of 

balance. 

Hearing 

Guidelines of Hearing Development 

Hearing loss may happen as your baby grows. This 

checklist describes normal hearing development. 

Refer to this list to see how your baby is doing. Not 

all children will fit this list exactly. Contact your 

baby’s doctor if you have any concerns. 

At birth, babies: 

• Feel soothed by your voice. 

• Awaken at loud sounds. 

• Startle or cry at noises. 

At three months, babies: 

• Seem to recognize mother’s voice. 

• Stop playing and appear to listen to sounds or 

speech. 

• Smile when spoken to. 

• Try to turn toward the speaker. 

Vision 

Your baby likes to look at faces. Hold your baby so 

your face is close enough (10-12 inches) for eye-toeye 

contact. You can also hold your baby to a mirror. 

Babies like dark and light or black-and-white objects 

best because they offer a strong contrast. Bull’s-eyes, 

checkerboards, small stuffed toys and black-andwhite 

mobiles are all good sight stimulators; you can 

make them inexpensively. 

Smell 

Babies enjoy the smell of household cooking odors. 

They also enjoy the smells of your perfume and 

lotions. They soon know the smells of mom and dad. 

54

Sibling Relationships 

Most families experience growing pains with the addition of a new baby. Your older children may need assurance that 

your baby is a family addition, not a replacement. Assure your children that there is plenty of love to go around and 

that each child is special. 

In The Hospital 

Hospital Visits 

Older siblings often want to be the first visitors to 

see the baby. Try to schedule the first visit without 

other visitors present, and when the child is well 

rested and fed. 

Keep your baby in the crib until the child is ready 

to meet her. This keeps mom’s arms ready for a big 

hug and greeting. Some families like the children to 

exchange a small gift. 

Base the length of the visit on the child’s behavior. 

Sibling visits are important, but set aside some time 

for just mom, dad and the new baby. 

At Home 

Baby’s Homecoming 

Some families make the trip home from the hospital 

a family event. Others prefer to have the older 

children wait at home for your baby to arrive. Mom’s 

arms should be free and ready to receive the older 

children. 

Visitors 

If possible, delay visitors for a few days to keep the 

family focused on each other. Children have enough 

trouble sharing their parent’s attention with the new 

baby. 

When visitors do arrive, encourage their attention 

toward the older children. It’s nice to let the older 

children introduce the baby to guests and open any 

baby gifts they might bring. Visitors sometimes help 

by bringing a special treat or gift for the older 

children. 

Helping Your Child Adjust To The Baby 

Parents need to let the sibling relationship develop 

at its own pace, while at the same time providing 

guidance and support for sibling bonds. 

Your older child may surprise you with behaviors 

you have never seen before. Some children have even 

asked their parents to “take the baby back to the 

hospital.” 

It is important to understand the developmental level 

of the older child. Try to look at the world and your 

new baby through that child’s eyes. Just because there 

is a new baby, you cannot expect older children to 

behave more maturely than their age allows. 

You should relate changing roles and responsibilities 

for older children to their age rather than because of 

a new baby. Resist making other major changes in 

your older children’s lives until they have had time to 

adjust to the new baby. 

Visit your local library or bookstore for books on 

child development and sibling relationships. 

Siblings And Safety Issues 

Children, especially toddlers and preschoolers, are 

not aware of safe behavior around babies. Parents 

must set rules and teach appropriate behaviors. Here 

are several ways to increase your children’s safety: 

• Monitor your older child and baby until you 

feel comfortable leaving them in a room alone 

together. 

• Teach your older child how to gently touch and 

cuddle your baby. 

• Remind your older child not to throw things 

around the baby, to keep small toys out of baby’s 

reach and never put things in the baby’s mouth. 

• Make sure your older child is seated when holding 

a baby. Do not let your child walk while carrying 

the baby. 

• Emphasize that the older child should always 

support your baby’s head. 

• Teach proper use and safety around baby 

equipment such as swings, strollers and bouncy 

seats. 

• Utilize audio monitors can be helpful for listening 

to sibling interactions. 

55

• Audio monitors can be helpful for listening to 

sibling interactions. 

• Review your home’s childproof status. Your older 

child will have more alone time when you are busy 

with your baby. 

Common Adjustment Feelings And 

Behaviors 

When a new baby joins the family, it’s an adjustment 

for everyone. It is normal for older children to 

feel jealousy and anger, and to return to baby-like 

behaviors. 

It may seem kinder to “soften” consequences during 

this adjustment period. However, things will get back 

to normal faster if you stick with your regular limits 

and consequences. Remember, children thrive on 

predictable routines. Consequences for inappropriate 

behaviors should remain constant. 

Jealousy 

Being jealous of a new little brother or sister is 

natural—your older child does not want to share you! 

You can help your children overcome these feelings 

by reinforcing their sense of importance: 

• Take time to listen to and acknowledge feelings 

without being judgmental. Even when your hands 

are busy with the baby, your older children can 

have your eyes and ears. Letting children vent 

their negative feelings will reduce their feelings of 

jealousy and anger. 

• Let your older child help you care for the baby 

and feel part of the activity. At feeding time, pick a 

place where the older child can sit beside you. 

• Sometimes a special activity, short videotape, book 

on tape or snack can help your young helpers 

endure the baby’s feeding. Some children like to 

have their own doll to care for. 

• Spend “special time” alone with older children 

each day doing something they enjoy. 

• Give your older child a new privilege. Although 

it is sometimes hard to be the big brother/sister, 

remind older children that they can do things the 

baby cannot. 

• Praise older children for all their wonderful 

behaviors. 

Anger 

Many children feel anger at their parents as well as at 

the new baby. Parents can help the child vent anger 

in acceptable ways: 

• Acknowledge the child’s angry feelings, helping 

him put feelings into words rather than into 

physically harmful actions. 

• Remind your children that it’s not okay to 

hurt people, no matter how they feel. Use ageappropriate 

timeouts or privilege removal as 

consequences for behaviors such as hitting. 

• Help your children find ways to use up extra 

energy. Encourage physical activity such as playing 

outdoors. 

• Remember, tension is contagious. Remain calm. 

Regression 

Another common reaction among older children 

is returning to baby-like behaviors. They want to 

remain your baby, your focus. They see the baby 

getting lots of attention for dependent behaviors, so 

they want to become more dependent. Even schoolage 

children may request help with things they have 

normally done independently. 

• Treat regression matter-of-factly. Don’t punish 

these behaviors. Children may simply be curious 

and want to try the bottle, pacifier, etc. 

• Help them work it out by indulging them in 

the behavior. Then redirect them to their ageappropriate 

behaviors. 

• Praise their mature behaviors. 

• Make sure other caregivers understand and follow 

your approach to regressive behaviors. 

As a general rule, and as long as safety and sanity are 

in line, try to ignore the negative behaviors. Instead, 

praise, praise, praise the positive behaviors. 

56

Baby Blues 

The most common, least severe and best known of 

all postpartum reactions, “baby blues” are common 

during the first few days, usually appearing suddenly 

on the third or fourth day following delivery. 

Estimates are that 50-75 percent of new mothers 

experience a sense of let down after the emotionally 

charged experience of giving birth. 

These emotions are briefly unpleasant and usually 

disappear on their own, often as quickly as they 

came. Signs of the blues may include: 

• Crying for no apparent reason 

• Irritability 

• Impatience 

• Restlessness 

• Anxiety 

To help cope with the blues: 

• Rest when your baby sleeps 

• Eat healthy foods 

• Take care of yourself 

• Ask for and accept help from others 

• Take a break from your baby and let someone 

else care for the baby for a while 

Postpartum Depression 

New mothers may experience different levels of 

postpartum depression. Postpartum depression can 

occur within days or appear gradually, sometimes up 

to a year after delivery. Symptoms may include: 

• Nervousness and anxiety 

• Sluggishness 

• Exhaustion 

• Sadness and hopelessness 

Feelings After Birth 

Following the birth of your baby, many emotions are normal. Often, you will feel excitement and joy, along with relief... 

the long wait is finally over! 

Sometimes, however, women may experience emotions that are unsettling, even frightening. Mothers may feel overwhelmed, 

anxious or uncertain. Regardless of how much you prepared or how much you looked forward to your baby’s 

birth, this first year may include unexpected “lows.” Such emotions can affect any woman who has had a baby, regardless 

of how she felt after the births of previous children. 

The following information describes the common “blues” that new moms may feel, and more severe reactions that may 

require medical help. 

“Of all human experiences, 

birth is filled 

with more emotion 

than any other event.” 

57 

• Appetite and sleep disturbances 

• Poor concentration, memory loss and confusion 

• Over-concern for your baby 

• Uncontrollable crying 

• Lack of interest in your baby 

• Feelings of guilt or inadequacy 

• Fear of harming self or baby 

• Inability to care for self or baby 

Mothers suffering from postpartum depression may 

experience one or more of these symptoms in any 

combination. They may change from day to day, with 

good days alternating with bad. Symptoms may range 

from mild to severe. 

If you experience any of the above 

symptoms for more than a week, let 

your health care providers know. Tell 

them how you are feeling. The sooner 

you seek help, the sooner you will feel 

better so you can enjoy your new baby 

and your lives together. 

Postpartum Psychosis 

Postpartum psychosis, while quite rare, is a serious 

emergency and requires immediate medical attention. 

The psychosis usually develops within the first two 

weeks after delivery. 

Symptoms are much exaggerated and may include: 

• Insomnia 

• Hallucinations 

• Agitation 

• Bizarre feelings and behavior

Treatment for Postpartum Depression 

Disorders 

Treatment for these conditions varies with the 

symptoms. In some less severe cases, the symptoms 

disappear on their own. In more severe cases, 

medication and therapy are helpful. Regardless of 

the type or severity, these symptoms are temporary 

and treatable with support and skilled professional 

help. The “ideal” treatment plan includes medical 

evaluation, psychiatric evaluation, psychotherapy and 

participation in a support group. 

Resources for Postpartum Depression: 

• The National Women’s Health Information 

Center —www.4women.gov 

• Maternal and Child Health Hotline— 

1-800-722-2295 

This statewide comprehensive service provides 

information, around-the-clock, about many 

topics on maternal and child health. It includes 

resources for help with postpartum depression. 

The Wisconsin Department of Health and Family 

Services, Division of Public Health, Bureau of 

Family and Community Health sponsor this 

hotline. 

• Postpartum Support International— 

(503) 894-9459 or (800) 944-4773 or 

www.postpartum.net 

A volunteer listens to the reason for the call and 

then offers information, education and a referral as 

needed. 

Feeling Safe 

Violence in the home can be frightening and harmful 

to adults and children. Children need a safe and 

loving home where they do not have to grow up in 

fear. Children who have seen violence at home do 

not always become violent, but they may be more 

likely to try to resolve conflicts with violence. 

Your partner can perceive a new baby as threatening 

to your relationship. Now, you both have to share 

your time and attention with the child. In addition, 

having a child can lead to anger if the partner resents 

the added responsibility. 

If someone in your home physically or verbally 

hurts you or your child, help is available. Talk to your 

nurse or doctor, or call this 24-hour confidential 

helpline: (608) 251-4445 or 1-800-747-4045 (TDD/ 

Voice). You will reach Domestic Abuse Intervention 

Services (DAIS). Someone there can help with a 

safety plan—you do not have to give anyone your 

name. 

58

Edinburgh Postnatal Depression Scale (EPDS) 

How Are You Feeling 

We encourage you to use the following screening tool periodically throughout the first year after your baby’s birth to 

assess how you are feeling. Record the answer that comes closest to how you have felt in the past 7 days, not just how 

you feel today. 

Here is an example, already completed: I have felt happy: 0 Yes, all the time 

1 Yes, most of the time 

2 No, not very often 

3 No, not at all 

By circling 1, it would mean: “I have felt happy most of the time during the past week.” 

In the past 7 days: 

1. I have been able to laugh and see the funny 

side of things 

0 As much as I always could 

1 Not quite as much now 

2 Definitely not so much now 

3 Not at all 

2. I have looked forward with enjoyment to things 

0 As much as I ever did 

1 Rather less than I used to 

2 Definitely less than I used to 

3 Hardly at all 

3. I have blamed myself unnecessarily when things 

went wrong 


1 Hardly ever 

2 Yes, sometimes 

3 Yes, very often 

4. I have felt worried and anxious for no good 

reason 

3 Yes, quite a lot 


1 No, not much 


5. I have felt scared and panicky for no good reason 

3 Yes, quite a lot 


1 No, not much 


6. Things have been getting on top of me 

3 Yes, most of the time I have not been able to 

cope at all 

2 Yes, sometimes I have not been coping as well 

as usual 

1 No, most of the time I have coped quite well 

0 No, I have been coping as well as ever 

7. I have felt so unhappy that I have had difficulty 

sleeping 



1 Not very often 


8. I have felt sad and miserable 


2 Yes, quite often 

1 Not very often 


9. I have been so unhappy that I have been crying 



1 Only occasionally 

0 No, never 

10. The thought of harming myself has occurred 

to me 


2 Sometimes 

1 Hardly 

0 Never 

Total Score: 

• Add up the numbers circled for the 10 questions. 

• If you scored 10 or above, we recommend that 

you speak to your health care provider. 

• Mothers who score above 13 are likely to be 

suffering from a depressive illness of varying 

severity. 

59

Strengthening Your Pelvic Floor 

Muscles 

Strong pelvic floor muscles are vital to a woman’s 

health and sense of well-being. Your pelvic floor 

muscles are like a sling that supports your pelvic organs 

such as the bladder, uterus and rectum. These muscles 

are essential for bowel and bladder functioning, and 

contribute to the enjoyment of sexual intercourse. 

Pregnancy and childbirth can weaken these muscles 

in many ways. Below, we will explain how to get these 

muscles back in shape to prevent incontinence (the 

inability to hold back urine or stool) and increase your 

physical comfort during sexual intercourse. These 

gentle exercises can help you look and feel better after 

the birth of your baby. The most common and easiest 

way to strengthen your pelvic floor muscles is to do 

Kegels. First, visualize your muscles as a sling (see 

picture below). Try to tighten and lift your perineum 

(the area between your pubic bone and tailbone) as 

if you were stopping the stream of urine or holding 

in gas. Hold these muscles around your vagina and 

anus tight for a count of three. Relax for a count of 

three, and repeat working up to holding for a count of 

ten for 10 repetitions. You can also pulse the muscles 

quickly. Remember to relax and breathe deeply 

between repetitions. 

It is best to do these exercises 

every day; aim for three sets of 

10. Since no one can tell when 

you are doing them, good places 

to do them include when you 

are driving, at your desk, while 

watching TV or while nursing. 

Once you can do Kegels in 

Postnatal Exercises and Body Mechanics 

uterus 

bladder 

rectum 

Pelvic 

floor 

muscles 

the sitting position, try to do them while standing, 

walking, while coughing or sneezing and while lifting 

or carrying. Do not do them while urinating, as it 

may interfere with your ability to empty your bladder 

completely. 

If you still feel like you need additional help, your 

doctor or physical therapist can recommend additional 

exercises and other options. 

Babies Can Get Heavy! 

Right now your baby is light, but you should begin 

lifting and holding your baby correctly now. This will 

help prevent muscle pains and strains in the future. 

You may be so busy with your baby that you don’t 

think you have time for yourself, but remember— 

paying attention to yourself is a good gift to your 

baby! 

Realize that twisting or bending 

your spine while lifting is bad 

for your back. People often 

do this when picking up their 

child from a changing table. 

So, when you lift your child 

from the table, get close and face your hips towards 

him/her. Bend at your hips and knees by squatting or 

lunging, DO NOT bend at your waist or back. 

This is a good example of breaking down a movement. 

When you think of an action in slow motion, any steps 

that may be harmful to you will become obvious. Some 

good actions to analyze include placing your baby on 

the floor and putting your baby in a crib. 

Here are additional ways to prevent muscle aches: 

• Tighten abdominal and pelvic floor muscles when 

you lift or lower. This will protect your back. 

• Take a good look at the height of cribs, changing 

tables and other objects, and raise or lower them to 

fit your height. 

• Don’t step over child gates, as this can hurt your 

pelvic joints. 

• Kneel or squat when putting your child in an infant 

swing or stroller. You can also lower your child into 

a swing from behind. 

• If possible, have someone help you when you put 

on or take off an infant backpack or sling. 

• If you carry a diaper bag, frequently change the side 

you carry it on. 

• Watch your posture and stop yourself from 

slumping over. 

60

• Car seats should only be carried for short distances 

(car to house) 

Strengthening Exercises 

Do these gentle exercises daily, as able, to speed 

recovery. 

Abdominal Tightening 

Lie on your back with your hands around your 

abdomen and your knees bent. Breathe in, and then 

tighten or draw in your abdominal muscles while 

breathing out. Imagine drawing your 

navel in toward your spine as you 

draw your abdominals in. 

Ankle Circles 

When sitting or lying down, circle 

your feet clockwise. You should do this often to keep 

blood going to your feet. 

Shoulder Circles 

Circle your shoulders backward to 

prevent tight upper back and neck 

muscles. 

Scapular Retractions 

Stand or sit with good posture, back 

straight, head up. Pull shoulder blades 

down and back in the direction of your 

opposite back pockets. This exercise is 

especially helpful when holding or nursing 

your baby because it is easy to let your shoulders roll 

sloppily forward and strain your shoulders and back 

during these times. 

Heel Slides 

Lie on your back 

with one leg bent. 

Slide your other leg up toward the hips, and then 

straighten it out again while keeping your abdominals 

drawn in and your back still/neutral. 

Head Lifts 

Lie on your back 

with your knees 

bent and your 

arms around your 

abdomen. While 

breathing out, lift 

your head up off 

the bed tightening and drawing in your abdominal 

muscles, hold this position for 10 seconds. Then 

return to starting position and repeat 10 times, 

working up to 30-50 a day. If you notice a separation 

in the middle of your abdominal muscles while doing 

this exercise, this separation should lessen as you 

increase your strength. 

The Leg Roll 

Lie comfortably on your 

back with your arms out 

to your sides. Bring your 

knees up, while keeping 

your feet on the floor. 

Gently roll your legs first 

to one side and then the other. Keep 

your stomach drawn in as you move. The farther 

you go, the more you will stretch the opposite side 

of your lower back. You can stretch different places 

in your lower back by moving your feet closer to or 

farther away from your buttocks. 

The Pelvic Tilt 

Lie on your back and 

let your hands rest 

near your sides with 

your palms up. Tip 

your pelvis forward 

and hold. Next, rock 

your pelvis back and hold. 

Slowly repeat these motions. This exercise can help 

relieve pressure that you feel across the bottom of 

your back or in the center of your buttocks. 

Walking Is Good Exercise 

Now that you have an active baby to care for, you 

may forget about exercising. Most babies enjoy a 

ride in a stroller and this is a great way for you to 

get exercise. Start out with 10-20 minutes a day 

(you might even break it up into 2 ten minute 

walks initially), walk at a pace where you feel you 

61

are doing fairly light to somewhat hard work. 

Make sure to wear proper walking shoes and drink 

plenty of water. If you are nursing, it may be more 

comfortable initially to walk shortly after nursing 

when your breasts are less likely to be engorged. 

Postpartum Rehabilitation Program For 

Women Who Have Been on Bedrest 

Meriter Physical Therapy offers a program for 

women who have been on bedrest at home or in the 

hospital. Please speak to your health care provider 

if you feel you have lost muscle strength and/or 

endurance during your pregnancy. 

Physical Therapy Can Help Manage 

Many Postpardum Conditions 

If you experience any of these conditions after 

the birth of your baby, physical therapy can be 

beneficial. 

• Continuing or new low-back pain or pain in the 

posterior joints of the pelvis. 

• Pain in the pubis, especially with walking, rolling 

in bed or climbing stairs. 

• Urinary incontinence that persists to your sixweek 

follow-up visit with your health care 

provider. 

• Anal incontinence (loss of stool or gas that 

is uncontrollable) that persists to your six-week 

follow-up visit with your obstetrician or midwife. 

• Prolapse (dropping of organs) of your bladder, 

rectum or uterus that interferes with sexual 

activity, passing stool or is generally 

uncomfortable. 

• Postpartum nerve injury where you note a 

weakness that was not present before delivery. 

• Extreme fatigue or weakness that persists after 

being on bedrest. 

• Pain with intercourse or insertion of a tampon 

that is not resolving. 

• C-section scar pain that is not improving. 

• A separation in the middle of your abdominals 

that is wider than 2 finger widths and not 

resolving. 

A physical therapist can evaluate your condition and 

recommend an individualized plan of care with the 

goal of maximizing your health and wellness after 

delivery. 

Meriter has physical therapists who are specially 

trained in providing postpartum services, and who 

are located at multiple sites throughout the Madison 

area. Most insurances require a physician (or 

midwife) prescription for physical therapy. After you 

receive a physician or midwife referral, call Physical 

Therapy Central (608) 417-8250 to schedule an 

appointment. A receptionist will direct you to the 

therapist and clinic that best meets your needs. 

62

Postpartum Medication Log 

To assist you in remembering when you can request your pain medication, it may be helpful to write down the time you take it. By reading how often you 

can take a certain medication, you will know when you can request your next dose. For example, ibuprofen can be taken every 4 hours. If you were given 

a dose at 11 a.m. you could request a next dose at 3 p.m. or later. In the event the pain medication is not helping to relieve your pain or you need to take 

another dose earlier than what is prescribed, please call your nurse and let her know. We want to make sure that your pain needs are being met! 

Medication Time Time Time Time Time Time Time Time 

Med Taken Med Taken Med Taken Med Taken Med Taken Med Taken Med Taken Med Taken 

**Ibuprofen (200mg) 

(Motrin, Advil) 

1-2 tablets every 4 hours 

as needed for moderate pain 

# of tablets/time # of tablets/time # of tablets/time # of tablets/time # of tablets/time # of tablets/time # of tablets/time # of tablets/time 

*Acetaminophen (325mg) 

(Tylenol) 

2 tablets every 4 hours 

as needed for mild pain 


*Acetaminophen with 

Hydrocodone 

(Lortab,Vicodin) 

1-2 tablets every 4 hours as 

needed for moderate-severe pain 


Oxycodone 

1-2 tablets every 4 hours as 

needed for moderate-severe pain 


*Acetaminophen with 

Oxycodone (Percocet) 1-2 

tablets every 4 hours as needed 

for moderate to severe pain 


Docusate (Colace) 

1 capsule as needed at 

bedtime for constipation 


Polyethylene Glycol 3350 

(Miralax) - dissolve in 8 ounces 

of water - daily 


Benzocaine Ointment 

(Americaine ointment) as needed 

for pain 


Hydrocortisone 

topical - apply to hemorrhoids 

every 6 hours as needed 


63

Postpartum Medication Information 

Below is a list of medications that may have been prescribed for you while you are in the hospital or may be prescribed for you to take at home. 

The information provided in the chart below will help you know more about the medications you will be taking. If you have any questions, 

ask your nurse, call your provider’s office or your pharmacist after you go home. 

Medication Dose Per Tablet How Many How Often Potential Side Effects What Does It Do 

To Take To Take 

*Ibuprofen (200mg) 200 mg 1-2 tablets Every 4 hours Stomach discomfort. Helps relieve mild-moderate 

(Motrin, Advil) Max 16 tablets/day as needed for pain Take with food or milk pain, especially uterine cramps 

*Acetaminophen (325mg) 325 mg 2 tablets Every 4 hours Side Effects are uncommon Helps relieve mild-moderate 

(Tylenol) Max 12 tablets/day as needed for pain pain and reduces fever 

*Acetaminophen with 325 mg 1-2 tablets Every 4 hours Hydrocodone can cause drowsiness, Helps relieve 

Hydrocodone acetaminophen Max 12 tablets/day as needed for pain nausea or constipation moderate/severe pain 

(Lortab, Vicodin) + 5 mg hydrocodone 

Oxycodone 5 mg 1-2 tablets Every 4 hours Oxycodone can cause drowsiness, Helps relieve 

Max 12 tablets/day as needed for pain nausea, vomiting or constipation moderate/severe pain 

*Acetaminophen with 325 mg acetaminophen 1-2 tablets Every 4 hours Oxycodone can cause drowsiness, Helps relieve moderate 

Oxycodone (Percocet) + 5 mg oxycodone Max 12 tablets/day as needed for pain nausea, vomiting or constipation to severe pain 

Docusate 100 mg 1 capsule Every 12 hours at Cramping A stool softener, 

(Colace) bedtime as needed not a laxative 

for constipation 

Polyethylene Glycol 3350 17 grams Dissolve dose in Daily Nausea, bloating, Helps relieve constipation 

(Miralax) 8 ounces of water cramping and flatulence 

Benzocaine Ointment 20% 2 inch strip Apply to perineum Rash, burning, swelling in Helps relieve discomfort 

(Americaine ointment) (External use only!) as needed for pain. affected area. If these symptoms from episiotomy 

Keep in bathroom are present, discontinue use 

and apply to clean and notify your nurse 

vaginal pad. or physician. 

Hydrocortisone 2.5% Thin layer gently Apply to hemorrhoids Skin irritation Helps relieve 

topical rubbed into skin every 6 hours hemorrhoidal pain 

as needed 

*Acetaminophen. Do not take more than 4000 mg/day (from all sources combined) 

**Ibuprofen. Do not take more than 3200 mg/day 

PAIN SCALE 

No pain 0…1…2…3…4…5…6…7…8…9…10 Worst pain 

Moderate pain 

64

How Is Breastfeeding Going 

Answer these questions on day 4, 5, or 6. Bring this with you when you see your health care provider to see if your 

baby is doing well with breastfeeding. 

1. Do you feel breastfeeding is going well Yes No 

2. Has your milk come in yet Did your breasts feel firm or full between days Yes No 

2 and 4 after delivery 

3. Do your breasts feel full before feedings and/or emptier after feedings Yes No 

4. Are your nipples extremely sore Do you dread feedings No Yes 

5. Do you experience pain during the entire feeding No Yes 

6. Is your baby able to latch on to your breasts Opens wide and Yes No 

gets about 1 inch of areola into her mouth 

7. Do you hear rhythmic suckling and swallowing while your baby nurses Yes No 

8. Does your baby ask to feed (Answer no if you have to wake Yes No 

your baby most of the time.) 

9. Does your baby nurse about every 2-3 hours At least 8 times in 24 hours Yes No 

10. Is your baby having breast milk (yellow seedy) bowel movements Yes No 

At least 3 - 4 in 24 hours 

11. Is your baby wetting his diaper at least 4-6 times in 24 hours Yes No 

12. Does your baby often seem hungry after feedings (Crying, fussy, No Yes 

sucking hands frantically) 

If you have circled any answers in the right-hand column, please call the Breastfeeding Helpline 

at (608) 417-6547 or (800) 261-4449, or your health care provider to discuss in more detail. 

70

Mother and Baby Teaching Checklist 

Mother Care 

Check when 

First Weeks 

Topic Topic page number 

Complete 

NBC= information on 

Newborn Channel 

Rest 

13 NBC 

Cramping/Comfort/Vaginal Flow 

13-16 NBC 

Perineal Care/Whirlpool/Sitz Baths 16 

Bowel Care - Hemorrhoids 17 

Cesarean Birth: Recovery 19-20 

Breast Care/Post Partum 17, 26-27 

Nutrition 

18, 31 NBC 

Child Care 51 

Family/Sibling Adjustment 

55-56 NBC 

Postpartum Blues/Emotions 

57-59 NBC 

Sexuality/Birth Control 18 

Domestic/Family Violence 58 

Postnatal Exercise 60-62 

Common Signs of Illness 

Front Cover of First Weeks 

Baby Care 

Check when 

First Weeks 

Topic Topic page number 

Complete 

NBC= information on 

Newborn Channel 

Safety/Security/Car Seats 

50-51, NBC, Handout 

Breast Feeding Skills 

21-31 NBC 

Bottle Feeding Skills 33-35 

Diapering 

36 NBC 

Urine/Stool Patterns 33 

Quieting Tips/Shaken Baby Syndrome 

47-49 NBC 

Bathing/Skin/Cord Care 

37-38, 42-43 NBC 

Circumcision Care 41 

Jaundice 44 

Temperature Taking (rectal & axillary) 45 

Common Signs of Illness 

Front Cover of First 

Weeks, 46 NBC 

Back to Sleep/SIDS Prevention 

52-53 NBC 

Infant Behavior/Play 

54 NBC 

71

First Weeks Index 2010 

Activity............................................................ 19, 20 

Alcohol............................................................ 31, 50 

Anger.........................................................48, 49, 56 

Apgar score............................................................10 

Baby (see newborn) 

Baby blues..............................................................57 

Bath....................................................... 8, 42, 43, 50 

Birth certificate.......................................................9 

Birth control..........................................................18 

Birthing center........................................................6 

Blood pressure........................................................9 

Bowel movement, infant.....................................36 

Breast 

Infection...................................................28 

Soreness....................................................26 

Pumping...................................................29 

Massage....................................................28 

Breast Care............................................................17 

Breast self-exam....................................................17 

Breastfeeding 

Benefits.....................................................21 

Feeding on cue................................. 21, 24 

Latch.................................................. 23, 24 

Leaking breast milk......................... 25, 28 

Length of feeds.......................................24 

Let down..................................................29 

Pacifier use...............................................21 

Positions 

Cradle..........................................22 

Cross cradle................................22 

Football.......................................22 

Side lying....................................22 

Problems.............................. 26, 27, 28, 70 

Success............................................... 21, 70 

Breast milk 

Containers................................................30 

Pumping............................................ 29, 30 

Storage......................................................30 

Supply................................................ 25, 26 

Thawing/warming..................................30 

Colostrum................................................25 

Breast pump..........................................................29 

Bulb syringe...........................................................45 

Burping...................................................................32 

Car seat information............................................51 

Cesarean birth................................................ 19, 20 

Childcare................................................................51 

Circumcision 

Care of......................................................41 

Delay of....................................................40 

Pain control.............................................40 

Potential benefits....................................39 

Risks..........................................................40 

Classes.....................................................back cover 

Colic........................................................................47 

Cord care...............................................................38 

Cradle cap..............................................................37 

Cramping, uterine.................................................16 

Crying.............................................................. 47, 48 

Depression................................................57, 58, 59 

Development.........................................................54 

Diapering...............................................................36 

Diarrhea.................................................................36 

Diet and nutrition....................................18, 30, 31 

Domestic Violence...............................................58 

Driving, resuming.................................................20 

Drowsy...................................................................53 

Emergency.............................................................48 

Engorgement.........................................................27 

Episiotomy (Stitches)...........................................16 

Erythromycin........................................................12 

Exercises (see Postnatal Exercises)......60, 61, 62 

Family Adjustment....................................7, 55, 56 

Feeding cues................................................... 24, 34 

Feeding record................................................ 65-69 

Fingernails, newborn..................................... 37, 38 

Foreskin.......................................................... 39, 40 

Formula..................................................................33 

72

Formula feeding 

Amount....................................................35 

Preparation...............................................33 

Types.........................................................33 

Fussy baby...................................................... 26, 47 

Gas..........................................................................36 

Growth spurt.........................................................25 

Hand expression...................................................29 

Hearing screen..................................................8, 10 

Hepatitis B.........................................................9, 12 

Herbs......................................................................31 

Hemorrhoids.........................................................17 

Hiccups..................................................................32 

Hormones....................................................... 16, 29 

Illness, signs of...........Front cover, 19, 45, 46, 48 

Immunizations......................................................12 

Incision care..........................................................19 

Incontinence of urine/stool........................ 16, 17 

Infant abduction, prevention of.....................6, 50 

Infection.......................................................... 19, 28 

IV fluids.............................................................8, 20 

Jaundice........................................................... 44, 46 

Kegel exercises......................................................60 

Lanugo....................................................................10 

Lochia (see Vaginal Flow)...................................16 

Mature milk...........................................................25 

Meals.......................................................................18 

Medications..............................................14, 15, 64 

Medication log......................................................63 

Mother and Baby Teaching Checklist...............71 

Mother care.................................13, 14, 16, 17, 18 

Motion....................................................................54 

Neonatal screening...............................................12 

Newborn 

Appearance....................................... 10, 11 

Bath................................................8, 42, 43 

Bowel movement goals................... 36, 65 

Chest.........................................................11 

Diaper rash..............................................37 

Exam.........................................................10 

Eyes...........................................................11 

Head..........................................................11 

Hearing.....................................................54 

Hypoglycemia (low blood sugar).........11 

Medications....................................... 11, 12 

Reflexes....................................................11 

Skin............................................................10 

Skin conditions 

Acne............................................37 

Drooling rash.............................37 

Milia.............................................37 

Rash.............................................37 

Stork bite....................................37 

Mongolian spots........................37 

Yeast infections.........................37 

Sleepiness.......................................... 26, 52 

Smell..........................................................54 

Temperature...............................10, 12, 45 

Urine and stool goals................25, 36, 65 

Vision........................................................54 

Nipple, sore.................................................... 23, 26 

Nutrition......................................................... 18, 31 

Pacifiers.....................................................25, 32, 52 

Pain management.......................13, 14, 15, 63, 64 

Perineum 

Care..............................................14, 15, 16 

Laceration....................................14, 15, 16 

Episiotomy...............................................16 

Hygiene.............................................. 16, 17 

Pets.........................................................................50 

Photo ID, Birthing Center Staff..........................6 

Photography Service..............................................8 

Physical Therapy...................................................60 

Playing....................................................................54 

Plugged milk ducts........................................ 27, 28 

Postnatal exercises...................................60, 61, 62 

Postpartum Bedrest Program.............................62 

Postpartum Blues.................................................57 

Postpartum Depression 

Psychosis..................................................57 

Self-assessment scale..............................59 

Treatment.................................................58 

Prescriptions ............................................13, 14, 15 

Rest, maternal........................................................13 

73

Rooming In...........................................................21 

Safety/Security..............................6, 48, 49, 50, 51 

Settling a baby 

5 S’s of Settling a Baby..........................48 

Sexual Intercourse................................................18 

Shaken Baby Syndrome................................ 48, 49 

Siblings 

Adjustment..............................................55 

Anger........................................................56 

Jealousy.....................................................56 

Regression................................................56 

Safety.........................................................55 

Skin to Skin holding.............................................12 

Sleep and awake states.........................................53 

Sleepy baby............................................................26 

Smoking....................................................31, 50, 52 

Sudden Infant Death Syndrome (SIDS).... 21, 52 

Supplements...................................... 21, 25, 26, 31 

Temperature taking..............................................45 

Thermometers.......................................................45 

Touch.....................................................................54 

Tummy time..........................................................54 

Umbilical cord care (see “Cord care”)....... 38, 46 

Urinary catheter....................................................19 

Uterus.......................................................................8 

Vaginal flow...........................................................16 

Vernix.....................................................................10 

Vital signs........................................................ 10, 20 

Vitamin D supplements......................................30 

Vitamin K..............................................................11 

Water supply 

Well water testing............................ 33, 34 

Weight loss 

Maternal............................................. 18, 31 

Newborn..................................................25 

74

Notes 

Use this section to take notes during and after your hospital stay. 

75

Notes 

Use this section to take notes during and after your hospital stay. 

76

Parenting Classes and Resources at Meriter 

We’d like you to know that we are still here for you after you go home with your baby. Consider joining us 

in any of the following classes, and by signing up for our e-mail newsletters. Register online for classes at www.meriter. 

com/classes or call 417-8446. 

Mother Baby Hour 

Our weekly support group allows first-time moms 

and their babies to get together to ask questions, 

express concerns, learn about resources and share 

stories. Join as early as the first week after your baby 

is born. Topics include: 

• Time Management for New Parents 

• Nighttime Parenting 

• Infant Massage 

• Returning to Work & Childcare 

• Worries, Forgetfulness and Depression 

• Fussy Times 

• Traveling With Baby 

• Taking Care of Mom 

• Car Seat Safety 

• Feeding Concerns 

Breast Milk: Learn to Pump and Store 

A lactation consultant discusses equipment, collection, 

storage, introducing a bottle and strategies for 

continuing breastfeeding after returning to work. 

Parent Review Weekly E-Mail 

Newsletters 

Learn more about your baby every week...Meriter is 

proud to offer Parent Review, a free weekly e-mail newsletter 

for expecting and new moms. Sign up at www. 

meriter.com/enews and you’ll receive e-mail newsletters 

focused on what you need to know right now. You’ll 

also learn more about related Meriter classes and services. 

This resource is created with you in mind! 

Breastfeeding Resources at Meriter 

Health Services 

Meriter offers comprehensive breastfeeding support 

including inpatient consultations, outpatient clinic 

appointments and telephone assistance. Please call 

the Breastfeeding Helpline at (608) 417-6547 or 

(800) 261-4449 with questions. 

Meriter Hospital Physical Therapy’s 

Postpartum Rehabilitation Program 

(608) 417-8250. 

77

The Birthing Center 

202 S. Park Street 

Madison, WI 53715 

meriter.com 

9/11/10,000

A Guide To Your New Family's First Weeks - Meriter Health Services

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